Journal of Obstetrics, Gynecology and Cancer Research
Volume:9 Issue: 2, Mar-Apr 2024

Ovarian cancer is the second most common malignancy in women worldwide, causing many deaths each year. Chemotherapy is one of the most important therapeutic strategies that can increase the survival of these patients; however, one of the problems in chemotherapy is resistance against platinum treatment. Evaluating the effect of platinum- and non-platinum-based chemotherapy in patients with recurrent platinum-resistant ovarian cancer can enhance our view on this issue. The present review article sought to identify the treating efficacy of platinum and non-platinum-based chemotherapy in patients with recurrent platinum-resistant ovarian cancer by searching scientific databases and examining the aspects of platinum resistance in various articles. Oncological results have shown that ovarian cancer is a deadly disease, and most cases are diagnosed when the cancer spreads outside the ovary and often throughout the entire abdomen. On the other hand, in many cases, disease recurrence is associated with drug resistance. The use of a platinum-free interval has played an important role in its treatment efficacy. Understanding the cause of platinum resistance and discovering strategies to reduce drug resistance, especially to new ones, is very important. The present article suggested oncology teams agree on treatment methods and the best treatment approach against platinum resistance in malignant ovarian cancers and offer a better treatment solution by considering innovative strategies.

Preterm birth is the most important cause of neonatal mortality and morbidity. Finding the best treatment regimen, of antenatal corticosteroids, has been under serious concern. To compare the efficacy of intravascular versus intramuscular betamethasone phosphate on neonatal outcomes in the cases of imminent preterm birth.

A double-blind randomized clinical trial was performed on 136 eligible pregnant women with gestational age of 26- 34 weeks and imminent preterm birth (delivery within 24 hours). They were randomly assigned into two groups. Group A received intramuscular betamethasone phosphate, and group B received a similar dose of betamethasone phosphate intravenously. Women were followed up to delivery, and their neonatal outcomes were compared.

Women of the two groups (68 women in each group), did not show a significant difference in maternal age, BMI, gravidity and parity, gestational age at the time of admission and delivery, history of miscarriage and assisted reproductive techniques, delivery route, sex and weight of newborns, and Apgar score in minutes 1 and 5. The need for NICU admission, duration of hospitalization, neonatal respiratory distress syndrome, surfactant requirement, and intubation were lower in the IV betamethasone group. There were no significant differences between the two groups according to necrotizing enterocolitis, intraventricular hemorrhage, and neonatal death.

Using IV betamethasone, in cases where there is no enough time to complete the 24-hour betamethasone course due to the possibility of impending delivery, may reduce neonatal complications due to quicker onset of action.

The purpose of this study was to compare the effectiveness of Buccal, Vaginal, and Sublingual misoprostol for induction of labor in term pregnancy.

The research was done as an RCT from 2017 to 2018. About 300 participants were randomly allocated to obtain 50 µg Buccal, 25 µg Vaginal, and 50 µg Sublingual misoprostol in Kosar Hospital, Qazvin, Iran. The maternal and fetal complications, Bishop score hour 1, and hour 6 were observed.

There were no differences between fetal complications (p>0.05) and maternal complications (p>0.05) among the three groups. Bishop score hour 1 (P = 0.146), Bishop Score hour 6 (P = 0.704), and total dose (P = 0.15) also were no differences among these groups. Our study found a difference between the three groups (P = 0.015) in achieving standard vaginal delivery within 24 hours, as Buccal, Sublingual and Vaginal groups were performed respectively. The use of Oxytocin in the Buccal group was higher than that of other groups (P = 0.022).

This study found that there is no difference in terms of fetal complications and maternal complications in the three groups, but there was a significant difference in Oxytocin use and vaginal delivery within 24 h from the start of induction.

Despite the high efficacy of the Apgar score in finding respiratory distress, a low Apgar score doesn’t necessarily indicate fetal hypoxia-asphyxia. Umbilical Artery pH (UApH) is one of the best indicators of fetal hypoxia. Therefore, it’s so beneficial to consider these criteria and their relationship with the Apgar score for accurate diagnosis of prenatal respiratory distress retrospectively which reduces the unnecessary cesarean section (CS) rate.

