Journal of Obstetrics, Gynecology and Cancer Research
Volume:8 Issue: 6, Nov-Dec 2023

The COVID-19 pandemic has disrupted people’s lives all over the world, and vaccination is one of the best ways to eradicate this pandemic and save people’s lives. Despite this, vaccines have many known and unknown side effects like fever, fatigue, headache, etc. Fertility is an important aspect of human life, but there are too many concerns about its relationship with COVID-19 and its vaccines. Women are complaining of menstrual irregularities like postmenopausal bleeding, heavy menstrual bleeding, polymenorrhea and fertility concerns after receiving the second dose of the COVID-19 vaccine. The immunologic reactions between vaccine ingredients and the immune system of the body seem to be responsible for this global issue. Angiotensin-converting enzyme 2 (ACE2) and Basigin (BSG) are the receptors for SARS-COV-2. ACE2 is expressed in the human respiratory system, kidney, vagina, uterus and particularly widely in the ovaries, and BSG is expressed in the uterus, ovary stroma and granulosa cells. Therefore, SARS-COV-2 can invade the target cells by attachment to ACE2 and BSG and modulate their expression, and through these probable mechanisms, it can disturb female reproduction and menstruation. According to this accumulated evidence, in this study we aimed at summarizing the recent studies with a focus on probable mechanisms by which SARS-COV-2 and COVID-19 vaccines affect menstruation irregularities and reproduction complications.

 Because childbirth is a natural process, pain is therefore part of the process. The amount of labor pain is probably directly related to the pregnant woman's mood, familiarity, awareness and self-confidence. Therefore, it is illogical to accept the complications of surgery and anesthesia and harm to the baby in order to escape the pain. Therefore, the aim of current study was investigating the relationship between the perception of labor pain and the number of deliveries.

 This study is 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 maternal ward of the Persian Gulf Hospital in Bandar Abbas City, Iran. The data was analyzed by means of descriptive_ analytical measures such as Pearson Factor.

 The mean age of women was 27.15±4.6. Collected data showed that 31% of women were gravida 1, 33% gravida 2, 15% gravida 3, 10% gravida 4, 5% gravida 5, 4% gravida 6, and 2% were gravida 7. a significant relationship was found between pain in the first delivery and pain in the second, third, fifth and sixth deliveries, so that the pain in the first delivery was more than the pain in the second, third, fifth and sixth deliveries.

According to the results of this study the severity of labor pain in primiparous and multiparous women was not statistically significant and the intensity of reported pain level was high in all mothers.

 Some types of major surgeries are associated with postoperative pain, sometimes during the days after surgery. These pains mainly lead to the use of various analgesics and, ultimately, patient dissatisfaction. In the present study, we evaluated the effect of gabapentin at doses of 600 and 1200 mg on relieving pain due to cesarean section.

 In this randomized clinical trial, patients were randomly divided into three equal-size groups (25 patients in each group) through balanced block randomization. The first group was given 600 mg of gabapentin, the second group was given 1200 mg of gabapentin one hour before surgery, and the control group received a placebo. The pain intensity, nausea, vomiting, and drowsiness, as well as the need for postoperative analgesics, were assessed initially and at 2, 6, and 12 hours after surgery. The occurrence of nausea and drowsiness between groups was compared using the chi-square and Fisher's exact tests.

 The mean (SD) age of patients in the gabapentin 1200 mg, gabapentin 600 mg, and placebo groups was 26.32±6.15, 27.43±6.38, and 26.59±5.88, respectively (P=0.34). Pain intensity and the rate of analgesic consumption at different time points during the first 12 hours of surgery were significantly lower in the receiving gabapentin groups than in the placebo group (P<0.05). Comparing the prevalence rates of nausea and vomiting and also drowsiness, as the drug-related side effects don’t show a significant difference across the three groups at the different investigated time points (P>0.05).

Gabapentin with a minimum therapeutic dose can successfully reduce postoperative pain intensity and also needs analgesic use after a cesarean section.

 The maintenance of an appropriate weight before and during pregnancy has a significant effect on pregnancy outcomes. Therefore, this study attempts to explore the relationship between pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) in the Indian antenatal population. This was a prospective study.

 This study was conducted on a total of 301 pregnant women who fulfilled the inclusion criteria booked from the first trimester till delivery in the department of Obstetrics and Gynecology, SGRRIM & HS, from January 2020 to June 2021. The weight and height of the participants were recorded at their first visit to the antenatal clinic using standard protocol. BMI was recorded and GWG was calculated at each antenatal clinic visit. BMI and GWG were correlated with antepartum, intrapartum and postpartum complications with the application of appropriate statistical tests.

