تأثير ماتريژل بر روند تكاملي بلاستوسيست موش The effects of Matrigel on the developmental processes of mouse blastocysts 2 1 زمينه و هدف: كشت جنين روي ماتريژل، يكي از روش‌هاي مناسب بررسي تكامل جنين در محيط آزمايشگاه مي‌باشد. البته به‌كارگيري محيط‌هاي متفاوت كشت همراه با آن و همچنين تفاوت در مراحل تكاملي جنين، مي‌تواند منجر به پديد آمدن نتايج متفاوتي در مطالعات شود. از آنجايي كه استفاده از ماتريژل در مورد تمام گونه‌ها و در مراحل مختلف تكاملي جنين مورد بررسي قرار نگرفته است، مطالعه حاضر به منظور بررسي اثر ماتريژل بر روند تكاملي بلاستوسيست‌هاي جمع‌آوري شده موش صورت گرفت. مواد و روشها: به موش‌های ماده نژاد NMRI هورمون‌های hMG و hCG براي تحريك‌ تخمك‌گذاري تزريق شد. سپس موش‌هاي ماده با موش‌های نر از همان نژاد جفت‌‌گيری نمودند. بلاستوسيست‌هاي حاصل، به دو گروه 150 عددي برای گروه آزمايش و گروه 134 عددي برای گروه کنترل تقسيم شدند. بلاستوسيستها به مدت 48 ساعت در محيط کشت M16 داراي BSA به ميزانmg/ml 4 کشت داده شدند و با بلاستوسيست‌های کشت شده در ماتريژل همراه با محيط مشابه ((M16 +4mg/ml BSA مقايسه شدند. روند تکاملی هر 24 ساعت تا 48 ساعت مطالعه شد. نتايج حاصل با استفاده از آزمون 2 و نرم افزار آماري SPSS تجزيه و تحليل شد. نتايج: بعد از گذشت 24 ساعت از كشت، درصد بلاستوسيست‌هاي گروه آزمايش كه به مرحله بلاستوسيست‌های جوانه‌زده مرحله اول رسيدند (74%)، در مقايسه با گروه كنترل (2/52%)، به‌طور معني‌داري (05/0>p) بيشتر بود اما درصد بلاستوسيست‌هاي فراگمنته در گروه كنترل 9/11% بود كه تفاوت معني‌داري (05/0>p)، با گروه آزمايش (2%) داشت. بعد از 48 ساعت از کشت 41% از بلاستوسيست‌هاي كشت داده شده در گروه کنترل، به مرحلة بلاستوسيست‌هاي جوانة زده مرحلة اول پيشرفت نمودند و اين ميزان بالاتر از درصد بلاستوسيست‌هاي اين مرحله در گروه آزمايش بود (05/0>p). همچنين درصد بلاستوسيست‌های جوانه‌زده مرحله دوم، در گروه آزمايش بعد از 48 ساعت (78%)، با اختلاف معني‌دار (05/0>p)، نسبت به گروه کنترل (59%) بالاتر بود. نتيجه‌گيری: اين مطالعه نشان داد كه بلاستوسیست‌های کشت داده شده بر روی ماتريژل همراه با محيط كشت غني شده M16 حاوي BSA (mg/ml 4) در مقایسه با بلاستوسيست‌هايی که در محيطM16 حاوي BSA (mg/ml4) کشت داده شدند، تكامل و رشد بیشتری دارند. بررسي فراساختمانی جنينها و يا بررسي‌هاي ايمونوسيتوشيميايي در تكميل يافته‌هاي اين مطالعه پيشنهاد مي‌شود. 2 Introduction: Culturing embryos on Matrigel™, is one of the most suitable methods for study-ing in vitro embryonic developments. As Matrigel has not been used extensively in different species for embryonic development studies, this study was undertaken to determine the effects of Matrigel on the developmental processes of mouse blastocysts. Materials & Methods: To a number of female NMRI mice, hMG and HCG injections were made for ovulatory stimulation and then they mated with males from the same strain. Later on, blastocysts were obtained and randomly divided into 2 groups: 150 case blastocysts and 134 control blastocysts. Blastocysts were cultured for 48 hours in M16 medium, supplemented with 4mg/ml of bovine serum albumin (BSA). Later, the blastocysts were compared with the blastocysts cultured in Matrigel plus the same medium. Developmental studies were carried out every 24 hours for 2 days. The data was analyzed by SPSS software and the results were tested by chi-squared. Results: After 24 hours, a significantly higher ratio of embryos reached the hatched blastocysts stage Ι in the case group (74%), compared with that of the control group (52.2%), (p<0.05). At the same time the percentage of fragmented blastocysts in the control group was 11.9% which was significantly higher than the case group (2%), (p<0.05). After 48 hours, 41% of blastocysts cultured in the control medium, developed to stage I, the value being significantly more than the blastocysts in the case group (p<0.05). Moreover, after the same period of time (48 hours), the percentage of stage II hatched blastocysts in the case group (79%) was higher than the control groups (59%), (p<0.05). Conclusion: Matrigel use in enriched culture media can increase development and growth of mouse blastocysts. It also seems that ultrastructural studies of cultured embryos or immunocyto-chemical studies from this regard would be beneficial in understanding the processes involved. 07 17 Mariya M Zahiri ماریا زهیری Histology Department, Faculty of Medicine, Tabriz Medical Sciences University Histology Department, Faculty of Medicine, Tabriz Medical Sciences University Iran Maerefat M Ghaffari معرفت غفاری نوین Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Iran mghaffarin@yahoo.com Behrooz B Niknafs Laboratory of Histology & Cellular Biology, Drug Applied Research Center, Tabriz University of Medical Sciences Laboratory of Histology & Cellular Biology, Drug Applied Research Center, Tabriz University of Medical Sciences Iran Mahnaz M Heidari مهناز حیدری Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Iran BlastocystCulture mediaMatrigelEmbryo DevelopmentLaboratory mouse 219.pdf Ben-Rafael Z., Benadiva C.A., Ausmanas M., Barber B., Blasco L., Flickinger G.L., Masteroianni L. 