Mehdi Yousefi; Malihe Hasanzadeh; Vesam Rostaminezhad; Maryam Gaffarean; Azam Sadat Mousavi
Volume 2, Issue 1 , March and April 2017
Shilan Amir Hosseini; Bakhtiar Piroozi; Mohammad Amerzade; Hooman Ghasri; Salah Aldin Farshadi; Hossein Safari; Seyfollah Moradi
Volume 2, Issue 1 , March and April 2017
Abstract
Background: Since April 22, 2014, the natural childbirth promotion package has been implemented in the form of the Health Transformation Plan (HTP) to decrease the cesarean section rate in Iran. This study aimed to determine the amount of subsidy allocated to the natural childbirth package and to examine ...
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Background: Since April 22, 2014, the natural childbirth promotion package has been implemented in the form of the Health Transformation Plan (HTP) to decrease the cesarean section rate in Iran. This study aimed to determine the amount of subsidy allocated to the natural childbirth package and to examine its effects on the cesarean section rate in hospitals affiliated with Kurdistan University of Medical Sciences (KUMS), Kurdistan Province, Iran.
Methods: This is a descriptive study implemented by retrospective and longitudinal design. The population in this study to determine the budget amount allocated to “childbirth promotion package” and all mothers that had natural childbirth deliveries from May 5, 2014 (beginning of HTP) to September 2015 in hospitals affiliated with KUMS. Study populations to determine the C-section ratio included all mothers who had deliveries in hospitals affiliated with KUMS from December 2012 to May 4, 2014 (before HTP) and from May 5, 2014 to September 2015 (after HTP). Using a checklist, the required data was collected from the Statistics and Health Economics Department of Treatment Deputy of KUMS. Afterwards, the obtained data were described using the descriptive statistical indicators including frequency, percent, and mean via Microsoft Excel 2013 (Microsoft Corp., Redmond, WA, USA).
Results: Since the beginning of implementing the natural childbirth promotion package until September 21, 2015, a total of 23 566 mothers had natural childbirth deliveries in the hospitals affiliated with KUMS. These mothers benefited from a total amount of 23 939 046 090 IRR provided by the natural childbirth package. In addition, the cesarean ratio has decreased 7% after implementing HTP.
Conclusions: It seems that HTP caused for the cesarean ratio to decrease in hospitals affiliated to KUMS. Further studies are recommended to determine the causality between a decrease in cesarean rate and HTP.
Maryam Moshfeghi; Mohammad Hossein Eftekhari
Volume 2, Issue 1 , March and April 2017
Abstract
Introduction: When a mother is contaminated with the parasitic protozoan Toxoplasma gondii as a primary infection in pregnancy, the golden test to confirm fetus infection is polymerase chain reaction (PCR), for the parasite DNA in amniotic fluid that may reach fetus and cause congenital toxoplasmosis. ...
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Introduction: When a mother is contaminated with the parasitic protozoan Toxoplasma gondii as a primary infection in pregnancy, the golden test to confirm fetus infection is polymerase chain reaction (PCR), for the parasite DNA in amniotic fluid that may reach fetus and cause congenital toxoplasmosis. Toxoplasmosis sometimes appears with very rare presentations that should be considered and treated to save mother and her baby.
Case Presentation: A 28-year-old pregnant mother was referred to the perinatology clinic of Shariati hospital, Tehran, Iran, for the diagnosis of her fetus problem. She was a rare case of congenital toxoplasmosis.
Conclusions: Diagnosis of toxoplasmosis in pregnancy is based on seroconversion of antibodies; based on many studies in the literature, the best method to confirm fetus is PCR for Toxoplasma gondii DNA in amniotic fluid.
Zahra Vahedpoor; Tahereh Khamechian; Nazila Zandi
Volume 2, Issue 1 , March and April 2017
Abstract
Introduction: Uterine smooth muscle tumors are the most common human neoplasms. These tumors are clinically classified into two groups of benign and malignant. However, uterine smooth muscle tumors of uncertain malignant potential (STUMP) are another group between these two groups that cause many diagnostic ...
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Introduction: Uterine smooth muscle tumors are the most common human neoplasms. These tumors are clinically classified into two groups of benign and malignant. However, uterine smooth muscle tumors of uncertain malignant potential (STUMP) are another group between these two groups that cause many diagnostic problems. The present report aimed at introducing a case of STUMP mistaken with ovarian tumor in a female with polio.
