zahra najmi

 Pregnancy is a significant cause of sleep disorders, leading to adverse effects on the health of the mother and fetus.

 The current study aimed to investigate the association of sleep disorders with pregnancy outcomes during the third trimester.

 Following a descriptive-analytical approach, 100 pregnant women referring to the prenatal clinic of Mousavi Hospital of Zanjan City from April to September 2021 were recruited by convenience sampling. Data were collected using the Pittsburgh Sleep Quality Questionnaire, filled by mothers, and a researcher-made checklist on pregnancy outcomes. Data were analyzed using the SPSS version 24, and the significance level was considered at P ≤ 0.05.

 The mean age of participants was 32.43 ± 4.6 years and, 46 (46%) participants were at the age of 36 years and older, 62 (62%) participants were nulligravid, and 65 (65%) participants were nulliparous. There was a significant association between study outcomes (low birth weight, intrauterine growth delay, preterm, preeclampsia, gestational hypertension, and gestational diabetes) and sleep disorders (P-value = 0.001).

 It seems that sleep disorders result in adverse pregnancy outcomes; however, further studies are needed to extend our knowledge.

 Some recent trials have reported high efficacy for nonsteroidal anti-inflammatory drugs (NSAIDs) in relieving medical abortion-related pain. The aim of this study was to determine the beneficial effect of oral NSAIDs (ibuprofen lysine) in reduction of pain and hemorrhage in first-trimester medical abortion.

 This randomized triple-blinded clinical trial was performed on 98 pregnant women who were candidate for medical abortion within the first-trimester period (gestational age<12 weeks). The participants were randomly assigned to receive ibuprofen lysine (684 mg orally every 4 hours) or placebo. All patients were initially treated with misoprostol (800 µg every 3 hours). Pain intensity and rate of hemorrhage were assessed every hour up to 15 hours after receiving the first dose of misoprostol by visual analogue scaling (VAS) and pictorial blood loss assessment chart (PBAC), respectively.

 Assessing the mean pain score within 15 hours of receiving misoprostol showed significantly lower pain intensity within the first 10 hours of assessment in the group receiving NSAID in comparison with the control group (P<0.001). The bleeding rate was also significantly lower in the NSAID group at the fifth (P=0.013) and ninth (P=0.040) hour of receiving misoprostol compared to the control group. We found no difference in abortion-related complication rate between the NSAID and placebo groups (8.3% versus 8.0%, P=0.952).

 The use of NSAIDs (ibuprofen lysine) is a good pharmacological analgesic option for relieving medical abortionrelated pain and hemorrhage.

 Pregnancy is a unique immunological condition in which the immune system is affected and therefore there is a greater risk of severe disease and mortality from COVID-19 disease. The present study aimed to evaluate the clinical manifestation, laboratory findings, and adverse outcomes among a population of pregnant women confirmed with COVID 19 infection.

 In present cross-sectional study, all pregnant women with COVID-19 referred to Mousavi Hospital in Zanjan City from February 2020 to August 2021 including 232 patients were examined. We used a researcher-made checklist to extract the required information, including socio-demographic data, potential risk factors, clinical manifestations, laboratory parameters, and fetal, and neonatal outcomes of the patients. Comparison of laboratory parameters in women with COVID-19 according to ICU admission was made using independent t-test and Mann-Whitney U test.

 47.4%, of women were 30 to 40 years old, 45.7% were illiterate. Weakness, myalgia, dry cough, and fatigue were the most common clinical symptoms (>90%). Patients had abnormal levels of ALT and AST, whereas the means of other laboratory parameters were in the normal range. Forty- one (17.6%) of patients were admitted to the ICU. The means of C - reactive protein (46.58 vs. 25.87), lactate dehydrogenase (586.31 vs. 480.97), Blood urea nitrogen (9.43 vs. 8.26), and erythrocyte sedimentation rate (62.40 vs. 46.11) were statistically higher in patients admitted to ICU than those who were not in the ICU (P <0.05). Mortality rates among women who had a vaginal delivery and C-section were 3% and 6.1%, respectively.

 The most common laboratory findings in COVID-19- infected mothers were lymphopenia and elevated CRP, ALT, D-Dimer, and LDH. An increased hospitalization in ICU and higher rates of mother and fetal death were complications of pregnancy and childbirth in COVID-19- infected women.

