Journal of Obstetrics, Gynecology and Cancer Research
Volume:8 Issue: 3, May-Jun 2023

Postpartum hemorrhage is the most common cause of maternal morbidity and mortality, which can occur unexpectedly without warning, and without any underlying causes. We hypothesized that administering fibrinogen concentrate to cesarean section patients before surgery would reduce perioperative blood loss.

In this double-blind randomized controlled parallel group study, a single dosage of fibrinogen concentrate or a placebo was given to 260 cesarean section patients at random (by G*Power software, Heinrich-Heine-Universität Düsseldorf, Germany) in a university-affiliated general hospital between November 11, 2022, to January 8, 2023. Individuals in the fibrinogen group received a dose of one gram of fibrinogen concentrate and those in the placebo group received normal saline solution with the same volume in the placebo group. Total blood loss was the primary outcome of this study.

A total of 280 cases were screened and 260 were randomized. With a P-value of 0.001, the median (IQR) volume of bleeding in the fibrinogen group was 660 (341.25) mL, as opposed to 790 (475.00) mL in the placebo group. Comparatively, only 10 (7.7%) of the fibrinogen group and 26 (20%) of the placebo group required blood transfusions (P=0.006). No adverse event related to fibrinogen was reported.

Empiric treatment with fibrinogen concentrate results in reduced blood loss.

Gynecological cancer survivors have been growing, as a result of advancements in national cancer screening strategies, resulting in early-stage diagnosis, and cancer treatments developments. Lack of a valid documented assessment tool to measure their requirements for supportive care is detected. The aim was to develop a comprehensive scale that comprises all features of gynecologic cancer survivors` requirements in Iranian population.

The Cancer Survivors Assessment Questionnaire NCCN2.2020 (National comprehensive cancer network) was translated including the instructions, and the answer choices by two native translators, including one fluent translator and one linguist. For qualitative face validity of the questionnaire at the disposal of 10 specialists were delegated to make the necessary changes. Content validity and content validity index were evaluated in terms of qualitative face validity and quantitative face validity. Necessary changes were applied.

The original Cancer Survivors Assessment Questionnaire NCCN2.2020 (National comprehensive cancer network) was condensed from 27 to 24 questions during the customization process. Questions related to lymphedema, and immunization were eliminated from the survey, as a result of low content validity index and scores. According to the panel of experts, ten questions including number 3, 5, 6, 9, 10, 13, 17, 18, 19, and 25 of the questionnaires were changed to a more suitable and comprehensible ones in Persian language.

We suggest that the Persian version of cancer survivors’ assessment questionnaire be applied in populations with Persian language and that its sensitivity to variation be measured.

Hysterectomy is the most common gynecological surgery. Every year, numerous women around the world undergo this type of surgery for various reasons. Regardless of the type of surgery, bleeding during surgery and after surgery is the most common consequence? Tranexamic acid is a cheap, available and low-complication drug that has been considered in recent years to control bleeding. The present study investigated the effectiveness of Tranexamic acid on the bleeding during laparotomy hysterectomy in women aged 35 to 55 years.

This study was a randomized, double-blind clinical trial performed on 80 patients undergoing laparotomy hysterectomy. Using a random number table, patients were divided into two groups A (receiving Transid) and the other group receiving drug B (not receiving Transid), both of which received 100 ml of normal saline prepared to reduce bias in the prepared syringe.

Mean age of the patients was 46.24 ± 5.21 years. Based on the results of mean hemoglobin before surgery, the rate of infection, infusion and induction in the control and intervention groups were not statistically different (P > 0.05). Also, the mean hemoglobin variables before and after hemorrhage were estimated by the surgeon and hemorrhage estimated according to Hernandez formula were not statistically different in the two groups (P > 0.05).

Tranexamic acid administration has no effect on the amount of bleeding during hysterectomy laparotomy.

Most pain relief methods are associated with some side effects and limitations. Magnesium sulfate, due to its osmotic properties and absorption of cervical water (moisture) can shorten labor duration and decrease labor pain via improving effacement and cervical edema. The aim of our study was to evaluate the effect of intravaginal magnesium sulfate on pain severity and duration of the first and second stages of labor.

In this double-blind randomized clinical trial study, 70 nulliparous women were allocated into two groups after the beginning of the active phase of labor. In group 1, 10 ccs of magnesium sulfate 50% was poured on the whole cervix during the vaginal examination. In group 2, a placebo (sterile water) in a similar way and amount was used. Then the two groups were compared in variables of demographic, obstetrics, clinical, pain severity, duration of the first and second stages of labor, and maternal and neonatal outcomes.