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ارزيابي تغييرات فعاليت آنزيم اسيد فسفاتاز تخمدان موش طي ابتداي دوران بارداري طبيعي و كاذب تا زمان لانه‌گزيني Evaluation of acid phosphatase activity alterations in mouse ovary after ovarian hyperstimulation in early stages of pseudo and normal pregnancies until implantation time 2 1 زمينه و هدف: آنزيم اسيد فسفاتاز يك آنزيم ليزوزومي است كه در فعاليت‌هاي متابوليكي تخمدان مانند بلوغ تخمك، از سرگيري مجدد تقسيم ميتوز، شكستن ژرمينال وزيكول و پديده تخمك‌گذاري نقش دارد و همچنين با فعاليت اتوفاژي و هتروفاژي باعث هضم جسم زرد و فوليكول آترتيك مي‌شود. با توجه به اينكه اين آنزيم توسط هورمون استروئيدي كنترل مي‌شود، اين مطالعه براي بررسي الگوي تغييرات فعاليت اين آنزيم در تخمدان موش پس از تحريك تخمك‌گذاري با استفاده از تزريق گنادوتروپين‌هاي PMSG و hCG نسبت به گروه شاهد طي دوران ابتداي حاملگي طبيعي و كاذب طراحي گرديد. روش بررسي: موش‌هاي ماده نژاد NMRI با سن بين 10-6 هفته انتخاب و به‌طور تصادفي به دو گروه شاهد و تحريك شده (با به كارگيري PMSG و hCG) تقسيم شدند. سپس هر گروه نيز به دو گروه باردار به روش طبيعي و باردار كاذب تقسيم گرديدند. جهت القاي بارداري كاذب از تحريك مكانيكي واژن استفاده شد. در هر گروه روزانه 5 سر موش از روز اول تا ششم به طريق جابجايي مهره‌هاي گردني كشته شدند و به منظور ارزيابي‌هاي بيوشيميايي، هر دو تخمدان آنها جدا و پس از هوموژن نمودن و سانتريفوژ كردن با دور g 14000 استخراج بافتي در معرض سوبستراي پارانيتروفنيل فسفات قرار گرفت و فعاليت آنزيم برحسب IU/dl محاسبه و پس از تعيين مقدار پروتئين نمونه‌ها برحسب واحد mg/dl ، فعاليت اختصاصي ACP برحسب واحد IU/mg محاسبه شد. داده‌هاي تحقيق حاضر با استفاده از آزمون Mann Whitheny مورد تجزيه و تحليل قرارگرفت. اختلاف آماری در سطح 05/0p< معني‌دار در نظر گرفته شده و به صورت ميانگين خطای استاندارد تعريف گرديد. براي بررسي‌هاي هيستوشيميايي، يکي از تخمدانها انتخاب و با استفاده از دستگاه كرايوستات، برش‌هايي به ضخامت m5 تهيه شد. سپس برشها طبق روش گوموري، رنگ‌آميزي شدند. نتايج: فعاليت اختصاصي آنزيم ACP در نمونه‌هاي بافتي تخمدان در گروه‌های شاهد بارداري طبيعي، شاهد بارداري كاذب، تحريک بارداري طبيعي و تحريک بارداري کاذب در روز اول به ترتيب شامل IU/mg 12/034/0، IU/mg 04/039/0، IU/mg 08/040/0، IU/mg 01/045/0 و در روز چهارم به ترتيب شامل IU/mg 10/069/0، IU/mg 065/061/0، IU/mg 10/009/1، IU/mg 05/079/0 بود. تغييرات فعاليت آنزيم تخمدان در مطالعات بيوشيميايي با نتايج به‌دست آمده در بررسي‌هاي هيستوشيميايي در كليه گروهها مطابقت داشت. يافته‌هاي حاصل نشان داد كه بيشترين تغييرات فعاليت آنزيم در سلول‌هاي گرانولوزا بود به طوريکه در کليه گروهها حداقل فعاليت آنزيم در روز اول حاملگي (0) و حداکثر آن در روز چهارم (3+) ديده شد. نتيجه‌گيري: در مجموع نتايج اين تحقيق نشان داد كه افزايش فعاليت آنزيم اسيد فسفاتاز در روزهاي سوم و چهارم بارداري مؤيد نقش اين آنزيم در فرايندهاي متابوليکي تخمدان و استروئيدسازي است و همچنين تحريك تخمك‌گذاري نمي‌تواند باعث تغييرات مشخصي در الگوي فعاليت آنزيم ACP تخمدان طي بارداري اوليه شود، هر چند كه به مطالعات بيشتري در اين زمينه نياز است. 2 Introduction: Acid phosphatase (ACP) is a lysosomal enzyme which contributes in ovarian metabolic functions such as oocyte maturation, resumption of mitotic divisions, germinal vesicle breakdown and ovulation. It digestes the corpus lutetium and helps the atresia of follicles by autophagia and hetrophagia activities. Considering the hormonal control of this enzyme, the present study was designed to deterimine the ovarian ACP activity after ovulation stimulation by the administration fo PMSG and hCG during preimplantation period. Materials & Methods: For this purpose a number of 6 to 10-week old female NMRI mice were selected and randomly divided into control and hyperstimulated groups after the administeration of PMSG and hCG, and later to pregnant and pseudopregnant groups. The mice were rendered pseudopregnant by mechanical vaginal stimulatin. Five mice in each group were sacrificed by cervical dislocation at the first to the sixth day of pregnancy for biochemical assays. The ovarian samples were obtained and were hemo-genated and centrifuged at 14000 g. The activity of the enzyme was determined using paranitrophenyl phosphate as substrate and later the specific activity of the enzyme was calculalated according to the amount of total protein. The data were analysed by Mann Whitheny test. Statistical significance was indicated by a P value less than 0.05. For hisotchemical evaluations, the sampels were obtained from one of the ovaries in each mouse and then 5 m thick cryosections were prepared. Cryosections were stained by Goumory method. Results: The ACP activity of ovarian tissues in the first day of pregnancy in the normal pregnant and pseudopregnant control groups, hyperstimulated normal pregnant and pseudopregnant groups were 0.340.04 IU/mg, 0.390.04 IU/mg, 0.40.08 IU/mg, 0.450.01 IU/mg respectively and in the fourth day were 0.690.1 IU/mg, 0.61 0.06 IU/mg, 1.090.10 IU/mg and 0.79 0.05 IU/mg. The results showed that biochemical findings correlated with histochemical observations. The ACP reaction changes were seen mainly in granulosa cells with a minimum enzyme activity in the first day (zero activity) and a maximum activity in the fourth day of pregnancy (+3). Conclusion: The increased ACP activity on the 3rd- 4th days of pregnancy, may be due to the este-roidogenic activity of granulosa cells. Also, the results showed that ovarian hyperstimulation could not change the pattern of ovarian ACP activity during early stages of pregnancy. 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مطالعه مورفولوژي و مورفومتری بیضه موش بالغ بدنبال تجویز مقادیر مختلف بوسولفان A morphologic and morphometric study of adult mouse testis following different doses of busulfan administration 2 1 زمينه و هدف: داروهاي ضد سرطان مي‌توانند باعث اختلال اسپرماتوژنز شوند. آگاهي از نحوه عمل آنها براي جلوگيري از تخريب اپیتلیوم ژرمینال ضروري است. با توجه به اينكه یافته‌های کمی می‌توانند پاسخ مهمی برای سوالاتی در زمینه فیزیولوژی بیضه و همچنین کمک موثری برای درک بهتر و کاملتر اسپرماتوژنز باشند مطالعه حاضر با هدف بررسی مورفولوژیك و مورفومتریك بيضه، حجم و دانسیته حجمی پارامترهای بیضه، اندازه‌گیری اقطار لوله سمینیفروس و مطالعه کمی سلول‌های ژرمينال و سوماتیک در بیضه موش بدنبال تجویز دوزهای مختلف بوسولفان انجام گرفت. روش بررسي: در مطالعه حاضر 42 موش نژاد NMRI با سن 8-6 هفته مورد آزمایش قرار گرفتند. حیوانات به 5 گروه تقسیم شدند. حیوانات در گروه‌های آزمایش اول، دوم، سوم و چهارم به ترتیب یک دوز mg/kg 5، 10، 20، 40 بوسولفان و حیوانات کنترل فقط حلال بوسولفان را به صورت داخل صفاقی دریافت نمودند. پس از گذشت 35 روز، حیوانات را کشته و از بیضه آنها نمونه‌برداری شد. نمونه‌ها جهت بررسی با میکروسکوپ نوری تحت پاساژ و رنگ‌آمیزی قرار گرفتند. سپس مطالعات مورفومتریك بیضه انجام شد و پس از