Assessing the efficacy of vaginal hyoscine butyl bromide on cervical ripening prior to intrauterine procedures: a double-blinded clinical trial

Background: Unripe cervix prevents entering the endometrial cavity during intrauterine procedures. Mechanical dilatation of cervical canal might cause undesirable complications

Objective: To investigate the substitute of mechanical intervention with chemical treatment by administering hyoscine to patients

Materials and Methods: Sixty non-pregnant women, 20-70 years of age, with a closed cervix who were scheduled for an intrauterine procedure, were randomly divided into two groups. Group A as experimental [received two doses of hyoscine] and group B, as control group [received two doses of vitamin B6] in the vagina [8 hrs and 2 hrs before procedure] and the effect of these two drugs on dilatation and consistency of cervix were studied

Results: Statistics resulted from Mann-Whitney U test [p=0.027] and x[2][p=0.002] indicated that in premenopausal women, the priming effect of hyoscine on dilatation and consistency of uterine cervix was significant, but there were no significant benefits from giving vaginal hyoscine to menopausal women preoperatively [p=0.603]

Conclusion: Hyoscine proved a good choice for inducing cervical priming before intrauterine procedures in premenopausal women

Cervical priming by misoprostol before diagnostic dilatation and curettage: a randomized clinical trial

Difficulty in cervical dilatation is a hard situation during the procedure of diagnostic dilatation and curettage in some cases. This study was performed to evaluate the effect of vaginal misoprostol for cervical priming before diagnostic dilatation and curettage. In this study 56 women were selected as the candidates for dilatation and curettage. The study was double blind and was performed for two parallel groups. One misoprostol tablet [200 micro g] was administered in posterior fornix of vagina 2-4 hr before operation in 28 patients whereas in other 28 patients, placebo [VitB6] was used. Then, the two groups were compared according to the patency of the cervix measured by No. 5 Hegar dilators and the duration of dilatation and curettage procedure as well. Chi-square test, t-test, and Mann-Whitney U test were used for comparing two groups, and a p-value less than 0.05 was considered as statistically significant. Before the procedure of dilatation and curettage, the patency of the cervix was measured by passing Hegar dilator number 5 through the cervical canal in fifteen [53.6%] patients in the misoprostol group and 8 patients [28.6%] in the placebo group [p=0.05] which their difference was statistically significant. The effect of misoprostol was not significant in nulliparous women and postmenopausal period either. Vaginal misoprostol is a useful drug for ripening and dilating the cervix. It also facilitates the procedure of dilatation and curettage in premenopausal and multiparous women. Misoprostol was less effective in nulliparous women and in postmenopausal period

effect of progesterone suppositories on threatened abortion: a randomized clinical trial

Threatened abortion is a common complication of pregnancy. In order to prevent miscarriage in the cases with threatened abortion, this study was conducted to determine whether progesterone suppository is effective in allowing pregnancy to proceed beyond week 20 in women with threatened abortion. This single-blind clinical trial study was done on 60 pregnant women with threatened abortion. Pregnant women, who had vaginal bleeding until 20 weeks of their pregnancy, were assessed for inclusion. Participants were divided into two groups by random allocation; the control group, which did not undergo any treatment and the case group. The case group was given 400 mg of vaginal progesterone suppository [Cyclogest] each day until their bleeding stopped in less than one week. Participants were followed up until the end of their pregnancy. The treatment was considered successful if pregnancy continued beyond 20 weeks of gestation. Qualitative and quantitative variables were analyzed statistically by Chi Square and T- test respectively. The p-values of less than 0.05 were considered significant. There was no statistically significant difference between the case and the control groups in terms of background variables. The number of abortions in the case group [6 cases, 20%] was lower than the control group which had 10 abortions [33.3%]. The study demonstrated that the rate of abortion was reduced in women treated with progesterone suppositories. However, the difference was not statistically significant

Outcome of subsequent pregnancies in familial molar pregnancy

Familial recurrent molar pregnancy is an exceedingly rare condition, in which complete hydatidiform moles are mostly diploid but biparental in origin and the outcome of subsequent pregnancies is likely to be a hydatidiform mole or other type of reproductive loss. We previously reported a case of familial molar pregnancy [family K] comprising five affected members [four sisters and one of their cousins] each with at least one hydatidiform mole [HM]. In addition to the molar pregnancies, these patients have a total of three miscarriages and 8 normal pregnancies leading to healthy children; but the youngest member of this family has given birth to a boy with Down syndrome. Our second family [case S] includes two sisters with diploid biparental complete moles. They have a total of six molar pregnancies with no living child. Recently the younger sister had a partial molar pregnancy with apparently normal XX fetus accompanying diffuse molar changes of the placenta that led to preeclampsia and preterm delivery. Overall, these families have had 26 pregnancies including 12 molar pregnancies [complete or partial] and three abortions. We concluded that these families are predisposed to various genetic mutations, chromosomal abnormalities and clinical manifestations, which affect their offspring. Further studies of patients are needed to determine any relationship between a history of familial molar pregnancy and trisomy or other chromosomal abnormalities in offspring and genetic mutations in the products of conception to complete the puzzle and manage familial molar pregnancy

