Iranian Journal of Obstetrics, Gynecology and Infertility
Year:2007 | Volume:10 | Issue:1|Papers Count:22

Introduction: Applying mechanical or pharmacological techniques before onset of spontaneous labor condition of cervix is important to the success of labor induction. Because of the efficacy and safety of oxytocin, it is the most common prescribed drug all over the world. Other medical preparations proposed to cervical ripening are prostaglandins such as Misoprostol a synthetic prostaglandin E1. The aim of this study was to compare efficacy of mosoprostol and low-dose oxytocine in cervix ripening and labor induction. Methods and Material: This study was a clinical trial study on 100 pregnant women in Yazd Shahid Sadeghi Hospital in 2003-2005. They all had singletone fetus with GA>37 weeks, and unripped cervix and indications for labor induction. All of data were gathered in the questionnaire. Then, they were analyzed by chi-square, T test and Fisher exact tests. Results: The patients' demographic finding for the groups and indication of labor induction had not significant difference. The time-length between onset of ripening to delivery for misoprostol group was 20.6±2.6 hours and for low dose oxytocin group was 25.1±2.5 hours (p=0.001). There was no singnificant difference in kind of delivery between two groups (p=0.93). There was singnificant difference between two groups about consumption of magnesium sulfate. It was more in misoprostol group compared to low dose oxytocin group (p=0.001).Conclusion: Vaginal misoprostol (25mg/Q4h) is a safe and useful medicine for cervical ripening in low risk patients. It has not any serious side effects for mother and fetus.

Introduction: Fathernity and fertility is a tremendous desire of male and female patients with end stage renal disease (ESRD) after successfully renal transplantation. Investigations have been shown that one out of fifty female patients, which underwent successful renal transplant, became pregnant. As some drugs are harmful and may have teratogenic effect, in this study the teratogenic effects of new cyclosporine (Galena) on pregnant mouse was investigated. Methods and Material: In this experimental study 14 pregnant balb/c mice divided into three groups. Experimental group I with 5 pregnant mice received 20 mg/kg cyclosporin on days 7, 8, 9, 10 of gestation. Experimental group II with 5 pregnant mice received 30 mg/kg on the same days, and control group with 4 mice received the same volume of physiologic serum at the same time. On day 18th of gestation all pregnant mice were sacrified by cervical dislocation and their fetuses were examined under microscope for congenital malformation. The weight and length of fetuses were also investigated. Results: Our data revealed that there was no anomaly in the fetuses in both groups, but the median weight of fetuses were lower in experimental groups than control group (1.4 gr in group I versus 1.05 gr in group II and 1.6 gr in control group) (p<0.05). In addition the median length of the fetuses was also lower in experimental groups in comparison with control group (2.3 cm in group I & II versus 2.4 cm in control group). Most placentas in experimental groups show infarcted area on maternal site.Conclusion: These data indicated that although Galena cyclosporine has no teratogenic effect on mouse balb/c fetus, consumption of cyclosporine during pregnancy results in intrauterine growth retardation.

Introduction: Diabetes is the most common medical complication of pregnancy. If it is not controlled, it can cause lots of complications for both mother and fetus. The purpose of this study was evaluation of complications of gestational and overt diabetes in the patients in Clinics of Medical Science of Tabriz University. Materials and Methods: In this cross-sectional descriptive study in Al-Zahra and Taleghani Hospitals of Tabriz in the year 2004-2005, 300 patients with overt or gestational diabetes were chosen and studied for 20 month. Data of prenatal care and delivery were documented and then analyzed by SPSS software and statistical methods of t-test, chi-square and compare of ratio. Result: 126 cases had overt diabetes and 174 cases had gestational diabetes. Mean of age was 30.22±5.71 years. 90% of cases had not any program for pregnancy or preconception counseling. Nephropathy, retinopathy, hypertension and preeclampsia were significantly higher in overt diabetes. Prevalence of polyhydramnios is was 10%, macrosomy 19%, preterm labor 18%, urinary tract infection 30%, candida infection 40%, cesarean section 88.3%, dehiscence 3.3%, thromboembolism 3.3% and still birth 2%. There was no significant difference in these complications between the two groups.Conclusion: Hypertension, preeclampsia, macrosomy, cesarean and infection were most common maternal complications of diabetes in pregnancy. Hypertension, preeclampsia, nephropathy and retinopathy were significantly for pregnancy or prenatal care. Education about preconception counseling for women of reproductive age, screening for high risk diabetes group and attention to the complications seems necessary.

