Iranian Journal of Obstetrics, Gynecology and Infertility
Year:2007 | Volume:9 | Issue:2|Papers Count:22

Introduction: Colporrhaphy is a common surgery in gynecology and urinary retention is occasionally seen after this operation; so, bladder catheterization sometimes becomes necessary.However, this may cause infection with classic signs of urgency, dysuria and frequency. Catheterization also causes destruction of bladder neck, if applied for a long period. Therefore, the goal of the study was to evaluate the frequency of urinary retention and urinary infection due to catheterization following anterior Colporrhaphy surgery.Materials and Methods: The clinical trial study was done in Qhaem Hospital in 2001-2002. Premenopausal women entered this study. The patients were divided into two groups, A (Control group) and B (study group). Urinoanalysis was done for all patients before entrance to study. In group A the patients were catheterized post operatively, and the catheter was removed after 3 days with samples taken for urinoanalysis and urine culture. The patients were controlled after the removal of catheter. In group B the patients were not catheterized but were observed for urinary retention. Samples were taken for urine analysis and urine culture after 48 hours. Individual characteristics collected in the questionnaire were analyzed by the chi-square test and descriptive statistics.Result: The study revealed that there is no significant difference between group A and group B in urinary retention following anterior Colporrhaphy (P=0.3). The study shows that in group A the frequency of urinary infection was 45%, but in group B, it was 20%. Therefore, in this group urinary infection was reduced (P=0.08). The days of hospitalization in group B were less than group A, as well (2 vs.3 days).Conclusion: Avoiding of bladder catheterization after Colporrhaphy doesn’t cause urinary retention and instead diminishes the risk of infection.

Introduction: Malignant ovarian tumor is one of the most fatal gynaecologic malignancies. Of all the gynecologic cancers, ovarian malignancies represent the greatest clinical challenges. It has the highest fatality to case ratio of all the gynecologic malignancies.To provide optimal management of a patient with an adnexal mass, it is important to differentiate between malignant and benign pathology prior to and during surgery. Preoperative discrimination between the malignant and benign adnexal mass can be made with patient characteristics such as age, menopausal status, sonography and CA125 level in the peripheral blood.Frozen section has long been used as a diagnostic tool for intraoperative histopathologic determination of various surgical conditions and has an acceptable accuracy for clinical use, including gynecological diseases.The accuracy of the technique has been reported. The aim of the present study was to examine the accuracy of frozen section diagnosis of adnexal mass in Isfahan University.Materials and Methods: This is a descriptive study done in Isfahan in 2005. A total of 45 surgically removed ovarian tumors were studied. Each ovarian tumor sample was evaluated for histopathologic diagnosis using both frozen section and paraffin seethes. Interpretation was separate and blinded to benign and malignant in each technique.Results: From 45 patients of whom 68.8% had a benign tumor, 31.2% had a malignant tumor at definitive histological assessment. Sensitivity of frozen section for benign and malignant tumors was 100% and 88.5% respectively. Specificity of frozen section for benign tumors was 88.5%, and for malignant tumors 77%.Conclusion: Frozen section appears to be an accurate technique for the histopathologic diagnosis of ovarian tumors.

Introduction: polycystic ovary syndrome is one of the most common endocrine disorders in women at reproductive age. Characteristics of this syndrome are menstrual irregularities with clinical or laboratory evidence of androgen excess. This syndrome increases the risk of infertility, type 2 diabetes, dyslipidemia and cardiovascular diseases, and it has recently been showed that the cause of increased risk of cardiovascular diseases is low grade chronic inflammation which can be evaluated by measuring high sensitive C-reactive protein. The aim of this study is to compare the effects of metformin and cyproterone compound on serum androgen and CRP levels.Material and methods: in a clinical trial study during a period of 16 mouths from December 2004 to March 2006, sixty patients with PCOS were enrolled, 30 subjects in each group treated with one gram of metformin and cyproterone compound for 21 days, every month. At the beginning and after 3 and 6 months, weight, height, testosterone, DHEA-S and Hs-CRP levels were measured.Result: mean age of patients was 23.5±8.7 years with the range of 15 to 49 years. In both groups a significant decrease in DHEA-S levels was observed. In compound group, after six mounts a significant decrease in testosterone levels were seen, but there was no significant decrease in Hs-CRP levels.Comparison of two groups showed that there were no significant differences in the effects of these two drugs on serum testosterone, DHEA-S and Hs-CRP levels.Conclusion: the results of this study are different from those of previous studies about beneficial effects of meformin of Hs-CRP levels.

