مجله زنان مامائی و نازائی ایران
سال دهم شماره 2 (پاییز و زمستان 1386)

Genital cancers are the most common female cancers, some of which, such as ovarian cancer, have highest mortality rates. Genital cancers treatment does not only increase survival, but also improves life quality. The goal of this study was to determine genital cancers morbidity and mortality. This cross- sectional descriptive study was done in the years 1996- 2002 on referral patients to Beheshti and Alzahra Centers of Isfahan University of Medical Sciences, who had genital cancers. 302 cases with genital cancers, through simple sampling, were studied. Individual, treatment results, and treatment complications were recorded in a questionnaire and analyzed with SPSS –10 statistical package including chi square, analysis of variance, spearman’s correlation coefficient, and T-test. Results of this study showed that bleeding was seen in 6.1%, operation site infection in 3%, thromboembolic disease in 1.1%, UTI in 3%, bowel obstruction in 2.7%, pelvic abscess in 1.1%, anuria in 1.1%, lymphocyst in 0.76%, incisional dehiscence in 0.38%, bladder atonia in 1.9%, major blood vessels injury in 0.38%, ureterovaginal fistula in 0.76%, rectovaginal fistula in 0.76%, rectovesical fistula in 0.38%, vesicovaginal fistula in 0.38%, ileovaginal fistula in 0.38%, urinary incontinence in 0.76%, and death in 0.38%. In this study intraoperative complications rate was 3.04% that was 6% in other studies. Infectious complications were seen in 7% that in other studies was around 4% (perhaps due to proper antibiotics). Post infectious complications were seen in 6.8% in this study, 4% in others.

Anovulation, as irregular menstrual cycle, causes 40% of infertility. Determining of the response to ovulation induction in these patients appears to be important at the beginning of the treatment. The aim of this study was to evaluate ovarian reserve with clomiphene citrate challenge test. This descriptive study was performed in the year 2003, on 56 infertile women less than 40 years old who were candidate for micro injection in Infertility Center in Babol. Baseline FSH on day 3 of cycle was measured. They were given 100 mg of oral clomiphene citrate on days 5-9 of their cycles, and FSH on day 10 of cycle was measured again. A long protocol was used for ovulation induction in all patients. FSH on day 3 plus FSH on day 10 of cycle less than 26 miu/ml was considered as normal CCCT. Data was analyzed by t-test and fisher exact test and p<0.05 was considered significant. In this study, mean age of patients was 31.1±9.1 years old. From 56 cases, forty nine had normal CCCT, and 38 of 49 cases had suitable ovarian reserve. seven cases had abnormal CCCT and five of them had suitable ovarian reserve. The mean of CCCT result was 15.5±9.1mIu/ml. The most cases who had normal CCCT and suitable ovarian reserve were less than 35 years old. But there were no significant differences between normal and abnormal CCCT groups in women less than or above 35 years. Also, there were no significant differeces between two groups in folicle number, fertilized oocyte and number of emberyos transferred. In evaluation of ovarian reserve not only ccct results, but also age, basal FSH level and anteral follicullar number mast be considered.