162 full-term (≥259 days) neonates delivered by CS with the diagnosis of decreased fetal heart rate (FHR) were evaluated. 1-min and 5-min Apgar scores and UApH were measured. The correlation between Apgar scores with UApH and the association between UapH and Apgar with the NICU admission were evaluated. The effect of other variables including mother’s age, gravidity, gestational age, birth weight, newborn sex, and causes of decreased FHR on Apgar scores and UApH were studied as well.

The most common cause of decreased FHR was fetal distress, boys had higher weight (P=0.033) and lower UApH (P=0.049) than girls. Other parameters were not different significantly between both sexes. There was a positive correlation between UApH and 1-min and 5-min Apgar scores (r=0.464 and r=0.370 respectively) when controlled for birth weight (P<0.0001). The RR for NICU admission in male acidemic neonates with abnormal 1-min Apgar was 14.05 (CI95%: 5.7-34.6) in comparison to females (RR=1.06, CI95%: 1-1.26).

Mild acidemia (UApH<7.2) at least in a male fetus would be a good predictor for postnatal complications and need for NICU admission. Future studies with more samples are suggested.

Defecatory dysfunction is a common problem among women who are referred for urogynecological care. Pelvic organs prolapse (POP) which is a downward displacement of pelvic organs is one of the common conditions among patients with defecatory problems. This study was planned to evaluate the correlation of obstructive defecatory symptoms with the site and severity of pelvic organ prolapse and the anorectal manometry results.

This cross-sectional study was performed between Dec 2018 and Nov 2019. A total of 150 women with symptoms of defecatory problems were enrolled. Patients were classified in two groups according to each compartment prolapse staging and severity: stage ≤2 and stage >2. The correlation between defecatory symptoms and pelvic organ prolapse examination, anorectal examination and anal manometry were evaluated.

A total of 150 women were evaluated. There was a significant correlation between higher stage of anterior compartment prolapse (cystocele stage>2) and constipation (P=0.035). Although all the defecatory symptoms were more frequent in anterior prolapse stage>2, but the difference was not significant (P>0.05). There was no significant correlation between defecatory symptoms and severity of posterior compartment prolapse. There was a significant correlation between stage>2 of apical prolapse and all the defecatory symptoms (P≤0.05). The abnormal anal resting and squeeze pressure and abnormal balloon expulsion test were more frequent in stage >2 of all compartments prolapse, but the difference was not significant (P>0.05).

Obstructed defecation syndrome was more frequent in patients with higher stages of anterior and apical prolapse. Abnormal manometry results were more frequent in patients with defecatory dysfunction with advanced vaginal prolapse.

Endometrial cancer is the most prevalent type of genital system cancers. It is needed to assess discrimination power of CEA, CA 15-3, CA 125 tumor markers in endometrial cancer patients and moreover in cases with abnormal uterine bleeding. We examined tumor markers (CA 15-3, CA 125, CEA) in differentiating endometrial cancer and unusual uterine bleeding.

The present case-control study was conducted on 60 women with endometrial cancer and evidence of abnormal uterine bleeding who referred to Ali Ibn Abitaleb Hospital in Zahedan in 2021. The sampling method was easy and accessible and was used to collect observation information, examination, and data form data. For data analysis, SPSS software version 26, statistical graphs and independent t-test were used.

The difference in serum levels of CEA marker tumor in patients of case (endometrial cancer patients) and control (abnormal uterine bleeding patients) was statistically significant. Differences in serum levels of CA 15-3 tumor marker in patients between case group (endometrial cancer patients) and control (patients with abnormal uterine bleeding) and difference in serum levels of CA 125 tumor marker in patients between case (endometrial cancer patients) and control groups (bleeding patients) uterine abnormalities were not statistically significant.

Serum level of CEA tumor marker has a statistically significant relationship with endometrial cancer patients and abnormal bleeding patients, but serum tumor marker level CA 15-3 and serum tumor marker CA 125 and with endometrial cancer patients and abnormal bleeding patients do not have.

The aim of this study was to describe the female to male (FTM)transgenders demographic, epidemiologic characteristics and outcomes after laparoscopic hysterectomy and bilateral oophorectomy surgery by one surgeon in FTM transgender people.

This retrospective cohort study on FTM patients that referred to one of the referral centers for transgender surgeries in the capital of Iran (Tehran) since 2016 and 2022. Consecutive method used for sampling method. Data analyzing was done by SPSS, descriptive statistical, Pearson correlation coefficient and t-test.

