Investigating the role of Epstein-Barr virus and human papillomavirus types 16 and 18 co-infections in cervical disease of Iranian women.

Introduction: High-risk human papillomaviruses (HR-HPVs) are known to contribute to cervical cancer (CC), but the role of Epstein-Barr virus (EBV) in this process remains unclear, despite EBV's widespread detection in premalignant and malignant cervical tissues. Methods: In this cross-sectional study of 258 cervical samples, including both formalin-fixed paraffin-embedded (FFPE) and fresh cervical tissues, the presence and viral load of HR-HPVs (HPV-16 and HPV-18) and EBV were evaluated in Iranian women with cervical intraepithelial neoplasia (CIN), squamous cell carcinoma (SCC), and a cervicitis control group using real-time PCR. Results: The study revealed a significant correlation between disease severity and both increased HPV-16 positivity and HPV-16 and HPV-18 co-infection (p<0.001). Interestingly, the control group had a higher frequency of EBV-positive cases than SCC/CIN groups (p<0.001). HPV-16 DNA load increased with disease severity (P<0.001), while HPV-18 showed no significant difference (P=0.058). The control group had a higher EBV DNA load compared to SCC/CIN groups (P=0.033). HPV-16 increased the risk of CIN II, CIN III, and SCC, while HPV-18 increased the risk of CIN II and CIN III. Notably, EBV was associated with a lower risk of CIN groups and SCC. Conclusions: No significant difference in EBV co-infection with HPV-16/18 was found, failing to support the hypothesis that EBV is a cofactor in CC. However, high EBV viral load in the control group suggests a potential "hit and run hypothesis" role in CC progression. This hypothesis suggests that EBV may contribute briefly to the initiation of CC with an initial impact but then becomes less actively involved in its ongoing progression.

Predictive value of body mass index (BMI) and determination of optimum cut-off point in the diagnosis of endometrial hyperplasia in pre-menopausal women with abnormal uterine bleeding.

Background: The suitable BMI cut-off point in persons with endometrial cancer or hyperplasia with abnormal uterine bleeding was investigated in this study. Methods: This case-control research was conducted on 1470 women with abnormal uterine bleeding in Ayatollah Rouhani Hospital,Babol between 2010 and 2012, with 312 participants included in the study. In terms of uterine biopsy results, patients were split into six groups: simple hyperplasia without atypia, simple hyperplasia with atypia, complicated hyperplasia with atypia, complex hyperplasia without atypia, endometrial cancer, and normal persons. Results: The mean age and BMI of patients in these three groups were not significantly different (P equal to 0.081 and 0.435, respectively). The kind of disease exhibited a strong relationship with menstruation (P 0.001). The body mass index (BMI) values ​​did not have significant levels under the curve to determine the appropriate cut-off point in the diagnosis of hyperplasia plus endometrial cancer and endometrial cancer alone (P 0.380 and 0.124, respectively) and hyperplasia alone (P = 0.920). Based on logistic regression, age 50 years and older and irregular menstruation were significant with OR equal to 2.36 and 2.09 (P = 0.011) and HTN with OR equal to 0.44 (P = 0.026), respectively. Conclusion: BMI has little predictive value in the detection of endometrial cancer or hyperplasia, according to the findings, and other diagnostic and screening modalities should be utilized instead. The findings backed up the theory that old age and irregular menstruation are linked to an increased risk of endometrial cancer.

Challenges and Needs of HPV-Positive Women.

