فهرست مطالب شهلا یزدانی

Today, abortion treatment is performed legally for reasons such as preserving the health and life of the mother and fetus with disabilities. The aim of this study was to investigate the basic information and determine the main reasons for legal abortions in medical abortions referred from forensic medicine in Babol as a basis for designing and conducting studies in the future regarding the improvement of reproductive health among women of reproductive age.

This cross-sectional study was conducted via census sampling method among 104 cases of medical abortion referred from the forensic medicine of Babol to affiliated hospitals of Babol University of Medical Sciences in 2017-2020. Information related to individual and social factors and maternal and fetal causes leading to abortion was collected by a researcher-made checklist. Then, the data were reviewed and compared in terms of gestational age, termination of pregnancy, and maternal and fetal causes leading to abortion.

The mean gestational age at termination of pregnancy with fetal causes was 16.21±2.35 weeks and for maternal causes was 10.33±3.96 weeks. There was a statistically significant relationship between the history of underlying disease, gender at the time of abortion, gestational age, and the causes of termination of pregnancy (p<0.05). In maternal causes of abortion, the highest frequency (50%) was related to maternal cardiovascular causes, and in fetal causes of abortion, the highest frequency (51.08%) was related to genetic causes of the fetus. Misoprostol was used to terminate the pregnancy of 23.1% of mothers.

The results of the study showed that a large number of cases of medical abortions are related to the fetal cause.

Previous cesarean sections are the most common cause of increased cesarean section in many parts of the world, although it is not always necessary. Considering the high statistics of cesarean section in Iran and especially the high rate of repeat cesarean section and creating motivation for vaginal birth after cesarean section, this study was conducted in order to investigate the maternal and neonatal outcomes of vaginal birth after one cesarean section.

This cross-sectional study was conducted on 104 pregnant women with a previous caesarean section and transverse incision on the lower segment in Ayatollah Rouhani Hospital of Babol in two groups; 50 people in the first group who underwent repeat emergency cesarean section and 54 people in the second group who consented to vaginal birth after cesarean section (VBAC). Demographic characteristics and maternal and neonatal complications were investigated and compared between the two groups.

In this study, there were no significant differences between the two groups in terms of demographic characteristics. Infant mortality rate was reported in 6 cases (12%) in the first group and 2 cases (3.7%) in the second group. Furthermore, 3 babies (6%) in the repeat cesarean section group and 9 babies (16.7%) in the vaginal birth group after cesarean section were admitted to the neonatal intensive care unit. The 5-minute Apgar was also significantly higher in the babies of the vaginal birth group after cesarean section (p=0.04). The duration of mother's hospitalization was 3.98±5.53 and 2.11±0.31 days in the repeat cesarean and vaginal birth groups, respectively (p=0.02).

According to the results of this study, maternal and neonatal complications did not increase in vaginal birth after cesarean section, and if the mother wishes, vaginal birth can be performed after one cesarean section.

Ultrasound is performed to check the growth of endometrial cells outside the uterus and the pathology is performed to confirm endometriosis. A combination of diagnostic methods is important for summarizing and starting treatment of endometriosis. The present study was performed with aim to investigate and compare clinical and ultrasound diagnoses in patients with histopathological diagnoses of endometriosis.

This retrospective study was conducted in 2010-2021 on 140 women aged 18-65 years old suffering from endometriosis referred to Ayatollah Rouhani Hospital in Babol city. Confirmation of endometriosis was done based on tissue pathology and then comparing clinical history with ultrasound findings. The data collection tools were the patients' files and the researcher made checklist. Collected data included clinical manifestations, presence or absence of pain during menstruation, abdominal pain, pain during intercourse, pelvic pain, abnormal menstrual bleeding, backache, pain during defecation, and dysuria. Data were analyzed by SPSS software (version 22) and chi-square and independent t-tests. P<0.05 was considered statistically significant.

Dysmenorrhea (55.63%), abdominal pain (48.59%), and dyspareunia (31.69%) were the most common clinical symptoms. The state of uterine echogenicity was reported to be homogeneous in 99 patients (69.7%) and heterogeneous in 43 (30.3%). Echogenic status had a significant relationship with abdominal pain (p=0.004) and abnormal menstrual bleeding (p=0.032), adenomyosis with abdominal pain (p=0.004), ovarian adhesion with complaints of pain during intercourse (p=0.002) and status of fallopian tubes with complaints of pain during intercourse (p=0.015) and dysuria (p=0.049).

Dysmenorrhea, abdominal pain, dyspareunia, abnormal menstrual bleeding, and dysuria had significant difference with ultrasound findings. For definitive diagnosis and appropriate treatment, clinical manifestations, pathology, and ultrasound should be considered and treatment should be carried out based on that.