Introduction: Gestational choriocarcinoma is a rare and life threatening disease, but if patients are treated early in an experienced center, they have chance of cure. This study was done for the goal of ten-year evaluation of gestational choriocarcinoma patients. Methods and Material: This descriptive retrospective study was done in Oncology Departments in Omid and Ghaem Hospitals of Mashhad between years 1991-2001. The data were collected in a designed questionnaire according to the patient's files and presented by frequency charts, diagrams and statistical indices. Results: Out of 141 cases of GTD, 41 (23.2%) patients had gestational choriocarcinoma. Among the latter group, 50% were under 30 years old. The most common presenting symptom was vaginal bleeding (84.4%). The response to first line chemotherapy in 68.4% of patients was good, in 10.5% was poor and 21.1% had no response.Conclusion: Since a great number of these patients were young and curable, it is recommended to start treatment in an experienced center once diagnosis is established.

Introduction: Length of duration of sperm exposure had been proposed to influence the risk of preeclampsia. The main objective was to determine the relationship between extent and times of exposure to sperm, before pregnancy, and the risk of preeclampsia. Methods and Material: This case- control study was done on in the year 2004 in Hamadan Fatemieh Hospital 60 primigravid women delivering singleton birth with preeclampsia as defined by antepartum systolic blood pressure >or=140 or diastolic blood pressure >or=90 plus proteinuria (cases); with 146 women without preeclampsia (controls). The two groups were matched considering age and other known risk factors. Information was compiled by means of a confidential questionnaire. Data was analyzed by Student t test, chi (2) test, and logistic regression analysis.Results: A total of 60 cases were compared with 146 controls. The duration of exposure to sperm in preeclaptic women, and control group before pregnancy was 8.96 months and 5.52 months respectively (p=0.21). The preeclamptic women, 7.66 times per month and non-preeclamptic women 8.92 times pre month were exposed to sperm (p=0.049).Discussion: Although the data did not support the duration of sperm exposure before the pregnancy as a risk factor, but showed lower times of exposure to sperm in month associated with significantly increased risk for preeclampsia.

Introduction: Preeclampsia remains a major cause of maternal morbidity and mortality and is a leading cause of iatrogenic premature delivery. Oxidative stress is considered to be a key factor in disease process. The aim of this study was to determine the effect of supplementation of antioxidant, Vit E and C in reducing the incidence of preeclampsia. Methods and Material: This clinical-trial study was done in the year 2006 on pregnant women referring to Isfahan Medical University hospitals. 160 pregnant women, at risk for PIH, divided into two groups. First group received oral vitamin C 1000 mg/day and vit E 400 Iu/ day at 16 to 24 weeks of pregnancy. Control group didn't receive any supplementation. Individual and laboratory data were gathered in a questionnaire. Data was analyzed suing descriptive statistics and frequency distribution tables. Results: Incidence of preeclampsia in first group was 9.1% and in second group was 22.3% (p=0.05). That is statistically significant.Discussion: In this study incidence of PIH significantly decreased in study group in comparison to the control group. Preeclampsia rate in women with previous PIH significantly decreased with antioxidants. Antioxidant supplementation in these women is important.

Introduction: Considering the importance of recovery period and possible unpleasant and painful experiences in post anesthesia care unit (PACU) and known effects of music on pain; this study was conducted to evaluate the effect of favorite music on the level of pain after cesarean operation.  Methods and Material: In this single blind clinical trial, of those who were candidate of cesarean section in Amir Almoemenine Hospital, 80 patients were selected sequentially and were divided in 2 different groups of case and control, randomly. Case group received favorite music vai a disposable headphone, but controls headphones were off. Pain score, blood pressure, pulse rate and arterial O2 Saturation were evaluated at the time of entrance to PACU and then 30, 60 and 90 minutes after that. Data were gathered in questionnaire and analyzed suing descriptive statistics and SPSS software. Results: There was no significant difference between mean ages in two groups. There was no significant difference at the time of entrance and 30 minute after that in pain scores between two groups. Mean pain score at 60 minute in cases was 1.6±1.3 and in controls was 3±1.8 that showed significant difference between two groups (p<0.05). Mean pain score at 90 minute in cases was significant higher than the controls (1.2±1.1 vs. 3±1.2, p<0.05). Controls stayed longer in PACU than cases. (P=0.001).Conclusion: This study showed a lower pain scores in case group in time 60 and 90 that shows the effects of favorite music to reduce post operative pain. Similar pain score of two groups in the entrance time and 30; show music needs time to reduce pain.

