Atypical eclampsia at primary health care in a remote area: A case report

BACKGROUND

Eclampsia is a generalized tonic-clonic seizure induced by pregnancy. It contributes to a high rate of maternal and neonatal morbidity and mortality worldwide. Eclampsia is characterised by classic signs such as elevated blood pressure, proteinuria, and seizures. However, it may occur in the absence of hypertension and/or proteinuria. The uncommon appearance of eclampsia makes it difficult to immediately assess and treat it. In addition, the occurrence of this case in a remote area makes it more challenging to handle. The objective of this case report is to increase awareness of uncommon manifestations of eclampsia, particularly in limited-resource settings.

CASE SUMMARY

A young primigravida experienced a generalised seizure without hypertension and/or proteinuria. Sudden hearing loss, blurred vision, and vomiting were complained about before the seizure attack. The patient was diagnosed with eclampsia. A loading dose of magnesium sulphate was administered immediately. The patient was referred from community healthcare to a hospital and discharged without any complications.

CONCLUSION

Atypical eclampsia may be a diagnostic challenge. However, other symptoms may be beneficial, such as awareness of eclampsia signs.

Use of iron in perinatal anaemia: Indications for women’s health care policies and procedure

This paper reviews management of obstetric anaemia and the role of intravenous iron for the treatment of obstetric anaemia. Red blood cell transfusions are routinely used for haemoglobin restoration in anaemic women. The decision for red blood cell transfusion is made on a combination of haemoglobin level and clinical status, and it is suggested that transfusions are not necessary in those who are well compensated or when alternative therapy is available. To reduce the risk, intravenous iron infusion is proposed as a bloodless therapeutic approach. There are a variety of iron preparations. Intravenous iron infusion can reduce the requirement for blood transfusion in hemodynamically stable women with perinatal anaemia, especially in resource-scarce settings. It a cost-effective bloodless approach for the treatment of anaemia than can enhance patient outcomes. According to the literature, when haemoglobin is greater than 90 g/L, blood transfusion is not often required. In perinatal women with anaemia, the decision whether to administer blood or iron is based on patient preferences, haemoglobin levels, clinical symptoms, past and present medical conditions and the clinician’s judgement. Nevertheless, due to the lack of rigid criteria for blood transfusions in the majority of clinical settings, it is considered the default treatment for anaemia in perinatal women.

Clinical implication of platelet to lymphocyte ratio in early onset preeclampsia: A single-center experience

BACKGROUND

Preeclampsia (PE) is a pregnancy syndrome of undetermined etiology; inflammation was one of the proposed theories for its development.

AIM

To examine the platelet to lymphocyte ratio (PLR), an inflammatory biomarker, as a marker to predict poor maternal-neonatal outcomes in early-onset PE (EoPE).

METHODS

A cross-sectional study enrolled 60 pregnant women with EoPE (at 32-30 wk of gestation) at a university hospital. Demographic criteria and hematological indices were collected, including platelet counts and indices (mean platelet volume and platelet distribution width), PLR, and the Doppler study, which calculated estimated fetal weight (EFW), amniotic fluid index (AFI), resistance index (RI), and pulsatility index (PI). Participants were followed until delivery, where maternal outcomes were recorded, including; delivery mode and reason for cesarean section, and neonatal outcomes, including fetal growth restriction (FGR), meconium-stained liquid, the 5-min Apgar score, and admission to the intensive care unit.

RESULTS

There was a trend of insignificant increases in cesarean sections. Sixty-one-point two percent (37/60) fetuses were admitted to the neonatal care unit; 70.0% of admitted fetuses were meconium-stained liquor, and 56.7% of them had FGR. PLR was positively correlated with AFI and EFW as r = 0.98, 0.97, P < 0.001; PLR showed negative correlations with PI and RI as r = -0.99, -0.98, P < 0.001. The Apgar score and the number of days admitted to the intensive care unit had a positive and negative correlation (0.69, -0.98), P < 0.0001, respectively. Receiver operating characteristic calculated a PLR cutoff value (7.49) that distinguished FGR at 100% sensitivity and 80% specificity.

