Current Women's Health Reviews - Volume 19, Issue 4, 2023

Background: The covid-19 pandemic affected family planning management and the sexual and reproductive rights of couples. Objective: To determine the factors associated with the interruption of the use of contraceptive methods during the quarantine by COVID-19 in Peruvian women. Methods: Analytical and cross-sectional study, which included 342 women who used a contraceptive method before the COVID-19 quarantine, to whom a virtual questionnaire disseminated on social networks was applied. Pearson's chi-square evaluated associations between method discontinuation and the factors studied. Results: Of the total number of women, 45% discontinued the use of contraceptive methods during the COVID-19 quarantine. The predominant age range was from 18 to 34 years (93.9%). The factors associated with this interruption were age (p = 0.044), marital status (p < 0.001), parity (p < 0.001), sexual relations (p < 0.001), and searching for information by digital means (p = 0.044). The main reason for stopping use was fear of contagion by COVID-19 (42.8%). Conclusion: About half of contraceptive method users interrupted their use during the COVID-19 quarantine, and the factors associated with said interruption were personal, reproductive, and informational. Therefore, health personnel must provide comprehensive care for women, especially in health emergencies.

Introduction: Meconium-stained amniotic fluid (MSAF) may increase maternal and neonatal complications. The favorable mode of delivery is controversial in women with MSAF. This study aimed to compare umbilical cord arterial blood gas (ABG) and neonatal outcomes in deliveries complicated by meconium and clear amniotic fluid during the active phase of labor. Materials and Methods: This observational study was performed on 144 term pregnant women (72 with MSAF and 72 with clear amniotic fluid) during the active phase of labor with ruptured membranes admitted to Al-Zahra and Taleghani hospitals in Tabriz, Iran, from June 2019 to June 2020. A checklist was used to record the ABG and neonatal outcomes. Results: The frequency of cesarean delivery in the MSAF group (25%) was significantly higher than in the women with clear amniotic fluid (20%) (P = 0.006). There was no statistically significant difference between the groups regarding pH, base excess, PCO2, 1- and 5- minute Apgar scores, and neonatal intensive care unit (NICU) admission of the newborn due to MSAF (P> 0.05). There was no incidence of hypoxic-ischemic encephalopathy, sepsis, and seizure. Conclusion: Given the non-significant difference between two groups of women with and without MSAF during labor in terms of neonatal outcomes and umbilical cord ABG, it seems that MSAF alone is not an indication for cesarean delivery. Thus, vaginal delivery is recommended in pregnant women with MSAF.

Objective: This study was conducted to determine the effect of hyperemesis gravidarum diagnosis in pregnant women on their acceptance of pregnancy and quality of life. Methods: This case-control study was conducted with 375 pregnancy 175 diagnosed with hyperemesis gravidarum (case group), 200 pregnant women with healthy pregnancy (control group), between July 2018 and February 2019, in Turkey. Data were collected with the Personal Information Form, World Health Organization’s Quality of Life Questionnaire Brief Version was used to ascertain quality of life and to determine adaptation to pregnancy, the “Prenatal Self-Evaluation Scale” was applied. Only the “Acceptance of Pregnancy” subdimensions were included in the study. Results: Pregnancy acceptance was found to be significantly lower in pregnant women with hyperemesis gravidarum than in healthy pregnant women. The quality of life levels of the pregnant women with hyperemesis gravidarum were found to be lower than those in the healthy pregnant women. Conclusion: Quality of life is affected by hyperemesis gravidarum. In addition, low quality of life and hyperemesis gravidarum negatively affect the acceptance of pregnancy. This result highlights that healthcare professionals should develop a strategy to improve the quality of life of women with hyperemesis and help them accept their pregnancy.