The aim of this study was to find the causes of failure of natural childbirth in late-term pregnancy that can be useful for managing childbirth in these pregnant mothers and to design a solution to increase natural childbirth.

This cross-sectional study was conducted in the community of pregnant women with a late-term pregnancy of more than 41 weeks. The studied sample includes 148 pregnant mothers who were referred to Ayatollah Rouhani Hospital in Babol from March 2018 to February 2020. Mother's age, Body Mass Index, gestational age, number of pregnancies, number of deliveries, length of hospitalization, the state of the cervix and preparation method of the cervix for termination of pregnancy were extracted and recorded from patients' files. Data were compared in two groups of pregnancy termination methods (natural childbirth and cesarean delivery). Statistical analysis was done using SPSS software, version 22 (IBM SPSS, Armonk, NY, USA) and Chi-square test and Student’s t-test statistical tests and logistic regression model fitting. P-value less than 0.05 was considered significant.

In this study, 167 pregnant women with late-term pregnancy were studied. The age of pregnant women is reported with mean of 26.03 and standard deviation 5.98 of years. The high Bishop variable, with odds ratio of 0.44, is a variable protective factor for cesarean delivery (P=0.001). Higher body mass index with odds ratio of 1.09, is also known as a risk factor for cesarean delivery (P=0.01), so that for each unit of increase in Bishop score, the chance of cesarean delivery decreases by 56% and for each unit of increase in body mass index, the chance of cesarean delivery increases by 9%.

This study showed that nearly half of cases of late pregnancies lead to normal delivery. High body mass index reduces the chance of normal delivery in late term pregnancies. But a higher Bishop score can be effective in the success of natural delivery.

Anemia increases the risk of adverse pregnancy outcomes including preterm delivery and low birth weight. This study was performed with aim to determine the relationship between the severity of anemia with preterm delivery and low birth weight and the level of hemoglobin which causes these consequences.

This cross-sectional study was conducted in 2019-2020 on 737 pregnant women referred to Ayatollah Rouhani Hospital in Babol who underwent delivery. Demographic information, hemoglobin level of mothers, gestational age, type of delivery, weight, height, head circumference and Apgar of the newborn were recorded in the checklist. Data were analyzed by SPSS (version 25) and univariate ANOVA, t-test, Chi-square and correlation coefficient tests.

The prevalence of anemia in pregnant mothers was estimated at 24.15%. Gestational age, weight, height, head circumference, and Apgar of the newborn were significantly lower in the anemic group (p<0.001). By dividing the mothers into two groups of term and pre-term, there was no significant difference in their hemoglobin level (p=0.11); however, by dividing preterm mothers into early and late preterm groups, hemoglobin was reported to be lower in early preterm mothers (p=0.004). It was found that hemoglobin less than 11.7 g/dL in a pregnant mother increases the risk of preterm delivery (less than 34 weeks) and birth weight less than 2500 g.

It seems that despite reaching the hemoglobin to the minimum normal level, there is still a significant possibility of adverse outcomes in the newborn, so one should try to keep the hemoglobin level above the minimum normal level.

There are many studies on the health effects of dietary advice and physical activity in pregnancy while only a few reported the effects of simultaneous administration of motivational interviewing, dietary advice, and physical activity on neonatal outcome in pregnant women with metabolic syndrome (MetS). This study was designed to examine the effects of these interventions on fetal-neonatal outcome in pregnant women with MetS.

A randomized, single‑blind, controlled clinical trial was performed in 120 pregnant women with metabolic syndrome at 15- 20 weeks of gestation in two hospitals in Babol, north of Iran, 2018. The participants were allocated into two groups (n= 60 per group) using blocking randomization and were followed up until the end of pregnancy. Fetal-neonatal outcomes were compared between the two groups from week 32 of pregnancy. The interventional program included one motivational interview, two nutrition consultation sessions, and three sessions of physical activity (per week).  The control group received routine care. Demographic and fertility characteristics, anthropometric measurements, and biochemical and pregnancy outcomes were recorded. Data analysis was done applying independent t test, ANOVA, and logistic regression.

The incidence of respiratory distress syndrome was found to be significantly lower in intervention group (3.7%) compared with the control group (14.5%) at the end of the pregnancy (P=0.01).

Dietary recommendations, motivational interviewing, and physical activity in pregnant women with MetS during prenatal care can be used as safe and practical interventions to prevent respiratory distress syndrome.

Drug addiction causes complications such as preterm delivery, miscarriage, intrauterine growth retardation, prenatal mortality, placental abruption, preeclampsia, premature rupture of membranes, increased cesarean section and congenital anomalies. Therefore, this study was performed aimed to investigate the prevalence of substance abuse and pregnancy outcomes.