CONCLUSION

Strong, meaningful relationships between PLR and FGR parameters and a poor neonatal outcome with a significant P value make it a recommendable biomarker for screening EoPE-related complications. Further studies are suggested to see the impact on maternal-neonatal health.

Stone accumulation overlying vaginal mesh exposure: A case report

BACKGROUND

Vaginal stones are rare with current literature limited to case reports. Vaginal stones are classified as primary or secondary stones. Primary stones form in the vagina when there is urinary stasis. Secondary stones form in the presence of a vaginal foreign body that acts as a nidus for the deposition of urinary salts. Foreign bodies, such as surgical mesh, make vaginal stone formation more likely, particularly in patients with urinary incontinence and conditions that predispose them to urinary calculi formation.

CASE SUMMARY

A 71-year-old female with a history of sacrocolpopexy, hyperaldosteronism, and urgency urinary incontinence presented with vaginal stone accumulation overlying two areas of vaginal sacrocolpopexy mesh exposure. The vaginal stones were initially removed to permit examination, but the stones reaccumulated at the site of the exposed mesh, later requiring definitive surgical management.

CONCLUSION

Patients with vaginal mesh exposure and conditions that predispose them to kidney stones are not ideal candidates for expectant management of mesh exposure, particularly if they have coexisting urinary incontinence. These individuals should be counseled about possible vaginal stone accumulation, and surgical management should be considered.

Spilled gallstone mimicking metastasis from cervix cancer on positron emission tomography – computed tomography

BACKGROUND

Spilled gallstones from previous cholecystectomy is not an uncommon situation. It may further mimic neoplastic disease and can be misled by fluorine 18 fluorodeoxyglucose position emission tomography with computed tomography ([18F]FDG PET/CT).

CASE SUMMARY

A 63 year-old patient was diagnosed with a cancer of the cervix. Pretreatment [18F]FDG PET/CT showed a peritoneal lesion suspicious for metastasis. Surgical exploration and histologic examination revealed the lesion to be a spilled gallstone from a previous cholecystectomy.

CONCLUSION

[18F]FDG PET/CT carries pitfalls since benign conditions such as intraperitoneal gallstones may be confused as malignant lesions. This case highlights the importance to be aware of the possible implications of dropped gallstones for the future, minimize its occurrence, and make all efforts to properly evaluate cancer staging, particularly for the cervix cancer.

What to do when it is breech? A state-of-the-art review on management of breech presentation

Any non-cephalic presentation in a fetus is regarded as malpresentation. The most common malpresentation, breech, contributes to 3%-5% of term pregnancies and is a leading indication for cesarean delivery. Identification of risk factors and a proper physical examination are beneficial; however, ultrasound is the gold standard for the diagnosis of malpresentations. External cephalic version (ECV) refers to a procedure aimed to convert a non-cephalic presenting fetus to cephalic presentation. This procedure is performed manually through the mother’s abdomen by a trained health care provider, to reduce the likelihood of a cesarean section. Studies have reported a version success rate of above 50% by ECV. The main objective of this review is to present a broad perspective on fetal malpresentation, ECV, and delivery of a breech fetus. The focus is to elaborate all clinical scenarios of breech and to provide an evidence-based clinical approach for them. After discussing breech prevalence, risk factors, diagnosis, and management, an updated review of ECV is presented. Moreover, ECV indications/contraindications, alternatives, clinical techniques on how to perform ECV and breech vaginal delivery, and obstetrical considerations for the delivery of malpresentations are thoroughly discussed.

Primary peritoneal hemangioendothelioma simulating an ovarian cyst: A case report and review of literature

BACKGROUND

Epithelioid hemangioendothelioma (EHE) is an extremely rare tumor with a prevalence of one in a million and a very heterogenous spectrum of disease that varies from an indolent to a metastasizing aggressive disease, with the liver, lung and bone being the primarily involved organs. Peritoneal forms of EHE are even rare, and only 12 cases have been reported to date in the literature.

