Journal of Obstetrics, Gynecology and Cancer Research
Volume:7 Issue: 3, May - Jun 2022

 Given the significant role of low birth weight (LBW) in infant death and disability and relevant childhood diseases, the present systematic review was conducted to determine the factors affecting newborns’ birth weight in Iran.

This study systematically reviewed all the observational studies carried out in Iran between 1990 and 2021 (retrieval date: April 28, 2021) in four steps and through searches in Persian databases (including Magiran, SID, and IranDoc) and English databases (including Embase, Cochrane Library, Web of Sciences, Google Scholar, PubMed, and Scopus). All the relevant articles were searched by two researchers separately and collected using research keywords, Boolean operators, and a combination of relevant tags depending on the type of database. The quality of the articles was evaluated with 22-item Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) and Ottawa checklists, respectively.

Of the 251 articles collected, 31 met the study inclusion criteria. Variables such as the mother’s age (35%), body mass index (BMI) (25%), preterm childbirth, and diagnosis with a maternal chronic disease (25%) were found to be the most common causes of LBW in the reviewed studies, by order of prevalence.

Based on the results of this review study and given that many of the known risk factors of LBW are preventable, the timely diagnosis, proper treatment, and follow-up of women at risk can prevent the birth of LBW infants.

This study assessed the relationship between the ratio of fetal lung volume to head circumference and amniotic fluid index (AFI) in the third trimester of pregnancy.

This prospective study was performed on low-risk pregnant women in their third trimester of pregnancy. Fetal lung volume was determined separately using the lung-to-head ratio (LHR) for the right and left lungs. Moreover, the AFI was evaluated, and the Pearson correlation coefficient between LHR for both lungs and AFI was investigated.

Overall, 112 pregnant women were included in the study. The mean ± standard deviation (SD) of fetal Observed/Expected Right LHR (O/E RLHR) and O/E Left LHR (O/E LLHR) were 113.9±0.36 and 97.13±27.87, respectively. The mean ± SD of AFI was 12.5±4.96 cm. Pearson correlation coefficient did not show a significant relationship between AFI and the left and right LHR (P>0.05). However, O/E RLHR was significantly correlated with abdominal circumference (P=0.02, r=0.2), gestational age (P=0.21, r=0.27), and fetal weight (P<0.001, r=0.27). There was a positive correlation between the number of days the infant was admitted to the neonatal intensive care unit and the volume of the right lung of the fetus (P=0.03, r=-0.2). No correlation was observed between fetal parameters and the volume of the left lung of the fetus.

The results of this study showed that AFI in the third trimester of pregnancy was not significantly correlated with LHR.

 Recent advances in molecular testing for human papillomavirus (HPV) has increased the accuracy of cervical screening programs. This study intended to estimate the diagnostic value of high-risk (HR) HPV DNA- and E6/E7 mRNA-based methods for triage of Iranian women with abnormal cytological results regarding the histopathological cut-off.

In this cross-sectional study, 360 non-pregnant women (≥ 21 years) who had faced abnormal cytological findings (ASC-US and LSIL) were enrolled and referred for further diagnostic tests. The INNO-LiPA® HPV Genotyping Extra-II and Aptima HPV assay kits were used in DNA- and E6/E7 mRNA-based methods for detection of HR-HPV. Regarding the CIN-2+ histopathological cut-off, the diagnostic value of each molecular-based assay was calculated.

Among the study participants, 260 cases had ASC-US, and 100 had LSIL. The overall positivity rate for DNA- and mRNA-based methods was 74.4% (268/360) and 64.2% (231/360), respectively. Fifty-nine (16.4%) individuals showed CIN-2+. The DNA-based test showed higher sensitivity (100%) than the mRNA-based method (93.2%), while the mRNA-based method revealed greater clinical specificity (41.5%) compared to the DNA-based test (30.6%).

Our results revealed appropriate clinical sensitivity of the molecular-based methods for triage of Iranian women with abnormal cytological results; however, the mRNA-based method showed greater specificity for detection of CIN-2+.

