Current Women's Health Reviews - Volume 16, Issue 1, 2020

Background: Phytotherapy is used in developing countries to treat several gynecoobstetric disorders. Objective: This study aimed to collect information on herbal remedies traditionally used for the treatment of gyneco-obstetric disorders in the southeast region of Morocco (Tafilalet). Methods: Field work was undertaken as an ethnopharmacological survey involving 980 women, 60 herbalists and 20 midwives in 6 different areas of the Tafilalet region. Data was compiled using a semi-structured questionnaire via face-to-face interviews. Three quantitative ethnopharmacological indices (the use value (UV), informant consensus factor (ICF) and fidelity levels (Fl)) were calculated. Results: A total of 115 species of plants, belonging to 47 families were identified in this study. The most important species according to their use value were Rosmarinus officinalis (0.40), Lavandula angustifolia (0.35), Origanum vulgare (0.22), Cinnamomum cassia (0.18) and Phoenix dactylifera (0.15). Among the obstetric disorders, the highest ICF values were recorded for menstruation (0.95), female infertility (0.9), and maintenance of pregnancy as well as well-being of fetus (0.87). The analysis showed that the highest Fl value for menstruation was found for Origanum vulgare. (94.07 %) followed by Rosmarinus officinalis (87.29%). For female fertility, the highest Fl value was found in Phoenix dactylifera (77.50%) followed by Lepidium sativum (77.17%). Conclusion: This explorative survey emphasizes the need to preserve and document the traditional healing practices for managing gyneco-obstetric disorders and the valorization of this potential could be important for the improvement of women reproductive health.

Background: Clinicians commonly perform colposcopy directed biopsies on patients with low grade squamous intraepithelial lesion (LSIL) on PAP cytology even when not consistent with clinical guidelines. Objective: We study the association of PAP cytology screening results with cervical intra-epithelia neoplasia (CIN) 2-3 high-grade dysplasia, as confirmed by colposcopy-directed biopsy. Methods: A retrospective study of 263 women with an abnormality on the PAP smear. Multinomial logistic regression was performed with predictors of PAP cytology screening results with the outcome variable of colposcopy-directed biopsy. Results: High grade squamous intraepithelial lesion (HSIL) had significantly increased relative risk for CIN 2-3 (RR: 9.85, 95% CI: 1.84, 52.79, p=0.008). LSIL was not significantly associated with CIN 2-3. In the comparisons of negative with CIN-1, both HSIL and LSIL were not significantly associated with a negative biopsy. Conclusion: HSIL is associated with cervical dysplasia of CIN 2-3 while LSIL is not associated with cervical dysplasia of CIN 2-3. We do not recommend routine biopsies in patients with LSIL cytologic abnormalities unless additional compelling factors exist.

Background: Cesarean section trend has been rising steadily at an alarming rate worldwide, from 6.7 in 1990 to 19.1 in 2014. Objective: The aim of this study was to reduce the high prevalence of Cesarean Section in Iran including North West of country. Methods: This study was conducted, using special package provided by the ministry of health (MOH) to reduce unnecessary CS rate in the university-affiliated hospitals in East Azerbaijan province. Results: The average annual growth rate of decreasing primary cesarean section (CS) varied from 2 to 9% in 2013-2017. Conclusion: Holding training classes, continuous education for midwives and the establishment of a feedback system to obstetricians were found to be among the main factors bringing about the success in eliminating unnecessary CS in the present study. The program might prove to be even more successful through increasing cooperation between obstetricians and anesthesiologists.

