nayereh ghomian

 Simulation training, a novel learning method, provides medical students with opportunities to practice managing stressful situations as if they were experiencing them in reality. Recently, there has been increased recognition of the value of simulation-based education. This study aimed to evaluate the most effective approach for providing feedback during a simulation program.

 In this interventional study, a total of 43 obstetrics and gynecology residents were recruited and stratified into three groups based on their residency stage. These residents participated in a simulation-based program focused on the management of post-partum hemorrhage (PPH). The program involved handling a PPH scenario, during which they received feedback either during the task (in-task; IT) or after completing the task (end-task; ET). Following the simulation, a post-test was administered, and the results were compared between the IT and ET feedback groups.

 Demographic variables did not differ significantly between the ET and IT groups. Generally, there were no significant differences in secondary knowledge (P=0.232) or secondary performance (P=0.196) following the simulation program between the two groups. However, Among second-year residents, the change in primary and secondary performance was not significant in either the ET (P=0.76) or IT (P=0.74) group, while the IT group showed a significant improvement in knowledge (P=0.04). For third-year residents, the point change in primary and secondary knowledge and performance was not statistically significant in either the ET or IT groups.

 The final knowledge and performance following simulation programs do not significantly differ between the IT and ET groups. However, second-year residents experienced an improvement in knowledge.

Prolonged labor increases adverse maternal and neonatal outcomes. Very few interventions are known to shorten labor duration. The present study was performed with aim to evaluate the effect of intravenous dextrose-saline infusion compared with intravenous normal saline infusion on the duration of the active phase of labor in nulliparous women.

In this double-blind randomized clinical trial (blinding of patients and data analyst), which was performed in 2020-2021, 60 nulliparous women in the active phase of labor who had referred to the teaching hospitals of Mashhad University of Medical Sciences were randomized by block randomization method and allocated to two groups of receiving normal saline at a rate of 150cc per hour and dextrose at 5% saline at the same rate. The primary outcome was evaluating the duration of the active phase of the labor. Secondary outcomes included the duration of second phase of labor and the rate of cesarean section, maternal and neonatal outcomes. Data analysis was performed using SPSS statistical software (version 25) and Chi-square tests and Fisher's exact test. P<0.05 was considered statistically significant.

The basic variables were similar in the two groups. The active phase of labor and the second stage of labor was statistically lower in saline dextrose compared to the normal saline group (P<0.001). There was no significant difference between the two groups in the rate of cesarean section, the need for oxytocin, maternal complications, first and fifth minutes Apgar score, neonatal complications and the need for NICU (P> 0.05).

It seems that the use of dextrose-containing solutions in nulliparous women during labor shortens the duration of labor compared to normal saline.

Most studies showed that low cord blood pH was associated with short-term mortality as well as long-term neurological disorders, but few studies showed associations between high cord blood lactate and adverse short-term outcomes. This study aimed to determine the association between umbilical cord blood lactate during the first hour of birth in infants with 5th-minute Apgar scores <7 and short-term neonatal complications.

In this cross-sectional study, 49 pregnant women over 37 weeks gestation referred to the maternity wards of Academic Hospitals of the Mashhad university of medical sciences with the onset of labor, whose neonates scored below 7 in 5th-minute Apgar, were included after obtaining informed consent, by convenient sampling method. Preliminary information was recorded. Also, a blood sample was taken from the umbilical artery and its pH, pCO2, bicarbonate, and lactate levels were measured. The neonatal outcomes and complications and outcomes (discharge or infant death) were evaluated.

Overall, 25 male (51.0%) and 24 female neonates (49.0%) with a mean gestational age of 39.3±1.1 weeks were studied. Cord blood lactate concentrations were significantly higher in neonates with hypoxic-ischemic encephalopathy, intubation-ventilation, hypothermia, meconial aspiration, NICU admission, and those who died compared with the opposite groups (P<0.05). The best lactate cut-off point for predicting hypoxic ischemic encephalopathy and intubation was 4.55mg/dl, while for predicting neonatal death it was 6.19mg/dl with 100% sensitivity and 97.4% specificity.

Umbilical cord blood lactate measurement can be a highly accurate measure of neonatal outcome and early complications that can greatly help with the health status assessments of infants with adverse Apgar scores at birth, their prognosis, and management.

