Current Women's Health Reviews - Volume 18, Issue 1, 2022

Letter to the editor on research article entitled “Development of Secondary Osteoporosis in Teenage Girls with Menstrual Disorders” by Popova-Petrosyan E.V, Shanmugaraj Kulanthaivel and Keerthanaa Balasundaram, which was published in CWHR. Nowadays, we have more research and review papers available on osteoporosis in post-menopausal women; however, we still lack in researches for osteoporosis in teenage girls in our current literature. The authors conducted research work in the field of Obstetrics and Gynecology. This research paper has significant and appreciable scope in the field of pediatrics and pediatric gynecology as well. It is really interesting and exciting because there is no research paper published on osteoporosis in teenage girls due to menstrual disorders, such as oligomenorrhea, secondary amenorrhea, and polymenorrhea. As osteoporosis is one of the emerging medical and socioeconomic threats we need more researches similar to this in order to improve women health in the future. Hereby, we would like to appreciate the work of authors on their significant and interesting research paper. Further, we are eagerly expecting more researches like this from “Current Women`s Health Reviews”.

Background: Most informal caregivers are females. Females experience greater caregiver burden than males, including negative health consequences. Some caregivers show resilience i.e., maintain physical and mental health and usual functioning-despite experiencing high burden. Examining the factors that contribute to resilience and the gender differences among caregivers of people with dementia are burgeoning areas of research with implications for women’s health research and practice. Objective: To conduct a literature review about the resilience among caregivers of people with dementia (PWD), focusing on self-generated processes, and to assess the extent to which studies reported gender information. Methods: The U.S. National Library of Medicine PubMed database was searched for empirical studies on resilience among informal caregivers of people with dementia published between January 1, 2017 and April 7, 2020 and the retrieved abstracts screened using predetermined criteria. Out of 209 unique records screened, 41 were assessed for eligibility and 27 were reviewed. Results: All 27 studies reported participant gender distribution (average 71% female, 29% male). Most studies (n = 23) included both genders, and nine (39%) conducted a gender-based analysis of their results. Five categories of resilience-related processes emerged: (1) caregiver experiences, (2) coping strategies, (3) preserving the relationship with care recipients, (4) social support, and (5) specific individual processes with some gender differences. Conclusion: Although the studies reviewed reported the gender distribution of participants and included men and women, many did not analyze the results by gender. When analyzed, some resilience- related processes differed by gender, pointing to areas for future research.

Background: During the last decades, the postponement of motherhood became a reality in developed countries, leading to inevitable medical consequences, both maternal and fetal. Fertility preservation techniques constitute a matter of discussion in the context of voluntary delay of pregnancy. Objective: This study aims to analyse the causes of the postponement of motherhood, to address the maternal and fetal consequences and to explore the solutions to this problem, one of which is the applicability of fertility preservation techniques. Methods: A bibliographic search of studies published between 2008 and 2020 was conducted in the PubMed database using the MeSH terms “fertility preservation” and “maternal age”, among others. Results: The reasons that lead to the postponement of motherhood are the difficulty in establishing stable relationships, the expansion of differentiated education and demanding labor conditions, the use of contraceptive methods, economic insecurity, ideational changes and the lack of information about this issue. The increased infertility, fetal death, chromosomal anomalies, multiple pregnancies, preterm birth and increased caesarean sections are the associated medical consequences. The review of social policies and the provision of information about fertility constitute possible solutions to this phenomenon. Fertility preservation techniques, especially oocyte cryopreservation, appear as an option but cannot totally compensate for the age-related fertility decline. Conclusion: Advanced maternal age is a public health issue, essentially explained by a set of interconnected social factors, involving considerable risks for maternal and fetal health. Fertility preservation techniques, although promising, may contribute to the perpetuation of this reality.

