فهرست مطالب صغری ربیعی

Mycoplasma hominis is one of the smallest bacteria isolated from a natural source and is sometime as pathologic flora in plants, animals, and humans. Some of these bacteria are normal flora of the respiratory and genital systems. The aim of the study was molecular identification of M. hominis in a vaginal sample of women referred to the infertility center of Fatemieh Hospital in Hamadan.

In this Cross-sectional study, vaginal swab samples were collected from symptomatic females and M. hominis was identified by PCR and Real-Time PCR. DNA was extracted using an extraction kit. M. hominis strains were identified using 16 S rRNA gene. Finally, Statistical analysis was performed using SPSS 21 software.

A total of 234 vaginal samples were studied in women with a mean age of 39.8years. The results showed that M. hominis was identified by PCR (13%) and Real-time PCR (15%) methods, respectively. There was a significant relationship between PCR and Real-Time PCR methods (P≤0.05).

Real-time PCR assay was successfully used for rapid and accurate diagnosis of M.hominis. This method has significant potential for rapid, accurate, and is highly sensitive molecular detection of M. hominis compared to the PCR technic.

Cesarean section is performed with two technique of closure or non-closure of the peritoneum, but there is disagreement about the advantages and disadvantages of these techniques. Accordingly, this study was performed with aim to compare the early maternal complications of cesarean section in two technique of closure or non-closure of the parietal peritoneum.

This double-blind randomized clinical trial study was performed on 120 patients undergoing cesarean section at Hamadan Fatimah Hospital in 2019. Samples were randomly divided into two groups: closure of the peritoneum (n=60) and non-closure of the peritoneum (n=60). The maternal complications during and after surgery were recorded. Data were analyzed by SPSS software (version 21) and Chi-square, independent t-test and repeated measures.

The results showed that operative time and bleeding during surgery were significantly fewer in patients receiving non-closure technique (p<0.05). Also, the duration of ileus, the amount of received analgesic, and pain 12 and 24 hours after the surgery were significantly lower in patients receiving non-closure technique (p <0.05). However, there was no significant difference between the two groups in terms of pain after 6 hours of the surgery and the symptoms of surgical wound infection (p> 0.05).

The complications such as bleeding during surgery, the duration of surgery, ileus after surgery, pain, and consumption of analgesic will occurs with less intensity in patients receiving non-closure technique than patients with closure technique; however, these two methods were not different in terms of surgical wound infection.

Maternal BMI (body mass index) plays an important role in pregnancy outcome that can lead to more surgical complications in pregnant women. The aim of this study was to determine the prevalence of Maternal Short-Term Complications of cesarean section and its relationship with body mass index.

This cross-sectional study was performed on 120 patients undergoing cesarean section at Hamadan Fatemieh Hospital in June-July 2019. Samples were selected by random sampling. duration of surgery, bleeding during surgery, duration of ileus, pain, analgesic dose, surgical wound inflammation, surgical wound secretion and redness were evaluated by checklist. Data were analyzed in SPSS 23 using descriptive and inferential statistics.

The results showed that the mean duration of surgery was 44 minutes, mean bleeding during surgery was 776 ml, duration of ileus 17 hours, pain rate was 4.82 and the mean analgesic dose was 1.66 diclofenac. The incidence of inflammation was 4/2%, surgical wound secretion 4/2% and wound area redness 5/8%. There was a positive and significant relationship between body mass index and variables such as duration of surgery, bleeding, pain, and analgesic dose (P<0.05), but there was no significant relationship between this variable with duration of ileus and incidence of inflammation, secretion and redness of surgical wound area (P>0.05).

The results of this study showed that there is a relatively high prevalence of maternal short-term complications in cesarean section and there is a positive and significant relationship between duration of surgery, bleeding, pain and number of analgesics with maternal BMI.

Endometrial secretion analysis is a non-invasive and promising method in evaluation of endometrial receptivity.