CASE SUMMARY

A 66-year-old female came to our attention complaining low abdominal and perineal pain. Magnetic resonance imaging examination showed a 52 mm × 58 mm × 32 mm cystic mass with some smooth septa, simulating an ovarian cyst. Explorative laparoscopy demonstrated the presence of a peritoneal mass of augmented consistency connected with a sigmoid epiploic appendix in the right side of the Pouch of Douglas, that was surgically removed. Histological exa-mination revealed a primitive peritoneafl hemangioendothelioma. The patient easily recovered from surgery with no residual pain or discomfort. She is regularly attending a 3-years follow-up that is negative for local recurrence of disease or distant metastases.

CONCLUSION

Peritoneal form of EHE often simulates masses of other nature, as in our case. Given its unspecific clinical and radiological presentation, patients are often forced to a large series of tests and examinations before reaching a definitive diagnosis, that can only histologically made. The possibility of EHE should always be considered in case of unexplained chronic abdominal pain associated to a non-specific mass.

Prevalence and factors associated with non-adherence to therapy among partners of pregnant women with syphilis in a city of northeastern Brazil

BACKGROUND

One of the main difficulties faced in the prevention of the vertical transmission of syphilis is the inadequate treatment of pregnant women and their partners. The disease causes serious repercussions in infected newborns.

AIM

To evaluate the prevalence and factors associated with the therapeutic adhesion among partners of pregnant women with syphilis in a county in Northeastern Brazil.

METHODS

This is a descriptive, analytic, quantitative, cross-sectional study that was carried out through interviews with 46 pregnant women diagnosed with syphilis between 2017 and 2018 as well as with their partners. The interviews aimed at collecting data regarding sociodemographic characteristics, obstetric variables and information about syphilis, and partners’ related variables.

RESULTS

Our results showed that 73.91% of the partners did not undergo appropriate treatments, and obtaining negative results in syphilis tests was the main reason for the absence of therapies. The following factors were significantly associated with the lack of treatment among partners: Being a partner that is not the current mate of the pregnant woman, having a level of schooling inferior to 8 years [odds ratio (OR) = 10.28], and the pregnant woman undergoing up to two syphilis tests during the prenatal care (OR = 8.6). The study found a higher odds of absent treatment among partners if the pregnant woman is not white (OR = 13.88) or if the partner has less than 8 years of schooling (OR = 21.00) or has a monthly income of less than half the minimum wage (OR = 13.93).

CONCLUSION

The findings of this study show a high prevalence of partners that are not adequately treated for syphilis, a phenomenon that is strongly associated with socioeconomic factors.

Therapeutic challenges in metastatic follicular thyroid cancer occurring in pregnancy: A case report

BACKGROUND

Hormones could play a role in the evolution of follicular thyroid cancer (FTC) for which we discuss an unusual presentation of FTC occurring during pregnancy.

CASE SUMMARY

A pregnant woman was admitted with FTC metastasis resulting in a gluteal mass. Preoperative abdominal computed tomography revealed liver metastasis for which the patient underwent total thyroidectomy and liver resection, oral radioiodine therapy and radiotherapy, followed by embolization of the pelvic mass. The patient died of cerebral hemorrhage 16 mo after the initial diagnosis.

CONCLUSION

Human chorionic gonadotropin and estrogen stimulation might have a role in cancer growth, especially during pregnancy. FTC management aims to stop disease progression and overcome hormonal imbalances after thyroidectomy thus reducing fetal complications. It is still under debate whether it is possible to combine optimal timing for treatment to ensure the best possible outcome with reduction of fetal complications and risk of cancer growth.

Self-monitoring of blood glucose in gestational diabetes mellitus patients during the COVID-19 pandemic in low- and middle-income countries

Self-monitoring of blood glucose (SMBG) is critical for gestational diabetes mellitus (GDM) care. However, there are several hurdles to its practice during the coronavirus disease 2019 (COVID-19) pandemic in GDM patients in low- and middle-income countries when GDM care recommendations emphasize telemedicine-based care. Based on available knowledge, this letter proposes the following barriers to SMBG in these GDM patients during the ongoing COVID-19 pandemic: Poor internet connectivity, affordability of SMBG and digital applications to connect with healthcare providers, government-imposed social mobility restriction, psychological stress, and mental health conditions. Nevertheless, definitive evidence will only be acquired from rigorous research.

