role of G-CSF in recurrent implantation failure: a randomized double blind placebo control trial

Background: Recurrent implantation failure [RIF] is the absence of implantation after three consecutive In Vitro Fertilization [IVF] cycles with transferring at least four good quality embryos in a minimum of three fresh or frozen cycles in a woman under 40 years. The definition and management of RIF is under constant scrutiny

Objective: To investigate the effects of Granulocyte colony stimulating factor [GCSF] on RIF, pregnancy rate, abortion rate and implantation rates

Materials and Methods: A double blind placebo controlled randomized trial was conducted at two tertiary university based hospitals. One hundred patients with the history of RIF from December 2011 until January 2014 were recruited in the study. G-CSF 300 micro g/1ml was administered at the day of oocyte puncture or day of progesterone administration of FET cycle. Forty patients were recruited at G-CSF group, 40 in saline and 20 in placebo group

Results: The mean age for whole study group was 35.3 +/- 4.2 yrs [G-CSF 35.5 +/- 4.32, saline 35.3 +/- 3.98, placebo 35.4 +/- 4.01, respectively]. Seventeen patients had a positive pregnancy test after embryo transfer [10 [25%] in G-CSF; 5 [12.5%] in saline; and 2 [10%] in placebo group]. The mean of abortion rates was 17.6% [3], two of them in G-CSF, one in saline group. The implantation rate was 12.3% in G-CSF, 6.1% in saline and 4.7% in placebo group

Conclusion: G-CSF may increase chemical pregnancy and implantation rate in patients with recurrent implantation failure but clinical pregnancy rate and abortion rate was unaffected

Pregnancy complications and neonatal outcomes in multiple pregnancies: a comparison between assisted reproductive techniques and spontaneous conception

This study compared neonatal outcome and maternal complications in multiple pregnancies after assisted reproductive technologies [ART] to spontaneous pregnancies. In this cross-sectional study, we reviewed medical records of 190 multiple pregnancies and births conceived by ART or spontaneous conceptions between 2004 and 2009 in Women Hospital. Obstetric history and outcomes were recorded and compared between these two groups. SPSS version 13 was used for data analysis. The results were analyzed using student's t test, chi square and logistic regression [p<0.05]. There were 106 deliveries from spontaneous conceptions and 84 that resulted from ART. Parity history and mode of delivery significantly differed between the two groups [p<0.001]. The ART group had significantly higher preterm labor and premature rupture of membranes [PROM] whereas pregnanc-induced hypertension [PIH] was higher in the spontaneous group [p=0.01]. Newborn intensive care unit [NICU] admission, duration of hospitalization, still birth and low gestational age were significantly higher in the ART group while neonatal jaundice was higher in the spontaneous group. Logistic regression analysis by considering neonatal complications as the dependent variable showed that respiratory distress syndrome [RDS], NICU admission and Apgar score were independent predictors for neonatal complications. Obstetric and neonatal outcomes must be considered in multiple pregnancies conceived by ART

Luteal phase support in the intrauterine insemination [IUI] cycles: a randomized double blind, placebo controlled study

To evaluate the impact of luteal phase support with vaginal progesterone on pregnancy rates in the intrauterine insemination [IUI] cycles, stimulated with clomiphene citrate and human menopausal gonadotropin [hMG], in sub fertile couples. This prospective, randomized, double blind study was performed in a tertiary infertility center from March 2011 to January 2012. It consisted of 253 sub fertile couples undergoing ovarian stimulation for IUI cycles. They underwent ovarian stimulation with clomiphene citrate [100 mg] and hMG [75 IU] in preparation for the IUI cycle. Study group [n = 127] received luteal phase support in the form of vaginal progesterone [400 mg twice a day], and control group [n = 126] received placebo. Clinical pregnancy and abortion rates were assessed and compared between the two groups. The clinical pregnancy rate was not significantly higher for supported cycles than that for the unsupported ones [15.75% vs. 12.69%, p = 0.3]. The abortion rate in the patients with progesterone luteal support compared to placebo group was not statistically different [10% vs. 18.75%, p = 0.45]. It seems that luteal phase support with vaginal progesterone was not enhanced the success of IUI cycles outcomes, when clomiphene citrate and hMG were used for ovulation stimulation

Bipolar disorder in women with polycystic ovarian syndrome [PCO]

This study was designed to determine the prevalence of bipolar disorder in women with polycystic ovarian syndrome [PCO]. One hundred and ten women with definite diagnosis of PCO and one hundred and ten age-matched infertile women due to other reasons except for PCO were enrolled in this case control study. Ten ml fasting venous blood sample obtained to measure fasting glucose, LH and FSH. Height, weight and waist-to-hip ratio [WHR] were also recorded by an expert technician. A psychiatrist examined all 220 cases in order to determine the prevalence of depression and bipolarity. Mean age of each group participants were not significantly different while FBS, LH and LH/FSH levels were significantly higher in PCO patients. Eighty eight case were depressed in PCO group while 96 were depressed in control group [P=0.03]. Bipolar disorder were higher in PCO group in comparison with controls [8 vs. 0, P=0.004]. Psychiatric disorders should be considered in PCO women

