Journal of Obstetrics, Gynecology and Cancer Research
Volume:7 Issue: 5, Sep - Oct 2022

Uterine cancer affects more than 1.28 million people worldwide; considering current world trends in obesity and aging, a +52.7% growth by 2040 is foreseen. Around 5% of endometrial cancer patients are less than 40 years old, meaning that conventional oncologic approaches would result in fertility loss; thus, it is essential to consult patients regarding their fertility and family planning. Owing to developments of oncofertility, patients are now able to preserve their fertility and complete their childbearing, drafting from the standard of care in endometrial cancer. Strict criteria should be applied to make sure of selecting patients who benefit most from the fertility preservation approach. Furthermore, careful selection of patients increases the possibility of successful treatment. Most candidates for fertility preservation have risk factors in common with infertility, including polycystic ovarian syndrome, obesity, increasing of age and irregular menses; therefore, Advanced Reproductive Technology (ART) can improve their chances for pregnancy. Current applied knowledge towards the fertility preservation approach in patients with endometrial cancer is reviewed in this article.

Infertility is an important world-wide reproductive disorder and some couples are being affected everyday as the population increases. The study aimed to evaluate the levels of selected trace elements (zinc, magnesium, selenium) and glutathione peroxidase in female subjects diagnosed with infertility. The study investigated a total of 90 subjects; 25 subjects diagnosed of primary infertility, 25 subjects diagnosed with secondary infertility and 40 apparently healthy individuals which served as the control group within the age range of 20-45years. Samples were obtained from the patients who attended the obstetrics and gynecology department, Federal Medical Centre, Ido-Ekiti, Ekiti State, Nigeria. Zinc (Zn) and selenium (Se) were estimated using atomic absorption spectrophotometer (AAS), magnesium (Mg) was estimated spectrophotometrically, while glutathione peroxidase (GPx) was evaluated using enzyme linked immunosorbent assay (ELISA) technique. Zinc (Zn), magnesium (Mg) and glutathione peroxidase (GPx), were significantly lower (P<0.05) in subjects with infertility in relation to the control subjects, while selenium (Se) was found to be significantly higher (P<0.05) in subjects with infertility compared with control subjects. Selenium (Se) and magnesium (Mg) were significantly lower (P<0.05) in subjects diagnosed with primary infertility compared with subjects diagnosed with secondary infertility. No significant difference (P<0.05) was found in serum zinc (Zn) levels and glutathione peroxidase (GPx) between subjects with primary and secondary infertility. The study concluded that the parameters are useful and should be included in the routine assessment, diagnosis and monitoring of cases of infertility.

The aim of this study was to evaluate the effectiveness of adjunctive pessary therapy after cerclage in increasing the gestational age (GA) to 37 weeks in women with cervical insufficiency (CI).

This randomized controlled trial (RCT) was conducted at the infertility department of Royan Institute, Tehran, Iran. A total of 170 singleton pregnant women aged 18-42 years old, diagnosed with CI by GA 14-24weeks, who had intact membrane with no signs of intrauterine infection, vaginal bleeding, or uterine contraction, were enrolled. Patients were randomized 1:1 to receive either cervical cerclage or pessary after cerclage. The primary outcome was spontaneous preterm birth (SPB) (<37weeks). The secondary outcomes were GA at the time of delivery, SPB (less than 34, 32 & 28 weeks), delivery method, neonatal outcomes, maternal adverse events, and maternal satisfaction with the intervention.

The incidence of SPB (<37, 34, 32 & 28weeks), method of delivery, GA at time of delivery, and neonatal outcomes were not significantly different between the two groups. The incidence of vaginal bleeding (P=0.007) and pelvic pain (P=0.03) significantly was less in the intervention group. The mean score of satisfaction in the intervention group was significantly higher than the control group (P=0.01).

The placement of an adjunctive pessary for pregnant women with singleton pregnancy and CI, did not result in a lower rate of SPB (<37weeks) compared to cerclage alone. However, pregnancy complications after the intervention until delivery were less in these women, while the level of satisfaction was higher.

To see if 900 mg of vaginal isonicotinic acid hydrazide (INH) given 12 hours before insertion of a T380A copper intrauterine device (IUD) was more effective than placebo in increasing insertion ease and reducing insertion discomfort in nulliparous ladies.

