مجله زنان مامائی و نازائی ایران
سال بیست و چهارم شماره 5 (امرداد 1400)

One of the most common methods of pregnancy termination in postdate pregnancies is cervical ripening by insertion of a Foley catheter in the hospital. Recently, some studies have been performed on cervical ripening as outpatient to reduce the length of hospital stay. This study was performed with aim to compare the results of outpatient and inpatient cervical ripening.

This case-control study was performed on 231 women with prolonged pregnancies in 2019. First, Foley catheter was inserted through the cervix. Outpatient group was sent to the home and the other group was hospitalized. After spontaneous excretion of the catheter, induction was performed in both groups using misoprostol and oxytocin. Duration of catheter insertion until its excretion and until delivery, dose of misoprostol and oxytocin, length of hospital stay, incidence of postpartum fever and rate of cesarean section were determined in both groups. Data were analyzed by SPSS software version 16) and Chi-square, independent T-test and or non-parametric equivalent tests. p < 0.05 was considered statistically significant.

The time interval between Foley catheter incretion and excretion (P=0.000) and the time interval between insertion of the Foley catheter and delivery (p=0.046) was significant between the two groups and was less in the hospitalized group. The need for misoprostol (p=0.001) and oxytocin (p=0.02) was different between the two groups and was less in the outpatient group. Mode of delivery (p= 0.892) and postpartum fever (p=0.202) was not significantly different between the two groups; the duration of hospitalization was shorter in outpatient group (p=0.051).

Outpatient cervical ripening in postdate pregnancy has no complication and shortens the duration of hospitalization.

The current and alarming condition of Covid-19 pandemic may cause stress and anxiety in pregnant women. Due to the high prevalence of the disease in Kashan, this study was performed with aim to determine the anxiety and perceived stress of pregnant women toward Covid-19 and its related factors.

This cross-sectional descriptive study was performed in 2020 on 360 pregnant women by electronic questionnaire in Kashan. Data collection tools were demographic-fertility information questionnaire, the questions related to Covid-19 disease, coronavirus anxiety scale (score range: 0-54) and Cohen perceived stress questionnaire (score range: 0-56). Data were analyzed by SPSS software (version 16) and statistical tests of t-test, ANOVA, linear regression and Pearson correlation coefficient. P

The total anxiety score of pregnant women in relation to Covid-19 disease was 18.71 ±12.48 and the perceived stress score was 24.57±7.00. Linear regression test showed that person's job, problems during pregnancy, delivery history, family members infection with coronavirus and concern about the consequences of the disease for themselves and the infant were the predictive variables of perceived stress score; and the variables of family members infection with coronavirus, concerns about infection of themselves and the infant, concern about receiving prenatal care, and the presence of problems during pregnancy were the predictors of anxiety scores in pregnant women.

The level of anxiety and stress of pregnant women was high during the Covid-19 pandemic and women had many concerns about infecting themselves and the infant or referring to receive prenatal care.

Many changes occur in postpartum period in the body and soul of mothers that may lead to mothers' feeling fatigue. The use of reflexology has been well established as a branch of complementary medicine in the promotion of health care, especially in the field of maternal and neonatal health. Therefore, this study was performed with aim to investigate the effect of foot reflexology on postpartum fatigue in primiparous women.

This clinical trial study was performed on 70 primiparous women referred to the healthcare centers in the south of Tehran in 2018. The subjects were divided into two groups of control and reflexology. The mothers of the control group received postpartum routine care and the reflexology group received massage for 3 consecutive days for 30 minutes (15 minutes per leg). Both groups completed the fatigue assessment-visual questionnaire before and after the intervention (immediately and one week after completion). Data were analyzed by SPSS statistical software (version 21) and parametric inferential statistical tests such as analysis of variance with repeated measures and non-parametric measures (Chi-square). Also, independent t-test was used to determine the significant difference between the mean of some social demographic characteristics with the treatment outcome. p < 0.05 was considered statistically significant.

Demographic characteristics and severity of fatigue before the intervention were the same in both reflexology and control groups. Immediately after the intervention (p <0.001) and one week after the intervention, the severity of fatigue between the two groups of reflexology and control showed a statistically significant difference (p <0.001).

