Current Women's Health Reviews - Volume 15, Issue 3, 2019

Background: It is known that hormonal imbalances during pregnancy make women more susceptible to dental problems. High levels of progesterone and estrogen during pregnancy, lead to an increased inflammatory response to dental plaque thus causing predisposing to gum diseases such as gingivitis. If untreated, gingivitis leads to chronic periodontitis which may manifest systemically in form of cardiovascular, endocrine or even respiratory disorders. Also, hyperacidity in the oral cavity due to gastric reflux and vomiting leads to decreased pH thus damaging the tooth enamel making the oral cavity more prone to tooth decay and tooth loss. Studies also show that periodontal disease can also lead to adverse pregnancy outcomes such as pre-term and low birth weight babies. Objectives: We sought to understand the role of oral health in pregnancy. Methods: We identified major articles of interest in the field of oral health in pregnancy and drafted a mini-symposium based on relevant information. Conclusion: Regular dental visits and cognizant efforts to sustain a healthy oral environment can help women in the prevention and treatment of dental issues during pregnancy. The paper highlights the common oral manifestations during pregnancy and their local and systemic impact on the body during pregnancy. Furthermore, it also emphasizes the importance of good oral health practices to counteract the oral complications and the significance of oral health awareness in pregnant women.

Background: Preeclampsia complicates 2-8% of all pregnancies worldwide and is one of the leading causes of maternal and neonatal morbidity and mortality. It occurs after the 20th week of gestation and is characterized by high blood pressure, proteinuria or end-organ disease. The heterogeneous and multi-systemic nature of this disease has led to the elusive pathophysiology which delays timely diagnoses and the clinical treatment of those affected. Objective: Despite the extensive investigations surrounding the inclusion of various potential markers for PE prediction, early diagnosis remains unresolved. Quantification of copeptin, a stable component of the arginine vasopressin (AVP) precursor is shown to be relatively reliable in confirming the circulating levels of AVP. Conclusion: Elevated copeptin levels confirmed in pregnant women have also provided clinical support for its role in PE development. However, its clinical use in predicting disease severity in early-onset pre-eclampsia has been debatable. This review thus recapitulates the current literature surrounding copeptin and its potential as a risk indicator for PE development.

Background: The use of assisted reproductive techniques, in addition to mental and emotional stress in different stages, made some jurists, as fatwa authorities, to investigate and evaluate the problems of this type of transplantation. Objective: The aim of this study was the jurisprudence investigation of the rules and effects of ovarian transplants in women with infertility. Methods: This study was conducted through review and library studies using the keywords ovarian transplants, infertility, jurists’ opinions and religious rules as to ovarian transplantation. Results: Permission for transplanting one’s own ovarian tissue was issued through the consent of most scholars of Islamic schools and according to some verses, traditions, legal rules, and logical reasons. Although some of the Ancient religious scholars have dissenting opinions about transplantation, for some jurists, ovarian transplant from a woman to an infertile woman has no legal problem and the infant belongs to the recipient. However, some other jurists oppose this fatwa. They believe that there is a problem in the oocytes and ovarian transplantation due to mixed parentage and the holy legislator does not agree with this transplantation. So, they had opposing fatwa in this regard. Conclusion: According to the consensus of some Muslim jurists on ovarian transplant from one’s own ovary or from another woman, there is a new hope for infertile couples to use this method which is done from a woman to another woman.

Background: Cervical cancer is the second leading malignancy for women. In developing countries, it is becoming a public health trouble in adult women. Persistent cervical infection with high-risk human papillomavirus (HPV) may contribute to the development of cervical cancer. The danger is in the fact that woman with HPV can go unnoticed for years. So, women with early cervical cancer and pre-malignant neoplastic disease show no symptoms, until cancer becomes invasive and grows into the nearby tissue. A large number of females die from the disease each year due to late diagnosis and resistance to conventional treatment. In particular, in advanced tumor stage, low response to chemotherapy results in poor prognosis and recurrence. Therefore, new therapies and indicators are needed to overcome chemo-resistance as well as early diagnosis of cancer. There is a continuous search for prognostic and predictive markers in order to help optimize and personalize treatment for improvement in the outcome of cervical cancer. Recent Findings: Non-coding regulatory RNAs that control gene expression at the posttranscriptional level are seeking the attention of scientists in this area. Certain microRNAs have been located near cancer susceptibility loci that correlate tumorgenesis. Multiple profiling studies have revealed a significant change in miRNA expression in cervical cancer patients. A number of miRNAs have shown a consistent up-regulation or down regulation throughout the different stages of cervical cancer. Conclusion: Investigation of microRNAs involved in carcinogenesis and progression of cervical cancer in tissue-specific manner is opening a window in early diagnosis and therapeutics.