Background: A reduction in ovarian hormones, which is distinctive of menopause, often involves signs and symptoms that compromise the quality of life and health of women. The transient manifestations are changes in the menstrual cycle, vasomotor symptoms, neuropsychological symptoms, and genitourinary changes. In some cases, the hormonal changes can evolve to nontransitory manifestations, which include urinary incontinence, changes in metabolism, osteoporosis, and cardiovascular diseases. Hormone replacement therapy is the treatment of choice to alleviate transient symptoms of menopause; however, there are many limitations, contraindications, and situations in which the risks of adverse effects are high, such as coronary artery disease, stroke, venous thromboembolism, dementia, type 2 diabetes, and the increased incidence of breast cancer. Objectives: This work aims to highlight important medicinal plants for the treatment of the transient symptoms of menopause, with less side effects than traditional hormone replacement therapy. Conclusion: There is sufficient information regarding the efficacy and safety for the use of the following plant species in the treatment of transient symptoms of menopause: Actaea racemosa, Glycine max, Trifolium pratense, Salvia officinalis, Humulus lupulus, Panax ginseng, Vitex agnus-- castus, and Trigonella foenum-graecum. Additionally, the search indicated the chemical classes related to the benefits of the selected species, adverse effects, and interactions with other drugs.

Assisted reproductive techniques used in the treatment of infertility have been promising methods for infertile individuals. Embryo selection and embryo transfer are an important part of assisting reproductive techniques. The selection of the embryo to be transferred is important for implantation and clinical pregnancy success. In addition, whether to use a fresh embryo or frozen embryo for embryo transfer is a controversial issue. While the fresh embryo transfer technique is widely used, the frozen embryo transfer technique has become widespread. The main factor in choosing the method of freezing the embryos is to avoid the negative effects of controlled ovarian hyperstimulation on endometrial receptivity. Therefore, it is thought that the use of frozen embryos can improve pregnancy outcomes and reduce the risk of developing obstetric and perinatal problems. However, there are problems in the embryo freezing technique, such as the risk of developing degeneration in the embryo during the freezing or thawing process and postponing the transfer. In addition, adverse conditions have been reported, such as an increased risk of developing hypertensive disorders in the mother and macrosomia in the baby.

Introduction: The increasing rate of cesarean section and its greater number of complications compared to vaginal childbirth invoke efforts to reduce perioperative complications through evidence-based techniques. Objective: The present study mainly aims to assess the effect of intrauterine cleaning after placental delivery in the cesarean section on the frequency of endometritis (primary outcome) and postpartum hemorrhage (secondary outcome). Material and Methods: In this systematic review we have followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Both English and Persian databases were searched (with no time limit) for clinical trials and quasi-experimental studies that had investigated the effect of intrauterine cleaning after placental delivery in the cesarean section on the frequency of endometritis and hemorrhage compared to a control group (no intrauterine cleaning). Results: The meta-analysis on three clinical trials with 696 participants showed no significant difference between intervention and control groups in the frequency of endometritis (RR= 1.33; 95% CI: 0.74 to 2.41; P= 0.34) and postpartum hemorrhage (RR= 1.06; 95% CI: 0.55 to 2.06; P= 0.86). Conclusion: Based on the meta-analysis results, intrauterine cleaning after placental delivery in the cesarean section does not affect endometritis and postpartum hemorrhage. Further and more robust studies based on the Consort Declaration are required to investigate this method to be recommended for use in clinical practice.

Background: The use of pharmacological pain relief methods during labour is increasing, however, there is no clear evidence that pharmacological interventions can also improve women’s satisfaction with the birth experience. Objective: To assess the effectiveness of pharmacological interventions on women's satisfaction with birth experience (primary outcome) and satisfaction with the received method (secondary outcome). Methods: We searched databases in English (MEDLINE, Cochrane Library, Embase, ProQuest, Scopus and Web of Science) and Persian languages (SID and Magiran) from inception until April 30, 2018, for clinical trials that pharmacological pain relief methods were compared with standard or routine cares, or non-pharmacological methods. The evaluation of studies in terms of risk of bias was conducted using the Cochrane Handbook. Meta-analysis results were reported as OR and 95% confidence interval. In meta-analysis, subgroup analysis was performed based on the type of intervention. Due to the heterogeneity of over 30%, a random effect was reported instead of the fixed effect. The heterogeneity was evaluated using I², T² and Chi². The evaluation of the quality of the studies was also examined using the Grading of Recommendation, Assessment, Development and Evaluation Working Group (GRADE) approach. Results: The results of 7 studies with low-quality in meta-analysis, showed that pharmacological methods significantly improved satisfaction with birth experience (OR = 2.99; 95% CI: 1.37 to 6.52; P = 0.006). However, meta-analysis of subgroups showed that only inhalation of Entonox gas (OR = 6.51; 95% CI: 3.47 to 12.22; P < 0.001), in contrast to epidural analgesia (OR = 1.19; 95% CI: 0.62 to 2.27;P = 0.60) and Hyoscine injection (OR = 2.58; 95% CI: 0.93 to 7.20; P = 0.07) significantly improved satisfaction with birth experience. Conclusion: Pharmacological interventions such as epidural, although introduced as one of the effective methods for pain relief may not provide women with satisfaction with birth. However, more studies with precise methodology, high sample size, and standard tools should be performed to more accurately investigate the effect of pharmacological interventions on the birth experience.