The aim of the present study was to assess the relationship between the success rate of IVF procedures and some endometrial secretion cytokines, including interleukin-1β (IL-1β), tumor necrosis factor (TNF-α), interferon gamma-induced protein 10 (IP-10), and monocyte chemoattractant protein (MCP).

In a prospective cohort study, 50 women selected for IVF met the study inclusion criteria. All the patients underwent endometrial secretion aspiration prior to embryo transfer. The level of IL-1β, TNF-α, IP-10 and MCP were analyzed by enzyme-linked immunosorbent assay method using special standard kits. To detect successful implantation and pregnancy patients underwent serum human chorionic gonadotropin measurements and ultrasound evaluation.

Five samples were excluded. Nine women (20%) had successful clinical pregnancies, which resulted in live birth. Other 36 women (80%) were classified as failed pregnancy. Comparison of cytokine levels showed lower concentrations of TNF-α, IP-10, and MCP in the group with successful clinical pregnancy compared to the group with failed pregnancy (p=0.007, 0.005 and 0.001, respectively). However, no significant difference was revealed in IL-1β levels between two groups (p=0.614).

The current study suggested that lower concentrations of TNF-α, IP-10, and MCP in endometrial secretions might be associated with improved endometrial receptivity and IVF outcome. Regarding IL-1β, no statistically significant differences were seen between the groups with and without successful pregnancy.

Introduction & Cytokines produced by fetal and uterine mucus are responsible for regulating interactions between mother and fetus that improve uterus receptivity and leads to higher success rate of in vitro fertilization (IVF). The aim of the present study was to evaluate the relationship between levels of some cytokines (IL-1?, TNF-?, IP-10, and MCP) in endo-metrial secretions with success rate of IVF procedures. 50 consecutive women who were candidate for IVF due to infertility and referred to the clinics of Fatemieh Teaching Hospital in Hamadan were enrolled in a nested case-control study. Aspiration of endometrial secretion was performed in all women prior to embryo transfer using trans-cervical catheter insertion. The level of cytokines in aspirated fluid was determined by ELIZA assay and using especial standard kits. Among 50 enrolled women, 5 samples were initially excluded because of contact bleeding during sampling and thus aspirated endometrial secretions of 45 women were ana-lyzed to assess level of the cytokines. Comparing levels of cytokines in aspirated endometrial secretions showed lower concentrations of TNF-?, IP-10, and MCP in the group who experi-enced successful clinical pregnancy (n = 9) than the group with failed pregnancy (n = 36), however, no significant difference was revealed in level of IL-1? between the two groups. In IVF patients with implantation failure, an elevated level of TNF-?, IP-10, and MCP cytokines is observable. Low levels of these cytokines can be valuable predicting mark-ers for successful IVF pregnancy.

Introduction & Different methods for dressing of donor site in burnt patients who have similarl pain, limitation of mobility of donor site and local complications such as infection and scar. Amniotic membrane has been used for the improvement of healing in some wounds. Accordingly in this study amnion was used as biologic dressing for the donor site to evaluate it’s efficacy in the improvement of pain, movement score and the risk of local infection. This study was done as a clinical trial over 32 admitted patients in the burn department of the hospital. Amnion was prepared in the elective caesarean section after ruling out any placental site with routine dressing. Then the two sites were compared about the severity of the pain, movement score, infection and time of dressing sloughing. Fourteen patients were women and 18 men. The mean score of pain and movement up to the sixth post operative day respectively was less than the control site. No difference was seen in the infection and dressing slough in the two sites. It seems that the use of amnion for the dressing of donor site probably causes more rapid epithelialization and wound healing and can improve pain and movement score in early post operative days. Accordingly it is expected to need less analgesia and low rate of immobilization associated with the complication of burnt patients after graft and their early discharge.

