Current Women's Health Reviews - Volume 16, Issue 3, 2020

Background: Infertility and mental, social, and economic issues associated with it endanger some relationships. Adverse quality of lifestyle is a threat to reproductive health and can lead to infertility problems. Objective: The present systematic review study was conducted to investigate the impact of the adverse quality of lifestyle on increased risks of infertility. Methods: After selecting electronic databases, namely Scopus, Pub Med, SID, and Web of Science, we searched the total population of available and published observational studies [cohort, casecontrol and cross-sectional] in Persian and English, examining the impact of lifestyle on reproductive and infertility parameters. The employed keywords were infertility, sub-fertility, male infertility, female infertility, couple infertility, lifestyle, and quality of life and their equivalent Persian words from 2007 to January 2019 regardless of gender. Out of 1211 studies, 60 were finally included in the study after excluding unrelated and duplicate papers and animal samples. Results: In the present study, older age, inadequate diet and nutrient intake, high body mass index and abdominal fat, smoking and alcohol drinking, inadequate physical activity, intense physical activity, stress, and sexual dysfunction were observed to affect reproductive indices; however, some researchers did not find any relationship between the foregoing factors and fertility. Conclusion: Individuals with dysfunctions in reproductive indices had more adverse quality of lifestyle indices compared with others, possibly reducing their chances of fertility. However, more studies are required to determine the relationship between lifestyle and infertility.

Polycystic ovary syndrome (PCOS) is one of the major endocrine abnormalities in women. It is associated with the dysfunction of androgen metabolism, elevation in insulin resistance and impaired fertility. In addition, it is characterized by polycystic ovaries, chronic anovulation, hyperandrogenism, chronic low-grade inflammation and type 2 diabetes. Furthermore, the studies have indicated that PCOS is associated with higher rates of obesity and central adiposity, which are partly responsible for the clinical severity of PCOS. Over the years, PCOS has been associated with infertility in women, as it is responsible for subfertility and increases the risk of pregnancy-related complications like gestational diabetes, hypertensive disorders, and premature delivery. The pathogenesis of PCOS remains ambiguous, however PI3K-Akt and retinoid signaling pathways are known to be involved mechanisms. In this review, we will give a comprehensive summary based on the possible association of PI3K-Akt and retinoid signaling pathways in PCOS-related infertility.

Background: Every woman has the right to have children. Objective: This study aimed to investigate the Jurisprudence study of the importance of the role of a woman right to have a child. Methods: A review of the literature with keywords of motherhood. The viewpoints of the jurists, jurisprudent law, right contraception and breastfeeding, spiritual rewards, pregnant women, instinct of having a child and the Quran. The Information Centers such as Scopus and Iranmedex, Magi ran SID, Google Scholar, Science Direct, Pub med, and in the returns without any time limitations up to 2018. Therefore, Qur'anic verses based on the topic and authentic Hadith texts as well as authoritative, authentic scientific articles. Results: Narrations and Quran verses on greatness and respect of a mother show the importance of the maternal role. The maternal role is a fabulous facet of perfection of a woman and Islam has considered spiritual rewards for it. In the Quran, many biological changes such as pregnancy, childbirth, breastfeeding and taking care of a child and spiritual characteristics of mothers as the instinct seeking a child or generosity towards child have been mentioned. Islamic rules have a duty to extend this culture and aid mothers to achieve this right. Nobody can deprive a woman of it. Conclusion: In view of jurisprudent rules in Islam, if there is no limitation or natural barrier for a woman to have a child but her husband’s illogical unwillingness for having a child; this is, according to article 1130 of civil law, a kind of distress and embarrassment and the woman has the right to divorce.

