S. Borna, Azam Tarafdari, Hedyeh Khenar, Amirhossein Zabolian, Ava Ajir, Shima Mohammadi, A. Hosseini
Objectives: This study aimed to evaluate the association between cell-free fetal DNA (cffDNA) levels in the first and second trimesters and adverse pregnancy outcomes. Materials and Methods: This was a retrospective cohort study including all women who had cffDNA measurement as a primary or secondary screening test for chromosomal abnormalities in a screening laboratory in Iran. Results: Totally, 481 out of 634 pregnant women (75.9%) did not develop any pregnancy complications. On the other hand, 55 pregnancies (8.7%) led to preterm delivery. Based on the results, 33 pregnant women (5.2%) gave birth to intrauterine growth restriction (IUGR) babies and 16 pregnant women (2.52%) developed preeclampsia (PE). Moreover, 15 women developed gestational diabetes. Further, 11 pregnancies resulted in abortion and 6 pregnancies led to fetal death. There was a positive association between the duration of pregnancies and the weight of the babies at birth (r=0.362, P=0.000). There was a statistically significant association between the increase in cffDNA level and trisomy (P=0.000) and the decrease in cffDNA level and the incidence of PE (P=0.019). Conclusions: The reduction of plasma cffDNA level in pregnancies led to PE and the elevation of cffDNA results in fetal trisomy. However, further studies will be required to confirm these findings.
{"title":"Association of Cell-Free Fetal DNA at 11-17 Weeks of Pregnancy and the Outcome of Pregnancy","authors":"S. Borna, Azam Tarafdari, Hedyeh Khenar, Amirhossein Zabolian, Ava Ajir, Shima Mohammadi, A. Hosseini","doi":"10.15296/ijwhr.2023.15","DOIUrl":"https://doi.org/10.15296/ijwhr.2023.15","url":null,"abstract":"Objectives: This study aimed to evaluate the association between cell-free fetal DNA (cffDNA) levels in the first and second trimesters and adverse pregnancy outcomes. Materials and Methods: This was a retrospective cohort study including all women who had cffDNA measurement as a primary or secondary screening test for chromosomal abnormalities in a screening laboratory in Iran. Results: Totally, 481 out of 634 pregnant women (75.9%) did not develop any pregnancy complications. On the other hand, 55 pregnancies (8.7%) led to preterm delivery. Based on the results, 33 pregnant women (5.2%) gave birth to intrauterine growth restriction (IUGR) babies and 16 pregnant women (2.52%) developed preeclampsia (PE). Moreover, 15 women developed gestational diabetes. Further, 11 pregnancies resulted in abortion and 6 pregnancies led to fetal death. There was a positive association between the duration of pregnancies and the weight of the babies at birth (r=0.362, P=0.000). There was a statistically significant association between the increase in cffDNA level and trisomy (P=0.000) and the decrease in cffDNA level and the incidence of PE (P=0.019). Conclusions: The reduction of plasma cffDNA level in pregnancies led to PE and the elevation of cffDNA results in fetal trisomy. However, further studies will be required to confirm these findings.","PeriodicalId":14346,"journal":{"name":"International Journal of Women's Health and Reproduction Sciences","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2021-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82826744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
P. Dini, S. Aminimoghaddam, Setare Nassiri, Vahid Kaveh, S. Sadeghi, S. Moslemi
Introduction: Tuberculosis is relatively common in reproductive age and thereby can be observed in pregnancy. Some of the clinical presentations of tuberculosis overlap with nonspecific symptoms that are found in normal pregnancy. Therefore, delay in diagnosis is understandable. The aim of our study is to indicate that tuberculosis is related to sanitary inadequacy and crowding and should be considered in every patient with such circumstances. Case Presentation: This case report is about a pregnant woman who referred to us with low-grade fever and ascites and then disseminated intravascular coagulation was observable. Accordingly, several differential diagnoses were considered, and eventually, visceral tuberculosis was detectable. Conclusions: It is recommended that tuberculosis be considered in every patient even without any response to the usual treatments. Extrapulmonary tuberculosis, which is more common in pregnancy, poses a tremendous challenge on the diagnosis and treatment of tuberculosis.