Sleep, a physiological need, may be disturbed during pregnancy due to the psychological, anatomical, biochemical, hormonal, and emotional adaptations.

The present study aimed to investigate the frequency of morningness/eveningness, insomnia, and sleep disorders in pregnant mothers.

All healthy pregnant women who referred to Rasoul-Akram Hospital in 2018-2019 for prenatal care without severe medical diseases were included in the study by census method. They were asked to fill their demographics, Morningness Eveningness questionnaire (MEQ), Pittsburgh sleep quality index (PSQI), and insomnia severity index (ISI) after signing their informed consent. The data were analyzed using SPSS V.21. Women who gave birth before the third trimester were excluded from analysis.

A total of 347 women completed the study; mean age: 31.46 ± 5.36 years, mean gestational age: 24.68 ± 9.62 weeks. The mean MEQ score was 48.77 ± 5.15; 8.1% were moderate evening type, 85.3% intermediate, and 2.6% moderate morning type. Mean ISI score was 16.92 ± 5.51; 91.9% had insomnia; 31.1% reported (rather or very) poor sleep quality. The frequency of insomnia (based on ISI scores) and sleep disorders (based on PSQI dimensions) were neither different among the three trimesters of pregnancy, nor between complicated and uncomplicated pregnancies (P > 0.05). The MEQ score (P = 0.008, OR = 4.275) was positively, and the academic degree was negatively (P = 0.005, OR = 0.202) associated with sleep disorder.

The majority of pregnant mothers reported insomnia, and about one-third reported poor sleep quality, indicating the necessity of paying greater attention to the sleep disorders of pregnant women from the early trimester to prevent further complications.

Endometriosis is routinely treated with laparoscopy, which despite significant advantages over laparotomy cannot diminish postoperative pain. Insufficient postoperative pain control decreases patient satisfaction. This study was designed to evaluate the efficacy of intraperitoneal dexmedetomidine (DEX) combined with bupivacaine on postoperative pain in endometriosis laparoscopic surgery. Fifty-three patients with endometriosis, scheduled for laparoscopy in Rasoul-e-Akram Hospital, Tehran, from January 2016 to May 2017 who were randomly divided into three groups, including group 1 (G1, n = 21) received 50 mL intraperitoneal saline, group 2 (G2, n = 16) received 50 mL intraperitoneal instillation of bupivacaine 0.25%, and group 3 (G3, n = 16) received 50 mL bupivacaine 0.25% plus dexmedetomidine 1 µg/kg. Each patient with a history of allergy to local anesthetics or dexmedetomidine, cardiac disease, renal or hepatic failure, severe pulmonary disease; in addition, pregnant and comorbid obese patients were excluded from the study. Patients’ postoperative pain was assessed in the recovery room after 2, 6, 12, 24, and 48 hours using visual analogue scale (VAS). Total analgesic consumption was also recorded. The postoperative VAS scores were significantly lower in group 3 than other groups in the recovery room, and 2, 6, 12, 24 and 48 hours after the surgery (P < 0.001). However, there was no significant difference between 1 and 2 groups. Furthermore, total VAS in the first 24 hours in group 3 was significantly lower than the two other groups (P < 0.001). We conclude 1 μg/kg intraperitoneal DEX administration combined with bupivacaine may prolong postoperative analgesia and decrease rescue analgesia requirement compared with bupivacaine alone.

Endometriosis is a common gynecologic problem in women of reproductive age around the globe. The aim of this study was to specify the factors influencing endometriosis in women of reproductive age using logistic regression and artificial neural network (ANN).
The data of this case-control study was obtained from the medical records in Rasoul-e-Akram hospital, Tehran. Patients, who underwent laparoscopy from 2007 to 2015 and were diagnosed with endometriosis, were selected as the case group (n = 250), and patients diagnosed without endometriosis served as controls (n = 250). To investigate the factors affecting the occurrence of endometriosis, ANN and logistic regression were used and for evaluating the efficiency of the two methods, the area under the ROC curve (AUC) was used. To analyze the data, SPSS (version 22) and R (version 3.2.1) software were used.
The means of age in the cases (34.84 ± 0.62) and controls (33.75 ± 0.55) were significantly different (P value = 0.02). With multiple logistic regression, the number of live births and premenstrual spotting were found to be the factors associated with the occurrence of endometriosis. The most important variables entering ANN included BMI, menstrual duration, age, and premenstrual spotting.
The results showed that the fitted ANN with AUC of 0.94 could predict the likelihood of endometriosis better than logistic regression with AUC of 0.72. This suggests the superiority of ANN to the logistic regression and proposes ANN be used in further research on predicting the risk of endometriosis, instead of logistic regression. The most important factors affecting endometriosis in this model were BMI, menstrual duration, age, and premenstrual spotting that have to be considered in the clinical settings.