Nucleated red blood cells count in pregnancies with idiopathic intra-uterine growth restriction

Objective: Elevated nucleated red blood cell [NRBC] count is introduced as a potential marker of intra-uterine growth restriction [IUGR]. To investigate the probable association regardless of any known underlying disease, we aimed to study disturbances in NRBC count in infants experiencing idiopathic IUGR

Materials and methods: Twenty three infants regarded IUGR without any known cause were chosen to be compared to 48 normal neonates. Blood samples were collected instantly after birth and the same measurements were done in both groups

Results: NRBC count/100 white blood cells was significantly higher in the IUGR group [P value < 0.001]. pH measurements did not reveal any significant difference

Conclusion: Increased NRBC count in cases of idiopathic IUGR in absence of chronic hypoxia could strengthen its predictive value suggested in previous studies. It could help early IUGR detection and beneficial intervention

Dicephalic parapagus tribrachius conjoined twins in a triplet pregnancy: a case report

Dicephalic parapagus tribrachius conjoined twin is a very rare condition. We present a case of 5-days-old male dicephalic parapagus conjoined twins. The conjoined twins were diagnosed in 4[th] month of pregnancy by ultrasonography. The pregnancy terminates at 36 weeks by cesarean section and triplets were born. The babies were male conjoined twins and another healthy male baby. Many congenital defects of interest can now be detected before birth. Sever form of this malformation precludes postpartum life. It is supposed that with advances in screening methods for prenatal diagnosis these cases are terminated in first or second trimester of pregnancy

Vasopressin effect on operation time and frequency of electrocauterization during laparoscopic stripping of ovarian endometriomas: a randomized controlled clinical trial

The purpose of this study was to assess the vasopressin effect on operation time and the need for electrocauterization frequency and ovarian reserve during laparoscopic stripping of ovarian endometriomas. This was a randomized prospective clinical trial, in which twenty patients between 18-35 years with unilateral endometriomas were randomly divided in two groups of cases and controls. Laparoscopic cystectomy was performed by hydrodissection and stripping method in both groups with diluted vasopressin injected in cases, in comparison to only saline injection in controls. Ovarian hemostasis was achieved by bipolar electrocoagulation. The operation time and frequency of electrocoagulation were compared between two groups. The ovarian reserve was determined by ultrasound examination and laboratory assessment one month before and two months after surgery in two groups. Non parametric data was analyzed by Mann-Whitney test. The p-value less than 0.05 was considered statistically significant. The operation time was less in cases than control group, but the difference was not statistically significant [p=0.065]. The frequency of electrocoagulation for hemostasis was less in cases than controls but this difference was not statistically significant [p=0.132]. The antral follicle count decreased in both groups two months later, while no significant difference was found between two groups. This study shows that diluted vasopressin decreases operation time and electrocauterization frequency during laparoscopic stripping of ovarian endometriomas; however, the difference between case and control group is not statistically significant

effect of meperidine on peripartum breastfeeding and neonatal weight

To evaluate the effect of Meperidine, commonly administered for labor analgesia, on newborn weight and peripartum breastfeeding during two months after delivery. This pilot cohort study was conducted between October 2010 and October 2011 at the Women Hospital of the Tehran University of Medical Sciences. In this study, we examined the effects of meperidine on breastfeeding and neonatal weight. A total number of 184 full term pregnant women, planned to deliver at this center [normal vaginally delivery or cesarean], participated in this study. The study group included the women who received meperidine in peripartum time to be compared with a control group who did not receive any opioid. Meperidine was administrated to them based on their peripartum breastfeeding behaviour and baby weight, two month after delivery. Of the 184 woman recruited to the trial, 38 women had normal vaginal delivery and 146 had ccesarean. Within the first two-month, 4% of mothers in control group and 11% of meperidine group used formula. However, this differences were not statistically significant [p value= 0.07]. Furthermore, baby weight distribution was not statistically different between two groups. The inhibitory effect of using Meperidine on peripartum breastfeeding and weight of newborn in the first two months was not statistically significant in this study. More research is needed to clarify the association between meperidine and peripartum breastfeeding

Molar pregnancy presents as tubal ectopic pregnancy

Hydatidiform moles are abnormal gestations characterized by the presence of hydropic changes affecting some or all of the placental villi. Hydatidiform moles arise as a result of the fertilization of an abnormal ovum. In this report, the patient was a 29 year old Asian woman who had induction of ovulation with letrozol. Since the majority of molar gestations arise within the uterine cavity thus the occurrence of a hydatidiform mole within ectopic gestational tissue is rare. It is important to differentiate a hydatidiform mole from a conventional ectopic pregnancy, particularly in infertile women who have a history of ovulation induction

blinded study using celecoxib for prevention of morphine induced pruritus in patients undergoing cesarean section

