International Journal of Women's Health and Reproduction Sciences
Year:2019 | Volume:7 | Issue:2|Papers Count:17

In this editorial, I would like to mention an important issue concerning the change in incidence rate pattern of breast cancer in Iran. We know that breast cancer is the most prevalent type of malignancy in women and represents a major public health problem, which confers a huge burden on patients and societies around the world. Likewise, this cancer is the leading type of cancer in Iranian women, accounting for almost one-fourth of all cancers (1). Recently, several studies that assess the incidence rate of this cancer in Iran, reported that the average age of the patients diagnosed with this cancer decreased to lower ages in this country as compared to the rest of the world (2). Its peak incidence age in Iranian females is in the fourth and fifth decades of life, which is a decade earlier than the world peak age of incidence...

Objectives: The present study aimed to investigate medication adherence awareness among women undergoing infertility treatment. Materials and Methods: Several databases were searched including PubMed, Embase, CINAHL, PsycINFO, as well as ProQuest dissertations in order to collect the required data. In addition, based on the purpose of the study, English-language prospective, retrospective, observational, cross-sectional, quasi-experimental, and randomized controlled trial studies were selected which focused on medication adherence as a primary or secondary outcome in women with a diagnosis of infertility. Finally, critical appraisal for the quality of the study was assessed using Downs and Black Quality Checklist (1998) and STROBE guidelines. Results: Three studies conducted during 1993-2011 were analyzed. Further, sample sizes varied from 30 to 626 subjects with average rates of oral medication adherence ranging from 26% to 81% when used as the first-line therapy. More frequent daily dosing was associated with lower adherence rates. Based on the results, adherence was significantly lower when women were concerned about the side effects of medication adherence or reported 3 or more side effects rather than one or 2 cases. Furthermore, women with a body mass index of <23 kg/m² or those who viewed medical treatment as convenient had higher adherence rates. It is noteworthy that none of the studies evaluated medication adherence during controlled ovarian hyperstimulation (COH) cycles, along with intrauterine insemination (IUI) or in vitro fertilization (IVF). Conclusions: In general, rates of oral medication adherence are found suboptimal when used alone as first-line therapy. Accordingly, further studies regarding medication-taking behaviors are warranted in future research trials involving injection medications and COH cycles associated with IUI and IVF cycles in order to strengthen the clinical practice.

Objectives: Women constitute almost 50% of the world population and play a number of roles in the community. The present study aimed to assess the relationship between sex education and women empowerment in health. Methods: Based on the aim of the study, the data were obtained reviewing the related literature on electronic and non-electronic websites and using equivalent keywords published until the last week of February 2018. In addition, mesh terms and key words were included in this research. Inclusion criteria were articles published from 2005 to February 2018. All the observation or interventional studies including ten articles which met the search criteria were studied. Results: The results revealed that sex education has different effects on sexual attitudes or activities of women. Further, it was effective in increasing the sexual autonomy of female college students. Furthermore, health providers’ contribution may improve sexual autonomy. In the current study, sex education programs were effective at increasing HIV/AIDS ( Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome) knowledge and condom use, reducing the risk of unprotected intercourse and sexually transmitted infections (STIs), as well as unplanned pregnancy and abortion. Finally, abstinence-plus sex education programs increased health knowledge while they reduced risky sexual behaviors. Conclusions: In general, sex education is a critical method of women empowerment in health through increasing their health knowledge and related behaviors. Therefore, a compilation program of sex education is more useful. Accordingly, seeking to place sex training in the educational curriculum in accordance with the culture of the countries is a necessity.

Objectives: The present study aimed at reviewing the existing literature on the effects of maternal corticosteroid administration on pulsatility index (PI) values in the umbilical artery and middle cerebral artery (MCA). Materials and Methods: The search for relevant materials on “ evaluating the effect of corticosteroids on fetal circulation” included the following databases: PubMed, Scopus, Cochrane Library, ISI Web of Science, Proquest, Google Scholar, EMBASE, and Iranian Databases of Magiran, Iran Medex, Barakat knowledge network system, Scientific Information Database, Iranian Research Institute for Information Science and Technology, from 1990 to June 2017. Results: In our search for the relevant literature, 19 articles were found. In total, these studies included 654 pregnant women, who were evaluated for fetal circulation before and after corticosteroid (betamethasone or dexamethasone) injection, for PI values in the umbilical artery and MCA. The effects of steroid injection were evaluated between 23 and 34 weeks of gestation. Conclusions: Overall, the results of the reviewed studies indicated that antenatal exposure to corticosteroids reduces umbilical artery PI and MCA PI and improves fetal circulation during pregnancy.

