Farnoush Farzi; Sodabeh Kazemi; Ziba Zahiri Sorouri; Samaneh Ghazanfar; Mahin Tayefeh Ashrafiyeh; Mandana Javanak; Mohammad Shahbazi
Articles in Press, Accepted Manuscript, Available Online from 14 November 2022
Abstract
Having body mass index more than 29 is described as obesity in pregnancy. Anesthesia management in these patients has always been challenging. A 41-year-old woman, at 37weeks’ gestation with the weight of 200kg and body mass index of 66/05 was admitted with complaint of pain to Al-Zahra Hospital ...
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Having body mass index more than 29 is described as obesity in pregnancy. Anesthesia management in these patients has always been challenging. A 41-year-old woman, at 37weeks’ gestation with the weight of 200kg and body mass index of 66/05 was admitted with complaint of pain to Al-Zahra Hospital in Rasht. She reported a history of two previous caesarean sections and high blood sugar and hypothyroidism which were under control by drugs. The Anesthesiology team decided to choose Continuous Spinal Anesthesia method for her. After performing anesthesia, cesarean delivery was done and a female neonate was born with Apgar score of 5-9. They were discharged from the hospital in good condition after two days. Based on the results of this study, CSA approach is a suitable method for anesthesia management in cesarean section of obese patients. Also it is necessary to recommend these patients to refer to anesthesia counseling clinics before giving birth.
Sara Masihi; Elahe Shirazi; Farideh Moramezi; Najmieh Saadati; Mojgan Barati
Articles in Press, Accepted Manuscript, Available Online from 14 November 2022
Abstract
AbstractPurpose: This study aimed to compare CGH array and karyotype for prenatal diagnosis in high-risk individuals in the first trimester screening.Materials and Methods: The present cross-sectional descriptive prospective study was performed on high-risk mothers screened in the first trimester of ...
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AbstractPurpose: This study aimed to compare CGH array and karyotype for prenatal diagnosis in high-risk individuals in the first trimester screening.Materials and Methods: The present cross-sectional descriptive prospective study was performed on high-risk mothers screened in the first trimester of pregnancy. Individuals were allocated into two groups under karyotype and CGH array. Because this study is based on genetic testing data, it does not require a follow-up. Information on age, number of pregnancies, history of abortion, history of disease and screening results were collected and analyzed. Data analysis was done using SPSS Version 22 (IBM).Results: In total 247 cases were analyzed with 128 cases in the karyotype group and 119 cases in the CGH group. 116 samples (90.6%) in the karyotype group and 99 samples (83.2%) in the CGH group showed a normal karyotype. 4.2% (5 samples) and 7.9% (10 samples) of chromosomal abnormalities were trisomy in the CGH group and the karyotype group, respectively. CGH array analysis on chromosomal abnormalities identified copy number variation (CNV) in about 9.2% (11 samples) of cases. In terms of risk factors structural chromosomal, there was a statistically significant relationship in terms of history of disabled children in the family, maternal age, history of anomalies, screening of the first trimester of pregnancy, and increased NT (p<0.05).Conclusions: High-resolution arrays specifically prevented fetal malformations. Until now, normal prenatal chromosome analysis has been shown a relatively standard method but CGH may be helpful to specialists in diagnosing chromosomal abnormalities, especially in unknown chromosomal abnormalities.
Adibeh Mauwloudi; Laleh Eslamian; Vajiheh Marsousi; Ashraf Jamal; Maryam noorzadeh; Mahsa Naemi; Ali Reza Norouzi; Nazila Mesbah
Articles in Press, Accepted Manuscript, Available Online from 14 November 2022
Abstract
Epigenetic silencing of MLH1 in endometrial cancers is associated with larger tumor volume, increased rate of lymph node positivity, and reduced recurrence-free survival Background: The aim of this study was to determine which of the two drugs of ibuprofen, as a common non-steroidal anti-inflammatory ...
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Epigenetic silencing of MLH1 in endometrial cancers is associated with larger tumor volume, increased rate of lymph node positivity, and reduced recurrence-free survival Background: The aim of this study was to determine which of the two drugs of ibuprofen, as a common non-steroidal anti-inflammatory drugs NSAID, and acetaminophen would have the least effect on postpartum hypertension in patients with preeclampsia.Methods: Clinicodemographic data including age, gestational age at delivery, body mass index, parity, and route of delivery, were collected through interviews with patients and reviewing patient records. In this double-blind clinical trial, among 84 patients included in the study, 42 patients were randomly assigned into the acetaminophen (650 mg every 6 to 24 hours) and 42 patients into the ibuprofen (600 mg every 6 to 24 hours) group. Results: The two groups were not significantly different in terms of mean age (p = 0.322), body mass index (p = 0.950), route of delivery (p = 0.657), parity (p = 0.818), and mean systolic (p = 0.530) and diastolic blood pressure (p = 0.691). Following the intervention, the duration of blood pressure control (p = 0.182), mean systolic blood pressure (p = 0.371), and mean diastolic blood pressure (p = 0.13) were not significantly different in the acetaminophen and ibuprofen groups. There was no significant difference between the two groups in terms of the number of patients and the dosage of opioids used.Conclusion: The results revealed that in patients with preeclampsia, acetaminophen and ibuprofen to control postpartum pain have a similar impact on blood pressure.
Fereshteh Ameli; Maryam Entezarian; Noraidah Masir; Tan Geok Chin
Articles in Press, Accepted Manuscript, Available Online from 14 November 2022
Abstract
Introduction:The highest mortality rate in gynecologic cancers is attributed to ovarian origin. Expression of the estrogen and progesterone receptors (ER and PR); and Human epidermal growth factor receptor 2 (Her2/neu) in endometrial cancer and breast cancer were found to be associated with the response ...
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Introduction:The highest mortality rate in gynecologic cancers is attributed to ovarian origin. Expression of the estrogen and progesterone receptors (ER and PR); and Human epidermal growth factor receptor 2 (Her2/neu) in endometrial cancer and breast cancer were found to be associated with the response to treatment and prognosis. However, because of inconsistent results from previous studies, the data regarding ovarian cancer are still inconclusive.Materials and methods: Current retrospective cross-sectional study was performed on 234 tissue samples of different types of ovarian tumors (benign, borderline and malignant) from the archive of the University Kebangsaan Malaysia Medical Center during 10 years. Tissue microarrays were constructed on representative areas from formalin fixed paraffin embedded tissue blocks using ER, PR and HER2 immunohistochemical staining. Results: Prevalence of ER and PR overexpression was 36% and 35% in benign, 8% and 24% in borderline tumors with 51% and 46% in malignant tumors, respectively. ERα overexpression was more common among serous malignant ovarian tumors (49%) (p<0.001). PR positivity was more prevalent in serous benign tumors (p=0.02).There was no significant relationship between stage and the status of ERα (p=0.12) and PR (p=0.19). Her2/neu overexpression was only seen in borderline neoplasms (8%) and malignant mucinous tumors (4%). No association was found between Her2/neu overexpression and the level of tumor differentiation, tumor stage, size, and patient’s age.Conclusion: The observed ERα positivity in serous carcinoma and Her2/neu overexpression in malignant mucinous tumor, could be considered as a clue for choosing therapeutic agents. The role of anti-HER2 therapy in clear cell carcinoma is still debated and needs more investigations.
Original Research Article
Obstetrics and Gynecology
Khadijeh Elmizadeh; Marziyeh khezri; Hamideh Pakniat; vahideh pandamuz; nezal Azh; Simindokht Molaverdikhani
Articles in Press, Accepted Manuscript, Available Online from 02 October 2023
Abstract
Background: Cooling the uterus during cesarean section has emerged as one of the non-pharmacological management for blood loss during cesarean section. The aim of this study was to evaluate the effect of uterine cooling during the cesarean section on decreasing postpartum hemorrhage.
Methods: In this ...
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Background: Cooling the uterus during cesarean section has emerged as one of the non-pharmacological management for blood loss during cesarean section. The aim of this study was to evaluate the effect of uterine cooling during the cesarean section on decreasing postpartum hemorrhage.