 Hysterectomy is one of the major gynecologic operations. This procedure can be performed by different methods including abdominal, vaginal, and laparoscopic hysterectomy. In fast-track hysterectomy (FTH), patients do not receive opioids during surgery and there is no need for a 12-hour pre-surgery hospitalization. Patients are encouraged to eat and move at most 6 hours after operation. This study was performed to compare the outcomes of FTH with those of routine abdominal hysterectomy (RAH).

This case-control pilot study was carried out on 82 candidates for hysterectomy at Kowsar Training Hospital in Qazvin, Iran, during 2016. Patients were divided into two randomized groups of FTH and RAH. Parameters such as pain visual analogue scale (VAS) after 3, 6, 12, and 24 hours, diet tolerance, analgesic dose, postoperative nausea and vomiting, hospital stay, postoperative adverse effects, gas passing time, and readmission were investigated and compared between two groups.

Analgesic use, gas passing time, and hospital stay were significantly lower in the FTH group (P=0.0001). While postoperative nausea and vomiting, adverse effects, food tolerance, and readmission rate were the same in both groups (P>0.05). Moreover, diet tolerance was observed in all patients. In general, pain VAS was lower in FTH with significant difference at 3rd (P=0.002) and 12th (P=0.001) hours, and at suture removal time (P=0.026).

It can be concluded that FTH may result in reduced pain, analgesic use, gas passing time, and hospital stay in comparison with RAH.

IUGR (intrauterine growth restriction) fetuses have been known as a significant concern in clinical practice. It is associated with fetal mortality and morbidity and prenatal adverse cardiac remodeling. The aim of this study is the evaluation of the relation between MPI (myocardial performance index) abnormalities and doppler findings in both normal and IUGR fetuses.

In this cross-sectional study, 400 consecutive pregnant women in Shariati Hospital, Tehran, Iran, in 2019 and 2020 underwent ultrasound assessment at 28-40 weeks, in which among the 400 performed ultrasounds, 47 fetuses with IUGR were selected as a case group, and 47 fetuses with normal weight were selected based on AGA (appropriate gestational age). Cardiac function was evaluated by measuring MPI in diastolic and systolic function in two groups. The results were compared to the IUGR (case group) and control group by SPSS software version 20.

In receiver operating characteristic (ROC) analysis, the AUC (area under the curve) for left ventricular MPI (LV MPI) was 0.929 (CI95%: 0.868-0.991; P=0.001), and the sensitivity and specificity values were 87% and 69.4% with a cut-off point of 0.2850. In ROC analysis, the area under the curve for RV MPI was 0.842 (CI95%: 0.741-0.942; P=0.001), and the sensitivity and specificity values were 78.3% and 63.9%, with a cut-off point 0.2850. Left and right ventricular MPI showed a significant difference statistically between the case and the control groups.

The study showed a significant rise of MPI in IUGR fetuses. MPI can be considered as a useful parameter for evaluating the severity of growth restriction in IUGR fetuses.

This study aimed to investigate the relationship between the level of high-sensitivity C-reactive protein (hs-CRP; as an indicator of inflammatory response) and shoulder tip pain (STP) following cesarean section (C-section).

In this cohort study, a total of 120 pregnant women who were candidates for elective C-section at Imam Reza Hospital were included. The level of hs-CRP was measured perioperatively. STP was measured after the operation.

Mean hs-CRP was significantly higher in females with STP compared to counterparts (19±13.1 vs. 7.2±4.5; P<0.001). There was a positive and strong correlation between STP and postoperative hs-CRP (P<0.001).

The release of acute-phase proteins (such as hs-CRP) plays a significant role in STP after C-section; the intensity of STP is associated with the level of hs-CRP.

 Accordingly, this study aimed to assess pregnancy outcomes and pathological findings of the placenta caused by intrauterine growth restriction (IUGR) with or without pre-eclampsia (PE).

This cohort study was conducted on two groups: Group I was PE-induced IUGR (PE-IUGR), and group II was idiopathic IUGR (I-IUGR). Pregnancy and neonatal outcomes were evaluated in both groups. The placental assessment was also performed based on pathological findings. Data were compiled and analyzed by SPSS 21. An analytical study was conducted on the groups based on t (or non-parametric Mann-Whitney), chi-square, and Fisher’s exact tests.