Objectives: Globally, caesarean section (CS) has immensely contributed to improved obstetric outcome in circumstances where vaginal delivery is not feasible. However, in some low-income countries, there is aversion to the procedure. The aim of this study was to determine the level of awareness and socio-cultural barriers to the acceptance of CS. Materials and Methods: A cross-sectional study was conducted among 344 parturients at Federal Teaching Hospital in Abakaliki, from October 1 to November 30, 2016. Data were collated using a self-administered questionnaire and was analyzed using SPSS version 20. 0 and conclusions were drawn by means of descriptive statistics. Results: All the respondents were aware of CS as an operative abdominal procedure for delivery; of these, over one-tenth (14. 0%; 48/344) had experienced the procedure previously. Over four-fifths (82. 3%; 283/344) of those who have had a previous CS were well-informed about the indications. About one-fifth (20. 3%; 70/344) did not accept CS for any reasons. The major barriers to acceptance were being considered by peers as a reproductive failure (29. 2%; 7/24), high cost (20. 8%; 5/24) and religious beliefs (12. 5%; 3/24). Conclusions: Majority of antenatal attendees had a significant awareness of CS and the indications. Moreover, a vast majority had morbid aversion towards it; due to numerous, non-evidence based socio-cultural reasons. Therefore, adequate health education, female empowerment, access to free or affordable antenatal care service, elimination of harmful, religious/cultural beliefs and myth regarding caesarean delivery are necessary to curb this ugly trend if we hope to achieve the sustainable development goals related to maternal health.

Objectives: The study has evaluated bone health status among post-menopausal women in a public hospital of Malaysia. Materials and Methods: A total of 116 post-menopausal women, who met the criteria, participated in this study. The purposive sampling method was used to achieve the criteria of participants. Results: This cross-sectional study revealed that more than half of the respondents (52. 6%, n = 61) had osteopenia; whereas, 47. 4% (n=55) of the respondents had osteoporosis. There was a significant correlation between the age and menopausal years with the bone health status (i. e. P = 0. 004 and P = 0. 028, respectively) in postmenopausal women. Conclusions: Menopausal women experienced deterioration of bone mineral density (BMD) with advancing age and menopausal years.

Objectives: Delivery is a painful process and may impose different mental effects on the mother. The present study investigated the relationship between forgiveness and spiritual well-being on the mother’ s anxiety during her labor. Materials and Methods: This is a cross-sectional and descriptive-analytic study. The research population included all the pregnant women who referred to three maternity hospitals affiliated to Shiraz University of Medical Sciences. In addition, the sample contained 200 pregnant women (both the prime and multiparous mothers) based on multiple regression analysis and 10 samples were selected for each variable of the study. The Paloutzian and Ellison Spiritual Health Scale, Pollard Forgiveness Scale in Family and Spielberger’ s questionnaire were used to collect the data. Results: Based on Pearson correlation test, variables of the study demonstrated a significant relationship and the correlations between spiritual health and trait anxiety of the mothers, state anxiety, and the total score of anxiety were r=-0. 329,-0. 385, and-0. 363, respectively. Further, a significant relationship was observed between mother forgiveness and mother’ s anxiety (r=-0. 352), the state anxiety (r =-0. 39), and the anxiety variable (r =-0. 377) (P = 0. 001). Conclusions: In general, there was a significant negative relationship between spiritual health and forgiveness with the state, trait, and overall score of anxiety.

Objectives: The antagonist of gonadotropin-releasing hormone is proven to be effective and safe in preventing a surge in luteinizing hormone (LH) during in vitro fertilization (IVF) cycles. In addition, the differentiation of GnRH antagonist protocols is in timing the initiation of the GnRH antagonist. The present study aimed to compare fixed versus flexible antagonist regimens in patients with reduced ovarian reserve in order to identify a better regimen for these patients. Materials and Methods: This study was of a historical cohort type. Totally, 129 patient files were investigated including 48 versus 66 files related to fixed or flexible protocols, respectively. The mean of age, body mass index (BMI), follicle stimulating hormone (FSH), and anti-Mullerian hormone (AMH), as well as the mean dose of gonadotropin, the mean length of IVF/ICSI cycles, and the mean counts of oocytes and embryos with grading including good, fair, and poor were compared between the 2 groups. Results: The total and mean consumption of gonadotropin dose (recombinant FSH) in the flexible and fixed groups were significantly different (P = 0. 05). However, the mean antagonist (cetrotide) doses in the fixed and flexible groups were not significantly different while it was lower in the flexible group (P = 0. 50). Finally, the duration of gonadotropin consumption in IVF/ICSI period was not significantly different between the two groups. Conclusions: In general, the fixed protocol is recommended in patients with reduced ovarian reserve since it is simple to use and more cost effective compared to the flexible protocol.