Preeclampsia is a dangerous condition in pregnancy is associated with high mortality. Although the unknown nature of the disease is difficult to predict and prevent disease. However، the incidence of some problems with self-care education and maternal and fetal complications can be prevented. This study aimed to determine the effect of Educative Intervention on Preeclamptic Women on their Newborn''s. In a randomized controlled clinical trial، 60 patients with preeclampsia who were randomly allocated into the experimental group (n = 30) and control group (n = 30). Four sessions were conducted for the intervention group was followed up until the end of pregnancy. The control group received routine care. Forms and self- care skills checklist were completed in both groups before and after intervention. Data were analyzed using t-test، chi-square test، Mann-Whitney tests with a 95% confidence level in the SPSS/16. The difference between the mean and standard deviation in the first minute Apgar score of 8. 6 ± 1. 5 and 8. 3 ± 0. 8 in the experimental group and control group was not significant، respectively (P> 0. 05). But the difference between Apgar score at fifth minutes، in two groups was significant (P= 0. 03). The difference between the mean and standard deviation weight in control group (2773. 5±650 gm.) and experimental group (2973. 9±625. 6 gm.) was not significant (P =0. 2). Use care programs to increase their ability to care for patients with preeclampsia and fetal health in order to increase the Apgar score as a nursing intervention is suggested.

Previous studies have demonstrated that clinical features of 16TPolycystic ovary syndrome16T (PCOS) are associated with a lower degree of health, self, and sex satisfaction.

Our study aimed to investigate possible associations between depression and different clinicobiochemical markers of PCOS.

In a cross-sectional analytic study, 120 PCOS women aged 18-45 yr, were enrolled. Beck Depression Inventory was used to assess depression. Also, all participants underwent biochemical studies. Individuals with 15 points and more in Beck test were referred to a psychiatrist to participate in a complementary interview for the diagnosis of depression based on Diagnostic and Statistical Manual of Mental Disorders IV (DSMIV-TR) criteria.

Among the study participants, 82 women (68.3%) were non-depressed, and 38 patients (31.7%) had some degrees of depression. According to the psychiatric interview, 10 patients (8.3%) had major depression, 22 patients (18.3%) had minor depression and 6 patients (5%) had dysthymia. We failed to show any significant difference in body mass index, hirsutism, infertility, serum total testosterone, lipid profile, and the homeostasis model assessment of insulin resistance (HOMA-IR) between depressed and non-depressed subjects (p>0.05). Using Spearman correlation, we did not find a positive correlation between BDI scores and clinicobiochemical markers for all PCOS subjects (-0.139≤r≤+0.121, p>0.05).

In spite of high rate of depression in women with PCOS, there was no significant association between Clinicobiochemical Markers and depression.

Introduction & Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age. According to the Rotterdam criteria، this syndrome is identified by presence of two of three criteria: (1) polycystic ovaries (2) oligo/anovulation and/or (3) clinical or biochemical evidence of hyperandrogenism. Low mature oocyte and embryo have been reported in polycystic ovary syndrome patients undergoing assisted repro-duction. An inverse correlation between follicular fluid homocysteine (Hcy) concentration and oocyte and embryo maturity has also been found. This study has been implemented to do more evaluation on the relationship between homocysteine levels in follicular fluid and oo-cyte and embryo quality. 30 PCOS patients as case group and 30 women with male factor infertil-ity as control group were included in the study. The follicular fluid in the cases was collected during ovary punition and Hcy level was measured by ELISA method. The oocytes and em-bryos were classified into several groups. The Hcy levels of follicular fluid of two groups were compared and its relation with oocyte and embryo quality was assessed. Although the homocysteine concentration in follicular fluid of the case group was higher than the control group، the differences were not statistically significant. Moreover، no significant correlation was found between oocyte and embryo quality and homocysteine concentration of follicular fluid of the two groups. In our study، no significant correlation was found between oocyte and embryo quality and homocysteine concentration of follicular fluid of PCOS patients but further stud-ies with larger sample sizes are recommended.

