Iranian Journal of Obstetrics, Gynecology and Infertility
Year:2005 | Volume:7 | Issue:2|Papers Count:19

Objective: There are several methods for abortion either surgical or medical, and one of them is usage of prostaglandin. In purpose of comparing the effect and complication of vaginal suppository and IV PGE2 in termination of missed abortions in first trimester this study was done.Materials & Methods: This case-control study was done on 74 patients in Beheshti Hospital of Isfahan during 2002-2003.] Indication for termination of pregnancy was missed abortion in the first trimester. Patient was divided randomly into two equal groups. In first group 5mg of PGE2 was applied (diluted in 1000cc 5% dextrose serum) and according to necessity, the dosage of this drug was increased.In second group two vaginal suppositories PGE2 (3mg) were administered.Simultaneously, oxytocin (30 IU) was administered. Then results of two groups were compared with t-test (SPSS-10).Results: Patients of two groups were identical (age, gestational age, parity). Frequency of complete abortion in IV PGE2 group was significantly more than vaginal PGE2 group. (11 patient (29%), 3] patient (8%) respectively, p<0.001) Duration from induction to expulsion of fetus in IV PGE2 group was significantly less than vaginal PGE2 group. (9.3+3) hours against 13.2+5.8 hours and p<0.001). In 5 patients (13%) of IV PGE2 group complications were detected, but no complications were detected in vaginal PGE2 group.Conclusion: Efficacy of IV PGE2 in induction of abortion is better than vaginal PGE2 and has no serious complications.

Objective: Spinal anesthesia for cesarean section is associated with high incidence of hypotension, nausea and Vomiting. The synergism between intratecal opioids and local anesthetics may make it possible to achieve reliable spinal anesthesia in cesarean section with minimal side effects.Materials and Methods: 40 patients aged 17-35 years old underwent cesarean section were randomized into two groups. Half of them in group A received spinal anesthesia with 6mg of bupivacaine and 10µg fentanyl; and group B received only 12mg bupivacaine. Hypotension was defined as a systolic blood pressure of less than 90 mmHg or 25% decrease in mean arterial blood pressure from baseline.Results: All patients in both groups had satisfactory anesthesia. The mean dose of ephedrine was 4mg in group A, and 11.75mg in group B (P=0.006). The mean ratio of lowest systolic pressure to baseline systolic pressure was 0.75 for group. A and 0.65 for group B.(P=0.04). Nausea and vomiting was observed in 10% of group A and 20% of group B.Conclusion: Small dose of bupivacaine and Fentanyl provides good spinal anesthesia for cesarean section with less hypotension, nausea and vomiting.

Objective: This is a case report about a patient with three normal pregnancies and vaginal deliveries after partial hysterectomy and chemotherapy because of throphoblastic choriocarcinoma with lung metastases.Case report: In this study, we present a 17-year-old woman with throphoblastic choriocarcinoma and lung metastases.She had an invasive tumor into a part of the uterus.Partial hysterectomy was done because of massive bleeding.After treatment, she had three normal pregnancies and successful vaginal deliveries.Conclusion: In management of the GTN (gestational throphoblastic neoplasm), the treatment options must be selected according to minimal impact on the subsequent ability of fertility.

Objective: The purpose of this study was to compare the effect of methylprednisolone with promethazine for the treatment of hyperemesis gravidarum.Materials & Methods: In this clinical trial, one-hundred patients with a normal appearing singletone pregnancy of <16 weeks gestation with hyperemesis gravidarum were admitted to the Obstetric Department of Emam Reza Hospital from September 2001 to November 2002. Patients were randomly (50 per group) assigned to receive oral methylprednisolone/ 5mg 3 times daily/ or promethazine 25mg 3 times daily. Patients from the group who continued to vomiting after 3 days discontinued the study medication and drugs were altered.Patients continued to take the remainder of the assigned medication after discharge and were followed up weekly.Results: There were no significant differences between the groups with respect to maternal age/ gravidity/ parity/ gestational age at entry/ number of previous admission or body weight loss. 72% of patients in the promethazine group and 90% in the methylprednisolone group responsed to therapy. There was significant difference between two groups. (p:0.041). 17.8% of patients in the methylprednisolone group and 47.2 of patients receiving promethazine were recommended for readmission for hyperemesis; and after 2 weeks of discharge, there was significant difference between two groups. (p= 0.009)Conclusion: A short course of methylprednisolone is more effective than promethazine for the treatment of hyperemesis gravidarum.

