Current Women's Health Reviews - Volume 17, Issue 4, 2021

Coronavirus (COVID-19) outbreak was first reported in China in December 2019, and the World Health Organization declared the outbreak as a pandemic on March 11, 2020. The number of confirmed cases has risen alarmingly in most countries across all continents over the past few months. The current COVID-19 pandemic has had an immense impact on sexual and reproductive health and rights (SRHR) with disruptions in the regular provision of Sexual and Reproductive Health (SRH) services such as maternal care, safe abortion services, contraception, prevention and the treatment of HIV/AIDS and other sexually transmitted diseases. Other aspects that merit attention include a probable increase in domestic violence, sexual abuse, and the effects of the stigma associated with coronavirus infection on SRH clients and health care providers. Furthermore, as the coronavirus infection is relatively new, only minimal data is available to understand the impact of this disease on SRH, including coronavirus infection complicating pregnancies, and in people with STI/HIV-related immunosuppression. There is a serious necessity for the medical fraternity to generate psycho-social and clinico-epidemiological correlations between coronavirus disease and SRHR outcomes. The article reviews the hidden impact of coronavirus pandemic on sexual and reproductive health and rights of women, particularly in India.

Background: Prelabor rupture of membrane (PROM) refers to the breakage of fetal membranes before the onset of labor, resulting in the leakage of amniotic fluid. PROM affects approximately 3% and 8% of preterm and term pregnancies, respectively. Because of associated high maternal and perinatal mortality, correct and timely diagnosis together with effective management is highly recommended to prevent adverse fetal and maternal outcomes. Objective: To provide an overview of the novel concepts in the understanding of PROM including etiology, pathophysiology, risk factors, complications, assessment, diagnostic modalities, and contemporary management strategies for PROM at preterm and term. Methods: This narrative literature review was conducted through a literature search using the Cochrane library and electronic databases including PubMed, Web of Science, Medline, Scopus, Crossref, Google Scholar, Wiley Online Library, ScienceDirect with specific search terms in scientific publications published from March 1980 to March 2020. Results: Preterm PROM has the potential to cause prenatal morbidity and mortality. It is imperative to monitor the signs and symptoms of an impending infection due to the risk of infectious morbidity with PROM at preterm and preterm. PROM at preterm and term requires prompt diagnosis followed by an appropriate management strategy. Conclusion: The correct and timely diagnosis of PROM is essential for efficacious management. Furthermore, it can reduce avoidable emergent health care visits and related costs in a clinical setting subjected to pregnancy with suspected PROM. Further studies are needed to fill the gaps in identifying better diagnostic predictive tools in high- risk pregnancies.

Objective: The purpose of this article was to discuss and synthesize strategies for preventing repeated pregnancies in adolescents. Methods: An integrative review was conducted with a systematic search using Scopus, PubMed, CINAHL, PsycINFO, DynaMed, Cochrane, and ScienceDirect databases for articles published from 2015 to 2019 under the PICOT element for reviewing published articles. The data were selected and processed using PRISMA. Results: The results showed that the factors related to repeated pregnancy in adolescents were intention and motivation regarding repeated pregnancies, no sense of control over life experiences, not making decisions about contraceptive use, and barriers to accessing contraception. The strategies for preventing repeated pregnancies among adolescents were as follows: 1) enhancing awareness of repeated pregnancy; 2) empowerment regarding self-control; 3) effective youth-friendly care services; and 4) family and social support. Conclusion: The findings of this study can provide useful information for the midwife and nursing professions as well as other healthcare providers, leading to preventive strategies and guidelines to reduce repeated pregnancy among adolescents.

