ابوالفضل مهدیزاده

Endometriosis is one of the most common diseases with high socio- economic burden in women. The aim of this study was to investigate the factors influencing on endometriosis by logistic regression.
In this case- control study, data were collected from patients records in Hazrat Rasoole Akram Hospital in Tehran. The patients who suffered from endometriosis (250), and their disease was diagnosed by laparoscopy, were selected as case group, and 250 patients with gynecologic disorder, other than endometriosis, confirmed by laparoscopy were chosen as control group. Factors affecting endometriosis were evaluated by logistic regression using the software SPSS. P- value Mean age (±standard deviations) of women in case group (34.84±0.62) was significantly higher than control group (33.75±0.55) (P=0.02). Single variable logistic regression for independent variables candidate age, irregular menses, the duration of menstrual cycle, the duration of bleeding, the number of pregnancies, the number of live births, infertility, speck before menstrual bleeding to enter into multi variable logistic regression at error level of 0.2. Variables of age, the number of live births, and premenstrual spotting were predicted as factors influencing endometriosis.
According to the result of present study, age, the number of live births, premenstrual spotting were predicted as effective factors for endometriosis. As we know, increasing awareness of women about factors influencing endometriosis may help timely diagnosis and treatment of this important disease.

Satisfaction with police performance depends on the type and quality of the services that police force provides for citizens. So police plays an important role in gaining satisfaction of theft victims with its performance. The aim of this study was to investigate theft victims' satisfaction with police performance in relation with return time of stolen properties and theft types. The research method was survey and questionnaire was the data collection instrument. The statistical population was theft victims of Tabriz in 1392 total number of which 202 subjects were selected by simple random sampling,. The findings identified social activity dimension as the one with the highest average among the triple dimensions of satisfaction with the police force. No significant relationship was found between the theft victims' satisfaction with police performance and return time of the stolen properties and theft type. Also, gender and employment status of the victims did not make a change in their satisfaction with police performance. However, a significant positive correlation was found between victims' age and their satisfaction.

According to side effects of clomiphen citrate (cc), especially on thendometrium, it was replaced with letrozole, an aromatase inhibitor, for induction of ovulation. In this study, effects of these drugs on ovulation and fertility were compared in patients with polycystic ovarian (PCO) syndrome. In a randomized clinical trial, women with PCO and history of infertility referred to gynecology clinic of Rasoul Akram hospital and private office between 2007 and 2008 were studied. Subjects were randomly assigned to two groups of clomiphen citrate and letrozole. In CC group, subjects were received 100 milligram per day clomiphen citrate between 3rd and 7th day of each cycle for 3 cycles. In letrozole group, women treated with letrozole 2.5 mg daily between 3 and 7 day of each for 3 cycles. Number of follicles in days of 12-16 of cycle, diameter of the greatest one, pregnancy and outcome of pregnancy were compared in two groups. 40 patients in each group were studied. Numbers of follicles, mean diameter of the greatest one were not significantly different in two groups. Pregnancy was occurred in 15 patients (37.5%) of letrozole group Vs 13 patients (32.5%) of CC group. There was no abortion in letrozole group Vs 3 abortion in CC group. Preterm labor was significantly lower in letrozole treated patients (p= 0.04). This study showed that letrozole could be proper substitution of clomiphen citrate for induction of ovulation in patients with PCO and infertility.

Despite importance of Preeclampsia (PE), as a major cause of maternal mortality and fetal death especially in developing countries, its etiology remains unclear. This study was performed to analyze the susceptibility of erythrocytes and to evaluate antioxidant enzymes activity such as glutathione peroxidase (GPX), Superoxide dismutase (SOD) and Catalase (CAT) in women with preeclampsia and normal pregnancy. In this cross-sectional-comparative study, circulating levels of GPX, SOD, CAT and malondialdehyde (MDA) were analyzed in 30 healthy pregnant women, 25 women with mild PE and 26 with severe PE hospitalized in Rasoule Akram and Akbarabadi hospitals of Iran University of Medical Sciences. Susceptibility of erythrocytes in severe and mild PE pregnant women were significantly higher than healthy pregnant women (p<0.05). Levels of MDA, GPX, SOD and CAT in severe and mild PE pregnant women were significantly higher than healthy pregnant women (p<0.05). It seems that oxidative stress plays a significant role in pathophysiology of PE. Therefore, determination of antioxidant enzyme activity in these patients and using supplemental dietary with antioxidants such as vitamins C and E may play a role in prevention of preeclampsia.

