Journal of Obstetrics, Gynecology and Cancer Research
Volume:8 Issue: 4, Jul - Aug 2023

Polycystic ovary syndrome (PCOS) is a hormonal disorder and a common health problem that affects women at the early to late reproductive stage. Several genetic and environmental factors such as obesity, liver diseases, imbalance of androgens, and menstrual dysfunction have contributed to the progression of PCOS. Research has shown a link between diabetes, hypertension, miscarriages, and cardiovascular disease with PCOS. Experimental discoveries have begun to evaluate the mechanisms involved in PCOS. Although various classical interventions are used in the treatment of PCOS, current medications are not able to control outcomes of PCOS and the management of this syndrome is still challenging. Accumulating evidence showed that dysregulation of long non-coding RNAs (lncRNAs) is essential to PCOS pathogenesis. LncRNAs are a class of transcripts that mediate the process of gene expressions at the level of transcription and post-transcription. It has been found that lncRNA metastasis‐associated lung adenocarcinoma transcript‐1 (MALAT1 or nuclear-enriched abundant transcript 2 (NEAT2)) presents a vital role in regulating PCOS. MALAT-1 as a competing endogenous RNA (ceRNA) can suppress microRNAs (miRNAs) and decrease granulosa cell proliferation, apoptosis, and pathogenesis. Abnormal expression of MALAT1 is one of the prognostic factors for cell autophagy, migration, and drug resistance. MALAT1 can be used as a potential biomarker for treatment of PCOS. However, the exact roles of MALAT1 in granulosa cells of women with PCOS remain largely unknown and further studies are required to confirm its action. In the present article, we summarize the functions of the lncRNA MALAT-1/miRNA axes in women with PCOS.

Background &  Endometriosis, a common disease of the female reproductive system, could affect many aspects of women’s lives. Along with many other diseases, COVID-19 has affected the diagnostic or treatment approaches towards endometriosis. This systematic review aims to investigate COVID-19 in endometriosis patients in terms of prognosis, diagnosis, treatment, and quality of life during the pandemic.Materials &  Relevant studies were identified through searching for endometriosis and COVID-19 in different databases, including PubMed, Medline, Scopus, and Web of Science, on 17 January 2022. Peer-reviewed published articles evaluating COVID-19 and endometriosis written in English were included. Out of 115 articles, 9 manuscripts met our criteria. Endometriosis does not intensify the risk of COVID-19 infection. However, COVID-19 has changed the health care of endometriosis patients. COVID-19 has affected endometriosis patients’ life in many aspects, including their job, lifestyle, and health care. Further studies are recommended to evaluate how the pandemic has affected endometriosis patients.

Background &  Menarche is an important stage in the development of girls which can predict the adolescent’s puberty process and fertility onset. The changes in menstrual cycle have health consequences not only in adolescence but also over the life-course. Childhood obesity as a common health problem has been observed in both developed and developing countries, and its prevalence is continuing to increase. The aim of this study was to identify menstrual patterns and related disorders and also to investigate the relationship between menarche age, menstrual disorders, and (BMI) in high school girls in Urmia.Materials &  In this cross-sectional study, 716 adolescent girls aged 14-18 years were selected with multistage sampling from high schools of Urmia (Sept 2012 to Dec 2013). Participants completed the questionnaire of menstrual pattern characteristics including age at menarche, menstrual cycle length, dysmenorrhea, and the need for pain relief. BMI percentile was calculated and obesity was determined using the CDC’s 2000 BMI-for-age growth charts. The results showed that the average of age, BMI, and menarche age were: 15.66±1.019 year, 22.05±3.91 kg/m2 and 12.87±0.98 year, respectively. The prevalence of overweight and obesity were 13.7% and 8.4%, respectively. A large majority of the subjects (76.1%) had a normal, healthy weight. There was a significant association between BMI and the duration of flow, menarche age, menstruation flow, and pain severity (P<0.05). Based on the results, planning and intervention for decreasing the BMI in high school girls can help reduce menstrual disorders. Future studies are required to confirm and complete our results.

Background &  A number of procedures have been developed for multifetal pregnancy reduction (MPR) to reduce the overall number of fetuses in the gestation and improve the maternal outcomes as well as the outcomes of the surviving fetus.Materials &  An observational historical cohort study was conducted on multiple pregnancies that underwent fetal reduction in Shariati Hospital and Omid Clinic between January 2018 and September 2021. The study population was divided into two groups according to gestational age at fetal reduction: 11–14 weeks' gestation (early reduction group) and 15–19 weeks’ gestation (late reduction group). The main outcome measures were the rates of pregnancy complications, pregnancy loss, preterm delivery, and adverse neonatal outcomes. The study group included 107 patients with twin and multiple pregnancies that underwent abdominal MPR at 11-19 weeks’ gestation (79 in the early reduction group and 28 in the late group). The incidence of pregnancy complications (hypertension, diabetes, intrauterine growth disorder, preterm delivery, and pregnancy loss) was not significantly different between the two groups (P >0.05). The percentage of NICU admission was higher in the early reduction group compared to the late group (49% vs 18.5%, P=0.004). The weight of the first newborn was significantly heavier in the late versus early reduction group (2680.55±777.52 vs 2264.4±796.82, P=0.005). According to the present study, fetal reduction in twin or multiple pregnancies is a safe procedure with good obstetric outcomes if done by an expert specialist, especially when it is performed in the second trimester.

