Bushra J. Al Mousawi, M. Azzam, B. Zahawi, Hayder Adnan Fawzi
{"title":"Agonist Versus Antagonist in Intracytoplasmic Sperm Injection Cycles: Which Is the Best?","authors":"Bushra J. Al Mousawi, M. Azzam, B. Zahawi, Hayder Adnan Fawzi","doi":"10.15296/ijwhr.2020.46","DOIUrl":"https://doi.org/10.15296/ijwhr.2020.46","url":null,"abstract":"\u0000 Objectives: The comparison of gonadotropin-releasing hormone (GnRH) agonist against GnRH antagonists regarding the pregnancy rate and effect of various predictors on pregnancy outcomes. Materials and Methods: This prospective comparative study involved 189 women who underwent intracytoplasmic sperm injection (ICSI) cycles and were divided into agonist (107 patients) and antagonist arm (82 patients) groups. The chemical and clinical pregnancy rate was the main outcome and the other outcomes included the number and quality of oocyte measurement and pregnancy outcomes. Results: Based on the results, the agonist protocol showed a higher rate of pregnancy (32.7%, 95% CI: 23.9-42.4%) compared to the antagonist protocol (22.0%, 95% confidence interval (CI): 13.6-32.5%) with the odds ratio (OR) of (95% CI) = 1.73 (0.89-3.35). The results further revealed that the count of retrieved oocytes, count of M2 oocytes, count of fertilized oocytes, count of embryos, and the fertilization percent out of total retrieved oocytes were higher in the agonist arm compared to the antagonist arm. In the multivariate analysis after adjusting for the confounders, the agonist protocol had higher odds of a successful pregnancy compared to the antagonist protocol by 57% (partial OR = 1.57, P value = 0.23). Conclusions: In general, the agonist protocol offers a favourable outcome in comparison to the antagonist arm, and there seems to be an intrinsic benefit for the agonist protocol, which is not explained by the higher number of transferred embryos.","PeriodicalId":14346,"journal":{"name":"International Journal of Women's Health and Reproduction Sciences","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86176984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Khanbabayi Gol, M. Dadashzadeh, H. Mohammadipour Anvari
{"title":"Design and Implementation of a Checklist for Prediction of Anesthesia-Induced Nausea and Vomiting in Candidate Patients for Mastectomy","authors":"M. Khanbabayi Gol, M. Dadashzadeh, H. Mohammadipour Anvari","doi":"10.15296/ijwhr.2020.13","DOIUrl":"https://doi.org/10.15296/ijwhr.2020.13","url":null,"abstract":"\u0000 Objectives: Prediction of nausea and vomiting can positively contribute to the management of this post-anesthesia adverse effect. Therefore, the present study aimed to design and implement a checklist for predicting anesthesia-induced nausea and vomiting in candidate patients for mastectomy. Materials and Methods: This methodological study was conducted on 300 candidate patients for mastectomy during 2018-2019 at Imam Reza hospital, Tabriz, Iran. The checklist items were designed and developed based on scientific articles, expert opinions, and patient interviews. The Pearson correlation coefficient, Cronbach’s alpha, Spearman-Brown coefficient, factor analysis, the KaiserMeyer-Olsen measure of sampling adequacy, and VARIMAX rotation were used to analyze the data. Eventually, the distribution of data with a normal distribution was compared through the Kolmogorov-Smirnov test. Results: In the first stage, 100 items were collected, which were reduced to 35 cases after modification by a team of experts. Twenty items were ultimately selected after observing the 80/20 response rate. The overall scale reliability was calculated as 0.953 based on Cronbach’s alpha. The correlation coefficient of the first and second implementations was 0.853. Finally, the four extracted factors accounted for 69.51 of the variance of the checklist based on factor analysis. Conclusions: The prediction checklist for post-anesthesia nausea and vomiting in candidate patients for mastectomy comprised adequate psychometric indicators that could be used with high reliability according to the extracted indices.","PeriodicalId":14346,"journal":{"name":"International Journal of Women's Health and Reproduction Sciences","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90743589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Faramarz Rahmatizadeh, Fatima Pashaei-Asl, Manijeh Mohammadi Dehcheshmeh, S. Rahbar, Maryam LaleAtaei, Shiva Gholizadeh-Ghaleh Aziz, J. Soleimani Rad, M. Pashaiasl
