مجله زنان مامائی و نازائی ایران
سال یازدهم شماره 3 (پاییز 1387)

This study evaluates the efficacy of stripping the membranes after 40 weeks of gestation in reducing the incidence of post-term pregnancy in nulliparous women. In adouble-blind and prospective controlled clinical study 134 normal nulliparous women with no uterine contraction, were randomly (by using random number table) allocated at the 40th week (281 days) of gestation to membrane stripping group (n=66) or control group (n=68). The membranes in the first group were stripped every 48 hours until labor, while the patients in the control group were received pelvic examination only once. The main outcome measures included the time interval between the pelvic examination and delivery, the incidence of post-term pregnancy, and adverse effects such as preterm rupture of membranes, vaginal bleeding, and meconium staining in the two groups. We analyzed the data using SPSS software version 15.0. Chi square and t tests were used and P<0.05 was considered significant. Serial sweeping of the membranes decreased the risk of post-term pregnancy (16.5% v 44%, p<0.05).The onset of delivery was significantly shorter in stripped group (5.6 v 9.4 days, p<0.05). Spontaneous delivery was significantly more in stripped group (p<0.05). Adverse effects were similar in both groups (p> 0.05).Membrane stripping at 40th week of pregnancy can prevent post-term pregnancy in nulliparous women.

The aim of this study was to determine the efficacy of entonox inhalation on pain intensity and duration of delivery. This study was performed in Shoushtar city, south of Iran. In a random controlled clinical trail, 120 women with term pregnancy were randomly divided into 2 equal groups; Entonox group and control group. The study group received inhaled nitrous oxide premixed with oxygen (50%:50%) and control group only inhaled oxygen. Visual analog scale and McGill Pain Questionaire was used to measure the intensity of the labor pain. The groups were compared for labor pain, duration of the labor, method of delivery, and the Apgar scors of the newborn. Statistical analyses were performed by independent sample t test and chi squar test. p<0.05 was considered as statistically significant. The mean labor pain intensity was decreased significantly after administration of Entonox compared with the control group (4.17v6.78, P<0/001).The pain also decreased by increasing the concentration of inhaled nitrous oxide. There was not significantly difference between the two groups in the mean duration of active phase of the labour (p=0.2) and the neonatal Apgar scores (p=0.69).Fewer patients in the Entonox group required cesarean section compared with the control group, but the difference was not significant (p=0.48). 78.3% of the women had satisfaction from the analgesic effect of Entonox during the labor. Nitrous oxide (50%) with oxygen (50%) inhalation provides adequate pain relife for many women during the first and second stages of labor.

The necessity of reproduction to survive the human’s generation has been eclipsed by infertility. Having considered the psychological and social aspects of infertility, we aimed to assess the prevalence of mood and anxiety disorders in infertile women. This is a descriptive study on infertile women referred to Montaserie infertility clinic (in Mashhad, North-East Iran) during 2004-2006. Totally 963 patients were evaluated by using General Health Questionnaire and those with scores more than cut off point (28) were considered as high risk group for psychiatric disorders (102). High risk group were interviewed by two psychiatrists and evaluated for mood and anxiety disorders based on DSM IV criteria. The mean age of patients was 28.7 years. Of them 79/4% have more than elementary education and 75% were housewives. Therapeutic interventions had led to pregnancy in 32% of them. Medical management and intrauterine insemination (IUI) were the most common treatments and female causes of infertility were more common than the male causes. The most common disorder was general anxiety (44.1%). Other anxiety disorders were reported in 11.8% and depression was seen in 30.4%. There was not significant correlation between the tendency for psychiatric disorders and age, sex, job, duration of infertility, and educational status. But there was significant relationship between the type of therapeutic intervention(IUI) and high risk for psychiatric disorders (P<0.05). We suggest that psychiatric evaluation should be in the first step of infertility treatment and anxiety management techniques should be taught to high risks patients.

In the absence of vaginitis, elevated vaginal pH may indicate low circulating estrogen levels. So determining vaginal pH values can be a simple and low cost diagnostic tool for menopause.Aim ofthis study was to examine the correlation between serum follicle stimulating hormone and vaginal pH in menopausal women. This is an analytical cross-sectional study carried out on 100 menopausal women referring to gynecologic unit at Alzahra hospital (Rasht, north of Iran).Women who had no menstrual period during the last 1 year, without vaginitis, estrogen replacement therapy, use of vaginal drugs or douches and did not have coitus during the 2 days before the examination were included in the study. Vaginal pH values were assessed by Nitrazine papers. Serum follicle stimulating hormone was measured, and body mass index was calculated. The collected data were analyzed by SPSS software version 10. Statistical tests such as t, chi-square, and bi-variate correlation were used. The mean age of women was (54.92±8.3) years. There were a direct and significant correlation between serum follicle stimulating hormone and vaginal pH (r= 0.245), vaginal pH and age (r=0.004), and vaginal pH and duration of menopause (r=-0.0125). Also there was straight and significant correlation between serum follicle stimulating hormone and vaginal pH among women whose body mass indices were less than 25 or 25-29.9 kg/m2, and women with postmenopausal periods more than 1 year (P>0.05( Our study showed poor correlation between vaginal pH and serum follicle stimulating hormone in menopausal women(r=0.245).

