International Journal of Women’s Health and Reproduction Sciences
Volume:6 Issue: 2, Spring 2018

The adoption of health-promoting behaviors is an important strategy for achieving desirable pregnancy outcomes. It also affects maternal and neonatal health. The aim this systematic review was to assess health-related behaviors in pregnancy.
In this systematic review, databases including Google Scholar, Web of Science, PubMed (MEDLINE), Scopus, Irandoc, SID, Magiran, Iranmedex, and ProQuest were searched for retrieving articles published from 1995 to 2016. English and Persian keywords used in this study were “health promotion”, “pregnancy” and their equivalents in Mesh. Screening and selection of articles were conducted in 3 stages by 2 investigators independently and the quality studies was assessed using the NOS and COREQ scales.
Of 2366 articles, 21 articles were included in this study. There were low and average scores of health-promoting behaviors among pregnant women. Various factors such as maternal demographic characteristics, pregnancy and environmental factors influenced this condition. The most important motivator for health behaviors was the health of the fetus and newborn. The level of knowledge pertaining to the adoption of a healthy lifestyle was insufficient, and the main obstacles in dealing with health behaviors were time and a lack of a comprehensive approach in the healthcare system. Group activities and participation of men were considered facilitators. Nevertheless, due to differences in the study design and heterogeneous samples, no similar results were achieved.
Improving our knowledge about the healthy lifestyle can improve pregnancy outcomes. In this regard, carrying out well-designed studies within the social and cultural backgrounds for need assessment is suggested.

An increase in the number of women attending university is a relatively new phenomenon. According to international reports, greater numbers of academically educated women have reduced their fertility rate. This phenomenon has contributed to the reduced fertility in Iran in recent decades. According to international research, women’s empowerment has affected their fertility through education. This study applied a narrative review method. It set out to examine the impact of the increasing number of women in academic education and their reduced fertility on Iranian female empowerment. Searching electronic databases, 464 scientific documents published during 1994-2016 were retrieved out of which 71 were included in the study. Research showed that the higher level of women’s education did not lead to equality with men in terms of their economic, socio-cultural, and political status. Moreover, it was revealed that educated women were deprived of their right to make their own decisions on family planning issues. Female empowerment, as one of the main objectives in sustainable development, needs more emphasis on women’s reproductive rights and a strategy to reduce gender discrimination considering the related cultural issues.

Despite medical advances in the diagnosis and treatment of diseases, preterm birth is still a global problem. The aim of this study was to investigate the relationship between the social determinants of health and preterm birth in Iran based on the WHO model.
This systematic review and meta-analysis was performed based on the studies conducted in Iran. An advanced search was carried out in seven databases (Iranmedex, Magiran, SID, Irandoc, PubMed, Google Scholar, and Scopus) for relevant articles published during 2000-2016 using the keywords ‘social determinants of health’, ‘preterm birth’, and their Persian equivalents and MeSH terms. All the articles were screened by 2 of the researchers in 3 steps. After looking for relevant articles based on the reference list, quality assessment was performed using a STROBE checklist. After extracting the required data, they were combined using a random model and the heterogeneity of the studies was evaluated using the I2 index and the data were analyzed in STATA-11.
A total of 16 studies were included in the analysis of the relationship between the intermediate determinants of health and preterm birth; however, only 6 truly investigated the relationship between structural determinants and preterm birth. The overall odds ratios for the relationship of the structural and intermediate social determinants of health with preterm birth were estimated as 1.43 (0.84%-2.41%: 95% CI) and 2.17 (1.75%-2.68%: 95% CI). The results showed that preterm birth was more common in women with anxiety, depression, unwanted pregnancies, poor health behaviors (smoking, the use of alcohol and drugs), inadequate prenatal care, and those who were abused and exposed to secondhand tobacco smoke (P The results of the reviewed studies suggest that preterm birth is a common problem associated with several social determinants of health. Life skills, self-care training, and increased prenatal care are therefore recommended to reduce preterm birth, especially in high-risk pregnant women.

