International Journal of Women's Health and Reproduction Sciences
Year:2016 | Volume:4 | Issue:3|Papers Count:12

As I sat around the table at the annual Go Red for WomenTM” luncheon in Denton, Texas, United States in February, I was struck by this year’s theme "Hearts Around the World." Throughout my career in pediatric cardiovascular nursing in the last 40 years, I never even considered the fact that heart disease would ever surpass breast cancer (or any other forms of cancer combined) as the number one killer of women in the United States; the statistics from other countries are even more staggering. For example, one in eight women in the United Kingdom die from heart disease annually and almost 500 000 women in the United Kingdom have had a previous myocardial infarction (MI) or heart attack. This editorial will highlight the differences in heart disease in women compared to heart disease in men. Although risk factors for cardiovascular disease are incredibly important, the discussion of them is beyond the scope of this editorial. The importance of heart disease in women has been recently highlighted by two Scientific Statements from the American Heart Association (1, 2), both of which provide a dearth of information about the large body of evidence that has been gathered thus far regarding women’s heart health.

Polycystic ovary syndrome (PCOS) is a common endocrine disorder in women and it affects approximately 5%-8% of premenopausal women. Metabolic syndrome has been reported in the reproductive literature to fall under a cluster of endocrine disturbances, including hypertension, obesity, dyslipidemia, and insulin resistance. Literature findings have demonstrated that conditions of negative energy balance and metabolic stress, such as diabetes mellitus type 1, acute inflammation, and chronic dietary restriction can affect fertility. These conditions cause hypogonadism by suppressing the expression of the hypothalamic KiSS or kisspeptin. Diabetes affects reproductive function in women. The objective of the current review is to explore the correlation between metabolic syndrome and infertility in women. To achieve this, a review of literature studies between 2007 and 2015 was undertaken to evaluate current evidence-based practice on the topic. keywords, such as metabolic disorders, women fertility, and reproduction were used to search for data from PubMed, MEDLINE, CINAHL, ERIC, and EMBASE databases. The inclusion and exclusion criteria was based on the appropriateness of the research design in reference of research objectives, risks of bias, statistical issues, quality reporting, choice of measures of outcome, quality of intervention, and studies conducted between 2007 and 2015. The results from the highest evidence available confirm that metabolic disorders have adverse impacts on the reproductive health of women, and specifically their fertility. Metabolic disorders like hyperlipidemia, obesity, and diabetes can directly or indirectly affect the fertility of women through the interruption of either the ovarian functions or the pituitary-hypothalamic functions. Furthermore, metabolic disorders increase the risks of cervical and endometrial cancers in women that hamper the reproductive health and fertility of women.

Among the controversies about reproduction sciences, role of immune and inflammatory systems in implantation process and durability of pregnancy is a hot topic both in natural pregnancies resulting in spontaneous abortion and success rate of assisted reproductive technologies (ARTs). So we intend to represent and report our insights, reasoning and suggestions. This systematic and critical review includes investigation of scientific databases and tracing the citations. Our findings falls into three categories: role of immune system and leukocytes, vascular remodeling and histopathology of endometrium, role of inflammation in implantation process. According to the categories above, the immune and inflammatory systems not only are not harmful by itself, but also are necessary for spiral artery remodeling, implantation process and durability of pregnancy. At the end of the review it is notified and suggested that using a valid protocol is necessary for infertility clinical centers. The protocol mainly consists of human leukocyte antigen (HLA) C and G typing and also killer-cell immunoglobulin-like receptor (KIR) typing.

