Journal of Obstetrics, Gynecology and Cancer Research
Volume:9 Issue: 5, Sep-Oct 2024

To evaluate fertility outcomes in infertile women with severe endometriosis who underwent Frozen embryo transfer (FET) after laparoscopic surgery and assess the optimal time interval between laparoscopy and FET. Number of 215 females with advanced-stage endometriosis were included in this retrospective cohort study. At first embryo were then laparoscopic surgery was performed. Patients received gonadotropin-releasing hormone agonist (GnRH agonist) for the next three months after the laparoscopic surgery.  FET was scheduled during the next several time-points after the laparoscopic surgery. The results of treatment such as live birth, the interval between the operation and pregnancy, improved dysmenorrhea/dyspareunia, and post-operative complications were evaluated. A total of 215 patients with a mean ± SD age of 34.33 ± 6.62 were included, among which, 143 cases (86.2%) had no past medical history. Ninety-three individuals (44%) were referred for the first IVF procedure. The mean ± SD of the infertility period was 4.71 ± 5.43 years.    The mean ± SD number of frozen embryos was 2.53 ± 3.36 and the period between the laparoscopic intervention and IVF was 1.58 ± 2.65 months.  Women with severe endometriosis may benefit from embryo freezing before laparoscopic surgery then FET. The optimal time between laparoscopy and embryo transfer is seemed to be between two and four months.

Cooling the uterus during cesarean section has emerged as one of the non-pharmacological management for blood loss during cesarean section. The aim of this study was to evaluate the effect of uterine cooling during the cesarean section on decreasing postpartum hemorrhage. In this single-blinded randomized clinical trial, a sample of 300 women with a singleton pregnancy, at 37 to 40 weeks gestation, who were scheduled for cesarean section, was divided into two groups of 150 participants. In the intervention group after placental delivery, the uterus was covered with cold saline-soaked surgical sponges at 0-4°C at the time of hysterotomy repair, and the control group received standard cesarean section. The volume of blood loss, the hemoglobin level before surgery and 24 h after surgery, the need for additional oxytocin therapy, and the incidence of adverse effects were recorded. The bleeding volume and hemoglobin concentration reduction were significantly lower in the intervention group than in the control group (260.86± 150.25 Vs 214.35± 83.51, P<0.0001 and 1.24±0.75 Vs 1.54±0.92, P = 0.007 respectively). There were no statistically significant differences between the two groups in the frequency of need for additional uterotonic drugs. (18% vs. 21.33%, P = 0.475.) The use of uterine cooling during cesarean section reduced the volume of blood loss and the rate of decline in hemoglobin concentration.

Primary infertility affects a significant proportion of couples and is often attributed to female factors. Obesity, which is associated with increased levels of the hormone leptin, is a known risk factor for female infertility. The present study was conducted with aim to investigate the association between BMI and leptin levels in females with primary infertility.

This cross-sectional study was performed on 100 women with primary infertility at Al-Nuaman Hospital and Al-Salama private hospital from September 2022 to March 2023. The participants were divided into four groups: Group 1 (normal weight, fertile), Group 2 (overweight infertile), Group 3 (obese infertile), and Group 4 (severely obese infertile) women, each consisting of 25 participants, categorized based on their BMI: normal BMI (18.5–24.9 kg/m²), overweight BMI (25–29.9 kg/m²), obesity BMI (≥30 kg/m²), and severely obese BMI (35-40 kg/m²). The mean leptin levels were compared between the four groups using ANOVA, and the association between BMI and leptin levels was assessed using Pearson''s correlation coefficient.

There was a highly significant correlation between primary infertility and the parameters (BMI and leptin) (P

The endometriosis treatment was critical due to complications associated with current drug delivery system. The present study was conducted with aim to compare the curative effect of Vitamin D3 (VTD3) and Omega–3 (OG3) with Diphereline during the treatment of endometriosis.

