فهرست مطالب راضیه دهقانی فیروزآبادی

Infertility is a serious health problem that affects the individual, her/his family, and the community. Infertility is defined as failure to achieve clinical pregnancy after at least 12 months of unprotected coitus.

The purpose of this study was to investigate the prevalence of primary and secondary infertility and the associated factors in Yazd Greater Area during 2014-2015.

This is a cross-sectional analytic study using Yazd Health Study data which was conducted on 10,000 people. We studied 2611 women between 20-49 yr old who lived in Yazd Greater Area. Data were collected using a validated questionnaire. Anthropometrics were collected using standardized instruments.

Among women participating in the study, 135 cases of infertility were documented and the overall prevalence of infertility was 4.73% (95% CI: 3.94%-5.59%), among them 2.6% (95% CI: 2.4-3.8%) had primary and 2.1% (95% CI: 1.8-3.4%) had secondary infertility. In this study, infertility was significantly correlated with age (r=0.051, p=0.032), educational level (r=-0.41, p=0.001), body mass index (r=-0.012, p=0.018), waist circumference (r=0.027, p=0.022), history of abortion (r=0.099, p=0.026), and family history of infertility (r=0.121, p=0.001).

The results of our study showed that the prevalence of infertility among women living in Yazd was lower compared to the other regions in Iran. Female factors were the main cause of infertility in central part of Iran.

Endometriosis is a disease that affects women of reproductive age. This disease is characterized by the presence of endometrial-like tissues (endometrial or stromal glands) outside the uterus and shows significantly elevated prevalence in industrial regions. Additionally, an interaction between genetics and environmental factors is assumed for the disease. Enzymes belonging to the cytochrome P450 (CYP) family are participated in detoxification process of a wide range of environmental toxins and carcinogens. Thereby, they are good link for the interaction. CYP1A1 which belong to cytochrome P450 (CYPs) superfamily, is a very important gene for the metabolism of carcinogens.

The aim of this study was to analyze the frequency of the MspI polymorphism of CYP1A1 gene and its relation to endometriosis.

Genomic DNA was isolated from 93 endometriosis women and 139 healthy controls. Genotyping was performed using polymerase chain reaction followed by restriction fragment length polymorphism analysis.

Frequencies of the TT, TC, and CC genotype of CYP1A1 gene polymorphism in patients were 73.1%, 22.6%, and 4.3%, while frequencies in controls were 74.1%, 22.3%, and 3.6%, respectively. So there was no significant differences between the genotypes in two groups (p=0.961).

According to our study, MspI polymorphism of CYP1A1 gene appears to be not associated with the risk of endometriosis in the studied population. However, additional studies, especially with larger sample size are needed to validate these findings.

Selection of the best embryo for transfer is very important in assisted reproductive technology (ART). Using morphological assessment for this selection demonstrated that the correlation between embryo morphology and implantation potential is relatively weak. On the other hand, aneuploidy is a key genetic factor that can influence human reproductive success in ART.

The aim of this lab trial study was to evaluate the incidence of aneuploidies in five chromosomes in the morphologically high-quality embryos from young patients undergoing ART for sex selection.

A total of 97 high quality embryos from 23 women at the age of 37or younger years that had previously undergone preimplantation genetic screening for sex selection were included in this study. After washing, the slides of blastomeres from embryos of patients were reanalyzed by fluorescence in-situ hybridization for chromosomes 13, 18 and 21.

There was a significant rate of aneuploidy determination in the embryos using preimplantation genetic screening for both sex and three evaluated autosomal chromosomes compared to preimplantation genetic screening for only sex chromosomes (62.9% vs. 24.7%, p=0.000). The most frequent detected chromosomal aneuploidy was trisomy or monosomy of chromosome 13.

There is considerable numbers of chromosomal abnormalities in embryos generated in vitro which cause in vitro fertilization failure and it seems that morphological characterization of embryos is not a suitable method for choosing the embryos without these abnormalities.

Ovarian hyperstimulation syndrome (OHSS) is one of the most important complications of assisted reproduction treatment. Many substances are involved in the regulation of the vascular permeability, which have been concerned to cause OHSS. Vascular endothelial growth factor (VEGF) has emerged as one of the main angiogenic factors, which could be responsible for increased vascular permeability.

In this study the association of vascular endothelial growth factor -460C/T and  G/C polymorphisms and susceptibility to ovarian hyperstimulation syndrome was evaluated.