Introduction: Excessive menstrual bleeding is a common complaint and each year around 5% of 30-49 year old women have this problem. The aim of this study is to compare the efficacy and acceptability of mefenamic acid and tranexamic acid for treating menorrhea. Attempts have been made to choose a more effective with less complication to treat hyper menorrhea.Materials and Methods: This study is a control trial study and the setting is Shahid Sedugh University, department of obstetrics and gynecology, Yazd in 2001-2005. 75 women with excessive uterine bleeding (hyper menorrhea) were under treatment for five days from day 1 of menses during three consecutive menstrual periods. 36 patients were randomized to take mefenamic acid 500 mg, Tid; and 39 patients to take 500 mg tranexamic acid, Qid.Menstrual loss was measured in three control menstrual periods and three menstrual periods during treatment. Duration of bleeding patient's estimated blood loss, sanitary towel usage and unwanted events were also taken into consideration.Results: mefenamic acid reduced blood loss by 20% and tranexamic acid reduced blood loss by 50% (P=0.001). Duration of bleeding was not different in patients treated with mefenamic acid and tranexamic acid.Conclusions: Tranexamic acid given during menstruation is a safe and highly effective treatment for excessive bleeding. Patients with dysfunctional uterine bleeding should be offered medical treatment with tranexamic acid before a decision is made about surgery.

Introduction: Spontaneous abortion is referred to the termination of pregnancy prior to 20 weeks of gestational age. Numerous factors have been described which associate with recurrent wastage such as; uterine abnormalities, infections, immunological factors, endocrinologic imbalance, chromosomal and genetic defects. It is accepted that, if a balanced translocation is carried by one of the partners can cause repeated spontaneous abortions as well as autosomal recessive; trait carrier can increase homozygosity, which in turn, leads to an increased risk of abortion.The purpose of this study is to determine the frequency of recurrent abortions in consanguineous marriages in comparison to non-consanguineous marriages.Material and Method: Cytogenetic evaluation of 354 couples with the history of recurrent miscarriages was performed on the basis of G-banning technique. All other possible etiologic factors were excluded. Then 177 couples were grouped in the consanguineous marriage group and the remaining of 177 couples in non consanguineous marriage group. Individual characteristics were collected in a questionnaire and analyzed by descriptive statistical chi-Square and Fisher test.Results: The prevalence of state of balanced translocation was found in only 26 partners (7.34%). Among them, 12 individuals (3.38%) appeared in consanguineous group and the remaining 14 partners (3.95%) were seen in non-consanguineous group.The frequency of abortions was significantly more common in women with 2 spontaneous abortions whereas the fewer incidences appeared in women with 10 recurrent miscarriages. On the other hand the numbers of abortions beyond the 3 cases were more prominent in consanguineous group in contrast to the non-consanguineous group.Conclusion: In consanguineous marriages in which recurrent miscarriages are occurring, In the case of normal karyotype, an autosomal recessive disorder could be postulated.

Introduction: In many countries, the use of plants and natural products is popular as an alternative to classic medical care. Lack of information about the toxic effects of such plants allows them to be used for medical treatment. Matricaria chammomilla, with the Persian name of “Baboune”, belongs to the family Compositae and has been known for hundreds of years. The aim of this study was evaluation of tratogenic effects of matericavia ehammomillio in Balb/C Mouse.Materials and Methods: This experimental study was done in Mashhad in 2004-2005. Chammomilla is a herbal medicine and has unwanted effects on embryos. For this study the flowers of Matricaria chammomilla were used which contain numerous constituents including: terpenoids, biosabolo oxidase, chamazulene, sesquiterpenes, flavonoids, apigenin, luteoline, quercetin, anthemic acid, choline, tannin, ploysaccharides.In this study, the embryo Toxicity of aqueous and methanolic extracts of chammomilla was evaluated, applying the standard method for this purpose. Maximum tolerated doses of the two extracts were determined and appropriate doses were administered intraperitonely to pregnant mice on day 7-9 of gestation. Embryos were then harvested by caesarian section on 15.5 day of gestation and examined for morphologic and histologic characteristics.Results: Aqueous and methanolic extracts of chammomilla caused significant decrease in weight and crown – rump (CR) measurments of embryos (P<0.05). Also uterus weight of mice in the treatment group showed significant decrease (P<0.05).Conclusion: The results of this investigation showed that many compounds of aqueous and methanolic extracts of M.chammomilla have effects on development of Mice embryo. The results of this study suggest that the pregnant women should not use formulations containing this plant.