In this study, endometriosis was induced in different groups containing 60 adult female rats. The rat model was categorized into 6 groups untreated and treated (Olive Oil (solvent), VTD3 (42 mcg/kg/day), OG3 (450 mg/kg/day), VTD3+OG3, Diphereline (3 mg/kg/day)). The suspension containing combination of Diphereline and supplements was injected and treated for 4 weeks to analyze the effect of supplements. The interleukin -6 (IL-6) and Tumor necrosis factor – alpha (TNFα) inflammatory responses were measured from the serum samples while endometrial implants was dissected and histopathological investigation was done.

At the end of four weeks, pathologic score decreased significantly with simultaneous measurement of inflammation score of endometriotic lesion, size of implant area, IL-6, TNFα response and compared with untreated female rat. No significant different was observed in groups undergoing treatment of VTD3, OG3 and Diphereline. The combined effect of VTD3+OG3 has similar responses with Diphereline treated endometrial implants.

treatment of VTD3 deficiency and making a change in dietary habits of high-risk population for endometriosis from adolescence may also play a preventative role in adulthood.

A competent embryo, receptive endometrium and a series of highly coordinated molecular events between them are all essential for successful implantation. Evaluation of certain molecules which may be used as biomarkers may help to predict pregnancy outcome and detect subtle implantation defect. The present study was conducted with aim to assess the relationship between serum concentrations of adrenomedullin (ADM) and pentraxin3 (PTX3) measured at the day of embryo transfer and successful implantation in assisted reproductive technique cycles.

This prospective cohort study included 88 frozen embryo transfer (FET) cycles. All patients received sequential oestrogen & progesterone medications. Embryo transfer (with a minimum of one top quality embryo) was scheduled after 4 days (D3 embryo), 6 days (D5 embryo) of progesterone administration. The serum ADM and PTX3 levels were analyzed 1 hour before the embryo transfer (ET) using ELISA kits. A possible association between these two markers levels and embryo implantation was evaluated.

Overall, biochemical pregnancy rate was 25% (22/88). Data were then categorized into pregnant (22/88) & non pregnant (66/88). No significant difference were found between the two groups regarding female age, endometrial thickness, number of oocyte collected, oestradiol level (E2), FSH level, grade and number of embryo transferred (p>0.05). The ADM levels were higher on the day of ET, although was not significant in pregnant group (254.60 pg/ml vs 248.18pg/ml). PXT3 levels (pg/ml) were lower in pregnant compared to non-pregnant group (25.396±11.78 vs 28.431±16.51, p=0.428).

Higher ADM and lower PTX3 levels at the day of embro transfer may be associated with successful implantation.

Placenta Accreta Spectrum (PAS) is a condition in pregnant women where trophoblastic tissue attaches abnormally to the uterus myometrium, causing maternal deaths. Major risk factors include placenta previa and cesarean delivery, which is increasing without medical indication. This study was conducted with aim to explore the risk factors of PAS, clinical outcomes of affected patients, and strategies to minimize maternal morbidity and mortality.

A total of 142 women who had undergone at least one cesarean delivery in the past were included. Among them, 85 women had placenta accreta spectrum (PAS) in their current pregnancy (group 1), while 57 did not have PAS (group 2). The information regarding their demographics and previous gynecological history, including placenta previa were collected. P<0.05 was considered statistically significant.

The risk of placenta accreta spectrum (PAS) is significantly higher in cases where there has been a previous cesarean delivery and placenta previa (p<0.05). There were no significant differences between past elective or emergent cesarean delivery (p>0.05). PAS was associated with more emergent cesarean deliveries (p<0.001) and hysterectomies (p<0.001). Moreover, 97% of patients with history of placenta previa developed PAS (p<0.001). Most of the patients who underwent hysterectomy had PAS and placenta previa (p<0.001). There was no significant correlation between previous hysteroscopies and curettages and a higher risk of PAS (p>0.05).

Women with previous cesarean delivery are significantly at risk of placenta accreta in their future pregnancies. Pregnant women should avoid insisting on elective cesarean delivery without medical indication. Planned cesarean delivery could reduce the maternal complications.

The role of the mothers is very important in providing care and monitor their children`s health in general. Their awareness concerning quality of foods which is needed for each child`s developmental stage can effect on nutritional status This Study assess the effect of an nutritional education Program on mother knowledge regarding their children nutritional status.

