Current Women's Health Reviews - Volume 20, Issue 5, 2024

This paper provides a synopsis of maternal and fetal thyroid hormone stimulation during pregnancy. Treatment of thyroid illness during pregnancy is critical for avoiding negative maternal and fetal outcomes. Thyroid disorders are frequently asymptomatic and difficult to detect without specialized monitoring programs. Even mild maternal thyroid hormone insufficiency can result in fetal neurodevelopment difficulties. The thyroid is over-stimulated during pregnancy, resulting in alterations in thyroid hormone concentrations. Accurate thyroid function testing during pregnancy is crucial for both initiating thyroid hormone therapy and adjusting thyroid hormone dose in people who are already on thyroid hormone. Trimester-specific intervals are particularly critical during pregnancy, when thyroid insufficiency has been linked to poor obstetric outcomes and neuro-developmental impairments in the fetus. Knowing the natural changes in hormone concentrations that occur throughout pregnancy allows for customized supplementation of iodine when needed.

Introduction: During labor and delivery, mothers should be supported by people who give them comfort. The present study aims to determine the effect of continued midwifery support in labor on the childbirth experience and self-esteem of nulliparous women 6 weeks after childbirth. Methods: This randomized controlled trial was performed in 2021 on 70 pregnant women in the delivery ward. Participants were allocated to two groups through balanced block randomization. First, participants completed questionnaires. In the intervention group, the researcher stayed at the mother’s bedside and accompanied the mother continuously throughout the labor and up to 2 hours after childbirth. Both groups received routine care. Six weeks after childbirth, participants in both groups were contacted to complete the CEQ 2.0 and Rosenberg self-esteem questionnaires. The required data were collected and analyzed at a significance level of 0.05. Results: The mean (± SD) of childbirth experience 6 weeks after childbirth was 3.1 (± 0.2) in the intervention group and 2.6 (± 0.3) in the control group, and this difference was statistically significant (p < 0.001) (Cohen’s d = 1.7; 95% CI: 1.1, 2.3). The comparison of the mean of maternal self-esteem showed that this rate in the intervention group was 2.1 scores higher than that in the control group, and the difference was statistically significant (p = 0.02) (Cohen’s d = 0.6; 95% CI: 0.1, 1.1). Conclusions: Continued support of the midwife in labor and up to 2 hours after childbirth can lead to a better childbirth experience and enhance the mother’s self-esteem up to 6 weeks after childbirth.

Background: Minimizing the stress levels of pregnant women is important to giving healthy birth and raising healthy generations. Therefore, there is a need for effective methods to diagnose stress early in pregnancy. Objective: The purpose of this research was to examine the psychometric features of the Antenatal Psychosocial Stress Scale (APSS) in pregnant Turkish women. Methods: This methodological study was conducted on 290 pregnant women. Results: The Turkish version of the APSS based on Exploratory Factor Analysis was found to have 70.215 percent of the total variance. It had a Cronbach's alpha coefficient of 0.78. After the confirmatory factor analysis, the following were determined: χ2/df: 1.663, CFI: 0.978, RMSEA: 0.048, GFI: 0. 972. Conclusion: The Turkish sample found the APSS to be a valid and trustworthy assessment instrument for pregnant women.