Introduction: Premenstrual Syndrome (PMS) which is accompanied by Psychological and Physical Symptoms regularly occurs during the second half of the menstrual cycle and is estimated to affect up to 95% of women to some degree. Only 3-8% of these women have Premenstrual Symptoms that meet the criteria for premenstrual dysphoric disorder (PMDD), which significantly interferes with social activities or relationships with others. In this case there are medications one of which is serotonin reuptake inhibitors, including Fluoxetine.The aim of this study is to evaluate premenstrual daily dosing of fluoxetine for treatment of premenstrual dysphoric disorder.Materials and Methods: This was a double-blind clinical trial study. After a two cycle Screening 260 women were randomly prescribed fluoxetine 10mg capsules, fluoxetine 20mg capsules and placebo capsules (dosed daily from the 14th day before next expected menses through the first fall day of bleeding) for three cycles, and they had a follow-up visit without taking drugs. After this time data was gathered with questionnaire and analyzed by descriptive statistics.Results: Baseline demographics and severity of illness and length of menstrual cycle measures showed that the treatment groups were balanced. Premenstrual daily fluoxetine 20mg demonstrated significant improvement in symptoms compared with placebo (P=0.005) and Premenstrual daily fluoxetine 10mg groups. Both active treatment groups significantly improved by the first treatment cycle both fluoxetine groups showed significant improvement.All 20 symptoms such as fatigue sleep disorder, irritability, depression, appetite changes, and physical symptoms such as body dimorphic, breast tenderness, acnea, headache, arthralgia, low back pain, and weight increase had significant reduction or completely disappeared with Fluoxetine 20mg capsules.Discontinuation due to adverse side effects did not differ among the three groups.Conclusion: Premenstrual daily dosing with Fluoxetine effectively treats mood, physical and social function and symptoms associated with premenstrual dysphonic disorder. Fluoxetine 20mg appears to have comparably better efficacy than floxetine 10mg.

Introduction: Stress incontinence is one of the common difficulties in the population of European Union and United States. In various investigations, age, labor, number of urinary infections, and work conditions play important roles in the incidence of this disorder. Important defect or bad function of neuromuscular system of plevice and controller muscles is considered to be responsible. Diseased importance shown by high prevalence (%30-%50) in EU and US made us to investigate the severity and prevalence of the disease in Khorasan province.Materials and Methods: In this research, we have searched the prevalence and severity of stress incontinence in a population of women in south of Khorasan province in Iran (Kashmar and Gonabad). These women are housewives and/or seasonal workers in farms. Data was collected in standard forms that have been used in European clinics.Results: prevalence of job related disease: housewives 8.6%, women working on farms 14.2%, teachers 13.1% and women involved in husbandry 35.7%; Prevalence of UTI for these women is 20.6%, 28.7%, 31.4%, 26.2%, 50.05% respectively.Discussion: The housewives have less prevalence of Urinary infection and SI. Women involved in husbandry have the highest prevalence of UTI and SI.

Introduction: Sonographic measurements of fetal ultrasound parameters are the basis for accurate determination of gestational age and detection of fetal growth abnormalities. CRL (crown-rump length) is the best parameter for early dating of pregnancy.The objective of this study was to determine the relationship between gestational age and measurement of mean diameter of gestational sac, volume of sac, and crown-rump length in a group of pregnant women who had regular cycles and certain dates.Materials and Methods: This descriptive study was done in Sina Hospital in 2000-2004. Measurements of gestational sac diameter, volume, and crown-rump length (CRL) were collected from 417 normal singleton fetuses. Charts and predictive equations were constructed from data obtained from pregnancies in which the CRL was between 6 and 60 mm and for which the outcome was normal.Results: CRL maintained the highest correlation with gestational age (r=0.935, p less than 0.0001). The standard error of estimates using CRL was significantly lower than that using mean gestational sac or volume of the sac. The 95% reference interval was, ±4.86 days for CRL, The best fit regression equation was the quadratic model.Age (week) = 5.822+1.610 CRL (cm) - 0.080(CRL)2 (cm). A chart for CRL derived from the regression equation are presented and compared with those obtained by Robinson & Fleming and Hadlock.Linear relationships were found between the mean gestational sac diameters (MDS) and gestational age (r=0.886, p less than 0.0001), and volume of gestational sac (r=0.814, p less than 0.0001).Conclusion: There were no significant differences between the Iranian and European parameters for the CRL and mean gestational sac curves. Crown-rump length (CRL) between 6 and 12 weeks is the most accurate parameter for first trimester dating.