We identified 105 FTM transgender patients undergoing laparoscopic hysterectomy and bilateral oophorectomy. The mean age was 24.74±5.41 years, and the mean age of first experience of transgender was10.51±3.68 years. There was a significant correlation between transgender and marital status (P<0.04, r= 0.2) and unemployment (P<0.05, r= 0.5). There was a significant correlation between age of first experiences of transgender and educational status (P<0.05, r= -0.1).49.5%of patients have complications after surgery.

Hysterectomy and bilateral oophorectomy by laparoscopic approach may have appropriate outcomes for reassignment surgery. Also, this study suggests that probably less educational, occupational problems occur for transgender patients if they undergo gender reassignment surgery at a younger age.

Sexual activity is a major determinant of health-related quality of life. The aim of this study was to investigate sexual activity in women with polycystic ovary syndrome.

A case control survey was conducted at a tertiary care university hospital (Yas Hospital Complex.). A total of 193 women were enrolled in this study. The Female Sexual Function Index (FSFI) questionnaire was used to assess the sexual dysfunction. In this study, 100 cases with PCOS and 93 healthy controls were studied.

The mean FSFI total score and all domains except orgasm were significantly lower in PCOS patients as compared to healthy controls. With an FSFI score of less than 26.55, sexual dysfunction was found in 62% of PCOS cases versus 18.2% of the control group. Multiple regression analysis showed that FSH and free testosterone were independent predictors of FSFI score. The result showed that more than sixty percent of PCOS women suffer from sexual dysfunction.

PCOS women need to be asked about and managed for sexual dysfunction more frequently than non-PCOS women.

Conservative treatment of placenta accreta spectrum (PAS) become increasingly performed, especially due to acceptance of many obstetricians to preserve the uterus. To evaluate cesarean scar integrity following PAS conservative surgery using Shehata's technique and other conservative techniques because more than one level of pelvic devascularization was used. This cross-sectional study was conducted at Tanta University in the period from June 1, 2019 to October 31, 2022.

All patients underwent conservative uterine sparing technique (Shehata's technique) were assessed by 2 D ultrasound at 6-18 months later to detect the integrity of the CS scar. Fifty women with a history of other conservative treatment of PAS used as control.

Women who were operated with Shehata’s technique showed less incidence of scar dehiscence with less size of scar defects and more thickness of the myometrium over the scar site and more vascularity of these scars.

Shehata's technique resulted in a more integrated scar with less incidence of   dehiscence and more vascularity of the compared to other conservative methods of treatment of PAS. Therefore, it is an effective and safe method in treatment of PAS.

We considered maternal and birth anthropometric features and fetal sex in developing a labor protocol.

A prospective study of 400 mothers, having healthy pregnancies and their newborn singletons in gynecology ward of Alex Ekwueme Federal University Teaching Hospital, Abakaliki. The study adopted a convenient sampling technique to select the volunteers from 1st July to December 2020. Birth and maternal anthropometries; BMI, height, weight, birth head girth (BHG), waist girth (WG), hip girth (HG) and delivery outcomes: birth mode and duration of 1st and 2nd phases of labor, and Apgar score at 1 minute of birth were measured, using Institute of Medicine guidelines.

Maternal age, weight, and HG, and WG at term pregnancy and fetal sex could determine birth mode and weight (P<0.05). The associations for duration of 1st phase of labor and maternal and birth anthropometries were inconsistent. Fetal sex, birth mode and features and maternal anthropometries; body fat, age, BMI and HG were associated with duration of 2nd phase of labor and Apgar score.

Maternal anthropometries predispose birth features, and advance age of mothers, relatively large WHR and fetal macrosomia at term pregnancy could increase duration of 2nd phase of labor and risk of a male birth, developing abnormal Apgar score. The strong association between anthropometric variables of a mother and her baby suggests that anthropometric investigations could enhance the choice of birth mode and minimize vaginal birth complications. The study emphasized on the need of a sex specific state-of-the art anthropometric investigations at term pregnancy.

We aimed to compare sexual function and body image among cervical cancer survivors.

Between August 1, 2016 and January 31, 2019, we conducted a prospective study with 104 participants. The FSFI and the FACT-Cx v.4.0 (B4 and C7) were the measurement tools.