Background: With increasing uterine cancer in developing nations, there is a need for timely determination of the diagnosis, prognosis, and management options to reduce morbidity and mortality. Objective: To analyze the socio-demographic, etio-pathological features and management of uterine cancer and evaluate its correlation with grading/staging in our population. Methods: This retrospective descriptive study analyzed data from 97 histologically proven uterine cancer cases. Age, parity, symptoms, co-morbidities, body mass index (BMI), ultrasound features, histopathology type, stage and grade of the tumor, type of hysterectomy done, complications and mortality were analysed. Statistical analysis was done using ANOVA and chi-square test, and a p-value<0.05 indicated statistical significance. Results: The mean age of diagnosis was 57.91 years, and the mean BMI was 29.32 Kg/m². Majority of the patients were multiparous (42.27%), and only 10% were nulliparous. The disease was detected at an earlier age in nulliparous and obese women. Diabetes and hypertension were found in 75.25%. Most of the patients were detected with stage I cancer (80.6%). Patients diagnosed with uterine cancer on biopsy were treated with total abdominal hysterectomy with bilateral salpingo-oophorectomy andbilateral pelvic lymph node dissection (55.8%). Over 36% of patients received postop radiotherapy and/or chemotherapy. 21% patients were lost to follow-up and 12.37% died. Also, 24 cases had postoperative complications (wound infection). Conclusion: Uterine cancer is common among obese women with diabetes and hypertension. In nulliparous and the obese, the cancer was detected at an earlier age. Most of our patients had stage 1 disease, and 90% was endometroid cancer. The study highlights the importance of endometrial sampling before hysterectomy in perimenopausal women to avoid suboptimal surgery in patients diagnosed with uterine cancer after a simple hysterectomy.

Introduction: Niche or cesarean scar defect is a complication of a cesarean section that has long-term implications for both obstetrics and gynecology. The rate of niche is believed to be increasing with the high number of cesarean sections. This study assesses the risk factors for niche development after cesarean section. Methods: A prospective cohort study was conducted on women who underwent cesarean section at the Haji Adam Malik General Hospital Medan between August 2020 and August 2022. Niche was assessed six weeks after cesarean section using transvaginal ultrasonography. The primary outcome was the presence of a niche. The antepartum, intrapartum and postpartum risk factors were analyzed for niche development. A logistic regression model was used to assess independent risk factors from the bivariate analysis. Results: There were 280 patients enrolled in this study. The prevalence of niche was 44.3% by using transvaginal ultrasound. There was no significant relationship between maternal age, gestational age, parity, nutritional status based on upper arm circumference, hypertension in pregnancy, anemia status, surgical indications, duration of surgery, volume blood loss, and puerperal infection to niche development (P > 0.05). The independent risk factors for niche development were Cervical dilatation > 4 cm (P = 0.035; RR = 1.75), locking suture technique (P = 0.015; RR = 13.81), non-closure vesicouterine folds (P = 0.04; RR = 0.14) and a retroflexed uterus (P = 0.001; RR = 0.039). Conclusion: Cervical dilatation > 4 cm, locking suture technique, non-closure vesicouterine folds, and a retroflexed uterus are risk factors for niche development after CS.

Background: This review discusses epigenetic mechanisms and the relationship of infertility in men and women in relation to parameters pertaining to nutrition. Methods: A review of the line of the literature was conducted prior to June 2021 through the selected websites, including MEDLINE, Embase, Web of Science, www.ClinicalTrials.gov, Cochrane Central, PubMed, Google Scholar, Science Direct, and the WHO. Results: The prevalence of infertility worldwide is 8-12%, and one out of every 8 couples receives medical treatment. Epigenetic mechanisms, aging, environmental factors, dietary energy and nutrients and non-nutrient compounds; more or less energy intake, and methionine play a role in the onset of infertility. Furthermore, more factors that contribute to infertility include the vitamins B12, D, and B6, biotin, choline, selenium, zinc, folic acid, resveratrol, quercetin, and others. Discussion: To understand the molecular mechanisms regulating the expression of genes that affect infertility, the environment, the role of genotype, age, health, nutrition, and changes in the individual's epigenotype must first be considered. This will pave the way for the identification of the unknown causes of infertility. Insufficient or excessive intake of energy and certain macro and micronutrients may contribute to the occurrence of infertility as well. In addition, it is reported that 5-10% of body weight loss, moderate physical activity and nutritional interventions for improvement in insulin sensitivity contribute to the development of fertility. Conclusion: Epigenetic processes involve inherited changes but not encoded by the DNA sequence itself. Nutrition is thought to affect the epigenetic mechanisms that play a role in the pathogenesis of many diseases, including infertility. Epigenetic mechanisms of individuals with infertility are different from healthy individuals. Infertility is associated with epigenetic mechanisms, nutrients, bioactive components and numerous other factors.

