Current Women's Health Reviews - Volume 16, Issue 4, 2020

Background: Some studies have shown a relationship between uterine fibroids and PPH, while other studies have not shown a risk increase for PPH with uterine fibroids. Objective: The aim of performing the present study was in order to assess the association between uterine leiomyoma and postpartum hemorrhage (PPH) based on epidemiology studies. Methods: We searched for several major international databases (PubMed, Scopus, EBSCO and Web of Science) till Oct 2019. OR was used to measure the association between uterine leiomyoma and postpartum hemorrhage. The combined OR and the corresponding 95 % CI were calculated using random-effects models. In order to control potential confounders, a meta-analysis was carried out based on crude and adjusted form. Homogeneity of effect size was tested by using the Q statistic and to measure the inconsistency across studies and the I2 statistic was used. Funnel plot and the Begg's test was employed to assess possible publication bias. Data were analyzed by the Stata software, version 14, with significance level 0.05. Results: Based on OR estimates obtained from adjusted studies, there was a significant relationship between the uterine leiomyoma and PPH (OR=1.44; 95% CI: 1.14, 1.73). We assessed the association according to statistical adjustment for confounding factors (crude/adjusted) and the association between uterine leiomyoma and PPH in both crude (OR=1.96; 95% CI: 1.03, 2.88) and adjusted (OR=1.23; 95% CI: 1.02, 1.44) report was statistically significant. Conclusion: In this study, uterine leiomyoma was a risk factor for PPH. Therefore, based on our findings in pregnant women with uterine leiomyoma, clinicians should be prepared to manage postpartum hemorrhage after vaginal births and cesarean deliveries.

Background: Evening primrose oil (EPO) has been a treatment option for reducing menopausal symptoms, but evidence for its use is inadequate. Objective: The study aimed to determine the effectiveness of EPO in treating menopausal symptoms among peri and postmenopausal women. Study Design: This is a systematic review with meta-analyses of randomised clinical trials (RCTs). Methods: We searched CENTRAL, Medline, Embase and trial registries for relevant RCTs. The methodology and reporting were carried out grounded on references from the Cochrane collaboration and the preferred reporting items for systematic reviews and meta-analyses statement. Review Manager version 5.3.5 was used to perform all the statistical analyses. Results: Five RCTs, recruiting a total of 402 peri and postmenopausal women were identified. EPO did not reduce the frequency of daily vasomotor symptoms (MD 0.01 episodes, 95% CI -0.54 to 0.57, P=0.960), frequency of daytime hot flash episodes (MD -0.51 episodes, 95% CI -2.05 to 1.03, P=0.510), frequency of night sweat episodes (MD 0.33 episodes, 95% CI -0.48 to 1.13, P=0.430) and severity of vasomotor symptoms (SMD -0.45, 95% CI -1.56 to 0.66, P=0.420) in comparison to control. EPO was associated with a minimal reduction in the severity of overall menopausal symptoms in comparison to control (SMD -1.18; 95% CI-2.18 to -0.18, P=0.02). There were insufficient data to pool results for musculoskeletal symptoms, mood, sexuality, sleeping disorders and quality of life. Conclusion: EPO may reduce the severity of overall menopausal symptoms but is not effective to reduce the frequency and severity of vasomotor symptoms. The evidence quality ranged from very low to moderate. Further research is needed to enhance related evidence.

Background: Treatment team’s lack of knowledge about legal-religious doctrines of abortion can put mothers’ health at great risk. Objective: Importance and necessity of training the medical team regarding religious-moral doctrines related to abortion. Data Sources: The moral abortion studies conducted by Iranian authors between 2000 and 2018 can be found at SID, Iran Medex, PubMed, Google Scholar, and CINAHL search engines. In this review study, 20 out of 146 studies on legal and jurisprudence issues of various aspects of abortion were reviewed. Methods: The present study is a review of published evidence about knowledge and the attitudes of gynecologists, midwives, medical and midwifery students, and the views of senior planners on legal and abortion laws and pertinent issues of legal and religious education. Results: The study population had moderate knowledge about the laws and regulations of moral abortion (15.4-53.3%) and negative attitude towards criminal abortions (78.3%). Besides, 64.7% of the participants agreed about abortion in unwanted pregnancies. Moreover, the majority of executive managers considered abortion to be legal in case if mother or fetus’s life was in danger. However, a small number of participants agreed about abortion due to sexual harassment, unwanted pregnancy, pregnancy without proper interval between babies, unmarried pregnancies, and pregnancy out of temporary marriage. Conclusion: Medical team’s lack of spiritual awareness and positive attitude towards criminal abortion can increase the risk of hidden abortions. Thus, an increase in medical team’s knowledge about legal, moral, and religious aspects of abortion and penalties for criminal abortion should be considered as a health-treatment priority.

