فهرست مطالب leili hafizi

Intrauterine adhesion is a condition that can lead to infertility, amenorrhea, repeated abortion in the patient, and the treatment of these patients is usually associated with many challenges. The present study was performed with aim to compare the effect of two different doses of estrogen to prevent the recurrence of adhesions after hysteroscopic lysis in Asherman's syndrome.

This randomized controlled clinical trial study was performed on 30 patients with moderate and severe Asherman's syndrome in Imam Reza Hospital of Mashhad, 2017-2021. Patients underwent hysteroscopy to remove adhesions. For all patients, an intrauterine balloon was placed after the operation and then they were treated with estrogen for 30 days and medroxyprogesterone 10 mg daily for the last 10 days. Patients were randomly assigned to two groups of estrogen 2.5 mg and 5 mg daily. After the end of the treatment period, with hysteroscopy again, the state of the uterine cavity was checked and the response to the treatment was compared in terms of the return of adhesions and its intensity in the two groups. Data were analyzed using SPSS software (version 26) and Shapiro-Wilk and Mann-Whitney U statistical tests. P<0.05 was considered statistically significant.

The most common cause of Asherman in the 2.5 mg group was curettage (60%) and in the 5 mg group, other surgeries (60%). The two groups had no statistically significant difference in terms of confounding variables including age, cause of Asherman's disease and severity of adhesions (p=0.714). In examining the response to treatment, there was no statistically significant difference between the two groups in terms of adhesion severity in repeated hysteroscopy (p=0.858) and response to treatment (p=0.714).

For the prevention of recurrence of intrauterine adhesions (Asherman's syndrome) after hysteroscopic lysis of adhesions, the dose of 2.5 mg of Conjugated estrogen was as effective as the dose of 5 mg of estrogen.

This study aimed to evaluate the short-term and long-term outcomes of adopting two types of resectoscopes and hysteroscopic scissors metroplasty methods.

In this prospective, comparative, and cohort study, participants who were candidates for septum resection were recruited during 2015-2018. The uterine septum was removed using hysteroscopic scissors or a resectoscope. The second-look hysteroscopy was performed in the follicular phase after two months. In the second-look hysteroscopy, surgery outcomes were evaluated, and the residual septa or adhesions were removed in case of incidence. The study followed participants for up to five years to observe pregnancy outcomes. This involved recording the duration from hysteroscopy to pregnancy and determining if these pregnancies led to live births.

A total of 119 female patients with a mean age of 30.20±6.14 years were enrolled in this study, out of who 62 cases (52.1%) were in the hysteroscopic scissors group, and 57 cases (47.9%) were in the resectoscope group. The 63 (52.9%) cases had primary infertility, and the prevalence of abortion was 46 (38.7%). During the second look, hysteroscopy adhesion was diagnosed in 18 cases (15.1%), and septum residue was seen in 49 cases (67.1%). The adhesion rate in the hysteroscopic scissors group was higher than that in the resectoscope group, but it was insignificant (P=0.223). At the second follow-up stage, only 85 patients out of 119 ones were available. The successful pregnancy rate was 46 out of 85 (54.1%). The mean age of the patients in the successful pregnancy group was significantly lower than that in the unsuccessful pregnancy group (P<0.001).

There were no differences among resectoscope and hysteroscopic scissor methods’ outcomes in term of metroplasty associated with septate uterus (SU).

This study aimed to investigate the relationship between the level of high-sensitivity C-reactive protein (hs-CRP; as an indicator of inflammatory response) and shoulder tip pain (STP) following cesarean section (C-section).

In this cohort study, a total of 120 pregnant women who were candidates for elective C-section at Imam Reza Hospital were included. The level of hs-CRP was measured perioperatively. STP was measured after the operation.

Mean hs-CRP was significantly higher in females with STP compared to counterparts (19±13.1 vs. 7.2±4.5; P<0.001). There was a positive and strong correlation between STP and postoperative hs-CRP (P<0.001).

The release of acute-phase proteins (such as hs-CRP) plays a significant role in STP after C-section; the intensity of STP is associated with the level of hs-CRP.

The aim of this study was to evaluate the rate and severity of intrauterine adhesions (IUAs) and their association with septum morphology following the hysteroscopic resection of the uterine septum.

