Current Women's Health Reviews - Volume 16, Issue 2, 2020

Background: Increase in the number of unwanted pregnancies has been considered to be among the health indices of the society. A large number of children, illegitimate children, and undesirable fetal gender might increase the prevalence of illegal abortions. Objective: The present study aimed to investigate the abortion license according to religious and jurisprudential laws in Iran. Methods: In this review, the related articles were found through searching of PubMed, Scopus, Google Scholar, SID, and Magiran databases as well as Muslim authorities’ sites using the following keywords: ethics, religious, abortion, and Islamic jurists’ fatwas, without any time limitations. Results: The majority of Islamic jurisprudents have considered abortion to be forbidden and nonreligious at any stage of development in case there is no justifiable reason. In case of fetal anomalies or threats to the mother’s life, abortion is allowed, based on the jurisprudential law (al-'usr wa el-haraj) and written permission by the department of forensic medicine. However, abortion is not permitted after ensoulment to the fetus, according to all scholars, with the exception of a few jurisprudents. Conclusion: The prohibition of abortion, in the view of most jurists, is not an absolute issue and might include exceptions. According to jurisprudential laws (al-'usr wa el-haraj), the prohibition of abortion has been abolished. Harassment and conflict in maternal-fetal life can also provide a license for abortion.

Background: The prevalence of diabetic kidney diseases (DKD) in the Saudi population is increasing and its prevalence has been reported as 37.4%. Recently, a higher prevalence of albuminuria in women has been proven through population-based studies. Objective: Recently, the Kingdom of Saudi Arabia (KSA) has witnessed many changes in women’s activities, and women are more actively participating in the social and cultural development of the country. Thus, focusing on women’s health-related issues has become crucial. The necessity of research focusing on the influence of various risk factors on DKD has emerged as a priority. Methods: The literature search was done by search engines and databases (PubMed, Google scholar and EMBASE). From a total of 21 selected articles, 18 articles are included in this study. Results: This review emphasizes on the higher influence of certain DKD risk factors on Saudi women including a high prevalence of glucose intolerance during pregnancy, obesity due to lack of physical activity, and genetic predisposition due to consanguineous marriages, etc. Conclusion: This study can raise awareness regarding the prevention and management of DKD in Saudi diabetic women.

Introduction: One of the identified causes of infertility has been related to the inability to regulate immunological tolerance of the maternal immune system against the developing fetus, thereby inhibiting the process of implantation. Various immune cells have been identified to contribute to the concept of un-regulated immunological tolerance, such as mast cells (MCs) and natural killer cells (NK). There are available evidences that MC play a role in the pathogenesis of infertility diseases like endometriosis and NK in specific infertility disease. Objective: Presently, there are studies to formulate and develop immunosuppressive drugs in order to suppress or inhibit the process of immune rejection caused by maternal immune cells. In addition, there have been reports regarding the use of steroids for the treatment of miscarriage that can inhibit the activity of most immune cells. Conclusion: This review is to give a comprehensive mini-review on the role of immune cells, especially mast cells and NK cells in developing novel infertility treatment.

Background: Antenatal depression is often neglected and unrecognized. It is known to be associated with various unwanted outcomes for both mothers and babies. Objective: This study aims to assess the prevalence of a positive screen for antenatal depression and its risk factors as well as the labour and neonatal outcomes. Method: 265 pregnant women who received care from University Malaya Medical Centre were recruited in this study. They completed the Edinburgh Postnatal Depression Scale (EPDS) questionnaires twice; once during the antenatal period and once again during the postnatal period. Only 235 out of 265 data were analysed for the association between risk factors, labour and neonatal outcome. Postnatal data that were collected after 4-6 weeks of delivery were completed in 90 women. Results: 41 women (17%) were found to have a positive screen and it has a significant positive correlation with postnatal EDPS score (r=0.919, p=0.00). After adjustment for confounders, preexisting medical illness is the only risk factor found to be associated with the positive screen group (OR 3.0, 95% CI1.11-8.46). The positive screen group is also associated with reduced neonatal birth weight (0R=0.998; 95%CI0.997-0.999), reduced cord pH (OR=0.000; 95%CI0.000-0.202) and increased blood loss at birth (0R=1.005; 95%CI1.001-1.009). Conclusion: The positive screen group of antenatal depression is associated with few adverse pregnancy and neonatal outcomes. Therefore, a formal mental health assessment should be offered to all pregnant women who are found to have a positive screen of antenatal depression.

