The Putative Role of Factor V Leiden and Prothrombin Mutations in Pregnancy Complications

Context: Thrombophilia is an inherited or acquired predisposition in developing thrombosis. The two common thrombophilia polymorphisms are factor V Leiden (FVL) and factor II/ prothrombin G20210A (PT) gene mutations which can contribute to negative pregnancy outcomes such as miscarriage, in-vitro fertilization (IVF) failure, preeclampsia, intrauterine growth restriction (IUGR), placental abruption, stillbirth, and pregnancy-associated venous thromboembolism. This review study sought to describe the effects of FVL and PT mutations on pregnancy complications. Evidence Acquisition: In this review study, a comprehensive search was performed on Iranian and international databases including MEDLINE, PubMed, Scopus, Web of Sciences, Proquest and Google Scholar for articles published during 1996-2018. Out of 220 reviewed articles, 80 papers were ultimately selected.Results: According to these 80 selected papers, the possible relations of PT and FVL with recurrent pregnancy loss (RPL) have been widely evaluated. Several studies indicated higher risk of recurrent early miscarriages, implantation failure and fetal loss after IVF among women with FVL and PT mutations.Conclusion: Observational studies have suggested the benefits of screening patients for thrombophilic polymorphisms in identification of women with higher risk of developing thromboembolic events and other related pregnancy complications. Based on such screening programs, prophylactic therapy can be limited to a selected group of women who truly need it. 

The effect of misoprostol on intraoperative blood loss after myomectomy

Background: Uterine myomas are common benign tumors in the reproductive period. Bleeding during myomectomy is one of the major complications. We designed a randomized clinical trial to investigate the effectiveness of misoprostol on reducing Intraoperative Blood Loss (IBL) after myomectomy.Methods: Sixty four patients undergoing abdominal myomectomy were randomized into misoprostol group (n=32) that were given 200 micrograms sublingual misoprostol 0.5 hour before the operation and control group (n=32) that were given placebo. Hemoglobin (Hb) was recorded preoperative, 6 h and 24 h after surgery. Data were analyzed by SPSS software (V.20).Results: Mean of age, body mass index and baseline Hb were not statistically significant between the groups however Hb in 6h after operation were significantly higher in misoprostol group but not significant after 24 h (Hb 6h: 9.8 ±0.8 vs. 9.1 ± 0.9, P=0.003 and Hb 24 h: 10.50 ± 0.56 vs. 10.24 ± 0.58, P=0.066). No difference was observed in terms of anemia and need for blood transfusion after operation among the groups.  Conclusions: Preoperative use of sublingual misoprostol is effective in reducing IBL for women undergoing myomectomies in short time (after 6 h). Further studies should be performed to investigate the effectiveness of preoperative misoprostol with various routes and doses in other post-operative time on reducing IBL in abdominal myomectomy.

Factors affecting mental health and happiness in the elderly: A structural equation model by gender differences

Abstract Purpose There are few studies on the gender differences in mental health, happiness, and their related factors among the older population through the structural equation model (SEM) in Iran. We conducted this study to evaluate the factors affecting mental health and happiness in the elderly using an SEM by gender differences. Methods A cross‐sectional study was conducted on 739 elderly people in 2019 in Karaj, Iran. Sociodemographic, Symptom Checklist‐90‐Revised (SCL90‐R), and the Oxford Happiness Inventory were applied to evaluate the relationships between happiness, mental health, and sociodemographic factors by using statistical path analysis with Lisrel 8.8 and SPSS‐17. Results Overall, 55.5% of the participants in the study were female. The SCL90 (p value = .000) and happiness (p value = .000) scores showed significant differences between men and women. Fit indices confirmed the high model fitness, desirability, and logical relationships between the variables according to the conceptual model in both men (X2 = 3.2, df = 1) and women (X2 = 5.4, df = 2) groups. According to the path analysis, among the variables that affected happiness just through the direct path, education had the most positive causal relationship in men (B = .13) and women (B = .16), but mental health problems in men (B = −.33) and women (B = −.26), as well as the distance from home to the healthcare center in men (B = −.13) and women (B = −.11), had the most negative causal relationship with happiness respectively. Age was the only variable that was negatively related to happiness through direct and indirect paths in the women (B = −.188). Conclusion We provided an empirical model that illustrates the relationships between happiness, mental health, and related factors in the older population. Gender differences in path analysis showed that age negatively affects the happiness of older women but not men

