Journal of Obstetrics, Gynecology and Cancer Research
Volume:7 Issue: 6, Nov-Dec 2022

Several studies have described multisystem inflammatory syndrome (MIS) in children, but very few investigations presented this syndrome among neonates (MIS-N). The present study has reviewed the current knowledge about MIS-N, its etiology, symptoms, and outcomes to attract special attention with an eye on earlier diagnosis and treatment of newborns affected by perinatal SARS-CoV-2-infection. A narrative review study was conducted (Tehran, Iran, 2021). All types of full English articles (up to October 1 2021) were included. Detailed research on academic search engines was performed. The implemented Mesh-based keywords were "SARS-COVID-2" OR "COVID-19" OR "coronavirus" AND "Neonate" OR "Neonatal" OR "Newborn" AND "Multisystem Inflammatory Syndrome" OR "MIS-N" OR "inflammatory response syndrome" AND "Pregnancy" OR "Perinatal" OR "prenatal". Finally, 15 Full-text articles were included that met the eligibility criteria. Available data related to the disease, its etiology, presentations, and its outcome were collected and discussed. The cause of MIS-N is the transmission or production of SARS-CoV2 antibodies in response to SARS-CoV2 infection. By involving different organs, the clinical manifestations of MIS-N may mimic sepsis, toxic shock syndrome, RDS, Kawasaki disease, necrotizing enterocolitis, myocarditis, meningitis/encephalitis, aortic thrombosis, ETC. Besides the clinical presentations, detecting reactive anti-SARS-CoV-2 IgG antibodies could be a notable clue in MIS-N diagnosis. Supportive therapy, suppressing the autoimmune and inflammatory responses, anti-platelet agents, and anticoagulants were reported as effective therapeutic agents to improve the outcome. The present study highlighted the possibility of MIS-N as an infrequent but severe syndrome consequent to perinatal COVID-19 infection. Although the diagnosis is still controversial, clinical suspicion, laboratory findings, and early treatment initiation could improve the outcome of this immunological disease.

The aim of this study was to determine the endometriosis-associated symptoms and diagnostic delay through an online survey.

A cross-sectional study was conducted in Australia using an online web-based survey. All data were entered into and analyzed using the STATA software (version 14.1). A total of 903 respondents completed an online survey from September 2013 to October 2015.

Out of 903, 71.10% were Australians and 28.90% were Non-Australian, with a self-reported diagnosis of endometriosis confirmed by surgery. Out of the participants, 86.5% completed the online survey. Delay in diagnosis was 8.1±6.2 years. There was no difference in the age range (P = 0.35), mean age of onset of the first symptoms (P = 0.93), and delay in diagnosis (P = 0.11) between both groups. Most common endometriosis-related symptoms that all respondents had experienced in their lifetime were period pain (98.1%), fatigue (94%), bloating (90.7%), ovulation pain (88.7%), pelvic pain (87.3%), pain during and before/after sexual activity (82.7%), and heavy bleeding (82.2%). Treatments used by affected women included: pain killers (96%), hormonal medication (84.7%), surgical treatments (84.5%), and delayed fertility (37.1%).

Vast similarities in demographics and endometriosis-associated symptoms among the Australian and non-Australian women with endometriosis support the universality of the disease characteristics. Delay in diagnosis of endometriosis is a problem and the reasons for delayed diagnosis must be understood to try to shorten this delay. Besides pain, patients with endometriosis suffer from a variety of other symptoms; hence, any treatment must take into account the most prominent symptoms.

Premature rupture of membranes (PROM) and preterm delivery are the most important problems observed in pregnancies that can cause many consequences. The present study investigated the relationship between amniotic fluid index (AFI) and uterocervical angle in patients with PROM between 24 and 34 weeks of gestation.

This study was a cohort study carried out on 50 pregnant women with PROM. Inclusion criteria were 24 to 34 weeks of gestation and singleton deliveries. Demographic characteristics and pregnancy history of the subjects were determined through interviews and examinations. Moreover, AFI and uterocervical angle were determined based on ultrasound results. Subjects were followed up until delivery.