In this cross sectional study, VEGF gene polymorphisms were amplified by Polymerase chain reaction- Restriction Fragment Length Polymorphism in 75 women with established OHSS (case group) and 85 normoresponder (control group) which received conventional ovarian stimulation regimen.

There was no significant difference in the frequency of -460 C/T polymorphism between cases and controls (p=0.85). The frequency of  G/C polymorphism was significantly higher in the OHSS women (p=0.03, OR=2.44; 95% CI=1.23-4.82).

In women who developed OHSS, VEGF gene polymorphism  could be effective. Two of the polymorphisms -460 C/T and  G/C were reported to be associated with increased VEGF basal promoter activity. However, only  G/C gene polymorphisms were more frequent in cases than controls.

Implantation is one of the essential steps for the success of assisted reproductive techniques (ART). Their success depends on three main factors: embryo quality, endometrial receptivity (ER), and synchrony between embryo and endometrium. There are various factors that regulate the complex process of implantation. In this regard, one may refer to human chorionic gonadotropin (hCG) as the most important factor.

This study aims to investigate the effect of intrauterine hCG injection before embryo transfer (ET) on pregnancy outcome in infertile couples.

A total of 159 patients undergone In vitro Fertilization/ Intracytoplasmic Sperm Injection (IVF/ICSI) with an antagonist protocol were evaluated. Patients were divided into three groups (n=53). Group 1 received 500 IU of hCG, group 2 received 1000 IU of hCG intrauterine injection before ET, and the control group underwent ET without hCG preceding intrauterine injection.

There was no significant difference among the groups. The implantation rates were 18.86%, 13.52%, and 14.37%, chemical pregnancy rates were 34%, 32.1%, and 35.3%, and clinical pregnancy rates were 34%, 32.1%, and 31.4% respectively.

The pregnancy outcome in IVF/ICSI /ET cycles cannot be improved through hCG intrauterine injections before ET.

C-section is a method of delivery which has increasingly grown in different societies for different reasons. This invasive surgery can cause many problems in mothers. Following repeated C-sections, such complications as substantial intraoperative blood loss, increased maternal duration of hospitalization, and postoperative uterine adhesion are exacerbated. Ninety four patients candidate for first-time C-section referring to Shahid Sadoughi Hospital in Yazd during 2012-2014 were included in this study based on inclusion criteria. Non-random convenience sampling method was used which continued until the desired sample size was achieved. The required information was recorded in a questionnaire based on patients’ history, and the degree of adhesion was measured according to NAIR’s modified criteria during the second C-section. The participants’ mean age was 27.59 years with a minimum and maximum of 20 and 36 years, respectively. Moreover, 35.1%, 44.7% and 20.2% of the sample had no adhesion, mild adhesion, and severe adhesion, respectively. A significant difference was observed within mothers with adhesion in terms of blood loss amount (p<0.001). The mean duration of hospitalization in different degrees of adhesion was also significant (p<0.001). In this study, a significant relationship was detected between the degree of adhesion and hemoglobin loss, duration of hospitalization, duration of fetus delivery from uterus, as well as the overall duration of operation.

The endometrial thickness is an important determinant for the successful implantation and pregnancy. This research was aimed to evaluate relationship between the endometrial thickness with serum estradiol and progesterone levels in patients visited in Ob&Gyn clinic of Shahid Sadoughi hospital. Enrolled in the study were 440 patients visited in Ob&Gyn clinic of Shahid Sadoughi hospital between Jan. 2011 to Sep. 2012. Only patients with regular menstrual cycle were included in study. Patients with myoma, adenomyosis, endometrial polyps or other uterine anomaly, those who smoked, women with BMI greater than 30 and who were taking medications that could affect endometrial thickness were excluded. Endometrial thickness one day before and 5-7 days after ovulation was measured by using trans-vaginal ultrasonography. Also, serum estradiol and progesterone levels were measured in 5-7 days after ovulation. Data analysis was done through SPSS version 16 with using descriptive statistics and ANOVA. The mean age of patients was 27.37±4.44. Endometrial thicknesses were 9.80±0.80 and 10.13±1. one day before and 5-7 days after ovulution, respectively. 5% of patients had thin endometrium (<7 mm) in two measurements. Serum estradiol and progesterone levels were respectively 169.88±17.64 pg/ml and 7.32±6.93 mg/ml. There were no significant association between endometrial thickness and age, and also endometrial thickness and progesterone level. The same relation between endometrial thickness and estradiol serum level was observed only in age group of <20 years. (P=0.000). The results showed that serum stradiol and progesterone levels can not be the determinants of endometrial thickness in women.

