Journal of Obstetrics, Gynecology and Cancer Research
Volume:8 Issue: 2, Mar-Apr 2023

Surrogacy is an assisted reproductive technology in which the intended parents allocate the gestation and birth to another woman named the surrogate mother. From this view of surrogacy, although there is no genetic relationship between surrogate mother and fetus, this approach is faced with some issues such as the epigenetic effect, which is the environmental influence on gene expression. Epigenetics plays a critical role in ovulation, spermatogenesis, and embryonic growth, development, and health. DNA methylation, histone modification, and non-coding RNAs activity are the major epigenetic mechanisms. In this mini-review, we focus on the possibility of epigenetic alterations during in vivo embryo culture and intrauterine life.

Adenomyosis is a common benign endometrial disease which causes abnormal uterine bleeding in premenopausal women and affects the quality of life.  The definitive treatment is hysterectomy, however medical treatment is an option for those who wish to preserve fertility. This systematic review aims to assess the efficacy of levonorgestrel-releasing intrauterine device as medical management in women who have adenomyosis.

We searched PubMed, Cochrane and Scopus databases from 2000 to November 2019 for relevant studies containing the use of levonorgestrel-releasing intrauterine device (LNG-IUD) in managing patients with ultrasonographic diagnosed adenomyosis. Main outcomes measures in the study are menstrual blood loss (milliliters), pain score measured in 10cm-visual analogue scale, and uterine volume. 

Pooled results from meta-analysis showed that after LNG-IUD treatment for adenomyosis, there is significant reduction in dysmenorrhoea measured using Visual Analogue Scale after six months Standardized Mean Difference (SMD), ( 3.68; CI: 2.11-5.25), twelve months (SMD: 4.23; CI: 2.99-5.48), 24 months (SMD: 4.69; CI: 3.40-5.97) and 36 months (SMD: 4.01; CI: 3.57-4.45); significant reduction in menstrual bleeding after six months (SMD: 2.52; CI: 1.15-3.89), twelve months (SMD: 3.43; CI: 1.64-5.22) and 24 months (SMD: 3.57; CI: 1.88-5.26); significant reduction in uterine volume after six months (SMD: 0.49; CI: 0.04-0.93), twelve months (SMD: 0.80; CI: 0.11-1.48) and 24 months (SMD: 0.86; CI: 0.15-1.58). 

LNG-IUS is an effective method in alleviating the symptoms of adenomyosis.  It is a valuable long-term alternative for the treatment of adenomyosis for young and perimenopausal women in terms of dysmenorrhoea and heavy menstrual bleeding.

The aim of this study was to compare the efficacy of vaginal misoprostol with Foley balloon catheter for cervical ripening in women with singleton pregnancies and an unfavorable cervix. Eighty pregnant women with unfavorable cervix were randomly divided in two groups of Foley catheter or misoprostol modes. Cervical ripening in Foley catheter group was done with transcervical Foley catheter 18, and in misoprostol group with 25 μg single dose vaginal misoprostol(The maximum allowed dose for patients was 6 doses.). Bishop score, Apgar score, active phase duration, stage 2 duration and insertion to birth time were the main outcomes. The mean of time between ripening and the active phase in vaginal misoprostol group was significantly shorter than in Foley catheter group (2.32 versus 5.11 hour respectively, P-value = 0.0001). After intervention Bishop score in vaginal misoprostol group was significantly more than Foley catheter group (8.70 versus 6.68 respectively, P-value = 0.0001). Time from insertion to birth in vaginal misoprostol group was 9.54 hours and in Foley catheter group was 12.88 hours (P-value = 0.0001). The hospitalization time in Foley catheter group was significantly more than vaginal misoprostol group (P-value = 0.0001). other outcomes were similar between groups. By the decreasing in the total time from insertion to birth, vaginal misoprostol was more effective than Foley catheter as a cervical ripening method in our study.