HPV is the most prevalent sexually transmitted diseases causing a variety of clinical manifestations ranging from warts to cancer. This study aimed to examine the challenges and needs of HPV-positive women. In this qualitative study, we analyzed data extracted from semi-structured face-to-face interviews with 31 Iranian HPV-positive women using a conventional content analysis approach using MAXQDA.10 software. Data were collected from her at the women's clinic from 21 January 2022 to her 19 February 2022. The sampling process was purposeful, and the accuracy of this study was ensured according to her 4 criteria suggested by Guba and Lincoln. Four themes were identified from the interviewing of HPV-positive women that include: Needing support and counseling to adapt to the disease, needing counseling and training to improve the disease, needing a qualified health care provider, needing proper health care services. HPV-positive women had many adverse such as reproductive health challenges (Menstruation cycle, delivery type, fertility, pregnancy, and breastfeeding), low control, confusion, cancer-related concerns, relationship problems, sexual concerns, uncertainty, stigma, low trust, social impact, non-disclosure of results, idiosyncratic prevention, indirect clinical interaction, changes in sexual behavior. HPV-positive women face many challenges and seek information to address them. Therefore, at the primary level, providers need to be aware of the needs of these patients needs in order to make the necessary consultations.

Reproductive health needs of Human papillomavirus (HPV) positive women: A systematic review.

OBJECTIVES: Human papillomavirus is one of the most important causes of cervical cancer. Participating in an HPV test and receiving an HPV diagnosis can create questions about the needs and preferences. The present systematic review was conducted to determine the reproductive health needs of women with HPV. METHODS: We searched PubMed, Scopus, Web of Science, Google Scholar and Magiran, SID and Iranmedex. Without language restrictions and time constraints. We also searched the grey literature and carried out forward/backward citation searches. RESULTS: In the first, 1056 articles were retrieved, and, after removing them, 13 articles published were entered. The studies were qualitative (N = 9), quantitative (N = 3), and one was unclear. Most qualitative studies collected data using individual interviews (N = 7), two qualitative studies, narratives of HPV patients from a website of patient experiences and questions. Women wanted further information on different HPV viral types, transmission, implications for sexual partners, prevalence, latency and regression of HPV, their management options and the implications of infection for cancer risk and fertility. Women's experience of searching the Internet for further information about HPV was reported as difficult, anxiety provoking and contributing to the stigma of the infection because information was often located in the context of other sexually transmitted infections, with multiple sexual partners highlighted as a risk factor for infection. CONCLUSION: Surveys showed that the majority of women had unanswered questions about their HPV test results. The information that women thought was helpful in interpreting their test results included having a high-risk type of HPV, and cancer survival statistics for the virus. Women also needed information about sexual transmission, how HPV tested positive in a long-term relationship, and the potential consequences for their partners and the risk of re-infection. Younger women had questions about whether HPV could affect fertility.

The effect of caring intervention (physical activity, diet and counseling) on gestational diabetes for pregnant women with metabolic syndrome.

OBJECTIVE: Metabolic syndrome and its indexes is one of the critical health problems during pregnancy. This study aimed to examine the effects of a care intervention program on pregnancy outcome in pregnant women with Metabolic Syndrome during 2017-2018. METHODS: This randomized clinical trial study was conducted in 120 singleton pregnant women with metabolic syndrome. The participants were selected using purposive sampling method from pregnant women referred to two health centers of Babol. They were randomly divided in two control and intervention groups (60 samples in each group). Intervention group received one motivational interview session for 120 min, two consultation sessions with expert for nutritional recommendations based on Nutrition Guidelines of Ministry of Health for Pregnant Women. They were also theoretically and practically provided by three training sessions for physical activity and pregnancy exercises combining pelvic floor muscles, bodybuilding, muscle strengthening, stretching, and relaxation and walking activities. To follow up on the intervention, the researcher made a phone call with the participants in intervention group every 10 days to two weeks. Pregnancy outcomes were assessed using SPSS software. RESULTS: The obtained results showed that there was a significant difference between the two groups in maternal complications including gestational diabetes, hospitalization due to gestational diabetes, nutritional diet for gestational diabetes, pregnancy weight gain and 2-hour post-prandial blood glucose test (p ≤ .01). There was no significant difference in terms of demographic, midwifery and metabolic syndrome indices between the intervention and control groups. CONCLUSION: The results of the study indicated that intervention program improved the maternal pregnancy outcome such as gestational diabetes and weight gain during the pregnancy in the intervention group. This program had no adverse effects for the mother who is consistent with pregnancy health objectives.

