Backround In the developing countries millions of women in the reproductive age who don’t use contraceptives prefer to postpone or limit their birth. Unmet for family planning is defined as percentage of all fecund women who are married or living in union thus presumed to be sexually active but are not using any method of contraception, either do not want to have more children or want to postpone their next birth for at least two more years or do not know when or if they want another child. Objectives. 1. To determine use of contraceptive 2. To estimate the unmet need for family planning. 3. Determined factors affecting unmet need for family planning Methods. A community based survey was carried out in the selected Darkhan-uul aimags and 3 soums Orkhon,Shariin gol , Khongor. The survey was conducted among randomly selected 118 disadvantaged women in the study sites. Unmet need for family planning- the number of women with unmet need for family planning expressed as a percentage of women of reproductive age who are married or in union. Unmet need refers to women and couples who do not want another birth within the next two years, or ever, but are not using a method of contraception. Results There were in total 118 disadvantaged women participated in survey. Regarding highest education level 49.3 percent of women had complete secondary education and non complete secondary, one fifth (21.2 percent) primary education while 9.3 percent of them did no education at all. Few women had technical/vocational (10.2 percent) and high (7.6 percent) education.Many women (52.5 percent) were unemployed, 2.5 percent were herders and 26.3 percent were workers. The mean of household’s total monthly income was 164300 MNT ranging from 21,000 MNT over 20000 MNT in regions determined in 2014 by the National Statistical Office. Seventy point three percent of women were living in the household with monthly income of less than 100,000 MNT 46.6 percent or 118 disadvantaged women reported that they currently are using some methods of contraception. Out of the 118 disadvantaged women, 67 women (62.4 percent) were married. One third of the married women (61 percent) were not using any contraceptive methods. Thus the Unmet need for family planning among disadvantaged women was calculated = (8+17)/67= 37.2% Determined factors affecting unmet need for family planning, women education < secondary level (OR= 7.8 ; CI 5.6-10.7 P<0.00), housewife (OR= 3.9 ; CI 1.9-6.8 P<0.00), monthly household income is less (OR= 8.1 ; CI 5.1-11.1 P<0.00) . Conclusions 1. Many women reported that they are poor and very poor and most of them were living in the households with monthly income of less than 100,000 MNT. 2. Contraception use rate among disadvantaged women was 46.6 percent. 3. The estimation of unmet need for family planning among disadvantaged women was 37.2 percent. 4. Impact factor is unmet need for family planning, women education < secondary level (OR= 7.8 ; CI 5.6- 10.7 P<0.00), housewife (OR= 3.9 ; CI 1.9-6.8 P<0.00), monthly household income is less (OR= 8.1 ; CI 5.1-11.1 P<0.00) .

Background: Choriocarcinoma 15-20 new cases per year diagnosed at National Cancer Center of Mongolia. Due to insufficient necessary new drugs for choriocarcinoma patients, cancer center cannot provide the most useful treatment EMA/CO so patients were treated MAC or metothrexate, Adriamycin and cyclophosphamide. The outcomes of patients with choriocarcinoma treated with combined chemo drugs never been studied in Mongolia. Goal: To evaluate the results of combined chemotherapy in choriocarcinoma at National Cancer Center of Mongolia. Methods: Retrospective cohort review of 42 patients with choriocarcinoma who treated with MAC combination chemotherapy at NCC of Mongolia during 2004-2007. Based on MAC ppatients charts we evaluated clinical characteristics, level of HCG during treatment cycles, ultrasound changes and other lab tests. Results: We treated 42 patients with choriocarcinoma from 2004 through 2007. All patients were treated with MAC combination chemotherapy at NCC. The number of cases with choriocarcinoma is increasing in each year. 37.5% of these patients were aged between 30-34 years old, so it shows maximum incidence occurs during child bearing years. The most common clinical characteristics were 44% bleeding, 32% lower abdominal quadrant pain related to disease stages, 36% cough, and 28% fever. Out of 42 patients 35% of them had lung metastasis which was significantly different than other gynecological cancer metastasis. Conclusion: MAC combination treatment offers long-term disease-free survival and potential cure in patients with choriocarcinoma. The reported median survival in these group patients is 5 years. Importantly, 56% of patients were lived up to 5 years in remission.

