Acknowledgments to reviewers of World Journal of Obstetrics and Gynecology

Many reviewers have contributed their expertise and time to the peer review,a critical process to ensure the quality of World Journal of Obstetrics and Gynecology.The editors and authors of the articles submitted to the journal are grateful to the following reviewers for evaluating the articles(including those published in this issue and those rejected for this issue)during the last editing time period.

Propofol with Varied Functions: A Potential Therapeutic Opportunity for Postoperative Nausea, Vomiting and Pruritus—A Narrative Review

Background: Despite the advances in anesthetics and non-pharmacological techniques, the prevalence of postoperative nausea and vomiting in all patients remains high. It is one of the most common distressing symptoms that cause dissatisfaction among patients after anesthesia and surgery. A sub-hypnotic dose of propofol has been shown to reduce morphine-induced postoperative nausea, vomiting, and pruritus. This review article will provide sufficient knowledge on the role of propofol in minimizing opioid-induced postoperative nausea, vomiting, and pruritus by providing detailed information on propofol antiemetic and antipruritic effects, as well as discussions based on empirically available data. Method: We conducted a narrative review of the literature published between 1990 and 2023 from a range of databases;PubMed, BioMed Central, Biosis Previews, Nature, International Pharmaceutical Abstracts, Springer-Link, and Elsevier. Discussion and Conclusion: The literatures reviewed in this study have demonstrated that propofol may have diverse therapeutic effects including antiemetic and antipruritic. The antiemetic effect of propofol may be an effective therapeutic approach for the prevention of postoperative nausea and vomiting. The literature also demonstrated that the use of propofol for sedation during surgery may as well ameliorates opioids induced postoperative pruritus, which may be beneficial to surgical patients. Also, it was demonstrated that prophylactic use of propofol may be an effective way of preventing nausea and vomiting and pruritus during opioid use.

Prevalence and Demographic Distributions of Pre-Eclampsia among Pregnant Women at Ho Teaching Hospital

Background: In Sub-Saharan Africa, pre-eclampsia remains a major health problem contributing to high rates of maternal mortality. Despite this condition having adverse effects on maternal and child health, its prevalence and associated risk factors are still significant, especially in developing countries including Ghana. This study aimed to assess the prevalence and demographic distributions associated with pre-eclampsia among pregnant women at the Ho Teaching Hospital. Methods: A facility-based retrospective study was conducted by reviewing available data or hospital records of pregnant mothers admitted to the labor and maternity wards from January 2018 to December 2020. All pregnant women who were diagnosed with pre-eclampsia within this period were included in the study. The data were collected using a structured checklist. Results: 5609 data on pregnant women from 2018 to 2020 were recorded. Out of the 5609 data recorded, 314 pre-eclampsia cases were recorded giving an overall prevalence of 5.6%. The yearly prevalence for 2018, 2019, and 2020 were 4.6%, 5.6%, and 6.6%, respectively. The most recorded pre-eclampsia cases were seen among women within the age group of 18 - 24 years. The data showed that 112 (35.7%) of the pregnant women who had pre-eclampsia were nulliparous. Pre-eclampsia-associated maternal and fetal complications were;preterm delivery 221 (70.4%), intrauterine fetal death 62 (19.7%), eclampsia 9 (2.9%), HELLP syndrome 5 (1.6%) and maternal death 17 (5.4%). Associated factors of pre-eclampsia were parity, level of education, and occupation (p ≤ 0.05). Conclusion: The findings of this study showed a rising trend in the incidence of pre-eclampsia over the years at the Ho Teaching Hospital. Parity, level of education, and occupation were found to be associated with developing pre-eclampsia.

