---

Background and Aim: Gestational trophoblastic diseases are among the cases of high risk pregnancies. Lack of timely diagnosis may lead to complications such as high morbidity and mortality, HTN and hyperthyroidism. The aim of this study was to assess the incidence and epidemiologic status of gestational trophoblastic diseases in Besat Hospital in Sanandaj from 1373 to 1382. Materials and Methods: This descriptive study included all normal deliveries, cesarean sections, and curettages of the moles in Beast Hospital from 1373 to 1382. The sampling method was census. Data were analyzed by means of descriptive statistical methods using SPSS win11 program. Results: The results of this study showed that the incidence of trophoblastic diseases was 2.02 per 1000 pregnancy, namely 81 cases out of 39979. 78 (96.3%) patients had hydatidiform mole, 2 cases (2.5%) invasive mole and 1 case (1.2%) choriocarcinoma. The mean age of the patients was 27.25.2 years. 30 cases (38%) had history of abortion. Conclusion: The incidence of gestational trophoblastic diseases and the mean age of these patients in Sanandaj are the same as those of others regions of Iran. Therefore routine sonograpghy in the first trimester, for rapid diagnosis of gestational trophoblastic diseases is recommended.

---

  ABSTRACT

  Background and Aim: One of the basic principles of modern obstetrics is to provide adequate analgesia. An analgesic should have potent analgesic efficacy and minimal side effects to be suitable for pain relief during labour. The aim of this study was to evaluate and compare the analgesic efficacy and adverse effects of tramadol and pethidine on labour pain, labour duration, apgar score of the infants and maternal complications in primiparous women.

  Materials and Methods: This was a triple-blind randomized control trial. 30 full term parturient women were randomly assigned to one of tramadol or pethidine groups. Inclusion criteria were full term primiparous women without high risk pregnancy in active phase of labour, with 4 cm dilatation of cervix. Lack of induction of delivery, lack of pregnancy complications and drug reactions were regarded as other inclusion criteria. In active phase of delivary vital signs of the parturient women recorded. The pain was measured by means of NRS score. Group I received 50 mg pethedine group II, 50 mg tramadol in 200 cc Ringer solution, intravenously. The vital signs and pain were reassessed after one hour. The mothers and their fetuses were under control for potential complications. Collected data were introduced into SPSS soft ware and analyzed by means of t-test and X². p<0.05 was regarded statistically significant.

  Results: There was no significant difference in relation to age, maternal weight, maternal educational status, gestational age and infant`s weight between the two groups. There was no significant difference between the decrease in the mean systolic and diastolic blood pressures in the two groups. Maternal Side effects such as nausea, vomiting and drowsiness occurred more frequently in pethidine group (p≤0.05). There was no significant difference between the durations of active phase of labour in the two groups. Mean value of the first minute apgar score in tramadol and pethidine groups were 8.87 ±0.516 and 8.86 ±0.363 respectively. The m ean value of the fifth minute apgar score in tramadol and pethidine groups were 9.60±0.507 and 9.57±0.514 respectively (p>0.05). The mean values of pain reduction assessed by VAS score were 1.28±1.63 for pethidine group and 1.00±1.30 for tramadol group ) p≤0.05).

  Conclusion: We conclude that pethidine has more analgesic effect than tramadol on labour pain but frequency of side effects such as nausea and vomiting was higher with pethidine administration. Both drugs can cause shortening of active phase of labour. Apgar score was not influenced by any of the two drugs.

---

ABSTRACT Background and aim: Nausea and vomiting are common complications after surgery occurring in 20-70 percent of total surgeries and depends on factors such as anesthesia method and hemodynamic status, oxygen concentration, pain, etc. In some studies use of higher concentrations of oxygen prior to surgery has resulted in decreased incidence of nausea and vomiting and in some other studies such results had not been verified. In the present study, the effects of supplemental oxygen has been assessed on the incidence and severity of nausea and vomiting in the patients after cesarean surgery under spinal anesthesia Materials and Methods: This study was a randomized clinical trial and 122 women who were candidate for cesarean surgery were assigned randomly into intervention and control groups. Intervention group received 80 percent O2 equivalent to 12 liter per minute, continuously during surgery and after surgery in recovery room, and alternatively 6 hours by use of ventury mask in the ward. The control group received 30 percent O2, equivalent to 3-5 liters per minute with a regular mask as a routine measure. The incidence and severity of nausea and vomiting was recorded during surgery, up to 6 hours after surgery, in the recovery room and in the postpartum ward. Results: According to the results, the incidence of nausea during surgery showed no significant relationship but it showed a significant difference in the recovery room and at the postpartum ward in the intervention and control groups (p<0.01). Incidence of vomiting during surgery and at the postpartum ward in the intervention and control groups had no significant difference but it revealed a significant difference in the recovery room (p<0.001). There was a significant difference in the severity of nausea in the intervention and control groups during surgery, in recovery room and after 6 hours of surgery in the postpartum ward and the severity of nausea was higher in the control group (p<0.05). Conclusion: This study demonstrated that supplemental oxygen therapy during and after surgery by spinal anesthesia technique was not effective for the prevention of nausea. There was only a significant statistical difference in the rate of vomiting in the recovery room between the two groups. Use of supplemental oxygen decreased the need for analgesic drugs in these patients. Key words: Nausea and vomiting, Supplemental oxygen therapy, Cesarean surgery, Spinal anesthesia Conflict of Interest: Nill Received: June 7, 2010 Accepted: Jul 13, 2010