Background: The transcutaneous electrical nerve stimulation TENS was used following several surgical procedures involving gynecological ones and has shown a successful pain reduction rate. TENS was proposed to enhance recovery after cesarean section CS. Objective: This systematic review and meta-analysis were conducted to evaluate the clinical effectiveness of Transcutaneous electrical nerve stimulation (TENS) in enhancing recovery after a cesarean section. Methods: We performed the Meta-analyses using RevMan software. Data were pooled as mean difference (MD) if continuous and risk ratio (RR) if dichotomous, and the 95% confidence interval (CI) as calculated. Results: This systematic review included 12 RCTs, with a total of 1,116 women studied. The TENS effectively reduced the intensity of pain just by following its application (SMD=-0.61; 95% CI [-0.82, -0.39], P<0.00001), one day after (SMD=-0.25; 95% CI [-0.47, -0.04], P=0.02), and two days after (SMD=-0.27; 95% CI [-0.50, -0.03], P=0.03). Conclusion: The TENS effectively reduces the pain intensity following its application and after one or two days. TENS has no effect on the cumulative dose of diclofenac. Because of the inadequacy of safety data, we recommend conducting further RCTs.

Background: Hysterectomy is one of the factors that may affect women's body image and self-esteem and lead to serious psychological complications. Objective: The study aimed to compare self-esteem, body image, and depression in hysterectomized and non-hysterectomized Iranian women. Methods: In this cross-sectional comparative study, 140 women of the reproductive age, who have undergone hysterectomy with benign causes, were compared in terms of self-esteem, body image, and depression with 140 women receiving medical treatment due to abnormal bleeding in educational and medical centers in Tabriz, Iran. Sampling was conducted by convenience method. Self-esteem was assessed with the Rosenberg self-esteem questionnaire, body image was assessed with the multidimensional body-self relations questionnaire, and depression was assessed with the Beck II depression inventory. Data were analyzed by Pearson correlation test, independent t-test, chi-square test, and general linear model. Results: The mean (standard deviation) of the body image in hysterectomized and nonhysterectomized women was 235.3 (28.5) and 250.1 (23.4) out of an achievable score of 69-395, respectively. The mean (standard deviation) self-esteem score for hysterectomized women was 20.4 (4.8) and it was 24.2 (3.4) in non-hysterectomized women (out of an achievable score of 0-30). The mean (standard deviation) depression score was 18.1 (9.7) and 5.5 (4.6) out of 0-63 in hysterectomized and non-hysterectomized women, respectively. The differences in self-esteem, body image, and depression variables were statistically significant in hysterectomized and non-hysterectomized women, respectively (P<0.001). Conclusion: According to the results of the present study, the body image and self-esteem in hysterectomized women were low compared to non-hysterectomized women, while the level of depression was high, and this difference was statistically significant.

Propose: This study was done to reduce atrophic vaginitis. Aim: This study aimed to compare the effects of Vagiheal Gel and Estromarin in reducing atrophic vaginitis. Methods: This study was a randomized clinical trial with a parallel design. 70 postmenopausal women who had dyspareunia and were referred to the health clinics of Arak, Iran were included in this study. Patients were assigned to one of the 2 groups of Vagiheal or Estromarin. The patients in the Estromarin group were provided with 0.625 mg/g vaginal cream for intravaginal use 2.5 grams for 21 nights. After one week of medicinal rest, they were prescribed 2.5 grams of intravaginal cream for another 21 nights, and then, one week of medicinal rest was considered. The patients in the Vagiheal group were prescribed 2.5 grams of Vagiheal Gel by inserting the applicator into the vagina when sleeping for 7 consecutive nights, then as a maintenance treatment for 2 times a week for 2 months. The severity of the symptoms was measured by a visual Analog scale (VAS) before, 2 weeks, 1 month, and 2 months after starting the program. The data were analyzed using T-test, Mann-Whitney, Chi-square, and Friedman test. Results: The results of atrophic vaginitis follow-up processes showed that the mean of dryness, itching, and burning of the vagina in both groups significantly decreased after the intervention (p=0.01); however, the decrease of these symptoms in the dyspareunia group was more obvious in Vagiheal gel. Conclusion: It seems that Vagiheal gel is a suitable alternative to atrophic vaginitis treatment.