Methods: In this single-blinded randomized clinical trial, a sample of 300 women with a singleton pregnancy, at 37 to 40 weeks gestation, who were scheduled for cesarean section was divided into two groups of 150 participants. In the intervention group after placental delivery, the uterus was covered with cold saline-soaked surgical sponges at 0-4°C at the time of hysterotomy repair, and the control group received standard cesarean section. The volume of blood loss, the hemoglobin level before surgery and 24 h after surgery, the need for additional oxytocic therapy, and the incidence of adverse effects were recorded.
Results: The bleeding volume and hemoglobin concentration reduction were significantly lower in the intervention group than in the control group (260.86± 150.25 Vs 214.35± 83.51, P<0.0001 and 1.24±0.75 Vs 1.54±0.92, P = 0.007 respectively). There were no statistically significant differences between the two groups in the frequency of need for additional uterotonic drugs. (18% vs. 21.33%, P = 0.475.)
Conclusion: The use of uterine cooling during cesarean section reduced the volume of blood loss and the rate of decline in hemoglobin concentration.
Hamideh Parsapour; Aida Alizamir; Shahedeh Khansary; Nasrin Jiryaei; Fatemeh Navabi
Articles in Press, Accepted Manuscript, Available Online from 14 November 2022
Abstract
Background: Gonorrhea is an infection caused by Neisseria gonorrhoeae that is mainly transmitted through sexual intercourse. This study was performed to evaluate the frequency of Neisseria gonorrhoeae and antibiotic resistance pattern to this infection in women referred to Fatemieh Gynecology Clinic ...
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Background: Gonorrhea is an infection caused by Neisseria gonorrhoeae that is mainly transmitted through sexual intercourse. This study was performed to evaluate the frequency of Neisseria gonorrhoeae and antibiotic resistance pattern to this infection in women referred to Fatemieh Gynecology Clinic in Hamadan.Methods: In this cross-sectional study using the convenience sampling method, 348 women referred to the gynecology clinic of Fatemieh Hospital in Hamadan in 2020 with complaints of vaginal discharge or vague pelvic pain were investigated. Patients were examined by a gynecologist, and if were eligible, a sample of endocervix is prepared and sent to the laboratory. Samples were cultured in a Thayer –Martin agar, then were examined by a cytopathologist for Neisseriagnore and Chlamydia and the results were recorded in a researcher-made checklist. Data were analyzed using SPSS software version 16.Results: The mean age of women was 34.93 ±7.57 years, and 72.7% lived in urban areas. Common complaints of women included pelvic inflammatory disease (56.9%), cervical discharge (73.6%), dysuria (25.6%), and dyspareunia (22.7%). None of the women had multiple sexual partners, hepatitis B or hepatitis C. one case (0.29%) of Neisseria gonorrhoeae was observed that be resistant to the antibiotics penicillin tetracycline, minocycline, and cefazolin and was sensitive to the antibiotics chloramphenicol, rifampin, nitrosamine, cefoxitin, and ceftazidime.Conclusion: It seems that in women with cervicitis at reproductive age, without a history of high-risk sexual behaviors, Neisseria gonorrhoeae infection is less common and is not a significant problem.
Nahid Shahbazian; Mahvash Zargar; Mojgan Barati; Najmieh Saadati; Elham direkvand
Articles in Press, Accepted Manuscript, Available Online from 14 November 2022
Abstract
Background and Objective: Thyroid-related adverse pregnancy outcomes can be analyzed by Anti-thyroid peroxidase antibody (TPO-Ab). However, whether women with anti-thyroid peroxidase antibody (TPOAb) positivity have a higher risk of poor pregnancy outcomes is debatable. The aim of present study ...
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Background and Objective: Thyroid-related adverse pregnancy outcomes can be analyzed by Anti-thyroid peroxidase antibody (TPO-Ab). However, whether women with anti-thyroid peroxidase antibody (TPOAb) positivity have a higher risk of poor pregnancy outcomes is debatable. The aim of present study was to comparison of pregnancy outcomes in pregnant women with positive and negative TPO-Ab. Methods: 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.Results: 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. Conclusions: 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. .
Hamideh Pakniat; Khadijeh Elmizadeh; Fatemeh Lalouha; Hojjat Momenzade; Kimia Mahloojian
Articles in Press, Accepted Manuscript, Available Online from 14 November 2022
Abstract
Background & Objective: The importance of Pap smear in cervical cancer screening is clear. However, yet no organized program has been developed in Iran to screen cervical cancer. Due to the obvious difference in prevalence of cervical cancer in Iran compared to global statistics, it is necessary ...
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Background & Objective: The importance of Pap smear in cervical cancer screening is clear. However, yet no organized program has been developed in Iran to screen cervical cancer. Due to the obvious difference in prevalence of cervical cancer in Iran compared to global statistics, it is necessary to further investigate this issue. As pop smear is the most important factor to decrease the mortality and morbidity of cervical cancer in developed countries, it is important to study the results of abnormal Pap smears and the quality of the report in our region. Materials & Methods: This study was designed retrospectively with reference to the results of Pap smears performed during 3 years from 2016 in the Kosar hospital. The method of collecting samples was census. The results of Pap smears were extracted from the Hospital and 15208 pap smear results were analyzed.Results: From the 15208 women, 15150 had normal cytology results (99.62%) and 58 women had abnormal cytology (0.38%). The frequency of abnormal cytology was 0.246% (n=37) for atypical squamous cell of undetermined significance (ASCUS), 0.08% (n=12) for low-grade squamous intraepithelial lesion (LSIL), 0.006% (n=1)for ASC cannot exclude high-grade intraepithelial lesion (ASC-H), 0.046% (n=7) for high-grade squamous intraepithelial lesion(HSIL), 0.006 (n=1)for atypical glandular cells (AGC), and 0% (n=0) for invasive cancer. No SCC was found in this study. Conclusion: The prevalence of all abnormal results was much lower than other studies; However, in terms of prevalence of abnormalities, the ranking was similar to other studies.In order to obtain more accurate results, it is recommended to study other epidemiological regions.
Soudabeh Kazemi Aski,; Seyedeh Hajar Sharami; Azadeh Tavangar; ehsan Kazem Nezhad Leilie; Seyedeh Fatemeh Dalil Heirati; Atoosa Etezadi
Articles in Press, Accepted Manuscript, Available Online from 14 November 2022
Abstract
Background and objective: The initial diagnosis of predictive markers is essential for the IUGR. High levels of PAPP-A lead to increased levels of free IGF-1, which in turn reflects the function of the placenta and the fetus normal growth. The objective of this study was to compare the level ...
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Background and objective: The initial diagnosis of predictive markers is essential for the IUGR. High levels of PAPP-A lead to increased levels of free IGF-1, which in turn reflects the function of the placenta and the fetus normal growth. The objective of this study was to compare the level of PAPP-A in pregnancy weeks 11-14 in women with and without intrauterine growth restriction and to assess the ability of this marker to predict adverse outcomes in pregnancy. Methods: In this Comparative Cross-sectional study, 227 pregnant women were studied during 2017. Mothers were divided into two main groups with and without intrauterine growth restriction. The relevant data, including birth weight, preeclampsia, gestational diabetes, Apgar score, and PAPP-A, were recorded on special forms. Data analysis was done using SPSS-21 software. Results: The mean age of participating women in this study was 28.8 ± 5.6 years. The median (IOR) number of gravidity and Gestational weight gain was 1 (1) and 12 (7) kg respectively. The difference in median (IOR) PAPP-A in patients with and without IUGR was statistically significant 0.64(0.57) and 1 (0.57), respectively, P= 0.001.The cut-off point for PAPP-A was 0.73 with a sensitivity=72.2% (95% CI: 64.32-79.16%) and a specify =60.5% (95% CI: 48.65 -71.56%). Conclusion: The results of this study confirm the relationship between low levels of PAPP-A and adverse outcomes of pregnancy. In the present study, the optimal cut-off point (0.73) is higher than other studies, which can be due to racial and epidemiological differences.
zinat ghanbari; leila pourali; Tahereh Eftekhar; maryam deldar pesikhani; soudabeh darvish; zahra lotfi; elnaz ayati
Articles in Press, Accepted Manuscript, Available Online from 14 November 2022
Abstract
Introduction: Defecatory dysfunction is a common problem among women who referred for urogynecological care. Pelvic organ prolapse (POP) which is a downward displacement of pelvic organs is one of the common condition among patients with defecatory problems . This study was planned to evaluate the correlation ...
