مجله زنان مامائی و نازائی ایران
سال نوزدهم شماره 202 (هفته اول امرداد 1395)

Community women's health is more vulnerable than men due to various reasons, in addition to biological characteristics; it is influenced by cultural, social, economic and political factors. Nowadays,managing maternal health development is one of the World Health Organization priorities.This study was performed with aim to improve maternal and child health service package in Iran by providing variables derived from a comparative study conducted in selected developed countries.
In thiscomparative study, the studied countries(Singapore, Australia, England and Japan) wereselectedby comparingmaternal-child healthindicators from different continentsusing cluster sampling and with studying of their maternal and child health service package through referring to valid health documents, important variablesanddimensions were identified, and based on itand designed comparative tables, the conclusion was made.
Free sportsandtraining classeswiththe husband's presence, extensive maternal network emergency as specialized and boarding, varietyof vehicles fortransportto emergency centers,emotional supportpackages, home visit and delivery, newbornsfreesurgical facilitiesandcare, pregnant womenscreeningfacilitiesfor free, guideline booklet and unifiedrecording of servicesin allcountrycenters are the factorsidentified in successfulmaternal- child health servicespackage.
The role ofsome identified factors such as home visit and deliveryis loworabsent in Iran health service package. Implementation ofthesuggested factors canplay an important rolein promotingmaternal-child healthindicators inIran.

Delay in episiotomy repair leads to adverse anatomic outcomes, increased infections, decreased sexual function, and impaired relationships between mother and baby, but little research has been done in this field. Therefore, this study was performed with aim to determining the relationship between delivery and neonatal factors with healing of episiotomy in primiparous women.
This correlation study was conducted on 119 eligible mothers referring to Mashhad Omolbanin Hospital in 2013. Information about delivery, neonate and mother was gathered by the questionnaires and their relationship with wound healing as measured by Reda form on 1st, 7th, 10th and 14th days after delivery was determined. Data was analyzed using SPSS software (version 16) and Kolmogorov-Smirnov, one-way ANOVA, regression, Spearman’s test, and Pearson’s correlation tests. P At 10th and 14th days after delivery, inverse correlation was found between length skin incision (P=0.037, P=0.026), the number of sutures with 2/0 catgut (P=0.042, P=0.028), the activity leading to tension and pressure on the stitches (P=0.037, P=0.048), rate of sitting (P=0.011, P=0.030) with episiotomy healing; and direct correlation was found between hygiene (P=0.048, P=0.039) with episiotomy healing. Inverse correlation was found between pain and episiotomy healing at 7th (P=0.015) and 10th days (P=0.035). Also, inverse correlation was observed between the number of skin sutures (P=0.012) and episiotomy healing at 14th days after delivery; it means that more number of skin sutures leads to delay in episiotomy healing.
Among all variables, more extensive incision, more number of skin sutures and more sutures with 2/0 catgut, long sitting, tension and pressure on the stitches, severe episiotomy pain and lack of hygiene lead to delay in healing of episiotomy. Therefore, it is recommended to train health care providers and mothers about these factors.

Vulvar cancer, primary or metastatic, is a rare tumor constituting Case report: A 56 years old woman with history of renal cell carcinoma with ulcerative vulvar mass referred. Biopsy of vulva reported metastasis of renal cell carcinoma. Patient underwent local resection of lesion and chemotherapy.
The high clinical suspicion for vulvar metastasis should be considered in women with history of cancer who refer with vulvar lesion. Early diagnosis and appropriate treatment can affect the prognosis of these patients.