Journal of Obstetrics, Gynecology and Cancer Research
Volume:7 Issue: 1, Jan- Feb 2022

The coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a chief concern of the international community. As of May 2021, more than 150 million cases and 3.2 million deaths have been recorded. Considering the early struggle in treating COVID-19 patients, the researchers and clinicians have decided to try the previously available drugs according to their mechanisms of action. This article aims to review the potential drugs for COVID-19 patients during pregnancy and breastfeeding and their safety. PubMed and Scopus databases and Google Scholar engine were searched with the proper combination of the free keywords and MeSH Terms of COVID-19, SARS-CoV-2, Pregnancy, Breastfeeding, Treatment, Pharmacotherapy, Drug Therapy, and Drug Safety. All relevant clinical studies published until the end of 2020 were included in this review. Many antivirals, antibiotics, antiparasitics, and antipyretics have been proposed, but most of them are not registered for COVID-19 or have demonstrated little effect on the disease. Since there is still a long way to find an effective drug for the treatment of COVID-19, prevention is currently the most effective way. Also, prescribing drugs to these two groups of patients should be done according to the safety recommendations.

Concerns about adaptation to a new situation can cause anxiousness in pregnant women, which could lead to dangerous consequences. The aim of this study was to evaluate the severity of pregnancy anxiety in mothers with fetuses having cardiac anomalies and their association with birth outcomes.

A number of 50 pregnant women were enrolled as the accessible sampling. The diagnosis of congenital heart anomaly was considered in prenatal ultrasound screening (NT ultrasound and anomaly scan). The General Health Questionnaire (GHQ-28), Spielberger State-Trait Anxiety Inventory (STAI), Cambridge Worry Scale (CWS), and Pregnancy Concern Questionnaire (PCQ) were used to evaluate fear, concern and anxiety. Data were analyzed using Wilcoxon statistical test.

Six infants had fetal outcomes including low birth weight (IUGR). Fetal prematurity was observed in only one infant. The highest and the lowest levels of anxiety were reported before the echocardiography and within one week after the echocardiography. There was a significant difference between maternal general health score before and 5 days after echocardiography as well as 5 days after echo and 35th week of pregnancy (P<0.05). A significant difference between maternal general health score was observed before fetal echocardiography and at 35th week of pregnancy (P<0.05).

The results showed that mothers' anxiety increased significantly after the diagnosis of fetal cardiac anomaly. However, after fetal echocardiography and in the late pregnancy period, the anxiety level reduced in both stages. It was clear that receiving information about unhealthy fetus can cause significant anxiety in mothers.

One of the most common causes of maternal mortality in the first trimester of pregnancy is ectopic pregnancy (EP). Adenosine de aminase (ADA) plays an essential role in production, maturation and function of lymphoid cells, which is produced in all tissues of the body. Total serum adenosine deaminase levels decrease during normal pregnancy. Considering the importance of early detection of EP, this study aimed to investigate the relationship between adenosine deaminase and EP in pregnant women referred to Motahari Hospital in Urmia from 2017 to 2018.

This study consisted of two groups of patients including patients with EP as a case group and patients with normal pregnancy confirmed by sonography as a control group. The level of βHCG and serum ADA levels were compared in the two groups. P-values less than 0.05 were considered as significant.

In this study, 94 pregnant women were enrolled, including 47 patients as control group with normal pregnancy and 47 patients as case group with EP. The mean ADA level in patients with EP and the control group were 12.21±8.17 IU/L and 8.44±6.21 IU/L (P=0.01), respectively. The mean βHCG level in women with EP was 3215.60±1400.71 mIU/mL. In women with normal pregnancy, it was 11926.96±3408.23 mIU/mL (P=0.001).

High levels of ADA can be helpful in the early diagnosis of EP.

 Pain is the most common side effect of induced medical abortion. However, the optimal analgesia method remains as a clinical challenge. This study aimed to compare the efficacy of two methods of administration of diclofenac as a prophylactic or a therapeutic in pain management in induced second-trimester medical abortion. 

