Original Research Article
Obstetrics and Gynecology
Saeedeh Shahali; Farnaz Sahhaf Ebrahimi; Simin Taghavi; Elnaz Afsari
Volume 8, Issue 1 , November and December 2022, Pages 1-10
Abstract
Background & Objective: Diabetes mellitus and gestational diabetes are complications that may be associated with preterm premature rupture of the membrane (i.e. PPROM) during pregnancy. We have investigate the impact of gestational and overt diabetes on PPROM through a statistical campaign. Materials ...
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Background & Objective: Diabetes mellitus and gestational diabetes are complications that may be associated with preterm premature rupture of the membrane (i.e. PPROM) during pregnancy. We have investigate the impact of gestational and overt diabetes on PPROM through a statistical campaign. Materials & Methods: This study was conducted in two parts: In the first part, the PPROM patients (211 cases) were classified into three groups, without diabetes (W/ODM=126 cases), gestational diabetes (GDM=69 cases consist of 44 cases under insulin therapy and 25 cases of diet controlled), and diabetes mellitus (ODM=16 cases). PPROM complications were studied and compared between these three groups. In the second part, GDM patients under insulin therapy or diet control were compared to W/ODM patients in terms of PPROM complications. Results: There were no significant statistical differences between the groups regarding pregnancy outcomes, except, for mean gestational age at rupture of membrane and delivery. For maternal outcomes, there were significant changes between groups in terms of labor duration, hospital stay after childbirth, and severe preeclampsia. Fetus and neonatal outcomes suggested that the newborn weight, neonatal hyperglycemia, Apgar score, revive need, infant death, and umbilical cord blood gas test results (except BE) were significantly different between the three groups. Results of the second part of the study, in terms of statistically significant differences between insulin therapy, diet control, and W/ODM are consistent with the first part, for all discussed factors. Conclusion: Results revealed that PPROM protocol management on PPROM cases who have gestational or overt diabetes is applicable and does not have any further risk.
Original Research Article
Gynecology Oncology
Fariba Behnamfar; Fatemeh Ahmadi Solush; Tajossadat Allameh
Volume 8, Issue 1 , November and December 2022, Pages 11-16
Abstract
Background & Objective: Cervical Cancer (CC) is a common cancer which is associated with HPV-infection. The aim of this study is to investigate the risk factors which affects HPV-clearance.Materials & Methods: This study was carried out on women with high risk HPV infection. All the patients ...
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Background & Objective: Cervical Cancer (CC) is a common cancer which is associated with HPV-infection. The aim of this study is to investigate the risk factors which affects HPV-clearance.Materials & Methods: This study was carried out on women with high risk HPV infection. All the patients underwent pap smears and cervical biopsy. Demographic data, marital status, vaccination history and consumption of tobacco, alcohol, opium and oral contraceptive pills were asked through a questionnaire. Results: The results showed that in one year follow-up, 142 (67.1%) patients showed HPV clearance. The HPV clearance decreased by increasing age (P=0.028) or higher CIN grades (P=0.017). In case of parity, there was no significant difference in univariate analysis (P=0.147), but it was significant in multiple logistic regression analysis (95% CI: 0.413-0.941, OR=0624, P= 0.024).Conclusion: It seems that age and cervical histology at the start of HPV infection are the most important factors for HPV clearance.
Original Research Article
Gynecology Oncology
Tajossadat Allameh; Maryam Sadat Mirazimi; Fahimeh Sabet; Leila Mousavi Seresht; Fariba Behnamfar
Volume 8, Issue 1 , November and December 2022, Pages 17-22
Abstract
In gynecological cancers, sentinel lymph node (SLN) mapping has been proposed as an alternative to complete lymph node dissection. The goal of this study was to determine sentinel lymph node mapping's sensitivity, specificity, NPV, and PPV versus gold standard surgery (complete lymph node dissection) ...