Over the years, the efficacy of assisted reproductive technologies has significantly improved. Infertility-associated problems like tubal obstruction, severe male-factor infertility, severe endometriosis and ovulatory dysfunction have entailed the need for in vitro fertilization (IVF). Intracytoplasmic sperm injection (ICSI) is the insertion of a single and viable spermatozoon into the oocyte, thereby circumventing the penetration of the oocyte membranes and aiding gamete fusion process. The use of in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) are the most commonly practiced therapeutic measures. However, owing to the report-based outcomes, the success rate is still inconclusive. Besides, there are reports on low pregnancy rates after ICSI, using round spermatids from men, in the absence of elongated spermatids in testes. The use of elongated and round spermatids in ICSI procedures has raised some reasonable doubts regarding the safety of this treatment. In this review, we will give a comprehensive discussion on the role of IVF/ICSI for the treatment of infertility, based on the current researches.

Background: Both women and men wish to have control over when to become parents. Birth control or contraception methods basically entail different types of mechanisms to avoid pregnancy. Making choices about birth control methods is not easy since there are many types of fertility control techniques available to avoid pregnancy. Objective: Several health problems are associated with females or males on the prominent use of oral contraceptives/pills. To reduce the side effects of these pills, nature provides us with several medicinal plants that act as good birth control pills. So this review aims to focus on the database provided in the literature to use these medicinal plants to avoid or control the severe health problems which directly or indirectly affect the health of the individual. Methods: All significant databases were collected via electronic search using PubMed, Scopus, Web of Science and Science direct and were compiled. Results: Several common options include family planning through abstinence, hormonal methods like oral contraceptives, barrier methods, etc. Apart from this, some people who do not want to have children may opt for permanent sterilization, but these methods or pills, when taken orally, change the hormonal balance of the individual, which leads to the other disorders. Thus, this present review concludes the knowledgeable erudition on the natural plants acting as antifertility agents. Conclusion: This review article is mainly focused on the natural birth control methods to combat pregnancy and also emphasize on various medicinal active plants being used to avoid fertility.

Background: In the United States, rates of maternal morbidity and mortality (MMM) are high compared with other high-income countries and are characterized by significant racial/ethnic disparities. Typically, research on MMM focuses on obstetrical problems. Less research examines the role of intimate partner violence (IPV). Maternal health, IPV, and their intersection are linked with the impacts of social determinants of health. Objective: We sought to understand the intersection of MMM and IPV in the United States, particularly data issues that hinder research in this area and the resulting knowledge gaps. Methods: We identified major articles of interest regarding maternal morbidity and mortality and IPV in the United States and drafted a mini review based on relevant information. Results: Despite the prevalence of IPV during pregnancy, the intersection of maternal health and IPV has not been widely reviewed or discussed. Conclusion: There are a number of limitations in surveillance activities and data collection that underestimate the impact of IPV on MMM. Importantly, women who die by homicide or suicide— which in many cases is linked with IPV—are not counted as pregnancy-related deaths in the United States under the current definition. Establishing separate panels of local experts in maternal health or maternal mortality review committees (MMRCs) that are dedicated to examining violent deaths and use of the Maternal Mortality Review Information Application system would likely improve data accuracy of pregnancy-associated deaths. Based on the literature reviewed and limitations of current data, there are significant knowledge gaps on the effects of IPV and maternal health.