Background: Many women and pregnant women are front-line health care workers in the COVID-19 era and are worried about the possible impacts of COVID-19 on their fetuses. Due to the pressure and high working load on the healthcare workers during the COVID-19 crisis, the healthcare workers were potentially at risk of different types of mental health disorders. Objective: We aimed to evaluate the correlation between mental health status and the level of COVID- 19-related anxiety in pregnant healthcare workers in the COVID-19 era in Iran from August 2020 to December 2020. Methods: This cross-sectional study included 64 pregnant clinical residents, general physicians, nurses and other medical staff who worked in hospitals in Iran, from August 2020 to December 2020 using an anonymous online survey available on the Google Form platform. The online survey consisted of socio-demographic questions, pregnancy-related questions, and questions about medical/drug history. The participants filled the Persian versions of General Health Questionnaire – 28 (GHQ-28) and Corona Disease Anxiety Scale (CDAS). Results: The participants' mean age and gestational age were 31.3±3.9 years, and 24.5±10.1 weeks respectively. Psychological problems were moderate (total score GHQ-28> 40) in 9.4% (n: 6) of pregnant healthcare workers. The frequency of moderate/severe problems in the four subclasses, including somatic symptoms, anxiety/insomnia, social dysfunction, and depression were 9(14.1%), 25(39.0%), 7(10.9%), and 10(15.6%), respectively. According to CDAS, 26.5% of participants had moderate to severe COVID-19-related anxiety. COVID-19-related anxiety and its subclasses, physical and psychological, were significantly correlated with the GHQ-28 total score and its subclasses, including somatic symptoms, anxiety/insomnia, social dysfunction, and depression among pregnant healthcare workers (p<0.01). Conclusion: According to the results of the current study, over 25% of pregnant health care workers have moderate to severe COVID-19-related anxiety; so, it is crucial for policymakers to focus on the mental health of pregnant health care workers during the COVID-19 pandemic.

Background: Reproductive health is considered a cardinal component of an individual's overall health and well-being. Cultural beliefs, myths, and taboos about sexual practices during pregnancy depend on various factors, including education, occupation, religion, cultural practices, and even area of residence. Objectives: The present study was undertaken to evaluate the sexual patterns and beliefs regarding the sexuality of women during pregnancy and compare them with the pre-pregnancy period. Methods: A total of 190 pregnant women (> 18 years of age) in the third trimester of pregnancy, i.e., beyond 28 weeks of gestation, were interviewed using Female Sexual Function Index (FSFI) scale to assess female sexual dysfunction during pregnancy and pre-pregnancy periods. If the score was less than 26.55, the woman was diagnosed as suffering from female sexual dysfunction. An effort was also made to find the causes of female sexual dysfunction in these women. Results: A total of 64 (35.56%) participants considered sexual activity unsafe during pregnancy. Moreover, 45.56% of the study subjects reported no change in libido. The mean +/- 2SD FSFI score in the pre-pregnancy period was 30.93 ± 1.18, whereas, in the pregnancy, the score was 22.64 ± 7.91, with a wide range of 6.4-28.5. A significant decline was noted in all domains of sexual function, including desire, arousal, lubrication, orgasm, satisfaction, and pain. Conclusion: Pregnancy is associated with a significant decline in all domains of female sexual function, including desire, arousal, lubrication, orgasm, satisfaction, and pain. The fallacious knowledge regarding the safety of sex in pregnancy is the most important contributing factor.

Background: Fear of childbirth (FOC) is considered one of the factors influencing the increase in elective cesarean section. The appropriate solution to reduce the FOC has not yet been identified. Objective: The present study aimed to evaluate the effect of haptonomy intervention on FOC and maternal- fetal attachment (MFA) among primigravid women. Methods: This quasi-experimental study was conducted on 68 primigravid women with a gestational age of 24-28 weeks who were referred to health centers in Tabriz, Iran, with a FOC score above 65. Participants were randomly assigned to the intervention and control groups. The intervention group (n=34) received haptonomy in 5 sessions, once a week for 45-60 minutes, and the control group received an information pamphlet about pain management options in labor and fetal development during pregnancy. The data were collected using Wijma Delivery Expectancy/Experience Questionnaireversion A, Cranley’s MFA Scale, and Revised Pregnancy Related Anxiety Questionnaire, before the intervention and at a gestational age of 35-37 weeks. The data were analyzed using Chi-square, independent t-test, and ANCOVA. Results: After intervention and controlling the effect of baseline score, the mean score of FOC in the intervention group was significantly lower than that in the control group [Adjusted mean difference (AMD): -23.67, 95% CI: - 28.12 to -19.23, p = 0.001]. Further, the mean score of MFA indicated a significant difference between the two groups [AMD: 10.12, 95% CI: 6.44 to 13.8, p <0.001]. Conclusion: The results of the present study revealed the effectiveness of the haptonomy intervention in reducing FOC and increasing MFA. Therefore, the use of haptonomy intervention is recommended among mothers with high and severe FOC and low MFA.

