Tehran University of Medical Sciences Journal of Family and Reproductive Health 1735-8949 20 2 2026 09 13 101 107 Mina Jafarabadi Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Mitra Alizadeh Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Elahe Rezayof Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Leila Sahebi Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Yas Goudarzi Farzanegan 1, National Organization for Development of Exceptional Talents, Tehran, Iran 2026 06 13 2026 07 11 Objective: Given the invasive and costly nature of reference diagnostic methods like hysteroscopy , this study aimed to compare the diagnostic accuracy and the dimensional measurement agreement of uterine cavity lesions between two-dimensional saline infusion sonography (2D SIS) and three-dimensional saline infusion sonography (3D SIS) against the gold standard of hysteroscopy and histopathology. Materials and methods: This cross-sectional study was conducted on 283 female patients who were candidates for hysteroscopy. Prior to surgery, all patients underwent blinded evaluations via 2D SIS and 3D SIS performed by experienced radiologists, and the type, number, location, and size of the lesions were recorded. Subsequently, all patients underwent diagnostic hysteroscopy and tissue sampling for pathological evaluation as the gold standard. Diagnostic performance metrics were calculated, and the dimensional agreement of the lesions between the modalities was statistically evaluated using the Intraclass Correlation Coefficient (ICC) and Bland-Altman analysis. Results: The mean age of the patients was 35.9 ± 8.1 years. Histopathological examination confirmed endometrial polyps in 20.5% and leiomyomas in 17.3% of the patients. Compared to 2D SIS, 3D SIS demonstrated higher sensitivity (83.15% vs. 78.65%), higher specificity (93.30% vs. 91.75%), and higher overall diagnostic accuracy (90.11% vs. 87.63%). In the dimensional agreement analysis, 3D SIS showed an excellent correlation (ICC = 0.927) and a negligible mean systematic error (mean bias: -0.26 mm; 95% limits of agreement: -7.77 to 7.25 mm) compared to hysteroscopy. In contrast, 2D SIS systematically overestimated lesion dimensions compared to hysteroscopy (mean bias: 2.21 mm) and exhibited the widest limits of agreement when compared with 3D SIS (-8.76 to 13.70 mm). Conclusion: 3D SIS is an accurate, non-invasive tool that lacks systematic bias in measuring uterine tumors, offering superior performance compared to the 2D SIS method. Given its high overall accuracy, 3D SIS can be utilized as a reliable first-line diagnostic tool, significantly reducing the necessity for unnecessary diagnostic hysteroscopies and the associated financial burdens on the healthcare system. https://jfrh.tums.ac.ir/index.php/jfrh/article/view/3771 https://jfrh.tums.ac.ir/index.php/jfrh/article/download/3771/760

Tehran University of Medical Sciences Journal of Family and Reproductive Health 1735-8949 20 2 2026 09 13 154 155 Azar Moezy Exercise and Sports Medicine Department, Iran University of Medical Sciences, Tehran, Iran 2026 09 01 No abstract No abstract No abstract https://jfrh.tums.ac.ir/index.php/jfrh/article/view/3874 https://jfrh.tums.ac.ir/index.php/jfrh/article/download/3874/767