Mean age of the patients was 25.14±5.32 years; 23 patients (46%) had delivery latency less than 7 days. The mean uterocervical angle in the delivery latency group ≤7 was significantly higher than that in the group more than 7 days (P <0.001). Moreover, the mean AFI in the delivery latency group ≤7 was significantly higher (P <0.001). The uterocervical angle above 107.7 with a sensitivity of 87% and a specificity of 88.9% had a predictive power and its area under curve (AUC) was 0.912 (P <0.001). The mean AFI below 5.4 with a sensitivity of 81.5% and a specificity of 65.5% had a predictive power (AUC: 0.866, P <0.001).

Uteroservical angle and AFI can be good predictors for assessing delivery latency in women with PROM. Furthermore, the mean uterocervical angle in the delivery latency group ≤7 days is significantly higher than that in the group more than 7 days, but conversely AFI is less.

Pregnancy-induced hypertensive disorders (PIHD) are the main reasons for maternal and perinatal mortality, as they complicate 10% of pregnancies worldwide. Serum lactic acid dehydrogenase (LDH) and gamma-glutamyl transferase (GGT) are possible markers reflecting the occurrence of pregnancy-associated complications like preeclampsia and eclampsia. There is a paucity of data with conflicting results showing serum LDH and GGT on PIHD in Ethiopia. This investigation aimed to assess the serum LDH and GGT levels in pregnant women with PIHD along with their correlation with the severity of the disease at Jimma Medical Center (JMC), Ethiopia.

This hospital-based comparative cross-sectional study was undertaken from August 03 to September 27, 2020, in JMC. A total of 97 study participants were recruited. Serum GGT and LDH levels were determined using a fully automated Roche Cobas 6000 chemistry analyzer. The data were analyzed using SPSS 25.0. One-way ANOVA and independent samples t-test were employed to compare serum GGT and LDH levels with categories of PIHD.

 The significantly highest mean serum levels of LDH (580.9±193.8 U/L) and GGT (86.1±29.2 U/L) were observed in eclamptic women compared to gestational hypertensive (276.7±60.7 and 38.3±16.9 U/L) and preeclamptic patients (353±132.8 and 48.8±29.9 U/L), respectively. Both serum GGT and LDH levels were found to correlate with the severity of preeclampsia, respectively significantly.

Serum LDH and GGT were found to be at the highest levels in eclamptic than preeclamptic and gestational hypertensive women. Blood pressure, gestational age, and severity of hypertensive disorders of pregnancy were predictor variables associated with serum GGT and LDH.

 Breast cancer has a pivotal role in many deaths caused by malignancies. Epidermal growth factor receptor-2 (EGFR-2 or HER-2) and estrogen receptor (ER) have immense predictive values as prognostic factors. Breast cancers that have steroid receptors and respond to hormone therapy show a better prognosis than cancers without steroid receptors.

A retrospective cross-sectional study was performed on 500 pathology blocks of women with breast cancer sent to the pathology department of Amir-al-Momenin medical and educational center, Gerash, Iran, from 2016 to 2019. Data were analyzed by SPSS software (Version-16) via ANOVA test followed by Chi-square and t-tests. P-value <0.05 was considered as significant.

The utmost type of malignancy was invasive ductal carcinoma (IDC) at 35.03%. Among ER-positive patients 59.67% were HER-2-positive. Nonetheless, among the PR-positive patients 54.74% were HER-2-positive. ER-positive patients were correlated with p53 receptor, distant metastasis and HER-2 significantly (P<0.01). However, PR-positive patients just correlated with p53 receptor significantly (P<0.01).

Investigated samples were more ER-negative and less PR-positive compared to similar studies. Meanwhile, ER-positive patients were HER-2-positive. Regarding the correlation with prognosis of breast cancer, especially in HER-2-positive patients, there is a need to perform profound screening programs for HER-2 in breast cancer patients, especially with histopathological characteristics of invasive ductal carcinoma.