CavatermTM plus treatment in high - risk surgical patients.

BACKGROUND: The purpose of the study was to evaluate the effectiveness and safety of thermal balloon ablation in women with high anesthetic and surgical risk compared to invulnerable women according to the American Society of Anesthesia (ASA) physical status stratification. METHODS: This report was based on a retrospective cohort study of women with heavy menstrual bleeding (HMB) who were eligible for treatment with CavatermTM plus during 2012-2017. Women were classified as high-risk (HR) or low-risk (LR) cohorts based on ASA physical status stratification. The primary outcome includes amenorrhea in the twelfth months after the treatment. Risk adjustments were performed using regression models. RESULTS: This research study consisted of 63 women with mean age 44.42±5.48. Mean of body mass index (BMI) in the HR cohort was higher than the LR cohort (31.48±6.22 vs 26.83± 3.51, P=0.005) and results were also similar considering the uterine length (mm) between HR and LR women (58.27±35.70 vs 30.92± 35.30, P=0.01). The primary outcome of treatment after a one-year follow-up in the two groups (HR and LR) was 31 (93.9%) and 15 (78.9%), respectively. After adjusting for known confounders including age, uterine length, parity, dysmenorrheal, the adjusted odds ratio was 0.94 (95% CI, 0.14- 2.5; P= 0.60). CONCLUSION: For women with high anesthetic and surgical risks derived from serious underlying co morbidities, endometrial ablation can provide a minimally invasive, safe, and effective therapy for heavy menstrual bleeding.

The Effect of Brief Supportive Psychotherapy on Prevention of Psychiatric Morbidity in Women with Miscarriage: A Randomized Controlled Trial about the First 24-hours of Hospitalization.

OBJECTIVES: Miscarriage is a common pregnancy complication causing substantial psychiatric complications. This study was designed to investigate whether the administration of brief supportive psychotherapy (BSP) is effective on the management of women with miscarriage when conducted in the first 24 hours of hospitalization in order to prevent symptoms of anxiety, depression, and grief at four-months post-miscarriage. METHODS: We conducted a randomized clinical trial on 79 women with miscarriage hospitalized in Ayatollah Rohani teaching hospital. The women were randomly assigned into two groups (39 in the experimental group and 40 in the control group). All interventions were implemented for two study groups during the first 24 hours of hospitalization in a private room in the hospital. The experimental group received a two-hour BSP. The objective outcomes were assessed using Hospital Anxiety and Depression Scale and Perinatal Grief Scale (PGS), which has three subscales (active grief, difficulty coping, and despair) and were measured before the intervention and at four-months post-miscarriage. RESULTS: The results of pre-tests in the follow-up of the trial suggested that the participants who received BSP reported significant reductions in the mean scores of active grief (-34.2±9.7 vs. 28.1±-6.9), difficulty coping (27.1±6.4 vs. 23.3±4.3), despair (28.0±8.4 vs. 22.8±5.2), and total PGS (89.6±23.1 vs. 74.4±15.3), in contrast to participants in the control group who did not report such results. Further, the results of generalized estimating equations models revealed that brief supportive psychotherapy caused a significant decrease in the level of factors including active grief, difficulty coping, despair, total perinatal grief, anxiety symptoms, and depressive symptoms in subjects in the experimental group compared to those in the control group after miscarriage. Also, the frequency of anxiety symptoms (13.5% vs. 60.5%), depressive symptoms (32.4% vs. 71.1%), and grief symptoms (10.8% vs. 65.8%) was found to be significantly lower in the group receiving psychotherapy than in the control group at four-months follow-up. CONCLUSIONS: Administration of BSP session during the first 24 hours of hospitalization for women with miscarriage can be considered a reliable method to prevent anxiety symptoms, depression symptoms, and perinatal grief at four-months follow-up.