Background: Menstrual cramps is the occurrence of labor-like pain in the lower abdomen, accompanied by symptoms like nausea, vomiting, diarrhea, headache and dizziness. A natural approach towards the treatment of painful menstruation is the need of the hour to be imparted in mind/body practices to be considered for long-term relief from the pain of menstrual cramp forever. Objective: The current research is aimed at the review of the various aspects of plant alternates serving in different ways to relieve the cramps occurring in menstruation. Materials and Methods: The herbal alternates as relievers were categorized on the basis of the respective role being played by them as nutritional supplements, analgesics, anti-inflammatory and as aromatherapy agents. Results: There are various plant sources which are mild as well as effective relievers of menstrual cramps. This review highlights the various plants which have been proven to be useful in dealing with the various issues of painful menstruation. They deal with all the complications and issues, arising during this time. Conclusion: These herbs are a potent source of active medicaments that strengthens the body to overcome the cramps and pain occurring in menstruation. The demand of the present hour is to rely on the beneficial effects of various herbs, which relieve these complications in the most soothing and efficacious manner.

Background: Available data from South Asia and sub-Saharan Africa indicates that 12% and 34% of girls were married at age 15years and 18years respectively. This practice of child marriage may debar countries from achieving the Sustainable Development Goals. Objective: To extract and present disaggregated indices in the 2013 Nigeria Demographic and Health Survey (NDHS) on the effect of child marriage on health. Method: This desk review study extracted disaggregated maternal and child health indices on married females aged 15-19 years from the 2013 NDHS. Results: The result showed that married females aged 15-19 years were short, thin, and least likely to receive prophylactic Vitamin A dose postpartum and deworming medication at last pregnancy. Also, while awareness for Family Planning (FP) was high, its utilization was poor at only 1.2%. Their Antenatal clinic attendance, facility delivery, skilled birth attendance at delivery and post natal service utilization were lowest. Similarly, mortality of children under 5 was highest amongst these mothers. Although violence during pregnancy was highest amongst this group, nevertheless more than 20% of them agreed that the practice of female circumcision should be continued. Conclusion: These findings depict some of the negative outcomes of child marriage on maternal and child survival which require integrated multisectoral interventions to ensure that all girls have access to timely sexual reproductive health services and information.

Background: Studies have shown pre-natal memory underlining the ability of newborns to discriminate maternal vs. other voices and to recognize linguistic stimuli presented prenatally by the mother. The fetus reacts to maternal voice at the end of gestation but it is important to clarify the indicators and conditions of these responses. Objective: To understand the state of the art concerning: 1) indicators of fetal reactions to maternal voice vs. other voices; 2) conditions of maternal voice required to obtain fetal response, 3) neonatal recognition of maternal voice and of linguistic material presented prenatally and 4) obstetric and behavioral maternal conditions compromising fetal ability to discriminate between maternal and other female voices. Method: Systematic review using EBSCO, WEBSCIENCE and MEDLINE. Eligibility: studies with maternal voice delivered before birth as stimulus and with fetal or neonatal behavior as responses. Results: Fetal responses to maternal voice are observed through fetal cardiac, motor (fetal yawning decrease, mouth opening, fetal body movements) and brain responses (activation of the lower bank of the left temporal lobe). Newborns’ head orientation and non-nutritive sucking are shown as being neonatal indicators. Conclusion: Gestational age, baseline measures (fetal state, acoustic conditions and pre-stimulus time) and obstetrical conditions may enable or compromise fetal discrimination between maternal and other voices. The role of maternal voice for prenatal human bonding needs to be discussed according to different maternity conditions such as surrogate mothers. A new paradigm is suggested; the focus of research should be on maternal-fetal interaction under the presence of maternal voice.

Background: Cystectomy for ovarian endometriomas is commonly performed, however recent publications have shown a deleterious effect of cystectomy on ovarian reserve. Objectives: The study aimed to evaluate what effect laparoscopic cystectomy for ovarian endometriomas has on the ovarian reserve. Methods: This is a prospective cohort study performing standard laparoscopic cystectomies for ovarian endometriomas. The primary outcome was the assessment of the ovarian reserve using Anti-Müllerian hormone (AMH), done pre- and six months postoperatively. Secondary outcome was spontaneous pregnancy during follow up. Results: We enrolled 59 participants. Twenty-five participants were lost to follow up and a further 3 were excluded from the analysis. The average age was 33.1 years. Thirty-one participants completed the six months follow up. The mean preoperative and postoperative AMH value was 3.21ng/mL [95% CI: 2.24 - 4.18ng/mL, SD 2.64] and 1.48ng/mL [95% CI: 1.06 - 1.91ng/mL, SD 1.17] respectively: equating to a 53.89% decline, P=0.002. Twenty participants had unilateral cysts whilst the remaining 11 had bilateral endometriomas. The mean preoperative and postoperative AMH for unilateral cysts was 3.22ng/mL [95% CI:1.93 - 4.51ng/mL, SD 2.76] and 1.82ng/mL [95% CI: 1.23 – 2.41ng/mL, SD 1.26] respectively, representing a 43.48% decrease, P=0.072. Of the 11 with bilateral endometriomas, the mean preoperative AMH was 3.19ng/mL [95% CI: 1.49 - 4.89ng/mL, SD 2.54] with 0.88ng/mL [95% CI: 0.43 - 1.33ng/mL, SD 0.67] representing the postoperative AMH, equating to a 72.41% reduction, P=0.005. Conclusion: Serum AMH is negatively affected by laparoscopic cystectomy for ovarian endometriomas, with a significant decline in ovarian reserve as measured six months postoperatively. A greater decline was seen in patients with bilateral endometriomas compared to unilateral disease.