Introduction: Nowadays, the most common problem in teenage girls is them facing menstrual disorders that develop secondary osteoporosis in their adolescent period. The locomotor system disorder is noticed more often in girls with adolescence hormone pathology, than in the population. This has an enormous human and socio-economic impact. Osteoporosis is estimated to affect 200 million women worldwide. Objective: The aim of this research is to determine the development of secondary osteoporosis in girls during their adolescent period. Materials and Methods: An analysis of 173 girls aged from 13 to 17 were under our supervision in the children’s clinic sanatorium “Zdravnisa”. Girls were divided into four groups according to their menstrual disorders. Results: As per the correlation analysis data, the influence of steroid hormones level on bone content has a cumulative effect on girls. Conclusions: For patients with oligomenorrhea, secondary amenorrhea, and polymenorrhea, there were disordered correlations of gonadotropic hormones. Correlations between calcium, phosphorus, and magnesium are disordered, which can be proof of mineralization processes disorder. As per the correlation analysis data for the girls with adolescence pathology, there were revealed direct average correlation connections between the concentration of steroid hormones and structural-functional properties of bony tissue. Low concentration of progesterone in the blood of girls with adolescence pathology is one of the main reasons for bone content deficit, development of osteoporosis, and scoliosis progression.

Background: The use of folic acid in the preconception stage can prevent neural tube defects if taken at the right time. Objective: The purpose of this study was to investigate the intake of folic acid in the preconception period and its related knowledge among Iranian women. Materials and Methods: In this cross-sectional study, 230 married women who had decided to become pregnant were selected from health centers using the multistage cluster sampling method in Urmia-Iran, in 2018. The data collection tool was a self-structured, valid, reliable questionnaire consisting of the following parts: women’s demographic data, use of folic acid, and knowledge regarding the use of folic acid and its related benefits. Data analysis was carried out using SPSS v21 software. A P value < 0.05 was considered statistically significant. Results: In this study, the mean age of the participants was 30.73±6.77 years. About 49 (21.3%) women used folic acid supplements in the correct way. The mean score of women's knowledge was 6.20 ± 2.15. The minimum and maximum scores for knowledge were 1-10. There was a statistically significant relationship between taking folic acid with the subject's knowledge about folic acid (p=0.035), family income (p=0.027), women's job (p=0.046), education level (p=0.001) and the number of children (p=0.026). Conclusion: The study revealed that the status of taking folic acid among women and their knowledge concerning folic acid and its related importance were not satisfactory. This finding suggests that there is a need to give emphasis and deliver health education about preconception folic acid supplementation for women.

Background: Prediction of the mode of delivery is crucial for better labour outcome. Recent studies suggest that the angle of progression (AOP), measured using transperineal ultrasound, can substantially aid the assessment of fetal head descent during labor, thereby predicting the mode of delivery. Objective: To assess the ability of the AOP measured by transperineal ultrasound to predict the mode of delivery in nulliparous women before the onset of labor. Methods: A prospective observational study was conducted at our hospital, of nulliparous women who had presented to the antenatal clinic at ≥ 38 weeks of gestation but not in labor. AOP was measured using transperineal ultrasonography and compared among the women having Caesarean section (CS) due to labor dystocia and vaginal delivery (VD). Various other confounding factors which increase the risk of caesarean section were analyzed. Results: Among total 120 nulliparous women, the mean AOP was narrower in patients undergoing CS (n = 28) compared to those with VD (n = 92) (91.6 ± 6.1° vs. 100.7 ± 6.9°; P < 0.01). Multivariable logistic regression analysis revealed that narrow AOP values (OR 3.66; P < 0.001; 95% CI 1.7- 14.5) and occiput-posterior fetal position (OR 1.63; P = 0.04; 95% CI 1.0-7.5) were the independent risk factors for CS. An AOP ≥ 96° (calculated from the ROC curve) was associated with VD in 95% (76/80) of women and an AOP < 96° was observed among 60% (24/40) of women who underwent CS. Conclusion: Narrow AOP (< 96°) and occiput-posterior fetal position are at higher risk for CS due to labor dystocia. AOP measured at the antenatal period could accurately predict the mode of delivery, thereby modifying labor outcome.

