Journal of Obstetrics, Gynecology and Cancer Research
Volume:9 Issue: 3, May-Jun 2024

Background &

 Vaginal birth after Cesarean (VBAC) is often offered as an option after a single cesarean section (CS). To evaluate the success rate of vaginal birth after two cesarean sections (VBAC-2).Materials &

 We searched MEDLINE, EMBASE, PubMed, Scopus, using search terms (cesarean OR cesarean OR caesarean OR caesarian) AND (“Vaginal birth after cesar Keywords: Vaginal birth after Cesarean, Cesarean section, Maternal, Fetal outcomesean” OR VBAC) AND (two OR Twice OR second OR multiple). Two independent reviewers performed the study selection, and abstracted and tabulated data and pooled estimates were obtained. Meta-analyses were performed using Open-meta and Comprehensive Meta-Analysis.

 Mean success rate of VBAC-2 was 72% (2174 out of 3020 cases) with a range of 24-90%. The mean hysterectomy rate was 0.43% ranging from 0% to 1.7%. Our meta-analysis showed no significant difference between VBAC-2 and CS-3 in the case of hysterectomy, with a pooled odds ratio (OR) of 0.699, but with a wide confidence interval (95% CI was 0.347-1.407). VBAC-2 being associated with 2-fold increased risk of perinatal mortality compared to CS-3.

Vaginal delivery is a suitable option for women with two previous cesarean sections; the outcomes are significantly more favorable for women with a history of vaginal birth.

Background &  Thyroid-related adverse pregnancy outcomes can be analyzed by Anti-thyroid peroxidase antibody (Anti-TPO Ab). However, whether women with anti-thyroid peroxidase antibody (Anti- TPO Ab) positivity have a higher risk of poor pregnancy outcomes is debatable. The aim of the present study was to compare the pregnancy outcomes in pregnant women with positive and negative TPO-Ab.Materials &  This cross-sectional study was conducted on pregnant women with positive anti-TPO Ab (n= 108) and negative anti-TPO Ab (n=340) referring to Imam Khomeini Hospital and Ahvaz clinics from January 2020 to December 2020. The pregnancy outcomes, including gestational diabetes mellitus (GDM), preeclampsia, miscarriage, preterm birth, placental abruption, IUFD, IUGR, and TSH level, were compared between the two groups by SPSS software using student t-test and Chi-square test. The mean TSH level was significantly different in women with negative TPO-Ab than those with positive TPO-Ab (Mean (SD): 2.25(1.47) vs. 4.82(9.38), P<0.0001). In addition, 81 (75.00%) women in the positive anti-TPO group and 104 (30.58%) in the negative anti-TPO group had high TSH (P<0.001). The frequency of GDM in positive anti-TPO Ab pregnant women was significantly higher than that in the negative anti-TPO Ab group (46.29% vs. 34.11%, P=0.029). The results also indicated an enhancement in the rate of miscarriage (15.74% vs. 4.11%, P<0.001) and preterm parturition (13.88% vs. 3.52%, P<0.001) in positive anti-TPO Ab women. Presence of positive anti-TPO Ab was significantly associated with preterm delivery, abortion and GDM in pregnancy. Treatment with Levothyroxine can reduce the risk of adverse pregnancy outcomes in women who are positive for TPOAb.

