Current Women's Health Reviews - Volume 20, Issue 3, 2024

Introduction: Since mothers often express higher levels of stress, anxiety and depression, it is important to evaluate the effect of COVID-19 on their mental health during pregnancy and postpartum. Objective: The aim of this study was to explore the concerns of mothers in the postpartum period amidst the COVID-19 pandemic. Methods: This was a descriptive cross-sectional study on 600 postpartum mothers. The sample size was determined based on the households covered by the health centers. The selected mothers completed a demographic questionnaire and Cambridge Worry Scale (CWS). Results: The mean age of study participants was 28.9 (6.3) and 364 (60.7%) mothers had excessive anxiety during pregnancy. The highest concern was related to the fear of congestion in the maternity ward with a mean of 2.48, and the lowest level of concern was related to the health status of the mother with a mean of 1.41. Conclusion: we recommend that the health sector adopt new methods of providing care to mothers. Implementation of tests for assessment of the mother's mental state during pregnancy by a midwife consultant is also recommended.

Background: We have, herein, presented a case of an uterocutaneous fistula after cesarian delivery. Case Presentation: A 24-years old female, gravida 3 para 3 with 2 living children, who underwent an emergency cesarean section about one month before the term due to preterm labor at Hamedan, was diagnosed with uterocutaneous fistula. Her medical history included 2 previous term cesarean section deliveries. She reported having fever and chills three weeks after the cesarian delivery. She also developed nausea, vomiting, and epigastric pain. Abdominal examination revealed a 30×40mm, firm, and tender mass on the right side of the cesarian section suture without any discharge. She was admitted with metritis as a primary diagnosis at N.H.F hospital. The performed transvaginal ultrasonography reported a hetero-echo mass with a diameter of 38×30×37mm with several echogenic foci and cystic components in the right ovary. After that, an abdominopelvic CT scan was done, and a 30×40mm mass in the right ovary with non-homogeneous due to collection and abnormal density with local hematoma at the site of the previous cesarian section was reported. Due to suspicion of lesion, the surgery was performed with the diagnosis of fascia opening and right Tubo-ovarian abscess and the infectious discharge of the right ovary. Right salpingo-oophorectomy surgery was performed. She was admitted again with the complaint of infectious discharge from the right side of the suture and erythema for one month. She also developed generalized abdominal pain. The patient was, thus, diagnosed with a uterocutaneous fistula and was admitted to the center. She became a trans-abdominal hysterectomy candidate and underwent surgery. Conclusion: One of the important risk factors for the fistula to be formed is an abscess. A few cases have been reported of post-cesarean uterocutaneous fistula in the literature. Surgical treatment associated with medical therapy can be effective in women with multiple cesarian sections. Any infected dehiscence must be radically operated.

Introduction: Although the number of studies conducted among pregnant women with coronavirus (COVID-19) is increasing rapidly, most of the studies are small-scale. Accordingly, data on the relationship between COVID-19 and pregnancy are limited. In addition, there is limited information about which complications COVID-19 causes in pregnant women compared to the normal population, and at what rates. This meta-analysis aimed to examine the data of studies and metaanalyses on pregnancies with COVID-19, and to determine the complication rates caused by COVID- 19 in pregnancies. Methods: Clinical, observational, or cohort studies published (or epub ahead of print) between January 2020 and December 2021 in any language were scanned in PubMed and Google Scholar. While scanning, the combinations of the terms “COVID-19”, “SARS-CoV-2”, “coronavirus”, “pregnancy”, “PROM”, or “preterm birth” were used. Results: A total of 52 articles and data on 11088 pregnant women were included in the meta-analysis after the screening of 6166 studies. In addition, data belonging to 10 meta-analyses were examined in order to obtain additional information. In the studies covered by this meta-analysis, the rate of premature rupture of membranes was found in 16.8%; preterm birth in 10.3%; low birth weight newborns in 9.2%; maternal or fetal mortality in 3.0%, and other adverse outcomes (fetal distress or abnormal APGAR score, abortion, etc.) in 17.5%. The vertical contamination rate was found to be 2.1%. Conclusion: The findings obtained in this meta-analysis show that COVID-19 significantly increases the maternal or fetal mortality rate in pregnant women and has a negative effect on the preterm birth rate. According to the data we have obtained, COVID-19 also causes the development of some complications, such as fetal distress. The findings also show that COVID-19 is transmitted vertically at a rate of around 2% during pregnancy.