This study was conducted in two stages, initially a cross-sectional study was performed in all pregnant women referred to the maternity ward of Ayatollah Rouhani Hospital in Babol from April 2017 to March 2019. Then, a historical cohort study was conducted in which the subjects were divided into two groups: 112 addicted pregnant women and 224 non-addicted pregnant women. Data collection tool was a researcher-made checklist including: demographic information, maternal complications, and fetal-neonatal complications. Data were analyzed using SPSS software (version 21) and T-test and Chi-square test. P<0.05 was considered statistically significant.

The prevalence of addiction was 1.66% among 6713 pregnant women during these three years. Maternal, fetal and neonatal complications showed a significant increase among addicted mothers compared to the control group (P = 0.0001). Premature rupture of membranes in 44 women (39.28%) and preterm delivery in 32 (28.57%) were the most common complications. The chance of premature rupture of the amniotic sac was 9.09 times with a 95% confidence interval (0.058-0.211) and the chance of preterm delivery was 5 times higher with a 95% confidence interval (0.107-0.388) in addicted mothers. The chance of respiratory distress in infants born to addicted mothers was 10 times higher with a 95% confidence interval (0.058-0.227).

Addiction during pregnancy is associated with many maternal, fetal and neonatal complications, so it is recommended that a comprehensive and specific program be performed for diagnostic, treatment and rehabilitation measures, especially to reduce the damage caused by addiction for women.

Supplying vitamin D during pregnancy is necessary for fetal calcium homeostasis and bone growth and its mineralization, and its deficiency can lead to pregnancy complications. The present study was conducted to investigate the effect of vitamin D level on pregnancy outcomes in pregnant women.

This cross-sectional study was conducted among 450 pregnant women referring to Ayatollah Rouhani Hospital in Babol. Mothers' information was collected using a questionnaire. Blood samples were collected from people to measure the serum 25 hydroxyvitamin D3 level by ELISA method using the EUROIMMUN kit. Patients were divided into two groups (vitamin D level< 25 and vitamin D level> 25) and were compared.

247 people (54.8%) had vitamin D level< 25 and 203 people (44.8%) had vitamin D level> 25. People with lower vitamin D levels had significantly more gestational hypertension (p=0.03) and premature rupture of membranes (PROM) (p=0.04) compared to people with higher vitamin D levels. The variables of labor pain, diabetes, fetal growth restriction and prolonged pregnancy did not show significant differences in people with high and low levels of vitamin D. Pregnancy complications including pre-eclampsia, preterm delivery, placental abruption and fetal growth restriction did not show any significant difference in people with high and low levels of vitamin D. In the evaluation of neonatal outcomes, infant weight, infant gender, fifth minute Apgar, head circumference and admission to the neonatal intensive care unit, no significant differences were found.

The results of the study showed that some pregnancy complications such as gestational hypertension and premature rupture of membranes (PROM) in pregnant women are related to vitamin D deficiency. Therefore, it is necessary to design plans to check the vitamin D level of mothers before pregnancy and correct it during pregnancy.

Human papillomavirus (HPV) is one of the common infectious and pathogenic agents, and some of its genotypes have the ability to cause malignant changes in the surface of mucous cells. By examining the prevalence of HPV in atypical squamous cells of undetermined significance (ASCUS) Pap smear according to the risk factors, we can make a more correct decision in choosing the evaluation method and directing the patient to report the ASCUS lesion. Therefore, the aim of this study is to investigate the types of human papillomavirus (HPV) in patients with ASCUS Pap smear.

This cross-sectional study was conducted on 200 patients with ASCUS pap smear results and HPV test referred to the colposcopy clinic of Babol Ayatollah Rouhani Hospital during the last two years. Demographic information, history of obstetrics, history of OCP use, history of STD disease and high-risk behaviors, cervical treatments, HPV typing, Pap smear, colposcopy and cervical biopsy results were recorded and analyzed.

The mean age of the patients was 33.83±8.09 years, and ASCUS pap smear showed 129 cases (64.5%) of high-risk papillomavirus, 16 cases (0.8%) of low-risk papillomavirus and 55 cases (27.5%) of both types. Cervical intraepithelial neoplasia grade 2 was in 18 cases (0.9%), cervical intraepithelial neoplasia grade 1 in 10 cases (0.5%) and cervical intraepithelial neoplasia grade 3 in 2 cases (0.1%). 17.1% of high-risk viruses caused cervical neoplasm. None of the low-risk viruses led to neoplasms and all of them were inflammatory. In both high-risk and low-risk cases, 14.5% neoplasm was seen. However, the relationship between the type of papillomavirus and the incidence of neoplasm was significant (p=0.058).