Laparoscopic ovarian electrocautery is well established treatment in the women with clomiphen- resistant polycystic ovary syndrome (PCOS). With regard of its potential risks, performing of laparoscopic electrocautery may not be acceptable in women at high risk of persistant anovulation after electrocautery. The aim of this study was evaluation of predictors of treatment failure after laparoscopic electrocautery of the ovaries in clomiphene –resistant PCOS women. Methods and Material: This is a cross sectional and prospective study performed between March 2004 and March 2006 in Al-Zahra Hospital of Rasht. Ninety three women who did not ovulate on clomiphen with maximum dose of 150mg/d for 5 days were treated with laparoscopic electrocautery of ovaries. Of ninety-three women who were treated with laparoscopy, 6 women had concomitant tubal disease on laparoscopy & nine women did not complete the study according to protocol and dropped out and seventy-eight patients were studied. Studied variables before laparoscopy were age, menarche, type of infertility, duration of infertility, body mass index, ovarian volume, and levels of LH/FSH, Testosterone and DHEAS. After laparoscopic electrocauterization the patients underwent induction of ovulation with clomiphen citrate with maximum does of 150 mg /d for five days, and were evaluated for ovulation and subsequent ongoing pregnancy. To evaluate the predictors of ovulation and pregnancy failure, data were analyzed using SPSS, descriptive statistic & logistic regression analysis; p≤0.05 considered statistically significant. Of seventy –eight women treated with laparoscopic electrocautery of the ovaries, thirty nine (50%) did not ovulate on clomiphen citrate with maximum dose of 150mg/day for 5 days and were considered to be non-responders. Twenty- four women reached an ongoing pregnancy. Mean age of women was 25.9±4.4 and mean duration of infertility was 5.2±2.9. From the studied variables only increased DHEAS determined as predictor for failure to ovulation after laparoscopic electrocautery andno significant predictors of failure to reach an ongoing pregnancy could be identified. DHEAS is an androgen, absolutely secreted from adrenal glands, and if the pathophysiology of ovarian electrocauterization is noticed, it seems that in cases with increased DHEAS ovarian electrocauterization cannot improve the ovarian response to clomiphen citrate, so the other modality of treatment such as antiandrogens in these patients with increased DHEAS is recommended

mental and physical physiologic changes of pregnancy effects all the mother’s body systems consisting digestive tract. Among the digestive problems, the most prevalent ones in pregnant women are nausea, vomiting, heart burn, and constipation. Today, use of non–chemical and non–invasive methods is of priority in treatment of digestive problems in pregnancy; therefore, this research was done with the purpose of determination of effect of sole reflexology on pregnant women's constipation severity. This research was a two–group clinical trail, performed in 2005-2006 in health care centers of Ramsar. The sample in every group (case and control) consisted of 50 pregnant women suffering from constipation, selected by fitted pairs sampling method. Demographic and constipation situation data was collected by personal properties method and questionnaire of constipation investigation. Data wa analyzed by descriptive statistics and frequency distribution tables, using χ2 and T- pair test. T–pair test showed the significant difference between average and criterion deviation of constipation severity after and before of reflexology in case group (p =0/000); in control group such difference between average and criterion deviation of constipation severity in the begining and end of study was not seen. Regarding the fact that constipation outbreak in pregnancy and effect of reflexology in reduction of constipation is emerging, the necessity of reflexology as a fully and substitutly method in treatment was shown.

This study was planned to determine the effects of the administration of pretreatment oral contraceptive pills on in vitro fertilization. A clinical randomized controlled trial was conducted in Fatemeh – Alzahra Hospital of Babol University of Medical Sciences from 2004 – 2005, on 102 women with tubal or pelvic adhesive disease as the cause of their infertility, normal ovulatory cycle, of age under 40 years, and no male factor. Pretreatment with oral contraceptive pills was administered for 51 patients, and a similar number of women did not receive any pretreatment. The flare protocol was used in all treatment cycles combined with an individualized dose of human menopausal gonadotrophin depending on previous response, age, and early follicular stage serum FSH level. Both groups were similar in the mean of women’s age, the duration of infertility, the mean of FSH and LH levels, and the distribution of various infertility etiologies. Transvaginal ultrasonograghy was performed twice in pre-treatment cycle and initial cycle on day 2 to identify complication of ovarian cysts formation. The mean number of follicles (6. 4 ± 3.7 vs 8.8± 4.6) and oocyte retrieved 5.7± 4.7 vs 6.6 ± 5.5) were similar in OCP and control groups. OCP group had significantly the mean number of administration of ampoules of hMG used per cycle (39.9 ± 19.5 vs 34.8± 14.6) and the duration of ovarian stimulation (75.8± 11.8 vs 13.5 ± 7.1) more than the control group (P < %5). The ovarian cyst formation was similar in the two groups. Fertilization rate had no significant difference between OCP and control group (%54 vs 43%). In multivariate analysis, independent predictors of clinical fertilization were women’s age with negative correlation and the number of oocytes with positive correlation. Pre- treatment of OCP cycle with oral contraceptives did not improve fertilization OCP cycle

