International Journal of Women’s Health and Reproduction Sciences
Volume:8 Issue: 1, Jan 2020

Maternal mortality reduction is a key international sustainable development goal. Although maternal mortality ratio (MMR) has changed in the Eastern Mediterranean Region, the trend of maternal deaths in the countries of the region is important. This review article provided the current situation and trend of MMR in the Eastern Mediterranean region between 1990 and 2015.

In this review, country profiles and data were obtained through UNDPA, UNICEF, UNDP, WHO, and World Bank websites. Then, a literature search was performed in PubMed, Science Direct, Scopus, and Google Scholar in this regard.

Based on the collected data, 36 out of 66 studies met the required criteria and were chosen for analysis. All countries of this region showed a downward trend between 1990 and 2015, and this change varied from 16.30% in Yemen to 76.56% in Lebanon. The maternal mortality reduction was 69.88% in Iran in the same time.

Although all countries of the Eastern Mediterranean Region demonstrated a downward trend in MMR, this trend was not the same in all countries. Thus, it is needed to boost regional efforts to further reduce MMR and achieve sustainable development goals by 2030.

This study was conducted to estimate the mean ideal number of children and to determine the overall prevalence of childlessness, one child, two children, as well as three children and more as the ideal number of children in Iran. Further, the study investigated the effect size of the relationship between social factors and ideal fertility.

To this end, a systematic review and meta-analysis was conducted on all studies on ideal fertility that were published from January 2000 to February 2018. Totally, 37 qualified papers and two national surveys were selected with a total sample size of 37,079 women. The degree of correlation between the ideal fertility and variables was calculated using Spearman’s correlation, Pearson’s correlation coefficient, and r by using MedCalc 17 software.

The pooled mean ideal fertility by the random effect was 2.25 in Iran. The results of the Cochran test and I2 statistics showed considerable heterogeneity regarding the prevalence of the ideal number of children (Q=1722.0911, P<0.0001, and I2 =97.62%). In addition, the proportions of childlessness, 1 child, 2 children, along with 3 children and more as the ideal parity were 0.83, 15.99, 56.092, and 22.26, respectively. The pooled correlation coefficients demonstrated that age, actual fertility, and the economic costs of children are the most important predictors of ideal fertility.

Despite the differences in the actual fertility level in different regions of Iran, two children is the the predominant pattern of the number of desired children. This result implies a convergence of fertility ideals in Iran. If desirable conditions for childbearing are provided, fertility could be maintained at the replacement level.

The present paper attempted to discover the behaviour of fertility differentials across the districts of Punjab, Pakistan. More precisely, it aimed to investigate some salient determinants of fertility differential through fitted regression line and scatter plot including the confidence interval.

Data in this study were gathered from Multiple Indicator Cluster Survey 2013-2014. The regression analysis was employed to evaluate the relationship of fertility determinants, followed by plotting two-way scatter plots and confidence intervals. For the empirical analysis, the total fertility rate (TFR) was taken as an outcome variable while the employment rate, underfive mortality, and contraceptive use were considered as determinants.

The results indicated that child mortality is a very significant variable in determining the level of fertility and it had the coefficient value of 0.0096. It was further found that child mortality has a positive relationship with fertility rates. Thus, child mortality must be reduced to overcome the issue of high fertility rates at the district level of Punjab. Contraceptive use was also a very effective variable regarding determining the level of fertility and had a negative coefficient value of -0.033. Finally, the employment rate was a very useful variable for the determination of fertility level.

The empirical results revealed that child mortality should be reduced in order to decrease the level of fertility in Punjab, Pakistan, and contraceptive use should develop through family planning programs.

This study aimed to use a valid mouse model of chronic stress like a maternal separation (MS) to determine the effect of early life chronic stress on oocyte quality and subsequent in vitro embryo development.

This study was based on case-control, interventional, and quantitative applied research. Mice were subjected to 180 minutes of MS stress paradigm at postnatal day (PND) 2–14. Then, corticosterone and serotonin levels were measured in the serum and ovary samples, respectively. In addition, relevant behavioral tests including an elevated plus maze (EPM) and open field test (OFT) were performed for evaluating anxiety-like behaviors at PND 48. Finally, oocyte number, nuclear maturation, reactive oxygen species (ROS) and intracellular glutathione (GSH) levels, as well as in vitro embryo development were evaluated as well.

