مجله زنان مامائی و نازائی ایران
سال یازدهم شماره 2 (تابستان 1387)

Infertile women with induction ovulation that have appropriate follicules, need LH surge to release eggs, this is done routinely by HCG. This study designed to compare the pregnancy rate and hyper stimulation syndrome in PCOS patients with GnRH agonist instead of HCG. This descriptive study performed from 2003 to 2004 on 130 infertile patients with PCOS at Babol Infertility Center, Babol, Iran. This study was approved by the local committee of medical ethics. After induction ovulation if patients had 2 Follicules more than 16 mm or 3 folliculs more than 14 mm, we randomly used HCG or GnRH agonist for LH surge. The pregnancy rate and hyperstimulation syndrome evaluated. Data analyzed by spss. There were79 patients in HCG group and 44 patients in GnRH agonist group. There was no significante difference between HCG and GnRH agonist group, with regard to the mean age, infertility duration, number of HCG injection, body mass index and type of infertility (p>0.05). Over all 7(8.9%) patients in HCG group and 3(6.8%) in GnRH agonist group had ovarian hyperstimulation syndrome (p= 0.49). There was pregnancy in 35 (44.3%) patients of HCG group and in 20 (45.5%) patients of GnRH agonist group (p= 0.526). There was no significant difference in the rate of pregnancy and ovarian hyperstimulation in patients with polycystic ovary, having induction ovulation with HCG and GnRH agonist. So it can be concluded we can say that: GnRH can be used instead of HCG for doing LH surge in PCO patients.

Recently drug resistance to three species of Prevatella (P.bivia, P. melaninogemcus, P. disicns) is seen. The aim of this study was to evaluate the frequency of bacterial vaginosis and detection of drugs resistance of Prevotella species. This descriptive study performed from 2004 to 2005 at Fatemi Hospital of Hamadan, Iran, on 310 female patients with vaginal discharge. This study was approved by the local committee of medical ethics. Laboratory diagnosis of bacterial vaginosis was based on 4 criteria including study of the homogenesity of the discharges, performing of whiff test, search for clue cell in smear and determination of pH of the discharge. Antibiogram test was performed by method of Kirby-Bauer and 9 commonly used antibiotics were applied. The data collected in a questionnaire and analyzed, using spss software. Of 310 patients with discharge, 65.7% were diagnosed as bacterial vaginosis that 47.4% of them had clue cells, 66.2% were whiff test positive, pH of 87.1% of the discharge were more than 4.5 and 76.7% had non-homogenous discharge. Out of 310 samples, 60 (19.3%) Prevotella species isolated in which 80% was P.bivia, 11.6%P.disiens and 8.3% P.melaninogenicus.These isolates and 4 references strains were resistant to penicillin (100%) and to vancomycin, kanamycin (> 60%). Resistance to cefoxcetin, clindamycin, metronidazole and ciprofloxacin were less than 10%. The frequency of bacterial vaginosis in our patients was relatively high. The most frequent isolated strain was P.bivia and also the most effective antibiotics against Prevotella isolates were ciprofloxacin, cefoxcetin, clindamycin and metronidazole.

About 10-15% of women in the reproductive ages suffer from infertility. The most common cause of infertility with female factor is ovulation disorders (35-40%) and among them polycystic ovary syndrome (PCOS) is the most common. These patients suffer from insulin resistance, obesity and increase in androgens; many recent studies have focused on the effects of insulin sensitizing agents like metformine on the patients with PCOS. The aim of this study was to evaluate the efficacy of the three therapeutic methods of clomiphen citrate (CC), metformine and clomiphen citrate plus metformine on infertile women with PCOS. This clinical trial study performed in the year 2004 at Montaserie Hospital of Mashhad University of Medical Sciences, on three groups of 20 PCOS Patients. This study was approved by the local committee of medical ethics. The women in the first group were treated with clomiphen citrate, the second group with metformine and the third group with clomiphen plus metformine for 3 months. Data were analyzed by SPSS software, by using t-student and c2. p£0.05 was statistically significant. Over all twenty nine (48.3%) of women conceived, with the highest rate (%70) belonging to the group treated with clomiphen citrate plus metformine (group three). There was a significant difference comparing to the other two groups (p=0.028). This finding was even more significant in the cases with high levels of serum testosterone and hirsutism. Combination of metfomine plus clomiphen citrate significantly improves ovulation and pregnancy rates in patients with PCOS

Premature rupture of membranes (PROM) affects 10-20% of all pregnancies, occuring in approximately 30% to 40% of preterm deliveries. Vitamin C has a role in collagen metabolism and increases resistance maintenance of the chorioamniotic membranes. The objective of this study was to evaluate the relationship between vitamin C supplementation with PROM and preterm delivery.Methods and Materials: This clinical-trial study carried out from Jan to Jul 2006 at Hafez and Shoushtari Hospitals of Shiraz University of Medical Sciences. This study was approved by the local committee of medical ethics. Pregnant women (n=117) with 20 weeks gestational age, randomly divided into two groups 57 in the case group and 60 in the control group and evaluated every 4 weeks, from 20 to 36 weeks of pregnancy. At each evaluation, a vaginal examination was performed, to rule out bacterial vaginosis infection. The case group received a chewing tablet of 100 mg vitamin C daily. PROM and preterm delivery was recorded for each group as indicator of the protective effect of vitamin C supplementation. PROM occurred in 5 (8.77%) and 22 (36.67 %) pregnancies in the case and control group respectively (p<0/001). Four patients (7.41%) in the case group and 18 pregnant women (32.08 %(in the control group delivered at term with PROM (p=0.001). One woman (33.30%) in the case group and 4 women (57.10 %(in the control group delivered due to PROM at term (p> 0.5). Supplementation of vitamin C after 20 weeks of gestation prevents PROM.

