شعله شاه غیبی

Medical malpractice is one of the major concerns of the health system in the profession of midwifery and gynecological nursing which can lead to death and injury in two vulnerable groups of mothers and babies and can make it difficult for doctors and midwives who had committed malpractice to return to their usual medical practice and provide service to other patients. This study was conducted to determine the frequency of malpractice in the field of midwifery and gynecological nursing and factors related to it in the cases presented in the medical council of Kurdistan province in 2016-2020.

In this retrospective descriptive-analytical study, all complaint files related to midwifery in the medical council of Kurdistan province in 2016-2020 were reviewed. The data collection tool included a checklist that was prepared and completed by the researcher by using the patient files. Using SPSS software (version 24), Data were analyzed by descriptive statistical tests and chi-square and.

Among 68 cases raised in the medical council, 32 were acquitted and 36 were convicted. The mean age of the plaintiffs was 32.35±6.43 years and most of them had primary education (38.2%). 94.1% of plaintiffs had no history of illness. The most common complaint was physical injury (41.2%) and the most common malpractice was maternal defect (32.4%). Most cases of malpractice were related to gynecologists (55.6%). The most common cause of malpractice was imprudence (40.0%). In addition, most cases of malpractice occurred in a teaching hospital (91.7%), in the maternity ward (63.9%) and in the night shift (41.7%). The frequency of malpractice showed a significant relationship with the city (P<0.001) and the education level of the patients (P=0.002). Furthermore, among the factors related to malpractice, only the results of malpractice showed a significant relationship with the characteristics of malpractice (P=0.042).

The results of this study showed that most cases of medical malpractice occurred due to imprudence. Moreover, the most common cause of maternal and fetal death was due to imprudence and the most common cause of maternal and fetal defects was ineptitude. Therefore, we recommend necessary measures to increase the clinical skills of gynecologists and midwives in educational programs, and also workshops for increasing clinical skills according to the national protocols for those who have these professions.

Prolonged pregnancy is associated with many complications for both mother and fetus. The onset and progression of labor require cervical ripening. This study was performed to evaluate the effect of oral evening primrose capsules on the ripening of the cervix in primiparous women referring to selected centers in Sanandaj, 2020.

This study was a single-blind randomized clinical trial That was performed on 80 primiparous women referring to selected centers in Sanandaj in 2020 with a gestational age of 39 weeks to 39 weeks and 6 days. Subjects were randomly assigned to intervention (evening primrose) and control (placebo) groups. The outcome of the study was the ripening of the Cervix which was evaluated for both groups during the period before the intervention, one week after the intervention, and the time of hospitalization. A Bishop scoring table was used to evaluate was ripening of the Cervix. Data analysis was performed using STATA software version 14 and independent t-tests, Fisher's exact test, and Repeated measure ANOA.

Bishop score one week after taking the capsules in the intervention group (3.73±0.90) was not significantly different from the control group (2.88±1.35) (P>0.05), But the bishop score at the time of admission of the intervention group was higher than the control group; The bishop score in the intervention group was 4.56±1.29 and in the control group was 3.13±1.22 and there was a statistically significant difference between the two groups (P=0.005).

the use of oral capsules of evening primrose is effective on bishop score and cervical ripening And it can be used for cervical ripening.

Pregnancy causes several physical and psychological changes. Therefore, pregnant women may face with numerous issues and problems including stress and marital dissatisfaction. This study was conducted to compare the effectiveness of two cognitive-behavioral and emotion-oriented couple therapy training methods on perceived stress and marital satisfaction in primiparous women.

In a semi-experimental design using a pre-test and post-test with the control group plan, 60 pregnant women were chosen by considering the inclusion criteria, and then they randomly divided into three 20-subject groups (two experimental groups and one control group). The Experimental groups were trained on cognitive-behavioral and emotionally focused in 8 sessions of 90 minutes, while the control group did not receive any training during this time. The tools which are used to collect data were the Perceived Stress Scale of Cohen and Enrich Marital Satisfaction questionnaire. Data were analyzed by using mean, multivariate analysis of covariance in SPSS software version 23 at a significance level of 0.05.

