Current Women's Health Reviews - Volume 12, Issue 2, 2016

The aim of the present review was to summarize research methods, benefits, recommendations, current trends and determinants of physical activity (PA) with a focus on women. In the research methods section, models, difficulties of measurements and assessment methods of PA emphasizing questionnaires were included. The beneficial role of PA was presented separately for the various forms of PA (e.g. leisure, school physical education). The recommendations section presented the last guidelines provided by international organizations for optimal PA levels. The section on current trends is aimed to examine to what extent the abovementioned guidelines were met by various populations during childhood, adolescence and adulthood. Lastly, the determinants of PA were presented: school, educational background, periodicity, tracking during childhood and from childhood to adolescence, structured PA programs, social support and companion, facilities and equipment, socio-economic status, promotion and interventions, environment and neighbourhood, ethnicity and family and genetics.

Pre-existing autoimmune disease during pregnancy is infrequent occurring in 1.0-2.0% of pregnant women. Autoimmune diseases (ADs) are not lethal and can co-exist with other autoimmune types. In the present report, ADs were found to produce false positive maternal serum screens for both neural tube defects and Down syndrome. The course of ADs is highly influenced by maternal and placental proteins, hormonal factors, and cytokines. Such agents appear to serve as protective factors at the induction and effector stages of the immune response during pregnancy. During second and third trimester pregnancies and in postpartum, autoimmune-afflicted patients experience stages of remissions and relapses. Most remissions occur in the second and third trimesters when soluble immunoprotective factors attain peak levels. Some plausible immunosuppressive factors include quad biomarkers and pregnancy associated glycoproteins such as alpha-fetoprotein, human chorionic gonadotrophin, dimeric inhibin-A, and unconjugated Estriol. The mechanism of remission of ADs is not fully understood but is associated with induction of an immunosuppressive and/or immunotolerant state coincident with the presence of known and unknown soluble factors.

Background: The use of botulinum toxin for gynaecological indications is becoming increasingly established for women whose conditions remain refractory to conventional treatment. In this review we assessed the current available literature detailing the use of botulinum toxin to treat detrusor overactivity, painful bladder syndrome, vaginismus, localized vulvodynia and chronic pelvic pain. Methods: A review of literature was undertaken using the key words “botulinum toxin”, “vaginismus”, “vulvodynia”, “vulval vestibulitis”, “detrusor overactivity”, “overactive bladder”, “interstitial cystitis”, “painful bladder syndrome” and “chronic pelvic pain”. All relevant publications between 1985 and 2016 form the basis of this review. Results: The only licenced use of botulinum toxin is detrusor overactivity. Other uses include vaginismus, painful bladder syndrome, chronic pelvic pain and localized vulvodynia where there is some evidence for its use. The best evidence available is for detrusor overactivity where multiple randomised trials and two systematic reviews have been published. Further research is needed to determine long-term outcomes and the most effective regime for using botulinum toxin for detrusor overactivity. Three randomised controlled trials and multiple prospective non-randomised studies have been published regarding the use of botulinum toxin for painful bladder syndrome. This seems an effective treatment, but further research is needed. Evidence for the use of botulinum toxin for vaginismus, localized vulvodynia and chronic pelvic pain is based largely on case series and non-randomised prospective studies. Conclusion: An increasing body of evidence is emerging for the use of botulinum toxin for patients refractory to conventional treatment in these areas. Further good quality research is needed.

Introduction: Earlier, diagnosis of cancer ultimately led to death but now with complex therapies, not only many survive, but they have quality life too. Even preservation of fertility is possible. In addition to this, with early diagnosis, complete cure is possible. Objectives: To look into the existing evidence, challenges and possibilities. Methodology: Simple review of literature was done with the help of various search engines, Pubmed, Google, Uptodate and other databases to evaluate the relevant studies, reviews and short commentaries to get information as per the objectives. Evidence: Because of long-term effects of various cancers and their therapies, problems like quality of life, sexuality and fertility are the real concerns. Gonadal dysfunction is common, especially in gynaecological cancers and their therapies. Germ cell tumors of ovary are most common in young girls but with conservative surgery and chemotherapy the results are excellent. Same is true even for stage I epithelial ovarian cancers. Conservative therapies for cervical cancer, conization, simple / radical trachelectomy can do wonders. Endometrial cancer usually occurs after menopause, and there are no standard recommendations for conservative management, which is possible in younger women. Choriocarcinoma is highly malignant but has high cure rate too. So, quality survival is possible. Studies with Breast cancer, Hodgkin lymphoma have also revealed menstrual function resumption after chemotherapy. Presurgery assessment and close follow-up are necessary. Side effects of radiochemotherapy are real. Effects are drug, dose, and age dependent with possibilities of infertility and adverse pregnancy outcomes. Gonadotoxic effects may cause early menopause. Challenges increase if cancer occurs during pregnancy. Preventive Possibilities and Conclusion: Mission of any cancer therapy needs to be quality long life, preservation of pregnancy prospects: natural or assisted. Prepubertal ovary is least susceptible to gonadotoxicity with chances of better reproductive life. Ovarian transposition / shielding or transplantation is possible. Ovarian tissue rather than oocyte or embryo cryopreservation is better. Early diagnosis and safe therapy can do miracles for women who are diagnosed with cancer. Conservative surgery, safe chemotherapy and focused radiation can reduce gonadotoxicity and preserve fertility. Multidisciplinary treatments are essential. Role of psychotherapy is important. For quality survival with reduced risk of cardiac, renal, neurological problems, bone osteoporosis and also for preservation of fertility, therapy needs proper planning for all cancers.