A double-blind, randomized controlled study recruited nulliparous women who wanted to use the Copper IUD for contraception. Women who were WHO-eligible for IUD implantation were recruited and randomly assigned (1:1) to vaginal INH 900 mg or placebo (n=100 in each group), 12 hours before the IUD was placed. The primary endpoint was the ease of insertion for the providers. The number of unsuccessful IUD insertions was also recorded.

The groups had similar baseline characteristics. The ease of insertion score in the INH group was lower than in the placebo group (3 (2-5).5 vs. 6 (3-8); P=0.01), indicating that physicians in the INH group had an easier time inserting the device. The INH group had a reduced mean pain score during the procedure (3.97 ±  0.991 vs. 6.42 ±  0.66; P=0.001). In the INH group, two incidences of failed IUD insertion occurred (2%) compared to four cases in the control group (4 percent). 0.594 is the p-value.

Self-administered INH 900 mg vaginally 12 hours before a copper T380A IUD insertion successfully reduced discomfort during insertion and improved women's satisfaction and ease of insertion as measured by physicians in nulliparous teenagers and young ladies.

Preeclampsia is associated with the release of soluble endoglin (sENG) into the maternal circulation. It inhibits sENG secretion, inhibiting the complex I of the mitochondrial electron transport chain. Therefore, using metformin may be helpful in the prevention of preeclampsia. The aim of this study was to evaluate the effect of metformin in preventing superimposed preeclampsia.

This single-blind randomized clinical trial was conducted on 60 pregnant women 25-40 years old with chronic hypertension before the 20th week of pregnancy. The patients were randomized and divided into two groups (n=30). The first group received 1000 mg metformin (tablet metformin 500 mg bid), and the second group received a placebo (2 tablets daily). Then the incidence of preeclampsia and intrauterine retardation growth of the fetus were compared in the two groups.

The metformin consumption significantly reduced the incidence of preeclampsia (P=0.04) and intrauterine growth restriction (P=0.035) compared to the control group.

Metformin effectively reduced the incidence of superimposed preeclampsia and related factors in a pregnant patient with chronic hypertension.

Persistent infection with some types of Human papillomavirus (HPV), which are high-risk genotypes, can lead the patients toward cervical cancer and, finally, death. Recent studies showed HPV co-infection with non-HPV sexually transmitted infections (non-HPV STIs) could increase the persistency rate of HPV infections. This study aimed to estimate the prevalence of STIs and assess the association of HPV/non-HPV STIs co-infection on cervical cell changes based on cytological findings.

In this cross-sectional study, in addition to the routine cervical screening, including HPV testing and cytological assessment, non-HPV STI testing was performed on 1065 Iranian women. To assess the HPV and non-HPV STIs, commercial kits were used.

964 (90.5%) women had normal cytology (NILM) results. The overall prevalence of HPV and non-HPV STIs were 39.1% and 68.5%, respectively. HPV-53 (6.5%), -16 (6.1%) and -31 (5.5%) were found as the most prevalent genotypes. Ureaplasma Parvum (UP) (42.7%), Group B Streptococcus (GBS) (23.7%), Candida Species (CS) (23.6%), Ureaplasma Urealyticum (UU) (9.6%), and Mycoplasma Hominis (MH) (7.1%) were found as the most prevalent non-HPV STIs. The co-infection of HPV with GBS played an important role in developing the cervical lesion (P<0.05).

In the present study, the STIs, including HPV, UP, GBS, CS, UU, and MH, were prevalent among the study participant, and it was found that the HPV/GBS co-infection played a significant role in the development of LSIL or worse cytological grades. To clarify this issue, further studies will be conducted.

Gestational diabetes mellitus (GDM) is also defined as a metabolic disease associated with relative insulin resistance during pregnancy, and elevated circulating insulin may increase the risk of EH and EC development. This study aimed to investigate the association between GDM and the incidence of EH and EC.

We conducted a retrospective case-control study, including 300 women with abnormal uterine bleeding (AUB) referred to Ayatollah Rouhani Hospital in Babol. Cases (n=152) were patients with HC and EC based on medical records, and the controls (n=148) were individuals without HC and EC. The groups were compared according to demographic information, GDM or diabetes mellitus (DM) history, and body mass index (BMI). The Chi-square, independent t-test, and logistic regression analyses were performed to compare groups.