Based on the results of this study, the ASCUS pap smear needs more detailed investigation such as colposcopy and cervical biopsy under the supervision of experts because it is associated with the high-risk HPV virus in many cases.

Mature cystic teratoma of the ovary is one of the most common benign ovarian tumors, which may be confused with other adnexal lesions due to its extensive manifestations on ultrasound. Therefore, in this study, we tried to reduce the need for pathology frozen sections by examining more accurate preoperative ultrasound results and classifying ovarian lesions based on them.

In this study, 200 female patients with a definitive diagnosis of mature cystic teratoma of the ovary who have undergone surgery at Ayatollah Rouhani Hospital, February 2009 March 2019 were evaluated. After reviewing the files, demographic information, Ultrasound, intraoperative findings and final pathology were extracted and finally, the data were analyzed using statistical tests.

The age range of patients who were diagnosed with mature cystic teratoma of the ovary in the final pathology was 14-71 years. Most cysts were 5-10 cm in size. 86% of patients had unilateral right-sided ovarian involvement. The most common components of this cyst in the macroscopic report were hair (81%) and fat (80%). The diagnostic value of ultrasound for the diagnosis of mature teratoma of the ovary was 74.5%. The frozen section was used to diagnose and rule out the malignancy in 32.5% of patients.

The results of this study show that the prevalence of these tumors is higher in the reproductive age range. According to this study, these tumors have been seen in single people and pregnant women, Due to youth and fertility in the future, a good decision must be made about the surgical method. These tumors have a wide range of sizes. In addition, their most common complaint is abdominal pain, but it has been reported extensively in periodic ultrasounds for infertility. The diagnostic value of ultrasound for mature ovarian teratoma was high due to the presence of fat and hair in them. Therefore, the use of the frozen section (intraoperative pathology) can be reduced in more often unnecessary in cases.

Perinatal mortality rate (PMR) is one of the main indicators in evaluation of health community and healthcare systems. This study was performed to determine the perinatal mortality rate in the referral third level of maternal and infant care center affiliated to Babol University of Medical Sciences.

This descriptive-analytical study was performed on by cross-sectional method and 19234 births (9751 male and 9483 female) from 22 weeks gestation to 29 days after delivery Ayatollah Rouhani Hospital in Babol, northern Iran during 2011-18. Data on the cause of neonatal death, maternal age, type of delivery, malformations, maternal underlying disease, maternal pregnancy-related conditions, and diseases at the time of death in neonate were collected from website of the Ministry of Health. Then each of the indicators was calculated per 1000 live births.

In this study, the PMR was calculated per 1000 live births which was 29.01 (boys 16.17 and girls 12.84). The portion of vaginal delivery was 9.67 and cesarean section was 19.34. Out of 558 perinatal deaths, 59.9% died due to intrauterine death with an index of 17.37 and 40.1% of deaths were due to infant death with an index of 11.63. Most neonatal deaths (74%) occurred within the first 24 hours of birth and in terms of gestational age 86.02% were <37 weeks of gestation with an index of 24.95, and low birth weight were 83.8% with an index of 24.31. Underlying disease was found in 25.6% of mothers and pregnancy-related conditions in 74.4% of cases. Fetal distress in 14.4% with an index of 4.20 was the most common disease associated with infant death or cause of death in preterm infants. Other causes of perinatal death were specific disorders of perinatal origin, birth defects, chromosomal abnormalities, and accidents were 10.09, 4.06, and 0.58 per 1000 live births, respectively.

The most and important factors of prenatal mortality wrer prematurity and low birth weight that major causes include maternal pregnancy-related conditions and maternal underlying disease, Therefore, emphasis on adequate prenatal care, identification and follow-up of mothers with underlying diseases can be effective in reducing perinatal mortality.

Molar pregnancy is a type of abnormal pregnancy which is divided into complete and partial hydatiform mole. Its incidence varies in different countries and in different regions in every country. Its incidence is higher in Asia than elsewhere in the world, whereas occasionally its risk factors and clinical symptoms are different in various regions. Therefore, this study was performed with aim to evaluate the risk factors and clinical symptoms of hydatiform-mole in pregnant women referred to Ayatollah Rouhani hospital in Babol.

This retrospective descriptive study was performed on all pregnant women of hydatiforme mole with histopathologic definite diagnosis referred to the educational-therapeutic center of Ayatollah Rouhani Hospital in Babol from 2011-2017. Patients' information including demographic and clinical profiles was provided in a checklist format. Data were analyzed by SPSS software (version 18) and Chi-square and one-way ANOVA tests. P<0.05 was considered statistically significant.