Background &  Recurrent pregnancy loss (RPL) is the occurrence of three or more miscarriages before the 20th week of pregnancy. Thrombophilia factors are one of the common causes of RPL.Materials &  This retrospective study was performed on women with miscarriages. 620 patients’ documents with pregnancy loss were investigated. Based on the number of pregnancy loss, the women were divided into a control group with less than three miscarriages (212) and RPL group (180). Cytogenetics analysis and thrombophilia factors polymorphism tests were performed for all patients. In the analysis, none of the studied polymorphisms (MTHFR 677 C⁄T /Factor V Leiden /Prothrombin G20210A/ ACE I/D/ PAI-1) showed a significant relationship between Control and RPL groups (P-value ˃ 0.05). Cytogenetic analysis showed 2 numerical and 9 structural abnormalities among both groups. Statistical analysis indicated a significant association between the number of abortions and age (P value= 0.005, r= 0.139). We even realized that there was a significant relationship between polymorphism number and recurrent number of miscarriages (P value= 0.018, r= 0.6). We showed that polymorphisms analysis for thrombophilia factors is a more precious test than cytogenetics analysis (study of the banded pattern of chromosomes during metaphase of the cell cycle). We even indicated that no association was found between thrombophilia polymorphisms in the control and RPL groups. This means that screening for Factor V Leiden, prothrombin G20210A, MTHFR C677T, ACE I/D, and PAI-1 and cytogenetic analysis in patients with a history of RPL is not recommended.

Background &  Anti Mullerian hormone (AMH) level is a practical index of ovarian reserve and an indicator of ovarian response in infertile women. The aim of this study was to evaluate the relationship between AMH levels and demographic factors.Materials &  In this cross-sectional study, conducted in Al-Zahra hospital Rasht in the north of Iran, 234 patients, 18-45 years old, were enrolled. The demographic parameters (e.g. age, education, habitat and etc.) and AMH levels were recorded for each patient. The patients were divided into two groups based on their AMH levels [group 1: less than 1.1 (ng/ml) vs. group 2: more than (1.1 ng/ml)]. The data was analyzed by SPSS-21 software. The mean AMH level was 2.66 ng/ml. Age, education status and habitat showed significant differences among subjects with AMH levels, so that with aging the AMH levels decreased. Patients living in villages or the ones with low educational degrees and those with higher parities also revealed lower levels of AMH (p<0.05). There was a significant relationship between age, educational status and habitat with AMH values. Similar to other studies, we believe that with aging the AMH levels decrease. Furthermore, the other two aforementioned demographic features could affect a woman’s ovarian reserve and fertility status, too.

Background &  The present study compares between superficial and deep myometrial invasion in type 1 endometrial cancer in relation to regional lymph nodes metastasis, so we can answer the question to do or not do lymphadenectomy, this life-threatening procedure in both superficial and deep myometrial invasion with type 1, clinically and radiologically stage 1 endometrial cancer.Materials &  Patients were divided into 2 groups distributed as follows: group I includes 50 patients type 1 endometrial cancer with superficial myometrial invasion and group II includes 50 patients type 1 endometrial cancer with deep myometrial invasion. Total abdominal hysterectomy with bilateral salpingo-opherectomy with pelvic and lower para-aortic lymphadenectomy to all patients included in the study from both groups. Histopathological examinations were done to all the specimen from both groups to confirm diagnosis of type 1 endometrial cancer, depth of myometrial invasion, pathological grading and metastasis to the regional lymph nodes. Considering regional lymph nodes metastasis in both groups, there is a statistical difference between group I and group II in relation to regional lymph nodes metastasis as group II (cases with deep myometrial invasion) are associated with more regional lymph nodes metastasis (P= 0.0001)). Deep myometrial invasion in type 1 endometrial cancer is associated with significant increase in regional lymph nodes metastases.