Background: The COVID-19 pandemic affected both the maternity care and services provided by healthcare providers. Midwives are among the health professionals who are fighting on the frontlines of the COVID-19 pandemic. Objective: This study aimed to explore Iranian midwives' perceptions and experiences of the COVID- 19 pandemic. Methods: This qualitative description was carried out between March and May 2020 in Mashhad, Northeast Iran. Through purposive sampling, 15 midwives were selected from Corona Care-Centers. Semi-structured face-to-face interviews were used for data collection. Graneheim & Lundman's conventional content analysis approach was used to analyze the data. The data organization was performed using MAXQDA 12 software. Guba and Lincoln's elements of rigor, including credibility, dependability, confirmability, and transferability were considered. Results: Four overarching categories emerged based on the analysis of midwives' perceptions and experiences including "Facing challenges in confrontation with pregnant women", "Inefficiency of crisis management", "providing solutions and strategies to improve the current situation ", and "being affected by the pandemic in all aspects of life". Conclusion: Midwives faced different challenges since all aspects of pregnancy and childbirth care were influenced by the COVID-19 outbreak. Like other medical staff, midwives were on the frontline of health care during the COVID-19 pandemic, and it made problems for their personal feelings and professional responsibilities. Comprehensive support, promoting working status, and motivating midwives are vital in maintaining high-quality midwifery care.

Background: Non-coding RNA i.e. MicroRNA plays an important role in the progression and pathogenesis of different types of tumours including ovarian cancer. Deregulated microRNA expression could transform the passivity of cancer, disease progression, chemoresistance, and mobility. The miRNA profile of healthy and cancerous samples was observed to be different. MicroRNA expression analysis and profiling have a bright future in improving the effectiveness of ovarian cancer treatment that is customized to the patient's specific requirements. Expression analysis of serum microRNA- 126 and microRNA-22 in ovarian carcinogenesis has been done in the present study. 

Methods: Present study has been done in the serum of eighty- two epithelial ovarian cancer patients and eighty- two their age-matched healthy women to investigate the expression of miR-126 and miR- 22 was TaqMan PCR microRNA assay. The correlation of expression miR-126 and miR-22 with epidemiological and clinicopathological factors was determined statistically. 

Results: Results showed a 3.37-fold decrease in miR-126 expression and a 2.67-fold reduction in miR-22 expression in ovarian cancer patients. Decreased serum level of miR-22 and miR-126 in ovarian cancer patients has been correlated with the FIGO stage. Results revealed 87.46 sensitivity and 91.12 specificities for down-regulated microRNA 22 with FIGO stage of ovarian cancer and 71.26 sensitivity and 81.12 specificities respectively. More sensitivity and specificity of microRNA 22 with FIGO stage of ovarian cancer was revealed as compared to microRNA 126. 

Conclusion: Present study revealed downregulated expression of miR-126 and miR-22 in the serum of epithelial ovarian cancer patients. Among all epidemiological and clinical parameters, the FIGO stage of ovarian cancer revealed a substantial association with microRNA level. Results revealed that the sensitivity and specificity of down-regulated microRNA 22 in ovarian cancer were 87.46 and 91.12 and for microRNA 126 with 71.26 and 81.12 respectively. This may be investigated and verified as a durable diagnostic biomarker for the pre-diagnosis of ovarian carcinogenesis.