Microglandular hyperplasia-like mucinous adenocarcinoma of the endometrium: A rare case report

BACKGROUND

Microglandular hyperplasia (MGH) is a proliferation of endocervical glands, related to estrogen stimulation, mainly occurring in the reproductive age group. The differential diagnosis includes endometrial adenocarcinoma with MGH-like pattern (MGA), a distinction that may be particularly problematic in curettage specimen.

CASE SUMMARY

A 57-year-old, postmenopausal woman was admitted in our hospital for surgical treatment. She had been diagnosed with a uterine leiomyoma, after complaints of irregular vaginal bleeding. She underwent dilatation and curettage (D&C) and subsequent total abdominal hysterectomy with bilateral salpingo-oophorectomy. D&C were compatible with MGA. Histologically, a proliferation of small glands, without intervening stroma, with mucin production, accumulation of neutrophils in the gland lumen and stroma, mild nuclear atypia and rare mitoses, were seen. In the hysterectomy specimen, the endometrium was thickened, but without apparent tumor formation. On microscopic examination, a residual similar adenocarcinoma was seen in the isthmus and more conventional-of endometrioid and mucinous type, in the rest of the endometrium.

CONCLUSION

MGH-like proliferation with mild cytologic atypia, detected in the endometrial curettage specimen of a postmenopausal woman, should alert pathologists for MGA of the endometrium. VIM, p16, PAX-2, CD10 and CD34 may help in the differential diagnosis.

Mental fitness during transition to fatherhood

Transition into fatherhood is often marked by a period of adjustment, uncertainty and psychological distress and challenges for many men, along with social isolation and relationship problems. Risk factors for paternal mental health issues are maternal depression, marital distress, parenting stress, gender role stress, mismatched expectations for pregnancy and after childbirth, poor physical health, inadequate self-care behaviours, avoiding seeking help for mental health issues, and having a child with sleeping, feeding and temperament problems. Paternal depression, anxiety and post-traumatic stress disorder can have negative impacts on the social and emotional wellbeing of fathers, their partners and their children. Nevertheless, these issues are not widely acknowledged, recognised or treated. Men’s mental health illness is a silent crisis. They often fail to seek help due to their feeling of shame, stigma for a lack of emotional control, distress or anxiety related to utilising mental health support services, and underrating the severity of their symptoms. These necessitate the need for timely attention, psychological support and proper education to minimise their risk of mental health issues. Although research has indicated fathers’ inclination toward being included in practices such as the mental health assessment, perinatal education and postnatal educational approaches need to be inclusive of fathers and encourage them to seek support for their paternal mental health issues and parenting difficulties.

Teenage pregnancy and the sociodemographic attributes as a major contributor: Findings from an urban referral center in Nepal

BACKGROUND

Teenage pregnancy is a challenging issue worldwide. Yet, despite the increased health risk and socioeconomic impact of teenage pregnancy, the numbers remain high in Nepal.

AIM

To determine the prevalence and sociodemographic factors associated with teenage pregnancy in Nepal.

METHODS

A hospital-based cross-sectional study was conducted in the Paropakar Maternity and Women’s Hospital from April to August 2017. A total of 1359 mothers were assessed and interviewed regarding their reproductive history and sociodemographic attributes. Ethical approval from the Nepal Health Research Council, permission from the concerned hospital, and consent from study subjects were obtained.

RESULTS

Of the 5526 deliveries, 679 (12.3%) were teenage pregnancy deliveries. The majority (85.1%) of mothers (out of 1359) were married at < 20 years of age, with a mean age of marriage of 17.57 years (± 1.994, range: 12-25 years). Marriage age was a significant determinant of teenage pregnancy (odds ratio [OR] 2.423 [2.262-2.596]; P < 0.001). Likewise, a love marriage (OR: 2.018 [1.585-2.570]; P < 0.001) and first teenage pregnancy (OR: 3.622 [3.265-4.017]; P < 0.001) were significant determinants for subsequent teen pregnancies. Knowledge of family planning methods (OR: 0.474; 0.288-0.779; P = 0.003) and use of any methods of family planning utilization (OR: 0.345; 0.248-0.479; P = 0.000) significantly lowered the chance of teenage pregnancy.