Forty–seven and twelve hundredths percent reported sexual activity, with the surgical group considerably less sexually active than the non-surgical group (63% vs. 100%, P=0.0003). Throughout the follow-up, we found no significant changes in sexual function (P>0.05). A diagnosis of sexual dysfunction was made in 60.58% of cervical cancer survivors, 80.65% following surgery alone, and in 100% after radiotherapy and chemotherapy. In comparison with survivors who did not receive radiotherapy, irradiated survivors had lower FSFI total scores (1.2 vs. 21.4, P T1=0.0001; 2.1 vs. 21.75, P T2=0.0002). In comparison with the non–chemotherapy group, the chemotherapy group's scores were considerably lower (1.2 vs. 21.15, P T1 <0.0001; 2.4 vs. 18.95, P T2=0.004). We detected no significant changes in body image scores (P=0.184). Except for T1 time assessment (2 vs. 3, P T1=0.016), no differences in body image between the surgical and non-surgical groups were found throughout the follow-up (P T2=0.992; P T3=0.207; P T4=0.139).

The rate of female sexual dysfunction was 60.58%, prevailing after therapeutic multimodality, radiotherapy, and chemotherapy. Throughout the follow–up, we discovered no significant changes in sexual activity and function, or in body image. In terms of body image, there were no significant differences between the surgical and non–surgical groups.

Sexual dysfunction is the symptom with the greatest negative impact on the quality of life of cervical cancer survivors. However, the evaluation of sexual function is challenging, and there is ongoing debate concerning its determinants. We aimed to identify predictive variables for sexual function after cervical cancer treatment.

One hundred and four cervical cancer survivors participated in a prospective cohort study that we carried out employing FACT–Cx v.4.0 and FSFI questionnaires.

We developed a beta generalized linear model with a predictive accuracy of 78% (C–index=0.78) and based on vaginal shortening (Cx4) (P=0.077), age (P=0.0002), and ovarian preservation (P=0.01) as risk factors, and functional well–being (P<0.0001) and follow–up duration (P=0.015) as protective factors.

To the best of our knowledge, we may have created the first reliable and internally validated prediction model for cervical cancer survivors based on predictors like vaginal shortening, age, ovarian preservation, functional well–being, and follow–up duration that significantly affect female sexual function as targets for potential intervention.

The aim of the current study was comparison of the effectiveness of intravenous iron sucrose versus oral ferrous fumarate for the treatment of iron deficiency anemia during pregnancy.

This is a prospective randomized clinical trial enrolling 100 pregnant women with iron deficiency anemia who visited the Al-diwaniya Educational Hospital for maternity and children from October 2022 to July 2023 whose ferritin level was less than 15 ng/ml and Hb level was between 70-10.9g/L. They were treated with either intravenous iron sucrose or oral ferrous fumarate for four weeks.  Formerly, patients were allocated into two groups. The patients in the group I received ferrous fumarate pills, each enclosed with elemental Iron 100 mg.  Group II got 100 ml of 0.9% NaCl containing a dose of iron sucrose dissolved in it and calculated by a specific equation. After four weeks, serum ferritin and hemoglobin levels were assessed, and the adverse effects were also monitored.

Comparing hemoglobin levels produces a substantial pre- and post-treatment difference (P=0.001). Serum Ferritin Level harvest significant differences pre- and post-treatment (P=0.001). The post-treatment comparison of the two groups showed a significant difference in each group (P= 0.001).

Maternal iron reserves are more effectively increased by intravenous ferrous sucrose than by oral ferrous fumarate.

The presence of anesthetic drugs in the serum with potential negative effects on hormone concentration and pregnancy rate has been shown in a number of human research. To assess the effects on blood hormone concentration and pregnancy rate of two different medications (remifentanil vs. fentanyl) used for general anesthesia during oocyte retrieval.

the present prospective comparative study was conducted at Iraq's "High Institute of Infertility Diagnosis and Assisted Reproductive Technologies/Al-Nahrain University/Baghdad/Iraq" infertility center and was approved by Mansoura University for its validity. Sixty infertile women who were having (ICSI) for a range of infertility-related reasons that entered the study. The women's ages varied from 20 to 45 years. The study's length was extended from September 2022 to September 2023. According to the general anesthetic protocol for oocyte retrieval, those patients were divided into two groups. Midazolam, propofol, and fentanyl were given to the group one, while remifentanil, midazolam, and propofol were given to the group two.

