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Article
Antenatal diagnosis of myometrial invasion in anterior placenta previa by transabdominal color Doppler ultra sound

Author: Jwan N. Sulaiman جوان نجيب سليمان
Journal: Al-Kindy College Medical Journal مجلة كلية الطب الكندي ISSN: 18109543 Year: 2011 Volume: 7 Issue: 1 Pages: 27-32
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: The incidence of maternal mortality inplacenta previa accrete is 7%,and its preoperativediagnosis is of a great value.Objective: to evaluate the efficacy of transabdominalcolor Doppler ultrasound in diagnosing placentaprevia accreta and inccreta. Color Doppler imagingcriteria used in: includes diffuse parenchymalplacental lacunar flow, focal intra parenchymalplacental lacunar flow and bladder uterine serosainterphase hyper-vascularity.Design: Prospective study on patients fromJanuary2007 to January 2008.Patients and method: 48patients with one caesareansection or more and with persistent anterior placentaprevia diagnosed by transabdominal ultrasound wereexamined by color Doppler at 32 or more weeks ofgestation to determine the possibility of myometrialinvasion depending on the above color Dopplercriteria.Results: Out of 48 patients eleven exhibitedcharacteristic Doppler imaging pattern highly specificfor placenta accreta and inccreta according topreceding criteria , one patient had false positive colorDoppler imaging result, 5 patients underwentcaesarian hysterectomy , the remaining five weretreated conservatively by uterine artery ligation andother conservative measures because of bleedingfrom the lower uterine segment.Conclusion Color Doppler sonography is highlysensitive andspecific in the antenatal diagnosis of placenta previaaccreta .If a strong suspicion is found before delivery,appropriate location and timing for delivery should beconsidered ,to allow access to adequate surgicalpersonel and equipment ,preoperative bloodpreparation to reduce morbidity and mortality.Journal titleUltrasound in obstetric and gynecology ISSUN 0960-7692 Source 2000 Vol 15 In 1 PP. 28-35 (22rel)


Article
Goserelin versus Norethisterone in the Management of Menorrhagia with Uterine Fibroid

Authors: Yousif Abdul-Raheem --- Jwan N. Sulaiman --- Faris A. Rasheed
Journal: Iraqi Journal of Pharmaceutical Sciences المجلة العراقية للعلوم الصيدلانية ISSN: 16833597 Year: 2010 Volume: 19 Issue: 2 Pages: 54-58
Publisher: Baghdad University جامعة بغداد

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Abstract

Menorrhagia is common in patients with uterine fibroids, if operation needs to be delayed for a particular reason, goserelin can be used safely to reduce bleeding and the size of the tumor.The objective is to compare between goserelin acetate and norethisterone on patients with menorrhagia and uterine fibroid. A randomized controlled study conducted in Elwiya maternity teaching hospital, Baghdad from the first of November 2007 to the end of April 2009. 90 patients from the consultant outpatient clinic with menorrhagia and fibroid, and their operations were delayed for medical reason were allocated in two groups, the first group, was given 3.2 mg goserelin acetate subcutaneously monthly for 3 months and the second group was given 5 mg norethisterone orally three times daily during the attack of bleeding and 5 mg once daily, cyclically if no bleeding for 3 months. The fibroid was measured in two dimensions, using convex real-time ultrasound before treatment and three months after treatment. Haemoglobin and the number of pads used were also reported before and after treatment, also the side effects in both groups and the need for operations.The size of fibroid in two dimensions measurement was reduced from 28.24 cm2 ± 6.14 to 12.3 cm2 ± 3.45 in the goserelin group (P=0.0001) versus 26.56 cm2 ± 5.96 to 25.22 cm2 ± 5.01 in the norethisterone group (P= 0.2589). The haemoglobin level was 9.28 gm/100ml ± 2.44 pre-treatment in the goserelin group and 11.2 gm/100ml ± 1.88 post-treatment (P= 0.0001) versus 10.08 gm/100ml ± 2.86, and 10.24 gm/100ml ± 2.46 respectively in the norethisterone group (P= 0.7798). The need for operation was decreased significantly in the goserelin group. Goserelin showed better patient response and reduction in the tumor size than norethisterone in treatment of patients with menorrhagia and uterine fibroids if operation is delayed for medical or other reasons.

إن دواء كوزرلين ( Goserlin ) يظهر نتائج أفضل من دواء ( نوراثي ستيرون ) Norethisterone في معالجة وتقليص حجم العقد الليفية في الرحم و خاصة عند المريضات اللواتي يعانين من نزف شديد أثناء الدورة الشهرية أو هناك أسباب طبية تؤدي إلى تأجيل عملية رفع العقد الليفية جراحياً . ووجد أن إعطاء دواء ( الكوزرلين ) ) Goserlin ) لمدة 3 أشهر فعال في معالجة المريضات اللواتي يعانين من نزف شديد أثناء الدورة الشهرية بسبب وجود عقد ليفية على الرحم إذ وجد انه يقلل من شدة النزف ويرفع من نسبة الهيموكلوبين بالدم مما يقلل الحاجة إلى إعطاء دم أو اللجوء إلى التداخل الجراحي مع وجود إعراض جانبية طفيفة .

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