The findings of this study showed that maternal age, body mass index (BMI), the incidence of preterm delivery, and low birth weight were higher in the PE-IUGR group (P<0.001 in all) than in the I-IUGR group, and the difference was statistically significant. Additionally, circulatory disorders and impaired anomalies were higher in the PE-IUGR group (P>0.001) than in the I-IUGR group.

Placental disorders and reduced blood flow to the fetus due to placental disorders might lead to low birth weight and preterm delivery.

Spinal analgesia and Entonox analgesia are used as pain relief methods during labor. This cross-sectional study was conducted to determine the effect of spinal analgesia and Entonox analgesia on the duration of the first, second, and third stages of labor, Apgar score, and maternal and fetal outcomes.

Clinical information of 1,000 patients who delivered at Shahid Akbarabadi Hospital and underwent painless delivery with Entonox gas and spinal anesthesia was assessed; then, according to the inclusion criteria, 280 cases were divided into two groups: the spinal analgesia group (n=140) and Entonox analgesia group (n=140). In the spinal analgesia group, 25 μg of fentanyl and 1-2 mg of bupivacaine were administered. For the Entonox group, Entonox inhalation was administered via a face mask at the initiation of pain at each contraction. The duration of labor, mode of delivery, side effects, and maternal satisfaction were also compared in the two groups.

The duration of the first stage was significantly shorter in the spinal analgesia group than in the Entonox analgesia group (P<0.001), but the duration of the second stage in the spinal analgesia group was longer (P<0.001). There were no significant differences in the cesarean section rates, Apgar score, weight, and acidity (PH) and the partial pressure of carbon dioxide (pCO2) between the two groups. Measured pain was significantly lower in the spinal analgesia group (P=0.01) than in the Entonox analgesia group regarding visual analog scale (VAS) scores.

Spinal analgesia is a safe, suitable, and effective method for pain reduction with no adverse effects on the outcome of labor compared to Entonox analgesia.

At the beginning of the pandemic COVID-19, most health facilities suspended non-emergency surgeries to ensure emergency care capacity. Due to the need for surgery, and insufficient information about the complications of surgery in these patients, the present study aimed to investigate the outcome of surgeries in patients with COVID-19 in Motahari Hospital in Urmia.

This cross-sectional study was performed on 112 patients diagnosed with COVID-19 who underwent surgery. A Checklist including the following data was extracted from the patients' medical records, symptoms, laboratory tests, and any complications related to surgery up to one month after separate surgery.

A total of 6.3% of patients had limited complications due to the incision site after the surgery. The results did not show a significant relationship between age, type of anesthesia, and the type of operation with complications. However, the highest percentage of complications was seen in less than 40 years and emergency surgeries. It was found that patients with a history of diabetes had the highest rate of complications (57.1%), although there was no significant relationship between the underlying disease and complications (P = 0.40). In our study, none of the patients experienced complications such as vascular thrombosis or embolism, respiratory failure, and heart failure, or the need for cardiopulmonary resuscitation. Overall, 17.9% of patients needed ICU admission (mean 2.16 ± 1.50 days), indicating a higher ICU hospitalization demand. Also, in terms of in-ward hospitalization, patients with complications had a longer hospital stay than uncomplicated patients (7.85 ± 3.36 days) vs. (5.13 ± 1.66), which was not statistically significant (P = 0.88).

The results show that surgery is not directly associated with an increased risk of mortality and complications in patients with COVID-19. On the other hand, Underlying diseases, age, and the urgency of surgery are associated with a higher risk for complications than COVID-19.

Breast cancer is a malignant lesion caused by abnormal changes and growth in breast tissue epithelial cells, including glands, lobules, and larynx. Therefore, the current study's objective was to estimate the incidence of breast and cervical intraepithelial lesions in Iran. This study is based on results from a screening program implemented in the province of Isfahan, Iran.

Two stages of cancer screening were performed in the study on over 250000 women in 2018.

