afsaneh tehranian

Effective cervical intraepithelial neoplasia (CIN) treatment and detection of high-risk recurrence patients is very important.

The present study aimed to compare the recurrence rate of CIN after loop electrosurgical excision procedure (LEEP) versus cold knife conization (CKC).

This cross-sectional study involved 329 patients who underwent either LEEP (294 cases) or CKC (35 cases) in the colposcopy clinic of referral hospitals between March 2016 and March 2021. The study population was followed up every six months for two years after their first conization to monitor for any recurrence of the disease.

There was no significant difference between the two groups regards. Thirty-two patients experienced recurrence within two years after surgery. The rate of CIN recurrent was 30 (10.2%) cases in the LEEP group and 2(5.7%) cases in the CKC group, with no significant differences (P-value = 0.553, RR = 1.78; 95% CI = 0.44-7.15).

The present study compared the benefits and harms of LEEP and CKC. The recurrence rate and surgical complications associated with both methods appeared to be similar with no significant differences. However, further high-quality and comprehensive research with a long-term follow-up is necessary to confirm our findings.

Uterine fibroids are one of the most common benign tumors that cause abnormal bleeding and pain in women of reproductive age. One of the objectives of this study is to evaluate the effect of cabergoline drug on the size and volume of uterine bleeding as well as menopausal symptoms in women with uterine myomas.

This double-blind clinical trial was conducted among 80 women with fibroid myomas and Abnormal Uterine Bleeding (AUB). The participants were allocated to two groups after random allocation. Group I received Cabergoline, 1 tablet (0.5 mg/w) orally once a week for 3 months. Group II obtained a placebo tablet (0.5 mg/w), taken at the same time. 

80 patients were included in the study (40 patients in the control group and 40 patients in the cabergoline treatment group). No statistically significant difference was observed between the two groups in terms of age, number of pregnancies, number of births, body mass index, uterine myoma characteristics, myoma type, myoma volume, and myoma number. A 37% decrease in myoma size was observed in the cabergoline recipients, as well as a 25% decrease in the placebo group, which is not statistically significant (p-value >0.05).

Cabergoline drug reduces the volume of bleeding and the number of uterine myomas, but this reduction is not statistically significant and requires more studies in this field.

Considering the prevalence of Human Papillomavirus (HPV) infection and the lack of HPV vaccination program in Iran among young women and the importance of quality of life and sexual performance in women, we decided to conduct a study to examine the relationship between HPV infection and sexual dysfunction and quality of life in Iranian women.

In this cohort study, 250 married women who infected with HPV were recruited via convinence sampling from colposcopy clinic of Arash women hospital (Tehran, Iran) from April 2020 to May 2022.They were evaluated concerning their sexual function in the domains of desire, arousal, lubrication, orgasm, satisfaction and pain with the female sexual function index (FSFI) questionnaire (the total FSFI score is calculated by the sum of the nineteen items). Sexual quality of life-female (SQOL-F) items (Likert-type scale with a cut-off of 65 points) were organized into four sub-scales: psychosexual feelings, sexual and relationship satisfaction, self-worthlessness, and sexual repression. All patients filled out the female sexual function index (FSFI) and sexual quality of life (SQOL) questionnaires. Variables were analysed via correlation coefficient and linear regression tests.

Mean age and mean marriage duration were 38.5±4.5 and 12.2±7.2, respectively. There was a weak correlation between FSFI and SQOL (r=0.15, p=0.001).Time of marriage and genital warts were the predictors on the FSFI and SQOL.

The findings suggest that HPV infection can impair sexual function and quality of life. This research contributes valuable insights, especially considering the prevalence of HPV.

The study aims to determine the adverse effects of a mild COVID-19 infection on maternal and neonatal outcomes in pregnant women living in the eastern part of Tehran. In this prospective cohort study, we followed two groups of pregnant women until term and their pregnancy and neonatal outcomes. RT-PCR (reverse transcriptase polymerase chain reaction) positive tests of nasopharyngeal swabs were confirmed in one group, where at least three signs and symptoms associated with COVID-19, and/or chest CT scans identified highly specific findings for the disease were present. The control group is composed of healthy pregnant women tested negative for COVID-19. The study included 319 pregnant women (108 with mild COVID-19 infection and 211 healthy). A higher percentage of mothers with mild COVID-19 infection had preterm births (47.9% vs. 30%, p=0.007), and their neonates required hospitalization more often (45.8% vs. 22.6%, p<0.001). PTB was positively associated with maternal hypertension (relative risk (RR): 5.40), mild COVID-19 infection (RR: 2.05), and older age (RR: 1.05). Among the risk factors for neonatal hospitalization, PTB (RR: 5.94), maternal hypertension (RR: 2.74), and mild COVID-19 infection during pregnancy (RR: 2.57) were significant. The outcomes of pregnancy are significantly impacted by maternal infection with COVID-19, even if it is mild. Preterm births are more likely to happen in mothers with mild COVID-19 infection, and neonates need more hospitalizations.