Postoperative ileus causes patient discomfort, prolonged hospitalization and extra costs on health system. Few studies support the possible role of coffee consumption in reducing the incidence of ileus. The present study was performed aimed to investigate the role of coffee consumption in comparison with routine diet on improving intestinal function after abdominal hysterectomy.

This randomized double-blind clinical trial study was performed in 2020-2021 on 40 patients candidate for hysterectomy due to benign uterine disease who had referred to Imam Reza hospital in Mashhad. The patients were divided into two groups and from the day after surgery, every 6 hours for three times, patients in intervention group consumed 100 ml of coffee and patients in control group consumed 100 ml of food coloring and essence similar to coffee. The primary outcome was the time of first gas passing and secondary outcomes were the time of first bowel sound, first defecation and incidence of postoperative ileus. Data were analyzed by SPSS 27 software (version 27). P< 0.05 was considered statistically significant.

There was a statistically significant difference between the two groups in comparing the time of first bowel sound (P=0.02), first gas passing (P=0.007) and first defecation (P<0.00). There was no case of severe ileus in participants. In comparison between the absence of ileus with the sum of mild and moderate ileus cases, the difference between two groups was significant (P=0.047). Comparison of hospitalization period was not significant between the two groups (P=0.24).

There was a statistically significant difference between the intervention and control groups in comparing the time of first bowel sound, first gas passing, first defecation and incidence of ileus. It seems that coffee consumption after abdominal hysterectomy accelerates the onset of intestinal movements and reduces the incidence of ileus.

Based on the Millennium Development Goals, the maternal mortality rate should be reduced by two-thirds of 2010 until 2030 (in Iran below 10 per 100,000 live births). Since it is necessary to identify the risk factors of death and survive the near death mothers, this study was performed with aim to evaluate the ratio of severe maternal outcome and its related factors.

This cross-sectional study was performed in an academic hospital of Mashhad in 2019-2020. Pregnant women and women who in the first 42 days after delivery (puerperium) suffered from a severe complication but survived, and also cases that led to maternal death entered the study by census method. Using a checklist of the Ministry of Health organization, demographic data, risk factors, pregnancy complications, outcome of complications, vital interventions and ICU admission and outcomes of pregnancy and mother were extracted from the patient's file.

During one year, severe maternal outcome ratio was 50.26 per 1000 live births and near death mothers ratio was 45.60 per 1000 live births. The most common risk factors were hypertension (22%) and bleeding in the current pregnancy (19%), and the most common life-threatening complications were severe bleeding during pregnancy and postpartum (32%), and severe preeclampsia (22%). The most common critical intervention used was ICU admission (62%) and blood/blood products transfusion (37%). The most common organ failure was respiratory disorders (29%) and coagulopathy (20%). The most common cause of death was COVID-19 (30%).

Hypertension and bleeding are the most important risk factors during pregnancy and the most important life-threatening complications in cases of near death mothers. With proper prevention and treatment measures and education of mothers and medical team, the mortality due to these complications can be reduced.

Ectopic pregnancy (EP) is a life-threatening pregnancy complication and can cause maternal morbidity and mortality and early fetal death with the incidence rate of approximately 2% of all pregnancies. The rate of recurrence of EP increases in patients with a past history of EP. We present here two cases that have had three consecutive recurrent EPs during one year with different management.

Case 1: A 27-year-old woman gravida 3 Ep2 with 6 weeks gestational age was referred with abdominal pain. She had a history of two consecutive ectopic pregnancies 9 and 4 months ago that were treated with methotrexate (MTX) and right salpingectomy. Transvaginal ultrasonography showed left tubal ectopic pregnancy with intra-abdominal bleeding. Left salpingectomy was performed. Case 2: A 34-year-old women gravid 3 with a history of 2 consecutive Ep 11 and 6 months ago that were treated with left salpingectomy and MTX, was referred. She was treated with two doses of MTX.

The rate of recurrent EP considerably rises in patients with a history of the previous EP and considering this medical history is highly recommended in future pregnancies for early diagnosis

Hemorrhoids is one of the most common problems during pregnancy. Lifestyle modification recommendations are associated with patients' noncompliance. The potential therapeutic properties of coconut oil on hemorrhoids have been suggested, but its scientific evidence has not been reported, therefore this study was performed with aim to determine the effect of coconut oil ointment on hemorrhoids symptoms in pregnant women.