{"title":"Reduction in the Viability of Human Cervical Cancer HeLa Cell Line via Indirect Co-culture With Amniotic Fluid-Derived Mesenchymal Stem Cells","authors":"Faramarz Rahmatizadeh, Fatima Pashaei-Asl, Manijeh Mohammadi Dehcheshmeh, S. Rahbar, Maryam LaleAtaei, Shiva Gholizadeh-Ghaleh Aziz, J. Soleimani Rad, M. Pashaiasl","doi":"10.15296/ijwhr.2020.51","DOIUrl":"https://doi.org/10.15296/ijwhr.2020.51","url":null,"abstract":"\u0000 Objectives: This experiment was carried out to evaluate the impacts of unmodified human amniotic fluid-derived mesenchymal stromal/stem cells (hAF-MSCs) on the viability of HeLa cells, as well as the impact of these cells on the expression of common proapoptotic and pro-survival genes in tumor cells by establishing an indirect co-culture system. Materials and Methods: To this end, an indirect co-culture system was established, and hAF-MSCs were co-cultured with HeLa cells at a ratio of 1:2 for five days. The cell viability of co-cultured tumor cells was determined after the incubation period. Then, several parameters were examined, including the gene expression of tumor protein 53 (TP53), BCL2-associated X protein (BAX), B-cell lymphoma 2 (BCL-2), and cyclin-dependent kinase inhibitor 1A (CDKN1A). Finally, gene regulatory networks were analyzed as well. Results: The results of this study confirmed that the co-culture of hAF-MSCs with HeLa cells could decrease the viability of tumor cells. The reduction of HeLa cell viability was accompanied by an increase in BAX, TP53, and CDKN1A while a decrease in BCL2 gene expression. Eventually, the analysis of the regulatory network revealed that the co-culture of Hela ¬cells with hAF-MSCs activated several transcriptional factors and microRNAs which regulated the expression of these genes. Conclusions: In general, hAF-MSCs exerted the inhibitive effects on the growth of HeLa cells, along with alterations in the expression of common pro-apoptotic and pro-survival genes in a timely and concentration-dependent manner.","PeriodicalId":14346,"journal":{"name":"International Journal of Women's Health and Reproduction Sciences","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75537462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Fadia J Alizzi, Hamdiyah Talab Kokaz, Qasim S. Al-Mayah
{"title":"DENND1A and THADA Gene Polymorphism Among Iraqi Women With Polycystic Ovary Syndrome","authors":"Fadia J Alizzi, Hamdiyah Talab Kokaz, Qasim S. Al-Mayah","doi":"10.15296/ijwhr.2020.43","DOIUrl":"https://doi.org/10.15296/ijwhr.2020.43","url":null,"abstract":"\u0000 Objectives: To study the two gene polymorphism (DENND1A and THADA genes) among Iraqi women with polycystic ovary syndrome (PCOS). Materials and Methods: This case-control study was done at the Gynaecological Department of Al-Yarmouk Teaching Hospital of AI-Mustansiriyah College of Medicine, Baghdad during January-December 2018. Two-hundred women were enrolled in the study, including 100 women with PCOS as the case group and 100 healthy and age-matched women as the control group. Main outcome measures were to analyze DENND1a gene polymorphism rs2479106 and THADA gene polymorphism rs12478601 at genotype and allelic levels. Results: The DENND1A gene polymorphism rs2479106 had three genotypes of AA, AG, and GG. The homozygous mutant genotype (GG) was considerably related to the incidence of PCOS (OR=5.43, 95% CI=1.13-25.97, P=0.034) with 5-time more risk compared with those carrying the wild homozygous genotype (AA). The heterozygous genotype (AG) was more but not statistically different (OR=1.73, 95% CI=0.85-3.54, P=0.131). At the allelic level, G allele was two times more frequent among cases compared to control cases with a highly significant difference. THADA gene polymorphism rs12478601 had three genotypes of CC, CT, and TT. Although TT genotype was repeated more among the case group than controls, the difference was not significant (P=0.346). Likewise, no significant differences were found in the allele distribution of this polymorphism. Conclusions: In general, the DENND1A-rs 2479106 polymorphism was considerably related to the incidence of PCOS among Iraqi women while THADA-rs12478601 polymorphism was not.","PeriodicalId":14346,"journal":{"name":"International Journal of Women's Health and Reproduction Sciences","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2019-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73294535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nava Ainehchi, A. Farshbaf‐Khalili, Aliyeh Ghasemzadeh, K. Hamdi, A. Khaki, E. Ouladsahebmadarek, A. Delazar, Fahimeh Bakhtyari, M. Mazandarani
