International Journal of Women’s Health and Reproduction Sciences
Volume:9 Issue: 3, Jul 2021

Maternal mortality rate (MMR) in Indonesia was reported to be 305 per 100,000 live births. Preeclampsia is the first target to decrease because it is one of the preventable pregnancy complications. Currently, preeclampsia has patterns for treatment from early detection to delivery; therefore, reasonable chances of decreasing the MMR rapidly and significantly should be considered in Indonesia.

The reasons for choosing preeclampsia for reducing MMR included an early detection method, availability of affordable medication for the prevention of preeclampsia, development of a national guideline for medical practice regarding preeclampsia, establishment of health institutions by government and the private sector in remote areas, and availability of sufficient health personnel.

Early detection of risk factors of preeclampsia is of great importance. Recommended preventive medication includes a combination of acetyl salicylic acid and calcium for 12 weeks for a high-risk group. National guidelines for the management of preeclampsia should be distributed to all hospitals including those covered by national health insurance.

The goal of zero mother mortality preeclampsia program is to make policies for all health workers and the general public so that the prevention process can take place. Delivery of all cases with hypertension should be performed in the hospital without exception so no delivery should be performed at home without specialist supervision.

Polycystic ovary syndrome (PCOS) is the most common cause of female infertility. The aim of this study was to compare the oocyte and embryo quality between the PCOS women with the control group candidate for in vitro fertilization/ intracytoplasmic sperm injection (IVF/ICSI).

The present study was designed at the Infertility Research Center of Milad in the prospective cohort format and was carried out on 100 cases of infertile women with confirmed PCOS (case group) and the male factor (control group) as the first IVF cycle candidates. Both groups underwent the ovary stimulation cycle and ICSI under the standard antagonist protocol. The collected data were then processed and analyzed using the SPSS software, version 16.

The average age of study cases was 35±3, and oocyte necrosis was the underlying pathological factor in both groups (28% and 26% in the PCOS and control groups, respectively). In addition, most embryones belonged to either grade 1 or 2 or were 8-cell embryos. Furthermore, the highest number of transferred embryos among the patients was related to the 8-cell and grade 1. The occurrences of biochemical pregnancy in the PCOS and control groups were up to 31.91% and 22%, respectively, leading to 72.73% and 60% childbirth in cases of both groups. Finally, there were no significant differences observed with respect to the quality and the quantity of the embryones, the oocyte, the transferred embryo, the germinal vesicle oocytes, and the rate of pregnancy among the two groups (P>0.05).

According to the results of the present study, no differences were found concerning the oocyte quality, embryo, and the pregnancy rate between PCOS cases and any other patients requiring ICSI. Therefore, such cases can similarly benefit from ICSI methods as well.

Intravenous (IV) oxytocin during vaginal delivery has been rarely used since an intramuscular (IM) route or IV infusion have been preferred in this regard. The trial aimed to compare the low-dose IV bolus 3 IU of oxytocin, along with 7 IU oxytocin infusion with 10 IU oxytocin infusion in cesarean section.

A parallel control randomized study was conducted on a total of 320 consenting term pregnant women based on the inclusion criteria. The participants were randomized into either 3 IU IV bolus and 7 IU infusion of oxytocin or 10 IU of IM oxytocin following vaginal delivery. The difference in pre- and post-delivery hemoglobin (Hb) levels, tone of the uterus, hemodynamic changes, adverse effects of the drug, and the need for additional uterotonics and blood transfusions were assessed based on the aim of the study.

Based on the results, more women with severe blood loss were found in the IM oxytocin group in comparison to the IV bolus with infusion group following vaginal delivery. In addition, more women had a drop in the Hb of 3 gm/dL in the IM oxytocin group compared to the IV bolus-infusion group (11% vs. 4%, odds ratio=0.768, P=0.469) although there was no statistical significance in this respect. The tone of the uterus was firmer in the IV bolus with infusion group at 3 and 5 minutes. Eventually, the difference in hemodynamic changes, side effects, and the need for additional uterotonics or blood transfusions was not significant.