Background: Two techniques for sonographic evaluation of amniotic fluid are Amniotic Fluid Index (AFI) and Single Deepest Pocket (SDP). Objective: To determine the accuracy of Amniotic Fluid Index and Single Deepest Pocket in predicting of postdate pregnancy outcomes. Methods: In this prospective cross-sectional study, 362 pregnant women with gestational age > 40 weeks (postdate pregnancy) were evaluated. Evaluation of amniotic fluid was done for all patients by the measurement of AFI and SDP methods. Pregnancy outcomes and complications including meconiumstained amniotic fluid (MSAF), 5 minutes Apgar score <7, Neonatal Intensive Care Unit (NICU) admission, necessity of cesarean section, and neonatal mortality were evaluated. Sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and positive likelihood ratio were calculated. Results: Sensitivity and specificity of AFI in diagnosis of MSAF were 68% and 47%, respectively which were higher than SDP. We found higher sensitivity in AFI method than SDP in predicting necessity of cesarean section; 85% vs. 68%, respectively. No association was found between abnormal AFI or SDP and 5 minutes Apgar score <7. Conclusion: AFI is a better method for predicting of MSAF, need for NICU admission, and necessity of cesarean section than SDP in postdate pregnancies.

Background: Social capital is a proposed social and contextual factor that affects health. Social capital is a combination of social networks and social cohesions developed in the given networks. In this conventional content analysis study, we explored the role of social networks in women’s health. Methods: Ten semi-structured, in-depth interviews of women (according on data saturation) were conducted in 2014. Transcripts of interviews were analyzed using inductive systematic thematic analysis and the themes were noted and summarized. Results: From analyzing the data, two themes were extracted including “feeling of self-efflorescence” and “health improvement”, by an emphasis on some effective strategies of social networks on health. Conclusions: Social networks can both directly and indirectly result in keeping and enhancing women’s health status. In this regard, feeling of self-efflorescence and health improvement were respectively the indirect and direct paths of the relationship between social networks and health.

Background: Test anxiety is a common problem among Iranian students. In this study, we aimed to evaluate the effect of aromatherapy with lavender on test anxiety. Materials and Methods: This randomized clinical trial was performed from June 2012 to July in Arak 186 female students, who were randomly assigned to the intervention and control groups. After obtaining written informed consents from the participants, they were asked to complete the Test Anxiety Scale once at baseline and once following the intervention. The students in the intervention group received aromatherapy for seven nights. For this purpose, five to six drops of lavender were poured on a cotton ball and held at a 5 cm distance from the nose for 5 min. On the other hand, no intervention was applied for the control group. For statistical analysis, t-test and Chi-square test were performed. Results: The findings showed no significant difference between the intervention and control groups in terms of mild [30 (49.2%)and 25 (58.1%), respectively], moderate[18 (29.5%) and15 (35.7%), respectively], or severe [2 (3.3%) and 1 (2.4%), respectively] anxiety (P=0.232). However, the number of anxiety-free students was higher in the intervention group (n=11), compared to the controls (n=2)(P=0.03). Conclusion: The obtained findings showed that aromatherapy with lavender could increase the number of anxiety-free students. However, no significant difference was found in the severity of test anxiety between the two groups.

Introduction: Mitral stenosis (MS) is the most common type of valvular heart disease leading to maternal and neonatal complications. Balloon mitral valvuloplasty (BMV) is considered as a gold standard treatment for severe MS which does not respond to medical therapy. This study reports a case of emergent balloon mitral valvuloplasty during pregnancy. Case Report: A 35 year-old pregnant woman, G2L1 at 38th weeks of gestation was referred was referred because of dyspnea and orthopnea. Echocardiography revealed Severe MS, Mitral valve area of 0.9 cm and pulmonary artery pressure (PAP): 80 mmHg, ejection fraction (EF): 40%. Urgent BMV was planned. Delivery was carried out 4 hours after BMV without any maternal and neonatal complications. Conclusion: BMV is a safe and effective procedure for the treatment of severe mitral stenosis in pregnancy, even in emergent situation.