{"title":"Favorable Outcome of Disseminated Intravascular Coagulation in a Pregnant Woman due to Tuberculosis: A Case Report","authors":"P. Dini, S. Aminimoghaddam, Setare Nassiri, Vahid Kaveh, S. Sadeghi, S. Moslemi","doi":"10.15296/ijwhr.2023.16","DOIUrl":"https://doi.org/10.15296/ijwhr.2023.16","url":null,"abstract":"Introduction: Tuberculosis is relatively common in reproductive age and thereby can be observed in pregnancy. Some of the clinical presentations of tuberculosis overlap with nonspecific symptoms that are found in normal pregnancy. Therefore, delay in diagnosis is understandable. The aim of our study is to indicate that tuberculosis is related to sanitary inadequacy and crowding and should be considered in every patient with such circumstances. Case Presentation: This case report is about a pregnant woman who referred to us with low-grade fever and ascites and then disseminated intravascular coagulation was observable. Accordingly, several differential diagnoses were considered, and eventually, visceral tuberculosis was detectable. Conclusions: It is recommended that tuberculosis be considered in every patient even without any response to the usual treatments. Extrapulmonary tuberculosis, which is more common in pregnancy, poses a tremendous challenge on the diagnosis and treatment of tuberculosis.","PeriodicalId":14346,"journal":{"name":"International Journal of Women's Health and Reproduction Sciences","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2021-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77255490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Negin Sodagar, F. Ghaderi, T. Ghanavati, Fareshteh Ansari, M. Asghari jafarabadi
Objectives: Pelvic floor disorders (PFDs) during pregnancy and after delivery, and related risk factors are still debatable topics for research. Thus, the aim of the present study was to assess the probable risk factors associated with PFDs in Iran. Materials and Methods: This cross-sectional study was conducted in two state and private hospitals in Tabriz, Iran from the 1st of June to the 31st of August, 2018. The participants were 650 postpartum women, aged between 15 and 47 years six months after delivery. The type of delivery, type of hospital, history of episiotomy and induction, anesthesia, multiparity, the mother’s birth age, the infant’s weight and head circumference, the mother’s weight gain during pregnancy, and a wide variety of probably related risk factors were studied based on the study objective. According to their answer to the questions of PFDs, 147 women responded yes and completed the Pelvic Floor Distress Inventory-20 questionnaire. Results: Between the investigated risk factors, type of the hospital (OR: 0.27, CI: 0.126-0.564) and the amount of the mother’s weight gain during pregnancy (OR: 1.066, CI: 1.024-1.109) were significantly associated with PFDs. Finally, the number of PFDs and severity of dysfunctions according to PFDI-20 were higher in state hospitals, and excessive weight gain of the mother during pregnancy was related to the higher incidence of PFDs. Conclusions: Type of the hospital and the mother’s weight gain during pregnancy are the only two related risk factors in this study. This study was the first one to discuss the type of the hospital in such related risk factor studies. Accordingly, it is predictable that better supervision of medical attends in state hospitals is highly important for decreasing the rate of PFDs after delivery.