 Immunosuppression, HPV persistence, and smoking are the main-related risk factors of Cervical Intraepithelial Neoplasia (CIN) recurrence. However, age as a basic factor may be a main factor related to CIN recurrence. Therefore, our study aimed to detect the potential role of women's age in CIN recurrence.

 This cross-sectional study was conducted on 329 patients who underwent conization in the gynecology-oncology clinics of Arash and Imam Khomeini hospitals affiliated with Tehran University of Medical Sciences between March 2016 and March 2021.

 Totally, 329 cases were enrolled in the study. Most women were in their thirties. CIN recurrence was about 10.0% (32 cases). The CIN recurrence rate was 8.9% in women younger than 30, 10.2% in 30-40, 11.3% in 40-50, and 5.6% in 50–60 decades. There was no significant (p-value=0.802) difference in recurrence rate among age groups. There was a significant (p-value=0.023) difference in the frequency of endocervical involvement regarding age category, women aged 40 to 50 had the most frequent marginal involvement with 26.8%, while there was no significant (p-value=0.802) difference in frequency of marginal involvement regards age category.

 CIN cases with age higher than 40 years need to have more caution and tight follow-up visit after conization.

This study aimed to evaluate the effect of random biopsy and endo-cervical curettage (ECC), alone and together, in the diagnosis of high-grade cervical lesions in women with normal colposcopy.

This cross-sectional study was conducted on 356 women who underwent colposcopy examination in the gynecology-oncology clinic of Roointan-Arash Women’s Hospital, affiliated with Tehran University of Medical Sciences. All eligible women underwent colposcopy. In colposcopy examination, up to four biopsy samples were randomly taken for each quartile of the cervix and ECC was performed. Finally, the rate of intraepithelial neoplasia (CIN) and the relation between random biopsy and ECC and CIN diagnosis was determined.

In total, 27 (7.6%) low-grade squamous intraepithelial lesions (LSIL) and 19 (5.3%) high-grade squamous intraepithelial lesions (HSIL) were detected in cases that underwent random biopsy. There was a significant association between the abnormal random biopsy results and having multiple sexual partners (p=0.001), cigarette (p=0.041), and hookah (p=0.033) smoking. Furthermore, 31 (8.7%) LSIL and 42 (11.8%) HSIL were reported in women who underwent ECC. There was a significant relation between the abnormal results of ECC and hookah consumption (p=0.008) and human papillomavirus (HPV) infection (p=0.011). The concordance (p=0.001) between random biopsy and ECC result was 71.2% and only in 28.8% of the cases one of the methods was normal and the other was abnormal.

The present study showed that the simultaneous use of ECC and random biopsy in women with normal colposcopy increases the detection rate of precancerous lesions by up to 28.8%.

Considering the importance of the nursing profession, which serves as the link between the country’s health and treatment organization and patients, most recent research has aimed to investigate nurses’ career and family problems. However, fewer studies have addressed intervention and treatment approaches in this regard. This research was conducted to investigate the effectiveness of group therapy, based on acceptance and commitment, on occupational burnout, couple burnout, and family resilience among married nurses. The research method was experimental, utilizing a pre-test-post-test design with follow-up phases at one month and three months. The statistical population comprised all the nurses from one of the hospitals in Tehran during the 2020-2022 Coronavirus outbreak. The sample consisted of 24 nurses, 12 in the experimental and 12 in the control group, selected via simple random sampling. The questionnaires used in this research were Meslash’s Burnout Inventory (1981), Pines’s Couple Burnout Measure (1996), and Sixbey’s Family Resilience Assessment Scale (2006). The data were analyzed using a one-way repeated measures Analysis of Variance. The results demonstrated that therapy based on acceptance and commitment significantly reduced occupational and couple burnout and increased family resilience among married nurses (P<0.01). Furthermore, the effects of treatment based on acceptance and commitment were maintained in the follow-up stages (P<0.01). One of the key implications of this study’s findings is that emphasizing acceptance processes and mental focus can help mitigate occupational and couple burnout among nurses. Consequently, it is recommended that policymakers in the healthcare sector consider this therapeutic approach in their decision-making processes.