Preeclampsia/eclampsia, the most common medical complication of pregnancy, can affect visual system as an end organ damage. Visual symptoms occur in 25% of patients with severe preeclampsia and 50% of patients with eclampsia. Visual system may be affected by hypertensive retinopathy, exudative retinal detachment, and cortical blindness.
A literature search was conducted using MEDLINE, EMBASE, and Cochrane library until April 2017 in English and Persian. Additionally, extensive literature was searched using the Persian databases. Moreover, the cited references in the published articles were manually reviewed for relevant results.
The visual prognosis for ocular involvement was excellent in most cases because of its nature and high rate of spontaneous recovery, which occurred in a few weeks. The fact that there is a correlation between ocular finding and placental vascular abnormality emphasized correct diagnosis and evaluation of pregnant patients with visual changes. This review described the ocular involvement in pregnant patients with preeclampsia/eclampsia. The first purpose of this study was to discuss the pathophysiology and epidemiology of visual system involvement in preeclampsia/eclampsia. The second one was to diagnose the adverse effect on visual system as a last organ damage. Finally, in this review, the ophthalmologic finding, controversial issue of the treatment and prognosis with preventive care were discussed and monitoring methods for patients were followed up.
Visual involvement is common in pregnancy-induced hypertension and retinal vascular changes are the most common ocular findings. It seems that the progression of these changes is a sign of increasing severity of pregnancy induced hypertension (PIH) and has correlated with fetal mortality. As a result, these findings may be guideline for prompt intervention as they may reflect similar ischemic vascular changes in the placenta. Although ocular involvement has a good prognosis in PIH, repeated observations, early diagnosis, and prompt management are essential for both maternal and fetal ultimate outcomes.

Infertility is one of the wide-spreading problems that involves 15% of couples who are in reproductive age. Most of the young couples that suffer from infertility could be cured by means of highly-developed methods and associated reproductive technology (ART). It is important to study about the treatments and methods to improve fertility rate, oogenesis and folliculogenesis. In this study, different types of stem cells which could be used for treatment of infertility would be introduced and discussed.
Evidence Acquisition: Various internet search engines and data bases including Google, Google Scholar, PubMed, Medline, The British Library, and Library of Congress were used.
During the process of puberty, follicles grow and change. Finally they become Graffin follicles. There are various theories about the origin of the follicles and follicular cells. Many diseases or side effects of various therapies (specially the methods that are used in cancer treatment) affect a high range of female patients and cause infertility. The transplantation of exo-ovarian stem cells could be applied in these patients to get advantage of stem cells with non-ovarian derivation. These cells could be used in treatment procedures and in producing new oocytes and follicles. In this study, the role of bone marrow stem cells (BMSCs), mesenchymal stem cells, peripheral blood stem cells (PBSCs), somatic stem cells (SSCs), and ovarian surface epithelium (OSE) are reviewed in treatment of infertility.
The use of stem cells to provide new ovarian reserve or to treat damaged follicles could be successful methods to achieve fertility.

Cervical neoplasia and some forms of infertility are caused by sexually transmitted infections. We aimed at evaluating whether positive findings on digital cervicography (DC) (performed to screen and treat cervical neoplasia) is associated with female infertility.
In this cross-sectional study, women consulting for infertility underwent cervical cancer screening using DC alongside women without infertility. A total of 2128 Cameroonian women were studied. Women with infertility were sub-categorized into primary and secondary infertility. Potential confounders were assessed at the screening visit and logistic regression was used to compute adjusted relative risks for the relationship between infertility and positive DC findings.
Among 2128 women studied, 292 (13.7%) presented due to infertility and 1836 did not; 88 (30.1%) of women with infertility had primary infertility and 204 (69.9%) had secondary infertility. Women with infertility had a positive DC prevalence rate of 15.9% compared to 13.6% for women without infertility (P = 0.31). The prevalence rates of positive DC among women with primary infertility or among those with secondary infertility respectively, did not differ from the rate in those without infertility. After multivariable adjustments relative to those without infertility, the adjusted relative risks (aRRs) (95% CI) for a positive DC were: 0.91 (0.62-1.20) for any infertility, 0.99 (0.65-1.51) for secondary infertility and 0.73 (0.38-1.41) for primary infertility.
Results of DC were not significantly associated with infertility (and its subtypes). Further investigations are required to evaluate the association with other cervical cancer screening modalities like Pap smear and HPV DNA-testing.