Background: South India has a high prevalence of postpartum depression (PPD) compared to other regions. With declining maternal mortality, physicians need to focus on decreasing maternal morbidities, including postpartum mental health disorders. Objectives: To evaluate the incidence of PPD and the influence of demographic and pregnancy related factors on PPD and to identify major symptom subsets manifested postnatally. Methods: This cross-sectional study was conducted on 435 women between 2 weeks to 6 months postpartum, in a tertiary care centre in South India, Postnatal mothers were administered questionnaires including Edinburgh Postnatal Depression Scale (EPDS) and patient demographics and pregnancy related factors. Chi squared test was used to evaluate the association between EPDS scores and demographic and pregnancy variables. Subset analysis was carried out to identify the predominant symptoms in the patients. Results: Completed questionnaires were obtained from 427 postpartum women, among which 26.2% (n=112) had EPDS score >12. Among demographic variables, EPDS scores showed a significant association with relationship problems (p=.000) only, while among pregnancy factors, preterm birth (p=.019), neonatal intensive care admission (p=.005), pregnancy complications (p=.009), and history of depression (p=.043) were significantly associated with EPDS scores. Subset analysis revealed a high mean EPDS score for anxiety (1.91), followed by depressive (1.38) and anhedonia (0.91) symptoms. Conclusion: Several clinical factors and adverse events during pregnancy, including sociodemographic factors and pregnancy-related complications itself, can set the stage for PPD and other mental health conditions. Simple assessments like EPDS can be considered part of routine postnatal check-up examinations for early recognition and treatment of PPD.

Background: In the studies conducted in Iran, the determining role of lifestyle as a multifactorial concept of infertility in infertile Iranian women has rarely been investigated. Objective: To compare the lifestyles of fertile and infertile women in Iran. Methods: This case-control study was conducted on 400 women in 2022. The control group includes women aged 18-45 years, with no history of infertility and who had at least one child. The case group includes women whose primary infertility has been diagnosed and confirmed by a gynecologist and who were referred to the infertility ward in the west of Iran for treatment. The Miller-smith lifestyle assessment inventory was used in this study. We applied a significance level of 0.05 using the Stata ver. 14. Results: In multivariable analysis after adjusting for age, BMI, women's education, husband's education, women's Job, age at menarche, and menstrual cycle, the infertile women had higher scores on the Miller-Smith lifestyle questionnaire than fertile women (linear regression coefficient = 21.21; 95% confidence interval: 20.56 to 21.86; p<0.001). Conclusion: The situations of lifestyle components such as time of rest, attending club and social activities, physical activity, recreation, having close friends, and religious beliefs were better in fertile women, as compared to infertile women.

Background: In the COVID-19 epidemic, pregnant women, fetuses, and newborns are a high-risk population that is more susceptible than the general population. These groups are more susceptible to serious respiratory illnesses and pneumonia because of their weakened immune systems. This study compared maternal and neonatal outcomes in postpartum women with COVID-19 with similar healthy women at the hospital. Methods: In this retrospective cohort study, the characteristics of 100 pregnant women with COVID- 19 (confirmed by a positive PCR test during pregnancy) were compared to 150 healthy pregnant women who were referred to Fatemieh Hospital in Hamadan from March, 2020 to February, 2021. The maternal and neonatal outcomes were collected from the medical record of patients and analyzed using SPSS software (Ver. 26). Results: No significant differences were observed in the average ages (± standard deviation) of the two groups of COVID-19 (30.25 ± 6.24 years) and healthy (29.48 ± 6.73 years) women. In this study, pregnant women were infected with COVID-19 from weeks 7 to 41 of gestation, with a median infection time of 35 weeks. The odds ratio (95% confidence interval) of pre-eclampsia and preterm birth was significantly higher in women with COVID-19 than in healthy women with the following values 2.79 (1.61, 7.34) and 22.26 (2.86, 173.33), respectively. Conclusion: Pregnant women suffering from COVID-19 had considerably greater rates of gestational issues, neonatal difficulties, pre-eclampsia, and premature delivery, according to the findings of this study. During epidemics, it is advised that pregnant women and their newborns receive more basic care.