Sixty moms were chosen from Al-Ayn Social Care Foundation International in Al-Samawah City and take on using a quasi-experimental design. The researcher used a non-probability "purposive sample" and measured the height and weight for child before calculating the body mass index.

The current study found a relationship between moms' educational level and knowledge regard to sociodemographic characteristics with a p-value of .001. However, there were no significant correlations observed between mothers' knowledge in the control group and their age, level of education, occupation, residency, monthly income, and sources of information.

Following the interventional program on nutrition-related health, the level of knowledge among the mothers in the study group was enhanced. The study suggested that the nutrition education program should be offered to all moms in order to enhance their understanding and enthusiasm regarding the significance of child nutrition. Additionally, it was advised that their education should be regularly updated.

Polycystic ovary syndrome (PCOS) is a complex condition affecting multiple systems in women of reproductive age and can negatively impact quality of life and increase the risk of depressive disorders. The present study was performed with aim to evaluate the quality of life (QOL) and levels of depression in overweight women with PCOS.

This descriptive correlational study was conducted on overweight women with PCOS at the Hospitals of Baghdad in 2023-2024. The selected women completed three questionnaires, including the demographical data form, Depression scale for the Center for Epidemiological Studies Depression Scale (CES-D NIMH), and Questionnaire measuring the well-being and overall standard of living experienced by women diagnosed with polycystic ovary syndrome (PCOSQoL_53). Data were analyzed by SPSS software (version 21.0).

The average age of women was 27.5± 7 years and 55% of women were married. Also, the body mass index refers to overweight among 94% of women and 45% were at moderate risk of possible Major Depressive Disorder (31.26±9.873), but 28% with severe symptoms at risk of probable MDD. There was no significant difference in depression among overweight women regarding their age group, marital status, occupational status, monthly income, residency, while there was significant difference in depression among overweight women with regard to level of education (P= 0.010). There was significant relationship between quality of life among overweight women and marital status (P=0.008); however, there was no significant relationship among quality of life and age, level of education, occupation, monthly income, and residency.

The findings revealed a moderate level of depression with several major depressive disorder’s symptoms among women with different age groups and educational and occupational status. Overweight was the main risk factor and cause major depressive disorder as well as level of depression which increases due to PCO symptoms.

To evaluate the risk of uterine rupture during pregnancy, researchers use two-dimensional (2D) transvaginal ultrasound to assess lower uterine segment (LUS) thickness in the third trimester of pregnancy. This study aimed to compare the thickness of the LUS provided in a 2D transvaginal ultrasound with the findings during a cesarean section (C/S) of pregnant women with a history of previous C/S. This cross-sectional study was performed on 40 pregnant women referred to Izadi Obstetrics and Gynecology Hospital in Qom. All the women underwent transvaginal ultrasound followed by C/S within a maximum of one week later. Also, an expert gynecologist classified LUS thickness into four grades in the operation room. The mean age of women was 31.58 ± 4.56 years, and the mean thickness of the LUS was 2.17 ± 0.51 cm. Moreover, 57.5% of the women have graded I of LUS based on intraoperative findings. Results indicated that the mean thickness of the LUS measured by ultrasound significantly differed between the three grades detected by the gynecologist (P=0.04). However, there were no significant differences between maternal age, gestational age, parity, and time of last C/S among women with different LUS grades (P˃0.05). Transvaginal ultrasound could be helpful in evaluating the risk of scar dehiscence and uterine rupture among women with LUS grades I and II with a history of previous C/S.