Abdominal wall endometriosis is a complication of cesarean section, which can be diagnosed by sonography. The purpose of this study was to evaluate the clinical and sonographic findings of abdominal wall endometriosis and comparative these by surgical finding. In a retrospective study, we evaluated 19 patients who complained of suprapubic pain and palpable mass at the site of previous cesarean section. All patients were evaluated by sonography and in six of them color Doppler sonography was performed. Sonographic findings were compared with surgical findings. There was history of one cesarean section in 16 patients and twice in 3 patients. All patients complained of pain around the scar. In 13 patients the pain was permanent, but in 6 of them was cyclic and intermittent, which increased around the menstrual period. In 15 patients there was a palpable mass around the line of cesarean section. In all patients a mass was detected by sonography, which was solid and hypoechoic in 17 patients and solid and isoechoic in two patients. In six patients color Doppler sonography showed variable arterial and venous flow. In three of patients color Doppler sonography was performed around the menstrual period, which showed more prominent arterial and venous flow accompanied by some small echo free changes. Surgical findings were available in 15 patients, which were comparable to the sonographic findings. Abdominal wall endometriosis often presents as palpable masses and permanent supra pubic pain. In Doppler sonographic evaluation it appears as a hypoechoic mass with a variable flow pattern.

severe form of this condition that happens in 1% to 2% of all pregnancies. Recently Helicobacter pylori infection has been mentioned in the etiology of vomiting in pregnancy. Having considered that treatment of H pylori infection with antibiotics is possible; it can be a step toward the treatment of these patients. This study was carried out to find the correlation between nausea and vomiting in pregnancy and H pylori infection. This cross sectional study was performed on 100 hospitalized pregnant women (who had over three episodes of vomiting within 24 hours) and 100 outpatients (who had less than three episodes of vomiting within 24 hours or had not any vomiting). This study was carried out at Amir–al–momenin hospital from April 2004 to January 2005.Three cc bloods were taken from each patient and anti H pylori antibody was checked by ELISA method. Serum levels above 20 IU/ml were considered to be positive. The analyses of the data were carried out by using Chi- square and Mann-Whitiny tests. Fifty seven percent of hospitalized patients and 39% of outpatients were contaminated with H pylori, which showed a statistically significant difference (OR=2/70, 95%, CI:1/41-3/80, p=0/011). There is a correlation between H pyloi infection and three or more episodes of nausea and vomiting in 24 hours from the 6th to 16th weeks of pregnancy.

Treatment of infertility by using in vitro matured oocytes derived from pre-ovulatory follicles has many potential applications. It minimizes the risk of ovarian hyperstimulation syndrome and is an alternative treatment for polycystic ovary syndrome.It also reduces costs and duration of treatment and can be important for subjects who need preservation. So provides information about final stage of oocyte maturation. We aimed to study the effects of recombinant follicle stimulating hormone (r-FSH) and human menopausal gonadotropin hormone (HMG) on human immature oocyte maturation in culture media and evaluated rate of eight-cell embryos mediated by intracytoplasmic sperm injection (ICSI). This experimental study was done in 2006-2007 in Montaserieh IVF Center and Mashhad Islamic Azad University. One hudred fifty six immature oocytes produced by women undergoing IVF were divided to three groups. In control group the oocytes were supplemented by 10% human serum albumin. In r-FSH group the oocytes were supplemented by 0.075 IU/ml r-FSH. And in the HMG group the oocytes were supplemented by 0.075 IU/ml HMG. Then matured oocytes were fertilized by ICSI and the numbers of embryos up to eight cells were investigated by invert microscope. The precentage of oocytes reaching metaphase 2 and the rate of eight-cell embryos was significantly higher in the FSH and HMG groups compared with the control group (p<0.001). Using either HMG or r-FSH can increase the rate of human immature oocytes maturation in vitro. HMG significantly increased the production rate of eight-cell embryos compared with r-FSH (p<0.001).

Spontaneous abortion is the most common complication of pregnancy. Women with abortion are always worried about the outcome of their next pregnancy. This study was designed to evaluate the effects of spontaneous abortion on outcome of next pregnancy. This case – control study was performed at moatazedi Hospital in Kermanshah, west of Iran during 2003-2006.Six hundred and five women with history of one spontaneous abortion were selected as the case group and 1210 women with history of one term delivery were selected as the control group. The age range of the women was 20-35 years. Various variables including placenta abruption, placenta previa, preterm labour, still birth, premature rupture of membranes, pre-eclampsia, low birth weight, fetal malformations, fetal presentation, intrauterine growth retardation (IUGR), type of delivery, and Apgar score were studied. Data were analyzed by SPSS software version 11.5. Statistical tests including chi-square, Fischer, Lon, and independent t were used. Mean age of the patients in the case group was 24.6 versus 23.5 years for the women in the control group. Of the variables, only preterm labour (P=0.034) and cesarean section (p=0.034) were significantly more common in the case group. There was no significant difference between the two groups for the other variables. There is a higher risk for pregnancy complications in women with the history of previous spontaneous abortion. Such women have to be under close observation with meticulous perinatal care during the pregnancy.

Laurence-Moon-Biedl syndrome is one of the rare disorders. Herein we report a case of Laurence-Moon-Biedl syndrome with urogenital sinus anomaly.Case Report: The patient was a 17 years old girl with colicky and periodic abdominal pain since 4 months ago who was referred to the gynecology ward of Rasoul Akram hospital affiliated to Iran University of Medical Sciences. In the physical examination we found an abdomino-pelvic mass at the umbilical region. In examination of the genitalia, the vestibule was not seen and no orifice was found between the urethra and the anus.During the laparotomy we found the mass was a huge vagina full of old blood and pyometra, which were drained. The uterus was enlarged but the fallopian tubes and the ovaries were normal. An incision was performed in the perineum, between the urethra and the anus. Then a petzer drain was inserted from the inside of the uterus to the incision.After operation, the patient was treated with conjugated estrogen 0.625 mg/day for 25 days and medroxy progesterone acetate 10 mg/day for 10 days. After discontinuing the both drugs she menstruated. After the first menstruation the petzer drain was dislodged.