Hepatitis C infection seroprevalence in pregnant women worldwide: a systematic review and meta-analysis.

Background: Monitoring progress towards the WHO global target to eliminate hepatitis C virus (HCV) infection by 2030, entails reliable prevalence estimates for HCV infection in different populations. Little is known about the global burden of HCV infection in pregnant women. Here, for the first time to our knowledge, we estimated the global and regional seroprevalence of HCV antibody (Ab) and determinants in pregnant women. Methods: In this systematic review and meta-analysis study, we searched PubMed/MEDLINE, Web of Science, Embase, Scopus, and SciELO databases for peer-reviewed observational studies between January 1, 2000 and April 1, 2023, without language or geographical restrictions. Pooled global seroprevalence (and 95% confidence interval, CI) were estimated using random-effects meta-analysis and seroprevalences were categorised according to World Health Organization regions and subregions, publishing year, countries' income and human development index (HDI) levels. We used sensitivity analysis to assess the effect of four large sample size studies on pooled global prevalence through the "leave-one-out" method. We also investigated the association of potential risk factors with HCV seropositivity in pregnant women by subgroup and meta-regression analyses. The Protocol was registered in PROSPERO CRD42023423259. Findings: We included 192 eligible studies (208 datasets), with data for 148,509,760 pregnant women from 53 countries. The global seroprevalence of HCV Ab in pregnant women was 1.80% (95% CI, 1.72-1.89%) and 3.29% (3.01-3.57%) in overall and sensitivity analyses, respectively. The seroprevalence was highest in the Eastern Mediterranean region (6.21%, 4.39-8.29%) and lowest in the Western Pacific region (0.75%, 0.38-1.22%). Subgroup analysis indicated that the seroprevalence of HCV Ab among pregnant women was significantly higher for those with opioid use disorder (51.94%, 95% CI: 37.32-66.39) and HIV infection (4.34%, 95% CI: 2.21-7.06%) than for the general population of pregnant women (1.08%, 95% CI: 1.02-1.15%), as confirmed by multivariable meta-regression (p < 0.001). A significant decreasing trend was observed with increasing human development index levels. Other important risk factors for HCV seropositivity included older age, lower educational levels, poly sexual activity, history of blood transfusion, hospitalization, surgery, abortion and sexual transmitted diseases, having scarification/tattoo or piercing, and testing hepatitis B positive. Interpretation: This meta-analysis showed relatively high burden of exposure to HCV infection (2.2-5.3 million) in pregnant women globally. However, due to substantial heterogeneity between studies, our estimates might be different than the true seroprevalence. Our findings highlighted the need to expand HCV screening for women of reproductive age or during pregnancy, particularly in countries with high prevalence; as well as for more studies that assess safety of existing therapeutic drugs during pregnancy or potentially support development of drugs for pregnant women. Funding: There was no funding source for this study.

Unusual Site of Dermoid Cyst.

Epidermoid and dermoid cysts are benign tumors lined by stratified squamous epithelium. Any region of the body that is covered by squamous epithelium has the potential ability to develop them. Herein, we reported two rare cases with benign cystic teratoma at unusual sites in the genital system. The first case was a 29-year-old G1P1L1 female admitted in our center with pelvic pain 2 months ago. Magnetic resonance imaging (MRI) showed a mass in the posterior cul-de-sac with severe fat content. The patient underwent laparoscopy. Histopathological study of the removed mass showed a dermoid cyst. The second patient was a 35-year-old G3L1Ab2 female who was admitted to our clinic with the chief complaint of abnormal uterine bleeding since one year ago. The ultrasonography represents a hyperecho 65 × 27 mm mass lesion in the endometrial canal progressing toward cervical canal. After laparotomy, a degenerated myoma was resected. Surprisingly, histopathological study of the removed mass showed a mature cystic teratoma. To the best of our knowledge, it is the first study which reports cystic teratomas in the cervix region.

A transvaginal ultrasound-based diagnostic calculator for uterus post-cesarean scar defect.

