Clomiphene citrate versus letrozole with gonadotropins in intrauterine insemination cycles: a prospective randomized trial

Background: Clomiphene citrate is one of the effective drugs for infertilitytreatment due to oligo-ovulation or anovulation. Intrauterine insemination [IUI] isone of more adherent methods for treatment of infertile cases which is followed bycontrolled ovarian hyperstimulation [COH]

Objective: the aim of this study was to evaluate Clomiphene citrate versus letrozolewith gonadotropins in IUI cycles

Materials and Methods: In this prospective randomized trial, 180 infertile patientswho were referred to Milad Hospital were selected. The first group received 5mg/day letrozole on day 3-7 of menstrual cycle. The second group received 100mg/day Clomiphene in the same way as letrozole. In both groups, humanmenopausal gonadotropin was administered every day starting on day between 6-8of cycle. Ovulation was triggered with urinary Human Chorionic Gonadotropin[5000 IU] when have two follicles of >/=16 mm. IUI was performed 36 hr later

Results: The number of matured follicles, cycle cancellation, and abortion were thesame in both groups. Endometrial thickness was higher at the time of humanmenopausal gonadotropin administration in letrozole group. Chemical and clinicalpregnancy rates were much higher in letrozole group. Ovarian hyperstimulation wassignificantly higher in clomiphene group

Conclusion: Letrozole appears to be a good alternative to clomiphene citrate withfewer side effects

Accuracy of color Doppler ultrasonography and magnetic resonance imaging in diagnosis of placenta accreta: a survey of 82 cases

Background: placenta adhesive disorder [PAD] is one of the most common causes of postpartum hemorrhage and peripartum hysterectomy. The main risk factors are placenta previa and prior uterine surgery such as cesarean section. Diagnosis of placenta adhesive disorders can lead to a decrease of maternal mortality and morbidities

Objective: the purpose of this study was to compare the accuracy of color Doppler ultrasonography and magnetic resonance imaging [MRI] in the diagnosis of PADs

Materials and Methods: in this is cross-sectional study, Eighty-two pregnant women who were high risk for PAD underwent color Doppler ultrasound and MRI after 18 weeks of gestation. The sonographic and MRI findings were compared with the final pathologic or clinical findings. P<0.05 was considered statistically significant

Results: mean maternal age was 31.42+/-4.2 years. The average gravidity was third pregnancy. 46% of patients had placenta previa. The history of the previous cesarean section was seen in 79 cases [96%]. The diagnosis of placenta adhesive disorder was found in 17 cases [21%]. Doppler sonography sensitivity was 87% and MRI sensitivity was 76% [p=0.37]. Doppler sonography specificity was 63% and MRI specificity was 83% [p=0.01]

Conclusion: women with high-risk factors for PAD should undergo Doppler ultrasonography at first. When results on Doppler sonography are equivocal for PAD, MRI can be performed due to its high specificity

Sudden bilateral sensorineural hearing loss following postpartum hemorrhage: a case report

The prevalence of bilateral sudden sensorineural hearing loss [SSNHL] is less than 5% and the etiology of most cases is unknown. Due to many structural and functional similarities between the kidney and inner ear, many conditions, diseases, and drugs have both renal and cochlear effects and toxicities. There are several reports of SSNHL in patients with CRF, uraemic patient, hemodialysis treatment, and ARF. Here, we report a rare manifestation of SSNHL following severe postpartum hemorrhage that has simultaneous renal failure and cochlear impairment. The patient was a 22-year-old primigravida woman with term pregnancy who after delivery and episiotomy hematoma and postpartum hemorrhage subsequently suffered from kidney failure, oliguria, and SSNHL that occurred after 3 days of delivery. In conditions such as severe postpartum bleeding leading to acute renal involvement, the possibility of simultaneous involvement of cochlea due to hypoxia or received drugs should be considered

Acardiac acephalus twin pregnancy with poor prenatal outcomes: a case report

Introduction: Acardiac twin refers to a monochorionic pregnancy in which there is a twin with absent or nonfunctioning heart and a normal co-twin. This was a very rare disorder of monozygotic twin pregnancy. The aim of this report was to introduce a case of acardiac acephalus twin pregnancy

Case Presentation: A 32- year- old woman [G3 P2 L2] referred to the hospital because of a decrease in fetal movement at 32 weeks of gestation. Ultrasonography showed a dead fetus. Her earlier sonography showed the possibility of acardiac twin pregnancy, but she did not have any appropriate or special prenatal care for this problem. After delivery, there was a normal dead fetus without any gross abnormality and another acardiac fetus

Conclusions: Early diagnosis of acardiac twin pregnancy and appropriate prenatal care are of prime importance for appropriate intervention and best fetal outcomes

Comparison of the prevalence of human papillomaviruses among fertile and infertile women in Mashhad, northeast of Iran

Background: Human papillomaviruses [HPVs] are the most common viruses which can be sexually transmitted. They can cause different malignancies in asymptomatic women. The association of HPVs with infertility among men and women is controversial. In the current study, the authors compared the frequency of HPVs in fertile and infertile women in the city of Mashhad