Background &  Prenatal invasive procedures are used for diagnostic and therapeutic purposes. The present study aimed to assess the indications and early complications of invasive diagnostic tests.Materials &  This retrospective descriptive study was conducted on 708 pregnant women who were referred for prenatal invasive tests in Tehran, Iran from May 2018 to April 2022. All medical records of the participants were reviewed and entered into the study. According to the implemented procedures, medical records were categorized into two chorionic villus sampling (CVS) and amniocentesis groups. The primary outcome was determining the frequent indications of invasive diagnostic tests and post-procedure complications. Six hundred and sixty-eight medical records were included. Amniocentesis procedure was performed for 624 (93.7%) and 44 cases (6.3%) underwent CVS. The most frequent indication for invasive prenatal procedures was a history of abnormal findings related to the first trimester biomarkers followed by the abnormal findings of the second trimester biochemical markers, a history of high nuchal translucency>99th percentile, and abnormal biomarkers of sequential test. Comparing post-procedure complications, the results showed no significant difference between the CVS and amniocentesis groups (P=0.845). In the amniocentesis group, 2 cases had shown spontaneous abortion and 3 leakage of amniotic fluid, as well as two cases in the CVS group, had reported vaginal bleeding. Our results delineated that positive fetal aneuploidy screening tests together with increased nuchal translucency were the main indications of the invasive prenatal tests. Amniotic fluid leakage, vaginal bleeding, and spontaneous abortion should be considered as procedure-related complications.

Background &  Establishing a consensus on the appropriate use of prophylactic antibiotics in elective laparoscopic procedures for benign gynecological conditions would be beneficial. The necessity of preventive antibiotics during laparoscopy for uncomplicated gynecologic conditions is currently being debated. This study aims to ascertain the need for prophylactic antibiotics in preventing early post-surgery infections and febrile morbidity in elective laparoscopic surgery for benign gynecologic conditions.Materials &  One hundred women who underwent uncomplicated laparoscopic surgeries were studied for four years. Participants were randomly divided into two groups, and demographic data and postoperative outcomes were analyzed. Infections at the surgical site, fever, urinary tract infections, and respiratory infections were the outcomes studied. The studied variables and the post-operative outcomes assessed did not vary between the two groups. Routine use of antibiotics in laparoscopic gynecologic surgery may not be necessary, as postoperative infection rates remain low even in cases where antibiotics are not administered.

Background &  The purpose of the current study is to compare the diagnosis of gynecologic cancer before and after the COVID-19 pandemic in Fatemieh Hospital, Hamedan from 2018 to 2021, and finally to diagnose the effect of the COVID-19 pandemic on gynecologic cancer.Materials &  This quantitative-descriptive study was done from 2018 to 2021 in the oncology clinic of Fatemieh Hospital, Hamedan. The sample was selected from the medical records of female patients who visited the oncology clinic of Fatmieh Hospital, Hamedan. Based on the results, it was made clear that most examined patients were afflicted with ovarian cancer. The number of times that patients visited the hospital decreased after the COVID-19 pandemic, and more patients with symptoms of gynecologic cancer visited the hospital than before the outbreak. After the outbreak of the COVID-19 pandemic, patients visited the hospital with more symptoms of malignant disease complaining about abnormal bleeding, and in the medical examination, they had more obvious lumps/tumors. The result of our study showed that the COVID-19 epidemic decreased the number of times patients afflicted with gynecologic cancer visited this health center, and consequently their symptoms became much more severe.

Background &  Pregnant women need more nutritional intake than before pregnancy. If this nutritional intake is insufficient for the mother, it will result in Chronic Energy Deficiency (CED). To determine if pregnant women are experiencing malnutrition or cannot be known by measuring the Mid-Upper Arm Circumference (MUAC). Based on service regulations for pregnant women in Indonesia, the minimum number of Iron-Folic Acid (IFA) tablets pregnant women get is 120. Regarding this condition, a study was conducted to analyze the relationship between the amount of IFA consumption on MUAC and several other therapeutic outcomes.Materials &  This study used a cross-sectional method by examining the patient's medical records. Patients who received IFA as many as 120 tablets or more will become the exposure group. Data will be analyzed descriptively using chi-square. The MUAC size significantly differed at the end of pregnancy (P=0.01). However, overall, there was no significant difference between the two groups. The IFA administration generally gives good results, but the optimal number of IFA doses still needs further study.