This randomized clinical trial was performed on 60 pregnant women referred to comprehensive health services centers in Mashhad in 2018-2019. The subjects were randomly divided into intervention and control groups. In the intervention group, one applicator of coconut oil ointment was applied twice a day for two weeks; they also received lifestyle modification recommendations. The control group only received lifestyle modification recommendations based on national guidelines. The improvement of hemorrhoids symptoms was measured on the first, seventh and fourteenth days using Visual Analog Scale (pain, prolapse, itching and overall score of hemorrhoid symptom). Data were analyzed using SPSS software (version 16) and Mann-Whitney, Independent T and Friedman tests. P<0.05 was considered statistically significant.

The mean score of pain, prolapse, itching and overall score of hemorrhoid symptoms in coconut oil ointment group significantly decreased compared to the control group (p<0.05). In the intra-group evaluation, in the coconut oil ointment group, the pain score measured by day was significantly different (p<0.001) but in control group this difference was not significant (p=0.050).

Coconut oil ointment is effective in improving the hemorrhoids symptoms, therefore it is recommended for pregnant women with hemorrhoids grade 1 and 2.

Most cases of Ovarian Hyperstimulation Syndrome (OHSS) are associated with the use of exogenous gonadotropins for the induction of multiple oocytes. However, OHSS is rarely associated with a spontaneous ovulatory cycle in women with multiple gestations, hypothyroidism, polycystic ovary syndrome, or molar pregnancies. Herein, we report a case of OHSS in a woman with spontaneous pregnancy, without any underlying diseases or risk factors. The clinical findings showed abdominal pain, nausea, dyspnea, and amenorrhea. After imaging and laboratory tests, the final diagnosis was established. The patient was managed successfully without any complications. In conclusion, although spontaneous ovarian hyperstimulation is a rare condition, physicians should be able to diagnose this condition. In fact, early diagnosis and successful management can potentially prevent serious complications, which are likely to develop rapidly in patients

Preeclampsia is one of the most common pregnancy complications, which is one of the major causes of fetal and maternal mortality. To compare the serum Brain Natriuretic Peptide (BNP) level in patients with severe preeclampsia and normal pregnancy and investigate associated cardiovascular complications. This case-control study was performed on 94 women with a singleton pregnancy (severe preeclampsia and normal pregnancy) at Imam Reza Hospital in Mashhad, Iran. The venous blood samples were collected to evaluate the serum BNP level. All patients were subjected to echocardiography performed by a single cardiologist. The mean pro-BNP levels were 480.36 ± 754.52 and 67.46 ± 106.24 pg/dL in the severe preeclampsia and normal pregnancy patients, respectively (p < 0.001). However, adjusted BNP for maternal and gestational age was not different in the two groups (ANCOVA, p = 0.69). Furthermore, the two study groups showed no significant difference in terms of the cardiac parameters, including ejection fraction (EF), left ventricle end-diastolic and -systolic diameters (LVEDD and LVESD, respectively), tricuspid annular plane systolic excursion (TAPSE), and ratio of the early transmitral flow velocity to the early diastolic tissue velocity (E/Em). However, the serum BNP level showed a significant correlation with EF (r = -0.39, p = 0.008), TAPSE (r = -0.47, p = 0.001), and E/Em ratio (r = 0.48, p = 0.001) in patients with severe preeclampsia. It seems that BNP can be used as a predictor for some of the main cardiac functional indices (i.e., E/Em, EF, and TAPSE) in severe preeclampsia patients.

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.