Based on classical two-cell, two-gonadotropin theory, in the follicle, follicle-stimulating hormone (FSH) and luteinizing hormone (LH) put on their main effects on the granulosa and theca cells. LH is essential for androgens production. Androgens are used for estradiol production by granulosa cells. Profound suppression of LH concentrations in some normogonadotropic patients can cause several adverse effects. The main clinical purpose of this study was that normoresponder women treated with controlled ovarian super ovulation for IVF or ICSI may benefit from co-administration of rLH. 40 patients who were candidates for assisted reproductive technology (ART) were randomly selected. In all patients long luteal protocol was used for ovulation induction. Patients were randomly divided into two groups: Group 1 (n=20) with standard long protocol (GnRH agonist) and r-FSH alone, Group 2 (n=20) with standard long protocol (GnRH agonist) and r-FSH with r-LH. Results were statistically analyzed and compared in two groups. The number of retrieved oocytes, mature oocytes, cleaved embryos, transferred embryos, estradiol levels in Human chorionic gonadotropin (hCG) administration day, implantation rate and clinical pregnancy rate in group 2 were higher but not significantly different. Administration of rLH in late follicular phase had no beneficial effect on outcomes in young women with mean age of 31 years. Maybe a greater sample size should be used to see the effects more accurately; also it is possible that rLH will be useful in older patients.

This study was conducted to determine the effect of omega-3 supplementation on sex hormone-binding protein (SHBG), testosterone, free androgen index (FAI) and menstrual status in women with PCOS. This double-blind randomized clinical trial was conducted on 78 overweight/obese women with PCOS. Participants were randomized to receive omega-3 (3gr/day) or placebo for 8 weeks. Data about weight, height and nutrient intake as well as blood samples were collected before and after intervention. Serum concentrations of testosterone (nmol/L) and SHBG (nmol/L) were measured. FAI was also calculated as the ratio of testosterone to SHBG. Seventy eight patients (age: 26.92±5.46 yrs, Body Mass Index: 31.69±4.84 Kg/m2) completed the study. There was no significant difference in mean age, weight, height, Body Mass Index and intake of energy, and macronutrients between 2 study groups before and after treatment. All the participants had irregular periods. After the trial the percentage of regular menstruation in the omega-3 group was more than the placebo group (47.2% vs. 22.9%, p=0.049). Furthermore, testosterone concentration was significantly lower in the omega-3 group compared with placebo, after supplementation (p=0.04). SHBG and FAI did not change in either group. Omega-3 supplementation could reduce serum concentrations of testosterone and regulate menstrual cycle without significant effect on SHBG and FAI. Future studies with longer period of supplementation are warranted. There is some evidence regarding the effect of poly unsaturated fatty acid intake on androgen levels and gonadal function in polycystic ovary syndrome (PCOS).

Approximately one percent of current live births of the world are conceived via assisted reproductive technologies (ART).

The purpose of this study was to compare the developmental status of children born through assisted and natural conceptions at the age of five years.

In a retrospective cohort study, developmental status of 5 years old children was evaluated via Persian version of 60-month Ages and Stages Questionnaires. Case group consisted of 61 singletons, term babies whom were born through ART in the Research and Clinical Center for Infertility, Yazd, Iran in 2005. Control group consisted of 61 term, first child, singleton and spontaneously conceived born five years old children whom were referred to Shahid Akbari primary health care center in 2010.

58 girls (47.5%) and 64 boys (52.5%) were evaluated. Frequency of developmental delay in domains of fine motor (47.5% vs. 24.6%, p=0.008) and problem solving (60.6% vs. 34.4%, p=0.004) were more in ART born children. On logistic regression, fine motor development state was independently affected by maternal educational level (OR: 5.3, 95% CI: 1.67-16.30, p=0.004) and developmental status in problem solving domains was independently affected by maternal educational level (OR: 4.88, 95% CI: 1.25-19.07, p=0.02) and birth weight (OR: 7.1, 95% CI: 1.78-29.01, p=0.006)

Maternal educational level and birth weight are important factors that influenced developmental outcome of ART born children.

Sildenafil citrate may increase endometrial thickness and affect the outcome of frozen-thawed embryo transfer cycles.