This cross-sectional study was conducted on patients with septate uteri undergoing hysteroscopic septolysis with scissors. Two months after the surgery, the second look hysteroscopy was performed and the intrauterine cavity was evaluated for IUAs and residual septum. Afterward, the rate and severity of adhesions and residual septum and their association with the septal morphology were studied as well.

In general, 30 patients were entered into the study. The incidence rate of adhesions following septoplasty was 23.3%. It was mild and moderate in 16.7% and 6.7%, respectively. The incidence rate of adhesions was not related to the length and width of the septum (P=0.281, P=0.495). The rate of the residual septum in second-look hysteroscopy was 56.7%, which was less than 0.5 cm in most cases (33.3%). It was not more than 1 cm in any case. The possibility of the residual septum was significantly higher in long septa (P=0.045) whereas it was not related to the septum width (P=0.087).

IUA following hysteroscopic septolysis is a possibility, especially in infertile patients which is often mild. The presence of a uterine factor in such patients may justify the risk of increased IUAs in our study in comparison to others. Therefore, it is able to perform second-look hysteroscopy in infertile patients with a septate uterus for the diagnosis and early treatment of IUAs.

Herlyn-Werner-Wunderlich Syndrome (HWWs) is a rare variant of Mullerian duct anomalies. It is associated with a wide range of gynecological and obstetric complications, such as urinary incontinence, urinary retention, endometriosis, pelvic infection, pelvic pain and infertility.

We conducted the present study to investigate and manage HWWs with pelvic pain. The surgery was performed on the operative room of Imam Reza Hospital in April 2018.

The reported case is related to Herlyn-Werner-Wunderlich Syndrome, a rare congenital Mullerian duct anomaly, which it is not included in the current classification system of the Mullerian abnormalities of the American Fertility Association and is based on the typical pattern of caudal evolution towards cranial.

During the immediate post delivery period, women are particularly susceptible to distension of the bladder. Complementary and alternative medicine is becoming an established intervention modality within the contemporary health care system. However, very little is known about the impact of foot reflexology on the urinary system. The aim of this study was to evaluate the effect of the most popular type of complementary therapy (the foot reflexology) on first voiding time following elective cesarean section without urinary catheter.

This experimental study was performed on 61 pregnant women in Pastor Hospital, Mashhad, Iran, who met the inclusion criteria. Accordingly, participants were randomly allotted to either treatment or control groups. The intervention group received a single 20‑min foot reflexology session at 2–3 h after the surgery. The time taken for first void was recorded by research assistant that blinded to the allocation of groups. The findings were recorded and analyzed with the SPSS software by using of Chi‑square, independent t‑test, Mann–Whitney, and Fisher exact methods P < 0.05 was considered as statistically significant.

Using General Linear Model (GLM) for controlling of confounding variables, the results of t‑test showed significant differences between two groups in terms of first voiding time (P = 0.001) following surgery.

It seems that the use of foot reflexology as a nursing care plan to prevent urinary retention after cesarean section without urinary catheter does shorten first voiding time and increase maternal satisfaction.

 The report of fallopian tube obstruction in hysterosalpingography in infertile patients should be confirmed by laparoscopy. This study was performed with aim to assess the value of hysteroscopy in cases of fallopian tubes obstruction during laparoscopy.

This interventional study was performed on 54 infertile women who were candidates for laparoscopy due to fallopian tube obstruction in Hysterosalpingography (despite normal uterine cavity) in the gynecology ward of Mashhad Imam Reza Hospital in 2014-2016. Patients were included in the study if tube obstruction was observed during laparoscopy. At the same stage, the hysteroscopy was performed, and then the status of the tubes was again checked through laparoscopy. The value of performing hysteroscopy was evaluated in terms of detecting the uterus pathology, opening of the tubes or both. Data were analyzed by SPSS software (version 20) and student t-test, Q2, and Mc-nemar tests. P<0.05 was considered statistically significant.