Investigating the Relationship between Magnesium levels and Diabetes Mellitus in Pregnant Women.

Gestational diabetes mellitus (GDM) is defined as one of the three main types of diabetes mellitus (DM). It is established that GDM is associated with exceeding nutrient losses owing to glycosuria. Magnesium (Mg), as one of the essential micronutrients for fetus development, acts as the main cofactor in most enzymatic processes. The aim of this study was to measure serum and cellular levels of Mg, albumin, creatinine, and total protein to further clarify the relationship between these components and DM in pregnant women. Blood samples were obtained from 387 pregnant women. The participants were classified into four groups based on their type of diabetes, namely GDM (n=96), DM (n=44), at high-risk of DM (n=122), and healthy controls (n=125). All participants' fasting blood sugar (FBS), creatinine, albumin, Mg, and total protein in the serum levels and red blood cell Mg (RBC-Mg) were measured during 24-28 weeks of gestation. Groups were compared for possible association between DM and abortion, gravidity, and parity. The serum levels of creatinine, FBS, albumin, Mg, and RBC-Mg were statistically different among four groups (P =0.001). Significant lower levels of RBC- Mg was observed in all studied groups in comparison with controls. Given a positive correlation between DM and abortion, it seems that decreased levels of RBC-Mg and serum albumin can increase the risk of abortion in pregnant women. Our data demonstrated significant alterations in albumin, Mg, and creatinine concentrations in women with DM or those at high risk of DM during their gestational age. It seems that the measurement of these biochemical parameters might be helpful for preventing the complications, and improving pregnancy outcomes complicated with DM.

Is thermal balloon ablation in women with previous cesarean delivery successful?

Background/aim: Endometrial ablation is used to treat heavy menstrual bleeding in women who do not respond to standard therapy. This study aimed to compare treatment success in women with previous cesarean delivery and vaginal delivery who were subjected to thermal balloon ablation. Materials and methods: This cohort study enrolled women with symptoms of heavy menstrual bleeding who had major health problems and were considered as high-risk patients for hysterectomy. Patients were divided into two groups, vaginal delivery and cesarean section (C-section). Thermal balloon ablation was performed under general or regional anesthesia on days 3­5 of the menstrual cycle. Treatment success was compared between the two groups at 12 months. Results: This study involved 63 women with a mean age of 44.14 ± 6.56 years. Of these, 33 patients (54.1%) had a history of cesarean section and revealed positive results (69.7%) after 1 year of treatment. Age ≤ 45 years and uterine length < 9 cm were significantly associated with treatment success in women with a previous C-section. Conclusion: Thermal balloon ablation is a possible therapeutic option to treat menorrhagia occurring as a result of benign causes in women with previous C-section deliveries. The results are particularly successful in younger women with shorter uterine depth.

Vaginal discharge concentrations of ß-human chorionic gonadotropin, creatinine, and urea for the diagnosis of premature rupture of membranes.

OBJECTIVE: To determine the diagnostic value of vaginal discharge concentrations of ß human chorionic gonadotropin (ß-hCG), creatinine, and urea to identify premature rupture of membranes (PROM). METHODS: An observational cross-sectional study was conducted between 12 June, 2014, and 11 June, 2015, among 120 women who were admitted to an Iranian hospital at 28-41 weeks of pregnancy. Women with positive pooling and nitrazine test results were assigned to the PROM group (n=60), whereas those with negative test results were assigned to the control group (n=60). Samples of vaginal discharge were obtained. RESULTS: Mean concentrations of ß-hCG, urea, and creatinine were all higher in the PROM group than in the control group (all P=0.001). The diagnostic accuracies as defined by area under the curve for creatinine, urea, and ß-hCG were 0.891, 0.895, and 0.908, respectively. The corresponding optimal cutoff values were 20.33 µmol/L, 0.94 mmol/L, and 39.5 IU/L, respectively. CONCLUSION: The vaginal discharge concentrations of all three markers exhibited favorable predictive value for the diagnosis of PROM; however, ß-hCG showed greater diagnostic accuracy than either urea or creatinine.

