[Complete hydatidiform mole in triple pregnancy with coexistent two live fetuses [a case report]]

With the widespread use of ovulation induction regimen multiple pregnancy may occur more often and, thus, attention has been drawn to the increased possibility of multiple pregnancy with one or two normal fetuses and placenta and the other appearing as a complete or partial mole following a variety of different methods of assisted reproduction. Management of this condition is extremely challenging, especially when the pregnancy is highly desired and there is a significant risk of severe complications. A 28-yearold female, gravida1- para0 who presented with 8 years of primary infertility [as a result of ovulatory dysfunction] was referred to Alzahra Educational Center at 34 weeks of gestation with the ultrasound diagnosis of a twin pregnancy [the fetuses were female]. The current pregnancy had been conceived during the 2-3 cycle of superovulation with clomiphene- HMG and IUI. She had a history of hypothyrodism for 8 years and was controlled with levothyroxin. At 34 weeks of gestation due to active uterine contractions that made further conservative management impossible, the pregnancy was terminated by cesarean section. Two female fetuses both without malformations were delivered. Following delivery of fetuses, one placenta had normal appearance and was completely removed. The second one, molar tissues containing numerous vesicles, were delivered and microscopic examination confirmed the diagnosis of hydatidiform mole and placental hemangioma. In pregnant women following infertility treatment, close surveillance is certainly needed to evaluate the probability of coexistence of molar pregnancy

[Knowledge of post partum women about oral health]

Hormonal changes during pregnancy predispose women to gingivitis. Developed periodental infections during pregnancy caused problems for uterus and placenta and increased probable of preterm deliveries. To determine postpartum womens knowledge about oral health, and association between oral health and pregnancy outcomes and other related factors which use as dental health services during pregnancy. We carried out our research in the only teaching maternity center for gynecologic and midwifery in Rasht. The research tool was a researcher made questionnaire that made from integration of similar questionnaires which were used in Kuwait, England, and USA. The questionnaires completed by midwifery graduates in face to face interviewing. The studied population was 306 women [24-48 hours after deliveries] six women were extrcted. Data was analyzed by SPSS [version 16] and presented as descriptive statistics; and Pearson correlation coefficient test as appropriate. There was a significant difference between blood pressure and pre-eclamptic situation in women with dental problems group [p=0.048]. The pre-eclamptic conditions in women with dental problems group were 7 cases among 117 women [6%] and in women with no dental problems group were 23 cases 183 women [12.5%].Knowledge about oral health importance and teeth brushing habit were found less than other population; and dental problem more than other population. So suggested to conducting longitudinal studies accompanied with oral examinations before or during pregnancies to determine serious problems including periodentitis

[Comparison the women's quality life before and after hysterectomy]

Introduction: Gynecologic disorders are the most common health problems among women. If drug treatments lead to fail, hysterectomy was considered

Objective: Determine and compare the women's quality of life before and three months after hysterectomies

Materials and Methods: According to chronic disorders [diabetes mellitus, cardio-vascular diseases] fifty five women were selected. Subjects were selected upon a pilot study and by consecutive non-probability sampling. Data were collected by a predetermined questioner; and processed and analyzed with SPSS. Chi- square and t test were used for analyzing accordingly

Results: There was statistically different between mean scores of general health quality before and after hysterectomies [P<0/0001] but its depression component had no different. General disorders and clinical symptoms were different with different statistically degrees. [p=0.0005 for urinary incontinence to p=0.023 for urinary urgency]. Pelvic pain [p=0.056] and vertigo [p=0.21] showed no statistical differences

Conclusions: After hysterectomy total health quality scores statistically improved but anxiety score showed less, and depression score showed no statistical difference. In order to more generalizing findings, recommended carrying out a larger study with benign and malign disorders separately

[Effect of cervical cleaning with cotton on quality of Pap smear]

