Tehran University Medical Journal

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Background: As an important diagnostic and therapeutic procedure for patients with intrauterine diseases, hysteroscopy permits a good view of the uterine cavity, thereby increasing diagnostic accuracy. Complications often encountered during hysteroscopy primarily concern problems with cervical dilatation and include uterine perforation, cervical tears, and the creation of false tracts. In this study, we investigate the utility of vaginal misoprostol for cervical dilatation in women undergoing hysteroscopy.

Methods: This triple-blind, randomized, placebo-controlled study was carried out at Mirza Khoochak Khan Hospital, Tehran, Iran. We excluded women who were pregnant, had genital tract infection, or history of cervical trauma. We randomly assigned 80 women with abnormal uterine bleeding or intrauterine lesions to receive either 200 μg vaginal misoprostol or placebo. Ten to twelve hours prior to hysteroscopy, the placebo or misoprostol was administered to the posterior vaginal fornix. Data regarding cervical response and outcome of operative hysteroscopy, as well as complications, were analyzed.

Results: The mean cervical width, as estimated by Hegar dilator, was significantly greater in the treated group (7.8±1.6mm) than that in the control group (5.6±2.2mm, p<0.001). In the misoprostol group, 28 (70%) patients required cervical dilatation, compared with 38(95%) in the placebo group (p=0.001). A significantly shorter median time of cervical dilatation to Hegar number 9 was found in the treated subjects than in the controls (60 vs. 180 seconds, p<0.001). The mean operative time was significantly shorter in the treated group (8.8±8.7 minutes) compared with that of the control group (13.1±10.1 minutes, p=0.043).

Conclusions: Vaginal misoprostol before operative hysteroscopy lessens the need for cervical dilatation, facilitating hysteroscopic surgery.

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Normal 0 false false false EN-GB X-NONE AR-SA MicrosoftInternetExplorer4 B ackground: Preterm birth which is defined as delivery before 37 completed weeks was implicated in approximately two thirds of neonatal death. Also preterm labors are the most common cause of mortality and morbidity of infants in recent years and it costs high prices for health system. We evaluate the relationship between prepregnancy maternal body mass Index (BMI) and spontaneous and indicated preterm birth.
Methods: This study included 250 healthy pregnant women, without any risk factors of preterm birth, were classified into categories that were based on their body mass index. Association between BMI, weight gain and rout of delivery were examined. Rates of indicated and spontaneous preterm birth were compared.
Results: Obese women delivered at a more advanced gestational age. (38/34±1/66 weeks vs 37/61±2/44, p=0/006). Obese patients had significantly lower incidence of spontaneous preterm birth at < 37 weeks of gestation (16/8% vs 31/2% p=0/008). Obese women had larger infants (3354/95±596/75 vs 311.24±558/357 p=0/001), and had more frequent cesarean delivery (69/6% vs 52/8%, p=0/006). Weight gain during pregnancy is poorly correlated with prepregnancy BMI (14/41±7/93 kg vs 13/78±4/94kg, p=0/4) and preterm birth.
Conclusion: In this survey, there was adverse correlation between body mass index (BMI) before pregnancy and preterm labor less than 37 completed weeks and we suggest more study for evaluation between spontaneous and induced preterm labor mechanism and in obese and non obese women. However according to this survey obesity before pregnancy is associated with a lower rate of spontaneous preterm birth.

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Background: Endometrioma of ovary is one of the common diseases during reproductive age and the effect of laparoscopic cystectomy of endometrioma on infertility is still matter of debate. We designed this case control study to evaluate the ovarian response to controlled ovarian hyperstimulation during IVF (In vitro fertilization) cycle following laparoscopic unilateral cystectomy of endometrioma.
Methods: In a case control study, we enrolled 30 women with history of unilateral laparoscopic cystectomy of ovarian endometrioma in stripping method who underwent IVF cycle in women Hospital, 2009-2012. The numbers of follicles in response to controlled ovarian hyperstimulation during IVF cycle in the ovary with history of  unilateral laparoscopic cystectomy of endometrioma were compared with those from the contralateral ovary.
Results: The mean age (±SD) of patients was 32.3 (±3.4). The mean (±SD) diameter of excised ovarian endometrioma was 42.4 (±10.4) mm. Interval since ovarian surgery to induction ovulation was 2.7 (±2.6) years. Mean number of follicles in the ovary with history of unilateral laparoscopic cystectomy of endometrioma was 2.5 (±1.2) with the range of 1 to 5 and in the control ovary 3.9 (±1.4) with the range of 1 to 6. There was significant difference in the number of follicles in the ovary with laparascopic cystectomy of endometrioma compared with opposite one (P<0.001).
Conclusion: Laparoscopic cystectomy for unilateral endometrioma is associated with a reduced ovarian response to controlled ovarian hyperstimulation during IVF cycle. We did not find any statistically significant difference in reduced ovarian response with regard to patients age, body mass index, size and location of the cyst, and time duration since ovarian cystectomy.

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Background: Recent studies have suggested that impaired fetal growth are indicators that may be present in the first trimester. The aim of this study was to investigate the relationship between crown-rump length (CRL) and pregnancy associated plasma protein-A (PAPP-A) measurements in first trimester for low birth weight (LBW).
Methods: This prospective cohort study were on 120 pregnant women in first pregnan-cy trimester, in Women's Hospital Mirza Kochak Khan in 2011-2012. Gestational age according to crown-rump length and gestational age according to last menstrual period (LMP), neonatal weight, small for gestational age, pregnancy associated plasma protein-A and low birth weight were recorded. Main outcome measures was weight and gestational age at birth. Statistical tests used included descriptive statistics, t-test, χ² and all tests were two-tailed and differences with P<0.05 were considered to be statistically significant.
Results: Our findings showed that a total of 120 cases were included CRL Z-score and log 10 (MOM PAPP-A) were positively correlated with fetal birth weight. The mean Crown-rump length Z-score was significantly can be reduced in LBW in first trimester pregnancy. (P<0.001) Mean PAPP-A in low birth weight was (0.4±0.11 MOM), but in normal weight infants was (1.04±0.7 MOM). (P=0.011) also mean PAPP-A in pregnant women with SGA infants is significantly less than other pregnant women (0.5±0.2 versus 1.1±0.7) (P<0.001).
Conclusion: Our data suggest that crown-rump length and maternal levels of PAPP-A measured during the first trimester are independent factors that influence fetal birth weight. But their predictive powers are not sufficiently good for them to be used alone for low birth weight screening.