Case Presentation: A 43-year-old female with the complaint of abdominal pain and distention, which had started 3 years ago, referred to our center, Kashan, Iran. Abdominal examination showed firm and irregular distention greater than term pregnancy. Ultrasonography, CT scan, and MRI of the abdomen and the pelvis revealed multiple intramural and subserosal fibroids in the uterus, and a large complex cyst in the abdomen and pelvis that probably originated from the ovary. Laparotomy results showed 2 tumors arising from the anterior surface of the uterus sized 15 × 25 cm, which were extended under the liver, and attached to the omentum and posterior peritoneum of the abdominal cavity wall with moderate ascites. The tumors, which weighted 10 kg along with the uterus, were removed and the patient was discharged after two days in good general health. The pathology report was as follows: uterine adenomyosis and smooth muscle tumors of uncertain malignant potential (STUMP).
Conclusions: STUMP has unpredictable various clinical presentations. Even imaging may mislead the clinicians. Therefore, in patients with pelvic tumors and even with a strong suspicion of ovarian and retroperitoneal tumors, this type of uterine tumors should also be considered, moreover, appropriate treatment should be considered to preserve or not to preserve fertility.
Fatemeh Azadi; Maryam Moshfeghi; Narges Bahrami; Mohammad Hossein Eftekhari
Volume 2, Issue 1 , March and April 2017
Abstract
Background: Pelvic infections are among the most prevalent and serious postpartum complications. Over the past several decades, these infections, along with preeclampsia and hemorrhage, have constituted the triad of death among mothers. The presence of meconium in the amniotic fluid has been considered ...
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Background: Pelvic infections are among the most prevalent and serious postpartum complications. Over the past several decades, these infections, along with preeclampsia and hemorrhage, have constituted the triad of death among mothers. The presence of meconium in the amniotic fluid has been considered as one of the risk factors for postpartum infections. This study aimed to investigate the association of meconium-stained amniotic fluid with postpartum infection and fever.
Methods: This prospective cohort study included 200 singleton term pregnant women, referred for childbirth to Imam Khomeini and Razi hospitals of Ahvaz in 2014. The women were assigned to two groups, ie, subjects with meconium-stained amniotic fluid (exposure group) and subjects with clear amniotic fluid (control group). The participants in the two groups were identical in terms of maternal age, gestational age, parity, and duration of ruptured membranes. Pregnant women who had underlying medical problems were excluded from the study. Both groups received intravenous ampicillin half an hour before the surgery until 48 hours after the surgery, based on the protocol introduced by the hospital for women planning cesarean section. The two groups were compared regarding post-C. Section infection. The exposure group consisted of 100 subjects with meconium-stained amniotic fluid, while the control group included 100 subjects with clear amniotic fluid. The participants were observed for maternal prognosis, based on postpartum infections.
Results: Both groups underwent C-section. In the exposure and control groups, 14 (14%) and 12 (12%) women had fever after C-section, respectively. Moreover, 6 (6%) and 3 (3%) women in the exposure and control groups had post-C. section wound infections, respectively.
Conclusions: No significant difference was found in post-C. Section fever and wound infection between the two groups, which might be related to the duration of intravenous antibiotic administration. To examine the effects of intravenous antibiotics, further studies should be conducted. In both groups, the highest incidence of fever was observed among women younger than 20 years; this result was statistically significant.
Mina Jafarabadi; Fatemeh Ramezanzadeh; Samarand Salimi; Tahereh Forooghifar
Volume 2, Issue 1 , March and April 2017
Abstract
Background: Both in-vitro maturation and in-vitro fertilization have been used successfully to treat females with polycystic ovarian syndrome, who plan to have child. This study compared outcome of these two approaches to fertilize females with polycystic ovary side effects.
Methods: This prospective ...
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Background: Both in-vitro maturation and in-vitro fertilization have been used successfully to treat females with polycystic ovarian syndrome, who plan to have child. This study compared outcome of these two approaches to fertilize females with polycystic ovary side effects.
Methods: This prospective study was conducted at Vali-Asr reproductive health research center and included all females with polycystic ovarian syndrome, who underwent in-vitro maturation or in-vitro fertilization from January 2005 to January 2008. Measurements included demographic data, total cost (including drug and laboratory procedures), outcome (chemical and clinical pregnancy), and systemic complication (ovarian hyper-stimulation syndrome), obtained from the patients’ clinical files. Patients were informed about the procedures, side effects and goals, and the signed consent form for surgical approaches and use of their data in medical research. Finally, these variables were compared between the two groups.