Background &  The administration of tamoxifen to post-menopausal patients with breast cancer may lead to vaginal bleeding, necessitating a thorough understanding of associated factors. Our objective was to investigate sonographic, hysteroscopic, and pathologic findings in breast cancer patients experiencing vaginal bleeding following tamoxifen use.Materials &  In this cross-sectional study, we evaluated women with post-menopausal breast cancer reporting vaginal bleeding while undergoing tamoxifen treatment for more than six months. Data collection involved a checklist encompassing ultrasonographic, hysteroscopic, and pathologic findings. The study included 100 patients with a mean age of 56.2 ± 2.9 years and a mean endometrial thickness of 14.5 ± 3.4 mm. Notably, 25% of the patients exhibited abnormally large uterine size. Ultrasonography revealed polyps and myomas in 36% and 15% of cases, respectively. Positive hysteroscopy findings were observed in 72%, comprising polyps in 36%, hyperplasia in 32%, and atrophy in 4%. Pathological assessment identified abnormal features in 31% as polyps, 34% as hyperplasia, 4% as atrophy, and 5% as cancerous lesions. Patients who received tamoxifen had high endometrial thickness due to endometrial polyp, it seems that clinicians can consider using hysteroscopy with dilation and curettage in these patients.

Background &  Pregnancy is an exceptionally delicate time in the lives of most women. Sleep disorders during pregnancy can substantially impact a healthy pregnancy. This study investigated the relationship between sleep quality during pregnancy and adverse maternal and fetal pregnancy outcomes.Materials &  This was a prospective cohort study on 500 pregnant women referred to the Perinatology clinic. The Pittsburgh Sleep Quality Index questionnaire was used to evaluate sleep quality, and demographic data were collected from the case files of routine prenatal checkups. The study participants were followed until delivery. The association between sleep quality and postpartum complications, such as preterm birth, infant Apgar score, and (Neonatal Intensive Care Unit) NICU admission, was investigated. This study included 500 pregnant women with a mean age of 31.12 ± 5.84 years. The number of pregnancies ranged from one to seven, with a mean of 2.55±1.30. Of the infants, 12% of infants were born prematurely and 27.8% required NICU admission. Poor sleep quality was found to be associated with preterm delivery (OR: 1.27, P = 0.039) and preeclampsia (OR: 0.543, P = 0.004). Women who experienced preeclampsia during pregnancy (P = 0.01), delivered via cesarean section (P = 0.009), and had infants weighing more than 2500 g (P = 0.07) exhibited significantly poorer sleep quality. We found that poor sleep quality was associated with preterm birth, cesarean section delivery, maternal preeclampsia risk, and the 5-minute Apgar score. Considering the impact of a mother’s sleep quality on pregnancy outcomes, assessing mothers' sleep health appears essential in prenatal care.

Background &  This research aimed to study the role of the meaning of life in death anxiety and suicidal thoughts in women with cancer.Materials &  The method of this research is correlation. The statistical population of the study included all women with cancer referred to Tawheed Hospital in Sanandaj City in 1400-1401. The sample size consists of one hundred people selected by purposive sampling. To collect data, Steger's Meaning in Life (MLQ), Templer's Death (DAS), and Beck's Suicidal Thoughts (BSSI) questionnaires were used. SPSS software was used in this research. The information was analyzed using correlation tests and regression analysis. The regression conclusions showed that the meaning of life has an inverse relationship with suicidal thoughts, and death anxiety has a direct relationship with suicidal thoughts. The Pearson correlation results showed that the meaning of life predicts death anxiety and suicidal thoughts. In general, it can be concluded that the meaning of life plays an instrumental role in the death anxiety and suicidal thoughts of women with cancer.