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Introduction: Defecatory dysfunction is a common problem among women who referred for urogynecological care. Pelvic organ prolapse (POP) which is a downward displacement of pelvic organs is one of the common condition among patients with defecatory problems . This study was planned to evaluate the correlation of obstructive defecatory symptoms with the site and severity of pelvic organ prolapse and the anorectal manometry results.Methods: This cross-sectional study was performed between Dec 2018 and Nov 2019. About 150 women with symptoms of defecatory problems were enrolled. Patients were classified in two groups according to each compartment prolapse staging and severity; stage ≤2 and stage >2. The correlation between defecatory symptoms and pelvic organ prolapse examination, anorectal examination and anal manometry were evaluated.Results: A total of 150women were evaluated. There was a significant correlation between higher stage of anterior compartment prolapse (cystocele stage>2) and constipation (P=0.035). Although all the defecatory symptoms were more frequent in anterior prolapse stage>2, but the difference was not significant (P>0.05).There was no significant correlation between defecatory symptoms and severity of posterior compartment prolapse. There was a significant correlation between stage>2 of apical prolapse and all the defecatory symptoms (P≤0.05). The abnormal anal resting and squeeze pressure and also abnormal balloon expulsion test were more frequent in stage >2 of all compartment prolapse, but the difference was not significant (P>0.05).Conclusion:Obstructive defecatory symptoms were more frequent in patients with higher stage of anterior and apical prolapse. Abnormal manometry results were more frequent in patients with defecatory dysfunction with advanced vaginal prolapse.
Marzieh Talebian; Zohreh Talebi Mazreshahi; Elham Khosravi Mashizi; Nafiseh Khalili
Articles in Press, Accepted Manuscript, Available Online from 14 November 2022
Abstract
Introduction: Although 1% to 2% of all pregnancies are ectopic, ectopic pregnancy (EP) is the most frequent obstetrical disease leads to maternal mortality and morbidity at first trimester. The basic diagnostic method of EP is the human chorionic gonadotropin (HCG) test and transvaginal ultrasound. There ...
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Introduction: Although 1% to 2% of all pregnancies are ectopic, ectopic pregnancy (EP) is the most frequent obstetrical disease leads to maternal mortality and morbidity at first trimester. The basic diagnostic method of EP is the human chorionic gonadotropin (HCG) test and transvaginal ultrasound. There are some rare EP cases with negative HCG blood test. Case presentation: A 31-years old woman referred to the emergency department with hypogastric, periumbilical, and right upper quadrant intermittent pain and vaginal bleeding and prior history of EP 7-months ago that treated with methotrexate and her intra uterine device had been removed at that time. Her last menstrual period was undetermined. Although HCG blood test-qualitative was negative (2.08 IU /ml),ultrasound examination showed an 43×53 mm echogenic, heterogenic complex solid mass in the left adnexa and a large amount of echogenic fluid demonstrating hemoperitoneum. Taken surgery because of the exceeded abdominal pain revealed active bleeding in the left salpinx due to ruptured EP. Conclusion: Management of patients suspected of EP with negative HCG-blood test is difficult. In this uncommon cases in emergency, computed tomography, ultrasound and diagnostic laparoscopy or laparotomy can improve prognosis of patient.
Shahrzad Sheikhhasani; Maryam Noorzadeh; Mahsa Naemi
Articles in Press, Accepted Manuscript, Available Online from 14 November 2022
Abstract
Background: Ovarian cancer is the second most common malignancy in women worldwide, causing many deaths each year. Chemotherapy is one of the most important therapeutic strategies that can increase the survival of these patients; however, one of the problems in chemotherapy is resistance against platinum ...
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Background: Ovarian cancer is the second most common malignancy in women worldwide, causing many deaths each year. Chemotherapy is one of the most important therapeutic strategies that can increase the survival of these patients; however, one of the problems in chemotherapy is resistance against platinum treatment. Evaluating the effect of platinum- and non-platinum-based chemotherapy in patients with recurrent platinum-resistant ovarian cancer can enhance our view on this issue. Methods: The present review article sought to identify the treating efficacy of platinum and non-platinum-based chemotherapy in patients with recurrent platinum-resistant ovarian cancer by searching scientific databases and examining the aspects of platinum resistance in various articles. Results: Oncological results have shown that ovarian cancer is a deadly disease, and most cases are diagnosed when the cancer spreads outside the ovary and often throughout the entire abdomen. On the other hand, in many cases disease recurrence is associated with drug resistance. The use of a platinum-free interval has played an important role in its treatment efficacy. Understanding the cause of platinum resistance and discovering strategies to reduce drug resistance, especially to new ones, is very important.Conclusion: The present article suggested oncology teams agree on treatment methods and the best treatment approach against platinum resistance in malignant ovarian cancers and offer a better treatment solution by considering innovative strategies.
Marzieh Mehrafza; Azadeh Raoufi; Tahereh Zare Yousefi; Elmira Hosseinzadeh; Sajedeh Samadnia; Amirhossein Tamimi; Ahmad Hosseini
Articles in Press, Accepted Manuscript, Available Online from 14 November 2022
Abstract
Background and Objective: Repeated implantation failure (RIF) is still remain an ongoing challenge. RIF may be contributed to the embryo or the endometrium, which any abnormalities of each two may result implantation failure. The aim of present study was to report the effect of endometrial injury (EI) ...
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Background and Objective: Repeated implantation failure (RIF) is still remain an ongoing challenge. RIF may be contributed to the embryo or the endometrium, which any abnormalities of each two may result implantation failure. The aim of present study was to report the effect of endometrial injury (EI) during frozen embryo transfer (FET) on pregnancy outcome in RIF patients.Material and methods: In this retrospective case series, since 2018 to 2020, 20 patients with a history of RIF who underwent EI during FET cycle were evaluated. Results: Chemical, clinical and ongoing pregnancy and live birth was achieved in 8 (40%), 7 (35%), 6 (30%) and 6 (30%) patients, respectively.Conclusion: The present study shows that using EI in FET cycle is a feasible, safe and efficient method in improving clinical outcomes. More researches are needed to find out the real effect of EI during FET in RIF patients.
ahmed elkhyat; amal elsokary; shereef elshwaikh
Articles in Press, Accepted Manuscript, Available Online from 14 November 2022
Abstract
Objective: To evaluate the effect of weight gain in lean patients with polycystic ovary syndrome (PCOS) on ovulation and pregnancy rates.Study design: A prospective observational study.Patients: Lean patients with PCOS seeking fertility were invited to participate in the study. Weight gain was commenced ...
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Objective: To evaluate the effect of weight gain in lean patients with polycystic ovary syndrome (PCOS) on ovulation and pregnancy rates.Study design: A prospective observational study.Patients: Lean patients with PCOS seeking fertility were invited to participate in the study. Weight gain was commenced by dietary modifications. Patients were classified later into respondent and non-respondent. All patients were stimulated with letrozole 2.5 mg twice daily for 5 days for 6 cycles. Ovulation and pregnancy rates were assessed. Results: From 84 patients who were enrolled in our study, 33 patients were allocated into non responder group and 28 patients were allocated in responder group and It was found that despite there was statistical difference between both group as regard weight gain , weight after 6 months and BMI after 6 months , there was no significant difference between both groups as regard the ovulation rate , pregnancy rate and complications to ovulation induction (OHSS).Conclusion: weight gain in lean PCOS patients - although non-significant- but it may improve the reproductive outcomes (ovulation rate and pregnancy rate) and the need of further study with larger number and longer duration of follow up for confirmation of this results.
marjaneh zarkesh; Mandana Mansour Ghanaei; Marjan Malekifard; MARYAM GHALANDARI
Articles in Press, Accepted Manuscript, Available Online from 14 November 2022
Abstract
Objectives: We aimed to compare the correlation between nucleated red blood cell (NRBC) and creatine kinase (CK) levels with hypoxic-ischemic encephalopathy (HIE) in asphyxiated newborns.Materials and Methods: This case-control study included 30 asphyxiated (case) and 30 healthy neonates (control) ...