The association of Trichomonas vaginalis (T. vaginalis) and infertility is controversial. There is a doubt regarding the relation between T. vaginalis infection and female infertility. This study is the first meta-analysis that investigated the association between T. vaginalis infection and risk of female infertility.

 Web of Science, PubMed and Scopus were searched using appropriate keywords as major international electronic bibliographic databases up to January 2020. Q-test and I2 statistic were used for evaluating heterogeneity between studies as well as Begg's and Egger's tests for exploring publication. Results were reported by pooled odds ratio (OR) estimate from individual studies by choosing random-effects model.

In total, 650 articles were obtained by initial search until January 2020 with 9779 women. Results of the pooled OR estimates showed a significant association between T. vaginalis and infertility in adjusted studies (OR=1.95; 95% CI: 1.46, 2.43). Based on Begg's and Egger's tests, there was no evidence of publication bias (P=0.532 and P=0.896, respectively).

There was a significant association between T. vaginalis and female infertility. However, more evidence is necessary to prove the potential association of T. vaginalis with an increased risk of female infertility.

Autologous platelet-rich plasma consists of concentrated autologous plasma and several cytokines and growth factors released by activated platelets in injury and inflammation. There is an increasing trend towards the effectiveness of intrauterine PRP infusion in repeated implantation failure patients. The aim of the present study was to describe the impact of intrauterine platelet-rich plasma infusion on the live birth rate in patients with repeated implantation failure.

The present retrospective uncontrolled study was performed on 96 patients with more than two failed intracytoplasmic sperm injection cycles at Mehr medical institute between 2019 and 2021. Forty-eight hours before embryo transfer, patients received 1 mL lympho-platelet-rich plasma through an intrauterine insemination catheter. Patients were evaluated for pregnancy rate. Endometrial preparation for frozen-thawed embryo transfer was performed.

Participants' basal and stimulation characteristics, including gonadotropin dosage, the total number of oocytes, metaphase II oocytes and embryos, endometrial thickness, embryo transfer, quality of transferred embryos, and blastocyst transfer rate were evaluated. A total of 33 and 27 chemical (34.3%) and clinical pregnancies (28.1%) were achieved. Twenty (20.8%) and nineteen (20%) cycles resulted in ongoing pregnancies or live births, respectively.

The current study suggests that platelet-rich plasma infusion 48 hours before frozen-thawed embryo transfer may be a good option for repeated implantation failure patients and results in 20% live birth.

Maternal obesity can increases pregnancy consequences like postpartum hemorrhage, preeclampsia, need for cesarean section, neonatal death, and fetal macrosomia. In this study, the efficacy of prophylactic use of metformin to prevent gestational diabetes mellitus in nondiabetic pregnant women with obesity was examined.

 This study was a clinical trial. Totally, 340 pregnant women who were in the first trimester were referred to the gynecology clinic of Motahhari hospital in Urmia after ensuring the absence of underlying diseases such as diabetes, hypertension, kidney, liver, and cardiovascular disease, without a history of allergy to metformin, in case of a singleton pregnancy, and Body Mass Index (BMI) above 30 were allocated to two equal groups. The intervention group was given 1000 mg of metformin, and the control group was given a placebo. Demographic information, including age, gravity, parity, live birth, birth, and maternal weight, previous delivery method, abortion, delivery method with its cause, polyhydramnios, NICU hospitalization, gestational age, mortality, and neonatal anomalies was also recorded. The results were analyzed using SPSS version 26.

In the control group, 15 mothers (9.4%) out of 160 people, and in the intervention group, 13 mothers (8.1%) had gestational diabetes (P=0.692). In the intervention group, the mean insulin dose was 10.8 ±3 units; in the control group, the mean insulin dose was 21.2±15.7 units (P=0.048). Twenty patients (6.7%) out of 297 obese patients and 8 patients (34.8%) in the morbid obesity group had diabetes (P<0.001). In the control group, the mean weight of mothers was 8.04±2.5 kg; in the intervention group, it was 5.2±2.3 kg during pregnancy (P<0.001). Gestational diabetes, delivery method, death one week after birth, preterm birth, polyhydramnios, and intensive care unit were similar in the two groups.

