Journal of Obstetrics, Gynecology and Cancer Research
Volume:7 Issue: 2, Mar - Apr 2022

Coronavirus disease 2019 (COVID-19) is a major public health concern, highly contagious in nature and/or causing high mortalities. This review paper reveals comprehensive interpretations of current COVID-19 reports and their impact on pregnancy in conjunction with antenatal visits, mental health, and mode of delivery. We further review recent guidelines of distinct leading organizations, which intend to serve as assistance in managing pregnant women with suspected or confirmed COVID-19. Pregnancy amid the COVID-19 pandemic necessitates marked importance deliberating high-risk status and vulnerability to severe COVID-19 related illnesses. The risk of vertical transmission is low; however, neonatal illness varies from asymptomatic to mildly symptomatic. Healthcare providers should consider proper guidance and obvious illustration of preventive strategies to limit the further spread of COVID-19. We also discuss the safety and efficacy of COVID-19 vaccines in pregnant women, besides benefiting both mother and baby.

The recent surge in coronavirus disease 2019 (COVID-19) cases has exposed health care workers (HCWs) to a wide range of psychological stressors and predisposed them to anxiety-related disorders. In this study, we observed the anxiety level in this population.

This multicenter, cross-sectional study was performed on 1,038 HCWs in 14 hospitals of Tehran during the COVID-19 pandemic. In May 2020, Beck Anxiety Inventory (BAI) was used to measure the level of anxiety in this population.

The mean±SD age of participants was 36.30±8.23 years old. Most participants were 31 to 40 years old (43.2), female (87.6%), and nurses (49.5%). The BAI scores of the participants were in a positive skew distribution, with a score range of 0-63, a median of 12, and a mean value of 15.30±11.43. Out of 1,038 hospital staff, 411 (39.6%) had moderate to severe anxiety. The anxiety level was significantly higher in HCWs ≤40 years old, women, and nurses. However, there was no significant relationship between stress levels among frontline workers compared to second-line workers (P=0.82).

It seems that HCWs experienced a high level of anxiety in the COVID-19 outbreak. One of the critical measures in every epidemic is to provide supportive care to maintain the mental well-being of HCWs, especially in high-risk groups, including younger HCWs, women, and nurses.

Estradiol and misoprostol have been used for the enhancement of transformation zone (TZ) visibility in vaginal colposcopy. However, no consensus has been reached on the superiority of one medication over the other. This study aimed to compare the efficacy of estradiol and misoprostol for the enhancement of TZ visibility in vaginal colposcopy of premenopausal and postmenopausal women.

In this clinical trial, 78 patients with unsatisfactory colposcopy were randomly divided into three groups. Group 1 (n=25) received 25 µg of vaginal estradiol for 14 days prior to colposcopy. Group 2 (n=27) received 400 µg of misoprostol 12 h prior to colposcopy. Group 3 (n=26) served as the control group and did not receive any medication. Visibility of the TZ, age, body mass index (BMI), history of vaginal delivery, history of sexually transmitted diseases, history of human papillomavirus (HPV), the reason for colposcopy, and drug-related side effects were compared among the three groups and also between premenopausal and postmenopausal women. Data were analyzed using analysis of variance (ANOVA), Kruskal-Wallis, Chi-square, and Fisher’s exact tests.

The percentage of TZ visibility was 72%, 55.6%, and 26.9% in the estradiol, misoprostol, and control groups, respectively (P=0.005). These values were 70%, 33.3%, and 0%, respectively, in postmenopausal women (P=0.043) and 60%, 72.7%, and 33.3%, respectively, in premenopausal women (P=0.152). Regarding drug-related side effects, there was no statistically significant difference between the three groups (P=0.374).

Estradiol was significantly superior to misoprostol for the enhancement of TZ visibility, particularly in postmenopausal women, with no difference regarding side effects.

Opioids that are used during anesthesia may prolongate intestinal peristalsis. This study aimed to examine the effect of oral methylnaltrexone (OMNTX) on ileus after hysterectomy.