Introduction: Today, cancer of the cervix has been considered a preventable cancer due to its long pre- invasive state, availability of cervical cytology screening programs, and effectiveness of the treatment of preinvasive lesions. Due to slow progression of cervical cancer lesions, Pap smear is an efficient procedure for cancer detection and decreases mortality

Objective: The objective of this study is to compare the quality of Papsmear before and after cervical cleaning in females referred to Alzahra Hospital

Materials and Methods: This is a before - after clinical trial. Subjects were sampled by nonprobability convenience method. Inclusion criteria were absence of vaginal bleeding, infection, pregnancy, coitus and vaginal douching during past 48 hrs. After obtaining informed consent, two cytologic smears were taken by cytobrush [Cervex-Brush] before and after cervical cleaning by sterile cotton. Both smears were fixed, Coded and send to a special laboratory immediately. They were taken by a resident and were reported by a pathologist. After data collection analysis carried out with X[2], X[2] Mantel Hanszell, statistical software SPSS.10 was used

Results: In this study, 152 patients had met inclusion criteria .The mean age of women was 39.6 +/- 11.2yrs [range 17-65 yr]. Before cleaning, there were 39[25.7%] satisfactory versus 101 [66.4%] after cleaning [P<0.0001]. There were 22 [14.5%] unsatisfactory smears before cleaning versus 10 [6.6%] after it [P=0.0025]. Before cleaning 15 [9.9%] of smears were poor cellular although 4 [2.6%] of smears was poor cellular after procedure [P= 0.009]. Before cleaning, we had 1 [0.7%] smear with epithelial abnormality, which were increased by 7 [4.6%] after [5 ASCUS-1 AGUS-1 CIN-I] [P=0.032]

Conclusion: Pap smear sampling after cervical cleaning increases the quality of smear and is recommended. Due to similar standard results in other sites of the world, we advocate this procedure for accuracy improvement

[Survey the association between maternal age and pregnancy outcome]

Introduction: Age of mother at pregnancy can be one of the main risk factors for hazardous outcome of pregnancy

Objective: The aim of this study was to determine the association between the maternal age and the outcome of pregnancy

Materials and Methods: this is descriptive cross-sectional analytic study that pregnancy outcome in women presenting to Alzahra hospital for delivery was assessed variable studied included enduced hypertension and diabetes in placental complication placenta abruption, placental previa preterm labor and premature rupture of membranes [PROM] was divided into 3 groups based on age /=35. Pregnant women in two groups: 17-34 and >/=35 were matched according to parity. Data collection analysis was carried out with chi-square test by SPSS.9 software

Results: In this survey, 6045 pregnant women with gestational age over 20 weeks were studied. Frequency of delivered women according to age group showed that 52 cases [%0.8] were /=35.Data showed that there were significant differences between the three age groups and the risk of pregnancy-induced hypertension, gestational diabetes, placental abruption, placental previa, PROM, mal presentation, preterm labor and cesarean section [P<0/05]. In contrast, there wasn't a statistically significant difference between advanced maternal age and the frequency of PROM P>0/05

Conclusion: It appears that pregnancy in age >/=35 comparing with teenage pregnancy has special risk factors. Awareness of the risks and complications has an important role planning for appropriate prenatal services

[Effect of cervical mucus aspiration with insulin syringe on pregnancy rate in ART cycles]