Introduction: Pelvic floor exercises of Kegel exercises have an important role in strengthening and improvement of the tonicity of pelvic floor muscles without any complications. Many advantages have been described for these exercises; the most important is prevention and treatment of urinary incontinence. The purpose of this study is to determine the rate of making use of Kegel exercise during pregnancy and postpartum. Methods and Material: This was a descriptive study on 245 samples selected by simple randomized method among women visited at Hamadan health care centers in 2005. Data gathering was on the basis of questionnaire and interview; and was analyzed using SPSS software. Results: 15.1% of women were trained about Kegel exercise during pregnancy or postpartum, 62.1% of whose training was through mass media and personal study. 43.25% of women during pregnancy and 21.6% during postpartum used this exercise, but in 59.45% of cases not correctly. 29.7% of women did the exercise daily and only 2.7% did it three times a day. Majority of them used it once a day.Conclusion: Women are not familiar with Kegel exercise and in health care programs the education of this exercise is not concerned and health care staffs don't pay attention to the education of the strengthening of pelvic floor muscles as an important part of prenatal and postpartum training. So, a few numbers of women have been educated about Kegel exercise and among them the fewer do the exercise correctly.

Introduction: The objective of this study was to investigate the impact of chemotherapy-induced secondary amenorrhea in breast cancer patients and its relationship to number of therapy courses and type of chemotherapy agents. Methods and Material: This descriptive cross-sectional study was done during eight years in oncology department of Ghaem and Omid Hospitals of Mashhed University in 1997-2005. Trial group were 120 pre menopausal patients. That menstrual cycle status during treatment and in follow-up periods in these selected patients was recorded. These patients divided into three groups. For first group chemotherapy agents of cyclophosphamide, metotherexate and fluoroucil (CMF) recommended; versus the second group, who used cyclophosphamide, adriamycine and fluoroucil (CAF), and the third group, who received adriamycine and cyclophosphamide (AC). None of these patients used tamoxifen, In evaluation different criteria included; menstrual cycle status before and after chemotherapy, incidence of secondary amenorrhea and correlation between amenorrhea with types and courses of chemotherapy agents. Statistically analysis using SPSS software was performed and T-Test and 2 was used for comparative evaluation and p<0.05 considered significant. Results: Data of 120 patients was defined that the age of 58.3% of them were <40 years old. Majority of pathological type of breast cancer patients were ductal carcinoma (89.3%). The most common type of chemotherapy regimen was CMF, CAF and AC. Chemotherapy induced secondary amenorrhea established in 74.1% of patients; this finding was more common in patients >40 years old according to statistics, the incidence of amenorrhea in CMF group was 72.5% and in CAF group was 71.4% and in AC group was %83.4 (P=0.6). The average number of chemotherapy courses in CMF group was 6.2±2.6, in CAF group 7.2±0.6 and in AC group 6.4±0.5 (P=0.3). Duration of amenorrhea was between 2.3-4 years, but this data was not statistically significant.Conclusion: In pre menopausal patients with breast cancer receiving cytotoxic chemotherapy against tumor cells, amenorrhea due to ovarian failure may happen.

Introduction: Olygohydromniosis is a common phenomen in prolonged pregnancies and fetal growth rethardaton. The aim of this study was to determine the effect of maternal hydration with intravenous (IV) isotonic fluid, IV hypotonic fluid, and oral water on amniotic fluid index (AFI) in women with oligohydramnios. Methods and Material: This study was a clinical trial study, done in the year 2004 in Khoram Abad Asali Hospital. 80 patients with low AFI (less than 5cm) and gestational age over 35 weeks without maternal complications were randomized into four groups (2L/2h IV isotonic fluid, 21/2h IV hypotonic fluid, 2L/2horal water, control). Maternal AFI was measured before hydration and 1 hour after hydration. Variables such as maternal age, gestational age, gravity, parity and AFI were gathered by a check list and analyzed with SPSS. Data were compared using paired t-test and Fisher within each group (p<0.05) was considered statistically significant. Results: Eighty patients (n=20/group) completed the study without and maternal adverse effects. The mean increase in AFI after hydration was significantly greater in oral water groups (this pattern increased from 3.6±1 to 6±1.09 (p<0.001), in the IV hypotonic group mean AFI increased from 4.2±0.83 to 5.98±0.94 (p<0.001), in the IV isotonic group mean AFI increased from 4.42±-0.49 to 5.3±-0.7 (p<0.001), in the control group change in AFI was not significant (from 4.01±0.68 to 4.08±0.6).Conclusion: Maternal hydration with oral water, IV hypotonic fluid and IV Isotonic fluid increases AFI in oligohydramnios. Maternal hydration with oral water was more effective than other groups.