Tehran University of Medical Sciences Journal of Family and Reproductive Health 1735-8949 20 2 2026 09 13 146 148 Uday Modi Department of General Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India Nitin Gupta Department of Infectious Diseases, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India Muralidhar Varma Department of Infectious Diseases, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India Akhila Vasudeva Department of Obstetrics and Gynecology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India Praveen Tirlangi Department of Infectious Diseases, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India 2026 05 10 2026 08 05 Objective: To report a rare case of Edwardsiella tarda bacteremia in early pregnancy complicated by maternal sepsis, sepsis-induced coagulopathy, acute kidney injury, and intrauterine fetal demise. Case Report: A 32-year-old woman at 13 weeks of gestation presented with sudden-onset high-grade fever, abdominal pain, and vaginal bleeding shortly after consuming freshwater fish. She had no preceding diarrhea or vomiting. During hospitalization, she developed persistent fever, anemia, thrombocytopenia, acute kidney injury, and coagulopathy, with a sepsis-induced coagulopathy score of 5. Obstetric ultrasonography confirmed absence of fetal cardiac activity, and emergency vacuum aspiration was performed. Blood cultures grew Edwardsiella tarda, while stool cultures were sterile. She was treated with intravenous piperacillin-tazobactam, fluid resuscitation, oxygen supplementation, and blood transfusion. Her fever subsided, renal function and coagulation parameters normalized, and she was discharged in stable condition. Conclusion: Invasive Edwardsiella tarda infection during pregnancy is extremely uncommon but may cause severe maternal sepsis and adverse fetal outcome even without gastrointestinal symptoms. Recent freshwater fish exposure may provide an important diagnostic clue. Early blood culture sampling, prompt antimicrobial therapy, and supportive care are essential for maternal recovery. https://jfrh.tums.ac.ir/index.php/jfrh/article/view/3731 https://jfrh.tums.ac.ir/index.php/jfrh/article/download/3731/765

Tehran University of Medical Sciences Journal of Family and Reproductive Health 1735-8949 20 2 2026 09 13 84 93 Abigail Veenstra College of Natural Sciences, Grand Canyon University, Phoenix, Arizona, USA Jacob Lahti Noorda College of Medicine, Provo, Utah, USA Mahyar Shabani Noorda College of Medicine, Provo, Utah, USA Thomas Varkey University of Arizona College of Medicine, Phoenix, Arizona, USA 2026 03 12 2026 07 01 Objective: Hyperemesis gravidarum (HG) is a severe form of nausea and vomiting during pregnancy that can have significant physical consequences for the pregnant individual. However, studying affected patients often reveals an additional dimension of impact—specifically, the psychosocial effects on their quality of life. Materials and methods: This literature review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Relevant articles were identified through a systematic search across three major databases on May 18, 2024: Google Scholar, Cochrane, and PubMed. Results: 19 full-text articles met inclusion criteria. Across all studies, HG was consistently associated with poorer psychiatric health, strained social relationships, and broader psychosocial burdens. Conclusion: This particular review highlights the importance of appropriately taking a psychosocial history with patients at obstetric appointments. In addition, it encourages the practicing physician to delve further into the psychosocial health of each of their patients during these visits. Lastly, this review provides definitive evidence from a number of sources that these patients are truly suffering and calls to action investigation into new treatments and treatment methodologies to provide benefits for these needy patients. https://jfrh.tums.ac.ir/index.php/jfrh/article/view/3695 https://jfrh.tums.ac.ir/index.php/jfrh/article/download/3695/758

Tehran University of Medical Sciences Journal of Family and Reproductive Health 1735-8949 20 2 2026 09 13 108 119 EN Rose Patterson School of Social Welfare, University at Albany, Albany, New York, USA Kayleigh Smith School of Social Welfare, University at Albany, Albany, New York, USA 2026 02 21 2026 08 05 Objective: Anxiety disorders during the perinatal period, or perinatal anxiety (PNA), occur at rates comparable to perinatal depression and often go undetected. Obstetric providers are perfectly positioned to identify PNA; yet, most literature focuses on informal supports as primary protective factors the prevention and detection of PNA. This study aims to contribute to this gap by exploring the relationship between perceived support from medical providers and the detection of PNA. Materials and methods: The current study asked postpartum women to reflect on their levels of anxiety, perceived social support from obstetric care providers, help seeking behavior, and factors influencing their decision to disclose symptoms of PNA to their obstetric care provider during their perinatal period. Participants were recruited via an electronic flyer posted in social media groups for mothers. They completed an online survey consisting of a demographic questionnaire, Perinatal Anxiety Screening Scale (PASS), Modified Multidimensional Scale of Perceived Social Support (MSPSS), Subscale 1, Subscale 2. Results: Totally 98 postpartum women participated in this study. A Spearman correlation demonstrated a significant positive relationship between levels of perceived social support from obstetric providers and perinatal women ranking their obstetric provider as a barrier, neutral or motivating factor in help seeking behavior for PNA. A chi-square test of independence indicated a significant relationship between rankings of a provider as a barrier, neutral or motivator in help seeking behavior and the disclosure of PNA directly to obstetric care providers. It was found that levels of perceived social support reported on the Multidimensional Scale of Perceived Social Support (MSPSS) significantly predicted ranking obstetric providers as a barrier, neutral or motivating factor in the decision to disclose symptoms of PNA to their obstetric care provider. Conclusion: The results of this study indicate a missed opportunity in more effective detection of PNA. Specifically, the role of obstetric providers in detection of PNA and potential to serve as a protective factor or motivator in the disclosure of PNA is mentioned. https://jfrh.tums.ac.ir/index.php/jfrh/article/view/3674 https://jfrh.tums.ac.ir/index.php/jfrh/article/download/3674/761