{"title":"Related Risk Factors for Pelvic Floor Disorders in Postpartum Women: A Cross-sectional Study","authors":"Negin Sodagar, F. Ghaderi, T. Ghanavati, Fareshteh Ansari, M. Asghari jafarabadi","doi":"10.15296/ijwhr.2022.10","DOIUrl":"https://doi.org/10.15296/ijwhr.2022.10","url":null,"abstract":"Objectives: Pelvic floor disorders (PFDs) during pregnancy and after delivery, and related risk factors are still debatable topics for research. Thus, the aim of the present study was to assess the probable risk factors associated with PFDs in Iran. Materials and Methods: This cross-sectional study was conducted in two state and private hospitals in Tabriz, Iran from the 1st of June to the 31st of August, 2018. The participants were 650 postpartum women, aged between 15 and 47 years six months after delivery. The type of delivery, type of hospital, history of episiotomy and induction, anesthesia, multiparity, the mother’s birth age, the infant’s weight and head circumference, the mother’s weight gain during pregnancy, and a wide variety of probably related risk factors were studied based on the study objective. According to their answer to the questions of PFDs, 147 women responded yes and completed the Pelvic Floor Distress Inventory-20 questionnaire. Results: Between the investigated risk factors, type of the hospital (OR: 0.27, CI: 0.126-0.564) and the amount of the mother’s weight gain during pregnancy (OR: 1.066, CI: 1.024-1.109) were significantly associated with PFDs. Finally, the number of PFDs and severity of dysfunctions according to PFDI-20 were higher in state hospitals, and excessive weight gain of the mother during pregnancy was related to the higher incidence of PFDs. Conclusions: Type of the hospital and the mother’s weight gain during pregnancy are the only two related risk factors in this study. This study was the first one to discuss the type of the hospital in such related risk factor studies. Accordingly, it is predictable that better supervision of medical attends in state hospitals is highly important for decreasing the rate of PFDs after delivery.","PeriodicalId":14346,"journal":{"name":"International Journal of Women's Health and Reproduction Sciences","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2021-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78359445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hayedeh Hoorsan, M. Simbar, F. Ramezani Tehrani, F. Fathi, N. Mosaffa, H. Riazi, O. Banafshi
Objectives: This review inspects the usage of animal models and the practical solutions of this method for different challenges of endometriosis. The objectives of the study are to determine and compare the histopathology, biomarkers, and development of endometrial lesions in murine homologous and heterologous endometriosis models. Methods: The literature search was performed on PubMed, Scopus, Web Cochrane, and EMBASE from January 1990 to January 2019. Experimental articles in which the establishment of the endometriosis model had been proven through the examination of size, weight, number of implants, adhesion, histologic score, and altered biomarker were eligible for inclusion. Results: Based on type of induction, articles were categorized into two groups: heterologous-induced method (n=5) and autologousinduced method (n=13). In general, in case of establishing the heterologous induction method is less reliable than the autologous induction method. Conclusions: Using human endometrial tissues for endometrial inductions is possible in heterologous models under immunosuppression, which is more suitable for therapeutic studies, but time limitation considerations are mandatory for this type of model. Homologous endometriosis inductions cause larger endometrial lesions, biomarkers, and reproduction rate changes similar to those occurring in humans. Similarities make this method more appropriate for pathogenesis and genetic studies and also observe the impact of endometriosis on the next generation. Choosing an appropriate model for the induction of endometriosis is dependent on the purpose of each study.
{"title":"Murine Models of Endometriosis: A Systematic Review","authors":"Hayedeh Hoorsan, M. Simbar, F. Ramezani Tehrani, F. Fathi, N. Mosaffa, H. Riazi, O. Banafshi","doi":"10.15296/ijwhr.2022.23","DOIUrl":"https://doi.org/10.15296/ijwhr.2022.23","url":null,"abstract":"Objectives: This review inspects the usage of animal models and the practical solutions of this method for different challenges of endometriosis. The objectives of the study are to determine and compare the histopathology, biomarkers, and development of endometrial lesions in murine homologous and heterologous endometriosis models. Methods: The literature search was performed on PubMed, Scopus, Web Cochrane, and EMBASE from January 1990 to January 2019. Experimental articles in which the establishment of the endometriosis model had been proven through the examination of size, weight, number of implants, adhesion, histologic score, and altered biomarker were eligible for inclusion. Results: Based on type of induction, articles were categorized into two groups: heterologous-induced method (n=5) and autologousinduced method (n=13). In general, in case of establishing the heterologous induction method is less reliable than the autologous induction method. Conclusions: Using human endometrial tissues for endometrial inductions is possible in heterologous models under immunosuppression, which is more suitable for therapeutic studies, but time limitation considerations are mandatory for this type of model. Homologous endometriosis inductions cause larger endometrial lesions, biomarkers, and reproduction rate changes similar to those occurring in humans. Similarities make this method more appropriate for pathogenesis and genetic studies and also observe the impact of endometriosis on the next generation. Choosing an appropriate model for the induction of endometriosis is dependent on the purpose of each study.","PeriodicalId":14346,"journal":{"name":"International Journal of Women's Health and Reproduction Sciences","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2021-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90944936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
E. Akbari, F. Sarbazi, A. Karimi, B. Nouri, Shahla Noori Ardebili
Objectives: Myomas are the most common non-malignant pelvic neoplasm in women’s reproductive life. The aim of present study was to compare the outcome of large myoma Laparoscopy in Iranian reproductive-age women. Materials and Methods: This cross-sectional study was conducted on 86 women with symptomatic uterine myoma who underwent laparoscopic myomectomy between December 2013 and October 2018. Participants were divided into two groups based on the myoma weight (<80 (n=15) and ≥80 g (n=71)). Finally, age, body mass index, number of myomas removed, duration of surgery, postoperative hospitalization, amount of blood transfusion, and hemoglobin reduction were compared between the two groups. Data were analyzed by SPSS software version 22. Results: The mean age of participants were similar in both groups (P=0.48). There were no significant differences between the two groups regarding body mass index (P=0.56) and indications for laparoscopic myomectomy (P=0.46). The mean weight of myoma and duration of surgery were significantly different between the two groups (P<0.001 and P<0.007, respectively). Changes in hemoglobin and days of hospitalization after surgery were not significantly different between the two groups. Conclusions: The length of hospital stay and blood loss in laparoscopic myomectomy did not differ significantly based on myoma weight. So, laparoscopic myomectomy could be considered a minimally invasive alternative for managing symptomatic large myoma.
目的:子宫肌瘤是女性生殖期最常见的非恶性盆腔肿瘤。本研究的目的是比较伊朗育龄妇女大肌瘤腹腔镜检查的结果。材料与方法:本横断面研究对2013年12月至2018年10月期间行腹腔镜子宫肌瘤切除术的86例有症状的子宫肌瘤患者进行了研究。根据肌瘤重量(<80 g (n=15)和≥80 g (n=71))将参与者分为两组。最后比较两组患者的年龄、体重指数、肌瘤切除数、手术时间、术后住院时间、输血量、血红蛋白下降情况。数据采用SPSS软件22进行分析。结果:两组患者平均年龄相近(P=0.48)。两组患者的体重指数(P=0.56)和腹腔镜子宫肌瘤切除术的指征(P=0.46)差异无统计学意义。两组肌瘤的平均重量和手术时间差异有统计学意义(P<0.001和P<0.007)。两组患者术后血红蛋白及住院天数变化无明显差异。结论:腹腔镜子宫肌瘤切除术的住院时间和出血量与子宫肌瘤重量无显著差异。因此，腹腔镜子宫肌瘤切除术可以被认为是治疗有症状的大肌瘤的微创选择。
{"title":"Comparison of Laparoscopic Myomectomy Outcomes Based on Myoma Weight: A Cross-sectional Study","authors":"E. Akbari, F. Sarbazi, A. Karimi, B. Nouri, Shahla Noori Ardebili","doi":"10.15296/ijwhr.2022.04","DOIUrl":"https://doi.org/10.15296/ijwhr.2022.04","url":null,"abstract":"Objectives: Myomas are the most common non-malignant pelvic neoplasm in women’s reproductive life. The aim of present study was to compare the outcome of large myoma Laparoscopy in Iranian reproductive-age women. Materials and Methods: This cross-sectional study was conducted on 86 women with symptomatic uterine myoma who underwent laparoscopic myomectomy between December 2013 and October 2018. Participants were divided into two groups based on the myoma weight (<80 (n=15) and ≥80 g (n=71)). Finally, age, body mass index, number of myomas removed, duration of surgery, postoperative hospitalization, amount of blood transfusion, and hemoglobin reduction were compared between the two groups. Data were analyzed by SPSS software version 22. Results: The mean age of participants were similar in both groups (P=0.48). There were no significant differences between the two groups regarding body mass index (P=0.56) and indications for laparoscopic myomectomy (P=0.46). The mean weight of myoma and duration of surgery were significantly different between the two groups (P<0.001 and P<0.007, respectively). Changes in hemoglobin and days of hospitalization after surgery were not significantly different between the two groups. Conclusions: The length of hospital stay and blood loss in laparoscopic myomectomy did not differ significantly based on myoma weight. So, laparoscopic myomectomy could be considered a minimally invasive alternative for managing symptomatic large myoma.","PeriodicalId":14346,"journal":{"name":"International Journal of Women's Health and Reproduction Sciences","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2021-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77962122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Amini, M. Ranjkesh, S. Nikanfar, A. Fattahi, L. Farzadi, K. Hamdi