Background: Domestic violence against women during pregnancy is a major health problem worldwide. In addition, it affects the mother. Also it can be directly or indirectly associated with serious complications to the health of the fetus. Objective: The purpose of this study was to investigate the relationship between some adverse clinical outcomes of pregnancy and domestic violence against women during pregnancy in Iran via a systematic review and meta-analysis. Methods: This is a systematic review and meta-analysis of the available evidence on domestic violence against women during pregnancies in Iran between 2000 to 2018. International and national databases, including Scopus, Web of Science, PubMed via Medline, Cochrane Library, Science Direct, Google Scholar and Irandoc, MagIran, and SID were searched, and data were independently extracted by two researchers. Random effect meta-analysis was used to conduct analysis, and the Cochran test and meta-regression were also performed by STATA (ver. 14) software. Results: Thirteen studies with a total sample size of 11,818 individuals were included. The findings of this meta-analysis indicated that abortion (OR:6.4, CI95%:1.3-31), low birth weight (LBW) (OR: 3.7, CI 95%: 1.7-7.8), preterm delivery (OR: 1.8, CI 95%: 1.2-2.8) and premature rupture of membranes (OR: 4.5, CI 95%: 1.8-11.2) had a significant association with domestic violence against women during pregnancy. Conclusion: Considering the significance of domestic violence on adverseclinical outcomes of pregnancy, our results suggested an urgent need for community supportive cares during pregnancy. Also, effective measures are crucial to prevent domestic violence against women because of their significant role in outcomes of pregnancy.

Objectives: The purpose of this study is to explain which choices Turkish women prefer for prenatal diagnosis more frequently and to find out if there is an association between temperament and decisions through the prenatal diagnostic steps or consistency of decision. Materials and Methods: This is a cross-sectional study on pregnant women who were admitted to our outpatient clinic based on the responses to a self-administered questionnaire at the time of combined test or triple test as the first prenatal screening test. 198 pregnant women completed self-administered questionnaires comprising 131 questions including Temperament Evaluation of Memphis, Pisa, Paris, and San Diego questionnaire (TEMPS-A). Results: Overall, 88.4% of women were willing to learn if there was an anomaly, whereas 4.5% did not, and 7.5% were uncertain. Of the included patients, 87.9% would decide on the screening tests to be performed, 23.2% had a positive attitude on diagnostic tests, and only 13.1% were in favour of termination. No association was found between the temperament scores and positive, negative, and indecisive attitudes of the patients. In addition, there was no relation between being decisive and indecisive, and the temperament scores except for cyclothymic scores. Indecisive attitude to termination was associated with higher cyclothymic scores (5 (1–13) for decisive patients, 7 (0–17) for indecisive patients, p=0.035). Conclusion: We found that affective temperaments measured by the TEMPS-A are not related to the attitudes about prenatal screening or diagnostic tests or termination. Indecisive attitude to termination was associated with higher cyclothymic scores.