Materials and Methods: In the present case-control study, cervical and vaginal smears were collected from infertile and fertile women. HPVs were detected by polymerase chain reaction. Data was analyzed by SPSS v.20 and P-value <0.05 was considered statistically significant

Results: In the current study, 115 infertile women with the mean age of 30.5 +/- 5.6 years and 60 fertile women with the mean age of 32.6 +/- 9.3 years were included [p=0.07]. Among women who were infertile [cases], 121 [52.6%] of 230 smears were positive, while in control group [who were fertile], 50 [41.7%] of 120 smears were positive [p=0.052]

Conclusion: Frequency of HPV in both groups was high, which could be due to lack of routine HPV vaccination. HPV can cause placenta abnormality, our infertile women had multiple abortion history and history of abortion had significant differences among infertile and control group. The frequency of HPV had no significant differences between the infertile and control groups

Obstetrics and perinatal outcomes of dichorionic twin pregnancy following ART compared with spontaneous pregnancy

Introduction: Regarding to the recent advances in assisted reproductive techniques [ART], twin and multiple pregnancies have increased during past years

Objective: This study was performed to compare obstetrics and perinatal outcomes of dichorionic twin pregnancy following ART with spontaneous pregnancy

Materials and Methods: In this cross-sectional study which was performed in Ghaem Hospital, Mashhad University of Medical Sciences, 107 dichorionic twin pregnancy were enrolled in two groups: spontaneous group [n=96] and ART group [n=31]. Basic criteria and obstetrics and neonatal outcomes information including demographic data, gestational age, mode of delivery, pregnancy complications [preeclampsia, gestational diabetes, preterm labor, and intrauterine growth retardation [IUGR], postpartum hemorrhage], neonatal outcomes [weight, first and fifth minuteP PApgar score, Neonatal Intensive Care Unit [NICU] admission, mortality, respiratory distress, and icterus] were recorded using a questionnaire

Results: Preterm labor, gestational diabetes, and preeclampsia were significantly higher in ART group compared to spontaneous pregnancy group. However, other factors such as anemia, IUGR, postpartum hemorrhage, and intrauterine fetal death [IUFD] were not significantly different between groups. There were no significant differences between groups in terms of neonatal outcomes [weight, 1PstP and 5PthP min Apgar score <7, NICU hospitalization, mortality, respiratory distress, and icterus]

Conclusion: With regard of significantly higher poor outcomes such as preeclampsia, gestational diabetes and preterm labor in ART group, the couples should be aware of these potential risks before choosing ART

Vaginal versus sublingual misoprostol for labor induction at term and post term: a randomized prospective study

We want to compare the efficacy and safety of vaginal versus sublingual misoprostol for cervical ripening and induction of labor. This randomized clinical trial was performed on 140 women with medical or obstetric indications for labor induction. The patients were randomly divided into two groups: vaginal and sublingual administration of misoprostol. In first group, 25 Micro g misoprostol was placed in the posterior fornix of the vagina and second group received 25 Micro g misoprostol sublingually, every 6 hours for 24 h. Maternal and neonatal outcomes were analyzed. There was no significant difference in the demographic characteristics between two groups. The main indication for cesarean section in both groups was fetal distress, followed by absence of active labor progress. Evaluation of cesarean indication was not significantly different in two groups; including fetal distress, absence of active labor, uterine over activity and failure to progress. The maternal complication in sublingual group included residual placenta [2%], tachysystole [2%], vomiting [12%], atoni [3.3%] and abdominal pain [5.5%], although there was no significant difference between two groups. Sublingual misoprostol is as effective as vaginal misoprostol for induction of labor at term. However, sublingual misoprostol has the advantage of easy administration and may be more suitable than vaginal misoprostol

[Uterine rupture following incomplete molar pregnancy: a case report]

Background: In molar pregnancy, when hydatidiform changes are local and some embryonic components are observed, the term of partial mole is used. The risk of persistent trophoblastic tumor after partial mole is much lower than complete mole. In this persistent cases almost all are non metastatic. The aim of this study is to report a case of uterine rupture following incomplete molar pregnancy

Case presentation: The patient was a 26 year old woman with obstetric history of an abortion and one molar pregnancy and no child. She was referred to emergency unit in Ghaem University Hospital, Mashhad, Iran in May 2011. She had an evacuation curettage following molar pregnancy three months before and without any follow up visit. The patient was referred to emergency unit with hemorrhagic shock. She immediately underwent laparotomy. The uterine fundal rupture was repaired and evacuation curettage performed. In post operative evaluation, she had a nine millimeter metastatic nodule in base of right Lung. As a patient in low risk stage III, she received weekly intramuscular methotrexate [40mg/m2] for six courses. In follow up visit beta-hCG titer was negative [<10miu/ml] at 5th week