Findings showed that both cognitive-behavioral and emotionally focused approaches are practical on perceived stress, marital satisfaction (and its subscales) (p<0.05). Cognitive-behavioral couple therapy (17.6±2.99) was more effective than emotionally focused therapy (24.8±4.74) on perceived stress (p<0.05). On the other hand, emotionally focused couple therapy (158.7±6.64) was more effective than cognitive-behavioral therapy (144.9±4.9) on marital satisfaction and some of its components including personality issues and marital relationship.

Due to the greater effectiveness of cognitive-behavioral couple therapy on perceived stress and also the greater effectiveness of emotionally focused couple therapy on marital satisfaction, they reduce stress and improve marital satisfaction and then can be used as effective methods during pregnancy

Anxiety and depression are common during pregnancy, but often ignored and not treated, and this issue causes many problems during and after pregnancy both for the mother and baby. The present study was conducted with the aim of determining the level of anxiety and depression and its related factors in pregnant mothers who referred to clinics in Sanandaj city, 2017.

The present study is descriptive-analytical (cross-sectional). The study population included all pregnant women who referred to clinics in Sanandaj in 2017 and in this regard, 580 pregnant women completed the Spielberger Anxiety and Beck Depression Inventory by available sampling method. Data analysis was performed using spssv.18 as well as Pearson and Chi-square correlation coefficient.

The prevalence of overt and covert anxiety in pregnant women was moderate to high 23.4% and 27.9%, respectively, and the rate of moderate to severe depression was 15.3%. There was a significant inverse correlation between age and depression and anxiety (P <0.05).

According to the results of the study, which showed a high prevalence of anxiety and depression in pregnant women, it is required to educate and create appropriate contexts for pregnant mothers to receive psychological treatments

Chronic anovulation is one of the most common causes of infertility in women with polycystic ovary syndrome (PCOS) and there are several treatments for it. The present study was performed aimed to determine the efficacy of the stair-step protocol (SSP) using clomiphene citrate (CC) in patients with polycystic ovary syndrome and compare it with the traditional regimen.

This double-blind randomized clinical trial study was performed on 60 patients with PCOS in Sanandaj Besat Hospital in 2018-2019. Patients were randomly divided into control (traditional) and study (stair-step) groups. In the stair-step group, the patient received 50 mg of CC daily for 5 days from the fifth day of the cycle, and if there was no response, the dose was doubled, and failure to respond led to the use of 150 mg. In the control group, the process of CC administration in each cycle was for 5 days with the prescribed doses. The effect of CC administration was determined by ultrasonography one week after the end of the drug. Finally, the variables of egg size, ovulation interval, pregnancy rate, and CC side effects were compared in the two groups using SPSS software (version 18), Kolmogorov-Smirnov test, and t-test. P<0.05 was considered statistically significant.

The ovulation period was significantly shorter in the SSP than in the control group (21.40±0.98 vs. 51.86±5.94 days). Ovulation rate (17.72±2.40 vs. 19.03±4.40) and pregnancy rate (0.87±0.12 vs. 0.93±0.10) were not significantly different between the case and control groups. Moreover, no significant difference was found between the groups regarding the side effects of CC and endometrial thickness (p>0.05).

SSP has a very short treatment period with no adverse effects on ovulation and pregnancy. It also has no side effects in patients with PCOS.

this study was prepared to compare the effectiveness of cognitive-behavioral couple therapy training and EIS model on Marital Satisfaction in pregnant women

To achieve that, in a semi-experimental study with plan pre-test, post-test with the control group, 60 people among the statistical population were chosen by considering the criteria which is available in sampling method, and they randomly divided into three groups of 20 (two experimental groups and one control group). The Experimental participants were trained on cognitive-behavioral and EIS model in 8 sessions of 90 minutes, while the control group did not receive any training during this time. The tool which is used to collect data in pre-test, post-test were, Enrich Marital Satisfaction .Data were analyzed by using mean, multivariate analysis of covariance.