Metformin in pregnant women with a BMI>30 deals with low maternal weight, reduced birth weight, and reduced insulin dose in diabetic mothers.

Cervical cancer is one of the most common cancers in women. One of the most important indicators that deal with all aspects of the patients' health is the Health-related quality of life (QOL). In this study, the QOL of women with cervical cancer in Iran was investigated.

The present cross-sectional study examined the QOL of 139 patients with cervical cancer referred to Imam Khomeini hospital, affiliated with the Tehran University of Medical Sciences. For this study, a specific questionnaire of QOL in patients with cervical cancer was used. To determine the predictors of cervical cancer patients, the QOL linear regression model was used.

 Findings of this study showed that the total score of QOL of patients was 20.97±1.29. Moreover, in the regression model, a significant relationship was observed between the type of treatment and patients' QOL scores and those patients who had neoadjuvant therapy plus surgery (β=-17.45, P=0.02) and those who received brachytherapy (β=- 14.86 and P=0.09) had a significantly lower QOL score.

Overall, the QOL of people with cervical cancer was moderate. Implementing educational programs for service providers and choosing the appropriate type of treatment according to the stage of the disease and the patient's age can help control this type of disease and its complications and improve the QOL of patients.

 The thymus gland significantly affects fetal immune system maturation. Additionally, there is a linear association between thymus gland size and its performance. Given the high prevalence of vitamin D deficiency in Iran and scarce studies with conflicting results, subjecting maternal vitamin D concentration effect on fetal thymus, we decided to investigate maternal vitamin D concentration and its relation to fetal thymus size in mid-gestation. This study also aimed to generate a race-specific reference range.

We performed a cross-sectional study of ultrasound measurements of the fetal thymus at 18-22 weeks of gestational age in 94 pregnant women and its correlation with maternal serum vitamin D levels from May to July 2021 at the tertiary center of Imam Khomeini Hospital in Tehran, Iran.

The mean values of thymus perimeter, thymus-thoracic ratio, thymus transverse diameter, and thymus area in all participants were 4.18±0.56 cm, 0.37±0.04, 1.56±0.21 cm, and 1.11±0.76 cm2, respectively. There was a trend toward decreased thymus perimeter and transverse thymus diameter with decreasing level of maternal vitamin D. There was also a significant correlation between thymus perimeter and transverse thymus diameter with fetal biometric indices and gestational age. Furthermore, a significant correlation was observed between the thymus perimeter and transverse thymus diameter.

We generated a race-specific nomogram for fetal thymus size in Iranian pregnant women. Moreover, the observed trend toward decreased fetal thymus size with decreasing maternal vitamin D levels requires further prospective investigations. A high prevalence of vitamin D deficiency and low compliance with daily vitamin D intake during pregnancy was also shown, which requires a solution.

Although giving birth is quite a natural process in a woman's life; it is very painful. Different people, however, experience this pain on different levels. In fact, one's perception of labor pain is determined by physiological, cultural, social, mental, and psychological factors. The present study aims to investigate the relationship between personality traits and one's perception of labor pain.

 This study is a descriptive-analytical correlational study. Two questionnaires were used for Gathering information: one on personality traits and the other on labor pain. One hundred participants were chosen according to their demographic information from a pool of pregnant women at the Persian Gulf Hospital maternity ward in Bandar Abbas City. The data was analyzed using descriptive and analytical measures such as the Pearson Factor.

 Meaningful positive relationship between labor pain and Neuroticism (P=0.000, r=0.448), Openness (P=0.000, r=0.517) and Agreeableness (P=0.003, r=0.296). While Consciousness (P=0.047, r=-0.199) is found to have a meaningful negative relationship, extraversion shows no correlation with labor pain.

Good Childbirth Counseling and proper training, based explicitly on a mother's personality traits, could significantly help provide an enjoyable childbirth experience and reduce the unnecessary demand for C-section operations.

The objective of this study was to determine the association between the maternal serum concentration of PAPP-A and free B-HCG at 11-13(+6) weeks and the uterine artery pulsatility index (PI) at 30-34 weeks with the prediction of preeclampsia.