Background: Stress urinary incontinence (SUI) and pelvic organ prolapse (POP) would develop simultaneously because of the same etiopathogenesis of pelvic floor weakness. Some studies have said the association between SUI symptoms may be determined by the degree of anterior compartment prolapse. Then some incidences of occult SUI could also mask the symptom of SUI in the severe stage of POP. Methods: A total of 32 women diagnosed with POP and SUI from the urogynecology clinic were included in a cross-sectional study between 2019 and 2020. The degree of anterior compartment prolapse was measured using the POP-Q system (Ba point), while SUI's severity was measured using a 1- hour pad test in grams. The correlation between the severity of SUI (with the occurrence of occult SUI) and the anterior compartment prolapse was analyzed. Results: No correlation was observed between the degree of anterior compartment prolapse and SUI degree (r = 0.240, p = 0.182). Occult SUI was found in only 5/24 (20.8%) grade III and IV anterior compartment prolapse cases. Conclusion: SUI symptom was not determined by the severity of anterior compartment prolapse. The prevalence of occult SUI in severe POP was also low.

Background: Robson's Ten Group Classification System (RTGCS) is widely used to evaluate, monitor, and compare cesarean delivery (CD) rates within and between delivery service centers. This study aimed to investigate the causes of CD in Shiraz teaching hospitals using RTGCS. Materials and Methods: A cross-sectional study on 1787 pregnant women who underwent CD in selected teaching hospitals in Shiraz, Iran, was selected via convenience sampling within 3 months. The data collection tool was a demographic, midwifery, and fertility information questionnaire completed through interviews and medical records. Subjects’ classification was performed based on midwifery concepts and parameters described in RTGCS. The Robson's 10-group classification is based on simple obstetrical parameters (parity, previous CS, gestational age, onset of labour, fetal presentation, and number of fetuses). Data were analyzed using SPSS software and descriptive tests were used to describe the data. Results: Of the 1787 subjects, 455 (25.5%) had planned CS and 1332 (74.5%) had emergency CS. The most common causes of CD were previous CD (58.6%) and fetal distress (27.6%). Overall, 823 (46.1%) had fetal and placental causes, 1268 (71%) had uterine causes, and 78 (4.4%) had maternal causes. Conclusion: The biggest factors that played a role in the CD rate in the present study were termed multipara women with a history of previous CD. The CD rate and the overall size of this group are still increasing, and as a result, women with a history of a previous CD must be motivated more effectively to have a vaginal birth after cesarean delivery (VBAC).

According to WHO data, one in every four couples in developing countries is affected by infertility, and the prevalence remains high year by year. Infertility is considered to be a globally concerned health issue, which affects millions of people of reproductive age worldwide. Nowadays in our modern and developing field of medicine, we have different solutions and treatments for almost each and every disease. Treatment for infertility varies based on the cause, from simple psychological therapy to some complicated procedures. All these procedures are regulated by World Health Organization and their own country's legislation. Each country has uniqueness in their legislation, but almost all countries mainly focus on ethics, medical outcomes and health of both donor and recipients. However, in some parts of the world, laws are sometimes over-ruled and not abided properly. One of such recent incident took part in southern part of India (4 private hospitals in Tamilnadu, and 2 more hospitals in Andhra Pradesh and Kerala), which made a shocking news for people all over the country. The minor girl aged 16 years was exploited as egg (oocyte) donor. In the modern world, we are focusing and researching more and more on female related health problems, but such incidents worry us. We have a responsibility to prevent from such dreadful incidents in future, since respective governments and courts proceed the case for veracity and justice. As doctors or medical professionals, we have to follow our own medical and professional ethics. And as a citizen, all people including doctors and patients must obey our countries own rules and regulations accordingly. Further we request government authorities to make procedures and laws to be more strict and highly punishable when violated.

