Iranian Journal of Obstetrics, Gynecology and Infertility
Year:2008 | Volume:11 | Issue:1|Papers Count:10

Introduction: The hypotension following spinal anesthesia remains common place in cesarean delivery. Sympathetic blockade effects are more intense in preeclamptic parturients and these patients need more ephedrine after spinal block. Intrathecal opioids are synergistic with local anesthetics and intensify sensory block without increasing sympathetic block. The aim of this study was to evaluate maternal hemodynamic stability, following spinal anesthesia with lowdose of lidocaine plus fentanyl severe pre-eclamptic parturients undergoing in cesarean section.Materials and Methods: This clinical trial study was performed from 2005 to 2006 on patients at Al-Zahra Hospital of Tabriz University of Medical Sciences. A total of 60 patients with severe preeclampsia divided into two groups of case and control randomly. Thirty patients received 50mg lidocaine with 10mg fentanyl (study group), and in the other 30 patients 100mg lidocaine (control group) was used during spinal anesthesia. Heart rate and blood pressure were recorded at regular intervals. Pain, discomfort, nausea, and vomiting during surgery were observed. Neonatal Apgar score was assessed at 1 and 5 min after delivery. All data were recorded in a questionnaire and analyzed by descriptive statistics, Fisher, Ki Square and T-Tests.Results: Patients of the study group had a less frequent incidence of clinically significant hypotension (20% vs 63.33% of patients respectively; p<0.0001). The magnitude of the decrease in blood pressure was significantly larger in the control patients than the study group (34.6±10.3 percent vs 23.5±8.4 percent respectively; p<0.0001). Ephedrine requirements due to hypotension were more in the control group than in the study group (4.0±5.15 mg vs 1.33±2.60 mg respectively; p=0.015). The incidence in heart rate changes, higher than 30% was also similar between the groups. However, the incidence in heart rate was larger magnitude in the control group (p=0.19). Pain and discomfort during surgery were experienced more frequently in the control group (83.33%) than in study group (16.66%). Neonatal 1-and 5-min Apgar scores were also similar in two groups (p=0.75, p=0.22 respectively).Conclusion: Intrathecal low-dose of lidocaine with fentanyl provides a good surgical anesthesia with hemodynamic stability, without neonatal compromise in severe preeclamptic patients undergoing cesarean section.

Introduction: Breast parenchymal density is one of the factors that can cause false negative mammographic results. This work was performed to determine the frequency and distribution of dense mammograms.Materials and Methods: The peresent descriptive study was carried out from April 2003 to March 2004 on women referring to Radiology Department, Ghaem Hospital, Mashhad. A total of 1000 women with fatty (£50% density) or dense breasts (³90% density) who had screening or diagnostic mammography were studied. Breast density, breast size and presence of benign calcifications were analyzed. Clinical data such as age, parity, age at first conception, use of hormone replacement therapy (H.R.T), and family history of breast cancer were recorded and analyzed by the frequency distribution tables and descriptive statistic, Ki square and spirman test.Results: Parenchymal density on mammograms was found to correlate with the age, and decrease progressively from 25–29 years old through 75–79 years old (Spearman correlation P=0.001). Increased parenchymal density was more common in women who had smaller breast, and had fewer than two pregnancies, or underwent H.R.T (P<0.001). The prevalence of benign calcifications also increased with age. Conclusion: This study confirmed the effectiveness of age and HRT on mammographic density, suggesting a possible reduction of mammographic sensitivity and efficacy for detecting malignancy in these groups of patients.

