Journal of Obstetrics, Gynecology and Cancer Research
Volume:6 Issue: 1, Winter 2021

In all cancers, the tendency for conservative treatment is on the rise. There are several options for fertility-sparing in cervical cancer including: a) Conization, b) Simple trachelectomy, c) Radical Trachelectomy including: Vaginal, Abdominal, Laparoscopic and Robotic.In conclusion, in young women with cervical cancer, fertility-sparing should be considered. In Conization is done in Stage 1A1 cases without LVSI. Conservative Surgery can be performed in stage 1B1 and 1A2 (Trachelectomy).MRI should be done in the early-stage cervical cancer before fertility- sparing.

  Persistent ectopic pregnancy (PEP) occurs due to incomplete removal of trophoblastic tissue during tubal pregnancy surgery treatment. If PEP is not diagnosed and treated in time, it can have high mortality and morbidity. This study aimed to evaluate the efficacy of methotrexate (MTX) administration in the prevention of PEP after linear laparoscopic salpingostomy in tubal pregnancy.

This randomized clinical trial study was conducted on 140 subjects with a diagnosis of unruptured tubal pregnancy, who were randomly divided into intervention and control groups. While the intervention group underwent a prophylactic injection of 50 mg MTX, the control group did not receive any dose of MTX. PEP was considered if there was an increase in serum BHCG levels or a decrease of less than 20% in serum BHCG levels.

There was no significant difference between the intervention and control groups in terms of baseline variables such as age, severity, parity, and gestational age. While in the intervention group only one patient (1.4%) had PEP, in the control group 11 (15.7%) patients had PEP (P=0.003).

MTX administration seems to be an effective method in preventing PEP after linear laparoscopic salpingostomy in tubular pregnancy.

This study aimed to assess the effect of betamethasone on neonatal and maternal complications of late preterm labor.

The women at the gestational age of 34 weeks to 36 weeks and 6 days who referred to Shahid Motahari Hospital, Urmia, Iran for premature labor or had a maternal indication of pregnancy termination were selected for this study. The participants were classified into the case group receiving two doses of 12 mg intramuscular betamethasone every 24 h or the control group who did not receive betamethasone. The incidence of respiratory distress syndrome (RDS), need for mechanical or noninvasive ventilation, days of stay in Neonatal Intensive Care Unit (NICU) or Neonatal Ward, umbilical arterial blood gases, maternal hyperglycemia, and wound infection were evaluated.

A total of 200 pregnant women were enrolled with a mean age of 27.06±6.55 years. Out of 200 neonates, 52 cases had RDS of which 21 received betamethasone. The first-minute Apgar score was 6.96±0.75 in the control and 7.57±0.67 in the case groups (P<0.001). The incidence of RDS, need for surfactant administration, noninvasive ventilation, and days of stay at NICU or Neonatal Ward were significantly different between the study groups. However, because of the low number of cases (2 cases), we did not find a significant difference in the need for mechanical ventilation between the two groups (P=0.041). There was maternal hyperglycemia in 65% of women in the test group.

Administration of betamethasone in late premature pregnancies can be effective in the reduction of neonatal complications without any increase in maternal complications.

This study aimed to examine the extent to which postcoital bleeding (PCB) can be a predictive factor for cervical cancer.

In this observational study we selected and evaluated 280 females with PCB referred to Kowsar Hospital of Qazvin, Iran from 2017 to 2019.

Among the 189 patients diagnosed as normal in their Pap smear results, one patient had cancer in her biopsy results. A closer look at the biopsy results of the patients showed 45 patients as normal, 64 patients with cervical infection, 31 patients with polyp cervix, 45 patients with cervical intraepithelial neoplasia 1 (CIN 1), and one patients with squamous cell carcinoma (SCC). Among 63 patients diagnosed with atypical squamous cells of undetermined significance (ASCUS), three showed CIN 2 and CIN 3 in their biopsies. Furthermore, out of 21 patients with low-grade squamous intraepithelial lesion (LSIL), three patients had CIN 2 and CIN 3, one patient had carcinoma, and one had SCC. In addition, all of the patients with high-grade squamous intraepithelial lesion (HGSIL) were diagnosed with CIN 2, CIN 3, and SCC.

Because of the higher rate of cervical cancer in women with PCB and inconsistent screening programs in developing countries, it is essential to carefully consider the symptoms of PCB despite having a normal Pap smear.

Maternal serum levels of the first- and second-trimester markers for aneuploidy have been revealed to be associated with adverse pregnancy outcomes in the absence of neural tube defects or aneuploidy. This finding can guide clinicans for early diagnosis and management of such outcomes. However, previous finding are conflicting in this regard. Therefore, this study evaluated the detection of adverse pregnancy outcomes by first- and second-trimester serum screening analytes.

