Journal of Fertility, Gynecology and Andrology
Volume:2 Issue: 1, Dec 2022

 Preterm labor (PL) is a leading cause of perinatal morbidity and mortality. Different factors can result in preterm labor, including maternal vitamin D.

 This study aimed to evaluate the level of vitamin D in pregnant women with PL.

 This case-control study was conducted on 156 pregnant women (52 cases with PL and 104 controls without PL) in Ali Ibn Abitaleb Hospital, Zahedan, Iran, in 2018.

 The age was 30.92 ± 5.21 and 29.39 ± 4.86 years in the case and control groups, respectively. There were no significant (P-value > 0.05) differences between the two groups in baseline variables. Vitamin D supplement consumption (P-value = 0.128), sun exposure time (P-value = 0.304), history of admission in pregnancy (P-value = 0.608), and history of vaginal infection (P-value = 0.100) were not significantly different between the two groups. The mean vitamin D level was 30.88 and 31.93 ng/mL in pregnant women with and without PL, respectively, with no significant difference (P-value = 0.591). The mean babies' weight was significantly (P-value > 0.001) higher in the control group than in PL women (3338.75 ± 466.16 vs. 2655.76 ± 393.36 g).

 Although this study showed no association between vitamin D levels and PL, abnormal vitamin D levels might be related to PL in pregnant women with other comorbidities or risk factors.

 Acute colonic pseudo-obstruction (APCO), which is identified as colon dilatation without any mechanical obstruction, is a rare post-surgery complication.

 Herein, we report a 40-year-old woman who underwent total laparoscopic hysterectomy with no complications during the surgery. On post-op visits, she complained of vague abdominal pain, especially in the upper quadrants, with a mild abdominal distention on her physical examination. Despite normal abdominal imaging, C-reactive protein (CRP) level was rising. Although oral intake was discontinued, the abdominal distention progressed gradually, and CRP levels rose continuously. On the fifth post-surgery day, the patient was suffering from bilious vomiting. Additionally, the abdominal distention was accompanied by tenderness. Emergency laparotomy was scheduled for clinically suspected bowel problems that were resistant to conservative management. During emergency laparotomy, the small bowel was distended. Since 20 cm of ileum was ischemic due to bowel congestion, segmental resection and anastomosis were performed.

 The CRP value can help to predict latent complications. It is also necessary to observe these patients closely to detect and manage probable post-operation complications.

Human papillomavirus (HPV) is the primary cause of cervical dysplasia and the most common sexually-transmitted infection. Based on the available studies, HPV infection appears to correlate with adverse pregnancy outcomes, including preterm labor. However, there is inconsistency in the literature regarding this association. In this context, the aim of this mini-review was to bring together current research findings focusing on the impact of HPV infection on preterm birth.

 Cervical ripening is the process of initiating labor in women with an unripe cervix. Vaginally administered prostaglandin E1 analog (misoprostol) has been promising in cervical ripening and labor induction. However, optimal dosage and dose-dependent adverse effects in this administration route need further clarification.

 This trial aimed to compare the efficacy and adverse effects of 50 mcg vs. 25 mcg of vaginal misoprostol in low-risk term pregnant women.

 This double-blind, single-center, randomized clinical trial included 200 low-risk term pregnancies undergoing labor induction with a Bishop score of 2 or less. Patients were assigned randomly to receive 25 mcg or 50 mcg of vaginal misoprostol every six hours up to four times until the active phase of labor was reached. The primary outcome included time to vaginal delivery (latent and active phase of labor), and secondary outcomes included the total dosage of prescribed misoprostol, the need for oxytocin for labor augmentation, and the cesarean section rate.

 Misoprostol 50 micrograms resulted in a significantly shorter time in the first phase of labor (P-value = 0.002), the second phase of labor (P-value = 0.030), and the third phase of labor (P-value = 0.020). The number of administered misoprostol, the need for additional oxytocin, uterine hyperstimulation, cesarean delivery rate, Apgar score, umbilical artery pH, and neonatal intensive care unit (NICU) administration were statistically similar between the two groups.

 This study showed that 50 mcg of vaginal misoprostol (vs. 25 mcg) for cervical ripening could reduce labor phase duration without significantly increasing adverse maternal and neonatal outcomes.

 Ripening is the process of preparing the cervix for induction of labor and is crucial to identify a low-complication, low-cost, and safe method of inducing labor before spontaneous labor begins. Therefore, this study aimed to demonstrate the impact of the evening primrose capsule on inducing labor, as well as to compare its effect to that of misoprostol.