In this study, 54 patients with 74 blocked fallopian tubes were included. Hysteroscopic findings indicated intrauterine pathology in 30 cases (55.6%) and after performing hysteroscopy, at least one tube was opened in 25 cases (46.3%). 38 patients (70.4%) benefited from hysteroscopy (opening of tube or intrauterine pathology diagnosis). In the study of the relationship between hysteroscopic evidence (normal or pathologic) and consequent tube opening, the probability of tube opening was significantly higher in the pathologic cases (p<0.001).

In the cases of observation of tube obstruction in diagnostic laparoscopy in infertile women (despite normal endometrial cavity in HSG), hysteroscopy was helpful and in many cases lead to detection of unknown uterine pathologies or help to tubal opening.

Fibroma or leiomyoma is the most common benign tumor of the female reproductive system, which is usually found in the uterus, but may also occur in other places, such as the ovary, the broad ligament, and in rare cases in the abdominal wall. The formation of the abdominal wall leiomyoma may result from the implantation of myometrium tissue following surgical removal of the uterine leiomyoma, but sometimes these masses occur in a person who has no history of myomectomy.

This case was a patient who became a candidate for laparoscopy due to abnormal uterine bleeding and pain in the right upper quadrant of the abdomen and ovarian mass. The patient underwent laparotomy due to the inability of surgeons to insert the veress needle because of the presence of mass in the abdominal wall. The pathologic report of the abdominal mass was leiomyoma. This article has been approved by the Ethics Committee of the University (6562276).

The formation of myoma on the abdominal wall is rare but given the fact that leiomyoma can be created at each part of the body with smooth muscles, including the anterior abdominal wall, this diagnosis should be considered for the differential diagnosis of abdominal masses.

Asherman syndrome (uterine adhesion) occurs due to injuries to the basal layer of endometrium that is usually caused following surgeries of uterine such as curettage and myomectomy. In the next pregnancy, obstetrical complications such as abortion, placenta pravia and acreta may be increased.

In this study, a case of amenorrhea after one uncomplicated caesarean section is reported. She had spontaneous pregnancy after treatment with three times histroscopy. In the next pregnancy, she developed severe adhesion to the myometrium, resulting in severe hemorrhage and hysterectomy. 

Ashman syndrome may be caused following an uncomplicated cesarean section and may increase the chance of obstetrical complications in next pregnancy.

This study was performed to compare the success level of laparoscopic ovarian drillind by means of standard and dose-adjusted (on the basis of ovarian volume) treatment methods among infertile clomiphene resistant PCO women.

This randomized clinical trial was conducted on infertile clomiphene citrate resistant PCOS women in the Gynecology department of Imam Reza Hospital between 2016 and 2017. The patients were randomly divided into two groups based on the ovarian cautery

group A (standard method) and group B (cautery on the basis of ovarian volume). The two groups were examined and compared regarding the antral follicles, serum level of AMH and androgens and midluteal progesterone one month after the operation. Regularity of cycles, ovulation and pregnancy were examined monthly up to 6 months of the operation. The significance level was set at P<0.05.

In total 60 women received bilateral LOD (n=30 per group). The level of AMH, testosterone and DHEAS was not significantly different at study entrance (P= 0.73, 0.91 and 0.16, respectively). The same result was obtained after one month of ovarian cautery (P= 0.94, 0.46 and 0.12, respectively) and also for postoperative midluteal progesterone (P = 0.31). Regarding intragroup comparisons, the decrease in the number of antral follicles and testosterone in group A (P = 0.02) and AMH level in group B (P = 0.04) was statistically significant. During the 6 months after treatment, the two groups had no meaningful difference in the cycles regularity, ovulation and pregnancy (P= 0.22, 0.11 and 0.40, respectively)

According to the results of this study, none of the two methods of ovarian cautery has priority to the other with regard to establishing cycles’ regularity and ovulation, but both methods are highly effective in establishing regular cycles. Moreover, the standard treatment was effective on decreasing the numbers of antral follicles and testosterone level whereas the dose-adjusted method significantly affected the decrease in AMH level. Therefore conducting similar studies with a larger samples size is highly recommended.