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Objectives: We aimed to compare the correlation between nucleated red blood cell (NRBC) and creatine kinase (CK) levels with hypoxic-ischemic encephalopathy (HIE) in asphyxiated newborns.Materials and Methods: This case-control study included 30 asphyxiated (case) and 30 healthy neonates (control) born at Al-Zahra Hospital in Rasht, Iran. We collected the cord blood samples for CK level and NRBC at birth. The clinical stage of Sarnat indicated the severity of HIE. Data were analyzed in the two groups using IBM SPSS Statistics for Windows, version 22. Results: The case group had a higher NRBC count (P=0.001). The CK level was significantly different between the two groups and was higher in the case group than in the control group (P= 0.002). Results demonstrated a significant association between NRBC count and the occurrence of HIE in neonates with asphyxia (P = 0.021). Besides, a positive correlation was found between HIE and CK levels in the case group (r = 0.7, P=0.001).Conclusion: According to our results, NRBC count and umbilical cord CK level measurement are valuable predictors of asphyxia and HIE in neonates. In addition, measuring these parameters may help clinicians for faster diagnosis and better management.
Original Research Article
Akhmetzhanova Dinara Oralgazyevna; Entsar Hachim Muhammad; Mohammed Ali; Ahmed Jalil Kadhim; Ayad Abas Hasan; Fathi Jihad Hammady; Noora M. Hameed; Hayfaa Attia Thijail
Articles in Press, Accepted Manuscript, Available Online from 08 February 2023
Abstract
Background & Objective: Episiotomy complications include infection, pain, hematoma, and third- and fourth-degree tears, and all primiparous women must undergo this procedure routinely. The current study aimed to compare the length of perineal tears in women referred to the Basra maternity hospital ...
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Background & Objective: Episiotomy complications include infection, pain, hematoma, and third- and fourth-degree tears, and all primiparous women must undergo this procedure routinely. The current study aimed to compare the length of perineal tears in women referred to the Basra maternity hospital in 2020 for their first births with and without episiotomy. Materials & Methods: The current clinical trial study involved 212 full-term, singleton, primiparous women with cephalic fetuses weighing between 2500 and 3000 grams. Randomly and evenly, the samples were divided into two test and control groups. In the test group, delivery occurred without an episiotomy, whereas in the control group, an episiotomy was performed. The length of the posterior perineal tear, the presence of an anterior perineal tear, and the necessity for repair were subsequently compared. Results: The results revealed that 45.3% of women in the test group gave birth without perineal tears, while the remainder experienced posterior perineal tears (P<0.001). The mean length of posterior perineal tears in this group was 3.64±1.15 cm, compared to 7.12±1.67 cm in the control group (P<0.001). The mean length of a second-degree tear behind the perineum in the test group was 5.32±1.17 cm, compared to 6.13±1.62 cm in the control group (P>0.05). Conclusion: Delivery without episiotomy decreased the incidence of posterior perineal tears; however, delivery without episiotomy should not be performed on all primiparous women.
Case Report Article
Azar Danesh Shahraki; Leila Mousavi Seresht; Amir Reza Farhadi Dehkordi; Pegah Hedaiat; Fedyeh Haghollahi
Articles in Press, Accepted Manuscript, Available Online from 26 February 2023
Abstract
Invasive angiomyxoma as a mesenchymal tumor with a high recurrence rate has been reported mainly in reproductive age according to its association with the estrogenic level of plasma. Above that, it seems there is a need for further treatment despite complete resection of the tumor, to eliminate the hormonal ...
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Invasive angiomyxoma as a mesenchymal tumor with a high recurrence rate has been reported mainly in reproductive age according to its association with the estrogenic level of plasma. Above that, it seems there is a need for further treatment despite complete resection of the tumor, to eliminate the hormonal state.In the present study, we sought to introduce a rare case of invasive angiomyxoma in a post-menopausal but high-risk woman, discuss the relativity of risk factors in all hormonal-dependent gynecological malignancy, and intend to seek help from colleagues' opinions and experiences about treatment. It is clearly of great importance to emphasize the role of individualized medicine in such a rare case, in conclusion, there is not any debate on the role of surgical resection but the necessity of changing in lifestyle or adjuvant systemic or local therapy, and the needed duration is doubtful.
Original Research Article
Razieh Akbari; Ezat-Sadat Haj-seyed Javadi; Zahra Panahi
Articles in Press, Accepted Manuscript, Available Online from 15 May 2023
Abstract
Background and Objective: The aim of labor induction is to stimulate uterine contractions before the spontaneous onset of labor, resulting in vaginal delivery. Misoprostol is used off-label for a variety of indications in the practice of obstetrics and gynecology. Regarding the importance and lack of ...
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Background and Objective: The aim of labor induction is to stimulate uterine contractions before the spontaneous onset of labor, resulting in vaginal delivery. Misoprostol is used off-label for a variety of indications in the practice of obstetrics and gynecology. Regarding the importance and lack of similar research in Iran in Buccal, this research was done to compare the efficacy of Buccal, Vaginal, and Sublingual misoprostol for induction of labor in term pregnancy.Materials & Methods: This study was conducted as a randomized clinical trial from 2017 to 2018. In this study, 300 women were randomly assigned to receive 50 µg Buccal misoprostol, 25 µg Vaginal, and 50 µg Sublingual in Kosar Hospital, Qazvin. The maternal and fetal complications, and Bishop score hour 1, and hour 6 were monitored in three groups and the findings were analyzed.Results: The results showed that there were no differences between fetal complications (p>0.05) and maternal complications (p>0.05) among the three groups. Bishop score hour 1 (P = 0.146), Bishop Score hour 6 (P = 0.704), and total dose (P = 0.15) also were no differences among there groups. The results of the study showed that there was a significant difference between the three groups (P = 0.015) in achieving normal vaginal delivery within 24 hours, as Buccal, Sublingual and Vaginal groups were achieved respectively. Conclusion: This study found that there is no difference in terms of fetal complications and maternal complications in the three groups, but there was a significant difference in Oxytocin use and vaginal delivery within 24 h from the start of induction.
Original Research Article
Maternal Fetal Medicine
Zahra Panahi; Sedigheh Hantoushzadeh; Soudabeh Kazemi Aski,; Saeede Eslami Khotbesara; Mamak Shariat; Fahimeh Ghotbizadeh; Razieh Akbari
Articles in Press, Accepted Manuscript, Available Online from 17 May 2023
Abstract
Introduction: Despite the high efficacy of the Apgar score to find respiratory distress, a low Apgar score doesn’t necessarily indicate fetal hypoxia-asphyxia. Umbilical Artery pH (UApH) is one the best indicator of fetal hypoxia. Therefore it’s so beneficial to consider these criteria and ...
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Introduction: Despite the high efficacy of the Apgar score to find respiratory distress, a low Apgar score doesn’t necessarily indicate fetal hypoxia-asphyxia. Umbilical Artery pH (UApH) is one the best indicator of fetal hypoxia. Therefore it’s so beneficial to consider these criteria and its relationship with Apgar score for accurate diagnosis of prenatal respiratory distress retrospectively and by which reduces the unnecessary cesarean section(CS) rate.
Methods: 162 full-term (≥259 days) neonates delivered by CS with a diagnosis of decreased fetal heart rate (FHR) were evaluated. 1-min and 5-min Apgar scores and UApH were measured. The correlation between Apgar scores with UApH and the association between UapH and Apgar with the NICU admission were evaluated. The effect of other variables including mother’s age, gravidity, gestational age, birth weight, newborn gender, and causes of decreased FHR on Apgar scores and UApH were studied as well.
Results: The most common cause of decreased FHR was fetal distress, boys had higher weight (p=0.033) and lower UApH (p=0.049) than girls. Other parameters were not different significantly between males and females. There was a positive correlation between UApH and 1-min and 5-min Apgar scores (r=0.464 and r=0.370 respectively) when controlled for birth weight (p<0.0001). The RR for NICU admission in male acidemic neonates with abnormal 1-min Apgar was 14.05(CI95%: 5.7-34.6) in comparison to females (RR=1.06, CI95%:1-1.26).