In different dilatations, pain severity in group 1 was significantly lower (P=0.0001). The duration of the first and second stages of labor was shorter in group 1 (P =0.0001). The two groups were similar in neonatal outcomes, drug side effects, and treatment satisfaction (P >0.05).

Intravaginal magnesium sulfate improves the condition of the cervix, reduces the duration and the severity of labor pain, and has no medical or neonatal side effects.

Understanding the reproductive and sexual needs of pregnant women seems to be crucial in increasing the effectiveness of services and addressing their needs and expectations. Therefore, the aim of this study was to explain the needs and concerns of reproductive and sexual health of pregnant women during the COVID-19 pandemic.

This is a qualitative study with a content analysis approach. In this probe, 16 interviews were accomplished with 15 pregnant women who had been referred to pregnancy care centers. Data analysis was performed predicated on the content analysis approach using MAXQDA software version 12.

Based on 17 interviews conducted with pregnant women during the COVID-19 pandemic, pregnant women were found to be suffering from mental disorders, fears, disrupting prenatal care, and sexual problems.

Reproductive and sexual health of pregnant women in the Covid-19 epidemic should not be neglected and considered in health planning.

Infertility that cannot be explained by anovulation, poor sperm quality, tubal disease, or any other recognized cause of infertility is referred to as unexplained infertility. The aim of this study is to assess the correlation between integrin alpha-v beta-3 expression, endometrial thickness and subendometrial blood flow resistance index in unexplained infertility.

The study carried out on Kamal – Al-Samurai fertility center in the period from October 2020 - September 2021. Six days after detecting urinary Luteinizing Hormone (LH) surge, all the women were asked to come to do two-dimensional (2D) transvaginal ultrasound to assess endometrial thickness and subendometrial blood flow color Doppler resistance index and endometrial samples was taken and examined immunohistochemically to detect alpha-v beta-3 integrin. The cut-off value of integrin and subendometrial blood flow resistance index, sensitivity and specificity were calculated by applying Receiver Operative Characteristics (ROC) curve.

The endometrial thickness was lower and resistance index was higher in case group (P < 0.001). The expression of integrin alpha-v beta-3 in infertile group was significantly low (P < 0.001) with significant positive correlation between integrin score and endometrial thickness (r= -0.708 & P < 0.001) and significant negative correlation between integrin score and subendometrial resistance index (r= -0.786 & P <0.001).

Alpha-v beta-3 integrin expressions and endometrial thickness are reduced significantly in mid-luteal phase while the subendometrial blood flow color Doppler resistant index significantly increased, and using them together can possibly be used as a diagnostic predictor of unexplained infertility.

Fertility control has been used for thousands of years in a variety of ways. Women need to use contraceptive methods correctly to reduce unintended pregnancies and maternal mortality. The purpose of this research was to determine the factors that have an impact on the use of contraception in our community.

During the time period of December 2021 to April 2022, a descriptive cross-sectional study was conducted in primary healthcare centers in the city of Duhok, which is located in the Kurdistan Region of Iraq. A total of 400 married women between the ages of 18-45 years were studied. Information on sociodemographic characteristics, obstetrical history, contraceptive methods used, deciding factors, and discontinuation were obtained from respondents. The statistical calculations were performed in John's Macintosh Project (JMP project, version 14.3.0, Apple Macintosh. USA).

Out of 400 women, 269 (67.25%) were aged 18-34, 106 (26.50%) completed primary education, and 204 (51.00%) desired to conceive. The most frequently used method was withdrawal 257 (64.25%), followed by oral contraceptive pills 43 (10.75%), Intrauterine contraceptive devices 39 (9.75%), and male condoms 35 (8.75%). For the purpose of becoming pregnant, 256 (64.00%) women stopped using contraceptives. Most of the failure rates were seen among withdrawal users, which recorded 77 (19.25%), and those who experienced side effects were 42 (10.50%).

In every district of Dohuk, there is a need for comprehensive, easily accessible, client-centered, and modern family planning services. Educational program is requested to improve the behavior and attitude toward family control.

The fetal head's persistent posterior position, which ranges from 1 to 5% during birth, has long been acknowledged as a significant challenge of intrapartum treatment. 10% to 20% of fetuses are found to be in the occiput posterior (OP) position at the beginning of labor; 90% of them rotate to the occiput anterior. This research aims to analyze the rate of delivery in the OP position (also called sunny-side-up) concerning the outcome of manual rotation carried out contingent upon the OP position remains persistent. Perinatal outcomes were the secondary goals.