آن، جهت تحليل داده‌ها از آناليز يكطرفه استفاده شد و 05/0p< به‌عنوان سطح معني‌داري در نظرگرفته شد. نتايج: نتاج اين مطالعه نشان داد که تجویز بوسولفان در هر سه دوز mg/kg 20،10 و 40 می‌تواند عمده پارامترهای مورفومتریك بیضه را کاهش دهد و با افزایش دوز، این اثرات واضح‌تر و شدیدتر می‌گردد. حجم بیضه، توبولها و اپیتلیوم ژرمینال در گروه‌های آزمایش به طور معني‌دار کاهش (05/0p<) و حجم و دانسیته حجمی بافت بینابینی افزایش یافت (05/0p<). قطر توبولها و ضخامت اپیتلیوم ژرمینال در گروه‌های آزمایش به طور معنی‌داري کاهش نشان داد، ضمن این که قطر مجاري سمي‌نيفروس داراي افزایش بود (001/0p<). در شمارش سلولی، تمام سلول‌های ژرمينال کاهش داشتند؛ در حالی که تعداد سلول‌های سرتولی دچار تغییر نگرديده بود. تعداد سلول‌های لیدیگ در گروه‌های تحت درمان با mg/kg 10و 20 تغییري نداشت؛ ولي در گروه تحت درمان با mg/kg 40، تعداد آنها به طور معنی‌دار افزایش یافت (01/0p<). در گروه تحت درمان با mg/kg 5 چه از نظر مورفولوژی و چه از نظر مورفومتری تغییر خاصی در بافت بیضه مشاهده نشد. نتیجه‌گیری: بوسولفان از طریق تأثیر بر سلول‌های ژرمينال و سوماتیک موجود در بیضه می‌تواند در تخریب اسپرماتوژنز و کاهش پارامترهای بیضه نقش داشته باشد و اثرات آن به صورت وابسته به دوز افزایش یابد. بنابراین ضمن استفاده از این دارو در بیماران سرطانی این عارضه نیز باید مدنظر قرار گیرد. 2 Introduction: Anti-cancer drugs have adverse effects on spermatogenesis. Therefore, informa-tion on their role for the prevention of germinal epithelium destruction is necessary. The aim of this study was morphologic and morphometric evaluations of testes, measurement of volume and volume density of testes parameters, measurement of tubular diameters, germ and somatic cell counts following administration of different doses of busulfan in adult mice. Materials & Methods: In the present study, 42 male NMRI mice aged 6-8 weeks were used. The animals were divided into 5 groups. Case groups received a single dose of busulfan by intraperitoneal injection as 5, 10, 20 and 40 mg/kg in the first, second, third and forth groups respectively. The control group received only the solvent for busulfan. All the animals were killed 35 days after treatment and their testes were dissected out and processed for light microscope studies. Then morphometric studies were performed on testicular parameters. The data were analyzed using ANOVA and Tukey test and p values less than 0.05 were considered significant. Results: Busulfan administration in 5, 10, 20 and 40 mg/kg doses significantly reduced most morphometric parameters in testes with a maximum effect in the 40 mg/kg group. Volumes of testes, tubules and germinal epithelia were decreased significantly in the experiment groups (p<0.05) however, the volume of interstitial tissue increased (p<0.05). Tubular diameters and thickness of epithelia were also decreased in the experiment groups. Number of germ cells was reduced, but number of sertoli cells was not affected. The number of leydig cells were not affected in 10 and 20 mg/kg busulfan treated groups, however in the 40 mg/kg treated group they were increased significantly (p<0.003). In 5 mg/kg treated group there were no significant differences in morphologic and morphometric studies. Conclusion: Busulfan could reduce testicular parameters and disrupt spermatogenesis through affecting both germ and somatic cells in a dose dependent manner. Therefore, the side effects of busulfan on spermatogenesis should be considered during cancer therapies. 25 37 Mohammad Amin MA Homafar Mohammad Amin Homafar Faculty of Medicine, Tabriz University of Medical Sciences Faculty of Medicine, Tabriz University of Medical Sciences Iran ghasemi.histolab@gmail.com Jafar J Soleimanirad جعفر سلیمانی راد Histology Department, Faculty of Medicine, Tabriz Medical Sciences University Histology Department, Faculty of Medicine, Tabriz Medical Sciences University Iran Ahmad Ali AA Ghanbari احمد علی قنبری Department of Anatomy, Faculty of Medicine, Tabriz University of Medical Sciences Department of Anatomy, Faculty of Medicine, Tabriz University of Medical Sciences Iran SpermatogenesisBusulfanMorphometryMouseTestisChemotherapyGerm cells 221.pdf Nudell D.M., Monoski M.M., Hipshultz L.I. 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اثرات ضديخ‌های مختلف بر ميزان شكست DNA در جنين‌های خوک توليد شده به روش In vitro Influence of cryoprotectants on DNA fragmentation of in vitro produced porcine blastocysts 2 1 زمينه و هدف: تاکنون از ضديخ‌های زيادی جهت انجماد جنين‌های مرحله قبل از لانه‌گزينی به منظور جلوگيری از تشکيل يخ داخل سلولی استفاده شده است، ولي با اين وجود تعداد زيادي از جنينها پس از ذوب به دلايل مختلفي از جمله نوع ضديخ مورد استفاده و به دنبال آن شكست DNA جنين، در اثر سميت ضديخ از بين مي‌روند. اتيلن‌گليکول، 1و2 پروپانديول و گليسرول ضديخ‌های معمول می‌باشند که به طور وسيعی برای انجماد جنين حيوانات گوناگون و همچنين انسان استفاده مي‌شود. هدف از مطالعه حاضر، بررسی اثرات ضديخ‌های مختلف روی ميزان شكست DNA بلاستوسيست‌های خوک به منظور تعيين ضديخ مناسب برای انجماد جنين خوک بود. روش بررسي: تعداد 197 بلاستوسيست خوک به روش In vitro توليد شدند و به طور تصادفي به چهار گروه تقسيم گرديدند. تعداد 40 بلاستوسيست به‌عنوان گروه كنترل به مدت يک ساعت در محلول PBSبدون ضديخ قرار گرفتند. بقیه بلاستوسيستها در سه گروه متفاوت در معرض 3 نوع محلول ضديخ با غلظت 10% به مدت يک ساعت در يك روش 3 مرحله‌اي در درجه حرارت اتاق قرار گرفتند. به‌طوریکه40 بلاستوسيست در معرض اتيلن‌گليکول و 40 بلاستوسيست در معرض 1و2 پروپانديول و 40 بلاستوسيست در معرض گليسرول قرار گرفتند. شواهد مورفولوژيك از زنده ماندن بلاستوسيستها پس از 24 ساعت كشت مجدد در گروه‌هاي مختلف در محيط NCSU-37، براساس تشکيل مجدد حفره بلاستوسل به وسيله مشاهده استريوميکروسکوپي با بزرگنمايي 40 برابر ارزيابی گرديد. شاخص ميزان شكست DNA در آنها پس از نشانه‌گذاری با تكنيك TUNEL و رنگ‌آميزي زمينه‌ای با PI مشخص شد. داده‌ها با آناليز واريانس و آزمون تعقيبی فيشر و با كمك نرم