A unicornuate uterus is present in 0.1% of the general population. This müllerian anomaly carries significant obstetrical risk including abortion, preterm delivery, and rudimentary horn ruptures. The patient is a 24-yr-old primigravida with 12-wk gestational age and a twin pregnancy in the unicornuate uterus and non-communicating rudimentary horn. One fetus in the unicornuate uterus and other in the rudimentary horn that was ruptured. In urgent laparotomy rudimentary horn and fallopian tube excised. Pregnancy in theunicornuate uterus was continued and at 38-wk gestational age, cesarean section due to premature rupture of the membrane was performed and then normal fetus was delivered. Twin pregnancy in a unicornuate uterus and rudimentary horn is a rare condition that carries a considerable risk to the mother. There is a need for increased awareness of this rare condition to prevent maternal morbidity and mortality.

  Endometrial pathologies inside the cavity can occur simultaneously with gestational unpleasant consequences but are not always capable of being diagnosed by the hysterosalpingography (HSG). This study aimed to examine the value of performing diagnostic hysteroscopy beside diagnostic laparoscopy among infertile women with normal uterine cavities in HSG. A total of 103 infertile women with normal uterine cavities in the HSG and within the age range of 18-40 who referred to Imam Reza hospital for laparoscopy during 2016-2017 were included in this cross-sectional study. Hysteroscopy was performed simultaneously with diagnostic laparoscopy. Then, the existence of uterine pathologies like endometrial polyps, submucous myoma, and uterine endometrial adhesions and their relationship with the patient’s age, infertility type and duration, and cycle time were evaluated. A P value less than 0.05 was considered statistically significant. Overall, 64 patients (63.1 %) had a normal uterine cavity in the hysteroscopy while 39 of them had an abnormal uterine cavity, the HSG false negative cases of whom were reported 37.9%. The pathologies found in the hysteroscopy were endometrial polyp (16 cases), submucous myoma (1 case), uterine septum (6 cases), asherman syndrome (7 cases), bicornuate uterus (4 cases), polyp + asherman (3 cases), polyp + submucous myoma (1 case), and septum + submucous myoma (1 case). Patients’ age, type of infertility, and menstruation time during performing hysteroscopy made no particular difference in diagnosing pathologies of the uterine cavity in the hysteroscopy. Based on the findings, conducting hysteroscopy in infertile women who are candidates of laparoscopy and have normal uterine cavities in HSG can result in recognizing some cases of uterine pathologies which influence the outcomes of future pregnancies is not dependent upon the patient’s age, menstruation time, type and duration of infertility, and result of laparoscopy.

Triplet or higher-order multiple pregnancies are often caused due to ovulation induction. Spontaneous quadruplet pregnancy is a rare phenomenon which is associated with maternal and fetal complications. Here in, we report a spontaneous quadruplet pregnancy with no family history and as a result of an unwanted pregnancy. The patient was a 34-year-old, G4 L2 Ab1. She noticed being pregnant during breastfeeding, a spontaneous quadruplet pregnancy. There was no case of multiple pregnancies in her or her husband's family. In week 29 she was hospitalized due to the diagnosis of preterm labour. At 32 weeks and 4 days of gestation, because of the restart of labour contractions and dilatation development, she underwent a cesarean section. The outcome was the birth of 4 healthy neonates weighing between 1800 to 2100 gram and normal Apgar score. Quadruplet pregnancy can rarely occur spontaneously even unintentionally, and can reach the third trimester without prophylactic cerclage.

Despite the identification of hysteroscopy as the most accurate method for the diagnosis of uterine cavity disorders, the patients are initially subjected to hysterosalpingography (HSG). In this regard, the present study aimed to compare the diagnostic value of HSG and hysteroscopy in the detection of uterine cavity abnormalities in infertile women.
This cross-sectional study was conducted on 91 infertile women who needed to undergo hysteroscopy in the Gynecology Ward of Imam Reza Hospital in Mashhad, Iran, due to the detection of a uterine abnormality in their HSG or failure of intrauterine insemination and in vitro fertilization during 2013 to 2014. The results of HSG and hysteroscopy to detect uterine cavity changes were compared. Data analysis was performed in SPSS software (version 16) using McNemar’s test. P-value less than 0.05 was considered statistically significant.
Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of HSG were 38.78%, 78.57%, 67.86%, 52.38%, and 57.14%, respectively, in comparison to those of hysteroscopy. The results of the McNemar’s test revealed a significant difference between the results of HSG and hysteroscopy in the diagnosis of uterine cavity abnormalities (P=0.001).
As the findings indicated, HSG had lower sensitivity, specificity, as well as positive and negative predictive values. Consequently, this method can be concluded as insufficient for the diagnosis of endometrial cavity disorders and incapable of diagnosing many factors affecting the outcome of infertility treatments. Therefore, all infertile women who are candidate for laparoscopy or those who need expensive infertility treatments are suggested to undergo hysteroscopy before the onset of treatment.