Introduction: The ever-increasing attention of women to occupation in outside of family borders have caused new stresses in their lives, and have threatened their mental health and the basic role of women in House and children's nourishment. This study was accomplished with aim of determining relationship between role multiple and mental health in occupying nurses in the university of medical sciences in Babol. Methods and Material: This research was a descriptive study done in the year 2004. The sample of case group included 120 expert female nurses in Babol Medical University Hospitals chosen by sampling method of multi-stages to method of classification, cluster and random. In order to collect data and to survey mental health, standard questionnaire of GHQ-28 was used; also a researcher manufactured questionnaire was used to evaluate roles. Data was analyzed by descriptive statistics. Results: The results of this research showed that %41.8 of nurses of the study had higher stress levels than cut-off point of GHQ questionnaire, that is, these nurses were involved in disorders in respect with mental health. These results, also, showed that there was a significant relationship between the health-care role rate and mental health, but such relationship was not seen in other professional roles. The results also indicated that there was a significant relationship between the rate of non professional roles of (spousing, house keeping, bread-winner, provider, and motherhood) and mental health; no other non professional roles had such a relationship. The results of statistical tests showed a significant relationship between the number of non professional roles and mental health (p<0.001), such relationship in professional roles was not significant.Conclusions: The findings showed that %41.8 of nurses of case group were higher than cut-off point of questionnaire. Therefore, with respect to high prevalence of mental disorders in nurses, the importance of mental hygiene of this group of society has been distinguished. Findings can lead to suggestions in order to optimize women's partnership in social and vocational activities, with regard to the basic role of women in house and children's nurture.

Introduction: Menorrhagia is defined by loss of 80 cc blood or more per each menstoral cycle. 50% of patients are below 40 years old. It is estimated that 30% of women have menorrhagia. Over 20% of these women have anemia. NSAIDS are treatment of choice (due to administration in menstrual cycle and in patients, s with no complete family planning) vitex with 2000 years history of efficacy have used. Vitex rises the Lh secretion and inhibit fsh secretion, and is effective in fecundity, PMS, dysmenorrehea, menorrhagia, amenorrhea, premenopause breast fibrocystic disturbance disease, acnea and hyperprolactinemia. Duo to complication of long term use of NSAIDS, and multiple treatment effect of vitex, in this study the efficacy of mefenamic acid and vitex on reduction of menstrual blood loss and Hb change in patients with a complaint of menorrhagia is evaluated.Methods and Material: In this clinical-trial study in 2003-2004 on patients with a complaint of menorrhagia who were referred to Fatima Gynecology Clinic in Hamedan province, which were less than 45 years old and their menorrhagia was due to dysfunctional uterine bleeding. Bleeding volume was determined by Higam table, then Hb level was evaluated. The case group received mefenamic acid and the control group vitex for a period of 4 months. Oral iron therapy was prescribed for 3 months, if Hb was between 9-13 e gr/dl or the patients had anemia signs or symptoms. Then, bleeding volume and Hb level were, again, determined. Personal, laboratory, and treatment data were gathered in a questionnaire and analyzed by descriptive statistics and frequency distribution tables.Results: The age of patients in two groups didn't differ significantly. Both mefenamic acid and vitx in patients with a complaint of menorrhagia had caused considerably reduction of menstrual blood loss and Hb content increase, with no statistically significant difference. Mefenamic aicd had more complications in comparison with vitex with significant statistical difference. Mefenamic acid and vitex in patients with a complaint of menorrhagia had caused either considerably reduction of menstrual blood loss and increase in Hb content, but vitex in comparison with mefenamic acid had much less complications.

