International Journal of Women’s Health and Reproduction Sciences
Volume:10 Issue: 1, Jan 2022

Severe fear of childbirth (FOC) has adverse consequences for mother and child. This study aimed to update the global prevalence of severe FOC in low-risk pregnant women.

Observational studies published in English were obtained through PubMed, Scopus, Science Direct, Wiley Online, and Google Scholar databases up to April 2020. After reviewing the title and introduction, the quality of the articles that had full text and met the inclusion criteria of the study was checked with the JBI checklist. Then, the final extracted data were entered into the STATA software. The overall prevalence of severe FOC and fear in subgroups were obtained using meta-analysis. Tests of publication bias and sensitivity analysis were also performed.

Overall, 27 observational studies were included (26014 participants). The global prevalence of severe FOC was 16% (95% CI: 14%–19%). The subgroup analysis showed that after 2015, the prevalence of fear was higher than before (%18 versus %14). The results also showed a higher prevalence of fear in women with a diploma and lower compared to women with a university education (%19 versus %13), in single/divorced women compared to married/cohabitation women (%21 versus %15), in nulliparous women compared to multiparous women (%17 versus %14) and in women experiencing the second trimester of pregnancy compared to women in the third trimester of pregnancy (%23 versus %14).

The global prevalence of severe FOC was 16%. Diagnostic, preventive, therapeutic and follow-up strategies are needed to reduce fear in all countries.

Numerous studies have been performed on the effect of L-arginine supplementation on improving maternal outcomes, but studies on the impact of L-citrulline in pregnancy are limited. This study aimed to evaluate the L-citrulline level in pregnant adolescents with severe preeclampsia compared to those without preeclampsia.

This is a cross-sectional study among 60 adolescent pregnant women giving birth in the Emergency Room and Delivery Room in Hasan Sadikin Hospital, Bandung, Indonesia from May to October 2020. The L-citrulline levels were examined in women with severe preeclampsia (n = 30) and those without preeclampsia (n = 30).

The L-citrulline level in adolescent pregnancies with severe preeclampsia was lower than those without preeclampsia (79.7±40.4, 122.3±61.9 pg/mL, respectively and P=0.003). But no correlations were observed between L-citrulline levels with systolic blood pressure, diastolic blood pressure, and mean arterial pressure (MAP).

There was a difference in serum L-citrulline level of adolescent pregnancies with severe preeclampsia and without pre-eclampsia.

Myomas are the most common non-malignant pelvic neoplasm in women’s reproductive life. The aim of present study was to compare the outcome of large myoma Laparoscopy in Iranian reproductive-age women.

This cross-sectional study was conducted on 86 women with symptomatic uterine myoma who underwent laparoscopic myomectomy between December 2013 and October 2018. Participants were divided into two groups based on the myoma weight (<80 (n=15) and ≥80 g (n=71)). Finally, age, body mass index, number of myomas removed, duration of surgery, postoperative hospitalization, amount of blood transfusion, and hemoglobin reduction were compared between the two groups. Data were analyzed by SPSS software version 22.

The mean age of participants were similar in both groups (P=0.48). There were no significant differences between the two groups regarding body mass index (P=0.56) and indications for laparoscopic myomectomy (P=0.46). The mean weight of myoma and duration of surgery were significantly different between the two groups (P<0.001 and P<0.007, respectively). Changes in hemoglobin and days of hospitalization after surgery were not significantly different between the two groups.

The length of hospital stay and blood loss in laparoscopic myomectomy did not differ significantly based on myoma weight. So, laparoscopic myomectomy could be considered a minimally invasive alternative for managing symptomatic large myoma.

Gestational diabetes mellitus (GDM) is one of the most important medical conditions in high-risk pregnancies. Social capital is one of the essential factors affecting the prevention and control of diabetes and the blood glucose level. The purpose of this study was to investigate the level of social capital and its related factors in GDM in the north of Iran.

This cross-sectional study was conducted on 212 GDM women who referred to diabetes centers at Razi hospital in Ghaemshahr and Imam Khomeini hospital in Sari in 2019. The women were selected through the convenience sampling method. The data collection tools included Medical-Demographics Information Form and Onyx-Bullen’s Social Capital Questionnaire. Finally, data were analyzed by SPSS (version 25) using descriptive and inferential statistics (multiple regression analysis).