We aimed to evaluate the efficacy of celecoxib in reducing Intrathecal morphine-induced pruritus in parturient undergoing cesarean section delivery under spinal anesthesia. In a randomized double-blind placebo controlled study 126 women undergoing elective cesarean section under spinal anesthesia [0.5% bupivacaine 12mg plus 0.2 mg preservative free morphine]were randomly allocated to receive celecoxib 400 mg or placebo, 2 hours prior to surgery. Severity of pruritus and pain score and frequency of opioid's side effects were recorded. Patients receiving celecoxib had significantly lower pruritus incidence and severity at 30 min,2,4 and 8 hours [40% versus 82%], but not at 12 and 24 hours postoperatively. Also there was a reduction in pain score but it was not significant [1.5 +/- 0.5 versus 1.9 +/- 0.65].Analgesic requirement was similar between two groups. Oral administration of celecoxib significantly reduced Intrathecal morphine-induced pruritus in parturient undergoing cesarean section under spinal anesthesia. There was no significant difference in pain scores and analgesic requirement

Pregnancy outcomes in women of advanced age

The aim of this study was to investigate prenatal and obstetrical outcome in mothers aged 40 years or older. A prospective comparative study was conducted for the women aged 40 years and over who delivered at 20 week's gestation or beyond from January 2004 to December 2005 at four Hospitals of Tehran University of Medical Sciences. For comparison, a control group of patients who were 20-29 years of age was considered. There were statistically significant increases in the rates of gestational diabetes, preeclampsia, caesarean section, breech presentation and stillbirth in women 40 years of age or older. There is a need to offer older women special counseling both before and after conception so that they become informed of the increased risks involved

effect of ephedrine on fetal outcome in treatment of maternal hypotension caused by spinal anesthesia during cesarean section

Spinal anesthesia causes hypotension which is a physiologic component during cesarean section. Ephedrine is used for prevention and treatment of maternal hypotension during spinal anesthesia. The aim of this study is to evaluate the effect of transient hypotension which is normalized with ephedrine on fetal outcome. Eighty women with singleton pregnancies scheduled for elective cesarean section under spinal anesthesia were divided to two groups. The control group was women with normal BP, and case group were women with hypotension who received ephedrine. Two groups were compared for these variables: maternal BP and HR, nausea and vomiting, neonate Apgar and fetal cord blood gases. No difference was found between two groups for variables of age, BMI, weight, height, mean BP, mean HR, serum volume, fetal Apgar in 1 and 5 min and fetal cord fetal blood gases. Dosage of oxytocin used was significantly different between two groups [P-value = 0.003]. Transient hypotension which is treated by ephedrine does not have any effect on acid base situation of baby and treatment of hypotension with ephedrine in pregnant women is a safe procedure

Prevention of postoperative nausea and vomiting by administration of sub hypnotic doses of propofol and midazolam during spinal anesthesia for cesarean section

To evaluate, the efficacy of sub hypnotic doses of midazolam and propofol, in prophylactic control of postoperative nausea and vomiting, in parturients undergoing elective cesarean section under spinal anesthesia. In a double-blind, placebo-controlled, randomized trial, 114 ASA physical status I-II parturient undergoing elective cesarean section under spinal anesthesia [using 0.5% bupivacaine 12 mg] were allocated randomly to receive propofol [20 mg bolus and 1.0 mg/kg/hr infusion, n=38] or midazolam [1 mg bolus and 2.0 mg/hr infusion, n=38] or saline [2 cc IV, n=38] immediately after clamping of umbilical cord. The occurrence of nausea and/or vomiting and respiratory depression was recorded during operation until 12 hr after that. The incidence of nausea and vomiting was significantly lower in midazolam and propofol groups compared with saline group in all 12 hr, [nausea: 19%, 15.8% versus 57.9%], vomiting [7.9%, 5% versus 34.2%]. There was not manifestation of respiratory depression at the time of surgery and after it. Sub hypnotic dose of midazolam was as effective as the sub hypnotic dose of propofol for preventing of nausea and vomiting in parturients undergoing cesarean section under spinal anesthesia. We undertook this study in regard to examine a simple, safe and non-expensive antiemetic method

Fetal laceration injury at caesarean delivery

The purpose of this study was to investigate the incidence, type, location, and risk factors of accidental fetal lacerations during caesarean delivery. Total deliveries, caesarean deliveries, and neonatal records for documented accidental fetal lacerations were reviewed retrospectively in four university hospital. The gestational age, the presenting part of the fetus, the type of incision, and maternal age and parity were recorded. Caesarean deliveries were divided into elective and emergency procedures. Fetal lacerations were grouped according to the location and the need for surgical intervention. Of 19217 deliveries, 8840 women were delivered by caesarean birth [46%]. Neonatal records documented 87 accidental fetal lacerations. Of these accidental lacerations, 16 needed surgical repair and 62 recovered by dressing. Head and neck was the most common site of laceration [64.1%]. The overall rate of accidental fetal laceration per caesarean delivery was 0.88%. The rate of emergency caesarean was 45 [56.69%] and for elective procedures was 33 [42.4%]. The risk for fetal accidental laceration was higher in foetuses who underwent emergency caesarean birth [P<0.001]. Fetal accidental laceration may occur during caesarean delivery and its incidence is significantly higher during emergency caesarean delivery. The patient should be counselled about the occurrence of fetal laceration during caesarean delivery to avoid litigation