As a result of this study, it was determined that in 2018, there was an incidence of 422 benign breast tumors per 100 000 women (95% CI: 393-450). Also, the incidence of breast cancer was 65 (95% CI: 54-76) per 100 000 women, and that of Cervical intraepithelial lesions was 45 (95% CI: 27-63) per 100 000 women in 2018.

This study revealed that breast cancer and cervical intraepithelial lesions are increasing in Isfahan province. Moreover, it was found that screening for these 2 cancers leads to early detection of patients, which results in early treatment and an increase in the 5-year survival rate in these patients.

Cervical cancer is a common neoplasm in women, and the role of the HPV virus in the development of precancerous and cancerous cells has been established. There exist different strains of the HPV virus with varied functions. In the high-risk HPV strains, the p16 and ki67 proteins play a crucial role in regulating the cell cycle leading to cell proliferation and progression. P16 and ki67 proteins are positive in almost all lesions and indicate a high degree of malignancy. This study aims to investigate the predictive effect of p16 and ki67 on the progression of low-grade intraepithelial lesions to high-grade malignancy.

P16 and ki67 were measured on CIN1 lesions, and during the average two-year follow-up period, the outcome of positive cases was investigated. A total of 106 referred patients between the age of 15 to 75 years were examined from April 2015 to March 2019.

Among the patients with progression of CIN1 to CIN2 and other severe lesions, p16 was positive in 14 cases (60.9%), and a significant difference between groups with positive and negative markers in the progression or regression of lesions was noticed. Ki67 frequently occurs in CIN2 and other severe lesions.

The use of p16 and ki67 as predictive markers is still under debate. In countries like the United States, these are not yet used separately for prediction but are being used in combination together. The authors of this study strongly recommend the conduction of further studies to assess the role of p16 in association with other markers and within a larger population so as to apply the functional role of p16 and ki67 in the clinical setting thereby effectively preventing it.

Cesarean section (CS) rates have increased continuously worldwide in the past decades while not being associated with significant benefits for mothers and newborns. According to Robson's classification, the present research aimed to analyze the associating factor to cesarean section to set the practice system and decrease the cesarean section rate in the near future.

 This is a retrospective cross-sectional analytic study of the medical record of pregnant women who delivered in 2019 at MNST Hospital. The logistic regression model carried out the adjusted odds ratio (OR) of cesarean section rate and 95% confidence intervals.

 A total of 5,360 medical records were recruited. Of all birth, 55.4% occurred by cesarean section, most of whom were categorized in R1 to R4 of Robson classification (23.3%), followed by R5 (21.1%) and R10 (5.4%). The subgroup R1-R4 analysis demonstrated that obesity, Bachelor’s education, and private obstetrician were significantly related to the cesarean section in the group of spontaneous labor (R1, R3) and Bachelor’s education and private obstetrician were significantly related to the cesarean section in the group without spontaneous labor (R2, R4) (adjust OR 13.50, P<0.001 and adjust OR 2.11, P<0.001, respectively).

Private obstetrician and education level were factors related to the obstetric indication of unnecessary cesarean section.

Breast cancer is the most common cancer among females globally and its toll is rapidly rising in India. Accurate knowledge about prognostic factors could assist oncologists in making correct treatment decisions and acquiring a better understanding of the survival of patients. In patients with hormone receptor-positive, early diagnosis along with socioeconomic factors like education, income, etc., are said to play a vital role. Hence, the present study aimed to analyze the survival pattern depending on hormone receptor status, stages of breast cancer, and socioeconomic status.

An Ambi directional cohort study was conducted among 300 patients with breast cancer registered and treated in a tertiary care hospital in Dakshina Kannada, India, in the last 3 years. A validated proforma was used to collect data. The post-treatment survival was analyzed depending on their income, family history, staging (clinical & histopathological), and hormone receptor status (HER-2/ER).

The pattern of receptor among these patients showed 45% ER, 43% PR, and 14.3% HER2 positivity. Among the patients, 83% had undergone hormonal therapy as per the receptor status. The overall survival rate of breast cancer patients was found to be 81%. The clinical stage of disease had a statistically significant association with survival using the log-rank test. However, monthly income and hormonal status showed no significance.

