Iranian Journal of Obstetrics, Gynecology and Infertility
Year:2005 | Volume:8 | Issue:1|Papers Count:20

Objective: This study is due to consideration results of hystorgraphy and hysteroscopy-laparoscopy. Materials and Methods: Our study was a cross- sectional study that performed in 90 patients with complains of infertility and spontaneous abortion. This study was focused on women in reproductive ages. Hystroraphy and hysteroscopy-laparascopy performed for all patients. Results: We found diagnostic differences in 11 cases (12.2%) of uteral anomaly between of hystrography and uteral endoscopy. 9 cases (81%)had complete or incomplete uteral septum in hysteroscopy that were resected during hysteroscopy, but their diagnosis in hysteroscopy were arcuate uterus in 3 cases (33%), bicorn uterus in 2 case (22%), normal uterus in 3 cases (33%) and Didelphis uterus in 1cases (11%). One case was Didelphys uterus in endoscopy that was reported unicorn uterus in hystrography. One case was normal in endoscopy that was repored as T-shape uterus in hystorography. Conclusion: Due to importance effects of uterul anomalies diagnosis on type of treatment and necessitation of surgical therapy in diagnosis of uteral septum and due to this fact that in our study, in 9 cases uteral septum was resected in endoscopy, consideration of diagnostic methods was important and necessary.  

Objective: Breast cancer has been the most frightening horrible disease among women recently. This study is aimed at an overall view of evaluating reasons for referring of 1000 patients to the Breast Clinic of Ghaem Hospital. Materials and Methods: A descriptive cross-sectional, prospective study was carried on during a two-year period] (2001-2003) in Breast-Clinic in Ghaem Hospital. The following information was arranged on a questionnaire including age, the reason for reference, fertility and contraception methods and breast cancer and related cancer background in the patient and the history of this disease among other members of her family. The acquired data was analyzed statistically with T-student, Chi-square and Excel software. Results: The mean-age for these patients was 40 years. The cause of referral in 45.3% of the patients was pain and in 36.8% mass had been observed, 12.7% nipple discharge was noticeable and 15.3% referred for screening breast cancer. Oral contraceptive pill users were 13.2%. The relationship between breast cancer and using contraceptive pills was not noticeable. The duration of pill use was a few months to several years. Vitamin E was more effective in the patients who complained about breast pain. The patients with breast of mass who underwent surgery, were classified as 0.7% breast cancer patients. From the patients who had abnormal nipple discharge, the TSH and prolactine levels were 9.6% higher than the normal levels. Among the patients who came for screening, 13% had breast mass. Mammography was prescribed for 45% of these patients that 7.2% of the results were abnormal.  

Objective: Since umbilical artery PH is prediction of newborn health situation in comparison with Apgar score alone, this study was performed to determine the effect of episiotomy on Apgar and umbilical artery PH. Materials and Methods: This study was done as a randomized control trial among 300 women in their first or second pregnancy with 37 to 42 weeks gestational age and without any complication in Tehran’s Mahdieh Hospital. The women were randomized into case (with episiotomy) and control (without episiotomy) groups. Umbilical artery PH and Apgar scores at 1 st & fifth minutes were determined and compared in two groups with Mann] Withney test. Results: This study showed that within 300 uncomplicated vaginal deliveries, 140] (49%) newborn were delivered with episiotomy. No significant difference was seen between sex and weight of newborns in the two groups. Apgar scores were above 7 in all newborn. Mean arterial PH in control group (without episiotomy) was greater than case group (with episiotomy), (7.24 VS 7.21).] The number of PH under 7.2 was greater in episiotomy group and the difference was significant (P=0.001). Conclusion: Based on our data we believe that routine episiotomy for prevention of birth trauma in uncomplicated is not necessary.  