This cohort study was performed on 882 women with singleton pregnancies from March 2018 to November 2020 at the university hospital (referred center) in Ahvaz/Khuzestan. Maternal serum PAPP-A and free B-HCG at 11-13(+6) weeks and uterine artery PI at 30-34 weeks were measured and compared between women with and without PE. MOM PAPP-A<0.4, MOM-free B-HCG>3, and uterine artery pulsatility index >1 (>95%) were considered abnormal. Then The effect of each of the indicators on preeclampsia was determined by overlaying the layers and performing logical calculations in ARC GIS software. The distribution of PE in different cities of Khuzestan province was investigated.

The mean MOM PAPP-A was significantly lower (1.05 vs. 1.21 P=0.03), and uterine artery PI was significantly upper (0.93 vs. 0.88 P<0.01) in preeclamptic women compared to women without PE. No significant differences were observed in the mean MOM-free B-HCG between women with and without PE (1.33 vs. 1.2 P=0.667). The highest percentage of PE was in two regions of Ahvaz (80%), but concerning women referred from different cities was in Andimeshk (75%).

A low level of maternal serum PAPP-A and increased uterine artery PI promoted the chance of developing PE. The highest prevalence of PE was in two regions of the center of Khuzestan province, and the most preferred due to PE in different cities was in Andimeshk.

There are a lot of apps for pregnancy care using mHealth technologies. However, it has not been studied which criteria in these apps are essential for increasing the quality of these mHealth programs in pregnant women. Thus this study aimed to review the desirable features of mobile-based pregnancy care applications and provide a model to evaluate existing applications.

Features of a mobile-based pregnancy app were designed using a qualitative approach. In this research, an open questionnaire was developed. Obstetricians and gynecologists filled out this questionnaire. After thematic analysis of the questionnaires, the obtained items are embedded into a general framework for evaluation mHealth.

Fifteen gynecology and obstetrics experts participated in this study.  Eight themes were obtained from 34 items mentioned by the experts. Finally, a specialized framework for evaluating mHealth apps for pregnancy care is proposed.

To design mobile-based pregnancy care app and evaluate the existing apps in the field of pregnancy, the provided indicators can be used. This framework and other similar specialized frameworks could be developed to improve the quality of the mHealth apps.

Toxoplasmosis is a zoonotic infection caused by Toxoplasma gondii, a parasite that causes a variety of clinical symptoms in humans. It is a facultatively heteroxenous, polyxenous protozoon that has evolved several potential transmission routes within and between the host species. Infections caused by Toxoplasma gondii are more frequently seen in immunocompetent patients. The infection acquired by the mother during pregnancy puts the fetus at risk of congenital infection due to the parasite transmission across the placenta. The severity and frequency of infection are determined by the gestational age of the mother at the time of infection. The objective of this research was to study the toxoplasmosis infection in women, and to estimate the relationship between T. gondii infection and parameters including abortion time, chronic diseases, and age.

The case-control study was conducted on 50 healthy women (pregnant and non-pregnant) as control group and 135 women with abortion experience as case group at the Women's and Children's Hospital in Baghdad, Iraq from December 2021 until March 2022. The questionnaire was used to gather information from the women. The participant's name, age, gestational age, address, medications taken, medical history, previous abortions, and the date the sample was taken were all included. Under sterile conditions, five milliliters of the venous blood were drawn from each woman. The ELISA test was used to determine the level of anti-T. gondii IgM and IgG antibodies in serum samples.

The anti-Toxoplasma IgM and IgG antibodies were found to be positive in 51% and 8% of the cases, respectively. However, the anti-T. gondii antibodies seroprevalence was 59% in women who had abortion.  The healthy women had 0% for all antibodies.

Despite reporting the high rates of infection among women who had single abortions, the current study found no significant association between the percentage of infection and the number of abortions. The cause of high incidence among women who had abortion could be due to decrease in the immune system function.