افزار Stutview مورد تجزيه و تحليل قرار گرفت و سطح معني‌داري 05/0 در نظر گرفته شد. نتايج: قرار گرفتن بلاستوسيست‌هاي خوک در معرض ضديخ‌های مختلف، منجر به افزايش تعداد هسته‌هايی با شكست DNA می‌شود. در ضمن، ميزان شاخص شكست DNA در بلاستوسيست‌های دارای بلاستوسل نسبت به بلاستوسيست‌های فاقد بلاستوسل، بدون توجه به نوع ضديخ کمتر بود. نتيجه‌گيري: براساس نتايج اين مطالعه در معرض ضديخ قرار گرفتن بلاستوسيست‌های خوک، ميزان شكست DNA را افزايش مي‌دهد و در اين ميان اتيلن‌گليکول کمترين ميزان سميت را دارد. 2 Introduction: The aim of the present study was to investigate the effects of different cryoprotectants (CPs) on DNA fragmentation of in vitro produced blastocysts to determine an appropriate cryoprotectant for embryo cryopreservation. Therefore, the precise aims of the study were to assess the toxic effects of different cryoprotectants in terms of survival rate and to evaluate the effects of different CPs on DNA fragmentation in in vitro produced porcine blastocysts. Ethylene glycol, 1,2 propanediol and glycerol are common cryoprotectants widely used for embryo cryopreservation in different animals as well as humans. Materials & Methods: 197 porcine blastocysts were produced in vitro and 160 blastocysts were random-ly selected and divided into 4 groups. 40 blastocysts were placed in phosphate buffer solution (PBS) with-out any cryoprotectants for 1 hour in room temperature (23-25C) as the control group. The rest of the blastocysts were exposed to 3 different cryoprotectants (10% solutions) ethylene glycol (EG), 1, 2 pro-panediol (PG) and glycerol (Gly) for 1 hour in a 3- step method in room temperature. The survival rate was assessed after culture in NCSU-37 medium for 24 hours as the proportion of recovered embryos with the reformation of blastocele observed by stereomicroscopy at 40 magnifications. The apoptotic indices were evaluated after staining by TUNEL technique to label apoptotic nuclei and later were counter-stained by propidium iodide (PI) to label all nuclei and were analyzed by fluorescent microscopy. Then, the sur-vival rate was compared with the data obtained from the control group. Through ANOVA and Fishers exact test the data were analyzed while employing StatView software and the level of significance was considered as 0.05%. Results: Exposing porcine blastocysts to different cryoprotectants results in an increase in DNA fragmentation, although the apoptotic index in blastocysts with blastocele compared to those without them were lower in the study, disregard of the kind of cryoprotectant. 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اثرات تراتوژن لاموتريژين بر جنين موش The teratogenic effects of Lamotrigine on mouse fetus 2 1 مقدمه: يكي از مهمترين عوارض مصرف داروهاي ضد صرع در دوران بارداري افزايش ناهنجاري‌هاي جنيني در نوزادان مي‌باشد. جنين‌هايي كه در معرض استفاده از اين داروها قرار مي‌گيرند ريسك ابتلا به ناهنجاري در آنها 10-7% مي‌باشد در حالي كه اين نسبت در كل جامعه 4-2% است. لاموتريژين يكي از جديدترين داروهاي ضد صرع است كه نسبت به داروهاي ضد صرع قديمي‌تر بر روي عوارض تراتوژنيك آن مطالعه كمتري انجام شده اغلب موارد اين دارو را بدون عوارض تراتوژنيك گزارش كرده‌اند. اخيراً مواردي از ناهنجاري‌زايي اين دارو در انسان گزارش شده است ولي گزارشها كم و متناقض بوده و الگوي خاصي از نوع ناهنجاريها ارائه نشده است. لذا اين تحقيق با هدف تعيين اثرات تراتوژنيك دارو در جنين موش انجام شده است. روش بررسي: براي انجام كار موش‌هاي سوري حامله به چهار گروه تقسيم شدند. گروه اول (كنترل 1) هيچ ماده‌اي دريافت نكردند گروه دوم (كنترل 2) حلال اتانول به صورت داخل صفاقي دريافت كردند گروه سوم (مورد 1) mg/kg25 در سه دوز به روش داخل صفاقي دريافت كردند گروه چهارم (مورد 2) mg/kg75 لاموتريژين در سه دوز به روش داخل صفاقي دريافت كردند. شروع تزريق براي هر سه گروه 9 تا 18 حاملگي بود. در روز 18 جنينها از رحم مادر خارج شده پس از اندازه‌گيري قد و وزن؛ جنينها از نظر وجود ناهنجاريها (ناهنجاري‌هاي ستون مهره‌ها؛ ناهنجاري‌هاي اندام و ناهنجاري‌هاي جمجمه) بررسي شده و مشاهدات ثبت گرديد. ناهنجاري‌هاي موجود در چهار گروه بررسي و به كمك نرم افزارspss مقايسه شدند. نتايج: نتايج در گروهي كه mg/kg75-25 دارو دريافت كرده بودند كاهش قد و وزن و افزايش انواع ناهنجاري نسبت به گروه‌هاي كنترل 1 و 2 مشاهده گرديد كه با افزايش دوز و تزريق mg/kg 75 دارو اين نسبت نيز افزايش يافت. نتيجه‌گيري: با توجه به داده‌ها مي‌توان لاموتريژين را به عنوان يك ريسك فاكتور در بروز اين ناهنجاري در جنين موش دانست. عده‌اي از محققين كاهش غلظت سرمي فولات و اسيد آمينه متيونين را در بروز اين ناهنجاريها مؤثر مي‌دانند. 2 Introduction: One of the most important complications of antiepileptic drugs (AEDs) is increased congenital malformations. The risk of malformations in such fetuses is 7-10% compared to 2-4% in the general population. Lamotrigine is a recently introduced AED, with fewer teratogenic effects than that of the older ones and without reported teratogenic effects in most cases. Recently some malformations have been reported related to Lamotrigine use in human beings but the reports are scanty and contradictory and no particular patterns of malformations have been presented. This study has been done to detect the teratogenic effects of this drug in mouse fetus. Materials & Methods: In this study, NRMI mice were divided into four groups: I) control group 1, II) control group 2, with intraperitoneal administration of ethanol solution, III) case group 1, with intraperitoneal administration of three 25 mg/kg doses of Lamotrigine and IV) case group 2, with intraperitoneal administration of three 75 mg/kg doses of Lamotrigine. Injections were made during the 9th to the 18th days of gestation. On the 18th day of gestation, the fetuses were harvested. The body weight and height were measured and malformations in vertebral column, limbs and cranium were looked for and recorded. Malformations were compared in the four groups by SPSS software. Results: In the groups with 25 & 75 mg/kg Lamotrigine administrations, reduction of body weight and height and increased malformations of vertebral column and limbs were noticeable in a dose dependent fashion compared to the control groups number 1 & 2_ cranial malformations were insignificant. Conclusion: Based on the results, Lamotrigine can be considered as a risk factor for the increase of malformations in the treated animals. As a number of researchers believe that decrease of serum folate and methionine are effective in the appearance of malformations and they may implicate the situation, further studies on the mechanisms of Lamotrigine from this point of view are recom-mended. 