Iranian Journal of Obstetrics, Gynecology and Infertility
Year:2003 | Volume:6 | Issue:1|Papers Count:17

Objective: After war he community was encountered with many of the war wounded who suffered from the outcome of the chemical gases which were used by Iraq. These outcomes are divided into early and advanced stages. Pregnancy outcomes such as spontaneous abortion, low birth weight and preterm labor are advanced.There are limited studies about these out comes. The aim of this study is to survey pregnancy outcome in wives of the chemical war wounded. and to determine the relation between chemical gas exposure with such results as low birth weight, preterm labor, intra uterine fetal death, fetus abnormality and altered sex ration.Materials and Methods: Our study is descriptive. We sampled 50 accidentally chemically injured patients from 2100 victims in Kerman and obtained questionnaire data concerning chemical gas exposure and reproductive health experience.Results: Of these 50 chemically injured, patients there Were 120 cases of pregnancies. Among the 120 pregnancies, there were 19% LBW, 13%preterm labor and 8% abortion. Variables such as low birth weight, abortion and preterm labor with such variables as mother's and father's age, education and severity of chemical injuring were analyzed in SPSS system. Conclusion: Except for parents age, in other variables p was less than 0.05 that shows relations are meaningful.

Objective: During recent years, there has been significant progress in infertility medicine especially in ART. Since both patient, and doctor involved in ART have anxiety and mental stress about the outcome of pregnancy, the purpose of this study was to find a simple and safe method to predict pregnancy outcome as soon as possible in ART and relieve the stress of patients and their families.Materials & Methods: This was a cross -sectional study and was shown on 116 patients who had referred to infertility clinics of Isfahan for induction ovulation after ART procedure in serum. B - HCG at 17th day after induction ovulation was positive. The patients entered the study and their characteristics were age, time of infertility, B -HCG titer, gravidity recorded an questionnaire. Patients were followed until termination of pregnancy. The information of patients was analyzed with SPSS program by use of tests: ANOVA, Xl, Fisher exact test and Pearson correlation test.Results: he results were mean age: 28.83+0.46, Mean of B- HCG=499.31+ 0.571U/lit. 92 patients had B-HCG > 100 and 24 had BHCG < 100 IU/lit, the rate of term pregnancy was 64.1%, preterm pregnancy = 10 .8%.Abortion: 20.6% and IUFD: 4.3% In group with B-HCG < 100 the rate of term pregnancy was 29.1% preterm pregnancy and abortion 50% and IUFD: 4.1%. P value: 0.019. Conclusion: With regard to results of this study it seems that the B-HCG saved on the 17th day after ovulation induction by, can be a good, safe, and simple test to predict the outcome of pregnancy.

Objective: Stress urinary incontinence (SUI) is a common ailment in women, and it has different methods of treatment, either by medication or surgery, according to its intensity . There are various surgical methods, but the rate of beneficial success rates in some methods are more than in other in regard to operation time materials used, and hospitalization duration. In our technique all aspects of the problems were fully taken into consideration in order to treat the disease.Methods: From November 1991 up to the end of July 2001 six hundred-and-three SUI patients were treated by use of an innovative needle method. Patient's ages were between 35-65 years, and the mean was 50 years. The average number of patients' deliveries was 8.3. History of disease onset, completed questionnaires, lab tests, Marshall test and cystoscopy were recorded for each patient. Results: Follow-up of three months to ten years was carried out on 603 patients treated by this Method. Twenty-five patients had recurrence. Fifteen cases had been previously treated by SUI surgical methods with poor results. Eight cases had hysterectomy. From the 25 cases who had recurrence, three agreed to re-treatment by our surgical methods after which they fully recovered. Patients were satisfactorily treated for incontinence by anesthesia or spinal block Operation time, on average, was twenty minutes. Conclusion: Regarding the ease of this methods, the short time of hospitalization, and is low cost, we recommend its use for SUI.

Objective: Before the beginning of active phase a conclusive relation is suggested dilatation of cervix at initial admission and the rate of cesarean section and augmentation of labor. In this study, we have investigated this relationship.Materials and Methods: In this prospective study during the seventh month 500 singleton pregnant women (primigravida or multigravida) with cephalic presentation, intact amniotic sac, term pregnancy admitted to Imam Reza and Hazrat Zeinab Hospital's for vaginal delivery were observed. Patients were divided into two groups with cervical dilatation less than 4 cm at the beginning of admission and patients with cervical dilatation of 4 cm or more. Then valids such as the rate of cesarean section, the rate of augmentation of labor, vacuum delivery, neonatal birth weight and Apgar score 5at min were compared. Results: The results of this study revealed that the probability of cesarean section reduces with increase of dilatation of cervix at initial admission, both in nulliparous and multiparous women (P<0.001 in both groups). Also, there is a significant relation between dilatation of the cervix at initial admission and augmentation of labor in both groups of nulliparous and multiparous (P<0.001 in both groups). Duration of second phase of labor reduces with increase of dilatation of cervix of initial admission. There was no significant relationship between other variables. Conclusion: The rate of cesarean section and oxytocin-induced delivery and duration of second phase of labor reduces with increases of cervical dilatation at initial admission. Home assessment in early labor can delay hospital attendance with a concomitant reduction in interventions.