This prospective cohort study was carried out in Obstetrics & Gynecology Clinic (OGC) at Faruk Medical City, Iraq. The study included all women who experienced a singleton pregnancy after 36 weeks, had an effort to rotate the fetus manually and had the fetus remain in the persistent OP position. The primary result was the delivery's occiput position. Perineal injuries, labor length, and the method of delivery have been the secondary outcomes. According to the outcome of manual rotation, two groups were contrasted.

The overall number of women participating was 250, and the manual rotation success rate was 59.1%. The success was strongly correlated with a reduction in the OP position during vaginal, cesarean, operative vaginal delivery, episiotomy, and obstetric anal sphincter injury.

Reduced incidence of OP position at anal sphincter injury during operative vaginal delivery is linked to attempts at manual rotation in the case of persistent OP position.

Congenital anomalies are a global issue and the primary reason of death in both developed and advanced countries. Congenital anomalies occur at varying rates in various populations. The purpose of this research was to determine the prevalence and pattern of congenital anomalies in newborns, as well as the associated maternal and environmental factors in newborns, presented at the Babylon teaching hospital for motherhood and pediatrics in AL-Hilla city, between 2017 and 2021.

This study follows a descriptive design, and was based on population data from the statistic registry covering the AL-Hilla city, Iraq, 2017 to 2021. The registry covers live and still births. Also, maternal and neonatal information regarding sex, birth weight, parental consanguinity, and maternal age, were recorded.

There were 214 congenitally deformed newborns among the 46,777 births in AL-Hilla city. There were 109 males (50.69 percent) and 103 females (47.90 percent). The most common congenital malformations discovered were those relating to the neurological system, followed by those relating to the musculoskeletal system.

Anomalies in the central nervous system were most apparent, however, this research can help to determine the approximate distribution of the prevalence of congenital anomalies in AL-Hilla city in Iraq. Also, by identifying their main types, information can be applied to improve the clinical performance and public policies of Iraq.

The Covid-19 pandemic can cause complications for pregnant women and more serious maternal, fetal and neonatal care related to this disease should be considered in health systems. The aim of the present study was to investigate the maternal, fetal, and neonatal outcomes of pregnant women with COVID-19 disease.

We performed a prospective study with a longitudinal design of all pregnant women hospitalized due to moderate and severe COVID-19 referred to Al-Zahra hospital, Rasht, Iran. After patient discharge, patients were followed until delivery, maternal, fetal, and neonatal outcomes were assessed by a 4-part researcher-made questionnaire.

In total, 166 pregnant women with Covid-19 were included in the study. The median gestational age in patients was 35.5 weeks and the median delivery age was 38 weeks. Delivery in 137 (82.5%) women were cesarean section and 29 (17.5%) had a vaginal delivery. The most common clinical symptoms among patients were fever, cough, and dyspnea with 50.9%, 38.5%, and 31.5% frequency, respectively, 9.6% had poor prenatal outcomes, 15 patients (9%) were admitted to ICU and 4 patients died (2.4%). Poor maternal outcomes were reported in 61.5% of patients with severe clinical symptoms, (p <0.001). There was no significant relationship between the severity of the disease and the type of delivery (p = 0.41).

In our study we observed an increase in poor maternal, fetal and neonatal outcomes particularly in pregnant women with severe symptoms, although careful care is still recommended for affected pregnant women to reduce fetal, neonatal, and maternal complications. Further research will be needed to devise plan for pregnancy care and future health care crises.

Cervical cancer screening is crucial for the early detection and prevention of this disease in women. Due to the prevalence of cervical cancer in Iraq, the current study aimed to improve Pap smear screening practices.

The present semi-experimental study was conducted in 2019 on 192 Baghdad-based women aged 20 to 60 with active medical records. Two groups of 96 people, intervention and control, were created. The intervention group received training based on the constructs of health belief and stages of change models to enhance Pap smear screening behavior. The control group participated in routine training on Pap smear screening behavior in health centers from health professionals. The participants completed a questionnaire created by the researchers in the pre-test and post-test stages. For data analysis, version 19 of SPSS statistical software and independent t-tests, paired t-tests, chi-square, and Fisher's exact test were utilized.

A p-value of less than 0.05 was deemed statistically significant. Before the educational intervention, there was no significant difference between the two groups in the stages of behavior change (P>0.05). However, after the educational intervention, the intervention group significantly differed from the control group in the Pap smear screening change (P<0.01). Also, based on the paired t-test, the mean scores of the intervention group's knowledge, susceptibility, severity, barriers, and self-efficacy were significant before and after the intervention (P<0.05). After the intervention, the intervention group demonstrated significantly higher Pap smear screening behavior than the control group (P<0.01).

