Sima Kadkhodayan , Golrokh Sherafati ,
Volume 72, Issue 10 (1-2015)
Abstract
Background: Cervix is a rare and dangerous site for ectopic pregnancy. When the placenta is implanted lower than internal cervical os, it is called “cervical pregnancy”. Known risk factors for cervical pregnancy are previous cesarean section, cigarette smoking, premature transfer of fertilized ovum before having suitable endometrium and pelvic inflammatory disease. In the past, hysterectomy was the usual treatment. Nowadays, with the newer diagnostic and therapeutic managements, cases of cervical pregnancy treated by fertility sparing methods have been reported. Conservative treatments include using methotrexate and KCl, hyperosmolar glucose, and prostaglandins. Also, surgical methods with fertility sparing have been reported. The purpose of this study is introducing two cases of cervical pregnancies treated by fertility sparing.
Case presentation: The first patient had six weeks pregnancy with live fetus and detectable fetal heart beat. There was six weeks menstrual retard and βhCG titer was 10.000 UI/ml. Two doses of methotrexate were prescribed and pregnancy terminated successfully. The other patient had eight weeks pregnancy with fetal heart beat. There was eight weeks retardation and βhCG titer was 70379 UI/ml with no gestational sac in sonography in both patients. After prescribing two doses of methotrexate and doing curettage three days after the last dose of methotrexate, pregnancy terminated. The known risk factors for our patients were history of endometrial curettage in one and history of cesarean section in both of them.
Conclusion: Conservative method may be considered for the treatment of cervical pregnancy in patients who desire to preserve their fertility. The treatment is associated with high success rates. Methotrexate (MTX) is the most common medicine for resolving ectopic cervical pregnancy, other medications such as KCl, hyperosmolar glucose, RU486 and prostaglandins have also been used with different success rate. Methotrexate may be administered systemic (intramuscular or intravenous) or local (intra-amniotic transfusion or intrauterine).
Tannaz Ahadi , Nima Khaje , Bijan Forogh , Labaneh Janbazi, Masumeh Bagherzadehcham.m@iums.ac.ir,
Volume 80, Issue 4 (7-2022)
Abstract
Background: There are many conservative interventions to reduce the symptoms of coccydynia, but it is not clear which treatment can be more effective. The aim of this review study was to evaluate the types of conservative interventions and the effectiveness of each of them in reducing coccydynia symptoms.
Methods: This systematic review was carried out based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) instruction. A search for research studies published up to October 2021 was conducted in Neuromusculoskeletal Research Center, Firoozgar General Hospital, Iran University of Medical Sciences, Tehran, Iran, using Scopus, Science Direct, Web of Knowledge and Cochrane without data constraints. The search was carried out in October 2021 and continued for seven months. The quality of the articles was evaluated using the Physiotherapy Evidence Database scale (PEDro). All prospective randomized clinical trial studies in which participants suffered from coccydynia and were treated with nonsurgical treatments were included.
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Results: 945 articles were found in the primary search of the databases. After eliminating 493 repetitive papers, 452 studies remained which were screened by the two researchers of this study in terms of the title and abstract. 40 studies were selected for full-text evaluation. Finally, 12 articles were included in the review study. Two papers used extracorporeal shockwave, two papers used impar ganglion block, three papers manual therapy, and four studies injection. The remaining four studies used iontophoresis with ketoprofen, biofeedback therapy, acupuncture, and physiotherapy with Kinesio taping.
Conclusion: Treatment with extracorporeal shock wave and impar ganglion block significantly improve tailbone pain and show more permanent effects on patients' symptoms. Manual therapies are mostly used in cases where the tailbone is stable. It seems that achieving the desired response requires more than six sessions, which is not pleasant for patients. Injections, especially those performed under fluoroscopic guidance, require high skill in addition to being unpleasant and painful. However, this procedure is done in one session, so there is no need for the next visit.
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