Unicornate uterus is one of the congenital uterus abnormalities in several forms. In this article, we report a rare case of unicornate uterus with non-communicated rudimentary horn and active endometrium combined with the unilateral ovarian endometrioma undistinguished of it.
A 21 years old woman with acute abdominal pain and pelvic mass referred to Imam Reza hospital, Mashhad in 2015. Ultrasonography reported a bicornate uterus and a large cystic mass with size of 12.5×17.5 cm in the right ovary. CBC and tumour markers were normal, only CA-125 was increased. The patient was operated because of the acute abdomen. In the explanatory laparotomy and hysteroscopy, a unicornate uterus with right accessory corn combined to the right ovary was showed that they formed a unique cystic mass contained a chocolate liquid. Rudimentary horn accompanied by the right ovary and falopan tube were resected. Histopathological report confirmed simultaneous endometrioma of the right ovary and hematometra in the rudimentary horn.
Unicornate uterus with non-communicated rudimentary horn and active endometrium may be associated with hematometra and/or endometrioma. The accumulation of chocolate like fluid may lead to destroy of ovary tissue and elimination of rudimentary horn coincide with oophorectomy seemed unavoidable. Therefore, early diagnosis and removal of rudimentary horn can avoid of complication such as endometriosis, oophorectomy and ectopic pregnancy.

Partial or complete mole affects one in 1000 pregnancies.Partial mole is a rare form of ectopic pregnancy. There was a married woman,gravid 4,parity 1,abortion 1,and she had past medical history 0f right ectopic pregnancy.she had left ectopic pregnancy and was treated by laparascopic left salpyngectomy after failure of intramascular methotrexate treatment.After surgery the pathology exam showed partial mole

Meig’s syndrome is a triad of "ovarian benign tumor, ascites and plural effusion" and the patient refers with a probable malignant ovarian mass, but it is benign; and the symptoms would be vanished by eliminating the tumor. As this is a rare syndrome, we decided to present this case.
A 26 years old virgin girl with an abdominal mass and stable vital signs referred to Gynecology clinic of Imam Reza hospital. A pelvic mobile mass, sized 18 weeks of pregnancy was palpated. Sonography reported a solid pelvic mass with cystic components around 140×100 mm that indicated either submucosal pedanculated uterine fibroma or right ovarian mass. Ascites and right pleural effusion were reported in the second ultrasonography. Tumor markers except CA125 were normal. One liter of ascites fluid was evacuated during surgery. A 150×170 mm ovarian tumor in the ovary with a complete capsule without adhesion was obtained. Benign ovarian fibrothecoma was confirmed by frozen section. The permanent pathology report was benign ovarian fibroma. The peritoneal fluid cytology, left ovarian biopsy, diaphragmatic and paracolic groove specimens were normal. The patient was fine two weeks after surgery with no pleural effusion and ascites.
Although combination of ascites and elevated CA125 with a pelvic mass mostly indicates an ovarian malignancy, but Meig's syndrome must be considered in young women. So, ascites and pleural effusion and elevated CA125 in combination with a solid ovarian tumor is not always an indicator of a malignancy especially in young women.

Leiomyomata is the most frequent gynecological neoplasm. One of the major complications of myomectomy is intrauterine adhesion (synechiae).

To evaluate and compare the rate and severity of synechiae formation after myomectomy by laparotomy and laparoscopy.

In this non-randomized interventional trial, hysteroscopy was performed in all married fertile women who had undergone myomectomy (type 3-6 interamural and subserosal fibroids) via laparotomy and laparoscopy in Tehran’s Arash Hospital from 2010 to 2013. Three months after the operation, the occurrence rate and severity of intrauterine synechiae, and its relationship with type, number and location of myomas were investigated and compared in both groups.