The utilization of educational intervention of the stages of change and health beliefs models has proven to be highly effective in bringing individuals to the action stage.

Globally, postpartum hemorrhage (PPH) remains a leading cause of maternal deaths. However, in many low and middle-income countries, information on the magnitude of and risk factors for PPH is scarce. Understanding the relative contributions of different risk factors for PPH is important. We assessed the incidence of and risk factors for postpartum hemorrhage among women who had a cesarean section in Iran.

Between March 2021 and March 2022, a prospective cohort study was conducted at a university-affiliated general hospital for women who had a cesarean section in Iran. We used Spearman’s correlation for the variables associated with PPH.

Among the 300 women, the overall incidence of postpartum hemorrhage was 15.7%. Risk factors for postpartum hemorrhage among deliveries by cesarean section were: body-mass index, previous PPH, preoperative anemia, and preoperative hypofibrinogenemia.

The incidence of postpartum hemorrhage in the cesarean section was high. Extra vigilance in all women with cesarean section could address the risk factors identified.

Ovarian mature cystic teratomas (OMCTS) are one of the most common benign ovarian tumors. Most MCTs can be diagnosed by ultrasonography (us). Due to heterogeneous composition and a variety of appearance, in some non-diagnostic imaging reports it is suggested that we evaluate some tumor markers (CA125 and CA19-9) to complement imaging modalities. According to previous investigation, a single elevated CA 19-9 is in association with specific radio-pathologic features, such as size, torsion, bronchial glands, fat and teeth components. Here we are presenting three different cases of OMCT with different characteristics.

Case 1: asymptomatic, non-diagnostic US, single- elevated CA19-9, smaller than in 10 cm with bronchial glands and fat component. Case 2: symptomatic, non-diagnostic U.S. normal CA19-9, larger than 10 cm with torsion and necrosis. Case 3: symptomatic, diagnostic US, single- elevated CA19-9, smaller than 10 cm, full of hair and sebaceous material. Computer tomography (CT), in all of our cases was diagnostic based on OMCT. Apologia of pathologic pathway of elevated CA19-9 in both cases 1 and 3 were in agreement with the result of previous investigations. In case 2, despite its large size and torsion, CA 19-9 level was low.

Single- elevated CA 19-9 level in OMCTs could impact benign characteristics of this kind of tumor.

Low-grade appendiceal mucinous neoplasm (LAMN) is a very rare condition, diagnosed in 0.2-0.7% of appendectomies. The pathophysiology of the neoplasm involves accumulation of large volume of mucin in the appendiceal lumen, resulting in its obstructive dilation. Most epithelial tumors affecting the appendix are of the mucinous type and are manifested by mucin accumulation within an inflamed appendix with fibrotic and hyalinized wall.

A 29-year-old female presented with a history of chronic and intermittent episodes of abdominal pain and a palpable mass in the right lower abdominal quadrant. Sonography showed a 58 mm mass anterior to the uterus and adjacent to the ovary, probably a uterine myoma. Laparotomy revealed normal uterus, and ovaries with a translucent mass originating from the appendix and fixed to the cecum. Pathologic examination of the mass was reported as low grade appendiceal mucinous neoplasm.

This is a rare case of appendiceal mucocele in a young female, mimicking a pelvic mass, which was misinterpreted by sonography as a gynecologic solid mass near the uterus. Preoperative diagnosis of appendiceal mucocele is important due to the risk of concurrent GI and ovarian malignancy associated with the condition.

This letter comes to you in the hope of stressing the need to understand age differences and relevant requirements in delivering bad news to end-stage children. Among variables affecting the way healthcare providers communicate bad news, the age of the recipient is a critical factor requiring caregivers’ meticulous tactfulness. For practical purposes, various strategies are already suggested in communicating unexpectedly bad news to patients abruptly taken to face their end of life (1). However, patients of different ages may require different strategies. For some healthcare providers and physicians, breaking bad news to an elderly end-stage client may be taken for granted because public mindset is wired to assent to end-of-life deaths. While this tendency appears controversial by itself, communicating bad news to younger patients with life-threatening irremediable diseases appears more perplexing which should be given due attention in practice and special priority in training.Young frivolous patients hope for life rather than death because children conceive of disease as a temporary stage of abnormal functioning of body systems; never do they expect dying if they become ill. The concept gradually transforms; for instance, school-age children may tend to blame themselves by attributing illness to their own actions but as they grow up, illness becomes increasingly attributed to external causes. Therefore, such conceptualizations should guide healthcare providers’ behavior toward their patients.