Gestational trophoblastic neoplasia (GTN) is a rare neoplasm and is a spectrum of proliferative disorders of placenta. Invasive mole is a subtype of GTN that almost always arises after molar pregnancy. This report presents a 35-year-old woman with an atypical presentation of invasive mole after a normal pregnancy. The patient presented with a complaint of vaginal bleeding after normal vaginal delivery. Invasive mole was diagnosed based on findings of imaging and elevated beta human chorionic gonadotropin (ß-hCG) levels. Hysterectomy was finally decided upon due to severe vaginal bleeding and the patient’s request. Although GTN occurs after normal delivery, the patient recovered without receiving chemotherapy. It is important to consider all subtypes of GTN as a differential diagnosis of patients with abnormal postpartum bleeding and elevated ß-hCG levels even after a normal pregnancy.

Endometrial hyperplasia is the irregular proliferation of endometrial glands and an increase in the ratio of gland to stroma compared to normal proliferative endometrium. Endometrial hyperplasia is one of the precursors of endometrial cancer, which is one of the most common cancers among women. The present study was conducted with the aim of investigating changes in the expression level of FOXO1 and P27 kip genes in endometrial hyperplasia tissue samples compared to normal tissue sample. In this case-control study, samples of hyperplasia with normal marginal tissue were taken from the uterine endometrium of women who referred to the women's clinic of Arash Hospital with abnormal uterine bleeding or increased endometrial thickness. Marginal normal tissue sample and hyperplasia sample were considered as control and case, respectively. The relative expression level of FOXO1 and P27 kip genes was measured by real time PCR method after total RNA extraction and cDNA synthesis, and then the data obtained from the reaction was analyzed by RQ=2-ΔΔCT method. Data were analyzed using independent t-test. The relative expression level of FOXO1 and P27 kip genes in the hyperplasia tissue sample was not significantly different compared to the control group (P>0.05.( Although the results of some studies indicate that the expression level of FOXO1 and P27KIP genes can be changed in endometrial cancer, the results of the present study showed that, contrary to expectations, there is no significant change in relative expression level of FOXO1 and P27KIP genes in hyperplasia tissue compared to normal tissue.

In Iranian traditional medicine, donkey dung, known as "Anbar-Nesara" is used for its antimicrobial and antiallergic properties. Incorrect medical beliefs can lead to the incorrect use of complementary medicine and the creation of unnecessary harmful effects. Although there have been many reports about the traditional medical benefits and the use of Anbar-Nesara, we describe a woman with severe wound infection following surgical and administration of Anbar-Nesara smoke.

An association between microRNAs (miRNAs) and adhesion proteins expression with repeated implantationfailure (RIF) has been recently reported; however, these findings are controversial. This study aims to evaluatethe endometrial and circulating expressions of miR-145, miR-155-5p, and miR-224 in addition to the endometrialexpressions of membrane protein palmitoylated-5 (MPP-5) and endothelial cell adhesion molecule-1 (PECAM-1) inpatients with RIF compared to control subjects. This case-control study was carried out between June 2021-July 2022. Subjects included 17patients with RIF and 17 control subjects, who had previous spontaneous term pregnancy with a live birth, who referredto the Medical Centre of Arash Hospital, Tehran, Iran. Endometrial tissue samples were obtained via hysteroscopyand Pipelle catheter in the RIF and control subjects, respectively. Plasma samples were collected after ovulationin all subjects. The expression levels of MPP5, PECAM-1, miR-224, miR-145, and miR-155-5p were evaluated byquantitative real-time polymerase chain reaction (qRT-PCR). The student’s t test, chi-square, Mann-Whitney U, andanalysis of covariance (ANCOVA) were used for data analyses. RIF patients had less endometrial miR-155-5p expression, and higher endometrial and circulating expressions ofmiR-145 and miR-224 compared to control subjects. Endometrial PECAM-1 and MPP5 expression significantly decreased inpatients with RIF compared to the control group. There was a positive correlation between circulating miR-224 and endometrialmiR-155-5p, and between circulating miR-155-5p and endometrial PECAM-1 expression levels in patients with RIF. The present study suggests that circulating miR-224, endometrial miR-145, and PECAM-1 can bereliable, novel biomarkers for diagnosis of RIF.

