Iranian Journal of Obstetrics, Gynecology and Infertility
Year:2006 | Volume:9 | Issue:1|Papers Count:19

Objective: premature rupture of membranes (PROM) is one the most common problem occurring during pregnancy. Its early prediction and diagnosis has a vital importance in reduction of complications and appropriate treatment. This study was designed to evaluate the practicability and sensitivity of creatinin and Alfa- fetoprotein (AFP) in vaginal washing on PROM diagnosis in pregnant women in Imam Hussein Hospital. Material & Methods: In this prospective diagnostic clinical trial study 112 pregnant women were included. The patients were 18-37 years old. 56 women with 22-36 weeks of gestational age and obvious leakage, positive fern test and definite PROM diagnosis were included in the case group (GI) control group (GII) consisted of 56 moral pregnant women with 31- 41 weeks of pregnancy, without any signs and symptoms of fluid leakage. AFP and creatinin values in vaginal fluid of both groups were measured. Sensitivity, specificity, positive and negative predictive values of both parameters was calculated, and comparison was made between both groups and also with fern test. Sampling was done by washing the posterior vaginal for nix with 5 ml sterile water and aspiration of 3 ml to send to the laboratory.Results: Mean gestational age was 33.07±5.6 weeks in PROM group and 36.46±5.5 in the control group. AFP was 24.76±23.0 IU/ml in PROM versus 3.0±3.8 IU/ml in GII (P value<0.001). Creatinin was 0.52±1.1 mg/dl in group I vs 0.32±0.4 in the other group, respectively. There was no significant difference in Cr in both groups. Sensitivity, specificity of AFP was 100%, 100% compared with 14% and 96.2% in creatinin, respectively. Positive and negative predictive values were 98.2%, 100% in AFP and 80% and 51.51% in Cr, respectively. Sensitivity, specificity, PPV and NPV for fern test was 100% 88.6% 90.2% and 100%.Conclusion: AFP is a useful diagnostic tool with high diagnostic power for PROM detection. Thus, this valuable and noninvasive method provides appropriate treatment and reduces maternal and fetal complications of PROM.  

Syphilis, a chronic systemic infection caused by Treponema pallidum, is usually sexually transmitted and is characterized by episodes of active disease interrupted by periods of latency. VDRL is the commonest test used for screening syphilis. One of groups for screening syphilis in Iran is men at the time of marriage. With regards to the social position and the financial payments for this assessment, we investigated the necessity of this test in Yazd.Method: in this retrospective- descriptive study from 10725 men for first marriage, 15 women and 15 men for second marriages were referred to the medical health center of Yazd from 2003 to 2005 with positive VDRL test and investigated.Results: the incidence of the positive test for men at the time of first marriages was 0.00%.Conclusion: this percentage is fewer than reported by Dr. Tara in Mashhad and Dr. Sharify Mod in Sistand and Baluchestan. Anyway, more assessment in other parts of Iran is recommended, and we invite our readers to pay attention to the recommendation ot the authors.  

History and Aim: Dysmenorrhea is painful menstruation and premenstrual syndrome defined as a combination of destressing psychosomatic changes which appear as a cyclic recurrence during the luteal phase of the menstrual cycle. In the majority of cases these can interfere with familial or scoical activities. The aim of this study is assessment of the problem in hight school grils in babol.Methods & Materials: This is a descriptive analyctical study and a cross- sectional survey, which has been done on 410 high school girls in Babol, selectedwith two stagecluster sampling. Information was collected with a questionnaire. Data was statistically analyzed by spss10 (T-Test, Fisher's exact) and p<0.05 was significant.Findings: mean age of 410 students was 16.03±1.15(years). Mean age of menarche was 12.84±1 (years). 52% of girls had dysmenorrhea and 45.6% of them had irregular menses. In girls with dysmenorrhea, menarche began earlier (p=0.023), intermenustural intervals were shorter than in other girls (p=0.145), and menstrual day in each cycle was more (p=0.55) . the most common symptoms at the beginning of the menses were: generalized malasia (52.21%) and fatigue (30.39%). 91.18% of persons had experienced at least one of the symptoms of premenstrual syndromes. The most common symptoms were : abdominal cramps (56.37%) , fatigue (40.93%), loosening of efficascy (40.93%) . scottom in visual field had the lowest prevalence (5.15%) . often, there was statistically significant relation between dysmenorrhea and premenstural symptoms.Conclusion: Dysmenorrhea and premenstrual syndrome are one of the commonest gynecologic problems in high school girls, and these problems can interfere with familial, social or work- related activities, there fore educative and informative programs can be provided a beneficial useful step in health of girl students.

