Assessemnt of nasal bone in first trimester screening for chromosomal abnormalities in Khuzestan

Fetal nasal bone assessment is a non-invasive procedure that helps provide even greater assurance to patients undergoing their first trimester risk assessment for aneuploidies. Absence or presence of this factor is different in some races. The study was aimed to evaluate nasal bone in the first trimester of pregnancy in the indigenous population of Khuzestan Province, and to monitor its value in the diagnosis of chromosomal abnormalities. This study was conducted on 2314 pregnant women between 17-43 years old who referred for first trimester screening for chromosomal abnormalities. Gestational age was between 11-13w + 6 days. Nuchal translucency [NT], fetal heart rate [FHR], crown rump length [CRL], and maternal age and maternal blood serum factors [Free betaHCG] and pregnancy-associated plasma protein-A [PAPP-A] and nasal bone were assessed. Finally the risk of trisomies was calculated. The statistical tests are based on the relationship between chromosomal abnormality and the presence or absence of the nasal bone. In 114 cases we could not examine the nasal bone. Also, in 20 cases missed abortion happened without knowing the karyotype. 2173 cases were delivered normal baby, and in seven cases chromosomal abnormalities were diagnosed. Nasal bone was absent in all three cases with trisomy 21 and six of 2173 cases with normal phenotype [0.3%]. With use of the Fisher exact test [p=0.0001], a significant correlation was found between the absence of the nasal bone and the risk of chromosomal abnormality. Inclusion of the nasal bone in first-trimester combined screening for aneuploidies achieves greater detection rate especially in Down syndrome

Detection of neural tube defect in the first and second trimester of pregnancy by ultrasound in Imam Hospital, Ahwaz between December 2008-2010

Central nervous system malformations are the second most common congenital malformations after congenital heart diseases. These malformations are associated with many instances of morbidity and mortality which underline the importance of prevention and their early diagnosis. The objective of this study is the diagnosis of neural tube defect [NTDs] in the first trimester and its comparison to second trimester diagnoses in order to reduce the complications associated with late pregnancy terminations and its costs. This study was a trans-sectional study. A total number of 1074 patients who referred to Imam Khomeini Hospital were enrolled in this study. During the 11th-13th [+6 days] gestational week the patients were screened sonographically; subsequently they were re-scanned for fetal anomalies during 18[th]-20[th] gestational week, and we followed the babies after birth. Considering that Intracranial Translucency [IT] was introduced in the newer researches, it was, too, measured in 125 of the cases. In a total number of 1074 patients we had one patient with an anencephalous fetus whom was diagnosed in the first trimester of pregnancy. In the second trimester, we detected one case of myelomenigocele; when we referred to this patient's first trimester sonography, there was no visible IT. In the 125 cases in whom the IT length was measured, it was normal; the 2nd trimester sonographies in these patients were also normal. It must be noted that the diagnosis of NTD is more accurate in the second trimester of pregnancy. Consequently it is recommended that in high risk patients, the second trimester sonography be performed transvaginally, and in an earlier gestational age [14[th]-16[th] gestational weeks]

Evaluation of nuchal translucency measurement in first trimester pregnancy

A significant number of pregnancies, particularly in women with previous histories of infertility, are associated with fetal abnormalities. Methods such as the nuchal translucency [NT] measurement enable us to identify more pregnancies with chromosomal abnormalities. This analytic cross-sectional study was performed in 446 pregnant women at 11-14 weeks gestation, from 2009 to 2010 in the Fetal Medicine Unit of Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences. All NT measurements were performed by a certified sonographer using the Fetal Medicine Foundation [FMF] recommended protocol. FMF first trimester software was used for primary and secondary [adjusted] risk calculation. The average maternal age was 28.5 years and 15% of mothers were >/= 35 years of age. The average crown rump length [CRL], gestational age and NT thickness were 61.7, 12.4 weeks and 1.75 mm, respectively. There were 20 cases with increased adjusted risk [4.04%] and 4 cases of documented abnormal karyotype. In our study increased adjusted risk was 4.04%. Documented abnormal karyotype were 0.9% and 28% of total and high-risk groups who accepted amniocentesis, respectively. In this study, 50% of women with high-risk results and about half of those with abnormal karyotypes were seen in women under age 35. Knowing these risks is of utmost importance in pregnancy, particularly in patients with infertility histories

