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

Fetal gender screening based on placental location by 2-dimentional ultrasonography

Early detection of fetal gender can provide an alarm for parents who complicated by genetic disorders. Moreover, the invasive tests are used for detecting any sex-specific genetic syndromes before 12 weeks of gestation. This study was de-signed to discover any association between placental location and fetal gender between 11 to 13+6 weeks of gestation. A cross-sectional study was conducted on 200 singleton pregnant women. They were referred for Down syndrome screening sonography to prenatal clinic, Imam Khomeini Hospital a tertiary referral university affiliated hospital, Ahvaz, Iran, in 2013. Women were included if they are singleton and at 11 to 13[+6] weeks gestational age. Exclusion criteria were multifetal, ectopic pregnancies, or dead fetus. Information about placental location [upper, middle, below, anterior, posterior], gravidity, and fetal gender were recorded. All participants of our study were evaluated by one trained gynecologist in ultrasound examinations during nuchal translucency [NT] examinations. Ultrasonography was performed using the Accuvix V10 OB/GYN ultrasound. All patients were followed-up till delivery for confirming the predicted gender. Information regarding gender of newborn were collected using medical chart review or by phone contact. Among 200 placenta which had been assessed, 103 [51.5%] were anterior and 97 [48.5%] were posterior. Our results showed that 75 [72.8%] from girl cases had an anterior placenta, while just 28 [27.2%] from boy cases had an anterior placenta [P< 0.001]. In addition, there was significant association between placental location regarding below, middle, and upper and fetal gender. According to our results, an anterior and posterior positions of the placenta had significant relation with fetal gender. Our findings are consistent with previous studies regarding prediction of fetal gender using placental location. We suggest that more research with large sample size is required as well as investigations with more details about placental locations

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]

Comparison of complications of chorionic villus sampling and amniocentesis

Background: A significant number of pregnancies are associated with the cytogenetic abnormalities of the fetus. Amniocentesis and chorionic villus sampling [CVS] are procedures used for prenatal genetic diagnosis. In this study, we compare the safety and complications of mid-trimester amniocentesis and transabdominal CVS

Materials and Methods: This analytic cross-sectional study was performed in 308 patients from 2.11.2007 to 26.10.2009. We had 155 cases of amniocentesis, which we performed in weeks 15-23 of pregnancy; and 153 cases of CVS, which we performed during weeks 10-14 of pregnancy

Results: There were 2 cases [1.2%] of premature rupture of membrane [PROM] in amniocentesis which occurred 1 and 10 days after the procedure and caused pregnancy loss before 20 weeks. We had 1 case [0.7%] of abortion in CVS, which occurred 10 days after the procedure. Additionally, there was 1 case of amniotic fluid leakage [0.7%] in which, after admission to the hospital and observation, leakage was stopped and the pregnancy continued normally

Conclusion: In this study, we had more complications with amniocentesis cases than CVS. CVS is a procedure performed in the earlier stages of pregnancy and its complications are less than amniocentesis. We suggest CVS to be the procedure of choice for genetic diagnosis

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

Fixation and unfixatjon of folley catheter in cesarean section, a comparative study

It is recommended to fix Folley catheter during and after cesarean section. In such circumstances, not only the bladder is drained continuously but also it doesn't disturb surgeon. But Folley catheter induces infection, in this study we didn't fix Folley catheter and evaluated studied patients for complications. In this prospective study, 100 parturient who needed elective cesarean section and entered two hospitals in Ahwaz were evaluated. Control and study groups had 50 parturients each. In control study only eight women [16%] out of fifty needed Folley catheter fixation and Bladder trauma wasn't seen in both the groups. It is recommended to fix Folley catheter during casarean section, but it is uncomfortable for parturients. Hematuria and urinary tract infection were evaluated in both groups but the results weren't significantly different. It is suggested not to fix Folley catheter routinely but only in those patients in which it is indicated

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

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