After decades of discussion and dialogue, there is little agreement about suitable time for after birth umbilical cord clamping. By using the late cord clamping, neonate receives more placental transfusion that may affect the Apgar score. This study was designed to compare the effect of early and late cord clamping on the Apgar score of the neonate.Methods and Materials: This double blind, randomized, clinical trial carried out, in the year 2002 at Deziani Hospital of Gorgan, Iran. This study was approved by the local committee of medical ethics. Healthy full-term vaginally born neonates (n=64), were randomly allocated to early (30s) and late (3min) umbilical cord clamping group. During this period of time, the attendant held the neonate supine at the level of introitus. At the end of 1min and 5mins after birth The Apgar score of the neonate, residual placental blood volume and estimated neonatal blood volume were determined. Data obtained by interview and observation, analyzed by SPSS software, Mann Whitney, t student and Chi-squared tests. There was a significant difference between early and late umbilical cord clamping groups (p<0.001), in the 1min and 5mins Apgar scores of the neonate. Placental residual blood volume in the late cord clamping group was 39.5% lower than the early cord clamping group (p<0.001). Estimated neonatal blood volume in late cord clamping group was 7.1% higher than early cord clamping group (p<0.001). Late cord clamping leads to a significant increase in the Apgar score of the neonate and the estimated neonatal blood volume. However, the placental residual blood volume significantly decreased. Further trials should delay cord clamping until cessation of cord pulse or alter the level that the newborn is kept.

Delivery pain is one of the most severe known pains that can be considered a critical experience in lifelong for every woman. Different methods has been introduced for reducing delivery pain such as non pharmacological methods (hypnotism, Acupuncture) and pharmacological methods (systemic drugs, inhalant anesthetics, regional anesthesia). Now, the most popular methods for pain relief in labor is regional anesthesia. The most common techniques are spinal, epidural, para cervical and pudendal anesthesia. The most effective ways for pain relief in labor is spinal and epidural block that Produces a complete pain relief in most women. The purpose of this study is determining the distribution of hypotention as a most common complication of epidural anesthesia in vaginal delivery that can lead to fetal distress and low APGAR score and cesarean section. This is a cross sectional (descriptive–analytic) study and 137 cases were studied. Most of them were 21-30 years old. This study was approved by the local committee of medical ethics. Gestational age was 37-42 weeks. This study was established in fall and winter of year 2003 at Beheshti & Jorjani hospitals. All of them were at the same conditions and all epidural blocks were done with the same anesthesiologist. The data analysis of all cases showed that the distribution of hypotention was 16.1%. distribution of vertigo was 20.4%. The neonatal APGAR score of those mothers who had hypotention during delivery was (8+ 1.23) while APGAR score of those ones who didn’t have hypotention was 9 or more (p<0.001). Hypotension is a common side effect of epidural anesthesia and it can cause fetal distress and low APGAR score, but with infusion 500-1000 CC ringer lactate boxter before anesthesia, can reduce rate of hypotension, prevent hypoxia side effects and low score of APGAR. Of curse 1 degree reduction in APGAR score may be resulted from length of stage II of labor.So epidural anesthesia can be considered as a reliable and safe method for advertising vaginal delivery and reducing the number of unnecessary cesarean section.

the use of halogenated agents during balanced general anesthesia may result in an increase in blood loss associated with cesarean section but in some studies this result rejected. The aim of this study was, Comparison of hemoglobin concentration, after cesarean section between two general anesthesia and spinal anesthesia. This clinical trial study comprised 170 pregnant women, who were elective cesarean section candidates for the second time. This study was approved by the local committee of medical ethics. Patients were randomly divided into two groups, each with 85 members. Exclusion criteria were: cardiac diseases, coagulate disorders, anemia, preeclampsia, abruptio placenta, emergent cesarean section cases, atonia (polyhydramnius ….), birth weight more than 4kg, and long duration of the operation (more than 90’). Patients of the first group underwent general anesthesia and spinal anesthesia was applied for the second group. There was no significant difference between both groups regarding the mean age, operation, and anesthesia durations (p>0.05). The mean hemoglobin (HP) and hematocrit (Hct) levels were significantly lower in both groups post operatively compared with the same values pre operatively (p<0.05). Post operative, Hb.Hct reduction rate (preoperative Hb.Hct minus post operative Hct) was significantly higher in general anesthesia group (p<0.05). If duration of operation time was longer than one hour, Hct significantly decreased. Results of the present study showed that postoperative Hct reduction rate in cesaeran section was higher in patients who received general anesthesia in comparison with spinal anesthesia.

Achondrogesis is a rare severs skeletal displasia. Clinical findings include large head, small narrow thorax, extreme limb shortening, variable degree of hydrops fetalis. Most babies die in uterus.Case Report: In this article a rare case of this disease (type II) with all of clinical findings, and characteristics radiological features (short limb, large head, skeletal deformity, absence of ossification center of vertebra, pubis and sacrum is reponted. Antenatal diagnosis (villocentesis in the first trimesters and then experienced sonographer) and at birth clinical examination, radiographs, and autopsy are mandatory for making a specific diagnosis.