Third-trimester vaginal bleeding due to placental abruption occurs in 0.5-1% of pregnancies and is associated with 10-15% of maternal and perinatal mortality and morbidity. The etiology is unknown in most cases. Hyperhomocysteinemia is recognized as one of the independent risk factors of placental abruption. The objective of this study is to comparably measure the serum homocysteine in abruption group and normal control subjects. This case-control study is performed on 52 third- trimester pregnant women with clinical findings of abruption confirmed by after-delivery placental observation (case group) and 52 control subjects who had normal pregnancies. Samplings were done following an 8 hours of fasting. Serum homocysteine was measured with Axis R homocystein ELA kits manufactured by IBL company. Data were analyzed by chi-square and t-test. It was revealed that measures like age, number of pregnancies and deliveries did not show a statistically significant difference between two groups. Mean concentration of homocysteine in abruption and control groups were 6.8±2.7 and 5.5±2.2 μmol/L, respectively (p=0.013). Mean serum homocystein of abruption group was higher than that of controls’. This finding may light up brand ideas for future clinical trials about reducing the serum homocysteine level and therefore, reduction of placental abruption.

Pregnancy termination before the 20th week of gestational age is referred to as abortion. There are two common ways to treat early pregnancy failure: expectant management and surgical curettage. Some new methods have been suggested for the termanation of early pregnancy failure. The aim of the present study was to determine whether the medical management of vaginal misoprostol for early pregnancy failure is more effective than the expectant management. In this study 80 pregnant women with early pregnancy failure were referred to Fatemieh hospital, Hamadan, Iran. Inclusion criteria for the study were: fetal pole more than 6 mm, accompanied by the absence of fetal heart in the transvaginal ultrasonography fetal pole more than 10 mm in the absence of fetal heart rate in abdominal ultrasonograpgy empty gestational sac, (16 mm diameter) and gestational age less than 12 weeks. Exclusion criteria were: ectopic pregnancy (EP), severe vaginal bleeding, dilated cervix and misoprostol medical contraindications. The patients were randomly divided into two equal groups: A and B. Patients in group A received 4 vaginal misoprostol tablets (). Twenty four hours later, ultrasonography was repeated. In the case of the presence of pregnancy product, the first dose of misoprostol was readministered and again ultrasonography was performed. If abortion failed, surgical curettage was done. Patients received expectant management for 2 weeks in group B. Patients in group A were evaluated for adverse drug reactions. Using SPSS-13 statistical package, t-student and x2 were used for the comparison. Without the administration of any drug, patients in group B received expectational management for 2 weeks. There was no significant difference between two groups for both age and the gestational failure age (p>0.05). Abortion rate in misoprostol and expectational treatment groups were 87.5% and 20%, respectively. The percentage of vaginally delivered patients with the first and second dose of misoprostol was 60% (n=24) and 27.5% (n=11), respectively. Among the 40 patients of expectational management, 24 patients (57.5%) received dilation and curettage while a patients (22.5%) undertook curttage. Misoprostol-induced side effects (e.g. fever>38c, nausea, vomitting, diarrhea and pain) were seen in some patients (12.5%) of the first group. Misoprostol appears to be highly effective for the treatment of early pregnancy.

Background and Termination of pregnancy in fetus with severe anomaly is legal in Iran. This study was done in order to compare the rate of effectiveness and complications of intra-amniotic PG and oxytocin, with rising induction in patient candidates for second trimester abortion, at Fatemieh Hospital, in Hamadan. In a randomized clinical trial study, 40 pregnant women in their second trimester with fetal CNS anomalies, were divided into two groups (N=20). In the first group, one PG E2 Amp was injected intra-amniotic at first and then, 20 IU oxytocin was infused in 500 ml serum ringer for each patient. The infusion rate was increased up to induced effective concentrations every 15 to 30 minutes. In the second group, 50 IU oxytocin was infused with 1000 ml serum ringer and thereafter, an- other infusion of 50 IU oxytocin was added into the remaining 500 ml of serum. The rate of infusion was regulated on the basis of induced effective concentrations. Finally, both groups were compared for labor duration and probable side effects. The rate of success in both groups was 100%. The mean duration of labor was 19.75±5.9 hours and 30.2±6.49 hours in the group with intra-amniotic PG with oxytocin and rising induction group, respectively. This difference was statistically significant (P<0.00). Diarrhea was seen in only one case with intra-amniotic PG injection. Differences between the frequency of side effects in both groups was not statistically significant. This study showed that the mean duration of laboring intra-amniotic PG with oxytocin method, is less than of rising induction method.

