The Journal of Family & Reproductive Health (JFRH) is the quarterly official journal of Vali–e–Asr Reproductive Health Research Center. This journal features fulllength, peerreviewed papers reporting original research, clinical case histories, review articles, as well as opinions and debates on topical issues. Papers published cover the scientific and medical aspects of reproductive physiology and pathology including genetics, endocrinology, andrology, embryology, gynecologic urology, fetomaternal medicine, oncology, infectious disease, public health, nutrition, surgery, menopause, family planning, infertility, psychiatry–psychology, demographic modeling, perinatalogy–neonatolgy ethics and social issues, and pharmacotherapy. A high scientific and editorial standard is maintained throughout the journal along with a regular rate of publication.
Objective: During pregnancy, changes occur in the oral environment with gingivitis predominating. The development of odontogenic infections within the period of pregnancy may endanger the life of the mother as well as that of her unborn baby.
Materials and methods: A retrospective observational study of cases of cervicofacial infection in women during pregnancy was conducted at the oral and maxillofacial surgery clinic of a northern Nigerian tertiary health care center from January 2006 to June 2018.
Results: Seventy women were managed for cervicofacial infection during the period reviewed, out of which 20 women (28.6%) presented during pregnancy. Their mean age was 33.8 ± 9.35 years with a range of 20 to 55 years. The 30-39 years age bracket had the highest frequency (40%) and the mean duration of pregnancy at presentation was 24.9 ± 11.12 weeks with a range between 10 to 36 weeks. Majority (n=15, 75.0%) presented in the 3rd trimester. At presentation, the frequently involved fascial space was unilateral submandibular space (n=10; 50.0%), All the patients had incision/drainage/decompression on the dental chair under local anesthesia (2% lidocaine with 1:80,000 adrenaline). The mean length of hospital stay was 13.9 ± 6.2 days with a range of 6 to 26 days. The mortality rate was 15% (n=3 cases).
Conclusion: There is a need for oral health evaluation in pregnant women during ante-natal visits to prevent these complications. Oral health education should also form part of teachings received by women both in the ante-natal and postnatal clinics.
Objective: Maternal urinary tract infection is associated with intrauterine growth restriction, preterm delivery and low birth weight. The purpose of this study was to evaluate whether maternal urinary tract infection is related to neonatal urinary tract infection.
Materials and methods: The present prospective study included 230 singleton neonates. The participants were divided into two groups based on in utero exposure to maternal urinary tract infections. The study group (exposure to maternal urinary tract infection) included 115 neonates and the control group (without exposure to maternal urinary tract infection) included 115 healthy neonates. Physical examination, urinalysis, urine culture and urinary system ultrasonography were carried out for all neonates.
Results: There were 153 deliveries by cesarean section and 77 vaginal births. There was no statistically significant difference between the groups in terms of gender distribution, maternal age, birth weight, mode of delivery, gravida and gestational age. Although the difference was not significant, the incidence of low birth weight and preterm delivery were higher in the study group in comparison to that in the control group. There was a statistically significant higher rate of neonatal urinary tract infection in the study group compared with control group (25.2% vs. 7.8%, p<0.001). The most commonly discovered pathogens were Escherichia coli, followed by Klebsiella spp., Proteus spp., and Serratia spp. in the study group.
Conclusion: The results of this study showed that the presence of maternal urinary tract infection may contribute to increased urinary tract infection frequency in the neonatal period. Neonates at risk for a urinary tract infection should be regularly monitored due to nonspecific clinical presentation.
Objective: To determine the incidence and importance of transient asymptomatic hydronephrosis following total hysterectomy.
Materials and methods: In a prospective study over 4 year, 368 women were studied who had undergone a total abdominal or vaginal hysterectomy. Totally, 95% of operations were done for benign diseases (abnormal uterine bleeding, chronic pelvic pain, uterine prolapse, etc.) and 5% were performed for uterine malignancy. Renal ultrasonography was performed before and 3, 7 and 28 days after the surgery for diagnosing hydronephrosis. Intravenous urography was performed in patients with either persistent/progressive or symptomatic hydronephrosis.
Results: There was no intraoperative identifiable ureteral injury. Hydronephrosis was seen in 35 (9.5%), 21 (5.7%), and 1 (0.27%) patients at days 3, 7 and 28 after the operation, respectively. The degree of hydronephrosis was graded I, II or III. Considering the frequency and severity of hydronephrosis, the right kidney was affected more. Hydronephrosis correlated significantly with indication, duration and route of surgery as well as patient's age. All kidneys improved spontaneously, except one case which needed ureteral stenting with no surgical intervention (p=0.05).
Conclusion: Transient hydronephrosis could occur after simple total hysterectomy despite the absence of any obvious intraoperative ureteral injury. It is noted in 9.5% of the patients within three days after the non-complicated surgery. The clinical course may be continued until one month.