Objectives: The dynamics of blood flow in the endometrium plays a crucial role during the implantation process. This study aimed to assess the uterine perfusion during the follicular phase in patients with a history of recurrent implantation failure (RIF) and healthy fertile women using the transvaginal ultrasound color Doppler method. Materials and Methods: To this end, 50 patients with RIF and 50 age-matched healthy fertile women were recruited in this case-control study. The transvaginal color Doppler ultrasonography was used to evaluate the pulsatility index (PI) and resistance index (RI) of the uterine, arcuate, and sub-endometrial arteries during the follicular phase in both groups. Results: The RI and PI of both right and left uterine arteries were higher in the RIF group compared to the fertile women (P<0.05). Our results showed that the PI and RI of sub-endometrial blood flow and the RI of arcuate arteries were substantially higher in the group with a history of RIF in comparison with the control group. However, the PI of arcuate arteries was not significantly different between the groups. Conclusions: Adequate uterine perfusion and sub-endometrial blood flow are necessary to achieve successful implantation and pregnancy since our results demonstrated the higher resistance of uterine and sub-endometrial arteries in patients with a history of RIF. Thus, the assessments of uterine perfusion indices during the follicular phase could be used as a non-invasive method in the evaluation of patients with RIF.
{"title":"Alterations of Uterine Blood Flow During the Follicular Phase in Patients With Recurrent Implantation Failure: A Doppler Ultrasonographic Study","authors":"M. Amini, M. Ranjkesh, S. Nikanfar, A. Fattahi, L. Farzadi, K. Hamdi","doi":"10.15296/ijwhr.2021.40","DOIUrl":"https://doi.org/10.15296/ijwhr.2021.40","url":null,"abstract":"Objectives: The dynamics of blood flow in the endometrium plays a crucial role during the implantation process. This study aimed to assess the uterine perfusion during the follicular phase in patients with a history of recurrent implantation failure (RIF) and healthy fertile women using the transvaginal ultrasound color Doppler method. Materials and Methods: To this end, 50 patients with RIF and 50 age-matched healthy fertile women were recruited in this case-control study. The transvaginal color Doppler ultrasonography was used to evaluate the pulsatility index (PI) and resistance index (RI) of the uterine, arcuate, and sub-endometrial arteries during the follicular phase in both groups. Results: The RI and PI of both right and left uterine arteries were higher in the RIF group compared to the fertile women (P<0.05). Our results showed that the PI and RI of sub-endometrial blood flow and the RI of arcuate arteries were substantially higher in the group with a history of RIF in comparison with the control group. However, the PI of arcuate arteries was not significantly different between the groups. Conclusions: Adequate uterine perfusion and sub-endometrial blood flow are necessary to achieve successful implantation and pregnancy since our results demonstrated the higher resistance of uterine and sub-endometrial arteries in patients with a history of RIF. Thus, the assessments of uterine perfusion indices during the follicular phase could be used as a non-invasive method in the evaluation of patients with RIF.","PeriodicalId":14346,"journal":{"name":"International Journal of Women's Health and Reproduction Sciences","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86058414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: An abnormal passage connecting the skin and the uterus is the uterocutaneous fistula. It is rarely observed after a cesarean section or a gynecological surgery involving the uterus. The presence of an infection further complicates the management. In countries such as India where tuberculosis is highly prevalent, Mycobacterium tuberculosis should be ruled out. Case Presentation: A 29-year-old nulliparous woman who had undergone a laparotomy for removal of a large fibroid for primary infertility presented with complaints of abdominal pain and discharge from the scar site. These symptoms did not resolve with antibiotics and analgesics. An ultrasonography was performed and a fistulous tract extending up to the endometrium was revealed. She underwent a laparoscopic resection of the fistulous tract following which she was symptom free. Conclusion: One of the rarely observed complications following laparotomies and cesarean section is a uterocutaneous fistula. It is even rarer in women with no previous pregnancies. The management involves adhesiolysis and layer by layer closure of the uterus and abdomen wall after excising the tract. Most often a repeat laparotomy is performed to treat the condition, but in the current times it is well known that repeated open surgeries in the peritoneal cavity increase the chances of adhesions which can reduce the chances of pregnancies in nulliparous women. Hence, this article shows a successful outcome of laparoscopic uterocutaneous fistula repair.