BACKGROUND: A cesarean scar defect (CSD) is incomplete healing of the myometrium at the site of a prior cesarean section (CS), complicating more than half of all cesarean sections. While transvaginal ultrasound (TVU) is the most common modality for diagnosing this defect, hysteroscopy remains the gold standard. We aimed to develop an efficient diagnostic tool for CSD among women with abnormal uterine bleeding (AUB) by integrating TVU findings and participants' demographic features. METHODS: A single-center cross-sectional study was conducted on 100 premenopausal and non-pregnant women with a history of CS complaining of AUB without a known systemic or structural etiology. Each participant underwent a hysteroscopy followed by a TVU the next day. The defect dimensions in TVU, patients' age, and the number of previous CSs were integrated into a binary logistic regression model to evaluate their predictive ability for a hysteroscopy-confirmed CSD. RESULTS: Hysteroscopy identified 74 (74%) participants with CSD. The variables age, the number of CSs, defect length, and defect width significantly contributed to the logistic regression model to diagnose CSD with odds ratios of 9.7, 0.7, 2.6, and 1.7, respectively. The developed model exhibited accuracy, sensitivity, and specificity of 88.00%, 91.89%, and 76.92%, respectively. The area under the receiver operating curve was 0.955 (P-value < 0.001). CONCLUSION: Among non-pregnant women suspected of CSD due to AUB, looking at age, the number of previous CSs, and TVU-based defect width and length can efficiently rule CSD out.

Trichomonas vaginalis infection and risk of cervical neoplasia: A systematic review and meta-analysis.

OBJECTIVES: The evidence in the literature regarding the relationship between Trichomonas vaginalis (TV) infection and cervical neoplasia is conflicting. The main aim of this study was to evaluate the magnitude of the risk of cervical neoplasia associated with TV infection. METHODS: A meta-analysis of observational studies, which provided raw data on the association of TV infection with cervical neoplasia, was performed. For this aim, we searched scientific databases (PubMed/Medline, Scopus, the Web of Sciences, and Embase) from inception to March 15, 2023. A random-effects model was applied by Stata 17.0 to calculate the pooled and adjusted odds ratios (ORs) with 95% confidence intervals (CI), including subgroup, sensitivity, and cumulative analyses to explore sources of heterogeneity. RESULTS: Of the 2584 records initially identified, 35 eligible studies contributed data for 67,856 women with cervical neoplasia, and 933,697 healthy controls from 14 countries were included. The pooled (2.15; 1.61-2.87; I2 = 87.7%) and adjusted (2.17; 1.82-2.60; I2 = 31.27%) ORs indicated a significant positive association between TV infection and the development of cervical neoplasia. There was no significant change in pooled and adjusted ORs by applying sensitivity and cumulative analyses, indicating the robustness of our findings. The pooled OR was significant in most sub-group analyses. There was no publication bias in the included studies. CONCLUSION: Our findings indicated that women with a TV infection are at significantly greater risk of cervical neoplasia. Future research, particularly longitudinal and experimental studies, should be done to better understand the various aspects of this association.

Worldwide prevalence of human papillomavirus among pregnant women: A systematic review and meta-analysis.

Human papillomavirus (HPV) is the causative agent of cervical cancer and a suspected agent for ovarian and endometrial cancers in women. It is associated with adverse outcomes during pregnancy. To date, there is no estimate of the prevalence of HPV infection in pregnant women at the regional and global levels. This study evaluated the global prevalence of HPV infection based on all observational studies that had reported the prevalence of HPV among pregnant women between January 1980 and December 2021 in PubMed/MEDLINE, Scopus, Web of Science, Embase, and SciELO databases. We utilised a random-effect model to determine the global prevalence and related risk factors of HPV infection. Between-studies heterogeneity was assessed using I2 statistic. Moreover, subgroup and meta-regression analyses were employed to assess the source of heterogeneity and the relationship between HPV prevalence and socio-demographic factors, respectively. Among 144 eligible studies comprising 189 datasets, the overall prevalence rates of HPV at the 95% confidence interval (CI) were estimated as 30.38% (26.88%-33.99%), 17.81% (9.81%-27.46%), 32.1% (25.09%-39.67%), 2.26% (0.1%-8.08%) and 25.5% (23.3%-27.8%) in cervico-vaginal, placenta, serum, amniotic fluid and urine samples, respectively. The highest prevalence rates were estimated for countries in the African region, while countries in the European and Eastern Mediterranean regions showed the lowest prevalence rates. HPV-16 and -18 were the most prevalent isolated strains. The pregnant women living with HIV and those with pregnancy disorders had significantly higher prevalence rates than general pregnant women (p < 0.05). The younger ages for first intercourse and pregnancy, multiple lifetime sexual partners, and lower education levels were primary risk factors for HPV infection. In conclusion, although the overall HPV prevalence varied markedly based on sampling sites and geographical locations, the highest prevalence rates were observed in less-developed countries. Our findings imply that implementing behavioural and therapeutic interventions as well as vaccination programs are crucial to prevent and reduce the current burden of HPV infection among pregnant women.