Our findings showed that MS provokes anxiety-like behavior and increases serum corticosterone concentration (P < 0.05). On the other hand, the number of oocytes (P < 0.001), nuclear maturation (P < 0.05), and the concentration of ovarian serotonin (P < 0.01) decreased following MS. Further, the fertilization (P < 0.001) and blastocyst rate (P < 0.05) significantly decreased in MS mice. Eventually, chronic stress led to a reduction in the level of GSH (P < 0.01) while it increased the level of ROS production (P < 0.001).

Chronic stress through, at least in part, oxidative stress in the oocytes of mice undergoing MS paradigm negatively affected the oocyte competency and embryo development.

Human papillomavirus (HPV) is known as one of the sexually transmitted diseases and the main cause of cervical cancer with its own significant psychological problems. Considering the hidden social aspects associated with these behaviors and since no qualitative research has focused on this issue in Iran, the present study sought to explain women’s experiences of infection with HPV.

This qualitative research was conducted based on conventional content analysis. To this end, in-depth and semi-structured interviews were fulfilled with 20 individuals (13 women with HPV and 7 key informants) after obtaining participants’ consent. Data analysis was also carried out simultaneously with data collection.

Following the code extraction, participants’ experiences in the face of HPV symptoms were grouped into two main categories of psychological responses (i.e., concern, fear and panic, unbelievable acceptance, unpleasant feelings, individual’s response to the disease, as well as reactions by people, family, and husband in the face of the disease) and physical experiences of the disease (i.e., clinical symptoms and long incubation period of the virus). Each subcategory also contained a code that was demonstrated with statements provided by study participants.

The results of this study highlighted the importance of understanding the risk of HPV. It was further recommended to provide preventive counseling in community health centers, as well as advising and guiding patients in therapy clinics.

Perineal warm packs with an increase in subcutaneous temperature and the stimulation of cutaneous receptors are advocated in the belief of pain and probably increase comfort during labor and delivery. This study aimed to investigate the effectiveness of warm compress bi-stage on pain strength in the first two stages of labor and after delivery in primiparous women.

This study was a randomized clinical trial that was conducted in Shiraz hospitals from July 2012 to March 2013, in which 150 women participated and were separated into intervention (15-20-minute warm compress bi-stage in the first two stages of normal delivery at 7 and 10 cm dilations and zero position) and control (just usual hospital cares) groups. Then, pain strength was evaluated in both groups in the first two stages of normal delivery and after delivery similar to the frequency of episiotomy. The chi-square, t test, and odds ratio analysis were used for data analysis

The results of the t test showed that the mean intensity of pain reduced significantly in intervention group in both first (P < 0.002) and second stages (P < 0.001) and on the day after delivery (P < 0.001). Besides, the frequency of episiotomy meaningfully decreased in the intervention group in comparison with the control group (P < 0.001).

The research participants experienced less pain through the labor and after delivery by using warm compress bi-stage at 7 and 10 cm dilatations. Thus, this method might be suitable for reducing perineal pain resulting from episiotomy.

Oxidative stress can initiate the process of apoptosis which affects the oocyte quality and reduces development competency in the ovarian follicles. Accordingly, the present study determined the effects of curcumin as a well-known antioxidant on the apoptosis prevention of mature oocytes during the natural increasing age in female mice.

In this case-control, interventional, and quantitative applied research, 21-day-old NMRI (Naval Medical Research Institute) female mice were used as control, vehicle, and curcumin groups. The mice in the curcumin group received 100 mg/kg/d curcumin intraperitoneally. After initial interventions, the Annexin-V-FLUOS staining was applied to evaluate the oocyte apoptosis rate in the three groups at 6, 12, and 33 weeks of age. The expression of oocytes apoptosis-related genes (Bcl2 and Bax) was also assessed by the real-time polymerase chain reaction (PCR) technique, followed by measuring oxidation-reduction markers in the ovaries.

Our results showed that oocyte apoptosis and necrosis in the curcumin group decreased in comparison with the control and vehicle groups at 12 and 33 weeks (P < 0.001). Moreover, the use of curcumin led to the upregulation of Bcl2 and downregulation of Bax genes at 6, 12, and 33 weeks (P < 0.001). In addition, the superoxide dismutase (SOD) and glutathione peroxidase (GPx) activities increased in the curcumin group compared with control and vehicle groups at 12 and 33 weeks (P < 0.001) while malondialdehyde (MDA) decreased in the curcumin group at 12 (P < 0.001), in the control at 12 (P < 0.01), and in the vehicle at 33 weeks (P < 0.01).

In general, curcumin could suppress oocyte apoptosis through upregulating Bcl2 and the downregulating of Bax gene, as well as suppressing oxidative stress pathways involving oocyte apoptosis and necrosis.