---

ABSTRACT Background and Aim: Frequency and morbidity of hot flushes has led to development of multiple hormonal and non hormonal treatments in the recent years. Fluoxetine and citalopram with limited side effects and high tolerability by most women with hot flushes have attracted the researchers' attention but there are plenty of rooms for disagreement on their effectiveness. In this study the effects of fluoxetine, citalopram, hormone therapy and placebo on perimenopausal flushes, were compared with one another. Materials and Methods: This study was a randomized clinical trial (RCT). The study population included 46 to 55 year old women with hot flush who had lack of menstruation and reached menopause for at least 1 year. Sampling method was blocked randomization and the patients were divided into four groups including fluoxetine, citalopram, hormone therapy and placebo groups. The collected data were introduced into the SPSS software and analyzed by chi- square, ANOVA and Kruskal-Wallis tests. Results: There were no significant differences between the groups in the mean duration of menopause, history of any chronic disease, drug use and frequency of hypertension before intervention (p<0.05). But there was significant differences between the values of the mean age of the groups before intervention (P=0.03). The mean frequency of hot flushes decreased by 57%, 74.7%, 81.8% and 80% after intervention in estrogen + progesterone, fluoxetine, citalopram and placebo groups respectively (P<0.001). Conclusion: Considering the high rate of success of the treatment of the hot flushes with citalopram and fluoxetine and few side effects of these drugs, they can be regarded as good alternatives to hormone therapy and for thoese who are not willing to take estrogen. Key words: Menopause, Hot flushes, Citalopram, Fluoxetine, Hormonal therapy. Conflict of Interest: Nill Received: Oct 24, 2010 Accepted: Sep 1, 2011

---

ABSTRACT Background and Aim: Passing the medical abortion law in 2006 brought about, a major change in dealing with cases of therapeutic abortion. This study was performed to investigate the causes of therapeutic abortion request made by pregnant women who had referred to the Legal Medicine Organization in Sanandaj, from July 2004 to July 2008. Materials and Methods: This was a descriptive cross sectional study and included all the files of therapeutic abortion (58 files) in the Forensic Medicine Organization in Sanandaj from 2004 to 2008. Sampling method was census. The collected data were analyzed by using SPSS statistical software and frequency tables were prepared. Results: Most requests for therapeutic abortion were made in 2008 and included 18 cases (31%) and the least number of requests was in 2004 with six cases (10.3%). 16 patients between 30 and 35 years of age had the highest rate of abortion (27.6%). The lowest rate of abortion belonged to those with less than 18 years of age with one case (1.7%). The mean gestational age was 11.8± 4.1 (range 5-19 week). The approved cases of therapeutic abortion included 34 patients (58.6%).The prevalence rates of requests for abortion license due to fetal and maternal causes were 22 (37.9%) and 36 (62.1%), respectively. Among the confirmed cases of therapeutic abortion 18 (52.9%) had fetal causes and 16 (47.1%) had maternal causes. The most common fetal causes for therapeutic abortion permit was anencephaly with 7 cases (20.6%) and thalassemia with 3 cases (8.8%) and the most common maternal cause was cardiovascular diseases with 10 cases (29.4%). Conclusion: The results of this study indicated that after passing the medical abortion law, the numbers of requests for therapeutic abortion due to fetal causes are on the rise. Further interventions to promote knowledge in the field of therapeutic abortion among the medical staff and in the society and encourage use of certain methods of contraception by women with advanced cardiovascular disease are recommended. Key words: abortion, therapeutic abortion, criminal abortion, Forensic Medicine. Conflict of Interest: Nill Received: Mar 5, 2011 Accepted: Sep 13, 2011

---

Background and Aim: Dysfunctional uterine bleeding (DUB) is one of the common problems in peri-menopausal women that can affect their physical, emotional and social conditions. In addition DUB is one of the main causes of hysterectomy. The aim of this study was to investigate risk factors associated with DUB in peri-menopausal women in Sanandaj. Material and Method: This case–control study included 62 women with DUB(case group) and 124 women without DUB(control group). We used a questionnaire consisted of different items which was completed for every subject after clinical interview. Using SPSS software, data analysis was performed by chi-square, Fisher exact test and logistic regression. Results: DUB showed significant relationships with type of delivery (p=0.015) and age (p=0.045). DUB had no significant relationship with diabetes (p=0.095), hypertension (p=0.917) and type of contraceptive methods (p=0.906). Analysis by logistic regression revealed that women over 50 years of age and women with history of Cesarean section (C/S) had a respective risk of 2.284 (p=0.021) and 2.493 (p=0.009) times greater to develop DUB than women without these factors. Conclusion: The age over 50 years and C/S was suggested as risk factors which can be related to DUB. Attention to the advantages of vaginal delivery and complications of C/S is necessary and reduction of C/S rate can be effective in decreasing the incidence of DUB. Received: Jan 20, 2013 Accepted: Nov 27, 2013 Conflict of interest: None declared