45 53 Forouzan F Rahmani فروزان رحمانی Department of Anatomy, Faculty of Medicine, Shahr-e-Kord University of Medical Sciences Department of Anatomy, Faculty of Medicine, Shahr-e-Kord University of Medical Sciences Iran frajaei@qums.ac.ir Masoumeh M Delaram معصومه دل‌آرام Department of Midwifery, Faculty of Nursing & Midwifery, Shahrekord University of Medical Science & Health Services Department of Midwifery, Faculty of Nursing & Midwifery, Shahrekord University of Medical Science & Health Services Iran Nasrin N Forouzandeh نسرین فروزنده Department of Psychological Nursing, Faculty of Nursing & Midwifery, Shahrekord University of Medical Science & Health Services Department of Psychological Nursing, Faculty of Nursing & Midwifery, Shahrekord University of Medical Science & Health Services Iran LamotrigineMouseFetusTeratogenicEpilepsyPregnancyAnticoagulant drugsFolic acid 223.pdf بهادری مسلم، شکور عباس. نقایص زمان تولد. رویان شناسی پزشکی لانگمن. تجدید نظر هشتم. انتشارات چهر،1380، صفحات: 128-127.##Bastaki S.A.M., Padmanabhan R., Abdulrazzaq Y.M., Chandranth S.I., Shafiulla M. 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بررسی مقایسه‌ای تستهای FSH سرم و pH واژن در تشخیص یائسگی The comparison of serum Follicle-Stimulating Hormone (FSH) and vaginal pH for the diagnosis of menopause 2 1 زمينه و هدف: با وجود پیشرفت‌هایی که برای اندازه‌گیری هورمون محرکه فولیکولی (FSH) حاصل شده به بررسی pH واژن کمتر توجه شده است. تاكنون اندازه‌گيري FSH به عنوان تست تشخیص يائسگي مطرح بوده است. بررسي‌هاي انجام شده نشان مي‌دهد استفاده از pH واژن مي‌تواند به تشخيص يائسگي كمك نمايد كه روشي آسان، غيرتهاجمي و ارزان است. هدف از انجام اين پژوهش مقايسه‌اي بين ميزان FSH سرم و pH ترشحات واژن در تشخيص يائسگي است. روش بررسي: مطالعه حاضر مطالعه‌اي توصيفي- مقطعي است كه روي 120 بيمار با علائم باليني يائسگي در محدودة سني 95-31 سال، مراجعه كننده به درمانگاه يائسگي بيمارستان قائم (عج) از دي ماه 83 تا تير ماه 84 انجام شده است. روش نمونه‌گيري غيرتصادفی و مبتني بر هدف بود. جمع‌آوري اطلاعات به وسيله پرسشنامه انجام گرديد و دو متغير كمي pH واژينال با استفاده از pH سنج مخصوص و FSH سرم در آزمايشگاهي معين براي تمامي بيماران اندازه‌گيري و علاوه بر آن علائم بالینی بیماران ثبت شد. داده‌ها در برنامة آماري SPSS تجزيه و تحليل شدند و نتايج با آزمون 2 و محاسبه ضريب توافق Kappa مورد ارزيابي قرار گرفت. 05/0 p از نظر آماری معنی‌دار تلقی شد. نتايج: براساس اطلاعات حاصل از مطالعه حاضر ميزان متوسط pH واژن و در غياب عفونت‌هاي واژينال، در زنان يائسه مورد مطالعه 53/033/5 بود (با حداقل 1/4 و حداکثر 5). با در نظرگرفتن نقطه برش 5/4 برای pH واژن و تست مبنای FSH mIU/ml20FSH> که معیار و شاخص یائسگی است( ميزان حساسيت pH در تشخيص يائسگي 97% تعيين گرديد. میانگین و انحراف معیار میزان هورمون FSH در زنان تحت مطالعه mIU/ml 42/679/80 است. نتيجه‌گيري: اندازه گيري pH واژن در تشخيص يائسگي حساسيتي شبيه اندازه‌گيري ميزان FSH سرم دارد و می‌تواند جایگزین مناسبی درمقابل FSH سرم باشد. 2 Introduction: Because of improvements in the measurement methods of FSH levels in serum, there is less interest in evaluating vaginal pH for the diagnosis of menopause nowadays. The traditional test to diagnose menopause has been FSH, so far. In recent studies it has been shown that diagnosis of menopause by testing for vaginal pH is a simple, non-invasive and inexpensive method .This study intended to compare diagnostic value of vaginal pH and serum FSH in the diagnosis of menopause. Materials & Methods: This article is a descriptive cross-sectional study taking place from June to July 2005. 120 menopausal women, aged 31 to 95 years that were being referred to a meno-pausal clinic in Qaem Hospital during the study, were chosen by a target-based nonrandom sampling technique for the study. A questionnaire was used for collecting data from the patients. In addition, pH test strips were used for vaginal pH measurements and the patients' serum FSH were evaluated in a definite laboratory and their clinical signs and symptoms were recorded. The data was analyzed by SPSS software and the statistical significant of the results were tested by 2 in comparison with the kappa coefficient of agreement. P0.05 was consi-dered as the significance level of the study. Results: According to the gathered data in the study, the average vaginal pH in the patients, in the absence of vaginal infections, was 5.330.53 (with a minimum of 4.1 and a maximum of 5) With attention to the cut of point of 4.5 for vaginal pH and the baseline FSH >20 mIU/ml that characterizes menopause, the sensitivity of pH-meter in diagnosing menopause was determined to be 97%. The mean average and the standard deviation of FSH levels in this study was 80.79 6.42. Conclusion: Vaginal pH sensitivity in the diagnosis of menopause is similar to serum FSH and could be used as a suitable alternative. 