Introduction: the aim of this study was a comparison between celebrex and magnesium sulfate in prevention of preterm labor. Celeberex belongs to NSAIDS group and is specific inhibitor of cox -2 and has effect on treatment of preterm labor.Materials & Methods: this study was performed in Hazrat Rasoul Hospital, Iran University of medical sciences in 1382-83. It was a clinical trial that was performed on 10pregnant women admitted to hospital  for preterm labor treatment who were in 24-34 gestational weeks. Case group was treated with celebrex and control group with mgso4. treatment was continued for 48h, and drug response was evaluated. The results were compared with – test and chi2.Results: mean duration from onset of treatment to arrest of contraction in Mgso4 treated group was lower than celeprex but not statistically significant. Frequency of pretermdelivery was not significantly different between two groups.Conclusion: Based on this study and some previous studies, celebrex and magnesium sulfate have the same efficacy on treating preterm labor. So, this drug, because of lower side effects and simple use, can be used in treating preterm labor.    

Introduction and objective: one of the most common side effects of intrauterine devices is increasing of menstrual blood loss, which may cause discontinuation and iron- deficiency anemia. By considering the effect of IUD type on menstrual blood loss volume and high incidence of iron- deficiency anemia among women , developing countries this research was conducted to compare the effects of TCU-380A and TCU safe-300 IUDs on menstrual blood loss among subjects attending health care centers of Iran University of Medical sciences in 2004.Material& Methods: in this single blind clinical trial 110 healthy subjects enrolled as clients who were eligible for use of IUDs. They were selected by a purposive manner, then they were randomly divided in to two groups of TCU- 380A and TCU safe-300 users. Menstrual blood loss was measured one month before and 1, 2, and 3 months after IUD insertion by use of Higam chart. Date were analyzed by using statistical tests such as chi-square, Mann – Withney, Independent, Pair, Fisher exact, Fisher, ANCOVA.Results: Mean Menstrual blood loss before TCU safe-300 and TCU – 380 A usage were 44±17.8 mL respectively, for which there was no significant difference between them. But mean menstrual blood loss during the first 3 months after IUD insertions were 109.9±69.2 mL and 139±52.6 mL respectively (p=0.032). Menstrual cycle length was decreased and menstrual duration was increased after IUD insertion in both groups (p<0.001)Conclusion and comment: this research showed menstrual blood loss in the first 3 Months after IUD insertion in TCU safe-300 users were less than TCU 380A users. More studies are suggested on the side effects and effectiveness of TCU- safe 300 IUDs and other ways of decreasing the blood loss in IUD users to increase the client motivation for using IUDs and increasing its continuation rate as well.    

Objective: large placental weight and a high placental to birth weight ratio are both known predictors of higher adult blood pressure related to low maternal hemoglobin and a fall in mean cell volume. So we decided to study the association of maternal hemoglobin levels with placental weight, birth weight, and placental ratio.Methods: this prospective study was performed on 500 pregnant women who were hospitalized in Amir- Almomenin Hospital in Semnan, Iran, for delivery from September 2001 to September 2002. Maternal hemoglobin concentration was measured at first trimester during prenatal care and before delivery using Coulter counters method. Birth and placental weights were measured at delivery. The patients with systemic disease, history of smoking, poly or oligohydramnious, placental abnormality, twin or multiple pregnancies, high blood pressure and fetal congenital anomaly twin or multiple pregnancies, high blood pressure and fetal congenital anomaly were excluded from the study. Stepwise regression analysis was used to determine this association and p value<0.05 was significant.Results: krusskall wallis and ANOVA analysis showed that the lowest range of birth weight was associated with hemoglobin concentration of <10 gr/dl in pregnancy (p=0.1) and maternal age of less than 25 years old (p=0.007). The maximum of placental weight was in pregnant women with parity of 3 to 4 (p=0.005). The maximum of placental ratio (placental weight / birth weight) was with hemoglobin concentration of 9-9.9 gr/dl in third trimester. (p=0.001).Conclusion: using multiple regression analysis, we detected a positive correlation between birth weight and late maternal hemoglobin levels (p=0.0179), between placental weight and parity (P=0.0008) and a negative association of placental ratio with maternal hemoglobin concentration in first trimester (P=0.0034).  