This randomized clinical trial study was conducted upon pregnant women who were candidates for induced medical abortion and referred to a tertiary educational hospital between October 2019 and December 2020. Participants were divided into two groups based on the mode of diclofenac administration, which was either simultaneously with the first dose of misoprostol or after beginning of the pain. Pain severity, induction-to-abortion time interval, total misoprostol dosage, Hemoglobin concentration, length of hospitalization, and size of retained pregnancy products by ultrasound, and the cumulative dose of opioid usage were compared between the groups.

The severity of pain which was measured by a visual analog scale (VAS), residual of conceived products, hospitalization days, and the total misoprostol dosage were significantly lower (P<0.05) in the prophylaxis compared to the treatment group.

Simultaneous administration of diclofenac with misoprostol as prophylactic method of pain management may be an optimal method in induced medical abortion in the second trimester.

Nucleated red blood cells (NRBCs) enter the circulation in response to hypoxia, but it remains unknown how physiological delivery without fetal distress can change the NRBC level. Accordingly, in the present study, we compared the mean NRBCs per white blood cell (WBC) in the umbilical cord of normal vaginal delivery (NVD) with cesarean section (C/S). To compare the mean NRBCs per WBC within umbilical cord in normal term newborns who were born by NVD with those delivered by C/S. 

This case-control study was conducted for 305 neonates in two different groups, i.e., NVD (case) and C/S (control) groups. The blood samples were taken from umbilical veins to evaluate fetal NRBCs and WBC count after recording their demographic characteristics. Finally, all data were assessed using SPSS 16.

The average age of mothers was 25.79±5.35 years. The average Apgar score of neonates was 8.23±0.6. The average NRBC count was 4.63±5.2. There was no significant difference in maternal age, parity, neonatal weight, and NRBC count per 100 WBCs between the two groups. 

In the present study, the mean NRBC count within the umbilical cord of neonates born by elective C/S was less than those delivered by NVD, although this difference was not significant.

Comparative study between laparoscopic and laparotomy scoring in patients with advanced ovarian cancer.

This prospective study included 27 patients with advanced ovarian cancer who underwent laparoscopy and laparotomy scoring at hospitals affiliated with Isfahan University of Medical Sciences (IUMS) during 2020 and 2021. The laparoscopic predictive index value (PIV) score (range: 0-14) was calculated for all patients. In patients with PIV scores <8, primary cytoreductive surgery (PCS) was performed, and patients with scores ≥8 were candidates for neoadjuvant chemotherapy (NACT). In the PCS group, laparotomy scoring and surgical findings for each anatomical area were registered for all patients, and concordance between laparoscopy and laparotomy findings was compared. Residual disease following PCS was documented for all patients.

A total of 27 patients underwent laparoscopic scoring surgery; 25 patients (92/5%) had a PIV score <8, and two patients (7/5%) had a PIV score ≥8. There was 92% agreement between PIV scores at laparoscopy and laparotomy. Agreements in different anatomical regions in laparoscopy and laparotomy were as follows: involvement of the bowel 76%, mesenteric 92%, liver 96%, omental 92%, diaphragm 96%, stomach 100%, peritoneal carcinomatosis 96%. A laparoscopic PIV score of <8 had a PPV of 84% at predicting R0 at PCS.

Laparoscopic scoring is a precise approach in the management of patients with advanced ovarian cancer. Laparoscopic scoring is a screening method of selecting patients for primary surgery or NACT and improved R0 resection at PCS. The present study was designed to assess patients who would gain the maximum benefits from primary surgery.

Adult granulosa cell tumors (AGCTs) are potentially malignant ovarian neoplasms with a well-known tendency for local spread and recurrence, years after prolonged follow-up. This study investigated the immunohistochemical (IHC) expression of SMAD3 (mothers against decapentaplegic homolog 3) in AGCTs to evaluate its association with a number of confirmed AGCT prognostic variables. Prognostic predictors of recurrence in AGCT were further defined.

Upon database search, the clinicopathological data, slides, and paraffin blocks of 35 AGCTs were retrospectively retrieved from archives, then examined histopathologically, staged, and stained immunohistochemically using anti-SMAD3. After H scoring of SMAD3, the clinicopathological associations were investigated in positive- and negative-SMAD3 expression groups using appropriate statistical methods. Regression analysis was performed to define independent predictors of recurrence in AGCT.