We compared two different methods of visual inspection of the cervix, including Visual inspection of the cervix with acetic acid (VIA) and Visual inspection of the cervix with Lugol's iodine (VILI) in terms of sensitivity and specificity in diagnosis of pre-malignant cervical lesions in comparison to colposcopy guided biopsy.

In this cross-sectional study, a total number of 200 women who were referred to the colposcopy clinic of Arash women’s hospital (Tehran, Iran) for cervical cancer screening, underwent VIA, VILI, and colposcopy guided biopsy during 2018-2019.

 The calculated sensitivity and specificity of VIA and VILI in this population were (100% and 69.5%) and (100% and 60%), respectively, whereas the sensitivity and specificity of both VIA and VILI tests in combination were 100% and 77.2%. The positive and negative predictive values were 32.7% and 100%, respectively, when combined form of VIA and VILI was applied in this population.

VIA and VILI alone or in combination could be used as screening tests to evaluate the presence of cervical cancer and in case of positive results, supplementary tests such as colposcopy guided biopsy could be performed for definite diagnosis.

Visual Inspection with Acetic Acid (VIA) is an inexpensive option for cervical cancer screening.  In this study, we evaluated the role of the VIA as well as of the clinical symptoms/signs to find the best case-finding method for Cervical Intraepithelial Neoplasia (CIN) 2+.   

In a cross-sectional study, we extracted from records the demographic characteristics, clinical symptoms/signs, and indications for colposcopy referral of patients with CIN 2+ in pathology. Patients were divided into 1- Abnormal Pap smear, 2- Positive VIA, 3- abnormal Pap smear with clinical symptoms/signs, 4-VIA positive with clinical symptoms/signs, 5- only clinical symptoms/signs. The sensitivity of each method was studied to determine their effectiveness as a screening method.  

Out of 146 patients who underwent colposcopy, 38 patients had it due to abnormal Pap smears, 37 due to positive VIA, 21 due to abnormality of both these tests, and 50 due to clinical symptoms/signs despite having normal screening tests. The sensitivity for VIA and Pap smear was 73.39% (17.48%-83.31%) and 40.41% (32.47%-48.86%) respectively. Presence of at least one of the three clinical symptoms/signs and a positive VIA found 78.8% of CIN 2+ cases. Presence of at least one of the three clinical symptoms/signs and abnormal Pap smear identified 84.2% of the cases.  

To find high-grade CIN, focused attention to the clinical symptoms/signs, even in the presence of normal Pap smear, can increase the sensitivity of Pap smear and VIA. In low resource settings, a simple, highly sensitive method like VIA can be used in addition to or as an alternative to other means.

Borderline oligohydramnios always produces a dilemma of management and counseling among obstetricians. This study was designed to compare the effect of sildenafil plus fluid therapy versus fluid therapy alone on pregnancy outcomes and AFI improvement in pregnant women complicated by idiopathic borderline oligohydramnios.

This randomized clinical trial was conducted in Arash Women’s Hospital, Tehran, Iran from 2017 to 2020.  Fifty-one pregnant women with idiopathic borderline oligohydramnios were allocated to two groups. Group 1 received fluid therapy and Group 2 received fluid therapy and Sildenafil 25 mg three times daily for six weeks. AFI was measured at the time of randomization, 24 h after treatment and then weekly for six weeks. The changes in AFI, type of delivery, gestational age at delivery, and neonatal outcomes were compared between the two groups.

After the intervention, the change in AFI between two groups was not statistically significant. Maternal and fetal outcomes are compared between two groups and there was no significant difference between them. The median (Inter-quartile range) AFI after intervention, in Sildenafil group compared with hydration group, were in 24 hours (8.5 vs. 8, p=0.27), first (9.5 vs. 9.1, p=0.74), second (9 vs 10, p=0.12) third (10.4 vs. 9.4, p=0.33), fourth (10.8 vs 9.1, p=0.1) and Fifth week (10 vs 9.3, p=0.5) of follow-up respectively, but none of them were statistically significant.

The findings showed that sildenafil plus fluid therapy do not improve the pregnancy outcomes in women with isolated borderline oligohydramnios compared to fluid therapy alone.