Introduction:Prelabor rupture of membranes is defined as spontaneous rupture of membranes with no contractions and it is increased for serious maternal and fetal risk, as a inter and postpartum infections, dysfunctional labor, and the need for operative delivery. Prelabor rupture of membranes occurs in approximately 10 % of pregnancies, of these, approximately 90% in term parturiuents.Goal: To evaluate management of delivery with PROM in term labour.Materials and Мethods:The retrospective and prospective evaluation of 672 and 144 case series of women with PROM was done in First Maternity Hospital and DTC in Dornod Province. All medical records were reviewed by prestructured questionnaire consisting of 12 groups and analysed by descriptive and logistic regression.Results: The mean age of study subjects was 27.81 (SD 5.563) and the incidence of PROM was 11.3% and from them 69,1% were delivered vaginally and 31,9% by C-section. Induced labor the vaginally delivery was 87.8% and of them 33% use epidural anaesthesia and 50.3% of cases were women with unfavourable cervix. Conclusions: In women with PROM at term delivery to induct the labor with mizoprostol was more effective when use the regime by the guideline ‘’Management complication pregnancy and child birth’’. The positivie correlation was observed between induction of labor and cervical ripining scores (P<0.01).

Introduction: Sexually transmitted infections (STIs) are common in the developing countries. Sexually transmitted infections are among the most important causes of spontaneous abortion, premature rupture of membranes, preterm delivery, stillbirth, low birth weight, neonatal infection and postpartum endometritis and a major public health problem in the world.Goal: The goal of this study is to search peculiarity of delivery in women with STI.Materials and Methods: This study is a prospective cohort study which was done 2009-2010. In this study 120 pregnant women were involved. In case group were attended 60 women with STI and 60 women without STI in control group. The 40 pregnant women of case group (I group) were done treatment of STI and 20 pregnant women of case group (II group) were not done treatment of STI. All women were diagnosed with STI including syphilis, gonorrhea, Chlamydia and trichomoniasis. Statistical analysis has been done by SPSS 13.0 programm.Results: Mean gestational age at the first antenatal visit in I group was significantly earlier than in group II (13.5±4.5 weeks and 18.8±7.2 weeks respectively; p=0.005) but was similar to that of control group (13.6±5.2 weeks; P not significant). The frequency of preterm delivery and PROM was significantly lower in group I (12.5%, 17.5% respectively) than group II (30.0%, 40.0% respectively). In terms of II group preterm delivery and PROM were from 4 to 5 times more in comparison to control group. Low birth weight was significantly lower in women of group I (17.5%) than group II (30.0%; p=0.04) and in group II was 3 times more in comparison to control group(11.7%; p=0.008). Conclusions: The frequency of premature delivery, PROM, low birth weight were higher in the pregnant women who untreated STI. The first pprenatal visit is late and prenatal care inadequate were cause untreated in the pregnant women with STI.

INTRODUCTION:Uterine leiomyomas are the common smooth muscle tumors of female genital tract. Usually theirdiagnosis poses no problem. On the other hand leiomyosarcomas are highly malignant tumors.Distinction between the two poses no problem if the leiomyosarcoma shows significant dysplasia,however at times it may become a serious problem to differentiate between leiomyoma and well–differentiated leiomyosarcoma. Under such circumstances the mitotic count per 100 high powerfields considered by many as the most important criterion of distinction.MATERIAL AND METHODS:To investigate the role of mitotic activity in the growth of uterine leiomyomas, the mitotic count per100 high-power fields and the relation of this to the patient’s age (30 to 54 years) were examined intissue sections of leiomyomas from 130 surgically removed leiomyomatous uteri.RESULTS:The mean mitotic count in submucosal uterine leiomyoma was significantly higher (42.3%) than thatof the other location such as intermural and subserosal leiomyoma. We found the highest mitoticcount in a leiomyoma at the late reproductive aged women (46.1%) at early secretory phase. But therewas not a statistical correlation between women’s age and mitotic activity of uterine leiomyoma.CONCLUSION:Increased mitotic activity in leiomyomas under the late reproductive aged women suggests that thegrowth of these tumors is affected by progesterone level