CONCLUSION

Teenage pregnancy occupies a substantial proportion of total deliveries in the Nepalese maternity hospital. In addition, early pregnancy was significantly associated with age and type of marriage, education level, knowledge, and practice of contraceptive methods.

Relationship between Mollicutes and spontaneous abortion: An epidemiological analysis

BACKGROUND

Abortion is of great importance in public health, as it is among the main causes of maternal morbidity and mortality. In addition to sociodemographic- and lifestyle-related factors, studies have associated infections of the genital tract with higher rates of abortion. Therefore, the exacerbated presence and rise of Mollicutes in the genitourinary tract may be related to higher rates of abortion.

AIM

To perform an epidemiological analysis of women who had spontaneous abor-tions and placental colonization by Mollicutes in a maternity hospital.

METHODS

This cross-sectional study involved the collection of data and biological material from women hospitalized due to spontaneous abortion or term delivery. The sample consisted of 89 women who miscarried and 20 women who had full term pregnancy. Data collection was carried out in three stages: (1) Conducting research on the information and clinical data in medical records of patients hospitalized due to abortion; (2) Application of a semi-structured questionnaire to identify the patient's epidemiological profile and (3) Collection of placental tissue. Placental samples were collected after the curettage procedure (abortion) and after placental expulsion (delivery), both performed by an obstetrician. Microbial identification in the fragments was performed by real-time polymerase chain reaction. In this study, the following explanatory variables were considered: (1) Sociodemographic variables; (2) Variables related to access to health services; (3) Variables related to lifestyle; and (4) Variables related to sexual and reproductive health, all of which were used to perform descriptive, univariate and multivariate analyses.

RESULTS

In the final model, placental colonization by Mollicutes was independently associated with the variables age [odds ratio (OR) = 7.55; CI: 2.37-24.03] and menarche (OR = 3.43; CI: 1.03-11.44). In this investigation, the prevalence of Mollicutes colonization by at least one of the following three species: Mycoplasma hominis, Ureaplasma urealyticum, Ureaplasma parvum in women who had spontaneous abortion was 73.0%. When comparing colonization between the two groups of participating women, there was an 8.12-fold risk of placental colonization by at least one Mollicutes species in the women who had an abortion, compared to those who completed pregnancy. The final multivariate analysis model revealed a statistically significant association between placental colonization by Mollicutes in abortion with the following variables: age, as women up to 29 years old had a 7.55-fold risk of spontaneous abortion, compared to those who were older than 29 years; menarche, where women who had menarche up to 13 years old had a 3.43-fold risk of miscarriage compared to those who had menarche over 13 years old; and a change in eating habits, after the discovery of pregnancy, was a protective factor (OR = 0.16).

CONCLUSION

These findings revealed a positive association between spontaneous abortion and placental colonization by Mollicutes. This indicates the need for further investigation of this issue, to guide decision-making for the prevention of abortion.

Myasthenia gravis and pregnancy

Myasthenia gravis (MG) is an autoimmune disorder of neuromuscular junction that has higher incidence in younger women than men, which could be related to differences in sex hormones physiology and immune system functioning between males and females. MG can first present during pregnancy and variably affect pregnancy, labor, and postpartum period. In this paper, we had an updated overview on our understanding about MG presentation and its effect on pregnancy and vice versa, therapeutic options for MG pregnant women, management of pregnancy or labor complications in MG patients, and finally fetal and neonatal considerations in MG pregnant women. A multidisciplinary approach, involving obstetricians/gynecologists, neurologists, and anes-thesiologists, plays a pivotal role in improving the clinical outcomes in both MG mothers and their infants during pregnancy, delivery and postpartum.