Forty patients (19 laparoscopy and 21 laparotomy cases) were studied. Both groups were similar regarding the size, type (subserosal or intramural), number and location of myoma. The occurrence rate of synechiae in the laparoscopy and laparotomy group was 21% and 19%, respectively; showing no significant difference (p=0.99). Among all patients, no significant relationship was found between the endometrial opening (p=0.92), location (p=0.14) and type of myoma (p=0.08) with the occurrence rate of synechiae. However, a significant relationship was observed between myoma’s size (p=0.01) and the location of the largest myoma with the occurrence of synechiae (p=0.02).

With favorable suturing methods, the outcome of intrauterine synechiae formation after myomectomy, either performed by laparotomy or laparoscopy, is similar. In all cases of myomectomy in reproductive-aged women, postoperative hysteroscopy is highly recommended to better screen intrauterine synechiae.

Dysfunctional uterine bleeding (DUB) is the most common gynecologic disorder in women of reproductive age. Medical treatments are often ineffective. Endometrial ablation is an alternative to hysterectomy for these women.. To evaluate the response to treatment rate of the Cavaterm TM plus technique for management of menorrhagia secondary to dysfunctional uterine bleeding (DUB)..Patients and In this clinical trial study 40 women aged 35-50 years with menorrhagia secondary to DUB, who had been referred to the gynecology clinic of Arash Hospital, Tehran, Iran, were recruited. They underwent endometrial ablation via Cavaterm™ plus system and were followed for one year.. The observed mean number of days of bleeding per month decreased significantly from 14.95 ± 6.7 days before treatment to 3.42 ± 3.04 days after treatment (P < 0.001). Intervals between hemorrhagia increased significantly from 16.25 ± 5.50 to 21.30 ± 11.10 days (P = 0.01). The rate of dysmenorrhea decreased significantly from 32.5% to 10% (P < 0.05). The improvement rate of dysmenorrhea was 69.5%. The overall improvement of menorrhagia was reported 92.5% (P < 0.001). After one year the rates of hypomenorrhea, amenorrhea and eumenorrhea were 47.5%, 27.5% and 17.5%, respectively..The failure to treatment rate was reported 7.5%. Patient satisfaction rate was 85%.. The Cavaterm™ plus system is a safe and effective technique and it can be an excellent alternative to hysterectomy for the treatment of menorrhagia due to DUB..

The effects of exposure to electromagnetic fields (EMF) on reproduction systems have been widely debated. In this study, we aimed to investigate whether low frequency EMF could ameliorate the in vitro fertilization success rate in Naval medical research institute (NMRI) Mice. In this randomized comparative animal study, ten NMRI mice were randomly divided into 2 equal groups (control and experimental). 10 IU of human chorionic gonadotropin (hCG) was injected intraperitoneally to both groups in order to stimulate ovulating, and ovums were then aspirated and kept in KSOM (modified version of sequential simplex optimization medium with a higher K+ concentration) culture medium. Metaphase II ovums were separated, and sperms obtained by «swim out» method were added to metaphase II ovums in the culture medium. The experimental group was exposed to 1. 3 millitesla pulsed electromagnetic field at 4 kilohertz frequency for 5 hours. To assess the efficacy, we considered the identification of two-pronuclear zygote (2PN) under microscope as fertilizing criterion. Total number of collected ovums in the control and experimental groups was 191 and 173, respectively, from which 58 (30. 05%) and 52 (30. 36%) ovums were collected from metaphase II, respectively. In vitro fertilization (IVF) success rate was 77% in extremely low frequency- pulsed electromagnetic field (ELF-PEMF) for exposed group (experimental), whereas the rate was 68% for control group. Despite increased percentile of IVF success rate in exposed group, there was no statistically significant difference between 2 groups, but this hypothesis has still been stated as a question. Further studies with larger sample sizes and different EMF designs are suggested.

Ovarian hyper stimulation syndrome (OHSS) occurs mainly after excessive stimulation of the ovaries by exogenous gonadotropin administered in the context of ovulation induction and in vitro fertilization procedures (iatrogenic OHSS). Spontaneous OHSS is a rare event. Such cases would explain other etiologies except ovulation induction. In this case report, we have presented two cases of OHSS in spontaneously conceived pregnancies.