{"title":"The Effect of Herbal Medicine Supplementation on Clinical and Para-clinical Outcomes in Women With PCOS: A Systematic Review and Meta-analysis","authors":"Nava Ainehchi, A. Farshbaf‐Khalili, Aliyeh Ghasemzadeh, K. Hamdi, A. Khaki, E. Ouladsahebmadarek, A. Delazar, Fahimeh Bakhtyari, M. Mazandarani","doi":"10.15296/ijwhr.2019.72","DOIUrl":"https://doi.org/10.15296/ijwhr.2019.72","url":null,"abstract":"Objectives: The aim of this study is to assess the impact of Cinnamomum verum, Mentha spicata, Zingiberene officinal on polycystic ovary syndrome (PCOS) treatment. Materials and Methods: MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, Scopus, Web of Science, Google Scholar, ProQuest, Clinicaltrial.gov, and for Persian articles SID, Magiran, Irandoc, and Iranmedex were searched without any time limitation. Results: Thirteen randomized controlled trials (RCTs) consisting 668 women were entered in the meta-analysis. Significant differences in fasting blood sugar (FBS; weighted mean difference (WMD)=-3.69 mg/dL, 95% CI: -6.67 to -0.7, P=0.02; 241 participants), fasting insulin (WMD=-4.53 µIU/mL, 95% CI: -6.45 to -2.61, P<0.001;183 participants), triglyceride (TG; WMD=-17.97 mg/ dL, 95% CI: -30.51 to -5.43, P=0.005;183 participants), total cholesterol (TC; WMD=-14.60 mg/dL, 95% CI: -22.93 to -6.26, P=0.0006; 183 participants), low-density lipoprotein cholesterol (LDL; WMD=-16.58 mg/dL, 95% CI -23.91 to -9.24, P<0.001; 183 participants), malondialdehyde (MDA; WMD=-0.25 nmol/ml, 95% CI -0.41 to -0.09, P<0.002;124 participants), total testosterone (TT; WMD=-0.18 ng/mL, 95% CI -0.27 to -0.09, P<0.001; 116 participants), free testosterone (FT; WMD=-5.47 pg/mL, 95% CI -8.34 to -2.61, P=0.0002;78 participants) were obtained by using cinnamon alone and herbal mixture containing cinnamon in comparison to control. Conclusions: This meta-analysis showed that cinnamon alone and herbal mixture containing cinnamon improve level of FBS, fasting insulin, TG, TC, LDL, MDA, TT, and FT serum level.","PeriodicalId":14346,"journal":{"name":"International Journal of Women's Health and Reproduction Sciences","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2019-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81727640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Eftekhariyazdi, Behnaz Souizi, M. Moghaddam, F. Mortazavi
{"title":"Case of Complicated Fatty Liver of Pregnancy With Good Outcome","authors":"M. Eftekhariyazdi, Behnaz Souizi, M. Moghaddam, F. Mortazavi","doi":"10.15296/ijwhr.2020.16","DOIUrl":"https://doi.org/10.15296/ijwhr.2020.16","url":null,"abstract":"Acute fatty liver of pregnancy (AFLP) is a rare condition with an incidence rate of 1 to 20 000 that mostly occurs in the third trimester of pregnancy. There is no specific treatment for AFLP thus a conservative treatment is usually applied in this regard. This case report is related to a 28-year-old G3 P1 Ab1 L1 woman at 29 weeks of pregnancy who was referred to our emergency ward from a primary setting with an epigastric pain, a mild hypertension, and the suspicion of HELLP [Hemolysis, elevated liver enzymes, and low platelet count] syndrome. The lab exams ruled out viral infections including hepatitis B virus (HBV), hepatitis C virus (HCV), and Human immunodeficiency virus (HIV). In addition, the urine protein was 40 mg/600 cc. AFLP was diagnosed and a cesarean was performed under spinal analgesia because of elevated liver enzymes, proteinuria in the normal range for pregnancy, the presence of viral infections that involved the liver, and lack of pruritus. A 29-week girl with a weight of 1115 g was born and the patient was discharged with a good condition. At 5 days postpartum, she referred with abdominal pain, fever, as well as incisional redness and discharge. The ultrasound scan showed a hematoma in the depth of the subdermis point of the cesarean incision. Thus, antibiotics and one unit of fresh frozen plasma were infused. On 14-day postpartum, the patient was discharged with a good condition. The purpose of this study was to focus the attention of physicians to the point that AFLP may improve after childbirth but it may predispose the patient to coagulation disorders and hematoma.","PeriodicalId":14346,"journal":{"name":"International Journal of Women's Health and Reproduction Sciences","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2019-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91305128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Role