Streptococcus agalactiae: Sensitivity profile in pregnant women attending health units in northeastern Brazil

BACKGROUND

Group B Streptococcus agalactiae (GBS) is the main etiologic agent associated with early-onset neonatal sepsis, and of all newborns of parturients colonized by GBS, approximately 1%-2% develop invasive, early-onset disease. The risk of infection increases to 15.2% in premature neonates, to 10.7% when the parturient has chorioamnionitis or premature rupture of membranes for more than 24 h and to 9.7% if the mother has postpartum bacteremia. In addition to causing perinatal, neonatal and postnatal deaths, neonatal hospital infection is associated with high costs, as hospitalization is three times longer than in uninfected children. The identification of pregnant women colonized by GBS, through universal screening, associated with the adoption of appropriate antibiotics at the time of delivery are the most successful preventive measures.

AIM

To evaluate the sensitivity profile of GBS isolated from pregnant women attending Vitória da Conquista-BA.

METHODS

This is a cross-sectional study with a quantitative approach carried out in the municipality of Vitória da Conquista-Bahia between February 2017 and March 2018. The study population was composed of 210 pregnant women, with a gestational age of 32 to 40 wk, who were aged 18 years or older living in the urban area of the municipality of Vitória da Conquista. After a brief explanation about the research and obtaining a signed an informed consent form, data and vaginorectal swabs were collected from the women for GBS research. Examination of the samples in order to identify the presence of GBS was by culture on sheep blood agar and chromogenic agar for GBS and then, seeded on plates containing streptococcal culture medium and incubated for 18 h to 24 h at 35°C. The antimicrobial sensitivity profile of positive GBS samples was determined by the disk diffusion technique, according to the Clinical and Laboratory Standards Institute manual (2017). The data obtained were stored in a database using Microsoft Office Excel spreadsheets and a descriptive analysis was performed with the aid of the EPI-INFO statistical package (version 3.5.2).

RESULTS

Among the 210 pregnant women participating in the study, 38 (18.1%) had a positive GBS culture. All strains isolated from GBS were sensitive to 10 U penicillin, 10 µg ampicillin, 30 µg cefotaxime and 30 µg vancomycin. Seven strains (18.4%) resistant to clindamycin 2 µg and eight (21.1%) resistant to erythromycin 15 µg were found. Of these, six were concomitantly resistant to erythromycin and clindamycin, two resistant only to erythromycin and one resistant only to clindamycin. All nine GBS isolates that showed resistance to erythromycin and/or clindamycin showed negative results on the D-test. Two thirds of the isolates showed cMLSB phenotype and resistance only to erythromycin in specimens in this study (02), refers to strains with phenotype M and resistance to clindamycin (01) only with phenotype L.

CONCLUSION

Chemoprophylaxis for GBS in pregnant women, especially for those allergic to penicillin, should be guided by an antimicrobial susceptibility test as resistant GBS strains were reported in this study.

Primary extragenital mixed malignant Mullerian tumour presenting as a painful splenic mass: A case report and review of the literature

BACKGROUND

Mixed malignant Mullerian tumours (MMMTs) are highly aggressive cancers that present at a late stage and are associated with a poor long-term prognosis. They are characterised by the presence of both epithelial and sarcomatous tissue types on histological examination and hence are known as biphasic tumours or carcinosarcomas. MMMTs almost always arise in the female genital tract (most commonly the uterus) but extragenital sites are also possible. Treatment options are limited and usually consists of surgery and adjuvant chemotherapy.

CASE SUMMARY

A 74-year-old woman presented with a 1-wk history of worsening left upper quadrant abdominal pain and a perisplenic mass on computed tomography (CT) scan. Features on imaging raised the possibility of a malignant process but were not diagnostic. Splenectomy was performed and histology confirmed the presence of a mixed malignant Mullerian tumour. A subsequent pelvic ultrasound identified another heterogenous cystic mass in the Pouch of Douglas without evidence of primary pathology in the uterus or adnexa. A second operation was performed for this with curative intent but previously-unknown widespread metastases were encountered at laparotomy. A biopsy of the pelvic mass confirmed it was also a MMMT with identical histological features to the perisplenic mass. There was no clinical or histological evidence of the MMMT having arisen primarily from the female genital tract. The patient subsequently suffered multi-organ failure and was palliated, succumbing to death on the 19^th post-operative day.

