[Effect of betamethasone on neonatal respiratory failure in late preterm pregnancies]

Background and Objective: Respiratory failure is one of the most important respiratory problems in premature infants. Several studies have shown the efficacy of corticosteroids in gestational age less than 34 weeks. This study was done to determine the effect of prenatal betamethasone injection during 34 to 36 weeks of pregnancy on the prevention of newborn respiratory failure

Methods: This clinical trial study was conducted on 140 women with risk of preterm labor at 34 to 36 weeks of gestational age. Women in interventional group were received betamethasone 12 mg IM [2 doses, 12 hours apart].Women in control group were received the same volume of normal saline. Sex and birth weight, respiratory distress syndrome, requiring hospitalization in neonatal intensive care units and require respiratory support were recorded for each newborn

Results: No significant difference was seen in sex and weight of newborns between two groups. The precent of newborns with respiratory distress syndrome in the intervention and control groups was 12.5% and 22%, respectively. This difference was not significant. No significant difference was seen in the need to respiratory support, hospitalized in the NICU between intervention and control groups

Conclusion: Adminestration of betamethasone in 36-34 weeks of pregnancy has no effect on the prevention of respiratory failure in preterm infants

[Effect of N-acetylcysteine with letrozole to induction of ovulation in infertile women with polycystic ovarian syndrome]

Background and Objective: Polycystic ovary syndrome [PCOS] is the most endocrine disorder in women. This study was done to determine the effect of N-acetylcysteine with letrozole to induction of ovulation in infertile women with polycystic ovarian syndrome

Methods: This clinical trail study was carried out on forty PCOS women with normal TSH, prolactin, hysterosalpingographies and normal spermograms. The patients in control group were received letrozole 5 mg/d for 5 days starting at day 3 of the cycle. The patients in interventional group were received letrozole 5 mg/d with NAC 1.2 g/d [group II] for 5 days starting at day 3 of the cycle. On 14[th] day of cycle, transvaginal ultrasonography was performed to evaluate endometrial thickness and follicles properties. If mature follicle detected, hCG was injected and timed coitus at 12, 36 and 60 hours later advised. beta-hCG level was checked on day 16 after hCG injection

Results: The mean of endometrial thickness and follicles ovulation in hCG injection day was similar in the two groups. The pregnancy rate was 15% and 20% in control and interventional groups, respectively. This difference was not significant. The mean of follicles number was 1.13% and 1.47% in control and interventional groups, respectively. This difference was not significant

Conclusion: NAC as an adjuvant to letrozole was not effective for ovulation induction in patients with PCOS

validity of transvaginal sonography in the measurement of endometrial thickness

Transvaginal ultrasonography is a non invasive procedure for endometrial thickness evaluation in abnormal uterine bleeding. This technique is helpful for selecting patients for diagnostic tests. This study was designed to determine the validity of transvaginal sonography in the measurement of endometrial thickness. A total of 71 women who were admitted for abdominal hysterectomy due to different causes in Kosar Hospital [2008-2009] were enrolled in the study. The main exclusion criteria was inability to measure endometrial thickness via transvaginal sonography. Endometrial thickness measurements were done prior to surgery. Histopathologic measurement of the fresh specimen was carried out immediately after surgery. Data were analyzed using T-test and kappa index. No ultrasound measurement was possible in 15% [11] of the patients. No statistically significant difference was observed in endometrial thickness between the two procedures. Taking into account 5 mm as a cut- off point, in 70% [42] of the patients, endometrial thickness was < 5 mm in both procedures. In 30% [18] of the patients, endometrial thickness in sonography was >5 mm, 11 cases of which were confirmed by histopathologic measurement. The remaining 7 cases were falsely reported as thick endometrium by sonography. The overall accuracy of sonography was about 83/3%, which was more efficient for samples with thin endometrium [89/8% vs. 72/8%].Despite a concordance between transvaginal sonography and histopathology results for endometrial thickness evaluation, the former is faced with limitation as a single diagnostic test

[Comparison of early versus late amniotomy following cervical ripening with foley catheter]

Amniotomy is usually used for induction or augmentation of labor and if timely applied it could influence the labor promotion. The aim of the present study was to evaluate the time of amniotomy on labor course. This prospective randomized clinical trial was carried out at Kosar Hospital affiliated to Qazvin University of Medical Sciences [Iran] in 2005. Nulliparous women 40 weeks of a singleton gestation, cephalic presentation, intact membrane, and cervical dilatation 1cm were selected. All women underwent cervical ripening using a foley catheter. Following spontaneously removal of the catheter, women were randomly assigned to either early or late amniotomy. While in first group amniotomy was performed immediately, it was carried out in second group at active phase following the beginning of oxytocin infusion. Duration of labor, cesarean section rate and indications, and Apgar score at 5 minutes in two groups were recorded. Data were analyzed using statistical tools including t test and chi square test. Duration of labor from the time of catheter removal to delivery in early amniotomy was longer than that of late amniotomy [12 hours and 40 minutes versus 9 hours and 40 minutes, [P=0.35]]. The rate of cesarean section was shown to be higher in early amniotomy group compared to late amniotomy group [27.3% versus 14.5% with a relative risk value of 1.88]. An increase in rate of cesarean section was primarily due to dystocia [52.4% versus 16.4% and a relative risk of 1.44] however, no significant difference was found in rate of cesarean section due to others indications. Also, the difference between Apgar score at 5 minutes among two groups was shown to be insignificant, statistically [P=0.15]. In women undergoing cervical ripening using a foley catheter, the augmentation of labor by oxytocin followed by amniotomy during active phase of labor results in shortening of duration of labor and also lower rate of cesarean section for dystocia

