International Journal of Women’s Health and Reproduction Sciences
Volume:9 Issue: 4, Oct 2021

Phobia of natural childbirth is one of the most important and influencing factors leading women to request cesarean sections. The present study aimed to prepare a systematic review and meta-analysis to investigate the type of interventions related to fear of childbirth (FOC).

The data collection was based on an extensive search of articles related to clinical trials (1990-2019) posted on Google Scholar, Cochran, SID, Magiran, Web of Science, Scopus, and PubMed electronic databases. In general, 109 abstracts were selected after eliminating similar publications. As a result of the qualitative evaluations of these articles, 11 studies were kept for investigation.

The studies were categorized into three groups including prenatal education with childbirth counseling, yoga courses, and psychoeducational-based interventions. Based on the meta-analysis, psychoeducational interventions have a significant effect on childbirth fears and anxiety in comparison with the control group (mean difference: 0.85, 95% CI: -1.20–0.45, P < 0.0001, I2 = 82%).

Psychologically-based interventions, can creatively play an essential role in reducing the FOC during pregnancy and even childbirth. It can also create a pleasant and traumatic-free experience which is essential for encouraging women to have a natural childbirth

This study was conducted aiming at exploring strategies for reducing cesarean section (C-section) in Iranian and foreign studies.

The present study was carried out using a matrix approach and searching keywords including “Cesarean”, “Effective Intervention”, and “Cesarean Section Reduction Strategy” to find studies (2000-2019) in databases such as PubMed, SID, Science Direct, Google Scholar, and WHO.

CS reduction strategies were classified into 3 categories of psychological, clinical, and structural-policy interventions. The first category supports women throughout labor and childbirth by the midwife, doula, coping skills with fear and pain of labor, changes in the attitudes of service providers and pregnant women. Clinical interventions include vaginal birth after CS, vaginal breech delivery, external cephalic version (ECV) for breech presentation, encouragement of service providers into intermittent auscultation for the fetal heart rate instead of continuous electronic fetal monitoring (EFM), and training of service providers, pregnant woman, and her family. The last category encompassed managing insurance and financial services, receiving one-to-one care and midwifery care throughout active labor, and updating policy of labor induction in post-term pregnancy, as well as women’s admission policy with cervical dilatation of more than 4 cm with regular uterine contractions, active team care in labor, and auditing and feedback.

It seems that multi-dimensional interventions are required to reduce the CS rate. Concerning some of the strategies (e.g., ECV), it is suggested that further research should be performed by addressing the limitations and drawbacks of previous studies before applying clinical procedures due to contradictory results.

Globally, breast cancer is the commonest cancer in women. Empirical literature indicate that it is the second cause of cancerrelated mortality in high-resource regions, while it is the most common cause of cancer-related deaths among women in poor-resource regions. This study presents the suitability of the health belief model (HBM) as a framework for carrying out a comprehensive assessment of women with late-stage breast cancer in Nigeria.

This qualitative study employed interpretive description as its methodological approach, while the HBM was the conceptual framework. Two institutional review boards granted approval to conduct the study. Thirty women with advanced breast cancer were recruited for the study using purposeful sampling techniques. Components of the original HBM were identified to carry out the investigation. Data analysis was inductive.

Findings indicated that the participants viewed breast cancer as a definite threat- both as a spiritual attack – an arrow shot by the enemy, and as a killer disease. Many of their perceptions appeared to be culturally based, while others were based on their individual experiences. They perceived some benefits to both traditional and medical treatment options.

Interventions that address people’s cultural and individual perceptions enables a comprehensive assessment of the patients with breast cancer, which can improve the treatment outcomes and survival rates of disease.

There is no consensus on the management of cesarean scar pregnancy (CSP). In this regard, this study proposed an algorithm for CSP management with consecutive outcomes.

In this randomized clinical trial study, the data of 44 patients with CSP were collected, and the diagnosis was confirmed by transvaginal ultrasonography (TVS). Unstable patients underwent uterine artery embolization (UAE), and the fetal reduction was done for patients with the fetal heart rate (FHR). In addition, patients received systemic methotrexate (MTX) injections according to their beta-human chorionic gonadotropin (β-hCG) levels and then were followed on a predetermined schedule by β-hCG levels and TVS. Finally, prophylactic UAE was considered for patients with ongoing bleeding, placental hypervascularity, and the prospect of limited access to care.