Background: Maternal mortality is an important public health problem that is perceived as a sensitive indicator of socioeconomic status and healthcare services. Objective: This study aims to describe the epidemiological features of maternal mortality in Hamadan province in western Iran. Methods: In this cross-sectional study, 50 maternal deaths that occurred in all hospitals and delivery places in the Hamadan province from March 2011 to January 2019 were studied for epidemiological features and the history of pregnancy care prior to the maternal death was also analyzed. The extracted data were analyzed using descriptive statistics in Stata software version 14. Results: Our findings show that the mortality due to pregnancy and childbirth was 18.07 per 100,000 live birth. The majority of maternal death occurred in women aged 20- 34 years living in urban areas who were mostly housewives. Kabudrahang and Razan towns had the highest maternal mortality rate. Conclusion: The present study revealed that maternal mortality is higher among women aged 20-34 years (mainly housewives) living in urban areas. Cesarean delivery, having a history of abortion, and gestational age under 37 weeks were other factors associated with maternal death. Therefore, it is suggested to direct the focus of pregnancy care and training programs on these high-risk groups.

Background: Caesarean section is often perceived to be safer than vaginal delivery for mothers and neonates and thus has become increasingly common around the globe. However, it may actually be detrimental to maternal and neonatal health while consuming valuable resources. Objective: The objective of this study was to categorize the cesarean sections performed in our rural institute into various categories using NICE classification and to study the maternal and neonatal outcomes in them. Methods: This was a prospective study of all women who underwent caesarean section over a period of 18 months. Data was retrieved from the files of women for morbidity and mortality in mothers and babies. Data was entered in MS Excel sheet and analyzed with percentages and chisquare test using SPSS ver.17. Results: Caesarean section rate (CSR) was 36.88%. All CS were classified into four categories based on urgency as per NICE guidelines. There were 22.62% women in Category I, 38.61% in category II, 28.37% in category III and 10.40% in Category IV. Adhesions, an extension of angle, lacerations in the lower segment, scar dehiscence, atonic PPH and bladder injury were noted in (12.83%), 11.81%, 6.83%, 4.08%, 1.53% and 0.08% CS, respectively. Caesarean hysterectomy was done in 0.24% of cases. Postoperative morbidity was febrile morbidity (11.93%), post-dural puncture headache (13.85%), paralytic ileus (11.49%), wound infection (8.83%), ARDS (0.70%), sepsis (0.78%), pulmonary edema (0.47%) and pulmonary embolism (0.03%). Maternal mortality was 0.03%. Neonates born were 2577 (29 were twin deliveries). 82.46% of neonates were healthy, 16.80% had morbidities and 0.74% were stillborn. Apgar score of less than 7 was in 10% cases. 16.80% neonates were admitted to NICU during their hospital stay. Neonatal mortality was 1.47%. Conclusion: Intraoperative and post-operative complications were more in cesarean sections of category I and II as compared to category III and category IV. Neonatal morbidity, mortality and admissions to NICU were more in cesarean sections of category I and II as compared to category III and category IV. Thus though the caesarean section is an emergency lifesaving procedure for mother and baby, it may prove detrimental to their health.

Objective: We aimed to evaluate the maternal outcomes among pregnant women with major degree placenta previa. Methods: We conducted an observational cohort study on 80 pregnant women diagnosed with major placenta previa (grades III and IV where the placenta partially or completely covers the internal cervical os) after 20 weeks of pregnancy, during the period from January 2019 to June 2019. The diagnosis of placenta previa was made by ultrasound and confirmed at the time of delivery. The study participants were divided into three groups based on the placental location (Anterior, Central, and Posterior). All analyses were conducted using IBM SPSS software package version 20.0. Results: Eighty pregnant women, with a mean age of 32.3 (5.01) years and a mean gestational age of 36.2 (2.03) weeks, were included in our study. Of them, 56.30% had a previous abortion, and previous C-section delivery was reported in 75%. Most of the placenta previa cases were central (52.5%), with a completely covered internal cervical os (70%). Thirty-nine patients (48.8%) had placenta accreta. Blood transfusion, postpartum hemorrhage, and anemia were noted with a percentage of 75%, 32.5%, and 32.5%, respectively. Around 28.8% of the included patients had a hysterectomy. Before and after delivery, 9 patients (21.4%) and 15 patients (35.7%) of the placenta previa centralis group had anemia, respectively. Moreover, there was no statistically significant difference between the three studies groups in terms of anemia before and after delivery (P= 0.41 and P= 0.78. respectively). Placenta previa centralis showed a higher incidence of CS hysterectomy (45.2%) while wound infection was higher in anterior placenta previa (18.2%). Conclusion: As a predictor of possible obstetric adverse events, placenta previa should be considered. A combination of proper clinical assessment and timely delivery to reduce the associated complications should be considered as well as developing a prenatal screening protocol.