In this study during 2011-2017, there were 19145 pregnancies in Babol Rouhani hospital. According to the pathology report, 70 cases of molar pregnancy were recorded. There were 41 (58.6%) of partial hydatidiform mole and 28 (40%) of complete hydatidiform mole. Most patients with molar pregnancy were in the age range of 20-35 years. 31 patients (44.3%) had O blood group. The most common symptom of the patients was bleeding 43 (61.4%).

The incidence of molar pregnancy was high compared with other parts of the world and the prevalence of partial hydatidiform mol was higher than other studies. The risk factors for molar pregnancy were: history of molar pregnancy, and O positive blood group. The most common clinical manifestation of molar pregnancy was bleeding.

Ectopic pregnancy is a common complication and one of the causes of pregnancy-related deaths. Considering the increased prevalence of ectopic pregnancy in recent years and the increased risk factors such as assisted reproductive treatment, the present study was conducted to investigate the risk factors for ectopic pregnancy in Babol, northern Iran.

This case-control study was performed on pregnant women who were admitted with suspicion for ectopic pregnancy or acute abdomen within a 6-year period. Patients diagnosed with ectopic pregnancy were selected in the case group and the control group was selected from among the pregnant women's medical record during the same years. Patients were examined in terms of age, parity, history of abortion, type of contraception, history of ectopic pregnancy, history of pelvic infections, history of cesarean section, infertility treatment, history of smoking, marriages within the family, medical history and underlying disease.

In this study, 201 patients were examined in each group. The mean age for the case group was 29.75±5.6 and for the control group was 28.62±6.4 years. Among the risk factors, assisted reproductive treatment (OR=10.24, p≤0.001), abdominal and pelvic surgery (OR=2.35, p=0.002), infertility (p=6.76, p<0.001), contraceptive pills (OR=0.61, p<0.001) and nulliparity (OR = 1.61, p=0.019) were associated with increased risk of ectopic pregnancy.

According to the results of this study, the most important risk factors for ectopic pregnancy are the use of hormonal pills to prevent pregnancy and nulliparity, respectively.

Ovarian cancer is the sixth common cancer among women in the world. Preoperative blood cell count can be a biomarker that predicts the severity of different types of cancer and determine the type of surgery. Therefore, the present study was conducted to determine the predictive role of the three blood markers of anemia, leukocytosis and thrombocytosis in the stage and grade of epithelial ovarian cancer before the operation. In this cross-sectional study, the data of 60 patients with epithelial ovarian cancer were evaluated. Demographic data, hemoglobin, white blood cell count and platelets were statistically compared based on the stage of disease and the grade of mass differentiation as good, moderate and undifferentiated. 61.1% of patients with thrombocytosis were in stage 3 and 33.3% of patients with leukocytosis were in stage 2 (p≤0.05), while 20.5% of the patients with anemia were in stage 3 (p>0.05). Moreover, 52.4% of patients with leukocytosis and 61.1% of patients with thrombocytosis had grade 3 tumor (p≤0.05), but only 34.1% of patients with anemia were in this group (p>0.05). Based on the evaluation of the ROC curve, cut-off point of the white blood cell was calculated to be 9050/ml with a sensitivity of 64% and specificity of 65% and platelet count was calculated to be 266000/ml with a sensitivity of 88% and specificity of 53%. Based on the results of this study, preoperative leukocytosis and thrombocytosis were correlated with stage and grade of epithelial ovarian cancer and had a predictive role.

Intracellular magnesium is a cofactor for several enzymes in carbohydrate metabolism. The aim of this study is to demonstrate the role of magnesium as an effective and an underlying factor in disrupted glucose metabolism among pregnant women with and without gestational diabetes mellitus (GDM).
This cross-sectional was conducted among 24-32 weeks pregnant women admitted to gynecology clinic of Ayatollah Rohani Hospital in Babol. Patients were divided into four groups: healthy pregnant women, pregnant women with high-risk gestational diabetes, pregnant women with gestational diabetes mellitus and pregnant women with overt diabetes. The demographic information was gathered using a questionnaire and the serum level, magnesium RBC and the fasting blood sugar were measured by laboratory methods and were compared between the four groups.
FINDINGS: 399 patients with mean age of 26.53±5.54 participated in this study. Overall, mean serum magnesium level was 1.71±0.12 mg/dL and magnesium level in RBC was 4.88±0.29 mg/dL. The mean serum magnesium level was 1.73±0.10 in healthy pregnant women, 1.73±0.12 in pregnant women with high-risk gestational diabetes, 1.71±0.13 in pregnant women with gestational diabetes mellitus and 1.64±0.15 in pregnant women with overt diabetes and there was a significant difference between the four groups (p=0.001). The result regarding RBC magnesium level was found to be 5.12±0.18, 4.81±0.23, 4.77±0.24 and 4.66±0.38 in healthy pregnant women, pregnant women with high-risk gestational diabetes, pregnant women with gestational diabetes mellitus and pregnant women with overt diabetes, respectively, which was significant (p=0.001). Serum level and RBC magnesium in diabetic women was less than non-diabetic women.
Results of the study demonstrated that magnesium could be an effective and an underlying factor in identification of disrupted glucose metabolism in pregnant women.