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In gynecological cancers, sentinel lymph node (SLN) mapping has been proposed as an alternative to complete lymph node dissection. The goal of this study was to determine sentinel lymph node mapping's sensitivity, specificity, NPV, and PPV versus gold standard surgery (complete lymph node dissection) in patients with metastatic illness. A total of 26 patients were prospectively enrolled from spring 2021 to winter 2022. Sentinel lymph node mapping with complete pelvic lymph node dissection was done in all of them, and para-aortic lymphadenectomy was detected in 11 (43.33%) patients. At least one sentinel lymph node was successfully mapped in 22 (84.6%) patients. Three patients (11.5%) had positive lymph nodes, with an 85.7% sensitivity (95 percent CI) to detect node positive illness, a specificity of 74.93%, an NPV of 99.6 (99.5 CI), and a PPV of 5.9% calculated. There were no serious adverse effects due to blue dye. The accuracy rate of sentinel lymph node mapping by methylene blue was 75.1%.
Original Research Article
Obstetrics and Gynecology
Mahnaz Ashrafi; Sahar Golmohammadi
Volume 8, Issue 1 , November and December 2022, Pages 23-28
Abstract
Background & Objective: Clomiphene resistance is an important problem among women with Polycystic Ovarian Disease (PCOD) suffering from infertility. Recognition of the causes would result in better prognosis in these patients. This study was performed to determine different PCOD phenotypes and ...
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Background & Objective: Clomiphene resistance is an important problem among women with Polycystic Ovarian Disease (PCOD) suffering from infertility. Recognition of the causes would result in better prognosis in these patients. This study was performed to determine different PCOD phenotypes and their effects on clomiphene resistance in infertile women.Materials & Methods: In this descriptive-comparative cross-sectional study, 200 consecutive PCOD women with infertility taking clomiphene who were reffered to Akbarabadi hospital in 2017 and 2018 were enrolled. Different PCOD phenotypes and their effects on clomiphene resistance among these women were assessed.Results: The results showed that A, B, C, and D phenotypes were observed in 79 (39.5%), 13 (6.5%), 51 (25.5%), and 57 (28.5%) patients, respectively. Sixty-one patients (30.5%) had resistance. Despite no significant difference between phenotypes (P=0.064), the most common PCOD phenotype was A (HA+OA+PCO) found in 39.2% and D (OA+PCO) was seen in 29.8% of the patients.Conclusion: According to the results, there was no significant association between PCOD phenotypes and clomiphene resistance. Finally, A and D phenotypes were frequent types with clomiphene resistance.
Original Research Article
Gynecology Oncology
Mahdis Mohamadianamiri; Hossein Shirazi; Majid Aklamli; Kobra Tahermanesh; Shahin Keshtkar Rajabi
Volume 8, Issue 1 , November and December 2022, Pages 29-34
Abstract
Background & Objective: There are controversial results and paucity of data regarding the role of prolactin hormone in triple negative breast cancer. Hence, this study aimed to evaluate the role of prolactin receptor as a predictive factor in patients with triple negative breast cancer.Materials ...
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Background & Objective: There are controversial results and paucity of data regarding the role of prolactin hormone in triple negative breast cancer. Hence, this study aimed to evaluate the role of prolactin receptor as a predictive factor in patients with triple negative breast cancer.Materials & Methods: This was a descriptive-analytical study. All patients referred to three referral hospitals with triple negative breast cancer (ER−, PR−, HER-2−), were assessed to be included in the study. Patients' slides and blocks were re-examined for prolactin receptor by immunohistochemistry. Moreover, the association between the tumor size and grade was examined with prolactin receptor. Clinical characteristics and pathological features were recorded in researcher made questionnaire.Results: In total, 25 patients with triple negative breast cancer (TNBC) entered the study. Mean and standard deviation (SD) of tumor size in prolactin negative and positive groups were 4.82 ± 5.05 and 3.37 ± 1.61 cm, respectively with no significant difference (P-value> 0.05). Also, there was no statistically significant association between the tumor grade and prolactin receptor status (P-value = 0.056). Moreover, there was no statistically significant association between lymph nodes involvement and prolactin receptor status using Fisher’s exact test (P-value = 0.9). However, mean ± SD of age in negative and positive prolactin groups were 45.73 ± 12.12 and 56.60 ± 9.84, respectively with a statistically significant difference (P-value = 0.026).Conclusion: We did not find any association between prolactin receptor status and tumor size or grade in TNBC. Nonetheless, there is still ambiguity regarding the role of prolactin receptor expression in development of breast cancer. The controversial results are probably due to different effects of prolactin receptor in various breast cancer subtypes, which should be assessed in further trials.