Introduction: Osteoporosis is the most common metabolic bone disease. Vitamin D deficiency, often associated with osteoporosis and other bone tissue disorders, is spread worldwide. Among other factors, obesity seems to be a major cause of the growing hypovitaminosis D. The aim of the study was to assess the correlation between Body Mass Index (BMI) and vitamin D concentrations in postmenopausal women diagnosed with osteoporosis. Materials and Methods: Sixty-nine women with postmenopausal osteoporosis were included in the study. Dual-energy X-ray absorptiometry and vitamin D measures were performed in all patients. Three groups, BMI- dependent, were distinguished: normal weight, overweight and obesity group. Results: Vitamin D deficiency was found in all women with postmenopausal osteoporosis. There was no correlation between BMI and vitamin D level. Conclusions: Vitamin D deficiency is frequent in the population of patients diagnosed with postmenopausal osteoporosis, regardless of their BMI.

Aims: To know the maternal and perinatal outcome in women with complete uterine rupture. Background: Uterine rupture is a catastrophic obstetric event associated with high maternal, perinatal morbidity, and mortality. Objectives: The present study was conducted to know prevalence, risk factors, presentation, the maternal, perinatal outcome in women with complete uterine rupture. Methods: Present retrospective observational study was conducted on 31 women admitted to the Obstetrics ward of the rural tertiary center of Northern India with complete uterine rupture between January 2016 and December 2018 after Institutional ethical committee approval and informed written consent from participants. Data included socio-demographic parameters, gestation, predisposing factors, clinical features, site of rupture, associated bladder injury, need for hysterectomy, perinatal, and maternal outcome. Statistical analysis was conducted using Statistical Package for the Social Sciences software version 22.0. Results: Of the total of 9,156 deliveries during the study period, 31 women had a uterine rupture, indicating the prevalence of 0.34%. Of all 21(67.7%) women had an unscarred uterine rupture, and 10(32.3%) scarred uterine rupture. The majority cases were un-booked (77.4%), multiparous (90.3%), and term at gestation (66.7%), with an average age of all cases as 26.97±3.73 years. The most common risk factor was injudicious use of oxytocic (29.0%) and previous cesarean section scar (22.6%). The most common site of unscarred uterine rupture was the lower uterine segment (26.7%) and in the scarred uterus, the site of previous cesarean section (26.7%). Eight (25.8%) women had bladder injury. Total 24 (77.4%) fetuses were stillborn. Seventeen (54.8%) women needed hysterectomy as a lifesaving procedure, and three (9.7%) succumbed to death despite all resuscitative measures. Conclusion: Hence, complete uterine rupture is common in rural areas and is a serious obstetric emergency with high perinatal, maternal morbidity, and mortality. As most of the cases of complete uterine rupture occur in unbooked women hence, motivating all antenatal women for regular antenatal visits can prevent the dreadful condition to a large extent, thereby saving many maternal and fetal lives.

Background: Since women refer to the maternity hospital, they undergo vaginal examination for the investigation of cervical dilation, cervical effacement, fetal head position, and amniotic membrane status. Through this way, the health care team can monitor the delivery process and make proper decisions based on the women’s conditions. However, this can cause discomfort and dissatisfaction among women. One of the main goals of health systems is moving towards increasing patient satisfaction. This study aims to assess the effect of redesigning of childbirth room on mothers’ satisfaction. Methods: This quasi-experimental study was conducted on 128 term pregnant women (37-42 weeks of gestation) referred to the maternity ward of Amir-Al-Momenin hospital, Gerash, Fars province, Iran. The participants were divided into two groups of 64. In the control group, women were examined vaginally in the previous childbirth room (without a new design) and in the intervention group, women were examined in a room with a new design. One day after delivery, satisfaction was evaluated in both groups using a valid and reliable researcher-made questionnaire. Results: The results of comparing the mean rank of satisfaction and the mean satisfaction score, one day after delivery, between the two groups showed that in the intervention group there was a higher level of satisfaction than the control group. Results showed that pregnant women’s satisfaction with a vaginal examination in the intervention group was higher than control group one day after childbirth. Conclusion: The results indicated that redesigning of childbirth room, patient centric care, and privacy could improve pregnant women’s satisfaction with the vaginal examination.

