Can combination of hysterosalpingography and ultrasound replace hysteroscopy in diagnosis of uterine malformations in infertile women?

BACKGROUND: Müllerian anomalies are associated with infertility. Hysteroscopy as the gold standard for evaluating Müllerian anomalies is an invasive, expensive and risky procedure which requires enough experience. Transvaginal sonography (TVS) and hysterosalpingography (HSG) are less invasive procedures, but there is little known about the accuracy of these tests. The aim of this study was to evaluate the accuracy of the combination of TVS and HSG with hysteroscopy as the gold standard. METHODS: Medical records of infertile women who were undertaken all three diagnostic modalities were reviewed to analyze their sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). RESULTS: Ninety-nine infertile women were assessed with a mean±SD age of 29.1±6.47 years, mean±SD duration of themarriage of 8.9±10.28 years, and mean±SD duration of infertility of 5.6± 4.16 years. The sensitivity, specificity, PPV, and NPV of TVS were 98.55%, 30%, 76.4%, and 90%, respectively. HSG had a sensitivity of 95.6%, specificity of 60%, PPV of 84.62%, and NPV of 85.71%.When both modalities were combined, the sensitivity, specificity, PPV, and NPV were 94.2, 66.67, 86.67, and 83.33%, respectively. The diagnostic accuracy of single TVS, HSG or combined techniques was statistically similar that was equal to 77.7, 84.8 and 85.8 % respectively. CONCLUSION: The accuracy of combination of two diagnostic modalities, 2D TVS and HSG is not higher than HSG alone for assessing uterine malformation in infertile women.

A comparison between serum levels of interleukin-6 and CA125 in patients with endometriosis and normal women.

BACKGROUND: The purpose of the present study was to compare the serum levels of IL6 and CA125 in women with and without endometriosis. They were also compared in mild, moderate and severe cases. METHODS: In this case-control study, CA125 and IL6 levels in 76 women with laparoscopic proven endometriosis were compared with 76 women without evidence of endometriosis. Sensitivity, specificity, positive (PPV) and negative (NPV) predictive values were then calculated for each test. RESULTS: Both groups did not show significant difference in their age, BMI, ESR and gravidity. Mean serum levels of IL-6 and CA125 were significantly higher in the case group (30.4±6.43 vs 13.9±3.17 Pg/ml and 62.6±10.69 vs 16.6±1.79 IU/ml respectively). Considering a cutoff point of 30 Pg/ml for IL-6, sensitivity, specifically, PPV and NPV value of 21.1%, 66.6%, 86.8% and 23.37% were obtained, respectively. Considering a cutoff point of 35 IU/ml for CA125, sensitivity, specifically, PPV and NPV were 44.76%, 94.73%, 89.47% and 63.15%, respectively. Area under the ROC curve was 0.69 for CA125 and 0.54 for IL6, which showed a low value for these tests. CONCLUSION: Although CA125 and IL-6 were higher than normal controls in endometriosis, area under the ROC curve, did not show significant any diagnostic value for these tests.

Presenting features of idiopathic versus secondary restless legs syndrome in pregnancy.

BACKGROUND: Restless legs syndrome (RLS) is the most common movement disorder in pregnancy, which can be idiopathic or secondary. There are limited comparative data regarding these two forms of RLS. The aim of this study was to compare clinical features of idiopathic and secondary RLS in pregnant women. METHODS: Over a period of 3 months, 443 women who admitted for delivery in two clinical centers were screened for RLS using four diagnostic criteria of the international RLS study group. A total of 79 subjects diagnosed with RLS were consecutively enrolled in the present study. All of them were interviewed for medical history and complaints during pregnancy and responded to self-administer international RLS rating scale. RESULTS: Ten subjects (12.9%) out of 79 pregnant women with RLS had idiopathic form, and their mean age was significantly higher than patients with secondary RLS (30.6 ± 7.3 years vs. 26.4 ± 4.6 years, P = 0.0260). Compared with women with secondary RLS, sleep duration in pregnancy was significantly decreased in idiopathic RLS group (P = 0.0460), whereas RLS severity score was similar in both groups. No significant difference was observed between the two groups in terms of other sleep complaints, the positive family history of RLS, parity, duration of pregnancy, or frequency of cesarean section (P > 0.0500). CONCLUSION: Idiopathic and secondary RLS have relatively similar courses and features during pregnancy. However, the idiopathic form may have more negative impact on sleep in pregnancy. Careful screening and effective treatment of idiopathic RLS before pregnancy is recommended to limit these disturbances.

