Is There a Relationship Between the Severity of Preeclampsia and Fetal Renal Doppler Indices?

Objectives: Preeclampsia is a high prevalence complication in pregnancy and is responsible for 36% of maternal mortality worldwide. The offspring of mothers with preeclampsia face many problems after birth and in their lifetime. The fetal renal is one of the most vulnerable organs following maternal preeclampsia. In this regard, the present study investigated the relationship between the severity of preeclampsia and fetal renal artery resistance and pulsatility. Materials and Methods: In general, 91 pregnant women were included and divided into control and preeclampsia groups. The control group included 43 women with normal pregnancy and the preeclampsia group consisted of 48 pregnant women who suffered from preeclampsia and were classified into patients in severe and non-severe preeclampsia groups each containing 24 cases. Renal artery Doppler ultrasound was performed, and then the systole/diastole ratio (S/D), pulsatility index (PI), and resistance index (RI) were measured as well. Results: The S/D ratio, RI, and PI significantly decreased in the preeclampsia group (P<0.001) compared to the control group. The S/D ratio in severe preeclampsia was significantly lower in comparison with non-severe preeclampsia (P<0.001). Finally, the amniotic fluid index was related to the PI (P<0.05), and severe preeclampsia significantly increased the pregnancy termination before 34 weeks (P<0.001). Conclusions: Preeclampsia deceased the resistance of renal arteries by altering the fetal renal blood flow. These changes can intensify in patients with severe preeclampsia compared to non-severe preeclampsia.

Protective Effect of Hydroalcoholic Extract of Orange Peel on PCNA and FSH-R Gene Expression in Histological Damage and Oxidative Stress Due to Ovarian Torsion in Adult Rats

Objectives: The aim of this study was to evaluate the protective effect of the hydroalcoholic extract of orange peel on proliferating cell nuclear antigen (PCNA) and follicle-stimulating hormone receptor (FSH-R) gene expression in histological injuries and acid stress caused by ovarian torsion in adult rats. Materials and Methods: In this experimental study, 32 adult female rats were randomly divided into 4 groups. In group 1 (Sham), the abdominal wall was cut without applying torsion and in group 2, ovarian torsion was performed for 2 hours, followed by detorsion for 2 weeks. The hydro-alcoholic extract of orange peel was added to their diet for two weeks in group 3, followed by ovarian torsion for 2 hours and detorsion for 2 hours. Group 4 received the orange peel extract for two weeks and after then ovarian resection for the evaluation of histological damage and blood sampling to examine the serum level of antioxidant enzymes, as well as the expression of PCNA and FSH-R genes in the ovarian tissue. Results: Histological changes in the ovary tissue of rats showed that torsion and detorsion have destructive effects on the ovarian tissue, and torsion/detorsion led to a reduction in the expression of PCNA and FSH-R (P < 0.05). Based on biochemical and hormonal results, the ovarian torsion resulted in an imbalance in the oxidative stress markers and hormone profile of rats. Finally, the administration of the hydroalcoholic extract of orange peel due to its high antioxidant properties improves these effects. Conclusions: In general, administering an appropriate dose of the hydroalcoholic extract of orange peel for two consecutive weeks in the diet had a protective effect on the ovarian tissue at the risk of torsion/detorsion.

Lymph Node Involvement and Related Risk Factors in Patients With Breast Cancer Referred for Radiotherapy: A 20-Year Study on 15000 Women

Objectives: Tumor size and axillary lymph node (LN) involvement are used as prognostic markers and a guide for choosing adjuvant therapy. This study aimed to evaluate LN involvement and related risk factors in patients with breast cancer (BC) referred for radiotherapy. Materials and Methods: Using the census sampling method, 15,000 women with BC referring for radiotherapy were enrolled in this retrospective descriptive study performed at Tabriz University of Medical Sciences during 2000-2020. LN involvement and related risk factors were recorded and analyzed using the t test and ANOVA test at a significance level of P<0.05. Results: The prevalence of LN involvement in this study was 25%. The estrogen receptor status and LN involvement were associated with metastasis. The odds ratio of metastasis in patients with a negative estrogen receptor was about twice that of women with estrogen receptor positivity. Finally, the risk of metastasis in patients presenting with LN involvement was eight times higher than that of patients without LN involvement. Conclusion: In general, estrogen receptor status and LN involvement were associated with metastasis in patients with BC. Thus, these factors can be regarded as a guide to start necessary interventions earlier in at-risk patients.

Alterations of Uterine Blood Flow During the Follicular Phase in Patients With Recurrent Implantation Failure: A Doppler Ultrasonographic Study

Objectives: The dynamics of blood flow in the endometrium plays a crucial role during the implantation process. This study aimed to assess the uterine perfusion during the follicular phase in patients with a history of recurrent implantation failure (RIF) and healthy fertile women using the transvaginal ultrasound color Doppler method. Materials and Methods: To this end, 50 patients with RIF and 50 age-matched healthy fertile women were recruited in this case-control study. The transvaginal color Doppler ultrasonography was used to evaluate the pulsatility index (PI) and resistance index (RI) of the uterine, arcuate, and sub-endometrial arteries during the follicular phase in both groups. Results: The RI and PI of both right and left uterine arteries were higher in the RIF group compared to the fertile women (P<0.05). Our results showed that the PI and RI of sub-endometrial blood flow and the RI of arcuate arteries were substantially higher in the group with a history of RIF in comparison with the control group. However, the PI of arcuate arteries was not significantly different between the groups. Conclusions: Adequate uterine perfusion and sub-endometrial blood flow are necessary to achieve successful implantation and pregnancy since our results demonstrated the higher resistance of uterine and sub-endometrial arteries in patients with a history of RIF. Thus, the assessments of uterine perfusion indices during the follicular phase could be used as a non-invasive method in the evaluation of patients with RIF.