Objectives: Polycystic ovary syndrome (PCOS) is one of the frequent endocrine disorders among young females, which can cause infertility. Recently, evidence has shown the beneficial impacts of N-acetyl cysteine (NAC) use along with clomiphene citrate on the treatment of infertility caused by PCOS. Regarding this, the present study aimed to compare the pregnancy rate between the PCOS patients treated with clomiphene and those received clomiphene along with NAC. Materials and Methods: This blinded randomized controlled clinical trial was performed on 66 patients with PCOS who presented with infertility at Milad Infertility Center in Mashhad, Iran, in 2015. The patients were divided into two groups of intervention and control using a random number table. In the intervention group, 100 mg of clomiphene (i. e. two pills) along with 1200 mg of NAC (i. e. two 600 mg pills) were given to the participants from the third day of the menstrual cycle for five days. In the control group, 100 mg of clomiphene was administered from the third day of the cycle for 5 days. The patients’ response to medications as well as the number and size of follicles were assessed using the vaginal ultrasound. Results: The 2 study groups had no significant difference regarding age, duration of infertility, body mass index, history of infertility treatment, and endometrial thickness on the third day of the menstrual cycle. The mean endometrial thickness was 7. 47 ± 1. 6 (NAC/clomiphene) and 7. 58 ± 2. 1 mm (clomiphene) on the 12th day of the menstrual cycle (P = 0. 810). Furthermore, the mean sizes of the follicles were 13. 6 ± 4. 2 (clomiphene) and 15. 9 ± 5. 1 mm (NAC/clomiphene) (P = 0. 301). The mean numbers of follicles were 1. 56 ± 0. 9 (clomiphene) and 1. 8 ± 0. 9 (NAC/clomiphene) (P = 0. 069). In total, 7 (21. 2%) and 5 (15. 1%) patients in the intervention and control groups had a positive beta-hCG result, respectively (P = 0. 260). Conclusions: As the findings of this study revealed, the addition of NAC to clomiphene treatment was not associated with an increased chance of pregnancy in patients with PCOS-related infertility.

Objectives: Sexual behavior is considered an important aspect of marital life and is influenced by attitudes, experiences, actions, feelings, and thoughts. The present study aimed to develop a valid and reliable questionnaire to evaluate several aspects of sexual behavior of infertile women (SBIW). Materials and Methods: The current mixed sequential exploratory study was performed in two phases. In the qualitative phase, a preliminary questionnaire was developed based on in-depth interviews with 15 childless women and 8 specialists who were selected by purposeful sampling technique. In addition, qualitative and quantitative SBIW questionnaire was measured by internal consistency and test-retest. Results: In the qualitative phase, a primary questionnaire including 113 items was constructed. Finally, the items of the questionnaire were reduced from 113 to 77 items. The SBIW questionnaire was classified into 5 categories investigating the effects of infertility diagnosis, infertility treatment, common beliefs, sexual response cycle and related factors, and the women’ s husbands, relatives, family, community, and education on sexual behavior of these infertile women Further, each investigator could use each part he wished to. S-CVI (sum of content validity index) and S-CVR (sum of content validity ratio) were obtained as 0. 86 and 0. 68, respectively. Eventually, the Cronbach α = 0. 862 and the ICC (intraclass correlation) was obtained 0. 928 for the SBIW. Conclusions: In general, it was identified that the SBIW is a valid and reliable instrument which can be used to assess several dimensions of SBIW and is probably considered a useful instrument during infertility consulting and investigations.

