Journal of Obstetrics, Gynecology and Cancer Research
Volume:6 Issue: 4, Fall 2021

This retrospective study aims to evaluate the impact of pre-gestational maternal age and body weight on the outcome of IVF in women with polycystic ovary syndrome (PCOS).  

 Medical records of 200 known cases of PCOS treated in a third level referral center by the same therapeutic protocol were evaluated retrospectively. Demographic data, maternal body mass index (BMI), hormonal profile (LH, FSH, estradiol, and anti-mullerian), IVF cycle parameters and outcomes were documented. Patients were categorized into three groups based on their BMI (normal=18.5-24.9, overweight=25-30, obese≥30). IVF cycle parameters and outcomes were compared in the three groups. Effect of age was also evaluated by comparing the results in patients aged <35 and ≥35.

Mean age of patients was 32.5 (±5.2). A number of 72 patients had normal BMI, 85 patients were overweighed and 43 cases were obese. Baseline hormonal profile was similar in the three groups. Total dose of administered FSH was similar in the three groups. Number of retrieved oocytes was significantly higher in patients with BMI>30 but the number of mature oocytes and number of embryos were statistically lower in this group. Size of follicles showed no statistically significant difference in the three groups. Clinical pregnancy rate was significantly lower in patients with BMI>30 kg/m2 and age>35 years old.

 BMI>30 and age>35 years old have a statistically significant negative impact on IVF success rate.

Uterine fibroids (UF) in pregnancy is a condition, where symptomatic or asymptomatic fibroids in the uterine cavity may cause complications in pregnancies. Placental abruption and preterm labor, occurs in late pregnancy, postpartum hemorrhage, caesarean section and retained placenta in perinatal period. This study aimed to reckon whether the surgical Caesarean myomectomy is still a gold standard in myoma removal in pregnant women.

 This study was retrospectively conducted in pregnant women deliveries with uterine fibroids who underwent Myomectomy with lower segment caesarean section (LSCS). The caesarean myomectomy cases were compared with LSCS alone controls in 1:2 ratio. The primary outcome is to minimize blood loss and need for blood transfusion. The secondary outcome is the length of surgery duration and hospital stay.

The outcome of case and control compared was 43 caesarean myomectomy with LSCS as case group and 86 LSCS Alone as control group. The incidence of hemorrhage in case group was 10 out of 43 while control was 2 out of 86 (2.32%) with P-value of 0.0017. The secondary outcome was the length of surgery duration and hospital stay which were found statistically significant between the case and control groups, with P-value = 0.0001 and 0.0072, respectively.

 Caesarean Myomectomy can be the effective surgical option to enucleate uterine myoma, and preserve uterus and jettison from eventful or symptomatic uterine fibroids. To have the chances for prevention of immediate or interval - myomectomy / hysterectomy and control of post-partum menstrual over bleeding.

Some studies have suggested the association between the risk of osteoporosis and atherosclerosis. So, we aimed to compare the serum lipid levels of postmenopausal women with reduced bone density to serum lipid levels of those with normal bone density.

 In this cross-sectional study, all 48-65 year-old women, menopause for more than 1 year prior to the study, who referred to Akbarabadi Hospital, Tehran, Iran, during September 2011-March 2013 were recruited. They underwent bone densitometry using the Dual-Energy X-Ray Absorptiometry Method and were divided into two groups: normal density (control group) and low density (case group). Body mass index (BMI) and waist circumference were measured. After 14 hours, fasting serum levels of lipid, fasting blood sugar (FBS), and HbA1C were checked. Hypercholesterolemia, as low high density lipoprotein (HDL) (<35 mg/dL) and high cholesterol levels (>200 mg/dL), were compared between the groups in addition to low density lipoprotein (LDL) levels.

The data of 241 women were analyzed. The mean±SD levels of serum TC were 192±24.7 and 185±19 mg/dL, in the case and control groups, respectively (P=0.009), and that of serum LDL levels were 112±20.2 and 105±17 g/dL, respectively (P=0.005). There was a significant and negative correlation between the women’s Z-score and their cholesterol level (r=-0.162, P=0.012). Regression results revealed that the following factors significantly affected Z-score: BMI, LDL, TC, and duration of menopause.

 Serum LDL and TC levels were higher in menopausal women with reduced bone density, which indicates the relationship between hypercholesterolemia and reduced bone density.

 Spontaneous preterm birth (SPB) occurs in about 10 to 12 percentage of pregnancies and causes many complications and mortality during pregnancy periods (1). The aim of this study was to determine the evaluation of uterocervical angle compared to cervical length as a sonographic method in predicting preterm delivery for patients who were undergoing the transvaginal cerclage.

 The present study was performed on 91 pregnant women who were candidates for cerclage in 2019-2020. In this study, about 16.48 percentage of births were preterm and 27.47 percentage were post-term. During the study, routine cervical evaluation was performed by post-cerclage ultrasound and transvaginal ultrasound was performed in all patients one week after cerclage. Additional evaluation with transvaginal ultrasound was performed at intervals determined by the treating physicians with final ultrasound evaluation of the cervix up to 28 weeks of gestation. Finally, the obtained data were entered into SPSS 22 and statistically analyzed using t-test, Chi-square and Fisherchr('39')s exact test.