Tehran University of Medical Sciences Journal of Family and Reproductive Health 1735-8949 20 2 2026 09 13 149 153 Zahra Jahani Department of Obstetrics and Gynecology and Perinatology, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran Zohreh Jahani Department of Biochemistry, Institute of Biochemistry and Biophysics, University of Tehran, Tehran, Iran Taraneh Arbabzadeh Clinical Research Development Unit, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran Jalal Taghizadeh Department of Neurosurgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Behnaz Nouri Department of Obstetrics and Gynecology and Perinatology, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran 2026 05 12 2026 08 05 Objective: Myonecrosis is a complication of severe endometritis. The usual management of uterine incisional necrosis with dehiscence is hysterectomy. Conservative surgery, which involves wound debridement and resuture, presents a strong alternative to hysterectomy. Case Report: In this study, a 27-year-old woman underwent an emergency cesarean section at 37 weeks due to fetal distress after labor induction for severe preeclampsia and intrauterine growth restriction. Five days after cesarean section, the patient developed purulent discharge from the incision, followed by tachycardia, leukocytosis, and fever. Imaging revealed endometritis with peritonitis symptoms. Her condition deteriorated in spite of broad-spectrum antibiotics, requiring an urgent exploratory laparotomy. Necrotic tissue was excised during surgery, and the uterine incision was effectively healed without necessitating a hysterectomy. She exhibited a satisfactory recovery, and a three-month follow-up revealed an unblemished uterus. Conclusion: Uterine incision necrosis can be lethal if not appropriately recognized and treated. Conservative therapy can be a good alternative for properly chosen patients, even though hysterectomy is frequently required. Successful outcomes depend on early diagnosis, cautious patient selection, careful infection management, and surgical debridement. The long-term safety and reproductive implications of conservative treatment require further investigation. https://jfrh.tums.ac.ir/index.php/jfrh/article/view/3734 https://jfrh.tums.ac.ir/index.php/jfrh/article/download/3734/766

Tehran University of Medical Sciences Journal of Family and Reproductive Health 1735-8949 20 2 2026 09 13 94 100 Reza Saeedinia Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran Ava Hemmat Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Zohreh Heidary Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran 2026 06 30 2026 08 16 Objective: Recurrent implantation failure (RIF) remains a multifaceted challenge in assisted reproductive technology (ART), affecting a subset of in vitro fertilization (IVF) patients despite transfer of high-quality embryos. Conventional diagnostics often require invasive procedures that may disturb endometrial receptivity. This narrative review critically synthesizes the evidence on liquid-biopsy strategies for RIF screening, emphasizing biofluids such as uterine fluid (UF), spent embryo culture medium (SCM), peripheral blood, cervicovaginal fluid (CVF), and seminal plasma. Materials and methods: Literature searches covered PubMed, Scopus, and Web of Science through August 2025, with inclusion of pivotal pre-2022 studies. Eligible works included observational studies, clinical trials, multi-omics analyses, and systematic reviews reporting molecular biomarkers relevant to endometrial receptivity or embryo competence. Results: UF-derived microRNAs (miRNAs) and extracellular vesicle (EV) cargo during the window of implantation (WOI) consistently differentiate receptive from nonreceptive endometrium, with predictive accuracies (AUC 0.75–0.90) in small validation studies. SCM-based noninvasive PGT-A (niPGT-A) shows moderate concordance (~65%) with trophectoderm biopsy PGT-A, constrained by contamination and low cfDNA yield; recent advancesons, support from healthcare professionals, and family backing emerging as predominant themes. Conclusion: This study revealed profound physical and mental health challenges compounded by societal stigma and limited resources. Strengthening social support networks, reducing stigma, and promoting patient-centered care are imperative. Targeted interventions are also essential to enhance health outcomes for these young mothers and their children. https://jfrh.tums.ac.ir/index.php/jfrh/article/view/2905 https://jfrh.tums.ac.ir/index.php/jfrh/article/download/2905/703