53 59 Sedigheh Ayaty صدیقه آیتی Department of Obstet . and Gynecol .Faculty of Medicine, Mashhad Medical Sciences University Department of Obstet . and Gynecol .Faculty of Medicine, Mashhad Medical Sciences University Iran sed-ayati@yahoo.com Zohreh Z Yousefi زهره یوسفی Department of Obstet . and Gynecol .Faculty of Medicine, Mashhad Medical Sciences University Department of Obstet . and Gynecol .Faculty of Medicine, Mashhad Medical Sciences University Iran Mohammad Taghi MT Shakeri محمدتقی شاکری Department of Community Medicine & Public Health, Faculty of Medicine, Mashad University of Medical Sciences Department of Community Medicine & Public Health, Faculty of Medicine, Mashad University of Medical Sciences Iran MenopauseFollicle stimulating hormoneVaginal pHDiagnosisSensitivity 224.pdf Cedars M.I., Euans M., Scott J.R., Gibbs R.S., KarLan B.Y., Haney A.F. 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شيوع گرفتگي عضلاني در دوران بارداري و اثر مكمل درماني بر آن Prevalence of leg cramps during pregnancy and effects of supplemental therapy 2 1 زمينه و هدف: گرفتگی عضلانی، انقباض دردناک عضلات است که به طور شایع در دوران بارداري به خصوص در اندام تحتانی دیده می‌شود. در ايران درمان خاصي برای این اختلال، متداول نمي‌باشد؛ لذا با هدف دستیابی به راه حل مناسب با امکانات داخل کشور مطالعه حاضر طراحی شد. روش بررسي: از ميان 401 زن باردار مراجعه‌كننده (در نيمه دوم بارداري) به درمانگاه پره‌ناتال بيمارستان امام خميني (ره) تهران در سال 83-1382، 217 نفر (5/54%) كه از گرفتگي دردناك عضلات ساق پا (با شدت و تناوب متفاوت) شكايت داشتند مورد بررسي قرار گرفتند. تعدادي از اين بيماران كه پس از بررسي‌هاي پاراكلينيك، هيچگونه اختلال الكتروليتي نداشتند و همچنين متعاقب ارزيابي تغذيه‌اي ريزمغذيها را در رژيم غذايي در حد استاندارد و توصيه شده دريافت كرده بودند، وارد فاز دوم مطالعه شدند. در اين مرحله بيماران به دسته‌هاي مكمل درماني به مدت 2 هفته (كلسيم، منيزيوم، ويتامين‌هاي گروه B) و گروه شاهد تقسيم شدند. سپس براساس معيار بهبودي كامل (برطرف شدن كامل علائم از نظر شدت و تناوب) با يكديگر مقايسه شدند. داده‌ها پس از جمع‌آوري در نرم افزار آماريSPSS ذخيره شده و فرضيه‌هاي طرح از طريق آزمون‌هاي آماري 2، t و مدل رگرسيون لجستيك بررسي شدند. نتایج: رابطه آماری معنی‌داری بین بهبودی کامل با مکمل‌ درمانی ویتامین B در مقايسه با گروه كنترل مشاهده شد. به طوريكه بهبودي كامل 71% در گروه دريافت كننده مكمل ويتامين‌هاي گروه B در مقابل 9% در گروه كنترل، 29% در گروه منيزيوم و 52% در گروه كلسيم (0001/0p<) برآورد شد. نتیجه گیری: شیوع بالای گرفتگی عضلانی به خصوص در اندام تحتانی در میان زنان باردار ایرانی (54%)، با رژیم غذایی و عادات زندگی ارتباط خاصی ندارد؛ اما مکمل درمانی ریزمغذیها (اضافه بر تغذيه عادي روزانه) مي‌تواند تأثیر به سزایی در درمان اين مشكل داشته باشد. 2 Introduction: Leg cramps are common painful spasms especially in the lower extremities during pregnancy. The purpose of this study was to find a suitable alternative in the treatment of the disease. Materials & Methods: 217 patients reported leg cramps with different degrees and frequencies among 401 pregnant women in the second half of their pregnancies who visited the Prenatal Clinic of Imam Khomeini Hospital from July to December 2002. After preliminary evaluations for ruling out electrolyte imbalances or insufficient supply of dietary micronutrients, patients were randomly allocated into supplemental therapy (Calcium, magnesium or vitamin B intake for 2 weeks) and control groups. The groups were compared after 4 weeks according to their complete relief from leg cramps. The clinical findings and the data collected from the patients were analyzed by chi-square and t-student tests and a logistic regression model using the SPSS (V.10) software. Results: There was a significant improvement in patients receiving vitamin B with 71% complete and 19% relative relief from leg cramps, compared to 9% complete relief in the control group- 29% and 52% in the groups receiving magnesium and calcium respectively (p<0.0001). Conclusion: Although the high prevalence of leg cramps (55%) in the patients was not necessary-ly related to dietary habits, but it seemed that supplementing symptomatic patients with vitamin B could be beneficial. 59 65 Farnaz F Sohrabvand فرناز سهراب‌وند Vali-e- Asar Reproductive Health Research Center,Tehran Medical Sciences University Vali-e- Asar Reproductive Health Research Center,Tehran Medical Sciences University Iran fsohrabvand@yahoo.com Mamak M Shariat مامک شریعت Vali-e- Asar Reproductive Health Research Center,Tehran Medical Sciences University Vali-e- Asar Reproductive Health Research Center,Tehran Medical Sciences University Iran Fedyeh F Haghollahi فدیه حق‌اللهی Vali-e- Asar Reproductive Health Research Center,Tehran Medical Sciences University Vali-e- Asar Reproductive Health Research Center,Tehran Medical Sciences University Iran Soghra S Khezerdoust صغری خظردوست Vali-e- Asar Reproductive Health Research Center,Tehran Medical Sciences University Vali-e- Asar Reproductive Health Research Center,Tehran Medical Sciences University Iran Abbas A Rahimi Foroushani عباس رحیمی فروشانی Epidemiology Department, Faculty of Publi Health, Tehran Medical Sciences University Epidemiology Department, Faculty of Publi Health, Tehran Medical Sciences University Iran Leili L Nazemi لیلی ناظمی Human Nutrition and Biochemistry Department, Faculty of Public Health, Tehran Medical Sciences University Human Nutrition and Biochemistry Department, Faculty of Public Health, Tehran Medical Sciences University Iran Maryam M Chammari مریم چمری Human Nutrition and Biochemistry Department, Faculty of Public Health, Tehran Medical Sciences University Human Nutrition and Biochemistry Department, Faculty of Public Health, Tehran Medical Sciences University Iran Leg crampsVitamin B1Vitamin B6PregnancyCalciumMagnesiumSupplemental therapy 225.pdf Schwellnus M.P. Skeletal muscle cramps during exer- cise: The physician & Sport medicine.1999;27:12-13.##Duke J.A. Total health for women: Muscle cramp. 2000;Rodale book.##Herbal remedies, USA site. Muscle cramps, muscle spasm, leg cramps, feet cramps.2001.