Puerperal uterine inversion is a rare obstetric emergency that may cause maternal mortality. We describe a multiparous women with total uterine inversion after a normal vaginal delivery.

Case Report: 

A 28 years old, gravid3 pregnant women was admitted to the hospital in the first stage of labor. She had a Past medical history of curettage due to abnormal vaginal bleeding following her second vaginal delivery and the present pregnancy proceeded without complications. After the delivery of the fetal  due to the history of placental adhesion, umbilical cord traction was avoided and after 20 minutes, the patient was asked to push hard. During a Valsalva maneuver, the uterus and the placenta were suddenly expelled from the vagina. The placenta was completely adherent to the decidua and the patient displayed no signs of shock. Then manual repositioning of the uterus was performed by a closed fist. and subtotal abdominal hysterectomy was performed. Pathological examination revealed placenta inccreta and The placenta was found completely adherent at the fundus.

Conclusion :

Uterine inversion usually occurs unexpectedly and is unpreventable in some cases. Assessment of the possible risk factors before delivery may help predict its occurrence. Therefore, in women with a positive history, special measures should be taken in third stage of labor to manage the possibility of inversion.

Ovarian cancer is the fifth leading cancer-related cause of death in women worldwide and is often diagnosed at advanced stages. Regarding the low sensitivity and specificity of the currently available diagnostic techniques, in the present study, we aimed to evaluate the accuracy of RMI and ROMA indexes and comparing these two indexes with CA-125 and HE4 parameters for the diagnosis and differentiation between benign and malignant ovarian tumors. Also, we determined the optimal cut-off level of these markers in patients who attended Arash Women’s Hospital.

In this cross-sectional study, we included 137 women with ovarian mass who were attended the gynecology clinic of Arash Womenchr('39')s Hospital, Tehran, Iran (April 2017-April 2019), and were eligible according to the inclusion criteria. We included patients with an adnexal mass over 3 cm. Our exclusion criteria were as the following: pregnancy, age under 18 and over 90 years, taking hormonal agents, renal failure, suspected ovarian torsion, ovarian cancer and taking antibiotics, nitric oxide compounds, and heavy metals. Based on serum CA125, HE4, and ultrasound findings, ROMA and RMI indexes were determined for each patient, and the sensitivity and specificity of HE4, RMI, ROMA, and CA125 were compared with the result of the operative histopathologic assessment.

According to the area under the ROC curve, regardless of the patientschr('39') menopausal status, the highest diagnostic value was dedicated to RMI with 89% under the curve area and 95% confidence interval (81.6-96.4%). Diagnostic values of other markers were as the following: 87.7%(95%CI=80.3-95%) for HE4, 87.3(95%CI=79.1-95.4%) for CA125, and 86.2%(95%CI=78.7-93.6%) for ROMA. In terms of menopausal status, HE4 had the highest diagnostic value in premenopausal patients, while in the menopausal group CA125 had the highest diagnostic value.

Measurement of HE4 before menopause and CA125 during menopause seems to be helpful in the early detection of ovarian cancers in women with ovarian masses.

The World Health Organization has recommended exclusive breastfeeding for 6 months. Breastfeeding success may be influenced by different factors.
The aim of this study was to determine the association between prepregnancy body mass index (BMI) and breastfeeding duration in Iranian mothers.
This prospective cohort study was conducted at Arash Women's Hospital in Tehran, Iran. The analysis included 593 women, followed from pregnancy until 6 months postpartum. A logistic regression model was used to determine the association between prepregnancy BMI and exclusive breastfeeding duration and initiation.
Women with prepregnancy BMI above 25 kg/m2 had a higher risk (almost twice) of not initiating breastfeeding or breastfeeding for less than 1 month after delivery, compared to pregnant women who had a normal weight. In this study, adjustments were made for confounding factors, such as age, education level, mode of delivery, mother's opinion of breastfeeding, and mother's occupation.
This study showed that women who had a normal prepregnancy weight were more likely to continue breastfeeding for 6 months, while obese and overweight women had a shorter duration of breastfeeding in comparison with normal-weight women.