In general, an IV bolus of 3 IU with a 7 IU infusion of oxytocin is as safe as and more effective than the IM injection of 10 IU of oxytocin at the time of vaginal delivery for the prevention of postpartum hemorrhage.

Teenage pregnancy has generated much interest in Obstetrics practice due to increasing risk to the baby and the mother. In this regard, this study was done to ascertain its incidence, obstetric risk, and outcomes.

This study reviewed the obstetric data sheets of all teenage pregnancies managed between January 2013 and December 2017 at the Benue State University Teaching Hospital, Makurdi, North -Central, Nigeria.

Teenage deliveries included 43 cases constituting 2.06% of the total 2084 deliveries within the period. The mean age (SD) was 17.88 (±1.77) years. The commonest antenatal complications were malaria (39.5%), anaemia (37.2%), and hypertension in pregnancy (20.9%). The augmentation of labour was done for 16 parturient mothers (37.2%) and 16.3% had the induction of labour. The caesarean section rate was 16.3% and it was mostly related to obstructed labour (47.1%). In addition, episiotomy was done in 11.6% of parturient mothers and 46.5% had perineal tear. There were 37 live births out of which, 6 cases were neonatal admissions and 6 other cases were perinatal deaths. Finally, the perinatal mortality rate among the teenage deliveries was 139.5 per 1000.

The incidence of teenage births was 2.06% with associated obstetric risks and adverse pregnancy outcomes necessitating improved obstetric care during pregnancy and delivery.

This study aimed to measure the vascular endothelial growth factor (VEGF) expression in menstrual effluent from patients with endometriosis compared to non-endometriosis through immunocytochemical methods. We also measured the degree of pain level, endometrioma cyst size, and infertility status whether it is affected by VEGF expression.

The present case-control study was conducted in Hasan Sadikin General Hospital, Bandung. Thirty productive-age women diagnosed with endometrioma and 30 productive-age women without endometriosis as the control group were included in this study. Menstrual effluent was taken from the posterior fornix on the second day of menstruation and stained using immunocytochemistry staining for VEGF.

The results demonstrated a significant difference between the two study groups in terms of VEGF intensity and histoscore although no difference was found in VEGF distributions between the study groups. The subjects in the endometriosis group had significantly higher VEGF intensity and significantly higher VEGF histoscore compared to the control group. Women with VEGF histoscore more than 6 has 9.33 times risk of developing endometriosis compared to those with lower histoscore. There were no significant correlations between VEGF and pain scale, infertility, and the cyst size. Finally, the cyst size was proportionally related to pain.

VEGF distribution and expression in endometriosis women were significantly higher than VEGF levels in nonendometriosis women. Women with menstrual effluent containing higher VEGF levels had more chances of developing endometriosis compared to those with lower VEGF levels. Eventually, larger endometrioma size was proportionally related to higher pain levels in subjects with endometrioma.

Approximately one-third of women having breast surgery experience neuropathic pain although no study has so far identified its risk factors. It seems that the coronavirus infection increases the likelihood of neuropathic pain through influencing the neuropsychological system. Therefore, the current study aimed to investigate factors affecting the severity of neuropathic pain before and after coronavirus disease 19 (COVID-19) in patients who had breast cancer surgery.

The current descriptive-analytical study was conducted six months before June 4, 2020. In total, 40 women having breast surgery participated in this study. Postoperative neuropathic pain and its influencing factors were evaluated using demographic tools, Spielberger anxiety, and a 36-item short-form health survey for measuring the quality of life (QoL). Finally, data were analyzed by multivariate regression.

Neuropathic pain significantly increased during the COVID-19 pandemic. Mastectomy (P=0.009), removal of lymph nodes (P=0.011), number of radiotherapy sessions (P=0.003), history of chemotherapy (P=0.009), disease stage (P=0.015), hidden anxiety (P=0.005), and explicit anxiety (P=0.001), and all domains of QoL (P<0.05) significantly predicted neuropathic pain.

In general, adverse effects of coronavirus pandemic reduced the QoL while increasing anxiety (hidden and explicit), thus leading to an increase in the severity of postoperative neuropathic pain.