The aim of this study was to estimate the effect of sildenafil citrate on ultrasonographic endometrial thickness and pattern and to investigate the estrogen level on the day of progesterone administration, the implantation rate and chemical pregnancy rate in frozen embryo transfer cycles.

This randomized controlled trial was conducted on 80 patients who had an antecedent of poor endometrial response and frozen embryos. 40 patients were given estradiol by a step up method with menstruation to prepare the endometrium, and the other 40 were given sildenafil citrate tablets (50 mg) daily in addition to the above treatment protocol from the first day of the cycle until the day progesterone was started. This was discontinued 48-72 hours prior to the embryo transfer.

The endometrial thickness was significantly higher in the sildenafil citrate group (p<0.0001), the triple line patterns of the endometrium were significantly higher in the sildenafil citrate group (p<0.0001), while the intermediate patterns of the endometrium were not significantly different in the two groups. The echogen patterns of the endometrium were significantly higher in control group (p<0.0001). Finally, implantation rate and the chemical pregnancy rates were higher in the sildenafil citrate group but not significantly.

As our study shows, the oral use of sildenafil citrate is a good way to improve the endometrial receptivity. We recommend the routine use of oral sildenafil citrate in patients with a previous failure of assisted reproduction technology cycles due to poor endometrial thickness.

One of the most important steps in success of assisted reproductive techniques is appropriate ovulation induction and effective ovarian follicles stimulation. The aim of this study was to investigate the comparison of low-dose hCG plus gonadotropin releasing hormone (GnRH) agonist on ovulation induction and with standard dose hCG alone in intrauterine insemination technique with antagonist protocol. This clinical trial was conducted on 100 infertile couples who referred to infertility research center in Shahid Sadoughi university of medical sciences، Yazd، 2010 - 2011. Infertile women aged 18 to 35 who were treated with antagonist protocol were divided randomly into two groups after development of at least 3 follicles beyond 18mm diameter. Low dose of hCG (2500 IU) plus GnRH agonist (0. 2mg Triptorelin، intra muscular) were given to one group (n=70) and the next group (n=70) received hCG alone (10،000 IU، intra muscular). After 34 to 36 hours of injection intrauterine insemination was done in both groups. Data were analyzed with SPSS software version 11. 5 and T student and Chi-square tests. P value less than 0. 05 was considered significant. The patients were not different in terms of endometrial thickness، estradiol levels on day of hCG injection and the number of used gonadotropin ampoules (p=0. 1). Higher incidence of ovarian hyperstimulation syndrome (OHSS) was seen in the only hCG group، but this difference was not statistically significant (p=0. 1). Chemical pregnancy was significantly higher in low dose of hCG plus GnRH agonist (p=0. 03). However، no differences were observed between two groups in terms of clinical pregnancy (p=0. 07). Using low dose hCG plus GnRH agonist can be considered as an appropriate and alternative method instead of standard methods of hCG in ovulation induction with antagonist protocols.

Determination of oocyte fertilization and embryo quality are one of the most important purposes in ART cycles. Follicular fluid provides an important microenvironment for development of oocytes and some biochemical characteristics of the follicular fluid, such as pregnancy-associated plasma protein-A (PAPP-A), may play an important role in prediction of success rate of ART. This study was performed to evaluate whether there was any difference in follicular fluid PAPP-A, fertilization, and embryo quality between GnRH agonist long protocol and flexible GnRH antagonist multiple-dose protocol in ART cycles. A total of 100 women who were candidates for ART were enrolled the study and were divided into two groups, GnRH agonist (GnRHa) long protocol (n=51) and flexible GnRH antagonist (GnRHant) multiple-dose protocol (n=49). Follicular fluid sample was obtained from a single mature follicle and follicular fluid PAPP-A level, fertilization and embryo quality of the same oocyte were evaluated in both groups. There was no significant difference in the mean levels of follicular fluid PAPP-A between the GnRHa protocol and GnRHant protocol (3.5±1.4 vs. 3.8±1.9, respectively). The mean levels of follicular fluid PAPP-A in fertilized oocyte and good quality embryo were comparable in GnRHa and GnRHant protocols. Our data indicated that no differences of follicular fluid PAPP-A levels were observed between cycles using GnRHa long protocol and those of using flexible GnRHant multiple-dose protocol.