The relationship between ovulation induction and ovarian cancer is an important issue in gynecology..
The studied patient was a 32-year-old G1P1 woman with abdominal pain who was diagnosed with a large ovarian cyst during ovulation induction, which could possibly raise the risk of ovarian torsion. She had a 2-year secondary infertility and had received three cycles of ovulation induction with letrozole 6 months earlier. An emergency laparoscopy showed large complex ovarian cysts without torsion. We then performed a cystectomy. Based on the pathology report revealing a primary ovarian cystadenocarcinoma, the patient underwent a total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and retroperitoneal lymphadenectomy..
The emergence of a suspected ovarian cyst during letrozole-induced ovulation is of great importance and needs to be investigated..

Embryonal (Botryoid) Rhabdomyosarcoma (RMS) is an aggressive malignancy that arises from embryonal rhabdomyoblasts. It is commonly seen in the genital tract of female infants and young children. The primary site of these tumors is closely related to the age of the patient. Embryonal Rhabdomyosarcoma has a marked tendency for local recurrence after excision. Due to young age of affected patients who desire fertility, the management of this rapidly growing malignancy is very critical and poses challenges.

We report on two cases embryonal rhabdomyosarcoma of uterine cervix, who were referred to Imam Khomeini hospital during year 2014. Both of them were young virgin females. The presenting symptom for both was vaginal bleeding and protrusion of polypoid mass from the hymen. After neoadjuvant chemotherapy, radical hysterectomy was offered to them. One of them refused, thus local excision was done. Both patients received adjuvant chemotherapy yet in the patient with local excision, the tumor recurred with multiple metastases.

There are several methods of surgical approach and variation in adjuvant therapy in the management of embryonal rhabdomyosarcoma. If we choose a conservative approach for surgery of early stage, surgical margin should be negative and in other cases doing radical surgery is the best.

Platelet-rich plasma (PRP) is a human plasma product enriched by platelets, growth factors, and fibrinogen with high hemostatic and healing properties.
The aim of this study was to evaluate the effect of autologous PRP on wound healing in high-risk women undergoing cesarean sections.
Patients and In this balanced, randomized, and controlled trial, 140 patients were admitted to Arash women’s hospital, Tehran, Iran from May of 2013 to November of 2014 for elective cesarean surgery. The patients were randomly assigned into two groups. The intervention group received PRP after surgery, whereas the control group received the usual care. All patients were evaluated at baseline, five days, and eight weeks after the cesarean section. The primary endpoint used the REEDA scale for assessing the changes in wound healing. The secondary outcome measures used were the Vancouver scar scale (VSS) and the visual analog scale (VAS). All scale scores were analyzed using a repeated measures test for variance.
At the end of study, the PRP group showed a greater reduction in the edema ecchymosed discharge approximation (REEDA) score compared to the control group (85.5% reduction in the PRP group; 72% in the control group) (P It seems that applying PRP is an effective therapeutic approach for wound healing, and faster wound healing is expected due to the presence of more platelets and growth factors.

Endometrial hyperplasia (EH) is an abnormal overgrowth of endometrium that may lead to endometrial cancer, especially when accompanied by atypia. The treatment of EH is challenging and previous reports have provided conflicting results. Metformin (dimethyl biguanide) is an anti-diabetic and insulin sensitizer agent which is supposed to have antiproliferative and anti-cancer effects and the potential to decrease cell growth in endometrium. While some studies evaluated the anti-cancer effect of metformin, studies on its potential effect on endometrial hyperplasia are rare. To address this knowledge gap, in this comparative trial study, we evaluated the effect of additive metformin to progesterone in patients with endometrial hyperplasia. In this clinical trial, 64 women with endometrial hyperplasia referring to Arash hospital from 2014 to 2015 were randomized in two groups. The progesterone-alone group received progesterone 20 mg daily (14 days /month, from the 14th menstrual day) based on the kind of hyperplasia and progesterone +metformin group received metformin 1000 mg/day for 3 months in addition to progesterone. Duration of bleeding, hyperplasia, body mass index (BMI), and blood sugar (BS) of the patients were then compared between the two groups. A mean age of 44.5 years, mean BMI of 29 kg/m2 and mean duration of bleeding of 8 days, was calculated for the study sample. There was no significant difference in age, BMI, gravidity, bleeding duration, and duration of disease at baseline between two groups. While all patients in the progesterone +metformin group showed improvement regarding bleeding and hyperplasia, only 22 out of 32 patients in the progesterone-alone group showed the corresponding improvement, with the difference between two groups being significant (P = 0.001). Although the difference between two groups in the post treatment endometrial thickness was not significant (P = 0.55), post treatment BMI in the progesterone +metformin group was significantly lower than the progesterone-alone group (P = 0.01). In addition, the reduction in BS in the progesterone +metformin group was significantly larger than that in the progesterone-alone group (P = 0.001). Our results indicated that administration of progesterone 20 mg/day plus metformin 1000 mg/day can significantly decrease bleeding duration and hyperplasia, BMI and BS in women with endometrial hyperplasia.