Clinical Grand Rounds method is a common clinical training in most of university hospitals. Its purpose is to provide an opportunity for students to link their practical realities to theoretical ones. The study purpose was to compare the views of trainees, interns, residents, and teachers about grand rounds method at Iran University Medical Sciences in Iran.
This study is descriptive analytical performed on 237 individuals including trainees, interns assistant, and professors of teaching hospitals affiliated to Iran University of Medical Sciences using census method. The designed questionnaire used Likert type multiple-choice questions. The data were analyzed through SPSS v.21.
The results showed that 29.4% of interns and externs showed assessed Grand Rounds training as very well and good, 36.3 as moderate and 34.3% of poor and very poor. But 62% of professors and residents’ assessment was very good and good, 27.6 moderate and 10.4% of poor and very poor. The quality of Grand Round based on type of participants’ ward was: interior1.89%, surgery 1.87%, pediatrics 1.87%, gynecology 2.1%, and also for their academic levels as interns1.85%, externs 1.82%, residents 1.92%, and for professors as 2.13%
The results showed that undergraduates’ attitude toward medical Grand Round is more negative than residents. The dissatisfaction of medical students of Grand Rounds was mostly due to lack of participation because of large number of students. Strengths of Grand Rounds include strengthen reasoning skills, improving decision making, scientific findings, motivating students in education, ethics and professional communication, and evidence-based medicine.

Aim and The pathophysiologic changes of Hypertrophic Cardiomyopathy is complex and the physiologic changes of pregnancy and anesthesia for cesarean section have a great effect in the hemodynamic and it can even lead to maternal death. We report a 21-year pregnant woman with HCM who were candidate for elective cesarean section. Case report: A21-year-old woman, gestational age 38 weeks, with a history of Hypertrophic Cardiomyopathy who candidate for elective cesarean section.. Epidural anesthesia was performed with lidocaine% 1. The patient was discharged after 72 hours without any complication. We recommend epidural anesthesia with lidocaine for cesarean section in a patient with Hypertrophic Cardiomyopathy.

Premature delivery is the presence of progressive uterine contractions before reaching 37 weeks of pregnancy. Since it is associated with perinatal complications and high costs, this study aimed to study the risk factors for premature delivery. This cross-sectional study was conducted on 377 pregnant women with preterm labor (23-37 weeks) and 423 pregnant women of term delivery referring to Ayatollah Rohani Hospital of Babol city, Iran. We extracted and investigated the subjects’ demographic data, history of infertility, smoking habits, use of drugs, fast food consumption, history or presence of maternal illnesses and surgery, Urinary Tract Infections (UTI), Oligohydramnios, intrauterine growth restriction (IUGR), embryonic anomalies, premature rupture of membranes, vaginal bleeding as well as the neonatal data. As observed in the two groups of preterm and term delivery respectively, there was employment during pregnancy in 83 (22%) and 51 (12%) cases, a history of preterm labor in 41 (10.9%) versus 21 (5%) cases, bleeding during the first trimester in 118 (31.3%) versus 61 (14.4%) cases, fast food consumption in 34 (9%) versus 14 (3.3%) cases, UTI in 150 (39.8%) versus 111 (26.2%) cases, anemia in 62 (16.4%) versus 29 (6.9%) cases, hypertension in 72 (19.1%) versus 13 (3.1%) cases and finally, smoking habits in 22 (5.8%) versus 5 (1.2%) subjects. There was a statistically significant association between the aforementioned variables (p<0.05). According to the results of this study, the most significant risk factors for premature delivery could be managed and controlled