Preeclampsia is a main cause of morbidity and mortality of pregnant women worldwide. Recently oxidative stress was considered as a part of pathophysiolgy of preeclamsia and 8-iso-prostaglandin F2α (8-iso-PGF2α) is known as a marker of oxidative stress. The purpose of this study was to measure and compare plasma concentration of free 8-iso-PG F2α in women with normotensive and preeclamptic pregnancies. In this descriptive-analytic study, Plasma free 8-iso-PGF2α levels were measured in pregnant women with preeclamsia (n=42) and normotensive pregnant women (n=39) between 28-38 weeks of gestation. Women in two groups were matched in age, gestational age and socioeconomic statue and all women were nulligravid. Free 8-iso-PGF2α levels were not significantly different in women with preeclamsia and normotensive group (17808 vs. 24288 pg/dl, NS). Plasma free 8-iso-PGF2α levels were increased in severe compared to mild preeclampsia (NS). Neonates weight of preeclamptic mothers was significantly lower than neonates of normotensive women (p<0.0001). Although free 8-iso-PGF2α is a marker of oxidative stress in vitro, but its measurement is not valuable in clinical medicine. However, further studies in normal pregnancy and preeclampsia will be needed.

Epidural-spinal anesthesia is one of the modern methods used to establish adequate anesthesia in cesarean section. In order to reduce these adverse effects different drugs are added to the anesthetic solution. The main aim of this article is evaluation of maternal and neonatal effects of adding Midazolam to Bupivacaine under combined spinal-epidural anesthesia in elective cesarean section Ptatients and This study has been designed as a double blind randomized clinical trial. Study population included pregnant females who were admitted to Hazrat Rasool Akram hospital to undergo elective cesarean section. Sampling was simple and nonrandomized. After considering the inclusion and exclusion criteria, and obtaining an informed consent, 90 pregnant women were divided by block randomization into 3 groups. Epidural-spinal anesthesia was achieved by using 2cc of 0.5% Bupivacaine. Based on their groups, group one (A) received only 0.5% Bupivacaine group two 2.5 mg of Midazolam along with 0.5% Bupivacaine and group 3, (C) 5 mg Midazolam with 0.5% Bupivacaine. Time duration of complete motor block, time duration of the highest score of sedation, time duration of required analgesia after surgery as well as, maternal and neonatal side effects were evaluated. To compare the qualitative and quantitalive data between the two groups, Chi sqaure test was used for normal distribution and for quantization variables, One Way ANOVA analysis of variance was used. Level of significance in this study was considered as 0.05. SPSS V. 13 was used for statistical analysis. Time of sensory motor block in Midazolam group was significantly less than Bupivacaine group this time for 5 mg Midazolam group was in the minimal range. The most sedative effects belonged to the midazolam 5 mg group. Adding Midazolam decreased significantly the time of requiring additional analgesia in mothers after surgery. The most prevalent complications that was reported by the mothers was nausea and vomiting more than 70% of mothers who received Bupivacaine alone complained of it. In this study it was shown that addition of Midazolam was associated with rapid onset of motor and sensory blocks along with maximum sedation. It also decreased the incidence of nausea and vomiting due to Bupivacaine. In addition maternal and neonatal side effects are not increased.

A 69-year old menopause woman presented with severe vaginal bleeding lasting for 70 days. Sonographist reported a 7mm mass in uterus, however, serologic studies revealed an elevated β-hCG level. Patient was subjected for total hysterectomy and bilateral salpingoophorectomy, during which endometrial cancer tissue consisting of both adenosquamous and serous papillary cells were noted. β-hCG level is rarely supposed to elevate in endometrial cancer, however, its association with endometrial cancer should be further discussed.

