Laparoscopy Versus Laparotomy in Ectopic Pregnancy

Background: Ectopic pregnancy (EP) is the implantation of fertilized ovum in any site of the reproductive tract except uterine cavity. To choose laparotomy or laparoscopy for treatment is based on the patient’s hemodynamic status, her past surgical history, and the physician’s experience in endoscopic surgery. The goal of this study was to compare clinical and laboratory findings in women who have undergone laparoscopy or laparotomy for EP.Methods: In this cross-sectional study, 103 women, who had undergone laparoscopic or laparotomy treatment due to EP diagnosis, were enrolled. A structured questionnaire was used to collect information. Past fertility history, past medical and drug history, clinical symptoms and signs, laboratory findings (including Hb and serum β-hCG levels), size of EP mass and its location, endometrial thickness, free fluid in pelvic or abdominal cavity, type of treatment, and method were recorded.Results: Of the study population, 58 had undergone laparotomy and 45 had undergone laparoscopy. Mean age, mass size, and B-hCG level before surgery were significantly higher in women who had undergone laparotomy. Right tubes followed by left tubes were the most affected sites. Unstable vital sign was recorded in the laparotomy group more than the laparoscopy group.Conclusions: Results of the current study showed that women who had undergone laparotomy had significantly higher mean age, mass size, and B-hCG level and were more unstable than the laparoscopic group

A randomized clinical trial to compare levonorgestrel-releasing intrauterine system (Mirena) vs trans-cervical endometrial resection for treatment of menorrhagia

Shirin Ghazizadeh1, Fatemeh Bakhtiari1, Haleh Rahmanpour2, Fatemeh Davari-Tanha1, Fatemeh Ramezanzadeh11Valie-Asr Reproductive Health Research Center, Valie-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran; 2Department of Obstetrics and Gynecology, Ayatollah Mousavi Hospital, Zanjan, IranObjective: To compare the acceptability, efficacy, adverse effects, and user satisfaction of the levonorgestrel intrauterine system (LNG-IUS) and trans-cervical resection of the endometrium (TCRE) for the treatment of menorrhagia.Method: 104 women with menorrhagia were divided into 2 groups: 52 women had the LNG-IUS inserted and 52 underwent TCRE. Menstrual pattern, pictorial blood loss assessment chart score, adverse effects, and rates of acceptability and satisfaction, were recorded at 6 and 12 months after the procedure.Results: After a year there were reductions of 93.9% and 88.4% in menstrual blood loss in the TCRE and LNG-IUS groups, respectively. Amenorrhea was more common in the TCRE group and spotting and systemic effects in the LNG-IUS group. Satisfaction rates of the TCRE group were higher than the LNG-IUS group (80.8% vs 69.2%), but the difference was not statistically significant.Conclusion: Although both treatments were found to be equally effective, LNG-IUS was less invasive and can be advised for younger women with a desire to preserve fertility.Keywords: menorrhagia, trans-cervical endometrial resection, levonorgestrel-releasing intrauterine syste

Sleep Quality in Women with Endometriosis

Background: Endometriosis is a gynecological disorder characterized as the implantation of endometrial tissue outside the uterine cavity. Psychological symptoms such as anxiety, bipolar disorder, depressive symptom and impaired quality of life are common in these women. Sleep quality had not been considered in these women as it should be. The goal of this study was to evaluate sleep quality in women with endometriosis.Methods: In this cross-sectional study 61 married women with laparoscopically diagnosed endometriosis asked to fill valid and reliable Pittsburgh Sleep Quality Index (PSQI).Results: Mean age and mean education level were 31.4±6.7 years and 11.7±3.1 years, respectively. Dysmenorrhea followed by dyspareunia was the most common symptoms (68.8% and 40.3%). Mean PSQI score was 6.1±3.4, twenty eight (45.9%) had PSQI score equal or less than 5 and 33 (54.1%) had PSQI score more than 5 (poor sleep). Mean PSQI was significantly different between cases with and without dysmenorrhea and dyspareunia.Conclusion: Sleep quality should be considered in women with endometriosis

Effects of intrathecal opioids use in cesarean section on breastfeeding and newborns’ weight gaining