A 37-year-old woman underwent surgery to remove bilateral vulvar masses. The masses were firm, non-tender, and immobile. Pathologic finding was a well-delineated creamy grayish mass with a homogenous grayish solid surface and mild edema, chronic inflammatory infiltration, and focal dilation of the ducts with squamous metaplasia. The diagnosis was hyperplastic and hypertrophied Bartholin’s gland. Hyperplasia is a rare etiology for an enlarged Bartholin’s gland. Clinical presentation of Bartholin’s gland nodular hyperplasia is rather specific, although inflammatory lesion is the most common cause of swelling of the Bartholin’s gland in all age groups. Bartholin’s hyperplasia should be considered in cases with a solid mass. Total surgical excision is required for diagnosis. Only a few cases of Bartholin’s gland hyperplasia have been reported in the literature. Our patient has been receiving regular follow-up examination and there is no evidence of dyspareunia, perineal pain, and recurrent disease 12 months after surgery.

Fetal male gender may affect the progression of labor and could be a risk factor for labor arrest. This study was conducted to evaluate the effect of fetus gender on labor curve.

In this cohort study, 1550 singleton term pregnant women in labor phase (either spontaneous or by induction) were enrolled. Results of regular cervical examination, dilation, length of labor stages, mode of delivery, and sex of the fetus, and birth weight were recorded for all participants. Labor progression curve was compared between two sex groups with independent t test and chi2 test.

Finally, 1527 women completed the study (47.8% female and 52.1% male). Mean duration from beginning of the active phase up to full dilatation, from 4 to 6 cm, 6 to 8 cm, and 8 to 10 cm dilatations, were significantly longer in the male sex group compared to the female (p˂0.05). All durations were also significantly different when parity was considered (p˂0.05). We could not show fetal sex as an independent risk factor for active phase arrest (OR Adjusted: 1.18, CI 95% 1.01:1.42).

Active phase stage was slower and longer in women who carried male fetuses compared to those carrying female fetuses; however, fetal sex did not increase the risk of active phase arrest.

Threatened preterm labor (TPL) is the leading cause of hospitalization during pregnancy. Tocolytic agents are the primary therapeutic options for TPL. The aim of this study is to compare intramuscular progesterone with oral nifedipine as a tocolytic agent.
This randomized controlled trial was carried out in a teaching hospital (Shahid Akbarabadi) in Tehran, Iran, from December 2011 to November 2012. Three hundred and fifteen singleton pregnant women aged 18 yrs at 26-34 weeks’ gestation with the diagnosis of threatened preterm labor (TPL) were randomly received either intramuscular progesterone or oral nifedipine for tocolysis. Maternal and neonatal outcomes were then compared between the two interventions. P value less than 0.05 was considered statistically significant. IRCT registration number of this study is IRCT201112198469N1
The success rate of progesterone and nifedipine in treating TPL were 83% and 82.7%, respectively. There was no significant difference between the two interventions with regard to gestational age at delivery, type of delivery, the time interval until the delivery, birth weight, NICU admission rate and hospital stays. Progesterone administration was associated with lower duration of NICU stay as compared with nifedipine (0.33±0.77 days vs.1.5±3.2 days, p Single dose intramuscular progesterone is as effective as oral nifedipine in treating TPL. It also significantly reduces the NICU stay.

The virginity is a matter of concern in many eastern countries, especially Muslim societies. In some cultures, integrity of hymen before marriage causes deprivation of social rights for the females; even in some cases an honor killing is plausible.
In this descriptive cross-sectional study, total records of all virgin patients who underwent hysteroscopy for medical reasons in Hazrat Rasool Hospital between 2004 and 2014 were studied. Data were analyzed by SPSS version 19 using descriptive scales and simple proportion and ratios.
400 women with AUB (abnormal uterine bleeding) were referred to Hazrat Rasool Hospital for the diagnosis and treatment. 12 cases (3%) were virgin and 388 (97%) were non-virgins. In 12 Virgin patients admitted for hysteroscopy, 3 (25%) hymenal damage were reported, and in 9 virgin patients hymen remained intact postoperatively.
Regarding the high prevalence of congenital and acquired uterine diseases and successful treatment of these problems by hysteroscopy, it seems prudential to focus on more comprehensive teaching programs in the gynecologic endoscopic field. This will help better and earlier diagnosis and treatment of virgin patients, due to seeking earlier medical care.