Postpartom hemorrhage is one of the most major problems that threaten the mother's health and is regarded as one of the most important reasons for mortality specially in the developing countries. So far, many studies have been conducted in regard to effectiveness of chemical and herbal medicine on decrease of Postpartom hemorrhage. This study aimed to investigate effectiveness of date (Rutab) on postpartum hemorrhage. This is a clinical trial study in which 94 subjects, having the adequate criteria for the research, were selected in Shahid Sadoughi Hospital. The participants were divided into two groups. In the first group, immediately after placenta delivery infusion, 20 unit oxytocin in 1000 ml 5% dextrose in water with normal salin solution(group 1) were given, whereas in the second group, infusion of 10 unit oxytocin in 1000 ml 5% dextrose in water with normal salin solution associated with 100 gram date (Rutab) were given and the patients were required to have them in 10 minutes. At the same time a plastic and a cotton sheet were widen under the patients. Blood loss was determined by regular weighting of the buttocks that were previously weighted. The difference was calculated before and after weight (1 gram increase in weight was considered to be equivalent to 1ml blood). Data were submitted to SPSS software and then analyzed by T-test, Chi-squre, Mann-whitney. The two groups were homogenous in regard to all the variables. The study results indicated that the bleeding mean was 127/11 ml at the two hour after delivery in the first group and 68/5 ml in the second group. There was a significant difference between postpartum hemorrhages of the two groups Since date(Rutab) was more effective than infusion oxytocin on post partum hemorrhage and no side effect was reported for that, it is recommended that its significance will be prposed to related specialist. Moreover, extra investigations are necessitated for future studies.

GnRH agonist and antagonist were developed to control the premature release of LH surge. There is some difference between two protocols. We compared the outcome of frozen-thawed embryo transfer in infertile women who used GnRH agonist or antagonist protocol for previous COH cycle and evaluation of any adverse effect of GnRH antagonist on oocyte and embryo. The study group included all infertile women who referred to Yazd Research and Clinical Center for Infertility. Overall 20-35 years old women who were candidate for frozen-thawed embryo transfer with regard to inclusion and exclusion criteria were participated in the study. The patients based on previous control ovarian stimulation (COH) protocol divided in to two groups: GnRH agonist long protocol (n=165) and GnRH antagonist multiple dose protocol (n=165). Frozen-thawed embryos were transferred after endometrial preparation in both groups. Main outcome measures were: implantation, chemical and clinical pregnancy rate. The implantation and clinical pregnancy rate following cryopreserved embryo transfer in GnRH agonist group and antagonist group were 16.3% vs. 15.7% (p=0.806) and 38.1% (63/165) vs. 36.9% (61/165) (p=0.915) and chemical pregnancy rate was 44.8% (74/165) vs. 43.6% (72/165) (p=0.915) respectively. There was no statistically difference between two groups in terms of implantation and pregnancy rate. Although pregnancy rate in fresh embryo transfer in antagonist cycles was lower than agonist groups, Therefore decrease in these parameters might be due to detrimental effect of GnRH antagonist on the endometrium, not embryo or oocyte.

Hot flash is a medical complication of menopause and estrogens have been known as its main treatment. Likely due to increased risk of cancers such as breast cancer, use of estrogen is avoided by many patients. Hence, various medicines are taken in replacement of hormone therapy. The aim of this study is to compare the efficacy of Soy protein on menopausal hot flash. A randomized double-blind clinical trial was done on menopausal women that referred for hot flash symptoms to Shahid Sadoughi Hospital in Yazd from 2007 to 2009. Ninety women, aged 49 to 55 years were selected and divided into two groups. Soy group (n=45) received 20 gram soy powder for 12 weeks, and placebo group (n= 45) received 20 gram Bread powder at the same time. After 12 weeks, the changes in frequency and intensity of hot flashes of two groups were compared. Data were analyzed by SPSS software version 15, T-student and X2 tests. p<0.05 was considerate significant. After 12 weeks, of 45 women in Soy group 34 (77.6%) have improved; while only 6 women (13.3%) in placebo had improvement (p=0.001). Soy protein is a useful, costless and with lower side-effect diet in treatment of menopausal hot flash.