If pregnancy prolongs more than 42 weeks it is called prolonged pregnancy. It occurs in 10 percent of pregnancies. This problem increases the maternal morbidity and fetal morbidity and mortality. In order to avoid these complications and to manage prolonged pregnancies, different methods are used. The two current ways are the induction of labor at 41 weeks and the expecting management of pregnancy. The goal of this study was to compare the effectiveness of expecting management and induction in prolonged pregnancies. In this study 160 pregnant women with pregnancy age more than 41 weeks referring the Mobini Hospital in Sabzevar in the year 2005 were studied. After accurate determination of pregnancy age the patients were classified into two groups of elective induction and expecting management of pregnancy. The former group was admitted in hospital and the last were cared. Data was gathered through the questionnaire and analyzed by descriptive statistics. Results of this study showed that there was no difference in maternal and fetal complications such as meconium staining, fetal distress, and birth-time Apgar, weight and sex of neonates between the two groups. Incidence of cesarean section in elective induction was 57/5 % and in the expecting management of pregnancy was 22/5 % (p< 0/01). Also according to the results the mean time of hospitalization, differed in the two groups (2/17versus 1/17day, p < 0.05). According to the lack of maternal and fetal complications in expecting management of pregnancy, this method can be used for management of prolonged pregnancy instead of the elective induction in 41 weeks.

Usage of different types of pain relief during labor is the best method for relief of pain during labor. Spinal analgesia belongs to a long history in midwifery. This study was designed to evaluate the effect of spinal analgesia during stages of labor and delivery. This study was a randomized clinical trial done in 2005 in 17 Shahrivar Hospital of Mashhad. Two groups (62 patients) selected from pregnant term women. Patients were divided into two similar groups (case and control). The patients in the case group received spinal analgesia with 50 mg fentanyl (in prime gravid 15 mg petedine was added). Characteristics of patients such as length of labor, fetal heart rate, and demographic data was collected in a questionnaire and analyzed by SPSS software, Q square, and T. students test. Age, gravidity, condition of anemia, fetal heart rate before using spinal analgesia did not have significant difference in the two groups. The length of first stage of labor was 143.7 minutes for the case group and 311.45 in the control group (p<0/05). Apgar, length of the second and the third stages of labor were similar in both groups. Headaches in the forth stage of labor had significant difference in the two groups (p=0.5). The use of spinal analgesia provides a satisfactory result for labor and decreases the length of the first stage of labor without disrupting the normal course of labor. It can be recommended as a suitable method for pain reduction in labor.

Cervical cancer is one of the most common female genital tract malignancies and one of the most common causes of female death. The majority of cervical cancers develop through a series of gradual, precancerous lesions. Screening asymptomatic women with regular Pap smear allows diagnosis of the readily treatable preinvasive phase. In regard of stopping the cervical cancer screening programs in health care centers of Iran cities, this study was undertaken to determine the precancerous lesions incidence and assess the effect of demographic, pathologic, and family economic factors on developing lesions. This cross sectional, descriptive study was carried out in 2003- 2005 on 6024 women under coverage of Tabriz health care centers. Pap smear was done in all subjects and questionnaires were filled by health providers. The data were analyzed with SPSS statistical software. Of 6024 Pap smears 62 (1.02%) demonstrated precancerous lesions of which 41(0.68%) were ASCUS (Atypical Squamous Cells of Undetermined Significance), 11 (0.18%) were LSIL (Low Grade Squamous Intraepithelial Lesion) and 10(0.16%) were HSIL (High Grade Squamous Intraepithelial Lesion). No invasive cancer case was observed in this study. According to the present study, the following factors increased the risk of precancerous lesions: multiparity≥3, abortion≥1, gravida≥3, and multi partnership. The protective effect of condom as a barrier contraceptive was observed. These results indicated that screening of asymptomatic women could be of great importance.