Offspring sex ratio (OSR) serves as an important social factor, and various other factors are hypothesized to be associated with it, such as maternal diet, time of ovulation and insemination, environmental phenomena, parental age, and infertility treatment..
This research was performed to assess the association between mothers’ menarche age, first pregnancy age, and sex ratio of first offspring..
Patients and In this retrospective study, 2,000 Iranian women of reproductive age were recruited to assess their menarche age, first pregnancy age, and first OSR..
The mean age of the participants was 29.6 ± 7.09, their mean menarche age was 13.25 ± 1.21, and the mean age of their first pregnancy was 23.9 ± 4.35. Total OSR was 0.932. The OSR (calculated as the proportion of male to female offspring) was higher when the menarche age was younger (P Women of younger menarche age will have younger first pregnancy ages and a greater chance of having a male first offspring..

Premature rupture of membranes (PROM) and preterm PROM (PPROM) are the rupture of the fetal chorioamniotic membranes before the onset of labor contractions.. To evaluate whether detection of thyroid hormones in vaginal washouts can be used to diagnose premature rupture of membranes (PROM)..Patients and Total T4 (thyroxin), total T3 (triiodothyronine), and free T4 concentrations in vaginal washouts were analyzed in 45 women with the diagnosis of PROM and compared with 45 normal pregnancies (controls). A Student's t-test was used for comparison of thyroid hormone values and a ROC curve was used for analyzing the diagnostic accuracy.. There were no differences between the patients with PROM and the control women regarding maternal age, gestational age, and parity. The mean concentration of total T4 in the PROM group and the control subjects were 2.1 ± 1.3 µg/mL and 1.55 ± 0.58 µg/, respectively (P = 0.01). Total T3 concentration in the PROM group was significantly higher compared to the controls (1.28 ± 0.42 ng/ vs. 0.8 ± 0.26 ng/, P < 0.0001). Also, free T4 concentration was significantly higher in the PROM group as compared with the controls (0.026 ± 0.034 ng/ vs.0.007 ± 0.004 ng/, P < 0.0001). The ROC curve analysis showed that total T4 = 1.685 µg/ had a sensitivity of 62%, specificity of 76%, positive predictive value (PPV) of 71.8%, and negative predictive value (NPV) of 66.7%. Total T3 = 0.82 ng/ gave a sensitivity of 91%, specificity of 64%, PPV of 72%, and NPV of 87.8%. Free T4 = 0.01 ng/ gave a sensitivity of 51%, specificity of 82%, PPV of 74.2%, and NPV of 62.7%. The best cutoff values were total T4 = 1.685 ng/, total T3 = 0.82 ng/, and free T4 = 0.01 ng/.. Detecting total T4, total T3, and free T4 in vaginal washouts of patients suspected of PROM suspected is a simple, available, rapid, and inexpensive method for the diagnosis of PROM. However, a combination of three tests is recommended..

Müllerian anomalies are associated with infertility. Hysteroscopy as the gold standard for evaluating Müllerian anomalies is an invasive, expensive and risky procedure which requires enough experience. Transvaginal sonography (TVS) and hysterosalpingography (HSG) are less invasive procedures, but there is little known about the accuracy of these tests. The aim of this study was to evaluate the accuracy of the combination of TVS and HSG with hysteroscopy as the gold standard.
Medical records of infertile women who were undertaken all three diagnostic modalities were reviewed to analyze their sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).
Ninety-nine infertile women were assessed with a mean±SD age of 29.1±6.47 years, mean±SD duration of themarriage of 8.9±10.28 years, and mean±SD duration of infertility of 5.6± 4.16 years. The sensitivity, specificity, PPV, and NPV of TVS were 98.55%, 30%, 76.4%, and 90%, respectively. HSG had a sensitivity of 95.6%, specificity of 60%, PPV of 84.62%, and NPV of 85.71%.When both modalities were combined, the sensitivity, specificity, PPV, and NPV were 94.2, 66.67, 86.67, and 83.33%, respectively. The diagnostic accuracy of single TVS, HSG or combined techniques was statistically similar that was equal to 77.7, 84.8 and 85.8 % respectively.
The accuracy of combination of two diagnostic modalities, 2D TVS and HSG is not higher than HSG alone for assessing uterine malformation in infertile women.