Polycystic ovary syndrome (PCOS) is one of the frequent endocrine disorders among young females, which can cause infertility. Recently, evidence has shown the beneficial impacts of N-acetyl cysteine (NAC) use along with clomiphene citrate on the treatment of infertility caused by PCOS. Regarding this, the present study aimed to compare the pregnancy rate between the PCOS patients treated with clomiphene and those received clomiphene along with NAC. This blinded randomized controlled clinical trial was performed on 66 patients with PCOS who presented with infertility at Milad Infertility Center in Mashhad, Iran, in 2015. The patients were divided into two groups of intervention and control using a random number table. In the intervention group, 100 mg of clomiphene (i.e. two pills) along with 1200 mg of NAC (i.e. two 600 mg pills) were given to the participants from the third day of the menstrual cycle for five days. In the control group, 100 mg of clomiphene was administered from the third day of the cycle for 5 days. The patients’ response to medications as well as the number and size of follicles were assessed using the vaginal ultrasound. The 2 study groups had no significant difference regarding age, duration of infertility, body mass index, history of infertility treatment, and endometrial thickness on the third day of the menstrual cycle. The mean endometrial thickness was 7.47 ± 1.6 (NAC/clomiphene) and 7.58 ± 2.1 mm (clomiphene) on the 12th day of the menstrual cycle (P = 0.810). Furthermore, the mean sizes of the follicles were 13.6 ± 4.2 (clomiphene) and 15.9 ± 5.1 mm (NAC/clomiphene) (P = 0.301). The mean numbers of follicles were 1.56 ± 0.9 (clomiphene) and 1.8 ± 0.9 (NAC/clomiphene) (P = 0.069). In total, 7 (21.2%) and 5 (15.1%) patients in the intervention and control groups had a positive beta-hCG result, respectively (P = 0.260). As the findings of this study revealed, the addition of NAC to clomiphene treatment was not associated with an increased chance of pregnancy in patients with PCOS-related infertility.

Polycystic ovary syndrome (PCOS) is considered as one of the causes of infertility. Anti-Mullerian hormone (AMH) is 2-3 times higher in patients with the PCOS compared to others. The present study aimed to survey the association between basal AMH levels and ovarian response in infertile PCOS patients. In this cross-sectional study, 70 infertile PCOS women were enrolled referring to Milad Infertility Center (Mashhad, Iran) from May 2011 to April 2012. The basal blood level of AMH was evaluated. The patients received 5 mg of letrozole from the fifth cycle day (for 5 days) and then received 150 units of gonal F in the form of the recombinant follicle-stimulating hormone (FSH) on the ninth day of the cycle. Five thousand units of human chorionic gonadotropin (hCG) were prescribed for the patients who had one follicle of ≥ 18mm. Then, they should have had intercourse 36 hours later. After ovulation induction (OI) on the 10th cycle day, the second serum sample of AMH was taken. Changes of AMH did not have a significant relationship with the ovarian response, namely, it was lower in patients with positive ovarian response compared to those without any ovarian response. In addition, the basal level of AMH in patients with a positive response (3.91 ± 2.14) had no significant difference with the secondary AMH (3.27 ± 2.39) after the OI (P = 0.19). Generally, the AMH was not a predictor of ovarian response in PCOS patients and the amount of AMH reduced after the treatment. This effect was maybe related to letrozole and gonadotropin.

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.

Mirror syndrome is described as mother's generalized edema accompanied with hydrops fetalis, which sometimes leads to preeclampsia. Mirror syndrome is uncommon and its accompaniment with eclampsia is very rare. This report presents a rare case of pregnancy accompanied with mirror syndrome leading to eclampsia.
Case Report: The patient was a 21-year-old woman, gravida 2 with history of one abortion and with 33 weeks gestation. The patient was admitted in Mashhad Imam Reza hospital with hydrops fetalis, diagnosed by sonography, generalized edema, hypertension (blood pressure of 140/90 mmHg) without headache, epigastric pain, and blurred vision which caused suspicion of mirror syndrome. The laboratory tests showed normal liver and renal function, normal platelet count, and no proteinuria. Two days after admission, hypertensive crisis occurred, and her blood pressure was 170/110 mmHg, and preeclampsia occurred. Therefore, cesarean section was performed because of prematurity. The neonate died after 48 h due to respiratory distress. After three days, the patient was discharged following 48 h infusion of intravenous magnesium sulfate with a good general condition and normal blood pressure. Mirror syndrome is a rare complication of pregnancy accompanied with hydrops fetalis. Its symptoms can range from mother's edema to eclampsia. If maternal symptoms increased, emergency pregnancy termination leads to good prognosis and recovery of maternal symptoms

Small intestine gangrene during pregnancy is a rare and difficult diagnosis. This condition is mainly caused by a complicated obstruction of the small bowel resulting from adhesions due to previous surgical operations such as hernia, or small intestine volvulus. Vascular causes including thrombosis, emboli, and vasculitis are common. The current report discussed a case of entire small bowel gangrene following small intestinal volvulus in a 24 - year - old multigravida in the 36th week of pregnancy, presenting with severe abdominal and back pain. During the operation, the small intestine was not recoverable, leading to a successful near - total enterectomy. The current case demonstrated the importance of a full diagnostic work - up of pregnant females present with gastrointestinal symptoms, especially when there is more than one etiology possible for patient’s clinical condition

