Journal of

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Introduction: Almost every one in four women experiences an incomplete abortion in her life. During the twentieth century, uterine contents were evacuated using either forceps or curettage. Re-evaluation of this treatment seems logical. This study was designed to evaluate the results of medical treatment of first trimester incomplete abortion with methyl ergonovine maleate. Methods and Materials: An observational, descriptive-analytical and cross-sectional study was designed to assess the effectiveness of a maximum of four doses of 0.2mg methyl ergonovine maleate in the treatment of first trimester miscarriage. Patients received serum oxytocin concurrently. A total of 100 women were selected using convenience, consecutive sampling method. If after 24h, the interface line was seen completely and there was no bleeding, patients were discharged without medications. If not, they received oral methergine for 6days, qid.Results were analyzed by SPSS 11.5 software, chi-square and T-tests. Results: A total of 100 women aged between 14 and 45 years were selected. On the whole, methergine was successful in 97% of patients (injection or orally). Only 13% of the patients had mild side effects. Conclusion: Methergine is an effective and safe drug for the management of first trimester miscarriage.

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Introduction: Recurrent spontaneous abortion (RSA) is defined as three or more consecutive miscarriages, which affects 0.8 to 1% of pregnant women. Despite several well-established etiologic factors, the cause of RSA cannot be determined in almost 60% of the cases. It has been postulated that a part of these repeated pregnancy losses might be due to immune causes. Material and Methods: In the present case control study using flowcytometry, peripheral NK cytotoxicity was compared in three different groups. 21 women with history of RSA at the time of 3rd or higher abortion (Group I), 32 women with history of three or more previous abortions and at least three months had lapsed since the last abortion (Group II) and 32 pregnant women with no history of abortion and at least one successful pregnancy (Group III) were studied. Results: Group I and Group II showed significantly higher NK cytotoxicity than Group III in all of the effect to target (E: T) ratios (P≤0.045 and P≤0.002 respectively). NK cytotoxicity was similar in groups I and II. There were no significant correlation between the number of abortions, age and NK cytotoxicity. Conclusion: The results indicate an increased peripheral NK cell cytotoxicity in RSA groups as compared to pregnant control. NK cell cytotoxicity may be considered as a risk factor for RSA and for maintaining normal pregnancy, NK cell cytotoxicity may be down-regulated. Peripheral NK cytotoxicity is not elevated during first trimester in RSA women. It is suggested that detection of NK cytotoxicity in RSA women should be performed as a routine.

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Introduction: Missed Abortion is a important obstetric and gynecology complication because of its serious outcomes such as DIC, infection, shock, hemorrhage & death. There are various medical and surgical methods for treatment of missed abortion. Medical treatment of missed abortion is safe, effective, acceptable and an inexpensive alternative. Misoprostal is a synthetic prostaglandin (E1) and recommended by FDA for treatment of missed abortion. There are different views about its safety, dosage and effectiveness. Methods: This study was designed in order to determine the efficacy of vaginal misoprostol for termination of pregnancy in women with missed abortions admitted in Shahid Sadoughi, Madar and Mojibian hospitals of Yazd from 2003 to 2004. The method of study was semi-experimental. (Clinical trial without control group) 50 women with missed abortion and the required criteria (age 15 – 45 years, gestational age ≤ 25 weeks, no previous medical or surgical complication and confirmation of missed abortion on sonography) were selected. The data was collected by a questionnaire filled at the onset of study and after treatment (Misoprostol, (200 micrograms/dose) repeated every 4 hours till expulsion of pregnancy products for maximum of 4 doses).The data analysis was done by statistical tests such as x2 and ANOVA. Results: The mean duration of medical treatment in the group with complete expulsion (44%) and incomplete expulsion (56%) was 12.63± 9.13 hours and 8.81± 2.9 hours, respectively, which was significantly different. (P value = 0.037). Of the total, 29 women had received two tablets of misoprostol, but the highest rate of complete expulsion was observed in women who had received four tablets. This difference in result was statistically significant. (p ≈ 0.000 ). Observed side effects included headache (26%), nausea (16%), uterine cramps (12%) and diarrhea. (6%) There was no serious complication such as uterine rupture, excessive vaginal bleeding, DIC, prolonged PT or PTT. Conclusion: This study confirmed that medical evacuation of missed abortion with vaginal misoprostol is an effective, safe and cost efficient method without any serious complications and can be a suitable alternative to surgery.