 This prospective clinical trial study was performed on 200 low-risk pregnant women candidate for delivery in an academic hospital in Tehran from 2018 to 2020. Patients were randomly divided into two groups to receive 25 µg misoprostol vaginally or 500 mg evening primrose vaginal capsule to induce labor and repeated every three hours until reaching the bishop score > 4 in case of no effective up to three doses. The total drug dose, as well as maternal and neonatal outcomes evaluated and compared between groups.

 Although misoprostol was significantly more effective than evening primrose in increasing cervical bishop score in the inactive phase of labor, the active phase and delivery time were not different between the groups. Also, there was no significant difference between the two groups in the cesarean section rate. Maternal complications, including uterine hyperstimulation, headache, or gastrointestinal complications in the group receiving misoprostol were significantly higher in misoprostol group, but fetal complications, including Apgar score, pH, hospitalization, and meconium excretion, were not significantly different between the two groups.

 Evening primrose capsules are safe and can be used to induce labor because of the lower risk of hyperstimulation of the uterus and the higher tolerance. There should be more research done to see if this medicine can be used alone or in conjunction with misoprostol or mechanical dilators or if it can be administered at home rather than in the hospital.

 Cervical insufficiency occurs in the second trimester. Herein, we report a successful term pregnancy in a woman with glucose intolerance and a history of cervical insufficiency after two consecutive preterm deliveries in the second trimester.

 We present a 35-year-old woman, G3P2L0, with a history of two preterm deliveries in the second trimester. In the second pregnancy, vaginal cerclage at the 18th gestational week did not prevent premature delivery. Following two pregnancies with borderline fasting blood sugar (FBS) results, we decided to further evaluate the gestational diabetes mellitus (GDM) state with a two-hour postprandial (2 hpp) glucose test and glucose tolerance test (GTT). By impaired 2 hpp and GTT results, an insulin regimen was started with subsequent vaginal cerclage in the third pregnancy. She delivered a healthy 2,750-g girl at 38 weeks of gestation by tight blood sugar control.

 More attention should be paid to evaluating glucose intolerance in pregnancy, especially in patients with cervical insufficiency. Blood glucose control in these patients can probably improve pregnancy outcomes.

 COVID-19 infection may be associated with potential sequels on the hormonal system, which can substantially alter menstrual cycles in women.

 This study aimed to evaluate short-term menstrual distributions after COVID-19 infection and determine whether vaccination and type of vaccine could alter menstrual cycles.

 This study was carried out using an online survey to record any menstrual distributions such as any changes in duration, volume, and time of menstruation, intermenstrual bleeding (IMB) and dysmenorrhea as well as exacerbation of premenstrual syndrome (PMS) on 268 women aged 18 to 45 who were infected by COVID-19. The participants were followed at least for three months after their COVID-19 infection. The history of vaccine administration before infection was also recorded, and the results were compared regarding various vaccine types.

 Short-term menstrual distributions after infection were common. in this regard46.7% had IMB, 66.1% experienced exacerbation in PMS, 67.7% had increased volume of bleeding, 62.9% had dysmenorrhea or exacerbation in dysmenorrhea. Also, 27.4% and 35.4% experienced a shorter or longer duration of menstrual cycles, respectively. All distributions returned to normal after a maximum of two cycles. However, there was a substantial difference (P = 0.024) between women who received the AstraZeneca (recombinant) and Sinopharm (inactivated) vaccines, as the number of patients who experienced changes in menstrual cycles was relatively lower in the recombinant group.

 Menstrual distributions are common but temporary in the short term following COVID-19 infection. Although, the recombinant vaccine (AstraZeneca) was associated with lower menstrual disturbance rates compared to Sinopharm or Sputnik vaccines.

 Monitoring fetal movement is a simple and effective approach to assessing fetal well-being. Among other issues, the maternal perception of altered (not just reduced) fetal movements remains a complex issue. This study aimed to report a case of fetal demise following the increased fetal movements in the third trimester of pregnancy.

 A 32-year-old woman in 34th week of her first pregnancy attended the emergency room while she had no chief complaint of fetal movement from the previous night; the fetus was examined, but no fetal heart rate was detected. She had reported an increased perception of fetal movements in the earlier week. Her maternal history, as well as her labs and obstetrics data, were normal. Despite the normal appearance of the fetus and placenta, the triple loops of tied nuchal cord was abnormal.

 Increased fetal movement (IFM) was a controversial finding, and earlier studies had questioned its safety. Therefore, any fetal movement alteration may have had clinical and fateful importance. Thus, it was recommended that further prospective studies should be conducted in order to clarify the association between IFM patterns and pregnancy adverse outcomes.