Background: Recurrent vulvovaginal candidiasis (RVVC) is the second most common cause of genital tract infection in females. Excessive use of fluconazole and other azoles is likely to cause the emergence of the resistant species of Candida. Objective: The purpose of this research was to identify Candida isolates from RVVC and the antifungal effect of fluconazole against them. Methods: In this study, 152 patients with vulvovaginal candidiasis were evaluated for the RVVC form. The Candida isolates were purified using CHROMagar Candida and identified based on the nuclear ribosomal internal transcribed spacer (ITS1-ITS2 rDNA) sequence analysis by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. The antifungal susceptibility of C. albicans isolates against fluconazole was determined according to document M27-A3. Results: Out of 152 patients, 20 cases (13.2%) were identified as recurrent form. The frequencies of the Candida species among the patients with RVVC were C. albicans (n = 16, 80%), C. parapsilosis (n = 3, 15%) and C. tropicalis (n = 1, 5%). The most common clinical sign was vaginal discharge (60%). The mean minimum inhibitory concentration (MIC) and minimum fungicidal concentration (MFC) of fluconazole against Candida isolates were 32 μg/mL and 64 μg/mL, respectively. Conclusion: C. albicans was the dominant cause of RVVC. The Candida isolates showed relatively high resistance to fluconazole in vitro. Vaginal discharge was the most common clinical sign among patients with RVVC.

Background: Placenta plays a very important role in the growth and development of fetus. Objective: To know the correlation between placental weight and perinatal outcome in term antenatal women. Methods: Present prospective case-control study was conducted in the rural tertiary center of Northern India over one year (January-December 2018) on 1,118 term (≥37-≤42 weeks) antenatal women with singleton pregnancy fulfilling inclusion criteria with 559 women with high-risk pregnancy as cases and 559 low-risk pregnant women as controls. Placental weight, birth weight was measured immediately after delivery and compared between the two groups along with gestation, parity, fetal gender, and neonatal outcome. Statistical analysis was done using SPSS 22 version. Results: Mean placental weight [481.98±67.83 gm vs. 499.47±59.59 gm (p=.000)] and birth weight [2.68±0.53 Kg vs. 2.88±0.4 Kg (p=.000)] was significantly lower in high risk as compared to lowrisk participants, whereas placental birth weight ratio was higher in high-risk cases [18.35±2.37 vs. 17.41±1.38 (p=.000)] respectively. Placental weight was positively correlated with birth weight and placental weight and birth weight increased with increasing gestation in both cases and controls. Male neonates had higher placental weight [492.74±68.24 gm vs. 488±58.8 gm (p=0.224)] and birth weight [2.81±0.5 Kg vs. 2.74±0.45 Kg (p=0.033)] as compared to females. Neonatal Intensive Care Unit admission was significantly associated with low placental and birth weight (p=.000). Conclusion: There is a significant correlation between placental weight, birth weight and neonatal outcome, hence placental weight can be used as an indirect indicator of intrauterine fetal growth.

Background: Infertility, as a life crisis, affects women more than men, even when women are not infertile. Objective: This study was conducted aimed at exploring Iranian women’s perceptions and experiences of their husbands’ behavior towards male factor infertility. Methods: This qualitative study was performed using content analysis. A purposeful sampling method was employed and continued until data saturation for women who had referred to Milad Fertility Clinic and Health Care Centers within the time period of 2014-2015 in Mashhad, Iran, with their husbands being infertile. Thirty semi-structured in-depth interviews were conducted with 18 women. Conventional content analysis was employed to analyze the data. Besides, Lincoln and Guba's evaluative criteria were utilized to check the trustworthiness of the study. Results: Perceived spousal emotional distress was the main topic of the study, which consisted of two subgroups, i.e., 1- husbands’ chaotic emotions with the sub-categories, including the “feelings of inferiority and incompetence”, “isolationism in life”, “irritability and arrogance”, “pessimism and cynicism”, as well as “anxiety and aggression”, and 2- husbands’ reluctance to seek treatment, including “inattention to medical prescriptions”, “resistance to the sperm analysis test”, and “opposition to the assisted reproductive technology and adoption”. Conclusion: Male infertility can lead to marital problems and mistreatment of women. Hence, supportive and preventive measures are required to improve the conditions of such women.