Patients were within the age range of 33.9±4.9 years and the gestational age of 7.37±1.57 weeks. Twenty-two patients (50%) had vaginal bleeding, 3 of whom were unstable and underwent UAE. Five patients underwent a total abdominal hysterectomy, and fourteen patients with FHR underwent a fetal reduction. Based on β-hCG levels and changes, and placental vascularity, 4 patients received no treatment. In general, 11, 2, and 9 patients received single, double, and multiple MTX injections. A total of 10 patients underwent both multi-doses of MTX and prophylactic UAE. The median period to reach undetectable β-hCG levels was 7.3 weeks and the median interval to start menstruation was 2.8 weeks. In addition, the pregnancy remnant was resolved 3.6 months after the treatment. On the follow-up, no curettage or hysterectomy was needed and seven patients became pregnant (15.9%), 2 of whom presented recurrent CSP (28.6%).

The proposed stepwise algorithm could be employed for CSP management with accountable outcomes, low hysterectomy rates, and fertility preservation.

Preeclampsia is a high prevalence complication in pregnancy and is responsible for 36% of maternal mortality worldwide. The offspring of mothers with preeclampsia face many problems after birth and in their lifetime. The fetal renal is one of the most vulnerable organs following maternal preeclampsia. In this regard, the present study investigated the relationship between the severity of preeclampsia and fetal renal artery resistance and pulsatility.

In general, 91 pregnant women were included and divided into control and preeclampsia groups. The control group included 43 women with normal pregnancy and the preeclampsia group consisted of 48 pregnant women who suffered from preeclampsia and were classified into patients in severe and non-severe preeclampsia groups each containing 24 cases. Renal artery Doppler ultrasound was performed, and then the systole/diastole ratio (S/D), pulsatility index (PI), and resistance index (RI) were measured as well.

The S/D ratio, RI, and PI significantly decreased in the preeclampsia group (P<0.001) compared to the control group. The S/D ratio in severe preeclampsia was significantly lower in comparison with non-severe preeclampsia (P<0.001). Finally, the amniotic fluid index was related to the PI (P<0.05), and severe preeclampsia significantly increased the pregnancy termination before 34 weeks (P<0.001).

Preeclampsia deceased the resistance of renal arteries by altering the fetal renal blood flow. These changes can intensify in patients with severe preeclampsia compared to non-severe preeclampsia.

Many factors such as stress and psychological tension affect the mental and physical health of pregnant women in the third trimester during the coronavirus pandemic. These factors can cause severe complications such as sleep disorders and low back pain. Therefore, this study focused on investigating sleep disorders in women by diagnosing low back pain in pregnant women with coronavirus and the affecting factors.

This descriptive-analytical study was performed during the four months ending July 5, 2020 with the participation of 40 pregnant women (with coronavirus disease detected in the last trimester of pregnancy) with a diagnosis of low back pain in Tabriz (Iran) using a random sampling technique. Demographic data, anxiety and depression, Petersburg’s sleep quality, factors affecting sleep quality, and the severity of back pain (visual analog scale) were electronically collected and analyzed using SPSS 20 by ANOVA and multivariate regression.

All participants were at a weak level. The majority of participants had a score of “serious sleep problem”, and nausea and vomiting (P=0.041), low back pain (P=0.003), frequent urination (P=0.011), leg cramps (P=0.031), and constipation (P=0.018) caused severe sleep disturbance in pregnant women during coronavirus pandemic.

In general, having coronavirus disease causes severe pain in pregnant women, leading to severe back pain in pregnancy, eventually worsening sleep disorders.

The present study surveyed the prevalence of antibiotic resistance among Ureaplasma urealyticum in isolates from Gonabad (in the northeast of Iran) including susceptibility testing for U. urealyticum to different antibiotics.

In this research, a total of 95 vaginal swab specimens were aseptically collected from women who were admitted to the Bohlool Teaching Hospital and Jahad Daneshgahi Center from April 2016 to April 2017. Culture and subsequently antibiotic susceptibility testing were performed according to the Mycoplasma IST 2 kit. Then the cupules were read and interpreted in 24 and 48 hours according to kit guidelines.