Objectives: Health promotion leads to a higher quality of life among women. The present study aimed to investigate the relationship between menopausal symptoms and general health among women with menopause. Materials and Methods: In this cross-sectional, 600 postpartum women in Ahvaz, Iran were selected and recruited using the randomized cluster sampling method during 2013-2014. The data were collected by the women’ s demographic characteristics instrument, as well as the Goldenberg’ s and menopausal symptoms questionnaires. In addition, descriptive statistics and logistic regression were employed for data analysis by the SPSS software, version 19. The statistical tests were performed at 95% confidence interval. Results: As regards the menopausal symptoms, sleep disorders (39%), myalgia (42. 7%), and hot flashes (32. 5%) were reported as moderate, severe, and very severe, respectively. Further, 50. 2% of the participants had impaired general health. Finally, job, hot flashes, sleep disorders, myalgia, depression, and aggressiveness were associated with general health (P<0. 05). Conclusions: In general, there is a need to improve public health and reduce menopausal symptoms among postmenopausal women since menopause is changed to a crisis in a woman’ s life.

Objectives: Post-spinal puncture headache (PSPH) has constantly been one of the research priorities, especially in women undergoing cesarean section (C-section) and it is related to physical and psychological problems. The present study aimed to evaluate the effect of ginger on preventing PSPH in patients undergoing C-section. Materials and Methods: This clinical trial was conducted on 160 women undergoing C-section with spinal anesthesia, who were eligible to enter the study in the experimental and control groups. One ginger capsule (250 mg) was prescribed every 8 hours (TDS) to the experimental group 24 hours before the C-section. The prescription of ginger was continued half an hour after transfer to the post-partum ward until the PSPH onset. PSPH intensity was measured by using visual analog scale (VAS) pain scores at 6 time-points (Time 1 = 30, Time 2 = 60, and Time 3 = 90 minutes vs. Time 4 = 3, Time 5 = 6, and Time 6 = 12 hours) after C-section. No interventions were performed in the control group. The data were analyzed using the SPSS software by descriptive statistics and analytical tests were applied to determine the changes in PSPH intensity. Results: The comparison results of the mean score of PSPH intensity in the experimental and control groups indicated significant differences over time (P < 0. 05), except for the sixth time point (12 hours after C-section). In addition, the trend of changes at 6 time-points based on the results of the repeated-measures test demonstrated that PSPH intensity significantly differed in the two groups over time (P < 0. 001). Conclusions: Based on the result, the oral prescription of ginger to women undergoing C-section under spinal anesthesia led to effective PSPH prevention at 5 time-points (30, 60, and 90 minutes, along with 3 and 6 hours). Further, the trend of the changes represented that the intensity of PSPH decreased in the experimental group over time. Therefore, ginger is suggested as a non-invasive and efficient method used for preventing PSPH.

Objectives: Cervical cancer is a very common and lethal condition; however, owing to longstanding premalignant lesions, it is possible to prevent morbidity and mortality by screening tests. Pap smear, colposcopy, and biopsy are among the main modalities in this regard, however there is no consensus on the diagnostic utility of the first 2 methods. This study sought to examine the diagnostic utility of Pap smear, colposcopy, and cytology in evaluating the non-benign cervical lesions. Materials and Methods: A cross-sectional study was carried out between 2014 and 2016 in an out-patient setting at Alzahra teaching hospital of Tabriz University of Medical Sciences. After obtaining informed consent, all 315 participants with abnormal Pap test underwent colposcopy and biopsy from the abnormal areas. Cervical biopsy was considered as a gold standard and the diagnostic values of Pap smear and colposcopy were individually compared by calculating sensitivity, specificity, positive predictive value, negative predictive value, and likelihood ratio. Results: The mean age of patients was 38. 49± 10. 31 years (17-68 years). On the basis of biopsy findings, non-benign cervical lesions were present in 31 cases (9. 8%). Accordingly, the sensitivity, specificity, positive predictive value, negative predictive value, and positive likelihood ratio of Pap smear in revealing non-benign cervical lesions were 77. 4%, 69. 7%, 21. 8%, 95. 6%, 70. 7%, and 2. 55%, and for colposcopy, were 90. 3%, 90. 9%, 51. 9%, 98. 9%, 90. 8%, and 99. 2%, respectively. Conclusions: Based on our results, the colposcopy is a sensitive and specific method in differentiating benign cervical lesions from non-benign cervical lesions. The accuracy of Pap smear is intermediate in this regard, and the utility is limited. Therefore, this method should not be considered as the main criterion for decision making.