Objective: It is generally recommended that the first suckling of newborn babies begin within the first hour after birth to assure continuous lactation, and alleviate the mother's pain after Caesarian birth. The aim of this research is to define the effect of mother's nursing, regarding onset and continuation of lactation, on pain after surgical operation.Methods: We used a case-control method in this prospective research. Forty pregnant women, candidates for Caesarian deliveries, had general anesthesia, ASA Class I-II. The surgeon injected twenty patients in the study group under the skin with 10 ml 1.5% Lidocaine after repair of the stomach muscular wal . This injection was not given in the control group. Following surgery the rate of nausea, vomiting, and intensity of post operational pain were studied by the VAS method. Also, the time of lactation onset was recorded. Results: Cases in the group study were similar from the viewpoint of demographic specifications, number of pregnancies, and type of incisions. Post-operational nausea, vomiting, and pain intensity and time between operation and lactation onset, showed a meaningful difference, From the viewpoint of pain intensity at the point of incision and lactation, there was a meaningful difference that means the injection of Lidocaine under the skin caused a decrease of pain in the study group in comparison to the case control group. Conclusion: Although it is obvious in this study that the Lidocaine injection has no effect on decreasing nausea, vomiting, or post-surgical pain, the decrease in pain that occurs at the incisional point accelerates the onset of suckling and results in continuous lactation.

Objective: Comparison of two methods of hysterosalpingography (HSG) and hydrosonohysterosalpingography (HSHSG) for the evaluation of the uterine cavity and fallopian tubes in infertile women. Method (s): Fifty infertile women were choses by blind comparative study. All patients underwent standard hysterosalpingography by one radiologist and then underwent hydrosonography, by one Gynecologist.For hydrosonography, the first 2-3cc sterile normal saline was injected to visualize the uterine cavity, followed by injection of 10cc saline to check tubal patency and spillage. The instruments of injection were foli catheter No 5.5 or IDI catheter. For visualization we used vaginal sonography for comparision of the results of these two methods. All patients underwent laparascopy /hysteroscopy as a gold standard method.Results: Pain and spotting in HSHSG was significantly less than the HSG (10% vs 60%). Nine patients (18%) had tubal occlusion with HSHSG and eleven patients (22%) had HSG. Uterine intracurvitary abnormalities (endometrial polyps...) were imaged in 3 patients with HSHSG. The results of laparascopy /hysteroscopy showed that there were 4 false tubal occlusions in HSG.Conclusion(s): HSHSG is an easy, repetitious and without side effect method. It can be provided by specialized Gynecologists, It does not need x-ray, and for evaluation of the uterine cavity and pelvic .f1oorit has high sensitivity and specifity.

Objective: To describe the symptoms and signs of genitalia lesions caused by herpes simplex virus and compare with serologic evaluation of the illness.Methods: Participants were enrolled at a private gynecology and dermatology clinic in Mashhad. Women suspected of having active genital herpes were eligible. Patients' serum were examined for HSV IgG and IgM. Data from 17 participants with genitalia herpes were analyzed. Results: IgM and/or, IgG of herpes virus were positive in 100% of patients. Eight patients (47.5%) had positive IgG and IgM, in which 4 patients (23.5%) reported past history of genitalia. herpes, and in the other 9 patients (52.94%) only IgM of herpes was positive. The most common complaint of the patients was burning (35.3%, n=6), and the other signs were leukorhea (29%, n=5) fullness of prominence (23.5%, n=4) pruritus (17.6%, n=3), ulcerative lesions (11.8%, n=2) , dysuria(11.8%, n=2) and other signs such as spotting, dysparonia, pain and mass in inguinal region ,(5.9%, n=l). Most of the patients (88.2%, n=15) did not work outside of home. The husband's job in 88.2%, (n= 15) was not governmental. None of the wives or their husbands had traveled to other countries in their past histories. Conclusion: We found that patient complaints in genitalia herpes involvment in most of cases were burning. Since all of the clinical diagnosis IgM and/or IgG of herpes were positive, clinical diagnosis has high accuracy.

