Evaluation of Paracervical Block and IV Sedation for Pain Management during Hysteroscopic Polypectomy: A Randomized Clinical Trial

Background. The aim of this study was to compare the effectiveness of paracervical block (PB) and IV sedation (IVS) on women’s pain perception during operative hysteroscopy. Methods. A total of 84 patients with uterine polyps were randomized to either PB or IV sedation or general anesthesia (GA) as control group. In PB group, the patients received oral diazepam 10 mg and 100 mg diclofenac Na suppository 60 min before surgery and 10 cc of 2% buffered lidocaine was injected at cervix. Conscious sedation was performed with the IV administration of 2-3 mg/kg/h propofol 1% and midazolam 0.02 mg/kg and fentanyl (1-2 μg/kg) with o2 4-5 lit/min via face mask. Results. There were no significant differences between groups on VAS score at 3 hours after operation (PB: 1.22 ± (1.31), IVS: 1.10 ± (1.68), GA: 1.29 ± (2.03), P=0.671) and during recovery (PB: 0.85 ± (1.06), IVS: 0.68 ± (1.33), GA: 1.21 ± (2.04), P=0.458). There was no difference between PB (3.33 ± (2.81)) and IVS (2.31 ± (2.63)) groups at hysteroscopy (P=0.182). Patients undergoing IVS reported lower VAS score than PB group at dilation and curettage, although the difference was not statistically significant (PB: 2.59 ± (1.78), IVS: 1.72 ± (2.34), P=0.051). Moreover, patients undergoing IVS obtained lower VAS score than PB group at polypectomy, while the difference was not statistically significant (PB: 1.81 ± (1.52), IVS: 1.10 ± (1.32), P=0.073). Conclusion. The finding of the present study revealed that IVS and PB showed the same effect in reducing pain during and after gynecological surgical procedures. The study was registered in Iranian Registry of Clinical Trial with the number IRCT2016031426855N3, on April 28, 2016

Spinal Anesthesia and Spinal Anesthesia with Subdiaphragmatic Lidocaine in Shoulder Pain Reduction for Gynecological Laparoscopic Surgery: A Randomized Clinical Trial

Objective. The aim of this study was to compare the effectiveness of spinal anesthesia with subdiaphragmatic lidocaine at the beginning of surgery versus spinal anesthesia in pain reduction for gynecological laparoscopic surgery. Methods. This was a clinical trial conducted in Arash Hospital, Tehran, Iran. Eighty-four patients were randomized to either spinal anesthesia with subdiaphragmatic lidocaine, spinal anesthesia, or general anesthesia (GA). The primary outcome was patients’ pain perception during surgery, 2, 4, 6, and 12 hours after surgery, and prior to discharge and was assessed by visual analogue scale (VAS). Results. The results showed that there are no significant changes in pain perception over time in none of the three groups (F(4,76) = 0.37, P=0.82). The severity of pain experienced by patients at all-time interval after surgery was similar between groups [F(2,79) = 0.54, P=0.58]. Conclusion. The use of subdiaphragmatic lidocaine at the beginning of surgery combined with spinal anesthesia was not associated with a statistically significant difference in patients’ postoperative VAS scores compared to spinal anesthesia and GA during and after gynecological surgical procedures. The study was registered in Iranian Registry of Clinical Trial by the number of IRCT2016022226698N1

The Importance of Initial Evaluation by Trans Vaginal Sonography in Rudimentary Horn Pregnancy: A Case Report and Literature Review

Rudimentary&nbsp; horn&nbsp; pregnancy&nbsp; (RHP)&nbsp; as&nbsp; a&nbsp; rare&nbsp; incidence&nbsp; has&nbsp; been&nbsp; estimated&nbsp; at&nbsp; 1:76,000- 1:150,000 pregnancies. It has been also reported that 80-90% of RHP lead to uterine rupture in second trimester.&nbsp; Early&nbsp; diagnosis&nbsp; with&nbsp; the&nbsp; use&nbsp; of&nbsp; 3-dimentional&nbsp; ultrasonography&nbsp; (3-DUS)&nbsp; that&nbsp; is&nbsp; followed by&nbsp; laparoscopic&nbsp; resection&nbsp; of&nbsp; RH&nbsp; and&nbsp; ipsilateral&nbsp; fallopian&nbsp; tube&nbsp; is&nbsp; likely&nbsp; to&nbsp; be&nbsp; considered&nbsp; as&nbsp; the&nbsp; best management strategy that prevents maternal morbidity and mortality. We present a case of 9-week pregnancy&nbsp; in&nbsp; a&nbsp; non-communicating&nbsp; rudimentary&nbsp; horn&nbsp; with&nbsp; positive&nbsp; fetal&nbsp; heart&nbsp; rate&nbsp; (FHR)&nbsp; that&nbsp; was diagnosed by 3-DUS and successfully treated with laparoscopic resection.</p