Biology and treatment of cervical adenocarcinoma

Uterine cervical adenocarcinoma （ADC） has been increasing in its prevalence world widely despite the decrease of squamous cell carcinoma （SCC）. It comprises nearly 20-25% of the all cervical malignancy in developed countries. The worse biological behavior had been reported in patients with intermediateand high risk factors after surgery, and in advanced stage over III, radiotherapy （RT） alone and concurrent chemo-radiotherapy （CCRT） with cisplatin was not always effective. As for chemotherapy （CT）, the iaduction CT has not established, as well. Further molecular targeted therapy （MTT） has been studied. The targets of oncogenic driver mutations were vascular endothelial growth factor （VEGF） in SCC, or tyrosine kinase （TK） of endothelial growth factor receptor 2 （EGFR2, Her2/neu）-Ras-MAPK-ERK pathway. Bevacizumab （Bey, anti-VEGF monoclonal antibody） is considered as one of key agent with paclitaxel and carboplatin in SCC, but not for ADC. This article focuses on up-to-date knowledge of biology and possible specific therapeutic directions to explore in the management of cervical ADC.

The role of low-density lipoprotein （LDL） and high-density lipoprotein （HDL） in comparison with whole egg yolk for sperm cryopreservation in rhesus monkeys

Low-density lipoprotein （LDL） extracted from hen egg yolk has recently been considered to be superior to whole egg yolk in sperm cryopreservation of various animal species. Meanwhile, there was a notion that high-density lipoprotein （HDL） in egg yolk may have a negative effect on post-thaw survival. The role of LDL and HDL in sperm cryopreservation of rhesus monkeys has not been explored. The present study evaluates their effect in comparison with egg yolk with or without the addition of permeable cryoprotectant （glycerol） on sperm cryopreservation of rhesus macaques. In addition, various additives intended to change the lipid composition of LDL-sperm membrane complex have also been tested for their effectiveness in preserving post-thaw viability. Our findings indicated that LDL is the main component in egg yolk that is responsible for its protective role for sperm cryopreservation in rhesus monkeys. Regardless of the presence or absence of glycerol, the protective role of LDL is similar to that of egg yolk and we did not observe any superiority in post-thaw survival with LDL when compared to egg yolk. Modifying the lipid composition of LDL-sperm membrane complex with the addition of cholesterol, cholesterol loaded cyclodextrin and phosphatidylcholine also did not yield any improvements in pest-thaw survival; while addition of methyl-β-cyclodextrin reduced post-thaw motility. HDL plays a neutral role in sperm cryopreservation of rhesus monkeys. The present study suggests that egg yolk may still hold advantages when compared with LDL as effective components in extenders for sperm cryopreservation in rhesus monkeys.

The Role of Ankaferd Blood Stopper and Oxytocin as Potential Therapeutic Agents in Endometriosis:A Rat Model

To evaluate the potential effect of Ankaferd Blood Stopper(ABS)and oxytocin(OT)in an experimental endometriosis model,18 female Sprague Dawley rats were used in this study.The animals were divided randomly into three groups after surgical induction of endometriosis:group 1:control group(isotonic NaCl,1 mL/kg/day,intramuscular,n=6);group 2:OT group(OT,80 U/kg/day,intramuscular,n=6);group 3:ABS group(ABS,1.5 mL/kg/day,intraperitoneal,n=6).Each group was treated for four weeks(two times per week).Volumes of endometriotic explants were measured in biopsy samples for histopathological analysis.Vascular endothelial growth factor(VEGF),monocyte chemotactic protein-1(MCP-1),and tumour necrosis factor(TNF-α)levels were measured in plasma and peritoneal fluid.Endometriotic explant volumes were significantly decreased after OT administration(P<0.0001).The epithelial score was significantly decreased in both treatment groups compared to the control group(P<0.05).TUNEL immunohistochemistry showed more apoptotic changes in the endometriosis foci(gland epithelium and surrounding tissue)in the OT group than in the control group(P<0.05).The levels of VEGF,MCP-1,and TNF-αwere significantly reduced in the OT group(P<0.05),whereas no significant changes in protein levels were found in the ABS-applied group.The results indicate that OT has greater potential as a therapeutic agent in experimentally induced peritoneal endometriosis,where ABS,which is a VEGF modulator,appears to act through different mechanisms to show its palliative effects on a rat model of peritoneal endometriosis.

