International Journal of Women’s Health and Reproduction Sciences
Volume:8 Issue: 3, Jul 2020

Cesarean delivery without medical indication has regularly increased among Iranian women in the last three decades, and Iran has one of the highest rates of cesarean in the world. The present study aimed at reviewing the studies regarding the increase of cesarean in Iran and discussing the root causes for such an increase.

This literature review focused on the existing quantitative and qualitative studies conducted from January 1990 to January 2019 regarding the reasons for an increase in the cesarean section in Iran. The combination of keywords including “cesarean section”, “C-section”, “cesarean delivery”, and “Iran” was searched in several databases such as MEDLINE/PubMed, Embase, ISI Web of Science and Scopus, along with national databases (e.g., SID, MagIran, Iran Medex, and IranDoc).

A dramatic rise in cesarean birth stems from a number of factors including the role of health care professionals, insurance companies, socio-cultural factors, and the health policies, all of which have their roots in the medicalization of birth.

In general, reducing the cesarean on maternal request necessitates the de-medicalization of birth, cultural awareness through the mass media, informing women of the long-term complications of cesarean, and physical and mental preparation of the mother. In addition, other contributing factors include encouraging inter-professional teamwork and collaboration between midwives and obstetrician-gynecologists, transforming the current curriculum of the midwifery and residency education, applying the midwifery-led care models, and decreasing the fear of litigation in midwifery and obstetrics-gynecology. Otherwise, maternal and fetal mortality will rise in the near future due to increased complications in subsequent pregnancies.

This systematic review and meta-analysis aimed to evaluate the effect of betamethasone and dexamethasone on biophysical profile (BPP) parameters. In addition, it was performed in 2017, using several databases such as PubMed/MEDLINE, Scopus, EMBASE, Cochrane library, ISI Web of science, Proquest, and Google scholar, along with Magiran SID and IranMedex. Eligible studies were selected by two reviewers and the outcomes of interest were extracted as well. Meta-analysis was done using the random effect model. Further, I-square statistic test was used for heterogeneity analysis and the presence of publication bias was also checked. At last, 12 studies were included and a random and fixed effect model was used for analysis. The pooled event rates were 4.5% (95% CI = 0.01-64.3, P = 0.1), 76.8% (% 95 CI = 33.5-95.6, P = 0.21), 71.8% (% 95 CI=38.8-91.1, P = 0.18), 70.9% (%95 CI=38.4-90.5, P = 0.20), and 92.3% (%95 CI=76.0-97.8, P<0.001) for the reduced amniotic fluid volume, baseline fetal heart rate reactivity, fetal breathing, fetal movement, and heart rate variability, respectively. In summary, a significant decrease was observed in heart rate variability following betamethasone and dexamethasone administration. However, further systematic reviews are necessary to differentiate steroid induced changes in the fetal BPP from those due to fetal compromise.

To study the two gene polymorphism (DENND1A and THADA genes) among Iraqi women with polycystic ovary syndrome(PCOS).

This case-control study was done at the Gynaecological Department of Al-Yarmouk Teaching Hospital of AI-Mustansiriyah College of Medicine, Baghdad during January-December 2018. Two-hundred women were enrolled in the study, including 100 women with PCOS as the case group and 100 healthy and age-matched women as the control group. Main outcome measures were to analyze DENND1a gene polymorphism rs2479106 and THADA gene polymorphism rs12478601 at genotype and allelic levels.

The DENND1A gene polymorphism rs2479106 had three genotypes of AA, AG, and GG. The homozygous mutant genotype (GG) was considerably related to the incidence of PCOS (OR = 5.43, 95% CI = 1.13-25.97, P = 0.034) with 5-time more risk compared with those carrying the wild homozygous genotype (AA). The heterozygous genotype (AG) was more but not statistically different (OR = 1.73, 95% CI = 0.85-3.54, P = 0.131). At the allelic level, G allele was two times more frequent among cases compared to control cases with a highly significant difference. THADA gene polymorphism rs12478601 had three genotypes of CC, CT, and TT. Although TT genotype was repeated more among the case group than controls, the difference was not significant (P = 0.346). Likewise, no significant differences were found in the allele distribution of this polymorphism.

In general, the DENND1A-rs 2479106 polymorphism was considerably related to the incidence of PCOS among Iraqi women while THADA-rs12478601 polymorphism was not.