Clonidine, an alpha 2 agonist, attenuates sympathetic responses during general anesthesia and improves the intra-operative hemodynamic stability. In this randomized double blinded clinical trial study, we report the effects of 300µg oral clonidine premedication(n=22) or placebo(n=22) on hemodynamic alteration during gynecologic laparoscopic surgery, under general anesthesia. Previous works have reported the effectiveness of clonidine on blunting the sympathetic responses during open surgeries. Patients & Anesthesia consisted of isoflurane/O2 and remifentanil. Muscle relaxation was maintained by cis-atracurium. Hemodynamic data were obtained at 5 epochs: base, after induction of anesthesia, insufflation(after peumoperitoneum, supine position), trendelenburg 30 degrees, and end(after supine extubation. There was a significant increase in systolic blood pressure during peritoneal insufflation and trendelenburg position in patients in the control group(129±23, 115±29mmhg) compared with patients in the clonidine group(126±34, 116±25mmhg), P<0.05. Peritoneal insufflation and trendelenburg positioning resulted in significant increase in systolic blood pressure compared with base, in patients in both groups(control 127±15mmhg to 129±23 & 126±34mmhg clonidine 109±19mmhg to 115±29 & 116±25mmhg, P<0.05). After extubation, there was significant increase in diastolic BP in clonidine group: (98±32mmhg vs 86±8mmhg in control group). During laparoscopy, there was a significant increase in diastolic BP in the control group(89±16mmhg vs 75±18mmhg in clonidine group P<0.05). There was a significant increase in diastolic BP in the patients in clonidine group(98±32) compared with the patients in control group(86±8)P<0.05. There was significant slower HR during the procedure in both groups(71±29bpm, 63±22 vs base 85±22bpm, 85±39). It seems that clonidine can not blunt the hemodynamic responses in hyperdynamic phases after gynecologic laparoscopy in spite of its effectiveness during the procedure.

Ectopic pregnancy is still considered one of the major diagnostic and therapeutic problems in obstetrics and gynecology which may result in mortality and infertility in some cases. The aim of the present study was to evaluate benefits such as maintenance of fertility and risks such as obligation of laparatomy resulted by laparascopic surgery that is quite new in our country. Patients & In this historical cohort survey, 101 ectopic pregnancy patients admitted to gynecologic endoscopy ward of Rasoul-e-Akram Hospital from 1995-2003 were studied. Data collection was performed by checklists prepared through patients’ medical records. Involved tube was saved in 88 cases and salpingectomy was performed on 13 cases.There were 2 cases of postoperative bleeding that needed second laparascopy and one case needed laparatomy. Postoperative infection caused laparatomy in one more case. Two more cases underwent laparatomy in another center. There was one case of β-hCG rise after surgery that underwent chemotherapy. The rate of pregnancy after laparascopy was 58% in 37 patients with desire for childbearing, and the rate of recurrent EP in the involved and contralateral tube was 7% in total. Ectopic pregnancy is one of the most common emergencies in obstetrics and gynecology which should be considered as one of the differential diagnoses of acute abdomen in women of fertility age. The kind of treatment depends not only on the age and desire of the patient for more pregnancies but also on the gestational age and other findings during laparascopy. It is obvious that in older patients with no intention for pregnancy, the preferable method is simple salpingectomy by cautery, laser or 3-loop method. Conservative surgery for ectopic pregnancy carries the risk of recurrence, so the patient and her family should be aware and sign the consent form. 14 of the 101 patients had positive history of tubal surgery due to ectopic pregnancy(table 1) and new EP happened in the same or the other tube. Although some studies deny this risk, recurrence is a fact that depends to some extent on the method and kind of surgery.

Pregnancy and delivery are great experiences in a woman’s life. Many risk factors for fetus may harm mother and increase mothers’ mortality and morbidity. The most important factor related to neonatal mortality and morbidity is weight, therefore, there is no doubt over importance of recognizing fetal weight and its control during prenatal period. According to the studies and observations, there is an obvious and direct relationship between mothers’ fundal height, abdominal circumference, body mass index and infant weight. The present study was undertaken to determine the relationship between these three factors separately with infant weight and finally all three together. Also, the effect of age, occupation, mother’s previous gravidity, parity and abortions, gestational age, mother’s height and weight, mother’s weight and body mass index gain, presentation, infant’s sex, height, head and chest circumference, age and the weight of previous baby on these relationships were also evaluated. In this correlational study 1003 out of 1200 pregnant women who referred to delivery section of Be’sat and Shahid Fayazbakhsh Hospitals were selected and a checklist regarding pre and post-natal delivery was filled. The results indicated that there was a significant relationship between fundal height and infant weight with regression 0.723(t=33.133, P=0.000), abdominal circumference and infant weight with regression 0.530(t=19.770, P=0.000), body mass index and infant weight with regression 0.25(t=8.118, P=0.000) and between fundal height, abdominal circumference, body mass index and infant weight with regression 0.756(t1=23.94, P1=0.000), t2=10.58, P2=0.000), t3=-6.976, P3=0.000). Based on line equation, the relationship between mothers’ fundal height, abdominal circumference, body mass index and infant weight showed an error of less than 500 gr with 94.2% sensitivity, so this method can be used to estimate clincial fetal weight.

