Current Women's Health Reviews - Volume 18, Issue 2, 2022

High proportion of late presentation and poor survival of women with breast cancer in Malaysia does not reflect the country’s status as the third richest country in South East Asia. Herein, we examined, and collated research articles related to breast cancer trajectory i.e., primary, secondary, and tertiary prevention in Malaysia to understand, appreciate and recognize the achievements but also gaps which undermine Malaysia’s response in handling the disease. In summary, the integral task for Malaysia is to strategically align research to improve local data (research) on the extent of the country’s breast cancer problem, so that effective, comprehensive, and evidence- based cancer control programs founded on resource level can be generated.

Background: Regular physical activity and exercises play an important role in a healthy pregnancy in overweight and obese women.

Objective: To investigate the effect of exercise parameters (frequency, duration and intensity) and Physical Activity (PA) on maternal Gestational Weight Gain (GWG) in overweight and obese pregnant women.

Methods: PubMed and Cochrane database were used to locate the literature; randomized controlled trials comparing PA with standard care on combined overweight and obese pregnant women, published in English language from January 2011 to March 2020 were selected. PA interventions, including walking, aerobic and resistance exercise either alone or in combination compared with standard care during pregnancy in overweight and obese pregnant women were screened. Mean Difference (MD) with 95% Confidence Interval (CI) between the intervention and standard care for GWG was calculated.

Results: Twelve studies with 1667 pregnant women were included. The result showed a statistically significant reduction of GWG in the PA group as compared to the standard care (MD=0.99 kg, P<0.00001 & I² =25%). Overweight and obese pregnant women who performed exercises for the duration of 45-60 minutes/session (MD=1.01 kg, P=0.0008 and I² =61%), a frequency of 3 times/week (MD=1.19 kg, P=0.0002 and I² =58%) and light to moderate intensity (MD=1.37 kg, P<0.0001 & I² =62%), reported good weight control during pregnancy as compared with standard care group.

Conclusion: There was a statistically significant reduction in GWG in overweight and obese pregnant women. Owing to the promising results shown by exercise intervention and PA in maternal weight control, these interventions should be used as a tool for managing weight gain during pregnancy as routine care.

Background: The World health organization’s recommendations aim to provide comprehensive post-abortion care for all women coming for abortion services. Different investigations have been conducted in Ethiopia reporting the prevalence and the determinant factors of post-abortion contraception, but they lack consistency and are characterized by discrepancies. Therefore, this systematic review and meta-analysis aimed to estimate the pooled prevalence and associated factors of family planning utilization among women receiving abortion services in Ethiopia. Methods: A systematic review and meta-analysis of published and grey literature were conducted . The protocol was registered on PROSPERO at CRD42020162969. PubMed, Google Scholar, Science Direct, HINARI and Cochrane Library and Google were used to review studies starting from January 14, 2020 to March 11, 2020. STATA 14 software was used for analysis. JBI approach was used for critical appraisal, study selection, and data extraction. The possible risk of publication bias was examined using the Funnel plot, Begg’s and Egger’s test. Statistical heterogeneity was quantified using Cochran’s Q and the I2 test statistic. A random effect model was used as a method of analysis. Results: A total of 8236 women were involved using sixteen studies having 7 to 9 quality scores. The pooled prevalence of family planning utilization among women receiving abortion services in Ethiopia was 69.73% (95% CI: 63.67, 75.79). In addition, subgroup analysis showed the highest prevalence of post-abortion contraception on Addis Ababa city Administration,79.38 (95%- CI;66.87, 91.89). Counseling for contraceptive: (OR=3.48,95% CI: 1.94, 6.25), and history of contraceptive use: (OR=7.62, 95% CI: 3.28:17.69) have shown a positive association with post-abortion family planning utilization in Ethiopia. Conclusion: Family planning utilization among women receiving abortion services is shown to be less than the WHO and national recommendation. Counseling and history of contraceptive use were found to be significantly associated with post-abortion family planning utilization in Ethiopia.

Background: There is an increased proportion of non-endometrioid histologies in Lynch syndrome-associated compared to sporadic endometrial cancer; however, screening recommendations do not differ between type I and type II cancers.