{"title":"Laparoscopic Repair of a Post-myomectomy Uterocutaneous Fistula in a Nulligravida: A Case Report","authors":"A. Rao, Saravanan Nanjappan","doi":"10.15296/ijwhr.2021.41","DOIUrl":"https://doi.org/10.15296/ijwhr.2021.41","url":null,"abstract":"Introduction: An abnormal passage connecting the skin and the uterus is the uterocutaneous fistula. It is rarely observed after a cesarean section or a gynecological surgery involving the uterus. The presence of an infection further complicates the management. In countries such as India where tuberculosis is highly prevalent, Mycobacterium tuberculosis should be ruled out. Case Presentation: A 29-year-old nulliparous woman who had undergone a laparotomy for removal of a large fibroid for primary infertility presented with complaints of abdominal pain and discharge from the scar site. These symptoms did not resolve with antibiotics and analgesics. An ultrasonography was performed and a fistulous tract extending up to the endometrium was revealed. She underwent a laparoscopic resection of the fistulous tract following which she was symptom free. Conclusion: One of the rarely observed complications following laparotomies and cesarean section is a uterocutaneous fistula. It is even rarer in women with no previous pregnancies. The management involves adhesiolysis and layer by layer closure of the uterus and abdomen wall after excising the tract. Most often a repeat laparotomy is performed to treat the condition, but in the current times it is well known that repeated open surgeries in the peritoneal cavity increase the chances of adhesions which can reduce the chances of pregnancies in nulliparous women. Hence, this article shows a successful outcome of laparoscopic uterocutaneous fistula repair.","PeriodicalId":14346,"journal":{"name":"International Journal of Women's Health and Reproduction Sciences","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80750771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objectives: Maternal mortality rate (MMR) in Indonesia was reported to be 305 per 100,000 live births. Preeclampsia is the first target to decrease because it is one of the preventable pregnancy complications. Currently, preeclampsia has patterns for treatment from early detection to delivery; therefore, reasonable chances of decreasing the MMR rapidly and significantly should be considered in Indonesia. Materials and Methods: The reasons for choosing preeclampsia for reducing MMR included an early detection method, availability of affordable medication for the prevention of preeclampsia, development of a national guideline for medical practice regarding preeclampsia, establishment of health institutions by government and the private sector in remote areas, and availability of sufficient health personnel. Results: Early detection of risk factors of preeclampsia is of great importance. Recommended preventive medication includes a combination of acetyl salicylic acid and calcium for 12 weeks for a high-risk group. National guidelines for the management of preeclampsia should be distributed to all hospitals including those covered by national health insurance. Conclusions: The goal of zero mother mortality preeclampsia program is to make policies for all health workers and the general public so that the prevention process can take place. Delivery of all cases with hypertension should be performed in the hospital without exception so no delivery should be performed at home without specialist supervision.