Human Papillomavirus Infection during Pregnancy and Childhood: A Comprehensive Review.

Human papillomavirus (HPV), the most prevalent sexually transmitted disease worldwide, is the causative agent for several genital and oropharyngeal cancers and a suspected agent for many malignancies. HPV is associated with several adverse health outcomes during pregnancy. Infants are also at risk of HPV infection via different transmission routes: vertically from an infected mother and horizontally through sexual or non-sexual contact with infected individuals. Several HPV manifestations have been identified during childhood, ranging from common skin infections to severe complications such as juvenile recurrent respiratory papillomatosis. This review aims to provide a comprehensive overview of the epidemiology, manifestations, and treatment strategies of HPV infection during pregnancy and childhood. Moreover, we underline the role of vaccination in preventing complications.

A randomized trial assessing the efficacy of Silymarin on endometrioma-related manifestations.

To study the effect of silymarin on the Interleukin-6 (IL-6) level, size of endometrioma lesion, pain, sexual function, and Quality of Life (QoL) in women diagnosed with endometriosis. This randomized, double-blind placebo-controlled clinical trial was performed on 70 women with endometriosis which was divided into two groups of intervention and control. The intervention was 140 mg silymarin (or matching placebo) administered twice daily for 12 weeks. The volume of endometrioma lesions, the level of IL-6 concentration in serum, pain, sexual function, and QoL were analyzed before and after the intervention. The means of endometrioma volume (P = 0.04), IL-6 (P = 0.002), and pain (P < 0.001) were reduced significantly in the silymarin group after intervention. However, the QoL and female sexual function did not improve substantially in the two groups (P > 0.05). Silymarin significantly reduced interleukin-6 levels, sizes of endometrioma lesions, and pain-related symptoms. The trial has been registered in the Iranian Registry of Clinical Trials (IRCT20150905023897N5) on 4th February 2020 (04/02/2020) ( https://en.irct.ir/trial/42215 ) and the date of initial participant enrollment was 2nd March 2020 (02/03/2020).

Comparison of Ultrasound and Tumor Marker CA125 in Diagnosis of Adnexal Mass Malignancies.

Background: CA125 is the most used tumor marker for ovarian cancer monitoring and diagnosis. This study aimed to evaluate the capacity to predict malignancy in women with adnexal tumors using CA125 measurement and ultrasound criteria before the pathological examination. Materials and Methods: This observational diagnostic study was conducted on 300 patients with obvious diagnosis of adnexal mass consists of ovarian masses, fallopian tubes, and masses within the broad ligament referring to Alzahra and Beheshti Hospitals from 2018 to 2019. Ultrasound examinations were done before surgery and malignancy risk was investigated by the ADNEX criterion. Sensitivity, specificity, positive and negative likelihood ratio (likelihood ratio [LR]+ and LR-), and area under the curve (AUC) were calculated. Results: From 284 patients, 260 masses were categorized in benign, 18 were in borderline, and 18 masses were malignant. The mean age of patients with malignant tumors was significantly higher than the others (P = 0.01). Differences in the level of CA-125 were not statistically significant (P = 0.78). Furthermore, the proportion of ascites in the malignant group (16.3%) was significantly higher than the others (P = 0.003). The AUC in ADNEX model (cutoff ≥9%) for differentiation of benign and malignant tumors was 0.75 (95% confidence interval [CI]: 0.69-0.80) with a sensitivity of 0.63 (95% CI: 0.41-0.81) and a specificity of 0.80 (95% CI: 0.74-0.84). Receiver operating characteristic analysis for CA-125 revealed that this variable is not capable for discrimination between benign and malignant tumors as the AUCs of the aforementioned variable were 0.60, 0.60, and 0.52 for the whole patients, premenopause, and postmenopause categories. Conclusion: CA-125 marker, along with other ultrasound findings, can be more accurate in identifying the malignancy of the adnexa tumor.