Effects of Maternal Death on Children Living in the Sagnarigu Municipality

Introduction: The greatest effect of maternal mortality is renowned in children aged 2 - 5 months whose mothers had died. Children whose mothers died due to maternal complications were likely to record a higher mortality in infancy compared to children of surviving mothers. Motherless children mostly suffer a lot due to lack of day-to-day care, isolation, lack of motivation as well as economic cost associated with mother’s death. Thus, the purpose of this study was to ascertain the lives of children whose mothers passed away during childbirth at the Sagnarigu Municipality. Methods: This quantitative cross-sectional study was carried out at the Sagnarigu Municipal. The study recruited 297 respondents. To assess the effects of maternal death on the lives of children, families that experienced maternal death were assessed. The number of pregnancies experienced by the deceased woman, pregnancy-related complaints experienced, determinants of maternal death, number of children alive, and their standard of living were assessed with the aid of a structured questionnaire. Results: The data showed that negligence, illiteracy, poor road access, poverty, ignorance, delays in recognizing the problem, delays in making appropriate decisions, delays in the health facility, delays in giving the appropriate treatments, and traditional beliefs were some of the factors that led to maternal death in the Sagnarigu Municipality. Conclusion: The study concluded that determinants of maternal death in the Sagnarigu Municipal included the following;negligence, illiteracy, poverty, and delays in recognizing the problem. The study findings also demonstrated that the effects of maternal death on children are diverse and cut across different areas of a child’s life including livelihood sustenance, healthcare, education, and emotional and psychological development.

Neuronal injury and tumor necrosis factor-alpha immunoreactivity in the rat hippocampus in the early period of asphyxia-induced cardiac arrest under normothermia

Low survival rate occurs in patients who initially experience a spontaneous return of circulation after cardiac arrest（CA）. In this study, we induced asphyxial CA in adult male Sprague-Daley rats, maintained their body temperature at 37 ± 0.5°C, and then observed the survival rate during the post-resuscitation phase. We examined neuronal damage in the hippocampus using cresyl violet（CV） and Fluore-Jade B（F-J B） staining, and pro-inflammatory response using ionized calcium-binding adapter molecule 1（Iba-1）, glial fibrillary acidic protein（GFAP）, and tumor necrosis factor-alpha（TNF-α） immunohistochemistry in the hippocampus after asphyxial CA in rats under normothermia. Our results show that the survival rate decreased gradually post-CA（about 63% at 6 hours, 37% at 1 day, and 8% at 2 days post-CA）. Rats were sacrificed at these points in time post-CA, and no neuronal damage was found in the hippocampus until 1 day post-CA. However, some neurons in the stratum pyramidale of the CA region in the hippocampus were dead 2 days post-CA. Iba-1 immunoreactive microglia in the CA1 region did not change until 1 day postCA, and they were activated（enlarged cell bodies with short and thicken processes） in all layers 2 days postCA. Meanwhile, GFAP-immunoreactive astrocytes did not change significantly until 2 days post-CA. TNF-α immunoreactivity decreased significantly in neurons of the stratum pyramidale in the CA1 region 6 hours post-CA, decreased gradually until 1 day post-CA, and increased significantly again 2 days post-CA. These findings suggest that low survival rate of normothermic rats in the early period of asphyxia-induced CA is related to increased TNF-α immunoreactivity, but not to neuronal damage in the hippocampal CA1 region.

Diagnostic value of the combination of TruScreen and Pap smear in screening cervical epithelial lesions: Does it add advantages over the Pap smear alone?

Introduction: Pap smear is a well known test in screening of epithelial cell abnormalities of the cervix. However, adding other screening methods to this test may increase the sensitivity and specificity of case finding. Current study has been designed to assess the sensitivity and specificity of the combination of Tru-Screen and Pap tests in comparison to Pap smear alone in women referred for annual screening. Methods: This case-control study was conducted in two groups of 66 and 73 women with epithelial cell abnormality and normal results on Pap smear, respectively. Both groups were subsequently tested with Tru-Screen and colposcopy. Positive finding in any of the three studies made the patient candidate for biopsy as the standard diagnostic test. SPSS software was used to analyze sensitivity, specificity, positive predictive value, and negative predictive value of TruScreen, Pap smear, colposcopy and the combination of TruScreen and Pap tests. Results: 105 out of 139 women underwent biopsy. Of these, 32 (30.5%) had abnormal result in biopsy. Combination of True screen and Pap smear led to a sensitivity of 93.8% and specificity of 79.5% which means an improvement in both parameters. False negative rate decreased to 6.3% but false positive rate increased to 82.2%. Positive and negative predictive values of the combined tests were 33.3% and 86.7%, respectively. Conclusion: Combination of TruScreen and Pap smear is associated with a significant improvement in both sensitivity and specificity for early screening of preneoplastic and neoplastic cervical epithelial lesions.