Preeclampsia is a pregnancy-related multisystem medical disorder which adversely affects the health of the mother and fetus. Studies have shown varied changes in biochemical renal function indices in preeclampsia. These changes vary in different environments and affect renal health and pregnancy outcomes. Accordingly, this study aimed to determine changes in serum electrolytes, urea, and creatinine in women with preeclampsia in Calabar.

A cross-sectional comparative study was conducted on 144 pregnant women including 72 normotensive and 72 preeclamptic cases of similar age groups, with singleton pregnancies, and in the third trimester. The serum sodium, potassium, bicarbonate, chloride, urea, and creatinine were assayed in the two groups. Finally, statistical analysis was done using SPSS, version 22.

Based on the results, the preeclamptic group had significantly higher mean blood pressure (BP) and body mass index (BMI) compared to the normotensives. In addition, women with preeclampsia had a significant decrease in serum potassium and an increase in the serum creatinine compared to the normotensive group. The results further revealed that serum potassium, as well as systolic BP and diastolic BP had a significant inverse correlation in preeclampsia (P < 0.01 and P < 0.05, respectively). Eventually, the serum creatinine had a significant positive relationship with systolic and diastolic BP (P < 0.01)

In general, serum potassium and creatinine levels significantly altered in preeclampsia and were associated with increased disease severity. Therefore, it is suggested the serial electrolyte and creatinine profile should be used in the monitoring disease severity, which informs a timely intervention and reduces complications associated with preeclampsia.

Optimal antenatal care (ANC) visits help improve health outcomes and decrease perinatal mortality but they are often not optimal in low and middle-income countries (e.g., few mothers attend the recommended four or more ANC visits). The aim of this study was to identify determinants that influenced mothers who did make sufficient visits for ANC in rural Lao in order to inform the design of more effective interventions to change the behavior of mothers who do not make such visits.

A qualitative study was conducted using semi-structured interviews with mothers who made four or more ANC visits during their last pregnancy in rural Lao. Manual analysis was used for open and thematic coding of the interview data.

All mothers reported taking special care of themselves during pregnancy. They perceived the clear benefits of ANC visits regarding reassuring them of their health and reducing the risk of negative events. Family members, particularly husbands, played a key role in making decisions to seek more ANC when they were aware of its benefits. In addition, friends and neighbors were an important source of information for mothers. The quality of ANC provision and the provision of incentives such as an information booklet, along with soap and mosquito net were directly influencing factors in increasing ANC visits.

In general, feeling a need for taking special care during pregnancy was a common factor among pregnant women who did use ANC in rural Laos. Accordingly, improving the quality of ANC and increasing appreciation in communities regarding the need for good ANC are strongly recommended to increase attendance by all mothers.

The comparison of gonadotropin-releasing hormone (GnRH) agonist against GnRH antagonists regarding the pregnancy rate and effect of various predictors on pregnancy outcomes.

This prospective comparative study involved 189 women who underwent intracytoplasmic sperm injection (ICSI) cycles and were divided into agonist (107 patients) and antagonist arm (82 patients) groups. The chemical and clinical pregnancy rate was the main outcome and the other outcomes included the number and quality of oocyte measurement and pregnancy outcomes.

Based on the results, the agonist protocol showed a higher rate of pregnancy (32.7%, 95% CI: 23.9-42.4%) compared to the antagonist protocol (22.0%, 95% confidence interval (CI): 13.6-32.5%) with the odds ratio (OR) of (95% CI) = 1.73 (0.89-3.35). The results further revealed that the count of retrieved oocytes, count of M2 oocytes, count of fertilized oocytes, count of embryos, and the fertilization percent out of total retrieved oocytes were higher in the agonist arm compared to the antagonist arm . In the multivariate analysis after adjusting for the confounders, the agonist protocol had higher odds of a successful pregnancy compared to the antagonist protocol by 57% (partial OR = 1.57, P value = 0.23).

In general, the agonist protocol offers a favourable outcome in comparison to the antagonist arm, and there seems to be an intrinsic benefit for the agonist protocol, which is not explained by the higher number of transferred embryos.

Childhood obesity has reached alarming and concerning levels in many countries and poses an urgent and serious challenge to public health. In addition, gestational hypertension contributes to an elevated risk of obesity in children. The present study aimed at determining the relationship between exposure to preeclampsia and overweight/obesity occurrence in children aged 2-7 years old.