Conclusion: Mild acidemia (UApH<7.2) at least in male fetuses would be a good predictor for postnatal complications and the need for NICU admission. Future studies with more samples are suggested.
Original Research Article
Maternal Fetal Medicine
tayebeh sedighi
Articles in Press, Accepted Manuscript, Available Online from 27 May 2023
Abstract
Introduction: Elevated blood flow resistance in the uterine artery is related to the development of pre-eclampsia and fetal growth restriction, which can be evaluated with uterine artery Doppler ultrasound (UtA). However, there is a lack of studies regarding its reproducibility. Therefore, we aimed to ...
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Introduction: Elevated blood flow resistance in the uterine artery is related to the development of pre-eclampsia and fetal growth restriction, which can be evaluated with uterine artery Doppler ultrasound (UtA). However, there is a lack of studies regarding its reproducibility. Therefore, we aimed to compare the reproducibility of UtA using transvaginal (TV) and transabdominal (TA) methods in both the first and second trimesters.Materials and Method: This prospective, cross-sectional study was performed in the Prenatal Clinic at Yas Hospital, Tehran University of Medical Sciences. Inclusion criteria were gestational age between 11 to 13 weeks and 18 to 22 weeks based on crown-rump length. Both TV and TA techniques were performed by an experienced specialist in maternal and fetal medicine. Intra- and inter-observer variability of the UtA pulsatility index (UtA-PI) was evaluated using intra-class correlation coefficients.Results: This study included 400 pregnant women in the first and second trimesters of pregnancy. There was no significant difference in the mean UtA-PI measured by the operators. Intra-observer and inter-observer reproducibility of TV and TA in both the first and second trimesters, based on ICC and CCC, was moderate and poor, respectively. Intra-observer ICC ranged from 0.97 to 0.85, while the inter-observer ICC ranged from 0.93 to 0.84.Conclusion: Our results showed that intra-observer and inter-observer reproducibility of TV and TA was excellent, whereas the intra-observer and inter-observer reproducibility of TV was better. Measured UtA-PI was not influenced by the operator.
Original Research Article
Obstetrics and Gynecology
Hoora Amoozegar; Nayereh Rahmati; Zahra Naseri; samira Shah-Hamzehi; mostafa vahedian; enayatollah Noori; alireza moradi
Articles in Press, Accepted Manuscript, Available Online from 15 July 2023
Abstract
Background: To evaluate the risk of uterine rupture during pregnancy, researchers use two-dimensional (2D) transvaginal ultrasound to assess lower uterine segment (LUS) thickness in the third trimester of pregnancy. This study aimed to compare the thickness of the LUS provided in a 2D transvaginal ultrasound ...
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Background: To evaluate the risk of uterine rupture during pregnancy, researchers use two-dimensional (2D) transvaginal ultrasound to assess lower uterine segment (LUS) thickness in the third trimester of pregnancy. This study aimed to compare the thickness of the LUS provided in a 2D transvaginal ultrasound with the findings during a cesarean section (C/S) of pregnant women with a history of previous C/S.
Materials and Method: This cross-sectional study was performed on 40 pregnant women referred to Izadi Obstetrics and Gynecology Hospital in Qom. All the women underwent transvaginal ultrasound followed by C/S within a maximum of one week later. Also, an expert gynecologist classified LUS thickness into four grades in the operation room.
Results: The mean age of women was 31.58 ± 4.56 years, and the mean thickness of the LUS was 2.17 ± 0.51 cm. Moreover, 57.5% of the women have grade I of LUS based on intraoperative findings. Results indicated that the mean thickness of the LUS measured by ultrasound significantly differed between the three grades detected by the gynecologist (P=0.04). However, there were no significant differences between maternal age, gestational age, parity, and time of last C/S among women with different LUS grades (P˃0.05). Transvaginal ultrasound could be helpful in evaluating the risk of scar dehiscence and uterine rupture among women with LUS grades I and II with a history of previous C/S.
Review Article
General Gynecology and Pelvic Floor
Leila Pourali; maryam salehi; reyhaneh rahmani; elmira fardi; sedigheh ayati; hasan Mehrad-Majd; mehrdad gazanchian; elham rahmanipour; mohammad ghorbani; Ali mehri
Articles in Press, Accepted Manuscript, Available Online from 16 July 2023
Abstract
Background: Vaginal birth after Caesarean (VBAC) is often offered as an option after a single caesarean section (CS).
Objectives: to evaluate the success rate of vaginal birth after two caesarean sections (VBAC-2).
Search strategy: Systematic review and meta-analysis
Selection criteria and Data collection: ...
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Background: Vaginal birth after Caesarean (VBAC) is often offered as an option after a single caesarean section (CS).
Objectives: to evaluate the success rate of vaginal birth after two caesarean sections (VBAC-2).
Search strategy: Systematic review and meta-analysis
Selection criteria and Data collection: We searched MEDLINE, EMBASE, PubMed, Scopus, using search terms (cesarean OR cesarean OR caesarean OR caesarian) AND (“Vaginal birth after” 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.
Main results: Mean success rate of VBAC-2 was 72% (2174 out of 3020 cases) with a range of 24-90%. 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.
Conclusion: Vaginal delivery is a suitable option for women with two previous cesarean sections, the outcomes are significantly more favorable for women with history of vaginal birth.
Case Report Article
Obstetrics and Gynecology
Mahsa Akbari Oryani; Mohaddeseh Shahraki; Marjaneh Farazestanian
Articles in Press, Accepted Manuscript, Available Online from 23 July 2023
Abstract
Disorders of sex development (DSD) result from intrauterine defects in sex discrimination. The clinical phenotype differs based on the disease type. Cases with ambiguous external genitalia are diagnosed at birth. However, diagnosis of cases with normal-appearing external genitalia may be delayed until ...
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Disorders of sex development (DSD) result from intrauterine defects in sex discrimination. The clinical phenotype differs based on the disease type. Cases with ambiguous external genitalia are diagnosed at birth. However, diagnosis of cases with normal-appearing external genitalia may be delayed until puberty. Here, we report a patient with a pelvic mass and a small uterus that was diagnosed by abdominal ultrasound, in addition to the history of primary amenorrhea and physical examination suggested Swyer syndrome, confirmed by genetic karyotyping. Pathological examination of the surgically removed mass revealed dysgerminoma. Until the age of 19, the patient did not have any idea about 46, XY karyotype, and assumed to be a female. The development of dysgerminoma (as a result of the simultaneous presence of gonadal dysgenesis and Y-chromosome) was another challenge that the patient had to deal with. The diagnosis of this patient at an earlier age could have prevented the development of gonadoblastoma, by removal of the streak gonads. By the presentation of this case, we intend to increase the physician’s awareness about DSDs; earlier diagnosis may help the patient deal with her disease better and reduce the risk of further complications.
Original Research Article
Obstetrics and Gynecology
fatemeh davari tanha; Mojgan Asadi; Faeze Mirbagheri; Elham Feizabad; Zahra kaveh; Kazem Mousavizadeh
Articles in Press, Accepted Manuscript, Available Online from 01 August 2023
Abstract
Background and Objective: Endometriosis is a chronic gynecological condition that affects approximately 10% of women of reproductive age. Chronic pelvic pain is a common symptom of endometriosis and can have a significant impact on a woman's quality of life, including sexual satisfaction. Botulinum toxin ...
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Background and Objective: Endometriosis is a chronic gynecological condition that affects approximately 10% of women of reproductive age. Chronic pelvic pain is a common symptom of endometriosis and can have a significant impact on a woman's quality of life, including sexual satisfaction. Botulinum toxin injection has been used as a treatment for chronic pelvic pain in endometriosis, but its effect on sexual satisfaction is not well understood.Methods: A randomized controlled trial was conducted to evaluate the effect of botulinum toxin injection on chronic pelvic pain and sexual satisfaction in women with endometriosis. The study included 32 women with endometriosis who were randomly assigned to receive either botulinum toxin injection or placebo. The primary outcome measure was change in chronic pelvic pain assessed using the visual analog scale (VAS) at one month after treatment. Secondary outcome measures included changes in sexual satisfaction assessed using the Female Sexual Function Index (FSFI) at one month after treatment.Results: The results showed that botulinum toxin injection significantly reduced chronic pelvic pain compared to placebo at one month after treatment (p<0.001). There was also a significant improvement in sexual satisfaction in the botulinum toxin group compared to placebo at one month after treatment (p=0.001). Conclusion: Botulinum toxin injection may be an effective treatment option for women with endometriosis, chronic pelvic pain and sexual dysfunction.This research was also registered with the code IRCT20091012002576N20 in the Clinical Trial Registration Center of Iran. Date of registration performed between July2021and July 2022
Original Research Article
Obstetrics and Gynecology
Najmiatul Fitria; Nauratul Ikramah; Ade Sukma; Hansen Nasif
Articles in Press, Accepted Manuscript, Available Online from 05 August 2023
Abstract
Background and Objective: 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 ...