Objective: To investigate patient characteristics and observe pregnancy outcome in eclamptics in two referral hospitals in Kerman during the period 2000-2002 and to explore avoidable factors contributing to the adverse outcome.Materials & Methods: This prospective, observational, case series study included all the patients admitted to the obstetric unit with eclampsia. Sociodemographic, clinical data and laboratory results were collected along with results of investigations to categorize the complications; and data was analyzed using statistical tests.Results: During the study period, 49 patients developed eclampsia. The mean age of cases was 23.7± 5.9 years. 87.8% of them were rural, and 59.2% were primipara. The mean age of gestational age was 36.5±4 weeks. Most patients had convulsion, before admission and labor pain. Only 5 out of 49 cases received prenatal care (10%). There was no positive family history of eclampsia or past medical history of DM, renal or heart disease, twin and molar pregnancy in patients. Most of patients (65.3%) had cesarean section for delivery. Overall case fatality rate was 14.3%. Thrombocytopenia and brain edema were the most frequent complications in these women. There was no significant relationship between complications of eclampsia and mortality rate.Conclusion: The results of this study showed that regular prenatal care, teaching of pregnant women for early accurate recognition of PIH and, eclampsia and also better management, is necessary for decrease of maternal mortality.

Objective: The purpose of this study is to determine the rate of congenital anomalies in relation with gestational age at the onset of prenatal care in insulin-dependent diabetic women.Material and Methods: From 10/2000-10/2004, we prospectively collected data from 92 pregnancies and offspring's of women with IDD who were registered for prenatal care in Khorasan Diabetic Research. The data of different causes in relation to the rate of congenital anomalies in offspring defined and statistical analysis utilized Fishers exact test and Z test.Results: A total of 92 pregnant women with IDD who registered for prenatal care in the Khorasan diabetic research studied. The mean age of pregnancy at onset for prenatal care was 15.1 weeks. 69 women initiate a prenatal care early and before 20 weeks of pregnancy, 23 women later and after 20 weeks of pregnancy. In a total 11 neonatal congenital anomalies, 1 in early prenatal care group and 10 in late prenatal care group, the different was significant. Maternal age, parity, duration of diabetes, regularity in care and gestational age at onset the prenatal care were significant in association with the occurrence of malformations. Mean value of blood glucose and neonatal birth weight was not significant in association with the occurrence of malformations.Conclusions: Poor glucose control before and during the early weeks of gestational age has emerged as the major cause of congenital malformations and perinatal mortality. Therefore insulin dependent diabetic women should be initiate a early to prenatal care and normoglycaemia should strive for pregnancy.

Objective: To study the relation of method of delivery and maternal and fetal complications in pregnancy with ITP.Materials and Methods: In this research that was background and descriptive information collated to 96 pregnant women suffering with ITP who referred to the Isfahan Treatment Center (1990-2002). Results: Overall incidence of NVD was 65.6%, and CS was 34.4%. Incidence of cephalohematoma was 2.1 %, and incidence of abnormal bleeding was 7.2 %.Conclusion: Prevalence of abnormal delivery bleeding in CS was more than NVD. Prevalence of cephalohematoma in NVD was more than CS but cephalohematoma was not difficult for the in neonate, therefore NVD is safe delivery if there were not obstetrical indications.

objective: The purpose of this study is to assess the causes of cesarean and tendency of patients about the method of delivery and causes of selection and increase rate of cesarean.materials & Methods: This study was done from the first of April 2004 till the end of September 2004 in semnan. The study groups were all pregnant women that referred to Amir Almomenin hospital or private offices of obstetricians and gynecologists. Patients tendency and causes of selection of kind of delivery, job, education, and parity were record. Exclusion Criteria was previous cesarean section or patients had no tendency to any route of delivery. After collection of information, the data assessed by statistical analysis by SPSS software.Results: The total number of study groups were 400 pregnant women. 248 (62%) women selected the normal vaginal delivery and 152 (38%) women preferred cesarean section. The most common cause of tendency to normal vaginal delivery were less postpartum pain 36% and rapid recovery 33%. The most common cause of tendency to cesarean were fear from pain during vaginal delivery about 59%. About the correlation of job and selection of cesarean in housewife group significant correlation was present and also about the education and selection of cesarean in low educated group significant correlation was present. (p<0/000 and P<0.000 respectively) and finally about the correlation of parity (p1, P2 and P>3) and selection of cesarean in prime pare significant correlation was present. (P<0.000).Conclusions: In this study the tendency to cesarean section was high in compare to others countries, and the common causes of preferring of normal vaginal delivery were less post partum pain and more rapid recovery. The most common cause of selection of cesarean section was labor pain during normal vaginal delivery also, job, education and parity are important factors for selection of route of delivery.