Background: Pelvic inflammatory disease (PID) is a public health problem that demands rapid diagnosis and treatment and may severely impair female reproductive health. Objective: To analyze anamnestic information, laboratory findings, and clinical and microbiological features of patients with severe acute PID that underwent a surgical procedure. Methods: This retrospective study enrolled 97 cases that were surgically treated in the Department of Obstetrics and Gynecology, University Hospital Sveti Duh“ between 2009 and 2019. Results: Most women were within the age group 35-44 (38.14%). Lower abdominal pain was the most common symptom (92.78%). Compared to intraoperatively confirmed PID, C-reactive protein (CRP) yielded the highest sensitivity (88.10%) while cervical motion tenderness possessed the highest specificity (53.85%). The tubo-ovarian abscess was detected in 35.05% of intraoperative specimens, mainly occurring in women between 45-54 years (p = 0.017) and absent between 15-24 (p = 0.012) and 25-34 years (p = 0.049). The length of hospital stay was influenced by the number of symptoms (ρ = 0.316, p = 0.002), admission CRP levels (ρ = 0.620, P < 0.001), and admission body temperature (ρ = 0.386, p < 0.001). Out of 59.30% of positive cultures, one pathogen was isolated in 70.59%, mainly Escherichia coli (41.18%). Admission CRP levels impacted the efficacy of microbiologic isolation (p = 0.001). The empirical treatment was mostly based on the clindamycin/gentamicin combination (51.72%). Conclusion: Severe clinical picture that requires surgical treatment can be expected in women >35 years. Longer hospital stay was associated with more symptoms, higher CRP, and temperature values on admission. It is important to have a low threshold for diagnosis and to consider both aerobic and anaerobic pathogens when selecting antibiotic treatment.

Background: The postpartum period is a challenging time for mothers, in which the quality of life (QOL) is an important indicator of health. Assessing the factors related to postpartum QOL (PQOL) can provide a holistic approach to health programs from an individual to a macro level. This study identified predictive factors for PQOL among Iranian postpartum women. Methods: This cross-sectional study was conducted using demographic, obstetric, and PQOL questionnaires on 236 postpartum women. The data were subsequently analyzed using descriptive and analytical statistics. Results: The results identified education level, delivery method (p< 0.05), planned pregnancy, and sufficient family income (p< 0.001) as the four factors associated with PQOL. In addition, adequate family income was identified as a predictor of PQOL (p< 0.001). Conclusion: Given that mothers' health helps to ensure the health of their families and communities, they should be classified according to PQOL predictors and matched with appropriate health programs to provide a high-quality postpartum period.

Objectives: Hydatiform mole can progress to gestational trophoblastic neoplasia (GTN), and we are looking for non-invasive methods to predict it. Old age, higher serum BHCG levels, and expression of genes, such as VEGF-EG, HIF-1α, and TGF-ß are known as predictive factors. We performed this study to evaluate the role of bilateral uterine artery doppler ultrasound in predicting postmolar- GTN. Methods: In this prospective cohort study, 42 patients with complete molar pregnancy were examined. Inclusion criteria confirmed molar pregnancy by histopathological examination. Exclusion criteria were patients more than 40 years old, patients with completed family childbearing planning, and diagnosis of GTN during the routine histopathological study. Before molar evacuation and four weeks later, bilateral uterine artery doppler sonography to determine the PI, RI, and PSV was performed. Serum BHCG levels were also measured before molar evacuation and weekly after evacuation until it exhibited spontaneous remission or developed GTN. Results: About 36 patients were cured, and six others developed post-molar GTN. The bilateral uterine artery doppler sonography between the two groups showed a lower UA RI in the post-molar-GTN group before evacuation (P=0.048). Data demonstrated significant increases in Right.UA.RI (P=0/008), Left.UA.PI (P=0/037), and Right.UA.PSV (P=0/024) in the spontaneous remission group during 28 days follow-up period. There were no significant differences in these parameters in the GTN group throughout the time of follow-up. Conclusion: It seems that Doppler ultrasound plays a role in predicting GTN following uterine evacuation. A lower resistance in the uterine artery before evacuation and the remaining uterine artery blood flow constant after evacuation is associated with the development of post-molar- GTN.