Determining the correct date of pregnancy and fetal age has a very important role in the management of pregnancy from the first trimester to delivery, which makes it  necessary to know the exact method in this field. Therefore, this study aimed to compare the accuracy of ultrasound at 8-16 weeks with Naegele’s Revised Rule of the delivery date. This study was performed on 50 pregnant women. After recording demographic information and age of delivery, sonography of weeks 8-16 and Naegel’s Revised Rule were also recorded. A Paired t-test was used to compare data. The results of our study showed that the average difference between the Naegele’s Revised Rule and real age was 3.52 days, which is a significant difference. However, the average difference between the estimated date by ultrasound and real age is 0.58 days, which is not a significant difference. Ultrasound is more accurate than the Naegele’s Revised Rule, which still did not differ significantly from the actual date of delivery by grouping by age, sex of the fetus, number of pregnancies, and deliveries. Ultrasound has more accuracy in accurately estimating the date of delivery, and therefore using this method and relying on it has more reliability than the Naegele’s Revised  Rule.

Preeclampsia (PE) is a major complication of pregnancy worldwide. Doppler ultrasound of maternal arteries, including uterine and ophthalmic arteries (OA), plays an important role in determining individuals progressing PE. The aim of this study is to compare OA indices in pregnant women with a diagnosis of PE and women without it. Out of 148 included participants, 48 cases progressed to PE at 35 to 37 weeks of gestation and 100 cases did not have PE at the same gestational age. All OA parameters including (First and second peak systolic velocities (PSV), Second to first PSV Ratio (PR) and Pulsatility Index (PI) in each eye; as well as, the average of these indices in both eyes) were assessed. PR and PI between the two eyes were statistically different in those with PE.

Due to the uncertainties of maternal and neonatal complications after delivery and the lack of similar studies in this regard, this study aimed to compare the maternal and fetal complications of vaginal birth after C-Section (VBAC), natural delivery and repeat Cesarean section in Isfahan province. In this one-year descriptive cross-sectional study, 49889 pregnant women who had the natural childbirth (29631 deliveries), elective repeat Cesarean section (20148 deliveries) and VBAC delivery (110 deliveries) were enrolled, then maternal and neonatal complications were compared in three groups. There was a significant difference between the three groups based on the maternal and neonatal outcome, Apgar scores in the first and fifth minutes after delivery and the need for resuscitation at birth (P <0.05). Neonatal outcome was better in natural delivery and then VBAC compared to repeat C-section, respectively. Maternal outcome was better in VBAC and then repeat C-section than the natural childbirth, Apgar scores in the first and fifth minute were better in VBAC, and later natural delivery than repeat C-section and resuscitation at birth demonstrated better results for natural delivery and then VBAC than repeat C-section. Utilizing VBAC and natural delivery have better maternal and fetal outcomes compared to C-section along with being more satisfactory and safer.

Infertility in women can be attributed to a wide variety of factors, including inherited and acquired abnormalities of the uterus. Ultrasonography is used for determining the thickness of the endometrium during various phases of the menstrual cycle. The purpose of this study is to determine the thickness of the endometrium in women who are unable to conceive using ultrasound imaging during the secretory phase. A total of 134 adult females between the ages of 22 and 45 were examined by means of an endo-vaginal and transabdominal approach with EVN 4-9 MHZ and CA1-7AD probes, respectively, during the course of this research project, which took place in Imam Al-Hujjah Charitable Hospital, Karbala, Iraq, between February 2021 and April 2022. The findings showed that primary infertility accounted for 69.4% of cases, which was significantly higher than women with secondary infertility, which accounted for 30.6% of cases. There were 68.8% of women who presented with primary infertility who had endometrial thickness between 9-12 mm, and there were 31.1% of women who presented with secondary infertility who had this thickness. 65.8% of women who are experiencing primary infertility and 34.1% of women who are experiencing secondary infertility have an endometrial thickness of 14-18 mm. Our study showed that 40% of women who suffer from primary infertility and 60% of those who have secondary infertility have an endometrial thickness of 19-23 mm. When it comes to diagnosing and treating infertility, ultrasound is a crucial tool for measuring the thickness of the endometrium in women.