Background &  The presence of anesthetic drugs in the serum with possible negative effects on FSH and LH hormone concentration and vital signs has been shown in a number of experimental and human research.To measure the effects on blood hormone concentration and the effect on the vital signs (blood pressure and heart rate) of two different medications (remifentanil vs. fentanyl) used for general anesthesia during oocyte retrieval.Materials &  The present prospective comparative study was carried out at Iraq's "High Institute of Infertility Diagnosis and Assisted Reproductive Technologies/Reproductive Physiology/Al-Nahrain University/Baghdad/Iraq" infertility center with the approval of the Faculty of Science's ethical committee. Mansoura University approved the study's validity. Ninety infertile women who are undergoing intracytoplasmic sperm injections (ICSI) for a variety of infertility-related reasons. The women ranged in age from 25 to 45. The study's original December 2022 deadline was pushed out to December 2023. Patients were split into two groups based on the general anesthesia technique for oocyte retrieval. Group one (45 patients) received midazolam, propofol, and fentanyl; group two (45 patients) received remifentanil, midazolam, and propofol. We compared the FSH and LH hormone levels before and after anesthesia and also compared the effect of anesthesia on vital signs between two groups of patients before and after anesthesia; accordingly, there was significantly higher systolic blood pressure in remifentanil group (p=0.30); however, there were no significant differences in diastolic blood pressure (p=0.767) and heart rates (p=0.512). The associations of LH and FSH with anesthesia are different depending on the type of anesthetic drugs.

Background &  Endometrial hyperplasia is the primary precursor of endometrial cancer in the female reproductive system, with abnormal uterine bleeding (AUB) being the predominant manifestation of this condition. The purpose of this study was to determine the prevalence of endometrial hyperplasia and its correlation with various factors among patients presenting with abnormal uterine bleeding.Materials &  This cross-sectional descriptive-analytical study reviewed the hospital records of all patients with abnormal uterine bleeding admitted to Ali Ebn-e Abi Taleb Hospital in Zahedan from April 2015 to April 2018. Data were analyzed using the SPSS. The prevalence of endometrial hyperplasia was estimated to be 20.3%. The average age of the study subjects was about 45 years. The highest number of patients (37, 52.9%) belonged to the age group of 36-50 years. Among the different types of endometrial hyperplasia observed, the most common was "simple non-atypical hyperplasia" found in 45 patients (64.3%), while the least common was "simple atypical hyperplasia" observed in three patients (4.3%). Overall, "non-atypical hyperplasia" (including both simple and complex types) was present in 58 patients (82.85%). The prevalence of infertility, obesity, hypertension, diabetes, premature menarche, late menopause, family history, oligomenorrhea, and polycystic ovary syndrome (PCOS) was reported in 7.1%, 32.9%, 24.3%, 22.9%, 8.5%, 13.6%, 7.1%, 5.7%, and 3.4% of cases, respectively. Women with a history of diabetes, hypertension, and obesity are at an increased risk of developing endometrial hyperplasia. Therefore, it is crucial to evaluate these patients for the presence of endometrial hyperplasia.

Background &  Uncertainties exist about the diagnostic and prognostic role of hemocytometry values in patients with COVID-19 especially in pregnancy. This study aims to investigate hemostatic changes in pregnant woman with coronavirus disease (COVID-19) and their relationship to disease severity.Materials &  This research is an analytic observational study with case control design. Subject was gathered from Hasan Sadikin General Hospital Bandung, Indonesia patients' medical records from June 2021 – March 2022. Inclusion criteria for this study are all pregnant COVID-19 patients with prothrombin time (PT), activated partial thromboplastin time (aPTT), and D-dimer examination. The exclusion of this study, all pregnant COVID-19 patients without required examination. PT, aPTT, and D-dimer were measured by Stago kits on a Stago automated coagulation analyzer (STA Compact Max®). Data was then analyzed by Kruskal Wallis with IBM SPSS Statistic 26th with α=0.05. Statistical analysis shows there’s correlation between different severity levels with D-Dimer. This study shows the mean of D-Dimer of each severity levels; asymptomatic 4.85 mg/L, mild 2.86 mg/L, moderate 5.47 mg/L and severe 14.51 mg/L (p <0.000). Changes seen after mild group which increase to 5.47 mg/dL in moderate COVID-19 and furthermore increase in severe become 14.51 mg/L. No changes in PT and aPTT were found. In conclusion, our findings demonstrate that coagulopathy is associated with the severity of COVID-19 illness. D-dimer is an important parameter for evaluating the COVID-19 severity in pregnancy. This further could serve as a diagnostic category to differ the severity of COVID-19 in pregnancy.

