فهرست مطالب

Midwifery & Reproductive health - Volume:8 Issue: 1, 2019
  • Volume:8 Issue: 1, 2019
  • تاریخ انتشار: 1398/10/09
  • تعداد عناوین: 16
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  • Somayeh Alirezaei, Robab Latifnejad Roudsari * Pages 1986-1987
  • Kobra Mirzakhani, Fatemeh Zahra Karimi, Atieh Mohamadzadeh Vatanchi, Fakhera Feroz Zaidi, Khadijeh Mirzaei Najmabadi * Pages 1988-2004
    Background & aim

    Maternal care during the different stages of labor should be targeted towards the promotion of maternal, fetal, and neonatal health status. Maternal position is very important in labour and delivery Care. Nevertheless, there is controversial results regarding the effect of maternal position in labor. The present study reviewed the effect of maternal position on maternal, fetal, and neonatal outcomes.     

    Methods

    In this systematic review, databases including PubMed, Web of Science, Scopus, Google Scholar as well as Persian databases of Magiran and SID, were searched and all related articles between 2005 to 2018 were retrieved. The quality of the studies was examined using the Joanna Briggs Institute tool.

    Results

    17 clinical trials performed on 4,848 subjects were reviewed. Maternal position during the labour were the upright and lying positions. The outcome measures included duration of the different stages of labor, persistent posterior position, postpartum hemorrhage, maternal pain, anxiety and fatigue. The fetal and neonatal outcomes entailed Apgar score, umbilical venous blood pH, need for neonatal resuscitation, and need for hospitalization in NICU. The results revealed that different maternal positions during the first- and second-stage of labor did not affect maternal, fetal, and neonatal outcomes. However, all studies stated that low-risk mothers should have the chance for choosing a comfortable position in the different stages of labor.

    Conclusion

    In order to propose an evidence-based care plan concerning maternal position in labor, it is required to perform further studies with higher quality regarding the effect of maternal position on maternal, fetal, and neonatal outcomes.

    Keywords: Maternal position, Pregnancy outcomes, labor, Systematic review
  • Muhammad Younas *, Yasmin Parpio, Tazeen Saeed Ali, Safia Awan Pages 2005-2015
    Background & aim

    Active participation of men in antenatal care and their considerable knowledge about this issue is resulted in favorable pregnancy outcomes. This study aimed to assess the knowledge and practices of male partners regarding antenatal care (ANC) and their associated factors in district Swat, Khyber Pakhtunkhwa, Pakistan (KPK).

    Methods

    This cross-sectional study was conducted on 200 married men residing in district Swat KPK, Pakistan in 2015 who were selected by convenience sampling. The data were collected by valid and reliable self-structured questionnaire and were completed by participants. The data were analyzed with STATA (version 11) using descriptive and inferential statistics.

    Results

    The findings of the study revealed that almost half of the participants (52%) demonstrated a good knowledge of ANC. Moreover, factors as the socio-demographic variables, men’s level of education (P < 0.01), occupation (P < 0.01), number of family members (P < 0.01), and history of wife's premature delivery (P< 0.01) were found to be significantly associated with men’s knowledge of ANC. With regard to practices of ANC, majority (84%) had good practices in terms of male involvement in ANC. Also 95/5% men allowed their wives to refer to ANC facilities and 85/5% accompanied them.

    Conclusion

    The present study concluded that men demonstrated a reasonable practice of ANC, as compared to their knowledge. This study paved the way for further research on men’s involvement in ANC in Pakistan.

    Keywords: Antenatal care, Men, Knowledge, Practices
  • Alireza Nazari, Mohammadreza Mokhtari, Ramin Rouhafza, Soheila Pourmasumi * Pages 2016-2021
    Background & aim

    Idiopathic male infertility refers to the condition in which there is no clear cause for the diagnosis of infertility. Human menopausal gonadotropin (HMG) containing the follicle-stimulating hormone and luteinizing hormone is a medication that causes ovarian follicles to grow in women. This medication can also induce spermatogenesis in men. The present study was conducted to investigate and compare the rates of pregnancy and live birth in partners of men with unexplained infertility after the injection of 8 and 12 ampules of HMG.