Objective: Our objective was to examine the frequency of Lynch syndrome identified in type I and type II endometrial cancers and their associated characteristics.

Methods: We reviewed patients with type I and type II endometrial cancer who were screened for Lynch Syndrome or referred for genetic testing according to an age and family history-based screening protocol. All patients were seen and treated at a large academic institution affiliated with a county safety-net hospital. Clinical, pathologic, immunohistochemistry, and germline genetic testing results were obtained as well as the choice of genetic screening approach, personal and family history, and compliance with testing were assessed.

Results: 234 women with type I and 29 patients with type II endometrial cancer were identified. Lynch syndrome was diagnosed in a total of eight (3.4%) type I endometrial cancer patients, all identified after age-based tumor screening. In type II endometrial cancer group, three (10.3%) patients had Lynch syndrome. One was referred for testing after abnormal immunohistochemistry screening under age 60. The other two were >60 years old and identified after abnormal immunohistochemistry screening performed on physician’s request.

Conclusion: Age-based screening may not diagnose Lynch Syndrome in women with type II endometrial cancers. Our findings underscore the need for a universal screening approach in patients with type II endometrial cancers, even in a low-resource population.

Background: Infertility is an increasing health problem which affects 10-15% of couples across the world. Infertility can cause various psychosocial problems such as stress, anxiety, depression, loneliness, social isolation and stigmatization during the diagnosis and treatment process. Objective: The study was designed to reveal what kinds of cognitive images (metaphors) women produce in defining infertility, why they produce them and whether the metaphors produced by them differ depending on their professional culture. Methods: This study is a qualitative research carried out based on metaphor analysis in phenomenology design. The study was conducted on 15 participants. The data were collected by the researcher between May-July 2019. Results: The metaphors revealed by participants on what infertility meant to them, according to their professional culture, included dry and fruitless tree, a defective human, cube, cactus and rose, empty tin can, hope and snowdrop, orzo, parasite, national lottery ticket, stock market, figures, surprise egg, bird, a slowly filled lake, and a disease that is very difficult to treat. Conclusion: Metaphors reflect the beliefs, values and norms of individuals. According to the findings, we can understand and comment on infertile women’s perceptions regarding infertility and what infertility means to them.

Background: Adolescent pregnancy, pregnancy in women aged between 13-19 years, is considered a major health problem. Objective: This study was performed to determine the maternal, perinatal, and neonatal outcomes of adolescent pregnancies. Materials and Methods: The present hospital-based case-control study was performed on pregnant women who were referred to Fatemieh Hospital in Hamadan City for delivery. The case group was pregnant women whose gestational age was less than 19 years (adolescent pregnancy), and the control group included pregnant women whose gestational age was at 19-35 years (adult women pregnancy). Data were analyzed using Stata software version 14. The significant level was considered less than 0.05. Results: The unwanted pregnancy was significantly higher in adolescent women (45% vs. 28.5%, P=0.002). 18% of adolescent women had the experience of spouse violence compared to 4.25% in the control group (P<0.001). Accessing prenatal care and supplements were significantly higher in adult women (P<0.05). The adult mothers had significantly higher cesarean section delivery compared adolescent group (54.91% vs. 33%, P<0.001). Also, there was a significant association between postpartum hemorrhages and the study group (22% in cases compared to 13.75% in the control group, P=0.04). The Apgar score 1 minute was significantly higher in adult mothers (8.05±2.08 vs. 7.39±2.05, P<0.001). Conclusion: In conclusion, adolescent mothers in the west of Iran had a higher risk of inadequate prenatal care, low Apgar score, and postpartum hemorrhage. Therefore, society should focus on public health policies that can improve the adequacy of prenatal care among adolescents.