[Comparison of intramuscular syntometrine and intravenous oxytocin in management of the third stage of labor]

One of the main etiologies of maternal mortality is obstetrical hemorrhage. The first step in decreasing hemorrhage is the use of uterotonic drugs in the third stage of labor. To compare the efficacy and safety of intravenous oxytocin and intramuscular syntometrine in management of the third stage of labor. This randomized double blind clinical trial was carried out at Kosar Hospital, Qazvin [Iran] in 2005. A total of 800 women having a singleton pregnancy and vaginal delivery were randomized to receive either 1 ml of syntometrine intramuscularly, or 10 units of intravenous oxytocine following delivery of the anterior shoulder of fetus. Hemoglobin level pre- and 24 hours post-delivery, duration of third stage, need for re-administration of uterotonic drugs, need for manual removal of placenta, and unpleasant side effects including nausea, vomiting, headache and hypertension were recorded. The data were analyzed using chi-square test. Mean drop percent of hemoglobin level in oxytocin group was 3.7 +/- 2.54% and in syntometrine group 3.6+2.49% with no significant difference, statistically. There was also no statistically significant difference between the need for re-administration of uterotonic drugs, duration of third stage of labor, need for manual removal of placenta and the maternal side effect in two groups. Regarding the efficacy and side effects of intravenous oxytocin and intramuscular syntometrine, no difference was found

[Diagnosis of preeclampsia using urinary protein/creatinine ratio]

Proteinuria is the most important factor in diagnosis and management of preeclamptic patients. The use of a method providing rapid diagnosis of preeclampsia is of prime importance and critical to immediate treatment. To measure the protein content of a 24-hour urine samples by determining protein/creatinine ratio in a random urine sample obtained from a pregnant women suspected of preeclampsia. This was a cross-sectional study carried out in Kosar hospital, Qazvin, Iran, during 2003-2004. The subjects were 50 pregnant women with gestationl age>/= 20 weeks and blood pressure>/=140/90. Following admission, the protein content of a 24-hour urine sample was measured and later, a random urine sample collected for determination of protein/creatinine ratio. Correlation coefficient between 24-hour proteinuria and protein/creatinine ratio was further calculated. Among 50 pregnant women, 12 cases had a proteinuria>300mg/day and 38 with proteinuria<300mg/day. Regarding the results of our study, a protein/creatinine ratio of 0.25 with 24-hour proteinuria>300mg [r=0/99, p<0/001]. Sensitivity, specificity, and the positive/negative predictive value for this ratio was 98% with an accuracy of 96%. Determination of protein/creatinine ratio of a random urine sample could predict significant proteinuria[>300mg/24h]

[Comparison of indomethacin suppository with intramuscular pethedine on the pain after cesarean section]

Background: Management of the pain after cesarean section brings comfort for patient, in addition reduces cost and duration of hospitalization

Objective: This study was done compare indomethacin suppository with intramuscular pethedine on post operative pain. The used method for anesthesia in these patients was spinal anesthesia

Methods: In this double-blind clinical trial, 130 pregnant women from October 2001 to February 2002 in Kosar hospital were selected. All of them were operated under spinal anesthesia. Patients were divided randomly into two groups. In suppository group after operation 50 mg rectal suppository was used and every 6 hours was repeated for 12 hours. If pain was sever, 25 mg intramuscular pethedine was used. In pethedine group, after operation 25 mg pethedine was used and if pain was sever, this injection was repeated. Primary information include age, weight, parity, time and amount of pethedine, nausea and abdominal distention recorded. Two groups were compared by T-test and Chi-square

Findings: Two groups were similar in the view of age, weight, parity, and cause of cesarean. In suppositiry, 100 mg pethedine was used, but in pethedine group 2525 mg pethedine was used, that a significant difference was shown [P=0.000]. In first group 12.3% and in second group 70.8% of patients had nausea, also 6.2% [in first group] and 53.8% [in second group] of patients had abdominal distention that between them there were a significant difference [P=0.000]

Conclusion: Indomethacin suppository is a good analgesic and has less complications than pethedine for control of pain after cesarean section