The results showed that both cognitive-behavioral and EIS model approaches on Marital Satisfaction and Its subscales are effective and there is a difference between the effectiveness of these two approaches on mentioned variable. The EIS model had a greater effect on Marital Satisfaction and subscales Personality Issues, marital relationship, Sexual Relationship, Religious Orientation than the cognitive-behavioral approach, But in the financial management subscale, the effectiveness of the cognitive-behavioral approach was greater

Therefore, it can be concluded that despite the differences between these two approaches, both are useful in term of Marital Satisfaction and Its subscales. However, due to the greater effectiveness of the EIS model in marital satisfaction and most of its subscales, it can be used during pregnancy besides the other cares.

Endometriosis is one of the most common chronic diseases in women that can cause infertility. Surgical removal of endometrioma can reduce pain and improve the quality of life of patients, while its effect on fertility is still controversial. This study was performed with aim to evaluate the effect of endometriosis surgery on fertility rate and outcomes in women with endometrioma.                                               

This randomized controlled clinical trial was performed in 2017 on 64 women with endometrioma ≥ 4 cm. After random allocation, the intervention group received endometrioma surgery and the control group received expectant treatment. The two groups were followed for six months in terms of fertility. Data were collected using a researcher-made checklist. Data were analyzed by SPSS software (version 20) and independent t-test and Chi-square test. p < 0.05 was considered statistically significant                                                                    

Frequency of pregnancy in the intervention group (76.6%) was significantly different from the control group (46.6%) (p =0.023). Also, the frequency of spontaneous pregnancy was significantly different in the intervention and control groups (95.7%, N=22 vs. 42.9%, N=6) (P=0.001).

Surgery of endometrium ≥4 cm is effective in infertile women and increases the chance of spontaneous pregnancy without other infertility treatments.

The aim of this study was to compare the effects of three tailored interventions for repeated mammography among non-adherent women using the Health Belief Model as a theoretical framework.

In this randomized trial, 360 women (≥50 years) from Sanandaj, were randomly divided into 4 groups. Intervention groups were pamphlet group, face to face counseling group, telephone counseling group and the 4th group was control group. All groups were compared with one another before the intervention, 2 weeks, 3 months, and 6 months after the intervention. Data were analyzed by using SPSS software. The statistically significant level was considered as p<0.05.

Demographic characteristics (age, education, and income) were not significantly different before the intervention (p> 0.05). In terms of perceived susceptibility, severity, benefits, and barriers to mammography, mean scores of intervention groups had statistically significant differences six months after the intervention (p<0.01). The highest rate of repeated mammography (50%) was observed in the face to face counseling group.

This study provided empirical support for the Health Belief Model as a framework to conduct repeated mammography. In addition, face to face counseling was the most effective way.

Cesarean section is the most common surgical procedures in the field of obstetrics and gynecology. Caesarean section is the major surgery and may impose a lot of complications for mother and baby. The aim of this study was to evaluate changes in caesarean trends and causes of cesarean section and its changes in the 1995, 2005 and 2008 in Sanandaj Besat Hospital.
This study was a retrospective cross-sectional study. The required data was collected through analysis of all caesarian related cases of the intended years. Statistical analysis was conducted using SPSS software version 18 and descriptive statistics.
Findings: The rate of cesarean section in 1995 was (4.16%) which had increased to (38%) in 2005. In 2008 it decreased by 3 percent and it reached to (35%). Elective cesarean rate has increased over time. The most common causes of cesarean in three years were cesarean section experience, dystocia during labor and fetal distress.
Due to the increase in cesarean rates in our center, it seems logical that in order to increase the rate of vaginal delivery and reduce cesarean, measures such as encouraging vaginal birth after cesarean, creating medical facilities and required personnel, determining labor dystocia accurately and correct diagnosis of fetal distress are required. Also, promoting vaginal delivery using non-pharmacological methods of pain control and improving the quality of midwifery care can be helpful in preventing unnecessary Caesarean deliveries.