The study aims to determine the adverse effects of a mild COVID-19 infection on maternal and neonatal outcomes in pregnant women living in the eastern part of Tehran. In this prospective cohort study, we followed two groups of pregnant women until term and their pregnancy and neonatal outcomes. RT-PCR (reverse transcriptase polymerase chain reaction) positive tests of nasopharyngeal swabs were confirmed in one group, where at least three signs and symptoms associated with COVID-19, and/or chest CT scans identified highly specific findings for the disease were present. The control group is composed of healthy pregnant women tested negative for COVID-19. The study included 319 pregnant women (108 with mild COVID-19 infection and 211 healthy). A higher percentage of mothers with mild COVID-19 infection had preterm births (47.9% vs. 30%, p=0.007), and their neonates required hospitalization more often (45.8% vs. 22.6%, p<0.001). PTB was positively associated with maternal hypertension (relative risk (RR): 5.40), mild COVID-19 infection (RR: 2.05), and older age (RR: 1.05). Among the risk factors for neonatal hospitalization, PTB (RR: 5.94), maternal hypertension (RR: 2.74), and mild COVID-19 infection during pregnancy (RR: 2.57) were significant. The outcomes of pregnancy are significantly impacted by maternal infection with COVID-19, even if it is mild. Preterm births are more likely to happen in mothers with mild COVID-19 infection, and neonates need more hospitalizations.

The study explores human papillomavirus (HPV), a significant cause of cervical cancer, and its potential coinfections with other viruses like human herpes virus type 4 (HHV-4) or Epstein-Barr virus (EBV) and HIV. Next-generation sequencing (NGS) technology is used to analyze viral content in cervical samples from Iraqi women.

Eight cervical samples were collected and processed using Illumina DNA Prep on the iSeq100 System. Viral genomic DNA was isolated and libraries prepared for sequencing.

MetaviralSPAdes assembled contigs from each sample, which were then blasted against the NT database. HPV16, HHV4, HIV, and bovine alpha herpesvirus 5 were among the viruses identified across samples.

Viral coinfections identified through NGS underscore their potential impact on cervical health, emphasizing NGS's diagnostic sensitivity for viral infections not typically detected by standard gynecological methods.

There is disagreement about the correlation between serum 25-OH vitamin D (25OH-D) concentrations and ovarian reserve. The aim of this study was to evaluate the correlation between serum levels of 25OH-D and ovarian reserve parameters, including Anti-mullerian hormone (AMH), Follicle stimulating hormone (FSH), and Antral follicular count (AFC) in the tropical zone.

In this cross-sectional study, 148 infertile women were enrolled. On the third day of their cycles, vitamin D3, FSH, and AMH were measured. An ultrasound scan was done for the measurement of the ovaries AFC. Participants were divided into women with normal ovarian reserve (NOR) and women with diminished ovarian reserve (DOR). Then two groups were compared based on the levels of vitamin D.

Our findings showed that there were significant differences in vitamin D levels between the DOR and NOR groups (11.52±12.24 and 22.74±12.7, respectively), (P value <0.001). The partial Spearman correlation test depicted an inverse relationship between vitamin D and FSH (rho =-0.21, P =0.009). Also, there was a positive relationship between vitamin D and AMH and AFC, (rho=0.27, P=0.001) and (rho=0.39, P< 0.001) respectively.

This study demonstrated that there was an inverse relationship between levels of vitamin D and FSH and a positive relationship with AMH and AFC. It appears that the level of vitamin D is important in DOR.

Endometrial carcinoma (EC) is one of the most common cancers and the fourth most common cancer affecting females, mostly affecting postmenopausal women. EC originates from the endometrium and is further sub-divided into two types that are estrogen dependent; type 1 and type 2 with different gene expression patterns. This research was carried out between December 2021 and August 2022 in the Laboratories of the College of Science/Department of Biology and the other local lab and PCR was employed to establish HOXA11 presence. The aims of the study were to reveal the histological alterations in malignant and benign tumors and normal endometrium and to examine the relationship between HOXA11 levels and clinicopathological parameters including stage, grade, muscle and lymph node invasion, and histological type.  The mean HOXA11 expression values were compared in cancer, benign, and control endometrial patients’ groups. The mean HOXA11 expression level was the lowest in endometrial cancer patients; they had a mean of 0. 24±0. 03, those with benign endometrial tumors had the second lowest with a mean of 0. 94±0. 06, while the control patients had the highest mean expression with 1. 00±0. 07. The comparison of the HOXA11 expression between the endometrial cancer patients and the control group showed a statistically significant difference (P-value >0. 001), thus underlining its diagnostic value. Also, there was a significant difference in the HOXA11 expression means between patients with benign tumors and control patients (P-value = 0. 021). As for HOXA11, the mean expression was relatively lower in the patients with benign endometrial tumors, 0. 94±0. 06 as compared to the control group 1. 00±0. 07. In addition, the mean HOXA11 expression in endometrial cancer patients was 0. 24±0. 03 which was significantly (P-value >0. 001) less than that in benign endometrial tumor patients. These results stress the importance of HOXA11 expression as a diagnostic marker and its possible application in differential diagnosis between endometrial cancer and benign neoplasms and normal tissues.

