Pregnancy in non-communicating rudimentary horn of a unicornuate uterus

Diagnosis and management of pre-rupture stage of the pregnant horn are difficult and usually missed on a routine ultrasound scan. Also most cases are detected after rupture of pregnant horn. We presented a 28-year-oldG2 L1 woman with diagnosis of rudimentary horn pregnancy [RHP] at 14 weeks of gestation. We diagnosed her with a normal intrauterine pregnancy, whereas a pregnancy in a right-sided non-communicating rudimentary horn with massive hemoperitoneum was later discovered on laparotomy. RHP has a high risk of death for mother, so there must be a strong clinical suspicion for the diagnosis of RHP. Although there is a major advancement in field of diagnostic ultrasound and other imaging modalities, prenatal diagnosis has remained elusive and a laparotomy surgery is considered as a definitive diagnosis

Assessment of serum progesterone level on the day of hCG injection in infertile polycystic ovarian syndrome patients referred to women's hospital, Tehran, 2009

Background: Polycystic ovarian syndrome [PCOS] is one of the most common causes of endocrine disorders and main reasons for infertility due to unovulation and recurrent abortions. There is no consensus on effect of serum progesterone level on the day of human chorionic gonadotropin [hCG] injection. This study aims to evaluate the effect of plasma levels of progesterone on the day of hCG injection on the rate of pregnancy in in vitro fertilization [IVF] cycles of PCOS cases

Materials and Methods: A stratified cohort study was conducted over a period of one year [2009] on 38 infertile women with PCOS who were suitable candidates for the IVF program. Patients were evaluated for other causes of infertility with hysterosalpingography [HSG], laparoscopy and normal sperm analysis. Patients were placed on the long protocol, followed by oocyte pick up, and finally IVF-embryo transfer [ET]. Study patients were grouped according to progesterone levels of greater or less than 1.2 ng/ml on the day of hCG injection. Pregnancy rates were defined in each group. Levels on day of hCG day clinical pregnancy outcome were assessed. Experimental data were then compared against Fisher's exact test in SPSS version 18

Results: The overall pregnancy rate in this study was 26.3%. In the group with progesterone levels more than 1.2 ng/ml on the day of hCG injection, the clinical pregnancy rate was 4 [21.1%] and chemical pregnancy rate was 3[15.8%]. In the group with progesterone levels less than 1.2 ng/ml, the clinical pregnancy rate was 1[5.3%] and chemical pregnancy rate was 2[10. 5%]

Conclusion: This study showed that PCOS patients with progesterone levels more than 1.2 ng/ml on the day of hCG injection resulted in higher chemical and clinical pregnancy rates. However, no significant statistical differences were found between the two groups. For further verification, we recommend additional studies with larger numbers of subjects

Effect of predictive value of progesterone level on the day of HCG injection for IVF success in women with infertility due to tubal factor or polycystic ovarian syndrome referred to the women hospital, Tehran, 2009

Polycystic ovarian syndrome is one of the most common causes of endocrine disorders and main reason of infertility due to anovulation and recurrent abortions. Progesterone has been shown to have an important role in fertilization of oocyte and fetal implantation. The purpose of this study was to compare the predictive value of progesterone level on IVF success in women with infertility due to tubal factor or PCOS. In a stratified cohort study, we assigned 76 infertile women of 20-38 years old who referred to women hospital into two equal groups with fallopian tube factor infertility and PCOS. We measured the plasma levels of progesterone and estradiol on the day of HCG administration. The patients were divided into two groups based on progesterone level cut off point of 1.2ng/ml. Thereafter the incidence of pregnancy [chemical by beta-HCG measurement and clinical by ultrasonography up to the 6 weeks after fetal transfer] was compared in these groups. Total pregnancy rates were 15.8% in patients with tubal factor infertility and 26.3% in women with PCOS. In women with PCOS, the pregnancy rate was less in patients with progesterone level <1.2 ng/ml. However this difference was not statistically significant. Likewise, we did not observe any significant differences in pregnancy rate in patients with fallopian tube factor infertility. Serum progesterone level on the day of HCG administration is not well predictive of the IVF success in infertile women due to fallopian tube factor or PCOS. To obtain more uniform results, we recommend use of larger samples while the bias variable is taken into account and the ROC curve is used for determination of the unique serum progesterone level

Effect of metformin on diabetes mellitus prevention in pregnant women with risk factors

This study evaluated the efficacy and safety of metformin on prevention of gestational diabetes mellitus in women with high risk of GDM. Total number of 189 pregnant women aged between 25 to 35, and 10 to 14 weeks pregnancy, admitted to Mirza Koochakkhan Hospital, Tehran in January 2008 - January 2009 entered to this randomized controlled clinical trial. The women had one of the three risk factors; history of GDM, family history of diabetes, or BMI >/- 30 kg/m[2], with normal results in the glucose challenge test [GCT] or the glucose tolerance test [GTT]. Subjects were randomly split to two groups; 63 women [group A] who received metformin [500 mg, twice a day] and 126 women [group B] did not use metformin. Incidence of gestational diabetes was compared between two groups. The incidence of gestational diabetes was significantly different between two groups [%1.4 in group A,%15.4 in group B] [p<0.001]. The study also showed that the insulin requirement was significantly different between two groups after developing GDM [group A%3.6, group B%9.5, p=0.001]. Using Metformin can effectively reduce the incidence of GDM in pregnant women at risk