Objectives: To evaluate the knowledge, perception and treatment seeking behaviour of infertile women in Bauchi, northern Nigeria.Materials and Methods: Four hundred and six infertile women were surveyed in two hospitals using a structured questionnaire between July 2013 and June 2014.Results: The ages of the respondents ranged from 19 to 42 years with a mean age of 30.5 years (SD: ± 5 years). Many (81%) of the respondents had poor knowledge of risk factors for infertility and over 80% believed in supernatural causes. The women who had secondary level of education or higher (4.78, CI: 2.35-9.71, P<0.001) and those who were employed (3.08, CI: 1.44-6.58, P=0.04) had significantly better knowledge compared to those who had lower level of education and were unemployed. Almost three-quarters (n=299, 73.6%) believed that women bear the blame for infertility and 40.4% see it as a reason for the man to take another wife. Half of the women felt the woman alone should seek for treatment and only 28% reported hospital as their site of initial treatment. Most (n=370, 91%) felt infertility should be given priority in public hospitals and 308 (76%) believed the government should pay for infertility services as done for other reproductive health (RH) services.Conclusion: There is low level of knowledge of infertility among infertile women in Bauchi and women bear the blame for infertility. There is need for initiatives to improve RH education in Bauchi.

Objectives: Breast cancer is a major health problem. Breast self-examination (BSE) is a simple method for breast cancer screening. The health belief model (HBM) is a model for conventionalizing and management of health-related behaviors such as breast cancer screening. The objective of this study was to determine the relationship between HBM and BSE among Iranian university students.Materials and Methods: This was a cross-sectional study conducted on 247 medical and paramedical students of Guilan University of Medical Sciences in 2010. Data was collected using Champion’s Health Belief Model Scale (CHBMS) for breast cancer screening whose validity and reliability have been verified in previous studies. Data was analyzed using descriptive and inferential statistics.Results: The average age of samples was 21.76 ± 2.6 years. Students with a positive family history of breast cancer performed BSE more frequently (9.2% compared with 82.2%, P<0.05). The mean score of Health Belief Questionnaire was low for the majority of samples (61.94%, n=153). Students’ health beliefs had a statistically significant relationship with performing BSE (P<0.05).Conclusion: Since medical and paramedical students are regarded as role models of healthy behaviors, it is critical to have an awareness of their health beliefs on BSE. In addition, positive behavior and attitude towards BSE enables students to perform breast cancer screening tests more effectively. According to the results, it is necessary to improve students’ knowledge of and attitude towards BSE by training programs.

Objectives: Gestational diabetes is defined as impaired glucose tolerance during early pregnancy. Many evidence showed that proper regimen and physical activity have inhibitory effect on incidence of gestational diabetes. In many guidelines, it is advised for performing screening tests for gestational diabetes in early stages of pregnancy and post-partum consulting for changes in life style.Materials and Methods: In this study, 40 pregnant women with gestational diabetes were enrolled. In this study, 40 pregnant women with gestational diabetes were enrolled. In this research an experimental design with pre-test and post-test and control group, in the form of a written program to reduce stress among pregnant women was carried out. The effectiveness of the educational principles of nutrition in diabetes program to reduce the stress was evaluated in experimental group and control group that did not receive any training.Results: The results indicate the effect of reducing stress in trained pregnant women. Also the effect of nutrition training on blood sugar, the results indicate a reduction in HbA1C levels compared to the control group.Conclusion: Due to the impact of education on reducing maternal stress and glycemia control and pregnancy, it is recommended to target the education of proper nutrition and self-care in pregnant women even in patient with diabetes type 2, as a simple and cheap therapeutic procedure.