Objective: breast cancer is a fatal disease that annually causes mobility and mortality in hundreds of thousands of women worldwide. It seems that its prevalence is increasing in the north area, there has not been comprehensive information related to it this area yet. The main goal of this study is natural statistical determination of this study on the patients referred to our center.Method: the radiotherapy- oncology unit of this center is a referral center of four provinces mazandaran, Gilan, semnan and Golestan that undertake the follow up of patients after treatment. This study is a 5 year assessment (1379-1383) that has been performed on all patients referred to this center (totally 403 cases).Results: breast cancer at the rate of 24.9% was the most prevalent cancer in women referred to this center. Also, the trend showed that cancer increase in that period. Incidence dependency on age showed an increase of disease in the middle of the third decade (35 years old) to the end of the forth decade (49 years old) and then showed a decreasing behavior. Detecting the breast mass was the most prevalent (94.1%) symptom for referring to the doctor. Also the most prevalent site involved was the upper external quarter (54.6%) of the left breast (52.8%). Staging of the disease manifested that 42.5% of the patients were at stage 3. The most common morphologic pattern 87.4% was ductal invasive carcinoma, and the most common pathology associated was fibrocystic change. Concerning TNM classification, tumor size in the majority of cases (38.3%) was T2 (2-5cm), 60% in position N1 and 7.2% of them have metastasis. It this study prevalence of the breast cancer during pregnancy was 1.2% and it's prevalence in men 1.7%. Also there is bilateral involvement of the breast in 3.2% of the cases. There is significant relation between tumor size with lymph node involvement and also between lymph node involvements with metastasis. But there is no significant relation between disease stage and age.Conclusion: disease age in our patients was much less than common age in the publications. However, new methods are developing for primary prevention of breast cancer today. Also, considering disease stage at the time of referral was higher at stage 3 in half of patients, thereby introduce approaches for ideal achievement of women to diagnostic programs for screening of breast cancer is the primary and principal women rights.    

Background and objectives: in the recent century, one of the most important problems and difficulties among families is anger that can be the origin of numbers mental disorders. Emotional and cyclothmic disorders are the most common representation of premenstrual syndrome. Therefore the researcher has tired to achieve a study with the aim of determining relationship between variables of anger and severe (density) premenstrual syndrome.Materials & Methods: this research (survey) is a descriptive- analytic study. The case study includes 152 high school students, who through sampling method- multi-stages. By the classification, cluster and random method, were selected. In order to collect the data, we use a evaluation form of signs, before premenstrual for surveying the rate of outbreak and severe (density) signs. Also, we used a standard Staxi questionnaire, in order to survey experience and presentation of anger.Findings: the results of this research indicated that 54.7% units of those researched suffer from premenstrual syndrome. From the point of relationship of variables of anger with sever of signs premenstrually the results showed that among anger-in, trend to anger and sever (destiny/violent) of anger on the time of testing with severe signs premenstrually is a meaningful relationship, (but) between variable of control of anger and anger – out with sever of signs premenstrual syndrome has no meaningful relationship. These results also showed that unit (attacked) by premenstrual syndrome, in comparison to units without syndrome, meaningfully, in sub set of severs of anger during the test, trend to anger, anger-in and anger– out have acquired high (degrees).Conclusion: Regarding the high spread a of anger among adolescents, and its relation to disorder of premenstrual syndrome, the necessity of attention to health and mental health of premenstrual synorme, the necessity of attention to health and mental health of a addescents, nationally has been revealed. In respect to findings of recent research, (responsible), of education system and families, have an important task, that to choose plans, tranining in field of premenstrual syndrome, and the effective factors on premenstrual syndrome and methods of therapeutics. This disorder will help with hygiene and health of adolescents.