There are still considerable morbidities associated with childbirth, despite of the fall in material mortality in the last country. Episiotomy is performed for most of primiparous women and the pain related to this treatment is typically treated with oral analgesic medications. Application of cooling devices is a new approach in pain reliefe.This research was carried out, from October 2005 to February 2006, to determine the effect of two cooling devices (gel pad and ice pack) on the intensity of perineal pain and to compare its effects with no localised treatment regime (control) in women who gave birth at Hazrat Ommolbanin University Maternity Hospital in Mashhad –Iran. In this randomized controlled trial, 121women, with the necessary criteria were sampled and randomely allocated in the two groups of cold therapy (ice pack, cooling gel pad) and the control group (acetaminophen). At hospital, during a period of 4 hours after episiotomy, and then on demand of individuals, to reclnce the intensity of perineal pain at home, subjects received analgesia. During the first 4 hours and on the days 1, 2, 5, 10 after episotomy, perineal pain intensity was evaluated, using Numeric Rating Scale (NRS). Evaluation of women satisfaction from analgesia accomplished on the day 10. Data analyzed by statistics parametric and nonparametric methods, using the SPSS software. There was a statistically significant difference in the intensity of perineal pain in three groups at 4 hours (p=0.003) and on the day 10 (p= 0.044), after episiotomy, which was in favour of the maternity gel pad group. A considerable variation, observed in the reduced necessity for medication and satisfactory treatment, among three groups. Maternity gel pads are effective in reducing the perineal pain intensity, and the need for medication. Therefore, cooling gel pads are suggested as a safe and adequate method of perineal pain relief, which is applicable both at hospital and home.

Cardiopulmonary resuscitation is a critical performance in pregnant women, and if it is done correctly mother and fetus will be rescued. Anatomic and physiologic changes in pregnancy should be considered. The fetus increases the oxygen demand and carbon dioxide production, so the function of cardiopulmonary system increases and consequently cardiac output, heart rate, minute ventilation, tidal volume and respiratory rate increase. In airway management, since the respiratory tract is fragile and edematous, in applying supportive devices occurrence of hemorrhage and more edema should be considered. In breathing support we should avoid the increase or decrease of ventilation, since changes in Co2 and PH decreases placental perfusion. Because of pendulous breast and diaphragm heightening, cardiac massage should be done in the middle of sternum. Drugs are contraindicated in pregnancy, but tratogenicity should be afforded. Finally, after five minutes if CPR was not successful cesarean section should be done, since it is an effective factor in better resuscitation of mother and will improve the survival and neurological state of infant.

Although the total number of pregnancies has declined over the past three decades, the rate of ectopic pregnancies has continued to increase in most western nations and it still accounts for ten percent of all maternal death. This report is the introduction of ovarian ectopic pregnancy in a patient with recurrent ectopic pregnancy.Case Report: The patient was a 35 year old woman (gestational age = 6 weeks) with history of 2 previous ectopic pregnancies (treated with right salpyngectomy in the first and expectant management in the second ectopic pregnancy) and presentation of hypogastric pain,, and empty uterine cavity at vaginal sonography. The patient was operated due to clinical diagnosis of ectopic pregnancy and histopathological report was ovarian pregnancy. This case report confirmed that ovarian pregnancy is rare and difficult to diagnose clinically and even intraoperativly. Ovarian pregnancy can be detected early with the use of combined transvaginal sonography and serum level. The standard of care is conservative treatment in order to preserve patient’s fertility. Recurrence is exceptional and future fertility is usually preserved.