Background: Despite the great importance of controlling and preventing postpartum hemorrhage, no evidence has been provided to reduce postpartum hemorrhage physiologically compared to conventional vaginal delivery. While it is claimed that physiological delivery can be better than conventional delivery, in many ways, there is insufficient available information about the effect of the delivery method on postpartum hemoglobin and hematocrit levels. Objective: The current study aimed to compare the postpartum hemoglobin and hematocrit levels in deliveries carried out with conventional and physiological delivery methods at Fatemieh Hospital of Hamedan. Methods: This quasi-experimental study was conducted on 400 pregnant women candidates for physiological delivery and 400 pregnant women for conventional vaginal delivery in 2019. Mothers in the physiological delivery group were provided with the necessary training. In the conventional vaginal delivery group, the mother went through the usual procedures upon hospitalization. All mothers' venous blood samples were analyzed for hemoglobin and hematocrit levels at the time of hospitalization and six hours after delivery. The significance level was considered at p = 0.05. Results: The outcomes indicated that by controlling the confounding variables, the mean of hemoglobin in the physiologic delivery group was significantly higher than conventional vaginal delivery, 11.93 (1.20) and 11.64 (1.20) respectively (P <0.001), but the Cohen's d value of 0.25 indicated a weak relationship between the mean of hemoglobin level six hours after delivery and the type of delivery. The results also indicated that by controlling the effect of confounding variables, the mean of hematocrit in the physiological group was significantly more than conventional vaginal delivery (36.53 (3.33) and 35.50 (3.33) respectively) (p <0.001) but the Cohen's d value of 0.31 indicated a weak relationship between mean hematocrit 6 hours after delivery and the type of delivery. Conclusion: The results indicated that physiologic delivery did not show a valuable/considerable or the expected effect on improving postpartum maternal hemoglobin and hematocrit levels compared to conventional delivery.

Background: Acute appendicitis has been considered as the most common non-obstetric indication that requires surgical intervention in pregnant women. Objective: The aim of this study is to compare clinical manifestations and para-clinical indices between pregnant and non-pregnant patients who have undergone appendectomy. Methods: In this prospective cohort study, 57 pregnant and non-pregnant women presenting appendicitis were compared in terms of diagnostic indicators, histopathological characteristics and laboratory findings. Results: Periumbilical region was the point of initiation of the pain; however, it was more prominent in non-pregnant women. Similarly, tenderness in RLQ (right lower quadrant) of the abdomen was more detectable in the non-pregnant group, and some of the cases showed no rebound tenderness. Pregnant women with appendicitis presented an abnormal increase in the WBC count. Conclusion: Pregnancy and appendicitis-related signs and symptoms have similarity among them. Due to pregnancy, the physical examination might not present an exact diagnosis; therefore, pregnant women susceptible to have appendicitis must undergo a complete and careful on-time examination that includes ultrasound and labs.

Background: According to the previous studies, Iranian university students do not have a firm belief in the effectiveness of HPV vaccination. Objective: The present study aimed to investigate the effect of a Health Belief Model (HBM)-based training program on beliefs of Iranian female nursing students towards HPV vaccination. Materials and Methods: The present quasi-experimental study was conducted on 80 female nursing students in West Azerbaijan province, Iran, in 2019. A total of 80 nursing students were selected as the participants via convenience sampling and were randomly assigned into two groups (40 in each group). The participants in the intervention group attended the HBM training program for 4 weeks and received instructions on HPV related diseases and HPV vaccination, whereas the members of the control group received no education. The HBM questionnaire was administered to the participants in both groups before the intervention, immediately after the intervention, and one month later. The collected data were analyzed using SPSS 22 through chi-square test, independent samples t-test, and repeated measures ANOVA at a significance level of 0.05. Results: Immediately after the intervention and one month later, the intervention group showed a significant increase in perceived severity, perceived benefits, and cues to action compared to the control group (P < 0.05). There was a difference of borderline significance between the intervention and control groups in terms of perceived barriers immediately after the intervention (P=.061). Conclusion: According to the results of the present study, HBM-training interventions can be used to change students’ beliefs toward HPV vaccine and its acceptance.