Adequate serum level of zinc and selenium is required for normal metabolic performance and successful fertility. The present study was conducted to evaluate the association of serum zinc and selenium in early stage of gestation with the incidence of miscarriage in Iranian women. One hundred two females were studied in three matched groups. Group 1 consisted of 34 females with miscarriage, healthy parturients (n=34) and non-pregnant females were included in the second and third groups, respectively. Serum zinc and selenium were analyzed by atomic absorption spectroscopy. TSlight increment in zinc level of healthy parturients was observed in comparison with females with miscarriage however, this difference did not reach the statistical significance. Meanwhile, zinc level of non-pregnant females did not show a significant difference with other groups. There was no significant difference between the selenium level between groups. Serum zinc and selenium level of all three groups of Iranian females were within normal ranges, even higher value for selenium was obtained indicating regional variation in consumption of selenium in diet in different regions of the world. Miscarriage is not related to diet alone in Iranian females.

Pelvic abcess is one of the most dangerous & distressfull gynecologic disorders, that causes controversy among authors for treatment methods. This comparative study was performed in the aim of evaluation af laparoscopy & laparotomy methods in the T.O.A. (tubo- ovarian-abcess) Meterial & This was a prospective controlled new method evaluation study, that porformed on patients who needed surgery for treatment of T.O.A. during 8 years since 1995 till 2002 at Rasoul Akram Hospital. In this study 22 women underwent surgery. Surgical method selected on the basis of patients age, symptoms, signs & findingss during therapy. It was no difference between two groups from the standpoint of antibiotictherapy. In laparoscopy group mean duration of addmission was 2 days shorter than laparatomy group. 80% of genital organs preserved in laparoscopy group. chronic pelvic pain Persisted 2 years after operation in 39% of patients of laparotomy group and only in 27% of patients in laparoscopy group. From prsent & other studies we can conclude that laparoscopy for the treatment of T.O.A. specially in younger patients is a very good choice & perhaps it will be the standard method of surgery for preserving of fertility abilities in these patients at the near future.

Since lack of awareness, fear of unknown and also lack of prenatal preparation in pregnant women increase complication of the pregnancy, labor and consequently the medical intervention, this investigation was carried out in order to assess the effectiveness of the preparation classes for pregnancy courses on decrease of complications and medical intervention in pregnant women who referred to Hedayat hospital between May 2000 and March 2001. A clinical experimental study (Sequential Randomized control trial) was carried out on 200 pregnant women expecting their first child, under 35 years of age, with gestational age of about 20 weeks and absence of hypertension, diabetes, multifetal pregnancy, smoking, habit and threatened abortion symptoms in their history. They were randomly divided to experimental & control group. Mothers in exprimental group were trained both theoretically and practically in 8 sessions, while those in control group received routine care only. Mother’s emotional and physical health during pregnancy and the collected data from labor and neonates health situations were recorded and analysed and then compared between the 2 groups. The collected data showed that back pain, pelvic pain and tiredness during pregnancy were less in trained women and their daily activities were more in comparison with non-trained women. There was not any significant difference in the quality of sleep, marriage and social relationship between the two groups. Women who attended antenatal classes had an increase in the percentage of fullterm delivery(7%), whereas the others had a higher risk of cesarean sections (16%) Moreover, duration of active labor and the second stage of it was shorter in trained women. Statistically, there were significant differences between the criteria mentioned above (P<0.04, P<0.04, P<0.002, P<0.004). The rate of prescription of oxytocin, antispasmodic drugs and sedative and also birth weight and apgar in neonates were the same in the two groups. The findings show that an increase in awareness and preparations during pregnancy help mothers to pass this important period of their life with more ease and enjoyment and less medical interventions. Hence, arranging preparation for pregnancy courses and more studies on methods of preparations for childbirth used in other countries is recommended.

Intraventricular hemorrhage (IVH) is one of the most important complications in prematurity and low birth weight. Its early diagnosis and treatment has an effective impact on patients’ outcome. This study was conducted to determine IVH percent in under 2000 gram newborns and its related factors. During this observational retrospective study, 641 neonates with 2000 grams or lower birth weight were identified among 12251 total live births in hospitals of Iran University of Medical Sciences (1999-2001). After exclusion of newborns, who expired or left the hospital before diagnosis, 200 newborns were evaluated. IVH was investigated via brain Ultra sonography. The percentage of IVH among assessed newborns was 28.0% (95%CI: 25.2-30.9%). The most common and the least common types of IVH were degree I (37.5%) and degree IV(3.7%) respectively. The percentage of IVH in the present study was lower than that of some similar studies. This can be due to higher mortality of very low birth weight newborns(under 1500 grams) in Iran or transfer of some cases to other centers because of intensive care limitations.