Background: Cervical cancer affects women in the time that they are critical to economic and social stability. Objective: The aim of this narrative review to assess the socio-economic consequences of cervical cancer. Methods: In this review, Pubmed, Scopus, ISI web of science, Conferences databases and Iranian databases were searched. In order to search related articles, researchers used the following terms: “Uterine cervical neoplasms” OR ‘cervical cancer”; Costs and cost analysis; costs of illness, burden, socioeconomic. After the primary search, some records were obtained from 1960 to 2018. After studying titles, abstracts, and in some cases the full texts, 48 relevant articles were included in this research. Results: Hospitalization costs were the highest direct costs. However, total social costs are higher than health and medical costs. There is a dramatic increase in direct costs with the increase in age and stage of the disease. The costs are less for people aged 75 and up and for stage 4 because of less invasive treatment received by older women and the limited choice of treatment in advanced stages. The costs for persons who were screened 6 months to 5 years before diagnosis were lower. Conclusion: The burden of the disease is high. Early detection of cancer can save lives and reduce health care costs. Studies evaluating the costs associated with cervical cancer as well as virusrelated diseases in developing countries, calculating indirect costs and the impact of the disease on family members, relatives, and especially the spouse of the affected women are recommended.

Background: Abnormal invasive placentation or placenta accreta spectrum (PAS) has been an emerging disease in developing countries where cesarean sections are routinely performed. Here we report our own data to contribute to the variety of techniques for reducing morbidity and mortality in placenta accreta cases across the world. Objective: This study aims to analyze maternal outcomes, associated risk factors, and our surgery technique in placenta accreta patients treated at Haji Adam Malik Hospital, Indonesia. Methods: We conducted a retrospective study in a tertiary hospital in North Sumatra, with a total of 70 patients suspected to have placenta accreta between January 2017 and June 2019. We compared age, gestational age, previous cesarean section, history of antepartum bleeding, placenta accreta index score, and intraoperative data, including the type of anesthesia, estimated blood loss, the need for transfusion, duration of surgery, complication, and management of the patient. Results: From 70 suspected cases of placenta accreta, 52 (74.2%) patients were diagnosed with placenta accreta and 18 (25.7%) were diagnosed with placenta previa (non-accreta) during surgery. Of the 52 placenta accreta patients, hysterectomy was performed in 42 and the other 10 were treated with conservative surgical procedures. Morbidities such as bladder injury (5.8%; 3/42) and iliac vein injury (4.8%; 2/42) were reported during hysterectomy. There were two (4.8%) mortalities reported. Conclusion: PAS is an emerging disease with high mortality and morbidity rates, which requires comprehensive management including referral to a multidisciplinary care team for diagnosis and management.

Background: Unplanned pregnancy is a potential danger for women’s lives in the reproduction ages. Objective: The present study aimed to compare planned and unplanned pregnancies regarding the maternal-infant attachment behaviors in emotional, proximity-seeking, and caretaking dimensions. Methods: The present analytical case-control study was conducted on 140 women who had given birth to their children in the hospitals affiliated to Shiraz University of Medical Sciences in 2017. The participants were divided into planned and unplanned pregnancy groups. Within the first hour and 24 hours after birth, the babies were put naked in skin-to-skin contact with their mothers for 15 minutes and the study questionnaire was completed. The data were collected using the Avant checklist. P<0.05 was considered to be statistically significant. Results: The mean score of attachment in the early hours was 84.22±12.59 in the planned pregnancy group and 74.28±15.81 in the unplanned pregnancy group, and the difference was statistically significant (p<0.001). However, no significant difference was observed between the two groups in this regard after 24 hours (p=0.122). Additionally, the results revealed a significant difference between the two groups concerning emotional (p<0.001) and caretaking (p=0.007) behaviors. However, no significant difference was found between the two groups regarding the three behaviors after 24 hours. Emotional (talking and smiling, p=0.001), proximity-seeking (circling one’s arms around the baby, p=0.001), and caretaking (paying attention to the baby, p=0.001) behaviors were significantly more observed in the two groups in the early hours and the first 24 hours. Conclusions: Mother’s skin-to-skin contact with her baby during lactation increased attachment in unplanned pregnancies after 24 hours.