Background: Failure to attain pregnancy or even miscarriage leads to a challenging type of infertility which is premature ovarian failure (POF). Stem cells have the ability to repair ovarian damage; adipose tissue-derived stromal cells (AT-SCs) and bone marrow mesenchymal stromal cells (BM-MSCs) have demonstrated promising regenerative abilities in several diseases, including POF. Methods: Various experiments were performed to prove the ability of AT-SCs and BM-MSCs in restoring ovarian functions; a total of 20 rats were randomly selected and assigned to four experimental groups with 5 rats in each group; 1^st untreated, 2^nd cyclophosphamide and busulfan, 3^rd cyclophosphamide and busulfan + AT-SCs, and 4^th cyclophosphamide and busulfan + BM-MSCs treated. Results: Groups 3 and 4 showed a restoration of ovarian functions in the form of an increase in weight (including body weight and ovarian weight), anti-mullerian hormone (AMH) and estradiol (E2) level, a decrease in follicle stimulating hormone (FSH) serum levels and an increase in antioxidant level of glutathione (GSH) and superoxide dismutase (SOD) in comparison with group 2. Histochemistry analysis demonstrated normal tissue distribution in the 3^rd and 4^th groups compared to 2^nd group. Conclusion: We demonstrated the ability of AT-SCs and BM-MSCs to restore ovarian functions in females with POF.

Background: Anemia is a major public health problem with raising prevalence worldwide, including Bangladesh. Objectives: To identify the risk factors of anemia among women in Bangladesh and its prediction using Machine Learning (ML) based techniques. Methods: The anemia dataset, comprising of 3,020 respondents, was extracted from the Bangladesh Demographic and Health Survey (BDHS). Two feature selection techniques as Logistic Regression (LR) and Random Forest (RF), have been utilized to determine the risk factors of anemia. Additionally, eight ML-based techniques, namely LR, Linear Discriminant Analysis (LDA), K-Nearest Neighborhood (KNN), Support Vector Machine (SVM), Quadratic Discriminant Analysis (QDA), Neural Network (NN), Classification And Regression Tree (CART), and RF have also been utilized to predict anemia disease among women in Bangladesh. Classification accuracy and Area Under the Curve (AUC) are used to evaluate the performances of these classifiers. Results: LR and RF-based feature selection results indicate that out of 15 factors, 13 for LR and 14 factors for RF appear to be significant risk factors for anemia among women. All predictive models provide the highest classification accuracy and AUC of 74.10-81.29% and 0.744-0.819 under RF features. However, the combination of RF-based feature selection along with RF-based classifier gives the highest classification accuracy (81.29%) and AUC (0.819). Conclusion: Out of the eight predictive models, RF-RF based combination model shows the best performance for the prediction of anemia. This study suggests policymakers to make appropriate decisions to control the anemia using RF-RF combination to save time and reduce the cost for Bangladeshi women.

Background: Induction of labor (IOL) is a common obstetrical procedure. Bishop's score was the single predictor element used by practitioners to assess the risk of failure, which led to an increase in cesarean sections (CS). Ultrasound (US) examination was proposed since the variability limitations of Bishop score warranted alternative assessment tools. Objective: This study verifies how the US and other maternal parameters are used in the transperineal approach as an indication and as a predictor of successful induction. Material and Methods: A prospective clinical study of 100 participants was conducted with term singleton pregnancy referred for IOL and who fit the criteria of this study. Their maternal parameters and fetal head to perineum distance (HPD), measured by the transperineal US, were calculated before the induction. After the induction, the patients were stratified into two groups, vaginal delivery (68%) and CS (32%). The estimated time interval to delivery was also recorded. Results: None of the maternal parameters was significant; the P-values of maternal age, parity, body mass index (BMI), gestational age, and weight of the fetus were 0.75, 0.75, 0.69, 0.81, and 0.81, respectively. One-way ANOVA test estimated the most significant factors for inducing labor. Fetal HPD and induction to delivery interval were remarkably significant in both groups <0.0001. Conclusion: The shorter the HPD (<47.65±1.66 mm), the higher the possibility of vaginal delivery and a shorter delivery interval. By contrast, the longer HPD (>52.56±1.93mm), the lower the possibility of vaginal delivery and a longer delivery interval. These promising results may serve as a valuable tool in predicting a mode of delivery.