This study was designed to investigate the role of cultural beliefs on weaning. Therefore, the obtained results can be used for health policymakers who design strategies to prevent physical and mental damage to mothers and their children. The main objective of this study was to design a questionnaire probing the role of cultural beliefs on weaning.

The sequential combination exploratory mixed methods design was used to develop the questionnaire format in two sections. The qualitative section was designed to probe the role of cultural beliefs on weaning, which included a literature and related tools review and fieldwork (semi-structured interviews with mothers). Twenty-two studies were examined in the literature review and 14 mothers were selected and interviewed by a purposive sampling technique. The interviews continued up to data saturation as well. In addition, data analyses for both steps were conducted using conventional and textual content analyses. The quantitative section was a methodology study that was accomplished in two parts. Questionnaire items were formed using the data and item pool obtained from the first part. Finally, the psychometric properties of the questionnaire were checked using face, content, and construct validity, followed by probing reliability using Cronbach’s alpha reliability in the second part.

Qualitative data analysis results were organized according to the foundational issues regarding the need for weaning, attitude toward weaning, awareness about weaning, society’s culture, health literacy, self-action, others’ experiences, professional help, family members’ support, and the outcomes. The item pool was formed using literature reviews and interviews. A 49-item questionnaire was developed after the completion of the psychometric process. The Kaiser-Meyer-Olkin Index of Sampling Adequacy and Bartlett’s test of sphericity showed good results in this regard. Five components from the exploratory content analysis encompassing contexts, solutions, searching for help, maternal outcomes, and child-related outcomes demonstrated a 62.112% variance. Further, the Cronbach’s alpha was 0.88 and the interclass correlation coefficient was 0.89 based on responses to the items over two administrations of the questionnaire (P < 0.001). Thus, these results showed a high level of tool stability.

For this study, a questionnaire was developed for understanding the role of cultural beliefs on weaning. It can be used for educational, research, and treatment purposes as a tool with appropriate validity and reliability, as well as short, easy, and grammatically simple items. Eventually, the questionnaire is useful for examining mothers’ false beliefs about weaning and their educational needs since false beliefs could cause destructive and health-threatening behaviors.

Parental attachment is effective on parents’ feelings of commitment toward infant care and increases maternal efficiency. Given that the parity is considered as the main factor and moderator of the mother-infant interaction, the present study aimed to investigate the relationship between marital satisfaction with mother-infant attachment and breastfeeding self-efficacy and its comparison in primiparous and multiparous women.

This descriptive-correlational study was carried out using a random sampling method. A total of 420 mothers having 4-6 months children were randomly selected from health centers in Ahvaz and enrolled in the study. The required data were collected using a demographic questionnaire, ENRICH marital satisfaction scale, Müller’s mother-infant attachment inventory, and Denis’s breastfeeding self-efficacy questionnaire. Statistical analysis was performed using SPSS, version 20.

The findings revealed that the mean scores of marital satisfaction, mother-infant attachment, and breastfeeding self-efficacy was 136.57±19.76, 100.82±4.604, and 13.148±135.75 in primiparous women and the values of the same variables were 127.65±18.67, 9±95.31, and 138.66±13.889 in multiparous women, respectively. In addition, the Pearson correlation test showed that marital satisfaction was significantly correlated with mother-infant attachment in two groups of primiparous and multiparous mothers, as well as breastfeeding self-efficacy in multiparous mothers (P < 0.05).

In general, multiparous mothers are often neglected since most of the training and counseling services provided during the perinatal period focus on new mothers. Thus, this research supports the need for educating and informing parents regarding the importance of spousal support and its effect on improving family functions.

Pain and shoulder dysfunction are among the adverse and prevalent conditions in post-mastectomy women. Therefore, the present study aimed to examine massage therapy with and without elastic bandaging on pain, edema, and shoulder dysfunction after modified radical mastectomy.

This was a clinical trial conducted at Imam Reza hospital, Tabriz, Iran, from December 22, 2018, to May 5, 2019. Ninety women participated in this study and were randomly divided into three groups of 30 (i.e., Manual lymph drainage, Manual lymph drainage plus reduced-compression bandaging, and control) based on a random number table. Patients and their companions were instructed on the intervention to be performed at home on a daily basis 24 hours after surgery with the help of a trained research assistant. Data were entered in the relevant forms before and after the intervention, including demographic information, shoulder pain and dysfunction index (SPDI), and edema checklist. Data were analyzed through descriptive statistics, one-way ANOVA, and the Kruskal-Wallis test in SPSS 19. P < 0.05 was considered statistically significant.