Background: Urine alkalinization with oral sodium bicarbonate seems to improve urinary symptoms in female patients with overactive bladder with acidic urinary pH. Aim: Therefore, the aim of this study was to compare the effect of oral sodium bicarbonate and tolterodine in women with symptoms of overactive bladder with acidic urinary pH. Methods: In this single-blind randomized clinical trial, 72 female patients with symptoms of overactive bladder syndrome with acidic urinary pH in the age group of 28-60 years were referred to the gynecology clinic of Mahdieh Hospital affiliated with Shahid Beheshti University of Medical Sciences, Tehran, Iran in 2021-2022 were studied. These patients were randomly divided into two groups oral sodium bicarbonate (36 patients) and tolterodine group (36 patients) and received the treatment for one month. Group matching was performed between patients. At the end of the study, the Overactive Bladder- Validated 8-question Awareness tool (OAB-V8), frequency, nocturia, urgency, and urinary incontinence (UI) was measured and compared between patients in the two groups. Results: Patients were matched for age, underlying disease, BMI, acidic urinary pH, and menopause status at the baseline. After 30 days of medication therapy, a significant decrease in OAB-V8 score, frequency, nocturia, urgency, and urinary incontinence (UI) was observed in both groups receiving oral sodium bicarbonate and tolterodine in female patients with symptoms of overactive bladder syndrome with acidic urine. The degree of improvement in outcomes after treatment was similar between both groups. Conclusion: Oral sodium bicarbonate administration in patients with overactive bladder with acidic urinary pH has a significant positive effect on OAB-V8 symptoms, frequency, nocturia, urgency, and urinary incontinence (UI) and these results are similar to tolterodine treatment. Given that the acidic urinary pH may play a role in the etiology of an overactive bladder, it seems that sodium bicarbonate improves the symptoms of an overactive bladder by alkalizing the urine.

Primary postpartum haemorrhage (PPH) complicates the postpartum up to 11% of deliveries with different incidences based on geographical regions and is the first cause of maternal deaths, accounting for 25% of cases. Tranexamic acid may play a role in the delicate postpartum balance in case of PPH, inhibiting the conversion of plasminogen to plasmin and reducing the degradation of fibrin. We analyze literature evidence and the possible role of tranexamic acid in clinical practice and future scenarios.

Preterm birth (PTB) remains a leading cause of neonatal morbidity and mortality in the United States and worldwide. Efforts to predict and delay preterm birth have been largely unsuccessful thus far. This paper seeks to illuminate the history and relevant discoveries regarding the role of progesterone in the prevention of PTB, which includes maintaining quiescence of the myometrium and counteracting cervical ripening. We will review the outcomes and methodologies of recent clinical trials, which have led to debate over the efficacy of progesterone in delaying PTB among at-risk women. The aim of this paper is to explore the historical and scientific basis for progestin treatments in the prevention of PTB, briefly discuss the results of recent clinical trials, and suggest direction for future research.

Various assisted reproductive technologies (ART) are applied in the infertility treatment. However, considerable attention is addressed to use alternative approaches, such as non-biotechnology, probiotics, and traditional medicinal plants to treat cancerous and non-cancerous cases of infertility. Nanotechnology was remarkably aided in treatment, diagnosis, and drug delivery. The existing data of this technology might demonstrate the enormous potential of nanomaterials and their viability in clinical trials for the study of reproductive issues. In order to understand the function of the microbiome in infertility and the many good effects of probiotics in illnesses such as colon cancer, obesity, diabetes, and inflammatory bowel disease, research on infertility must be conducted. Healthy reproductive systems are important for successful fertility in males and females, and using probiotics can help reduce the associated complications. Besides, in vivo models are required to determine the probiotics proper administration, identify the functional species, effective doses, administration forms, and the effects of their combination with conventional antibiotics. In addition, medicinal herbs should be explored, notably in the treatment of male infertility and the improvement of sperm abnormalities. The antioxidant capacity, anti-inflammatory reactions, increased sperm production, and increased testosterone levels in the blood are all examples of medicinal plant benefits. More study is needed to establish specific findings on which substances are involved and have effective and safe fertility potential. This review presents an overview of potential applications for nanotechnology, probiotics, and medicinal plants in infertility, discussing the advantages, their feasibility, and associated concerns, which demand more investigations to set of clinical applications.

