Journal of Obstetrics, Gynecology and Cancer Research
Volume:9 Issue: 1, Jan-Feb 2024

Epigenetic silencing of MLH1 in endometrial cancers is associated with larger tumor volume, increased rate of lymph node positivity, and reduced recurrence-free survival The aim of this study was to determine which of the two drugs of ibuprofen, as a common non-steroidal anti-inflammatory drugs NSAID, and acetaminophen would have the least effect on postpartum hypertension in patients with preeclampsia. Clinicodemographic data including age, gestational age at delivery, body mass index, parity, and route of delivery, were collected through interviews with patients and reviewing patient records. In this double-blind clinical trial, among 84 patients included in the study, 42 patients were randomly assigned into the acetaminophen (650 mg every 6 to 24 hours) and 42 patients into the ibuprofen (600 mg every 6 to 24 hours) group. The two groups were not significantly different in terms of mean age (p = 0.322), body mass index (p = 0.950), route of delivery (p = 0.657), parity (p = 0.818), and mean systolic (p = 0.530) and diastolic blood pressure (p = 0.691). Following the intervention, the duration of blood pressure control (p = 0.182), mean systolic blood pressure (p = 0.371), and mean diastolic blood pressure (p = 0.13) were not significantly different in the acetaminophen and ibuprofen groups. There was no significant difference between the two groups in terms of the number of patients and the dosage of opioids used. The results revealed that in patients with preeclampsia, acetaminophen and ibuprofen to control postpartum pain have a similar impact on blood pressure.

The highest mortality rate in gynecologic cancers is attributed to ovarian origin. Expression of the estrogen and progesterone receptors (ER and PR); and Human epidermal growth factor receptor 2 (Her2/neu) in endometrial cancer and breast cancer were found to be associated with the response to treatment and prognosis. However, because of inconsistent results from previous studies, the data regarding ovarian cancer are still inconclusive. Current retrospective cross-sectional study was performed on 234 tissue samples of different types of ovarian tumors (benign, borderline and malignant) from the archive of the University Kebangsaan Malaysia Medical Center during 10 years. Tissue microarrays were constructed on representative areas from formalin fixed paraffin embedded tissue blocks using ER, PR and HER2 immunohistochemical staining. Prevalence of ER and PR overexpression was 36% and 35% in benign, 8% and 24% in borderline tumors with 51% and 46% in malignant tumors, respectively. ERα overexpression was more common among serous malignant ovarian tumors (49%) (p<0.001). PR positivity was more prevalent in serous benign tumors (p=0.02).There was no significant relationship between stage and the status of ERα (p=0.12) and PR (p=0.19). Her2/neu overexpression was only seen in borderline neoplasms (8%) and malignant mucinous tumors (4%). No association was found between Her2/neu overexpression and the level of tumor differentiation, tumor stage, size, and patient’s age. The observed ERα positivity in serous carcinoma and Her2/neu overexpression in malignant mucinous tumor, could be considered as a clue for choosing therapeutic agents. The role of anti-HER2 therapy in clear cell carcinoma is still debated and needs more investigations.

  The initial diagnosis of predictive markers is essential for the IUGR. High levels of PAPP-A lead to increased levels of free IGF-1, which in turn reflects the function of the placenta and the fetus normal growth. The objective of this study was to compare the level of PAPP-A in pregnancy weeks 11-14 in women with and without intrauterine growth restriction and to assess the ability of this marker to predict adverse outcomes in pregnancy.   In this Comparative Cross-sectional study, 227 pregnant women were studied during 2017. Mothers were divided into two main groups with and without intrauterine growth restriction. The relevant data, including birth weight, preeclampsia, gestational diabetes, Apgar score, and PAPP-A, were recorded on special forms. Data analysis was done using SPSS-21 software.  The mean age of participating women in this study was 28.8 ± 5.6 years. The median (IOR) number of gravidity and Gestational weight gain was 1 (1) and 12 (7) kg respectively. The difference in median (IOR) PAPP-A in patients with and without IUGR was statistically significant 0.64(0.57) and 1 (0.57), respectively, P= 0.001.The cut-off point for PAPP-A was 0.73 with a sensitivity=72.2% (95% CI: 64.32-79.16%) and a specify =60.5% (95% CI: 48.65 -71.56%).  The results of this study confirm the relationship between low levels of PAPP-A and adverse outcomes of pregnancy. In the present study, the optimal cut-off point (0.73) is higher than other studies, which can be due to racial and epidemiological differences.