Objectives: Glycated hemoglobin (HbA1c) is the most commonly used glycemic index among diabetic patients. The present study sought to investigate the relationship between HbA1c and lipid parameters among healthy pregnancies and gestational diabetic cases. Materials and Methods: Seventy-five Saudi pregnant women within the age group of 19 to 43 years were selected for this cross-sectional study. The participants were categorized into with and without gestational diabetes (GDM), all of whom were non-smokers; in addition, they neither had a previous history of chronic illnesses nor were they on any medications which could alter lipid profile and HbA1c concentrations. Totally, 75 g of oral glucose tolerance test (OGTT) was utilized to identify 25 women with GDM. All biochemical tests including HbA1c, fasting blood sugar (FBG), total cholesterol (TC), low-density lipoprotein (LDL-cholesterol), triglycerides (TG), and high-density lipoprotein (HDL-cholesterol) were performed by a biochemical auto-analyzer. The collected data were statistically analyzed using a paired student’ s t test. The P values of <0. 05 were considered statistically significant on all the analyses related to healthy pregnancies and those associated with GDM. Results: The HbA1c and FBG values demonstrated significant correlation with GDM (P < 0. 001 each). However, TC, LDL-cholesterol, and TG failed to indicate any significant difference between the 2 groups. Conversely, HDL-cholesterol and the ratio of TG and HDL-cholesterol revealed remarkable differences between GDM and healthy participants (P < 0. 05 each). Conclusions: In general, the blood levels of glucose, HbA1c, TG, and HDL-cholesterol are of paramount significance in GDM. Predictably, HbA1c can be employed as one of the markers in evaluating the risk factors in developing dyslipidemia among pregnant women.

Objectives: Despite the increasing knowledge about family planning and modern contraceptive methods, as well as high failure rates of the traditional method, a significant percentage of couples use withdrawal for contraception. Accordingly, the present study mainly aimed to investigate the determinants of using withdrawal to avoid pregnancy in Tabriz. Materials and Methods: The sample of the study included 383 married women aged 15-49 years. Multivariate logistic regression analyses were employed to determine factors associated with using withdrawal as a contraceptive method. Results: Based on the results, about 19. 5% of the women were relying on withdrawal. In addition, 55% reported that they were currently using a modern method to avoid pregnancy while the remaining 25. 5% used no method in order to prevent contraception. The results of multivariate logistic regression demonstrated that university-educated couples with no child who were within the age range of 15-24 and born in urban areas were more likely to use withdrawal rather than modern contraceptive methods (P<0. 05). Conclusions: In general, the rate of employing the traditional method in Iran and, especially in Tabriz is increasing. Regarding higher proportion of withdrawal use among higher educated women due to the fear of side effects resulted from other methods, family planning providers and reproductive health services should be sensitive to the women’ s concern and provide programs to decrease the unmet need of family planning.

Primary vaginal calculi exist as an extremely rare topic discussed only through a handful of case reports. Based on the cases studied, it was reported that they have an association with urethral diverticulum, urogenital sinus anomalies, urogenital fistula or with utilization of transvaginal urethral slings. We present a case of an incidental finding of multiple vaginal calculi impacted in the proximal vagina in an iatrogenically created pocket after a failed Latzko procedure which were later discovered during a robotically assisted laparoscopic vesicovaginal fistula (VVF) repair by the extravesical approach. This is the first reported incident of multiple vaginal calculi associated with iatrogenically created intravaginal pocket after Latzko procedure.

Interruption of the activity of ovary before the age of forty is called premature ovarian failure (POF) in which ovaries lose their follicular and hormonal functions. A decline in the number of ovules before the age of menopause is a physiologic phenomenon. In the present case report, treatment of a patient by POF was reported using traditional Persian medicine principles. In Persian medicine, each humor has its own temperament. A change in the temperament and quality or quantity of these humors causes the disease and therefore modifying the temperament is the milestone of treatment. The patient was a 39-year-old married woman with irregular menstruation cycles and finally, cessation of menstruation. In this period, the patient had vaginal dryness, severe dyspareunia, gastritis, and parasomnia. At first, some instructions were ordered to change her lifestyle, for example, a change in food intakes, enough sleep, and exercise. In addition, several medications were ordered including the digestive system electuary (Majoun Jahaz Hazemeh), Eyaraj Fighara capsule and powder containing Glycyrrhiza glabra roots, Foeniculum vulgare and white sugar, oil massage of the abdomen and flanks, and cupping of the uterus. At the end of treatment, complete rehabilitation was achieved and menstruation irregularity, gastritis, and parasomnia were resolved. Based on the results, if a patient follows the rules and has a healthy lifestyle, inappropriate humor is unable to appear, the healing can be stable, and this disease or similar melancholic disorders fail to occur.