This study analyzed for the first time the effects of diabetes mellitus on the sexual function of Brazilian postmenopausal women.
In total, 184 postmenopausal participants were selected after meeting the inclusion criteria of occurrence of menopause, diagnosis of type 2 diabetes (T2D), ≥1 year stable heterosexual relationship, active sexual life for >6 months, controlled associated chronic diseases, and absence of recent acute illness or psychiatric diseases. The participants were categorized into two groups, with and without T2D (control group). The control group comprised 84 women without diabetes, with mean 55 years of age, whereas the diabetes group comprised 100 women with T2D with a mean 59 years of age. Each participant filled out the nine-item Female Sexual Function Index (FSFI) questionnaire. The analyzed domains included desire, arousal, lubrication, orgasm, satisfaction, and pain. An FSFI score ≤26.5 determined the occurrence of sexual dysfunction (SD).
The prevalence of SD was significantly increased in women with T2D (85%) compared with controls (69%; P = 0.001). Women in the T2D group had lower mean total FSFI score when compared with those in the control group (P = 0.004). As for specific questionnaire items, we found significant differences in regards to decreased arousal (P = 0.004), desire (P = 0.001), lubrication (P = 0.015), orgasm (P = 0.019), satisfaction (P = 0.002), and pain (P = 0.002) in the T2D group. SD was associated with diabetes duration in the T2D group and with age (P = 0.001) and menopause duration (P = 0.001) in both groups.
Among postmenopausal women in Brazil, a diagnosis of diabetes increased SD prevalence and had an impact on arousal, desire, lubrication, orgasm, satisfaction, and pain.

The aim of this study is to evaluate the effect of fat emulsion intralipid 20% on reproductive outcome of patients with multiple implantation failure (MIF).
A retrospective study of 30 women with MIF who received intralipid 20% with in vitro fertilization, intracytoplasmic sperm injection (IVF-ICSI). The treatment cycle was conducted in reproductive endocrine and infertility medicine department (REIMD) at Women Specialized Hospital, King Fahad Medical City (KFMC), from January 2015 to December 2016.
Thirteen of 30 women (43.3%) had a positive pregnancy test and 17 (56.7%) did not. Pregnancy rate showed no statistically significant difference with the use of long protocol in comparison to short antagonist protocol. Use of intralipid 20% did not affect the embryo grading or yield the higher number of frozen embryos.
MIF is a challenging situation in reproductive medicine. Intralipid 20% might be an effective treatment for patients with MIF.

The worldwide rise in the cesarean section rates might be associated with maternal factors and health care services. This study aimed to measure the rate of cesarean section in a sample of primigravida women and find out the association of the cesarean section rate with the socio-demographic characteristics of pregnant women, pregnancy risk factors, and the utilization of antenatal care services.
A cross-sectional study was carried out from the 1st of July, 2015 to 30th of June, 2016. The study sample included 400 primigravida women with singleton pregnancy at the labor room of Erbil Maternity Teaching Hospital. A specially designed questionnaire was used for data collection. Chi-square test and Fishers exact test were used for statistical analyses.
The rate of cesarean section in the primigravida women was 30%. Caesarean section was significantly associated with the increasing maternal age (P The cesarean section rate in the primigravida women was much higher than the “ideal rate” recommended by the World Health Organization (WHO). Efforts should be undertaken to reduce the rate of cesarean delivery as recommended by the WHO.