A huge number of inefficient embryo implantation caused by embryo transfertechniques. Cervical mucus aspiration is the most important factor in successful embryo transfer.Based on reports pregnancy rate in woman with positive culture of cervical mucus is lower thanwomen with negative culture. Mucus plague on the catheter tip can cause improper embryoimplantation. This study evaluated the effect of cervical mucus aspiration on embryo transferresults.A Randomized Clinical trial study was performed on 340 women [in twogroups] by cycles of ART [Assisted reproductive technology] such as IVF [In vitro Fertilization] orICSI [Intra cytoplasmic sperm injection] referred to the Research and Clinical Center of Infertilityand Madar Hospital of Yazd. Male's and female's age, duration and cause of infertility were machedin two groups. The long time protocol was used for induction of the ovaries. In 170 patients, cervical mucus aspiration was done with insulin syringe [A or case group]. In the control group orgroup B [170 women], cervical mucus was aspirated only with cotton swabe. The patients werefollowed up by beta-HCG serum level measurement on the day 14 after embryo transfer. The datawere analyzed by Chi-square and t-test.Mean of men's age in group A was 35.26 +/- 5.2 years and in group B was 35.13 +/- 5.4 years.Mean of women's age in group A was 29.8 +/- 5.3 years and in group B was 30.2 +/- 5.4 years. Mean ofinfertility duration was 8.6 +/- 4.6 years in both groups. Mean of follicle number, oocytes number, embryos number, cause of infertility and IVF/ICSI method in both groups were similar and therewas no significant difference. Pregnancy rate in group A, was more than group B, [26.9% Vs19.2%], but was not statistically significant.Cervical mucus aspiration with insulin syringe before embryo transfer can increase thepregnancy rate. This has confirmed by other studies, so it seems that cervical mucus aspirationbefore embryo transfer is useful

[Early neonatal injuries in normal vaginal and cesarean deliveries]

Introduction: About one percent of all deliveries are abnormal; and 4% are "difficult" deliveries and since a long time ago vaginal delivery is considered as preferred method or delivery

Objective: The goal of this study was to provide a relatively complete picture of early neonatal injuries in vaginal and cesarean deliveries

Materials and Methods: This is a retrospective descriptive study and the sample consisted of all women who delivered in Al-Zahra Maternity Hospital [Rasht] between 1998 June 20th to 1999 October 20th, whose neonate had some sort of injury. Their appropriate data was collected in a census sampling procedure

Results: There were 5289 [40%] cesarean section and 7828 [60%] normal vaginal deliveries with 24 [4.5 per 1000] early neonatal injuries in cesarean and 117 [1.5 per 1000] in vaginal deliveries. Most injuries in cesarean deliveries were ulcerations located on faces and skulls; and in vaginal deliveries were clavicle fractures; 19 [3.6 per 1000] and 40 [5.3 per 1000] respectively

Conclusion: It appears that early neonatal injuries are more in vaginal deliveries than cesareans; and elective cesarean may be a preferred procedure for some pregnant women. Although for thorough assessment a randomized clinical trial may be needed

[Assessment of women's knowledge regarding postpartum complications and cares]

Introduction: Mother and child health is one of the major concerns of public health throughout the world. Health education and increased knowledge of mothers in relation to their health is an important strategy for improving maternal and child health

Objective: The aim of this study was the survey of postpartum women's knowledge about complications and cares after delivery

Materials and Methods: This is a descriptive, cross-sectional study that assesses postpartum women's knowledge about postpartum complications and cares in Alzahra hospital in spring of 2003. The subjects were selected with convenience sampling method [non-probability] from women with the same case. A standard questionnaire [designed by ministry of health] was used to collect the data. This questionnaire consisted of a two-part questionnaire which included: [1] the demographics [2] assessment of knowledge level. After data collection, analysis was carried out with chi-square test by spss.10 software

Results: In this study, 384 women were assessed. Data showed that the mean age of the women was 26.5 +/- 0.3 yrs. Only 10 cases [2.6%]of women had university education. The majority of subjects were housewives 389[95.8%]. An evaluation of their knowledge about postpartum complications and cares showed that 360 [93.8%] of them had very poor and 22[5.7%] of them had poor and 2[0.5%] of them had intermediate knowledge. The results indicated that there weren't statistically significant relationship between age, parity and information source with level of knowledge [P>0.05] but there were significant correlations between education level and job with knowledge level.[p<0.05]