Objective: comparing the changes of fasting homocysteine during the second and third trimesters in pre- eclamptic women with normal control group. Methods: in a nested case control study within a cohort of 324 pregnant women with normal blood pressure in 20th gestational week , 20 pre- eclamptic women were selected. Having been matched for pregestational body mass index, age, gestational age at time clinical manifestation of preeclampsia, a control group of 40 were selected. Coming back to their serological data, the homocysteine levels of cases and controls during the second trimester (20th to 24th weeks) of pregnancy were compared. The comparisons were also carried out in third trimester when preeclampsia occurred.Results: the fasting homocysteine levels were increased from 5.31±1.4 μm.l to 7.54±1.6 μm.l between second and third trimesters in preeclamptic group (p<0.01) and 4.1±1.3 μm.l to 5.2±1.4 μm.l in control group (p<0.01).Conclusion: the women who develop preeclampsia have higher homocysteine levels before clinical evidence of disease than women who remain normotensive during pregnancy. This data suggests. Endothelial dysfunction in preeclamptic women before clinical manifestation of preeclampsia  

Introduction: preeclampsia occurs in approximately 5-12% of pregnaniceis, and its etiology remains unknown. The most prevalent quantitative assessment of the amount of protein excreted in the urine for the diagnosis of preeclampsia is a 24 hour urine collection. However, the collection and analysis of 24- hour urine specimens is cumbersome and time consuming for both the patient and the laboratory.Objective: this study was undertaken to validate the prediction of 24 hour urine protein excretion by a single voided urine protein – to – creatinine (p:c) ratio in a hospitalized pregnant populationat our institution.Method: this study was an analytical observation study investigation and was performed on 30 hospitalized pregnant women who were diagnosed as preeclampsia at 22 Bahman Hospital from 1382-1383. Pregnant patients who were admitted to the antepartum unit at 22- Bahman Hospital, and who were undergoing a 24-hour urine collection for the quantitation of proteinuria, were recruited. A single urine specimen was obtained after the completion of 24- hour urine collection and analyzed for the protein- to creatinint ratio. Multiple linear regression was used to determine the correlation between the 24- hour urine protein excretion and spot urine protein- to creatinine ratio. The strength of the association was assessed with the Pearson correlation coefficient. The correlation of the 24-hour urine protein and protein – to creatinint ratio with other variables (Including maternal age, gestational age, parity, blood pressure and weight) were assessed. Multiple linear regression was used to detect any confounding effects. Reults: thirty patients completed the study. There was a significant correlation between the 24-hour urine protein and the protein- to creatinine ratio (r=85%, p<0.001). The associations of maternal age, gestational age, weight, parity and blood pressure at the time of collection with proteine - to - creatinine ratio and 24- hour urine protein were weak and not significant, on the basis of multiple linear regression, there was no confounding effect of maternal age, gestational age, parity, weight and blood pressure.Conclusion: our data supports the use of single protein – to – creatinine ratio in hospitalized pregnant patients to predict the 24- hour urine protein result.  

Background: Postmenopausal bleeding (PMB) is a common problem of elderly women. Golden standard diagnostic method is the pathologic report of dilatation and curettage (D&C). In recent studies Transvaginal Ultrasonography (TVS) is discussed as a noninvasive useful method for screening malignancy change in the endometrum. We evaluated vaginal sonography in uterine malignancy.Methods & materials: This was an analytical" Clinical Trial" study performed in menopause women who referred to specialized Clinics of Gynecology in Babol. Inclusion criteria were PMB and no hormonal treatment. D&C endometrial sampling and TVS were accomplished for all individuals.Result: The most common pathologic diagnosis in 50 cases, were studied was proliferating endometrium means. Endometrial thickness in them was 12.6±10.4mm. No malignancy was reported in less than 5 mm endometrial thickness. Mean of endometrial thickness in 4 cases (8%), which had malignant changes, was 17.6±13.3 mm. Malignant changes in these patients were adenocarcinoma and hyperplasia . Sensitivity of TVS was 100% and specificity was 26% positive predictive value was 10.6% and negative predictive value was 100% efficacy of this method was 32%.Conclusion: TVS is not a reliable diagnostic test for malignancy or premalignancy screening in PMB, if we get endometrial thickness as the only basis of evaluation. But it is reliable in follow- up of patient with less than 5–mm endometrial thickness. It seems that pathologic assessment is still the golden standard for malignancy diagnosis.  

