Background Hepatitis B virus (HBV) has been considered a significant cause of human reproductive failure in different studies; however, there is a considerable disagreement on the true impacts of HBV on female reproduction. This study has evaluated the impact of HBV infection on pregnancy complications in natural pregnancy and also on pregnancy outcomes in women undergoing in vitro fertilization (IVF) treatment. Method We searched Embase, Web of Science, PubMed and Google Scholar databases to identify the potentially relevant studies. Summary odds ratio (OR) or standardized mean difference (SMD) with 95% confidence interval (CI) was applied to assess the relationship. Heterogeneity testing, sensitivity analysis and publication bias testing were also performed. Results A total of 42 studies concerning the effect of HBV infection on the natural and IVF pregnancy were included in this study. Our meta‐analysis results revealed that HBV infection had a positive correlation to gestational diabetes mellitus (GDM) [OR = 1.32 (1.17–1.48) (p < 0.01)] and preterm birth [OR = 1.26 (1.14–1.40) (p < 0.01)] in natural pregnancy; however, HBV infection was not significantly associated with decreased fertility rates among the patients who underwent IVF. Conclusion This study revealed a strong association of GDM and preterm birth with higher rates of HBV infection in pregnant women. Also, our results suggested that HBV infection in patients undergoing IVF may not negatively influence the pregnancy outcome. It may be rational to conclude that IVF might be rather a safe and effective method for HBV+ females who desire to have children.

Background  The term morbidly adherent placenta characterized by abnormally implanted, invasive, or adhered placenta, which is increasing in obstetrical practice mainly due to increasing rate of cesarean section associated with increasing mortality and morbidity which can be avoidable by good assessment by ultrasound before operation. Objectives  The aim of this study was to assess the diagnostic accuracy of pre-natal ultrasound in detecting morbidly adherent placenta in patients at risk. Materials and Methods Prospective observational study, case sheets of 125 women reviewed having placenta previa and previous uterine surgery (CS, myomectomy or curettage) from May 2018 to May 2019, population included 38 pregnant women. All cases of complete placenta previa or low-lying placenta, scans performed through either trans abdominal ultrasonography or transvaginal ultrasonography in their second and third trimesters of pregnancy, signs were loss of clear zone, placental lacunae, myometrial thinning, placental bulge, focal exophytic mass, and bladder wall interruption with the availability of more than three finding regarded as highly suspicious and final diagnosis made during cesarean section. Results Among 38 patients with risks, there was a significant correlation between increasing age and extend of morbidly adherent placenta. The average gestational age of the patients was 36.2 weeks, ranging from 20-39.3 weeks. All cases at least underwent prior caesarean delivery. There was increasing incidence of MAP with increasing number in C/S. In women with risk of MAP along with highly suspicious ultrasound findings, fourteen cases underwent hysterectomy, uterus-sparing alternatives to manage this condition can be an option in selected cases, the most reliable signs for suspecting percreta were placental bulge, focal exophytic mass, and bladder wall interruption, the sensitivity and positive predictive value was 70% and 90% respectively.  Conclusion Management with prediction of MAP by ultrasonography is useful for obtaining permissible morbidity.

Background  Over the last three decades, the incidence of placenta accreta has increased dramatically in concert with the increase in cesarean delivery rate. Moreover, placenta previa has been reported to be associated with a high rate of placenta accreta, which is mainly responsible for direct maternal mortality and morbidity. Objectives  The present study aimed to determine the risk factors of the morbidly adherent placenta and their outcomes. Patients and Methods The present cross-sectional study was carried out from May 1, 2018, to May 1, 2019. For this purpose, a total number of 38 pregnant women with morbidly adherent placenta above 20 weeks’ gestations were selected. Afterwards, the patients were interviewed using a constructed questionnaire. The data were analyzed using the Chi-square test by Statistical Package for Social Science (version 24). P-values of less than 0.05 were regarded as significant. Results Approximately 63% of patients did not report a previous history of previous surgical evacuation, and more than half of them did not have a history of previous abortions. More than 88% of cases of placenta accreta were reported among those with late gestational age. In more than 76% of the patients, the placental position was in an anterior position. Cesarean hysterectomy was the most commonly used surgical intervention. Also, more than two-thirds of them needed a blood transfusion. Furthermore, 75% of placenta increta occurred among anterior placental positions.  Conclusion The morbidly adherent placenta is common in patients with repeated cesarean section. Cesarean hysterectomy is the traditional method of managing mean arterial pressure (MAP) to prevent severe blood loss and other maternal morbidities.

Introduction and importance Leiomyomas can affect 20–30% of women of reproductive age and are commonly observed in the uterus. Their occurrence in the vagina is exceedingly rare, representing the least common presentation among all locations. Herein, we report a case of vaginal leiomyomas in a 48-year-old lady. Case presentation A 48-year-old female presented to our gynecology clinic complaining of feeling a mass within her vagina. Physical examination revealed a round, smooth mass in the anterior vaginal wall with a normal-looking cervix. Ultrasound examination showed an enlarged anteverted uterus with an endometrial thickness of 14 mm and an endometrial polyp of 15 × 7mm arising from the left upper anterolateral wall. Magnetic resonance imaging demonstrated a well-defined, fusiform, submucosal vaginal mass originating from the anterior vaginal wall, measuring 37× 22 × 36 mm. Hysteroscopy was performed, and the uterine and vaginal masses were resected. The masses were confirmed to be conventional leiomyomas. Clinical discussion The diagnosis is seldom established preoperatively and the preferred therapeutic approach for treating vaginal leiomyoma is surgical removal via the vaginal route. However, in the case of large tumors, the abdominoperineal route may be necessary. Conclusion Vaginal leiomyoma is a rare tumor with approximately 300 reported cases worldwide. It can be asymptomatic or cause to feel it within the vagina. Besides the necessity of surgical resection, colporrhaphy as a reconstructive surgery may be required.