Background: A retrospective study that analysed data for three consecutive years from the Hysteroscopy Clinic at the Department of Obstetrics and Gynecology, Valme University Hospital. Objective: To analyse the data of lesions removed in the hysteroscopy clinic in comparison with those scheduled for the operating room to show that hysteroscopy could be a more effective procedure. Methods: Patients undergoing operative hysteroscopy for various indications were included. The 5 mm Bettocchi hysteroscopes and the 5.8 mm Palex Mini-Resectoscope were used. Results: A total of 1233 patients were seen in the hysteroscopy clinic between 2015 and 2017. In 2015, 344 hysteroscopies were performed, of which 57 (16.5%) were performed in the operating room. In 2016, 445 hysteroscopies were performed and 46 (10.3%) were scheduled in the operating room. During 2017, a total of 444 hysteroscopies were performed, of which only 6 (1.3%) were performed in the operating room (P < 0.001). Five large fibroids and one case of complex polyp were removed in the operating room in 2017. The mini-resector was used in 202 cases (45.4%). Paracervical local anaesthesia was given to 383 (86.2%) patients. Conclusion: The data obtained in our study shows a significant reduction in the number of hysteroscopies scheduled for surgery in 2017 (1.3%) and, therefore, hysteroscopy has been shown to be a more effective procedure. This trend may be due to the introduction of the mini-resectoscope and the use of paracervical local anaesthesia.

Background: Today, breast cancer is the second major cause of cancer deaths in women. Objective: The present study aimed to determine the effect of acceptance and commitment therapy (ACT) on self-esteem and self-efficacy of cancer adaptation behaviors in women. Methods: The present study was a randomized educational trial (IRCT Registration number: IRCT2016100430140N1) based on intervention and control groups including 30 patients with breast cancer who were referred to Cancer comprehensive center of Imam Khomeini Hospital in Sari 2017. The intervention group participated in ACT sessions for 8 weeks held as 8 sessions. In the control group, there was no intervention and only chemotherapy was carried out. Self-esteem and self-efficacy of cancer adaptation behaviors were assessed using Rosenberg Self-esteem Scale and Cancer Behavior Inventory before and after the intervention and one month later. Data analysis was tested by repeated measurement, ANOVA and Tukey post-hoc tests. Results: The mean of self-esteem before and after intervention and one month later was 13.46 ± 1.12, 16.86 ± 0.91, 15.86 ± 0.99 in ACT group, and 14 ± 1, 14.40 ± 0.98, 14.20 ± 1.08 in the control group, respectively (F(2,27)=11.90, P=0.001). The mean of self-efficacy of cancer adjustment behaviors before and after the intervention and one month later was 104.40 ± 20.19, 218.20 ± 15.32, 214.86 ± 16.97 in ACT group, and 96.86 ± 15.04, 97.06 ± 18.61, 94.53 ± 14.69 in the control group, respectively (F(2,27)=8.26, P=0.001). Conclusion: This counseling approach can be used as an easy, non-invasive and helpful method to increase self-esteem and self-efficacy among patients for adaptation to cancer.

Introduction: Vulvar leiomyomas are rare and usually misdiagnosed as Bartholin’s cyst on initial presentation. Leiomyoma of vulva accounts for only 0.03% of all gynecological neoplasm. Definite diagnosis is based on surgical excision of the tumor. The aim of this report is to introduce a case of leiomyoma of the vulva which was initially misdiagnosed as Bartholin’s cyst. Case Presentation: We present a case of a 36-year old virgin female (BMI>30) who was referred to the clinic with a 5-year history of left labial mass which was initially diagnosed as Bartholin’s cyst. The mass was removed and the pathologist confirmed that the final diagnosis was vulvar leiomyoma. Conclusion: Vulvar leiomyoma is usually misdiagnosed with Bartholin cyst and distinguishing between benign and malignant forms is confusing, so it is a diagnostic challenge. Surgical excision is the treatment of choice in all smooth muscle tumors of the vulva. Continuing follow-up after treatment is highly recommended.