Endometriosis is a gynecologic disease. The prevalence of endometriosis in the reproductive age of women varies between 3-10%. Cesarean scar endometriosis is a rare event and rare cases have been reported in gynecologic and surgical articles. The incidence of cesarean section scar endometriosis is not accurately determined but ranges from 0.03% to 0.15% and in some other articles the incidence up to 1% has been reported. Frequently the cesarean scar endometriosis is not diagnosed until before surgery (80%) and usually the patients are operated on the basis of some pre-operative diagnoses such as kelloid, hematoma, suture granuloma, incisional herina and neoplasm. The most common symptom is cyclic and periodic pains in the area of operation which appear approximately 1-7 years after cesarean section. The accurate diagnosis is made by pathology. In this article a patient with cyclic and severe pain in cesarean scar area for 8 years is reported. The patient had been treated with anti- inflammatory drugs for several years without any diagnosis. The patient was operated with diagnosis of subcutaneous mass and probably suture granuloma and the final pathologic report was Endometriosis. The choice treatment for cesarean scar endometriosis is surgery, and awareness about this unusual complication of it will increase the probability of preoperative diagnosis.

  Background & Objective : When a cesarean is necessary, it can be a life-saving technique for both mother and infant. In recent twenty years, the cesarean childbirth rate has increased dramatically. Moreover a cesarean costs nearly twice as much as a vaginal birth. The world Health organization states that a cesarean rate greater than 10-15% cannot be justified. The aim of this study was to determine the cesarean rates and its indications in social security hospital of Ardabil.

 Methods: In this cross-sectional study was conducted all of the deliveries (both cesarean and normal delivery) in Ardabil social security hospital were investigated using a questionnaire including the characteristics of indication. The data were analyzed using SPSS software.

  Results : 45.4% of the deliveries were done using cesarean and 54.6% of them with a normal procedure. 55.8% of all the cesareans had an accepted indication. 44.2% of cesareans were controversial or elective, 22.7% were repeated cesarean, 8.4% were breech presentation and 2.3% were golden baby and 10.8% of the cesareans did not have a clear indication.

 Conclusions: The cesarean section rates in this study were higher than world rates. As a result the rising cesarean birth rate must be stopped and reversed with health interventions.

  Background & Objective : Regional anesthesia is a method of choice in cesarean section. But in emergency cesarean sections general anesthesia is usually preferred. On the other hand, intravenous sedative drugs used in general anesthesia induction rapidly crosses the placenta and result in fetal depression. Because of higher prevalence of general anesthesia in Iran it is reasonable to conduct more researches in this field. This study set out to compare the effects of Propofol and Thiopental-Na as induction agents on the neonatal Apgar score and maternal hemodynamic status.

  Methods: In this double blind clinical trial 60 pregnant women with ASA class I & II were studied. In a random way 30 patients received 2mg/kg Propofol and the rest of them were given 4mg/kg of Thiopental-Na. All these subjects had full term and normal fetus. Pre and post-induction status of the patients was monitored noninvasively after tracheal intubations and during 12 minutes after that. Also time intervals between induction and birth (cord clipping) and between uterus incision and birth were measured. Apgar score of neonates was evaluated through clinical examination in 1^st, 5^th, 10^th and 15^th minutes after birth. The data were analyzed in SPSS software using descriptive and analytical statistics such as T-test, chi-square and ANOVA.

 Results: Apgar score in different times (1.5,10&15 minute) had no significant difference between two groups. (In the 1^st minute Propofol was 7.1 ± 2.2 and Thiopental was 74 ± 1.8, in the 5^th minute Propofol was 9.2 ± 0.7 and Thiopental was 9.1 ± 0.9) Maximum variation of heart rate and blood pressure in two groups were not significantly different. The time intervals between induction and birth (less than 8 minutes) on the one hand and uterus incision and birth(less than 130 seconds) on the other were similar in two groups.

  Conclusions : Thiopental-Na and Propofol can be used with similar results for induction of general anesthesia in cesarean section.

  Background & Objectives: Cesarean section is one of the most common surgeries in women. In developed countries the rate of cesarean section is reported to be 21.2%. In Iran, the rate of cesarean section is even higher than the international norms. In a study in Ardabil, in 2001, cesarean section rate came out to be 42.86%. Postoperative pain after cesarean is one of the complications that all mothers experience in one-way or another. Besides bothering mother it can disorder newborn feeding, ambulation of mother and bonding between newborn and mother if it is not controlled effectively. This study was conducted to compare the effect of intramuscular Methadone and Diclofenac suppository for pain relief after cesarean section in Alavi hospital, Ardabil.

  Methods: This study was a double blind clinical trial. 56 women who experienced cesarean section for the first time were randomly divided into two groups. Diclofenac suppository (100 mg every 8hr) was given to first group and Methadone (5 mg every 8hr) was injected to the second group for 24 hours. Then, the severity of pain was measured with numerical scoring in serial postoperative visits. The data were analyzed by SPSS software using descriptive and analytical statistics such as chi-square and ANOVA.

  Results: The findings indicated that the severity of pain in 2^nd, 3^rd and 4^th postoperative visits was significantly lower in patients who received Diclofenac suppositories than the other group (p<0.05). But overall, there was no statistically significant difference between the pain severity in Methadone receiving group (Mean & SD= 5.85 ± 3.5) and Diclofenac receiving group (Mean & SD= 6.46 ± 2.9).