In the studied patients, 38 (40.4 %), 12 (12.8 %), and 11 (11.7%) cases were single positive for U. urealyticum, single positive for Mycoplasma hominis (M. hominis), and dually positive for U. urealyticum and M. hominis, respectively. The positive rates of genital U. urealyticum in the symptomatic and asymptomatic groups were 86.8% and 13.2%, respectively. The highest positive rate (42.1%) was found in the 26-30-year-old group. In addition, tetracycline (TET) and doxycycline (DOT) were the most effective antibiotics against isolates, and one strain was multi-drug resistant. The U. urealyticum resistance rates were more than 39% to erythromycin and pristinamycin, and more than 55% to ciprofloxacin. All U. urealyticum isolates with <104 CFU/specimen were sensitive to all tested drugs.

Although the emerging resistance to TETs among our isolates is alarming, these data show that the standard therapeutic regimen for urogenital infections caused by U. urealyticum is DOT, TET, and clarithromycin, leading to better outcomes in most respective patients.

Invasive cervical cancer is one of the most fatal genital cancers of women which can be detected by having Pap smear in precancerous stage. Various approaches can be taken for treating or preventing the progress of these precancerous lesions. The aim of this study was to investigate the cytopathological and colposcopic response of precancerous lesions to multivitamin, mineral (multimineral), and coenzyme Q10 supplements.

The present randomized clinical trial was conducted on 120 participants with clinical complaints or abnormal Pap smear test results. The intervention and control groups received supplemental and placebo treatments, respectively, for 3 months after a primarily Pap smear test. The Pap smear test was also performed after the treatment and patients with abnormal results were screened by colposcopy. Data were analyzed by SPSS software and P-value less than 0.05 was considered significant.

The percentage of participants in the intervention and control groups were 40% and 28.3% in the age range of 20-29, 26.7% and 41.7% in the age range of 30–39, and finally 33.3% and 30% over 40 years of age, respectively (P=0.19). The percentage of normalization in Pap smear test result was 83.3% and 53.3% in the intervention and control groups, respectively (P<0.001).

It was found that short-term usage of multi-mineral and Q10 supplements may decrease the risk of cervical cancer in women with abnormal Pap smear. However, studies with larger population and longer trial period are needed for further investigation.

The present study was performed to compare the analgesic effects of bupivacaine and magnesium sulfate combination on post-cesarean (C) section pain.

The present single-blind randomized clinical trial was conducted on 160 C-section candidates. The participants were randomly divided into four groups. When the fascia healed, the first group received 20 mL of 0.25% bupivacaine and the second group received 20 mL of 0.25% bupivacaine combined with subcutaneous adrenaline. In addition, both groups received 50 mL of intravenous normal saline. Further, the third group received subcutaneous bupivacaine and 50 mg/kg of magnesium sulfate and the fourth group received subcutaneous and intravenous normal saline as a placebo. The pain intensity was assessed 2, 6, 12, 18, and 24 hours after spinal anesthesia using the visual analogue scale (VAS) for pain. The dose of pethidine (as a standard analgesic) and hemodynamic parameters (i.e., heart rate [HR] and blood pressure [BP]) was recorded as well. The obtained data were then analyzed utilizing ANOVA, Tukey’s HSD, and repeated measures ANOVA tests.

The intensity of pain and the dose of pethidine decreased significantly in the combination of bupivacaine with magnesium compared to the other groups at all times (P < 0.001). However, diastolic BP significantly increased in the bupivacaine + adrenaline group in comparison with the other groups (P = 0.02).

Overall, bupivacaine combination with magnesium sulfate is suitable for controlling post-cesarean section pain.

To evaluate the efficacy of mefenamic acid for the reduction of bleeding and spotting in post-partum women initiating the use of depot-medroxyprogesterone acetate (DMPA) for contraception.

This double-blind, placebo-controlled study included postpartum breastfeeding women in Khon Kaen, Thailand. Mefenamic acid or placebo was administered over the first 12 weeks of DMPA use. Then, participants completed a self-report bleeding diary.

Forty women, initiating the use of DMPA for postpartum contraception, were randomized to mefenamic acid (n=20) or placebo (n=20) group. The study was discontinued after 27 months because of suboptimal enrollment. The mefenamic acid group was less likely to have prolonged bleeding compared to placebo although this was not statistically significant (37.5% vs. 50%, respectively, P = 0.491). DMPA discontinuation rates were high at 50% in both groups although no participants in the mefenamic acid group stopped using DMPA due to bleeding side effects.

The high discontinuation rates in the postpartum use of DMPA are attributed to the occurrence of bleeding/spotting side effects. Although mefenamic acid prophylaxis appeared to be beneficial to some women, a larger randomized controlled trial is required to confirm the effectiveness of this approach.