In this case report, we are going to present two cases of OHSS occurring in spontaneously conceived pregnancies. One of the patients mentioned the history of this syndrome in her sister, and the other one confronted with this syndrome in her second pregnancy. Both of them referred to the hospital with typical symptoms and signs of OHSS. They did not have Polycystic Ovary Syndrome (PCOS) and any other problem in pregnancy. Thrombophilia workup, Tumor markers, renin-aldosterone and thyroid function tests were normal.

The presence of OHSS in spontaneous pregnancy especially in familial pattern may lead us to evaluate some endogenous pathogenic factors.

Development of complications during gynecologic laparoscopic surgery depends on many factors such as history of previous laparotomies. This factor usually increases the veres and first trocar complications.. In this study, we compared all operative complications between the patients with and without previous abdominal surgery.. Patients and All operative complications due to the first trocar insertion complications were recorded for 100 women who had laparoscopic surgery history during 2005-2010, and were compared with 100 age range in control groups. Influence of different parameters on the risk of adverse complications after surgery was also taken into account.. In both case and control groups, there is no major complication due to the insertion of the first torcar or other procedures of laparoscopy. Adhesion bands were identified in 69 of cases and 24% of them were lysed during laparoscopic surgery; but abdominal wall adhesions were not observed in any patients of control group. Moreover, minor complications did not differ between cases and controls. seven percent of cases and 6% of controls required blood transfusion. There is a significant direct association between the number of previous surgery and increasing NPO days(r = 0.28, P = 0.004). Duration of postoperative hospital admission showed a significant difference between four types of surgery (P < 0.001).. Closed approach gynecological laparoscopy with careful method and preoperatively perdition of complication can be applied in patients having previous laparotomy history with inconsiderable complication increase..

Development of complications during gynecologic laparoscopic surgery depends on many factors such as history of previous laparotomies. This factor usually increases the veres and first trocar complications.. In this study, we compared all operative complications between the patients with and without previous abdominal surgery.. Patients and All operative complications due to the first trocar insertion complications were recorded for 100 women who had laparoscopic surgery history during 2005-2010, and were compared with 100 age range in control groups. Influence of different parameters on the risk of adverse complications after surgery was also taken into account.. In both case and control groups, there is no major complication due to the insertion of the first torcar or other procedures of laparoscopy. Adhesion bands were identified in 69 of cases and 24% of them were lysed during laparoscopic surgery; but abdominal wall adhesions were not observed in any patients of control group. Moreover, minor complications did not differ between cases and controls. seven percent of cases and 6% of controls required blood transfusion. There is a significant direct association between the number of previous surgery and increasing NPO days(r = 0.28, P = 0.004). Duration of postoperative hospital admission showed a significant difference between four types of surgery (P < 0.001).. Closed approach gynecological laparoscopy with careful method and preoperatively perdition of complication can be applied in patients having previous laparotomy history with inconsiderable complication increase..

Job stress can interfere with endocrine function and result in dysfunctional menstrual bleeding patterns. The aim of this study was to assess the relationship between job stress with menstrual bleeding pattern among midwives. Methods & Materials: In this cross-sectional study، we recruited 150 midwives working in hospitals and health centers of Mashhad using two-stage sampling. Data were collected using a questionnaire including demographic characteristics، Karazek Job Content، a daily diary for menstrual periods to record duration and interval of periods، and the Higham Chart for recording the bleeding amount. The diary was completed for three menstrual periods. Collected data were analyzed using independent t-student، one way ANOVA، Mann-Whitney U، Chi-squared test، correlation test and linear regression in the SPSS-14.

The findings showed that 21. 3% of the midwives reported mild job stress، 19. 3% had moderate stress and 59. 3% reported severe job stress. Mean of the duration of the periods was 7. 06 days، the mean interval of the periods was 27. 9 days and the mean amount of bleeding was 79. 72 cc. There was a significant relationship between job stress and the duration and interval of periods (P<0. 001). There was not any significant relationship between job stress with the amount of bleeding.

Our study showed that job stress was related to menstrual bleeding patterns among midwives. It is necessary introduce strategies to decrease job stress and provide professional support for midwives.