Endometriosis is one of the most common gynecologic disorders. It is a complex trait and both genetic and environmental factors have been implicated in its pathogenesis. There is growing evidence indicating that exposure to environmental contaminants is a risk factor for endometriosis. Glutathione-S-Transferase M1 (GSTM1) is one of the genes involved in detoxification of endogenous and exogenous compounds. Several studies have indicated an association between GSTM1 null mutation and endometriosis. In this study, the possible association between the GSTM1 gene null genotype and susceptibility to endometriosis in woman from central and southern Iran was investigated. One hundred and one unrelated premenopausal women with endometriosis and 142 unrelated healthy premenopausal women without endometriosis were enrolled in the study. Genomic DNA was extracted from Peripheral blood in all subjects. GSTM1 null genotyping was performed by polymerase chain reaction (PCR). There was no significant difference between frequencies of GSTM1 null genotype in case and control groups (50.5% Vs. 52.1%, p=0.804). Furthermore, this genotype was not associated with severity of endometriosis in our sample (p=0.77). further studies involving gene-environment and gene-gene interactions, particularly combination of GSTM1 and other GST gene family polymorphisms are needed.

Cervical ripening for labor induction is one of the obstetrical problems. The aim of this study was to compare the efficacy profile of isosorbide mononitrate with low dose syntocinon for cervical ripening at labor. The study population was nulliparous women referred to Shahid Sadoughi Hospital of Yazd in 2008-2009. 100 primigravid women were randomly assigned to two groups that received either vaginal isosorbide mononitrate tablets 40 mg (n= 50) or low-dose syntocinon (n= 50) with simplification method. Effectiveness of each agent was the cervical ripening effect and the time from initiation of the treatment to delivery that were compared between two groups. Efficacy and safety outcomes were compared in two groups. Data were analyzed by t-test and Fisher’s exact test with SPSS software version 15. The results showed that there were no significant differences between the two groups regarding mean of age and gestational age (with sonography and Last Menstrual Period). Mean of cervical ripening time was 36.13±4.057 hours in isosorbide mononitrate group and 36.28±3.886 hours in low–dose syntocinon group (P=0.876). There was no significant difference in mode of delivery (cesarean or vaginal) between two groups. The most common side effect in isosorbide mononitrate group was light headache (70%) and in low-dose syntosinon group it was tachysystole/hypertone (4%). One and five minute’s neonatal apgar were similar in two groups. Use of vaginal isosorbide mononitrate was as effective as low dose syntocinon in cervical ripening can be used as an effective, simple, low cost and safety method in cervical ripening.

Abnormal uterine bleeding is a common presentation of uterine abnormalities among premenopausal and postmenopausal women. To evaluate and compare the diagnostic accuracy of saline contrast sonohysterography and hysteroscopy for detecting the cause of abnormal uterine bleeding. A total of 65 women with abnormal uterine bleeding were enrolled in this study. A prior saline contrast sonohysetrography followed by a hysteroscopy was performed in all cases. Sensitivity, specificity, positive and negative predictive value and test accuracy were calculated. As the most common abnormality, SCSH showed hyperplasia in 19 patients while hysteroscopy diagnosed polyp in 15 cases. A sensitivity of 73.3%, 71.4% and 90.9% were reported for polyp, hyperplasia and submucous myoma respectively whereas the specificity was calculated 96% for polyps, 82.3% for hyperplasia and 90.7% for submucous myoma. Comparing with hysteroscopy, sonohysterography showed a high sensitivity and specificity for detecting submucous myoma but not for endometrial polyp and endometrial hyperplasia.

Medical and surgical methods are used for induction of abortion. Prostaglandins are used in various forms such as vaginal tabs, gels, intra-amniotic and extra-amniotic injections. The object of this study was to compare the effectivenes of extra-amniotic PGE2 and high-dose oxytocin in induction of abortion.

The study included 60 women admitted for induction of abortion in Shahid Sadoughi hospital of Yazd from 2007 till 2009. They were randomly allocated in two groups. Data was collected by a questionnaire and statistical tests such as Fisher’s exact and chi square were used for analysis of data. The success rate in PGE2 group (P=0.014) was higher than oxytocin group. The mean time of induction of abortion in PGE2 method was shorter than oxytocin method (p=0.0001). In both the two groups, the mean time of induction of abortion in dead fetuses was shorter than that in live fetuses (p=0.0001 for PGE2 group and =0.011 for oxytocin group). There was no significant difference in the rate of complications of treatment in the two groups. In both the two groups, the mean time of induction of abortion in the 12-14 weeks period was longer than 8-11 and 15-19 weeks, which was significant in the PGE2 group (p=0.001). The use of extra-amniotic PGE2 method in induction of abortion is more effective than high-dose oxytocin and by decreasing the induction period and need for currettage, hospitaliztion period and expenditure ca be decreased leading to increased satisfaction of patients.