The association between diabetes and age at the onset of menopause: a systematic review protocol

Abstract Background Age at the onset of menopause is the most important determinant of women’s future health outcomes. While the basic mechanisms contributing to the onset of menopause are still not fully understood, age at menopause depends on a complex set of various factors. In this regard, the effects of diabetes (DM I/II) on the age at the onset of menopause have received little attention. Methods and analysis Electronic databases including PubMed/MEDLINE, Web of Science, Scopus, EMBASE, and Google Scholar will be searched for articles published during January 2000 to August 2018 and containing combinations of related MeSH terms, i.e., “age at menopause” and “diabetes.” Additional studies will also be extracted from the reference lists of the selected papers, gray literature, and key journals in the field. A set of inclusion criteria will be defined, and all eligible observational studies will be included. Two reviewers will independently conduct the study selection, data extraction, and quality assessment of the selected studies. All cases of disagreement will be resolved through consensus. The methodological assessment of the primary studies will be performed based on the Newcastle-Ottawa Scale (NOS). In case of the availability of sufficient data, fixed or random effects models will be used to combine all data. Heterogeneity will be assessed by I 2 statistic and chi-square test. Stata V.11.1 will be used for data analysis (CRD42017080789). Ethics and dissemination This systematic review will not raise any ethical issues. Journal publication and conference presentations will facilitate the wide dissemination of the findings to relevant clinicians and researchers

The relationships of spiritual health, pregnancy worries and stress and perceived social support with childbirth fear and experience: A path analysis.

BackgroundGiven maternal health is a major health indicator, the present research aimed at determining the causal relationships of spiritual health, worries, stress and perceived social support with the fear and experience of childbirth in pregnant women.MethodsThe present longitudinal prospective research recruited 352 pregnant women presenting to selected health centers in Qazvin, Iran in 2021. The data were collected using the Childbirth Experience Questionnaire-2 (CEQ-2), the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ), the Multidimensional Scale of Perceived Social Support (MSPSS), the Persian version of the Pregnancy Worries and Stress Questionnaire (PWSQ), the Spiritual Health Questionnaire, the Socioeconomic Status (SES) questionnaire and a sociodemographic checklist, and were analyzed in SPSS-25 and Lisrel-8.8.ResultsThe mean age of the participants was 28.1±6.8 years. According to the results of the path analysis, among the variables related to fear of childbirth, childbirth experience (B = -0.37, CI:-0.44;-0.22) in the direct path and perceived social support (B = -0.51, CI:-0.58;-0.43) in both direct and indirect paths demonstrated the most significant negative relationship. Among the variables related to childbirth experience, pregnancy worries and stress had a negative causal relationship (B = -0.06, CI:-0.079;-0.043) in the direct path, spiritual health showed the highest significant positive relationship (B = 0.01, CI: 0.008; 0.012) in the indirect path, and perceived social support (B = 0.112, CI: 0.092; 0.131) and the number of children (B = 0.32,CI: 0.30; 0.34) demonstrated the highest significant positive relationship in both direct and indirect paths. In other words, childbirth experience becomes more desirable as spiritual health, social support, and the number of children increases, and it becomes less desirable as pregnancy worries and stress rise.ConclusionAccording to the present findings, various psychological, social, and spiritual factors are associated with childbirth fear and experience. It is thus necessary to utilize appropriate methods and promote training and support to reduce the adverse outcomes of childbirth