    Methods

    This clinical trial study was carried out on 22 men with unexplained infertility who referred to the Urology Clinic of Rafsanjan University of Medical Sciences, Rafsanjan, Iran, during March 2016 and December 2018. The patients were randomly divided into two groups each of which included 11 cases. For one group 8 HMG injections and for the other group 12 HMG injections were administered (two injections per week). Afterward, the results of clinical pregnancy were assessed, and the cases were followed up to live birth after the clinical pregnancy. Data analysis was carried out using the Chi-square test.

    Results

    In this study, the rate of positive pregnancy was reported as 62.5% in the group with 12 HMG injections in comparison to 37.5% in the group with 8 HMG injections. Although the pregnancy rate was higher in the 12-injection group, statistically there was no significant difference (P=0.7).

    Conclusion

    According to the results of the present study, it can be concluded that for couples with unexplained male infertility, the administration of 8 to 12 HMG injections can increase the chance of pregnancy and live birth. Since this study was the first attempt to evaluate the pregnancy rate after treatment with HMG, it is suggested to perform further studies for the assessment of HMG effect on hormonal profile and chromatin quality.

    Keywords: Male Infertility, HMG, Pregnancy rate, Live birth
  • Muhammed Abdu Muhammed, Ritbano Abdo * Pages 2022-2032
    Background & aim

    Long-acting reversible contraceptives (LARC) have been very effective in the reduction of unintended pregnancies at least for 3 to 12 years. However, the use of LARC is low in developing countries, including Ethiopia. This study aimed to assess LARC utilization and associated factors among family planning users in public health facilities in the Afar region, northeast Ethiopia.

    Methods

    This facility-based cross-sectional study was carried out on 524 participants using systematic sampling method during December 15 to February 15 in 2018. The data collection was performed using a structured interviewer-administered questionnaire. The data were entered into EpiData software (version 3.1) and analyzed using SPSS software (version 21). Multiple logistic regression analysis was used to identify the association between the independent variables and outcome variable with a 95% confidence interval (CI).

    Results

    Overall prevalence of LARC utilization was observed to be 33.4%. The factors significantly associated with the utilization were knowledgeability (AOR=2.7; 95% CI: 1.7-4.4), positive attitude toward LARC (AOR=1.5; 95% CI: 1.1-2.3), discussion with husbands about LARC (AOR=2.4; 95% CI: 1.5-3.8), and women's age 15≥ "> 35 years (AOR=0.3; 95% CI: 0.2-0.7).

    Conclusion

    Utilization of LARC was low in the study area. Factors related to utilization suggested that strengthening maternal knowledge, creating a positive attitude, and encouraging discussion between the husband and wife about LARC are important to increase the use of LARC.

    Keywords: Long-acting reversible, contraceptive, Utilization, Associated factors, Afar region
  • Marzyeh Azizi, Sedigheh Yousefzadeh *, Hassan Rakhshandeh, Hamid Reza Behnam, Masoumeh Mirteymouri Pages 2033-2040
    Background & aim

    The negative effect of labor pain on the tendency of mothers to choose vaginal delivery demands identifying effective and safe methods to reduce pain. Regarding the analgesic effects of ginger, the present study aimed to determine the effect of back massage with and without ginger oil on the pain intensityin the active phase of labor in primiparous women.

    Methods

    This randomized clinical trial was conducted on 90 primiparous women in Umm al-Banin Hospital, Mashhad, Iran (2017). The subjects were selected using convenient sampling and randomly assigned into three groups, namely massage with ginger oil, massage with placebo (i.e., paraffin), and control group. The intervention and placebo groups received 15-minutes back massage in the active phase of labor. The pain intensity was measured in three groups before and after each dilation. The data were collected using questionnaires for demographic and obstetric data as well as Visual Analog Scale for pain measurement. The obtained data were analyzed in SPSS software (Version 16) through Kruskal-Wallis and the Chi-square tests.