Crimean- Congo hemorrhagic fever (CCHF) is caused by Nairovirus, genus Bunyavirus in the family of bunyaviridae , and is spread by the tick hyalomma spp or via blood transfusion and contaminated blood of humans and animals. In recent years, disease has been reported from Iran, specially from Sistan and Baluchistan, Isfahan, Kermanshah and kohkilouyeh-boyerahmad provinces. Now CCHF is endemic in Sistan and Baluchistan provinces. There are several epidemiological reports about CCHF from Iran and other countries, but there was no survey about CCHF and pregnant women. In order to study the clinical manifestations, laboratory results and prognosis of CCHF during pregnancy, this study was conducted.Herein, we report six pregnant women with CCHF, who were admitted to Boo-Ali hospital in a time period of 5 years from 2000 to 2005. All patients were treated by Ribavirin. We studied the clinical manifestations- laboratory results and clinical outcome of disease in all cases.Our results showed that, fever, headache, myalgia and gum bleeding were the most common clinical manifestations. Thrombocytopenia- anemia and decreasing of prothrombin time were the commonest laboratory results. Abortion was observed in 3 patients and stillbirth in one patient. In fact, 66.6% of pregnant women had fetal loss. It is found that fetal loss is hight in this disease, but it more studies, especially in endemic areas, should be done.  

Sexuality is one of the most complex and important aspects of a woman's life. Sexuality is multidimensional, including biologic, psychological, socioeconomic and spiritual components. Sexuality is influenced by many things such as family, religion, values, media images of women, personal experience of violence, disease, et. Relationships, both personal and scoical, are very important to women. If a woman is ambivalent or unsure about her relationship with her husband , her sexual functioning can be negatively affected. For most women, sexuality is a positve, joyful, creative, and connective process. However, because sexuality is so complex, any life experience or illness can affect sexuality and sexual functioning. Sexual health care for women involves diagnosing the concerns and assisting women to enhance sexual functioning and sexual satisfaction.  

Purpose: The study of causes of delayed puberty in female referred to pediatric endocrine ward of university centers of Mashhad University of Medical Sciences from 1374 to 1382.Method: This study was done both retrospectively and prospectively in a descriptive analytic manner. The studied population was 31 girls with delayed puberty referred to endocrinology pediatric clinic. The data was collected through history, physical examination, completing questionnaires, and was compared by T Test student Statistical analysis performed with SPSS- excel.Result: On the whole, 31 girls with delayed puberty were studied. The mean age of the patients was 14.93±1.46 yr. Average bone age and weight was 10±1.5 yr. and 31±8.3 k gr respectively. Z score of height and weight for age was -3.83 and -2.68 respectively.Serum estradiol level in all patients was less than normal. Delayed puberty in 27% was constitutional, 23% had Turner syndrome. Major thalassemia was the cause in 13% of the cases. The prevalence of hypothyroidism in the population was 10% other systemic diseases such as, fancony syndrome etc were the less common causes of delayed puberty.Conclusion: Constitutional delayed puberty (27%) and turner syndrome (23%) were the most common causese of hypogonadism and delayed puberty which concurs with other studies. The prevalence of major thalassemia (13%) is more than other studies which needs further studies, attention to signs of puberty in the girls referring to physician at the time of puberty, leads to early diagnosis of delayed puberty in the patients. And also karyotype study is recommended in all girls with short stature and growth retardation.  

