Current Women's Health Reviews - Volume 18, Issue 4, 2022

Background: Pregnant women are a vulnerable group in viral outbreaks, especially in the COVID-19 pandemic. Objective: The aim of this review was to identify maternal and neonatal outcomes in available articles on pregnancies affected by COVID-19. Methods: The articles that had assessed outcomes of pregnancy and perinatal of women with COVID-19 between Oct 2019 and Aug 2020 without language limitation were considered. We searched databases, selected relevant studies and extracted data regarding maternal and neonatal outcomes from each article. Results: Data of 11078 pregnant women with COVID-19 of 23 countries were assessed from 77 articles between December 8, 2019 and Aug 18, 2020. Most pregnant women reported in their third trimester, out of which 6229 (56.22%) cases were symptomatic at the time of admission. Common onset symptoms, abnormal laboratory findings, and chest computed tomography pattern were cough (40.88%%), lymphocytopenia (43.38%), and multiple ground-glass opacities (4.42%), respectively. 51.37% of all deliveries were done through cesarean section. 158 maternal mortality and 4.2% ICU admission were reported. Vertical transmission was not reported, but its possibility was suggested in thirty-two neonates. Ten neonatal deaths, thirteen stillbirths, and nineteen abortions were reported. 60% of newborns were not breastfed. Conclusion: This review showed fewer adverse maternal and neonatal outcomes in pregnant women with COVID-19 in comparison with previous coronavirus outbreak infection in pregnancy. Limited data are available regarding the possibility of virus transmission in utero, during vaginal childbirth and breastfeeding. The effect of COVID-19 on the first and second trimesters and ongoing pregnancy outcomes in infected mothers is still questionable.

Background: Maternal COVID-19 infection has been reported to be associated with an increase in the rates of C-sections. However, studies have not reported this association consistently. Therefore, this systematic review and meta-analysis were conducted regarding this issue. Methods: We identified all publications up to January 2021 in databases of PubMed, Scopus, and Web of Science. In addition, we reviewed gray literature and conference proceedings. The pooled odds ratios (OR) and 95% confidence intervals (CI) measured from eligible studies were used as random effect estimates of association among studies. Heterogeneity testing using I2 statistics was performed to assess variance between the studies. Results: The pooled estimates of OR did not report a significant association between COVID-19 and the risk of cesarean section, respectively (OR = 2.02, 95% CI = 0. 4 to 3.64). There was low heterogeneity among the studies reporting the risk of diseases associated with cesarean section among children based on OR (I²=12.7%, P=0.333). The P-values for Begg’s and Eggers regression were 0.573 and 0.555, respectively. Conclusion: While we did not find an association between COVID-19 and increased rates of cesarean sections, we cannot exclude a type II error; therefore, additional studies, including large cohort studies by controlling confounding variables, should be performed in the future.

Aim: The present study is a meta-analysis to identify the relationship between BMI and uterine leiomyoma. Methods: The major international databases PubMed, Scopus, and Web of Sciences (WOS) were searched to identify eligible studies in English language from their inception to 30 of June 2019. The pooled Odds Ratios (OR), Relative Ratio (RR), and 95% Confidence Intervals (CI) were calculated as random effect estimates of association among studies. The findings of 10 studies showed an increased risk of uterine leiomyoma in the overweight and obese women compared to women with normal weight: RR=1.21 (95% CI: 1.12, 1.30) and OR=1.50 (95% CI: 1.29, 1.71) for overweight women and RR=1.34 (95% CI: 1.11, 1.57) and OR=1.99 (95% CI: 1.11, 2.87) for obese women. Results: Our meta-analysis suggests that obesity and overweight in women are associated with an increase in the risk of uterine leiomyoma. Conclusion: Therefore, increased clinical attention to uterine leiomyoma should be given , because leiomyoma can be a source of mortality in women.