Activin A, a protein in the TGF-β superfamily, plays a crucial role in reproductive regulation by regulating FSH secretion and activating intracellular signaling pathways. Follistatin regulates FSH secretion, affecting follicle genesis and ovulation, playing a crucial role in reproductive processes, especially in ectopic pregnancy and missed abortions. Missed abortions are often caused by genetic factors like chromosomal abnormalities and maternal hormonal imbalances. Evaluated the blood levels of follistatin and activin A in women diagnosed with ectopic pregnancy and missed miscarriage. Research into how follistatin and activin A regulate physiological processes.

The study included 120 women between the ages of 18 and 45 years, divided into three groups: normal pregnancies (60 women), ectopic pregnancy (30 women), and missed miscarriage (30 women), the gynecology clinic of Baghdad Teaching Hospital for the period from Sept 2023 to Jan 2024.

Activin A and follistatin significantly higher in women with ectopic pregnancy and missed abortions than in the control groups. In addition, compared to patients in the missed abortion group, the ectopic group's incidence was significantly lower.

Serum Activin A and Follistatin levels can be used as indicators of ectopic pregnancy and missed abortion. Serum FST level at cut-off (>5.24) can be used as a novel biomarker of women with missed abortions. Activin A is involved in the regulation of ovarian follicle development and corpus luteum function in females.

Although 1% to 2% of all pregnancies are ectopic, ectopic pregnancy (EP) is the most frequent obstetrical disease leading to maternal mortality and morbidity in the first trimester. The basic diagnostic method for EP is the human chorionic gonadotropin (HCG) test and transvaginal ultrasound. There are some rare EP cases with a negative HCG -beta test.

A 31-years-old woman was referred to the emergency department with hypogastric, periumbilical, right upper quadrant intermittent pain, vaginal bleeding, and prior history of EP 7-months ago that was treated with methotrexate and her intrauterine device had been removed at that time. Her last menstrual period was undetermined. Although the qualitative HCG- betatest was negative (2.08 IU /ml), the ultrasound examination showed an 43×53 mm echogenic, heterogenic complex solid mass in the left adnexa and a large amount of echogenic fluid demonstrating hemoperitoneum. Surgery because of the exceeded abdominal pain, revealed active bleeding in the left salpinx due to a ruptured EP.

Management of patients suspected of EP with a negative HCG-beta test is difficult. In these uncommon cases in an emergency, computed tomography, ultrasound and diagnostic laparoscopy or laparotomy can improve the prognosis of the patient.

Disorders of sex development (DSD) result from intrauterine defects in sex discrimination. The clinical phenotype differs based on the disease type. Cases with ambiguous external genitalia are diagnosed at birth. However, diagnosis of cases with normal-appearing external genitalia may be delayed until puberty. Here, we report a patient with a pelvic mass and a small uterus that was diagnosed by abdominal ultrasound, in addition to the history of primary amenorrhea and physical examination suggested Swyer syndrome, confirmed by genetic karyotyping. Pathological examination of the surgically removed mass revealed dysgerminoma. Until the age of 19, the patient did not have any idea about 46, XY karyotype, and assumed to be a female. The development of dysgerminoma (as a result of the simultaneous presence of gonadal dysgenesis and Y-chromosome) was another challenge that the patient had to deal with. The diagnosis of this patient at an earlier age could have prevented the development of gonadoblastoma, by removal of the streak gonads. By the presentation of this case, we intend to increase the physician’s awareness about DSDs; earlier diagnosis may help the patient deal with her disease better and reduce the risk of further complications.