{"title":"Zero Mother Mortality Preeclampsia Program: Opportunity for a Rapid Acceleration in the Decline of Maternal Mortality Rate in Indonesia","authors":"Adhi Pribadi","doi":"10.15296/ijwhr.2021.30","DOIUrl":"https://doi.org/10.15296/ijwhr.2021.30","url":null,"abstract":"Objectives: Maternal mortality rate (MMR) in Indonesia was reported to be 305 per 100,000 live births. Preeclampsia is the first target to decrease because it is one of the preventable pregnancy complications. Currently, preeclampsia has patterns for treatment from early detection to delivery; therefore, reasonable chances of decreasing the MMR rapidly and significantly should be considered in Indonesia. Materials and Methods: The reasons for choosing preeclampsia for reducing MMR included an early detection method, availability of affordable medication for the prevention of preeclampsia, development of a national guideline for medical practice regarding preeclampsia, establishment of health institutions by government and the private sector in remote areas, and availability of sufficient health personnel. Results: Early detection of risk factors of preeclampsia is of great importance. Recommended preventive medication includes a combination of acetyl salicylic acid and calcium for 12 weeks for a high-risk group. National guidelines for the management of preeclampsia should be distributed to all hospitals including those covered by national health insurance. Conclusions: The goal of zero mother mortality preeclampsia program is to make policies for all health workers and the general public so that the prevention process can take place. Delivery of all cases with hypertension should be performed in the hospital without exception so no delivery should be performed at home without specialist supervision.","PeriodicalId":14346,"journal":{"name":"International Journal of Women's Health and Reproduction Sciences","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91077707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Parvin Mostafa Gharabaghi, Masumeh Bakhshandeh Saraskanrood, Manizheh Sayyahmelli, M. Jafari, Elahe Saheb Olad Madarek, Maryam Vaezi, V. Rahmani, A. Adili, Malahat Ebrahimpour, Atieh Amidfar, Maryam Pourbargi
Objectives: In this study, radical hysterectomy, followed by neoadjuvant chemotherapy (NACT) in patients with locally advanced cervical cancer (LACC) was compared with radical hysterectomy in patients with early-stage cervical cancer. Material and Methods: This retrospective comparative observational study was performed on 13 patients with LACC International Federation of Gynecology and Obstetrics (FIGO) stage IB2-IIB who underwent a radical hysterectomy after NACT between March 2014 and November 2018. This group was compared with 18 patients undergoing radical hysterectomy with cervical cancer FIGO stage IIA-IB1 in the same period of time. Results: In the NACT group, 8 (61.5%) and 5 (38.4%) patients were in stages IIB and IB2, respectively, and 13 (72.2%) cases were in the IB1 stage in the non-NACT group. Post-operative blood transfusion in the NACT group was significantly higher compared to the non-NACT group [5 (38.4%) patients versus 0, P = 0.008]. The estimated blood loss (EBL) and operative time were similar between the groups. Finally, there were no significant differences in terms of intra-operative and other post-operative complications. Conclusions: Radical hysterectomy after NACT in women with LACC seems to be safe and reduces the need for radiation in patients with NACT who are at stage IIB. These results need to be confirmed in studies with a larger patient sample.
{"title":"Radical Hysterectomy With and Without Neoadjuvant Chemotherapy in Patients With Cervical Cancer Stage IB-IIB","authors":"Parvin Mostafa Gharabaghi, Masumeh Bakhshandeh Saraskanrood, Manizheh Sayyahmelli, M. Jafari, Elahe Saheb Olad Madarek, Maryam Vaezi, V. Rahmani, A. Adili, Malahat Ebrahimpour, Atieh Amidfar, Maryam Pourbargi","doi":"10.15296/ijwhr.2021.37","DOIUrl":"https://doi.org/10.15296/ijwhr.2021.37","url":null,"abstract":"Objectives: In this study, radical hysterectomy, followed by neoadjuvant chemotherapy (NACT) in patients with locally advanced cervical cancer (LACC) was compared with radical hysterectomy in patients with early-stage cervical cancer. Material and Methods: This retrospective comparative observational study was performed on 13 patients with LACC International Federation of Gynecology and Obstetrics (FIGO) stage IB2-IIB who underwent a radical hysterectomy after NACT between March 2014 and November 2018. This group was compared with 18 patients undergoing radical hysterectomy with cervical cancer FIGO stage IIA-IB1 in the same period of time. Results: In the NACT group, 8 (61.5%) and 5 (38.4%) patients were in stages IIB and IB2, respectively, and 13 (72.2%) cases were in the IB1 stage in the non-NACT group. Post-operative blood transfusion in the NACT group was significantly higher compared to the non-NACT group [5 (38.4%) patients versus 0, P = 0.008]. The estimated blood loss (EBL) and operative time were similar between the groups. Finally, there were no significant differences in terms of intra-operative and other post-operative complications. Conclusions: Radical hysterectomy after NACT in women with LACC seems to be safe and reduces the need for radiation in patients with NACT who are at stage IIB. These results need to be confirmed in studies with a larger patient sample.","PeriodicalId":14346,"journal":{"name":"International Journal of Women's Health and Reproduction Sciences","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80159433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Azam Tarafdari, S. Borna, Sheida Janatrostami, S. Hantoushzadeh, F. Keikha
