Tehran University Medical Journal

Cesarean section (CS) is a relatively safe procedure, performed for different maiernal and fetal indications. Despite complications of general anesthesia, post-operative infections, and thromboembolic events, CS is being performed with increasing frequency. In this study, we have examined the indications and complications of CS's performed in Arash Hospital from December 1993 to November 1994. Of the total 3480 cases of chiidbrilh, 900 (24.45%) were performed by CS, most and last frequently in December/January and November/December respectively. However, Ute ratio of CS cases to all cases was equal throughout the year. The most common indication of CS was failure to progress in labor (38.54%), and the other causes were repeat CS (21.77%), meconium excretion (11.97%), malpresenlation (8.55%) and fetal distress (5.58%). The indication of CS varies with meternal age. Between 41-45 years, the most common indications were prior CS (42.5%), and request for concommitant tubal ligation (12.5%), whereas in the younger age groups, the most common indication was failure to progress in labor. In primiparous cases, 44.55% of the CS's were performed due to failure to progress in labor, while the latter was the indication of CS in only 14.5% of the multiparous women. Complications were observed in only 4.54% of CS cases

Background: Post-menopausal hemorrhage is one of the most common complains in gynecologic clinics. More than 60% of these cases have abnormal findings in diagnostic work ups. There is contraversy about the best diagnostic method for evaluating post-menopausal hemorrhage. The aim of this study was to evaluate the results of Trans-Vaginal Ultrasonography and compare its result to ones derived from direct endometrial biopsy and Hysteroscopy findings.

Methods: In a cross-sectional study, menopausal women who attended the outpatient clinic of Arash Hospital, Tehran University of medical Sciences, from April 2005 to March 2006 with the complain of hemorrhage were evaluated. In all of these patients, after getting informed consent, Trans-Vaginal Ultrasonography, Dilatation and Curettage and Hysteroscopy were performed.

Results: The total number of 90 women was recruited to the study with the age range of 41-80 years. The mean age of participants was 53.84 ± 6 years and 4.3 ± 5.1 years had passed from their menopause. The mean thickness of endometrium, measured by Trans Vaginal ultrasonography was 6.25 ± 3.7 millimeter. In the biopsy derived specimens, the most finding pathological presentation was atrophy (48.9%) and the Proliferative endometrium had the second prevalence (36.7%). Atrophy (44.4%) and Proliferative endometrium (33.3%) were the most prevalent finding in Hysteroscopy. There was a significant difference in endometrial thickness between groups of different pathological findings. A significant difference in endometrial thickness was also seen between groups with different Hysteroscopic finding. By grouping the data according to endometrial thickness, it became evident that endometrial thickness can predict the outcome of endometrial biopsy and Hysteroscopic finding efficiently. We used ROC curves to find the best grouping threshold for endometrial thickness to achieve the best sensitivity and specificity.

Conclusion: Measuring the endometrial thickness by Trans-Vaginal Ultrasonography is an appropriate non-invasive test for screening post-menopausal hemorrhage.