Objective: To assess the association between intrapartum intrathecal opioid use and breastfeeding and weight gain following cesarean section. Materials and methods: The prospective double-blinded study was conducted on term pregnant women, undergoing elective cesarean section under spinal anesthesia. They divided into two groups. In the first group, intrathecal Morphine was used to achieve analgesia during or after the operation. The remainder divided into two subgroups, those who did not receive any opioid or those received systemic opioids. Following labor breastfeeding accessed in a follow-up, two month latter. Results: There was no difference between the demographic variables of the mothers and newborns APGAR score and weight at the time of birth. Breastfeeding rate was similar in intrathecal group in compare with other patents (P value = 0.518). While, the infants’ weight at the end of second month was lower in spinal opioid group (P value = 0.036). Conclusion: The present study was the first to suggest that spinal (intrathecal) opioids do not have any impact on breastfeeding. However the relationship between spinal anesthesia on weight gaining needs more investigation

Comparison of Preventive Acetaminophen and Placebo in Pain Reduction After Cesarean Section; A Randomized Clinical Trial

Background: In subjects having a cesarean section, pain can increase hospital length of stay and postoperative complications. The preventive analgesia in the postoperative phase is known to be more effective than analgesic treatment in response to pain. Objectives: In this study, the analgesic efficacy of preventive intravenous acetaminophen was compared with placebo in relieving postoperative pain after cesarean sections under spinal anesthesia. Methods: In this double-blind randomized controlled study, 49 women undergoing elective cesarean section under spinal anesthesia were randomly allocated into two groups by block randomization in a referral hospital in Tehran in 2016. The intervention group received intravenous acetaminophen (Apotel®) (1 gram) and the placebo group received normal saline on arrival to the recovery room within 20 minutes. Then the total consumed doses of meperidine, visual analogue scale (VAS) score of pain, and the incidence of vomiting were determined and recorded for 24 hours postoperatively. Results: Pain scores (VAS) were lower in the acetaminophen group throughout the study, but the difference was only significant at forth to eighth hours after the surgery (P = 0.0001). The total consumed doses of meperidine to treat the pain was significantly lower in the acetaminophen group at the fourth to the eighth hours after the surgery (P = 0.0001). The incidence of vomiting was the same between the groups (P > 0.05). Conclusions: A single dose preventive intravenous acetaminophen has good efficacy in reduction of postoperative pain and reduces opioid use after cesarean sections under spinal anesthesia up to 8 hours after the administration

Depression, sexual dysfunction and sexual quality of life in women with infertility

Abstract Background Women suffering from infertility are at higher risk of experiencing psychological problems. Sexual function and sexual related quality of life is not considered as it should be. We designed this study to assess depression, sexual function and sexual quality of life in Iranian women with infertility. Methods Two hundred and sixty four individuals participated in the study (115 healthy controls, 78 with primary and 71 with secondary infertility). All participants were asked to fill a valid and reliable Persian versions of BDI (Beck depression inventory), FSFIS (Female Sexual Function Index) and sexual quality of life-Female (SQOL-F) questionnaires. Results Mean BDI score was significantly lower in healthy individuals.Individuals with primary infertility suffered more from sexual dysfunction, while BDI score was significantly higher and SQOL-F was significantly lower in cases with sexual dysfunction. There was significant positive correlation between SQOL-F and total FSFI score (r = 0.59, p  26.55) showed that BDI and sexual dysfunction were independent predictors of SQOL-F. Conclusion Sexual function and quality of life related to sexual life should be considered in Iranian infertile ones. Depression as a crucial factor should be focused more in infertile women

A Blinded Study Using Celecoxib for Prevention of Morphine Induced Pruritus in Patients Undergoing Cesarean Section

 Objective: we aimed to evaluate the efficacy of celecoxib in reducing Intrathecal morphine-induced pruritus in parturient undergoing cesarean section delivery under spinal anesthesia. Materials and methods: In a randomized double-blind placebo controlled study 126 women undergoing elective cesarean section under spinal anesthesia (0.5% bupivacaine 12mg plus 0.2 mg preservativefree morphine )were randomly allocated to receive celecoxib 400 mg or placebo, 2 hours prior to surgery. Severity of pruritus and pain score and frequency of opioid's side effects were recorded. Results: patients receiving celecoxib had significantly lower pruritus incidence and severity at 30 min,2,4 and 8 hours (40% versus 82%), but not at 12 and 24 hours postoperatively. Also there was a reduction in pain score but it was not significant (1.5±0.5 versus 1.9±0.65).Analgesic requirement was similar between two groups. Conclusion: Oral administration of celecoxib significantly reduced Intrathecal morphine-induced pruritus in parturient undergoing cesarean section under spinal anesthesia. There was no significant difference in pain scores and analgesic requirement