This study was performed as a randomized, double-blind screening for an elective abdominal hysterectomy at Alzahra Hospital in Rasht, Iran; 33 patients were assigned to the OMNTX group (25 mg) and 33 to the placebo group using the random block method. Patients were asked and recorded about gas passing, constipation, vomiting, itching, and urinary retention.

There was a significant difference in the meantime of initiation of intestinal sound (P=0.039) and constipation (P=0.62) between the two groups. There was a positive correlation coefficient in the placebo group (P=0.02) between the hours of surgery and the time of initiation of bowel movements after the surgery. Still, there was not in the OMNTX group (P=0.0001). The mean onset of bowel sounds after the surgery was not related to age (P=0.599) and the duration of surgery significantly (P=0.926).

It is possible that OMNTX before the surgery can trigger bowel sounds sooner after the surgery and prevent ileus.

Pregnancy is a stressful event in and of itself, which may have an impact on the present prevalence of COVID-19 illness. It is crucial to think about what factors can help pregnant women cope with the anxiety brought on by the COVID-19 outbreak. The purpose of this study was to determine the prevalence of COVID-19 in pregnant women, as well as the impact of COVID-19 anxiety on pregnant women's Apgar scores and birth weights of newborns.

From early January to late March 2021, 102 pregnant women were included in this descriptive cross-sectional study using any accessible sampling method. Questionnaires such as the "Demographic" and "Corona Anxiety Scale" were used to collect data. SPSS software version 22 was used to analyze the data.

The mean score of total anxiety caused by COVID-19 in pregnant women was 20.88 ± 21.08, which was moderate. Among the components of anxiety, the mean score of psychological symptoms (13.05 ± 5.31) of pregnant women was higher than physical symptoms (5.64 ± 5.72). There was no statistically significant link between demographic characteristics and COVID-19-induced anxiety (P>0.05). The findings also revealed no statistically significant connection between COVID-19-induced anxiety and newborn weight or Apgar score 1 and 5 minutes after birth (P>0.05).

The definitive incidence of COVID-19 in pregnant women was low. They experienced a moderate level of anxiety caused by COVID-19, which requires the necessary measurements to be taken by the relevant authorities, family and others to reduce this anxiety during the coronavirus pandemic.

 Multifetal reduction not only lowers the number of fetuses but also improves pregnancy outcomes. A great conflict emerges when obstetrician faces triplet or higher order multifetal pregnancies. Decision-making is so difficult whether to continue pregnancy as such with its risks or reduce the number of fetuses to improve outcomes. This study aimed to assess the obstetrical outcomes of Embryo Reduction to Twins (ERTT) procedures in IVF/ICSI centers in Egypt.

This retrospective cross-sectional study was conducted from June 2017 to December 2020. Data of the patients in five IVF/ICSI centers were accessed using the computer-stored patients' files. Patients who got pregnant spontaneously or after IVF/ICSI procedures with 3 or more embryos were recruited in the study. The patients were counseled for ERTT and those who accepted the procedure were included. The measured obstetrical outcomes were abortion rate, preterm labor, and preeclampsia, premature rupture of membranes, and neonatal morbidity and mortality.

One hundred and twenty four cases were included in this study from 5 IVF/ICSI centers. Most cases (83.87%) of multifetal pregnancies were due to IVF/ICSI procedures. The mean age was 28.3 ± 2.5 years and the mean gestational age at reduction was 8.4 ± 0.6 weeks. The great majority of cases (72.58%) were operated by aspiration. The abortion rate was 29.84%. The mean gestation age at delivery was 34.51 ± 1.82 weeks. The incubator admission rate was 41.93% and the overall postoperative complication was 9.68%.

Embryo Reduction to Twins in triplets or higher order pregnancies was considered feasible, safe and linked to minimal complications. The ERTT procedure improved obstetrical and neonatal outcomes.

Pelvic organ prolapse (POP) is accompanied by a remarkable decline in the quality of life. Determining the best surgical approach for women with POP is difficult because of outcome variations. We compared the outcomes of pelvic organ prolapse (POP) treatment by abdominal sacrocolpopexy (ASC) and vaginal sacrospinous ligament suspension (SSLS) for advanced apical prolapse beyond the level of the hymen (stage≥ II). 