Diagnosis of premature rupture of membranes by assessment of urea and creatinine in vaginal washing fluid

Background: rupture of fetal membranes can occur at any gestational age. Premature rupture of membranes [PROM] means rupture of fetal membranes before the onset of labor

Objective: the purpose of this study was to evaluate and compare the reliability of the vaginal washing fluid urea and creatinine for the diagnosis of PROM and to determine cut-off values

Materials and Methods: a total of 179 pregnant women were recruited. All patients underwent different examinations. These included nitrazine paper test, fern test, amniotic fluid pooling, vaginal washing fluid urea and creatinine sampling. The one group consisted of 126 pregnant women between 14 and 41 weeks of gestation with the complaint of vaginal fluid leakage. Patients who had positive pooling, nitrating paper test and fern test were considered as confirmed PROM group [group 1]. On the other side, patients with pooling [-] and/or nitrazine paper test [-] and/or fern test [-] were taken as suspected unconfirmed PROM cases [group 2]. The control group consisted of 53 pregnant women between 14 and 41 weeks of gestation without any complaint or complication. We conducted one-way ANOVA test on the urea and creatinine measures and post-hoc comparison test. Cut-off value was determined by receiver operating characteristic [ROC] curve

Results: vaginal fluid concentrations of urea and creatinine were significantly different between the three groups [p<0.001]. The sensitivity, specificity, positive and negative predictive values and accuracy were all 100% in detecting premature rupture of membranes by evaluation of vaginal fluid creatinine concentration with a cut-off value of 0.45 mg/dl, respectively

Conclusion: this study demonstrates that of two markers investigated creatinine has the higher diagnostic power

Maternal and neonatal complications of substance abuse in Iranian pregnant women

There is an increased prevalence of maternal substance abuse during pregnancy in younger women in all socioeconomic classes and races. Our aim was to determine the prevalence and correlates of self-reported substance abuse among pregnant women and obstetric complications or neonatal outcomes in Iran. This retrospective cohort study is covering a five year period on medical records of pregnant women attending the maternity unit of four major hospitals [Mahdieh, Taleghani, Imam Hossein and Akbarabadi Hospitals]. Women who reported using opium, heroin, crack, cannabis or methamphetamine were compared with women with no reported history of drug abuse for obstetric complications and prenatal morbidity and neonatal mortality. From 100,620 deliveries substance abuse was recorded for 519 women giving a prevalence of 0.5%. Opium was the most prevalent substance abused followed by crack [a mix of heroin and amphetamines]. The exposed group had significantly more obstetric complications including preterm low birth weight and postpartum hemorrhage than the non-exposed group. The exposed group had significantly worse prenatal outcomes including more admissions to intensive care unit and higher infant mortality than the non-exposed group. None of the women in the exposed group was on methadone treatment at time of delivery. Risks of maternal and neonatal complications were increased in substance using pregnant women, especially preterm birth and low birth weight. We recommend a multidisciplinary team to provide methadone maintenance therapy for substance using pregnant women and urinary screen of all pregnant women presenting to hospital

Asymptomatic bacteriuria in users of intrauterine devices

The aim of this study was to compare the frequency of asymptomatic bacteriuria in women who use intrauterine devices [IUDs] as a contraceptive method with subjects who use tubal ligation [TL]. A cohort study was conducted on women who were candidates for IUD insertion or TL [control]. The patients were followed for 3 months, and urine cultures were assessed for bacteriuria at the end of the study. Overall, 131 women [mean age, 31.9 +/- 4.25 years] in the IUD group and 78 [mean age, 32.1 +/- 4.0 years] in the control group were studied. The parity score was 2 or more in 72% of the women in the IUD group and in 74% of the controls. The average intercourse frequency was twice per week in 82% of IUD users and 80% of controls. Fifty-seven percent of the women in the IUD group and 55% of the women in the control group had graduated secondary school [high school]. Asymptomatic bacteriuria was detected in 13 IUD users [9.9%] and in 1 woman [1.3%] in the control group [risk ratio=7.74, confidence interval: 1.03 to 58.03; P=.019]. The detected microorganism in the urine culture was Escherichia coli in 12 IUD users and in 1 patient in control group. Klebsiella was found in 1 IUD user. Use of an IUD is a risk factor for urinary tract infection and should be considered, especially in women with recurrent urinary tract infections