Background &  There is a need for studies to find the best method for inhibiting the pituitary gland in in vitro fertilization (IVF) cycles. This study was conducted with the aim of comparing triptorelin 1% and buserelin in women undergoing intracytoplasmic sperm injection/ embryo transfer (ICSI/ET).Materials &  The present study was a randomized single-blind clinical trial to compare the short-acting triptorelin and buserelin in ovarian response. The patients are divided into two groups A and B based on random allocation and 67 people in each group were included in the study. To evaluate the basic level of hormones, the FSH, LH, and estradiol levels were checked. In addition, AMH level on the third day of the cycle, age, body mass index (BMI), duration of infertility (years), frequency of using IVF/ICSI based on each cycle, duration of ovarian stimulation (days), and average dose gonadotropin consumption (the ampoule dose per unit) was recorded. The mean dose of gonadotropin in the group treated with triptorelin (3181.29±710.13) was higher than in the group treated with buserelin (2433.87±936.52) (P-value<0.001). The frequency of positive OHSS in the group treated with buserelin was 14 (22.6%), which was higher than in the group treated with triptorelin 0 (0.0%) (P-value<0.001). In the findings of our study, no significant difference was observed in the progesterone level on the day of trigger injection in the comparison of two agonists, and both agonists were successful in preventing LH surge.

Background &  An unusual manifestation of prenatal trophoblastic illness is a twin molar pregnancy with a live fetus and a hydatidiform mole. Due to increased ovulation stimulation, this unusual scenario is rising. Most hydatidiform moles are complete with a fetus, while 0.005 to 0.01% of gestations have a partial mole. This report examined the clinical appearance and outcome of live fetuses with molar pregnancies.Materials &  This study was done at Adiwaniyah, where the Maternity and Pediatrics Teaching Hospital has one obstetrics center.  The researcher reviewed 20 years of obstetric reports and found 12 cases of hydatidiform mole pregnancies, with ultrasound reports and/or postpartum examination of the product of gestation indicating twin pregnancy with a single viable fetus. The average age was 27.00 ±6.87 years, with a range of 18–37 years. The parity breakdown was eight (66.7%) primiparous and four (33.3%) multiparous.  The average gestational age upon diagnosis was 19.50 ±3.09 weeks, ranging from 15 to 25 weeks. The average gestational age at delivery commencement was 26.67 ±7.09 weeks, with a range of 17–35 weeks. Seven (58.3%) amniocenteses were normal. Maternal complications included bleeding, anemia, blood transfusion, threatening miscarriage, and pre-eclampsia. End-of-gestation outcomes comprised five (41.7%) living and healthy newborns and three (25.0%) dead babies. There were five (41.7%) men and two (16.7%) women. Moreover, cesarean sections, early labor, and miscarriages were documented. Twin pregnancies with a live viable fetus and a molar pregnancy is rare, hence early detection and care are crucial to prevent difficulties for the mother and fetus.

Background &  The etiology of endometriosis is unknown and many hormonal, inflammatory, genetic and environmental factors are effective in the formation of endometriosis. The present study investigated the epidemiology of endometriosis in patients referred to ShohadayeTajrish Hospital in six years.Materials &  This descriptive study performed on endometriosis Iranian women who referred to ShohadayeTajrish Hospital between 2016 and 2022. The sample size of this study was determined using the census method, and 711 patients. For analysis, SPSS version 22 was used, and results were reported as mean ± SD. Finally, 711 patients enrolled in this study and the average age of patients was 34.69± 7.53 years and the mean age of onset of disease was 29.97±4.61years. More than 55% of patients had a healthy weight and normal body mass index. 17.72 percent of patients had a history of infertility in their life’s. Endometriosis patients’ life in many aspects, including their job, lifestyle, education, marital status and health care is affected.