PCOS is a complex multigenic condition influenced by significant epigenetic and environmental variables, including nutrition and lifestyle. Insulin resistance IR is found in roughly 80% of obese women with PCOS and 30-40% of lean women. IR is an impairment of insulin to mediate metabolism in skeletal muscle, adipocytes and liver. Following weight gain, the severity of IR in women with PCOS increases. IR affects many PCOS women who are not overweight, and minor weight loss improves clinical results in those with near-normal body weight. The effect of exercise on Insulin sensitivity IS is optimized through glucose transport and metabolism. Exercise is the first-line treatment for PCOS. Moderate intensity (60-70% VO2max; comparable to 75-80% HRmax) and high-intensity aerobic exercise (heart rate >80%) improves IR in women with PCOS. These exercises are performed for at least 30 minutes per session and 3-5 days per week. A single bout of exercise (2-72 hours postexercise) can improve IS immediately. Exercise improves IS and glycemic management as well as helps in lowering the abdominal fat. Therefore, exercise performed on a regular basis can help improve insulin resistance in women with PCOS.

Background: Fatigue is a complex phenomenon. It is a common problem that occurs at all periods of childbearing. Pregnancy and labor are recognized as a normal physiological process, and fatigue, a common symptom that occurs frequently throughout the childbearing experience, has the potential to negatively affect the woman’s prenatal and birth experience. Fatigue is often overlooked by health professionals. Objective: The aim of this systematic review is to review the literature regarding the factors influencing maternal fatigue during childbirth and its management. Methods: The Joanna Briggs Institute (JBI) systematic review was used to guide this study. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was performed to report this systematic review. The database was searched from CINALH, Pubmed, PsyInfo, ThaiJO, and other sources for grey literature from 1990-2021. The methodological quality process used the critical appraisal tool for RCT study and MINORS (Methodological Index for Non-randomized Studies). Nine published articles were selected for this study. Results: The factors influencing maternal fatigue during childbirth were found to be physiological, psychological, and situational. The physiological factors were age, parity, uterine contractility, available energy substrate, nutrition adequacy, and prenatal exercise. The psychological factors were pain and anxiety. The situational factors were childbirth education, pain medication, prenatal employment, sleep, breathing technique, and pushing intervention. The strategies of managing fatigue during childbirth were 1) assessing maternal fatigue in early pregnancy; 2) childbirth preparation; 3) conservation of energy; 4) shortened duration of labor; and 5) reduced labor pain and anxiety. Conclusion: Maternal fatigue during childbirth impacts the mother, the child, and the family. It is important for nurses to understand the deleterious effects of fatigue on childbearing women and to promote interventions that reduce or prevent fatigue during pregnancy and childbirth.

Background: Performing myomectomy concurrently with a caesarean section has been controversial for many decades. Objective: The present study mainly aims to evaluate the consequences of concurrent myomectomy and caesarean section versus caesarean section alone. Methods: In this systematic review, we have followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Electronic resources, such as MEDLINE, Cochrane, EMBASE, Scopus, and PubMed, were searched. A total of 3057 articles were reviewed. Of these, 33 met the inclusion criteria and were included in the final analysis. The reviewed outcomes were hemoglobin (Hb) before and after the operation, blood transfusion rate, hemorrhage, operation time, duration of hospitalization, and complications, such as fever. Results: A meta-analysis of 33 articles with 5586 participants in the caesarean myomectomy (CM) group and 2935 participants in the caesarean section (CS) group showed a statistically significant Hb decrease in the CM group [MD = 0.26, CI=95%(-0.33 to -0.19)]. The transfusion rate was higher in the CM group [OR=0.39(0.42-0.67)], and intraoperative hemorrhage was higher in the CM group [OR=0.56 (0.45 - 0.75) CI=95%]. The mean operation time [MD=1.17(1.10 -1.24) CI=95] and hospitalization time [MD=0.41 (0.34-0.48) CI=95%] were significantly higher in the CM group. There was no significant difference in the incidence of fever between the two groups [MD =1.06, CI=95%, p=0.923(0.78-1.43)]. Conclusion: Concurrent CM is associated with a reduction in mean Hb and an increase in operation time and hospitalization time; however, it prevents additional surgery and costs; it is worthwhile to perform myomectomy at the time of caesarean section, especially by experienced surgeons with necessary preparations.