Frozen embryo replacement (FER) cycle is a procedure that assists in vitro fertilization (IVF) outcome by using the storage and transfer of excess embryos. This study evaluated the success of FER using spinnbarkeit and endometrial thickness. This cross-sectional study was performed on 97 infertile women at the Imam Khomeini hospital of Ahvaz, from March 2019 to March 2020. Endometrium was prepared with Estradiol valerate from the third day of menstruation and followed by serial vaginal ultrasound till the thickness of the endometrium attain 7 millimeter to 8 millimeter. The cervical secretions were collected from the external os and were estimated based on centimeters. Also, endometrial thickness was recorded. no substantial difference between endometrial thickness and spinnbarkeit in the FER cycles with pregnancy outcomes was observed (P>0.05). Some variables such as endometrial thickness, spinnbarkiet, estradiol dose intake, and quality of embryos have no relationship with the success of FER cycles.

Labor pain is one of the most severe pains that a woman may experience, so it is important to research the methods to reduce this pain. Paracetamol infusion is an efficient and available remedy to alleviate labor pain in an active phase. This study was conducted to assess the efficacy of intravenous paracetamol injection on reducing labor pain. In this double-blind randomized clinical trial study, the number of 110 nulliparous pregnant women who were candidates for vaginal delivery were included in the study. After the onset of the active phase of labor, the control group received only 300 cc normal saline and the intervention group received 300 cc normal saline plus one gram of paracetamol. The maternal pain score, duration of the first and second stages of labor, delivery type and Apgar score were compared between two groups. Repeated measure ANOVA was used for comparison of means of the VAS score between groups based on repeated observations. The mean age of the patients was 25.09 ± 4.2 years (18-35 years). The mean length of the first stage (2.85 vs. 3.52 hours, P = 0.001) and second stage (38.77 vs. 43.44 minutes, P = 037) in the intervention group was significantly lower than the control group. Moreover, the mean score of pain was significantly lower in the paracetamol group at all times than the control group (P <0.05). The prescription of intravenous paracetamol not only reduces pain during labor in women but also reduces the duration of different stages of labor, increases patients’ satisfaction with natural childbirth, and reduces the demand for Cesarean.

Delayed diagnosis and treatment of postpartum hemorrhage could result in mortality. Today, there is a strong desire to determine the factors affecting postpartum hemorrhage, particularly fibrinogen levels. This study aimed to investigate the role of plasma fibrinogen levels in postpartum hemorrhage and severe postpartum hemorrhage. This cross-sectional study was conducted on 169 term pregnant women who were candidates for an elective Cesarean section. Fibrinogen and other coagulating factors were measured before and at the end of the surgery, and twenty-four hours after surgery. Bleeding volume was also measured during and at the end of the surgery, and twenty-four hours after that. The relationship between coagulation factors and the amount of bleeding was examined using statistical tests. Mean plasma fibrinogen levels measured before, at the end of, and 24 hours after surgery were 247.65±91.07 mg/dl, 219.4±75.60 mg/dl, and 223.91±65.44 mg/dl, respectively. Sixty-five patients (38.5%) had postpartum hemorrhage (1000-2000mL) and seven patients (4.1%) had severe postpartum hemorrhage (>2000mL). Of the cases with preoperative fibrinogen levels less than 200mg/dl, 72% had postpartum hemorrhage and 14% had the severe form. There was a strong association between the patient's plasma fibrinogen level with PPH and sPPH (P=0.000). This study showed a strong correlation between plasma fibrinogen levels and postpartum hemorrhage and severe postpartum hemorrhage. In addition, it has been shown that low plasma fibrinogen levels could be a direct prognostic factor for postpartum hemorrhage and severe postpartum hemorrhage. Younger women and preoperative anemia were other strong predictors.