    Results

    The mean values of pain intensity after three evaluations were obtained as 4.1±2.29, 6.8±1.73, and 7.6±1.43 in ginger, placebo, and control groups, respectively. The results showed that the ginger group reported the lowest level of pain during the active phase of labor (P<0.001).

    Conclusion

    Back Massage with ginger oil not only has effect on pain relief but also was completely safe in order to be administered to mothers during their first experience of childbirth.

    Keywords: ginger, Labor pain, Massage, Women
  • Suneela Garg, Saurav Basu *, Dinesh Baswal, Warisha Mariram, Ruchir Rustagi Pages 2041-2049
    Background & aim

    Most maternal mortalities are preventable; however, there are significant regional and global disparities in this regard. Maternal Death Surveillance and Response (MDSR) launched in India is a continuous cycle of identification, notification, and review of maternal mortalities to improve the quality of care and prevent future deaths. The Ministry of Health and Family Welfare in India conducted five national capacity-building workshops for MDSR during October 2017 and February 2018 with the objective of training medical doctors as future trainers and developing competency-based skills for each component of the program. 

    Methods

    A training evaluation study was carried out on 144 workshop participants. Workshop outcomes in terms of trainees’ knowledge were assessed using a 20-item pre-post questionnaire and skill evaluations through group work. The data were analyzed using SPSS software (version 25). The difference in proportions was ascertained using the Chi-square test.

    Results

    The mean score of the participants (n=144) increased from 13.2±2.3 in the pretest to 17±1.9 in the posttest (maximum score: 20). Themes generated during community and facility review sessions indicated the need for the capacity building of peripheral health facilities, sensitization for mandatory birth preparedness, complication readiness of all pregnant mothers by the frontline health workers, and regional-level MDSR training of all stakeholders involved in maternal mortality reporting.

    Conclusion

    Training sessions were effective in the skill development of the participants in understanding the structure and function of the MDSR program.

    Keywords: Maternal mortality, Surveillance, Training evaluation
  • Gulbahtiyar Demirel *, Funda Evcili, Nurdan Kaya, Adem Doganer Pages 2050-2057
    Background & aim

    The prevalence of episiotomy varies significantly between countries (9%-100%). During simulation-based training, the use of materials which are considerably similar to human tissues is critical for the long-term success of training while performing episiotomy on laboring women. This study was performed to determine the effects of episiotomy repair simulation on the anxiety and self-efficacy levels of midwifery students.

    Methods

    This one-group, quasi-experimental study with a pretest-posttest design was conducted at the Midwifery Department of a State University in Turkey between March and April 2017. The participants included 73 junior students, who trained during March-April 2017 on the beef tongue model for episiotomy repair, following participation in a lecture in the classroom environment which included theoretical information about episiotomy. The data were collected using a student demographic questionnaire, the state anxiety inventory and the general self-efficacy scale. Data analysis was carried out using SPSS software (version 22.0) through McNemar’s and Wilcoxon test.

    Results

    There was a significant difference before and after the simulation process regarding the state anxiety scores (39 vs 43, P<0.000). Moreover, a significant difference was observed before and after the simulation in terms of the general self-efficacy scores (76 vs 67, P<0.000). In other words, the students' anxiety levels decreased followed by increasing levels of self-efficacy after simulation (P<0.05).

    Conclusion

    A beef tongue episiotomy repair simulation training and application reduced the anxiety and increased the self-efficacy levels of the students. In light of these results, it is recommended to include the beef tongue episiotomy repair simulation into the pre-clinical practice in the midwifery curriculum.