Objective: Present study was undertaken to determine incidence and some characteristic of twin pregnancy in Motazedi Hospital of Kermanshah.Materials & Methods: This is a retrospective study on total childbirth during a 3-year period. Data were collected for mothers and infants, and analysis done with descriptive statistics include mean, standard deviation, and percentage.Results: There were 24.983 births during 3 years, and 402 twins were recorded. The incidence was 16/1000 (1/62 birth). Most twining was related to mothers with 20 - 25 (123 case, 30.6%) and 26 - 30 (117 case, 29.1 %) years old. 170 (42.3%) twins were belonging to first and 91 case (22.6%) to second parity. Twins sexuality includes; 150 (37.3%) boys - boy, 128(31.8%) girls - girl and 122 (30.3%) boy -girl. The average of infant weight was 2220 gr. (700 - 3600) and average of length was 44.6 cm (29.5 -54.5). In 52 (13%) both and 23 case (5.7%) one of the twins died.Conclusion: According to twins problems, making good plan for education to young mothers, increasing pregnancy and infants care for twins is recommended.

Objective: Comparison of vaginal sonography reports and anatomopathological reports of curettage biopsy in 100 pre menopausal and menopausal women with abnormal uterine bleeding (AUB).Material & methods: This is a descriptive and analytic research in which we assessed 100 women with AUB who referred to the Gynecolog Center of Ghaem Hospital. In all of them we did vaginal sonography and curettage biopsy, then the pathologic and sonographic reports were compared and evaluated.Results: The pathologic results of this study are secretory endometrium 28% - proliferative endometrium 20% - Hyperplastic 17% -Malignancy 11% -Atrophic endometrium 8%- Others 5% . The more correct vaginal ultrasonography diagnosis were in hyperplastic endometrial cases (39%) and uterine myoma (34%).Conclusion: Vaginal sonography is a noninvasive diagnostic methods for many gynecologic a diseases that we can do before medical treatment as surgery.

Objective: Since anemia in patients with cervical cancer is accompanied by poor prognosis in this research we studied the hemoglobin levels before and during radiotherapy.Materials & methods: During a four-year period a prospective study was done on 201 patients with cervical cancer in the Radiotherapy section of Ghaem Hospital carried on and 54 patients selected. During and before treatment, the hemoglobin level (Hb) was measured repeatedly in the above mentioned patients, and the patients whose (Hb) level was below 12 g/dl were considered anemic.The second procedure was comparing the age, stage, survival recurrence and disease free survival in two groups anemic and normal.Results: 41.7% of the patients were anemic before treatment and 58.3% were normal. 56.8% of the latter group became anemic after radiotherapy.The average age in anemic patients was 52.33 years and in normal patients was 53.93. The stage of disease showed little difference between two groups.Response to radiotherapy after 3 months of treatment in the anemic group was 57.1% and in the second group was 66.7% , P=0.48, Comparison in overall survival led to this result, in the first group (anemic) 37% and in second group 41%, (P=0.941).Disease free survival in the first group was 8 months, and the second group was 10.67 months (P=0.748). Disease-free survival in later anemic patients was 6.28 and in normal group was 8.09.Conclusion: Although the low HB level (under 12g/dl) showed an increase in local recurrence and a decrease in overall survival, this difference was not significant statistically.

Objective: Plasma Cholineestrase Activity has been decreased by several factors. Some patients have genetically abnormal Succinyl Choline metabolism.The prevalence of the hemozygote form of this abnormality is about 1:1500 till 1:2000, and based on other studies is about 1:3200. In this study, after using of Succinyl Choline for inducing general anestnesia in a patient that was candid for Cesarean Section because of breech presentation, prolonged hypotonia and apnea were observed in the newborn.Therefore, controlled ventilation was used about 20 minutes. Neuromuscular blocking of the mother was prolonged about 45 minutes after operation. Return of neuromuscular block to normal occurs by using Fresh Frozen Plasma for about 30 minutes. In this case report we assessed probable or underlying causes of prolonged apnea after use of Succinyl choline.