Objective: Acute pyelonephritis is one of the most common causes of hospitalization in pregnant women. It’s a long time that Ampicillin has used as the first step of treatment, but now we encounter resistant species of bacteria against it. The purpose of this study was a survey of clinical and laboratory resistance to intravenous Ampicllin in pregnant women with acute pyelonephritis. Materials and Methods: This survey was done on 74 pregnant women who have been admitted to the obstetric center of Emam Reza Hospital with diagnosis of acute pyelonephritis for a period of one year] (1378-79). All of the patients were prescribed intravenous Ampicllin] (1gr Qid) after taking urine culture and analysis. Clinical response was assessed after 72 hours and compared with the first urine culture. Results: The most common pathogen was E. coli (79.4%). Ampicllin resistance rate regarding antibiogram was common (88.2%), but clinically 43.2% of patients taking Ampicillin were resistant. There was a significant difference between laboratoary and clinical resistant in this study] (P=0.03). Conclusion: At last like other studies and of course with more emphasis, we can say that Ampicillin alone for empirical treatment of pregnancy acute pyelonephritis is not effective. So we propose that an aminoglycoside should be added to Ampicillin regimen foe acute pyelonephritis of pregnancy.  

Objective: Postoperative nausea and Vomiting (PONV) are common complication after surgery. Propofol based nesthesia is an effective technique for decreasing of PONV. Most study are formed to evaluate efficacy of Dexamethasone in preventing of PONV , but there have been no reports to evaluate the efficacy of dexamethasone for preventing PONV in propofol-based anesthesia for D & C. Materials and Methods: In a prospective, randomized double- masked, placebo controlled trial, 202 women received placebo or dexamethasone intravenously at doses of 4 mg, 8mg, or 16mg immediately before Indrction of anesthesia. Propofol based general anesthesia was used. Emetic episodes and safety assessments were performed to estimate a sufficient sample size using chi-squar test with confidence interval 95%, (A=0.05 and B=0.2). Results: The rate of patients who were emesis free (no nausea or vomiting 0-24 hours after anesthesia was 78.4%in placebo, 81.1% in dexamethasone 4 mg, 90.0% in dexamethasone 8 mg and 95.8% in dexamethasone 16 mg. No clinically important adverse events were observed in any of the groups. Conclusion: Dexamethasone 8 mg is an effective antiemetice drug for prevention of postoperative nousea and vomiting 0-24 hours after anesthesia in women undergoing propofol based general anesthesia for termination of pregnancy. Increasing the dose to 16mg provided no additional benefit. In regard to cost, Dexamethasone is prefer to other drugs.  

Objective: Premature rupture of membranes occurs in 5-10% of pregnancies and leads to different complication, one of the most important is abruption placenta which would be seen in 4-7% of  patient with PROM. We evaluated the combination of these two major pregnancy complications in 518 patients during one year in Mashhad Ghaem Hospital, Mashhad. Materials and Methods: This is a prospective research in 518] (20-42 weeks) pregnant women during one year. Different factors like temperature rising, the time between PROM and abruption placenta, blood pressure, parity and the percent of abruption and the method of pregnancy termination is evaluated. Results: We found 25 cases of abruption placenta in 518 pregnant women with PROM] (4.8%). Most of them were preterm] (84%). Between PROM and abruption placenta was 24-84 hours in 48%. The percent of abruption was 10% in most of them (60%), and in 8% it was more than 80%. In 32% of patients there was a moderate hypertension. The pregnancy was terminated by C/S in 48%, and in 56% fetal distress was diagnosed. Conclusion: The combination of these two major complication especially when is prolonged is quite important and needs special attention.  

Objective: Abnormal uterine bleeding (AUB) is one of the most frequent complaints in women at all age groups, but causes are different in different age groups. Materials and Methods: In our discriptional and observational research, we collected demographic data, results of physical examination and work ups and sonographies in 225 women during 6 months. Results: With omission of pregnancy and its complication, most frequent causes of AUB in premenarchal, reproductive, perimenopausal and postmenopausal groups were anovulation, infections and endometrial atrophy respectively. The common pattern of AUB were oligomenorrhea, menometrorrhagia, unexpected spotting respectively. Conclusion: These results are the same as other researches. Also as an alternative object, usefulness of sonography and paraclinical workups were evaluated.  