##Valbo A., Bohmer T. Leg cramps in pregnancy How common are they? Tidsskr Nor laegeform.1999;119 (11):1589-90.##Gary F. Cunningham F.C. Medical & surgical compli-cations in pregnancy. Williams Obstetrics.21st Edition, Mc Graw hill.2001;p:1141.##Cunningham F.C. Renal & Urinary Tract disorders: Williams Obstetrics. 21st Edition, MC Graw Hill.2001; p:1251.##Young G.L., Jewell D. Interventions for leg cramps in pregnancy. Cochrane Database Syst Nov.2002;(2):CD 000121.##Avsar A.F., Ozmen S., Soylemez F. Vit ?1 & B6 substitution in pregnancy for leg cramps. Am J Obsted Gynecol.1996;125(1):233-4.##Dahle L.O., Berg G., Hammar M., Hurtig M., Larsson L., et al. The effect of oral Magnesium substation on pregnancy, Induced leg cramps. Am J Obstet Gynecol. 1995;173 (1):175-180.##Young G.C., Jewell D. Intervention for leg cramps in pregnancy. Cochrane Database Syst Rev.2000;(2): CD 000121.##Hammer M., Larsson L. Calcium treatment of leg cramps in pregnancy effect on clinical symptoms and total serum and ionized serum calcium concentration. Acta Obstet Gynecol Scand.1981;60(4):345-7.##Frussor A., Zarate M., Augustovki M. Magnesium for the treatment of nocturnal leg cramps: a cross over randomized trial. J Fam Pract.1999;48(11):868-71.##Surgery B.C., Sowerbery T. Interventions for leg cramps in pregnancy. Cochrane Data Base Syst Rev. 2002;(1):CD000121.##

دلايل ختم بارداري در سه ماهه سوم در مركز آموزشي‌ـ درماني هاجر شهركرد در سال 1383 The reasons for the termination of pregnancies in the third trimester in Shahr-e-kord’s Hadjar hospital during 2005 2 1 زمينه و هدف: امروزه مشاهده مي‌شود بيشتر مادران مراجعه كننده به بيمارستان جهت ختم بارداري در سه ماهه سوم، در فاز زايماني قرار ندارند و بدون شروع انقباضات رحمي بستري مي‌شوند و بارداري آنها ختم مي‌گردد. با توجه به اهميت سلامت مادران و نوزادان و نقش سزارين‌هاي غيرضروري، پژوهش حاضر به منظور تعيين دلايل ختم بارداري در سه ماهه سوم در مركز آموزشي‌‌‌ـ درماني هاجر شهركرد انجام شده است. روش بررسي: در اين مطالعه توصيفي‌ـ تحليلي تعداد 750 نفر از زناني كه جهت ختم بارداري در سه ماهه سوم در بخش زايمان مركز آموزشي‌ـ درماني هاجر شهركرد طي ارديبهشت تا آذر 1383 بستري شده بودند، به روش تصادفي و در سه شيفت صبح، عصر و شب انتخاب شده و مورد بررسي قرار گرفتند. ابزار گردآوري اطلاعات در اين پژوهش، فرم ثبت اطلاعات و چك ليست بود. از معاينه واژينال بيمار، مطالعه پرونده، مصاحبه با مادر و معاينه فيزيكي نوزاد براي تكميل فرم ثبت اطلاعات و چك ليست استفاده شد. اطلاعات حاصل با استفاده از نرم افزار SPSS و آزمون‌هاي آماري T و 2 مورد تجزيه و تحليل قرار گرفت و 05/0p< به عنوان سطح معني‌داري در نظر گرفته شد. نتايج: براساس نتايج حاصل از پژوهش 298 نفر (7/39%) از واحدهاي پژوهش به علت شروع دردهاي زايماني و 452 نفر (3/60%) بدون درد زايمان و به توصيه پزشك و ساير مراقبين بهداشتي‌ـ درماني، جهت ختم بارداري مراجعه كرده بودند. در گروه اخير در 2/23% افراد، مواردي مثل سزارين قبلي، تمايل به سزارين، كاهش حركات جنين، بارداري ديررس، فشار خون بالا در مادر، جفت سرراهي، جدا شدن زودرس جفت و كاهش حجم مايع آمنيوتيك به عنوان علت اقدام به سزارين مطرح بود. ميانگين امتياز بيشاپ سرويكس در گروهي كه به علت شروع درد زايمان مورد ختم بارداري قرار گرفته بودند، بيشتر از گروهي بود كه بدون درد زايمان و به توصيه پزشك و ساير فراهم كنندگان مراقبت بستري و مورد ختم بارداري قرار گرفته بودند (001/0p<، 541=df، 45/40=t). ارتباط امتياز بيشاپ سرويكس با نوع زايمان معني‌دار بود و در افرادي كه اين امتياز كمتر از 5 بود، عمل سزارين بيشتر انجام شده بود(001/0p<، 1=df، 9/113=2). رابطه بين علت ختم بارداري و نوع زايمان پس از حذف موارد سزارين تكراري و تمايل به سزارين معني‌‌دار بود و افرادي كه بدون شروع درد زايمان بستري شده بودند، بيشتر تحت عمل سزارين قرار گرفته بودند (001/0p<، 1=df، 26/64=2). سن بارداري براساس تاريخ اولين روز قاعدگي بيمار (LMP) و سونوگرافي در اين گروه بيشتر از گروهي بود كه به علت شروع دردهاي زايماني مورد ختم بارداري قرار گرفته بودند(001/0p<، 311=df، 70/3=t). تفاوت معني‌داري در وزن نوزادان در دو گروه وجود نداشت. نتيجه‌گيري: گرفتن شرح حال دقيق در مراقبت‌هاي دوران بارداري جهت تعيين سن بارداري، انجام سونوگرافي در 26 هفته اول بارداري و آموزش به تمامي خانم‌هاي باردار در مورد زمان مراجعه به بيمارستان جهت ختم بارداري و عوارض ناشي از بستري شدن زودرس، تشکيل کميته‌های تخصصی تصميم‌گيري در مورد ختم بارداری در بيمارستانها و تدوين آئين‌نامه‌هاي خاص در اين مورد، از اقداماتي است كه مي‌توان در جهت جلوگيري از ختم زودرس بارداري انجام داد. 2 Introduction: Observations show that the majority of pregnant women hospitalized in the third trimester of pregnancy, their pregnancies are terminated in the absence of any labor pain. Because of the importance of mother and baby health, this study was designed to assess the reasons for these terminations in Hadjar’s University Hospital in Shahr-e-Kord. Materials & Methods: In this descriptive and analytical study, 750 women who were hospi-talized for the termination of pregnancy, were selected randomly and assessed in morning, evening and night shifts. A questionnaire and a check list were used for data collection. Hospital records, interviews with mothers, a vaginal exam and physical exam of infants were used to complete the form and the check list. Data were analized by SPSS software and t, Chi square tests were used and p<0.05 was considered significant. Results: Based on the results, 298 (39.7%) of pregnancies were terminated for labor pain and 452 (60.3%) were terminated according to physicians’ advice or other health care providers’ without presence of labor pain. In the latter group, 23.2% of pregnancies were terminated for a history of previous cesarean section, elective cesarean sections, reduction of fetal movements, post-term pregnancies, maternal hypertention, placenta previa, placenta abruption or oligohydro-amnious.The mean Bishop score for induction was greater in women whose pregnancies were terminated for labor pain than those terminated according to physicians’ or any other health care providers’ advice (df=541, p<0.001). The correlation between Bishop score and mode of delivery was significant and in women whose Bishop score was less than 5, cesarean section was higher (df=20, p<0.001). After the elimination of previous and elective cesarean sections, the correlation between the causes of terminations and mode of delivery was significant and most hospitalized women terminated their pregnancieis, by cesarean section without presence of labor pain (df=16, p<0.001), although in this group the mean gestational age based on LMP and sonography was greater than those with labor pain (t= 3.7, df= 311, p<0.001). There were no significant differences in the weight of infants in the two groups. Conclusion: Taking the exact information in prenatal cares about the gestational age, carrying out a sonography in the first 26 weeks of pregnancy, educating pregnant women about the time of hospitalization for the termination of pregnancy and complications of early hospitalization, forming a specialty committee to decide on the termination of pregnancies in hospitals and setting practice guidelines in this regard,are efforts to prevent early termination of pregnancies. 65 73 Masoumeh M Delaram معصومه دل‌آرام Department of Midwifery, Faculty of Nursing & Midwifery, Shahrekord University of Medical Science & Health Services Department of Midwifery, Faculty of Nursing & Midwifery, Shahrekord University of Medical Science & Health Services Iran mdelaram@skums.ac.ir Forouzan F Rahmani فروزان رحمانی Department of Anatomy, Faculty of Medicine, Shahr-e-Kord University of Medical Science & Health Services Department of Anatomy, Faculty of Medicine, Shahr-e-Kord University of Medical Science & Health Services Iran Alireza A Ahmadi علیرضا احمدی Department of Biomedicine women, Research Center,Alzahra University Department of Biomedicine women, Research Center,Alzahra University Iran Termination of pregnancyThird trimesterCesarean sectionDeliveryHigh risk pregnancy 226.pdf Savitz D.A., Terry J.W. Jr., Dole N., Thorp J.M. Jr., Siega-Riz A.M., Herring A.H. Comparison of preg-nancy dating by last menstrual period, ultrasound scan-ning, and their combination. Am J Obstet Gynecol. 2002;187(6):1660-6.##Cunningham F.G., Gant N.F., Leveno K.J., Gilstrap L. C., Hauth J.C., Wenstrom K.D. Ultrasound and dopp-ler. Williams obstetrics. from McGRAW-Hill company Newyork.2001;pp:1111-39.##Johnson D.P., Davis N.R., Brown A.J. Risk of cesa-rean delivery after induction at term in nulliparous women with an unfavorable cervix. Am J Obstet Gynecol.2003;188(6):1565-9.##Bailit J.L., Garrett J.M., Miller W.C., McMahon M.J., Cefalo R.C. Hospital primary cesarean delivery rates and the risk of poor neonatal outcomes. Am J Obstet Gynecol.2002;187(3):721-7.##Jerbi M., Hidar S., Ammar A., Khairi H. Predictive factors of vaginal birth after cesarean delivery. Int J Gynaecol Obstet.2006;94(1):43-4.##Hoffman M.K., Vahratian A., Sciscione A.C., Troen-dle J.F., Zhang J. Comparison of labor progression between induced and noninduced multiparous women. Obstet Gynecol. 2006;107 (5):1029-34.##Heinberg E.M., Wood R.A., Chambers R.B. Elective induction of labor in multiparous women. Does it increase the risk of cesarean section? J Reprod Med. 2002;47(5):399-403.##Seyb S.T., Berka R.J., Socol M.L., Dooley S.L. Risk of cesarean delivery with elective induction of labor at term in nulliparous women. Obstet Gynecol.1999;94 (4):600-7.##Maslow A.S., Sweeny A.L. Elective induction of labor as a risk factor for cesarean delivery among low-risk women at term. Obstet Gynecol.2000;95(6Pt1):917-22.##Dublin S., Lydon-Rochelle M., Kaplan R.C., Watts D.H., Critchlow C.W. Maternal and neonatal outcomes after induction of labor without an identified indica-tion. Am J Obstet Gynecol.2000;183(4):986-94.##Dommergues M., Benachi A., Benifla J.L., des Noettes R., Dumez Y. The reasons for termination of pregnancy in the third trimester. Br J Obstet Gynaecol. 1999;106(4):297-303.##Burrough A. Health problems complicating pregnan-cy. In: Burrough Arlene. Maternity nursing. An Intro-duction Text. 7th Edition. W.B saunders company. 1997;pp:366-372.##Bosma J.M., van der Wal G., Hosman-Benjaminse S. L. Late termination of pregnancy in North Holland. Br J Obstet Gynaecol.1997;104 (4):478-87.##Cunningham F.G., Gant N.F., Leveno K.J., Gilstrap L.C., Hauth J.C., Wenstrom K.D. Obstetrics in Broad Perspective. Williams Obstetrics. From McGRAW-Hill company, Newyork.2001;pp:3-13.##Yeast J.D., Jones A., Poskin M. Induction of labor and the relationship to cesarean delivery: A review of 7001 consecutive inductions. Am J Obstet Gynecol. 1999;180(3 Pt 1):628-33.##Cunningham F.G., Gant N.F., Leveno K.J., Gilstrap L.C., Hauth J.C., Wenstrom K.D. Cesarean Section and Post partum hysterectomy. Williams Obstet. From McGRAW-Hill company, Newyork. 2001;pp:537-563.##Porter M., Bhattacharya S., van Teijlingen E., Templeton A. Reproductive Outcome Following Cae-sarean Section (ROCS) Collaborative Group. Does Caesarean section cause infertility? Hum Reprod.2003; 18(10):1983-6. Review.##شاکریان بهار. بررسی فراوانی نسبی سزارین و علل انجام آن در استان چهار محال و بختیاری. مجله دانشگاه علوم پزشکی شهرکرد، 1383، 6(1). صفحات: 69-63.##Rahnama P., Ziaei S., Faghihzadeh S. Impact of early admission in labor on method of delivery. Int JGynaecol Obstet.2006;92(3):217-20.##Alves B., Sheikh A. Investigating the relationship between affluence and elective caesarean sections. BJOG.2005;112(7):994-6.##Kwee A., Cohlen B.J., Kanhai H.H., Bruinse H.W., Visser G.H. Caesarean section on request: a survey in The Netherlands. Eur J Obstet Gynecol Reprod Biol. 2004;15;113(2):186-90.##Woodrow N.L. Termination review committees: are they necessary? Med J Aust.2003;179(2):92-4.Review.##