The presence of air in the catheter was found to affect the success of embryo transfer into the uterine cavity. This study determined the chances of achieving pregnancy using the intrauterine insemination (IUI) method with different air volumes inside the IUI catheter.  

This clinical trial study was performed on 521 IUI cycles among 270 couples from 2013 to 2014. The patients were divided into three groups (each group of 90 patients), based on three volumes of air inside the catheter (0.0 ml, 0.5 ml, and 1 ml). Other variables, include the woman’s age, menstrual cycle status, duration of infertility, type of infertility, sperm morphology, total motile sperm count (TMSC), number of motile sperm inseminated (NMSI), and pregnancy rate or the success rates of IUI were evaluated.

The mean age of women and men were 33 and 30 years, respectively. Based on three volumes of air inside the catheter (0.0 ml, 0.5 ml, and 1.0 ml), the pregnancy rates were 5%, 9.4%, and 16.5%, respectively. TMSC of more than 5.6x106 and NMSI of more than 3.4x106 were associated with the chance of IUI achievement. At the same time, there was no significant relationship between the woman’s age, irregular menstrual cycles, and duration of infertility with the success rate of IUI. We found that the air volume of 1.0 ml inside the IUI catheter significantly increased the pregnancy rate compared to other groups.

The volume of air within the catheter had a significant relationship with the success rate of IUI.

Studies have shown contradictory results regarding the use of pregabalin and melatonin as analgesic agents. Because the analgesic effects of these drugs as preemptive have not been compared in abdominal hysterectomy, one of the most common surgical procedures in women with moderate to severe pain, under general anesthesia. The aim of this study was to compare the pretreatment effects of melatonin and pregabalin on postoperative pain intensity in total abdominal hysterectomy (TAH).

90 Patients were randomly divided to 3 groups (N=30): 1- receive oral melatonin (6 mg), 2- received pregabalin (50 mg), and third who take no drug. Serum melatonin and beta-endorphin levels were measured before and after the surgery. Pain intensity was assessed by the Numerical Rating Scale at 1,6,12, and 24 hours after the surgeries.

At 12 h after the surgery, mean pain intensity in the melatonin group was significantly lower than the pregabalin group, and in the pregabalin group was significantly lower than the third group (P<0.05). At 24 h after the TAH, the mean pain intensity in the melatonin group was significantly lower than the third group (P<0.05).

injection preventive melatonin is more effective than pregabalin to reduce pain throughout the first 24 h after the TAH

 Preeclampsia is a disorder of pregnancy with increased maternal and perinatal morbidity and mortality. The detection of a short femur length, particularly below the 5th centile is often a diagnostic dilemma. It might be associated with fetal growth restriction at the time of the ultrasound examination The purpose of this study was to assess the contribution of short femur diaphysis length (FDL) at 32–37 weeks of gestation in preeclampsia. The study included pregnant women who underwent a routine anomaly scan at 32–37 weeks of gestation at the Shahid Motahari University Hospital (Iran, Urmia) between February 2021 and February 2022. Fetal biometry and Doppler ultrasound of uterine arteries were assessed as part of the anomaly scan, and the mean pulsatility index of both uterine arteries was recorded. Maternal obstetric characteristics, such as ethnicity, age, weight, parity, cigarette smoking, and medical history including hypertension and diabetes mellitus were collected from our database system. the results of the present study illustrated that multivariate analysis of fetal femoral length percentile was associated with maternal age, preeclampsia, and the number of previous pregnancies. Furthermore, the sensitivity and specificity of the 50th-percentile femoral in the diagnosis of preeclampsia were % 96.88 and %81.88  respectively. our results suggest that Short FDL at 32–37 weeks of gestation is a significant relationship with PE.