This study intended to compare the serum magnesium level in women with preterm labor, with its level in women with normal pregnancy of the same age, and assess the relationship between serum magnesium level and response to magnesium sulfate (MgSO4).
Forty women aged 18-40, with gestational age of 26-32 weeks and signs of preterm labor, and 40 women in similar age and gestational age with normal pregnancy were included in this study. Case group received betamethasone 12 mg in 2 separate doses with 24-hour interval. MgSO4 was administrated (in dose of 4 mg), and continued by 2 mg/h. Once the tocolytic therapy goal was achieved, the administration of MgSO4 continued for an additional 12-hour.
The mean age, gestational age, gravidity, parity, number of live born children, number of dead children, miscarriage, and molar pregnancy were similar in 2 groups. The mean of serum magnesium level showed a significant difference between 2 groups. In the case group, 27 patients showed positive therapeutic response to MgSO4; the difference between the mean of serum magnesium level in these 27 patients and the other 13 patients who did not respond well was significant. The serum magnesium level Serum magnesium level can be used as a predictive tool for preterm labor. It can help in preterm labor in selecting patients who benefit from MgSO4 as a tocolytic agent. Magnesium supplementation may be helpful in patients with decreased serum magnesium level to prevent preterm labor.

High incidence of infertility in our society (24.9%) is considered as a main problem. Intrauterine insemination (IUI) due to its low cost and non-invasiveness is selected as a first-line treatment for infertility treatment in assisted reproductive technique. This study was performed with aim to evaluate the frequency of pregnancy and its predicting factors in IUI cycles.
This cross-sectional study was performed on 308 infertile couples who had referred to Milad infertility center during 2011-2013. A total of 370 IUI cycles were performed for infertile women. Infertile women underwent Letrozole regimen along with recombinant FSH, and after monitoring by transvaginal ultrasound, when observing at least one mature follicle with size over 16 mm, HCG (5000 IU intramuscularly) was injected. 36 hours later, IUI was performed. IUI success and pregnancy rate were confirmed by pregnancy test and transvaginal ultrasound. Data was analyzed by SPSS software (version 16). P
The overall pregnancy rate was 23.8% in this study. The factors such as less IUI cycles (P=0.035), existence of just one known infertility factor (P=0.01), at least two mature follicles (P=0.001), endometrial thickness of at least 10mm (P=0.003), no use of tenaculum (P=0.01), ratio of progressive motile sperm more than 50% (P=0.015) and Total Motile Functional Sperm more than 5 million (P=0.015) significantly affect pregnancy rate. The woman's age (P =0.08), duration of infertility (P =0.94), type and etiology of infertility (P =0.083) and sperm concentration (P=0.269) and sperm morphology (P=0.67) did not significantly affect the pregnancy rate.
Less IUI cycles, existence of just one known infertility factor, at least two mature follicles, endometrial thickness of at least 10mm, no use of tenaculum, ratio of progressive motile sperm more than 50%, and TMFS more than 5 million are significantly effective on pregnancy rate in IUI cycles.

Thyroid disorders are common in young women. Hypothyroidism has a broad clinical range of subclinical to severe disease along with various complications. Hypothyroidism in pregnancy causes many complications on pregnancy. Considering the contradictory results in this regard, this study was performed with aim to evaluate the prevalence of subclinical hypothyroidism and compare the complications of this disease in patients treated with or without levothyroxine.
This cross-sectional and interventional study was conducted on 1,000 pregnant women who referred to Prenatal Clinic of Imam Reza Hospital and the clinics of two gynecologist colleagues in Mashhad in 2012-2013. 212 women with TSH > 3 in the first trimester of pregnancy were selected and randomly divided into intervention (n=112) and control (n = 100) groups. Individuals in the intervention group received 0.5 to 1.5 pills of levothyroxine from diagnosis until delivery. Patients were monitored until the end of pregnancy and complications of pregnancy were evaluated between the two groups. Data were analyzed using SPSS software (version 11.5), Chi-square and independent t-test. P In this study, the prevalence of hypothyroidism was 21%. Based on Chi-square test, two groups did not show significant difference in terms of abortion, preeclampsia, preterm labor, Apgar score less than 7, and need for NICU admission (p>0.05). However, there was a significant difference between the two groups in terms of abruption, (P=0.015) and abruption was higher in untreated group. Based on the independent t-test, the weight of newborns was higher in the treated group and the two groups were significantly different (P=0.025).
Hypothyroidism is a common disease in pregnancy and TSH is a prerequisite for pregnancy testing in order to prevent its complications when diagnosed.