The results of the present study showed that considering the existing thresholds (95 and 105) for the anterior uterosacral angle and the threshold 25 for the cervical length index, all these indices were included 100% sensitive.

 This sensitivity in the case of UCA higher than 95°C was about 80%, but the disadvantage of these indicators was their low specificity, so that these indicators were different ranging from 30% in the case of (UCA 105) to 7.15% in the case of (UCA 95).

Awareness of breast cancer risk factors, clinical presentations and screening rules and methods may encourage women to use preventive measures more commonly. 

 A total of 691 women from general population were interviewed using a standardized questionnaire. Demographic data, level of awareness about risk factors, presentations and screening the breast cancer and their general perception about the treatment’s efficacy were evaluated.

Of the participants, 45.7% had “good” knowledge about the presentations of breast cancer while the level of awareness was “good” in 19.2% of them in field of risk factors (statistically significant difference). As only about 16% of them knew that women should perform breast self-examination once a month and about 15% of them were aware of the screening role of the annual clinician performed breast examination.

 Most of our participants had statistically significant lower level of knowledge about the risk factors and screening rules and tools of breast cancer than its clinical presentation.

 Pessary is a silicone, rubber or plastic device, available in different shapes and sizes, which may prevent preterm labor in some pregnant women.

 We enrolled >18-year-old women with gestational age between 24 weeks and 0 days to 34 weeks and 0 days, admitted to hospital with signs/symptoms of preterm labor (threatened preterm labor) and shortened cervical length (<25 mm in ultrasound measurement). Included subjects were randomly allocated to 2 groups. In first group a cervical pessary was placed for patient in lithotomy position. In second group no pessary was inserted and patients received only the routine standard institutional treatments.

 Demographic characteristics, Body Mass Index, mean cervical length, parity status, fertilization type (natural, assisted) and route of delivery had no statistically significant difference in 2 studied groups. Although gestational age at which patient had experienced her first preterm labor episode was similar in 2 groups, gestational age at delivery was higher in pessary group compared with expectant management group (38.64 weeks versus 35.80 weeks which was statistically significant). Neonatal outcome measures (like rate of respiratory distress, orotracheal intubation, low birth weight, NICU admission, fetal death, etc.) were better (statistically significant) in pessary group.

 Using cervical pessary after successful control of a threatened preterm labor episode in women with short cervix can postpone the labor significantly, leading to increased gestational age and improved neonatal outcome.

 The objective of this study was to evaluate colposcopic, endocervical curettage (ECC) and endometrial curettage (EMC) findings in comparison with Pap smears findings.

 Out of 100,000 Pap smears, a total number of 75 eligible women with atypical glandular cells (AGCs) referred to gynecology clinics in Isfahan, Iran, and seventy women were selected to undergo Pap smear test, colposcopic examination and ECC. EMC was performed in women older than 35. Pap smear test results were classified as normal, inflammation, AGCs and necrosis. Colposcopy, ECC and EMC findings were classified as normal, benign and malignant pathologic lesions.

 Repetitive Pap smears findings were as follows: 15.7% were normal, 77.2% had inflammation, 4% had AGC and 3.1% had necrosis. Based on colposcopy findings, 61.2%, 7.5%, and 31.3% of the samples were classified as normal, benign and malignant, respectively. ECC findings in 95.5% of women was indicative of benign lesions and malignant lesions in 4.5%. EMC findings showed that 79.7% were normal, 8.5% had benign lesions and 11.9% had malignant lesions. Pap smears with several AGCs were associated with benign lesions in 24.2% of the cases and premalignant and malignant lesions in 14.2% of the cases.

 According to our study, due to the significant association between AGC cytology and pathologic cervical and endometrial lesions, intensive assessment is necessary in women with AGC Pap smears, especially in older and post-menopausal women, in order to reduce mortality.

 To determine the factors affecting Iranian obstetricians and gynecologists’ (OB/GYNs’) decision about performing a cesarean section on maternal request.

 A four-part questionnaire was designed and distributed between 150 randomly selected OB/GYNs in Iran during a national conference. One hundred questionnaires were sent back by the participants. The data were analyzed using SPSS 25. The influential factors on OB/GYNs’ decision about the mode of delivery, as well as the correlations between their knowledge, attitude, practice, gender, and years of work experience, were assessed.

A positive correlation was found between OB/GYNs’ knowledge and attitude about the benefits of cesarean section and performing a cesarean section on maternal request in public and private hospitals. We did not find any correlation between age, gender, and years of practice with the practice of cesarean section on demand. Approximately 52.8% of female participants and 38.5% of male participants recommend cesarean section to their immediate families, and 81% of participants accepted the pregnant mother’s request for cesarean section. The stress of the potential impact of vaginal delivery on the pelvic floor and sexual function is the leading reason behind this decision.  

 Since the views and concerns of OB/GYNs have a significant role in guiding pregnant women to decide the mode of delivery, and the fear of future sexual dysfunction is an important issue affecting obstetricians’ perspective, it should be taken into consideration.