Background: Premenstrual syndrome is the symptom that occurs prior to the menstrual cycle and includes physical and psychological changes that interfere with the daily activities. There is inadequate knowledge regarding premenstrual syndrome among adolescents and very little information is found regarding it among adolescents in Nepal. Objective: To find out knowledge and prevalence regarding premenstrual syndrome among adolescent students of a selected school in Morang District, Nepal. Methods: A descriptive cross-sectional study was conducted among 137 female adolescents from 13-19 years having a menstrual cycle. Non-probability purposive sampling was used to select the school and census sampling at the time of data collection for the selection of samples. The data was collected by a self-administered questionnaire and interview method, which was analyzed using descriptive and inferential statistics. Results: The study revealed that most (90.5%) of the respondents had inadequate knowledge regarding premenstrual syndrome and 57.7% of the respondents had a prevalence of premenstrual syndrome. Most (73%) of the respondents said that they had experienced fatigue/lack of energy prior to menstruation and many (56.93%) of the respondents said that the prevailing symptoms interfered with their work efficiency and productivity. Statistically, a significant association was found between the knowledge of premenstrual syndrome and ethnicity at (p=0.037). Similarly, a statistically significant association was also found between the prevalence of premenstrual syndrome and family history at (p=0.018); the prevalence of premenstrual syndrome and regularity of menstruation at (p= 0.002). Conclusion: The findings of this study concluded that there was inadequate knowledge and the premenstrual syndrome was present among most of the respondents. The findings highlight the importance of awareness regarding premenstrual syndrome among adolescents.

Background: Anaemia is a leading haematological disorder and one of the most common health problems worldwide affecting over a billion people. Anaemia leads to the lowered ability of the blood to carry oxygen. In this study, we focused particularly on the prevalence of anaemia in students currently enrolled at the Hashemite University/Jordan, shining light on the overall prevalence in this age group elsewhere. These individuals are at an increased risk of developing anaemia and are a nutritionally susceptible part of the population. Methods: Complete blood counts were determined for a total of two hundred students. Questionnaires were also completed by students regarding their life-style and dietary habits. Results: A significant 27% of female students were found to be anaemic. 17% of females had mild type of anaemia, whereas 10% of females tested suffered from moderate anaemia. The percentage of anaemia among males was also determined and found to be insignificant with only 2% of male students affected. A direct link was found between anaemia and a lack of consumption of foods rich in iron and/or over-consumption of foods that inhibit iron absorption. An inverse correlation was also observed with body mass index (BMI). Conclusion: Prevention of anaemia is particularly relevant in females and may be implemented by different but complementary means such as education workshops, iron fortification of foods and the adaption of lifestyle habits.

Background: Breast cancer is the most prevalent type of cancer among women that is fatal if not diagnosed and treated in due time. Health beliefs play an important role in people's willingness to engage in health-promoting behaviors. Objective: The aim of the study was to examine the effects of the health belief model (HBM)-based training intervention on women’s health beliefs towards breast cancer screening behaviors. Methods: The study of educational intervention was conducted on women referred to healthcare centers. The sample was selected by convenient sampling and randomly assigned to control and intervention groups of 50 subjects. The intervention group received the theory-based training intervention, but the control group received only the routine care. Champion’s Health Belief Model Scale (CHBMS) was used for collecting the study data. Data analysis was performed using independent t-test, paired t-test, Chi-squared test, and correlation coefficient in SPSS software version 16.00. Results: The mean age of the subjects for control and intervention groups was 39.06±9.78, 38.32±8.27, respectively. Overall, 38%, 12% and 13%of the subjects reported breast selfexamination behavior, mammography and clinical breast examinations, respectively. Before the intervention program, the overall mean score of health beliefs in groups of control and intervention was 160.82±23.28, and 159.14±20.61, respectively. After educational intervention, the overall mean score of beliefs in the intervention group changed from 159.14±20.61 to 195.26±24.42, and it was statistically significant (p<0.001). In the control group, after the intervention, no significant changes were observed in the mean score of total health beliefs and were not statistically significant (p>0.05). Among the variables of the HBM, women's perceived self-efficacy toward breast selfexamination experienced the most positive change after an educational intervention. Conclusion: Our results indicated that HBM-based training significantly improved women’s beliefs toward breast cancer screening behaviors. It is suggested that trainers in the healthcare system use these educational approaches to promote people’s beliefs toward breast cancer and its screening methods.