Background &  An essential issue in obstetrics is the prevalence of maternal and fetal complications in pregnant women with polycystic ovary syndrome (PCOS). The purpose of the present study was to investigate the prevalence of pregnancy complications among various phenotypes of pregnant women with PCOS.Materials &  In the current study, the pregnancy period of 143 women with PCOS who were referred to the Babylon teaching hospital in Iraq in 2021 was analyzed based on their medical records. These women were separated into two groups based on their PCOS-related clinical symptoms. People in the first group possessed a severe phenotype, while those in the second group possessed a mild phenotype. SPSS version 23 was utilized for comparing maternal and fetal complications during pregnancy and for data analysis. Regarding maternal and fetal complications, there was a significant difference between the two groups regarding low birth weight (LBW) (P<0.05). In this study, there was no statistically significant difference between PCOS phenotypes and the incidence of gestational diabetes, preterm birth, or spontaneous abortion (P>0.05). In conclusion, women with a more severe phenotype are more likely to give birth to babies with low birth weight (LBW) (approximately 1.9 times). In clinical considerations of pregnant women with PCOS, it appears necessary to consider the disease's phenotype as one of the factors influencing fetal outcomes.

Background &  Low and high hemoglobin concentration is one of the main concerns of women during pregnancy due to its high prevalence and adverse effects. The present study aimed to examine the correlation between maternal hemoglobin concentration and the baby's birth weight and height in 326 pregnant women referred to the Alwiyah hospital for obstetrics and gynecology in Baghdad, Iraq, in 2019.Materials &  In the current descriptive-analytical study, pregnant women were classified into two groups: anemia and normal; four groups of moderate to severe anemia, mild, regular, and high hemoglobin; and eight groups with intervals of 12 g/L from severe anemia to high hemoglobin. This study's variables included infants' age, number of children, education level, socioeconomic status, weight, and height. The data was analyzed using SPSS version 19, descriptive statistics, t-test, and logistic regression. In this study, the level of statistical significance was deemed to be 0.001. The results showed that the probability of low birth weight and abnormal height increases 4.96 times and 4.13 times, respectively, in mothers with high hemoglobin concentrations versus mothers with low hemoglobin concentrations; these ratios are statistically significant (P<0.001). Also, hemoglobin concentrations ranging from 104 to 115 g/L have the lowest probability. Furthermore, hemoglobin concentrations greater than 125 g/L are statistically significant (P<0.001). The current study revealed that high maternal hemoglobin concentrations during pregnancy could significantly impact the baby's weight and height.

Background &  There is a well-established link between multiple pregnancies and assisted reproductive techniques (ARTs). Increased maternal and perinatal morbidity and mortality are directly related to multiple pregnancies. The purpose of the current study is to examine the effects of multiple pregnancies on women using various reproductive techniques.Materials &  This study used a comparative-analytical approach. We assessed a cohort of 130 pregnant women of which 120 had twins and 10 had triplets. In vitro fertilization and embryo transfer (IVF-ET) were performed on 62.0% of women, while 6.0% had ovulation induction. Using ultrasound examination, twin and triplet pregnancies were found in 92% and 8%, respectively. Our results show that 11% of women experience the physiological course of pregnancy with multiple pregnancies. Pregnancy concludes in the delivery of twins only in 50% of patients with multiple pregnancies diagnosed by ultrasound examination before 10 weeks. It was found that 46% of births in women carrying multiple pregnancies happened prematurely after studying more than 100 births. Of these, 6% occurred before 28 weeks, 20% between 29 and 34 weeks, and 20% between 35 and 37 weeks. Preeclampsia and placental insufficiency are more likely to occur in multiple pregnancies than in single pregnancies. As a result, at the beginning of the second trimester, all preventative measures should be implemented. Although abdominal delivery is not the preferred option for multiple pregnancies, there is a need to increase the indications for surgical delivery for the benefit of the fetuses.

Background &  Preeclampsia is related to numerous maternal and fetal complications, like intrauterine increase restriction, preterm delivery, and a raised danger of baby death. In order to determine the predictive amount of uterine artery Doppler sonography indices for neonatal complications in pregnant patients with preeclampsia, the present study was conducted.Materials &  In 2020, in Alwiyah Hospital for Obstetrics and Gynecology, Al-Jadiriah Private Hospital, Al-Karama Teaching Hospital, and Yarmouk Teaching Hospital in Baghdad, 87 pregnant women with preeclampsia and 160 healthy pregnant women participated in the present prospective study. The Doppler signal of the uterine arteries was evaluated during a supine abdominal Doppler ultrasound examination between 26 and 36 weeks of pregnancy. The survey form was updated with information about the birth of the children following the termination of the pregnancy. The data were evaluated using SPSS software (version 19) and independent t, Mann-Whitney, and chi-square tests. The mean uterine artery pulsatility index of mothers with preeclampsia had the greatest sensitivity, specificity, and positive predictive amount of predicting a baby's low birth weight at 54.8%, 87.3%, and 91.6%, respectively. In addition, the sensitivity, specificity, and positive predictive amount of the mean uterine artery resistance index for predicting a baby's low birth weight were 65.2%, 96.4%, and 95.4%, respectively. Although uterine artery indices in Doppler ultrasound do not have a high sensitivity for predicting neonatal complications, abnormal indices can predict low birth weight with high confidence.