Of 300 women studied, 72 people (24.1%) had a GDM history, and 64 people had a diabetes mellitus history. There was a significant difference between the incidence of EC and EH with GDM (P=0.001). Both GDM and DM were associated with the increased EC (OR: 17.98, 95% CI: 6.73-48.08, and OR: 1.84, 95% CI: 1.26-2.68, respectively). GDM was also associated with the increased risk of EH (OR: 6.68, 95% CI: 2.77-16.10), whereas diabetes mellitus had not a significant role in the increased risk of EH (P=0.14).

This study indicated that a GDM history is significantly associated with HC and EC. Therefore, to prevent and control these two complications in the future, management and monitoring of diabetes during pregnancy should be considered.

Vaginal discharge caused by infection and inflammation could lead to premature rupture of the membranes, which increases the risk of premature labor. If not handled properly, preterm delivery elevates the neonatal mortality risk and morbidity rate. This study aims to know the relationship between uterine contractions with preterm.

Observational research and cross-sectional design on pregnant women with vaginal discharge and without vaginal discharge based on criteria inclusion was gestational age 16–37 weeks, and exclusion criteria were pregnant women with a history of sexually transmitted diseases.

The results showed that there were 130 pregnant women, of whom 77 (59.23%) have vaginal discharge complaints, and 53 (40.77%) do not have vaginal discharge complaints. Most pregnant women were in their first pregnancy (primigravida) and with 29–36 weeks gestational age. Uterine contractions (his) occurred in 68.8% (P=0.000) of pregnant women with vaginal discharge complaints but did not occur in pregnant women without vaginal discharge complaints.

Vaginal discharge in pregnancy carries the risk of uterine contractions, which may increase the incidence of preterm birth. To conclude, vaginal discharge in pregnancy has a relationship with preterm birth.

Endometriosis is associated with the increased risk of coronary heart disease and immune alterations, which may be attributed to the altered lipid profile and decreased serum level of 25–hydroxyl vitamin D (25(OH)D). The present study aimed to evaluate the effect of radical laparoscopic surgery of endometriosis on serum lipid profile and 25(OH)D.

This cross-sectional study was performed on 47 women aged 15 to 45, with body mass index <30kg/m2, who were referred to Shohaday-eTajrish Hospital, from May 2018 until Jan 2020, for surgical treatment of endometriosis and did not have a systemic disease and did not use oral contraceptives and/or other hormonal therapies three months before surgery were enrolled into the study. The serum lipid profile and 25(OH)D levels of patients two months after surgery were compared with presurgical levels. The results were analyzed by using paired t-test.

A total of 47 patients completed the study (mean age: 32.8±7.5years). About half had no pregnancies (49.1%). Comparing the serum lipid profile of patients before and two months after surgery showed a significant decrease in triglyceride from 108.4±46.2 to 86.4±51.1 mg/dL (P=0.001), ], total cholesterol from 172.5±26.5 to 160.0±28.3mg/dl (P=0.002), and low-density lipoprotein levels from 97±28.3 to 89.8±26.1 mg/dL (P=.003); however, high-density lipoprotein and 25(OH)D levels did not show a significant difference (P>0.05).

the results of the current study showed that laparoscopic resection of endometriotic lesions resulted in a significant reduction of the unfavorable lipid profile after two months, but not 25(OH)D levels.

Secondary infertility resulting from tubal adhesions following cesarean section are not uncommon. The decision to do adhesiolysis or direct IVF/ICSI is to some extent difficult. This study was conducted to evaluate the benefits/risks of either adhesiolysis or direct IVF/ICSI for patients with secondary infertility due to post-cesarean tubal adhesions.

Three hundred infertile women with post-cesarean adhesion were recruited and divided into 2 groups either laparoscopic adhesiolysis or ICSI procedure.

Demographic data of enrolled patients in both groups were comparable. Regarding types of adhesions, mild adhesions were found in (47.65%) cases, moderate adhesions in (24.83%) cases and severe adhesions in (27.52%) cases. Pregnancy rates were found to be higher in cases with mild adhesions (62.67%) when compared to cases with moderate or severe adhesions (28.00%) and (9.33%) respectively. The overall pregnancy rate in group 1 was 67 (44.97%), while it was 83 (55.70%) in group 2. The pregnancy rate was higher in group 2 but didn't reach statistical significance. The cost of the procedure was significantly higher in group 2 but with significantly lower complication rates.

Although assisted reproduction gives the patient higher pregnancy rates with less possibility of complications, it should not be considered the first-choice treatment for patients with post-cesarean adhesions, especially in mild and moderate cases.