Background: Accurate timing for diagnosis and treatment of latent tuberculosis (LTB) is important to reduce morbidity and mortality for both mother and child. Objectives: To investigate the prevalence rate of LTB and its associated factors during pregnancy using gamma interferon (IFN- γ) release assay (IGRA). Methods: A cross-sectional facility-based study carried out in Kassala hospital, Eastern Sudan between January and March 2015. Results: Two hundred and forty-nine women were enrolled in this study and 18.1% (45/249) had confirmed positive for M. tuberculosis infection using IGRA. The mean age, parity and gestational age of the LTB patients were 29.6 (4.4), 2.2 (1.2) and 21.9 (8.8), respectively. The vast majority of these patients was of rural residence (72.7%), housewives (91.1%) and illiterate (73.3%). More than half (25, 55.6%) gave a history of contact with tuberculosis patients, 26.7% (12/45) were vaccinated and 11.1% (5/45) had a medical history of diabetes mellitus. In logistic regression model, while age, parity, education, occupation, size of family members, smoking, BCG status and medical history of diabetes mellitus were not associated with latent tuberculosis during pregnancy, history of contact with TB patients (OR=13.5; CI=5.6 to 32.5; P<0.001) and rural residence (OR=0.3; CI=0.1 to 0.7; P=0.006) was significantly correlated to LTB in pregnancy. Conclusion: Thus, screening of all pregnant women living in high burden setting of tuberculosis is recommended even in the absence of overt clinical signs of the disease.

Background: Malaria is extended to more than 90 countries of the world, and is also considered as a major public health and socio-economical problem. Objective: The aim of this study is the elucidation of malaria on metabolic activities in pregnancy. Material and Methods: A total of 60 patients with gestational vivax malaria were recruited in this study, and 60 healthy pregnant women were selected as a control group. These women were selected using simple random sampling technique. A sample of 5 ml venous blood was drawn from each patient, centrifuged at 5000 rpm for 20 minutes to separate the serum. The serum samples were analyzed for enzyme activity such as Alkaline Phosphatase (ALP), Creatine Phospho Kinase (CPK), Lactate Dehydrogenase (LDH), and Serum Glutamic Oxaloacetic Transaminase / aspartate aminotransferase (SGOT/AST) by using kit method on Microlab 300 and trace metal content Magnesium, Iron, Copper and Zinc (Mg, Fe, Cu, and Zn) by Atomic Absorption Spectroscopy (Varian AAS Model A-20). Results: There was an increased level of Alkaline Phosphatase (ALP), Creatine Phospho Kinase (CPK), Lactate Dehydrogenase (LDH), and Serum Glutamic Oxaloacetic Transaminase / aspartate aminotransferase in sixty pregnant women suffering from vivax malaria as compared to the control subjects. Whereas, the low concentrations of serum iron, copper, magnesium and zinc were observed in patients as compared to the control subjects. Conclusion: The findings of this study suggest that in order to enhance the immunity and develop resistance towards malaria during pregnancy, it is necessary to balance enzyme activity and provide diverse metals in the therapy to cure this disease.

Background: Male medical student interest in the field of obstetrics-gynecology has significantly decreased in the last three decades. A perceived patient preference for female obstetrician- gynecologists (Ob-Gyn) and subsequent gender differences in clinical productivity and compensation may influence this trend. Objective: To explore how provider gender affects clinical productivity and salary among obstetrics- gynecology generalists. Methods: An analysis of productivity and salary data for generalist Ob-Gyns employed by an academic integrated health system was performed. Gross charges, net collections, physician payroll information, work relative value units (wRVUs), new and existing patient encounter volumes and clinical full-time equivalent (FTE) status were compared year over year by physician gender using a repeated measures ANOVA test. Results: On average, male providers earned a numerically higher salary in each year studied, but when the entire timeframe was evaluated, there was no significant difference in salary nor total productivity between women and men (p=0.19 and 0.15, respectively). There was a gender difference in how total productivity was achieved, with women seeing twice as many new patients (p= 0.0025), and men achieving higher average wRVUs per patient encounter (p=0.02). Conclusions: There was no significant difference in total productivity and there was no significant difference in salaries between male and female Ob-Gyns. However, there were differences in the type of care that contributed to productivity by gender. Female providers saw a higher proportion of new patient encounters, while male providers accrued a higher wRVU per encounter, likely as a result of higher procedure volumes. These findings are an encouraging sign that men are not disadvantaged in terms of productivity in obstetrics-gynecology and that compensation models such as the one in this system can promote fair payment in mixed-gender physician groups.