Comparison Between Intraperitoneal and Intravenous Lidocaine for Postoperative Analgesia After Elective Abdominal Hysterectomy, a Double-Blind Placebo Controlled Study

Objective: To compare the efficacy of intravenous and intraperitoneal injection of lidocaine and normal saline in relieving postoperative pain after elective abdominal hysterectomy. Materials and methods: For this double-blind randomized controlled study 109 patients undergoing elective abdominal hysterectomy were randomly allocated to three groups :1) IV group (intravenous injection group) received intravenous lidocaine %2 bolus 1.5mg/kg 30 min before incision and then a continuous lidocaine infusion of 2mg/kg and before the wound closure an intraperitoneal injection of N/S , 2) IP group (intraperitoneal group) received intravenous N/S and intraperitoneal lidocaine 3mg/kg , 3) P group (placebo, N/S) received both intravenous and intraperitoneal N/S. The pain scores (VAS) at rest, total morphine consumption , the time to first need for rescue analgesic ,incidence of lidocaine related adverse effects and nausea and vomiting were recorded at 0,2,4,8,12 and 24 hrs postoperatively. Results: The VAS scores were significantly lower in IP and IV groups compared with placebo (p = 0.001). Total consumption of morphine (p = 0.001) and time to firs request of recue analgesic (p = 0.001) were lower too in IP and IV groups.Incidence of vomiting was comparable between groups (p 0.05).There were not notable lidocaine-related adverse effects. IP and IV groups were not statistically different for all investigated variables. Conclusion: This study showed lidocaine administration both intravenously and intraperitoneally are effective in reducing the postoperative pain and also have opioid sparing effect and can be safely used in elective abdominal hysterectomy without any major adverse effects

Prevention of Postoperative Nausea and Vomiting by Administration of Sub Hypnotic Doses of Propofol and Midazolam during Spinal Anesthesia for Cesarean Section

Objective: To evaluate, the efficacy of sub hypnotic doses of midazolam and propofol, in prophylactic control of postoperative nausea and vomiting, in parturients undergoing elective cesarean section under spinal anesthesia. Materials and methods: In a double-blind, placebo-controlled, randomized trial, 114 ASA physical status I-II parturient undergoing elective cesarean section under spinal anesthesia (using 0.5% bupivacaine 12 mg) were allocated randomly to receive propofol (20 mg bolus and 1.0 mg/kg/hr infusion, n=38) or midazolam (1 mg bolus and 2.0 mg/hr infusion, n=38) or saline (2 cc IV, n=38) immediately after clamping of umbilical cord. The occurrence of nausea and/or vomiting and respiratory depression was recorded during operation until 12 hr after that. Results: The incidence of nausea and vomiting was significantly lower in midazolam and propofol groups compared with saline group in all 12 hr, (nausea: 19%, 15.8% versus 57.9%), vomiting (7.9%, 5% versus 34.2%). There was not manifestation of respiratory depression at the time of surgery and after it. Conclusion: Sub hypnotic dose of midazolam was as effective as the sub hypnotic dose of propofol for preventing of nausea and vomiting in parturients undergoing cesarean section under spinal anesthesia. We undertook this study in regard to examine a simple, safe and non-expensive antiemetic method

The Role of Plasma Creatine Phosphokinase (CPK) Level in Prediction of Response to Methotrexate for Ectopic Pregnancy

Objective: To evaluate the plasma creatine phosphokinase (CPK) level after injection of methotrexate (MTX) as a predictor of treatment success in ectopic pregnancy (EP). Materials and methods: One hundred women treated with single dose of methotrexate for ectopic pregnancy were evaluated in a prospective study, for CPK and ß-subunit of human chorionic gonadotropin (ß-hCG) levels. They received intramuscular MTX at a dose of 50 mg/m2. The day of injection was considered as day 1 (D1). CPK level on the day of Methotrexate injection was compared between success group who were treated by a single MTX injection, and the unsuccessful groupwho were treated by two or three MTX injections or by surgery. Results: The success rate of single dose of MTX injection was 78 (78%). The mean of CPK was higher in success group than unsuccessful group. (86 ± 10.7 vs. 73 ± 11.8), the difference was significant (p = 0.04). The mean of ß-hCG was significantly lower in treatment success group than unsuccessful group (1421.3 ± 443.6 vs. 1925.6 ± 185.4, p = 0.01). Conclusion: The success of single dose of MTX treatment in ectopic pregnancy may be predicted by CPK levels and the higher levels of CPK may be useful for detecting of patients with successful response to MTX