Endometrial and follicular development following stair-step and traditional protocols in women with polycystic ovary syndrome: An RCT

Background: Various strategies have been proposed for polycystic ovary syndrome (PCOS) treatment. Objective: To investigate and compare the number and size of ovarian follicles, endometrial thickness, and ovulation rate by traditional protocol (TP) and stair-step protocol (SSP). Materials and Methods: Sixty infertile PCOS women were allocated into two groups (SSP = 30 and control TP = 30) between May and October 2019 in the Besat Hospital, Sanandaj, Iran. In the SSP group, the infertile women were treated with 50 mg/daily clomiphene citrate (CC) for five days, while the nonresponsive women were prescribed 100 mg daily CC for five days in the same cycle. The maximum dose (150 mg) was administered until ovulation occurred. In the control group, in non-ovulatory cases, the dose was increased in the next cycle. Ultrasound was used to detect ovulation. Results: Endometrial thickness changes with various doses of CC were significantly different in the TP. The comparison of both protocols showed a significant difference in endometrial thickness only at 50 mg CC. The number of follicles in the left ovary was significantly different in both protocols at 150-mg CC. The size of ovarian follicles in the left ovary was significantly different between the two protocols at 100-mg CC. The ovulation rate was significantly different in the SSP at 100- and 150-mg doses of CC. Moreover, 86% of ovulation occurred at 100-mg CC in the SSP, while this rate was 73% in the TP. Conclusion: The most appropriate dose for ovulation in patients with PCOS is 100 mg CC. Key words: Polycystic ovary syndrome, Clomiphene, Infertility, Ovulation induction

Association between response to the medical treatment and predicting factors in ectopic pregnancy

BACKGROUND: Ectopic pregnancy (EP) is the leading cause of maternal death in the first trimester of pregnancy. There are many variables which can predispose EP. The aim of this study was to evaluate the possible association between individual’s response to given medical treatment and predicting factors of ectopic pregnancy among pregnant women.METHODS: In this cross-sectional study, 277 patients with ectopic pregnancy who were admitted to obstetrics and gynecology ward of Besat hospital, Sanandaj, Iran, were evaluated. The necessary information was obtained from all women diagnosed with EP during 2008 to 2013. Patients who received any medication before study or those who could not use methotrexate (MTX) were excluded from study.RESULTS: In this study, 205 (74.1%) patients responded to the medical therapy. There was a significant association between successful response to the treatment and beta human chorionic gonadotropin (β-hCG) serum level less than 5000 mIU/ml, pregnancy sac size less than 4 cm and lack of fetal heart rate (FHR) in transvaginal sonography (TVS).CONCLUSION: In conclusion, it was found that β-hCG serum level, pregnancy sac size and presence of FHR play a key role in predicting the response to the medical treatment in women with ectopic pregnancy, and might be helpful in selecting appropriate therapeutic scheme.

Association between response to the medical treatment and predicting factors in ectopic pregnancy

BACKGROUND: Ectopic pregnancy (EP) is the leading cause of maternal death in the first trimester of pregnancy. There are many variables which can predispose EP. The aim of this study was to evaluate the possible association between individual’s response to given medical treatment and predicting factors of ectopic pregnancy among pregnant women. METHODS: In this cross-sectional study, 277 patients with ectopic pregnancy who were admitted to obstetrics and gynecology ward of Besat hospital, Sanandaj, Iran, were evaluated. The necessary information was obtained from all women diagnosed with EP during 2008 to 2013. Patients who received any medication before study or those who could not use methotrexate (MTX) were excluded from study. RESULTS: In this study, 205 (74.1%) patients responded to the medical therapy. There was a significant association between successful response to the treatment and beta human chorionic gonadotropin (β-hCG) serum level less than 5000 mIU/ml, pregnancy sac size less than 4 cm and lack of fetal heart rate (FHR) in transvaginal sonography (TVS). CONCLUSION: In conclusion, it was found that β-hCG serum level, pregnancy sac size and presence of FHR play a key role in predicting the response to the medical treatment in women with ectopic pregnancy, and might be helpful in selecting appropriate therapeutic scheme