In the patients diagnosed with abnormal uterine bleeding, if the patient does not respond to drug treatment or is not a good candidate for hysterectomy, endometrial destruction is recommended. The aim of this study was to evaluate complications, blood loss and patient satisfaction regarding this method of treatment. This retrospective study was performed on 56 women who admitted to Ayatollah Roohani Hospital of Babol and Imam Hossein Hospital in Tehran, Iran. Upon the diagnosis of abnormal uterine bleeding, they underwent a treatment called "endometrial destruction by thermal balloon". A questionnaire including the following items was completed after the sugery: demographic characteristics, menstrual status, postoperative complications, treatment success and a 12-month post-surgery patient satisfaction. In order to assess the patients’ satisfaction, 4 questions were asked (excellent, good, fair, poor). Successful treatment was defined as 6 months of amenorrhea after treatment with cavaterm and a reduction in the menstrual blood loss in the form of spotting or volume degression. Of the 56 patients who were treated with balloon thermal endometrial destruction, 4 were excluded due to the lack of follow-up. The mean age of the patients was 91/5±38/43 years. No complications occurred in any of the new patients, and the percentage of amenorrhea was 23 after the treatment. Twelve months after the surgery, the success of treatment was reported in 46 patients (5/88%) and patient satisfaction was also rated in 45 of the patients (5/86%). The results of the study showed that the thermal balloon treatment had no major side effects. Thus, it could be inferred that the study was a success in terms of the outcomes and high patient satisfaction. This method could be taken into consideration before a hysterectomy.

Accurate fetal weight estimation is clinically important because of known complications of the wrong estimation. Since there are different ideas about fetal weight estimation methods, this study was designed to compare fetal weight estimation with clinical and ultrasonographic methods, and combined formula of ultrasonography and maternal weight. This descriptive-analytic study was conducted on 160 singleton pregnant women with gestational age of 37-41 weeks in Ayatollah Rohani hospital of Babol, Iran during 2010-2011. Fetal weight was estimated clinically by Leopold's maneuvers, ultrasonographic and a combination of ultrasonography and maternal weight (Hart formula). Birth weight of neonates was measured accurately during less than three days after estimating fetal weight and child birth. Estimation error and percentage of estimates within 10% of actual birth weight were measured and analyzed by SPSS software version 18, t-test and Pearson correlation coefficient tests. P value less than 0.05 was considered significant. Mean of actual birth weight was 3422.56±442.24 grams. Mean of fetal weight estimation with clinical, ultrasonographic, and Hart formula methods were respectively 3395±336.28, 3367.57±388.11, and 3178.89±428.71 grams. Clinical estimation had fewer errors in weight estimation. The percentage of estimates within 10% of actual birth weight was 74.4% in clinical, 73.1% in ultrasonographic estimation by Hadlock Ш formula, and 3.46% in Hart formula methods. The difference between clinical estimation by Leopold's maneuvers and ultrasonographic method was not statistically significant (p=0.79). The estimate within 10% of actual birth weight with Hart formula was significantly different with two other methods (p=0.001). Both clinical estimation by Leopold's maneuvers and ultrasound assessment (Hadlock III) of fetal weight are associated with actual birth weight but hart formula assessment has less accuracy in compared of two methods.

Polycystic ovary syndrome (PCOS) is one of the most widespread illnesses of endocrine system in women at reproductive age. The Other studies have shown PCOS as a risk factor to increase the prevalence of pregnancy complications such as pre-eclampsia and gestational diabetes. The aim of this study was to compare the pregnancy outcome in women with and without PCOS. This case-control study was conducted on 120 pregnant women with and without PCOS syndrome who referred to Fatemeh Alzahra infertility clinical center and Ayattolah Rohani hospital since 2010 to 2012 in Babol، Iran. Demographic information and maternal and neonatal outcomes of two groups were extracted from the files of patients and recorded in a questionnaire. Data were analyzed by SPSS software (version 18)، chi-square test and t-test. P value less than 0. 05 was considered significant. 60 women of 120 participants had PCOS and 60 women had not. The mean age of PCOS group was 26. 4±9. 42 and control group was 26. 18±5. 43 years، that was not significant (p=0. 81). In pregnancy complications، there was no significant differences between two groups in terms of the ratio of intra uterine fetal death (p=0. 09)، intra uterine growth restriction (p=0. 59) and neonatal weight (p=0. 1). Preterm labor was seen in 16 women of PCOS group (32%) and 7 women of control group (11. 7%) that the difference was significant (p=0. 009). 10 cases of abortion occurred in PCOS group and 2 cases in control group that the difference was significant (p=0. 001). Some pregnancy complications such as abortion and preterm labor were seen more in women with PCOS who need more attention during pregnancy.