Objectives: Although the fertilization and cleavage rate of implanted embryos is about 70%-90% in most patients, only a small number of embryos grown in vitro have the potential to implant. This indicates that many factors are responsible for a successful implantation, including obtaining viable embryos for transfer. This study aimed to examine the clinical results of pregnancy and implantation rates between day 2 and day 3 embryo transfer (ET) in women under the age of 40 experiencing fresh intracytoplasmic sperm injection-embryo transfer (ICSI-ET) cycles.Materials and Methods: In a retrospective study, a total of 284 ETs were examined from March 2013 to December 2014. The transfer was done according to physician’s preference, patient characteristics or number of embryos available.Results: The data suggested that clinical (35.4% vs.28.9%, P=0.26) or ongoing pregnancy (32.5% vs.23.7%, P=0.11) or implantation rate (0.267 ± 0.2 vs.0.216, P=0.09) was slightly better and the miscarriage rate (3.1% vs.7%, P=0.153) was slightly lower on day 3 ET vs. day 2, however, this difference was not significant. Although most of the baseline characteristics were similar between groups, the number of high-quality embryos (5.29 ± 3.9 vs.4.47 ± 3.05, P=0.011) and average embryo cleavage score (2.85 ± 0.4 vs.2.25 ± 0.3, P<0.001) was significantly higher in the day 3 ET in comparison to the day 2 ET.Conclusion: A similar clinical outcome between ET performed on days 2 and 3 in women younger than 40 years undergoing fresh ICSI-ET is suggested by the results of this study.

Objectives: Episiotomy is the most common surgical incision in midwifery. Given its questionable benefits, the present study aimed to determine the frequency of episiotomy and its associated factors in women with vaginal childbirth.Materials and Methods: This descriptive cross-sectional study was conducted on a population consisting of all women that had vaginal childbirth over a six-month period (from October 2014 to April 2015) in Fatemieh Teaching hospital in Shahroud city. Participants were selected by census. Data were collected using a researcher-made questionnaire consisting of four parts, whose validity and reliability had been confirmed. Data were analyzed in SPSS 21 using descriptive statistics and chi-square, t test and logistic regression analysis.Results: Of the 978 cases of vaginal childbirth, 406 (41.5%) had undergone episiotomy. Mean age of participating women was 27.32±5.14 years. Episiotomy was found to have significant relationships with mother’s age, parity, first and fifth minute Apgar scores, duration of the second stage of labor, birth spacing, use of oxytocin, vacuum deliveries and use of analgesics (P<0.05). Overall, prevalence of intact perinea was 34.7%. In the final logistic regression analysis, among significant variables and variables with P<0.1 in univariate analysis, parity, use of oxytocin, first minute Apgar score and infant’s head circumference with P<0.0001 and birth spacing with P=0.043 were considered predictors of episiotomy.Conclusion: The overall rate of episiotomy in this study was 41.5%, which is much higher than the standards set by the World Health Organization (WHO). Further research is required to provide appropriate solutions to reduce episiotomy.

Objectives: Fetal cardiac arrhythmia has good prognosis. However, some can lead to hydrops fetalis and perinatal mortality. There are not sufficient studies on the prevalence and complications of fetal arrhythmias in Iran, thus, making parents anxious. Therefore, we performed this study to determine its proper management and to prevent its complications during pregnancy. Then we can help parents by giving them sufficient information about their fetal problem.Materials and Methods: This descriptive-analytic study included 81 pregnant women with fetal arrhythmia detected in routine monitoring. For cases, we performed fetal echocardiography. Data was analyzed by SPSS 20 (P<0.05).Results: This study assessed the fetal period until 28 days after labor. Fetal arrhythmia was confirmed in 37 cases through echocardiography. The most prevalent arrhythmia was extrasystole with 27 cases (72.97%). Two cases with congenital heart disease experienced heart failure and hydrops fetalis and died in neonatal period and 25 cases survived. Eight cases had bradycardia including 5 with sinus bradycardia and 3 with atrioventricular block. Seven cases had congenital heart problems and 4 of them led to heart failure. Perinatal mortality was seen in six cases. Tachycardia was seen in two cases (5.4%) with no heart failure or hydrops fetalis. One case died of preterm delivery.Conclusion: Congenital heart disease is considered as an important risk, affecting fetal and neonatal outcome in fetuses with arrhythmias. As pregnancy advances, the frequency of arrhythmias decreased and converted to sinus rhythm.