Background: There is inconsistency in the evidence about the effect of adding vitamin D supplements to metformin therapy among women with polycystic ovary syndrome (PCOS). Objective: In this systematic review, we described the differences in menstrual cycle irregularities between women who received vitamin D supplementation and those who didn’t receive vitamin D among women who diagnosed with PCOS and received metformin. Methods: We reviewed previous literature to identify all relevant studies. The included studies' quality and risk of bias were assessed using the Consolidated Standards of Reporting Trials (CONSORT) and the Reporting of Observational Studies in Epidemiology (STROBE) instrument. Cochrane's Q-test and I² statistic were used to assess the heterogeneity across included studies. The fixed-effect model was used to calculate the total effect size. Results: Six studies were included, involving 633 women diagnosed with PCOS. Supplementation of vitamin D with metformin could have a significant impact on the improvement of menstrual cycles compared to receiving metformin alone (OR = 2.11, 95% CI, 1.40- 3.19). There was no evidence of heterogeneity across included studies. Subgroup analysis showed that the magnitude of the association increased when only infertile women with PCOS were included (OR = 2.37, 95% CI, 1.52-3.72). Conclusion: This evidence suggests the possible benefit of adding vitamin D to metformin in regulating the menstrual cycle among women with PCOS, especially infertile women.

Objective: This study aimed to compare the effect of jainus syrup and Ondansetron syrup on nausea and vomiting during pregnancy. Methods: The present study is a single-blind randomized clinical trial that was conducted on 120 pregnant women referred to the health centers of Hamadan during 2017-2018. The participants were randomly divided into two groups, control and intervention, with 60 subjects in each group. Two groups of 60 received jalinus syrup and Ondansetron syrup for 7 days. Data collection tools, demographic questionnaire, and information associated with pregnancy, and PUQE-24 questionnaire were used to assess the severity of nausea and vomiting, and questions related to the assessment of side effects as well asparticipants’ level of satisfaction with the treatment were provided. All the data were analyzed using the SPSS software version 16. P-value < 0.05 was considered significant. Results: The severity of nausea and vomiting in both groups decreased after the intervention, but considering the independent t-test, there was no significant difference between the two groups in terms of severity of nausea (P >0.05). According to the Chi-square test, the severity of nausea of all participants was moderate in both groups before taking the medication, and after taking the medication, the severity of nausea reduced in most participants and they were placed in the mild group. Conclusion: Due to the similar effects of jalinus syrup and Ondansetron syrup in the treatment of nausea and vomiting in pregnancy and the absence of side effects arising from its use, herbal medicine can be used instead of chemical drugs.

Background: Sonographic visualization of intrauterine pregnancy after multiple embryo transfers does not preclude the coexistence of an ectopic pregnancy, which should be excluded routinely. Heterotopic pregnancy carries high morbidity and mortality. Therefore, it needs high index of suspicion to diagnose and manage accordingly. Case Presentation: Our case reports a 39-year-old woman who presented with heterotopic triplet pregnancy at 5 weeks and 5 days of gestation. It resulted in a successful delivery of intrauterine monozygotic twins at 37 weeks. This pregnancy is an outcome of ICSI treatment due to low ovarian reserve. Only two embryos were obtained through the protocol and double frozen embryo transfer was done afterwards. Tubal pregnancy was successfully managed expectantly. Conclusion: Our case highlights the importance of early surveillance and close monitoring of patients undergoing multiple embryo transfers. Thus, keeping the possibility of heterotopic pregnancy in mind after ART cannot be over-emphasized.