Original Research Article
Obstetrics and Gynecology
Soheila Dabiran; Shahla Khosravi; Leila Pourali; Sedigheh Ayati; Zahra Mohaddes Ardebili; Shamim Delavari
Volume 8, Issue 1 , November and December 2022, Pages 35-40
Abstract
Background & Objective: Delayed childbearing has become a worldwide phenomenon, yet the association between advanced maternal age (AMA ≥35 years) and pregnancy outcomes remains unclear. This issue has also been inadequately explored in Iran. To assess the relationship between pregnancy complications ...
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Background & Objective: Delayed childbearing has become a worldwide phenomenon, yet the association between advanced maternal age (AMA ≥35 years) and pregnancy outcomes remains unclear. This issue has also been inadequately explored in Iran. To assess the relationship between pregnancy complications and AMA in the Iranian context.Materials & Methods: This cross-sectional study involved 891 women who had consecutive pregnancies and were referred for delivery to an academic hospital at Mashhad university of medical sciences, Mashhad , Iran, from March 2015 to March 2019 for The women were considered into the two age groups, namely, a 20 to 34year group and an AMA group, who were then assessed in terms of complications of late childbearing, such as preeclampsia, gestational hypertension, and gestational diabetes mellitus (GDM); mode of delivery; and five-minute Apgar score. The data were analyzed using the chi-square test and the Mann–Whitney U test in SPSS version 9. The P<0.05 was considered statistically significant.Results: The AMA group exhibited lower five-minute Apgar scores and a significantly higher prevalence of preeclampsia, gestational hypertension, and GDM (p < 0.05). The two groups also substantially differed concerningquality of prenatal care (p < 0.001). Regarding the mode of delivery, cesarean section was more prevalent in the AMA group, whereas vaginal delivery was more common in the younger group (p < 0.001).Conclusion: With regard to trend to pregnancy in higher maternal age and higher pregnancy complication in this population, precise preconception counseling is crucial to educating couples for early childbearing at younger age.
Original Research Article
Obstetrics and Gynecology
Zahra Soleimani; Mansoor Nourmohammadi; Neda Hashemi; Maryam Aghaei
Volume 8, Issue 1 , November and December 2022, Pages 41-46
Abstract
Background & Objective: Considering the importance of good sleep quality during pregnancy and the adverse effects of poor sleep quality on mother before and after childbirth and also its adverse effects on the fetus and newborn, identifying the related factors to sleep disturbance is important. ...
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Background & Objective: Considering the importance of good sleep quality during pregnancy and the adverse effects of poor sleep quality on mother before and after childbirth and also its adverse effects on the fetus and newborn, identifying the related factors to sleep disturbance is important. Therefore, this study was conducted to evaluate the relationship between prenatal and sleep quality in pregnant women.Materials & Methods: The present cross-sectional study was done on 150 pregnant women who were referred to Baqiyatallah Hospital, Tehran, Iran. Convenience sampling method was used for choosing participants. Pittsburgh Sleep Quality Index (PSQI) and Prenatal Distress Questionnaire (PDQ) were used for gathering information.Results: The prevalence rates of poor sleep quality in first, second and third trimesters were 36%, 54% and 62%, respectively. In all three trimesters, the newborn health parameter had the highest score and relationship score had the lowest score. There was a statistically significant relationship between prenatal concerns and sleep quality of pregnant women in all three trimesters of pregnancy (P<0.05).Conclusion: We found the significant relationship between pregnancy concerns and sleep quality of pregnant women in all three trimesters of pregnancy, and this finding indicates the direct effect of pregnancy concerns on sleep quality during pregnancy. Therefore, it is necessary to plan and perform the necessary interventions to minimize the concerns of pregnant women.
Original Research Article
Obstetrics and Gynecology
Fadhil Hussam; Shaymaa Abdulhameed Khudair; Waleed K. Alkhafaje; Yasir S. Alnassar; Rashad M. Kaoud; Ahmed Najm Abed; Haneen Saad Jabbar; Hiba Ali Numan
Volume 8, Issue 1 , November and December 2022, Pages 47-52
Abstract
Background & Objective: Infertility is the inability to become pregnant despite trying for at least a year. Infertility is also referred to as when a woman continues to experience miscarriages. Environmental factors, lifestyle, hormone issues, physical problems, and age can all contribute to ...