    Keywords: Anxiety, Beef Tongue model, Episiotomy, Self-efficacy, Simulation, Training
  • Seyede Sara Kharazi, Nooshin Peyman *, Habibolah Esmaily Pages 2058-2068
    Background & aim

    The investigation and identification of health predictive factors in promoting healthy behaviors of women at reproductive age can improve maternal health and pregnancy outcomes. This study aimed to determine the relationship between maternal health literacy and dietary self-efficacy and its impact on pregnancy outcomes and neonatal birth weight.

    Methods

    This descriptive-analytical cross-sectional study was conducted on 120 pregnant women referred to health care centers of Mashhad University of Medical Sciences in 2016. The study population was selected using multistage sampling method. The data were collected utilizing Maternal Health Literacy and Pregnancy Outcome Questionnaire, Perceived Dietary Self-Efficacy, Perceived Nutritional Status and Dietary Behavior Questionnaire after the confirming validity and reliability. Data was analyzed in SPSS software (version 15) and descriptive-analytic tests, namely Pearson’s correlation coefficient, Stepwise regression method, independent t-test, one-way analysis of variance, as well as Tukey's range test, with the significant level of 95% and 99%.

    Results

    Perceived nutritional status (r=0.585, P<0.01), nutritional self-efficacy (P<0.01, r=0.711), dietary behavior (P<0.01, r=0.682), and health literacy (P<0.01, r=0.679) had a positive and significant correlation with the pregnancy outcomes and neonatal birth weight. The results of stepwise regression analysis showed that, dietary self-efficacy (R=0.71), health literacy (R=0.76), and dietary behaviors (R=0.77) could significantly predict pregnancy outcomes in the first, second, and third steps, respectively. Totally, these variables could anticipate 59% of the pregnancy outcome variance (P<0.01).

    Conclusion

    Maternal health literacy and dietary self-efficacy in pregnant women played an important role in the prediction of pregnancy outcomes and neonatal birth weight.

    Keywords: Birth weight, Dietary self-efficacy, Health Literacy, Pregnancy outcome, Pregnant Women
  • Samira Khayat *, Mahrokh Dolatian, Hamed Fanaei, Ali Navidian, Zohreh Mahmoodi, Amir Kasaeian Pages 2069-2082
    Background & aim

    Reproductive health has been documented as international human rights. In this respect, residing in slums can lead to poor reproductive health status due to reduced access to healthcare services. Therefore, the present study was conducted to determine women’s reproductive health status in urban slums in southeast Iran.

    Methods

    In this cross-sectional study, a total number of 400 married slum-dwelling women in southeastern Iran were selected through random sampling in 2017. The inclusion criteria were marriage, residence in slum areas, and age group of 15-49 years. To collect the data, the Reproductive Health Needs Assessment questionnaire was completed using face-to-face interviews. Descriptive statistics were employed to analyze the data using SPSS software (version 19).

    Results

    67.8% of sample were women who were married before the age of 18. Also 36% of the subjects had more than four children, and 79.9% of them experienced an inter-pregnancy interval of less than 3 years. Moreover, 96.8% of the participants received prenatal care services, and 81% of the individuals used family planning methods. Unintended pregnancies experienced by 26% of the subjects, and 59% of them suffered from reproductive tract infections within the last year. The prevalence rate of sexual and physical violence were 40% and 20.5%, respectively.

    Conclusion

    Although the coverage of prenatal, childbirth, and family planning services was appropriate in this region, the domains of family planning, physical and sexual violence, as well as marriage age in women living in urban slums, were undesirable and required more efforts to be improved by reproductive health professionals.

    Keywords: Reproductive Health Prenatal Care, Family Planning Services, Suburban Population, Poverty area
  • Masoumeh Kordi, Mahsima Banaei Heravan * Pages 2083-2095
    Background & aim

    Gestational diabetes is the most common metabolic disorder in pregnancy, and lack of self-care is one of the important reasons for mortality in diabetic patients. Considering that glycemic control is controlled by physiological and psychological mechanisms, it seems that depression, anxiety, and stress could affect the performance of pregnant women towards their own self-care. This study aimed to determine the relationship of depression, anxiety, and stress with self-care behaviors in women with gestational diabetes.