---

Background and Aim: Identification of fetus health risk factors can be helpful in the diagnosis, immediate treatment, and prevention of irreversible damages on the fetus. Fetal sex is considered as a risk factor in fetal and neonatal conditions. The aim of this study was to evaluate the relationship between fetal gender and adverse fetal outcomes in the term pregnant women. Materials and Methods: This cross-sectional study was performed in Besat Hospital in Sanandaj, in 2011 and included 2389 pregnant women. Gestational diabetes and presence of any underlying chronic disease such as hypertension, asthma, diabetes, and cardiac diseases were considered as our exclusion criteria. Data about stages and conditions of delivery and demographic variables were recorded in a questionnaire for every subject. Data about the neonates including Apgar score, fetal distress, and macrosomia were collected and recorded. Using SPSS 16 software, data were analyzed by descriptive and inferential statistics including chi-square, Fisher's exact test, and t-test. Results: There were no statistically significant differences between male and female neonates in relation to maternal age, gestational age, duration of the first and second stages of labor, and average time of rupture of membrane (p>0.05). However, male neonates had higher birth weights (p=0.0001). In addition, there were no statistically significant relationship between boys and girls in regard to preeclampsia, mode of delivery, Apgar score, meconium, detachment of placenta, IUGR, umbilical cord prolapse, and stillbirths (p>0.05). However, prevalence of fetal distress syndrome was higher in boys (OR=1.83). Conclusion: Apart from respiratory distress syndrome, fetal sex is not associated with any other adverse fetal outcome. Even though, frequencies of cesarean delivery and Apgar scores of less than 7 were more in the boys compared to the girls. Key word: Gender, Pregnancy outcome, Preterm delivery. Received: Apr 30, 2013 Accepted: Jun 23, 2014

---

Background and Aim: Reduction of maternal deaths due to pregnancy and childbirth complications is one of the most important health indices and priorities for communities. Despite efforts in this context, maternal death rate is still high in developing countries. This study was aimed to assess the factors affecting maternal mortality and compare them by using the results of verbal autopsy and forensic autopsy. Material and Methods: This was a descriptive analytical study. The study population was all pregnant women who had died between 2001 and 2013 in Kurdistan province. To collect data we used a checklist which was designed based on the documents obtained from maternal mortality surveillance system. The collected data were entered into SPSS V.16 software. Fisher and chi-square tests were used for data analysis. Results: During the study period, we detected 79 maternal deaths. The top three causes of death based on the results of verbal autopsy were bleeding (34.2%), embolism (22.8%), and eclampsia (19%). 48.1% of the cases underwent forensic autopsy. Based on the results of forensic autopsy, the three causes of death were bleeding (16.5%), eclampsia (6.3%) and embolism (10.10%). The kappa coefficient for agreement between the two autopsies was 0.528. Conclusion: In addition to interventions and decisions on the basis of clear results of legal medicine, identification of the major causes of maternal death and their underlying risk factors recorded in maternal death surveillance system, can lead to decreased maternal morbidity and mortality. Keyword: Maternal Mortality, Verbal Autopsy, Forensic Autopsy. Received: Sep 22, 2014 Accepted: Dec 7, 2014

---

Background and Aim: Standard diagnostic procedure for significant proteinuria is based on 24-hour urine collection. However, this method is time consuming and may lead to incomplete urine collection. Instead, random urine protein/creatinine ratio could be used as an alternative method for evaluation of proteinuria. This study investigates the diagnostic value of random urine protein/creatinine ratio for the diagnosis of pre-eclampsia. Material and Methods: In this cross-sectional study a group of 96 patients with pre-eclampsia and a group of healthy pregnant women were recruited. All cases were checked for urine protein by assessing urine analysis, 24-hour urine, and random urine protein/creatinine ratio. Data were analyzed using SPSS and ROC curve. Then a cutoff point of random urine protein/ creatinine ratio was determined. Results: Area under the curve for random Pr/Cr was calculated as 0.785 (CI %95: 0.721-0.849) (p<0.001). The best diagnostic cutoff point for protein/creatinine ratio was determined as 0.325. In this point sensitivity and specificity were 81.3% and 66.7% respectively. As a result, a positive correlation between random urine protein/creatinine ratio and systolic blood pressure (r = 0.284, p = 0.005) was observed. Conclusion: Based on these results, random urine protein/creatinine ratio in a cutoff point of 0.325 could be suggested for preeclampsia. Keywords: Preeclampsia, Proteinuria, Diagnosis. Received: Oct 19, 2014 Accepted: Feb 24, 2015

---