The incidence of nonobstetrical acute abdomen during pregnancy is 0.2 to 2 percent. In spite of low incidence of Acute Abdomen in pregnancy, it is with high complications and mortality rate because differential diagnosis between obstetrical and nonobstetrical causes are difficult and often diagnosis and management are too late and inappropriate. This case series prospective study was done from 1995 to 2001 in teaching centers of Iran University of Medical Sciences. All of the pregnant women with diagnosis of Acute Surgical Abdomen entered in this study. The mean age of cases was 22.86 years(SD +4.22 years) and mean number of previous pregnancies and previous live deliveries were 3.26 (SD +2.18) and 2.37 (SD+0.99) respectively. Most of cases were in second trimester of pregnancy and the most common synptom was abdominal pain and the most common sign was abdominal tenderness. The most common cause of Acute Abdomen was Ectopic pregnancy(%62) and then Ruptured ovarian cyst(%27), hemorrhagic ovarian cyst (%10) and acute appendicitis(%1). Fortunately there was no mortality in this study. In conclusion, acute abdomen during pregnancy can be risky. Thus, appropriate & quick diagnosis is highly important in its prognosis and result.

Vesicouterine fistula is a very rare disease which develops after cesarean section in most of the reported cases. The patients usually have symptoms such as urinary incontinence in early stages of disease and cyclic hematurea in late stages. Prolonged use of Intra-Uterine Devices(IUDs) was reported rarely to be the cause of vesicouterine fistula. This is the report of a 30-year-old woman with history of repeated cesarean sections and pregnancy with IUD in uterus. Six months after her last cesarean, with symptom of cyclic hematurea, she was diagnosed to have vesicouterine fistula which was repaired via surgery. Disease presentations, diagnosis criteria and complications of Vesicouterine fistula along with medical and surgical approaches in treatment of this disease were discussed in this paper.

Legal surgical pregnancy terminations are commonly performed in Iran. Lidocaine is used widely for cervical anesthesia during suction curettage . Lidocaine carries the potential risk of side effects and toxicity if over – dosed. The aim of this study was to compare lidocaine and saline for cervical anesthesia to blunt the reported pain during curettage. For this purpose a double – blind randomized clinical trial was conducted on 85 women presenting for legal pregnancy termination procedure.Participants received either paracervical submucosal injections of 1% lidocaine (n=44) or saline (n=41) just before cervical dilation. Anxiety level or all subjects about the procedure was assessed by using of Anxiety Self – evaluation Questionnaire. Self – roported pain intensity was assessed after dilation and 30 minutes after procedure. Eighty–five eligible women presenting for legal pregnancy termination procedure participated in the study. No statistically significant differences were found between lidocaine and saline subjects on prior pregnancies, abortions, and level of anxiety about the procedures. Pain intensity ratings in lidocaine and saline treatment subjects did not differ significantly at any point. Furthermore, of those women receiving lidocaine, toxicity symptoms were not reported. To minimize lidocaine side effects and toxicity for a curettage procedure, saline could be considered for the paracervical injection solution. The local anesthesia mechanism of saline may be distention rather than blockage of specific autonomic nerves when there is no waiting period.

Spontaneous rupture of splenic artery aneurysm (SAA) during pregnancy is a rare event with catastrophic consequences. The risk of rupture, generally given as 3% to 5%, rises in pregnancy up to over 20%, with a 70% maternal and 95% fetal mortality rate. Review of the literature reveals that more than 100 cases of ruptured SAAs in pregnancy have been reported. However, mother and fetus have survived in only 13 of these cases. This paper describes a case of SM rupture during pregnancy, reporting survival of the mother.
A 27-year-old primigravid at 31 st week of gestation was admitted because of acute severe epigastric pain, nausea and vomiting. Physical examination showed that she was in a hypovolemic preshock state with tenderness on abdominal palpation in the epigastrium and left upper quadrant. From the obstetrical point of view there was no bleeding and no uterine contraction, but fetus showed severe bradycardia. She immediately underwent an emergency laparotomy, SM was resected and splenectomy was performed but unfortunately, fetus did not survive. The patient recovered with no complication, however, further evaluation revealed esophageal varices due to portal hypertension.

The role of cytokines and growth factor on reproduction is a rapidly growing new area of investigation. Immune cells and related cytokines have been shown to affect the neuroendocrine events of reproduction, ovarian function, placenta and the developing embryo.
Further more, it is now becomming apparent that these relationships are reciprocal in that the different cellular components of the neuroendocrine and reproductive systems and the developing embryo can modulate the production of cytokine by immune system and can also produce certain cytokines.