    Methods

    This descriptive correlational study was conducted on 400 females with gestational diabetes who referred to health-care centers and clinics of hospitals affiliated to Mashhad University of Medical Sciences, Mashhad, Iran, in 2015. Data were collected using a demographic questionnaire, a self-care scale retrieved from the Summary of Diabetes Self-Care Activities as well as Depression, Anxiety, and Stress Scale-21. The data were analyzed in SPSS software (version 22) through the Spearman correlation coefficient and multiple linear regression.

    Results

    The results of the Spearman correlation coefficient revealed that depression, anxiety, and stress had no significant correlation with self-care (P>0.05). According to the linear regression model, none of the main variables under study obtained a significant level of less than 0.05; therefore, they were not considered as predictors of self-care (P>0.05).

    Conclusion

    Since the results revealed that depression, anxiety, and stress had no correlation with self-care in females with gestational diabetes, further studies are recommended to be conducted in this regard with a larger sample size and in different settings.

    Keywords: Anxiety, Depression, stress, self-care, Gestational diabetes
  • Tadesse Nigussie *, Tegene Legesse, Lemi Abebe, Selamawit Getachew, Dereje Alemayehu Pages 2096-2104
    Background & aim

    Adolescence is the period when young people learn about sexual activity. This period exposes them to different challenges if not properly managed. Therefore, the present study aimed to determine the prevalence of risky sexual behaviors as well as its associated factors and consequences among high school and preparatory school students.

    Methods

    This facility-based cross-sectional study was carried out among 349 randomly selected high school and preparatory students of Mizan Aman Town, Ethiopia, during May, 2018. For data collection a structured and validated questionnaire regarding risky sexual behaviors was filled out by students. The data were analyzed using SPSS software (version 21). Logistic regression with 95% confidence interval (CI) was used to determine independent factors, and p-value less than 0.05 in multivariable logistic regression was used to demonstrate statistical significance.

    Results

    The prevalence rate of risky sexual behaviors was reported as 30.5%. Risky sexual behaviors were associated with issues including being from rural areas (AOR=2.041; 95% CI: 1.224-3.403), watching pornography (AOR=2.142; 95% CI: 1.219-3.766), and discussing the issue of sexuality with family (AOR=0.349; 95% CI: 0.191-0.541). Regarding the consequences of risky sexual behaviors, 8% of the respondents reported a history of signs or symptoms related to sexually transmitted infections (STIs), and 7.05% of the females had a history of an unplanned pregnancy.

    Conclusion

    One-third of the study participants had risky sexual behaviors. The residents of rural areas and students who watched pornographic films were at a higher risk and the participants who had a discussion about sexuality with their families were at a lower risk of risky sexual behaviors. The STIs, unplanned pregnancy, and abortion were the consequences of risky sexual behaviors.

    Keywords: Sexual behavior, Risky behaviors, Unsafe sex, Adolescents
  • Samira Ebrahimzadeh Zagami, Roksana Janghorban, Robab Latifnejad Roudsari * Pages 2105-2114
    Background & aim

    Increased number of unsuccessful cycles of infertility treatments might result in an increase in couples’ physical and psychological problems, which affect their expectations from family, society and healthcare system. The present study aimed to explore the expectations and preferences of Iranian infertile couples from healthcare system after unsuccessful treatment with assisted reproductive technologies.

    Methods

    This descriptive qualitative study was carried out during 2016-2017 in one of the referral infertility clinics in Mashhad, Iran. Data collection was completed through face-to-face semi-structured interviews with 29 infertile couples selected by purposive sampling. The collected data were analyzed in four stages according to the Graneheim and Lundman method using MAXQDA software (version 2010).