Introduction: Heterotopic pregnancy occurs when there is coexisting intrauterine and ectopic pregnancy. Usually it happens after using of assisted reproductive techniques and it is very rare in natural conception. Immediately diagnosis and treatmem of this condition is very important and could prevent morbidity and mortality of these patients. The goal of this very important and could prevent morbidity and these of these patients. The goal of this study was to report a case of heterotopic pregnancy in a natural conception. Case Report: The patient was a 33 year old woman, primipara, 8 weeks of pregnancy, without positive history of infertility or using assisted reproductive technique. Her chief complaint was vaginal spotting and acute abdominal pain. In physical examination there was generalized abdominal, adnexal and cervical motion tenderness.Results: The patient was in shock. A ruptured right ampullary tube ectopic pregnancy was detected, which led to right salpingectomy. There was also a dead fetus in the uterus in emergency ultrasonograph which was completely aborted after 30 minites. However heterotopic pregnancy is a rare type of pregnancy especially during natural conception but it could happen even without any risk factors.

Introduction: The combined spinal-epidural anesthesia (CSEA) is commonly used for cesarean delivery. Its advantages include rapid onset and density spinal anesthesia, with flexibility of continuous epidural block to extend duration of anesthesia and analgesia. The main aim in our study is evaluation of this technique in cesarean section in Imam Reza Hospital. Material and Methods: This descriptive study was done in Imam Reza Hospital in 2004-2005. 56 women, at term of pregnancy, about to undergo an elective or urgent surgery under CSEA were studied. All parturients were hydrated preinduction. The technique was performed at sitting position. Design included a 18G touhy epidural needle and a 26G whitacre lancet point spinal needle. Local anesthetic was hyperbaric bupivacaine 0.5% (12mg) with fentanyl (25mg) intratech and a T4 sensory block was targeted. Total failure rate, maternal hemodynamic changes and ephedrine requirement, PDPH and nausea were evaluated. Results: Total failure rate was 16.07% including a need for general anesthesia (1.78%), cases in whom we could not obtain CSF (3.57%), the block through epidural catheter and failure rate in epidural catheter supplementation (3.57%). Maternal hemodynamic changes (83.9%), ephedrine requirement PDPH and nausea frequency were 83.9%, 50%, 0%, 42.8% respectively.Conclusion: In attention to these result, we believe that it is better to use CSEA in cesarean section surgeries only when there is a risk for long operation or when general anesthesia is high risk or as a postoperative analgesia.

Introduction: D & C as a routine endometrial assessment method has many problems such as high hospitalization expenses and anesthesia complications. Recently, uterobrush has been used for the diagnosis and expenses. In this study the two methods were compared in terms of sensitivity, specificity, positive value and negative predictive values. Materials and Methods: This cross-sectional descriptive study was performed in Beheshti and Al-Zahra Hospitals of Isfahan, Iran, in the year 2003 on women who had been hospitalized for D & C with different complaints. All study sample under went anesthesia and first an uterobrush sample and then the routine D & C sample were obtained to be sent to the same pathologist. Then, pathology reports were gathered and analyzed with SPSS 10 software.Results: Sensitivity, specificity, positive predictive value and negative predictive values were 93%, 100%, 100%, and 65% respectively in uterobrush group in ratio to the D & C group. The rate of unsatisfactory results reports in uterobrush group was 16.7%, while D & C had a report of 10-8% of such results.Conclusion: Uterobrush is an almost new method for diagnosing benign and malignant uterine lesions. It may be performed as the screening and primary evaluation method for endometrial problems. Therefore it could replace D & C; due to its convenience for both patient and physician, and also the lower expenses and less pain suffered by the client.

Introduction: There are several methods to reduce pain of labor. In this study we evaluated the analgesic effects of indomethacin (according to its accessibility, easy usage and low price) in reducing pain of labor also its probable side effects on fetus and mother. Methods and Material: This was a clinical trial, double blind study on primy gravid pregnant women who came to Mashad Zeinab Hospital for delivery in 2004. 100 Patients were divided into two groups, case and control, randomly; and rectal indomethacin and placebo were used at the active phase of labor in them respectively. Labor progression, pain score in different steps of delivery, first and fifth minute apgar score, and weight of neonate and hematocrit of mother were compared between two groups. Results: Mean age of patients was 21.51±2.97 years and 81% of the patients came to hospital because of beginning of labor and others because of rupture of membranes. Pain score at the active phase of labor was almost the same in two groups but pain score 1 hours after intervention and at the complete dilatation in the case group was significantly less than control group (P=0.001, P=0.049). Pain score after fetus delivery was almost the same in both groups. First and fifth minute Apgar, Pre and post delivery hematocrit of mother did not differ significantly in the two groups.Conclusion: Administration of rectal indomethacin at the active phase of labor can reduce labor pain significantly but may elongate labor duration (non-significantly). So it is a safe method for painless delivery.