Currently, the use of electromagnetic waves in medicine, especially in diagnostic devices such as magnetic resonance imaging (MRI) has increased and many of its biological effects have been reported. The aim of this study was to investigate the adverse effects of 1.5 T MRI on fertility and reproductive parameters of male mice. Forty NMRI adult male mice were randomly divided into two groups of control and experimental. The mice in the experimental group were exposed to MRI at 1.5T for 36 minutes once a week for a period of 3 weeks. Then, in the 1st day and 35th day after the final exposure, 10 mice were used for IVF and 10 mice for In vivo studies. MRI effects on testis weight, the duration of pregnancy, the number of newborns, sperm count, and fertility were evaluated. The obtained data were analyzed by using ANOVA and Tukey’s tests. According to the present study, one day after MRI exposure, testis weight, sperm count, and the number of born children were significantly decreased in the experimental group (P <0.05). Moreover, a significant number of the embryos failed to develop to the blastocyst stage. In contrast, 35 days after exposure, no statistically significant difference was found (P> 0.05). Discussion & Based on the results of the present study, it seems that although the MRI at 1.5T has adverse effects on fertility and reproductive parameters of the adult male mice, these side-effects are reversible.

Standard diagnostic procedure for significant proteinuria is based on 24-hour urine collection. However, this method is time consuming and may lead to incomplete urine collection. Instead, random urine protein/creatinine ratio could be used as an alternative method for evaluation of proteinuria. This study investigates the diagnostic value of random urine protein/creatinine ratio for the diagnosis of pre-eclampsia. In this cross-sectional study a group of 96 patients with pre-eclampsia and a group of healthy pregnant women were recruited. All cases were checked for urine protein by assessing urine analysis, 24-hour urine, and random urine protein/creatinine ratio. Data were analyzed using SPSS and ROC curve. Then a cutoff point of random urine protein/ creatinine ratio was determined. Area under the curve for random Pr/Cr was calculated as 0.785 (CI %95: 0.721-0.849) (p<0.001). The best diagnostic cutoff point for protein/creatinine ratio was determined as 0.325. In this point sensitivity and specificity were 81.3% and 66.7% respectively. As a result, a positive correlation between random urine protein/creatinine ratio and systolic blood pressure (r = 0.284, p = 0.005) was observed. Based on these results, random urine protein/creatinine ratio in a cutoff point of 0.325 could be suggested for preeclampsia.

Identification of fetus health risk factors can be helpful in the diagnosis, immediate treatment, and prevention of irreversible damages on the fetus. Fetal sex is considered as a risk factor in fetal and neonatal conditions. The aim of this study was to evaluate the relationship between fetal gender and adverse fetal outcomes in the term pregnant women. This cross-sectional study was performed in Besat Hospital in Sanandaj, in 2011 and included 2389 pregnant women. Gestational diabetes and presence of any underlying chronic disease such as hypertension, asthma, diabetes, and cardiac diseases were considered as our exclusion criteria. Data about stages and conditions of delivery and demographic variables were recorded in a questionnaire for every subject. Data about the neonates including Apgar score, fetal distress, and macrosomia were collected and recorded. Using SPSS 16 software, data were analyzed by descriptive and inferential statistics including chi-square, Fisher's exact test, and t-test. There were no statistically significant differences between male and female neonates in relation to maternal age, gestational age, duration of the first and second stages of labor, and average time of rupture of membrane (p>0.05). However, male neonates had higher birth weights (p=0.0001). In addition, there were no statistically significant relationship between boys and girls in regard to preeclampsia, mode of delivery, Apgar score, meconium, detachment of placenta, IUGR, umbilical cord prolapse, and stillbirths (p>0.05). However, prevalence of fetal distress syndrome was higher in boys (OR=1.83). Apart from respiratory distress syndrome, fetal sex is not associated with any other adverse fetal outcome. Even though, frequencies of cesarean delivery and Apgar scores of less than 7 were more in the boys compared to the girls.