    Results

    The overarching theme of “expecting improvement of treatment process” included three categories of expecting enhancement of therapeutic and healthcare services, demanding financial services, and requesting for more male involvement in the treatment process were emerged. Infertile couples expected continuous high-quality follow-up appointments and requested for a systematic recording of infertility-related data. They also expected that healthcare system provide them the basis for a wide range of governmental facilities including medical loans with low interests and insurance facilities. Additionally, they preferred that physicians to communicate with both partners during consultation and expected healthcare system to provide counselling centres for male partners.

    Conclusion

    Understanding infertile couples' expectations and preferences from healthcare system after unsuccessful infertility treatment could help policy makers to adopt appropriate policies and programs to meet these vulnerable population needs, so that improve their treatment outcomes.

    Keywords: infertile couples, Unsuccessful treatment, Assisted reproductive technology, Healthcare system
  • Seyedeh Zahra Hoseini Haji, Mahboobeh Firoozi *, Negar Asghari Pour, Mohammad Taghi Shakeri Pages 2115-2125
    Background & aim

    Promoting vaginal birth after cesarean section (VBAC) is a suitable approach to reduce repeat cesarean section. It seems that counseling can help women to choose VBAC appropriately. The present study, therefore, aimed to investigate the impact of motivational interviewing on knowledge, attitude, and intention of women to choose VBAC.     

    Methods

    In this randomized clinical trial 60 pregnant women who referred to the health centers of Mashhad, Iran in 2018, were randomly assigned to two groups of motivational interviewing and control. Intervention group received three 60-90 minutes sessions of group counseling, which scheduled every other week based on motivational interviewing. The control group only received routine care. Subjects' knowledge, attitude, and intention were assessed before and two weeks after intervention. Self-structured tools were used to measure knowledge, attitude and intention of participants towards VBAC. The data were analyzed using SPSS version 25 with independent and paired t-test, U Mann-Whitney, Chi-Square and Kruskal-Wallis tests.  

    Results

    The mean score of knowledge and attitude during weeks 34-36 of pregnancy was 14.57±0.54 and 65.6±1.3 in the intervention group and 11.7±0.56 and 58.2±1.42 in the control group, respectively; which was significantly different between two groups (P<0.05). However, there was no significant difference between the two groups in terms of intention towards VBAC (P> 0.05); although a difference was seen in intention of intervention group after compared with before intervention (22.7 vs 43.4%, P < 0.05).

    Conclusion

    motivational interviewing enhances knowledge and attitude toward vaginal birth after cesarean. Therefore, this method can be applied for prenatal counseling about vaginal birth after cesarean.

    Keywords: Motivational interviewing, Vaginal birth after Cesarean Knowledge, Attitude, Intention, pregnancy
  • Mojgan Nazari * Pages 2126-2128
  • Mitra Eftekhariyazdi, Forough Mortazavi * Pages 2129-2133
    Background

    A unicornuate uterus with a rudimentary horn is a rare uterine anomaly occurring in 1 out of 100,000 to 140,000 pregnancies. The diagnosis of this complication is conventionally difficult and missed, which may cause uterine rupture leading to hemoperitoneum. The standard treatment is the surgical excision of the horn through laparotomy. The aim of this report was to introduce a case of pregnancy in a rudimentary horn of the uterus. Case report: We present a 31-year old nulliparous woman at 19 weeks of gestation with a live fetus in a rudimentary horn. The first ultrasound showed a bicornuate uterus at 13 weeks. The patient was referred to Mobini Hospital with abdominal and epigastric pain, nausea, and vomiting. Repeated blood tests, ultrasonography, and clinical signs raised the suspicion of a ruptured ectopic pregnancy. The diagnosis of a rudimentary horn pregnancy was made in the operative room. The rudimentary horn with the left tube was excised and the patient was discharged in good condition two days later.

    Conclusion

    This case highlights the importance of following up of patients whose early ultrasound indicates a uterine anomaly. In addition, obstetricians and midwives must have a high level of clinical suspicion and pay careful attention to such complicated cases.

    Keywords: Rudimentary horn, Uterus, case report, Ultrasonography, pregnancy