Endometriosis changes the management of infertile women.. Our aim was to evaluate some of the clinical predictive factors among an Iranian infertile population..Patients and Infertile women, scheduled for diagnostic laparoscopy, were recruited into the study and their information including age, weight, height, educational level, marriage and breast-feeding duration, history of fertility, menstrual characteristics, dysmenorrhea, and dyspareunia were collected. Clinical characteristics were then compared with laparoscopic results.. Of 441 infertile women, 82 (18.6%) had endometriosis. No statistically significant difference was identified in the participants’ age, educational level, duration of breast-feeding, duration of infertility, and menstrual flow. On the contrary, women with endometriosis had longer duration of marriage (OR = 1.03, P = 0.002), older age at first pregnancy (OR = 1.21, P < 0.05), lower BMI (OR = 0.9, P = 0.001), shorter interval of menses (OR = 0.98, P < 0.05), and history of irregular menstrual cycles (OR = 0.54, P < 0.05), compared to those without endometriosis. The risk of the endometriosis also decreased significantly with increased numbers of previous pregnancies. The OR for endometriosis in the presence of dysmenorrhea and dyspareunia were 1.80 (1.02 - 3.04) and 1.82 (1.01 - 3.29), respectively.. Lower BMI, longer duration of marriage, shorter menstrual cycles, dyspareunia, and dysmenorrhea are predictive factors for diagnosis of endometriosis in infertile population. These clinical factors should be considered prior to diagnostic laparoscopy for infertility..

Müllerian anomalies are associated with infertility. Hysteroscopy as the gold standard of evaluating Müllerian anomalies is an invasive, expensive and risky procedure which requires enough experience. Transvaginal sonography (TVS) and hysterosalpingography (HSG) are less invasive procedures, but there is little known about accuracy of these tests. The aim of this study was to compare the accuracy of combination of TVS and HSG with hysteroscopy. Medical records of an infertile women who were undertaken all three diagnostic modalities were reviewed concerning their sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Ninety nine infertile women with the mean age of 29.1± 6.47 years, mean duration of marriage of 8.93± 10.28 years, and mean duration of infertility of 5.59± 4.16 years were assessed. The sensitivity, specificity, PPV, and NPV of TVS were 30, 98.5, 90, and 23.6%, respectively. HSG had a sensitivity of 60%, specificity of 95.6%, PPV of 85.8%, and NPV of 15.4%. When both modalities were combined, the sensitivity, specificity, PPV, and NPV were 67, 94.2, 83.3, and 13.3%, respectively. Two dimensional TVS, HSG, and combination of both diagnostic modalities are not accurate enough for assessing uterine malformation in infertile women.

The largest percentage of failed invitro fertilization (IVF (cycles, are due to lack of implantation. As hereditary thrombophilia can cause in placentation failure, it may have a role in recurrent IVF failure.

Aim of this case-control study was to determine whether hereditary thrombophilia is more prevalent in women with recurrent IVF failures.

Case group comprised 96 infertile women, with a history of recurrent IVF failure. Control group was comprised of 95 healthy women with proven fertility who had conceived spontaneously. All participants were assessed for the presence of inherited thrombophilias including: factor V Leiden, methilen tetrahydrofolate reductase (MTHFR) mutation, prothrombin mutation, homocystein level, protein S and C deficiency, antithrombin III (AT-III) deficiency and plasminogen activator inhibitor-1 (PAI-1) mutation. Presence of thrombophilia was compared between groups.

Having at least one thrombophilia known as a risk factor for recurrent IVF failure (95% CI=1.74-5.70, OR=3.15, p=0.00). Mutation of factor V Leiden (95% CI=1.26-10.27, OR=3.06, P=0.01) and homozygote form of MTHFR mutation (95% CI=1.55-97.86, OR=12.33, p=0.05) were also risk factors for recurrent IVF failure. However, we could not find significant difference in other inherited thrombophilia’s.

Inherited thrombophilia is more prevalent in women with recurrent IVF failure compared with healthy women. Having at least one thrombophilia, mutation of factor V Leiden and homozygote form of MTHFR mutation were risk factors for recurrent IVF failure.