Poor knowledge about importance of early antenatal care visit and awareness on health risk during pregnancy among pregnant women prevented them from accessing early antenatal care services. This study examined the impact of health education intervention (HEI) on access to antenatal care services by pregnant women in Edu Local Government Area (LGA), Nigeria.
A quasi-experimental research employing pre-test and post-test control group design was adopted. A researchers-designed questionnaire was used for data collection and the split-half test of reliability was used to determine its reliability. One hundred and twenty pregnant women were exposed to 10 weeks of HEI after pre-test, 60 experimental groups were exposed to the lectures on antenatal care services, and 60 control groups were exposed to HIV/AIDS sessions, followed by post-test. The descriptive statistics was used to answer research questions, while the inferential statistics of t-test was used to test the hypothesis at 0.05 significance level.
This study showed upward shift from pre-intervention mean of 71.08 to 93.33 post intervention mean in the experimental groups which implied the positive impact of HEI on the knowledge and willingness of pregnant women to access antenatal care services in Edu LGA.
It was concluded that HEI could have positive impact on the knowledge and willingness of pregnant women to access antenatal care services, hence HEI needs to be sustained to improve the pregnant women’s health-seeking behaviors about antenatal care services in Edu LGA.

A large number of women suffer from lumbopelvic pain during pregnancy. This pain continues in considerable percentage of women after pregnancy and causes considerable distress and disability. The purpose of this study was to investigate the efficacy of a physical training program on lumbopelvic pain and its physical disability during pregnancy.
A quasi-experimental study was performed to investigate the effects of a physical training program in women with lumbopelvic pain in 2010-2011. A total of 180 pregnant women were randomly assigned to the intervention (n = 90) and control groups (n = 90). The physical training program consisted of stretching and strengthening exercises and body posture modifications. This 12-week program was administered to the intervention group only and the control group received the routine prenatal care. The main outcome for measurement were pain and physical disability that was assessed at baseline and 12 weeks post treatment by visual analog scale (VAS) and Oswestry Disability Index, respectively.
There was no significant difference in pain intensity and physical disability between groups before intervention (P > 0.05), however pain and physical disability decreased significantly in the intervention group (P It seems that a designed physical program and body postures modification may reduce the severity of lumbopelvic pain and its related disability in pregnant women. It is recommended that midwives emphasize the importance of back pain and pelvic pain in prenatal counseling sessions and provide solutions for pain relief, including physical exercise and posture modification.

Evidence suggests that health-promoting behaviors can help improve the functional abilities of the patients with multiple sclerosis (MS). We examined the relation of health promoting lifestyle with social support among the women with MS.
This correlational study was conducted in 2017 among 250 Iranian women with MS in Tabriz city. The sampling was purposive, and frequency of health-promoting behaviors was obtained from the Health Promoting Lifestyle-II and modified Social Support Questionnaires. The relationship between health promoting lifestyle and social support was determined by the Pearson correlation test.
The mean score of health promoting lifestyle was 2.40 (SD = 0.46) within the achievable range of 1 to 4. Women obtained the highest mean score on the sub-domain of interpersonal relationships (Mean = 2.63, SD = 0.54) and the lowest mean score on the sub-domain of physical activity (Mean = 1.81, SD = 0.60). The mean (SD) score of social support within the achievable range of 0 to 100 was 70.39 (SD = 25.60). A significant positive correlation was found between health promoting lifestyle and social support (r = 0.19, P = 0.003) and all its sub-domains (r = 0.19 to 0.42, P Health promoting lifestyle is significantly associated with social support and it can be enhanced by social support among the women with MS along with other treatments.

One stage of divorce is emotional divorce, in which, couples live separately under the same roof. This situation seems to happen for most nurses, due to the job conditions, working long hours, stressful job and low salary, as well as the impact of workplace stress on marital relations. This article was intended to assess the rate of emotional divorce among nurses who worked in hospitals of Rasht, Iran.
This was a descriptive cross-sectional study, for which 382 nurses from hospitals of Rasht were selected by the way of quota and random sampling. The desired survey consisted of a 2-part questionnaire: demographic information, and Gottmann’s emotional divorce scale. Results were analyzed using SPSS software (version 19.0), and t test, analysis of variance (ANOVA), and logistic regression were used. P The results showed that the participation rates for women and men were 93.5% and 6.5%, respectively. Moreover, the rate of emotional divorce among nurses who participated in this study was 7.6%. The main predictive variables for emotional divorce were living with spouse’s family, having relationship with family members, and attempt to divorce.
Although the results suggested low rate of emotional divorce among nurses who lived in Rasht, it is recommended that appropriate ways be used for improving a life of greatness and emotional support of couples, and also improving the nurses’ quality services for calmness in married life, to decrease this low percentage with regard to the importance of this subject.