Introduction: Preeclampsia (P.E) has remained a public health threat to both developed and developing countries. The incidence of preeclampsia in Lebanon is high at 2.84%. Awareness of P.E among pregnant females is crucial to reduce morbidity and mortality for both fetus and mother. Objective: A cross-sectional observational study was conducted to analyze data from Lebanese’s pregnant women. This study aims to assess the level of knowledge of PE among pregnant women in the Lebanese population. Methods: This cross-sectional study was conducted between September and December 2020 in obstetricians’ clinics of different health care institutions in five governorates in Lebanon. A closedended questionnaire was distributed to 400 pregnant females. The first part of the questionnaire aimed to collect socio-demographic information about the participants. The second part was specified to assess knowledge on PE. Signs and symptoms, risk factors, and consequences were among the twenty-three knowledge items assessed. The last part addressed some attitudes about dealing with this disorder. Responses were scored percentage-wise and grouped into low <60%, moderate (60-80%), and high (80-100%). Results: There is inadequate knowledge of P.E among the Lebanese population. In total, 15.3% had adequate knowledge of P.E. A linear regression showed that the knowledge score increased in working pregnant women (p=0.04), who lived in Bekaa (p<0.001), who had a vocational (p=0.01) or university education (p=0.001) and who had any relative, who developed preeclampsia (p=0.03) or was suffering from diabetes (p=0.03). Furthermore, knowing when blood pressure is considered high (p<0.001) and hearing about preeclampsia (p<0.001) also increased the preeclampsia knowledge score. Conclusion: The knowledge of PE among pregnant women in Lebanon is low.

Background: Women experience a significant increase in nutritional needs during pregnancy due to the several changes during this phase. Failure to meet these increased nutritional needs may cause irreversible effects and predispose outcomes to metabolic complications. Scarce data to establish the base of nutritional status among pregnant women in Jordan was available. Objective: The study aimed to assess and evaluate energy and nutrients consumption among a group of pregnant women in Amman Governorate during the second or third trimesters; in order to compare the consumption with “Recommended Dietary Allowance” (RDA). Methods: A cross-sectional study was carried out in 2018 at the Ministry of Health’s (MoH) Maternal and Children Health Centers (MCHC) in Amman to assess the dietary intake for a convenient sample of 300 seemingly healthy pregnant women aged between 17 and 40 years-old and at ≥ 13 weeks of gestation. Maternal demographic cheracteristics, medical history, anthropometric measurements and dietary data (three days recall) were collected. Results: The daily mean intake of carbohydrates exceeded the recommended intake for 45.3% of pregnant women. Fiber intake was less than 28 g/day for 90% of them. Total fats intake (45.6 g/- day) was lower than the RDA for 42.3% of the pregnant women. Two-thirds of the pregnant women consumed a moderate amount of saturated fats (14.6 g/day). The mean daily intake of proteins was 50.5±20.2g. More than two-thirds consumed protein less than the RDA; subsequently, intakes of all essential amino acids were below RDAs. The intake of fat-soluble vitamins was lower than RDA for vitamins D, E, and K.While, the intake of vitamin A, was higher than RDA. The intake of minerals was lower than RDA for (calcium, fluoride, iodine, iron, zinc, and selenium), while the intakes of sodium and copper were higher. Conclusion: The results showed inadequate and imbalanced dietary intake in comparison with RDA. Maternal nutrition and diets of pregnant women in this study show alarming indicators that may negatively affect the well-being of both pregnant women and fetal growth.

Introduction: Infant hospitalization in the Neonatal Intensive Care Unit (NICU) causes the separation of mother from her infant. Kangaroo Care (KC) is a bio-care method for preterm newborns. This study was conducted with the aim of investigating the experiences of mothers that could be helpful for the further development and expansion of continuous kangaroo mother care (C-KMC). Materials and Methods: This is a qualitative study with a content analysis approach. In order to collect data, in-depth individual interviews were conducted with thirteen mothers who were able to care for their infants in the form of C-KMC. The sampling was of purposeful type; the interviews were recorded, and their contents were written accurately and word by word. Findings: Analysis of mothers' experiences led to the emergence of three main themes of mother’s positive attitude, facilitator factors and barriers to perform C-KMC. Conclusion: The results of this study showed that performing KMC caused a sense of calm, empowerment, and satisfaction of the mother and had many medical benefits for the infant. On the other hand, physicians and nurses can act as facilitators or barriers based on the support they make from mothers. Also, the support of the spouse and family play an important role in continuing to perform the continuous KMC by the mother.