Background: One of the most important causes of anxiety during pregnancy is postpartum anxiety and the effects that this anxiety can have on the health of mother and infant and the role that studies have considered for spiritual health in promoting mental health. Objective: The aim of this study is to investigate the correlation between anxiety and spiritual health of mothers with cesarean section and vaginal delivery. Methods: This study was performed on 171 women referred to Amir al-momenin (PB) in Gerash Hospital (Fars, Iran) from August 2017 to October 2018. Convenience sampling was used. Data were collected through Demographic Information Questionnaire, Spielberger Anxiety Inventory, and Pulotzin and Ellison Spiritual Health Questionnaire. Data were analyzed by descriptive statistical methods including mean, standard deviation and frequency percentage and analytical methods, such as independent T-test and Pearson correlation. Results: There was no significant difference between the mean of total score of anxiety (P = 0.560) and spiritual health (P = 0.313) in mothers with cesarean section and vaginal delivery). There was no significant correlation between maternal spiritual health, maternal anxiety, cesarean delivery (r = -0.111, p = 0.269) and vaginal delivery (r = 0.152, P = 0.209). Conclusion: In this study, anxiety and spiritual health were not different among cesarean section and vaginal delivery women and unlike other studies, no correlation was found between spiritual health and anxiety. However, further studies in this field and attention to other strategies to control labor anxiety among women seem necessary.

Background: Several risk factors have been identified for postpartum hemorrhage, one of which being the duration of the third stage of labour. This stage refers to the interval between the expulsion of the fetus to the expulsion of the placenta. Some bleeding occurs in this stage due to the separation of the placenta. Objective: This study aimed to identify the factors associated with the length of the third stage of labour. Methods: In this cross-sectional study, 300 women hospitalized for vaginal birth were selected via convenience sampling. The study data were collected using a researcher-made questionnaire. The data were then analyzed using univariate and multivariate linear regression analyses. Results: The mean (SD) age of the participants was 26.41 (6.26) years. Investigation of the relationship between the study variables and the time of placental separation indicated that a minute increase in the length of membrane ruptures caused a 0.003 minute decrease in the time of placental separation. However, this time increased by 2.75, 6.68, and 2.86 minutes in the individuals without history of abortion, those with history of stillbirth, and those who had not received hyoscine, respectively. The results of multivariate analysis indicated that suffering from preeclampsia or hypertension, history of stillbirth, not receiving hyoscine, and not receiving misoprostol increased the length of the third stage by 4.40, 8.55, 2.38, and 6.04 minutes, respectively. Conclusion: Suffering from preeclampsia and having the history of stillbirth increased and using hyoscine and misoprostol decreased the length of the third stage of labour. However, no significant relationship was found between the length of the third stage of labour and mother’s age, gestational age, parity, mother’s body mass index, mother’s chronic disorders, history of manual placenta removal, length of the first and second stages, membranes rupture, induction, amount of oxytocin after delivery, and infant’s weight and gender.

Background: Brucellosis in pregnancy is associated with severe outcomes ranging from abortion to neonatal development problems. Objective: The aim of this study is to evaluate the seroprevalence of brucellosis antibodies among pregnant women presented with spontaneous abortion and stillbirth. Methods: In this cross-sectional study, 80 cases (stillbirth or spontaneous abortion) and 80 healthy pregnant women were serologically examined for brucellosis antibodies using Coombs, Wright and 2-mercaptoethanol (2ME) brucella agglutination tests. The questionnaire consisting of the following data was prepared for all the participants: gestational age, age, history of abortion, parity, source of dairy consumption, contact with livestock, urban or rural living setup, serological outcomes and education levels. Results: The two groups were not significantly different in terms of the brucellosis test. Patients in the case group with and without infection were not significant in terms of contact with livestock, place of residence, dairy consumption, and history of abortion. However, education level was significantly different in the two, seropositive and seronegative, groups. Conclusion: Our study did not find a significant number of seropositive brucellosis cases associated with stillbirth and spontaneous abortion. Further studies with greater samples are therefore recommended.