Objective: To determine whether 2- hour urine protein values can be used instead of 24-hour urine protein value in patients a with pre eclampsia. Materials and Methods: We did a cross sectional study on 26 women with pre eclanpsia and a positive urinary test strip for protein of at least 1+and a BP_>140/90. Urine samples were collected within 24 hours in successive periods: the first 2-hours and the next 22-hours urine, in separate containers. The correlation between both groups was determined by Pearson’s correlation Results: 26 patients were studied, 16 had mild proteinuria, 2 had servere proteinuria, and 8 had no proteinuria. There was significant correlation between the 2-hour and 24-hour urine protein. Pearson’s correlation coefficient: 0.86 (P=0.002) with the use of cut off ≥0.015 gram in 2-hour sample, sensivity, specifity, PPV and NPV were respectively: 77.8%, 93.3%, 63.3%. Conclusion: Total protein values of 2-hour samples, positively correlated with values of 24-hour samples of pre eclamptic women and should be substituted for assessment of proteinuria instead of 24-hour urine collection. In women with pre eclampsia, as a simpler, faster and cheaper method for diagnosis of pre eclampsia.

Background: Post partum hemorrhage as a consequence of uterine atony represents a leading of maternal morbidity and mortality. Prophylactic oxytocin, commonly administered after fetal or placental delivery, reduces the incidence of post partum hemorrhage by up to 40%. Evidence from studies suggests that giving oxytocin before rather than after placental expulsion, minimizes third- stage duration and blood loss. Objective: The general objective was to compare oxytocin administration before and after placental delivery in the prevention of post partum hemorrhage. Materials and Methods: This research was a prospective randomized clinical trial study, parturient who presented for vaginal delivery were randomized to receive oxytocin, 20 units in a 500 ml serum Ringer, beginning upon delivery of either the fetal anterior shoulder or placenta. For all patients, the third stage of labor was similar. Patients were excluded if they had a pervious caesarean section, multiple gestation, an tepartum hemorrhage, of bleeding disorder. Results: A total 70 patients were enrolled: 35 in the before placenta group and 35 in the after placenta group. The groups were similar with respect to gestational age, maternal age fetal weight, Labor duration, parity and pervious postpartum hemorrhage. The incidence of post partum hemorrhage were significantly between the two groups (90±22 ml VS 127±50ml). There were significant differences between two groups in third stage duration (4±2 min VS 7±1 min).but there were no significant differences between the two groups with no incidence of retained placenta. Conclusion: The administration of prophylactic oxytocin before placerntal delivery significantly reduces the incidence of postpartum hemorrhage or third stage duration when compared with oxytocin after placental delivery.  

Objective: The technique of repair and choosing the way of suturing are likely the most important factors on the morbidity associated with perineal trauma, so this research was done to evaluate perineal pain in two methods of episiotomy repair (with and without skin suture) in primiparous women who gave birth at Hazrat zeinab Hospital in Mashhad from July 1999 to Januery 2000. Materials and Methods: In this clinical trial research, 54 healthy peiniparous women with term pregnancies requiring surgical repair of episiotomy following a normal spontancies delivery, were chosen for experimental and control groups randomly. In experimental group after repairing vaginal mucus and perineal muscles, fascia was repaired with continuous sutures not to leave skin edges more than 0.5cm apart and skin was left without suture, but in control group skin was repaired with interrupted sutures. Perineal pain was measured in all women by VAS at first 24 hours and 5th, 10th, 21st  days postpartum. Results: Perineal pain at first 24 hours postpartum (P<0.0001), 5th day (P<0.0001), 10 th day (P=0.0004) and 21st day (P=0.0018) was less in lexperimental group. There was no significant difference in wound healing between two groups. Conclusion: Episiotomy repair without skin sutures reduces postpartum perineal pain. In this method wound healing was not postponed, and there were no apparent disadvantages like infection and wound breakdown observed.  