Background: The mental health of the mother has a great influence on the health of her fetus. Objective: The aim of this study was to investigate the relationship between the mother's spiritual well-being and forgiveness with maternal-fetal attachment (MFA). Methods: This is a descriptive-analytic cross-sectional study. A sample of 200 female participants was selected by applying a simple sampling method among the mothers hospitalized in 3 clinics during the period of 2017-2018. The Paloutzian and Ellison Spiritual Health and Pollard & Anderson Forgiveness Questionnaires were used toassess the correlation between the spiritual health and forgiveness of the mother with MFA. Results: The relationship between attachment parameters including sentimental and emotional behaviors (r = 0.365, p = 0.0001), near-proximity-keeping behaviors (r = 0.261, p = 0.002), care behaviors (r = 0.339, p = 0.0001), mother’s attention to baby (r = 0.19, p = 0.026), versus all attachment behaviors (r = 0.349, p = 0.0001) and high level of spiritual well-being was significant, whereas the relationship between the mother’s forgiveness score and all the attachment components was not meaningful. However, the high level of forgiveness score was significant with all of the attachment components (p<0.0001). Conclusion: There was a significant relationship between the mother’s mental health and forgiveness and the attachment versus its components. It is recommended that in order to reduce the stress level and promotion of MFA, training courses for spiritual programs and mechanisms for the creation of forgiveness should be scheduled in the pregnancy plans.

Background: Ultrasonography is the first complementary examination and it is an efficient method to identify different types of cystic lesions of the ovary as well as their complications. Objective: This work aims to study ultrasound characteristics of complicated ovarian cysts and their contribution to emergency department management. Methods: It is a retrospective study of 61 patients who have consulted the emergency department, during 6 months, from November 2016 to April 2017. We included all patients consulting the emergency department for symptoms related to an ovarian cyst. Results: The average size of the cysts was 5.38± 2.27 cm long axis, ranging from 3 to 12 cm. Their wall was thin in 59 cases and thick in 4 cases. They were unilocular in 82% and multilocular in 17.5% of cases. The echogenicity of the cysts varied. The contour of the cysts was regular in 54 cases, while irregularity was shown in 9 cases. Intracystic vegetations were illustrated in 4 cases. The solid component was demonstrated in only 1 cyst. The Douglas effusion was shown in 12.7% of cases. The comparison of ultrasound findings between outpatient and hospitalized ones shows that there is no significant relationship between the following ultrasound features of ovarian cysts and hospitalization‘ s indication (p>5%). Conclusion: Pelvic ultrasound is of great benefit in the diagnosis of ovarian cysts, however, there is no significant relationship between the features of ovarian cysts and indication of hospitalization (p>5%).

Background: The indigenous people are socially, linguistically, and scientifically diverse. A global trend leads us to the notion that primitive women are somewhat less privileged than non-tribal mothers around the world. This problem also sounds true in the context of Bangladesh. A competent birth attendant at birth is the most important intervention for pregnant women. However, the use of skilled birth attendants has been widely discriminated among tribal and non-tribal women. Objective: This study assesses SBA acceptance and utilization barriers during childbirth among Bangladesh tribal women. Methods: A quantitative approach was employed, and the data were collected via questionnaires. Descriptive statistics, Chi-square (χ ²) tests and Binary Logistic Regression were used to analyze the frequency, relationship, and to determine tribal women seeking the services of SBA during childbirth. Results: The results showed that the highest prevalence of delivery (66%) among tribal women occurred at home. 46% of the mothers gave birth to their children with the assistance of a skilled birth attendant, of which 12% of them were at home, and 34% were in the hospital. The remaining 54% of mothers gave birth to their babies with the assistance of a traditional midwife. Results also show that socio-economic conditions, education of women, distance from health care facilities, family planning, husbands’ occupation, and media exposure are the key determinants in pursuing SBA. Conclusion: The study revealed a low prevalence of utilizing skilled birth attendance among tribal women of Bangladesh. Hence, upgrading socio-economic conditions and boosting the education levels of tribal women, ensuring easy access to the media, and launching short-term training to train typical birth attendants are the key recommendations for seeking expert birth attendants.

Background: The age at menarche is a chief determinant of female puberty, which also indicates the health of the target population that is influenced by various environmental and hereditary factors. Objective: This study aims to evaluate the factors that impact the age at menarche in high school students of Khorramabad. Methods: This study is a cross-sectional correlational study that included 544 students attending high school in Khorramabad. The following information was collected: demographic data, age at menarche and anthropometric characteristics. Results: The mean age at menarche subjects was 13.10±1.06 years and menarche age ranges from 10 to 16 years. There was no significant difference in the demographic data and age at menarche. The height of students was the significant determinant of the age at menarche; whereas, students’ weight showed had an inverse relationship. Consequently, the body mass index (BMI) of students had a significant difference with the age at menarche. Conclusion: The age of menarche was positively associated with growth in height and inversely associated with weight and BMI.