It is necessary to prevent postoperative infection following abdominal hysterectomy. The present study aimed to assess the relationship of anthropometric indices with vitamin D, zinc (Zn), and fasting blood sugar (FBS) levels in women with and without infection following abdominal hysterectomy in order to determine the exact effects of these factors on infection.

This case-control study was conducted in three teaching hospitals affiliated with Tabriz University of Medical Sciences in an 18-month period leading up to 2020. The participants consisted of 90 women who were candidates for abdominal hysterectomy. Anthropometric indices and vitamin D, Zn, and FBS levels were measured before the surgery. These factors were compared in the two groups of women with and without infection using the independent t-test and Pearson correlation coefficient, and P<0.05 was statistically significant.

No significant relationship was found between vitamin D, Zn, and FBS levels and anthropometric indices except for body mass index (BMI) that had a significant negative relationship with vitamin D blood levels (r = -0.20 and P = 0.043) while a significant positive relationship with FBS levels (r= +30 and P = 0.036) in infected patients. Therefore, patients with a higher BMI showed lower vitamin D whereas higher FBS levels in the group with infection.

In general, vitamin D levels decreased and FBS levels increased by an increase in the BMI. These factors altogether increased the risk of postoperative infection following abdominal hysterectomy.

In this study, radical hysterectomy, followed by neoadjuvant chemotherapy (NACT) in patients with locally advanced cervical cancer (LACC) was compared with radical hysterectomy in patients with early-stage cervical cancer.

This retrospective comparative observational study was performed on 13 patients with LACC International Federation of Gynecology and Obstetrics (FIGO) stage IB2-IIB who underwent a radical hysterectomy after NACT between March 2014 and November 2018. This group was compared with 18 patients undergoing radical hysterectomy with cervical cancer FIGO stage IIA-IB1 in the same period of time.

In the NACT group, 8 (61.5%) and 5 (38.4%) patients were in stages IIB and IB2, respectively, and 13 (72.2%) cases were in the IB1 stage in the non-NACT group. Post-operative blood transfusion in the NACT group was significantly higher compared to the non-NACT group [5 (38.4%) patients versus 0, P = 0.008]. The estimated blood loss (EBL) and operative time were similar between the groups. Finally, there were no significant differences in terms of intra-operative and other post-operative complications.

Radical hysterectomy after NACT in women with LACC seems to be safe and reduces the need for radiation in patients with NACT who are at stage IIB. These results need to be confirmed in studies with a larger patient sample.

The aim of this study was to evaluate the protective effect of the hydroalcoholic extract of orange peel on proliferating cell nuclear antigen (PCNA) and follicle-stimulating hormone receptor (FSH-R) gene expression in histological injuries and acid stress caused by ovarian torsion in adult rats.

In this experimental study, 32 adult female rats were randomly divided into 4 groups. In group 1 (Sham), the abdominal wall was cut without applying torsion and in group 2, ovarian torsion was performed for 2 hours, followed by detorsion for 2 weeks. The hydro-alcoholic extract of orange peel was added to their diet for two weeks in group 3, followed by ovarian torsion for 2 hours and detorsion for 2 hours. Group 4 received the orange peel extract for two weeks and after then ovarian resection for the evaluation of histological damage and blood sampling to examine the serum level of antioxidant enzymes, as well as the expression of PCNA and FSH-R genes in the ovarian tissue.

Histological changes in the ovary tissue of rats showed that torsion and detorsion have destructive effects on the ovarian tissue, and torsion/detorsion led to a reduction in the expression of PCNA and FSH-R (P < 0.05). Based on biochemical and hormonal results, the ovarian torsion resulted in an imbalance in the oxidative stress markers and hormone profile of rats. Finally, the administration of the hydroalcoholic extract of orange peel due to its high antioxidant properties improves these effects.