The Efficacy of Ropivacaine 0.5% in Transversus Abdominis Plane Block to Relieve the Postoperative Pain of Female Laparoscopic Surgery Grade II.

Background: The aim of this study was determination of the effect of the transversus abdominis plane block (TAP block) with ropivacaine 0.5% in relieving postoperative pain after laparoscopic gynecologic surgery. Materials and Methods: The population of the double-blinded clinical trial study included 200 women candidates for elective laparoscopic gynecologic surgery who referred to Al-Zahra and Beheshti hospitals in Isfahan during 2016-2018. In the TAP block group in addition to standard general anesthesia, an anesthetic drug Ropivacaine (Naropin, 0.5%) was injected at a dose of 0.5 mg/kg between transverse abdominal muscle and internal oblique muscle facia. And in control group just received standard general anesthesia. Hence, the severity of pain and nausea and vomiting is recorded at the time of recovery, at 30 min, 2, 4, 6, 12, and 48 h after the surgery. Results: The results of this study showed that in all periods of time (30 min, 2, 4, 6, 12, 24, 36, and 48 h after the surgery), mean pain score in TAP block group was lower than control group (P < 0.001). Hence that, in the 48 h after the surgery, the pain score in the TAP block group with a mean of 0.46 ± 0.50 was significantly lower than the control group with a mean of 1.06 ± 0.68 (P < 0.001). Nausea and vomiting between the two groups were no significant differences. There was no decrease in narcotic use or length of stay among those who received the TAP block. Conclusions: TAP block with ropivacaine 0.5% had a significant role in reducing postoperative pain of laparoscopic surgery.

The Effect of Vasopressin during Hysteroscopic Myomectomy in Patients with Submucosal Myoma: A Randomized Controlled Trial.

BACKGROUND: The aim was to assess the effect of vasopressin in reducing the time of surgery, amount of bleeding, and fluid deficit during hysteroscopic myomectomy of submucosal myoma from 2016 to 2018. MATERIALS AND METHODS: This study was conducted as a prospective, randomized, single-blinded clinical trial on the premenopausal women ranged from 18 to 62 years' old. A number of 80 patients were randomly assigned to each arm of the study according to random consecutive numbers. The control group (n = 40) of patients underwent conventional hysteroscopic myomectomy without vasopressin and the case group (n = 40) underwent hysteroscopic myomectomy with the injection of diluted vasopressin. Measured outcomes were time for myomectomy, fluid deficit, inflow volume, visual clarity, and postoperation hemoglobin level. RESULTS: The mean time of myomectomy was 38.1 and 77.38 min in vasopressin and control groups, respectively (P < 0.001). The mean inflow volume was 2800 and 4100 in vasopressin and control groups, respectively (P = 0.029). The visual clarity score was 8.5 and 6.5 in the vasopressin and control groups, respectively (P < 0.001). CONCLUSIONS: The injection of vasopressin during hysteroscopic myomectomy is effective in the management of fluid deficit, time of surgery, and improvement of visual clarity.

Intrauterine infusion of autologous platelet-rich plasma in women undergoing assisted reproduction: A systematic review and meta-analysis.