Diabetes Mellitus refers to a group of specific metabolic diseases with a hyperglycemic phenotype. The present study compares pregnancy outcomes and nonstress tests (NST) in insulin-treated diabetic women with healthy pregnant women.

In this cross-sectional study, pregnancy outcomes and NST results were evaluated in 45 diabetic pregnant women who had received insulin therapy and 90 healthy pregnant women. The NST tracings of all women were applied and evaluated regarding reactive and non-reactive parameters. Data were analyzed using SPSS software version 20 and Fisher's exact test.

Our results demonstrated that NST was reactive in 75.6%and was non-reactive in 24.4% of diabetic mothers. There was a significant increase in macrosomia in diabetic mothers with non-reactive NST, while there was no statistical significance between NST results in the two groups.

Pregnant women with diabetes are more prone to complications than healthy women. The main complication is the fetal size which leads to difficulties in delivery and increased incidence of cesarean section.

Primary lymphoma of the cervix is rare and can be misdiagnosed most of the time. On the other hand, there is no consensus on the best treatment and follow-up strategy for this type of cervical malignancy. The present study aimed to present a misdiagnosed primary cervical lymphoma due to its confusing presentation and rarity.

A 41-year-old woman presented with abnormal vaginal discharge and dyspareunia complaints. Unfortunately, the patient was not examined, and cervicitis was reported on biopsy. Therefore, the patient was treated for vaginitis for a long time. Due to a lack of response to antibiotic therapy, an ultrasound was performed, which showed a huge mass in the cervix. Patient was referred to the oncology department of obstetrics and gynecology center, Beheshti Hospital, Isphahan, Iran, in July 2013. Diffuse large B-cell lymphomas was diagnosed on a CT-guided biopsy of the presacral mass. Fortunately, despite the delay in diagnosis, 5 years after the last R-CHOP chemotherapic session (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone), the patient has good quality of life with no sign of recurrences.

Due to the rarity of uterine cervix lymphoma, the diagnosis of genital lymphoma could be missed if the clinician does not consider this malignancy. High suspicion, rapid diagnosis and proper communication between clinician and pathologist lead to an excellent prognosis.

GTN (Gestational trophoblastic neoplasm) complications such as uterine rupture or massive bleeding can be life-threatening and usually need a hysterectomy. In young patients who want to preserve fertility, hysterectomy is not suitable. Under specific circumstances, some physicians choose conservative management. Uterine preservation after complicated GTN is rare by itself. In conclusion, conservative management of GTN patients who develop high-risk complications and desire for future pregnancies must be considered an option. In published case reports, outcomes of conservative surgical management have been very good if managed properly.

Severe injury to the nervous system in pregnancy needs advanced critical care support to the mother and consideration of fetal effects. Managing persistent vegetative state (PSV) cases in pregnant patients is complex due to the lack of clear guidelines for medical and ethical reasons. This reports a gravida 4, maternal persistent vegetative state case due to a car accident for a 25-year-old woman at 20 pregnancy weeks. Aggressive support enabled the continuation of pregnancy toward 3th trimester without any impediment to the infant's development. A fetal scan for growth monitoring showed an estimated fetal weight near the 75th centile. Intervention in the pregnancy of a patient suffering PSV is not required if both mother and fetus are stable. Maternal malnutrition may adversely affect the fetus and neonate. In this case, high caloric nutrition with partial parenteral nutrition was employed. We monitored both the mother and her child in an attempt to gather data pertinent to the appropriate care of pregnancy in a persistent vegetative state and the potential sequel for offspring.

Clindamycin, IVIg, and corticosteroids are widely used in medicine. In this study, we represent an unusual case of sinus bradycardia following the administration of these drugs. The patient was a 31-year-old woman who presented a complaint of vaginal bleeding at Shahid Motahhari Hospital, Urmia, Iran. Vaginal examination revealed active bleeding. Laboratory tests reported a positive HCG level. Ultrasonography was performed, and the results showed the presence of retained products of conception. The patient became a candidate for curettage. The initial pulse rate was tachycardia. Laboratory data were reported, platelet count of 16000. corticosteroids and IVIgs were started. Due to the possibility of infectious abortion, Clindamycin and Gentamicin was started. About 24 hours after curettage and 4 hours after starting clindamycin, the patient felt dizziness. Vital signs were obtained that PR: 38-40. We concluded that clindamycin and IVIg can result in severe bradycardia, even in patients with no previous cardiac history, especially when combined with corticosteroids. As a result, we recommend physicians be more cautious when administrating these medications.