Compare the hormone levels before and after fentanyl anesthesia. The current study's findings indicated that remifentanil led to a greater pregnancy rate (40.0%) than fentanyl (36.7%). According to the results, there were significantly higher LH levels after fentanyl anesthesia (P = 0.014). However, insignificantly higher FSH (P = 0.481) and prolactin (P = 0.076) levels post-fentanyl anesthesia. Also, significantly higher LH levels after remifentanil anesthesia (P = 0.046), insignificantly higher FSH levels (P = 0.383) and prolactin levels (P = 0.16) after remifentanil anesthesia. In the fentanyl group, the recovery time was substantially longer (P<0.001).

Because of its quicker recovery time and much greater pregnancy rate, remifentanil is preferred over fentanyl in normal general anesthetic treatments for egg harvest in ICSI operations.

Determining the clinical manifestations of COVID-19 in pregnant and recently pregnant women is important to identify risk factors in order to evaluate complications and maternal and perinatal outcomes. The aim of the present study was to investigate the symptoms of COVID-19 in pregnant women and its effects on the newborn.

The Now study was a prospective descriptive study. This research was conducted in 2020 on 101 pregnant women with COVID-19 infection admitted to the intensive care unit in Zabol city, Iran. All studied patients were examined in terms of clinical symptoms, maternal and neonatal complications, and laboratory findings such as WBC and ESR in all patients were checked. Finally, all information was entered into each patient's form and by using SPSS V22 software analyzed.

Number of 101 pregnant women participated in the study, with an average age of 31.09 years. In this study, 93 individuals had PCR positive (92.1%), 84 individuals with COVID+ in CT scan (83.2%), 25 individuals with an underlying disease (24.8%), and 54 individuals with addiction (53.5%). 20 feet (19.8%) were reported. 20 deaths (19.8%) were reported. The average BMI of the participants was 25.46. Among maternal complications, pulmonary involvement (71.28%) the most frequently was reported. Among the hospitalized patients (95 individuals), 25 individuals had underlying diseases. In this population, maternal complications were significantly more reported (P value=0.012). Among neonatal complications, the most common cases of death were IUFD and abortion. 62.1% of the participants had a natural delivery and 63.4% had a term delivery.

Fever, throat redness and swelling, respiratory distress and cough are the most common clinical symptoms and lung involvement is the most common complication of COVID infection in pregnant mothers. In infants, IUFD and abortion were also very common. PCR and CT scan are two high-sensitivity tests for detecting COVID.

Management of hemoperitoneum due to ruptured ovarian cyst in patients on anticoagulation is a dilemma. Low threshold of surgery intervention may increase the risk of some events operatively. There is a trend for less invasive treatment in highly selected patients. We present two cases   of massive hemoperitoneum due to ruptured ovarian cyst that were on anticoagulation. Successful conservative management was done in both of them and one patient, due to refractory abdominal pain, required interventional radiologic drainage, instead of surgery approach with good outcome. Ovulation suppression was started in both of them with regular uneventful follow up heretofore. Less invasive management is preferred in carefully selected patients of hemoperitoneum in women on anticoagulation. Ovulation suppression to avoid recurrence must be emphasized.

Endometrial cancer is the 6th most common cancer in women worldwide. Rarely does occur in the postpartum period. Fifteen cases of endometrial cancer in the postpartum period have been reported before, but the diagnosis of endometrial carcinoma as a cause of secondary postpartum hemorrhage is hardly predicted. A 37-year-old, Para 4, presented two weeks after a cesarean section and had recurrent vaginal bleeding. The patient was treated conservatively. While being observed, vaginal bleeding still occurred with more volume. We decided to perform a total abdominal hysterectomy. Histopathology confirmed a low-grade endometrioid carcinoma of the corpus uteri. Endometrial cancer might cause a secondary postpartum hemorrhage, with the hypothesis that the depth of tumor invasion into the uterine muscle causes a distorted tissue architecture and the formation of new blood vessels that easily disrupt. The most common type of endometrial cancer in a postpartum woman is low grade with a favorable prognosis.