Background: One of the most effective ways to prevent cervical cancer is to identify the risk factors for the disease. Objective: The purpose of this research was to determine the risk factors for cervical cancer in women in Iran. Methods: This was a matched case-control study. 105 participants (35 patients with cervical cancer and 70 healthy women) were selected from the registered patients and women attending a women’s specialized hospital in Hamadan, Iran. One case was matched to 2 controls by age (±3 years). Demographic and clinical data were collected using a semi-structured questionnaire. Conditional multivariate logistic regression model and STATA 11 software were used for data analysis. Results: The mean age of women in the case and control group were 58.02(12.32) and 58.11(12.25) years (p = 0.486), respectively. Patients had lower education levels (p = 0.037), lower economic status (p#130;0.001), and lower spouse education levels (p = 0.009). The results showed OCP users were 8.79 times more likely to develop cervical cancer than women who do not use OCP (p = 0.007), and the probability of cervical cancer in women increased by 8.33 times (<0.001) with decreasing each level of socio-economic status. Conclusion: The results of the present study showed low economic status, and a history of using oral contraceptive pills are risk factors for cervical cancer.

Objective: The purpose of the study was to assess the effects of a lifestyle promotion based on the principles of the Mediterranean diet (MD) combined with regular physical exercise on climacteric symptoms, sleep quality, and quality of life in women in the menopausal transition. Methods: Among 100 perimenopausal women recruited, 80 (48 ± 2 years) with climacteric symptoms were eligible for the study and were randomized into two groups: an intervention group (n=40) that received nutritional counselling based on the principles of MD with the practice of regular activity during 8 weeks, and a control group (n=40). At baseline and 8 weeks after the initiation of nutritional intervention, we assessed daily energy expenditure and food intake, anthropometric characteristics, climacteric symptoms, sleep quality, and quality of life. Results: Results showed that in the intervention group, compared to the control group, after 8 weeks of nutritional counselling, a significant decrease was noted in somatic and psychologic (p<0.01) symptoms. No significant difference was noted in urogenital symptoms. The quality of life was improved by the decrease of the Menopause Rating Score (-25%, p<0.001). A decrease was observed in subjective sleep quality (-27%, p<0.05), sleep duration (-39%, p<0.05), habitual sleep efficiency (-43%, p<0.05), and daytime dysfunction (-43%, p<0.01). The score of PSQI was decreased by (-31%, p<0.01), which meant that the quality of sleep improved. Conclusion: Anthropometric characteristics, climacteric symptoms, sleep quality and quality of life were improved in women on menopausal transition adopting a healthy lifestyle based on the principles of Mediterranean eating pattern combined with regular physical activity.