Prevalence and associated features of restless legs syndrome in a population of Iranian women during pregnancy.

OBJECTIVE: To investigate the prevalence of restless legs syndrome (RLS) during pregnancy and to evaluate factors associated with RLS in a population of Iranian pregnant women. METHODS: In the present cross-sectional study, 443 consecutive pregnant women admitted for delivery underwent an interview within 2 days of parturition. The diagnosis of RLS was established by the 4 criteria of the International Restless Legs Syndrome Study Group (IRLSSG). The severity of RLS was assessed through the IRLSSG Rating Scale. RESULTS: Seventy-nine (17.8%) women met the RLS diagnostic criteria, with most (74.7%) having RLS of moderate severity. The mean RLS duration before delivery was 3.1 ± 2.1 months among 69 (87.3%) women; 10 (12.7%) had RLS onset before pregnancy. Sleep disturbances including insomnia and early awakening were significantly more common among women with RLS than among those without (P < 0.001), and the frequency of cesarean delivery was also significantly higher (58.2% versus 44.5%, P = 0.027; odds ratio 2.4). There were no significant differences between the 2 groups in terms of age, number of pregnancies, folate and iron supplementation, hemoglobin level, and neonatal anthropometric data. CONCLUSION: Restless legs syndrome is common during pregnancy and is associated with poor sleep and an increased risk of cesarean delivery.

Colonic obstruction as an unusual presentation of endometrioma: a case report.

Endometriosis usually occurs in the pelvis but can be found nearly anywhere in the body. Bowel involvement in endometriosis is uncommon and it is estimated to be present in 3.7% to 35% of women with endometriosis. It can rarely result in intestinal obstruction. Here, we present a synchronous localization of endometriosis, ovarian and intestinal, resulting in chronic gastrointestinal symptoms and colonic obstruction in a 33-year-old woman.

Cerebro vascular reactivity (CVR) of middle cerebral artery in response to CO2 5% inhalation in preeclamptic women.

OBJECTIVE: To compare the cerebro vascular reactivity (CVR) of middle cerebral artery (MCA) in response to CO2 5% inhalation between preeclamptic and normotensive pregnant women, also, between mild and severe preeclampsia. STUDY DESIGN: A comparative study was performed on 61 women with preeclampsia and 65 normotensive pregnant women who were in the third trimester of gestation. MCA transcranial Doppler ultrasound was used to measure CVR in response to CO2 5% inhalation. Pulsatility index (PI), resistance index (RI), blood pressure, maternal age, gestational age and gravidity were also recorded. RESULTS: Baseline PI and RI were lower in the preeclamptic group (p < 0.05). Inhalation of CO2 5% caused significant increase in CVR among normotensive pregnant women in comparison with preeclamptic group (1.006 ± 0.229 versus 0.503 ± 0.209, p = 0.0001). Significantly, more cerebral vasodilatation was found among mild preeclamptic women in comparison with severe preeclamptic women (0.583 ± 0.193 versus 0.383 ± 0.173, p = 0.0001). The receiver operating characteristics curve analysis revealed acceptable difference between CO2 stimulation test of preeclamptic and normotensive women (Area under curve = 0.973, p = 0.0001). CONCLUSION: CVR in response to CO2 5% is less in preeclamptic pregnant women than normotensives, also, in severe preeclampsia, it is less than mild preeclampsia.

Placenta percreta invading broad ligament and parametrium in a woman with two previous cesarean sections: a case report.

Introduction. The incidence of placenta accreta has dramatically increased due to increasing caesarean section rate all over the world. Placenta percreta is the most severe form of placenta accretes. It frequently results in maternal morbidity and mortality mainly caused by massive obstetric hemorrhage or emergency hysterectomy. Percreta invading into the broad ligament has rarely been previously reported. Case presenting. We presented a case of placenta percreta invading left broad ligament and parametrium in a woman with two previous cesarean sections, which led to massive intraoperative hemorrhage during hysterectomy and transient ischemic encephalopathy. Conclusion. In cases of parametrial involvement, it would be more difficult to decide whether to remove placenta or leave it in site. In surgical removal neither local excision of placental bed and uterine repair nor traditional hysterectomy is adequate if parametrium invaded by placenta. We suggest delayed elective hysterectomy in such cases. So, pregnancy-induced pelvic congestion would be decreased, we can gather an expert team of gynecologists, urologists, and vascular surgeons, we could get plenty of blood products, and we may have the chance to administer methotrexate.