Today, the donation of embryos, produced in vitro, is a common way to help the infertile cases who cannot produce embryo themselves by any of assisted reproductive procedures. The quality of endometrium and the time of embryo transfer are the most important factors in achieveing high pregnancy rate in these cases. The aim of this study was the assessment of pregnancy rate after embryo donation in natural cycle. This descriptive study was carried out in the year 2005 at Hamadan Infetility Center on 24 couples. A total of 24 couples went through the treatment cycles with embryos donated by 17 couples. Embryo donation was done on days of 14-17 of natural cycle and 2-3 days after the progesterone administration to the recipients. A pregnancy test was performed 2 weeks after ET, and positive results were confirmed by sonographic evaluation of the embryo. Individual, hormone administration results and embryo donation data were collected in a questionnaire, analyzed by descriptive statistics and frequency distribution tables. The mean age of the recipient and donor women were 32.2 and 26.2 years respectively.An average of 2.3 embryos were transferred on each occasion. The clinical pregnancy rate in the recipients was 30% (8.24) per embryo transfer. Transfer of donated embryos in natural cycle, results in a high pregnancy rate and is an easy, acceptable and cost-effective way of treatment for infertility.

Severe and intermediate polyhydramnios may cause various maternal and fetal complications. Indometacin therapy in moderate to severe polyhydramnios is recommended in some studies but, there no such study has been done in Iran. This study was done in order to investigate the effect of indomethacin in decreasing AFI and on enhancing duration of pregnancy. This randomized clinical trial was carried out in the year 2006 at Hamadan Fatemieh Hospital on 40 women who were 22 to 30 weeks pregnant, suffering from moderate to sever polyhydramnios (diagnosed by sonographic examination). Patients divided randomly into two groups. Twenty patients (case group) were treated with 1/5mg/kg/day of indomethacin for two weeks and the control group were just observed and hospitalized only in case of respiratory distress or abdominal pain occurrence. patients in the case group were assessed for drug complications, then after intervention to evaluate the AFI, they were checked by sonography in the second and forth week. Both groups followed up to delivery time and neonates examined for PDA. Individual data, pregnancy duration, Apgar score, and complications were collected in the questionnaire and analyzed by SPSS software, using the descriptive statistics, frequency distribution tables and statistical tests. Statistical significance was p<0.05. The mean duration of pregnancy in case and control group was 38±1.33 and 34±2.93 weeks respectively, with the statistically significant difference (p=0.0001). After 4 weeks of treatment, AFI decreased from 24.2±3.54 cm to 17.15±2.36 cm. The neonate's APGAR scores were much higher for case group in comparison with controls. Indomethacin had no maternal or fetal complications. This study showed that, the success rate in case group was 100%. The mean duration of pregnancy was longer in case group, AFI decreased and neonates’ APGAR was better than the control group.

