Medical Journal of The Islamic Republic of Iran (MJIRI)

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210 Iranian women participated in a study in two main categories (comprising six subgroups) for comparison of prophylactic antibiotic prescription by the intravenous route with the irrigation method together with control subgroups. Interesting results from our study were: 1- There was no significant statistical difference between subgroups with regard to infectious morbidity. 2- The rate of early infectious morbidity in our patients was lower than in American studies. 3- Late infections were more common than early infections in our study. 4- The rate of late endometritis in the irrigation subgroup under category of labor lasting less than six hours was significantly lower than the irrigation subgroup in the category of labor lasting more than six hours. We think that the results of a particular study investigating the usefulness of prophylactic use of antibiotics at cesarean section from one country is not necessarily relevant for another country having a different culture and customs.

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Regarding the false negative results of culdocentesis, it is believed that the protocol of B-hCG, sonography, D&C and free use of laparoscopy gives more reliable information to the physician than the protocol of B-hCG, sonography and culdocentesis. We used the former protocol on 50 patients suspected of having ectopic pregnancy. The most common diagnoses were EP (48%) and PID (16%), respectively. It seems, in contrary to reports from abroad, among differential diagnosis of EP, ovarian cyst is not very common in Iranian patients. One of the objectives of our protocol was to determine if the use of laparoscopy with laparotomy causes an increase in the rate of postoperative infection and elongates the stay of the patient in hospital. Thus we compared our new protocol with the old protocol (gravindex, culdocentesis, laparotomy) of management ofEPin our hospitaifrom the point of: 1- the length of stay in hospital before and after laparotomy, and 2- the rate of laparotomy infection. There was no statistical difference between the two groups. The results of this comparison proved that laparoscopy when used with laparotomy does not cause increased morbidity for the patients. The most prominent feature of our special new protocol was the free use of laparoscopy.1t is believed that the free use of laparoscopy has the following advantages: 1- Elimination of false negative results of culdocentesis and encourage the surgeon to perform essential laparotomies. 2- Identification of some cases of EP that can be managed conservatively. 3- Identification of the non-EP cases that should not be operated on.

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In circumstances such as in vitro fertilization (IVF) or in patients with luteal phase defect, one needs to ensure the establishment of pregnancy as soon as possible. At the same time, a question arises: How can a physician make sure that the β-hCG is of an endogenous source and not the residue of the prescribed drugs (hCG)? In this article we have studied the elimination time of 1M injection of 5000 IU hCG in 11 normal, and 1M injection of 5000 and 10,000 IU hCG in 11 Rokitansky patients. The time of complete elimination of β-hCG from the circulation in 10 normal women and 5 Rokitansky patients receiving 5000 IU of hCG were 7-11, and 7-8 days respectively. There was no statistically significant difference between these two groups. Comparing the two groups of Rokitansky patients receiving 5,000 and 10,000 IV of hCG, the elimination time were dose-dependent, and were significantly different from each other (P<0.01). We conclude that when the serum level of β-hCG is higher than 5m IU/ml after 11 and 14 days with 5,000 and 10,000 IV of hCG injection, it could be accepted as an implanted pregnancy.