Evaluation of the value of calcium to creatinine ratio for predicting of pre-eclampsia.

INTRODUCTION: Pre-eclampsia is one of the most serious complications in pregnancy and is one of the major causes of maternal death. Therefore, its prediction has special importance and many studies have been performed on different materials, which may be useful for its prediction. OBJECTIVE: The purpose of the present study is to evaluate the calcium to creatinine ratio for the prediction of pre-eclampsia. METHOD: A prospective cohort study was performed on 150 pregnant women, who were aged from 15 to 35 years. A single urine sample was obtained at 20-24 weeks of gestation for measurement of urine calcium to creatinine ratio. The women were then monitored for delivery and this ratio was compared between the women with and without pre-eclampsia. RESULTS: Mean urine calcium of pre-eclamptic women was significantly lower than normotensive women (179 ± 35 mg/dl vs 272 ± 59 mg/dl, P < 0.001). Mean calcium to creatinine ratio was significantly lower in pre-eclamptic women (0.07 ± 0.007 vs 0.16 ± 0.006, P < 0.001). The optimal cut off point for calcium to creatinine ratio was calculated to be 0.071 with a sensitivity of 77% and specificity of 78%. CONCLUSION: Urine calcium and calcium to creatinine ratio are lower in pre-eclamptic women and may be used as a screening test for the prediction of pre-eclampsia.

Comparison of the dermatoglyphic characteristics of women with and without breast cancer.

OBJECTIVE: To compare the dermatoglyphic characteristics of women with and without breast cancer. STUDY DESIGN: Case-control study. One hundred and thirty women=130 women with histopathologically confirmed breast cancer (case group) were compared with 127 women in the same age group but without breast cancer (control group). Fingerprints of the two groups were compared in terms of whorl, loop and arch patterns. RESULTS: The loop pattern was most common in both groups [68 women (52.3%) in the case group and 58 women (45.7%) in the control group], followed by the whorl pattern [60 women (46.2%) in the case group and 64 women (50.4%) in the control group]; the difference was not significant (p=0.337). The number of whorl patterns and the breakdown by classification group did not differ significantly between the two groups. In addition, no significant difference was found in the dermatologlyphic patterns of the women with breast cancer with and without a family history of breast cancer. CONCLUSION: No difference was found in the dermatoglyphic characteristics of women with and without breast cancer. As such, this does not appear to be an effective screening method for women at risk for breast cancer.

Comparison of polymerase chain reaction and culture for detection of genital mycoplasma in clinical samples from patients with genital infections.

OBJECTIVE: Comparison of polymerase chain reaction (PCR) and culture for detection of genital mycoplasma (Mycoplasma hominis, Mycoplasma genitalium, and Ureaplasma urealyticum) in clinical samples from patients with genital infections. METHODS: Duplicate genital swabs were taken from 210 patients, referred to the gynecology clinic of Rasool Hospital, Tehran, Iran between December 2007 and June 2008. They were transported to the laboratory in a selective mycoplasma transport medium and in phosphate buffer solution. The specimens were inoculated into specific broth and solid medium for culture. Characteristic mycoplasma colonies were determined with Diennes' stain and examined microscopically. For PCR, samples were analyzed with genus specific primers. The primer sets, which were originally designed in our laboratory, amplified a 465 bp fragment (Mycoplasma genitalium), 559 bp fragment (Ureaplasma urealyticum), and 630 bp fragment (Mycoplasma hominis). Samples containing a band of the expected sizes for mycoplasma strains were subjected to digestion with a restriction endonuclease enzyme. RESULTS: Of the 210 samples, mycoplasma strains were isolated from 83 patients (39.5%), (23 mycoplasma isolates, 11%; and 69 ureaplasma isolates, 32.9%) by using a selective mycoplasma isolation media. Using PCR, a total of 120 (57.1%) samples were found to be positive for mycoplasmas (28 mycoplasma spp., 13.3%; and 67 ureaplasma spp., 31.9%) and co-infections with both species were detected in 25 samples (11.9%). CONCLUSION: The PCR was found to be highly sensitive when genus specific primers were used for diagnosis of genital mycoplasmas in comparison with culture.