مجله زنان مامائی و نازائی ایران
سال هفدهم شماره 91 (هفته اول فروردین 1393)

Methotrexate and Actinomycin-D are still used for low risk gestational trophoblastic neoplasia (GTN). The aim of this study was to compare the efficacy and side effects of pulsed Actinomycin-D (ACT-D) and Methotrexate-Folinic Acid (MTX-FA) for Stage I، low-risk gestational trophoblastic neoplasia (GTN). This single-blind randomized clinical trial was conducted on 64 patients with stage I، low-risk GTN referred to gynecological oncology clinic of Tabriz University of Medical Sciences، Iran during 2011 and 2012. 32 patients were randomly assigned to receive a pulsed intravenous bolus of ACT-D 1. 25 mg/m2 every 2 weeks and 32 patients received an intramuscular Methotrexate 1mg/kg per day on days 1،3،5،and 7 with intramuscular Folinic Acid 0. 1 ml/kg per day on days 2،4،6، and 8. Data were analyzed using SPSS software (version 16) and Fisher exact test، Mann-Whitney U test، independent t-test and chi-square test. P value less than 0. 05 was considered significant. Response to treatment rate were 61. 3% (19 patients) for MTX-FA group and 84. 85% (28 patients) for ACT-D group (p=0. 032). The risk of treatment failure with MTX-FA was 72 times more than ACT-D (p=0. 032). The interval between drug administration and response was shorter with ACT-D in compare with MTX-FA (p<0. 001). Drug toxicity necessitating changes in chemotherapy was reported in one out of 33 patients only in MTX-FA group. MTX-FA was more cost-effect regimen than ACT-D (p<0. 001). Pulsed ACT-D may be an appropriate option as a first-line chemotherapy agent for patients with stage I، low-risk GTN

The most common reason for discontinue depot medroxyprogesterone acetate in first year of using is correlated with menstruation disorders and weight gain. The aim of this study was determining and comparing the effects of cyclofem and depot medroxyprogesterone acetate on short time side effects، acceptability and continuation rates in women.

This clinical trial was conducted on 68 women who used contraceptive injections in Zahedan، Iran، 2010. During a period of 90 days، women registered bleeding events and possible side effects in the form of daily menstrual bleeding and side effects. User-satisfaction questionnaires were administered at 3 months after the first injection or earlier if a client decided to discontinue from the study. Data were analyzed using SPSS software version 18 and chi-square، Fisher exact test، t-test and Mann-Whitney tests. P value less than 0. 05 was considered significant.

The continuation rate for cyclofem was 52. 9% compared with 79. 4% for Depo-Provera. Nausea and mean of weight gain was showed significant differences in two groups (p=0. 01). Although user satisfaction was not statistically significant difference (p=0. 7) but main reasons in two groups for non- accepting was different.

Menstruation disturbances were main reason for non- accepting of Depo-Provera and difficult to come for visits was main reason for discontinuing of cyclofem.

Vaginal bleeding is the common sign of clinical manifestation of late vaginal bleeding of postpartum and choriocarcinoma. Choriocarcinoma grows rapidly and metastases and damage vessels and result bleeding. We have described a case of postpartum hemorrhage with metastatic choriocarcinoma. Case report: A 34 year old woman with vaginal bleeding after 45 days of vaginal delivery admitted and evaluation revealed choriocarcinoma. Because of multi organs metastasis، surgery and chemotherapy was done but the patient did not respond to treatment and died.

Regarding vaginal bleeding is the common sign of clinical manifestation of late postpartum hemorrhage and choriocarcinoma، it is recommended to be considered in differential diagnosis of choriocarcinoma