 In our study, higher pre-pregnancy BMI and GWG significantly increased the risk of perinatal adverse outcomes. Increased rates of cesarean section (57.1%), operative vaginal delivery (9.5%), gestational diabetes mellitus (9.5%), and pre-eclampsia (28.6%) were observed in obese women as compared to women with normal pre-pregnancy BMI and gestational weight gain. These were found to be statistically significant (p-value <0.001).

Appropriate nutrition prior to and throughout the pregnancy plays an important role in determining the health of both mother and fetus. There is a positive correlation between early pregnancy BMI and GWG, and the course of pregnancy, and its outcome.

 High-risk (HR) HPV infection is the major cause of cervical cancer, which is still one of the most common cancers among women. Based on some not-published results, it seems that some of the other HR HPVs might be as important as HPV 16, and 18 in developing high-grade CIN. This study was conducted to determine the relationship between Other HPV and high-grade CIN.

 In this prospective study from 2019 to 2022 (approved by the ethics committee), all women with positive HPV based on the COBAS method were invited to participate in the study (N=646). For all the patients, colposcopy was done, and then the liquid-based samples of women with Other HPV positives were reanalyzed by HPV typing.

 All the patients who were infected with HPV18 were involved in CIN1. On the other hand, 50% of patients who were infected with HPV18 were involved in CIN2. 50% of patients with HPV45 were involved in CIN2. There is also a significant relationship between HPV31 and CIN3.

Because in our study there was a significant relationship between CIN3 and HPV31; and CIN2 with HPV45, and in the COBAS method, HPV31 and HPV45 are only reported under the general title of Other HPV, because of the possibility of the importance of other HPV with high-grade neoplasias, it is recommended to analyze the other HPV with HPV typing. Further studies are needed to confirm our findings.

 To determine the safety and adequacy of intravenous (IV) carbetocin compared to IV tranexamic acid (TA) plus sublingual misoprostol in reducing hemorrhage during and following cesarean delivery (CD) in women with at least one risk factor for postpartum hemorrhage.

 This clinical study was randomized. We randomly assigned 400 term pregnant women who were candidates for elective CD to receive either a 100 μg intravenous infusion of carbetocin or 1gm. IV TA along with 400 μg of sublingual misoprostol after delivery. Comparing the quantity of blood loss at and six hours following a CD was the primary result. We also disclosed the necessity for any extra medications and any adverse drug reactions.

 When compared to the misoprostol plus tranexamic acid group, the carbetocin group's total mean blood loss was considerably higher (829.7 293.3 mL vs. 609.33 211.5 mL; P = 0.0001). Following the administration of carbetocin and misoprostol with TA, respectively, 9.5% and 26.5% of patients required further uterotonics treatment (P = 0.0001). When compared to the carbetocin group, the misoprostol group's side effects, such as a bad taste in the mouth and fever, were much greater (P = 0.0001).

 When it comes to minimizing overall blood loss during and after CD, IV tranexamic acid combined with sublingual misoprostol is superior to IV carbetocin.

 The safety of women during childbirth and personnel working in maternity care amidst the COVID-19 pandemic is a priority for the health system. Hence, good risk management practices need to be implemented to reduce the spread of infection between healthcare workers and pregnant women who have contracted COVID-19. Therefore, this study aimed to establish a risk map for managing dyspneic parturients suffering from COVID-19-related pneumopathy during delivery.

 This study focuses on examining potential risks beforehand in the context of the management of a dyspneic parturient suffering from COVID-19-related pneumopathy during delivery, executed using the method FMECA (Failure Mode, Effects and Criticality Analysis); this was conducted from September to December 2021 in the maternity service of the Hospital Center ElJadida, Morocco.

 The risk analysis of a dyspneic parturient suffering from COVID-19-related pneumopathy during delivery revealed thirteen failure modes. Proposed are corrective measures aimed at addressing the failure modes of criticality class C3 whose vital risks are linked to the care of the dyspneic parturient suffering from COVID-19-related pneumopathy at the level of the reanimation service and the level of the neonatal intensive care unit.

Employing risk mapping is a fundamental instrument for the ongoing enhancement of quality to maximize the safety of the parturient care process by changing the organizational culture from a reactive to a preventive approach.

 Gonadotropin-releasing hormone acts on the anterior pituitary and promotes the release of both follicle-stimulating hormone (FSH) and luteinizing hormone (LH), both of great importance in the ovarian cycle.