Prior studies have provided conflicting results regarding the use of platelet-rich plasma (PRP) in women undergoing in-vitro fertilization (IVF) or intracytoplasmic injection (ICSI). The objective of this study was to evaluate the effect of the intrauterine infusion of PRP on the outcome of embryo transfer (ET) in women undergoing IVF/ICSI. We searched databases, including PubMed, Embase, Scopus, Web of Science, and the Cochrane Database of Clinical Trials (CENTRAL). Meta-analysis using a random-effects model was performed to calculate the pooled estimates. Seven studies involving 625 patients (311 cases and 314 controls) were included. The probability of chemical pregnancy (n = 3, risk ratio (RR): 1.79, 95 % confidence intervals (CI): 1.29, 2.50; P < 0.001, I2 = 0 %), clinical pregnancy (n = 7, RR: 1.79, 95 % CI: 1.37, 2.32; P < 0.001, I2 = 16 %), and implantation rate (n = 3, RR: 1.97, 95 % CI: 1.40, 2.79; P < 0.001, I2 = 0 %) was significantly higher in women who received PRP compared with control. There was no difference between women who received PRP compared with control group regarding miscarriage (RR: 0.72, 95 % CI: 0.27, 1.93; P = 0.51, I2 = 0 %). Following the intervention, endometrial thickness increased in women who received PRP compared to control group (SMD: 1.79, 95 % CI: 1.13, 2.44; P < 0.001, I2 = 64 %). The findings of this systematic review suggest that PRP is an alternative treatment strategy in patients with thin endometrium and recurrent implantation failure (RIF). Further prospective, large, and high quality randomized controlled trials (RCTs) are needed to identify the subpopulation that would most benefit from PRP.

Systematic review and meta-analysis of adverse pregnancy outcomes after uterine adenomyosis.

BACKGROUND: Studies on the impact of adenomyosis and its pregnancy complications have yielded conflicting results. OBJECTIVE: To determine the likelihood of adverse pregnancy outcomes among women with adenomyosis relative to women without adenomyosis. SEARCH STRATEGY: PubMed, Embase, Scopus, and Web of Science were searched for studies published up to June 15, 2018. SELECTION CRITERIA: Observational studies with medically confirmed pregnancy outcomes as endpoints. DATA COLLECTION AND ANALYSIS: Two researchers independently screened and selected relevant studies. Dichotomous data for all adverse pregnancy outcomes were expressed as an odds ratio (OR) with 95% confidence interval (CI), and combined in a meta-analysis by using a random-effects model. MAIN RESULTS: Six studies (322 cases and 9420 controls) were eligible for inclusion in the meta-analysis. Women with adenomyosis had an increased likelihood of preterm birth (OR, 3.05; 95% CI, 2.08-4.47; P˂0.001), small for gestational age (OR, 3.22; 95% CI, 1.71-6.08; P˂0.001), and pre-eclampsia (OR, 4.35; 95% CI, 1.07-17.72; P=0.042). CONCLUSION: Adenomyosis seems to have a detrimental impact on pregnancy outcomes, resulting in a higher likelihood of preterm birth, small for gestational age, and pre-eclampsia.

The effect of frankincense (Boswellia serrata, oleoresin) and ginger (Zingiber officinale, rhizoma) on heavy menstrual bleeding: A randomized, placebo-controlled, clinical trial.

OBJECTIVES: To evaluate the effect of frankincense (Boswellia serrata, oleoresin) and ginger (Zingiber officinale, rhizoma) as complementary treatments for heavy menstrual bleeding (HMB) among women of reproductive age. DESIGN: Randomized, placebo-controlled, clinical trial. SETTING: Gynecology outpatient clinics. INTERVENTIONS: Patients with HMB (n = 102) were randomly assigned to three groups. All patients received ibuprofen (200 mg) and either frankincense (300 mg), ginger (300 mg), or a placebo, which contains 200 mg anhydrous lactose as the filling agent and was similar in appearance to the two other drugs. Patients received the medications three times a day for seven days of the menstrual cycle, starting from the first bleeding day and this was repeated for two consecutive menstrual cycles. MAIN OUTCOME MEASURES: Amount and duration of menstrual bleeding and quality of life (QOL). RESULTS: Duration of menstrual bleeding was decreased in the frankincense (-1.77 ± 2.47 days, P = 0.003) and ginger (-1.8 ± 1.79 days, P = 0.001) groups, but not in the placebo group (-0.52 ± 1.86 days, P = 0.42). Amount of menstrual bleeding was decreased in all (P < 0.05), with no difference among the study groups (P > 0.05). More improvement in QOL was observed in the frankincense (-25.7 ± 3.1; P < 0.001) and ginger (-29.2 ± 3.7: P < 0.001) groups compared to the placebo group (-15.07 ± 3.52; P < 0.001) and between the groups, differences were statistically significant (P = 0.02). CONCLUSIONS: Ginger and frankincense seem to be effective complementary treatments for HMB. Further studies with a larger sample size and longer follow-up are warranted in this regard.

