Placenta accreta outcomes and risk factors in a referral hospital in north of Iran: A case control study.

Background: Placenta accreta syndrome (PAS) may led to heavy blood loss and maternal death. Here we analyzed the main risk factors of PAS+ pregnancies and its complications in a referral hospital in the north of Iran. Methods: In a case control study, all pregnant women with PAS referred to our department during 2016 till 2021 were enrolled and divided in two groups case (PAS+) and control (PAS-) based on preoperative imaging, intraoperative findings, and pathological reports. The sociodemographic features and neonatal-maternal outcomes also were recorded. Results: The most frequent reason for cesarean (C/S) was repeated C/S (62.9%, 56/89). A significant difference showed up in the time lag between previous C/S and the present delivery (p < 0.001) which shows that when the time distance is longer, the risk of PAS rises (OR: 1.01 [95% CI: 1.003-1.017]). Also, a positive history of prior abortion and elective type of previous C/S were related to PAS+ pregnancies. Our other finding showed that PAS+ pregnancies will end in lower gestational age and have a longer duration of operation and hospitalization, heavy blood transfusion, and hysterectomy. Also, PAS+ pregnancies were not related to poor neonatal outcomes. Conclusions: It seems that, in addition to repeated C/S as a strong risk factor, previous abortion is a forgotten key which leads to incomplete evacuation or damage the endometrial-myometrial layers.

Central nervous system metastasis in epithelial ovarian carcinoma: a case report and literature review.

OBJECTIVE: To report involvement of the central nervous system (CNS) following epithelial ovarian cancer is rare. Advances in management of ovarian cancer by use of primary surgery including abdominal hysterectomy, bilateral salpingo'oophorectomy should attain as complete a cytoreduction as possible and effective platinum-based chemotherapy have prolonged survival. CASE REPORT: We present a case involving a 35-year-old Iranian woman diagnosed and treated for primary ovarian cancer in 2002. She underwent optimal cytoreductive surgery and chemotherapy treatment. Eight months after the initiation of therapy, multiple brain metastases without intraperitoneal lesions were found and treated with combination chemotherapy and whole brain radiotherapy (WBRT), without evidence of recurrent disease. The patient died from disease in December 2005. CONCLUSION: In a patient suffering from neoplasm that rarely metastasizes to CNS, a careful clinical examination and proper therapeutic approach including chemotherapy may lead to prolong survival.

Clinical assessment, gross examination, frozen section of ovarian masses: do patients benefit?

OBJECTIVE: The overall risk of malignancy in ovarian neoplasm is 13% in premenopausal women and 45% in postmenopausal women. Differentiating benign and malignant disease with frozen section is possible during operation; however, information on patients' history, physical examination, paraclinical criteria (tumour markers, imaging) and gross examination of tumour can also be helpful in planing the surgery. METHODS: This study was conducted on 150 women who underwent laparotomy due to adnexal mass between April 2003 and October 2005 at Vali-e-Asr Hospital, Tehran, Iran. Sensitivity and specificity of clinical assessment (history, tumour marker and imaging), gross examination and frozen section were calculated. RESULTS: Based on our findings frozen section had the highest sensitivity for diagnosing malignant tumour comparing with other methods of diagnosis (88.9%). Sensitivity was 71.3% for preoperative clinical examination, 83% for ultrasonography, 89.8% for CT scan, 70% for CA125 and 84.1% for gross examination, likewise the highest specificity was seen for frozen section (93.5%). CONCLUSION: This data confirm that frozen section diagnosis is a reliable method for the surgical management of patients with an ovarian mass, but history of disease, Para clinical criteria and gross examination can help to surgeon to perform on appropriate operation in the areas where frozen section is not possible.

A prospective study to evaluate the correlation between Reid colposcopic index impression and biopsy histology.

OBJECTIVE: To determine the strength of correlation between colposcopic impression using Reid index and biopsy histology. METHODS: In a colposcopy referral clinic in Tehran University, Iran. Colposcopy was carried out using Reid colposcopic index (RCI) scoring system and directed biopsy on 344 women between March 2004 and October 2005 by fellows supervised by a board-certified gynecologic oncologist. Results were retrospectively compared with a previous study carried out on 353 women by the same physicians. In this previous study, the colposcopy findings did not use RCI index; the significance of association between these 2 studies was assessed by chi(2) and kappa statistics. RESULT: The association between colposcopic impression and biopsy histology was highly significant (p < .001), both in RCI colposcopy group and general colposcopy group. However, the strength of the correlation between colposcopy impression and biopsy histology in RCI colposcopy group was more than the general colposcopy group (0.74 vs 0.45). The positive predictive value of any colposcopic abnormality for any histologic abnormalities in the RCI group was 92%. The negative predictive value of a benign colposcopic impression was 70.5%. The sensitivity was 74%, and the specificity was 90.7%. CONCLUSIONS: The good correlation between colposcopic impression and histological diagnosis by using Reid index in colposcopy would produce higher agreement and strength of the correlation. Therefore, the Reid index can be used as a reproducible technique which is easy to learn in colposcopic clinic.