Objectives: There is no consensus on the management of cesarean scar pregnancy (CSP). In this regard, this study proposed an algorithm for CSP management with consecutive outcomes. Materials and Methods: In this randomized clinical trial study, the data of 44 patients with CSP were collected, and the diagnosis was confirmed by transvaginal ultrasonography (TVS). Unstable patients underwent uterine artery embolization (UAE), and the fetal reduction was done for patients with the fetal heart rate (FHR). In addition, patients received systemic methotrexate (MTX) injections according to their beta-human chorionic gonadotropin (β-hCG) levels and then were followed on a predetermined schedule by β-hCG levels and TVS. Finally, prophylactic UAE was considered for patients with ongoing bleeding, placental hypervascularity, and the prospect of limited access to care. Results: Patients were within the age range of 33.9±4.9 years and the gestational age of 7.37±1.57 weeks. Twenty-two patients (50%) had vaginal bleeding, 3 of whom were unstable and underwent UAE. Five patients underwent a total abdominal hysterectomy, and fourteen patients with FHR underwent a fetal reduction. Based on β-hCG levels and changes, and placental vascularity, 4 patients received no treatment. In general, 11, 2, and 9 patients received single, double, and multiple MTX injections. A total of 10 patients underwent both multi-doses of MTX and prophylactic UAE. The median period to reach undetectable β-hCG levels was 7.3 weeks and the median interval to start menstruation was 2.8 weeks. In addition, the pregnancy remnant was resolved 3.6 months after the treatment. On the follow-up, no curettage or hysterectomy was needed and seven patients became pregnant (15.9%), 2 of whom presented recurrent CSP (28.6%). Conclusions: The proposed stepwise algorithm could be employed for CSP management with accountable outcomes, low hysterectomy rates, and fertility preservation.
{"title":"A Preliminary Study to Propose an Algorithm for Management of Cesarean Scar Pregnancy","authors":"Azam Tarafdari, S. Borna, Sheida Janatrostami, S. Hantoushzadeh, F. Keikha","doi":"10.15296/ijwhr.2021.47","DOIUrl":"https://doi.org/10.15296/ijwhr.2021.47","url":null,"abstract":"Objectives: There is no consensus on the management of cesarean scar pregnancy (CSP). In this regard, this study proposed an algorithm for CSP management with consecutive outcomes. Materials and Methods: In this randomized clinical trial study, the data of 44 patients with CSP were collected, and the diagnosis was confirmed by transvaginal ultrasonography (TVS). Unstable patients underwent uterine artery embolization (UAE), and the fetal reduction was done for patients with the fetal heart rate (FHR). In addition, patients received systemic methotrexate (MTX) injections according to their beta-human chorionic gonadotropin (β-hCG) levels and then were followed on a predetermined schedule by β-hCG levels and TVS. Finally, prophylactic UAE was considered for patients with ongoing bleeding, placental hypervascularity, and the prospect of limited access to care. Results: Patients were within the age range of 33.9±4.9 years and the gestational age of 7.37±1.57 weeks. Twenty-two patients (50%) had vaginal bleeding, 3 of whom were unstable and underwent UAE. Five patients underwent a total abdominal hysterectomy, and fourteen patients with FHR underwent a fetal reduction. Based on β-hCG levels and changes, and placental vascularity, 4 patients received no treatment. In general, 11, 2, and 9 patients received single, double, and multiple MTX injections. A total of 10 patients underwent both multi-doses of MTX and prophylactic UAE. The median period to reach undetectable β-hCG levels was 7.3 weeks and the median interval to start menstruation was 2.8 weeks. In addition, the pregnancy remnant was resolved 3.6 months after the treatment. On the follow-up, no curettage or hysterectomy was needed and seven patients became pregnant (15.9%), 2 of whom presented recurrent CSP (28.6%). Conclusions: The proposed stepwise algorithm could be employed for CSP management with accountable outcomes, low hysterectomy rates, and fertility preservation.","PeriodicalId":14346,"journal":{"name":"International Journal of Women's Health and Reproduction Sciences","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2020-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79682683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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