Background: Premature membrane rupture is an obstetric emergency when the fetal membrane ruptures and the amniotic fluid is expelled from the uterus at least one hour before the start of labor. The incidence of PROM during pregnancy is a concern to obstetrics as it is associated with many adverse pregnancy outcomes such as chorioamnionitis oligohydramnios, preterm labour, neonatal sepsis and neonatal asphyxia. Objective: The aim of this study was to explore the incidence of premature rupture of membranes and its associated factors in public hospitals of the eastern zone, Tigray region, Northern Ethiopia, 2019. Methods: The authors used a facility-based cross-sectional study design to study 212 participants from April to May 2019. The sample size was calculated by using a single population proportion formula. An interviewer-administered, pre-tested, and structured questionnaire was used to collect the data. The analysis was run using SPSS version 20. Finally, the odds ratio with 95% CI was used to measure the association after multivariable analysis and statistical significance was evaluated at p-value <0.05. Results: The incidence of premature rupture of a membrane in this study was 29 (13.7%). The multivariate logistic regression analysis revealed that predictors like multigravida 2.1(1.94-6.03) having sexually transmitted infection AOR 1.3 and 95% CI (1.02-5.56) and previous history of premature rupture of membrane AOR and 95% CI 3.9 (1.9-10.02) were found to be associated with the occurrence of premature rupture of membrane. Conclusion: The incidence of premature rupture of the membrane in this study was high. Hence its occurrence put the health of the mother and the fetus in danger. Pregnant mothers with preexisting obstetric and medical cases should be followed with special emphasis as a pretext to prevent the occurrence of maternal and neonatal adverse outcomes.

Background: Nipple fissures are frequent complaints of breastfeeding mothers. Many treatments have been used to treat this problem. However, low-risk methods are more useful for treatment. Objective: This study aimed to investigate the effect of consulting correct techniques of breastfeeding on the treatment of fissures on the nipple in primiparous mothers referred to Hamadan healthcare centers during 2017. Methods: This is a clinical trial study that was conducted on two groups comprised of 74 primiparous mothers who were admitted to Hamadan health centers in 2017. They were randomly assigned to two groups of treatment and control. After completing the demographic questionnaire, the intervention group received breastfeeding consultation 3-5, 10, and 15 days after birth, and the control group received routine training like applying a little expressed milk on nipples. Storr and Bristol Scales were completed by the researcher before and one week after the last consultation session. Data were analyzed using SPSS software version 20, and the significance level was considered 0.05. Results: The results showed that the mean score of the Bristol checklist in the intervention group after counseling was significantly increased (p < 0.05), and there were also more people in the intervention group with improvement in their nipple fissures (66.7% vs. 37.9% at the score of zero). Conclusion: Multi-session and face-to-face correct techniques of breastfeeding counselling can help nipple fissure healing in nursing mothers.

Background: Sarcoidosis is usually diagnosed by ruling out other granulomatous inflammatory diseases. Rarely, it may be suspected with a pathological examination after surgical intervention for another disease. The sarcoid reaction is noninfectious granulomatous lymphadenitis, which can occur at nodes draining a neoplasm. We demonstrated granulomatous lesions masquerading metastasis by Positron Emission Tomography/Computed Tomography (PET/CT) in endometrial cancer. We presented two cases of endometrial cancer with sarcoidosis and sarcoid-like reactions because of their challenging clinical and radiological findings. Cases: In case 1, there was diffuse granulomatous inflammation (no metastasis) in lymph nodes (n = 92) and giant cells containing calcifications (Schaumann bodies). In case 2, PET/CT revealed hypermetabolism with malignancy suspicion in the pelvic lymph nodes (maximum standardized uptake value= 13) and pathological evaluation reported a 4.5 cm tumor within the uterine cavity without any nodal metastasis. Results: PET/CT has no role in the evaluation of differential diagnosis between granulomatous lymphadenitis and metastatic disease. Conclusion: Granulomatous lesions might mimic the metastasis of coexisting malignant diseases.