The comparison of the main variables between the three groups before and after the intervention showed no statistically significant difference (P > 0.0560). The intervention could significantly change pain intensity and shoulder movement limitation (P = 0.001). However, there was no difference in the edema variable before and after the intervention (P = 0.25).

In general, massage therapy with and without elastic bandaging had a positive effect on shoulder movement limitation and pain whereas it had no such effect on edema drainage.

So far, there is no concrete consensus on using uterine Doppler measurements for predicting the adverse outcomes in the early stages of pregnancy between 6-14 weeks. Hence, the current study was planned to investigate the role of uterine artery Doppler in predicting the miscarriage in early pregnancy and to evaluate whether uterine artery Doppler indices abnormality is associated with a complicated pregnancy and adverse outcomes.

The present cross-sectional prospective study estimated the uterine artery Doppler of right and left uterine arteries and the mean of pulsatility index (PI), resistance index (RI), and systolic/diastolic (SD) ratio was obtained for each patient. The gestational age, at which the Doppler study was performed, was 6-14 weeks for all groups. Finally, the groups of normal and threatened miscarriage were followed up for the outcome up to 20 weeks of gestation.

There was a significant difference in the means of PI, RI, and S/D ratio among the three groups. However, PI was the only parameter which was significantly associated with the outcome of pregnancy. In addition, the cut-off value for PI was 2.64 at 91% sensitivity and 81% specificity for predicting miscarriage.

In general, uterine artery Doppler should be introduced as the routine screening test for identifying the women who could have an adverse pregnancy outcome for its effective management.

This study was aimed to examine the endometrial scratch injury effect to improve pregnancy rate in women undergoing intrauterine insemination (IUI).

This randomized controlled clinical trial was conducted in a University Clinic from November 2017 to January 2019. A total of 120 candidates entered the study, who were assigned to intervention (n=60) and control (n=60) groups. All subjects underwent controlled ovarian stimulation using letrozole 2.5 mg/BD on a day between 3 and 7 of the cycle. Then, the sonographic monitoring was started from day 8 of the cycles, followed by injecting human chorionic gonadotropins (HCG) 100001U intramuscularly when 1-2 follicles reached 18 mm in diameter. Approximately 36-38 hours afterward, IUI was done and a B-HCG test was performed after 15 days as well. In addition, luteal phase support was performed with the vaginal progesterone 400 mg twice daily for 15 days. In the intervention group, on day 3 of the cycle endometrial cavity on the posterior wall was scratched with the vaginal cannula No. 4 by a single infertility specialist in addition to the routine procedure. The chemical and clinical pregnancy rates were the main outcome measurements.

The overall clinical pregnancy rates were 11/59 (18.6%) and 10/59 (16.9%) in intervention and control groups, respectively (P=0.810). Further, the abortion rates were 1/59 (1.7%) and 3/59 (5.1%) in intervention and control groups, respectively (P=0.303). Eventually, no cases of ectopic pregnancy were observed in either group.

Based on the findings of this study, endometrial scratch by pipelle cannot improve pregnancy rate in the early proliferative phase.

Prediction of nausea and vomiting can positively contribute to the management of this post-anesthesia adverse effect. Therefore, the present study aimed to design and implement a checklist for predicting anesthesia-induced nausea and vomiting in candidate patients for mastectomy.

This methodological study was conducted on 300 candidate patients for mastectomy during 2018-2019 at Imam Reza hospital, Tabriz, Iran. The checklist items were designed and developed based on scientific articles, expert opinions, and patient interviews. The Pearson correlation coefficient, Cronbach’s alpha, Spearman-Brown coefficient, factor analysis, the KaiserMeyer-Olsen measure of sampling adequacy, and VARIMAX rotation were used to analyze the data. Eventually, the distribution of data with a normal distribution was compared through the Kolmogorov-Smirnov test.

In the first stage, 100 items were collected, which were reduced to 35 cases after modification by a team of experts. Twenty items were ultimately selected after observing the 80/20 response rate. The overall scale reliability was calculated as 0.953 based on Cronbach’s alpha. The correlation coefficient of the first and second implementations was 0.853. Finally, the four extracted factors accounted for 69.51 of the variance of the checklist based on factor analysis.

The prediction checklist for post-anesthesia nausea and vomiting in candidate patients for mastectomy comprised adequate psychometric indicators that could be used with high reliability according to the extracted indices.