The prevalence of menstrual disorders in Iran: A systematic review and meta-analysis

Background: Understanding the prevalence of menstrual disorders has important implications for both health service planning and risk factor epidemiology. Objective: The aim of this review is to identify and collate studies describing the prevalence of menstrual disorders in Iran. Materials and Methods: Studies with original data related to the prevalence of menstrual disorders were identified via searching six electronic databases and reviewing citations. All abstracts or titles found by the electronic searches were independently scrutinized by two reviewers. The Meta-analysis was performed with a random effects model, considering the remarkable heterogeneity among studies. A total of 35 eligible epidemiological studies were included in this review. Results: Overall, the pooled prevalence of primary dysmenorrhea was 73.27% (95% CI=65.12-81.42). The mean proportion of women with oligomenorrhea was 13.11% (95.5%, 95% CI: 10.04-16.19). We identified 16 studies that reported polymenorrhoea with a random effect of pooled prevalence estimate of 9.94% (95% CI 7.33%-12.56%). The prevalence estimate of hypermenorrhea was 12.94% (95% CI 9.31%-16.57%). Overall prevalence of hypomenorrhea was 5.25% (95% CI 3.20%-7.30%), ranging from 0.9- 12.90%. Pooling six studies that reported estimates for menorrhagia, the overall prevalence was 19.24% (95% CI 12.78-25.69). Overall, 6.04% (95% CI: 1.99-10.08) of the women were shown to have metrorrhagia. Conclusion: This systematic review suggests that the average prevalence of menstrual disorders in Iran is substantial. It has been neglected as a fundamental problem of women's reproductive health. Diagnosis and treatment of these disorders should be included in the primary health care system of reproductive health. &nbsp

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

The association between maternal infection and intellectual disability in children: A systematic review and meta-analysis.

BackgroundThere is arguing evidence regarding the association between maternal infections during pregnancy and the risk of intellectual disability (ID) in children. This systematic review and meta-analysis are essential to determine and address inconsistent findings between maternal infections during pregnancy and the risk of ID in children.MethodsThe MOOSE and PRISMA guidelines were followed to perform and report on this study. The Medline/PubMed, Web of Science, Embase, and Scopus databases were searched from inception up to March 15, 2023, to identify potentially eligible studies. Inclusion and exclusion criteria were applied, as well as the Newcastle-Ottawa Scale was used to assess the methodological quality of studies included. The included studies were divided into two types based on the participants: (1) ID-based studies, which involved children with ID as cases and healthy children as controls and evaluated maternal infection in these participants; (2) infection-based studies, which assessed the prevalence or incidence of ID in the follow-up of children with or without exposure to maternal infection. We used Random-effects models (REM) to estimate the overall pooled odds ratio (OR) and 95% confidence intervals (CIs). The between-studies heterogeneity was assessed with the χ2-based Q-test and I2 statistic. Subgroup and sensitivity analyses were applied to explore the source of heterogeneity and results consistency.ResultsA total of eight studies including 1,375,662 participants (60,479 cases and 1,315,183 controls) met the eligibility criteria. The REM found that maternal infection significantly increased the risk of ID in children (OR, 1.33; 95% CI, 1.21-1.46; I2 = 64.6). Subgroup analysis showed a significant association for both infection-based (OR, 1.27; 95%CI, 1.15-1.40; I2 = 51.2) and ID-based (OR, 1.44; 95%CI, 1.19-1.74; I2 = 77.1) studies. Furthermore, subgroup analysis based on diagnostic criteria revealed a significant association when maternal infection or ID were diagnosed using ICD codes (OR, 1.33; 95% CI, 1.20-1.48; I2 = 75.8).ConclusionOur study suggests that maternal infection during pregnancy could be associated with an increased risk of ID in children. This finding is consistent across different types of studies and diagnostic criteria. However, due to the heterogeneity and limitations of the included studies, we recommend further longitudinal studies to confirm the causal relationship and the underlying mechanisms

Sensitivity analysis after each study was excluded.

Sensitivity analysis after each study was excluded.</p

Pooled OR estimates in subgroups according to the publication year for studies assessing the association between maternal infection and ID in children.

Pooled OR estimates in subgroups according to the publication year for studies assessing the association between maternal infection and ID in children.</p

PRISMA flow chart showing study selection process.

PRISMA flow chart showing study selection process.</p

Sub-group analysis of the pooled prevalence and odds ratios for the association between maternal infection and intellectual disability.

Sub-group analysis of the pooled prevalence and odds ratios for the association between maternal infection and intellectual disability.</p