Due to the high rate of caesarian-section (C-section) in Iran, the aim of this research was to design and implement interventions based on the theory of reasoned action in pregnant women to promote the choice of natural delivery.
This quasi-experimental intervention was performed in Abhar, Iran on 200 pregnant women in the two groups of intervention and control. Data were collected, using a questionnaire designed by the researcher, before and after the intervention. Validity and reliability of the questionnaire were confirmed. The single-stage random cluster sampling was used. Data were analyzed using IBM SPSS Statistics 23 and statistical tests such as analysis of variance (ANOVA), Pearson correlation coefficient, t test, regression, and logistic regression.
Paired t test showed a significant difference in the mean scores of constructs of theory of reasoned action before and after training in the intervention group; however, no statistically significant difference was observed in the control group in terms of mean scores of constructs of theory of reasoned action. Logistic regression showed that, before training, none of the reasoned action constructs predicted natural delivery in the intervention group; however, in the intervention group after training, normative beliefs, motivations to comply and behavioral intention predicted natural delivery. The same test showed that only motivations to comply predicted natural delivery in the control group before and after training.
It can be concluded that the theory of reasoned action can be effective in creating and enhancing pregnant women’s choice of natural delivery. Therefore, considering that rate of C-section is increasing in Iran, this theory can be a useful tool for designing and implementing educational interventions aimed at improving the choice of natural delivery by pregnant women.

The aim of the study was to investigate the role of medroxyprogesterone acetate (MPA) in the prevention of luteinizing hormone (LH) surge during controlled ovarian hyperstimulation (COH). Characteristics of cycle and pregnancy outcomes were compared in subsequent frozen-thawed embryo transfer (FET) cycles.
In a prospective controlled study, In vitro fertilization (IVF)/intracytoplasmic sperm injection treatment was done in 99 patients. In the case group, hMG and MPA were administered from third day of the cycle, simultaneously. As dominant follicles matured, ovulation was induced by hCG or GnRH agonist. hMG and GnRH were administrated to the control group. For later transfer in both protocols, viable embryos were cryopreserved. The primary outcome measured was the incidence of premature LH surge and a number of oocytes retrieved. Clinical pregnancy outcomes from FETs were secondary outcomes.
The number of oocytes retrieved in both case and control groups were equal. LH suppression persisted during ovarian stimulation in the case group, and there was no incidence of premature LH surge. There was no significant difference between amounts of follicles, mature follicles, oocytes resumed and obtained embryos between 2 groups (P > 0.05).
The results showed that in a woman undergoing COH, MPA as an oral drug was effective in the prevention of premature LH surge. The results would help to establish a new method for ovarian stimulation in combination with embryo cryopreservation.

Intrauterine device (IUD) is one of the most common methods of pregnancy prevention that is widely used in the world. Bleeding is one of the key reasons of stopping the use of IUD. Vaginal bleeding can be occurred due to the reduction of adequate motivation and functioning of neuroendocrine system and subsequent hormones (oxytocin, serotonin); and accordingly sexual functioning would be decreased. Therefore, the hemostatic impact of Capsella bursa-pastoris through several mechanisms can play a leading role in increasing the orgasm and sexual responses. The aim of current study was to determine the impact of C. bursa-pastoris on sexual functioning of females having copper IUD.
This triple blind clinical trial was done in 2014 on 90 females visiting healthcare centers of Ardebil city, Iran. Women were complaining about excessive menstrual bleeding which occurred at least 3 months after placing IUDs. The first group received C. bursa-pastoris (700 mg) and the second group received mefenamic acid (500 mg) from first day of menstruation till bleeding completion, one every 8 hours. The questionnaire of sexual functioning was completed by the participants prior and 3 months after the treatment. The analysis of covariance (ANCOVA) test was used for comparing sexual functioning after the intervention among the studied groups with some adjustments on baseline scores.
Mean (standard deviation) score of sexual functioning in mefenamic acid group was 23.39 (4.18) before the intervention which was increased to 24.24 ± 3.45 after applying intervention. In C. bursa-pastoris group, mean (standard deviation) score of sexual functioning was 21.40 (4.70) before the intervention which was increased to 24.85 ± 3.81 after applying intervention. According to the findings of study, mefenamic acid and C. bursa-pastoris were effective in improving the sexual functioning, but increase of sexual functioning score after the intervention was significant in the C. bursa-pastoris group (the justified mean difference: 0.60, 95% CI [-0.91–2.13], P = 0.01).
Capsella bursa-pastoris can be more effective compared to chemical drugs including mefenamic acid in increasing the sexual functioning of females with IUD.