One of the most serious complications of pregnancy is preterm labor (PTL) and delivery. Further, there are different tocolytic agents available to enhance the time of delivery.. The aim of this study was to compare the effectiveness of transdermal nitroglycerin (glyceryl trinitrate, GTN) and oral nifedipine for managing preterm labor..Patients and This was a randomized clinical trial involving women who were admitted to our hospital with a diagnosis of PTL. Group one received transdermal GTN, whereas group two received oral nifedipine. All vital signs, fetal heart rate (FHR), contractions, dilation, and effacement, as well as gestation age at the time of delivery, have been monitored and evaluated in both groups of patients. Our main goal was the postponement of delivery so as to secure the most beneficial effect of primary corticosteroid administration for the fetus.. Both groups were matched regarding age, gestational age at the time of tocolytic therapy, height of fundus, history of pregnancy, abortion, delivery, and stillbirth, primary body temperature, and systolic and diastolic blood pressure. Those who received GTN had a more prolonged delay of delivery. Also, the GTN group had infants with better one- and five-minute Apgar scores. Although both groups reported minimal side effects, tachycardia and nausea were reported more frequently in GTN patients.. Transdermal GTN was shown to be more effective in controlling PTL compared to oral nifedipine in terms of both maternal and neonatal effects..

Bilateral spontaneous tubal ectopic pregnancy is the rarest form of extra uterine pregnancy. The diagnosis is usually made intraoperatively and levels of serum BHCG and ultrasound has not been useful in the diagnosis of bilateral tubal ectopic pregnancy.A 33-year-old woman with 8 weeks amenorrhea and sever lower abdominal pain was admitted. A transvaginal pelvic ultrasound revealed left adnexal mass and massive fluid collection in the pelvis and abdomen. The serum BHCG was 5,700 mIU/ml and in laparotomy bilateral unruptured tubal pregnancy was noted. Left salpingectomy and right salpingostomy were performed.The diagnosis of bilateral spontaneous tubal ectopic pregnancy is usually made intraoperatively. Both tubes at the time of surgery should be closely examined in order to prevent maternal morbidity and mortality.

There are still many questions about the ideal protocol for letrozole (LTZ) as the commonest aromatase inhibitor (AI) used in ovulation induction. The aim of this study is to compare the ultrasonographic and hormonal characteristics of two different initiation times of LTZ in clomiphene citrate (CC) failure patients and to study androgen dynamics during the cycle. This randomized clinical trial was done from March to November 2010 at the Mashhad IVF Center, a university based IVF center. Seventy infertile polycystic ovarian syndrome (PCOS) patients who were refractory to at least 3 CC treatment cycles were randomly divided into two groups. Group A (n=35) receiving 5 mg LTZ on cycle days 3-7 (CD3), and group B (n=35) receiving the same amount on cycle days 5-9 (CD5). Hormonal profile and ultrasonographic scanning were done on cycle day 3 and three days after completion of LTZ treatment (cycle day 10 or 12). Afterward, 5,000-10,000 IU human chorionic gonadotropin (hCG) was injected if at least one follicle ≥18 mm was seen in ultrasonographic scanning. Intrauterine insemination (IUI) has been done 36-40 hours later. The cycle characteristics, the ovulation and pregnancy rate were compared between two groups. The statistical analysis was done using Fisher’s exact test, t test, logistic regression, and Mann-Whitney U test. There were no significant differences between two groups considering patient characteristics. The ovulation rate (48.6 vs. 32.4% in group A and B, respectively), the endometrial thickness, the number of mature follicles, and length of follicular phase were not significantly different between the two groups. LTZ is an effective treatment in CC failure PCOS patients. There are no significant differences regarding ovulation and pregnancy rates between two different protocols of LTZ starting on days 3 and 5 of menstrual cycle (Registration Number: IRCT201307096467N3).

Epidemiologic events show the associations of vitamin D deficiency andhypertension، cardiovascular disease and some cancers. Vitamin D is diagnosed as one of the molecules in the pathogenesis of preeclampsia. This study was performed with aim to evaluate serum level of maternal 1 and 25-hydroxyvitamin D and its relationship with preeclampsia.