Maternal position during the second stage of labor can be considered to be an intervention in the natural course of labor. This study aimed to establish the effect of sitting versus lithotomic position on duration of second stage of labor, preneal truma and neonatal outcome. This clinical trial study was done on 110 term nuliparuse women with normal conducte of labor in second stage, which divided randomly in sitting position, (n=55) and lithotomic position (n=55) in teaching hospital in Yazd, Iran during 2005-06. Duration of second stage, Perinea trauma and first 5 minutes APGAR evaluated and compared in two groups. Data analyzed by SPSS-11.5 with T student and Chi square tests. P<0.05 was significant. Duration of second stage of labor was 34 and 42 minutes in sitting and lithotomic position respectively (P<0.05). Perinea damage was seen in 15 (27.3%) and 24 (43.6%) women of sitting and lithotomic position respectively (P<0.05). No significant difference existed between the groups in neonatal first 5 minutes APGAR. This study showed that sitting position reduce second stage duration and perinea trauma versus lithotomic position.

Infertility is a common complication present in 10-15% of the population. It causes serious problems for the family. There are different methods for evaluation and treatment of infertility. One of the routine tests is hysterosalpingography that was first used in1922 and with changes in types of contrast media and its techniques, it is the primary test for simultaneous evaluation of tube, uterus body and cervix. This descriptive clinical outcome study was carried out on the base of a case series study. The study was performed on 117 patients who referred for HSG procedure and were followed for 2 years for detection of pregnancy. Data was analyzed by SPSS.14, and statistical tests included student’s t-test, chi-square and Fisher exact test. The mean age of patients was 26±4.7 years. Duration of infertility was 6 years. Of the total, 98(83.8%) cases had one or both patent tubes on HSG. They didn’t have any established causes of infertility after scrutiny of other findings and 51(43.6%) cases became pregnant during 2 years (CI=95%,34.6-52.6%). Notable point was that 86.3% of pregnancies occurred in the first 6-months after HSG procedure. HSG plays a significant role in infertility diagnosis and treatment in spite of the new techniques and methods for infertility diagnosis and treatment so follow up and control of patient for 6 months after HSG is recommended. If HSG fails, other procedures such as laparoscopy can be done.

Wound disruption after cesarean section is a common complication; and obesity has been identified as strong independent risk factor for wound complications. The aim of this study was to test the hypothesis that closure of the subcutaneous fat decreases the incidence of wound infection and disruption after cesarean delivery. In a clinical trial study conducted in Yazd, a hundred women with at least 2 cm of subcutaneous fat and cesarean delivery were included in the study. In 50 patients, subcutaneous tissue was closed using synthetic suture (group A), while in 50 control patients subcutaneous tissue was not closed (group B). Two groups were compare in relation to wound infection and disruption. Data were analyzed using student and X2 tests. Complications leading to wound infections (positive culture) were 2 women in group A and 5 women in group B (P<0.05) and disruption or opening of the incision were in 7 women in group A and in 17 women in group B (P<0.01). Closure of the subcutaneous tissue can significantly reduce the rate of postoperative wound disruption in women with at least 2 cm of subcutaneous adipose tissue.

This study has been designed to evaluate the effects of Atropine on improving dilatation of cervix and promoting the progression of labor course in active phase of primiparus women referring to Shahid Sodughi Hospital of Yazd in 2006. In this randomized clinical trial, 200 pregnant primiparus women were enrolled into two groups. One hundred normal primiparus ladies recieved one ml of intravenous atropine as case group and 100 women received nothing as control group, randomly. Placebo was given to both groups in active phase. Finally, the effect of atropine on Friedman curve, dilatation of cervix and progression of labor course was evaluated. The statistical analysis was done using t-test, Chi square and Fisher exact tests. The mean time from drug administration to full dilation of the cervix was 2.05 h in the case group and 2.39 h in the control group (P<001). In addition, the mean time of labor was 4.96 h in the case group and 6.12 h in the control group. Cesarean delivery in the case and control groups was 3% and 9%, respectively. In the case group, 49% of women complained of thirst, 29% had increased heart rate, 1% complained of urinary retention, and 21% showed no obvious complication. Atropine not only decreases the active phase of labor but also decrease the rate of cesarean.