Results: The in-vitro maturation and in-vitro fertilization groups included 20 and 22 patients, respectively. The range of body mass index was between 17.4 and 28.3 kg/m2 and the mean age of the patients was 29.35 ± 4.94 and 28.95 ± 3.84 years, respectively (P > 0.05). The total cost was significantly lower in in-vitro maturation group compared to in-vitro fertilization (201.6 ± 60.1 USD versus 380.5 ± 143.8 USD, respectively, P < 0.001). Positive outcomes were achieved significantly more frequently with the in-vitro fertilization method (1 chemical and no clinical pregnancy in in-vitro maturation versus 7 and 6 in in-vitro fertilization group, respectively, P < 0.001). Although, the rate of ovarian hyper-stimulation syndrome was higher in in-vitro fertilization than in in-vitro maturation approach, yet, it was not statistically significant (P = 0.233).
Conclusions: Our findings showed the superiority of execution of the in-vitro fertilization approach compared with the in-vitro maturation method in infertile females with polycystic ovary syndrome, who planned to have a child. However, in-vitro maturation approach is cheaper than in-vitro fertilization and is also associated with lower risk of ovarian hyper-stimulation syndrome.
Mansooreh Zanjani; Jalil Kohpayeh; Zhila Karimi
Volume 2, Issue 1 , March and April 2017
Abstract
Background: Vaginal misoprostol is said to dissolve better in an acidic environment, thus, in this study we aimed to evaluate the influence of increasing vaginal acidity on the effectiveness of vaginal misoprostol for the induction of midtrimester pregnancy using acidic environment.
Methods: A total ...
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Background: Vaginal misoprostol is said to dissolve better in an acidic environment, thus, in this study we aimed to evaluate the influence of increasing vaginal acidity on the effectiveness of vaginal misoprostol for the induction of midtrimester pregnancy using acidic environment.
Methods: A total of 40 women requiring second trimester pregnancy termination were randomly assigned to one of two treatment groups: (A) in the saline group, 400 µg of intra-vaginal misoprostol was moistened in normal saline before the vaginal insertion as controls (n = 20); and (B) in the acetic acid group, the acidity of the vagina was increased with 3% of acetic acid, (4 mL of 3% acetic acid was delivered into the vagina every 6 hours) before the insertion of an initial dose of 400 µg misoprostol (n = 20). Then 200 µg dosage was repeated every 4 hours for a maximum of 5 doses within 24 hours. If the patient did not have adequate uterine contractions, the same regimen was repeated over the following 24 hours and if no response was achieved, this was considered a failure of therapy.
Results: There was no significant difference in the vaginal pH between the control and intervention groups before the vaginal application of acetic acid (5.80 ± 0.62 versus 5.89 ± 0.49, P = 0.622,). The vaginal pH was significantly lower in the acetic acid group after the vaginal application of acetic acid compared to the control group (5.11 ± 0.56 versus 5.80 ± 0.62, P = 0.001). Overall, 95% of pregnancies were successfully terminated in the acetic acid group compared to 85% in the control group. These differences were not statistically significant (P =0.241). The success rate within 24 hours and 48 hours, the adverse effects, mean termination time, total misoprostol administered, and the number of curettage were, also, comparable between the two groups.
Conclusions: Findings from this study shows that increasing Vaginal acidity does not improve the efficacy of misoprostol administered intra-vaginally for the second trimester pregnancy termination.
Setare Akhavan; Azamsat Mousavi; Mitra Modaresgilani; Abbas Alibakhshi
Volume 2, Issue 1 , March and April 2017
Abstract
Anogenital warts (AGWs) are the most prevalent sexually transmitted viral infections in the United States of America. Symptomatic warts can be seen in nearly 1% of the population aged 15 to 49 years. Genital warts are highly contagious through sexual contact. AGWs can be diagnosed by careful visual inspection. ...
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Anogenital warts (AGWs) are the most prevalent sexually transmitted viral infections in the United States of America. Symptomatic warts can be seen in nearly 1% of the population aged 15 to 49 years. Genital warts are highly contagious through sexual contact. AGWs can be diagnosed by careful visual inspection. Several methods have been described for the treatment of warts; however, all have their own limitations and are not always successful. Warts often recur even after being completely removed. The treatments of warts can be divided into two broad categories, ie, surgical and nonsurgical methods. The patient himself/herself can apply the nonsurgical methods, or a physician can perform it. Podophyllotoxin is a good medical substance. Imiquimod can act as an immune response modifier and stimulate locally produced cytokine. Topical treatments of warts increase local production of interferon and decrease viral load of human papiloma virus (HPV). The surgical methods for genital warts include curettage, electrosurgery, and application of a scalpel under general or local anesthesia. Scattered keratinized lesions can be removed by electrosurgery. Patients with multiple or large warts of any location should be referred for surgical treatment under general anesthesia.
