Journal of Obstetrics, Gynecology and Cancer Research
Volume:5 Issue: 2, Spring 2020

Episiotomy is the most prevalent surgery in midwifery which can lead to infection or delay in wound healing like any other wound. Prophylactic antibiotics are currently prescribed after episiotomies in most Iranian centers. According to global efforts as well as WHO strategies to reduce antibacterial resistance, antibiotics are only prescribed when there is a definite medical indication and the benefit of taking them outweighs the harm. Therefore, this study aimed to compare the incidence of episiotomy site infection in two groups of primiparas with and without taking prophylactic antibiotics after normal vaginal delivery at Bent Al-Huda Hospital in Bojnourd.

This double-blind randomized clinical trial was conducted on 140 primiparas (70 women in two groups, i.e., cephalexin and placebo capsules) at Bent Al-Huda Hospital in Bojnourd. After episiotomies, the patients took the prescribed medication every 6 hours for 7 days. The wound healing assessment was done by applying the REEDA scale (redness, edema, ecchymosis, discharge, and approximation of wound edges) seven days after the delivery. SPSS 18 were used to analyze the data. P-values below 0.05 were considered significant.

On the seventh day after the delivery, the two groups were different in terms of healing score based on the REEDA scale, and statistically significant differences were observed. The healing score was lower in the antibiotic group compared to the placebo group, indicating a better wound healing.

 The results showed the effectiveness of prophylactic antibiotics in treating episiotomy wounds.

An endometrial thickness of less than 7 mm adversely affects pregnancy outcomes. There is also ample evidence of the impact of granulocyte colony-stimulating factor (G-CSF) on treatment-resistant thin endometrium. Therefore, this study compares the effects of intrauterine and subcutaneous injections of G-CSF on increasing endometrial thickness (ET) and pregnancy outcomes in infertile women who were candidates for in vitro fertilization (IVF).

In the current randomized, double-blind clinical trial, 34 patients with a history of failed IVF cycles and treatment-resistant thin endometrium were randomized into two routes of G-CSF injection, i.e., intrauterine and subcutaneous, by using a random number table method. Outcomes including ET and chemical and clinical pregnancy rates were compared in two groups.

ET increased significantly in both groups after G-CSF administration (intrauterine and subcutaneous); however, this increase in thickness was significantly greater in the intrauterine injection group than in the subcutaneous injection group. Pregnancy outcomes were similar in two groups. Drug side effects were significantly lower in the intrauterine injection group than in the subcutaneous injection group.

G-CSF can significantly increase ET in cases of repeated IVF failure, and intrauterine injection of this drug was more effective than subcutaneous injection.

Laparoscopic ovarian drilling (LOD) is a method for ovulation induction in polycystic ovary syndrome (PCOS) patients. The aim of this study was to evaluate the serum levels of anti-Mullerian hormone (AMH) and follicle-stimulating hormone (FSH) before and after LOD in one or two ovaries in women with PCOS.

This study was a prospective cohort study. The study population included infertile women with PCOS resistant to clomiphene referred to the Infertility Clinic of Yas Hospital. They were candidates for LOD in 2016–2017. The serum levels of AMH and FSH were measured before and after three months in two groups of unilateral and bilateral LOD. Data were analyzed using Stata software.

A total of 35 female patients were enrolled in the study, 18 (51.4%) in bilateral and 17 (46%) in unilateral LOD groups; the average age of patients was 27 ± 3.4 years old. AMH levels significantly (P<0.001) decreased in both unilateral and bilateral groups after LOD. FSH levels significantly (P<0.001) increased in both groups after LOD, but this increase was higher in the unilateral group than in the bilateral group, and this difference was statistically significant (P<0.001).

 It seems women with clomiphene-resistant PCOS when underwent unilateral or bilateral ovarian drilling experienced a significant decrease in AMH and a significant increase in FSH, indicating a decrease in their ovarian reserve.

In this present study, we reported a 31-week pregnant woman who had a history of fever and chills in the past two daysreferred to Mostafa Khomeini Hospital in Tabas.

Case report:

 A 29-year-old pregnant woman with a gestational age of 31 weeks presented to the gynecology clinic. Her chief complaint was a history of fever and chills in the recent past two days. Since there were no suspicious findings in favor of infections, related to obstetrics and gynecology, the patient was referred to Mostafa Khomeini Hospital in Tabas (June 2020). The initial clinical examination revealed no fever, chills, cough, respiratory distress, body aches, gastrointestinal problems or anything else. The patient’s oxygen saturation level was 98%. Routine laboratorytests were requested for the patient. WBC count was 14000, lymphocyte count was 875 (6.25%), and platelet count was 117000. According to the recent history of clinical symptoms and positive paraclinical results, COVID-19 was suspected. In the chest CT findings, bilateral ground glass opacities (GGO) and consolidations were observed, which were compatible with COVID-19 pattern. Based on the positive clinical and lab tests, COVID-19 was detected and positive RT-PCR COVID-19 test confirmed our diagnosis.

The patient was asymptomatic at the time of admission to our ward; however, she reported fever and chills in the last two days, which raised our suspicion about COVID-19. Due to significant lymphopenia and the increase in granulocytes counts, and thrombocytopenia accompanied with complementary lab tests, severe COVID-19 was diagnosed and confirmed with positive RT-PCR test.