A Shift Toward Childbearing in One-Child Families Through a Mindfulness-Based Stress Reduction Program: A Randomized Controlled Trial
Objective: Fertility patterns are a key to the estimation of future population size, but they are restricted by serious indecision. One-child families are one of these patterns that is caused by a set of factors and one of these factors is the fear of re-pregnancy. In this regard, this study aimed to use a mindfulness-based stress reduction (MBSR) program to reduce the fear of women who have been experiencing anxiety after their first pregnancy and delivery.
Materials and methods: This interventional study was conducted on 67 one-child women, who at least 6 years have been passed since the birth of their child and according to the short form of the Pregnancy Related Anxiety Questionnaire (PRAQ-17), have been experienced anxiety. These women were randomly divided into control and intervention groups. For the intervention group, the MBSR program was conducted in 8 sessions, once every week, each session lasting 2.5 hours. At the end of the program, a second PRAQ-17 was completed by both groups.
Results: The findings showed that the MBSR approach in the intervention group significantly decreased the anxiety score in total (p=0.001) and individually in all subcategories.
Conclusion: The MBSR approach can reduce the anxiety of one-child women who have experienced anxiety after their pregnancy and childbirth. Thus, using this method in helping women with pregnancy-related anxiety is recommended to increase the birth rate.
Antioxidant Effects of Aerobic Training and Crocin Consumption on Doxorubicin-Induced Testicular Toxicity in Rats
Objective: Doxorubicin (DOX) treatment has been reported to increase the risk of serious toxicity in testis, therefore the aim of the present study was to investigate the antioxidant effects of training and Crocin on doxorubicin-induced testicular toxicity in rats.
Materials and methods: In this experimental study, 42 Wistar rats were randomized into seven groups of six rats, including 1) Control, 2) DOX, 3) DOX + 10 mg/kg/d (day) Crocin, 4) DOX + 50 mg/kg/d Crocin, 5) DOX + high intensity interval training (HIIT), 6) DOX + HIIT with 10 mg/kg/d Crocin and 7) DOX + HIIT with 50 mg/kg/d Crocin. During eight weeks, rats in groups 3, 4, 6, and 7 administered Crocin daily at specific doses by gavage, and groups 5 to 7 performed HIIT(2-8rep2min at 80-110% Vmax) 5 day/w. Also, groups 2 to 7 administered 2 mg/kg/w DOX intraperitoneal. The testes were removed and glutathione peroxidase (GPX), total antioxidant capacity (TAC) and protein carbonyl (PC) were analyzed using ELISA methods, one-way analysis of variance along with Bonferroni’s post hoc test were used for analysis in SPSS (P≤0.05).
Results: The results of the present study showed that doxorubicin induced oxidative stress in testicular tissue by decreasing the level of GPX and TAC and increasing PC level (P≤0.05); TAC and GPX improved in all groups except groups 2 and 5, respectively, and their increase in the group 7 was significantly higher compared to other groups (P≤0.05). Increased PC levels were significantly reduced in the groups 5, 6 and 7.
Conclusion: The increase in antioxidant levels in the concurrent Crocin and training group seems to be dose-dependent, but the oxidative stress in both Crocin and training groups of 10 and 50 mg/kg/d is associated with a decrease, but its modulation in the Crocin consumption group alone depends on the dose.
Objective: Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune disorder where the disease activity itself and the medications used for its treatment, may have adverse effects on ovarian function. This study aimed to assess the ovarian reserve (OR) in SLE patients.
Materials and methods: The anti-müllerian hormone (AMH) and the antral follicle count (AFC), two markers to evaluate the OR was assessed in 64 SLE patients and compared to normal individuals. Additionally, we assessed whether the disease per se or the pharmacological treatments affect the OR.
Results: Patients with SLE displayed alterations in the OR regardless of the presence of alterations of the menstrual cycle. The AFC and AMH were significantly lower in SLE patients with and without menstrual alterations when compared to control individuals (p<0.0001). However, the AFC and AMH levels were significantly correlated (p=0.006) in the SLE patients with menstrual alterations. Except for hydroxychloroquine that was statistically higher in SLE patients with menstrual alterations (p=0.04), the cumulative dose for cyclophosphamide, corticosteroid, and methotrexate was similar in SLE patients regardless of the occurrence of menstrual alterations.
Conclusion: The monitoring of AMH and AFC in SLE patients should be used to detect the rapid and irreversible decline of the OR to provide a possibility of pregnancy to the SLE patients.
Effects of Ethinyl Estradiol in Combined Oral Contraceptives on Cell Proliferation and Apoptosis in Ectopic Endometrial Tissue: A Randomized Controlled Study
Objective: Since endometriosis is an estrogen-dependent disease; therefore, combined oral contraceptives (COCs) may not be the best choice for the treatment of endometriosis. The objective of the present study was to investigate the effects of ethinyl estradiol (EE) and desogestrel (DSG) in COCs on cell proliferation and apoptosis in ectopic endometrial tissue as compared to DSG alone.