Supportive and rehabilitation measures such as foot reflexology can be effective in reducing fatigue of primiparous mothers after normal delivery.

Premature Rupture of Membranes (PROM) is one of the common problems of midwifery, which its early diagnosis is essential in the process of treatment and prevention of pregnancy adverse outcomes. Therefore, this study was performed with aim to evaluate the diagnostic accuracy of Creatinine and human chorionic Gonadotropin (HCG) test of cervical mucusdischarge to diagnose PROM in pregnant women.

This prospective study was conducted in 2017-2018 on 150 pregnant women with gestational age of 24 to 37 weeks and suspected to PROM. The subjects were divided into two groups of Rupture Membranes (Pooling and Fern test both of them were positive) and control group (Pooling and Fern test both of them were negative and AFI was normal). Creatinine was measured with Automated Analyzer method (Prestige device) and βHCG with Chemi-luminescence Signal Band method (Abbott device). Cut-off point and diagnostic accuracy were measured for two tests by rock curve. P-value<0.05 was considered statistically significant.

The highest sensitivity and specificity for creatinine in the diagnosis of PPROM was obtained at cut-off point 0.135 and for βHCG at cut-off point 26.78, with sensitivity of 91.7% and specificity 56.1%, and positive predictive value of 39.75% and negative predictive value of 95.52% and overall accuracy was 64.66% and the agreement rate was 0.33 (P <0.001). For βHCG, the sensitivity 58.3% and specificity 63.2%, and positive predictive value 33.33%, and negative predictive value of 82.75% and overall accuracy was 62% and the agreement rate was 0.171 (P=0.023).

The sensitivity and diagnostic power of Creatinine in preterm women was higher than βHCG. Reasonable price, simplicity, and safety are the advantages of both methods. The diagnostic accuracy obtained in this study was low, but due to the limited studies in preterm patients, the clinical use of these markers cannot be recommended or rejected; therefore, more studies are suggested.

Cesarean section is one of the most common surgeries in midwifery. Due to the lack of a coordinated approach for antibiotic injection before cesarean section and not knowing the advantages and disadvantages of antibiotic injection time on mother and fetus, therefore, this study was performed with aim to compare the effectiveness of prophylactic antibiotics prescribing before cesarean section with prescribing after umbilical cord clamping to prevent infection after cesarean section.

This triple-blind randomized clinical trial study was performed on 150 women with cesarean delivery in Shahidan Mobini Hospital of Sabzevar in 2019. In the intervention group, antibiotic was administered after umbilical cord clamping and in the control group, antibiotic was administered before cesarean section incision. Symptoms of infection were assessed using the checklist on the 3rd, 10th, and 14th days. Data were analyzed by SPSS software (version 19) and Chi-square, Exact Fisher and Mann-Whitney tests. p < 0.05 was considered statistically significant.

On the 3rd day after surgery, none of the patients in the two groups had infection. On the 10th day, 1 patient (1.3%) in the intervention group and 3 (4%) in the control group developed symptoms of infection (p = 0.31). On the 14th day after surgery, 1 patient (1.3%) in the control group and 5 (6.7%) in the intervention group had symptoms of infection (p = 0.10). The difference of infection on the 10th and 14th days was not statistically significant in the two groups.

Antibiotic injection after umbilical cord clamping and one hour before surgery does not differ in the rate of postoperative infection.

Neonatal jaundice is one of the most common neonatal problems that occur for various reasons and may lead to brain complications and even death. Considering the effect of mothers' beliefs on the timely referral of neonates for treatment and prevention of its serious complications, this study was performed with aim to identify the women's viewpoint on the traditional and complementary medicine in the case of neonatal jaundice.

This qualitative study was conducted with participation of 103 mothers with different personal and social characteristic in Neyshabour in 2019. Data were collected through focused group discussions and semi-structured individual interviews. Purposeful sampling continued until data saturation. Data were analyzed by conventional content analysis and Atlas.ti software. The proposed methods of Lincoln and Guba were used to evaluate and increase the validity and reliability of the research.