Background: A polycystic ovarian syndrome (PCOS) is a common endocrine syndrome in which women have a wide range of clinical presentations; insulin resistance was linked to its pathogenesis. Objective: We aimed to investigate the copeptin role as a predictive marker of insulin resistance among PCOS women. Materials and Methods: In University Hospital, we included 280 women, with 140 of them being healthy controls. 140 out of 280 cases of PCOS subdivided into two groups depending on the insulin resistance; group 1 with homeostasis model assessment for the insulin resistance < 2.5. Group 2 with homeostasis model assessment for the insulin resistance >2.5. The evaluation of body mass index and blood pressure for all besides the blood sampling for estimation of a follicular stimulating hormone, luteinizing hormone, prolactin, estradiol, sex hormone-binding globulin, total testosterone, fasting insulin dehydroepiandrosterone sulfate, C-reactive protein, plasma glucose, free androgen index, and plasma copeptin using the Copeptin-Human EIA Kit besides the transvaginal ultrasound for ovarian assessment. Results: When compared to other groups, PCOS women with positive insulin resistance >2.5 had a significantly higher plasma copeptin level. The ROC curve calculated a 1.94 pmol/L; plasma copeptin cutoff value for detecting the insulin resistance in PCOS with 88 % sensitivity value and 36 % specificity, AUC was 0.88. Conclusion: The significant positive relationship between serum copeptin and insulin resistance with high sensitivity implies its usefulness as a marker of insulin resistance among PCOS patients with a high prediction of its complication.

Background: Late preterm infants suffer from several problems after birth, and the key factor in fighting these problems is effective breastfeeding. Objective: To determine breastfeeding self-efficacy and its relationship with perceived stress and assess breastfeeding performance in mothers with late preterm infants. Methods: In this prospective study, 171 eligible nursing mothers with late preterm infants born in Alzahra Medical Center of Tabriz, Iran, were selected via convenience sampling. The Breastfeeding Self-Efficacy Scale-Short Form was employed to measure breastfeeding self-efficacy, and the 14-item Perceived Stress Scale was used to measure the perceived stress 24 hours after giving birth. When the child was 4 months old, breastfeeding performance was measured by the Standard Breastfeeding Performance Questionnaire. The data were analyzed by Pearson and Spearman’s correlation tests, independent t-test, one-way ANOVA, and multiple linear regression analysis. Results: The mean (standard deviation) of breastfeeding self-efficacy was 50.0 (7.8) with scores ranging from 13 to 65, and the mean (standard deviation) of perceived stress was 26.5 (8.8) with scores ranging from 0 to 56. The median (25-75 percentiles) of breastfeeding performance score equaled 2.0 (1.0 to 3.0) with scores ranging from 0 to 6. Based on multiple linear regression analysis and after adjusting the personal-social characteristics, by increasing the score of breastfeeding self-efficacy, perceived stress was significantly decreased (B=-0.1, 95 %CI=-0.3 to 0.0). However, there was no statistically significant relationship between breastfeeding self-efficacy and breastfeeding performance (p = 0.418). Conclusion: Due to the possibility of adjusting breastfeeding self-efficacy and its role in mothers’ perceived stress, developing proper strategies seems to be essential for enhancing breastfeeding self-efficacy.

Background: Management of unusual not scar ectopic pregnancies (UNSEPs) is an unexplored clinical field because of their low incidence and lack of guidelines. Objective: To report the clinical presentation, the first- and second-line treatment and outcomes of UNSEPs. Methods: We retrospectively collected patients treated for UNSEP (namely cervical, interstitial, ovarian, angular, abdominal, cornual and intramural), their baseline characteristics, risk factors, symptoms, diagnostic pathway and the type of first-line treatment (medical, surgical or combined). We further collected treatment failures and the type of second- line treatment. We assessed treatment outcomes, time to serum beta human chorionic gonadotropin (β-hCG) level negativity, length of recovery, follow up and return to a normal menstrual cycle. Results: From 2009 to 2019, we collected 79 cases. Of them, 27 (34%), 23 (29%), 12 (15%), 8 (10%), 6 (8%) and 3 (4%) were cervical, interstitial, ovarian, angular, abdominal and cornual, respectively. Forty women (50.6%) were submitted to medical treatment, mostly methotrexate based; conversely, 36 patients (45.6%) underwent surgery and only 3 women (3.8%) received a combined treatment. The success of first-line treatment rate, regardless of UNSEP location, was 53% and 89% for medical and surgical treatment, respectively. Treatment failures (21 patients) were submitted to second-line treatment, respectively 47.6% and 52.4% to medical and surgical approach. Of interest, cervical pregnancies achieved the lowest rate of first-line medical treatment success (22%) and received more frequently (69%) a subsequent surgical approach with no hysterectomy. Interstitial pregnancies were submitted to surgery mostly for a matter of urgency (71%), otherwise, they were treated with a medical approach both at first- and second-line treatment. Ovarian pregnancies were treated with ovariectomy in 44% of the cases submitted to surgery. Angular pregnancies underwent surgery more often, while all the abdominal pregnancies underwent endoscopic or open surgery. Cornual pregnancies received cornuostomy in 75% of the cases. Overall, the need for blood transfusion was 23.1% among the patients submitted to surgery. The median length of hospitalisation was shorter for women submitted to surgical first-line treatment (5 vs. 10 days; p = 0.002). In case of first-line medical treatment and in case of failure, we found an increase of 3 days (CI95% 0.6-5.5; p = 0.01) and of 3.6 days (CI95% 0.89-6.30; p = 0.01) in the length of hospitalisation, respectively. Negative β-HCG levels were obtained earlier in the surgical group (median 25 vs. 51 days; p = 0.001), as well as the return to normal menstrual cycle (median 31 vs. 67 days; p < 0.000). Post-treatment follow-up, regardless of the failure of first-line treatment was shorter in the surgical group (median 32 versus 68 days; p= 0.003). Conclusion: Cervical pregnancies were successfully managed with a surgical approach without hysterectomy, and hence, we suggest avoiding medical treatment. No consensus emerged for other UNSEPs. Ovarian, angular and interstitial pregnancies are burdened by a non-conservative approach on the utero-ovarian structures. The surgical approach led to shorter recovery, earlier β-hCG negativity and shorter follow-up, even though there is an increased risk for blood transfusion.