Background: Polycystic ovary syndrome (PCOS) is a leading cause of infertility. Insulin resistance is a key element in pathogenesis. The insulin receptor causes phosphorylation of the insulin receptor substrate (IRS); IRS-1 rs1801278G > A polymorphism variant is the most common genetic variant associated with IR and PCOS. Objective: We aimed to examine the frequency of IRS-1 rs1801278G > A polymorphism variant and test its value in evaluating infertile PCOS women. Methods: A case-control study recruited 140 age and body-mass-matched participants in the university hospital, subdivided according to Rotterdam criteria into PCOS cases (70/140) and healthy controls (70/140). We collected demographic data, ultrasonic [antral follicles and endometrial thickness], hormonal [FSH, LH, AMH, E2], and genetic data by polymerase chain reaction for analysis. Result: Wild GG SNP rs1801278 G was meaningfully higher among controls (58.57%, P<0.0001). Mutant AA SNP rs1801278 was significantly higher in PCOS women (37.14%, P-value =0.0001, an odds ratio of 20.50, 95% CI (9.42-28.63) to develop PCOS. Heterogenous GA gene SNP rs1801278 showed a trend of higher frequency in PCOS patients with 44.29%; OR of 3.91, 95% CI (1.37–7.55); P = 0.422. Upon correlating infertility parameters to SNP rs1801278 G>A polymorphism, statistical differences were found with AFC, LH/FSH ratio, and serum testosterone. As for the AMH, E2, and endometrial thickness, they failed to have a statistical value. Conclusion: The significant correlation of genetic polymorphism to infertility parameters among PCOS women opens a new therapeutic and prognostic avenue that helps gynecologists tailor management for a better and safer outcome.

Background: Women often face decisional challenges and hesitation while choosing the appropriate method to follow up on their abnormal results of cervix cytology. Objective: The present study aimed to determine the effect of shared decision-making (SDM) on decision self-efficacy (DSE) and decisional conflict (DC) about follow-up methods among women with abnormal cervix cytology results. Methods: This interventional study was performed on 54 women referred to the subspecialty clinic of gynecologic oncology. The women were assigned into intervention and control groups using a randomized block design with block sizes of 4 and 6 and an allocation ratio of 1:1. The intervention group received counseling based on the SDM and a decision aid (DA) booklet. The data collection tools included the questionnaires of the demographic and obstetrics characteristics, DC, DSE, and Decision Regret. The collected data were analyzed using SPSS24 software, and independent t-tests and ANCOVA were used. Results: After the intervention, the total mean score of the DC in the intervention group was significantly lower than that in the control group [MD: -22.84 with 95% CI: -23.52 to -21.95, (P <0.001)]. The mean score of DSE in the intervention group was significantly higher than that in the control group [MD: 14.56 with 95% CI: 21.47 to 7.65, (P <0.001)]. Conclusion: The present study results indicated that counseling based on the SDM effectively promotes DSE and reduces DC among women with minor abnormal cervical cytology. Therefore, it is recommended that healthcare providers use SDM for women with abnormal cervical cancer screening results.

Background: Fetuses with Fetal Growth Restriction (FGR) are at increased risk of chronic intra-uterine hypoxia, due to increased secretion of corticosterone from the fetal adrenal glands. This plays a major role in the cardiovascular and circulatory adaptation of FGR fetuses. These modifications are untimely identified by sonographic imaging. Objective: To study the association between ultrasound features of the adrenal gland and growth restriction in the fetus. Methods: A total of 104 pregnant women (52 FGR pregnancies and 52 controls) were evaluated between 28 and 36 weeks of gestation. All the study participants underwent transabdominal ultrasonography to measure bilateral fetal adrenal gland volume and fetal zone volume, corrected for gestational age. They were followed up until delivery. The two groups were compared to analyze the perinatal outcome in relation to ultrasonographic changes in the adrenal gland. Results: The adrenal gland measurements were significantly larger in fetuses with FGR as compared to the control group. FGR group had a larger corrected adrenal gland volume(cAGV) and fetal zone and adrenal gland (FZ/AG) ratio A statistically significant correlation was found between the two groups regarding gestational age at delivery, birth weight, APGAR score, and NICU admissions. Perinatal morbidity was found to be higher among women diagnosed with FGR, i.e., 14 (53.84%). Conclusion: Fetal adrenal gland size measurement is important to identify FGR fetuses that are vulnerable to hypoxia. It helps the obstetrician prepare for effective in-utero management to reduce perinatal morbidity and mortality.