Introduction: Induction ovulation and intrauterine insemination is one of the therapeutic approaches for male infertility. Timing of intrauterine insemination based on number and diameter of follicles and endometrial thickness is essential to maximize pregnancy rate and minimize complications such as hyperstimulation syndrome. Therefore this study was done for evaluation of relationship between pregnancy rate and number and diameter of follicles and endometrial thickness after induction ovulation with clomiphene citrate and IUI. Methods and Materials: In this case-control study in 2001among patients referring to Mashhad infertility center, 100 Patient were randomly assigned to case (50 pregnant women) or control (50 non pregnant women) group. The number and diameter of follicles and endometrial thickness were evaluated and compared by transvaginal ultrasound in these 2 groups in the day of injection of Human Chorionic Gonadotropine. Results of study were analyzed by chi–square, T-test, ANCOVA and multiple regressions. Results: This study was revealed that there is significant differences between pregnancy rate and follicles diameter in two groups (P=0.38, X2=5.8). Also in two groups there is significant differences between pregnancy rate and follicles number (P=0.01, R=0.29). There is significant differences between pregnancy rate and endometrial thickness in two groups (P=0.033, R=0.29). Conclusion: In this study “pregnancy rate was correlated with number and diameter of follicles and endometrial thickness after induction of ovulation with clomiphene citrate and IUI”.

Introduction: Brucella infection in animals has got documented association with high incidence of abortion, but in human there are controversies about the role of brucellosis in spontaneous abortion. Since brucellosis is endemic in Iran and is a disease that can be diagnosed and treated and many causes of abortion are undiagnosed, this study was designed to evaluate probable association between maternal brucella infection and spontaneous abortion.Materials and Methods: This clinical-trial study was done in the year 2006 at Amir-al Momenin Hospital of Semnan University of Medical Sciences. 81 women with spontaneous abortion were considered as case and 103 women with normal pregnancy outcome as control group. Previous pregnancy rates, previous abortion rates, and pregnancy age were similar in both groups. Two milliliter blood samples obtained from each one and IgG and IgM antibody measured by ELISA method in both groups. IgG or IgM equal or greater than ten considered positive. Individual, pregnancy age, fresh cheese and milk consumption, blood examination tests were gathered in a questionnaire and analyzed by descriptive statistics and statistical tests with significance of 5%.Results: Both groups were matched based on age, number of previous pregnancies and abortion, pregnancy age and consumption of fresh cheese. 6.2% of cases and 13.6% of control group had positive IgG titer (IgG³ 10 units). In both groups IgM was negative (IgM<10 units). There was no significant relationship between brucella antibody and spontaneous abortion. There was significant relationship between raw milk consumption and spontaneous abortion (OR=6.31).Conclusion: This study showed that asymptomatic brucella infection has no role in spontaneous abortion.

Introduction: Episiotomy and perineal lacerations are common perineal traumas during the primiparous vaginal birth and is the most common operation in obstetrics. There is no reliable evidence for routine use of episiotomy and it is recommended to perform selective episiotomy for fetal maternal indications. There for this study was performed by the objective, comparison of perineal traumas level in primiparous women with routine and selective episiotomy.Materials and Methods: This randomized clinical trial was carried out in 2003 on 100 primiparous women, between 17-35 years old with spontaneous delivery, at Modarres hospital in Kashmar. Sampling accomplished by purposeful method. They randomly allocated in two groups with routine and selective episiotomy. Delivery of subjects done by the researcher, but evaluation of perineal outcome, after delivery completed by the assistant researcher, who did not know about the group of samples. Trial allocation data obtained by interviewing, observation forms, measurement of pelvic muscle strength and were analyzed with t-test, chi-square, Mann Whitney and Fisher test, using SPSS software. Results: Of 100 women studied, 12 (24%) in selective group and 50 (100%) in routine group had episiotomy (p<0.0001). Perineal traumas in selective, routine groups were 62% and 100% respectively. These findings varied statistically (p<0.0001). In this study, two groups did not differ statistically regarding the effectiveness of variables on perineal traumas.Conclusion: Selective episiotomy can reduce the perineal traumas Level, thus as a safe method, should replace the routine episiotomy.