Tehran University of Medical Sciences Journal of Family and Reproductive Health 1735-8949 18 4 2024 12 22 253 260 EN Maria Nascimento Department of General and Specialized Surgery, Professional Master's Program in Maternal and Child Health, Faculty of Medicine, Universidade Federal Fluminense (UFF), Niterói, RJ, Brazil Lara Marchesi Faculty of Medicine, Department of Clinical Medicine, Universidade Federal Fluminense – UFF, Niterói, RJ, Brazil Wender Soares Faculty of Medicine, Department of Clinical Medicine, Universidade Federal Fluminense – UFF, Niterói, RJ, Brazil Jenaine Rosa Emiliano Faculty of Medicine, Department of Clinical Medicine, Universidade Federal Fluminense – UFF, Niterói, RJ, Brazil Maria Auxiliadora Saad Faculty of Medicine, Department of Clinical Medicine, Universidade Federal Fluminense – UFF, Niterói, RJ, Brazil Glaucimara Hacar Maternity Ward, Rede D’Or São Luiz, Oeste D’Or Hospital, Rio de Janeiro (RJ)- Brazil Gabriel Chiracava Faculty of Medicine, Department of Clinical Medicine, Universidade Federal Fluminense – UFF, Niterói, RJ, Brazil 2024 09 14 2024 11 27 Objective: Stillbirth is a neglected problem that needs to be given a greater visibility, especially in developing countries. This study aimed to describe temporal trends of stillbirth rates disaggregated by maternal and gestational age. Materials and methods: This is an ecological study conducted in Brazil. Stillbirth rates and temporal trends were calculated using data from 2011-2021, considering variables such as gestational age (≥ 22 weeks) and maternal age (10-19, 20-34, and ≥ 35 years old). Stillbirth rates were presented per 1,000 births, and trends were assessed via autoregressive models. Results: There were 228,386 stillbirths in Brazil, corresponding to 1 event per 133 live births at ≥ 22 gestational weeks in singleton pregnancies. At ≥28 weeks, the average stillbirth rates were 139.46 per 1,000 births (28-31 weeks), 36.59 per 1,000 births (28-36 weeks), 6.07 per 1,000 births (28-41 weeks), and 5.94 per 1,000 births (28-42 weeks and more). Data disaggregation by maternal age showed that average stillbirth rates were 7.69 per 1,000 births (mothers aged 10-19 years), 6.90 per 1,000 births (mothers aged 20-34 years), and 10.34 per 1,000 births (mothers aged ≥ 35 years). The temporal trends showed statistically significant increase in stillbirth rates in almost all gestational age strata among adolescent mothers, but not among older women. Conclusion: Older women experienced the highest stillbirth rates in Brazil but with a clear declining trend. The upward stillbirth trends revealed among adolescent mothers suggest that the fetal death prevention must be prioritized in the Brazilian adolescent health policy agenda. https://jfrh.tums.ac.ir/index.php/jfrh/article/view/2914 https://jfrh.tums.ac.ir/index.php/jfrh/article/download/2914/704