Uterine fibroids (UFs) the most common pelvic tumors among women at reproductive age affecting women’s quality of life even their confidence with its symptoms. We designed a study to investigate the clinical, laboratory, and imaging characteristics of Iranian women with UF. This cross-sectional study was performed April 2016- September 2022 at Imam Hossein hospital (Tehran, Iran). We included all women with UF referring to the Obstetrics and Gynecology Clinic of Imam Hossein Hospital. Based on a checklist a research team interviewed the patients to investigate clinical characteristics. Also we explored laboratory and transvaginal sonography (TVS) findings of all patients. The mean age of 439 studied patients was 44.47±8.80 years (range: 23-81). The most prevalent underlying disease was hypertension (17.1%), followed by thyroid diseases (15.7%) and diabetes mellitus (13.7%). The patients mainly complained of AUB (abnormal menstrual bleeding) (60.0%), abdominal pain (23.7%). The mean NLR (neutrophil to lymphocyte ratio) and the mean PLR (platelet to lymphocyte ratio) were significantly higher than the normal upper limit (P<0.001). Largest diameter of UF was 49.89±47.92 mm. Most fibroids were located anteriorly (43.1%). The multivariate linear regression model revealed that age (β=-0.931, 95%CI= (-1.657, -0.204), P=0.012) and number of fibroid (β=22.418, 95%CI= (16.360, 28.476), P<0.001) could predict the size of fibroid. Our results showed that NLR and PLR were increased in UF patients. It seems that patient’s age and number of fibroid may be the predict factors for UF's size. Keywords: Abnormal Uterine Bleeding, hypertension, Neutrophil, Leiomyoma, Lymphocyte, Ultrasonography.

Evaluation of the alpha-fetoprotein is one of the screening tests during pregnancy. The purpose of this study was to determine the relationship between the level of alpha-fetoprotein in amniotic fluid (AF-AFP) and adverse pregnancy outcomes. This comparative analytical study was performed on 244 pregnant women who referred to a private prenatal clinic in Rasht (Iran). Amniocentesis was performed on pregnant women with maternal serum alpha-fetoprotein (MS-AFP) was higher than 2.5MoM in the second trimester and based on this finding, participants were divided into four groups of 61 patients. The first group (control group) included pregnant women with normal MS-AFP, the second group included pregnant women with high MS-AFP and normal AF-AFP, the third group included pregnant women with high MS-AFP and low AF-AFP and the fourth group included pregnant women with high MS-AFP and high AF-AFP. Adverse outcomes include abortion (6.6%), stillbirth (6.6%), IUGR (18%), LBW (29.5%), PTL (21.3%), fetal abnormalities (4.9%), preeclampsia (14.8%), gestational diabetes (8.2%), in the fourth group (high AF-AFP) was higher than other groups. The incidence of adverse pregnancy outcomes in the fourth group was 1.2 times higher than the control group, and this relationship was borderline statistically significant (P=0.056). Considering that adverse pregnancy outcomes are important causes of mortality and morbidity, early diagnosis of high-risk pregnancies and efforts for preventive interventions can be associated with reducing mortality and morbidity. Therefore, evaluation of the level AF-AFP can be helpful in determining adverse pregnancy outcomes.

In this placebo-controlled randomized clinical trial, we aimed to investigate the effect of low molecular weight heparin (LMWH) on the assisted reproductive technology (ART) success rate in women without thrombophilic disorder undergoing assisted reproductive technology.

The study population consisted of 276 patients referred to the infertility center at Shiraz University of Medical Sciences and who underwent in vitro fertilization (IVF) for the first time. Patients were randomly assigned into two groups (control group = 137 women who underwent IVF and received placebo; case group = 139 women who underwent IVF and received LMWH). The case group was treated with LMWH and the control group received placebo. Specifications for egg harvesting, processing sperm, the number of fertilized eggs and embryos, the number of frozen and transferred embryos, and the IVF outcome were assessed.

The mean age of subjects was 32.59 ± 4.41 years old in the case group and 32.62 ± 5.18 in the control group (p = 0.955). The final outcome of IVF treatment in the control group was treatment failure (62%), clinical pregnancy (21.2%), chemical pregnancy (5.9%), and live birth (7.3%), while in the case group, it was treatment failure (48.2 %), clinical pregnancy (21.6%), chemical pregnancy (2.2%), and live births (28.1%). There was a significant difference in IVF outcome in the two groups (P < 0.001).