Background: Menopause is one of a woman's most crucial life stages. Identifying menopause's educational needs is critical. Objective: This study aims to explain the educational needs of women during menopause. Methods: The current study employs a qualitative content analysis method. The study included 12 women around menopause who were referred to Fatemieh Hospital's menopause clinic in Hamadan in 2020 and seven midwives. Individual semi-structured interviews with open-ended questions were used to collect data for the study. Data analysis was performed by Cheevakumjon method and conceptual content analysis was used to extract the concepts. After reading the text of the data, key sentences and concepts were derived and finally categorized. Results: The mean age of menopausal women and midwives was 54.15±4.24 and 34.35±3.54 years, respectively. In this study, three main themes were found in each of the perspectives of menopausal women (educational needs, expectations from the health system, expectations from others) and midwives (effective factors in the successful implementation of programs related to the health of menopausal women, obstacles and challenges of successful program implementation, strategies to increase program performance) regarding health needs related to menopause. The experiences of postmenopausal women had 3 themes, 4 categories and 15 subcategories and midwives' point of view was also divided into 3 themes and 5 categories and 14 sub categories. Conclusion: In order to manage the challenges of menopause, education and counseling are needed regarding the physical, mental, psychological and social changes that menopausal women may face. Moreover, to achieve these goals, there is a need for comprehensive support from the relevant politicians.

Puberty refers to physical transitions that occur in the body of adolescents, taking them from a stage of sexual immaturity to sexual maturity. Nowadays, it is being observed that more and more girls are attaining menarche at an age less than ten years, so the age of onset of Puberty being somewhere around 7.5 to 8 years. The reasons and implications are manifold. Early age of onset of puberty is a risk factor for ovarian and breast malignancies and also for a number of chronic diseases. The present article expresses author’s opinion regarding the issue on the basis of recent literature and tries to highlight the reasons responsible for this, especially in the current scenario and discusses modifiable factors so that the process can be halted.

Introduction: COVID-19 pandemic has severely affected the diagnosis and management of cancer patients to a large extent, with many patients being diagnosed at a later stage, and many are not able to get appropriate treatment. Furthermore, cancer patients are more prone to suffer from severe COVID-19 infection and its associated morbidity and mortality. Breast cancer is one of the commonest cancers affecting women worldwide and its number is projected to increase sharply in the post- COVID-19 era due to a serious fall in screening modalities, as patients stopped reporting to the hospital because of lockdown, movement restrictions, and fear of contracting the infection. Case Presentation: The present case report briefs a mother's sufferings and the impact it has on a daughter who is a doctor herself. It reports a rare combination of two primaries in the breast and thyroid in an asymptomatic patient with a rare mutation of the BLM gene detected incidentally. The patient was successfully operated on for stage IB ductal carcinoma breast with hemithyroidectomy and was put on chemotherapy with Cyclophosphamide 1000mg (600mg/m²) and Doxorubicin 100 mg (60mg/m²) per cycle on day one every fortnightly followed by four cycles of Paclitaxel 175mg/m2 every fortnightly. After the second cycle, the patient developed severe neutropenia and COVID-19 infection with atypical symptoms that severely involved her lungs, leading to the loss of the patient. Conclusion: With the onset of the COVID-19 pandemic, thousands of cancer patients have lost their lives, not due to cancer directly but due to failed early detection, treatment, loss of follow-up, and superadded severe COVID-19 infection.