Background: Infertility can cause low marital satisfaction. Marital satisfaction has an important effect on infertile couples’ health. Objective: This study aimed to assess the effect of relationship enrichment training to improve the marital satisfaction of infertile couples. Methods: This randomized clinical trial was conducted on 50 infertile couples in the infertility center of Fatemiyeh Hospital in Hamadan, Iran in 2018. Participants were matched for demographic characteristics and randomly assigned to intervention and control groups (each group had 25 couples). Informed consent was obtained from all participants. The Enrich Marital Satisfaction questionnaire and demographic information were used to collect data before the study and two months after the intervention. Two trained midwifery students taught only the intervention group about the relationship enrichment topics in seven sessions (each session = 90 minutes). The data were analyzed by SPSS Statistics version 21 using analysis of covariance, independent t-test, chi-square, and Mann–Whitney. The significance level was set at p ≤ 0.05. Results: There was no significant difference in demographic and obstetric information between the two groups (p >0.05). The mean of marital satisfaction in the intervention group significantly increased among women and men from 151.00 ±28.61 to 154.88 ±22.62 and from 152.56 ±27.33 to 159.24 ±22.14, respectively, (p <0.001). Conversely, the mean of marital satisfaction decreased among women and men from 158.13 ±13.86 to 146.25 ±19.53 and from 164.25 ±17.00 to 153.17 ±27.50 in the control group (p=0.02). Conclusion: Relationship enrichment training can be effective in promoting the marital satisfaction of infertile couples.

Background: Childbirth is an important experience in a woman's life; and the quality of childbirth has short- and long-term effects on them. Objective: The present study aimed to determine the effect of positive mental imagery on the labor pain tolerance in primiparous women referred to Atieh Teaching-Medical Center in Hamadan. Methods: The present clinical trial study IRCT20120215009014N242 by IRCT was conducted on 90 primiparous mothers referred to Atieh Hospital of Hamadan in interventional (n=45) and control (n=45) groups. Data collection tools included demographic information forms, behavioral pain scale, Visual Analogue Scale (VAS), and the birth registration checklist that were administered to both groups through interviews and observation during labor. The intervention group participated in 4 weekly counseling sessions in groups of 5 to 7 participants, but the control group received only routine care. Finally, the data obtained from the above questionnaires was analyzed using SPSS 21 and analysis of covariance (ANCOVA), Independent t-test and chi-square test and the significance level of tests was considered to be 5%. Results: The research results indicated that the mean age of control and intervention groups was 25.98±4.82 years, 25.32±4.85 years, respectively. The mean scores of the Visual analogue scale (VAS) and the Behavioral Pain Scale significantly decreased compared to the control group (P <0.001). The mean scores of behavioral changes in the intervention group were 1.77±0.68, 2.39±0.54 and 3.09±0.60 in 4-5 cm, 6-7 cm and 8-10 cm dilatations, respectively, which showed a statistically significant decrease compared to the control group (P=0.005). Conclusion: Positive mental imagery counseling reduced the visual analogue intensity and behavioral pain intensity in primiparous women. It seems that continuing education and counseling during pregnancy and empowering mothers to control themselves and learn mental imagery techniques and practice during pregnancy and childbirth can help mothers to feel more relaxed and alleviate the labor pain intensity.

Introduction: There are a limited number of studies about COVID-19 during delivery and postpartum. Case Presentation: A 38 -years- old G3p2 woman at 35 weeks and 4 days of gestation was referred with the chief complaints of dyspnea, cough, headache, and fever. Pharyngeal swab polymerase chain reaction (PCR) was negative for COVID-19; however, in chest Computed Tomography (CT) angiography, ground glass was observed in the basal lobe of the left lung. The infant was born via cesarean section with a gestational age of 36 weeks and an Apgar score of 8/9. No infant document was found about COVID-19 and other infections in several days after delivery. The patient died eight days after the onset of symptoms due to cardiovascular collapse. Discussion: we reported the first postpartum maternal death with COVID-19 and a healthy baby with no evidence of COVID-19 and a gestational age of 36 weeks. Conclusion: Physicians should be aware that pregnant women with symptoms of respiratory infection and pulse negative PCR test should be followed for infection with COVID-19. This infection may lead to maternal death.