Surgical wound infection is the most common complication following surgery. This study was done to determine the incidence risk factors of surgical wound infection following abdominal hysterectomy. This descriptive study was done on 400 patients who underwent abdominal hysterectomy in Babol، North of Iran، during 2008-10. Age، underlying disease، BMI، use of immunosuppressive drugs hospitalization period prior to surgery، shaving and bath time، prophylactic antibiotic، duration of surgery، diagnosis and pathology were recorded for each patient. Evidence of surgical location of infection including surgical discharge، erythema and dehiscence of surgical wound with and without fever during 10 days after surgery were recorded. Surgical wound infection was seen in 26 patients (6. 5%) following abdominal hysterectomy. Regression analysis determined، use of immune-suppressive (95% CI: 1. 71-480. 30، P=0. 020، OR: 28. 70) and emergency operation (95% CI: 1. 42-14. 39، P=0. 011، OR: 4. 52)، diabetes (95% CI: 1. 23-11. 26، P=0. 020، OR: 3. 72) were risk factors for surgical wound infection. Immuno-suppressive agents، emergency operation and diabetes increased surgical wound infection in post- abdominal hysterectomy.

Pre-eclampsia is one of the most important complications in pregnancy. Early detection of pre-eclampsia in prenatal care is important. The aim of this study was to evaluate the value of increased levels of hemoglobin and hematocrit in first and second trimesters of pregnancy in predicting pre-eclampsia.

This case-control study was conducted on 140 pregnant women referred for delivery to Ayatollah Roohani hospital of Babol، Iran. Women with no signs of chronic hypertension، diabetes، kidney disease، smoking and using drugs that affect blood parameters were chosen. Data about pregnant hospitalized women، 70 ones diagnosed with pre-eclampsia (case group) and 70 ones from healthy pregnant women (control group) was filled in special forms and compared.

The mean age of patients was 27. 21±5. 7. The mean and standard deviation of hemoglobin in first trimester in case and control groups was 12. 82±1. 10 and 12. 30±1. 39، respectively (p=0. 016). The mean and standard deviation of hemoglobin in second trimester in case and control groups was 11. 90±1. 39 and 11. 46±1. 37 respectively (p=0. 011).

This study showed that the level of hemoglobin and hematocrit in first and second trimesters of pregnancy is associated with preeclampsia.

The rate of preterm labor in twin pregnancy is 7 times more than singleton pregnancy. Due to applying cerclage as prophylaxis for preventing preterm labor in some centers، we decided to compare the outcome of twin pregnancies between a group who were applied cerclage and a group who were not applied cerclage. This case-control study was done on 115 cases of twin pregnancy with gestational age of 20-40 weeks who referred to Ayatollah Rouhani hospital in Babol، Iran in 2010-2012. Cases were divided into two groups. 80 cases without cerclage (group 1) and 35 cases with the use of MacDonald cerclage (group 2). The clinical and demographic data were recorded in questionnaires. Data were analyzed using SPSS software version 18 and t-test، chi-square and Fisher''s exact test. P value less than 0. 05 was considered significant. The mean of gestational age in time of delivery was 34. 36±3. 65 weeks in group 1 and 34. 11±5. 05 weeks in group 2، that the difference was not significant (p=0. 794). The rate of preterm labor was 52 women (65%) in group 1 and 20 women (57. 1%) in group 2، that the difference was not significant (p=0. 089). No significant difference was found regarding maternal and neonatal outcomes in two groups (p=0. 514). Cerclage has no effect on preventing preterm labor and complication of prematurity in twin pregnancy.

Emergency peripartum hysterectomy (EPH) is a major surgery that usually performs in severe and life threatening bleeding after vaginal or cesarean delivery. Since، maternal morbidity and mortality is important in health system of our country so we studied incidence، indications، risk factors and complications of this surgery in pregnant women undergoing emergency peripartum hysterectomy at the hospitals of Babol University of medical sciences during 10 years. This cross-sectional study was performed on pregnant women undergoing emergency peripartum hysterectomy in Shahid Yahyanejad and Ayatollah Roohani hospitals of Babol، Iran during 2002-2011. Data such as demographic data، type of delivery and hysterectomy، amount of blood transfusion، days of hospitalization، maternal and neonatal morbidity and mortality were gathered and the results were analyzed. Twenty two EPH cases were identified among 37595 deliveries giving an incidence of 0. 5 per 1000 deliveries that its rate in cesarean section delivery was 0. 7 per 1000 and in vaginal delivery was 0. 2 per 1000. The most indications of peripartum hysterectomy were 8 cases with uterine atony (36. 4%) and 6 cases with abnormal placentation (27. 3%)، and the cesarean section and curettage were major risk factors for abnormal placentation. Blood transfusion was performed in all of patients and intra and postoperative complications included: 11 cases (84. 6%) with intensive care admission that 5 cases (38. 5%) of them had febrile morbidity and also 2 cases (15. 2%) of them had vesical and urethral injury. There was 3 (13. 6%) maternal death due to hemorrhagic shock. According to the results of this study، incidence of EPH in our study was more in cesarean section than vaginal delivery and history of previous cesarean section and curettage were the risk factors for abnormal placentation.