Background: Preeclampsia occurs in 2-10% of pregnancies, worldwide, and is characterized as a combination of hypertension and proteinuria. Objective: The purpose of this study is to determine the risk factors associated with the incidence of preeclampsia in the west of Iran and associated factors. Methods: This is a cross sectional study that was performed on 740 pregnant women between 2014- 2017, who were referred to different health care centers of Khorramabad. The data was collected from these centers and a questionnaire was filled for every woman that included age, height, gender of the neonate, number of pregnancies, multiparity, season of the pregnancy, birth weight, mothers’ body mass index (BMI) before delivery, smoking history and diagnosis of preeclampsia. The data obtained was statistically analyzed using SPSS software. Results: Of the 760 subjects included, 1.1% (8 cases) were reported to be presented with preeclampsia. We found a significant difference between non pre-eclamptic and pre-eclamptic patients in terms of BMI (p=0.006), number of pregnancies (p<0.05), maternal age (p<0.05) and weight (p=0.004). With an increase in BMI and the number of pregnancies, the risk of preeclampsia was elevated. Pre-eclamptic mothers had higher body weight than non-pre-eclamptic ones (75.9 kg vs. 65.6 kg) and the prevalence of preeclampsia increased with age. Conclusion: The prevalence of preeclampsia was seen to be positively associated with higher BMI, pregnancy rate, mother weight and age are associated with higher prevalence of preeclampsia.

Background: High-risk pregnancies are associated with adverse perinatal and maternal outcomes. Aim: To know the overall perinatal outcome in high-risk pregnancies. Methods: Present observational study was conducted in the Obstetrics and Gynecology department of a rural tertiary center of Northern India over eight months (February-October 2018) on 3,085 antenatal women at gestation ≥ 28 weeks with 1,309 high-risk cases and 1,776 normal pregnancy cases after Institutional ethical committee approval and informed written consent from the participants. The demographic features including age, gravidity, parity, gestation, high-risk factors, the onset of labor, mode of delivery of all the selected antenatal women at gestation ≥ 28 weeks were recorded on a preformed datasheet by trained staff. All the participants were observed till delivery and the perinatal outcome was recorded. Statistical analysis was done using software SPSS 22.0 version and a p-value <0.05 was considered statistically significant. Results: Of total 1,309 high-risk pregnancies, 365(27.9%) were preterm, 936(71.5%) term and eight (0.6%) post-term cases. Of 1,309 neonates delivered, 66(5.04%) were intra-uterine dead fetuses, 1,243 live fetuses, of which nine (0.7%) had intrapartum still-birth, 278(22.4%) required neonatal intensive care unit admission, 70(5.6%) intubated, 238(19.1%) needed oxygen support, 343(27.6%) developed complications, while 11(0.9%) had early neonatal deaths. The average birth weight of neonates delivered to high-risk mothers was 2.47±0.571 Kg with 271(20.7%) neonates having low birth weight (<2.5 Kg). Of all high-risk factor Hypertensive disorders of pregnancy, Antepartum hemorrhage, Anemia, Gestational diabetes mellitus, Intra-uterine growth restriction, oligohydramnios was significantly associated with adverse perinatal outcomes (p<0.05). High-risk pregnancy was associated with preterm births, low birth weight, NICU admission, intubation, complications, neonatal deaths, still-births as compared to normal pregnancy. Most common neonatal complication was the low birth weight (20.7%) followed by Respiratory distress syndrome (17.6%), prematurity (13.1%). Conclusion: High-risk pregnancy was associated with an adverse overall perinatal outcome with increased risk of perinatal morbidities and mortalities.

Background: The discovery of the benefits of antenatal corticosteroids (ACS) for preterm infants was one of the most significant developments in obstetric care. However, due to the difficulty in predicting preterm delivery, optimal use of ACS, is challenging. Objective: To describe prescribing practices for antenatal corticosteroids (ACS) at a tertiary hospital over five years to determine whether ACS were received at optimal timing; to determine patient characteristics of women receiving ACS at optimal timing; to determine patient characteristics of those who did not receive ACS as indicated and to examine the trend in ACS prescribing over the study period. Methods: We performed a retrospective study of all deliveries from January 2011 to December 2015. The rates of ACS prescription for each group of women (preterm, late preterm, and term) were recorded and analysed. Results: A total of 65% of women who delivered before 34 weeks’ gestation received ACS. Of these women, 63% delivered within 7 days of receiving ACS. Women most likely to receive ACS with optimal timing were primiparous (relative risk [RR], 1.25 [CI, 1.08-1.45]), or women diagnosed with pre-eclampsia (RR, 1.34 [CI 1.10-1.63]), preterm premature rupture of membranes (RR, 1.33 [CI, 1.15-1.54]) or threatened preterm labour (RR, 1.42 [CI, 1.22-1.65]). Conclusion: A significant number of women and babies are exposed to ACS without commensurate benefit, and a significant number who deliver preterm do not receive ACS. The percentage of preterm and term infants receiving ACS should be determined to optimise service delivery.