Background &  Endocrine disorders like polycystic ovarian syndrome affect reproductive-age women. It causes infertility and has several clinical symptoms. Clomiphene citrate ovulation induction is a first-line treatment. Serum anti-Mullerian hormone can indicate positive pregnancy outcomes in women with this disease, however this is controversial. To assess the value of anti-Mullerian hormone (AMH) as an anticipator of ovary response to clomiphene citrate in patients with “polycystic ovary syndrome (PCOS).Materials &  A cross-sectional study of 50 women diagnosed with Rotterdam-based polycystic ovarian syndrome by two gynecologists was conducted. The Maternity and Pediatric Teaching Hospital in Diwaniyah Province, Iraq, conducted the study from August 1, 2022, to May 15, 2023, at the obstetrics and gynecology department. Women with diabetes or hypertension were excluded from the trial. These women sought medical treatment for infertility and received clomiphene citrate to induce ovulation. The findings of hCG urine and blood testing divided women into positive and negative biochemical pregnancy groups. The mean FSH of all recruited women was 5.19±1.14 IU/L, with no significant difference between pregnant and non-pregnant women (p = 0.849). AMH levels were significantly lower in pregnant women compared to non-pregnant women (p< 0.001). The mean AMH was 6.97±2.88 ng/ml for all enrolled women. ROC curve research determined the optimal AMH cutoff value for predicting positive biochemical pregnancy: ≤6.5 ng/ml with 100% sensitivity, 67.7% specificity, and 80.9 % accuracy. Serum anti-Mullerian hormone accurately predicts pregnancy success in PCOS women taking clomiphene citrate to induce ovulation.

Background &  As bleeding is a serious complication during and after hysterectomy, this paper aims to compare the short-term outcomes of ChitoHem and Surgicel use in posterior bladder bleeding during hysterectomy.Materials &  In the present clinical trial, 46 patients who were candidates for abdominal hysterectomy in Hajar Hospital in Shahrekord, were randomly divided into two groups. In group A, superficial cauter and Surgicel were used and in group B, superficial cauter and ChitoHem were used to control bleeding. Hematocrit and hemoglobin levels were determined before, and six and 12 hours after surgery. Drain discharge volume, time to stop bleeding and bleeding volume were also determined. The pain was determined by the VAS scale at the time of recovery, 48 hours postoperatively, and one and three months postoperatively. Data were analyzed by SPSS statistical software. Based on repeated-measures test, the mean of hemoglobin in the studied times showed a significant difference, so that in six and 12 hours after surgery they were significantly less than the ones before surgery, but their mean was not significantly different between the two groups. The mean pain score one month after surgery in group B was significantly lower than group A (P <0.001). The mean volume of drainage and clotting time in group B were significantly lower than group A (P <0.01). The mean volume of intraoperative bleeding, the frequency of vaginal bleeding and cuff-related complications were not significantly different in the two groups. The results of the present study show that ChitoHem is probably effective in reducing bleeding during hysterectomy surgery.

Nowadays, the prevalence of uterine myoma in pregnant women has increased due to the increasing age of pregnancy in women.In this case report, a pregnant woman (window period) with a negative result of ßhCG test and ultrasound in terms of pregnancy underwent myomectomy surgery to remove a large uterine myoma. A 40-year-old patient referred to the physician because of heavy and prolonged menses caused by a large uterine myoma and primary infertility for 10 years. ßhCG test and ultrasound of the patient were negative in terms of pregnancy, and she underwent myomectomy surgery while the patient was in the early stages of pregnancy (window period). Therefore, the patient was under close care during pregnancy. With continuous follow-up, the newborn was born without any problems at 37 weeks. Although in this study, with proper management during surgery, and continuous and regular follow-ups, the newborn was born healthy, but confirmation of myomectomy during pregnancy requires the implementation of more studies.