The ovarian mucinous tumors include 10%–15% of ovarian tumors. These tumors are either having ovarian origin or they are metastatic from other organs, particularly from gastrointestinal tract. According to ancient studies, routine appendectomy for tumours was determined based on differentiation of primary appendix carcinoma from ovarian tumors. However, recent investigations showed that appendectomy was performed only in cases with abnormal macroscopic appearance of appendix and in advanced stages of ovarian cancer. The aim of the present study is to investigate the correlation between macroscopic appearance of appendix and histopathology results of ovarian mucinous tumors as well as determining the stage of ovarian cancer appendices.
This descriptive and cross-sectional study was conducted for inquiring about patients with pathologic diagnosis of ovarian and appendix mucinous tumors who had a surgery from 2010 to 2016 in Alzahra teaching hospital, Tabriz-Iran. The presented data were collected through a printed questionnaire followed by analysis.
This study was done on 257 patients with definite diagnosis of ovarian and appendix mucinous tumors. Total number of 121 patients had undergone appendectomy and 110 cases of them had normal macroscopic appearance of appendix. Furthermore, 98.2% of patients with grossly normal looking appendix had normal pathology results and 63.6% of patients with abnormal looking appendix had abnormal pathology results. Totally 5.9% of patients with borderline and 30% of invasive ovarian mucinous tumors had affected appendix. A number of 4 patients were at stage III and 2 of the cases were at stage IV.
According to our investigation and previously published studies, appendectomy during ovarian tumor surgery is the only recommended option in cases with abnormal macroscopic appearance of appendix and advanced stages of ovarian mucinous cancer.

Quick recognition of intimate partner violence (IPV) victimization is important in women with mental disorders. Therefore, we assessed the accuracy of the brief and comprehensive 8-item woman abuse screening tool (WAST) and its 2-item short form (WAST-SF) by comparison to the reference standard for past year IPV with the 39-item revised conflict tactics scale (CTS-2) at this population.

In this cross-sectional study, 400 women with mental disorders within the age range of 19-49 years were interviewed using the WAST and CTS-2 at a psychiatric hospital in Tabriz, Iran. Receiver operating characteristic (ROC) was used to determine characteristics of the screening tools.

All types of IPV were very common in the past year; 90% overall, 86% psychological aggression, 62% physical assault, 53% sexual coercion and 53% injury. The highest diagnostic accuracy of WAST was at the cutoff score of 12 (area under the curve [AUC] 0.90, 95% CI 0.83 to 0.96) with 96% (93% to 98%) sensitivity and 84% (67% to 93%) specificity. Predictive values of the optimal score were 99% (97% to 99.4%) for victims and 64% (48% to77%) for non-victims. Its agreement with CTS2 was good (r = 0.69). The highest diagnostic accuracy of WAST-SF was at the cutoff score of 3 (AUC 84%, 95% CI 0.77 to 0.91) with sensitivity 93%, specificity 71%, positive predictive value 97.5%, and negative predictive value 47%.

The WAST at cutoff score of 12 and WAST-SF at cutoff score of 3 have good accuracy in diagnosis of the past year IPV among women with mental disorders. Healthcare providers at psychiatric facilities should use these tools for IPV screening.