Thromboembolism is the most important complication of cancers.The aim of this study was to determine D-dimer levels in benign and malignant tumors of the uterus, ovary and cervix. Subjects and This was a cross sectional study and it was conducted on 90 female patients referred to Imam Khomeini and Arash Hospitals because of uterine, cervical and ovarian tumors in 2013-2014. After surgical resection or tissue biopsy, 2 cc of each patient’s blood was taken to be sent to laboratory of hospitals. “Nycocard” kit was chosen to measure D-dimer levels in Mg/Lit by neflumetry method. Data were analyzed in SPSS-16 by T-test and One-Way ANOVA test. The highest mean of D-dimer was 3.9 (± 2.9SD) in malignant cervical tumors. The mean plasma levels of D-dimer in malignant uterine cancers (P = 0.008), ovarian cancers (P = 0.007) and cervical cancers (P = 0.006) was significantly higher than benign tumors. In all three types of uterine, ovarian and cervical cancers, D-dimer was significantly higher in advanced stages than lower stages. The plasma D-dimer levels in patients with malignant tumors of the uterus, cervix and ovary were higher than benign types. By increasing the stage of gynecologic malignant tumors, the levels of plasma D-dimer were increased.

AUB is a common cause of women’s referring to gynecologists. Although hysteroscopy is known as the gold standard technique for diagnosing the cause of AUB, sonohysterography is less invasive, and it is performed by general gynecologists. The purpose of this study was to evaluate the diagnostic performance of sonohysterography compared to the results of the endometrial biopsy, guided by hysteroscopy in premenopausal women with AUB. This cross- sectional Study was conducted at the gynecological clinic of Roointan -Arash women''s Hospital from February 2011 to February 2012. The study participants were 90 premenopausal female patients, who visited the clinic for AUB, for whom, hormonal, iatrogenic and systemic causes were ruled out. They underwent sonohysterography and hysteroscopy and endometrial biopsy. The results of sonohysterography and pathological reports of endometrial biopsy were compared, and the diagnostic accuracy of sonohysterography for normal endometrium, endometrial polyps, sub mucosal fibroids and endometrial hyperplasia was evaluated. The diagnostic accuracy of sonohysterography was found to be 89.1% for the normal endometrium, 90% for endometrial polyps, 99% for sub mucosal fibroids and 94.4% for endometrial hyperplasia. Sonohysterography is an accurate, non-invasive and cost-effective method for diagnosing AUB causes compared to hysteroscopy and endometrial biopsy. Therefore, as an initial diagnostic step, it can replace the alternative and less accurate methods such as transvaginal ultrasound, blind endometrial curettage or more costly and invasive methods such as hysteroscopy requiring anesthesia.

Intravaginal misoprostol has been shown to be an effective agent for cervical ripening and induction of labor. The aim of present study was to assess the effects of adding hyoscine to vaginal misoprostol on its success rate. In a clinical trial, 74 women who were referred to undergo legal induction of labor during first pregnancy trimester in Arash Hospital, in Tehran, Iran, between March 2006 and March 2007 were enrolled, and were randomly divided in to two groups of misoprostol (400 µg/4h, vaginal) (n=37) or misoprostol (400 µg/4h, vaginal) plus hyoscine (20 mg IV) (n=37). Their complications including nausea, vomiting, fever, abdominal pain, need for analgesics, diarrhea, vaginal bleeding

Hydatid disease is a widespread parasitic infection caused by tapewormEchinococcus and it affects mainly the liver, but other organs such as pelvic organscould be involved very rare. Here we report a case of hydatid cyst with involvementof oviduct in a woman with endometrial cancer. It was misdiagnosed as a multicysticright ovarian mass before surgery and by microscopic study it was shown as a primarydegenerated hydatid cyst which was also unusual. Although pelvic echinococcalcysts rarely occur, the gynecologists should be consider, and the possibility of ahydatid cyst when they find a pelvic cystic mass, especially in areas where the diseaseis endemic.