CONCLUSION

Primary extragenital MMMT arising from the spleen or peritoneum represents an atypical form of an already rare gynaecological tumour.

Association of endometrioma with ovarian teratoma and mucinous cystadenoma in a patient diagnosed with endometriosis: A case report

BACKGROUND

Co-occurrence of different tumor types in a same patient’s ovaries diagnosed with endometriosis is a rare phenomenon.

CASE SUMMARY

In this article we present an uncommon association of three distinct ovarian pathologies in a same woman presenting with adnexal mass. A 31-year-old nulliparous woman with a large persistent adnexal mass underwent laparoscopic surgery. Imaging demonstrated a multi-cystic mass with internal echoes. Tumor markers were within normal range. Based on histopathologic assessment, benign mucinous cystadenoma and mature cystic teratoma of the right ovary together with endometrioma of left ovary were revealed.

CONCLUSION

In cases of large adnexal mass, the of existence of more than one tumor type and the involvement of the contralateral ovary is possible. Also, the possibility of concurrent underlying malignancy or diminished ovarian reserve should be kept in mind.

Assessing quality of life using the brief cancer-related worry inventory for gynecological surgery

BACKGROUND

The mental status of gynecologic patients has an important influence on their quality of life (QOL). Although high-quality QOL studies into breast cancer patients have been performed internationally, few QOL studies have examined patients with gynecological cancer.

AIM

To investigate the brief cancer-related worry inventory (BCWI) could evaluate the mental status of gynecological patients.

METHODS

Between July 2018 and December 2018, 19 consecutive gynecological cancer patients were prospectively recruited for this study. The BCWI is a 15-item self-reported questionnaire that assesses cancer-related worries on a numeric scale (0–100).

RESULTS

The high BCWI group was significantly younger than the low BCWI group. Regarding social status, the absence of a spouse and children was significantly more common in the high BCWI group than in the low BCWI group. The operation time was longer in the worsening BCWI group than in the stable BCWI group (305.3 ± 140.5 min vs 171.1 ± 97.2 min; P = 0.026).

CONCLUSION

Being young, having no family, and a long operation time were found to be risk factors for increased anxiety. Therefore, gynecological cancer patients should be assessed using the BCWI, and specific perioperative mental care should be considered for highly anxious patients.

Endorphins, oxytocin, sexuality and romantic relationships: An understudied area

Endorphins are the body’s natural opioids that are created and released by the central nervous system, hypothalamus and pituitary gland. Endorphins have a reputation for pain reduction, enhancing excitement or satisfaction, boosting confidence, enabling control of emotions and generating feelings of euphoria, and are involved in the natural reward cycle. There is also evidence in the literature suggesting the role of endorphins in sexuality (including sexual function and sexual behaviours), as they may regulate the release of sex hormones, prolactin and growth hormone, which are involved in sexual function and love. Endogenous oxytocin is another intrinsic hormone whose role in inducing labour contractions, the delivery of the baby and stimulating lactation has been well studied. However, the potential impact of endorphins and oxytocin on sexuality and romantic relationships is not well understood. This article reviews the research on endorphins and endogenous oxytocin and how they relate to human sexuality and romantic relationships. Some animal studies report the effect of endorphin and oxytocin on sex hormones and mating behaviours, but these findings have not been supported by research into human behaviour, indicating many gaps in knowledge relating to the association between these hormones and human sexuality.

Hypothyroidism during pregnancy: Controversy over screening and intervention

Thyroid hormones are critical for foetal neurological development and maternal health. Maternal hypothyroidism during pregnancy is associated with adverse impact on health of the mother as well as the progeny. Reduced thyroid hormone levels predispose the child to develop mental retardation and cognitive delay in early life. In the mother, hypothyroidism during pregnancy is associated with spontaneous abortion, placental abruption, preterm delivery and hypertensive disorders. Therefore, screening and therapeutic intervention is justified to prevent foetal as well as maternal co-morbidities. In view of impact of such a large-scale screening and intervention program on limited healthcare resources, it is debatable if a targeted rather than universal screening program will result in comparable outcomes. In addition, there is an ongoing debate regarding best evidence-based practice for the management of isolated hypothyroxinaemia, subclinical hypothyroidism and euthyroid women with autoimmune hypothyroidism. We have carried out a review of the literature; firstly, to determine whether universal screening for asymptomatic women in early pregnancy would be cost-effective. Secondly, we have retrospectively reviewed the literature to analyse the evidence regarding the impact of therapeutic intervention in women with subclinical hypothyroidism.