Background: The birth of a child is one of the most important events in a mother's life. The use of religious beliefs and spirituality is often considered as a constructive coping strategy in improving the psychological health of individuals. Objective: the present study aimed to examine the role of spiritual health experience with intensity and duration of labor pain during childbearing and postpartum. Materials and Methods: In a cross-sectional study, a total of 200 pregnant women who were 37-42 weeks pregnant and referred to Shiraz Medical Hospital for delivery were selected by nonprobability convenience sampling method. Personal and Midwifery Information Questionnaire and Ellison- Paloutzian Spiritual Health Questionnaire were used for data collection. These questionnaires were completed by interviews. Data analysis was performed using Statistical Package for the Social Sciences (SPSS) software. Descriptive test was used for data description and Chi-square test was used for data analysis. The significance level in all testes was set at <0.05. Results: There is a significant negative relationship between the variable of spiritual health and duration of the admission stage until the full opening of the cervix in primipara and multipara. However, there is no significant relationship between the variables of complete opening of the cervix to fetal delivery and fetal delivery to placental delivery and maternal spiritual health. Conclusion: This study increases our knowledge about spiritual health strategies to prevent labor pains and promote mental health in pregnant women. Midwives should be sensitive to the spiritual health of pregnant women and integrate this element into maternal care.

Background: Triple-negative breast carcinoma (TNBC) is a breast cancer subtype associated with high mortality and inadequate therapeutic options when compared to non-TNBC. Clinical data indirectly suggests where Oral Contraceptive Pill (OCP) usage is high, the prevalence of Estrogen Receptor+ (ER+) breast cancer is high, and the prevalence of TNBC is low. This has lead to our hypothesis that OCP use may increase the risk of ER+ breast cancer, and OCP use may reduce the risk of TNBC. We aimed to compare the prevalence and association of subtypes of breast cancer in OCP users with that of non-users among women 30 to 60 years of age.

Methods: This hospital-based observational study of three-year duration included 155 subjects of primary invasive breast cancer who got admitted to our institution. The data was obtained for ER, PR, HER2 status, clinical classification, and data in relation to demographic factors, reproductive history, and history of OCP use. 155 subjects were divided into two groups. Group-1 included 48 patients with a history of OCP use, and group-2 included 107 patients who have not used OCP. Data was analysed using SPSS-20.

Results: A significant increase in the prevalence of molecular subtypes ER+, Progesterone Receptor+ (PR+) and Luminal B breast cancer in OCP users was observed compared to non-users. There was a significant decrease in the age at the time of admission in ER+ cancer in OCP users (45.3 years) compared to non-users (52.2 years). While age at the time of admission of Basal (TNBC) cancer patients in OCP users (53.1 years) was higher when compared to non-users (45.4 years). Upon logistic regression, the likelihood of ER+, PR+ and Luminal B in OCP users was 11%,10% and 13% less, respectively, with 1 year of higher age and the likelihood of TNBC in OCP users was 18% more and 8% less in non-users.

Conclusion: OCP use may be associated with increased prevalence of ER+, PR+ and Luminal B breast cancer. On the contrary, OCP use may be associated with a delay in the progression of the TNBC.

Background: The best method of estimation of amniotic fluid volume is a matter of ongoing debate. Objectives: To determine the perinatal & maternal outcomes in pregnant patients when the amniotic fluid volume was assessed by the Amniotic Fluid Index (AFI) in comparison to the Single Deepest Vertical Pocket (SDVP). Methods: We studied abnormal cardiotocograph, meconium stained amniotic fluid, birth weight < 2.5 kg, Apgar score at 5 min < 7, cord blood pH < 7.2 & necessity for NICU admission as perinatal outcomes. Rate of diagnosis of oligohydramnios, induction of labor for oligohydramnios & mode of delivery were observed in maternal outcomes. Results: Of the 697 pregnant patients recruited, 353 were in the AFI and 344 in the SDVP group. Perinatal outcomes were similar in both. In the AFI group, the number of women diagnosed with oligohydramnios was higher (p = 0.0333) & the rate of induction was also higher (p = 0.003378). Vaginal deliveries were more in the SDVP group. The Receiver Operating Characteristic curves showed statistically significant correlation with NICU stay, birth-weight, and mode of delivery. While an AFI of > 5 cm and SDVP of > 1.9 cm had good sensitivity in predicting babies with a birth weight of ≥ 2.5 kg and avoiding NICU admissions, an AFI of > 5.8 cm and an SDVP of > 1.9 cm had a sensitivity of around 80% in predicting successful vaginal deliveries. Conclusion: The SDVP method has a slight edge over the AFI in terms of lower inductions and higher vaginal deliveries with comparable perinatal outcomes.