A 3-year survival rate was 100% for stage Ⅰ patients, 96.6% for stage Ⅱ, 82.1% for stage Ⅲ, and 40% for stage Ⅳ. Hormone receptor positivity is highly predictive for better prognosis in breast cancer patients.

In pregnancy, the serum level of cancer antigen-125 (CA-125) increases in the first trimester and abortion. However, different studies reported conflicting results about the use of serum CA-125 to determine the prognosis of threatened abortion. In the present study, we try to determine if the measurement of CA-125 level could be used as a predictor of outcome in women with threatened abortion.

This prospective case-control study was performed on 58 patients with threatened abortion and 58 healthy pregnant women with a gestational age of fewer than 20 weeks (as the control group). In both groups, serum CA-125 level was measured. The patients were followed to determine who completed the pregnancy period and who eventually miscarried. Finally, the levels of CA-125 in these groups were compared.

The mean age of patients was 28.47 and 27.84 in the case and control groups, respectively; there was no significant statistical difference between the two groups (95% CI: -1.94 to 3.18, P=0.632). Also, there was no significant difference between them for BMI (95% CI: -1.09 to 1.38, P=0.813), gestational age (95% CI: -1.31 to 1.04, P=0.816), and parity (P=0.51). The mean serum level of CA-125 in the control group was 22.51 ± 6.82 IU/mL, and in the threatened abortion group was 27.70 ± 7.50 IU/mL. This difference was statistically significant (P<0.001). Of the patients, 51.72% with threatened abortion continued their pregnancy, and 48.28% eventually miscarried. The mean serum levels of CA-125 were 25.30±6.63 IU/mL and 30.28±7.63 IU/ml in patients who continued the pregnancy and miscarried, respectively (P=0.01).

A single measurement of the maternal CA-125 may be used as an available, inexpensive prognostic test to determine the outcome of threatened abortion. However, a small number of patients is the main limitation of the present study. More studies with a larger sample size are required to accept the role of maternal CA-125 in predicting the outcome of threatened miscarriage.

Adnexal masses are among the most important neoplastic lesions observed in women. Considering different results of laparoscopy versus laparotomy for adnexal masses, this study compared the surgical consequences of laparoscopy and laparotomy of adnexal masses.

This prospective observational study was performed on females aged 10 to 75 years with adnexal mass referred to the gynecology clinic of Shohaday-e Tajrish Hospital (2019-2020) by convenience sampling. A total of 34 patients in the laparoscopy group and 29 patients in the laparotomy group were included in the study. SPSS  25 was used for data analysis.

The mean duration of surgery and anesthesia in laparoscopic patients was significantly more than in the laparotomy patients (P<0.05). There were no significant differences between patients in the two groups in terms of complications during surgery (P=0.62). The mean of pre-discharge pain (based on scoring from 1 to 10) in laparoscopic patients was significantly lower than in the laparotomy group (3.5 ± 1.2 and 6.7 ± 1.0, respectively, P<0.001). The mean length of hospital stay after surgery was significantly lower in the laparoscopic group compared with the laparotomy group (29 ± 9 hours and 44 ± 7 hours, respectively, P<0.001).

Although the use of laparoscopy in adnexal masses is associated with a longer duration of surgery and anesthesia, due to the shorter hospital stay, it can be concluded that the use of laparoscopy in adnexal masses is better than laparotomy.

 With the outbreak of the new coronavirus, some sections of society are more vulnerable, including pregnant women. Today, with the pandemic of COVID-19, anxiety, and worries about pregnancy and fetal health have increased and will be associated with adverse consequences for the health of mothers and infants. There is also insufficient information on the effects of coronary heart disease and COVID-19 on the fetus and pregnancy. Therefore, this study aimed to examine the level of awareness of pregnant women about coronavirus disease (COVID-19) and its correlation with observed stress in pregnant women.

 This cross-sectional analytical research was conducted on 384 pregnant women who were referred To Al-Zahra Medical Center at Rasht, Iran in 2020 and were selected through simple random sampling. Data collection tools were a demographic questionnaire, standard perceived stress questionnaire, and a researcher-made questionnaire on COVID-19 disease. Using statistical tests, the collected information was analyzed using SPSS 23 at an importance level of less than 0.05.