Background: Tuberculosis is one of the most important health problems in the world especially in Developing countries. Female genital tuberculosis begins with a hematogenous focus in the endosalpinx from which it may spread to the endometrium (50%), ovaries (30%), cervix (10%), and vagina (1%).'Common complaints are infertility or local symptoms consisting of menstrual disorders and pelvic pain. Although cultures of menstrual blood or endometrial scrapings may be positive, the diagnosis is usually made by analysis of biopsy specimens obtained from the endometrium, laparacopic biopsy specimens. Hysterosalpingography images may suggest female genital tuberculosis by demonstrating abnormal findings within the uterus and fallopian tubes. The variations and dispersion of genital tuberculosis observed between the developed and developing countries tempted us to evaluate entire cases of genital tuberculosis in Zahedan between 1998-2003.Method: This study was a retrospective-descriptive survey among 27 women who were referred to the Medical Health Center of Zahedan ffom1998 till 2003 with genital tuberculosis.Results: Our study sl10wedthat female genital tuberculosis formed 6.47% of all extrapulmonary tuberculosis cases.A total of 27 patients were evaluated. Peak incidence (66.4%) was diagnosed in age group 20-30 years. Majority of patients were Iranian 81.5%). 94% of the patients had positive tuberculin test.Common complaints were infertility (88.9%) and abnormal menstrual (7.4%), pelvic and abdominal pain (3.7%). Diagnosis was made bYl1ysterosalpingographyimages and endometrial biopsy specimens. Evidence of old tuberculosis was not seen in any patients.Conclusion: Our study sample though small., still reflects the high prevalence rate of infertility due to genital tuberculosis in endemic areas such as Zahedan.

Objective: This study was done to investigate the most Common causes of infertility and the choice of the more suitable and more easily achievable treatment for the patients who are being treated by diagnosis of infertility. Method and materials: In this study a complete history and physical examination were done for all the patients who referred to Mahdishar 15 Khordad Hospital with chief complaint of infertility from October, 2000 to the end of September 2001 From them 70 patients, who had frequent intercourse without using any contraceptive methods, but for one year, were not pregnant were chosen as the study group. Among the patients who complained of oligomenorrhea or galactorrhea or in their laboratory check hyperprolactinemia was found, the treatment started with ovulation induction drugs. In all these groups of patients endometrial thickness and the size of follicles was measured by sonography on the 14th day of their periods, among the patients with two or more follicles bigger or equal to 18mm (If they were treated with clomiphene citrate, beromocriptine or dexamethazone )or two or more follicles bigger or equal to16 mm (if they were treated with HMG human Menopausal gonadotropin) and endometrical thickness bigger or equal to 6 mm an HCG ampul with 10000 dose was injected . All these patients were followed to control their response to the treatment and during the entire period of pregnancy.Other patients were evaluated with spermogram , hysterosalpingography and postcoital test for other causes of infertility. Results: In 57% of the patienls (40 persons) there were symptoms of oligomenorrhea, galactorrhea or hyperprolactinemia. For these patients ovulation induction was done by clomiphene'bromocriptine, dexamethasone and HMG drugs. 67 percent (27 patients) of these became pregnant, among which 20 cases resulted in term pregnancy birth of a normal child, 5 cases resulted in abortion, and two cases into unexpected birth, both happened in 21 weeks of pregnancy. Male factor infertility was 28.5% (20 patients) and tubal factor 8 cervical factor were 2.8% (20 patients) 8%1.4 (2 patients) of cause of infertility in our patients.Conclusion: From this study we conclude that the most common cause of infertility in Mahdishahr is ovulatory factor. Other causes respectively are male factor, tubal factor, cervical factor, and other factors. Besides a large percent of these patients who were treated by ovulation induction drugs because of anovulation or oligo ovulation pregnancy happens which is noticeable.

Introduction: Untreated urinary tract infection has some serious consequences for both the mother and the fetus. Since the majority of infections are in the form of asymptomatic bacteriuria, quantitative urine culture and screening should be done in all pregnant women at the initial prenatal visit. Materials & Methods: We conducted a cross sectional study in 1431 pregnant women referring to Ghods Hospital. Four hundred and ninety, 478 and 463 pregnant women were in the first, second and third trimester of pregnancy, respectively. For each pregnant woman urine culture and urine analysis was done. Antibiogram with disk diffusion test method was performed in positive culture. Results: In a total of 1431 women screened, 198 clinical specimens showed significant bacteriuria, representing a prevalence of 13.1%. The most common pathogens were E. Coli and Staphylococcus Saprophyticcus. Ampicillin was the most prevalent antibiotic in which resistance was reported. Cephalexin and Co-trimoxazole were the next and Nitrofurantoin was the least, respectively. Urine analysis was negative in 33% of culture positive specimens. There was a significant difference in asymptomatic bacteriuria between the first and third trimester with the second trimester of pregnancy. (P<0.027) Conclusion: Due to high prevalence of asymptomatic bacteriuria in pregnancy, urine culture is recommended in each pregnant woman in order to prevent severe maternal and neonatal consequences. Urine analysis is negative in nearly 1/3 of the positive results. Consequently urine culture is a gold standard procedure for detection of asymptomatic bacteriuria.

Objective: This is a case report of the result of reconstructive laparoscopic surgery in a patient with primary infertility due to tubal factor. Case: The patient is a 27 year old woman with 7 years infertility due to distal obstruction of both fallopian tubes and left unilateral hydrosalpinx who became pregnant three months after laparoscopic surgery.Conclusion: This case report confirms that diagnostic and therapeutic laparoscopic procedure is a safe and efficient method for treating fallopian obstruction when guidelines are observed and the surgeon is aware of the limitations of the technique.