Perineal lacerations are common complications during childbirth and may occur spontaneously during this process. Midwives or obstetricians may need to make a surgical incision (episiotomy) to increase the diameter of the vaginal outlet and facilitate the neonate’s birth. The aim of this study was to compare perineal lacerations in routine versus selective episiotomy. The current study was performed on 986 nulliparous women، admitted to Besat Hospital of Sanandaj in 2010-2011. Patients were randomly allocated to routine and selective episiotomy (only in case of vacuum-assisted delivery or fetal distress) groups. For data analysis، t-test، Chi-square، and Fisher''s exact test were performed، using SPSS version 15. P-value less than 0. 05 was considered statistically significant. duration of the second stage of labor، first-degree tears، and labia minora lacerations in selective episiotomy was significantly greater than the routine episiotomy group (P=0. 0001). However، there was no significant difference between the two groups regarding second-، third-، or fourth-degree lacerations. Routine mediolateral episiotomy could not prevent severe perineal lacerations but failure to do this in all cases (performed only in selected cases) resulted in first-degree lacerations and anterior perineal trauma. So it seems، limited use of episiotomy is a more rational approach for managing perineal outcomes during labor.

Preeclampsia is a pregnancy-specific syndrome that has two stages، the first stage occurs before 20 weeks of gestation before the onset of clinical symptoms. The second stage includes the incidence of clinical symptoms. one of the causes of its incidence is vitamin D deficiency. This study was performed with the aim to evaluate the relationship between serum level of vitamin D and preeclampsia in pregnant women. This case - control study was done on 50 pregnant women with severe preeclampsia and gestational age below 34 weeks and 100 non-preeclampsia pregnant women to delivery department of Besat Hospital in 2011. Data collection tool in this study was a questionnaire that was designed based on the variables. Blood sample was taken from all the research units to measure level of vitamin D. Maternal serum levels of 25-hydroxyvitamin D was measured by radio immunoassay method. in the laboratory. Data analysis was performed using SPSS software (version 18)، Chi-square، Fisher exact، Independent t، and Kolmogorov-Smirnov tests. Vitamin D deficiency was observed in 80% of cases and 75% of controls. The mean of 25-hydroxyvitamin D in the case group was 11. 0 ± 9. 4 (ml / ng) and in control group was 16. 3 ± 10. 0، which had statistically significant difference (p=0. 003). vitamin D level of most pregnant women was lower than normal. According to the findings of this study، D deficiency can be considered as a risk factor for preeclampsia. Although، more cohort studies are needed to confirm this.

Thyroid peroxides antibodies are associated with recognized complications during and after pregnancy like Abortion and postpartum depression، but other complications such as preterm labor، preterm rupture of membrane (PROM) and effect of antibodies on newborns weight and newborns Apgar score not be evaluated. Studies were demonstrated، treatment with levothyroxine in pregnant women with thyroid peroxides antibodies may prevent maternal and fetal complications. This study illustrated the prevalence of thyroid peroxides antibodies and induced pregnancy complications and then evaluates the effects of levothyroxine in reducing pregnancy complications among pregnant women having such antibodies. Methods and materials: we designed single blind RCT study in 300 first trimester pregnant women attending Prenatal Clinic in Sanandaj from September 2009 to January 2011. of 266 pregnant women without clinical hypothyroidism، 32 women were thyroid peroxides antibody positive. This 32 thyroid peroxides antibody positive women were divided in two groups via simple randomized allocation. Intervention group received a daily dose of 50 microgram levothyroxine in the pregnancy period. Control group did not receive any treatment. Participants were observed until the end of pregnancy period and outcome was assessed. Then data was analyzed by SPSS 11. 5 software and Chi square، Fisher and Kruskal-Wallis test. P-values less than 0. 05 were considered statistically significant. of 266 pregnant women، 32 women (12%) were thyroid peroxides antibody positive. There were no significant statistical differences between delivery type and delivery time. (p=0. 37) Though premature delivery and premature rupture of membrane in treated group was lower than non-treated group and the average of newborns weight and newborns Apgar score was higher than non-treated group، this difference was not statistically significant. (p=0. 22، p=0. 34 and p=0. 16) Add tests for thyroid peroxidase antibodies to pregnancy care and treatment with levothyroxine in pregnant women with thyroid peroxides antibodies can reduce premature delivery and premature rupture of membrane and increase the average of newborns weight and newborns Apgar score.

