[Efficacy of transcervical foley catheter and laminaria on induction of labor in post-term pregnancy: a clinical study]

Background: Any time before labor that termination of pregnancy is better than keeping pregnancy for both mother and fetus, it is an indication for induction of labor

The condition of cervix is the most important factor for labor induction. Cervical condition, In many cases that candidate for induction of labor before labor pain, is poor

As the cervical ripening is quite important for success of labor induction

This study is attempting to compare two methods of cervical ripening

Methods: During this clinical study, 100 patients admitted in Ahwaz Imam Khomeini Hospital from 2010 to 2011. All of these patients had BISHOP score bellow 5, were divided to two groups for cervical ripening. Group one: trans cervical catheter and group two: laminaria. After placing transcervical foley catheter and laminaria for patient induction with oxytocin was started according to classic protocol

Then the time lapse from the beginning of induction to enter the active phase of labor and also from start of induction till delivery and appearing the side effect in both group was assessed

The result was analysed by SPSS 16 program

Results: Fifty three of patient [53%] were primiparous and the rest 47 [47%] were mul-tiparous. All of them had bishop score bellow 5

The average age for the patient group 1 was 27.1 and the average age for other group was 27.18. The time lapse from start of induction to enter active phase of labor in first group was 5.7+/-2.67 hours and this time for 2[nd] group was 7.51+/-2.33 hours. Also the time interval between the start of induction and delivery in group 1 was 10.3+/-4.35 hours and this time for group 2 was 12.5+/-4.9 hours. In both cases there was meaningful difference between two groups. There was no difference between both group for appearing the side effects

Conclusion: Based on this study, it seems using trans- cervical catheter for cervical ripening and aid to successful induction of labor is beneficial

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

Comparison of single and multidose of methotrexate in medical treatment of ectopic pregnancy

The purpose of this study was to compare the efficacy and safety of two regimens of methotrexate for medical treatment of ectopic pregnancy. In this prospective randomized clinical trial 100 women clinically suspected to have un ruptured ectopic pregnancy were randomly [One by one] treated with single [50mg/m2] and multi dose [1mg/kg MTX+ 0.1mg/kg folinic acid] Methotrexate [50 cases in each group]. Results of two groups were compared. The overall success rate of treatment was 94%. The use of single dose was associated with a greater chance of response to medical management than multi dose. [97% versus 91%]. The single dose regimen was associated with greater side effects. Women who experienced side effects were more likely to have successful treatment regardless of regimen. Three percent of patients had serum B hCG >10000IU/ml and in 5% of cases fetal heart reported in adnexal mass. Both these groups were much more responsive to single dose treatment. Efficacy of single dose in medical treatment of Ectopic pregnancy is better than multi dose regimen