Prevalence and risk factors of infertility in a Mongolian population

Objective:To investigate and analyze the prevalence and risk factors of infertility in a Mongolian population.Methods:We conducted a population-based cross-sectional study between September 2016 and November 2021.Our study population of 1919 participants consisted of residents of Ulaanbaatar city and four regions of Mongolia.A pretested standardized and structured questionnaire was used to gather data from the participants.Our questionnaire comprised categories influencing infertility,such as socioeconomic status,lifestyle factors,health,reproductive history,present status,and sexual function.In addition,trained staff conducted face-to-face interviews with the participants.Results:Our study showed an infertility incidence of 8.2%,with primary infertility at 2.76%and secondary infertility at 5.47%.Compared with the urban area of Ulaanbaatar,the prevalence of infertility was significantly higher amongst the rural population(P<0.001).Risk factors of infertility included advanced age(35-39 years,OR 1.8,95%CI 1.99-6.55;>40 years,OR 2.1,95%CI 2.62-8.55),living rural region(aOR 2.4,95%CI 1.62-3.69),alcohol consumption(aOR 1.6,95%CI 1.11-2.44),chronic diseases(aOR 1.6,95%CI 1.20-2.38),reproductive disease(aOR 2.6,95%CI 1.86-3.88),gynecological operative history(aOR 2.1,95%CI 1.38-3.21),ovarian cyst(aOR 4.2,95%CI 2.70-6.40),gonorrhea(aOR 2.4,95%CI 1.01-6.16),non-malignant uterine cancer(aOR 2.9,95%CI 1.40-6.70),and endometriosis(aOR 4.7,95%CI 1.41-15.62).Conclusions:In Mongolia,the average infertility rate is 8.2%,similar to the average worldwide and is significantly higher in rural communities.Our study shows the most significant risk factors for infertility are age,alcohol consumption,and rural living.In addition,an unfavorable gynecological history and some diseases also pose a risk to fertility.

Microenvironment and related genes predict outcomes of patients with cervical cancer:evidence from TCGA and bioinformatic analysis

Cervical cancer(CESC)is one of the most common cancers and affects the female genital tract.Consistent HPV infection status has been determined to be a vital cause of tumorigenesis.HPV infection may induce changes to the immune system and limit the host’s immune response.Immunotherapy is therefore essential to improving the overall survival of both locally advanced and recurrent CESC patients.Using 304 relevant samples from TCGA,we assessed immune cell function in CESC patients to better understand the status of both tumor micro-environment cells and immune cells in CESC.Functional enrichment analysis,pathway enrichment analysis,and PPI network construction were performed to explore the differentially expressed genes(DEGs).The analysis identified 425 DEGs,which included 295 up-regulated genes and 130 down-regulated genes.We established that upregulation of CCL5 was correlated with significantly better survival,meaning that CCL5 expression could serve as a novel prognostic biomarker for CESC patients.We further focused on CCL5 as a hub gene in CESC,as it had significant correlations with increased numbers of several types of immune cells.Cell-type fractions of M1 macrophages were significantly higher in the high-immune-scores group,which was associated with better overall survival.Finally,we concluded that CCL5 is a promising prognostic biomarker for CESC,as well as a novel chemotherapeutic target.