Given the significant difference in the number of live births and reduction of pregnancy complications in the LMWH group, it can be concluded that LMWH prophylaxis may be effective in ART success.

To evaluate the effect of weight gain in lean patients with polycystic ovary syndrome (PCOS) on ovulation and pregnancy rates. Lean patients with PCOS seeking fertility were invited to participate in the study. Weight gain was commenced by dietary modifications. Patients were classified later into respondent and non-respondent. All patients were stimulated with Letrozole 2.5 mg twice daily for five days for six cycles. Ovulation and pregnancy rates were assessed.   From 84 patients who were enrolled in our study, 33 patients were allocated into non responder group and 28 patients were allocated to the responder group, and it was found that despite there was statistical difference between both groups as regard weight gain, weight after six months and BMI after six months, there was no significant difference between both groups as regard the ovulation rate, pregnancy rate and complications to ovulation induction ovarian hyperstimulation syndrome (OHSS). weight gain in lean PCOS patients - although non-significant- but it may improve the reproductive outcomes (ovulation rate and pregnancy rate) and the need of further study with larger number and longer duration of follow up for confirmation of these results.

Urinary tract infection is one of the most common asymptomatic infectious diseases during pregnancy, which is mostly caused by Escherichia coli infection, which, if not diagnosed and treated, causes harm to the mother and the fetus.

In a cross-sectional study of 50 pregnant women who referred to the outpatient clinic of Zabol hospital center after completing the questionnaire and examining the patients by obstetrician and gynecologist and ensuring that they were healthy, a sterile mid-stream urine sample was prepared and examined and diagnosed in terms of a complete urine test and placed were and Escherichia coli samples were separated from other colonies by diagnostic tests. The characterization of ZnO-NPs was performed by, Fourier-transform infrared spectroscopy, scanning and transmission electron microscopes, and X-ray diffraction.  The antimicrobial activity of ZnO-NPs synthesis in Eucalyptus was studied both in vitro against E. coli clinical isolates from woman.

The results of the analyzes showed that the zinc oxide nanoparticles were synthesized in a polyhedral to round shape and the size of the nanoparticles was 21 nm. The results of the antibiotic resistance pattern investigation showed that the most sensitive to the antibiotic amikacin was and also the minimum inhibitory concentration of synthetic zinc nanoparticles was equal to 1500 μg/ml.

In this study, it was found that aqueous extract of Eucalyptus leaves has the ability to produce zinc nanoparticles oxide nanoparticles have been synthesized from zinc sulfate, and the synthetic nanoparticles have shown good antimicrobial properties against antibiotic-resistant Escherichia coli bacteria.

Ectopic pregnancy (EP) is one of the important issues in the field of obstetrics and gynecology. Proper assessment of fallopian tube patency following medical treatment of an EP in women who wish to have future children seems reasonable. Therefore, the purpose of this study was to investigate the patency of fallopian tubes after clinical and surgical treatment of EP. In this quasi-experimental study, our research population was 270 people who were referred to Ali-Ibn-Abitaleb hospital in Zahedan with a definite diagnosis of EP in 2020. Patients were divided into three groups: drug treatment (90 people), surgical treatment (90 people) and expectant treatment (90 people). For each patient, the patency of the left and right fallopian tubes was investigated and the obtained data were statistically analyzed by t-test and chi-square test methods using SPSS software version 22 (IBM, USA). A total of 270 patients were examined. The mean age of the patients in the drug treatment, surgical therapy and expectant treatment groups were 32.34 ± 6.17, 32.02 ± 6.12 and 32.12 ± 6.40 years, (P=0.389). Moreover, there was no statistically significant difference between the right fallopian tubes (P=1.00), and the left fallopian tubes in the investigated groups (P=0.08). Based on the results of this study, there was no statistically significant difference between the drug treatment and the surgery treatment groups. The findings of this study revealed that the uterine tube opening was similar on both sides after drug treatment, surgical treatment and expectant treatment.