Materials and methods: Forty-five women of reproductive age with at least one endometriotic cyst were recruited into this single-blind randomized controlled trial study and randomly divided equally into three groups. EE-DSG and DSG groups received EE (0.03 mg) and DSG (0.15 mg) or DSG alone daily for 28-35 days before surgery. The control group was prescribed nothing. Endometriotic cyst tissues were collected during ovarian cystectomy for immunohistochemistry.
Results: Levels of Ki-67 positive cells in the ectopic endometrial tissue of the EE-DSG group were significantly higher than the DSG group (median [IQR]; 1.4[1.2] vs 0.6 [0.7], P <0.016). There were significantly more TUNEL-positive cells in the EE-DSG group compared to the DSG group (median [IQR]; 2.8[0.7] vs 1.8[1.4], P < 0.016, respectively). Moreover, the number of TUNEL-positive cells in the EE-DSG and DSG groups were significantly higher than the control (median [IQR]; 2.8[0.7] vs 0.2[0.2] and 1.8[1.4] vs 0.2[0.2], P <0.016). The levels of cells that positively stained for Bcl2 were not different among all groups.
Conclusion: Progestin alone increased cell apoptosis in ectopic endometria. However, concurrent EE in COCs enhanced proliferation and promoted a greater apoptotic effect in ectopic endometria compared to progestin alone.
Maternal Sleep and Related Pregnancy Outcomes: A Multicenter Cross-Sectional Study in 11 Provinces of Iran
Objective: Sleep disturbance during pregnancy is one of the most common maternal complaints. Not only does it play a crucial role in a mother’s life, but also it comes with a multitude number of complications. This study aimed at assessing the association between sleep disturbance in pregnancy and maternal and child outcomes. Materials and methods: This was a multicenter cross-sectional study, conducted on pregnant women across 11 provinces in Iran in 2018. Sleep disturbance as a composite variable was defined using the principal component analysis based on five questions. Abortion, anemia in the first and third trimester, gestational diabetes, gestational age, glucose tolerance test (GTT), fasting blood sugar (FBS), mode of delivery, low birth weight and stillbirth were defined as study outcomes.
Results: Totally, 3675 pregnant women enrolled in the study. Most of the participants (84.5%) reported that their sleep duration is less than 8 hours per day. The prevalence of sleep disturbance was 20.7% (95% CI: 19.1, 22.3). After adjusting for maternal age, education, job, place of residency and physical violence, sleep disturbance would increase the odds of abortion (p=0.009), anemia in both first(p=0.001) and third (p=0.003) trimester, gestational age (p=0.049), abnormal FBS (p=0.015) and cesarean section (p<0.001).
Conclusion: Regarding the effect of sleep quality on maternal outcomes, planning and implementing a
suitable intervention in the context of primary health care is necessary. Increasing the awareness of
mothers, health workers and medical personnel about the suitable quality and quantity of sleep during
pregnancy is of great importance.
Insights Into the Vaginismus Treatment by Cognitive Behavioral Therapies: Correlation With Sexual Dysfunction Identified in Male Spouses of the Patients
Objective: To examine retrospectively sexual dysfunction in the male spouses of 425 female patients who had presented to our clinic and were diagnosed with primary vaginismus.
Materials and methods: Seven questions related to age, profession, educational status, number of marriages, personality structure, sexual experience, and sexual dysfunction history were directed to the spouses of the 425 female patients presenting to our clinic for vaginismus treatment between 2015 and 2018. Men reporting sexual dysfunction were evaluated by a urologist, and the necessary treatment was initiated. Cognitive-behavioral couple therapy was started for all patients.
Results: Of the 425 men, 73.9% stated that they did not have any sexual problems. Of the 111 men (26.1%) stated that they had one or more sexual problems, 77 (18.1%) were diagnosed with premature ejaculation, 25 (5.8%) erectile dysfunction, 36 (8.4%) hypoactive sexual desire, and one (0.2%) had delayed ejaculation. Premature ejaculation and erectile dysfunction were identified in nine patients, premature ejaculation and hypoactive sexual desire in seven, and erectile dysfunction and hypoactive sexual desire in four patients. There was an increased rate of sexual dysfunction in men in cases where the duration of marriage without coitus was longer than three years.
Conclusion: In the treatment of vaginismus, male sexual dysfunction should not be ignored. Spouses should be questioned for sexual dysfunction and included in the treatment process.
Objective: Syringoma is a benign adnexal neoplasm of sweat gland, usually presenting as extra-genital lesions, while vulvar localization is rare. Moreover, syringoma is an uncommon vulvar neoplasms.
Case report: A 44-year-old woman with previous diagnosis of duodenal gastrointestinal stromal tumour, underwent a local surgical excision for an isolated, painful, vulvar lesion. The specimen was submitted for histological examination. A vulvar syringoma was diagnosed.
Conclusion: We describe this case according on its rarity and atypical presentation as well; therefore, vulvar neoplasms encompass many differential diagnoses, among which the incidence rate of syringoma is very low. Although its rarity, syringoma should be included among the differential diagnosis for vulvar neoplasm.