Conclusion: Regarding the low level of the women's knowledge about postpartum cares and complications, the researchers suggest on increasing knowledge levels by means of holding different classes and counseling sessions and also continuous visiting of the patients which can help them to reach this goal

Fetal laceration injury during cesarean delivery

The rate of cesarean delivery has increased in last decade, whereas it has some complications. This study was conducted to determine the incidence of fetal laceration injury in cesarean delivery in Al-Zahara teaching maternity hospital [Rasht, June1999-October2000]. It was a retrospective study using records of all neonates delivered by cesarean section during a 16 months period in Al-Zahara teaching maternity hospital. Maternal and neonatal records were reviewed in those cases with documented fetal laceration injuries. Lacerated and non-lacerated neonates were compared for maternal and neonatal characteristics. There were 21 lacerated neonates [approximately%o. 4] out of 5289 neonates delivered by cesarean section during the study period. The incidence of laceration appeared to be higher in breach presentation and fetal distress when the indication of cesarean was considered [1.1% and 1%; p=0.045 and p=0.0026, respectively]. Fetal laceration injury is a rare complication of cesarean delivery in cases of breech presentation and fetal distress

[Survey of placental weight and associated factors]

Introduction: placenta is essential for normal fetal development. Failure of the placenta can result in many fetal conditions. Placental development and function can be assessed by a number of methods, including measurement of placental weight

Objective: the aim of this study was to evaluate survey of placental weight and associated factors

Materials and Methods: in this study pregnant, women with singleton pregnancy and gestational age between 37-42 weeks delivered following complicated or no complicated pregnancies were included in a cross-sectional study. Also the patients were categorized into high placental weight [>750gr], normal placental weight [330-750gr] and low placental weight]<330gr]. The placental weight, birth weight, maternal age, gestational age, parity, preeclampsia, history of maternal diabetes, route of delivery, infants' gender and Apgar score were recorded and analyzed with chi2 test

Results: 1088 patients were included in this study. The mean maternal age was25.35+/-5.6 and gestational age at delivery was 274.51+/-9.56 days. The mean weight of birth and placental weight were 3214.28+/-529, 529.72+/-113 respectively. The prevalence rates of low and high placental weight were 2% and 2.8% respectively. There were statistically significant relationships between placental weight and birth weight, fetal distress, Apgar score, maternal diabetes, preeclampsia and kind of delivery. [P<0/05]

Conclusion: in this study, it was seen that placental weight can be related to some important variables that influence some maternal and neonatal outcomes. Therefore, attention to placenta and its growth during pregnancy, for example by sonography can guide us in providing neonatal health and even can be the base of preventive medicine. It appears that placental weight lower than 330gr can be a warning

[Comparison of progesterone administration before and after embryo transfer in ART cycles]

Nowadays the wide spread use of GnRH agonists in ART protocols has emerged the need for luteal phase support by progesterone. However the time of starting progesterone administration is still obscure, some investigators recommend the day of oocyte retrieval and the others later. The present study was designed to investigate the effect of the progesterone administration timing before or after embryo transfer on the outcome of ART. A randomized clinical trial was designed to study a total of 575 women referred to Shahid Sadooghi University of Medical Sciences and Yazd Madar Hospital, undergone ART treatment. Using long GnRH-a protocol, the patients were randomly divided into two groups. Progesterone administration was started on oocyte retrieval day in the first group [n= 307], versus after embryo transfer in the second group [n=268]. Pregnancy rate were analyzed using statistical trials including x[2] and T. Regarding the age of couples, the duration and etiology of infertility, the number of follicles, retrieved oocytes and zygotes [3.0 +/- 1.4 in first group versus 2.8 +/- 1.4 in second group] no statistically significant difference was observed. The outcome, defined as a positive pregnancy test was not different in two groups. Considering the results and the disturbances following intramuscular injection of progesterone including the risk of bleeding, the administration of progesterone after embryo transfer is recommended