Inducing labor is a common practice in obstetrics to prevent maternal and fetal complications. There are several methods of labor induction, including pharmacological and mechanical approaches. The objective of this study was to determine the most effective approach for labor induction. A cross-sectional study at Al-Kadhimiya Teaching Hospital compared labor induction in pregnant females at their third trimester using Misoprostol & Foley Catheter (group A) and Misoprostol alone (group B). The study collected data on maternal age, gestational age, BMI, time frames, mode of delivery, and neonatal outcomes such as Apgar scores and ICU admissions. In a cross-sectional study comparing labor induction with Misoprostol & Foley Catheter (group A) vs. Misoprostol alone (group B), most females in both groups had no cesarean section inductions, normal vaginal deliveries, and no complications. The study found significant differences in BMI, time frame, and time for ripening between the two groups, with group A having lower values for these variables. Foley's with vaginal misoprostol results in a shortened time between induction and delivery than misoprostol alone.

Although the safety of cesarean sections has increased, there are still considerations, especially for women with a history of repeated cesarean sections. This study was conducted with the aim of investigating maternal and neonatal outcomes in candidates for cesarean sections due to repeat cesarean sections according to the number of previous cesarean sections.

This prospective descriptive study was conducted from April 2020 to June 2022 at Taleghani Hospital. All candidates for cesarean sections due to repeated cesarean sections were included in the study. According to the number of previous cesarean sections, they were divided into three groups. Statistical analysis was performed with Kruskal-Wallis, Chi-squared and Fisher’s exact tests. A P value < 0.05 indicated statistical significance.

 A total of 345 women were included in the study. The results of this study showed that these three groups were significantly different in terms of duration of surgery (P<0.001), abnormal placental adhesion (0.012), and the presence of intraperitoneal adhesions (P<0.001), but there was not a significant difference in terms of other maternal and neonatal outcomes (P<0.05).

The results of this study showed that an increase in the number of previous cesarean sections does not increase most maternal and neonatal complications during a current cesarean section. Of course, it should be noted that the number of women with a history of three or more previous cesarean sections was small in this study, and for this reason, more studies are needed.

Invasive angiomyxoma as a mesenchymal tumor with a high recurrence rate has been reported mainly in reproductive age according to its association with the estrogenic level of plasma. Above that, it seems there is a need for further treatment despite complete resection of the tumor, to eliminate the hormonal state. In the present study, we sought to introduce a rare case of invasive angiomyxoma in a post-menopausal but high-risk woman, discuss the relativity of risk factors in all hormonal-dependent gynecological malignancy, and intend to seek help from colleagues' opinions and experiences about treatment. It is clearly of great importance to emphasize the role of individualized medicine in such a rare case, in conclusion, there is not any debate on the role of surgical resection but the necessity of changing in lifestyle or adjuvant systemic or local therapy, and the needed duration is doubtful.

Mucinous carcinoma is a tumor composed of gastrointestinal-type cells with intracytoplasmic mucin. They are unilateral solid-cystic masses. A 38-year-old G2 L2 woman with a complaint of rapidly increasing severe abdominal distension was referred. Surgery was performed and a huge complicated mass showed up. We sucked about 42 liters of brown color fluid out of the cyst and then we could extract the residual mass. Chemotherapy protocol began under the supervision of oncologic service. Despite diagnostic delay, before any dissemination the cystadenocarcinoma was removed. To our best knowledge, our patient had the biggest tumor among other previous case presentations.

Single umbilical artery (SUA) is an uncommon yet clinically noticeable anomaly that has been suspected to be correlated with a wide range of pregnancy complications. We hereby present a 30-year-old pregnant woman who was diagnosed with SUA fetus in the 20th week of her pregnancy and was admitted to our center in the 33rd week. During the hospitalization, Doppler studies were performed to monitor fetal development. Later, fetoplacental insufficiency and brain-sparing effect were reported on Doppler ultrasound, indicating asymmetrical Intrauterine growth restriction (IUGR). SUA might be associated with concurrent fetal anomalies including cardiological, nephrological, gastrointestinal, and nervous disorders. Moreover, there is an increased risk of small for gestational age and IUGR compared with normal pregnancies. It is crucial to assess the umbilical cord anatomy during pregnancy to diagnose SUA at lower gestational ages and schedule a precise follow-up to prevent adverse outcomes.