Association between estradiol levels and clinical outcomes of IVF cycles with single blastocyst embryo transfer

Objective:To determine the correlation of different serum estradiol levels on the trigger day with the clinical and laboratory outcomes of in-vitro fertilization(IVF)cycles comprising a single fresh top-quality blastocyst transfer.Methods:This was a retrospective observational study performed in Morula IVF Clinic Jakarta.Five hundred forty-two women were recruited and grouped according to their serum estradiol levels on the trigger day of follicular maturation as follows:<2000 pg/mL,2000-2999 pg/mL,3000-3999 pg/mL,and≥4000 pg/mL.Clinical pregnancy and miscarriage rates were evaluated as the primary outcomes and embryology laboratory results as the secondary outcomes which consisted of the number of retrieved,mature,and fertilized oocytes,the total sum of derived embryos,and top-quality embryos at cleavage and blastocyst stage.Results:Clinical pregnancy and miscarriage rates did not differ among the groups(P>0.05).Nonetheless,the study demonstrated a positive correlation of the serum estradiol levels with the overall laboratory outcomes including the number of retrieved,mature,and fertilized oocytes,the total sum of derived embryos,and top-quality embryos at cleavage and blastocyst stage(P<0.001).The subject group with estradiol level of≥4000 pg/mL was superior to the other groups in its respective median number of retrieved,mature,fertilized oocytes,total derived embryos,and top-quality cleavage-and blastocyst-stage embryos.Conclusions:Although an apparent positive correlation is observed between estradiol levels and laboratory outcomes,serum estradiol level on hCG trigger day is not associated with the clinical outcomes of IVF.

PPARα activator irbesartan suppresses the proliferation of endometrial carcinoma cells via SREBP1 and ARID1A

Endometrial carcinoma(EMC)is associated with obesity;however,the underlying mechanisms have not yet been elucidated.Peroxisome proliferator-activated receptor alpha(PPARα)is a nuclear receptor that is involved in lipid,glucose,and energy metabolism.PPARαreportedly functions as a tumor suppressor through its effects on lipid metabolism;however,the involvement of PPARαin the development of EMC remains unclear.The present study demonstrated that the immunohistochemical expression of nuclear PPARαwas lower in EMC than in normal endometrial tissues,suggesting the tumor suppressive nature of PPARα.A treatment with the PPARαactivator,irbesartan,inhibited the EMC cell lines,Ishikawa and HEC1A,by down-regulating sterol regulatory element-binding protein 1(SREBP1)and fatty acid synthase(FAS)and up-regulating the tumor suppressor genes p21 and p27,antioxidant enzymes,and AT-rich interaction domain 1A(ARID1A).These results indicate the potential of the activation of PPARαas a novel therapeutic approach against EMC.

KIAA1199 induces advanced biological behavior and development of ovarian cancer through activation of the IL-6/STAT3 pathway

Recently,abnormal expression of KIAA1199 has been detected in Epithelial Ovarian Cancer(EOC).However,the underlined anti-ovarian cancer mechanism of KIAA1199 remains to be enlightened.In our study,we performed to elucidate the effects of KIAA1199 on the advanced biological behavior of EOC cells through activation of the IL-6/STAT3 pathway.Confirmed by immunohistochemistry,KIAA1199 was highly expressed in ovarian borderline and malignant epithelial tumors.A retrospective analysis found that EOC patients with low expression of KIAA1199 had a significantly higher 5-year survival rate than those with high expression.Mechanistically,IL-6 was used to stimulate EOC cells,and the expression of KIAA1199,STAT3 and p-STAT3 increased after IL-6 stimulation.These results could show that KIAA1199 is transcriptionally activated by IL6/STAT3 pathway,thereby accelerating the deterioration of EOC.KIAA1199 could also be used as a poor prognosis factor and potential target in treatment.

Promoter Methylation, BRAF Mutation Analysis and Topoisomerase IIa Expression for the Detection of Endometrial Carcinoma in Liquid Based Cytology Samples

