Current Women's Health Reviews - Volume 15, Issue 2, 2019

Background: Diastasis Recti Abdominis (DRA) can occur during pregnancy and postpartum. It is defined as an increase of the inter-recti distance (IRD) beyond normal values. The diagnosis of DRA is inconsistent within the literature and varies depending on measurement instrument and activity during measurement (rest versus active curl-up). DRA is characterized by the stretching of linea alba (LA) and contributes to a protrusion of the anterior abdominal wall due to increased laxity in the myofascial system that supports abdominal viscera. DRA has been postulated to affect lumbopelvic support and function due to laxity of the LA and altered angle of muscle insertion, but recent studies have not confirmed this. Risk factors for the development of DRA have been investigated in pregnancy to 12-months postpartum. Objective: Rehabilitation for DRA has been traditionally focused on reducing the IRD, but recent research has proposed that a sole focus on closing the DRA is suboptimal. Results: It is important alongside the rehabilitation of the abdominal wall that there is the consideration of the pelvic floor (PF). In healthy individuals, with the activation of the transversus abdominis, there is a sub-maximal co-contraction of the PF muscles. This co-contraction can be lost or altered in women with urinary incontinence. An increase in intra-abdominal pressure without simultaneous co-contraction of the PF may cause caudal displacement of the PF. Conclusion: The aim of this review is to bring the reader up to date on the evidence on DRA and to propose a rehabilitation framework for the whole abdominal wall in DRA with consideration of the impact on the PF.

Background: Postpartum is an important phase of life after childbirth. It needs to be highly important as in terms of health in future life. This time brings lots of complications with it. Lots of aspects need to be looked after as the care of the new mom is essential to bring back her stamina and strength. Objective: The objective of this review article is to explore the heeding power hidden in nature for returning back to the mothers to the pre-pregnancy state. There are various areas of concern after postpartum to heal up the body overall, such as to heal up the uterus, providing galactagogues, nutritives, maintenance of hormones and restoring back the strength and tone of the abdomen. Materials and Methods: A literature search has been done on the various herbs, which fulfill the various desired aspects to be looked after post pregnancy. Results: There are various herbs present in nature, regarding their hidden potential still the awareness is not up to the mark. This review highlights the various plants which have been proven to be useful in dealing the post-pregnancy issues. They deal with all the aspects of complications and issues occurring post pregnancy. They heal the uterus which has undergone so many types of changes, maintains the balance of hormones back, besides providing nutrition and increasing the production of milk, they also restore back the tone and strength of the walls of the abdomen. Conclusion: These herbs are full-fledged with the phytoconstituents that heal the whole system after delivery. The need of present time is to take patiently these as the source of medicines regularly under medical supervision to overcome the various concerned problems of post pregnancy.

Background: The use of effective contraceptive methods must be encouraged among adolescents, not only to prevent unintended pregnancies but also to promote the sexual health and well-being of these young people. In effect, hormonal contraceptives offer several benefits beyond prevention of pregnancy to every woman, in particular to adolescents (e.g., dysmenorrhea, irregular bleeding, hirsutism, acne); moreover, they can be a targeted therapy for some gynecological diseases (e.g., endometriosis, polycystic ovary syndrome), to ensure a better quality of life. Objective: The purpose of this article is to review the different formulations of COCs for adolescent and young adult women, and analyze their efficacy, safety, and benefits of specific pathological conditions. Methods: We screened published literature on PubMed/MEDLINE and Scopus, using as keywords “oral contraceptive” in adolescent and young adult women. We included only articles in English about the COCs, different regimens and formulations. Results: Our literature analysis allows us to underline the important role of COC not only as birth control method, but also as valid treatments for gynecological disorders related to hormonal fluctuations (e.g., dysmenorrhea, irregular bleeding, hirsutism, acne) and pathological diseases, such as polycystic ovarian syndrome (PCOS), endometriosis, with a preventive role for fertility preservation and pelvic inflammatory disease. Conclusion: Adequate, care and competent counseling is the key to achieve good compliance of young women with contraception. Through the “GATHER” method suggested by WHO, health care providers should first evaluate the balance between benefits and risks of hormonal treatment, create an appropriate safety profile and then recommend COC prescription in adolescent and young women.

Background: Binge Eating Disorder (BED) is the most prevalent eating disorder across all age groups. Objectives & Results: Estimates are that it is more common than anorexia nervosa and bulimia nervosa. Unfortunately, there are numerous psychiatric and medical co-morbidities associated with BED which will exert a heavy toll on health care expenditures. However, too often, BED and its relative medical co-morbidities are underdiagnosed by primary care physicians. Conclusion: The relationships between BED, Diabetes Mellitus Type 2, the Metabolic Syndrome components and other medical complications are reviewed here in order to increase awareness of this increasingly common eating disorder.