Is nitric oxide level affected in postmenopausal women with hypothyroidism?

AIM

To analyze serum levels of nitric oxide (NO), an indicator of cardiovascular health, in post-menopausal females with and without hypothyroidism.

METHODS

NO was analyzed colorimetrically in 30 newly diagnosed hypothyroid postmenopausal females and 30 postmenopausal females with normal thyroid profile. Results were compared and subjected to appropriate statistical analysis.

RESULTS

The levels of serum NO were found to be significantly decreased in postmenopausal females with hypothyroidism as compared to the levels in those with normal thyroid profile (P value < 0.05). A negative correlation of NO was observed with thyroid stimulating hormone whereas a positive correlation of NO was observed with free T3 (FT3), free T4 (FT4), T3 and T4 though it was statistically significant only for FT4 among postmenopausal females with hypothyroidism.

CONCLUSION

Postmenopausal hypothyroid females may be at a risk of compromised cardiovascular health as indicated by low NO levels. Regular monitoring and risk assessment is essential for timely intervention.

Observed prevalence and risk factors of birth defects in Shanghai, China

AIM

To investigate the prevalence and related risk factors of birth defects in Shanghai.

METHODS

This report describes a population-based study of all births at the Obstetrics and Gynecology Hospital of Fudan University in Shanghai, China from January 2008 to December 2014. A logistic regression analysis was used to identify the parameters that are independently associated with birth defects.

RESULTS

A total of 82814 births, including 824 cases of birth defects, were recorded. The rate of birth defects was 0.995 per 100 births. In the multivariable regression analysis, neonatal birth defects were likely to be associated with higher gravidity [odds ratio (OR), 1.099, 95%CI: 1.024-1.178], premature birth (OR = 1.905, 95%CI: 1.501-2.418), low birth weight (OR = 3.844, 95%CI: 3.004-4.919), twin births or higher order multiple pregnancies (OR = 1.477, 95%CI: 1.107-1.969), cesarean delivery (OR = 1.184, 95%CI: 1.016-1.380) and registration as part of a migrant population (OR = 1.380, 95%CI: 1.167-1.632). Female infants were less likely to have birth defects than male infants (OR = 0.710, 95%CI: 0.616-0.818).

CONCLUSION

Higher gravidity, premature birth, lower birth weight, twin births or higher order multiple pregnancies, and registration as part of a migrant population are independent predictors of birth defects.

Birth experience of fathers in the setting of teenage pregnancy: Are they prepared?

AIM

To explore the birth experiences of teenage fathers and determine the extent to which they are prepared for childbirth.

METHODS

A mixed methods observational study was undertaken comparing the birth experience of 50 fathers in the setting of teenage pregnancy (teenage) compared to a group of 50 older fathers. Fathers were recruited in the antenatal period and completed structured questionnaires following the birth of their child. Quantitative and qualitative analysis was undertaken.

RESULTS

Teenage fathers were younger, less educated and less likely to attend prenatal childbirth education classes (P < 0.0001). During birth, they were less prepared and consulted by attending staff (both P < 0.05). They reported limited roles in intrapartum decision-making (< 20%). In multivariate analysis being a father in the setting of teenage pregnancy remained significantly associated with feeling unprepared for birth. The major themes in qualitative analysis were feeling unprepared, shock, fear, a sense of detachment, happiness, pride, love of the baby and satisfaction with fertility.

CONCLUSION

Teenage fathers are less prepared for the birth of their child and this results in shock, fear and detachment that may impact on the early father-infant relationship.