Cancer of the corpus uteri remains the most common gynecological related cancer in developed countries. Cytology, after the induction of liquid based cytology, has reemerged as a possible first line non-interventional diagnostic procedure with promising results. Apart from slide preparation for cytology diagnosis, LBC allows the application of elaborate molecular tests on the residual material. Samples from 74 symptomatic women were collected in ThinPrep?PreservCyt medium, from witch immunocytochemical and molecular tests were performed. Final diagnosis of 39 endometrioid carcinomas, 20 non-endometrioid carcinomas and 15 non-malignant was set after hysterectomy. Topoisomerase IIa expression was common (42%) in both types of cancer. Promoter methylation analysis revealed that hMLH1 is commonly methylated in cancers (52.7%), CDKN2A and MGMT less often (27.1%) and RARB rarely methylated (8.4%). BRAF activating mutation V600E was a rare event (8.4%) only found in low grade endometrioid carcinomas. Topoisomerase IIa expression correlated with BRAF mutations, hMLH1 and to lesser extent with CDKN2A methylation. Almost none of the biomarkers were positive in cytological negative or hyperplastic without atypia samples. Detection of methylation in any gene displayed sensitivity, specificity, PPV and NPV similar to cytology of cancer. However, inclusion of cytology diagnosis of hyperlasias with atypia increased sensitivity and NPV of cytology outperforming methylation of any gene. Further evaluation of the panel of promoter methylation, especially in cytology diagnoses of hyperplasia with or without atypia should be evaluated since initial results are promising. Even though methylation of MGMT and RARB are rare events, some patients could be benefit from specific chemotherapeutics that target either of them or the more frequently expressed topoisomerase IIa.

Incongruence between the Preferred Mode of Delivery and Risk of Childbirth Complications among Antepartum Women in Mulago Hospital, Uganda

Objective: Women’s preferences for the mode of delivery provide clues on their knowledge and perceptions of anticipated risk of childbirth complications.?The objective was toinvestigate?incongruence between preferred mode of delivery and risk of adverse pregnancy outcomes. Methods: Through a cross-sectional study, data were?collected from 327?women admitted to Mulago hospital. Data included socio-demographic?characteristics, past medical, gynaecological and obstetric history, pregnancy complications, knowledge of pregnancy complications and preferred mode of delivery. The preferred mode of delivery and knowledge of related risks for adverse pregnancy outcomes were compared. Results: The mean age of participants was 24.7 years (±5.9), ranging?14?-?43 years, of whom 41.4% were nulliparous. The preferred mode of delivery was vaginal (84.1%). Incongruence?(preference for a mode of delivery that did not correspond to expected or anticipated risks) occurred in 88 (26.9%) of the women, and was associated with having secondary school or higher level of education (OR 2.49, CI 1.52?-?4.08) and history of previous vaginal delivery (OR 3.82,?CI 1.94?-?7.49). Conclusion: One in four women had incongruence between preferred mode of delivery and risks of adverse pregnancy outcomes, which called?for urgent interventions to improve decision-making about intrapartum care.

Effects of Melatonin on Ischemia-Reperfusion Injury in Rat Ovary:Histopathologic and Immunohistochemical Study

Aim: To investigate the effect of melatonin on ischemia–reperfusion (I/R) injury in rat ovary. Material and Method: A total of 24 Wistar rats were divided into four groups. The rats were first numbered randomly and then randomly divided into four equal groups: sham, torsion, detorsion and melatonin groups. In group I (n = 6) sham, as well as in group II ovary torsion was not performed and no drug was administered. In group III, 1 hour of ischemia and 2 hours of reperfusion were performed and no drug was given. In group IV, melatonin was dissolved in 1% ethanol just before use. Melatonin was injected 1 hour before torsion to the torsion plus melatonin group. Right ovaries were surgically removed in all groups. Result: Malondialdehyde (MDA) levels were measured. We suggested that administration of melatonin would be in treating ovaries from torsion/detorsion induced damage in humans. The histopathological changes such as vascular congestion, edema, hemorrhage, and follicular degeneration were found to be decreased in the melatonin + ischemia-reperfusion group. Ischemia-reperfusion group: PECAM-I expression is positive in vessel of the stromal area. The follicles and interfolicular area infiltrated with CD68 positive cells were increased in a time of ischemia-reperfusion exposure dependent manner. Conclusions: Melatonin after ischemia-reperfusion CD31 and CD68 expressions is weak, due to the reduction of the inflammatory effects and hemorrhage is thought that melatonin is effective.