 In a prospective cross-sectional study conducted at the High Institute for Infertility Diagnosis and Assisted Reproductive Technologies / Al-Nahrain University and Kamal Al-Sameraie Hospital for Infertility and In Vitro Fertilization, Baghdad, Iraq during the period from April 2022 to April 2023, women received rFSH in a single daily dose of (150-300 IU) for ovarian stimulation. Women in groups B and C received ovarian stimulation antagonists, while those in group A did not.

 Both clinical and ongoing pregnancy rates were measured for each group. A positive hCG test was found in 27 (79.4%) in Group A while it was positive in 19 (55.9%) in Group B with a significant difference (P=0.03), clinical pregnancy was 25 (73.5%) in Group A while it was positive in 17 (50.0%) in Group B with a significant difference (P=0.04), and ongoing pregnancy was found in 24 (70.6%) in Group A while it was positive in 15 (44.1%) in Group B with significant difference (P=0.01).

Women with LH <4 IU presented with a significantly higher pregnancy rate than those with ≥4 IU, and do not need GnRH antagonist addition as co-treatment.

 The birth weight is an essential indicator of a baby's health. The birth of infants with low birth weight (LBW) is one of the most significant health issues and one of the leading causes of infant mortality. The current study aimed to investigate the impact of demographic and delivery factors on low- and normal-weight infants.

 The current retrospective study collected data from all 2,731 babies born in Basra in 2022 and their mothers from electronic files. The data consists of demographic information and delivery factors. Babies were divided into two groups based on their weight: LBW (n=192) and normal (n=768). Data analysis was performed with SPSS version 19 and the chi-square, Fisher, Mann-Whitney, and logistic regression tests. The level of statistical significance was determined to be equal to 0.05.

 The results showed that the variable of intrauterine age less than 37 weeks increases the risk of having a baby with LBW by 1.84 times (0.95CI=0.52-3.12), age less than 20 years increases the risk by 1.76 times (0.95CI=0.83-2.64), BMI in the thin range increases the risk by 1.42 times (0.95CI=0.87-1.84), and anemia with hemoglobin less than 11 g/dl increases the risk by 1.34 times (0.95CI=0.76-1.86).

The results revealed that age, BMI, anemia, and intrauterine age impact birth weight. Therefore, controlling the risk factors mentioned above in mothers before becoming pregnant can reduce the number of LBW babies.

 Adnexal torsion is a complete or incomplete twisting of the ovary, fallopian tubes, or ovarian cyst around its vascular axis, which can cause blood flow disruption. This disorder is rare but serious and accounts for about 3% of women's emergency surgeries. Early diagnosis of this disease and the necessary surgeries are very important to preserve fertility. The purpose of this study is to investigate the epidemiology, clinical symptoms, imaging and pathology of patients with torsion of the adnexa referred to the emergency rooms of Mahdiyeh and Shohadaye Tajrish hospitals.

 This study is a retrospective cross-sectional study. In the present study, 190 patients with torsion of the adnexa were examined in the period 2011–2021, in Mahdiyeh and Shohadaye Tajrish hospitals. Demographic, clinical and surgical information about patients was extracted from medical records. Data analysis was done using SPSS version 22 statistical software.

 The average age of 190 patients was 29.2. Most of the ovarian torsion patients had a history of more than one previous delivery (57.9%) and also, an ovarian mass was observed in 157 patients, and the ovarian mass of 146 patients was larger than 5 cm. The rate of ovarian preservation in this study was 61%. Hemorrhagic cysts were the most common type of cyst in patients and were reported in 37 patients.

 It is necessary to identify effective diagnostic methods. Therefore, it may be useful to investigate more serum biomarkers for early detection of adnexal torsion and to reduce diagnostic errors.

 Increasing urinary tract infections (UTI) in pregnant women was a reason for which this study aimed to find out the spread of bacteria in them and also study the resistance of bacteria to antibiotics and the type of resistance.

 During November 2022, 50 urine samples were collected from pregnant women with symptoms of UTI. Direct microscopy tests were conducted on the samples. The samples were cultured on the media of MacConkey agar (MAC) and blood agar. Biochemical tests were performed and diagnosed using the VITEC-2 system.  Antibiotic susceptibility screening test was done for all isolates.