Background: Ectopic pregnancy accounts for 1-2 percent of all pregnancies and a certain proportion of maternal death. The incidence of ectopic pregnancies has seen more than 3-fold increase over the last 20 years. In 2004, around 70000 women in the United States were diagnosed with ectopic pregnancy and it is one for every 250 pregnant women². Ectopic pregnancy case in South Korea is 17.3 per 1000 pregnant women⁹. In Ireland, the prevalence of the ectopic pregnancy increased from 12.8 per 1000 births in 2005 to 17.1 per 1,000 births in 2016⁸. According to the MCHR study in Mongolia, 2.4% of total pregnant women was reported in maternal death. In Ulaanbaatar, 1.3% of the inpatient women were treated due to ectopic pregnancy and 33.7% of gynecologic surgical patients were women with ectopic pregnancy. In 2005, 171 women were hospitalized for ectopic pregnancy and this increased to 647 in 2015⁷. Incidence of ectopic pregnancy is increasing each year, but this type of comprehensive survey is not enough to provide a basis for selecting the subject. The objective of the study is to study the medical history of inpatient admissions with ectopic pregnancy, retrospectively. Methods: The present retrospective study was carried out through a retrospective database analysis. We studied each patient’s history; total of 615 cases of ectopic pregnancy hospitalized in the Urguu Maternity Hospital, using 5 sections of questionnaires with of 48 questions, between 1 January 2015 and 1 January 2016. We used the Statistical Package for the Social Sciences (SPSS) 20 for data processing and estimation of survey findings. Conclusion As a result of this study, the highest rate of ectopic pregnancy is 3.8/100 and the highest incidence of ectopic pregnancy was found among women aged 25-35 years, the youngest patient was 19 and the oldest patient was 49, respectively. A 38.6% of women who diagnosed with ectopic pregnancies had to have abortions, 13% had miscarriage, 42.1% had history of vaginal surgery and 32.6% had history of uterine surgery which is most common causes of ectopic pregnancy.

Background: The average of cesarean has increased over the last 30 years in developed as well as in developing countries. During the last decade, cesarean surgery rates increased by 1 to 2 times. As of 2015, there were 80434 mothers gave birth nationwide. In Ulaanbaatar city, 267106 births were recorded, from which 14,327 (30.7%) was born with cesarean section. In 2015, 32.2% of all births born in Ulaanbaatar delivered by cesarean surgery, which is 2.5% higher than the previous year. The rate of cesarean surgery has increased dramatically, however, causes and complications are unclear and these subjects are rarely investigated, thus, we decided to study this important issue. Material and methods: The study was carried out through a retrospective design of descriptive statistics. Using cross-sectional study, we randomly collected data from the history of total of 5125 births recorded in the Urguu Maternity Hospital, in 2015 and 408 were selected. Data was collected by using 48 questions in 5 sections. We used the Statistical Package for the Social Sciences (SPSS) 20 for data processing and estimation of survey findings. Results: From the total of 408 women, who given birth by cesarean delivery, 50.2% done under cesarean surgery for the first time, 33.3% for the second time and 16.5% of them experienced with cesarean surgery 3 or more times. The impact of cesarean section on abortions was studied by comparing the rates of cesarean section compared to rates of abortion and we had revealed that 25.3% of cesarean surgery had an abortion once and 11.2% of them twice and 7.4% had 3 or more abortions. Conclusion Number of chances getting pregnant is age-related (p=0.001). Cases of first cesarean delivery have increased to 50.2%. The frequency of cesarean section and the number of pregnancies was statistically significant (p=0.001). According to the retrospective study of maternity history, 43.9% had abortions. There is an inverse correlation between the rates of cesarean section and rates of abortion (p=0.004). Combination of disorders of the organ systems do not affect the rate of the cesarean section (p= 0.941). Vaginal inflammation does not affect the frequency of cesarean section (p=0.237).

Aim was to investigate expression of tumor suppressor P53 gene, proliferating Ki-67 protein inordinary and proliferating uterine leiomyomato establish possible usefulness of these two parametersin distinguishing between ordinary leiomyoma and proliferating leiomyoma. Retrospective study of49uterine leiomyoma (25 ordinary leiomyoma, 24 proliferating leiomyoma) technically acceptable foranalysis from years 2010–2013 department of Obstetrics and Gynecology and department of Pathology,Mongolian National University of Medical Science, Ulaanbaatar, Mongolia.MethodAll tissue specimens were obtained from surgically removed tumors. Tissue was fixed in formalinand cut to thickness of 5 mm from paraffin-embedded blocks. All haematoxylineosin slides and allimunohistochemical slides for each case were reviewed by two experienced pathologist.ImmunohistochemistryParaffin-embedded tumor sections were deparaffinized and stained in automated platformDakoCytomationusing monoclonal mouse anti-human Ki-67 antigen (Dako,Glostrup, Denmark), monoclonal mouse anti-humanP53 protein (Dako, Glostrup, Denmark).Immunohistochemicalanalysis of P53 and Ki67 expression was performed. Every nuclei stained brown,regardless of shade intensivity, was considered positive. The interpretation of immunohistochemicalstaining was expressed as number of positive cells in 100 cell count in most active area of the slide.Non-parametric analysis of variance Kruskal-Walistest was performed.P53 expressionExpression of P53 was negative in 24/24 ordinary uterine leiomyoma, 2/10 mitotic activity leiomyoma,11/15 cellular leiomyoma. Expression of P53 in 1–10% of cells showed 3/10(30%) mitotic activeleiomyoma and 1/15(6.6%) cellular leiomyoma. Expression in 10-70% of cells showed 5/10(50) mitoticactivity leiomyoma, 3/15(20%) cellular leiomyoma. A significant difference in expression of P53 wasseen between ordinary and proliferative (mitotic activity and cellular) uterine leiomyoma (p<0.007, Table1).Ki-67 expressionExpression of Ki67 was negative in 20/20 (100%) ordinary leiomyoma, 4/11(36.3%) mitotic activityleiomyoma and 7/18(38.8%) cellular uterine leiomyoma. 1–10% of cells were positive in 4/11 (36.6%)mitotic activity leiomyoma, and 5/18% cellular leiomyoma. Expression was positive in 10-70%of cellsof 3/11(27.2%) mitotic activity leiomyoma and 6/18(33.3%). Statistically significant differences in Ki67expression was found between ordinary leiomyoma and proliferating leiomyoma (p<0.014, Table 2) andbetween LM and LMS (p=0.000, Table 1).Conclusion:The findings of our study in concordance with other study results are helpful information establishingmore diagnostic criteria and parameters for diagnosis in doubtful cases between two entities.Immunoassaying for Ki-67 and P53 are such parameters. The panel of their expression in specific caseeases diagnosis.