 Gestational diabetes mellitus (GDM) is the most prevalent disorder during pregnancy, which is the result of insulin resistance and hyperinsulinemia due to the secretion of placental diabetogenic hormones. This study aimed to investigate the utility of glycated hemoglobin A1c (HbA1c) alone and in combination with hematocrit for early detection of gestational diabetes mellitus.

 In this prospective cohort research, 373 pregnant women who referred to prenatal clinics were included. Hematocrit and HbA1c were determined at gestational age of 12 to 16 weeks and compared with the oral glucose tolerance test (OGTT) results at gestational age of 24-28 weeks.

 The best cut-off hematocrit for determining pregnancy diabetes mellitus was 37.3. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 70.15%, 64.12%, 32.71 %, and 89.51% respectively.In terms of HbA1c, the best cut-off value to determine GDM in pregnant women was 5, with a sensitivity of 98.51%, specificity rate of 99.02%, PPV of 95.07%, and NPV of 99.49%. In terms of diagnosing GDM, the area under the ROC curve (AUC) for HbA1c was equal to 0.985 which was higher than the AUC for the combination of HbA1c with HCT.

 Measuring HbA1c can be useful as a screening test for GDM, which is an inexpensive and available test. The combined evaluation of HbA1c and hematocrit did not improve the diagnostic value of HbA1c in GDM screening compared to exclusive evaluation of HbA1c.

Malignant pericardial effusion presenting with cardiac tamponade is a rare manifestation of metastatic gynecological cancer. Our patient, a 62-year-old female was presented with papillary serous adenocarcinoma of the right ovary in 2016. She was treated with interval cytoreduction surgery and platinum-based chemotherapy until 2018. Now, she presented with sudden onset dyspnea, tachypnea, tachycardia with hypotension, and distended jugular venous pressure. Echocardiography confirmed a large pericardial effusion with mild bilateral pleural effusion. She underwent an emergent pericardiocentesis which yielded 350 mL of hemorrhagic fluid and cytological examination of smears confirmed the presence of metastatic adenocarcinoma cells. The patient was managed conservatively and discharged after one week of hospitalization with a referral to the oncology center for further treatment. With increasing longevity and improved chemotherapeutic regimens, cases of malignant pericardial effusion with cardiac tamponade are on the rise, and therefore, clinicians need to be familiar with the prompt diagnosis and management of this life-threatening disease process.

 Since the first reported respiratory distress syndrome due to the new version of the coronaviruses family, COVID-19, there is a concern about the possible maternal and perinatal outcome of new infection in a short and even long time, our information about the prognosis of pregnancy in sync with COVID-19 is limited. What is our task as scientists in eliminating the unknown facts?

 Here we try to present a couple of pregnant cases in their third trimesters of pregnancy that complicated with two contrary complication of COVID-19 infection, intending to illuminate the best management strategy in COVID-19 infected pregnant.

The first case had experienced thromboembolism, and also bleeding accident, who fortunately survived unlike the other case, who expired due to multi-organ failure and impossibility of anticoagulant agent administration for the suspected pulmonary thromboembolic accident.

 The prior report revealed the thrombo-inflammatory and hypoxic effect of COVID-19 that could lead to microvascular thrombosis and progression, which enforce health care providers, introducing the anticoagulant agents to decline COVID-19 mortality, especially in a critically ill patient. Pregnancy is associated with coagulation abnormality which could intensify the COVID-19-induced coagulopathy. But, one should balance the harm and benefit of such a hazard approach, is there any concern about vascular damage of COVID-19 and subsequent bleeding, that could be exacerbated with high dose anticoagulant agent administration? The other question that we want to discuss in the present report is about comparing the cost and benefit of anticoagulant therapy?

Mature cystic teratomas, also named dermoid cysts, are the most benign ovarian germ cell tumors and can occur in any age group. Transformation of the mature elements within the dermoid cyst to the malignancy termed mature cystic teratomas (MCTs) with malignant transformation occurs in only 1-2 % of cases. Of these, squamous cell carcinoma (SCC) with 80% prevalence is the most common type. A 54-year-old peri-menopausal woman -gravida 5, para 4, live 4, and abortion 1- presented to our clinic with a complaint of abdominal pain for about five months. Transvaginal ultrasonography revealed a mass with a diameter of 125-millimeter in the left adnexa with a complex appearance containing fine-echo liquid, solid internal component, and thickened wall. Spiral CT scan of abdomen & pelvis showed 147×121-millimeter bilocular lesion consistent with an ovarian dermoid cyst. Left salpingo-oophorectomy was performed, and a frozen section was requested during the surgery, which showed a malignant epithelial tumor consistent with squamous cell carcinoma arising in teratoma. Total abdominal hysterectomy, bilateral salpingo-oophorectomy, pelvic lymphadenectomy, and partial omentectomy were done successfully. The patient was discharged from the hospital after two days without any complaints or adverse events. Regarding the rarity of MCT with malignant transformation, it is recommended to consider patient characteristics, preoperative imaging, laboratory evaluations, and the results of the frozen section during surgery since they can significantly change the treatment plan and the prognosis of the patient.