Aims: The present study was conducted to know presentations and nature of Müllerian- duct anomalies in rural women. Background: Müllerian anomalies are congenital defects of female reproductive tract resulting from faulty development and fusion of Müllerian ducts. Objectives: To identify common Müllerian anomalies, their presentation, radiological appearances, complications, associated renal anomalies in rural women of Northern India. Methods: Present observational study was conducted on 181 female patients with suspected Müllerian anomalies presenting to the outpatient department of Obstetrics and Gynecology with various complaints. Data included age, religion, menarche, previous pregnancy if any, duration of infertility, presenting complaints, type of Müllerian anomaly, incidental or symptomatic, diagnostic method, associated anomalies. Statistical analysis was done using SPSS 22.0 version software. Results: Of 181 patients, 16.5% were adolescents, 83.5% adult women with an overall mean (SD) age of 25.02 (5.96) years. Of these, 170 had true Müllerian-duct anomalies and 11 had defects other than Müllerian anomalies, hence excluded. Total 158 (92.9%) patients were symptomatic and 12 (7.1%) asymptomatic at presentation. The majority (75.9%) were diagnosed incidentally during their visit to the department for various complaints of which infertility (32.4%) was most common. Septate uterus (29.4%) was most common anomaly diagnosed followed by Müllerian agenesis/hypoplasia (22.9%). Around 11.2% of cases had associated renal and collecting system anomalies with unilateral renal agenesis (47.4%) being most common. Conclusion: Hence, Müllerian-duct anomalies have diverse presentations and most of them are diagnosed incidentally. The exact prevalence of Müllerian-duct anomalies may be high, especially in rural India, due to lack of knowledge and societal pressures.

Background: India is the second most populous country in the world. Appropriate knowledge and usage of contraception are important. Objective: This cross-sectional observational study was done to assess the awareness and usage of different methods of contraception among women of reproductive age group. Materials and Methods: Six hundred women between the ages 18-45 years, attending Gynae OPD at SIMS, Hapur were interviewed with the help of a predesigned questionnaire from May 2019 to January 2020. Women having medical disorders were excluded. Results: Among 600 women, 52.5% were between 21 to 30 years of age. 81.2% had parity equal to or more than two. 86% of women were of rural origin and 66.5% belonged to the Muslim community. 85.3% of women were aware of barrier contraception, 81% were aware of natural methods, 47.7% knew about IUCD, and 57.5% were aware of OCP’s. 78.2% were aware of permanent methods of family planning. 96.3% of women were aware of at least one method of contraception. Only 37.4% of women were using contraception. There was a statistical difference among the rural and urban populations for awareness and usage of contraception. Conclusion: Despite awareness of contraception, in our study population, the acceptance of contraception was low in comparison to other studies. Fear of side effects is the most common reason for less usage.

Background: Voice is one of the many systems which may show deviancies during pregnancy. The present study aimed to profile the acoustic and perceptual characteristics of voice during pregnancy. Methods: Pregnant women in the age range of 18-30 years were divided into seven groups starting from the third month of pregnancy to the ninth month of pregnancy, with 30 participants in each group. Praat software was used to collect the phonation and narration samples from each participant at their most comfortable pitch and loudness. The acoustic and perceptual analyses were performed on recorded voice samples. Results: Results revealed that fundamental frequency (F0) is affected by 6th month until 9th month of pregnancy. However, jitter and shimmer abnormalities are evident from the 3rd month of pregnancy. The results of the perceptual analysis indicated the presence of roughness and breathiness from the third month of pregnancy until the 9th month of pregnancy. Discussion: The results indicated that fundamental frequency (F0) was affected by the 6th month of pregnancy and continued until the 9th month of pregnancy. The jitter and shimmer abnormalities were evident from the 3rd month of pregnancy. These findings were further supported by perceptual deviations on the Grade Roughness Breathiness Asthenia Strain (GRBAS) scale. Conclusion: These findings are of value for a pregnant woman who is sensitive to the vocal deviations and also for a professional voice user as they are more prone to voice changes or disorders due to their extensive voice usage.