Objective: The purpose of this study was to review our clinical experience with abdominal wound dehiscence. Materoals & Methods: During the 5-year period from (1997-2001), there were 2.761 major abdominal operations performed at the Department of Surgery Imam Reza Hospital. Mashhad, Iran. Twenty-one specific local and systemic risk factors were analyzed and compared with the control group.Results: 31 (1%) abdominal wound dehiscence's occurred in 2.761 patients undergoing major abdominal surgery. Significant risk factors were found to include age over 65 year, wound infection, pulmonary disease, hemodynamic instability, and ostomies through incision. Risk factors not found to be important included, sex, type of incision, type of closure, anemia-jaundice and diabetes. When dehiscence and control groups were combined 30% of patients with at least five significant risk factor developed dehiscence, and all the patients with more than eight risk factors developed a wound dehiscence. There was an overall mortality of 29% which was directly related to the number of significant risk factors. The coexistence of 9 risk factors portended death in one third of the patients, and all the patients with more than 10 risk factor died.Conclusion: Wound dehiscence carries a very high mortality rate and major morbidity. It is a dreaded complication that increases hospital stay and cost. We believe that serious consideration should be given to placing retention sutures in high risk patients to try to prevent evisceration and dehiscence. Serous drainage from a wound after surgery should alert the physician to possible wound dehiscence.

Objective: In this study we evaluated cardiovascular changes during pregnancy. Our main aim was, in cardiovascular disease, pregnancy causing worse heart problems and increase functional classes during gestation. In which groups of patients, before pregnancy, is therapeutic management like intervention or surgery necessary to be performed, and fetal and newborn complications, evaluated.Methods and Materials: In this prospective study we evaluated, 53 pregnant women with heart disease who were admitted to Dept of Cardiology, Imam Reza Hospital before or immediately after delivery. Maternal gestational age, parity, the kind of heart disease history of cardiac surgery, and also Abortion, stillbirth, and functional classes based on New York Heart Association classification were done.After collection of information, percent of the data was assessed and presented.Results: At the time of admission (47.1%) of patients were in functional class II, class I (33.9%) class III. (13.2%), class IV (5.6%). In this study the most common cause of cardiovascular disease (Figure III) was rheumatic heart disease (69.8%) and the most common cause of patients admission to hospital (Figure I) was those, with the history of heart disease (81.1%), and most common clinical manifestation (Figure II) was exertional dyspnea (35.8%) .Conclusion: Patients with MR, mild MS, AI & mild AS, VSD and functional class I & II can tolerate pregnancy and delivery well. But usually for pts in class III, IV, they will have serious problems during pregnancy and delivery. The decision of continuation or termination of pregnancy in high risk pts for example severe MS, AS and pulmonary hypertension, izenmenger's syndrome, high functional class are depending on the consultation between cardiologist, cardiac surgeon, obstetrician and pts family.

Background: Postoperatively, early enteral feeding has been associated with reduced protein-store depletion, improved wound healing, and a positive psychological impact, resulting in faster recovery. Thus, early oral feeding after abdominal surgery has been the goal of surgeons for several decades.Objective: To evaluate the safety and efficacy of early oral feeding as compared with those placed on a delayed feeding schedule in patients undergoing abdominal hysterectomy.Material and Methods: This was a prospective randomized study of 80 women who were undergoing abdominal hysterectomy. They were enrolled in a randomized controlled trial and compared with delayed postoperative oral feeding. Women were divided in two groups. Patients in the early feeding group received oral diet within 6-8 hours of surgery, but those in the control group were given nothing by mouth for 18- 24 hours. They were given clear liquids, and were advanced to solid food on the second or third postoperative day.We reviewed the gastrointestinal outcomes and hospital stays.Results: Eighty women were studied, with assigned 40 versus 40 to each group. Two groups were similar in age, disease and surgical length. In early-fed patients nausea was more developed (43% versus 22.4%, p=0.006). Despite this, vomiting, abdominal distention, length of post operative ileus, need of nasogastric tube use were comparable in both groups. Time to development of bowel sound (1.7±1.1 days vs 2.2±1.1 days, p=0.007), time to initiation of solid diet (1.8±1.2 days vs. 2.9±1.4 days, p<0.0001)and hospital stay (2.3±1 days vs. 3.9±1.3 days, p<0.003) were significantly sooner in the early feeding group.Conclusions: Early postoperative feeding in abdominal hysterectomy seems to be safe, well tolerated, and may lead to earlier hospital discharge. Key Words: Postoperative Feeding, Early Oral Feeding, Abdominal Hysterectomy, Nutrition.Acknowledgment:All physicians and co-workers in Imam reza hospital, department of obs&gyn, that kindly helped us.

Objective: This is a report of a heterotopic pregnancy coexisting with intrauterine and ectopic pregnancies(1). For occurrence of heterotopic pregnancy, at least two ova must be fertilized; and separate implantation must be done like dizygous twins (2). Clinincal manifestions of heterotopic pregnancy has differed in recent years, due to the patients early follow-up and transvaginal ultrasonography method. In this study we report a case of heterotopic pregnancy.