  Conclusion: There was no significant difference between Diclofenac suppository and Methadone in terms of decreasing the postoperative pain after cesarean section. However, regarding the restrictions in the use of opioids, Diclofenac can be a suitable replacement for these drugs.

  Background & Objectives: Nitroglycerin is found to have vasodilatory effect. It has also a relaxing effect on the smooth muscles of other organs including uterus. This study investigates the effect of intravenous nitroglycerin in emergency cesarean sections in which rapid and transient uterine relaxation for rapid and nontraumatic extraction of the fetus is necessary.

  Methods: Sixty pregnant women who were candidated for emergency cesarean and needed rapid uterine relaxation for different reasons were selected. These subjects underwent spinal anesthesia and at the time of uterine incision, 100 micrograms of nitroglycerin was injected to them intravenously. The time lapse between nitroglycerin administration and fetal extraction, the degree of uterine relaxation, the amount of intraoperative hemorrhage, uterine tone after fetal delivery and APGAR scores of the infants were all controlled and recorded. Also with regard to the vasodilatory effect of nitroglycerin and probably its resultant homodynamic problems, blood pressure, heart rate and arterial O₂ saturation were recorded before and after nitroglycerin injection and throughout the surgery.

  Results: The results showed that in 53 (88.3%) of the patients the uterus was acceptably relaxed and the fetus was delivered very easily. Only in 7 patients (11.7%) uterine relaxation was not acceptable. The mean decrease in systolic and diastolic blood pressures after nitroglycerin administration compared with before injection BP was 12.97 mmHg (12.210 %) and 7.86 mmHg (12.208 %), respectively. There was not seen any prolonged effect of the drug such as uterus relaxation tone or abnormal bleeding. Also, none of the delivered infants had low APGAR scores. Besides, in patients with acceptable uterine relaxation the first and fifth minute APGAR score of infants were higher (p = 0.008, p = 0.000).

  Conclusion: This study shows that nitroglycerin can relax uterine smooth muscles very rapidly and transiently and in emergencies it can be an appropriate alternative to the other tocolytic agents with prolonged effect or onset time.

  Background & Objective: Flatulence is one of the most common postoperative disorders, which leads to abdominal distension, respiratory disorders and the openning of sutures. Some of the drugs used to alleviate the abdominal flatulence are associated with complications and harmful effects, which gives us a hint to adopt herbal medicine. The present study investigates the effect of supermint on the flatulence intensity after cesarean section.

  Methods: This double-blinded clinical trial study was conducted on 107 women (47 cases as placebo group and 60 cases as drug group) who had cesarean section in shahid Mobini hospital, Sabzevar. After stopping the administration of IV fluid, the subjects in both groups received 40 drops of drug and placebo every 20 minutes for 3 days.

  Results: The intensity of flatulence in the first 20 minutes (p=0.042), in second 20 minutes (p=0.001), in the third 20 minutes (p<0.001) and 120 minutes after intervention (p<0.001) was lower in drug group compared to before intervention.

  Conclusion: Supermint is effective in reducing the postoperative flatulence in cesarean section and is recommended to be used in these cases.

  Background & Objectives: Respiatory Distress Synderome (RDS) is one of the major risks of elective cesarian section whose negative health and econemical outcomes are obvious. Maternal prophylactic injection of corticosteroid drugs can reduce RDS of neonate to some extent. On the other hand corticosteroid drugs have some side effects such as delay in the healing of the incision. This study considered the effect of betamethasone on surgical incision.

  Methods: This study was conducted on 60 primipara women divied into two equal groups that were candidate for elective cesarean. We injected betamethasone (IM) to trial group twice 48 hours poior to operation, (every 24 hours) and complication of surgical incision was clinically evaluated within 7 days after operation in both groups. The data were collected and analyzed by SPSS software chi-square and Fisher tests.

  Results: Most patients (60%) were 20-30 years old and the average age in both groups was 21. The relative frequency of patients with complication of surgical incision in trial group (betamethasone recipients) was 30% and in control group was 23.33% (the difference between them was not statistically significant). The most common complications were erythema and hyperemia. Other complications observed in 15% of the patients included serousal discharge, local warmness and enduration. Rgarding these complications also there wasn’t a statistically significant difference between two groups.

  Conclusion: Betamethasone does not increase early onest complications of surgical incision and we can safely use betamethasone prophylactically for fetal maturion in elective cesareans.

 Background & Objectives: Ceasarean section (CS) has increased in rate during the past years. Due to postoperative complications, long recovery time and high costs of surgery, normal delivery is recommended as a routine method. Regarding the increase in the number of CS and its acceptability on the part of the public, it seems that women’s as well as health personnels' attitudes play an effective role in selecting the termination method. The aim of this study was to evaluate and compare pregnant women’s and health personnels' attitude toward termination procedures.

 Methods: This was a descriptive and comparative study. 84 health personnels and 300 pregnant women who referred to Ardabil health centers in 2002 were selected. These subjects' attitudes were collected through Likert questionnaire and the collected data were analyzed by SPSS, using t-test.

 Results: The findings showed that 30.1% of women and 50% of health personnels had positive attitudes towards normal delivery. The findings also indicated that there was a significant difference between pregnant women and health personnels in their attitudes toward normal delivery and cesarean (p=0.001).

 Conclusions: Since health personnels had a more positive attitude towards normal delivery than pregnant women did, it seems that the young as well as the pregnant individuals in society need more education and awareness to be able to change their attitudes towards delivery methods. Health personnel, due to their high positive attitude towards normal delivery, can play a more beneficial role in this regard.