Background: Ectopic pregnancy is the most common cause of death among women during the first trimester of pregnancy despite the progress made with early diagnosis. It occurs at a rate of 1 to 2% that of live births. In Mauritania, EP is a public health issue mostly affecting young women. Objective: The aim of the study was to evaluate the diagnostic abilities and the management of EP. Methods: This study is transverse descriptive and was carried out in the maternity of Nouakchott’s teaching hospital. The aim of this study was to provide data on the epidemiological profile, diagnosis, management and prognosis of ectopic pregnancy. During the period from May 2013 to April 2014, 44 cases of ectopic pregnancies were collected. The collected data were analysed by means of SPSS version 20, Microsoft Excel 2007. Results: The incidence of EP was 0.99% coefficient to 1 EP per 100 live births. EP management represented 7.3% of emergency surgery. The average patient age was 29.84 ± 5.988 years. The most affected age group was 25-34 year olds (61.4%). Multigravida were more affected with a rate of 80%. Patients with an EP commonly presented with pelvic pain (91% of our patients), late in menstruation (86.3%), and vaginal bleeding (61.3%). Pelvic ultrasound was performed in 41 patients with a coefficient of 93%. The treatment was surgical by performing laparotomy in all of the cases. The surgical treatment was radical in 93.2%, salpingectomy was performed in 86.4% of the cases, while adnexectomy was performed in 6.8% of the cases. Conservative treatment was performed in 3 patients: 2 cases of salpingotomy and 1 case of tubal expression. In most cases, the postoperative evolution was simple. Conclusion: Until this day, ectopic pregnancy is a severe disease. Despite the progress made in early diagnonsis, in many cases, the treatment is surgical with all its consequences and especially in the developing countries, including Mauritania. Improving the therapeutic management above all improves the diagnostic procedure in a very early period.

Background: Sexual dysfunction is one of the most common causes of family breakdown. In recent years, different approaches have been used to solve this problem. Due to the negative effects of sexual dysfunction in women and its complications. Objective: The present study was conducted to investigate the effect of stress management counseling on the sexual function of infertile women referred to Fatemieh Hospital in Hamadan. Methods: The present study was conducted as a randomized two-group clinical trial with two pretest and post-test stages on 104 eligible women referring to Fatemieh Hospital in Hamadan in 2017-2018. Intervention group subjects received 4 two-hour group counseling sessions with a cognitive- behavioral approach on sexual issues. Data were obtained using two questionnaires of demographic characteristics and the Female Sexual Function Index. To analyze the data, SPSS version 21 software and paired t-test, independent t-test, and analysis of covariance were used. The level of significance was considered to be less than 0.05. Results: The results of the present study showed that the mean scores in all areas of total sexual function did not differ significantly before the intervention in two groups. However, after stress management counseling, a significant increase was observed in all areas and general sexual function in the intervention group compared to the control group (P <0.05). Conclusion: Stress management counseling in infertile women can play a positive and effective role in improving sexual function. Therefore, the effectiveness of this counseling in promoting sexual function can be confirmed with more confidence.