Leiomyomas are tumors of the soft tissues. The incidence of myomas within the perineum is absolutely rare and only a few reports have been made on the matter. We herein report a case of perineal myoma in a virgin woman, which was successfully excised.

Case report:

 We present a 35-year-old virgin woman, with complaint referred to a mass in her perineum which had first exhibited signs 5 years prior to the time she referred to us and had increased in size in a steady manner ever since. The mass had caused no gynecologic, rectal, or urinary symptoms. Clinical examination revealed a painless, mobile mass (6cm*6cm) with [unknown consistency] in the right perineum with extension to the distal of the labium majus of the same side.

Treatment of symptomatic leiomyomas relies on surgical excision of the mass. However, the surgical method of choice is a matter of debate in previous studies.

Management of caesarean myomectomy (CM) in lower uterine segment obstruction is a hard process. Here I present a pregnant woman with multiple fibroid pregnancy and an obstructing intramural fibroid in the lower segment. The CM procedure was modified here with initially excision of obstructing myoma and delivery of baby.

  A primigravida woman visited emergency room with abdominal pain at 22 week gestation, receiving antenatal care elsewhere. The emergency abdomen USG showed multiple fibroids in pregnancy with a huge obstructing fibroid in lower segment and a breech presentation with no anomalies. Comparing earlier USG reports exposed that the multiple fibroids were growing across the gestation weeks along the developing fetus. The mother was followed for watchful expectancy till 37 weeks gestation and delivery was planned as elective LSCS. Cesarean myomectomy was carried out through initial excision of lower uterine segment myoma to remove the obstruction, and then deliver the baby through the same incision.

Here the cesarean myomectomy procedure was altered from a regular one, featuring preliminary myomectomy of uterine fibroid in the lower segment, and then delivering the baby and myomectomies again. The outcome was delivering a live baby with hemostasis in a case, with multiple and large fibroids.

Many factors are essential for a pregnancy to be successful. Recognizing the factors caused by surgical trauma may be effective in guiding pregnancies toward success using the assisted reproductive treatment methods. Surgery changes the natural anatomical relation between the ovaries and fallopian tubes. Tubal surgery is hypothesized to reduce ovarian reserve due to the anatomical relationship between the ovarian arteries and nerves and fallopian tubes. There is no consensus on whether or not salpingectomy affects ovarian reserve. Some authors believe that salpingectomy has no effects, while others suggest that it diminishes ovarian reserve. Therefore, comparing fertility rates between women undergoing in vitro fertilization with tubal factor infertility with surgery, tubal factor infertility without surgery, and unexplained infertility can provide valuable data.

Eighty patients who met the inclusion criteria were studied. Study groups included people with a history of tubal surgery, individuals who had tubal problems without a history of surgery, and cases with unexplained infertility. Anti-Mullerian hormone (AMH) was measured every day of the cycle and other hormones, including follicle-stimulating hormone (FSH), luteinizing hormone, prolactin, and thyroid-stimulating hormone (TSH) were assessed on days 2-5 of the cycle. On the third day of the menstrual cycle, the uterus, endometrial thickness, ovaries, the size of the ovaries, and antral follicle count were evaluated using transvaginal sonography. Following ovulation induction, treatment-related factors, namely endometrial thickness, gonadotropin (Gn) time and count, E2, viable embryos, and good quality embryos, were examined.

Our findings showed no difference between the study groups in terms of treatment-related factors. No significant correlation was observed between the studied groups and chemical pregnancy (P=0.9514). moreover, the studied groups were not significantly correlated with clinical pregnancy (P=0.5052).

 The AMH was correlated with FSH, AFC, E2, and gonadotropin time and count. According to the results of the present study, tubal surgery does not affect the outcome of assisted reproductive cycles.

Screening tests for common aneuploidy, especially trisomies 21, 18, and 13, should be offered to pregnant people of all ages at first and second trimesters. Theses include combined tests (nuchal translucency (NT)+biochemical pregnancy-associated plasma protein-A (PAPP-A), free beta-human chorionic gonadotropin (β-hCG)) and quad test. If the tests are positive based on cut-off value of 1:250, diagnostic tests such as amniocentesis and chorionic villus sampling (CVS) are suggested. The current study aimed to comparatively evaluate the results of these screening tests and amniocentesis.

This practical-basic study was designed to evaluate the accuracy of first and second trimester screening tests with amniocentesis results. A total of 45 subjects were selected from the patients referred for abnormal screening tests toShohadaya-ye-Tajrish hospital in Tehran, Iran, during 2014-2015. The results of tests (combined or quad) were positive based on cut-off value of 1:250. Data was collected through a questionnaire containing such information as age, gravidity, previous aneuploidy births, placenta location, blood group, amniotic fluid color, type of sampling needle, and mode of needle entrance.

The mean age of patients was 33.16 years. There was significant p-value between positive results of amniocentesis and age of the patients. Out of 45 amniocentesis tests, four had abnormal results (two in the first trimester (2/17) and two in the second trimester (2/24)). Also, three items were T21 and the forth was translocation between chromosome 11-22. We had one fetal loss due to amniocentesis procedure.

 Diagnostic tests are suggested for better evaluation of abnormal results. These screening tests have false positive and negative results. We attempted to evaluate the real results with invasive tests. Further research is needed to investigate the accuracy of screening aneuploidy tests.