Fetus skeleton is formed during pregnancy and calcium and phosphorous for this mineralization is provided by mother, so significant changes may occur in the mother’s skeleton. This study was conducted to evaluate the changes of serum and urinary markers of ossification and bone absorption during pregnancy. In this cross-sectional study, from Oct. 2005 to Jul. 2006, 307 pregnant women, at Imam Reza Hospital in Mashhad, were randomly assessed. Serum calcium, phosphorous, ALP, 24 hours urinary excretion of calcium and phosphorus were determined. Data were analyzed by SPSS 9.5 software, ANOVA and Tukey HSD tests. ANOVA test indicated that, there was no significant difference between dependent variables (calcium, phosphorous, alkaline phosphatase), 24 hours urinary excretion of calcium, phosphorous and the age of mother (P=0.057), but there was meaningful relationship between serum ALP level, 24 hours urinary excretion of phosphorous and different trimesters of pregnancy (P=0.007). Serum ALP level in the third trimester was varied, compared to the first and second trimesters. However there was no difference in these amounts in the first and the second trimesters. There was no significant alteration in the mean ratio of serum calcium, phosphorus level and 24 hours urinary excretion of calcium in different trimesters of pregnancy (P= 0.070). Noticeable correlation observed between mean serum ALP, 24 hours urinary excretion of phosphorous and different trimesters of pregnancy (P= 0.007, P= 0.025 respectively). Also, differences in the mean serum calcium level, 24 hours urinary excretion of phosphorous in multiparous and nulliparous patientswas very clear.

Congenital uterine anomalies resulting from mullerian fusion defects are the most common malformations of the reproductive system. The purpose of this study was to evaluate the reproductive outcome after hysteroscopic metroplasty in women with septated uterus who suffer from infertility or recurrent abortion. This descriptive study was performed during the period from 2003 to 2004 at Rasul-e-Akram Hospital of Iran Medical University. A total of 19 women (aged 21-35 years) with primary infertility or recurrent abortion and septateuteri underwent hysteroscopic septum resection. All septa were removed with a scissor at 90◦ and patients were followed up. The patients were seen on the first postoperative day and visited approximately 2 months later for assessment of surgical outcomes. This assesment was accomplished with hysterosalpingography (HSG). Statistical analysis was carried out using SPSS V. 11.5. The duration of infertility among the patients differed from 2 to 14 years with the mean of 5.4 (SD=3.26) years. The mean follow-up period for 9 women was 7.3 (SD=1.94) months and six of them (66.6%) concived a pregnancy within 3-12 months after the surgery. It seems that the hysteroscopic septum resection is accompanied by a significant improvement in the reproductive performance of women who suffer from infertility or recurrent abortion.

Following national family planning programs in Iran, oral contraceptive pills (OCPs) have been widely used by women in reproductive ages. Although OCPs considered safe in many cases, some complications are rarely reported and its prescription is contraindicated in some disorders. In most references OCP is one of the probable predisposing factors mentioned for pityriasis versicolor Since there are no studies supporting a definite relation between OCP and Pityriasis versicolor, the present study was conducted to confirm this theory. Methods and Material: A case-control study was carried out, from oct 2004 to oct 2005, on samples of female patients (n=186) referring to Dermatology clinic of Imam Reza Hospital in Mashhad. Of these patients, 62 were pityriasis versicolor case group and 124 were the control group. A questionnaire was used as a profile seeking information. The diagnosis was based on clinical manifestations and direct smear of the lesions and Wood lamp findings. Data were analysed by SPSS and statistical tests. Most of the patients (46.2%) were 20-29 years old. The majority of patients were housewives, mostly rural population (90.3%). There was no considerable association, between rural or urban localizations and pityriasis versicolor (p= 0.59). The most common form of the lesions was hyperpigmented and localized ones in upper trunk. Positive family history was recorded in 41.6% of cases, and 7.3% in controls. Cases, 24.2% consumed OCP, indicating that there was no significant relationship between OCP consumption and pityriasis versicolor (p =1.00). All OCP users used LD (Low Dose) pills. According to this study OCPs do seem to be a predisposing factor for pityriasis versicolor. OCPs may even have a protective effect on pityriasis versicolor by decreasing the sebum secretion. Therefore a change in contraception method for eradication of Pityriasis versicolor in OCP users is unnecessary.