of Ghrelin in Postmenopausal obesity","authors":"M. Abdalla, R. Jegasothy","doi":"10.15296/ijwhr.2020.19","DOIUrl":"https://doi.org/10.15296/ijwhr.2020.19","url":null,"abstract":"\u0000 Objectives: Obesity is considered a worldwide important health problem with continuously increasing prevalence, particularly among postmenopausal women. Weight gain is one of the major concerns of menopause. Understanding the contributing factors to postmenopausal obesity helps to reduce its incidence and thus its associated health complications. The present study aimed to review the role of ghrelin in mediating postmenopausal obesity. Methods: A literature review was done to understand the possible association between ghrelin levels and obesity in postmenopausal women. Results: It was found that the lack of estrogen during menopause increases the serum ghrelin level. In addition, the results revealed that ghrelin stimulates appetite, changes food preference, and causes an accumulation of visceral fat resulting in weight gain. On the other hand, ghrelin was found to have many protective effects as an anti-inflammatory and a neuroprotective agent. Conclusions: In general, the ghrelin hormone is a double-edged sword as it mediates the increase of body weight in postmenopausal women. More importantly, it plays a considerable role in protecting postmenopausal women from cardiovascular and neurodegenerative diseases. The selective blockage of appetite-stimulating and metabolic effects of ghrelin may be of a potential prophylactic or therapeutic effect for postmenopausal overweight and obesity.","PeriodicalId":14346,"journal":{"name":"International Journal of Women's Health and Reproduction Sciences","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2019-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83008035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Simin Haghdoost, F. Pazandeh, M. Khabazkhoob, Tahereh Behroozi Lak
{"title":"Association Between Sexual and Genital Hygiene Habits With the Urinary Tract Infection During Pregnancy: A Case-Control Study","authors":"Simin Haghdoost, F. Pazandeh, M. Khabazkhoob, Tahereh Behroozi Lak","doi":"10.15296/ijwhr.2020.25","DOIUrl":"https://doi.org/10.15296/ijwhr.2020.25","url":null,"abstract":"\u0000 Objectives: Urinary tract infections (UTIs) are the most common type of infection during pregnancy, which cause serious complications for the mother and baby. The present study was conducted to investigate the relationship between sexual and genital hygiene habits and UTIs in pregnant women. Materials and Methods: This case-control study was conducted on 187 pregnant women including 97 pregnant women with symptomatic bacteriuria (case) and 90 healthy pregnant women (control). Controls were frequency matched with the cases with respect to the number of pregnancy and trimesters of pregnancy. Both groups were compared for the presence of UTI. Finally, the binary multivariate unconditional logistic regression approach was used to evaluate the association between UTI and the confounding variables. Results: The results of this study showed a significant association between UTI in pregnancy and sexual and genital hygiene habits (P<0.05). Based on the binary multivariate logistic regression analysis, attributable risks for UTI included having sexual intercourse >3 times/week (adjusted odds ratio [AOR] =3.68, 95% CI = 2.09-5.41, P=0.001), changing the underwear per week (AOR =1.39, 95% CI=1-1.76, P=0.012), not voiding post-coitus (AOR=2.01, 95% CI=1.34-2.69, P=0.01), washing genitalia from back to the front (AOR=1.96, 95% CI=1.06-2.78, P=0.01), and not washing genitals pre-coitus by the husband (AOR=1.20, 95% CI=0.54-1.9, P=0.024) were among the sexual and hygiene habit variables associated with UTI in pregnant women in this model. Conclusions: In general, sexual and genital hygiene habits are vital preventive actions for controlling the UTI in pregnant women. These actions may lead to UTI complications and a preterm birth reduction. Thus, informing spouses about these practices is highly suggested.","PeriodicalId":14346,"journal":{"name":"International Journal of Women's Health and Reproduction Sciences","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2019-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84406516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. M. Al-Jeborry, Fadia J Alizzi, Lubna A Al-Anbari