Background: Vaccination is known as the safest and the most effective method to control the COVID-19 pandemic. However, the spread of misconceptions is one of the causes of vaccination hesitancy worldwide. Google is one of the most popular databases used by people to search for answers to their health concerns. Objective: This study aimed to identify the most public reproductive health concerns in relation to the COVID-19 vaccination of Iranians using data obtained from Google Trends. Methods: In this infodemiology study, the data were retrieved from Google Trends regarding the most public reproductive health concerns of COVID-19 vaccination using search terms "abortion", ‘infertility’, ‘menstruation’, ‘pregnancy’ and ‘sexuality’ in combination with "COVID-19 vaccine" in Iran. The period chosen was from February 1, 2021, to December 31, 2022. The relative search volumes (RSV) of the search terms were compared. Results: The comparison of the top five searched terms showed that the combination of the terms "pregnancy" and "Corona vaccine" had the highest popularity. The combination of search terms "sexuality"," abortion","menstruation", and "infertility" with the "Corona vaccine" was the next in the search rankings, respectively. The search interest increased after July 2020, and peaked in August and September 2021, when the vaccination of pregnant women was announced. From December 2021, the search interest decreased with a generally slow slope across all curves. The search interests differed among the 31 provinces of Iran. Conclusion: Public health authorities can use this study to better understand the reproductive health concerns of the community regarding COVID-19 vaccination. They can then apply this data for health planning, setting up agendas, and policy making.

Introduction: Cervical cancer can be prevented through vaccination against HPV and routine screening through HPV DNA testing or Pap smear. This cross-sectional study aimed to assess functional cervical cancer literacy (FCCL) levels and correlates among women of reproductive age in Lebanon. Methods: The Arabic self-administered questionnaire consisted of the Cervical Cancer Literacy Assessment Tool, socio-demographic characteristics (age, education, employment status, religiosity, ability to pay), and health-related factors (smoking, parity, chronic diseases, self-perceived health, history of uterine or cervix surgeries, health insurance, visits to physician in the past three months, and regular Pap smear and HPV DNA testing). Results: Of 619 women mean age of 33.9 years (±12.0), 51.7% had insufficient FCCL. Lower educational level, difficulty in covering medical expenses, lack of health insurance and poor self-perceived health were significantly associated with insufficient FCCL. Multiple logistic regression analysis showed that monthly income (OR: 1.74 [95% CI: 1.12 – 2.72]), ability to pay for medical expenses (OR: 1.81 [1.05 – 3.14]), and visits to the doctor in the last three months (OR: 1.51 [1.07 – 2.12]) were predictive of FCCL level. Conclusion: In addition to a national vaccination program against HPV combined with cervical cancer screening, we recommend the inclusion of cervical cancer as a topic within sexuality education programs. Special attention should be given to women with limited FCCL and uninsured women of low socioeconomic status. To enhance cervical cancer literacy, and promote vaccination and screening, efforts should extend beyond health care settings and leverage various media channels, including social media.

Background: Intimate partner violence (IPV) in all its physical, mental, overt and covert forms is an important issue in terms of its consequences. Objective: This study aimed to provide legal-jurisprudential support for women in cases of spousal abuse and unauthorized psychological violence. Material and Methods: This review article is the result of reviewing the published evidence on the supportive aspects of unauthorized psychological-verbal IPV between 1995 and 2021 in Magiran, SID, Iranmedex Persian databases, and in Scopus, PubMed, Science Direct, and EBSCO English databases. To gather information first, articles and jurisprudential texts containing one of the words “verbal violence, domestic violence, spousal abuse, legal protection of women, law, Islam” in the title or text, alone or in combination, were searched for. Results: Twenty-three out of 58 studies related to legal-jurisprudential support for women in Iran in cases of psychological-verbal IPV were reviewed. Verbal psychological IPV, attack on the spiritual status of the wife, accusing the wife of sexual infidelity, insulting, using inappropriate instincts, harshness, humiliation, intimidation and misbehavior, the verbal threat of harassment, and even threat of murder, etc., were the instances of such violence. The Shari’a supported the wife with punishments of Solemn Imprecation, imprisonment, lashes, and fines. Conclusion: In addition to the current legal solutions, the main legal gap that causes the ineffectiveness of laws and the violation of women’s rights is the solution and removal of obstacles that, in practice and in court, have made it difficult to prove psychological-verbal violence against women at home.