This observational case-control study was designed to assess the relationship between exposure to preeclampsia and overweight/obesity in children aged 2-7 years old. The study population included 205 children within the age range of 2-7 years old referring to Sari Pediatric Endocrinology Clinic as the case group and 209 healthy children who were selected from health centers as the control group and were homogenous in terms of demographic variables. Finally, data were analyzed in SPSS software (version 24), and P value of less than 0.05 was considered statistically significant.

The present study was conducted on a total number of 414 children aged 2-7 years old with a mean and standard deviation of 4.41±1.76 years, including 226 females (54.6%) and 188 males (45.4%). The obtained results revealed that gestational hypertension increased the risk of obesity in children significantly (OR=1.88, 95% CI=1.46-2.68).

Based on the results of the present research and similar studies, gestational hypertension is associated with overweight and obesity in children.

Hepatitis B virus (HBV) infection in pregnant women can lead to the development of serious complications in neonates. Therefore, this study aimed to develop a new tool for predicting this infection in pregnant women and to assess the psychometric properties of this scale.

This methodological study was carried out on 220 pregnant women visiting Al-Zahra and Taleghani hospitals of Tabriz, Iran in 2019. First, the relevant items were formulated and the respective questionnaire was developed and then, the validity (i.e., face, content, and construct) and reliability of the questionnaire were assessed as well. The data were analyzed in SPSS 21 using descriptive statistics, exploratory factor analysis (EFA), dependent t test, and Cronbach alpha coefficient.

A 22-item questionnaire was designed and the items were scored using a five-point Likert-type scale (Min=22, Max=120). Finally, the Kaiser-Meyer-Olkin value, Bartlett’s test of the Sphericity value, the internal consistency of the tool based on Cronbach’s alpha coefficient, and the intra-cluster correlation coefficient were 0.801, 4035.810, 0.811, and 0.81, respectively.

In general, the present tool can reliably predict HBV infection in pregnant women thus its application is recommended in preventing relevant complications.

Reflexology is a popular type of complementary medicine in medical practices, especially in midwifery fields.

This randomized controlled trial aimed to determine the effect of foot reflexology on idiopathic constipation symptoms, as well as anxiety and fetal activity during pregnancy. This study was conducted on seventy-four nulliparous women with constipation, referring to private and public health care centers in Tabriz-Iran, between 2017 and 2018. The participants were then randomly assigned to foot reflexology or control groups. The intervention group underwent 12 minutes of weekly foot reflexology treatment for 6 weeks. Constipation symptoms were measured at baseline and 6 times (weekly) after the intervention by the Constipation Assessment Scale (CAS). In addition, the State-Trait Anxiety Inventory (STAI) questionnaire was used to measure the participant’s anxiety at baseline and 6 weeks after the completion of the study. Finally, fetal movements were measured at baseline and 6 times (weekly) after the intervention using a kick chart.

Based on the results, 97% of women reported improvement in their CAS measures at the end of six weeks following reflexology. The mean scores of STAI at the end of the intervention were 38.5 and 42.2 (State anxiety), as well as 39.1 and 40.2 (Trait anxiety) in the reflexology and control groups, respectively. Statistically significant differences in fetal movements between the two groups were only observed in the fourth (P = 0.001) and fifth weeks (P = 0.007) after intervention sessions. The results further indicated that about 67% of mothers were satisfied with reflexology intervention for improvement in their constipation symptoms. Eventually, no harmful side events were reported among women.

Short-term foot reflexology in this context may have potential healing benefits in improving constipation and anxiety symptoms during pregnancy. However, further investigation for antenatal reflexology is necessary.

The administration of betamethasone is associated with increased placental vascular resistance results in the return of the diastolic flow. This study aimed to assess the changes in the flow velocity waveform (FVW) color Doppler in the umbilical artery after the administration of betamethasone in pregnancies with fetal growth retardation (FGR).

This descriptive-analytical research included all pregnant women who were referred to Al-Zahra teaching hospital and diagnosed with FGR. The eligibility criteria were the impaired umbilical artery FVW color Doppler, qualified for the administration of a fix-dosed Betamethasone, and no fetal abnormalities. The perinatologists performed the FVW color Doppler ultrasonography before and after the administration of betamethasone at intervals of 24, 48, and 96 hours and weeks 1 and 2. FVWs were obtained by pulsed-wave Doppler ultrasonography. Then, neonatal outcomes were recorded based on neonates’ admission documents. Finally, one-way repeated measures ANOVA, Cochran’s Q test, and paired-samples t-test were used to compare Doppler indices before and after betamethasone administration.