Dysfunctional uterine bleeding (DUB) is one of the common problems in peri-menopausal women that can affect their physical، emotional and social conditions. In addition DUB is one of the main causes of hysterectomy. The aim of this study was to investigate risk factors associated with DUB in peri-menopausal women in Sanandaj. This case–control study included 62 women with DUB (case group) and 124 women without DUB (control group). We used a questionnaire consisted of different items which was completed for every subject after clinical interview. Using SPSS software، data analysis was performed by chi-square، Fisher exact test and logistic regression. DUB showed significant relationships with type of delivery (p=0. 015) and age (p=0. 045). DUB had no significant relationship with diabetes (p=0. 095)، hypertension (p=0. 917) and type of contraceptive methods (p=0. 906). Analysis by logistic regression revealed that women over 50 years of age and women with history of Cesarean section (C/S) had a respective risk of 2. 284 (p=0. 021) and 2. 493 (p=0. 009) times greater to develop DUB than women without these factors. The age over 50 years and C/S was suggested as risk factors which can be related to DUB. Attention to the advantages of vaginal delivery and complications of C/S is necessary and reduction of C/S rate can be effective in decreasing the incidence of DUB.

Prostaglandin analogs such as misoprostol and dinoprostone are used for ripening of cervix and stimulation of uterine contractions in order to induce vaginal delivery. The aim of this study was: to compare the efficacy of vaginal misoprostol versus dinoprostone for induction of term pregnancies.

This study subjects were pregnant women who referred to maternity ward. A total of 84 women with singleton pregnancy of 37 weeks of gestational age with cephalic presentation، and low bishop scores were recruited. The subjects were randomized to receive either 25 µg misoprostol or 3 mg of dinoprostone intra vaginaly every 6 hours for a maximum of 2 doses.

There was no significance difference in rate of cesarean section between groups. Rate of cesarean in misoprostol group was 45. 2%. Abnormal fetal heart rate 57. 9%، meconium passage 26. 3%، non-response to induction 15. 8% and in dinoprostone group the rate of cesarean section was 5o%. Abnormal fetal heart rate in 42. 9%، meconium passage in 23. 8%، non-response to induction in 23. 8% and arrest of labor in 9. 5% were the clinical indications of cs in dinoprostone group.

This study showed that cesarean section in both groups was high. Furthermore، abnormal fetal heart rate and fetal distress in misoprostol group were higher than dinoproston group.

Unovulation is the most common cause of infertility. The first line oral treatment has been clomiphene citrate. Another anti-estrogen used for ovulation induction is tamoxifen. Many unovulatory infertile women are resistance to anti-estrogens and need another treatment. Alternative treatments are aromatas inhibitors. This study was designed to compare the effectiveness of clomiphene, tamoxifen and letrozole in ovulation induction outcomes in isolated non PCOS unovulatory patients. 150 unovulatory infertile women who had isolated non- polycystic ovarian syndrome (PCOS), randomized to 3 groups. Group A received clomiphene 50 mg to maximum 150 mg for 5 days, Group B received tamoxifen 10mg to maximum 30 mg for 5 days, Group C received letrozole 2.5 mg for 5 days, to maximum 7.5 mg until ovulation was induced. If ovulation failed to occur with 5 days treatments, drug continued for 7 days. Treatment has been stopped if they became pregnant or if patient didn’t ovulate with maximum dose for 7 days (resistant to treatment) or failed to concept after six months despite ovulation (failure of treatment). Main outcome measures were: number of mature follicles, endometrial thickness, pregnancy rate, multiple pregnancy rate, live birth and miscarriage. Overall ovulation rate was 60 (73.4%), this rate in group A was 39 (78%), in group B it was 24 (68%) and in group C was 37 (74%). Pregnancy rate in groups A, B and C were, 32 (64%), 20 (40%), and 25 (50%) respectively, and live birth rate was 22 (44%) in A, 17 (34%) in B and 21 (42%) in C. Miscarriage rate with clomiphene was 10 (20%) while this was 3 (6%) in tamoxifen and 4 (8%) in letrozole group (p=0.05). One twin pregnancy was occurred with clomiphene and one with tamoxifen, while all pregnancies with letrozole were singleton. Because of higher pregnancy rate with clomiphene citrate than tamoxifen and letrozole, Clomiphene citrate is still the first-line therapy for ovulation induction. Surprisingly, pregnancies after tamoxifen and letrozole have lower miscarriage rate than clomiphene.