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Background and Objective: 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
Methods: 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
Results: The MUAC size significantly differed at the end of pregnancy (p=0.01). However, overall there was no significant difference between the two groups
Conclusion: The IFA administration generally gives good results, but the optimal number of IFA doses still needs further study.
Original Research Article
Obstetrics and Gynecology
fatemeh davari tanha; Mojgan Asadi; Zahra shahraki; Mahsa Ghajarzadeh; zeinab Assaf; Zahra Kaveh
Articles in Press, Accepted Manuscript, Available Online from 07 August 2023
Abstract
Sexual activity is a major determinant of health-related quality of life. The aim of this study was to investigate sexual activity in women with polycystic ovary syndrome.Hence this case control survey was conducted at a tertiary care university hospital (Yas Hospital Complex.). One hundred and ninety-three ...
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Sexual activity is a major determinant of health-related quality of life. The aim of this study was to investigate sexual activity in women with polycystic ovary syndrome.Hence this case control survey was conducted at a tertiary care university hospital (Yas Hospital Complex.). One hundred and ninety-three women were enrolled in this study. The Female Sexual Function Index (FSFI) questionnaire was used to assess the sexual dysfunction. One hundred cases with PCOS and ninety three healthy controls were studied in this study.According to the obtained results, The mean FSFI total score and all domains except orgasm were significantly lower in PCOS patients as compared to healthy controls. With an FSFI score of less than 26.55, sexual dysfunction was found in 62% of PCOS cases versus 18.2% of the control group. Multiple regression analysis showed that FSH and free testosterone were independent predictors of FSFI score. The result showed that more than sixty percent of PCOS women suffer from sexual dysfunction.In conclusion PCOS women need to be asked about and managed for sexual dysfunction more frequently than non-PCOS women.
Original Research Article
Gynecology Oncology
Zahra Shiravani; Fatemehsadat Najib; Mahvash Alirahimi; Elham Askary; Tahereh Poordast; Nader Tanideh; Shohreh Roozmeh; Golsa Shekarkhar; Sana Atbaei; danilo porro; Soudabeh Sabetian; Claudia Cava
Articles in Press, Accepted Manuscript, Available Online from 03 September 2023
Abstract
The endometriosis treatment was critical issue due to complications associated with current drug delivery system. Present investigation compared the curative effect of Vitamin D3 (VTD3) and Omega–3 (OG3) with Diphereline during the treatment of endometriosis. Endometriosis was induced in different ...
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The endometriosis treatment was critical issue due to complications associated with current drug delivery system. Present investigation compared the curative effect of Vitamin D3 (VTD3) and Omega–3 (OG3) with Diphereline during the treatment of endometriosis. Endometriosis was induced in different groups containing 60 adult female rats. The rat model is categorized into 6 groups untreated and treated (Olive Oil (solvent), VTD3 (42 mcg/kg/day), OG3 (450 mg/kg/day), VTD3+OG3, Diphereline (3 mg/kg/day)). The suspension containing combination of Diphereline and supplements was injected and treated for 4 weeks to analyses the effect of supplements. The interleukin -6 (IL-6) and Tumor necrosis factor – alpha (TNFα) inflammatory responses were measured from the serum samples while endometrial implants was dissected and histopathological investigation was done. At the end of four weeks pathologic score was decreases significantly with simultaneous measurement of inflammation score of endometriotic lesion, size of implant area, IL-6, TNFα response and compared with untreated female rat. No significant different was observed in groups undergoing treatment of VTD3, OG3 and Diphereline. The combined effect of VTD3+OG3 has similar responses with Diphereline treated endometrial implants. In conclusion, treatment of VTD3 deficiency and making a change in dietary habits of high-risk population for endometriosis from adolescence may also play a preventative role in adulthood.
Original Research Article
Pathology
Nasrin Ziamajidi; Nazi Moini; Hiva Danesh; Roghayeh Abbasalipourkabir; Nahid Radnia; Zeinab Barartabar
Articles in Press, Accepted Manuscript, Available Online from 05 September 2023
Abstract
Background & Objective: Breast cancer has the highest incidence of all cancers and the incidence of this disease is increasing rapidly in many countries around the world, including Iran. In this study, some epidemiological and pathological factors have been investigated in breast cancer patients.Methods: ...
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Background & Objective: Breast cancer has the highest incidence of all cancers and the incidence of this disease is increasing rapidly in many countries around the world, including Iran. In this study, some epidemiological and pathological factors have been investigated in breast cancer patients.Methods: This is a cross-sectional study which contains 476 patients with a confirmed diagnosis of breast cancer, was conducted in Tehran, Dr. Moini Breast Clinic from 2019 to 2021. Results: The mean age of patients was 50.2±11.40 years, of which 80.9% patients over 40 years. Ductal carcinoma was the most common in terms of histology (81.7%) and most patients are in grade 2 (63.6%). According to hormonal receptors, 73.8% of women had estrogen receptor positive and 68.9% of women had progesterone receptor positive and 18.9% of patients were triple negative. There is a significant relationship between grade and lymph node involvement (P-value=0.00) and also a significant relationship between metastasis with grade (P-value = 0.00 (and metastasis with lymph node involvement (P-value = 0.00) was seen.Conclusion The results of this study show that breast cancer has a high prevalence in Iranian women in Tehran, mainly seen in the 4th and 5th decades of breast cancer. HER-2 (epidermal growth factor 2 receptor overexpression) and triple negatives were the least subgroups. Considering that diagnosis happens late and about 63.6% of patients are in grade 2, it is necessary to implement programs in the field of screening and prevention in the female population of this province.
Original Research Article
General surgery
Lobat Jafarzadeh; Shirin Alsadat Mousavi; Fatemeh Deris
Articles in Press, Accepted Manuscript, Available Online from 09 September 2023
Abstract
Background and Goal: Bleeding is a serious complication during and after hysterectomy. This study aimed to compare the short-term outcomes of ChitoHem and Surgicel use in posterior bladder bleeding during hysterectomy.Methods: In the present clinical trial, 46 patients who were candidates for abdominal ...
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Background and Goal: Bleeding is a serious complication during and after hysterectomy. This study aimed to compare the short-term outcomes of ChitoHem and Surgicel use in posterior bladder bleeding during hysterectomy.Methods: In the present clinical trial, 46 patients who were candidates for abdominal hysterectomy in Hajar Hospital in Shahrekord, Iran, were randomly divided into two groups. In group A, superficial (cauter and Surgicel) and in group B (superficial cauterand ChitoHem) were used to control bleeding. Hematocrit and hemoglobin levels were determined before, 6 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. Data were analyzed by SPSS statistical software.Results: Based on repeated-measures test, the mean of hemoglobin and hematocrit in the studied times showed a significant difference, so that in 6 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 1 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 was not significantly different in the two groups.Conclusion: The results of the present study indicate a better efficacy of ChitoHem on bleeding during hysterectomy surgery.
Original Research Article
General Gynecology and Pelvic Floor
Mahnaz Ashrafi; Behnood Farazmand; Souzan Soufizadeh Balaneji; Maryam Dadkhah
Articles in Press, Accepted Manuscript, Available Online from 01 October 2023
Abstract
Background: Polycystic ovarian syndrome (PCOS), the most common cause of infertility, is widely treated with clomiphene citrate and human gonadotropins. Letrozole, an aromatase inhibitor, can also induce ovulation in patients resistant to clomiphene. However, there has been no comprehensive study comparing ...