In general, administering an appropriate dose of the hydroalcoholic extract of orange peel for two consecutive weeks in the diet had a protective effect on the ovarian tissue at the risk of torsion/detorsion

Tumor size and axillary lymph node (LN) involvement are used as prognostic markers and a guide for choosing adjuvant therapy. This study aimed to evaluate LN involvement and related risk factors in patients with breast cancer (BC) referred for radiotherapy.

Using the census sampling method, 15,000 women with BC referring for radiotherapy were enrolled in this retrospective descriptive study performed at Tabriz University of Medical Sciences during 2000-2020. LN involvement and related risk factors were recorded and analyzed using the t test and ANOVA test at a significance level of P<0.05.

The prevalence of LN involvement in this study was 25%. The estrogen receptor status and LN involvement were associated with metastasis. The odds ratio of metastasis in patients with a negative estrogen receptor was about twice that of women with estrogen receptor positivity. Finally, the risk of metastasis in patients presenting with LN involvement was eight times higher than that of patients without LN involvement.

In general, estrogen receptor status and LN involvement were associated with metastasis in patients with BC. Thus, these factors can be regarded as a guide to start necessary interventions earlier in at-risk patients.

The dynamics of blood flow in the endometrium plays a crucial role during the implantation process. This study aimed to assess the uterine perfusion during the follicular phase in patients with a history of recurrent implantation failure (RIF) and healthy fertile women using the transvaginal ultrasound color Doppler method.

To this end, 50 patients with RIF and 50 age-matched healthy fertile women were recruited in this casecontrol study. The transvaginal color Doppler ultrasonography was used to evaluate the pulsatility index (PI) and resistance index (RI) of the uterine, arcuate, and sub-endometrial arteries during the follicular phase in both groups.

The RI and PI of both right and left uterine arteries were higher in the RIF group compared to the fertile women (P<0.05). Our results showed that the PI and RI of sub-endometrial blood flow and the RI of arcuate arteries were substantially higher in the group with a history of RIF in comparison with the control group. However, the PI of arcuate arteries was not significantly different between the groups.

Adequate uterine perfusion and sub-endometrial blood flow are necessary to achieve successful implantation and pregnancy since our results demonstrated the higher resistance of uterine and sub-endometrial arteries in patients with a history of RIF. Thus, the assessments of uterine perfusion indices during the follicular phase could be used as a non-invasive method in the evaluation of patients with RIF.

An abnormal passage connecting the skin and the uterus is the uterocutaneous fistula. It is rarely observed after a cesarean section or a gynecological surgery involving the uterus. The presence of an infection further complicates the management. In countries such as India where tuberculosis is highly prevalent, Mycobacterium tuberculosis should be ruled out.

A 29-year-old nulliparous woman who had undergone a laparotomy for removal of a large fibroid for primary infertility presented with complaints of abdominal pain and discharge from the scar site. These symptoms did not resolve with antibiotics and analgesics. An ultrasonography was performed and a fistulous tract extending up to the endometrium was revealed. She underwent a laparoscopic resection of the fistulous tract following which she was symptom free.

One of the rarely observed complications following laparotomies and cesarean section is a uterocutaneous fistula. It is even rarer in women with no previous pregnancies. The management involves adhesiolysis and layer by layer closure of the uterus and abdomen wall after excising the tract. Most often a repeat laparotomy is performed to treat the condition, but in the current times it is well known that repeated open surgeries in the peritoneal cavity increase the chances of adhesions which can reduce the chances of pregnancies in nulliparous women. Hence, this article shows a successful outcome of laparoscopic uterocutaneous fistula repair.

Vaginal pessaries are commonly used to manage pelvic organ prolapse. Pessaries are usually tolerated although some severe complications can occur in cases of negligence, including vesicovaginal and rectovaginal fistulas.

This is a report of two cases of a neglected vaginal pessary and migration into the rectovaginal space to form a vaginal orifice. Based on examinations, no vaginal pessaries in both cases migrated into the rectum. These pessaries were removed by cutting and rotating movements. Finally, the two patients were discharged after surgery without any complications.

Neglected pessaries can lead to serious complications. Thus, patient education, local estrogen treatment, and careful follow-ups are important to prevent such complications.