Influence of Previous Abdominal and Pelvic Surgeries on Uterine Artery Embolization

Objective: To assess the influence of previous abdominal and pelvic surgeries on uterine artery embolization (UAE). We hypothesize that the formation of postoperative adhesions can impose technical difficulties for UAE, resulting in longer fluoroscopy time and less reduction of uterus and largest tumor volumes after the procedure. Methods: We retrospectively reviewed the medical records of 122 consecutive patients who underwent uterine artery embolization for the treatment of uterine fibroids in our department. Patients were divided into two groups according to the presence or absence of previous abdominal or pelvic surgery. Fluoroscopy time, change in symptoms, and volume variation of uterus and largest tumor were compared between groups. Results: Forty-seven patients underwent abdominopelvic surgery before UAE (Group 1) and 75 did not (Group 2). Median (IQR) fluoroscopy time was 22 minutes (IQR: 18 - 26.4) for Group 1, and 23.3 minutes (IQR: 19.05 - 28.25) for Group 2. No difference was found between the groups (P = 0.17). Regarding the results after UAE, neither the change in symptoms (P = 0.30) nor the volume variation for uterus (P = 0.41) and largest fibroid (P = 0.18) showed significant difference. Conclusions: In this study, previous abdominopelvic surgeries had no significant influence on fluoroscopy time, and overall outcomes of uterine artery embolization.

A Comparative Study on the Effects of Vaginal Misoprostol and Vaginal Misoprostol Plus Estradiol on Labor Induction

Background:Cervical ripening is an important factor in predicting successful labor induction.In an unfavorable cervix,ripening should be done before induction.In this study,the effect of misoprostol and that of misoprostol plus estradiol on cervical ripening were compared.Methods:This randomized,double-blinded study included a total of 190 pregnant women who were identified for pregnancy termination due to maternal or fetal cause at 37 weeks with Bishop score of less than 4.The patients were assessed between April 2015 to April 2016 in two university hospitals at northeast Iran(Omol-Banin Hospital and Emam Reza Hospital,Mashhad).The patients who met the inclusion criteria were randomly assigned to two groups:the intervention group(Group A),who received 25 micrograms of vaginal misoprostol plus 50 micrograms of estradiol,and the control group(Group B),who received 25 micrograms of vaginal misoprostol only.Misoprostol was administered at 4-hour intervals until cervical ripening(Bishop score≥8)or upon initiation of active phase in both the groups.The maximum dosage of misoprostol was three doses,whereas estradiol was administered only once.Results:In this study,the main causes of pregnancy termination were ROM and post-term.There was no significant statistical difference in the Bishop score between the two groups(P=0.13).In addition,no significant difference was observed in the duration of time for cervical ripening(Bishop≥8)between the two groups(P=0.7).The duration between drug administration to the initiation of active phase and also from active phase to delivery showed no significant differences between the two groups(P=0.49 and 0.24,respectively).There was also no significant difference in the delivery route(operative vaginal delivery or Cesarean section)(P=0.2 and P=0.91,respectively).Conclusion:From this study,the use of misoprostol plus estradiol did not improve cervical ripening or decrease the induction time.Further studies are recommended to investigate complementary results.

Review of a challenging clinical issue:Intrahepatic cholestasis of pregnancy

Intrahepatic cholestasis of pregnancy(ICP) is a reversible pregnancy-specific cholestatic condition characterized by pruritus, elevated liver enzymes, and increased serum bile acids. It commences usually in the late second or third trimester, and quickly resolves after delivery. The incidence is higher in South American and Scandinavian countries(9.2%-15.6% and 1.5%, respectively) than in Europe(0.1%-0.2%). The etiology is multifactorial where genetic, endocrine, and environmental factors interact. Maternal outcome is usually benign, whereas fetal complications such as preterm labor, meconium staining, fetal distress, and sudden intrauterine fetal demise not infrequently lead to considerable perinatal morbidity and mortality. Ursodeoxycholic acid is shown to be the most efficient therapeutic agent with proven safety and efficacy. Management of ICP consists of careful monitoring of maternal hepatic function tests and serum bile acid levels in addition to the assessment of fetal well-being and timely delivery after completion of fetal pulmonary maturity. This review focuses on the current concepts about ICP based on recent literature data and presents an update regarding the diagnosis and management of this challenging issue.