Comparing surgical outcome and ovarian reserve after laparoscopic hysterectomy between two methods of with and without prophylactic bilateral salpingectomy: A randomized controlled trial.

BACKGROUND: This study aimed to compare the surgical outcome and ovarian reserve in premenopausal women undergoing laparoscopic hysterectomy (without oophorectomy) for benign cause between two methods of with and without prophylactic bilateral salpingectomy. MATERIALS AND METHODS: In a prospective randomized clinical trial, 62 premenopausal women with benign indication underwent a laparoscopic hysterectomy. Patients were then randomized to undergo hysterectomy with bilateral salpingectomy (Group 1; n = 15) or without bilateral salpingectomy (Group 2; n = 15). We evaluated the impact of bilateral salpingectomy on surgical outcome and ovarian reserve using serum levels of anti-Mullerian hormone (AMH) and follicle stimulating hormone (FSH) that were measured preoperatively and at 3 months postoperatively (P < 0.001). RESULTS: Baseline characteristics such as age, uterine size, body mass index, and preoperative AMH and FSH levels were similar between the two study groups. The average operative time, estimated blood loss, uterine size, uterine weight, and intraoperative complication were similar between two groups. The mean AMH levels were not significantly different at baseline (1.44 ng/mL vs. 1.2 ng/mL) and at 3-month postoperatively (1.13 ng/mL vs. 0.97 ng/mL) among women with salpingectomy versus no salpingectomy. At 3-month follow-up, in both groups, postoperative AMH levels were significantly lower and FSH levels were significantly higher than before surgery. CONCLUSION: Prophylactic bilateral salpingectomy at the time of laparoscopic hysterectomy neither has a negative effect on ovarian reserve nor increases the surgical risk. Therefore, we may recommend gynecologic surgeons to perform prophylactic bilateral salpingectomy during laparoscopic hysterectomy to conserve both ovaries.

Presentation of Placental Site Trophoblastic Tumor with Amenorrhea.

Placental site throphoblastic tumor (PSTT) is a rare manifestation of gestational trophoblastic neoplasia that may complicate any type of pregnancy. The disease is unique from other type, and is defined by slow growth, low human chorionic gonadotropin (hCG) serum levels, the late-onset metastatic potential, and most significantly, insensitivity to chemotherapy. We describe a case of a 31-year-old woman with prolonged amenorrhea and slightly elevated serum beta hCG (ßhCG) level, referred for termination of abnormal pregnancy. During curettage, necrotic tissue was removed and severs vaginal bleeding was controlled with medical therapy. Histology examination showed neoplastic intermediate trophoblastic cells with invasion to the vessel wall compatible with PSTT. After that, hysterectomy was down and serum ßhCG declined to undetectable level 2 weeks after surgery and was followed for 2 years without complication.

Dose ranging effects of pregabalin on pain in patients undergoing laparoscopic hysterectomy: A randomized, double blinded, placebo controlled, clinical trial.