The main extracted concepts included preventive beliefs and therapeutic-based beliefs. The theme of preventive beliefs originated from the subclass of protective nutritional beliefs. In addition, the theme of therapeutic-based beliefs included the subclass of beliefs in herbal medicine, common non-herbal beliefs, nutrition therapy, and alternative therapy.

The preventive and therapeutic-based aspects of traditional and complementary medicine about neonatal jaundice were the important beliefs of mothers. It is suggested that in the health planning and interventions to pay attention to modifying these beliefs in the formation of mothers' behavior for the prevention and treatment of neonatal jaundice.

Diabetes is the most common medical complication of pregnancy. Identifying the new risk factor can help to early diagnosis of the disorder. CRP and Interleukin-6 are two inflammatory markers which can anticipate some pregnancy adverse complications. This study was performed with aim to assess the relationships between maternal serum CRP and Interleukin-6 (IL-6) at first trimester of pregnancy and gestational diabetes Mellitus (GDM) occurrence.

This descriptive-analytical cross-sectional study was performed in 2015-2016 on 500 pregnant women with gestational age < 14 weeks in Nilou laborator, Tehran. Serum levels of CRP, IL-6, fasting blood sugar (FBS) and lipid profile were measured. GDM screening was performed in 24-28 weeks of gestation. Data were analyzed by SPSS statistical software (version 21) and Kolmogorov-Smirnov, Chi-square, Mann-Whitney tests and Logistic regression model. P<0.05 was considered statistically significant.

GDM was found in 78 women (15.6%). Median CRP levels in GDM and non-GDM groups (4.8 vs. 5.22 mg/ml) (P=0.089) and median IL-6 (1.45 vs. 1.5 pg/ml) (P=0.574) was different, but the difference was not statistically significant. After adjusting the confounding variables in the logistic regression model, there were no statistically significant relations between serum level of CRP (OR=1.01, CI95%=0.96-1.07) (P=0.50) and IL-6 (OR=1.01, CI95%=0.89-1.46) (P=0.88) with GDM occurrence.

CRP and IL-6 levels are not significantly associated with the occurrence of GDM.

Most women experience some degree of sleep disorder during the postpartum period. Since rose water essence is effective in depression, nervous tension and drowsiness, this study was performed with aim to investigate the effect of rose water aroma on the quality of sleep in breastfeeding women.

In this randomized clinical trial study, 84 women at the puerperium period who referred to the five selected health centers in Arak in 2019 were studied. Aromatherapy with rose water essence was performed for three nights in the intervention group. The control group didn't receive any intervention. Sleep quality was collected in the two groups before and at the end of the study by the Pittsburgh questionnaire. Data were analyzed by SPSS software (version 21) and independent paired t, covariance and chi-square tests. P <0.05 was considered statistically significant.

After the intervention group, sleep quality increased in the aromatherapy group)p<0.05), while in the control group, the quality of sleep did not change before and at the end of the study (0.824) . Also, at the end of the study, sleep quality significantly increased in the intervention group compared to the control group (p<0.05).

It seems that women's sleep quality during puerperium period improved with rose water aromatherapy. Therefore, the use of rose water aromatherapy during lactation is recommended to improve the sleep quality of women during puerperium period.

Low back pain is one of the most common and costly problems during pregnancy. Exercise is one of the therapeutic strategies. Therefore, this study was performed with aim to determine the effect of water exercise on improving pain and disability in pregnant women with low back pain.

This randomized clinical trial study was conducted on 54 pregnant women with low back pain referred to the healthcare centers in Qazvin in 2019. The subjects were randomly divided into two groups of intervention and control using block allocation. The intervention group participated in 24 sessions of water exercise from 20 to 34 weeks of pregnancy. The control group received the standard prenatal care. The Roland-Morris Questionnaire (RMQ) and the Visual Analogue Scale (VAS) were completed before, 4 and 8 weeks after the intervention in both groups. Data were analyzed by SPSS software (version 24) and U Mann-Whitney and Friedman tests. P< 0.05 was considered statistically significant.