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Background: Polycystic ovarian syndrome (PCOS), the most common cause of infertility, is widely treated with clomiphene citrate and human gonadotropins. Letrozole, an aromatase inhibitor, can also induce ovulation in patients resistant to clomiphene. However, there has been no comprehensive study comparing ovulation induction with clomiphene and letrozole versus clomiphene and human gonadotropin. This study aimed to compare an aromatase inhibitor with human gonadotropin for patients with clomiphene-resistant polycystic ovary syndrome. Methods: This randomized clinical trial was conducted on PCOS women resistant to clomiphene at Akbarabadi hospital, Tehran, Iran. Patients were randomly divided into two groups. The first group received letrozole and clomiphene citrate and the second received clomiphene citrate and human gonadotropin.Results: Total number of 120 patients enrolled in our study. No significant difference was seen between the two groups in terms of demographic and basic clinical characteristics (P>0.05). We also found no significant difference between the two groups in terms of hirsutism, galactorrhea, pregnancy rate, human chorionic gonadotropin (HCG) intake, primary and secondary infertility, and number of follicles (P>0.05). Conclusion: The combination of letrozole and clomiphene citrate was as effective as human gonadotropin and clomiphene citrate and it could be a treatment option for patients with infertility due to PCOS.Keywords: Clomiphene, Human menopausal gonadotropin, Letrozole, Polycystic ovary syndrome, Ovulation
Original Research Article
Reproductive Medicine
Kong Chi Pham; Viet Quoc Dao; Le Thi Phuong Nguyen; Vinh Dinh Tran
Articles in Press, Accepted Manuscript, Available Online from 07 October 2023
Abstract
Objective: To determine the causes of infertility of couples examined at Da Nang Hospital for Women and Children. Methods: A cross-sectional descriptive study included 512 reproductive-age couples diagnosed with infertility and treated at Da Nang Hospital for Women and Children from August 2018 to August ...
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Objective: To determine the causes of infertility of couples examined at Da Nang Hospital for Women and Children. Methods: A cross-sectional descriptive study included 512 reproductive-age couples diagnosed with infertility and treated at Da Nang Hospital for Women and Children from August 2018 to August 2020. Results: The mean age of the men and women was 31.0 ± 4.4 years and 33.5±5.0 years, respectively. Primary infertility accounted for 70.9%, whereas secondary infertility was only 29.1%. The mean time of infertility was 3.0±2.5 years. Male factor infertility accounted for the highest rate (39.6%), followed by female infertility (30.5%). Infertility due to both male and female factors was18.0%. Among the causes of male infertility, abnormal semen analysis accounted for the highest rate (57.6%), followed by varicocele (19.3%). Among the abnormalities of semen parameters, oligo-astheno-teratozoospermia (OAT) represented the highest rate (37.5%). There were 46 cases of azoospermia, accounting for 9.0%. Endometriosis accounted for the highest rate (17.6%) among causes of female factor infertility, followed by PCOS (15.6%). There were 51 cases of diminished ovarian reserve, accounting for 9.9%. Conclusion: Male factor infertility accounted for the highest rate in this study. Among the causes of male infertility, abnormal semen analysis had the highest rate. Endometriosis and PCOS were common causes of female infertility.
Original Research Article
Obstetrics and Gynecology
Alfonsus Zeus Suryawan; Amillia Siddiq
Articles in Press, Accepted Manuscript, Available Online from 09 November 2023
Abstract
Background: Uncertainities 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.Methods: ...
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Background: Uncertainities 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.Methods: This research is an analytic observational study with case control design. Subject was gathered from Hasan Sadikin General Hospital patients medical records from June 2021 – March 2022. Inclusion criteria on this study is all pregnant COVID-19 patient with Prothrombin time (PT), activated partial thromboplastin time (aPTT), and D-dimer examination. The exclusion of this study all pregnant COVID-19 patient 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.Results: Statistical analysis shows there’s corelation between different severity levels with D-Dimer. This study shows 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 was found.Conclusion: In conclusion, our findings demonstrate that coagulopathy is associated with the severity of COVID-19 illness. D-dimer is important parameter for evaluating the COVID-19 severity in pregnancy. This further could serve as diagnostic category to differ the severity of COVID-19 in pregnancy.
Original Research Article
Reproductive Medicine
Abdelrehman Saber; Mohammed Ahmed Faris; Sayed Bakry
Articles in Press, Accepted Manuscript, Available Online from 13 November 2023
Abstract
Background: Intracytoplasmic sperm injection (ICSI), a technique that involves an injection of a spermatozoon into the oocyte cytoplasm, has allowed the achievement of fertilization for a wide range of couples suffering from infertility.
Objective: The study assesses the influence of modified ICSI followed ...
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Background: Intracytoplasmic sperm injection (ICSI), a technique that involves an injection of a spermatozoon into the oocyte cytoplasm, has allowed the achievement of fertilization for a wide range of couples suffering from infertility.
Objective: The study assesses the influence of modified ICSI followed by chemically induced activation by calcimycin and Ionomycin in couples with a history of total fertilization failure (TFF).
Methods: A prospective analysis study was conducted with sibling oocytes to compare the application of calcimycin and Ionomycin after the M-ICSI technique. The study was conducted in a private IVF centre in Cairo, Egypt. A case with a TFF history assessed their fertilization rates, cleavage, and good-quality embryos on day three.
Results: 21 cycles comprised 134 oocytes treated with calcimycin and 125 oocytes treated with Ionomycin. Calcimycin-treated oocytes showed a fertilization rate of 39.5 %, a degeneration rate of 3.7 %, an arrest rate of 3.6 %, a cleavage rate of 45.5 %, and a good quality embryo rate of 37.1 %. On the other hand, ionomycin-treated oocytes showed a fertilization rate of 68.0 %, a degeneration rate of 6.0 %, an arrest rate of 3.7 %, a cleavage rate of 74.3 %, and a good quality embryo rate of 31.5 %. Ionomycin-treated oocytes had a significantly higher t-value of fertilization and cleavage rates than calcimycin-treated (p-value < 0.05).
Conclusion: M-ICSI followed by Ionomycin or ready-to-use calcimycin may treat TFF patients. Calcium increase could be achieved directly by mechanical activation and last longer by assisted oocyte activation (AOA) treatment.
Original Research Article
General Gynecology and Pelvic Floor
Rihab Majeed Shareef; Najah Shaker Yassen; Sallama Hamid Alkhudair
Articles in Press, Accepted Manuscript, Available Online from 13 November 2023
Abstract
Background: Melatonin play a role in pubertal development and reproductive function through the Hypothalamus-hypophysis-gonadal axis. In addition, melatonin production decreases with age, so that indolamine could be an anti-ageing agent. To assess Intra follicular melatonin level's role in ovarian ...
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Background: Melatonin play a role in pubertal development and reproductive function through the Hypothalamus-hypophysis-gonadal axis. In addition, melatonin production decreases with age, so that indolamine could be an anti-ageing agent. To assess Intra follicular melatonin level's role in ovarian reserve and the IVF cycle outcomes.
Patients and method: A prospective cross-sectional study was conducted from April 2022 to April 2023. Patients on a mini-long agonist, short agonist, and antagonist protocols were enrolled in the current study. Using ultrasound, the follicle development was observed from the stimulation day until the hCG day (done every 2 or 3 days).
Results: Melatonin were positively correlated with oocyte retrieved (r=0.705, P<0.001), number of fertilized oocyte (r=0.68, P<0.001), number of zygotes cleaved (r=0.660, P<0.001), high quality embryos (r=0.591, P<0.001), embryos for transplantation (r=0.604, P<0.001), percent of high quality embryos (r=0.58, P<0.001), and with percent of blastocyst rate.
Conclusion: Melatonin mean levels in follicular fluid were significantly decreased in poor response than in standard and high response. The follicular fluid melatonin levels were associated with each oocyte quantity and quality and can expect ICSI consequences and act as highly important biochemical indicators of ovarian reserve.
Original Research Article
Gynecology Oncology
Ahmad Shuib Yahaya; Mohd Norazam Mohd Abas; Jamil Omar
Articles in Press, Accepted Manuscript, Available Online from 18 November 2023
Abstract
Objective:
This study aims to analyze the survival outcomes and prognostic factors of patients with uterine sarcoma in the Department of Gynae-Oncology, between June 2015 and December 2022.