 Of the 50 bacterial isolates diagnosed and isolated from pregnant women with UTI, 84% were gram-negative and 16% were gram-positive. The most prevalent bacteria were E. coli, with a rate of 60%, followed by Proteus mirabilis, with a rate of 12%. All E. coli isolates were resistant (100%) to the AMOX antibiotic, and the isolates showed high resistance (87%) to CFR, CN, CZ, CXM, CAE, CPD, CRO NA and SXT antibiotics. 13.3% of E.coli isolates were extended detection and response (XDR), 50% and 25% of Staphylococcus hominis and aureus isolates were XRD, respectively.

 E. coli is the most common and most resistant bacteria of type XRD, and gram-positive bacteria, staph bacteria, showed resistance to type XRD. In addition, gram-negative bacteria showed high resistance to many antibiotics, including AMOX, CFR, CN, CZ, CXM, and CAE. Gram-positive bacteria showed complete resistance against BENPEN, OXA, CLIN, TEC, VAN, TET, FUS and VAN.

Cesarean scars in pregnancy have become a worrisome obstetric problem. Furthermore, given the challenge of diagnosis in cases of low suspicion in the initial prenatal sonographic screening, there is still debate over the standard of management. According to rare reported cases, the most acceptable recommendation is still termination of pregnancy to decrease the chance of further maternal dreadful complications. A case of twin pregnancy had been terminated at gestational age of 34 weeks with a history of diagnosis of cesarean scar pregnancy. Since pregnancy at the site of a previous cesarean section is very rare, but due to the complications of this type of pregnancy, choosing a suitable clinical approach for these patients is desirable. This type of pregnancy can increase the value of antenatal care if it can be continued until the fetus is viable and its complications, including placenta accreta and bleeding, are managed.

Primary fallopian tube carcinoma is a very rare gynecological malignancy and poses a challenge in diagnosis preoperatively. We are reporting a rare case of bilateral primary fallopian tube carcinoma in a 48-year-old lady with classical symptoms. These symptoms are seen in less than 15% of cases. The differential diagnosis for bilateral fallopian tube cancer includes secondary malignancies arising from endometrial, ovarian and gastrointestinal cancers. Although the prognosis is poor. Early diagnosis, optimum cytoreduction and adjuvant chemotherapy are important to improve survival in such patients.

Ovarian mature cystic teratomas (OMCTs) due to their heterogeneous histologic entity, have a wide spectrum of radiologic features. A type of floating spherical globule that has been called “Sack of marble” or "Coins-in-sack,” but without a fat or calcification component that results in misdiagnosis on computed tomography (CT), is a rare finding. The patient was a 35-year-old healthy woman with abdominal pain and sonographic findings based on OMCT with the Coins-in-sack sign, whereas the CT manifestation was a unilocular huge cyst suggesting an adnexal cystadenoma. She had a final diagnosis of the Coins-in-sack variant of OMCT but with keratin balls, not common fat balls. Understanding the unconventional radiologic and histologic manifestations of OMCTs, is necessary to make an accurate diagnosis.

Guillain-Barré syndrome is a rare neurological complication that presents in pregnancy and postpartum. We present a case of a 23-year-old Gravida 2 Para 1 Living 1 with 39 weeks of gestation and previous lower (uterine) segment cesarean section (LSCS) who presented with nonspecific symptoms in the antenatal period and progressed to develop symmetrical progressive ascending paralysis in the postpartum period with no antecedent history of infection. The patient was managed by a multidisciplinary team and treated with plasma exchange, with complete recovery at follow-up. We are reporting this case because of the rarity of Guillain-Barre syndrome in pregnancy and postpartum and the nonspecific initial presentation with an unexpected diagnosis in the immediate postpartum.

Non-Hodgkin lymphomas are a heterogeneous group of lymphoproliferative disorders with various behaviors and responses to treatment. As a primary extranodal NHL, the disease must be confined to one location, and bone marrow should not be involved. Primary uterine cervix lymphoma is a rare malignancy as well as a rare site of extranodal lymphoma. Because of the rarity of the disease, there is no standard treatment guideline for women with primary uterine cervix lymphoma. Patients mostly present with abnormal uterine bleeding, vaginal discharge or pelvic pain. Typically, a pap smear may not show the malignant cells in the specimen. When the diagnosis is made, management may be debated due to its rarity and lack of standard treatment. Surgery, chemotherapy, chemo-immunotherapy and radiotherapy, either alone or in combination, are the treatment options.  Most patients respond well to chemotherapy and radiation therapy. The prognosis is usually favorable. Here, we report a case of primary cervical lymphoma in a 50-year-old woman who presented with abnormal vaginal bleeding. She was treated with radiotherapy and chemo-immunotherapy and remained disease-free after nine months of treatment.