Menstrual disorders cause a lot of problems for the women. Sometimes diagnosis and treatment of these problems seems very sophisticated. Early diagnosis and treatment of menstrual disorders together with its clinical complications, recognition of their underlying causes and their relation with one another, are essential for treatment of these disorders. The aim of this study was to determine the incidence of menstrual disorders and some of its potential causes in 17 and 18 year old high school female students in Sanandaj in 2005. This was a descriptive-analytic cross sectional study and included 511 high school female students at the age of 17 and 18 years. After obtaining primary information, in case of any menstrual disorder, the subjects were referred to a gynecologist for confirmation of the diagnosis. After confirmation of diagnosis sonographic and hormonal studies were performed. Using SPSS software, the data were analyzed by means of descriptive statistics and x2 test. The incidence of menstrual disorders in the study population was 43.25%. Hypermenorrhea was the most and hypomenorrhea was the least common disorders (13.9% and 3.13% respectively). Polymenorrhea was detected in 13.31% of the cases. The incidence rates of dysmenorrhea, premenstrual syndrome (PMS), and spotting were 78.1%, 72.4% and 8.2% respectively. Menstrual disorders and its symptoms showed no significant relationship with presence of any evidence of PCO in sonoghraphy (P>0.05). High incidence of menstrual disorders in high school students should be taken into consideration and necessary instructions should be given to these students to decrease their stress. In case of persistence of the menstrual disorder, hormonal and sonographic examinations should be performed to detect the underlying cause of menstrual disorder.

Unilateral Twin Ectopic Pregnancy is very rare and only 100 cases have been reported till now. Bilateral Twin Ectopic pregnancy is the rarest type of Dizigotic twin pregnancy. We have reported a case of Bilateral Twin ectopic pregnancy with live simultaneous IIntra Uterine Pregnancy that its prevalence is unclear. We didn’t find any similar cases in the literature. Case: The patient was a 34-year-old woman with intermittent crampic pain in both abdominal lower quadrants for 2 days. The patient had a history of abortion and also a secondary infertility and HMG Injection. The ultra-sonography showed a 12 week pregnancy uterus with bilateral ovarian cyst where one of them was ruptured and a large amount of fluid in pelvic cavity was seen. Therefore, a decision was made for surgery. During operation, two much dilated non ruptured area in left falopian tube and two ectopic pregnancies in the right fallopian tube were seen which one of them was ruptured. Considering the ectopic pregnancy, when encountering women in reproductive age, is necessary and any pregnant woman with abdominal pain must be considered for.

This study was designed to determine the presence of any correlation between 4-hour and 24-hour urine protein values in pregnant women with hypertensive disorders in Besat Hospital, in Sanandaj in 1383. This was a cross-sectional study and included 58 inpatient pregnant women who had been initially diagnosed as having hypertensive disorders in pregnancy. Urine samples were collected in 2 successive periods. The first 4 hour and the next 20-hour urine samples were collected in separate containers. The urine volume, urine protein and creatinine concentration of the 4-hour and 24-hour samples were separately measured and the correlation between both urine samples was determined by Pearson`s Correlation Method. A total of 58 patients were entered into this study, 42 of them with no proteinuria and 16 with mild proteinuria. The value for the 4-hour urine protein was found to correlate with those of the 24-hour samples (R=0.821) in patients with hypertensive disorders in pregnancy. Also sensitivity and specifity of 4-hour urine test were 70.6% and 90.2% respectively. Total protein values of 4-hour urine samples correlated well with those of 24-hour urine samples (p<0.001) of the patients with hypertensive disorders in pregnancy.