Introduction: Transcutaneous electrical nerve stimulation (TENS) has been a non-chemical effective method in reducing pain. The mechanism of TENS is not clear but gate control theory may explain it. The purpose of this study was to evaluate the analgesic effect of TENS on the post cesarean section pain.Materials & Methods: In a randomized clinical trial, in the year 2006, at Oncology Ward of Kerman Afzalipur Hospital 72 women with cesarean delivery, participated in this study and were assigned randomly to two groups. For the TENS group (36 patients) TENS was applied and for the control group (36 patients), placebo TENS. Intensity of pain before and after interventions was assessed by visual analogue scale (VAS). Also the first request of analgesic by the patient was compared between the two groups. The individual, and VAS results were collected in a questionnaire, analyzed by SPSS, and statistical tests.Results: The mean scores of pain for TENS group and control group were 3.78±1.72 and 6.61±2.11 respectively (p=0.0001). There was a significant statistical difference (p=0.0001), between the different mean scores for TENS group (2.25) and control group (0.22). Reducing pain in the TENS group and control group were 91% and16.6% respectively (p=0.0001). Conclusion: This study demonstrated that, using the postoperative TENS can reduce the intensity of pain and it can also, be an effective and safe method in controlling the pain of patients with cesarean section.

Introduction: Severe and intermediate polyhydramnios may cause various maternal and fetal complications. Indometacin therapy in moderate to severe polyhydramnios is recommended in some studies but, there no such study has been done in Iran. This study was done in order to investigate the effect of indomethacin in decreasing AFI and on enhancing duration of pregnancy. Materials and Methods: This randomized clinical trial was carried out in the year 2006 at Hamadan Fatemieh Hospital on 40 women who were 22 to 30 weeks pregnant, suffering from moderate to sever polyhydramnios (diagnosed by sonographic examination). Patients divided randomly into two groups. Twenty patients (case group) were treated with 1/5mg/kg/day of indomethacin for two weeks and the control group were just observed and hospitalized only in case of respiratory distress or abdominal pain occurrence. patients in the case group were assessed for drug complications, then after intervention to evaluate the AFI, they were checked by sonography in the second and forth week. Both groups followed up to delivery time and neonates examined for PDA. Individual data, pregnancy duration, Apgar score, and complications were collected in the questionnaire and analyzed by SPSS software, using the descriptive statistics, frequency distribution tables and statistical tests. Statistical significance was p<0.05. Results: The mean duration of pregnancy in case and control group was 38±1.33 and 34±2.93 weeks respectively, with the statistically significant difference (p=0.0001). After 4 weeks of treatment, AFI decreased from 24.2±3.54 cm to 17.15±2.36 cm. The neonates' APGAR scores were much higher for case group in comparison with controls. Indomethacin had no maternal or fetal complications.Conclusion: This study showed that, the success rate in case group was 100%. The mean duration of pregnancy was longer in case group, AFI decreased and neonates’ APGAR was better than the control group.

Introduction: Today, the donation of embryos, produced in vitro, is a common way to help the infertile cases who cannot produce embryo themselves by any of assisted reproductive procedures. The quality of endometrium and the time of embryo transfer are the most important factors in achieveing high pregnancy rate in these cases. The aim of this study was the assessment of pregnancy rate after embryo donation in natural cycle.Material and Methods: This descriptive study was carried out in the year 2005 at Hamadan Infetility Center on 24 couples. A total of 24 couples went through the treatment cycles with embryos donated by 17 couples. Embryo donation was done on days of 14-17 of natural cycle and 2-3 days after the progesterone administration to the recipients. A pregnancy test was performed 2 weeks after ET, and positive results were confirmed by sonographic evaluation of the embryo. Individual, hormone administration results and embryo donation data were collected in a questionnaire, analyzed by descriptive statistics and frequency distribution tables. Results: The mean age of the recipient and donor women were 32.2 and 26.2 years respectively. An average of 2.3 embryos were transferred on each occasion. The clinical pregnancy rate in the recipients was 30% (8.24) per embryo transfer. Conclusion: Transfer of donated embryos in natural cycle, results in a high pregnancy rate and is an easy, acceptable and cost-effective way of treatment for infertility.