Objectives: Considering the prevalence age of breast cancer (BC) as whole and involvement of young aged Iranian women and as Behbood hospital is a screening center for BC in Tabriz, East Azerbaijan, this study aimed to present the results of screening tests.Materials and Methods: For 5000 women referred to BC clinic of Behbood hospital, a self-designed questionnaire including demographic-social characteristics and risk factors of BC was completed by researcher. Then breasts of women were examined by midwives and recorded in questionnaire. In case of abnormal results ultrasonography, mammography and fine needle aspiration (FNA) were prescribed and results were recorded in the questionnaire.Results: A total 516 cases of left breast mass and 480 cases of right breast mass were palpated. Forty cases out of 996 ultrasonography were abnormal. A total of 183 cases out of 636 mammography were abnormal. One case out of 14 FNA was cancer (7.1%). Occupation, menopause status, history of performing FNA, education level, marriage status, age of first pregnancy and body mass index (BMI) had significant relationship with abnormal clinical breast examination (CBE). Breastfeeding had significant relationship with abnormal sonography results. Menopause, diet, use of chemical agents and type of oils used in diet had significant relationship with abnormal mammography results (P<0.05).Conclusion: Based on these results, women should be encouraged to undergo BC screening tests more regularly and to increase their knowledge on BC and benefits of screening through public media.

Objectives: In this study we investigated whether 50 Hz power frequency electric field of 1.01×103 V/m and the magnetic field flux density of 3 mT have effect on serum sex hormones and antioxidant capacity and if Allium cepa and cinnamon can moderate potential adverse effects of power frequency electromagnetic exposure.Materials and Methods: Forty female Wistar rats, weighting 220 ± 10 g were used for this study. Rats were allocated randomly to four groups. The first group (the control group) received 3 cc normal saline (0.9%) daily and was treated for 6 weeks. The second group was exposed to power frequency of 3 mT for 4 h/day, 7 days/week for 6 weeks. The third group received Allium cepa (3 cc onion juice) and cinnamon (75 mg/kg body weight) daily for 6 weeks by Gavage method. The fourth group was exposed to power frequency EMF of 3 mT for 4 h/day, 7 days/week and received Allium cepa (3 cc onion juice) and cinnamon (75 mg/kg body weight) daily for 6 weeks by Gavage method.Results: Levels of luteinizing hormone (LH), follicle-stimulating hormone (FSH) and estrogen, significantly decreased in second group that exposed to power frequency EMF of 3 mT and 103 V/m (P<0.05) and modified in exposed rats which received Allium cepa and cinnamon (P<0.05). Also, TAC levels were significantly decreased in exposed rats and were moderate in exposed rats received Allium cepa and cinnamon (P<0.05).Conclusion: Power frequency electromagnetic field could adversely affect sex hormones and total antioxidant capacity (TAC) levels in exposed rats and Allium cepa and cinnamon could prescribed as an effective pharmacological supplement to moderate exposure degenerative effects.

Introduction: Cesarean section is a risky procedure. In most of the world, trial of vaginal birth after cesarean section (VBAC) is suggested and performed. In this case report, we aimed to show the possibility of vaginal labor in a patient who underwent repeated cesarean section and to review the risk of cesarean section.Case Presentation: A female patient aged 32 years, who had cesarean section three times (gravida 5, parity 3, abortion 1) with 3 children, came to the delivery service when she went into final labor pain. On examination, it was seen that there was full dilatation of cervix and the fetus was in the vertex position. With episiotomy given and normal spontaneous vaginal delivery, a live baby boy of 3280 grams, 50 cm and Apgar score of 6-8 (at first and fifth minutes) was delivered. Having normal vital findings, the patient was discharged from the hospital on these conditions postpartum day 1.Conclusion: Cesarean section increases maternal, prenatal mortality and morbidity. In health centers which have operative conditions, the option of normal spontaneous delivery should not be ignored for appropriate pregnant women.