Introduction: Successful implantation during assisted reproductive technique cycles depend on many factors including embryonic and uterine variables. The aim of this study was to investigate the difference between embryonic and endometrial ultrasonographic parameters in patients who had undergone In Vitro Fertilization (IVF) and Intracytoplasmic (ICSI) in successful and failed cycles.Methods: In this descriptive study 108 patients aged<38 with basal serum FSH level<12 and no more than two failed attempts of ART cycles, whose uterin were confirmed by ultrasound to be morphologically normal, were studied. Ultrasound evaluation was performed by a single expert on the day of embryo transfer. Ultrasonographic parameters of endometrium and embryonic variables were analyzed based on the occurrence of pregnancy.Results: 33.3% of patients conceived. No significant difference was found between pregnant and non-pregnant group regarding demographic, hormonal and cycle characteristics and ultrasonographic parameters. On the contrary, embryonic factors differed significantly between the two groups.Conclusion: While embryonic factors significantly influence successful implantation, there is no relationship between ultrasonographic parameters of endometrium on the day of embryo and implantation.

Introduction: Abnormal uterine bleeding in pre and post menopausal period may be caused by of benign or malignant causes in endometrium or endocervix that need careful investigations by multiple diagnostic methods such as dilatation and curettage, diagnostic hysterectomy, endometrial biopsy and tran’s vaginal biopsy.The aim of this study was to evaluate the diagnostic value of fractional D&C in assessment of abnormal uterine bleeding.Methods and Materials: In this descriptive study 156 women between 35 to 70 years old were admitted because of abnormal uterine bleeding after ruling out pregnancy, hormonal disorder and coagulation disorders. The study was done in 2002 and patients underwent fractional D&C and then hysterectomy because of histological findings or persistence of symptoms. The results were compared with histological findings of the hysterectomy specimen (gold standard) and were evaluated for sensitivity, specificity, positive and negative predictive values of these methods.Results: In all focal and diffuse uterine disease fractional D&C was 29.5% sensitive and 88.2% specific and its positive predictive value was 76.5% and its negative predictive value was 49.2%. In endometrial pathologies (such as hyperplasia and …) its sensitivity was 68.4% and its specificity was 98.3% and positive and negative predictive value was 92.9% and 90.6% respectively. 100% of lyomyoma and adenomyosis cases, 66.6% of endometrial polyp cases and 2.5% of different endometrial hyperplasia cases were miss-diagnosed in fractional D&C.Conclusion: Fractional D&C is not a reliable method for diagnosis of focal uterine diseases such as myoma or adenomyosis and also endometrial polyps but it is useful in the diagnosis of endometrial hyperplasia. Based on to the costs of fractional D& C compared with other diagnostic methods and its pathologic results, routine use of this method in evaluation of AUB is not recommended.

Introduction: Prevention of sex–linked diseases, reduction of elective abortions and physical and mental effects followed by abortion, the control of population growth and consequent problems signify the importance of pre-selection of the neonatal sex.The purpose of this research is to survey the relationship between neonatal sex and sexual relations of the couples.Methods and Materials: This descriptive study was conducted on 346 pregnant women referring to Health centers in Sabzevar in (2003). They were selected through convenient non-probability sampling. Relevant data were privately obtained through face-to-face interview. They were not aware of the sex of their neonate. Chi-square was utilized for data analysis.Results: The findings revealed that couples' satisfaction of sexual relations rendered more frequent male births (p=0.009). Also, increased libido in men (p=0.039) and less orgasm frequency in women enhanced chances of female births (p=0.006).Conclusion: Considering various factors affecting the choice of neonatal sex and the role of psychosocial factors, couples' sexual knowledge can help couples achieve the desired gender and improve the quality of sexual relations.

Introduction: Symptoms like hot flashes and night sweating, atrophic vaginitis, osteoporosis, increase of heart diseases and possibility of depression result from menopause and cessation of menses. Menopausal symptoms may cause depression but existence of a relationship between menopausal symptoms and severity of depression is doubtful. Therefore, this research is done with the objective of assessing the relationship between menopausal symptoms and severity of depression in postmenopausal women.Method and materials: In this descriptive correlation research, 60 menopausal women who referred to Mashad menopausal and gynecologic clinics were studied.They had no history of psychiateric disorders, chronic disease, smoking and use of narcotics, hystrectomy or oophorectomy .Evaluations for BMI, BP, laboratory test, a pelvic and breast examination, Beck depression inventory were done at first. If they had a beck depression inventory score of more than 9, demographic characteristics, Cassidy social support, uzeng self steem by interview and blat menopausal symptoms, attitude to hormone replacement therapy and menopause by subjects, were answered.Data were analyzed by utilizing T test, Pearson correlation, one way Anova with SPSS software.Result: Findings showed that the mean depression score and duration of amenorrea were 19.4±7.9 and 36.6±4.8, respectively. In a total of 60 women, borderline depression was 26/8%, mild depression 26.8%, moderate depression 26.8% and sever depression 14.3%. 62.5% participants reported hot flash, 73.2% bone pain, 26/8 breast pain, 41.1% headache, 67.9% numbness, 57.1% skin crawls, 46.4% urinary incontinence, 19.6% dysuria, 22.1% dysparonia and 64.3% complained of low sexual desire.There was no significant relationship between mean of depression score and severity of menopausal symptoms, but dysuria. Depression scores in women without dysuria (20.47 versus 15.18) was significantly higher (p<0.05) compared with those without dysuria.Conclusion: According to the result of this research, menopausal symptoms had no effect on severity of depression. So another extensive study with a different cause of depression is recommended.

