مجله زنان مامائی و نازائی ایران
سال هفدهم شماره 104 (هفته دوم تیر 1393)

Cesarean delivery on maternal request is defined as an elective cesarean for term pregnancy in the absence of any maternal or fetal indication. Rate of vaginal delivery and cesarean section is one of the mother health program indexes. Increase of cesarean section and decrease of vaginal birth is representative of poor performance of the health program. The purpose of this study was explanation of nulliparous women''s lived experience of cesarean delivery as a birth choice. This qualitative study with phenomenology approach was conducted on 12 nulliparous women using in-depth interview method and semi-structured. Interviews were done in health care centers or women''s home. The participants discussed reasons for the request for cesarean six weeks after childbirth. All interviews were recorded and analyzed by Colaizzi method. Three main themes and many sub-themes were extracted during this study. The main themes were: fear، unpleasant experience and others encouragement. According to the results of this study and effective factors in choice of elective cesarean in nulliparous women، it seems the best way to reduce cesarean section rate is decreasing the rate of cesarean in nulliparous women. Therefore nulliparous women with knowledge about the benefits، risks and possible complications of delivery methods should encourage selecting vaginal delivery.

Pre-eclampsia is one of the main cause of death in pregnant mothers and their babies، but its cause is still unknown. Studies have shown that increased maternal homocysteine ​​in the blood is associated with various diseases such as pre-eclampsia. For inhibition from serum homocysteine elevation، high dose folic acid can be prescribed in these cases. This study aimed to assess the association of serum levels of folic acid and homocysteine with pre-eclampsia. This case-control study was conducted on 125 women with pre-eclampsia and 125 healthy pregnant women referred to Hajar hospital of Shahrekord، Iran during 2011-2012. 5 ml of blood sample was taken and serum levels of folic acid and homocysteine ​​were measured. Data were analyzed using SPSS software version 20 and t-test، chi-square، two-way ANOVA and correlation regresion. P value less than 0. 05 was considered significant. Mean levels of homocysteine were elevated in cases with pre-eclampsia compared to control group (p=0. 01) (11. 27±4. 8 vs. 9. 9±3. 9 µmol/l) and mean level of folic acid were significantly lower in cases with pre-eclampsia (p=0. 002) (9. 96±4. 3 vs. 8. 39±3. 6 ng/ml). BMI، age، gestational age and neonatal weight have been shown to be different statistically in two groups (p<0. 001) and other variables such as education level revealed no significant differences between two groups (p=0. 257). Mothers with high serum levels of homocysteine and folic acid and high age and BMI are more at risk of pre-eclampsia. It seems that upper dose of folic acid can prevent or decrease the risk of pre-eclampsia.