Uterine endometrial cancer (EC) is the most common female reproductive system malignancy. There are various comments on pelvic and para-aortic lymphadenectomy during the surgical staging of EC. Several oncologists believe that total lymphadenectomy, in some cases, may lead to operative morbidity without any considerable advantage over more surveillance, especially in patients with comorbidities. The purpose of the current study was to examine the correlation between serum tumor marker levels and stage, grade, histological type, myometrial invasion, and lymph node involvement in EC.

A total of 131 patients with EC participated in the present cross-sectional study. Preoperative serum CA125 and HE4 levels were evaluated 1 week before surgery. Then, the stage, grade, and lymph node involvement were recorded according to the pathological findings. After Data analysis through SPSS software, P value<0.05 was considered to be significant.

One hundred thirty-one patients with EC (70, 31, 15, and 15 patients in sequence with stages IA, IB, II, and III) were analyzed. The serum CA125 and HE4 levels were significantly higher in more advanced stages (over IA), (P = 0.016 and P = 0.004, respectively). Levels of both tumor markers were significantly higher in patients with lymph node involvement, and cervical and myometrial invasions. In logistic regression analysis, a significant correlation was found between HE4 level (odds ratio [OR] = 1.005, P = 0.035) and grade of disease (OR = 2.137, P = 0.005).

HE4 and CA125 are useful for predicting high-risk patients. Sensitivity of 64% and specificity of 60% were indicated at cut-off value of 70 pmol/L for HE4 in stage IA in comparison with stages over IA. Although the ideal cut-off which is defined as higher than 80% was not obtained, such a cut-off (60%) can also be considered for preoperative evaluation of surgical staging of EC.

Dysmenorrhea is a frequent complaint in young females. In recent years, researchers have grown an interest in the use of herbal drugs to decrease menstrual pain given the side effects of chemical drugs. This project was conducted to evaluate the effect of valerian and ginger on the duration of pain and analgesic use in dysmenorrhea.

This triple-blind randomized clinical trial was performed on 210 dormitory females who were randomly divided into valerian, ginger, and control groups after opening an envelope. In this study, 250 and 350 mg of ginger and valerian in each capsule were administered, respectively, and 250 mg sugar was used as a placebo. The number of days with pain and analgesic use were evaluated as well. Finally, descriptive (percentage and mean) and inferential (t test, post hoc, and chi-square at a significance level of 0.05) statistics were used to analyze the data.

The results of the study showed a marginally significant difference in the duration of pain between ginger (1.61 ± 0.64 days) and control (2.12 ± 0.81 days) groups (P = 0.052), and significant difference between ginger (1.61 ± 0.64 days) and valerian (2.53 ± 1.43 days) groups (P = 0.001). The mean days of analgesic use among the three groups were not different significantly (P > 0.05). However, the mean severity of symptoms significantly differed between ginger (0.73 ± 0.28) and control (0.3 ± 0.04) groups and increased in the ginger group (P = 0.003).

In general, the administration of valerian and ginger at the doses used in this study failed to produce desirable analgesic effects and thus could not decrease the symptoms associated with dysmenorrhea

Acute fatty liver of pregnancy (AFLP) is a rare condition with an incidence rate of 1 to 20 000 that mostly occurs in the third trimester of pregnancy. There is no specific treatment for AFLP thus a conservative treatment is usually applied in this regard. This case report is related to a 28-year-old G3 P1 Ab1 L1 woman at 29 weeks of pregnancy who was referred to our emergency ward from a primary setting with an epigastric pain, a mild hypertension, and the suspicion of HELLP [Hemolysis, elevated liver enzymes, and low platelet count] syndrome. The lab exams ruled out viral infections including hepatitis B virus (HBV), hepatitis C virus (HCV), and Human immunodeficiency virus (HIV). In addition, the urine protein was 40 mg/600 cc. AFLP was diagnosed and a cesarean was performed under spinal analgesia because of elevated liver enzymes, proteinuria in the normal range for pregnancy, the presence of viral infections that involved the liver, and lack of pruritus. A 29-week girl with a weight of 1115 g was born and the patient was discharged with a good condition. At 5 days postpartum, she referred with abdominal pain, fever, as well as incisional redness and discharge. The ultrasound scan showed a hematoma in the depth of the subdermis point of the cesarean incision. Thus, antibiotics and one unit of fresh frozen plasma were infused. On 14-day postpartum, the patient was discharged with a good condition. The purpose of this study was to focus the attention of physicians to the point that AFLP may improve after childbirth but it may predispose the patient to coagulation disorders and hematoma.