Endometrial stromal sarcoma is a rare condition, constituting nearly 0.2% of all reproductive tract malignancies. The condition mainly affects the peri-menopausal population; however, it can occasionally be found in younger women and adolescents. Here, this is a case of a 20-year-old primiparous female who was referred to us with the main complaint of vaginal bleeding (menometrorrhagia), ongoing for 6 months after delivery. Her sonography report indicated a 5 cm intra-cavitary mass suspicious for myoma or placental polyp. Given the pathology report of low-grade endometrial stromal sarcoma (LGESS) on samples obtained through hysteroscopy and D&C, she underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH+BSO). Endometrial stromal sarcoma is a rare uterine malignancy of mesenchymal origin that should be considered, even in very young patients.

Fraser syndrome is a rare genetic disorder characterized by multiple structural abnormalities, above all of which are cryptophthalmos and syndactyly. According to reviews of reported cases, diagnostic criteria have been established. Here, we report a case of 18 weeks pregnancy diagnosed with Fraser syndrome presenting with cryptophthalmos, syndactyly, kidney agenesis, and hyper-echogenic lungs during an ultrasound examination. The pregnancy was terminated, and diagnostic features of the syndrome were confirmed afterward. Since the imaging characteristics are unique, it is of value that clinicians become familiar with the appearance of the syndrome to provide families with the opportunity to make timely decisions regarding pregnancy termination and use the prenatal diagnostic tools to have healthy children in subsequent pregnancies.

Isolated fallopian tube torsion is a rare situation in reproductive-aged women. The gold standard for diagnosis is laparoscopic evaluation, and the treatment of choice is salpingectomy without oophorectomy to preserve fertility. Still, inpatient with a presentation of the acute abdomen or hemodynamically unstable, urgent laparotomy is the treatment of choice. Here, we reported a 15-year-old virgin girl presented with acute abdominal pain and evidence of adnexal torsion on the abdominal ultrasonography. Urgent laparotomy revealed an isolated right fallopian tube torsion. Due to irreversible necrosis of the tube, right salpingectomy was performed. It's crucial to consider isolated fallopian tube torsion as a potential cause of abdominal pain in reproductive-aged women and use appropriate diagnostic measures to diagnose it early and preserve their future fertility.

Paratubal cysts account for 5-20% of all adnexal lesions. Malignant modifications seldom arise in the paratubal cysts that are usually known as primary carcinomas of fallopian tube. Paratubal borderline tumors are very infrequent conditions and until now only sixteen cases of primary paratubal borderline tumors have been previously reported in the literature. Herein, we describe a rare paratubal serous borderline tumor occurring in a woman of reproductive age and provide insights into its management. A 32-year-old woman referred to Imam Hussein Hospital, Tehran with chief complaint of amenorrhea for the last year and transvaginal sonography (TVS) report indicating a 68×74 mm persistent right adnexal cyst from 10 months ago. The patient was candidate for laparotomy and due to the report of paratubal serous borderline tumor in frozen section she underwent right total salpingectomy and infracolic omentectomy. No evidence of recurrence or metastasis was observed after 3 years of follow up. Persistent adnexal cysts need to be evaluated precisely even in young women in order to rule out the malignancy of fallopian tubes.

Adnexal masses characterization is a really challenging issue and is essential for appropriate patient management. Ovarian Adnexal Reporting and Data System (O-RADS) is tone excellent standardized lexicons to provide practical uniform terms, definitions and measurements for describing and classifying ovarian masses.In the first publication of O-RADS system, they noted that cystic lesions with maximum diameter of solid component of ≥7 mm, are at higher risk for malignancy. On the other hand, the number of papillary projections had nearly similar positive LR (2.2). Despite this and inclusion of the number of papillary projections in the final risk stratification system, the maximal size of solid part was not included and no cystic lesion with solid component could be categorized in O-RADS 3 category, and size of papillary projection make no change in malignancy risk stratification.In conclusion, we propose that in O-RADS lexicon the use of maximal diameter of solid components (with 7 mm cut off point) along with number of papillary projections is helpful to categorize cystic ovarian mass lesions as auxiliary item for classifying risk of malignancy less than 10% to higher than 50% (O-RADS 3 to ORADS 5).