Background: Menstruation, also known as the menstrual cycle, is a hormonal process that a woman's body experiences monthly to prepare for a possible pregnancy. Objective: The main aim of this study is to identify the status of knowledge and practice of menstrual hygiene among adolescent girls residing in Panauti Municipality, Kavrepalanchowk, Nepal. Methods: A descriptive cross-sectional study was carried out among 200 adolescent girls residing in ward no. one, two, and three of the Panauti Municipality. A semi-structured questionnaire was used to assess the knowledge and practice level among the respondents. Suitable statistical tools were used to reach the conclusions. Results: The level of knowledge regarding menstruation was adequate in 53.5% of respondents and the level of practice of menstrual hygiene was adequate in 59% of the respondents. The study found that factors like the age of respondents, academics, mother's occupation, annual income and household source of water were significantly associated with the level of practice of menstrual hygiene by adolescent girls. The study also inferred that there was no significant association between the level of knowledge regarding menstruation in adolescent girls and the level of practice of menstrual hygiene. Conclusion: The study concluded that 53.5% of adolescent girls were having good knowledge and 59% of girls were practicing menstrual hygiene. Socio-economic and environmental factors like age of respondents, level of education, occupation of mother, annual household income and household source of water were significantly associated with menstrual hygiene practice.

Background#144;: Abortion results in emotional stress affecting the mental health of women. Women become more anxious in the subsequent pregnancy. The severity of anxiety depends on the number of prior pregnancy losses. Aim: To study the prevalence of anxiety during pregnancy in women with previous spontaneous abortions. Materials and Methods: A case control study was conducted on 200 women (study group) with a previous history of spontaneous abortions and compared with 200 women (control group) with a previous normal delivery. Anxiety levels were measured using the Hamilton Anxiety Scale for all women in the first trimester. Anxiety score <17 indicates mild severity, 18-24 mild to moderate severity and 25-30 moderate to severe anxiety. Results: In the study population, most women were found to be in the age group of 26-30 years. 149 (74.5%) women had previous one spontaneous abortion and 51 (25.5%) had previous two spontaneous abortions in the study group. The prevalence of anxiety was observed in 42 (21%) in the study group and 20 (10%) in the control group and was found to be statistically significant. In the study group, 26 (62%) women had mild anxiety, 13 (31%) with moderate anxiety and 3 (7%) had severe anxiety and 14 (60%) had mild anxiety, 6(40%) moderate anxiety in the control group. Conclusion: Women experience emotional trauma and stress following previous pregnancy losses, which can have a negative impact on their mental health. Anxiety increases in the subsequent pregnancy. Anxiety level depends on the number of previous pregnancy losses. Hence careful prenatal care and psychological support should be advised to pregnant women with prior spontaneous abortions to improve the quality of life.

Background: Good response to ovulation induction and in turn improving pregnancy rates represents a big challenge in patients with PCOS. Aim: To assess the effectiveness of adjuvant therapy to clomiphene citrate and metformin (in the form of N-acetyl cysteine versus Chromium Picolinate) as regards response to ovulation induction and metabolic syndrome improvement in patients with PCOS and infertility. Materials and Methods: This randomized controlled trial involved 108 women diagnosed with PCOS and infertility and were divided into 3 groups; according to the treatment protocol; group 1 received clomiphene citrate plus metformin only, group2 received clomiphene citrate and metformin plus N-acetyl cysteine and Group 3 received clomiphene citrate and metformin plus chromium picolinate. Results: There was a statistically significant difference as regards good ovulation in the form of mature follicles (≥18 mm in diameter), with the best results in group 3, followed by group 2. Both Nacetyl cysteine and chromium picolinate, as adjuvant therapies, were more effective in reducing the fasting insulin levels than clomiphene citrate plus metformin alone. Conclusion: Chromium picolinate and N-acetyl cysteine are effective adjuvant therapies for improving ovulation, insulin resistance, and endocrinal outcomes in women with PCOS.