Methods & Materials:

 We prospectively recruited 972 females who underwent first and second-trimester aneuploidy screening. We gathered information on maternal demographic characteristics and serum biomarkers (free B-hCG and PAPP-A for the first-trimester; AFP, Β-hCG, Inhibin-A, and unconjugated estradiol for second-trimester). At the end of the study, adverse pregnancy outcome was recorded.

Abnormal screening results were reported in 34 (3.5%) patients. Two groups were significantly different in maternal age, BMI, and gestational period (P=0.017, 0.003 and 0.021, respectively). Among the measured adverse outcomes, preeclampsia was significantly more prevalent in the case group (P<0.0001). Abnormal levels of Inhibin-A is associated with the incidence of preeclampsia (RR: 29.87, CI: 13.22-67.49, P<0.0001). Additionally, patients with an abnormal level of Inhibin-A had a shorter gestational period (255.5 ± 24.53 vs. 264.79 ± 8.99, P=0.006). Likewise, patients with an abnormal level of maternal serum alpha-fetoprotein (MSAFP) had a shorter gestational period (252.0 ± 29.3 vs. 264.8 ± 8.93, P=0.001).

First- and second-trimester maternal serum biomarkers could provide a possible screening tool for early detection of preeclampsia.

Gestational hypertension (GH) is considered as one of the important health-related issues of pregnant women. One of the raised problems in the pathogenesis of GH is obstructive sleep apnea (OSA). This study aimed to evaluate associated factors of OSA among an employed pregnant population.

In this study, 200 employed pregnant women with GH as the case group and 200 healthy pregnant ones as the control group were enrolled. Blood pressure >140/90 after 20 weeks of gestational age without proteinuria was defined as GH. Chi-square and Mann-Whitney tests were applied for statistical analysis.

Mean ± SD of age and body mass index (BMI) were 32.85 ± 5.45 (years) and 31.85±5.97 (kg/m2) among the case group, respectively. Participants with GH had higher mean BMI, neck circumference, and more frequency of snoring than the control group, which was statistically significant (P<0.012, P<0.025, and P<0.007, respectively). Sales and service occupations consisted the group with the highest frequency of GH.

Participants with GH had higher BMI, snoring, observed apnea, and neck circumference. This observation warrants comprehensive assessment of OSA and related risk factors among patients with GH.

Choriocarcinoma is the most aggressive kind of gestational trophoblastic neoplasia (GTN). Although the risk of brain metastasis in GTN is rare, in patients with choriocarcinoma, the incidence of brain metastasis is 11%. In this paper, we reported a case of choriocarcinoma with brain metastasis, which was successfully treated with an etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine (EMACO) regimen.

A 34-year-old woman was presented with vaginal bleeding, dyspnea, and moderate abdominal pain. She had a menstrual delay of about two weeks. She had a primary β-human chorionic gonadotropin (β-hCG) of 132 600 mIU/mL. On lung computed tomography (CT) scan images, a metastatic lesion with a size of 68×50 mm was observed in the lower lobe of the left lung. The patient underwent dilation and curettage (D&C) that revealed choriocarcinoma. Brain magnetic resonance imaging (MRI) also showed a small metastatic mass with a size of 7 mm at the right occipital lobe. The patient was started on chemotherapy with an EMACO regimen. The patient’s β-hCG decreased continuously, and it was negative after the fourth cycle and six sessions of radiotherapy. It also remained negative six months after chemotherapy. The final examinations of the patient had no abnormal findings.   

Brain metastasis may be relatively asymptomatic in patients with choriocarcinoma, and it should be considered by physicians, even when there are no neurological symptoms. Also, the EMACO regimen seems to be an appropriate regimen for the treatment of metastatic choriocarcinoma.

Vulvar Paget’s disease is rare among patients with vulvar cancer. Commonly, this disease is presented in the vulva and seen in postmenopausal women. In this study, we reported five cases of vulvar Paget’s disease referred to Bahman Hospital, Tehran, Iran, from 2013 to 2019. The median age of patients diagnosed with Paget’s vulvar disease was 56.2 years (ranges from 52 to 62 years); the oncology history of patients was negative. All patients underwent surgery, including wide local excision, hemivulvectomy, and bilateral vulvectomy. The invasive disease was observed in three patients. Surgical margins in three patients were involved by Paget’s disease, and one recurrence (25%) was observed. Paget’s disease should be diagnosed and treated by surgery as soon as possible to avoid worsening the prognosis of patients and recurrence.