Background &  Today, the prevalence of cervical cancer in developing societies and its impacts on various body functions, mainly sexual performance, is of particular significance. In order to examine the relationship between sexual function and its domains with different stages of cervical cancer, the present study was conducted.Materials &  Examined in the current study were 284 cervical cancer patients with a history of trachelectomy surgery, referred to the Baghdad Women's Hospitals in 2020 and 2021 and selected randomly. The personal profile form and the female sexual function index (FSFI) were among the research instruments. The data were investigated by statistical software SPSS.23 and the Spearman correlation coefficient test. A P-value of less than 0.05 was deemed statistically significant. The results revealed that 26.8% of women complained of low sexual desire, 43.0% did not receive adequate sexual arousal, and 39.1% experienced deficient vaginal lubrication. Additionally, 46.8% of women did not experience a proper orgasm, 27.8% were dissatisfied with their sexual satisfaction, and 37.0% reported experiencing pain during intercourse. In addition, there was an inverse correlation between the stages of cervical cancer and sexual performance (r= -0.25, P= 0.002), as well as its domains, including sexual desire (r= -0.18, P= 0.02), sexual arousal (r= -0.23, P= 0.004), vaginal lubrication (r= -0.23, P= 0.003), orgasm (r= -0.20, P= 0.009), sexual satisfaction (r= -0.21, P= 0.005), and pain during intercourse (r= -0.26, P= 0.001). The sexual performance of cervical cancer patients is impaired, and the more advanced stages of the disease weaken sexual performance and its domains.

Background &  Antenatal care service satisfaction is a measure of the degree to which a woman seeking care is happy with the antenatal care service provided to her. As well as, the pregnant women satisfaction is a first indicator about the quality of antenatal care. This study aimed to identify if the reproductive factors can predict the level of satisfaction towards ANC.Materials &  A descriptive cross-sectional study conducted in the city of Diwaniyah in primary health care centers for the period from October 1st, 2022 to March 1st, 2023. The study sample consisted of 150 pregnant women who were selected according to a non-probability sampling approach. The questionnaire was validated according to experts and its reliability was verified through a pilot study. The total number of items included in the questionnaire was 38 items. Data were collected using interviews and analyzed by applying descriptive and inferential statistical analysis. The results of the study indicate that the average age of pregnant women is 27.8 years, (30%) of primary school graduates, and (62%) of housewives, (34.7%) of them expressed more than 900,000 Iraqi dinars as a monthly income, and (60.7%) of them live in the regions Urban area. The results showed that the level of satisfaction was relatively moderate (48%). The reproductive related factors of pregnant women such as number of abortions, number of visits to ANC and gestational age are predicted variables of satisfaction. The most of influencing related factors are number of abortions, number of visits of ANC and gestational age are considered predicted the level of satisfaction. Decision makers in the Health Directorate should be employed based on quality guidelines in order to improve antenatal care services compared to international standards and take into consideration reproductive characteristics in providing those services.

Background &  Pelvic exenteration and other types of super-radical procedures are the standard of care in the management of patients with recurrent or persistent cervical cancer. But, since the extent of surgery and possible morbidities are considered as an important challenge in low-resource countries, there is need to investigate the outcomes of similar patient.Materials &  The present study tries to report the successful outcome of radical surgery in detailed in 7 cases in a low-economic setting. Total Pelvic exenteration was performed in three but free margin could be achieved by less radical approach in others. All were alive up to 5yaers of follow-up. What we had noticed was the excellent survival prognosis even in curative intent. It is highly recommended, considering the psychological effect of such an extensive surgery and quality of life in these patients with advanced disease and loss of hope.

Hereditary non polyposis colorectal cancer (HNPCC) also known as Lynch syndrome (LS), is an autosomal dominant cancer syndrome. Besides colorectal cancers, it predisposes patients to extracolonic cancers. Despite several extracolonic cancers have been reported on LS, we found a new face of it. A 43-year-old G2L2 patient with chief complaint of abnormal uterine bleeding.  Her endometrium biopsy showed clear cell carcinoma, and the necessary work-ups have been done. But the patient's family history demonstrated HNPCC based on the Amsterdam 2 criteria. After some years, the patient presented to our hospital for fever, shivering and abdominal LUQ pain. Spiral CT scan showed a solid cyst with heterogeneous enhancement in the spleen, and hepatosplenomegaly. In this paper, another case with endometrial cancer as a sentinel cancer of LS is reported. This fact implicate that physicians should notice the family history of malignancies in patients with gynecologic cancers and consider LS.