Does Coronavirus Disease Affect Sleep Disorders in the Third Trimester of Pregnancy in Women With Low Back Pain?

Objectives: Many factors such as stress and psychological tension affect the mental and physical health of pregnant women in the third trimester during the coronavirus pandemic. These factors can cause severe complications such as sleep disorders and low back pain. Therefore, this study focused on investigating sleep disorders in women by diagnosing low back pain in pregnant women with coronavirus and the affecting factors. Materials and Methods: This descriptive-analytical study was performed during the four months ending July 5, 2020 with the participation of 40 pregnant women (with coronavirus disease detected in the last trimester of pregnancy) with a diagnosis of low back pain in Tabriz (Iran) using a random sampling technique. Demographic data, anxiety and depression, Petersburg’s sleep quality, factors affecting sleep quality, and the severity of back pain (visual analog scale) were electronically collected and analyzed using SPSS 20 by ANOVA and multivariate regression. Results: All participants were at a weak level. The majority of participants had a score of "serious sleep problem", and nausea and vomiting (P=0.041), low back pain (P=0.003), frequent urination (P=0.011), leg cramps (P=0.031), and constipation (P=0.018) caused severe sleep disturbance in pregnant women during coronavirus pandemic. Conclusions: In general, having coronavirus disease causes severe pain in pregnant women, leading to severe back pain in pregnancy, eventually worsening sleep disorders.

Mefenamic Acid for the Prevention of Bleeding and Spotting From Depot-medroxyprogesterone Acetate: A Randomized Controlled Trial

Objectives: To evaluate the efficacy of mefenamic acid for the reduction of bleeding and spotting in post-partum women initiating the use of depot-medroxyprogesterone acetate (DMPA) for contraception. Materials and Methods: This double-blind, placebo-controlled study included postpartum breastfeeding women in Khon Kaen, Thailand. Mefenamic acid or placebo was administered over the first 12 weeks of DMPA use. Then, participants completed a self-report bleeding diary. Results: Forty women, initiating the use of DMPA for postpartum contraception, were randomized to mefenamic acid (n=20) or placebo (n=20) group. The study was discontinued after 27 months because of suboptimal enrollment. The mefenamic acid group was less likely to have prolonged bleeding compared to placebo although this was not statistically significant (37.5% vs. 50%, respectively, P = 0.491). DMPA discontinuation rates were high at 50% in both groups although no participants in the mefenamic acid group stopped using DMPA due to bleeding side effects. Conclusions: The high discontinuation rates in the postpartum use of DMPA are attributed to the occurrence of bleeding/spotting side effects. Although mefenamic acid prophylaxis appeared to be beneficial to some women, a larger randomized controlled trial is required to confirm the effectiveness of this approach.

Radical Hysterectomy With and Without Neoadjuvant Chemotherapy in Patients With Cervical Cancer Stage IB-IIB

Objectives: In this study, radical hysterectomy, followed by neoadjuvant chemotherapy (NACT) in patients with locally advanced cervical cancer (LACC) was compared with radical hysterectomy in patients with early-stage cervical cancer. Material and Methods: This retrospective comparative observational study was performed on 13 patients with LACC International Federation of Gynecology and Obstetrics (FIGO) stage IB2-IIB who underwent a radical hysterectomy after NACT between March 2014 and November 2018. This group was compared with 18 patients undergoing radical hysterectomy with cervical cancer FIGO stage IIA-IB1 in the same period of time. Results: In the NACT group, 8 (61.5%) and 5 (38.4%) patients were in stages IIB and IB2, respectively, and 13 (72.2%) cases were in the IB1 stage in the non-NACT group. Post-operative blood transfusion in the NACT group was significantly higher compared to the non-NACT group [5 (38.4%) patients versus 0, P = 0.008]. The estimated blood loss (EBL) and operative time were similar between the groups. Finally, there were no significant differences in terms of intra-operative and other post-operative complications. Conclusions: Radical hysterectomy after NACT in women with LACC seems to be safe and reduces the need for radiation in patients with NACT who are at stage IIB. These results need to be confirmed in studies with a larger patient sample.

Laparoscopic Repair of a Post-myomectomy Uterocutaneous Fistula in a Nulligravida: A Case Report

Introduction: An abnormal passage connecting the skin and the uterus is the uterocutaneous fistula. It is rarely observed after a cesarean section or a gynecological surgery involving the uterus. The presence of an infection further complicates the management. In countries such as India where tuberculosis is highly prevalent, Mycobacterium tuberculosis should be ruled out. Case Presentation: A 29-year-old nulliparous woman who had undergone a laparotomy for removal of a large fibroid for primary infertility presented with complaints of abdominal pain and discharge from the scar site. These symptoms did not resolve with antibiotics and analgesics. An ultrasonography was performed and a fistulous tract extending up to the endometrium was revealed. She underwent a laparoscopic resection of the fistulous tract following which she was symptom free. Conclusion: One of the rarely observed complications following laparotomies and cesarean section is a uterocutaneous fistula. It is even rarer in women with no previous pregnancies. The management involves adhesiolysis and layer by layer closure of the uterus and abdomen wall after excising the tract. Most often a repeat laparotomy is performed to treat the condition, but in the current times it is well known that repeated open surgeries in the peritoneal cavity increase the chances of adhesions which can reduce the chances of pregnancies in nulliparous women. Hence, this article shows a successful outcome of laparoscopic uterocutaneous fistula repair.