SMAD3 was actively expressed in the nuclei of 51.4% of AGCTs. It was significantly associated with tumor recurrence, capsular rupture, and size (P=0.011, 0.018, and 0.028, respectively), but not with age, presentation, laterality, stage, tumor morphological pattern, or mitotic index. Capsular rupture and tumor size were defined as highly significant (P≤0.001), as well as SMAD3+ve expression and FIGO stage as significant independent predictors of recurrence (P=0.05 and 0.049, respectively) in AGCT.

SMAD3 is actively expressed in the tumor cell nuclei of around one half of AGCTs and this expression associates with high propensity for tumor recurrence, capsular rupture, and increasing tumor size. Along with the other observed independent predictors of recurrence, SMAD3 may provide an outline for direct discovery of new risk-stratification criteria as well as therapeutic targets for AGCTs.

Premature preterm rupture of membranes (PPROM) occurs in about 2-5% of singleton pregnancies and is known to cause one-third of preterm births. Our primary aim was to determine the maternal and neonatal outcomes in PPROM cases in mothers with a gestational age of less than 37 weeks.

In this prospective cross-sectional study, eligible singleton women between 24+0-37+6 weeks of gestation with the PPROM enrolled who had referred to Ayatollah Rouhani Hospital in Babol, Iran, during the years 2019-2020. Maternal and neonatal outcomes were obtained by the checklist.

The mean age of the studied mothers was 29.3± 6.19 years, and their mean body mass index was 30.6 ±5. The incidence of chorioamnionitis at the gestational age of >32 weeks was more than that in women at gestational age equal to or over 32 weeks (P≤0.0001). Vaginal bleeding was almost more than twice as high in women with a gestational age of less than 32 weeks compared to those with a gestational age equal to or over 32 weeks (P≤0.0001). Neonatal morbidity was higher in all cases at less than 32 weeks of gestation (P≤0.0001). The neonatal mortality rate was 5.35%, but it was 25% at less than 32 weeks of gestation (P≤0.0001). The latency period greater than 7 days had more odds ratio for neonatal morbidity.

Due to the high incidence of maternal and neonatal outcomes in gestational age less than 32 weeks, it is suggested that appropriate instructional materials and proper proceeding should be taken to prevent preterm labor and preterm rupture of the membranes.

Pregnant women appear to be more severely affected by COVID-19. Coagulopathy is known as one of the most challenging effects of COVID-19, and the effects of acute airway diseases resulting from the coronavirus on pregnant mothers and their fetuses can be dangerous. Two women who where pregnant suffering from coagulopathy (one of them with disseminated intravascular coagulation (DIC) and the other one with hypercoagulation) and COVID-19 infection are reported in this study. During hospitalization due to severe vaginal bleeding and placental detachment, cesarean section was performed on the first caseand because of acute severe DIC, she received a massive transfusion. The second patient  epigastric pain and tachycardia. COVID-19 might have a variety of effects on pregnancy outcome, from vascular and placental involvement to respiratory involvement; there is an association between the coronavirus and hyper-coagulopathy state and coagulopathy like DIC.

Uterine adenosarcoma (UA) is an infrequent malignancy which contains the epithelium of benign glands and malignant mesenchymal elements. Low-grade adenosarcoma has a sarcomatous part that is uniformly low grade. Uterine adenosarcoma includes 8% of all uterine sarcomas and less than 0.2% of uterine neoplasms. It is more common in perimenopausal or postmenopausal women. Due to the rarity of uterine adenosarcoma, limited information is available to help guide treatment. A 33-year-old woman, who had one child referred to ????  with a complaint of abnormal uterine bleeding for one year; the sonography reported a polyp in fundal cavity of uterus. The patient underwent hysteroscopy and curettage. The pathology examination revealed uterine adenosarcoma which led to a total hysterectomy and bilateral salpingo-oophorectomy. Abnormal uterine bleeding is the most common symptom of UA. At a young age there is a possibility of misdiagnosis. Hysteroscopy should also be performed if symptomatic or enlarge polypoid lesions are diagnosed preoperatively.