Background: Preterm delivery is a predominant cause of neonatal morbidity and mortality. Below 20% of women with threatened preterm labor, progress to active labor and delivery. Identification of such women will help to improve neonatal outcome by an early intervention such as administration of steroids and in utero transfer to the hospitals with better neonatal care. Objective: To evaluate the importance of ultrasonographic measurement of the upper and lower uterine segments thickness ratio to distinguish between true and false labor in women with threatened preterm. Methods: A prospective cohort study was carried out at a tertiary care hospital in Southern India from June 2017 to July 2018 on 151 singleton pregnant women at 24-36 weeks of gestation with regular or painful uterine contractions. Transabdominal ultrasound was performed to measure upper and lower uterine segments wall thickness and then the thickness ratio was calculated. Delivery within 7 days was the primary outcome of study. Results: Out of 151 patients, 32 (21.2%) delivered within 7 days of presentation and the rest (78.8%) delivered after 7 days and had a significant difference in the ratio of upper/lower uterine segments thickness (p<0.001). The ROC curve showed a sensitivity of 81.3% and specificity of 84.2% when the cut-off value of the thickness ratio was ≥1.61. Conclusion: The sonographic assessment of upper and lower uterine segment thickness ratio may be helpful to differentiate true labor from false labor among women with threatened preterm labor.

Background: Polycystic ovary syndrome (PCOS) is the major endocrine disorder in women that promptly affects psychological perception and associated social and cultural relations with women. Health-related quality of life (HRQOL) was assessed to explore the effects of PCOS in terms of emotional aspects and related anxiety in women. Objective: The purpose of this study was to explore the psychological burden in adolescent women due to PCOS. Methods: A prospective questionnaire-based study was conducted at a tertiary care hospital, and 100 PCOS and 200 healthy cases were enrolled based on Rotterdam criteria during the year 2017 and 2018. Pre-validated HRQOL questionnaires like Short Form Health survey-36 (SF-36) were used for evaluating the impact of PCOS in women. Results: In PCOS cases, mean age and body mass index was 22.81±5.33 and 24.35±5.49 respectively. A significant difference (P=0.001) regarding age was observed between PCOS and healthy control. The higher percentage of PCOS cases (90 %) were among the category of less than 5 years of PCOS symptoms. In addition, we observed a significant (P=0.001) reduction in quality of life in all eight domains of SF-36 questionnaire between PCOS and healthy control cases. Moreover, a decreasing pattern of SF-36 score was observed with an increase in the duration of PCOS symptoms. Conclusion: Altogether, our result of this study concluded that HRQOL especially emotional changes were more affected in adolescent and middle age group patients that may be due to fear of infertility and cosmetic problems.

Background: Small bowel obstruction (SBO) is defined as the partial or complete interruption of intestinal content progression in the oral to the aboral sense. It is the third leading cause of non-obstetrical surgical condition on pregnancy. It is a real emergency that requires early diagnosis and adequate management to reduce maternal and foetal morbidity and mortality, which remain high in developing countries. Case Presentation: This is the case of a 32-year-old black female refugee. She had a history of abdominal surgery indicated for splenic rupture during a road accident some 10years ago. She was admitted to the emergency unit for abdominal pain, vomiting and constipation persistent 4 hours after home delivery. On admission, the patient was hemodynamically unstable with abdominal distention. Abdominal ultrasonography revealed dilated loops. After intensive fluid resuscitation, the patient underwent an emergency laparotomy. Results: The findings were a small bowel adhesion obstruction. The postoperative evolution was good. Conclusion: Intestinal obstruction on pregnancy is usually diagnosed late. This delays its management and thus increases the rate of fetal and maternal mortality. The presentation of this case should appeal to clinicians in emergency rooms (ED) who receive pregnant women to think about nonobstetrical surgical conditions on pregnancies.