Background: Endometriosis is a condition in which cells in the endometrium, layer of tissue normally covers uterine cavity, which grows outside to ovaries and other pelvic organs [1-4]. That may happen chronic pelvic pain, adhesion and pelvic organs dysfunction which leads to infertility later life [1-4]. In worldwide, 19-45 aged women have endometriosis, which is counted for 176 million, from 44% women have ovarian endometrioma [5]. In our country, 56% women received laparoscopic surgery due to ovarian cysts, which is diagnosed endometrioma. In recent years, ovarian endometriosis treated by synthetic progestin, gonadotropin analogues, combined contraceptive pills, intra-uterine device containing with progestin, and non-steroid anti-inflammatory drugs and laparoscopic surgeries [6, 7]. Serum antimullerian hormone (AMH) is key marker to define ovarian reserve, which correlates ovarian number of antral follicle counts [6, 7]. Material and Methods: We studied 129 patients who has diagnosed with ovarian endometrioma, aged 20-46 years, using case-control study design. There are 4 groups with medication and surgeries.
Approval for the study was obtained from the review board and the ethics committee of MNUMS. All the recruited patients provided their informed written consents. Results: When treatment groups were compared, level of AMH before synthetic progestin therapy was 3.48±0.9 and after it 3.41±1.0 (p-0.456), and that was before non-steroid anti-inflammatory drugs 3.68±0.8 and after it 3.11±0.8 ng/ml (p-0.212). Before laparoscopic surgeries for severe endometrioma, average level of AMH was 2.3±1.8ng/ml for synthetic progestin therapy group and it was 1.68±0.2ng/ml (p-0.007) after surgical peeling of endometrioma. For patients of 4th group who had not taking oral synthetic progestin before laparoscopic surgeries average level of AMH was 3.11±1.88 ng/ml before surgery and it became 2.21±0.28 ng/ml (p-0.005). Level of СА-125 marker was before medical therapy for group 1 was 37,9±5,25 IU/ml and after therapy - 20,6±2,03 IU/ml. For group 2 it was 69,9±9,79IU/ml and 35.1±6.76 IU/ml respectively. Average level for group 4 before surgical treatment it was 96.6±36.6 IU/ml, and after surgery became 25.71±2.96 IU/ml, and that for group 3 was before surgery 102±29.1 IU/ml and decreased after surgery to 29.2±4.15 IU/ml.
There are significant reduction of pain in patients who received synthetic progestin (p=0.001) groups. Serum AMH were 3.48±0.9 before treatment and 3.41±1.0 after treatment respectively (p=0.456). Prior treatment of laparoscopic surgery with progestin 3 months, it decreases abdominal lower pain (p=0.001) and dysmenorrhea (p=0.001). Serum AMH level were 3.11±1.8 before surgery and 2.21±0.2 after surgery,respectively, (p=0.005). Conclusion
1. There were little decrease in level of antimullerian hormone and less risk for ovarian reserve when mild endometrioma was treated with synthetic progestin and non-steroid anti-inflammatory drugs in two groups.
When severe and middle degree of endometrioma was treated with laparoscopic surgery there were significant decrease of antimullerian hormone, but it was less in group that had synthetic progestin therapy before surgery and it was more effective that surgical therapy without preparation.
2. Comparison of Serum level of СА-125, marker of ovarian tumor, was decreased less in group of non-steroid anti-inflammatory drugs, and was decreased more or it was more effective.