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Background & Objective: Infertility is the inability to become pregnant despite trying for at least a year. Infertility is also referred to as when a woman continues to experience miscarriages. Environmental factors, lifestyle, hormone issues, physical problems, and age can all contribute to female infertility. About 10-12% of couples struggle with infertility, a multifaceted issue with ramifications for society, the economy, and culture. The majority of female infertility cases are caused by issues with egg production. By analyzing samples from infertility clinics, the current study aims to investigate the degree of female infertility in Erbil, Iraq, while covering all facets of the condition.Materials & Methods: 595 infertile females receiving medical counseling from three infertile institutions between February 2020 to December 2021 were screened for the current study. In addition to anthropometric measurements, information about the etiology, duration, and lifestyle, factors of infertility has been gathered using a standardized questionnaire. Additionally, the sample was subjected to clinical examinations. Five groups of reproductive abnormalities were identified. Around 61.79% of women in the infertile group for the first two years had tubal obstruction, and 49.92% had hormonal deficiencies. Ovulation defects (4.62%) and undersized uteri (4.82%) predominated in the >10-year infertile group. Both weight and body mass index have shown a favorable association with infertility duration.Results: Our findings demonstrated a significant correlation between body mass index and infertility. Most academic and wealthy groups pursued medical advice to resolve issues related to infertility.Conclusion: Finally, it is suggested that female infertility can be managed and cured with hormone therapy, laparoscopic procedures, minor surgical procedures, and medicine.
Original Research Article
Gynecology Oncology
Afsaneh Tehranian; Akram Ghahghaei-Nezamabadi; Maryam Motiei Langeroudi; Reyhaneh Aghajani
Volume 8, Issue 1 , November and December 2022, Pages 53-56
Abstract
Background & Objective: We compared two different methods of visual inspection of the cervix, including Visual inspection of the cervix with acetic acid (VIA) and Visual inspection of the cervix with Lugol's iodine (VILI) in terms of sensitivity and specificity in diagnosis of pre-malignant cervical ...
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Background & Objective: We compared two different methods of visual inspection of the cervix, including Visual inspection of the cervix with acetic acid (VIA) and Visual inspection of the cervix with Lugol's iodine (VILI) in terms of sensitivity and specificity in diagnosis of pre-malignant cervical lesions in comparison to colposcopy guided biopsy.Materials & Methods: In this cross-sectional study, a total number of 200 women who were referred to the colposcopy clinic of Arash women’s hospital (Tehran, Iran) for cervical cancer screening, underwent VIA, VILI, and colposcopy guided biopsy during 2018-2019.Results: The calculated sensitivity and specificity of VIA and VILI in this population were (100% and 69.5%) and (100% and 60%), respectively, whereas the sensitivity and specificity of both VIA and VILI tests in combination were 100% and 77.2%. The positive and negative predictive values were 32.7% and 100%, respectively, when combined form of VIA and VILI was applied in this population.Conclusion: VIA and VILI alone or in combination could be used as screening tests to evaluate the presence of cervical cancer and in case of positive results, supplementary tests such as colposcopy guided biopsy could be performed for definite diagnosis.
Original Research Article
Obstetrics and Gynecology
Minoo Gharouni; Abolfazl Mehdizadeh Kashi; Shahla Chaichian; Zahra Azizian; Kobra Tahermanesh; Samaneh Rokhgireh
Volume 8, Issue 1 , November and December 2022, Pages 57-62
Abstract
Background & Objective: Fast-track surgery (FTS) consists of different pathways to decrease surgical complications and improve outcomes and patient satisfaction. FTS in an elective gynecologic laparoscopic surgery has not been well assessed. No consensus guidelines have been developed for gynecologic ...