Effect of early amniotomy on labor outcome in nulliparous women: a randomized clinical trial

Early amniotomy is one of the main interventions to enhance the labor progress and prevent dystocia in pregnant women. However, the efficacy of amniotomy has not been approved via labor-related indices and outcomes and has remained a subject for debate and future research. The present study was conducted to evaluate the effect of early amniotomy on labor indices and outcomes in nulliparous women. This randomized clinical trial was performed on 151 singleton pregnant women who were referred to Besat Hospital in Sanandaj, Iran, from March 2016 to March 2018. Participants were randomly divided into an early amniotomy (EA) group and a control group. Duration of the first and second phases of labor, corioamionit, dystocia rate, Apgar score at the first and fifth minutes, prolonged labor and post-partum haemorrhage were evaluated and compared between the two groups. Data were recorded in a checklist and analysed using SPSS Version 23. The p value <0.05 was considered significant. Results showed that labor indices such as duration of the first and second phases, Apgar score one and five minutes after delivery and frequency of prolonged labor, foetal distress and postpartum haemorrhage were significantly improved in patients of the early amniotomy group, compared with the control group (p≤0.05). Early amniotomy significantly decreased the total labor duration without significant increase in the rate of maternal and neonatal complications

Endometrial and Follicular Development Following Stair-step and Traditional Protocols in Women with Polycystic Ovary Syndrome: an RCT

Background: Various strategies have been proposed for polycystic ovary syndrome (PCOS) treatment. Objective: To investigate and compare the number and size of ovarian follicles, endometrial thickness, and ovulation rate by traditional protocol (TP) and stair-step protocol (SSP). Materials and Methods: Sixty infertile PCOS women were allocated into two groups (SSP = 30 and control TP = 30) between May and October 2019 in the Besat Hospital, Sanandaj, Iran. In the SSP group, the infertile women were treated with 50 mg/daily clomiphene citrate (CC) for five days, while the nonresponsive women were prescribed 100 mg daily CC for five days in the same cycle. The maximum dose (150 mg) was administered until ovulation occurred. In the control group, in non-ovulatory cases, the dose was increased in the next cycle. Ultrasound was used to detect ovulation. Results: Endometrial thickness changes with various doses of CC were significantly different in the TP. The comparison of both protocols showed a significant difference in endometrial thickness only at 50 mg CC. The number of follicles in the left ovary was significantly different in both protocols at 150-mg CC. The size of ovarian follicles in the left ovary was significantly different between the two protocols at 100-mg CC. The ovulation rate was significantly different in the SSP at 100- and 150-mg doses of CC. Moreover, 86% of ovulation occurred at 100-mg CC in the SSP, while this rate was 73% in the TP. Conclusion: The most appropriate dose for ovulation in patients with PCOS is 100 mg CC. Key words: Polycystic ovary syndrome, Clomiphene, Infertility, Ovulation induction

Examining the Learning Requirements of General Practitioner Courses in the Areas of Cognitive, Psychological-Motor and Emotion from the Perspective of Professors of Kurdistan University of Medical Sciences

Introduction: It is necessary to analyze the limitations and essentials of the medical students’ learning compatible with their future working environment in order to control the quality of the education. This study was designed to investigate the basics of learning and to prepare educational logbooks for all clinical departments at Kurdistan University of Medical Sciences in line with promotion of educational and students’ assessment. Methods: This study was carried out in three phases. In the first phase, content was confirmed according to the expert views. In the second phase, materials were analyzed in terms of being core and non-core. In the third phase, prioritized subjects were summarized and locations selected for teaching each skill, rotation style, regulations and responsibilities of the students, assessment method and group’s expectations from students were determined. The data were analyzed by analytic hierarchy process (AHP), comparison of the content of materials and qualitative methods.Results: All the faculty members considered capabilities such as taking the patient’s history, physical examination, diagnostic decision, patient’s referral skills, and appropriate relationship with patient and colleagues as the priorities of education. In addition, 93% of the faculty members added the interpretation of laboratory tests to the given list. Conclusion: In this model, the main focus was on the content and process of education. It seems necessary, however, to pay attention to other issues like student’s motivational and research factors during designing the parallel patterns