Background: Episiotomy is one of the most common surgical procedures in the world that is associated with perineal pain and can be exposed to infection, or might be healed with delay. Objective: The aim of this study was to investigate the effects of honey-olive oil combination on episiotomy wound healing and pain relief in primiparous women. Methods: This single-blind, parallel randomized clinical trial (IRCT20120215009014N208) was conducted on 80 primiparous women. They were allocated randomly to each of the groups through random allocation rule: 40 in honey-olive oil group and 40 in the control group. Every 12 hours and for 14 days, the treatment group used about 1 inch of the cream on the wound area. Pain intensity and wound healing were measured by REEDA Scale and Visual Analogue Scale on days 7, 10, and 14 in both groups. The statistical analyst was not informed about the allocation of the groups. A significant level of 0.05 was considered. Results: There was a significant difference between healing score and pain intensity between the two groups on 7th, 10th and 14th postpartum days (p <0.05). Wound healing occurred much faster (Scores on days 7,10, and 14 were 11.25±2.13, 7.47±1.96 and 4.95±1.53 in the control group and 4.45±1.25, 2.32±.69 and 10±.30 in the intervention group, p <0.05). Moreover, pain intensity was significantly relieved in those who used Honey and olive oil cream (the scores were 5.6750±1.43, 3.3500±1.52, 2.2250±1.34 in the control group and 1.9750±1.52, .2250±.57, .0250±.15 in the intervention group, P<0.05). Conclusion: Using honey and olive oil combination improves episiotomy wound healing and also relieves its’ associated pain.

Background: Treatment of breast cancer can be accompanied by long-term consequences affecting women’s participation in many tasks. Objective: This study aimed to assess the effect of cognitive behavioral stress management (CBSM) program on occupational performance of women with breast cancer. Methods: In this randomized clinical trial, conducted between Feb 3 and Oct 26, 2016, 104 women with breast cancer who had referred to Imam Khomeini clinic in Hamadan, and who fulfilled the inclusion criteria (20-60 years old, married, suffering from grade 1-3 breast cancer with a history of recent surgery) were enrolled. They were randomly divided into two groups of 52 using a permuted block size of four. The intervention group took part in four 60-minute sessions of CBSM over four weeks. The study data were collected using a demographic information form and the Canadian Occupational Performance Measure. The statistical analyst was masked to intervention allocation. The data were analyzed using descriptive statistics, paired t-test, and repeated measures ANOVA. Results: A significant difference was observed between the two groups regarding the mean scores of occupational performance (p=0.02) and satisfaction (p=0.005) after the intervention. Each variable was measured at three time points (before the intervention, immediately and 2 weeks after intervention). A significant difference was observed in the two groups’ mean scores of performance (p=0.026) and satisfaction (p=0.01), irrespective of the time of assessment. Conclusion: The CBSM program promoted the occupational performance immediately and two weeks after the intervention in women with breast cancer. This technique can be used as a complementary method alongside medical therapies in oncology centers.

Background: Spontaneous abortion is the most common complication of pregnancy which is considered an unfavorable experience both physically and psychologically. Objective: This study was conducted to investigate the effect of group counseling through cognitive behavioral therapy (CBT) on the anxiety of pregnant women with a history of spontaneous abortion. Methods: This study was randomized clinical trial type, in which convenient sampling was performed to select 64 subjects from healthcare centers in Arak province. After receiving written consent from the participants, the sampling was performed and the subjects were categorized randomly into two 32-subject groups as intervention and control. The intervention was performed as six 60- min sessions through cognitive behavioral therapy (CBT). Control group, however, only routine cares of pregnancy were provided. For data collection, The Spielberger State-Trait Anxiety Inventory was utilized at the beginning and end of the study. Then, the collected information was analyzed by SPSS 21 through paired t-test, independent t-test. Results: The mean anxiety after the intervention in the intervention and control groups was 65.13±8.11 and 75.91±5.56, respectively, whereby a significant difference was observed between the two groups (p≤0.05). Conclusion: It seems that women with a previous history of abortion require psychological support during pregnancy. It is recommended that the skills of midwives also be improved to psychologically support these women.