Objective: This is a research which defines prevalence of cesarean section and the related causes in Kohgikoyeh and Boyerahmad provinces in] 1382 in order to plan for immune child birth soon. Materials and Methods: This is in the cross-sectionsl, descriptive analytic type. There were 7,649 subjects of which round samples were chosen. Subjects were mothers in deliveries. The questionnaires were completed by them, and their files. They were analysed by descriptive statistics. Results: The results showed that the total number of reported delivery were7, 649, 66.94% natural, 32.62% cesarean, 14%with forcepts and vacuum. About 70%] of women were in cesarean for the first and second times, 42%] of multi para women with cesarean closed tube. Also the most common reason for cesarean has been the repeated cesarean section (25.10%) fetal distress (22.16%),] elective (11.68%) non cephalic presentation (11.44%),] mother’s disease (10.52%). Conclusion: This study should that the amount of cesarean incontrast with the world standard is high] (32.92%).  

Objective: The cervical prolapsus is rare during the pregnancy. Less than 245 cases were reported in the literature, and only 5 cases reported after 1968. Case Report: This article reports two cases of cervical prolapsus during the second and third thrimester of the pregnancy. They had referred with incarcerated the cervical prolapsus in our center. Premature labor occurred all the two women regardless conservative management. A patient developed the sepsis. Conclution: Appropriate management of cervical prolapsus needs to diagnose of prolapsus pre- pregnancy and conservative and management in pregnancy were not always successful.  

objective: To Determine the incidence of diminished ovarian reserve in unexplained recurrent abortion. Materials and methods: among 116 women with complaint of recurrent abortion who referred to Ghaem hospital, after evaluation, 25 women with unexplained recurrent abortion were chosen as the test group and the control group (n=25) were women with a history of normal pregnancy. Mean age, day 3 serum FSH and E2 levels, presence or absence of a history of infertility and menstrual cycle lengths were compared between two groups. Results: Day 3 FSH and E2 Levels were higher in the unexplained recurrent abortion group compared with the control group (61% VS 16%) P<0.005. Other factors did not differ between two groups. Conclusion: Women with unexplained recurrent abortion have a greater incidence of elevated day 3 serum FSH and E2 levels than do women with a normal pregnancy history. Therefore diminished ovarian reserve may contribute to recurrent pregnancy loss and should be considered as a part of the work – up for unexplained recurrent abortion.  

Objective: This study is aimed at evaluation fetal and maternal outcome in pregnant women with heart disease candidate for open heart surgery.Materials and Methods: In this study we evaluated adverse complications in 14 pregnant women underwent open heart surgery during three years period.Variable parameters were: age, parity, gestational age, history of cardiac surgery and medications, cardiac complications during pregnancy, surgical indications of cardiac disease, fetal and maternal mortality and related complications. Results: Mean age and gestational age were 38.4 years and 17.28 weeks respectively. Most of the patients were multiparous (71.42%) and in functional NYHA class III or IV (85.70%). During pregnancy 71.43 percent of patients showed signs and symptoms of CHF and 64.28 precent of them had atrial fibrillation. All patients underwent emergent open heart surgery. Maternal and fetal mortality following surgery were 35.71 and 78/57 percent respectively. Conclusion: Cardiac Surgery during pregnancy was accompanied with high fetal and maternal mortality. Such pregnancies need to be managed by a team including obstetrician, cardiologist, anesthetist and cardiac surgeon. For best result, it is better to postpone surgery whenever possible and surgery is performed only when it was indicated. The present study demonstrates that emergency surgery, poor NYHA class, Atrial Fibrilation, unstable heart disease, poor economical cultural conditions will result in adverse outcome in mother and fetus following cardiac surgery.    

Objective: Management of nipple discharge by clinical finding. Materials and Methods: All of the data on patients referred for nipple discharge in period from 1990-2000 at the Department of Surgery IMAM REZA Hospital were reviewed. Results: The breast nodularity and duct ectasia was seen in 73% of patients. The age of the patient in this group was 30-40 years. Only 10 of 249 patients (5%) who presented with nipple discharge were proved to have carcinoma of the breast. Conclusion: Breast nodularity and duct ectasia is the most cause of nipple discharge (73%). Nipple discharge was not commonly associated with carcinoma and when it was the carcinoma was almost always palpable.