Water exercise had significant effect on the mean score of pain intensity (1.44±1.42, 8.14±1.76) and the disability of low back pain (3.44±2.45, 17.29±2.98) in the intervention group compared to the control group after 8 weeks of intervention (p<0.001).

Water exercise during pregnancy can improve pain intensity and disability in women with low back pain; it is recommended as a non-pharmacological method for low-risk pregnant women with low back pain.

One of the most important factors affecting the stability of marital life is sexual health, which affects the human's quality of life. Therefore, it is important to take appropriate measures to maintain sexual health and prevent and treat the sexual disorders. This study was performed with aim to review the effect of medicinal plants in the treatment of sexual disorders.

To find the related articles in this narrative review study, the related keywords were searched in the databases of PubMed, Scopus, Web of Science, SID, Magiran, Embaseand Google Scholar until March 2020 without time limitation. For each plant, the selected clinical trials and reviews with full text and published in English or Persian were used.

In the present review study, after an initial review of 717 articles, finally 75 articles were reviewed.According to the findings of this study, the effects of plants on sexual disorders are different. Some plants like as Rose reduce dyspareunia, create orgasm and increase libido and some plants such as Ginger improve erectile dysfunction and sexual satisfaction. Some plants like as Tribulus are effective in reducing sexual dysfunction by increasing the number and quality of sperm as well as the increasing testosterone hormone.

The findings of this study showed that the use of appropriate plants can be effective in treating sexual disorders; however, more studies in this field are needed.

Breastfeeding is one of the most important strategies for the growth and survival of children, because it provides their physical, physiological and mental needs up to 6 months, so this review study was performed with aim to determine the prevalence of exclusive breastfeeding and its related factors in Iran.

In this systematic review and meta-analysis study, the databases of Scopus, PubMed, web of science, SID, Magiran, Iranmedex, IranDoc and Google Scholar, the references of selected articles and unpublished sources (conferences, thesis) with the keywords of Breastfeeding, Exclusive, Prevalence and Iran were evaluated from 2010-2019. The Strobe checklist was used to assess the quality, the I2 index was used to assess the heterogeneity, and the Egger’s test was used to assess the diffusion bias. The random effects model was used for the combined prevalence and odds ratio with 95% confidence interval. Data were analyzed by Stata software (version 16).

From 30 studies that their results were extracted, 19740 children were examined. The prevalence of exclusive breastfeeding was 0.49 (CI 95%; 0.38-0.59). The exclusive feeding odds ratio for type of delivery was 1.36 (CI 95%; 1.7-1.72), for education level was 1.36 (CI 95%; 1.01-1.84) and for maternal occupation was 2.15 (CI 95%; 1.09-4.23).

The present study showed that the prevalence of exclusive breastfeeding was low and requires intervention measures.

Abscess formation afterpubis symphysial separation in normal vaginal delivery is rare, and few cases have been reported in the literature. In this study, a case of abscess formation following pubis symphysis separation in normal vaginal delivery is reported that was successfully treated after identifying the infection causative organism.

The patient was a 23-year-old female referring to Besat Hospital Clinic, Sanandaj, with pain, swelling, and redness of the suprapubic region following second normal delivery along with increasing fever and chills. The patient reported pain and difficulty in movement before delivery, which increased after delivery. Clinical examination of the patient showed pain, sensitivity, and swelling at the suprapubic region. In laboratory studies, inflammatory markers were elevated. The patient underwent ultrasound, which showed rectus sheath hematoma and edema. The pelvic X-ray showed a pubic symphysis separation of 20 mm. The patient underwent Spire ultrasound, which indicated an abscess. In the sample culture, Streptococcus viridans was grown. The patient was treated with antibiotics imipenem and vancomycin. Due to the lack of fever, pelvic abscess was diagnosed, so a laparotomy was performed and a drain was inserted. On day 35 of hospitalization, the patient underwent X-ray before discharge; the results of the X-ray indicated a 10-mm pubic symphysis separation. The patient was discharged in good condition.

In pregnant or postpartum women with general symptoms of infection, the presence of septic symphysis should be suspected and immediate and comprehensive action should be taken to treat it..