{"title":"A Comparison of 3 Different Controlled Ovarian Stimulation Protocols in Poor Women Responders Chosen According to POSEIDON Criteria: Micro-dose, Standard Flare-up, and Antagonist Protocol","authors":"M. M. Al-Jeborry, Fadia J Alizzi, Lubna A Al-Anbari","doi":"10.15296/ijwhr.2020.23","DOIUrl":"https://doi.org/10.15296/ijwhr.2020.23","url":null,"abstract":"\u0000 Objectives: To compare the effectiveness and outcomes of pregnancy accomplished by in vitro fertilization between micro-dose and standard flare-up, along with antagonist protocols in the treatment of poor responders using POSEIDON (Patient-Oriented Strategies Encompassing Individualized Oocyte Number) criteria for diagnosis. Materials and Methods: This prospective study included 114 poor responder Iraqi women undergoing intracytoplasmic sperm injection (ICSI) cycles, who were randomly allocated to 3 groups according to the treatment protocol. Micro-dose (n=38), standard flare-up (n=38) and antagonist (n=38) protocols. High dose gonadotrophins (300-450 IU/day) from day 2 of the cycle until the day of human chorionic gonadotropin (hCG) administration were used in the three groups. The primary outcome measure was the number of retrieved mature oocytes and the secondary outcomes included fertilization, implantation, and pregnancy rates (PRs). Results: The estradiol level at the day of hCG trigger was higher in women who received a standard flare-up protocol while there was a higher endometrial thickness in the micro-dose group compared to standard flare-up and antagonist groups (P<0.05). In addition, non-statistically significantly higher fertilization, implantation, and PRs with less cancellation rates were observed in the micro-dose group. Conclusions: The micro-dose protocol in the poor responder improved pregnancy, fertilization, and implantation rates while reducing the cancellation rate compared to standard flare-up and antagonist protocols although the result represented no statistical significance.","PeriodicalId":14346,"journal":{"name":"International Journal of Women's Health and Reproduction Sciences","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2019-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87127527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Masihi, M. Najafian, M. Barati, Zohreh Mirfazli
{"title":"The Success of Surgical and Medical Approach in the Treatment of Cesarean Scar Pregnancy","authors":"S. Masihi, M. Najafian, M. Barati, Zohreh Mirfazli","doi":"10.15296/ijwhr.2020.31","DOIUrl":"https://doi.org/10.15296/ijwhr.2020.31","url":null,"abstract":"\u0000 Objectives: The ectopic pregnancy in the cesarean section (CS) scar (CSP) is one of the potentially dangerous and late complications of CS. The current study aimed to evaluate the therapeutic approaches in managing CS scar ectopic pregnancy. Materials and Methods: This cross-sectional study was carried out on 63 CSP patients. The treatment approach was considered based on the shape and nature of the gestational sac (GS) during ultrasound evolutions. Patients’ demographic data, clinical manifestations, and systemic drug treatment (methotrexate, MTX), as well as the type of surgery, hospitalization times, and treatment-related complications were evaluated, followed by comparing the treatment efficacy in different approaches based on the human chorionic gonadotropin (hCG) resolution time. Results: The mean age of the subjects was 34.2±5.1 years (within the range of 22-44 years) and the median of B-hCG serum levels at diagnosis was 2319 IU. The vaginal bleeding and abdominal pain (27 [42.9%]) were the most common complaints, followed by a delayed menstrual cycle (8 [12.7%]). The majority of patients were subjected to surgical treatment and 29 cases (46%) were treated by medical approaches. The median time to B-hCG resolution was 42 days. The Cox proportional hazards model showed the significant effect of the treatment approach on time to B-hCG resolution (χ2 =37.78, df=4, P<0.0001). Finally, the MTX plus surgery was the most effective treatment approach (OR=10.56, P<0.0001) in managing CSP patients. Conclusions: Our findings in line with previous studies showed the superiority of the surgical approach alone or in combination with medical treatments compared to medical approaches alone.","PeriodicalId":14346,"journal":{"name":"International Journal of Women's Health and Reproduction Sciences","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77915397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}