The results of this study showed that the mean (standard deviation, SD) of age for GDM women was 29.28 (±5.75). The majority of women (58%) had an academic education. The mean (SD) of social capital was 96.46 (±21.17). Based on the results, a positive and significant correlation was observed between spouse’s education (lower than high school, P=0.001 and academic education, P=0.001), wife’s occupation (employee, P=0.015), spouse’s occupation (employee, P=0.027), and fasting blood sugar (FBS) (P=0.048), as well as a significant negative correlation with 2-hour FBS (P=0.048), 1-hour postprandial glucose level (P=0.001), economic status (dissatisfied, P=0.42), overweight (P=0.009), and obesity (P=0.020).

The social capital of GDM women is influenced by various socio-economic factors. According to the findings of this study, women who are economically disadvantaged, overweight, obese, and at high blood sugar levels are at greater risk of rejecting treatment due to low social capital, resulting in poor blood sugar control. Therefore, interventions related to promoting social capital in these groups should be pursued more vigorously, and strengthening of social capital and its influencing factors should be considered as one of the main approaches of health promotion.

The quality of recovery can affect the results of abdominal hysterectomy although this effect is unknown in different methods of anesthesia. Therefore, the present study was conducted to compare general anesthesia (GA) and spinal anesthesia (SA) methods on the quality of the recovery of patients with selective abdominal hysterectomy in patients visiting the largest women’s disease hospital in Northwestern Iran.

This cross-sectional descriptive study was conducted with the participation of 350 patients with abdominal hysterectomy, who were selected by convenience sampling in Al-Zahra hospital, Tabriz, Iran in 2019. Demographic data, visual pain scale, hemodynamic status, and Aldrete-Kroulik index were recorded for each patient. Data were analyzed using Mann-Whitney, t-test, multivariate regression, and Kolmogorov-Simonov tests in SPSS 20, and P<0.05 was considered statistically significant.

In the hemodynamic status, it was found that the SA group was more stable than the GA group but this difference was not significant (P>0.05). Regarding the need for pethidine, the results revealed that the mean (± standard deviation) of the GA group was significantly higher (35.14 ± 10.14) than that of the SA group (20.15 ± 05.25, P=0.039) while there were no significant differences between the two groups in the use of the antiemetic drug (P=0.203). Finally, the evaluations of the quality of recovery showed that the mean±) SD) of the quality of recovery in SA patients was significantly higher compared to GA patients (P=0.015).

In general, the quality of recovery was higher in the SA compared to the GA regarding abdominal hysterectomy

This study aimed to evaluate the effect of cognitive-behavioral therapy focused on self-esteem (CBT-S) on fear of childbirth in nulliparous women.

In this randomized clinical trial, 24 nulliparous women willing to cesarean section delivery referred to Milad hospital, Tehran, Iran, between July to August 2015 were enrolled with a convenient sampling method. Participants were assigned into two CBT-S and control groups (24 in each group) using randomized blocks of 4. Seven sessions were performed for the CBT-S group, but the control group received routine prenatal classes. FOC was assessed using Harman’s childbirth attitudes questionnaire. The Rosenberg self-esteem scale was used to assess self-esteem at the beginning of the study. Two weeks after the intervention, both groups filled out the FOC and self-esteem questionnaire.

The mean score of fear at the end of the study in the CBT-S and control group was significantly different (P=0.001). Also, selfesteem scores increased after intervention in the CBT-S counseling group (4.77 ± 4.07vs -1.79 ± 2.26; P=0.001).

This study confirms the importance of the CBT-S approach focusing on self-esteem in reducing FOC.

The aim of the present study was to evaluate the effect of the intrauterine administration of platelet-rich plasma (PRP) before embryo transfer (ET) on pregnancy outcomes in women with repeated implantation failure (RIF).

This randomized controlled trial included 120 RIF women who were candidates for frozen-thawed ET. In the PRP group (n=60), the intrauterine infusion of 0.5 mL PRP was performed 48 hours before ET, and the control group (n=60) underwent ET without intrauterine administration.

The implantation rate (28% vs. 11.9%, P<0.001), clinical pregnancy (51.6% vs. 26.6%, P=0.005), and live birth rate (58.3% vs. 28.3%, P=0.001) in PRP group were significantly higher compared to the control group. Based on the results, there was no significant difference with regard to miscarriage (12.5% vs. 12.9%, P=0.97) and multiple pregnancy rate (0.133% vs. 0.05%, P=0.11) between the two groups. Finally, preterm delivery was significantly higher in the PRP group (P<0.001).