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Introduction: The aim of the study was determination of the rate of bleeding, abortion, and ectopic pregnancy in three methods of treatment of infertility in patients with different ages and realization of the predictive value of bleeding result. Methods: This study was done prospectively on 252 female patients who had become pregnant through infertility treatment at the IVF ward of Imam Khomeini Hospital (Ahwaz). They were followed until the end of the 20 th week of pregnancy. Three groups of patients included 100 patients who had become pregnant through induction ovulation, 122 patients who had become pregnant through IUI and 30 patients who had become pregnant through IVF. Results: Group I( Pregnant women via induction Ovulation): 37% had bleeding of which 35% were aborted. 63% did not have bleeding of which 11% were aborted and one EP was detected as well. 40% of the bleeding cases were younger than 30 years old and 29% of them were older then 30 years. The rate of abortion in this group was 20% and EP was 1%. The highest abortion rate was detected inpatients older than 36 years. Group II: Pregnant women via IUI: 37% had bleeding of which 31% had abortion. 63% didn’t have bleeding of which 10% had abortion and 3 cases had EP. The rate of abortion was 18% and EP 3% The rate of abortion increased with age but the rate of bleeding stayed constant. Group III: Pregnant women via IVF: 36% had bleeding of which 27% had abortion. 64% didn’t have bleeding of which 10.5% had abortion. The rate of abortion was 17% and EP 6.6%. All of them were greater than 30 years old. The rate of abortion and bleeding was not different in three groups and did not disagree with world’s statistics. Conclusion: The rate of EP in IVF group was higher than other groups but similar to world’s data (2-8%) . The rate of bleeding didn’t increase with age. However, bleeding in all ages and groups could predict a 2.5-3 fold increase in the rate of abortion (PV =0.008, 0.014 and 0.05 in three groups). Also, 11% of all abortions were without bleeding.

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Introduction: Medical and surgical methods are used for induction of abortion. Prostaglandins are used in various forms such as vaginal tabs, gels, intra-amniotic and extra-amniotic injections. The object of this study was to compare the effectivenes of extra-amniotic PGE2 and high-dose oxytocin in induction of abortion. Methods: The study included 60 women admitted for induction of abortion in Shahid Sadoughi hospital of Yazd from 2007 till 2009. They were randomly allocated in two groups. Data was collected by a questionnaire and statistical tests such as Fisher’s exact and chi square were used for analysis of data. Results: The success rate in PGE2 group (P=0.014) was higher than oxytocin group. The mean time of induction of abortion in PGE2 method was shorter than oxytocin method (p=0.0001). In both the two groups, the mean time of induction of abortion in dead fetuses was shorter than that in live fetuses (p=0.0001 for PGE2 group and =0.011 for oxytocin group). There was no significant difference in the rate of complications of treatment in the two groups. In both the two groups, the mean time of induction of abortion in the 12-14 weeks period was longer than 8-11 and 15-19 weeks, which was significant in the PGE2 group (p=0.001). Conclusion: The use of extra-amniotic PGE2 method in induction of abortion is more effective than high-dose oxytocin and by decreasing the induction period and need for currettage, hospitaliztion period and expenditure ca be decreased leading to increased satisfaction of patients.

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Introduction: Abortion has always been a controversial issue and all religions, humanistic and medical communities have opposed it . The complications of illegal abortion are one of the most common reasons of hospital admission in developing countries. W.H.O estimates that the one eight of all pregnancy deaths is due to illegal abortion. Lack of knowledge of the medical team about the abortion regulations and rules can endanger the pregnant mothers life and also create certain problems for medical communities . Methods: This cross- sectional study was conducted in 2007 and included 110 gynecologists and midwives in Yazd who were studied by census method. Data was collected via self-made questionnaire and data analysis was done by software SPSS program and statistical tests included square K and T test. Results : Of the total of 110 patients, 16.4% were gynecologists and 83.3% were midwives, 31.8% worked in academic centers and 68.2% were employed at other centers. The awareness level of 25.5% was good. There was a meaningful difference between the awareness level of academic employed and nonacademic employed and also between those who had studied abortion rules regulations. Conclusion: As 74.5% of the study population had low levels of awareness about the abortion rules, education of midwives & gynecologists about rules & regulations is strongly recommended as it not only helps women's health, but also decreases their legal problems.

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Introduction: Undoubtedly, reproduction is a necessity for survival and successful pregnancy is an immunological paradox. In the present study, we investigated the proportional changes of CD4+CD25bright T cells, CD4+CD25dim T cells in peripheral blood in unexplained recurrent spontaneous abortions (URSA) and compared it with normal pregnant women by antibody monoclonal method. Methods: The study group comprised of women with miscarriages of unexplained etiology who had normal karyotypes, anticardiolipin antibodies, prolactin levels and normal spousal spermograms. They did not have polycystic ovaries and also did not receive any drugs at the time of the study. PBLs lymphocytes were isolated, then FITC-conjugated and anti-CD4 and PE-conjugated anti-CD25 antibody levels were measured. Then results of the study and control group were analyzed and compared. Results: The absolute number of CD25 bright cells in the CD4‏+T cells in peripheral blood was statistically significantly lower in the study group as compared to the control group(P=0.000). The absolute number of CD4+CD25dimT cells in peripheral blood was statistically significantly higher in the study group as compared to the control group (P=0.000). Conclusion: As decrease in the number of CD4+CD25+Tcells or their functional deficiency may be linked with miscarriage, CD4+CD25+‏ Tells could serve as a novel biomarker for monitoring in URSA patients, but more studies are needed in this field.