 This retrospective study was conducted on a case series of 58 ASC and 48 SSLS surgeries, which were performed through the posterior approach for advance prolapse during January 2019-April 2020. Pelvic Floor Disability Index (PFDI-20) questionnaire was completed both at the first visit and a year postop. All patients were visited ten days after the procedure and re-visited after 2, 4, 6, and 12 months.

Of a total of 106 women, 80 cases completed the study (n=40 in each group). Within-group analysis showed that the overall score of PFDI-20 and its subscales decreased in both evaluated groups after surgery (P<0.001). However, the between-group analysis revealed that this reduction in the ASC group was statistically significant in the total score of PFDI, POPDI-6, and UDI-6 subscales (P<0.05). In addition, vaginal length was demonstrated to improve in both groups, which was statistically significant in the ASC group (P=0.001). The stage of prolapse was improved in both groups (P<0.001), and it was more significant in the ASC group (P=0.049). There was no statistically significant difference between the SSLS and ASC in terms of the rate of satisfaction (93% vs. 100%; P=0.241).

 According to our findings, ASC and SSLS diminished the symptoms of POP. The surgery approach should be chosen based on the condition of patients, POP stage, and the experience of surgeons.

Pelvic floor disorders (PFDs) are common devastating situations among women globally. The present study aimed to evaluate the clinical efficacy of radiofrequency (RF) on pelvic floor distress, restoration, and sexual function among women with PFDs.

 This pre-post intervention study was performed on forty-three women with PFDs, who referred to a teaching pelvic floor clinic. Patients underwent RF three times fortnightly. Women were examined at three time points of baseline, one month post-intervention, and in a three months follow-up. In addition, a biofeedback evaluation was performed by a physiotherapist at the first session and follow-up. All women were asked to complete the Female Sexual Function Index and Pelvic Floor Distress Inventory questionnaires at the first session and in follow-up assessments. Descriptive statistics, the paired samples t-test, and the Friedman test were used to analyze the data.

 The mean and standard deviation of the age and gravidity of participants were 40.3±8.01 years and 2.65±1.3, respectively. We observed that 81.4% of women had a history of vaginal delivery. A significant improvement was found in the levator muscle tonicity by manual examination in the three-month follow-up (P<0.001). Moreover, maximal pelvic floor contraction measured by biofeedback improved (P=0.075). There were significant improvements in female sexual function and pelvic floor distress, including pelvic organ prolapse, colorectal-anal distress, and urinary distress after RF therapy (P<0.001).

 The findings of the current investigation showed that RF could be applied for pelvic floor restoration and is likely to improve sexual function and pelvic floor distress.

With increase in the second-trimester pregnancy termination, debates continue on the most suitable mode of termination. Misoprostol is used as an agent for the medical abortion. Some authors believe that uterine rupture risk as a complication of medical termination is higher in the patients with positive cesarean section history while some others have no report of such effect. This complication cannot be predicted and can occur under various circumstances with different misoprostol regimens. Hereby, we reported three cases with positive cesarean section history undergoing second-trimester pregnancy termination due to preterm premature rupture of the membranes (PPROM) who developed uterine rupture with similar misoprostol dosages. Finally, we conclude that more cautions should be undertaken in the setting of PPROM with previous history of cesarean section or gestational age >20 weeks about uterine rupture risk and full recommended misoprostol dose must not be administered to prevent life-threatening events.

This case report aimed to describe the clinical symptoms, pathological features, treatment, and prognosis of two cases of vulvar dermatofibrosarcoma protuberans (DFSP). Two Iranian women aged 37 and 35 presented with a nodular mass lesion in labia major and were initially diagnosed with DFSP in the vulva. Magnetic resonance imaging of the abdominopelvic region showed a small round lesion in the right side of the vulva vaginal region. The excisional procedure was performed under general anesthesia, and postoperative recovery was uneventful. Histopathology reported DFSP, which is a rare vulvar tumor. The patients were further investigated by computed tomography scan for metastasis, showing that the chest, abdomen, and pelvis were normal. The outcome was favorable. The DFSP is a rare tumor, constituting only 0.1% of all malignancies. Vulvar DFSP is exceptionally rare.