Background: Caesarean section (CS) rates are increasing in both developed and developing countries. Vaginal birth after cesarean (VBAC) is an important option for reducing the CS rate. Objective: The purpose of this study is to explore clinicians' and midwives' views of factors influencing decision-making for VBAC based on the theory of planned behavior. Methods: This qualitative study was carried out in Urmia- Iran, during 2017-2018. Data were collected using in-depth semi-structured interviews with 21 obstetricians and midwives. Participants were selected among governmental hospitals through purposeful sampling until data saturation was reached. Data were analyzed through a directed content analysis approach using the MAXQDA software version 10. Results: Three themes and seven sub-themes including 1. "attitude toward VBAC": positive attitude and negative attitude; 2. "control belief": organizational support, fear, and self-efficacy; and 3. "subjective norms": peer recommendation and maternal perceived pressure were emerged from data analysis. Conclusion: Clinicians' and midwives' positive attitude and clinicians' self-efficacy could reinforce their intentions to select VBAC and support the mother. Insufficient organization support, clinicians' and midwives' negative attitude, clinicians' and women's fear, clinicians' peer recommendation and pressure of outside sources, which is perceived by mothers, could be barrier factors for VBAC.

Background: Awareness of pubertal issues has a great influence on the ability of girls to cope with cognitive, social and physical changes that occur during puberty. Objective: The aim of this study was the evaluation of a school-based educational intervention to improve the knowledge and attitude of adolescent girls about puberty health. Methods: This randomized clinical trial (Registration number: IRCT 2013111715341N2) was conducted in Hamadan during the period of 2014-2015. Four hundred forty-six (446) adolescent female students were recruited randomly, using a multistage sampling method. Students were randomly assigned to three (3) groups. Group 1(educating to students) and group 2(educating to mothers) received two 90 minutes’ puberty health educational sessions by a midwife; group 3 did not receive any intervention. Girls' knowledge and attitude about puberty health were assessed using a questionnaire administered to each group before and after the intervention. SPSS 16 software was used for analyzing data. Results: The three groups were similar in terms of demographic characteristics. There was no significant difference in knowledge and attitude scores between the control group and two interventional groups before the intervention. However, after the intervention, there was a significant difference in the knowledge and attitude of the students in the two interventional groups compared with the control group (p<0.001). The knowledge score was significantly higher in the students' group that was taught by the midwife (p<0.001). The attitude score was significantly higher in the students' group to whom their mothers taught (p<0.001). Conclusion: Mothers would better improve the attitude of adolescent girls toward puberty health if they were properly informed and knew how to transfer this information to their daughters. It seems the involvement of mothers in the educating process by a specialist such as a midwife will have a much better impact on the attitude and awareness of girls about puberty health.

Background: Dysmenorrhea is one of the most frequent pelvic pains among young women, impairing their quality of life. Objective: This research aims to investigate the effect of ginger-chamomile herbs with honey in reducing dysmenorrhea pain, associated symptoms, and the extent of bleeding. Methods: In this randomized clinical trial (IRCT No.: 2016100825031N5), 200 female students with primary dysmenorrhea, from Arak universities, were included and randomly divided into two groups. All the students were evaluated for one cycle without intervention, then group (A) received mefenamic acid (250 mg) and group (B) received ginger (1000 mg), chamomile (5000 mg), and one teaspoonful of honey for two days before and for the first three days of menstruation, three times a day, in two consecutive cycles. Pain severity, associated symptoms of dysmenorrhea, and bleeding were assessed using a visual analogue scale, Andersch-Milsom Verbal Scale, and Higham chart. Data were analyzed by descriptive and inferential statistical tests through SPSS21. Results: The pain intensity in group B diminished significantly after the intervention in comparison to group A (p <0.05). The mean severity of dysmenorrhea accompanying symptoms decreased significantly in group B compared to group A (P=0.009). However, the mean quantity of bleeding significantly decreased in group A (P = 0.004), with no increase in the extent of bleeding in group B. Conclusion: The present study indicated that the combination of the ginger-chamomile sachet with honey has the same effect as nonsteroidal anti-inflammatory drugs for pain mitigation, and the associated symptoms reduced better than mefenamic acid.