Background: The current United Nations sustainable development goal 3 sets to reduce maternal mortality to less than 70 per 100 000 live births by 2030. To monitor whether India is on track to attaining sustainable development goals, it is essential to routinely assess trends of health indicators. Objectives: This study was conducted to assess trends of maternal mortality and cause-specific maternal death in tertiary care hospitals in Southern India. Methods: This is a retrospective study of hospital records and death summaries of all maternal deaths between January 1, 2009, and December 31, 2018, at the tertiary care hospital in Southern India. The demographic, clinical, and delivery details of all the maternal deaths were collected. Causes of maternal deaths were classified as direct, indirect, and nonspecific. To observe trends of maternal death, the maternal mortality ratio was calculated for each year, and Pearson’s chi-square test was used. Results: Maternal mortality ratio was 555/100000 and had a decreasing trend from its highest in 2010 of 1230/100000 to its lowest of 229/100000 in 2017 (t = 7.71 p = 0.02). The majority of women who died were aged 21-35 years, resided in rural, were primigravidae, and had operative delivery. Most of the maternal deaths had been referred to our facility (90.8%) from other healthcare units. Obstetric hemorrhage (27.8%) and puerperal sepsis (37.7%) among direct causes; H1N1 pneumonia (34.8%) among indirect causes were the major causes of maternal death. The number of maternal deaths due to sepsis increased from the beginning until the end of the study from 10% to 50% (t = 5.9, p = 0.01). On the contrary, there was a decline in maternal deaths due to obstetric hemorrhage from 50% to 25% (t = 4.2, p = 0.03). Conclusion: Although the maternal mortality ratio has reduced over the years, sepsis was an important cause of maternal deaths.

Background: The study aimed to evaluate the impact of a health education intervention on nutritional status among adolescent girls in government secondary schools in Maiduguri Metropolitan Council. Methods: The study was a randomized control trial among 417 adolescent girls aged 10-19 years old. Data were collected from October 2019 to March 2020 using KoBo collect toolbox. Chi-square and Fisher exact were used to compare baseline differences between the intervention and control group, a generalized estimating equation was used to evaluate the impact of health education intervention. Results: There was no significant difference in nutritional status (body mass index for age percentile and mid-upper arm circumference) between the intervention and control group at baseline. There was a statistically significant difference at three and six-months post-intervention for body mass index for age percentile p = 0.005; p < 0.001, while the mid-upper arm circumference was statistically significant at three months post-intervention p < 0.001, but not statistically significant at six months post-intervention. Conclusion: It is clear that health education intervention has an important role in improving the nutritional status of adolescents.

Background: In addition to physical discomfort, recurrent vulvovaginal candidiasis imposes a significant financial and psychosocial burden, such as lower levels of self-esteem, a higher level of stress, clinical depression, and less satisfaction with their life. Recurrent vulvovaginal candidiasis interferes with emotional and sexual relationships. Objective: This study aimed to compare the effect of vaginal Salvia officinalis, clotrimazole, and their combination on the prevention of recurrent vulvovaginal candidiasis. Methods: This randomized triple-blinded trial was conducted on 111 women aged 18-49 years with vulvovaginal candidiasis. Participants were randomly assigned into one of the three groups of vaginal tablets of Salvia officinalis 400 mg and placebo of clotrimazole 100 mg, clotrimazole 100 mg and placebo of Salvia officinalis 400 mg, or Salvia officinalis and clotrimazole that were applied every night for 7 consecutive days. A recurrence rate of vulvovaginal candidiasis was evaluated by WET test and vaginitis symptoms examination after 12 weeks. In the case of positive evaluation, the culture of vaginal discharge was performed. Results: Totally, 29 patients (80.6%) in group clotrimazole, 33 patients (94.3%) in group Salvia officinalis and 35 patients (97.2%) in group Salvia officinalis-clotrimazole were treated (P = 0.43). Out of cured patients, 4 (13.8%) patients in the group clotrimazole, 1 patient (3%) in group Salvia officinalis, and no case in group Salvia officinalis-clotrimazole experienced the recurrence of infection. There was a significant difference among the 3 groups in terms of recurrence (P = 0.023). Moreover, no adverse event during the 12 weeks after treatment was observed. Conclusion: Adjuvant therapy of Salvia officinalis alongside routine vaginal clotrimazole could successfully prevent recurrent vulvovaginal candidiasis after three months.