According to this study, the result revealed that PRP is effective in the improvement of pregnancy outcomes in RIF patients. Further studies are needed to identify the group of patients who would benefit from this intervention.

The coronavirus disease 2019 (COVID-19) pandemic increased the severity of the psychological problems of pregnant women, which can have severe consequences. The current study aimed to investigate the effects of COVID-19 on the stress, anxiety, depression, self-care behaviors, and the quality of the life of women at the risk of preterm labor.

The current descriptive-analytical study was conducted from March 20, 2020 to June 21, 2020. In total, 88 women who were at risk of preterm labor in Tabriz (Iran) participated in this study. The association between the Depression, Anxiety and Stress Scale-21 Items (DASS-21) questionnaire, Hart’s self-care behaviors during pregnancy, and SF-36 (for the quality of life) were investigated using Pearson and Spearman correlations in SPSS 20 at P<0.05.

Based on the results of the Pearson correlation test, stress and self-care scores (P=0.003, r=-482), self-care and depression scores (P=0.006, r=-396), as well as anxiety and self-care scores (P=0.001, r=-511) had significant inverse linear correlations. According to the regression model, only the stress variable had a significant association with self-care (P=0.039). There was a positive and significant (P<0.05) correlation between self-care behaviors and three dimensions of marital quality including physical function, mental function, and the feeling of pain and discomfort.

The results of the current study showed the significant inverse association between self-care and depression and stress and anxiety during pregnancy in women at risk of preterm labor during the COVID-19 pandemic. Low quality self-care behaviors also led to a decrease in the quality of life of these women.

Pelvic floor disorders (PFDs) during pregnancy and after delivery, and related risk factors are still debatable topics for research. Thus, the aim of the present study was to assess the probable risk factors associated with PFDs in Iran.

This cross-sectional study was conducted in two state and private hospitals in Tabriz, Iran from the 1st of June to the 31st of August, 2018. The participants were 650 postpartum women, aged between 15 and 47 years six months after delivery. The type of delivery, type of hospital, history of episiotomy and induction, anesthesia, multiparity, the mother’s birth age, the infant’s weight and head circumference, the mother’s weight gain during pregnancy, and a wide variety of probably related risk factors were studied based on the study objective. According to their answer to the questions of PFDs, 147 women responded yes and completed the Pelvic Floor Distress Inventory-20 questionnaire.

Between the investigated risk factors, type of the hospital (OR: 0.27, CI: 0.126-0.564) and the amount of the mother’s weight gain during pregnancy (OR: 1.066, CI: 1.024-1.109) were significantly associated with PFDs. Finally, the number of PFDs and severity of dysfunctions according to PFDI-20 were higher in state hospitals, and excessive weight gain of the mother during pregnancy was related to the higher incidence of PFDs.

Type of the hospital and the mother’s weight gain during pregnancy are the only two related risk factors in this study. This study was the first one to discuss the type of the hospital in such related risk factor studies. Accordingly, it is predictable that better supervision of medical attends in state hospitals is highly important for decreasing the rate of PFDs after delivery

Concurrent bleeding or existing clots usually obscure the vision field and decrease the hysteroscopy success rate. Therefore, any efforts made to have a clear view during the hysteroscopy will improve the diagnostic or treatment outcomes. We examined the effect of preoperative clot evacuation on hysteroscopy related outcomes.

In this parallel-group randomized clinical trial conducted in Al-Zahra hospital, Tabriz, Iran, 114 women with uterine bleeding were randomly assigned to receive either clot evacuation before standard operative hysteroscopy or after that from December 2018 to September 2019. The study outcomes were the clarity of vision, amount of bleeding, the volume of required distension media, duration of the procedure, and postoperative complications.

There were statistically significant differences in the frequency of the clear vision (P<0.001), the severity of bleeding, mean procedure time (P<0.001), mean used distension media and the mean postoperative hematocrit levels in favour of women with pre-hysteroscopy intrauterine evacuation. There was no difference in in-hospital stay and anaesthetic complications among the two groups. The procedure was successfully performed on all participants of both groups with no post-operative complications.

Removal of clots and other uterine contents before the insertion of the hysteroscope rendered better and faster access to the uterine wall to observe existing abnormalities. This additional surgical step could significantly impact surgical and clinical outcomes.