Success of assisted reproductive treatment may be dependent a variable factors such as the woman’s distress level at the term of the treatment. This study was designed to evaluate the effect of anxiety and depression of infertile women on the outcome of ART. This case-control study was performed on 300 infertile women who volunteered to undergo ART in Montasariya Infertility Center of Mashhad University of Medical Sciences. They consecutively invited and agreed to participate. Before down-regulation by means of gonadotrophin-releasing hormone (GnRH) analogues patients were asked to complete the State and Trait Anxiety Inventory to measure anxiety, and the Beck Depression Inventory (BDI) to measure depression and individual specifications’ questionnaires. Pregnancy tests were done 15 days after performing IUI and IVF. There were no significant statistical relation between different levels of depression and the infertility treatment outcome (p = 0.19). This relationship was significant between different levels of state and trait anxiety and treatment outcome (p = 0.019 & p = 0.016). With the increase of anxiety the positive result of pregnancy test was less probable. An accurate assessment of the infertile women by a team of specialists consisting of a clinical psychologist, a psychiatrist, and a gynecologist is needed so that their anxiety would be reduced and better outcome achieved.

Preimplantation genetic diagnosis (PGD) is an advanced diagnostic tool in the assisted reproductive technologies (ARTs) to avoid inheritance of genetic disease by transferring unaffected embryos. The presence of numerical sex chromosome abnormalities was studied using fluorescence in situ hybridization (FISH) with two sex chromosome specific probes for X and Y chromosomes.

In this experimental study, PGD has been performed for 10 couples, who were carriers of inherited X linked disorders. Conventional hormone therapy, intracytoplasmic sperm injection, blastomer, biopsy and fluorescent in situ hybridization were carried out for all candidates.

Data was analyzed by descriptive statistics.In FISH analysis 93% of cells provides clear signals for X and Y chromosomes from that 29(XX), 18(XY), 4(XXY), 1(XO) were diagnosed. Transferring of embryos into uterus was performed in 10 cycles resulting into two pregnancies and one born baby. The implantation rate of embryos was 20% and the take home baby rate was 10% following ten PGD experiments.

Chromosomal disorders more frequently in embryos with dismorphology especially in the embryos from older women.

Genital wart is a common sexually transmitted disease caused by human papiloma virus. Podophyllin is a plant extract, having been traditionally used to treat genital wart. Podophyllin is an anti- mitotic agent with direct effect on epithelial cells. Liquid nitrogen is most widely used as cryotherapy agent. Cryotherapy causes cell death, ice crystals formation in the cell, and cellular components damages. The purpose of this study was to evaluate the efficacy of podophyllin solution versus liquid nitrogen cryotherapy on genital warts. This clinical trial was performed from Feb 2003 to Dec 2005, on 70 patients with genital wart in Dermatology Clinic, Qaem Hospital. Patients divided into two groups randomly. Of the total patients, 35 received podophyllin solution and another 35 treated with liquid nitrogen cryotherapy. Study medication was applied once weekly until the complete clearance of lesion for a maximum duration of 8 weeks. Patients whose warts cleared completely were observed for up to 10 weeks to determine the recurrence rate. The mean duration of complete clearance was 3.9 weeks (range 1-7) for podophyllin and 4.9 weeks (range 1-9) for cryotherapy group (P=0.039). Of podophyllin and cryotherapy treated patients, whose wart cleared completely and who finished 10 week follow up period, 26% and 47 % experienced the recurrence of warts, respectively (P>0.05). Cryotherapy patients experienced a significantly greater number of local inflammatory reactions than the podophyllin group. This data indicated that podophyllin solution therapy of genital wart is more effective, with less recurrence rate and side effects, than liquid nitrogen cryotherapy.