The mean pulsatility index (PI) and resistance index (RI) of the umbilical artery showed a statistically significant reduction after the administration of betamethasone (P < 0.001). The measured umbilical artery PI at two weeks after drug administration predicted the neonatal intensive care unit admission (P = 0.042). Eventually, the results revealed no significant association between the amniotic fluid index (AFI) and betamethasone administration (P = 0.3).

In general, betamethasone administration improved the FVWs of the umbilical artery in pregnant women with fetal growth restriction while no association was found between the AFI and betamethasone administration.

This experiment was carried out to evaluate the impacts of unmodified human amniotic fluid-derived mesenchymal stromal/stem cells (hAF-MSCs) on the viability of HeLa cells, as well as the impact of these cells on the expression of common pro-apoptotic and pro-survival genes in tumor cells by establishing an indirect co-culture system.

To this end, an indirect co-culture system was established, and hAF-MSCs were co-cultured with HeLa cells at a ratio of 1:2 for five days. The cell viability of co-cultured tumor cells was determined after the incubation period. Then, several parameters were examined, including the gene expression of tumor protein 53 (TP53), BCL2-associated X protein (BAX), B-cell lymphoma 2 (BCL-2), and cyclin-dependent kinase inhibitor 1A (CDKN1A). Finally, gene regulatory networks were analyzed as well.

The results of this study confirmed that the co-culture of hAF-MSCs with HeLa cells could decrease the viability of tumor cells. The reduction of HeLa cell viability was accompanied by an increase in BAX, TP53, and CDKN1A while a decrease in BCL-2 gene expression. Eventually, the analysis of the regulatory network revealed that the co-culture of Hela cells with hAF-MSCs activated several transcriptional factors and microRNAs which regulated the expression of these genes.

In general, hAF-MSCs exerted the inhibitive effects on the growth of HeLa cells, along with alterations in the expression of common pro-apoptotic and pro-survival genes in a timely and concentration-dependent manner.

Hypertension, as a common problem during pregnancy, is a major cause of maternal and fetal morbidity and mortality. Anti-hypertensive drugs are used to prolong the pregnancy or modify perinatal outcomes in pregnant women with hypertensive disorders. Severe monitoring of blood pressure is subsequently essential in these mothers. The aim of this study was to evaluate the correlation between divided doses of chronic hypertensive drugs and the end of pregnancy in mothers with gestational hypertension.

In this prospective research, 99 pregnant women with chronic hypertension, who were treated with anti-hypertensive medicines, were studied during pregnancy. During routine follow-up of these mothers, the number of the drug and the divided doses were recorded. The incidence of maternal and fetal outcomes were evaluated according to the number of less or more than 5 divided doses.

Maternal and fetal-baby complications were observed in 5.50 and 5.53% cases, respectively. The incidence of maternal and fetal complications were significantly enhanced by increasing the number of up-taken anti-hypertensive drugs. The maternal and fetal-baby complications were higher in mothers who received more than five divided doses compared to those who received less than five doses.

Based on our results, chronic hypertension was associated with maternal and fetal-baby complications in half of the cases. It is clarified that precise blood pressure monitoring and regularly taking of anti-hypertensive medicine may decrease the hypertension side effects. The awareness about this field in the pre-pregnancy consulting is considered as the patients’ rights and should be respected

Carcinoma of the uterine cervix is the most common gynecological malignancies in developing countries. Human papilloma virus is known as the main etiology. In addition, the spread of uterine cervical cancer often occurs through direct local extension and the lymphatics although the hematogenous spread is uncommon. Further, the scalp metastasis of cervical cancer is extremely rare.

In this regard, a 50-year-old woman with scalp metastasis of previous cervical cancer was discussed in the present study. She was suffering from a fast-growing and painful nodule, located on the frontal part of the scalp as a sole site of metastasis. A multidisciplinary approach was considered for her, which consisted of radical excision, followed by radiotherapy and chemotherapy. Given the lack of abundant evidence for the efficacy of this treatment, our patient has fortunately survived for more than two years.

During the follow-up period after the completion of treatment, it is not sensible to only focus on the primary site of the tumor and thus entire examination is mandatory in this regard.