Objective: the aim of this study is evaluation of clinical findings, microscopic examination and culture of vaginal secretions, and response to treatment in prepubertal Girls with vulvovaginitis.Materials & methods: Over a period of about 5 years in a clinic for pediatric kidney and urinary tract disease, 157 girls aged 2.5-8 years with urogenital symptoms were studied prospectively.Results: Dysuria, erythema , itching, soreness, and vaginal discharge were genital symptoms and signs. Pathogenic bacteria were isolated in 27% of cases and streptococcus pyogenes was a common agent. Nonpathogenic enteric flora was isolated in about 43%. There was no growth of bacteria in 30%. Poor hygiene was an associated risk factor in those with nonpathogenic positive culture (p=0.001). There was statistically significant difference of purulent vaginal discharge between cases with vulvovaginal pathogenic infection and those with negative culture (p<0.001).Also there was significant difference of observing WBC in vaginal smears between those with pathogenic bacteria and patients who had no growth of pathogens (p<0.001). Candida and sexually transmitted agents were not found in any of the girls. Labial fusion was not an uncommon abnormality. Simple measure to improve hygiene and use of local estrogen were effective in the patients with nonpathogenic and nonspecific etiology.Conclusion: physical examination of genital area should be done in all grails with genitourinary symptoms. Antibiotics should be prescribed based on bacteriologic culture of vaginal secretion. Advice about hygiene practices and local estrogen is the most effective policy in children with noninfectious vulvovaginitis. Anti fungal creams usually have not place in the initial management of childhood vulvovaginitis.The possibility of sexual abuse or foreign body in vagina must be considered particularly if the vulvovaginitis is persistent or recurrent after adequate treatment, but our data indicate they are not contributory factors.    

Background: due to prevalence of urogenital infection and lack of knowledge about the relationship between bacterial vaginosis and urinary tract infection in this country, this study was conducted in patients referred to Shohada Hosptial during the years2001-2002.Materials & methods: this case-control study was carried out on 134 candidates. Patients were labeled as having urinary tract infection when urinary culture was positive. Normal individuals with either negative culture, matched with our cases, have compromised the control group. Matching was designed for age, frequency of coitus, marriage years, and contraception. Bacterial vaginosis based on standard Amsel criteria was determined in both groups. The results were analyzed using t- test and x- test. The odds ratio and confidence intervals were calculated.Results: 67 patients with urinary tract infection were compared with 67 normal individuals. Bacterial vaginosis was reported 40.3% and 62.7% in the control and case group (p<0.01, OR=2.49). Characteristic discharge, PH over 4.5 was reported in 91% , positive whiff in 74% clue cell in 72% of patients with bacterial vagionosis.Conclusion: individuals with urinary tract infection encountered bacterial vaginosis more than control group. Experimental studies seem to be useful to evaluate effectiveness of vaginitis treatment in prophylaxis of urinary tract infection and also further attention to pregnant woman.    

Introduction: Meningomyelocels is the most common congenital anomaly of the central nerves system (CNS). It is not only a spinal cord anomaly, associate hindbrain abnormalities, hydrocephalus, bladder, and bowel disturbance, and orthopedic deformities make a team effort necessary. We reviewed our patients with meningomyelocele and evaluated their early and long- term outcomes.Patients & methods: we included 45 patients with meningomyelocele operated on between 1990 and 2004 in this study. The medical records were reviewed from the aspects of neurological and physical findings, surgery performed, and complications.Parental age and education were analyzed when available. The chiary-square test was used for the statistical analyses.Results: there were 19 boys (42.2%) and 26 girls (57.8%) the lumbar region was the site of the meningomyelocele in 27 patients (62%) patients with cervical and sacral meningomyelocele had a higher rate of normal motor function than those with meningomyelocele at other levels (p= 0.0001). We also noted that the higher the location of meningomyelocele, the greater the control of both sphincters (p=0.0013).Conclusion: the management of children with meningomyelocele needs a team approach. The majority of patients can have a normal IQ and a socially acceptable degree of continence and be able to walk. The patients should be treated with aggressive therapies whenever possible.