Two cases of clear cell ovarian cancer in young patients.

BACKGROUND: Ovarian cancer is the most common cause of cancer death worldwide. Incidence of ovarian cancer is more common in postmenopausal women. Premenopausal onset is rare and the present study described two cases of ovarian clear cell tumors in young women. CASE PRESENTATION: The patients presented with pelvic mass which was confirmed by sonography and laparotomy and final diagnosis was made according to histologic examination. Both patients showed a solid mass with cystic components in adnexal areas and explorative laparotomy demonstrated extension of tumors to abdomen in both patients. The level of CA 125 increased in both patients. For both tumors, immunohistochemical stainings were positive for CK7 and CD15, but CK20 was negative. CONCLUSION: Although ovarian clear cell tumor is usually diagnosed in postmenopausal women but its diagnosis should be suspected in young women with pelvic mass.

A case report of peritoneal tuberculosis with multiple miliary peritoneal deposits mimicking advanced ovarian carcinoma.

BACKGROUND: Peritoneal tuberculosis accounts 1-2% of all forms of tuberculosis. Peritoneal tuberculosis is an important differential diagnosis for ovarian cancer in women with ascites, adnexal mass and elevated cancer antigen 125 (CA125) levels. We report a case of a 32- year -old woman with multiple miliary peritoneal deposits mimicking advanced ovarian carcinoma. CASE PRESENTATION: A 32-year-old drug addicted woman presented with menometrorrhagia, fever and shivering, ascites and pelvis mass. Ultrasonography revealed a 53×65 mm cyst in left ovary and ascites. Multiple miliary peritoneal deposits were observed during laparatomy without any mass, histologic examination confirmed tuberculosis of uterus, tubes, omentum, liver and external surfaces of small intestine. Finally, the patient recovered with anti-tuberculosis treatment. CONCLUSION: These findings highlight considering tuberculosis in the differential diagnosis of any patients with adnexal mass, ascitis and elevated serum CA125 even with negative cytology and bacteriology test results.

Correlation of pregnancy outcome with quadruple screening test at second trimester.

BACKGROUND: Abnormal levels of the markers AFP, hCG, and uE3 could be useful in predicting adverse pregnancy outcomes. This study was designed to determine the correlation between second trimester maternal serum markers and adverse pregnancy outcome (APO). METHODS: In this historical cohort study, we randomly followed 231 obstetric patients with quadruple screening test in 14-18 weeks of gestation from March 2012 to March 2013 in a medical laboratory in Babol, Iran. We measured maternal serum levels of alphafetoprotein (AFP), human chorionic gonadotropin (hCG), unconjugated estriol (uE3), and inhibin-A. The risk of adverse pregnancy outcomes (APOs) were then compared between patients with negative and positive test results. We used Chi-square and Fisher-exact tests for qualitative variables and t-test for quantitative variables. Demographic differences between the two groups were minimized by applying logistic regression. RESULTS: The risk of having an APO such as pre-eclampsia (p=0.008), fetal growth restriction (p=0.028) and premature rupture of membrane (p=0.040) increased significantly in patients with abnormal markers. CONCLUSION: Abnormal results of quadruple screening test could be associated with APO in women with normal appearing fetus.

Glucose Tolerance and lipid profile changes after surgical menopause.