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Background & Objective: Fast-track surgery (FTS) consists of different pathways to decrease surgical complications and improve outcomes and patient satisfaction. FTS in an elective gynecologic laparoscopic surgery has not been well assessed. No consensus guidelines have been developed for gynecologic laparoscopic surgeries. The purpose of this study is to evaluate enhanced recovery after surgery (ERAS) for total laparoscopic hysterectomy.Materials & Methods: 260 patients underwent for laparoscopic hysterectomy surgery. All patients were divided into two groups as follows: one group received traditional laparoscopic hysterectomy surgery and the intervention group was treated under ERAS protocol. ERAS protocol includes not receiving preoperative mechanical bowel preparation and laxatives as well as fasting 6 h and not drinking liquids 2h before surgery. The patients were allowed to resume the ordinary diet 6h post-operation. Ondansetron 4 mg were prescribed after surgery for nausea and vomiting, pain was controlled with non-narcotic analgesics diclofenac suppository 100 mg/q12 h and paracetamol 1000 mg/q6 h until discharge. Urinary catheter was removed whenever possible and early ambulation occurred 6h after the surgery.Results: A total of 260 patients were studied. Regarding the length of hospitalization, significant differences were shown between the groups (P<0.001). Return to daily functions was occurred earlier in the fast-track surgery group than another group. Complications and VAS pain scores showed no significant differences between the groups.Conclusion: Our results show that ERAS surgery has fewer side effects and better outcomes which make it more suitable for patients undergoing laparoscopic hysterectomy.
Original Research Article
Obstetrics and Gynecology
Sedigheh Ghasemian Dizajmehr; Afshin Mohammadi; Sara Malekshahi Nejad
Volume 8, Issue 1 , November and December 2022, Pages 63-67
Abstract
Background & Objective: Postpartum hemorrhage is the most common cause of maternal morbidity, especially in developing countries, and a major cause of direct maternal death worldwide. Considering the importance of timely postpartum hemorrhage management and access to low-risk methods, assessing ...
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Background & Objective: Postpartum hemorrhage is the most common cause of maternal morbidity, especially in developing countries, and a major cause of direct maternal death worldwide. Considering the importance of timely postpartum hemorrhage management and access to low-risk methods, assessing the efficacy of uterine artery embolization (UAE) is essential. Therefore, the present study was conducted to evaluate the success rate and outcomes of UAE in the treatment of delayed postpartum hemorrhage.Materials & Methods: This cross-sectional study was performed on women with delayed postpartum hemorrhage who were referred to the gynecology and obstetrics clinic of a referral hospital in Urmia city under treatment of UAE. The census method was used for choosing the patients and all women with delayed postpartum hemorrhage between April 2019 and March 2020 were entered into the study.Results: During the study period, he number of 22 women with delayed postpartum hemorrhage were entered into the study. The mean age of the women was 29.36±5.09 years. The success rate of UAE was 95.6%. The number of 20 (90.9%) cases did not report complications. For one case, UAE complication was associated with amenorrhea and for the other one with vaginal bleeding.Conclusion: The results showed that the UAE method as an effective method with high efficacy and low complications can be considered a suitable choice for the treatment of delayed postpartum hemorrhage.
Original Research Article
Obstetrics and Gynecology
Fahimeh Ghotbizadeh; Zahra Panahi; Azam Tarafdari Manshadi; Saeed Soltani; Razieh Akbari; Mahdieh Parsapur
Volume 8, Issue 1 , November and December 2022, Pages 68-75
Abstract
Background & Objective: Social factors which are integrated with health status are considered crucial in pregnancy morbidity. Mothers with a developed level of health literacy (HL) experience a lower risk of preterm delivery. This study aimed to evaluate the relationship between maternal HL ...
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Background & Objective: Social factors which are integrated with health status are considered crucial in pregnancy morbidity. Mothers with a developed level of health literacy (HL) experience a lower risk of preterm delivery. This study aimed to evaluate the relationship between maternal HL and prenatal care and pregnancy outcome.Materials & Methods: The research was a cohort study. A total of 323 participants were selected from prenatal clinics. The women were followed until delivery. Women who had gestational diabetes or preeclampsia or gestational hypertension during pregnancy were omitted. Data were collected with a survey.Results: The result found 34.1%, 33.1%, 23.8%, and 9% were categorized as having inadequate, problematic, sufficient, and excellent maternal HL. Women with sufficient and excellent literacy were meaningfully better in having earlier and more frequent antenatal care, earlier folic acid consumption, and exercise before and during pregnancy, pregnancy alarm sign awareness, neonatal birth weight, and breastfeeding.Conclusion: The results proposed that sufficient and excellent HL among women is related to good pregnancy outcomes and poor HL causes a poor chance to gain a positive pregnancy outcome. A cooperative work to grow maternal HL by considering HL levels, revision of educational materials into plain language, and provision of pregnant women with verbal and video instruction in addition to written materials are highly recommended.