Endometrial hyperplasia has an affinity for progression toward endometrial carcinoma. This study was conducted to compare the effect of metformin plus megestrol acetate with megestrol acetate alone on endometrial histology in the patients with endometrial proliferative and hyperplastic disorders.
In a single-blind clinical trial, 96 patients with abnormal uterine bleeding and endometrium with irregular or hyperplastic glands with or without atypical foundations were divided randomly into 2 equal groups. Group1 received metformin 500 mg twice a day plus megestrol acetate 40 mg daily for 3 months and group 2 received megestrol acetate 40 mg/d for 3 months. The treatment response was evaluated using pathologic samples of endometrial biopsies 2 weeks after completing the treatment.
In both groups, endometrial hyperplasia was resolved in most cases. Significant decrease was observed within groups in the endometrial thickness before and after the intervention. Comparison of thickness between 2 groups showed that in the megestrol acetate group, after intervention, significant decrease in the endometrial thickness was revealed (12.73 ± 6.04 mm [group 1], versus 8.55 ± 3.43 mm [group 2], P Both treatment modalities were effective in treating proliferative and hyperplastic disorders. However, the response to treatment in the megestrol group was greater than that in the megestrol plus metformin group.

This study intended to explore whether letrozole and metformin can change endometrial histology in the patients diagnosed with disordered proliferative endometrium.
In a pre- and post-interventional study, 31 patients with abnormal uterine bleeding (AUB) were participated to receive 5 mg letrozole and 500 mg metformin daily for 3 months after pathology report of disordered proliferative endometrium. The effect of this combination therapy on endometrial histology was evaluated through comparing the endometrial histology results before and after the intervention.
After treatment with letrozole and metformin, 77.4% of patients showed significant response to therapy in the form of inactive and atrophic endometrium (P Based on the results of this study, letrozole and metformin can be successfully used for treatment of disordered proliferative endometrium. Hence, the effects of these medications deserve to be noticed for careful treatment of the patients with AUB.

Cerebral venous sinus thrombosis (CVST) with cerebral hemorrhage is relatively rare but may result in a catastrophic outcome. Antithrombin III deficiency is an inherited disease that contributes to an increase in the occurrence of thromboembolic events during pregnancy.
A nulliparous, 34-year-old Chinese woman at 9 weeks of pregnancy with underlying antithrombin III deficiency was under treatment with low dose molecular weight heparin. She presented with a frontal headache and projectile vomiting. A plain computed tomography (CT) scan and magnetic resonance angiography and venography (MRAV) of the brain showed features suggestive of CVST involving superior sagittal sinus with venous infarct and right frontal and left parietal intraparenchymal hemorrhage. During admission, she developed episodes of fainting and loss of consciousness. A repeated brain CT scan showed worsening intraparenchymal hemorrhages with midline shift, subfalcine herniation and cerebral edema. An emergency bilateral craniectomy was performed to relieve the intracranial pressure. Despite the surgery and supportive measures, the patient succumbed to death.
Due to the highly hypercoagulable state of pregnancy with concomitant antithrombin III deficiency, preconception counselling including optimization of anticoagulant dosage is crucial. In addition, the administration of antithrombin III concentrate should be considered during pregnancy for women with antithrombin deficiency.

Uterine leiomyosarcoma (LMS) is a rare cancer originated from smooth muscle lining the walls of the uterus. LMS is known as an aggressive tumor with high mortality and morbidity rates as compared to other uterine cancers, despite the disease stage at the time of diagnosis. In most cases, LMS has been misdiagnosed as a benign uterine leiomyoma following hysterectomy or myomectomy.
We presented a 53-year-old G7 L7 woman who had referred to GYN clinic in Amir-al-Momenin hospital for abnormal uterine bleeding (AUB) for 6 months. On physical examination, we found an abdominal mass that had grown rapidly in the last 4 months. The computed tomography (CT) scan results showed a heterogeneous mass extending from the epigastric region to the pelvic area. Following an exploratory laparotomy, histopathology report confirmed the diagnosis of LMS. Her uterus, Fallopian tubes and ovaries were removed during a surgery, and she was referred to a gynecologic oncologist for possible chemotherapy.
We found that the surgery is the only treatment for LMS; however, there is a little possibility to diagnose LMS before surgery in the patient with uncertain diagnosis and suspicious of LMS. Analysis of LDH and LDH3 levels along with dynamic diethylenetriaminepentaacetic acid (Gd-DTPA) enhanced, and MRI are recommended.