Methods:
The study population consists of patients with histopathologically confirmed uterine sarcoma. Oncological ...
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Objective:
This study aims to analyze the survival outcomes and prognostic factors of patients with uterine sarcoma in the Department of Gynae-Oncology, between June 2015 and December 2022.
Methods:
The study population consists of patients with histopathologically confirmed uterine sarcoma. Oncological data collected includes stage, pathological report and type of surgery, adjuvant therapy, recurrence, and mortality. Kaplan-Meier analysis used to estimate survival.
Results:
We identified 58 eligible uterine sarcoma patients: 13 leiomyosarcoma (22.4%), 9 endometrial stromal sarcoma (15.5%), 32 carcinosarcoma (55.2%), 2 adenosarcoma (3.4%) and another 2 were undifferentiated sarcoma (3.4%). Mean age was 56.1 (SD=12.03) and 56% patients were postmenopausal. Majority of patients presented in stage III and IV (53.4%) and only 22 patients (37.9%) in stage I. Adjuvant radiotherapy was given to 21 patients (36.2%); 8 patients (13.8%) received chemotherapy and 9 patients (15.5%) received both radiotherapy and chemotherapy. Median follow up period was 13.5 months (range: 73 months) and total of 35 patients (60.3%) had recurrence with median time to recurrence of 6.0 months (range: 35). Death occurred in 21 patients (36.2%) with median time to death 5.0 months (range: 36 months). Progression free survival (PFS) among all patients was 26.64 (range: 4.32) months with significant correlation with stage of disease. Overall survival (OS) in patients received surgery only, radiotherapy and combine radiotherapy and chemotherapy were 23.3, 54.8 and 62.4 months respectively (p value 0.03).
Conclusion:
Uterine sarcoma is a relatively rare tumor type with worse survival. Multimodality adjuvant treatments showed to improve prognosis in those patients.
Original Research Article
Reproductive Medicine
shayamaa Abd Hasan; Basma Salman Abdul Hammed; Qasim Mohammed Banjah
Articles in Press, Accepted Manuscript, Available Online from 19 November 2023
Abstract
Primary infertility affects a significant proportion of couples and is often attributed to female factors. Obesity, which is associated with increased levels of the hormone leptin, is a known risk factor for female infertility. This cross-sectional study aimed to investigate the association between BMI ...
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Primary infertility affects a significant proportion of couples and is often attributed to female factors. Obesity, which is associated with increased levels of the hormone leptin, is a known risk factor for female infertility. This cross-sectional study aimed to investigate the association between BMI and leptin levels in primary infertile females at Al-Nuaman Hospital and Al-Salama private hospital from September 2022 to March 2023. A total of 100 females were enrolled, and their BMI and serum leptin levels were measured. The participants were divided into four groups: Group 1 (normal weight, fertile), Group 2 (overweight infertile), Group 3 (obese infertile), and Group 4 (severely obese infertile) women, each consisting of 25 participants, categorized based on their BMI: normal BMI (18.5–24.9 kg/m²), overweight BMI (25–29.9 kg/m²), obesity BMI (≥30 kg/m²), and severely obese BMI (35-40 kg/m²). The mean leptin levels were compared between the four groups using ANOVA, and the association between BMI and leptin levels was assessed using Pearson's correlation coefficient. The study revealed a highly significant correlation between primary infertility and the parameters (BMI and leptin) (P < 0.001) and showed a positive correlation between leptin and BMI. It was shown that primary infertile females with a high BMI have elevated serum leptin levels. This underscores the importance of weight management in addressing primary female infertility.
Original Research Article
Gynecology Oncology
farahnaz farzaneh; Shahla Mirgaloybayat; Abbas Ali Niazi; Marziyeh Ajdary; Javid Dehghan Haghighi; Neda Eslahi; Mohammad Raisi
Articles in Press, Accepted Manuscript, Available Online from 20 November 2023
Abstract
Background & Objective: 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 ...
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Background & Objective: 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 & Methods: 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. Results: 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.Conclusion: 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.
Original Research Article
Obstetrics and Gynecology
Hosna liravi; Fariba Seyedoshohadaei; Masomeh Rezaie; Nasrin Sofizadeh; farnaz zandvakili; Khaled Rahmani
Articles in Press, Accepted Manuscript, Available Online from 29 November 2023
Abstract
Introduction: This study aims to determine the effectiveness of simultaneous use of aspirin with clomiphene citrate and letrozole on the success rate of ovulation induction in women with PCOS.
Materials and methods: This study was a double-blind randomized clinical trial. 120 patients with PCOS with ...
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Introduction: This study aims to determine the effectiveness of simultaneous use of aspirin with clomiphene citrate and letrozole on the success rate of ovulation induction in women with PCOS.
Materials and methods: This study was a double-blind randomized clinical trial. 120 patients with PCOS with complaints of infertility due to lack of ovulation were randomly divided into four groups using clomiphene citrate + placebo, letrozole + placebo, clomiphene citrate + Aspirin, and letrozole + aspirin divided by block randomizes. Follicometry was performed with the help of transvaginal ultrasound on the 14th day of the cycle. In the case of a positive pregnancy, the patients underwent transvaginal ultrasound in the 6th week of pregnancy to observe the gestational sac. Patients were followed up until the 12th week of pregnancy in terms of the abortion rate.
Results: This study showed that there was no significant difference in the number of follicles of 14 to 18 mm, follicles larger than 18 mm, and the thickness of the endometrium of the studied women in the four investigated groups (p>0.05). The pregnancy test results showed that the clomiphene citrate + aspirin group and the letrozole + aspirin group each had the highest pregnancy rate with 13 people (36.1%) having a positive test.
conclusion: Although the addition of aspirin to letrozole or clomiphene citrate does not affect the number of mature follicles and the thickness of the endometrium, it can increase the probability of pregnancy.
Original Research Article
Anesthesia
Olumide Mathew Adebisi; Adebayo Augustine Adeniyi; Olabisi Timothy Adeyemo; Olayinka Tesleem Orewole; Olumide Emmanuel Adewara; Babatunde Sunday Awoyinka; Idowu Oluwaseyi Adebara; Adewumi Bakare; Oluwasesan Bamidele Afolabi; Adeola Emmanuel Adekanye
Articles in Press, Accepted Manuscript, Available Online from 01 December 2023
Abstract
Background and Objective: The commonly used analgesia for post caesarean pain include combination regimens containing acetaminophen, non-steroidal anti-inflammatory agents (NSAIDs) and opioids. The objective of this study is inter alia to determine the effects of dexamethasone as adjuvant to commonly ...
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Background and Objective: The commonly used analgesia for post caesarean pain include combination regimens containing acetaminophen, non-steroidal anti-inflammatory agents (NSAIDs) and opioids. The objective of this study is inter alia to determine the effects of dexamethasone as adjuvant to commonly used NSAIDs for post-caesarean pain management.
Materials and methods: One hundred and eighty-eight participants slated for caesarean delivery under spinal anaesthesia were randomized into two groups of 94 participants each. One group received 2ml intravenous 8mg dexamethasone while the second group received 2ml of intravenous sterile water as placebo . Both groups received similar doses of intramuscular acetaminophen and diclofenac. Intramuscular pentazocine at a dose of 0.5mg/kg body weight was used as rescue analgesia. Primary outcome was the mean summed pain intensity difference (MDPID) in the two groups while the secondary outcomes include the needs and frequency of rescue analgesia, and the levels of maternal satisfaction. P-value set as ≤0.05.
Results: The mean summed pain intensity difference (MSPID) at 24hours post-caesarean was higher in the dexamethasone group, (29.27±18.10 versus 24.24±13.14, p=0.036). The percentage of the participants that required rescue analgesia in the dexamethasone group was less (60.6% versus 76.1%, p=0.024). The Overall levels of maternal satisfaction were comparable in both groups.
Conclusion: Intraoperative dexamethasone given intravenously as adjuvant to intramuscular diclofenac and acetaminophen minimizes opioid administration within the first 24hours after caesarean section.
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