Introduction: in this study a case of chrioamnionitis in a cervical pregnancy in a 30 year old woman is presented. The patient referred with fever and chills and rupture of member 3 days prior to her referral. Sonography report indicated a 14 week gestational sac without amniotic fluid. With the diagnosis of inevitable abortion, curettage was done which led to laparotomy. Finally after diagnosing cervical pregnancy, hysterectomy with ovary preservation, due to server hemorrhage, was performed. The patient was discharged after 4 days in good health condition and in her pathological study the diagnosis of cervical pregnancy was confirmed.

Introduction: pregnancy is associated with insulin resistance. Eighty percent of obese and 30% of lean women with PCOS (poly cystic ovarian syndrome) demonstrate insulin resistance before conception and as many as 30% are affected by impaired glucose tolerance later in life. As there is paucity of data on the prevalence of carbohydrate impairment during pregnancy and its effect on perinatal outcome and infant morbidity in PCOS patients, this study was designed.Materials and Methods: In this descriptive analytical study, pregnancy records of 40 PCOS patients were compared with 60 non PCOS patients randomly. All cases in the study and the control group were screened for GDM (Gestational Diabetes Mellitus) with 50gr glucose challenge test (GCT) in initial weeks and 24-28 week of gestation. Patients with glucose challenge test values of > 140 mg/dl were referred for the 3h /100gr oral glucose tolerance test (GTT). The two groups were then compared for the complications of pregnancy and delivery.Results: BMI was significantly higher in patients in the study group than the control group. Prevalence of GDM and impaired glucose tolerance (IGT) between the groups was not statistically significance. Prevalence of preeclampcia was significantly higher in PCOS patients than control ones. Prevalence of preterm labor, mode of delivery, mean birth weight, proportion of babies admitted to NICU, placental abruption and placenta previa were not statistically different between two groups.Conclusion: We found no difference in GDM and IGT prevalence in two groups, but prevalence of preeclampcia in patients with this syndrome was higher.

Introduction: Since most of cases of pregnancy termination are induced by oxytocin of which needs special care, much time, costs, and it has side effects such as water toxicity especially in prolonged inductions trying to find suitable replacement for oxytocin is necessary. The aim of this research is compared on oxytocin with misoprostol in the second trimester of pregnancy gynecology ward of academic hospitals in Mashhad. (Imam Reza – Ghaem – Hazrat Zeinab)Materials and Methods: In this prospective case – control study, we divided 125 pregnant women in the second trimester to two groups. Pregnancy termination in the case group was induced by administration 3 100μg oral tablets of misoprostol and one vaginal misoprostol tablet.If there wasn’t any uterine contraction we used one oral tablet every 3 hours and a vaginal tablet every 4 –6 hours for 48 hours.In the control group pregnancy termination was induced by oxytocin. 50I/U of oxytocin was diluted with 500CC Ringer and infused in 3 hours then there was a resting period for l hour and then we increase 50I/U oxytocin in 500CC Ringer until maximum 300I/U in 500 CC Ringer. Our plan was 3 hours of induction and an hour resting until beginning of contraction or no responding after 48 hours induction.Another method of delivery induction was replaced, if no contraction was observed after 48 hours in both groups.Results: Labor contraction and pregnancy termination happened sooner in the misoprostol group than oxytocin group. (p=0.001) Placental retention and costs were less in the case group (p<0.05). Fever, bleeding, gastrointestinal tract complications and uterine rupture had no difference in both groups. (p>0.05)Conclusion: Misoprastol alone induced delivery sooner when was compared to oxytocin, in the second trimester and it also had less cost and less side effects. Besides it dose not need intensive nurse care. So we recommend misoprostol for pregnancy termination in the second trimester.