Ovarian fibroma is the most common benign solid tumor of the ovary, which is often difficult to diagnose preoperatively. The choice treatment for ovarian fibroma is surgical removal, but discussions for the operative approach, laparoscopic or open, in the literature seem to be scant. We presented a unique clinical experience of laparoscopic approach to a case of 15 cm unilateral ovarian fibroma in a 24 year old patient, with a successful and complete resection of the tumor beside ovarian tissue preservation in December 2012 in Rasoul-e-Akram hospital, Tehran, Iran. In conclusion, we should not forget the role of laparoscopy as a diagnostic procedure even in suspicious cases of ovarian fibroma with solid tumor, ascites, and pleural effusion.

Preterm birth (PTB) is responsible for 70% of neonatal mortalities. Various factors influence the risk of neonatal mortality in different populations. Our objective was to evaluate neonatal survival rate of preterm infants, and to define its predictors in Iranian population. This retrospective cohort study included all preterm (26-37 weeks) infants (n=1612) born alive in Shahid Akbar-abadi university hospital, during one year period (April 2010-2011). These infants were evaluated for fetal-neonatal, maternal, and pregnancy data. Survival analysis was performed and viability threshold and risk factors of neonatal mortality were evaluated. Total overall mortality rate was 9.1%. Survival rate were 11.11% for extremely low birth weights (LBW) and 45.12% for very early PTBs. The smallest surviving infant was a 750 gr female with gestational age (GA) of 30 weeks and the youngest infants was a 970 gram female with GA of 25weeks plus 2 days. History of previous dead neonate, need to cardio-pulmonary resuscitation (CPR), need to neonatal intensive care unit (NICU) admission, postnatal administration of surfactant, presence of anomalies, Apgar score <7, multiple pregnancy, non-cephalic presentation, early PTB, very early PTB, LBW, very low birth weight (VLBW) and extremely low birth weight (ELBW), were risk factors for mortality in preterm neonates. Our study revealed that neonatal survival rate is dramatically influenced by birth weight especially under 1000grams, GA especially below 30 weeks, neonatal anomalies, history of previous dead fetus, multiple pregnancy, non- cephalic presentation, and need for NICU admission, resuscitation and respiratory support with surfactant

Hysteroscopy is the gold standard method for diagnosis of intrauterine pathologies. Current study is a review of hysteroscopic findings performed over a period of 5 years in patients with abnormal uterine bleeding (AUB).. The aim of this study was a review of hysteroscopic findings performed over a period of 5 years in patients with abnormal uterine bleeding (AUB)..Patients and Materials: This descriptive analytic study was conducted prospectively on patients in reproductive, premenopausal or postmenopausal ages referring to our hospital with complaint of AUB. All patients underwent hysteroscopy (either diagnostic or therapeutic) by the same surgeons. Analysis was performed on the base of the hysteroscopic findings.. In our population study (379 patients) major menstrual pattern was menometrorrhagia. The most common diagnoses at operative hysteroscopy were endometrial polyps (17.8%), hyperplastic endometrium (15.2%), and uterine submucosal myoma (9.7%).The most common findings in patients with menometrorrhagia were myoma, and polyp where, the most common finding in patients with menorrhagia, and metrorrhagia was polyp. Our major complications were uterine perforation in 9, thermal injury in 3, and air emboli in one case.. In current study the most common pathology was found to be endometrial polyp. Myoma was the most common finding in patients with menometrorrhagic bleeding. Our major complications were uterine perforation, thermal injury, and air emboli..

A case of cervical ectopic pregnancy in a 37 years old woman with history of two previous cesarean sections and one dilatation/curettage. The case was the advanced cervical pregnancy reported in Iran, which diagnosed in 12 week of gestation by MRI and finally treated by hysterectomy

Endometriosis is an estrogen dependent disease. Levels of Cancer antigen-125 are significantly higher in women with moderate to severe endometriosis. However, patients with unruptured endometriosis rarely have serum CA-125 levels more than 1000 U/mL. This case report presents a diffuse, unruptured ovarian endometrioma in a 29- year-old woman, leading to an extraordinary high serum CA-125 and CA19-9 levels; usually typical of advanced ovarian carcinoma. Our experience emphasizes on benign gynecologic conditions such as endometrioma, which should be taken into account as a possible differential diagnosis in women with exaggerated elevation of the serum CA-125 level.