Background and The most common complication of pregnancy is abortion. The etiology of recurrent pregnancy loss is not completely known. There are few therapeutics and diagnostic strategies in recurrent abortion. The aim of this study was to compare the use of heparin with aspirin vs prednisolone with aspirin in patients with recurrent pregnancy loss (RPL). This randomized clinical trial study comprised of 50 patients with RPL referred to Fatemieh Hospital, Hamadan. These patients were selected when β-HCG test was positive and were divided into two groups (n=25 for each group). Patients in the first group received subcutaneous heparin (5000 U twice a day) and oral microcoated aspirin (80 mg once a day) up to 20th week of pregnancy. Ultrasonography was repeated 3 times for these patients. Ca tablet was administrated in order to prevent osteoporosis. Antiphospholipid and anticardiolipin antibodies were checked for all patients. Neonates were visited by a neonatologist and followed up for one month. Finally, the data were analyzed by t-test and Fisher’s exact test. The mean age of prednisolone with aspirin group were 31.8±3.3 years while, it was 30.7±3.2 years in heparin with aspirin group and, this difference was not significant (P>0.05). The mean pregnancy loss number was 2.8±1.1 while 2.4±1 in prednisolone with aspirin and heparin with aspirin groups respectively, which was not statistically significant (P>0.05). Anticardiolipin antibody was positive in 4 (8%) patients, and antiphospholipid antibody was also positive in 4(8%) patients. Pregnancy loss with heparin+aspirin was significantly higher than prednisolone+aspirin (P<0.05). There was not any case of complications in two groups. The results of this study showed that prednisolone with aspirin are more effective than heparin with aspirin in the management of recurrent pregnancy loss and are preferred to use in these patients.

Mutant genes, especially sex linked mutations can lead to fetal deaths and changing the secondary sex ratio, that can assume as long term or genetic consequences of exposure to the environmental and occupational hazards. The goals of present study were to determine the fetal deaths rate and sex ratios among progenies of workers at two high risk occupations (lead mine and dye-houses). In a cross-sectional investigation, the outcomes of all pregnancies of two high risk groups (wives of lead and dye workers) were studied for fetal deaths rate and sex ratio of live births and then statistically compared with each other and with general population. Result of pregnancies of wives of all workers of Ahangran lead mine and dye workers at Hamadan, Iran, were studied. Total of pregnancies were 545 cases and total of live births were 473. The basic primary data were collected by face to face interviews and fill appropriate questionnaires. Sex ratio of live births among pregnancies of workers of lead mine and dye-houses were 91.60 and 98.95 percent respectively. Also the rates of fetal deaths (abortions plus stillbirths) among their wives’ pregnancies were 13.15 and 13.30 percent respectively. Fetal death rates among those two groups were different with the same rate of general population (p<0.05). The results of present study showed an increase in fetal death rate and decrease in sex ratios of subject groups in comparison with general population. Working in lead mine and dye-houses as results of long-term genetic consequences in such high risk places can be subject of another survey

Background and This study was designed in order to compare the effects of spinal and epidural analgesia on labour and also several maternal and fetal factors in vaginal delivery. The study was a randomized clinical trail and participatnts were 120 gravid 1 and gravid 2 women in the active phase of delivery, admitted to the labour room of Fatemieh Hospital in Hamedan in 1381-1382. Sixty patients were randomly divided into two groups of 30, analgesia was induced by single spinal sufentanil injection in one group and, bupivacaine plus lidocaine injection in the other group. Maternal vital signs and pain score were recorded (VAS) at 1, 5, 15 and 30 minutes after administration of analgesia and every 30 minutes thereafter. Fetal heart rate every 15 minutes, vaginal examination every hour, urinary output every 4 hours after delivery and the incidence of headache and back pain, one week after delivery were the variables under study. Both groups were matched regarding demographic, gravida and Parity factors. There was no significant difference between groups regarding pain score, (based on VAS),duration of the first and second delivery phase, the incidence of fetal distress, meconium excretion, apgar scores at 1 and 5 minutes after delivery, abnormal laboar, operative or assisted delivery. Average analgesic duration was longer in spinal analgesia than single epidural injection analgesia. Considering the difficulty of the technique, the need for anaestheticianHs supervision and injection repeatition in epidural analgesia, it seems that spinal analgesia is a suitable replacement which is more practical, less expensive, easy to perform and induces a desirable analgesia.