[Comparison of closure of subcutaneous tissue versus non-closure in relation to wound infection and disruption after cesarean section delivery in obese patients]

Wound disruption after cesarean section is a common complication; and obesity has been identified as strong independent risk factor for wound complications. The aim of this study was to test the hypothesis that closure of the subcutaneous fat decreases the incidence of wound infection and disruption after cesarean delivery. In a clinical trial study conducted in Yazd, a hundred women with at least 2 cm of subcutaneous fat and cesarean delivery were included in the study. In 50 patients, subcutaneous tissue was closed using synthetic suture [group A], while in 50 control patients subcutaneous tissue was not closed [group B]. Two groups were compare in relation to wound infection and disruption. Data were analyzed using student and X[2] tests. Complications leading to wound infections [positive culture] were 2 women in group A and 5 women in group B [P<0.05] and disruption or opening of the incision were in 7 women in group A and in 17 women in group B [P<0.01]. Closure of the subcutaneous tissue can significantly reduce the rate of postoperative wound disruption in women with at least 2 cm of subcutaneous adipose tissue

[Effect of estradiol prescribed during luteal phase of art cycles and pregnancy outcome]

Implantation is one of the most important steps in ART cycles and it depends upon embryo and endometrial reception. Different protocols have been suggested for getting better endometrium. It seems estrogen increases the endometrial reception and pregnancy rate by inducing changes in the hormonal status. The aim of this study was to evaluate the effect of estradiol[E2] on luteal phase support and pregnancy rate in ART cycles. This prospective randomized study was done in Yazd at the IVF center from March until December, 2002. 68 patients who had undergone IVF or ICSI were enrolled in the study. Exclusion criteria was age>40, endometriosis and ovarian hyper stimulation syndrome. Induction ovulation protocol was long suppression with GnRH analogues.After embryo transfer, patients were divided in two groups randomly. Both groups received 100mg progesterone IM daily from the transfer day. Estradiol valerate 2 mg/day was added from the 7th transfer day to progesterone in Group I and continued if the BhCG became positive. Abortion and malformations were measured in all patients. Data analyzed with SPSS 11.0 and P value <0.05 considered statistically significant. Pregnancy rate in the 34 patients of estradiol group [group I] was 26.5%which was significantly higher than 11.8 %[ 4 cases] in the other group [Pvalue=0.034]. Abortion rate was higher in estradiol group [3 cases], but there was no abortion in the progesterone group[P=0.119]. 2 cases of major fetal malformations were observed in E2 supplementation group [P=0.246]. E2 suplementation to progesterone in the luteal phase of ART cycles, especially in the long GnRH analogues causes higher endometrial receptivity and pregnancy rate

[ Study of Complications in 1120 Cases of Transvaginal Ultrasound - guided Oocyte Pick-up in IVF Centre of Yazd]

To determine the prevalence of oocyte pick up complications in 1120 cycles of IVF. In this prospective study 1120 pationts that were reffered to infertility clinics for IVF were enrolled. The patients with the infertility following COH by regimens of CC + hMG/hCG, hMG/hCG, hMG + GnRH-a/hCG were punctured by transvaginal sonography, preformed after injection of sedatives. The follicular aspiration was performed only by vaginal preparation with sterile distilled water .The patients were discharged in an hour. Vaginal bleeding was observed in 190 cases [17%], who were not severe and treated with vaginal pack and discharged after 2 hours after exit the vaginal pack. 15 patients [1.3%] with severe abdominal pain were hospitalized for 24 hours, one with hypovolemic signs was operated by laparoscopy and ruptured ovary was cauterized. 3 cases [0.35%] with fever, chills and abdominal pain managed with diagnosis of PID. One patient with history of 2 previous laparatomy before IVF cycle, didn't respond to medical treatment and after further investigation pararectal abscess diagnosed which was managed surgically. Considering the number of patients, transvaginal follicular puncture is a safe procedure in oocyte retrieval.In patients with history of PID, previous surgery and endometrioma prophylactic antibiotic was given at the time of oocyte puncture