 The average scores of pregnant women's knowledge about the signs, symptoms, and ways of transmitting coronavirus are lower than the scores of mothers' awareness about the cause of the disease and how to prevent it. However, in general, the average score of pregnant women' knowledge about COVID-19 is high. Also, the mean scores of concern about COVID-19 and perceived stress of pregnant women about this disease in this reading are high. The present study's findings showed that the amount of knowledge of pregnant women about COVID-19 has a statistically significant relationship with anxiety and perceived stress about this disease and has a positive correlation.

This study's results showed that the more pregnant women are aware of COVID-19, the more anxious and stressed they are. As a result, to provide psychological support to pregnant women during pregnancy, medical staff training, the help of social media, and psychiatric experts can minimize harm to them and their fetuses.

Intravaginal misoprostol is used worldwide with excellent results for second-trimester pregnancy termination. However, it has a rare but serious complication of uterine rupture, both in previously scarred and unscarred uteri. In this report, we present a case of this rare complication in an unscarred uterus during termination with misoprostol. Uterine rupture was found on laparotomy after the patient showed signs of shock during termination. A 2- to 3-cm laceration was detected in the uterine wall along with the left cornea. The placenta was attached to the uterus on the other side. We found an unusual pregnancy in the cornea and successfully repaired it. Although using misoprostol for termination is safe, a regimen protocol should be established. However, uterine structure and implantation safety should be confirmed before administrating misoprostol. This case highlights a difficult diagnosis of abnormal placentation, especially cornual ectopic pregnancy.

Rhabdomyosarcoma (RMS) is a rare type of sarcoma. Botryoid type is the most common. The peak incidence is the second decade. Cervical RMS is rare in adults. We reported two cases, A, 31 years old woman G1L1 referred to a gynecologist oncologist with abnormal vaginal bleeding. And pathology reported RMS. She received 8courses of VAC regimen for chemotherapy .3 weeks after the last course, she underwent conization, and a remnant of sarcoma was seen. A hysterectomy was done for her. She has been disease free for 12 month. Case 2 was a 25 years old nulliparous woman presenting with abnormal vaginal bleeding, vaginal discharge, and cervical polypoid grape like lesion. Pathology reported RMS. Conization was done. Chemotherapy with VAC regimen was done for 8 courses. She has been disease free after 9 years. These two cases showed that RMS can occur in rare places and older ages.

Due to its rarity, the standard clinical presentation, treatment protocol, and prognosis of primitive neuroectodermal tumor (PNET) have not been clearly described yet. Hence, herein we reported a case of ovarian peripheral PNET whose histomorphology reports caused her certain diagnoses at Imam Khomeini Hospital, affiliated to Tehran University of Medical Sciences, Tehran, Iran, in 2020.Considering different clinical presentations, and poor prognosis of PNET compared to other ovarian malignancies, to on-time diagnosis and treatment, the patient's histomorphology and immunohistochemical (IHC) profile assessment, particularly in younger women, seems beneficial.

Pregnant women are at higher risk of severe COVID-19 than the general population. Furthermore, COVID-19 increases the preterm and cesarean rates due to maternal and fetal complications. Owing to the adverse effects of the COVID-19 on pregnant women, in-person prenatal visits face challenges. Thus, alternative solutions that reduce the number of visits while preserving maternal and fetal care quality should be considered. Digital health is one of the potential solutions. Obstetricians and gynecologists, and other clinical experts should cooperate to define digital tools’ requirements and standards for prenatal care. Moreover, governments and healthcare insurances should facilitate the coverage of provided services’ costs by digital health tools, especially in developing countries.

To update data published in the article “Leukocytes Parameters, CRP, and Ferritin in Iranian Patients with COVID-19 Infection; A Cross-sectional Study” in Iran J Med Microbiol 2021, 15(3): 361-368, we analyzed the IL-6 parameter in the aforementioned article’s statistical population. The analyzed results showed that IL-6 parameter had increased more in men and women infected by SARS-CoV-2 (76.7% and 87.3%, respectively) compared with normal people (up to 5.9 pg/mL).