Tehran University of Medical Sciences Journal of Family and Reproductive Health 1735-8949 18 4 2024 12 22 261 268 Hery Bemanana Regional Directorate of Public Health Atsinanana, Toamasina, Madagascar AND University of Toamasina, Madagascar AND Sylababa Association Madagascar 2024 09 25 2024 11 27 Objective: This study aims to analyze the association between the likelihood of giving birth in a healthcare facility and various sociodemographic characteristics in Madagascar. Materials and methods: This study utilized data from the 2021 Madagascar Demographic and Health Survey which included a representative sample of women of reproductive age (15-49 years). The sociodemographic variables analyzed included age, birth order, education level, region residence and economic status with the place of delivery being the primary dependent variable. Data analysis was conducted using R software. A chi-square test was applied to assess associations between variables, with a significance threshold set at 5%. Results: The prevalence of institutional childbirth services usage in Madagascar was 37.4% (35.1-39.7). The results showed that women under 20 years had an assistance rate of 36.7% (33.9-39.4), while the rate for primiparas reached 49.9% (48.5-51.3). Prenatal visits, mother’s age, birth order, region, residence, education level, and economic quintile significantly influenced access to care, with p-values < 0.0001. Only 17.5% (15.6-19.4) of women in the lowest quintile received qualified assistance at childbirth. Conclusion: The results highlight the impact of age, birth order, residence, education level, region and socioeconomic status on access to childbirth services, necessitating a multisectoral approach to improve equity. https://jfrh.tums.ac.ir/index.php/jfrh/article/view/2928 https://jfrh.tums.ac.ir/index.php/jfrh/article/download/2928/705

Tehran University of Medical Sciences Journal of Family and Reproductive Health 1735-8949 18 4 2024 12 22 269 273 EN Fatemeh Golshahi Department of Perinatology, Yas Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Fatemeh Rahimi-Sharbaf Department of Perinatology, Yas Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Mahbobeh Shirazi Maternal, Fetal and Neonatal Research Center, Yas Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Sara Saeedi Department of Perinatology, Yas Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Athar Abdolrazagh Nejad Department of Perinatology, Yas Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Sahar Garfami Department of Perinatology, Yas Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Nafise Saedi Department of Perinatology, Yas Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Jafar Golshahi Department of Cardiology, Isfahan University of Medical Sciences, Isfahan, Iran Zeynab Amiriarya Department of Perinatology, Yas Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Narjes Tavakolikia Vice-Chancellor for Health, Tehran University of Medical Sciences, Tehran, Iran Behrokh Sahebdel Department of Perinatology, Yas Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran 2024 06 09 2024 09 22 Objective: Amniocentesis and chorionic villus sampling (CVS) are the most widely used prenatal diagnostic methods. Despite their benefits, they can be associated with adverse pregnancy effects, but the exact prevalence of these complications especially in twin pregnancies is not exactly known. Therefore, the present study was conducted to determine post-amniocentesis or CVS complications in twin pregnancies. Materials and methods: This retrospective observational study was conducted on 187 pregnant women who underwent amniocentesis or CVS in the perinatology department of Yas Hospital affiliated with Tehran University of Medical Sciences from January 2011 to March 2020. All participants were evaluated with amniocentesis or CVS by an expert perinatologist. The study outcomes were considered as the occurrence of vaginal bleeding, rupture of the membranes, chorioamnionitis, and abortion. Results: The mean age of women was 33.5 ± 6.5 years. About 90 % of pregnant women underwent amniocentesis and the others underwent CVS. In 132 (70.6%) pregnant women, the most common indication for diagnostic prenatal tests was having high-risk first/second-trimester screening followed by abnormal ultrasound anomaly scan in 31 (16.6%) cases. It was also found that in 80 (42.8%) patients, the placenta site was in the anterior part and 65 (34.8%) in the posterior part. The diagnostic test results were normal in 170 (90.4%) cases, while trisomy 21 was detected in 13 (7%) cases and trisomy 13 in 4 (2.1%) cases. The rate of abortion following CVS or amniocentesis in twin pregnancies was 3.7%, which was not associated with the study variables. Conclusion: The results of the present study showed that the rate of miscarriage following amniocentesis and CVS in twin pregnancies is 3.7%. Therefore, r