Background: Urinary incontinence (UI) is a serious medical and social problem for about one-third of women in the world population. It is one of the most common chronic diseases of women. Despite significant improvement in the diagnosis and treatment of this illness, women continue to struggle with the stigma associated with incontinence. Research conducted in the last few years shows the importance of social support in respect of the illness. Aim: The purpose of this study was to determine how people perceive the disease and the influence of social support to deal with UI. Materials and Methods: The study involved 200 women in the age range of 34-78 with a diagnosis of incontinence. All women agreed to fill out an anonymous questionnaire, Acceptance of Illness Scale (AIS) and Disease-Related Social Support Scale (DSRSS). The obtained results were subject to statistical analysis. Results: The greater the social support, the lesser the tendencies to judge the condition in terms of harm. Material support among respondents makes it easier for them to distance themselves from UI. Women having a sense of spiritual, emotional, and global support information found it easier to come in terms with UI. Conclusion: There is a relationship between the perception of disease for women, and social support received by women. Awareness of the availability support in disease allows peaceful thinking about a situation as difficult as UI.

Background: Hyperemesis gravidarum (HG) is a major health burden affecting between 1-2% of all pregnancies. The sequelae of the condition can be fatal. There is current equipoise as to how best to manage the condition; that is inpatient versus outpatient management. Objective: This study investigated the total length of stay for patients diagnosed with HG, comparing those who were managed as inpatients as opposed to those managed in a day case setting. A case control methodology was utilized. Two tertiary referral centres for HG of similar size and demographic were selected. One preferentially used day case management. The other uses inpatient management. Results: In total 61 day, case managed patients and 91 inpatient managed patients were recruited to the study. Adjusting for readmission, total length of stay was 4.08 days for inpatient managed patients compared to 0.39 days for day case managed patients (p=0.0002). Conclusion: Day case managed patients for HG have a significantly shorter length of stay. There is no predictive value in the reviewed serum biomarkers as to the likelihood of re-admission.

Background: During fetal development, human placenta undergoes both angiogenesis and vasculogenesis. An imbalance in proangiogenic [placental growth factor (PlGF) and vascular endothelial growth factor] and antiangiogenic factors [soluble fms like tyrosine kinase-1 (sFlt-1), soluble endoglin (sEng)] seems to play an important role in the pathophysiology of preeclampsia. Heme oxygenase-1 HO-1 is induced by ROS (reactive oxygen species) and NO (nitric oxide) and was recently discovered to be involved in angiogenesis. Methods: Hence, the present study was designed to analyze the proangiogenic and antiangiogenic role of heme oxygenase-1 and endoglin in maternal and cord blood of normotensive and preeclamptic women. Fifty pregnant women were selected and grouped as group 1 (control, n=25) comprising of normotensive women immediately after delivery; group 2 (study group) comprising of age -and sex-matched preeclamptic women. Study samples were drawn (maternal venous blood and umbilical cord blood) and heme oxygenase-1 and endoglin levels were analyzed by competitive enzymelinked immunosorbent assay. Results: Maternal and cord blood heme oxygenase-1 levels were significantly elevated in preeclamptic mothers as compared to normotensive pregnant women (p<0.001). Serum and cord blood endoglin levels were significantly lower in preeclamptic women as compared to normotensive pregnant women (p<0.001). HO-1/Eng ratio was drastically doubled in preeclamptics as compared to normotensive pregnant women. In normotensive [HO]/ [Eng+ IGF] were lower in normotensive pregnant and drastically increased in preeclamptics. Conclusion: The findings of a present study indicating a shift towards antiangiogenic profile in women with preeclampsia confirm their possible role to induce characteristic clinical manifestations of preeclampsia such as proteinuria and hypertension.

Background: Pregnancy may increase the risk of Human Papillomavirus (HPV) infection because of pregnancy induced immune suppression. The objective of this study was to use a large population-based dataset to estimate the prevalence of HPV infection and its association with adverse outcomes among pregnant women. Methods: We analyzed Pregnancy Risk Monitoring System data from 2004-2011 (N=26,085) to estimate the self-reported HPV infection. Survey logistic procedures were used to examine the relationship between HPV infection and adverse perinatal outcomes. Results: Approximately 1.4% of women were estimated to have HPV infection during their pregnancy. The prevalence of adverse outcomes in this sample was preterm birth (8.4%), preeclampsia (7.5%), low birth weight (6.3%) and premature rupture of membranes (2.8%). Compared to women without HPV infection, HPV infection positive women were much more likely to have had other infections such as chlamydia (9.23% vs. 2.12%, p-value <.0001), Group B Strep (21.7% vs. 10.04%, p-value <.0001), and herpes (7.17% vs. 1.07%, p-value <.0001). After adjusting for other risk factors including other infections, HPV infection was significantly associated with low birth weight (OR: 1.94, 95% CI: 1.14-3.30). Conclusion: The study indicated a potential association between HPV infection and low birth weight. Because pregnant women with HPV infection are at higher risk of other infections, future research may focus on the roles of co-infection in the development of adverse perinatal effects.

Background: Uterine fibroid embolization (UFE) is as an effective alternative to hysterectomy and myomectomy. However, UFE is associated with a wide spectrum of complications including in rare instances thromboembolic events and even pulmonary embolism (PE). Case Presentation: A case of a 36-year-old woman suffering from a symptomatic uterine fibroid is described as follows. The patient underwent UFE and overnight she suddenly collapsed with signs of massive PE. In consequence of cardiopulmonary resuscitation and urgent systemic thrombolytic therapy, cardiac activity was restored successfully. Discussion & Conclusion: This constitutes another report of PE developed following UFE. In the case described here PE occurred 26 hours after the procedure was performed. Before UFE all patients should undergo complete examination for exclusion of pre-existing venous deep thrombosis and coagulopathies.