مجله زنان مامائی و نازائی ایران
سال نوزدهم شماره 212 (هفته سوم مهر 1395)

The increased rate of unnecessary cesarean indicates improper function of health system. Health education leads to promotion of mother's knowledge during pregnancy in order to select appropriate mode of delivery and do not choose cesarean section without clinical reason. Therefore, this study was performed with aim to determine the effect of educational interventions based on theory of planned behavior (TPB) on selecting mode of delivery.
This experimental study was conducted on 90 nulliparous pregnant women referred to Yazd health centers in 2015. The subjects were selected with multistage sampling method and were divided into 3 groups. Group I received educational training package based on TPB model during 3 sessions of 60 minutes. Group II received education in the form of Pamphlet and control group received routine training. Attitude, subjective norms, perceived behavioral control and intention were assessed by researcher-made tools before and after the intervention. Also, the mother's decision was again asked at 38 weeks of pregnancy. Data was analyzed by SPSS (version 21) and Chi-square, paired T-test and Kruskal-Wallis test. P Before the educational intervention, there was no significant difference between three groups in terms of attitude, subjective norms, perceived behavioral control and intention (P>0.001). After the intervention, there was significant difference in all domains in education group before and after the intervention. Also, the comparison between the groups showed significant difference between the intervention group based on model and pamphlet group and control group (P Training based on model is an effective method to increase motivation, decision-making ability and skill of pregnant women to choose normal vaginal delivery. Therefore, performing preventive measures and increasing awareness of pregnant women is necessary.

The rate of cesarean section is increasing in developing and developed countries. Due to the probability of side-effects of cesarean and the importance of knowing the growing trend of this type of delivery, this study was performed with aim to survey the trend of caesarian section in Iran and the world in different studies.
In this review article, data was collected through databases of PubMed, Science Direct, CINAHL, SID, Iranmedex, Magiran, Web of Science, Google Scholar, and Scopus using the keywords of Cesarean Section Rate, caesarian section prevalence, delivery, childhood, relative causes, relative frequency. Time duration for article's selection was 1990 to 2015. Eventually, 45 articles were included in the study.
Worldwide, the rate of cesarean increased from 6.7% in 1990 to 19.1% in 2014, which represents a 12.4% increase. Cesarean rates increased 14.6 % in developing countries and 12.7% in developed countries. The cesarean rate in the United States increased from 20.7% in 1996 to 32.8 % in 2011. In Iran, the caesarean rate increased from 16% in 1985 to 60% in 2013.
Current rate of cesarean section, except for less developed countries, is consistently increasing and is higher than what is considered medically justifiable. The steep increase and inappropriate rate of caesarean section represents a health problem in Iran and requires the attention of government officials. Since there are numerous factors about the need for caesarean section, various strategies including mother-friendly hospitals, development of standard protocols; preparation classes for mothers, midwives, and gynecologists, and workshops for specialists and midwives should be considered to avoid unnecessary use of this method.

Meig’s syndrome is a triad of "ovarian benign tumor, ascites and plural effusion" and the patient refers with a probable malignant ovarian mass, but it is benign; and the symptoms would be vanished by eliminating the tumor. As this is a rare syndrome, we decided to present this case.
A 26 years old virgin girl with an abdominal mass and stable vital signs referred to Gynecology clinic of Imam Reza hospital. A pelvic mobile mass, sized 18 weeks of pregnancy was palpated. Sonography reported a solid pelvic mass with cystic components around 140×100 mm that indicated either submucosal pedanculated uterine fibroma or right ovarian mass. Ascites and right pleural effusion were reported in the second ultrasonography. Tumor markers except CA125 were normal. One liter of ascites fluid was evacuated during surgery. A 150×170 mm ovarian tumor in the ovary with a complete capsule without adhesion was obtained. Benign ovarian fibrothecoma was confirmed by frozen section. The permanent pathology report was benign ovarian fibroma. The peritoneal fluid cytology, left ovarian biopsy, diaphragmatic and paracolic groove specimens were normal. The patient was fine two weeks after surgery with no pleural effusion and ascites.
Although combination of ascites and elevated CA125 with a pelvic mass mostly indicates an ovarian malignancy, but Meig's syndrome must be considered in young women. So, ascites and pleural effusion and elevated CA125 in combination with a solid ovarian tumor is not always an indicator of a malignancy especially in young women.