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Introduction: Immunological processes are most important in recurrent spontaneous abortion(RSA). According to studies T lymphocytes and natural killer cells(NK cells) are two effective cell groups in RSA. The aim of this study was to investigate the percentage and absolute number of natural killer(NK) cells in women with RSA with unknown etiology. Methods: 24 Women with a history of recurrent pregnancy losses with unknown etiology. We compared the percentage of peripheral blood NK cells with a group of fertile patients. Lymphocytes from peripheral blood were isolated by ficoll paque density centrifugation. Lymphocytes were stained using anti CD56 and(FITC)-anti CD16 and CYQ-CD3 monoclonal antibodies for identification of NK cells and was used anti CD56 and(FITC)-anti CD69 for detection of activated NK cells. We used BD FACS calibure flow cytometry for data analysis. Results: On the basis of the obtained results, absolute number of CD16+56+ cells showed significant increases in Recurrent spontaneous abortion(RSA) in comparison with control group(P= 0.43). Also absolute number of CD16+56bright cells had significant increase in RSA(P=0.00). There was no significant difference(P= 0.08) of CD16+56dim cells between RSA and control group. In RSA, the absolute number of CD69+cells significantly increased(P=0.02). Also, results showed significant increase in the absolute number of CD56+/CD69+ cells in RSA(P=0.04). Conclusion: The results suggested that the higher percentage of NK cells in peripheral blood of RSA patients compared to control group may indicate the same increase in number and cytotoxicity of uterin NK cells.

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Introduction: Various immunological abnormalities have been reported in women with RSA of unknown aetiologies including autoimmune abnormalities and increased cellular immunity such as elevated natural killer (NK) , Th1 and Th17 cell levels. Th17 and Th1 cells play a central role during inflammation. Th1 cells product cytokines IFN-γ, IL-2 and Th17 cells mainly cytokines IL-17A, F, IL-22. The aim of this study is evaluation of Th1 and Th17 activity in women with recurrent spontaneous abortion. Methods: In this case-control study, 30 women with history of two or more abortion who at least 3 months past after last abortion considered as case group and 30 normal fertile healthy women with at least one delivery as control group. We determined the levels of IL-17A, F and IFN-γ in cell culture supernatant of peripheral blood mononuclear cells (PBMC) stimulated with the mitogen phytohemagglutinin (PHA) by enzyme-linked immunosorbent assay (ELISA) method and compared in the two groups. The results obtained using the one-sample kolmogorov-smirnov Test, Kruskal-wallis Test and Spearman were analyzed using SPSS 16 software. Results: The level of IFN- γ in case group was significantly higher than control group (186/53±30/41 versus 88/06±21/44 pg/ml, P < 0.005). Also the level of IL-17 A, F in case group was significantly higher than control group (84/74±21/26 versus 28/41±8 pg/ml, P < 0.01). IFN-γ concentration showed positive correlation with IL-17 A, F in case group (P=0.015, r= 0.455). Conclusion: In this study the increased levels of cytokines IFN- γ and IL-17 A, F in women with recurrent spontaneous abortion shows a propensity of pro inflammation via Th17 and Th1 immunity and may be these cells play a pivotal role in rejecting fetus antigens.

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Introduction: Anxiety has an impressive effect on normal vaginal delivery. Since no study has been conducted in this regard, this research is designed to determine the effect of cognitive behavior therapy on the reduction of anxiety at first normal vaginal delivery. Methods: A semi-experimental study was carried out on 40 nulliparous women with six months age of pregnancy and without abortion and infertility background. After the completion of testimonial, the rate of anxiety was evaluated by Beck anxiety inventory. Then the participants were randomly divided into two groups (20 persons in each group). The experimental group received ten sessions of individual cognitive behavior therapy. The test was carried out again a week before delivery and twenty days after it. The data analysis was accomplished by SPSS16 and Co-variance analysis test. Results: At first the average of anxiety score in the experimental group was 34.16, in post test. 8.68 and in follow up test 7.79 and, thus the difference was meaningful(p<0.01), whereas in the control group, this score, at first, was 34.05, in post test 34.53 and in follow up test 26.89, which did not show any meaningful difference. Conclusions: Consequently the cognitive behavior therapy causes to decrease the anxiety with enduring effect at first normal vaginal delivery. Therefore, this treatment is proposed to reduce the anxiety of first delivery women.

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