This case-control study was performed on 70 mothers referred to Mashhad University hospitals from 2013 to 2014. The study was conducted on two groups of normal pregnant women and women with severe preeclampsia. The blood samples were assessed for vitamin D serum level. Data analysis was performed using the SPSS software (version 16)، and student-t and Chi-square test. P < 0. 05 was considered significant.

The mean serum vitamin D in case group was 5. 5±3. 32 (range 3-23) and in control group was 8. 05±4. 81 (range 3-37). T-test showed a significant difference between two groups in terms of mean serum vitamin D (P<0. 001).

According to the findings in this group، vitamin D deficiency was found in both groups. Vitamin D deficiency in case group is so that has caused severely clear difference. It is recommended that the study be conducted with larger sample size before pregnancy، the mothers be evaluated in terms of vitamin D level and supplement be provided to the deficient patients، and severe preeclampsia will be checked.

Complications related to pregnancy and childbirth are the leading causes of disability and death among women of reproductive age in developing countries, constituting at least 18% of the global burden of disease in this age-group. Preeclampsia is a serious, pregnancy-specific disorder that affects up to 8% of pregnant women. Preeclampsia may lead to maternal and offspring mortality and it increases the risk of premature birth and fetal growth restriction. Vitamin D is a potent immunomodulatory agent. There is an evidence pointing toward an association between the vitamin D status and preeclampsia risk. The purpose of the present study is to review the available literature investigating the role of serum levels of vitamin D in preeclampsia.The study findings further highlight the possibility that vitamin D deficiency is a strong, independent risk factor for preeclampsia and vitamin D supplementation may be a simple step to reduce the risk of adverse pregnancy outcomes providing lifelong benefits both to the mother and her developing child.

Birth of healthy term infant depends on normal placenta development with its disturbance causing problems like Intrauterine Growth Restriction (IUGR). The aim of this research was to evaluate morphologic and histopathologic changes of placenta in normal and IUGR infants to improve the management of the future pregnancies. This cross-sectional study was conducted on 23 pregnant women with IUGR and 23 normal fetus referred to Imam Reza Hospital between 2007 and 2009. Mother, newborn and placenta data were recorded after delivery. Inclusion criteria were material age of 18-35 yr and gestational period of 32-42w with IUGR or normal embryo. The subjects were matched for age, height, weight, social status. Exclusion criteria were twin pregnancy, gestational age <32w, preeclampsia or chronic hypertension during pregnancy and diabetes. Data were analyzed using SPSS software version 11.5. Infarction rate, thrombosis, tissue ischemia, increased thickness of membranes and intervillus fibrin were significantly higher in IUGR group. Mean placenta weight was lower in IUGR group (440 vs. 585g). Placenta of IUGR newborns were smaller with more microscopic infarction. Fetal placental weight ratio in IUGR group was lower than controls. The gross and microscopic measurements of a placenta are more objective and seem to offer a good way to get proper information about IUGR.

While tocolytic therapy can halt the process of delivery, some patients return before the 37th week of pregnancy with recurrence of preterm labor signs.. This study was designed to evaluate the efficacy of progesterone in the prolonging of gestation and reduction of neonatal complications.. In a clinical trial in 2010, 110 singleton pregnant women admitted at Imam Reza Hospital, Mashhad, Iran, with the diagnosis of preterm labor were divided into three groups: 400 mg/d vaginal progesterone suppositories; 250 mg/w 17-alpha-hydroxyl-progestrone-caproate; and a control group with no additional treatment. After delivery, we assessed the duration between the first phases of labor to the recurrence of preterm labor. The neonatal complications, apgar score, birth weight, need for admission to NICU, and congenital malformations were compared between groups.. The mean gestational age was 34± 3 weeks in the first, 33.5 ± 3 weeks in the second and 32.5 ± 2 weeks in the control group. The duration of first phase of labor was 31 ± 17 days in the first, 36 ± 14 days in the second and 26 ± 22 days in the control group. The difference between study groups and the control group was significant (P < 0.005). The complications were lower in progesterone-receiving group in comparison to the control group.. This study reveals that progesterone can significant reduce the rate of recurrent preterm labor and the several possible neonatal complications among women who had treated with tocolytics to suppress the acute phase..