Conclusion: In cases of in complete molar pregnancy risk of metastasis is very low. Serial beta-hCG titer is the most accurate method for detection of persistent gestational trophoblastic disease [GTN]. In neglected cases like this case preservation of ruptured uterus in GTN is possible

Comparison of serum levels of tri-iodothyronine [T3], thyroxine [T4], and thyroid-stimulating hormone [TSH] in preeclampsia and normal pregnancy

The physiological changes in thyroid gland during pregnancy have been suggested as one of the pathophysiologic causes of preeclampsia. The aim of this study was comparison of serum levels of Tri-iodothyronine [T3], Thyroxine [T4], and Thyroid-Stimulating Hormone [TSH] in preeclampsia and normal pregnancy. In this case-control study, 40 normal pregnant women and 40 cases of preeclamsia in third trimester of pregnancy were evaluated. They were compared for serum levels of Free T3 [FT3], Free T4 [FT4] and TSH. The data was analyzed by SPSS software with the use of t-student, Chi-square, Independent sample T-test and Bivariate correlation test. P

[Maternal death due to placenta percreta with bladder involvement: a case report]

Placenta accreta is a life-threatening complication after previous cesarean delivery. The aim of this case report is to present a case of placenta percreta with bladder involvement and subsequent maternal death. The patient was a 37-year old who had an unwanted pregnancy due to tubectomy failure two years afterwards. She was hospitalized at 26th and 30th week of gestation because of gross hematuria. Sonography reported placenta previa. Cesarean section was performed at 34th gestational week. Due to severe hemorrhage, hysterectomy with resection of some part of the bladder was done. Died at the operating room after four hours of severe uncontrollable hemorrhage. The increasing prevalence of different forms of placenta accreta is the result of the ever-increasing rate of cesarean deliveries. One of the strategies to prevent this catastrophic obstetric complication is decreasing the number of cesarean deliveries without appropriate indications

[Fertility outcome after IVF and related factors]

Success rate of IVF depends on infertility factors and its treatment cycle. Different methods of treatment and different centers have reported various rates of success. The aim of this study was to evaluate the fertility outcome after IVF and related factors. This descriptive analytic study was performed on 150 infertile couples following IVF in Montaserieh Infertility Center, Mashhad University of Medical Sciences, Mashhad, North - East of Iran during 2001-06. Data was collected by a questionnaire including woman's age, husband's age, infertility factor, spermogram, infertility period, the number of follicles caused by treatment, the number of oocytes, the number of produced and transferred fetus and treatment outcomes. Data was analyzed by SPSS software and Chi-square, t-studen test, One-way ANOVA and logistic regression. The mean age of women was 29.7 +/- 5.4. The mean +/- SD follicles oocytes and transferred fetus were 11+6, 6 +/- 3.9 and 2.6 +/- 1.5 respectively. There was significant relation between the number of follicles [P<0.05], obtained oocytes [P<0.05] and transfered fetus [P<0.05] with the success rate of IVF. The fertility rate was 24.6%. There was no significant relation between the age groups and fertility rate. This study showed that ovarian response to ovulation stimulation and the number of transferred fetus are the important and effective factors for predicting the outcomes of IVF

Medical abortion at first trimester of pregnancy with misoprostol

To evaluate the efficacy of medical abortion at first trimester of pregnancy with vaginal misoprostol. This is a descriptive analytic study. It was performed on 100 women at first trimester of pregnancy referred to teaching hospitals related to the Medical Sciences of Mashhad University, Mashhad, Iran for termination of pregnancy in 2006. Each patient received first dose of misoprostol [800 micro g/vaginal], the second dose [800 micro g/vaginal] was administered 24 hours after the first dose if expulsion of conceptus was not successful and curettage was performed if product of conception remained. From 100 patients, 83 women [83%] had successful complete abortion, and 17 cases required curettage. Among them, pregnancy was terminated in 55 [62%] with first dose of misoprostol and 28 [34%] of them required second dose. No important side-effects were noted due to vaginal misoprostol treatment. Termination of pregnancy by medical methods at first trimester of pregnancy with vaginal misoprostol is safe, cost effective, and without side-effects

[Three therapeutic methods for poly cystic ovarian syndrome]

About 10-15% of women in the reproductive ages suffer from infertility. The most common cause of infertility with female factor is ovulation disorders [35-40%] and among them polycystic ovary syndrome [PCOS] is the most common. These patients suffer from insulin resistance, obesity and increase in androgens; many recent studies have focused on the effects of insulin sensitizing agents like metformine on the patients with PCOS. The aim of this study was to evaluate the efficacy of the three therapeutic methods of clomiphen citrate [CC], metformine and clomiphen citrate plus metformine on infertile women with PCOS. This clinical trial study performed in the year 2004 at Montaserie Hospital of Mashhad University of Medical Sciences, on three groups of 20 PCOS Patients. This study was approved by the local committee of medical ethics. The women in the first group were treated with clomiphen citrate, the second group with metformine and the third group with clomiphen plus metformine for 3 months. Data were analyzed by SPSS software, by using t-student and X[2]. p