OBJECTIVE: The study aimed to investigate the preemptive analgesia efficacy of different concentrations (75, 150 and 300mg) of preemptive pregabalin for the postoperative pain management after laparoscopic hysterectomy. DESIGN: Prospective, randomized, placebo-controlled, double-blind study. SETTING: The Gynecology and Obstetrics Center of Arash Hospital, Tehran, Iran, from October 2013 to November 2014. PATIENTS: A total of 96 women with American Association of Anesthesiologist (ASA) physical status I and II underwent elective laparoscopic hysterectomy surgery. Patients were then randomly assigned to four groups, of which groups 1-3 (treatment groups; n=20) received orally pregabalin concentrations of 75mg, 150mg, and 300mg, respectively, for a night before surgery, 30min before surgery and 6h after surgery, whereas group 4 (control group; n=22) received a matching dosage of placebo at the same scheme. MEASUREMENTS: Visual Analog Scale (VAS) scores for postoperative pain at rest and on movement at first 24h after surgery were evaluated as primary outcome. Drug-related side effects were also evaluated as a secondary outcome. Somnolence was evaluated using Ramsay Sedation Scale, while nausea and vomiting were assessed using numeric scores. The data were analyzed using SPSS. MAIN RESULTS: Preemptive pregabalin in different concentrations provided better pain relief as compared with placebo. Post-hoc test indicated that there was a significant difference among four groups, indicating where the concentration was increased, the pain score decreased as an independent variable of time. The highest concentration of pregabalin (300mg) revealed higher sedation scores as compared with other groups. CONCLUSION: Our data demonstrated preemptive administration of 75, 150, and 300mg pregabalin play an important role in reducing postoperative pain after laparoscopic hysterectomy. Comparison of different concentrations and side effects indicates oral administration of 150mg pregabalin is an effective and safe method for postoperative pain management after laparoscopic hysterectomy.

Comparing ovarian reserve after laparoscopic excision of endometriotic cysts and hemostasis achieved either by bipolar coagulation or suturing: a randomized clinical trial.

PURPOSE: This study aimed to compare ovarian reserve between laparoscopic suturing and bipolar coagulation techniques in women with unilateral endometrioma. METHODS: In a prospective randomized clinical trial, 109 patients with unilateral endometrioma underwent laparoscopic cystectomy. Patients were then randomized to undergo hemostasis with either bipolar coagulation (n = 57) or suturing (n = 52) technique. We evaluated the impact of surgery and hemostasis techniques on ovarian reserve using serum levels of anti-Mullerian hormone (AMH) and follicle-stimulating hormone (FSH) that were measured preoperatively and at 3 months postoperatively. RESULTS: Baseline characteristics such as age and preoperative AMH and FSH levels were similar between the two study groups. At 3-month follow-up, in both groups, postoperative AMH levels were significantly lower and FSH levels were significantly higher than before surgery. The decline rate of AMH levels was significantly greater in the bipolar coagulation (53.42 ± 15.28) group than in the suturing group (15.94 ± 18.55). Furthermore, patients in the suturing group had higher AMH and lower FSH as compared with the other group (p < 0.001). CONCLUSION: After laparoscopic stripping of endometrioma, intracorporeal suturing showed less damage on ovarian reserve as compared with bipolar electrocoagulation. Therefore, hemostatic suturing technique may be considered as a better choice after laparoscopic ovarian cystectomy.

Evaluation of antimullerian hormone levels before and after laparoscopic management of endometriosis.

BACKGROUND: Serum antimullerian hormone (AMH) proposed to be a reliable marker of ovarian reserve; the aim of this study was to evaluate the influence and value of laparoscopic management in endometriosis as measured by serum AMH levels. MATERIALS AND METHODS: In this cross-sectional study, 33 infertile patients who referred to fertility - Infertility Center of Isfahan - with different stages of endometriosis managed by diagnostic operative laparoscopy and serum AMH levels were measured pre and one month postoperative laparoscopy. Main outcome measures were serum AMH levels in correlation with the type of infertility, stage of endometriosis, and type of surgery in infertile patients. RESULTS: 33 infertile patients enrolled in the study with mean age 28.9 ± 5 years, and thus did not show a significant difference. Mean serum AMH levels was 4.23 ± 3.75 ng/ml and 2.2 ± 2.47 ng/ml, respectively, in primary and secondary infertility groups before and one month after laparoscopy, which shows a significant difference (P < 0.001). Median AMH level changes in Cauterization (0.67 ± 0.76 ng/ml), endometrioma excision 2 ± 0.6 ng/ml, both 2.18 ± 0.81 ng/ml and shows no significant differences. Mean serum AMH levels were definitely decreased in minimal/mild and severe stage endometriosis before and 1 month after laparoscopy, (1.84 ± 2.06 ng/ml and 2.18 ± 3.45 ng/ml), respectively. Also serum AMH according to ovarian appearance and evolvement showed no significant differences after laparoscopy: (5.5 ± 1.4 ng/ml and 2.76 ± 0.96 ng/ml) and (3.37 ± 2.2 ng/ml and 1.84 ± 1.5 ng/ml). CONCLUSION: Serum AMH levels clearly decreased 1 month after operative laparoscopy.