Background and aim: This study aimed to investigate the effect of cognitive-behavioral stress management (CBSM) on adjustment among females with breast cancer. Materials and Methods: This randomized clinical trial study was conducted on 104 women with breast cancer who visited Hamedan Imam Khomeini Clinic between Feb 3 and Oct 26, 2016, and met the inclusion criteria. The inclusion criteria included being 20 to 60 years old, being married, and having grade 1-3 breast cancer with a history of recent surgery. The subjects were randomly assigned to two groups of 52 subjects, using a permuted block size of 4. The intervention group participated in 4 sessions of CBSM, each 90 minutes long, for a duration of 4 weeks. Data collection was done using a demographic information questionnaire and Bell adjustment questionnaire. The statistical analyst remained unaware of the intervention assignment. Data analysis was done using descriptive statistics, paired t-test, and repeated measures ANOVA. Results: There was a significant difference in the mean scores of the total adjustment (P = 0,0001) between the two groups after the intervention. Each variable was calculated three times, prior to the intervention, immediately after and 2 weeks after the intervention. Regardless of the time of measurement, there was a significant difference in the mean score of total adjustment between the two groups (P = 0.0001). Conclusion: The cognitive-behavioral stress management program improved the adjustment immediately and 2 weeks after the intervention was done among women with breast cancer. This method can be implemented as a complementary approach along with medical therapies provided by oncology centers.

Objective: To propose a concurrent training protocol and evaluate the effects on depressive symptoms, anxiety, mood, sexual function, body fat, muscular strength, cardiorespiratory capability, and hormonal profile of women in menopause through a randomized controlled trial. Methods: This is a randomized clinical trial of two arms with 6 months of intervention with concurrent training with menopausal women (40 to 59 years old) with positive symptomatology to the Menopause Rating Scale (MRS) questionnaire and blood collection of Follicle Stimulating Hormone (FSH) ≥25 UI/ml, being randomly and distributed in two groups: experimental group (EG) and control group (CG). In the first trimester, there will be 30 minutes of aerobic training and 30 minutes of resistance training; in the second trimester, 40 minutes of aerobic training and 20 minutes of resistance training. The weekly frequency will be 3 times a week, with sessions lasting 60 minutes, going through a period of neuromuscular adaptation. The intensity will be increased each month according to individual needs. The control group will maintain its activities, normally receiving monthly calls to control and monitor its usual daily activities. Main Outcome Measures: Comparative analyzes will be applied between the results of EG and CG after the intervention period, and also pre-and post-intragroup tests within both groups in order to observe possible changes after the intervention. Conclusion: It is believed that this protocol is capable of treating the psychological, physical symptoms, hormonal profile, and sexual function of menopausal women.

Introduction: Cervical polyps are small pedunculate, often sessile neoplasm of the cervix. It is not known whether this is due to chronic inflammation, or abnormal local responsiveness to hormonal stimulation, or localized vascular congestion of cervical blood vessels. They occur most frequently in multiparous women in the fifth decade of life. Case Description: Here, we are reporting a case of a giant cervical polyp in a 38-year-old nulliparous lady who reported heavy menstrual bleeding and mass per vagina. Conclusion: Since a giant cervical polyp can mimic chronic inversion of the uterus, cervical fibroid, endometrial polyp, and cervical malignancy, it requires ruling out of these conditions before GnRH therapy.

Introduction: Endometrial cancer is one of the most common malignancies of the female genital tract, which can be serious or life-threatening. Microbial infections can be one of the underlying causes of this type of cancer. Case Presentation: The present study describes the isolation of Pichia fermentans (Candida firmentaria var. firmentaria) from the vaginal secretions of a 61-year-old woman affected by endometrial cancer. She reported abdominal pain and vaginal discharge for 3 months, and had a history of diabetes, hypertension, Deep Vein Thrombosis (DVT), and Acute Myeloid Leukemia (AML). The isolated yeast was identified based on nuclear ribosomal internal transcribed spacer (ITS1-ITS2 rDNA) sequence analysis. The in vitro antifungal susceptibility testing showed a higher effect for ketoconazole against P. fermentans than fluconazole, itraconazole and voriconazole. Conclusion: Correct differentiation between P. fermentans and other yeast should be considered. In vitro antifungal susceptibility testing is recommended for rare yeast, and will help the physicians in providing the best treatment.