Case Report Article
Pathology
Tajossadat Allameh; Behnoosh Mohamadi
Volume 8, Issue 1 , November and December 2022, Pages 76-80
Abstract
Signet ring stromal tumor is a rare benign ovarian neoplasm, of which only about 17 cases have been reported since 1996. The signet ring appearance of this tumor may mimic a Krukenberg tumor and result in a diagnostic challenge in some cases. The previous cases occurred in adult or in old patients. We ...
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Signet ring stromal tumor is a rare benign ovarian neoplasm, of which only about 17 cases have been reported since 1996. The signet ring appearance of this tumor may mimic a Krukenberg tumor and result in a diagnostic challenge in some cases. The previous cases occurred in adult or in old patients. We have reporteda Signet ring stromal tumor in a 13-year-old girl.
Case Report Article
Pathology
Amal Abd El hafez
Volume 8, Issue 1 , November and December 2022, Pages 81-85
Abstract
Plasma cell myeloma (PCM) of the breast is extremely unusual. It probably constitutes 0.7% of extramedullary plasmacytomas, and 0.2% of all breast malignancies. Clinically and radiologically, PCM of the breast is indistinguishable from breast carcinoma or other primary breast disorders. Therefore, histomorphological ...
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Plasma cell myeloma (PCM) of the breast is extremely unusual. It probably constitutes 0.7% of extramedullary plasmacytomas, and 0.2% of all breast malignancies. Clinically and radiologically, PCM of the breast is indistinguishable from breast carcinoma or other primary breast disorders. Therefore, histomorphological examination with immunohistochemistry are considered as gold standards for its diagnosis in tissue samples. We report a case of a 30-year-old female presented with a progressive huge ulcerating left breast mass, despite chemotherapy. She had a history of an initially misdiagnosed humeral lytic lesion, and recurrent lytic boney lesions for the past 7 years. Positive CD138, CD56 and Kappa immunostaining has confirmed PC differentiation and monoclonality of the tumor cells. Subsequently, PCM of breast was diagnosed and the patient was transferred for chemotherapy and follow-up.
Case Report Article
Obstetrics and Gynecology
Mohammad Reza Zeraati; Hojjat Torkmandi; Mohammad Abdi; Mohammad Reza Jamshidi; Alireza Safaie
Volume 8, Issue 1 , November and December 2022, Pages 86-94
Abstract
Pyrexia and shivering are the most popular side effects of postpartum administration of misoprostol, but other side effects of this drug are very rare. A 27-year-old pregnant female patient was admitted to Ayatollah Mousavi hospital (Zanjan, Iran), complaining about severe headache and the primary diagnosis ...
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Pyrexia and shivering are the most popular side effects of postpartum administration of misoprostol, but other side effects of this drug are very rare. A 27-year-old pregnant female patient was admitted to Ayatollah Mousavi hospital (Zanjan, Iran), complaining about severe headache and the primary diagnosis of cerebral venous thrombosis. Treatment was successful after primary investigations and planed therapy for Cerebral Venous Thrombosis (CVT). Following the decision on terminating the pregnancy, five tablets of Sublingual misoprostol (200 mg) was used once evacuation of pregnancy remnants was done. About thirty minutes after the administration of misoprostol, onset of severe shivering and tachycardia (201/min) with high fever (about 41°C) and hypertension (182/123 mmHg) was observed. National Adverse Drug Reaction (ADR) form was completed. All of symptoms were alleviated 30 minutes after administration of Paracetamol 1gram (Intravenous infusion) followed by Metoprolol 50 mg (orally). According to the literature, we listed the various side effects of misoprostol. Even though the side effects of misoprostol are diverse and rare, the simultaneous occurrence of these side effects is not cited till date. These incidents are reported to the authorities as per ADR policy; nonetheless, no preventive measures are implemented. This necessitates medical educational policies to be taken into consideration to educate healthcare providers throughout their professional career as well as research.