The effect of preemptive pudendal nerve block on pain after anterior and posterior vaginal repair.

INTRODUCTION: Anterior and posterior vaginal repair (APR) is a common surgery for women with prolapse of pelvic organs which creates post-operative pain because of damage of tissues that we should manage and control this pain. For this purpose, this study was conducted in order to evaluate the effect of preemptive pudendal nerve block on post-operative pain in anterior and posterior vaginal wall repair. MATERIALS AND METHODS: In a double-blinded clinical trial study, 60 women candidates of APR were randomly divided to two groups. In both of them was injected 0.3 cc/kg bupivacaine 0.25% for the intervention group or normal saline for the control group in pudendal nerve tract with the guide of nerve stimulator. A visual analog scale was used to measure pain during the first 48 h after the surgery. Data were analyzed by repeated measures analysis of variance (ANOVA). RESULTS: Compared with the intervention group, the control group experienced greater pain during rest and walking. There were significant differences between the two groups from the first post-operative hour (P = 0.003) until 48 h after the operation (P = 0.021). Furthermore, the mean ± SD values of pain in the sitting position was not significantly different between control and intervention groups at the same time (P = 0.340). CONCLUSION: Preemptive pudendal nerve block can reduce post-operative pain score in anterior and posterior vaginal wall repair and this method was suggested in anterior and posterior vaginal wall repair.

A comparison of the effects of fentanyl and remifentanil on nausea, vomiting, and pain after cesarean section.

BACKGROUND: The effects of different opioids on postoperative nausea and vomiting (PONV) and pain have not been conclusively determined. The aim of this study was to compare the effects of fentanyl, remifentanil or fentanyl plus morphine on the incidence of PONV and pain in women subjected to cesarean section under general anesthesia. METHODS: The study was a randomized clinical trial recruiting 96 parturients with American Society of Anesthesiologists (ASA) physical status I and II. They scheduled for cesarean section under general anesthesia using sodium thiopental, succynylcholine, and isoflurane O2/N2O 50/50 mixture. After clamping the umbilical cord, the patients were given fentanyl (2 µg/kg/h), remifentanil (0.05 µg/kg/h), or fentanyl (2 µg/kg) pulse morphine (0.1 mg/kg) intravenously. Visual analog scale for pain and nausea, frequency of PONV, meperidine and metoclopramide consumption were evaluated at recovery, and 4, 8, 12 and 24 hours after the surgery. RESULTS: There was no significant difference between the three groups in terms of frequency of nausea, vomiting, and mean nausea and pain scores at any time points. None of the patients required the administration of metoclopramide. However, the mean VAS for pain in remifentanil-treated group was insignificantly more than that in fentanyl- or fentanyl plus morphine-treated group at recovery or 4 hours after the surgery. The mean mepridine consumption in remifentanil-treated group was significantly (P=0.001) more than that in fentanyl- or fentanyl plus morphine-treated group in 24 hours after the surgery respectively. There was no significant difference in hemodynamic parameters of the three groups in all measurements after the surgery. CONCLUSION: The findings of this study showed that early postoperative analgesia was better with fentanyl, and postoperative meperidine consumption was significantly less with fentanyl than with remifentanil or combined fentayl and morphine.