BACKGROUND: Bilateral salpingo-oophorectomy in women may lead to metabolic consequences in patients. This study was performed to determine the glucose tolerance and lipid profile after menopause resulting from bilateral salpingo-oophorectomy. METHODS: From September 2011 to March 2013, 31 women participants aged 46-52 years who underwent hysterectomy and bilateral salpingo-oophorectomy for benign reasons were recruited. An oral glucose tolerance test (OGTT), triglyceride (TG), total cholesterol, low density lipoproteis (LDL), high density lipoprotein (HDL) was performed before and 6 months after surgery. Fasting insulin and 2-hour insulin levels, fasting insulin / glucose indexes and homeostasis model assessment HOMA indexes were also measured. RESULTS: The mean age of the patients was 48.6±2.9 years. The mean 2-h glucose level in OGTT changed from 26.7 before surgery to 111.1 µUnit/ml (P=0.030). The mean level of lipid profile before and after surgery for TG was 132.3 versus 181.2 mg/dl (P=0.005), total cholesterol 177.4 versus 206.7 mg/dl (P=0.0001) and LDL 98.4 versus 115.3 mg/dl (P=0.003). The other variables showed no significant difference. CONCLUSION: The results indicate that lipid profile changes like increase of TG, total cholesterol and LDL should be considered before removing the ovary during hysterectomy in premenopausal women.

Meigs' syndrome with elevated serum CA125 in a case of ovarian fibroma /thecoma.

BACKGROUND: CA125 levels in Meig's syndrome can increase or be normal which an unusual laboratory condition is. In this paper, we present a case of Meigs' syndrome associated with increased CA125 level due to ovarian fibroma / thecoma. CASE PRESENTATION: A 50-year old Iranian woman presented with fever, abdominal pain and distention and in imaging assessment, a 90×109 mm heterogeneous pelvic mass with free abdominopelvic fluid was reported. Pleural effusion was detected in CXR. Aspiration of ascetic fluid showed no evidence of malignancy. CA125 level was greater than 600 IU/mL. The patient went under laparotomy in which a 120×100 mm mass was detected in her left adnexa attached to colon, bowels and bottom of pelvis. Histology reported ovarian fibro/ thecoma. The mass was resected and after that, the symptoms disappeared and CA125 level reached to 15 IU/mL. The patient had no problem after 18 months of follow up. CONCLUSION: Meigs' syndrome should be considered at the differential diagnosis for a patient with pelvic mass, pleural effusion and ascites with normal cytology, increased CA125 levels.

Thermal balloon endometrial ablation in the treatment of heavy menstrual bleeding.

AIM: Heavy menstrual bleeding is one of the common health problems in women. The first-line therapy of heavy menstrual bleeding is the medical therapy, but this is not successful. Currently, global ablation procedures were introduced for treating of heavy menstrual bleeding. The aim of this study was to the analysis of the patient with menorrhagia performed operations of Cavaterm in our university affiliated hospital, and explores its effectiveness and acceptability. METHODS: A retrospective study was conducted on 30 patients with menorrhagia who were unresponsive to hormone therapy or not candidates for hysterectomy underwent endometrial ablation using Cavaterm. Preoperative and postoperative PBAC Scoring System was used to assess menorrhagia. Outcome measures were amenorrhea rates, reduction of menstrual flow rates, heavy bleeding, menstrual and patients' satisfaction rates at 3, 6 and 12 months postoperative. RESULTS: After a follow-up at 3, 6, and 12 months postoperative, 36.7%, 43.3%, and 36.7% of women had a reduction in vaginal bleeding, respectively. Amenorrhea rates were 56.7%, 50.0%, and 56.7% in the Cavaterm at 3, 6, and 12 months. The rate of women's reported good or excellent satisfaction was 93.3% in 12 months. During the follow-up period, no woman received a subsequent hysterectomy. CONCLUSION: The findings of this research indicated that outcome with the Cavaterm was as good for women with menorrhagia. Therefore, it is necessary to emphasize on lower operative and post-operative procedural risk and a deleterious effect on patients who were unresponsive to hormone therapy.

Effect of maternal body mass index on pregnancy outcome and newborn weight.