One of the worldwide healthcare problems is Diabetes mellitus (DM), and the prevalence of this disease increases steadily, particularly in pregnancy. The several metabolic disorders in the pregnancy were revealed by the placenta. The pathogenesis of diabetes mellitus is associated with hyperglycemia, insulin resistance, and oxidative stress, and it negatively impacts the mother-placenta-fetus system. This research aims to compare the amount of leptin expression, as well as its score and intensity, in the placentas of women with diabetes with those of healthy controls. In this work, we used a case-control methodology. Thirty women were diagnosed with diabetes and were placed in one group, while the other 40 served as a comparison. Primary monoclonal antibodies were used for the immunohistochemical analysis of leptin (Abcam, UK). The patients group showed the greatest percentage (23%) of placental expression of leptin. The expression of leptin was high in around 53% of the patient population. The intensity of leptin expression was significantly higher in DM patient than control groups (P>0.05). About 77% of patients group had moderate intensity of leptin expression, while 37.5% of control group had no leptin expression. Diabetes mellitus was related with alterations in expressions of leptin as metabolic placental factor. Leptin may affect the pregnancy diverse disorders and pregnancy outcome.

In Iranian women, the age of breast cancer is 10-20 years earlier than women living in developed countries. Moreover, HPV infection has increased among Iranian women and it is more common compared to European women. The purpose of the present study is to investigate the role of HPV as a potential risk factor for breast cancer at younger ages. The results showed a significant difference between the two groups of women with breast cancer and without malignancy in the age of first pregnancy and gravidity. There was a significant difference in human papillomavirus type 16 infection between the two groups with breast cancer and without malignancy. The logistic regression model examined the effect of all variables and showed that infection with human papillomavirus type 16 increased the risk of breast cancer by 4.6 times, taking into account other variables. The present study, independent of other studies, showed that human papillomavirus type 16 could be a risk factor for breast cancer. If the virus is found in an individual, it is recommended that the patient be monitored frequently and more detailed examinations for breast malignancies be performed.

Angiomyofibroblastoma (AMF) is a benign mesenchymal neoplasm. They are typically well-circumscribed lesions more commonly occurring in the vulvo-vaginal region of reproductive age females. It is curable by complete excision. They do not have a characteristic clinical and radiological feature. It is an exclusive histopathological diagnosis. However, many mesenchymal neoplasms are predominantly perineal in location, with similar clinical and morphological features and may be confused with angiomyofibroblastoma. We present a 40-year-old married female with 5.5 x 3.5 x 2cm left vulval mass, clinically considered to be a Bartholin’s cyst. Magnetic resonance imaging (MRI) was suggestive of infected cystic lesion. Histologically it was an AMF. Histomorphological features are compared with other similar entities occurring in the vulva.

Echinococcus granulosus (sensu lato) is the main cause of cystic hydatid in human and livestock in the world and is considered a neglected tropical disease. Hydatid cysts often form in the liver (50–70%) and less frequently the lung, spleen, kidney, bone, brain and genital system. Ovarian hydatid cyst is one of the rarest cases with nonspecific clinical presentation. Here in a case report study we report a primary unilateral ovarian hydatid cyst in a 45-years-old woman. This patient was presented with a large pelvic mass. A pelvic multiloculated mass in abdominal ultrasound and a solid-cystic lesion of the left adnexa in CT scan was reported. All other laboratory tests and chest X-ray showed typical results. Molecular method was performed to confirm radiography and staining methods. A cystic mass on the left fallopian tube and ovary was found in the patient's laparotomy and all were resected with the appearance of a tubo-ovarian abscess. Postoperative pathological and molecular diagnosis confirmed a hydatid cyst disease. Five years follow-up revealed no recurrence of the disease. Hydatid cyst can cause cystic masses anywhere in the all anatomic of body, especially in endemic locations.

we present a case of A 26-year-old woman with hypothyroidism that was treated with levothyroxine,and was hospitalized at 25 weeks of gestational age that diagnosis of ovarian torsion and underwent detorsion surgery, but finally, after a few weeks during cesarean section, no trace and evidence of the ovary was observed, which suggests the phenomenon of spontaneous ovarian absorption.