Office hysteroscopy in infertility

For patients undergoing in vitro fertilization, lower pregnancy rates are observed in the presence of uterine cavity anomalies and correction of these anomalies has been associated with improved pregnancy rates. Office hysteroscopy has been proven to have superior sensitivity and specificity in evaluation of the endometrial cavity. Diagnostic hysteroscopy can be performed in an office with minimal discomfort and at a much lower cost than in an operating room. Our study was done to evaluate the importance of office hysteroscopy in diagnosis of pathology in normal appearing infertility work up. This study was performed from September 1, 2006 till September 1, 2008 at Imam Khomayni hospital, Ahwaz, Iran. All infertile patients who had unexplained infertility or uterine factor infertility were enrolled in the study and underwent office hysteroscopy. The participants were divided into two groups. Group one was composed of 54 patients with unexplained infertility and group two was composed of 53 patients with abnormal vaginal sonography or hysterosalpangography. Of the 54 patients with unexplained infertility; 33 patients [61.2%] had normal and 21 patients [38.8%] had abnormal hysteroscopic findings. Among 53 patients in the uterine factor group, there were 7 women [13.3%] who had a normal hysteroscopy and abnormal sonography or hysterography. In group one [unexplained infertility], there was a 38.8% positive finding in office hysteroscopy in spite of normal hysterosalpingography and sonography results. Therefore, it seems that office hysteroscopy should be a part of a routine work up in infertile patients

Hysteroscopic view of endometrial hyperplasia

To determine the hysteroscopic appearance of endometrial hyperplasia in women with subsequently confirmed diagnosis of endometrial hyperplasia. This study was done in Aria Hospital in Ahwaz,Iran fromJanuary 21, 2003 to May 24th 2005. Fifty women underwent hysteroscopy with eye direct biopsy of the endometrium. Cause of hysteroscopy was Abnormal Uterine Bleeding [AUB] in 93.5% of cases. Specimens were sent for histology assessment. From these patients five cases had pathologic diagnosis of endometrial hyperplasia. Hysteroscopic features of these five cases were reviewed. In case one which was simple cystic hyperplasia, there was obvious cystic bizarre view. In case two, three and four there were minimal hysteroscopic abnormal view. In case 5 which was endometrial hyperplasia with atypia, there were obvious white endometrial elevations in the endometrial lining. Endometrial hyperplasia may produce obvious space occupying lesions in which diagnosis is easy with hysteroscopy, but it may be not very obvious especially in early stages of the disease. In all these 5 cases there were white areas with markedly reduced or absent vascularity

Comparison of effectiveness of two different premarin dose in hot flash treatment

Hot flush is the most common and severe problem of menopausal period. Estrogen is used for elimination of hot flush as an original and selective medicine. The objective was to determine the lowest useful dose because of estrogen's side effects. This clinical trial was done on 180 menopausal women who were complaining of hot flush. They were randomly divided in three groups. Group one took 0.3mg conjugated estrogen plus 1.25mg medroxyprogestronacetate, group two took 0.15mg conjugated estrogen plus 1.25mg medroxyprogestronacetate and group three took placebo for one month. Hot flush improvements in these three groups were defined. The average improvement was 78.5% with median 80 and mode 80 in group one [0.3 mg]. The average improvement was 63.3 percent with median 60 and mode 60 in group two [0.15mg]. The average improvement was 13.8% with median one and mode one in group three [placebo]. Due to average improvement of 63.3% in 0.15mg conjugated estrogen user group it is logical to begin hot flush treatment with this 0.15mg conjugated estrogen dose