Background and ObjectivesHigh blood pressure is one of the causes of blood donor rejection; therefore, detection and treatment of the mild hypertension in donors have an important role in increasing the health level of blood donors and decreasing their hypertension-attributed mortality and morbidity rate and finally in preventing their rejection from blood donation. Materials and MethodsIt is a cross-sectional descriptive study conducted on 1854 donors of Kurdistan Blood Transfusion Center during a 6-month period. Blood pressure of donors is controlled by the physician two times with a 15-minute interval. Demographic data were collected through questionnaire and were analyzed by SPSS and Chi-square test.Results80.9% and 19.1% of the donor population were male and female respectively. Age average was 35.53 ± 11.19 years. Averages of systolic and diastolic blood pressures were 123.02 ± 13.23 mmHg and 77.35 ± 8.88 mmHg respectively. Isolated systolic hypertension was detected in 7.5% and isolated diastolic hypertension in 4.5% of blood donors. 3.4% had mild systolic and diastoic hypertension. There was a significant correlation between sex, age, education status, blood donation and systolic hypertension (p<0.05) and also between age, education status and diastolic hypertension (p<0.005) but there was no correlation between donation, sex and diastolic hypertension. ConclusionsThere was a low prevalence rate of hypertension in blood donors; it can be attributed to blood donor population being young and middle aged, good attention in donor selection, and careful physical examination.

Many pregnant women suffer from heart disease. This disease affect both mothers and fetus. In this study we evaluated the prevalence of cardiovascular disease, the complications during the pregnancy and its outcome come in pregnant women in Sanandaj. This study has been done in pregnant women in Sanandaj during 2002 to 2003. A descriptive-analytic method was used in this study. First the diagnosis of heart disease was established by a cardiac surgeon in pregnant women then the patients were followed during the pregnancy, labor, delivery and in post partum Period. The control group was 100 healthy pregnant women in same age. The data was analyzed by t-test, 2 and Fisher exact test using SPSS soft ware. 3125 pregnant women were considered in this study. The prevalence of heart disease was 1.6%. The cardiovascular diseases affect the outcome of pregnancy significantly. There were 4 cases of abortion, 2 cases of IUFD and 2 neonatal death. Weight gain during pregnancy in pregnant women with heart disease was less than pregnant women in control group. In addition, newborn weight in case group was 2300 gr comparison with 2730 gr in control group. The most common heart disease were mitral stenosis (22%) and mitral valve prolapse (20%). The elective method for delivery in pregnant women with cardiac heart disease is normal vaginal delivery (NVD) and in this study 64.4% of patients had vaginal delivery. According to the results of this study the prevalence of cardiac heart disease in pregnant women in Sanandaj is higher than some studies and causes complications for mothers and newborns.

Pregnancy diabetes is carbohydrate intolerance with different degree of severity that begins at the time of pregnancy or is diagnosed for the first time during that time. The popultation under study consisted of 170 pregnant women with pregnancy diabetes and 250 pregnant women without pregnancy diabetes as control group. Data was collected from patient documents and was recorded in check list.Analyse of data was done by SPSS win software, 2, ficher and t-test. The results of this study showed significant relation between pregnancy diabetes, obesity, patient age, history of abortion, history of stillbirth, infertility, family history of diabetes and hypertension. The above mentioned factors are important risk factors of pregnancy diabetes in this region. This study didn`t show any significant relation between pregnancy diabetes with the number of pregnancies, history of child birth, congenital abnormalities and smoking. With respect to the results of this study, obesity, patient age, history of abortion, history of stillbirth, family history of diabetes, hypertension and infertility are main risk factors of pregnancy diabetes in this region (In other studies, infertility history hasn`t been reported as a risk factor of pregnancy diabetes). By knowing these factors and paying attention to them at the time of pregnancy, it is possible to diagnose those who are at risk and act properly.