BACKGROUND: Maternal obesity has been associated with adverse pregnancy outcomes, such as pre-eclampsia, eclampsia, pre- and post-term delivery, induction of labor, macrosomia, increased rate of caesarean section, and post-partum hemorrhage. The objective of this study was to determine the effect of maternal Body Mass Index (BMI) on pregnancy outcomes. METHODS: 1000 pregnant women were enrolled in the study. In order to explore the relationship between maternal first trimester Body Mass Index and pregnancy outcomes, participants were categorized into five groups based on their first trimester Body Mass Index. The data were analyzed using Pearson Chi-square tests in SPSS 18. Differences were considered significant if p < 0.05. RESULTS: Women with an above-normal Body Mass Index had a higher incidence of pre-eclampsia, induction of labor, caesarean section, pre-term labor, and macrosomia than women with a normal Body Mass Index (controls). There was no significant difference in the incidence of post-term delivery between the control group and other groups. CONCLUSION: Increased BMI increases the incidence of induction of labor, caesarean section, pre-term labor and macrosomia. The BMI of women in the first trimester of pregnancy is associated with the risk of adverse pregnancy outcome.

A Randomized Clinical Trial of the Efficacy of KID21 Point (Youmen) Acupressure on Nausea and Vomiting of Pregnancy.

BACKGROUND: Nausea and vomiting in pregnancy is a common complaint of nearly 50-80% of pregnant women. The problem begins around the 4th weeks of pregnancy and often stays up to the 12th weeks and may continue to the 16th week in a few patients. OBJECTIVES: The aim of our study is to determine the effect of acupressure (on KID21 point) on nausea and vomiting of pregnancy. MATERIALS AND METHODS: This single blind clinical trial study was performed on 80 women with nausea and vomiting in the first trimester of pregnancy. Women were randomly divided to two groups; study group with the acupressure on KID21 point and the placebo group with pressure on sham acupressure for 20 minutes per day in four consecutive days. The intensity of nausea was assessed by visual Analogue scale (VAS) and vomiting frequency was evaluated by counting during these four days. Then the results compared with each other. RESULTS: The intensity of nausea and vomiting between two groups on the fourth day was shown differences (P<0.001). CONCLUSIONS: Acupressure on KID21 point is more effective than sham acupressure in reduction of nausea and vomiting in pregnancy.

Comparison of three malignancy risk indices and CA-125 in the preoperative evaluation of patients with pelvic masses.

BACKGROUND: Patients with pelvic mass are the most referred patients to gynecologist. The aim of this study was to evaluate the ability of three malignancy risk indices (RMI 1, RMI 2 and RMI 3) and CA-125 to discriminate a benign from a malignant pelvic mass in our region (North of Iran). METHODS: This retrospective study was performed on 182 women with pelvic masses referred to Yahyanejad Hospital from 2007 to 2009. Ultrasound scans were scored as one point for each of the following characteristics: multilocular cyst, solid areas, intra-abdominal metastases, ascites, and bilateral lesions. For each patient a total ultrasound score (U) was calculated. The difference of the three RMI was based on the allocation of the U and M scores. The sensitivity, specificity, positive predictive values (PPV) and negative predictive values (NPV) of level of serum CA-125, the RMI 1, 2 and 3 were compared. RESULTS: Mean age of the patients was 39.9 ± 9.3 years. Most of them were premenopausal (161 women or 88.4%). A significant linear trend for malignancy was found by increasing age, ultrasound score, and serum CA-125. The best performance of CA125 was at a cut-off 88 U/ml, with a sensitivity of 88%, a specificity of 97%, a positive predictive value of 84%, and a negative predictive value of 99%. RMI 1 and 3 at the optimal cut off point of 265 and RMI2 at the optimal cut off point of 355, had a sensitivity of 91%, specificity of 96%, a positive predictive value of 78%, and a negative predictive value of 99%. CONCLUSION: In our population we found that there is no statistically significant difference in the performance of three malignancy risk indices (RMI 1, RMI 2, and RMI 3) and CA125 in differentiating between benign and malignant pelvic masses.