Journal of Midwifery & Reproductive health
Volume:9 Issue: 4, Oct 2021

Novel coronavirusease 2019 (Covid-19) started in China and caused unexplained pneumonia. The risk of adverse pregnancy outcomes increase in respiratory viral infection during pregnancy. This systematic review was performed to investigate the maternal and neonatal outcomes in pregnant women infected with Covid-19.

In this systematic review, the international databases (PubMed, Cochrane Library, Web of Science, Scopus, Embase, PsycINFO, Google scholar) as well as national databases (SID and Magiran) were searched to find out the articles published from 1 September 2020 to 30  April 2021 regarding maternal and neonatal outcomes in pregnant women infected with Covid-19. Keywords were selected based on Mesh (“Pregnancy”, “Gravidity”, “Delivery”, “Infant”, “Newborn”, “Neonate”, “Outcome”, “Complication”, “Abortion”, “Obstetric Labor, Premature”, “Cesarean Section”, “Fetal Death”, “Infant, Premature”, “Coronavirus Infection”, “COVIDK19”). The full texts of articles were reviewed by two independent reviewers and the relevant data was extracted.

20 studies including 78 pregnant women entered in this review. All women were at third trimester of pregnancy except 2 cases who were less than 28 weeks. The most prevalent clinical symptoms were fever, cough and sore throat. The most common maternal outcomes were intrauterine distress, rupture of membranes and preterm delivery. Most infants delivered by cesarean section. The most common neonatal complications were prematurity, small for gestational age, fetal distress, low birth weight and bacterial pneumonia.

In this systematic review, we found some evidence to suggest that COVID-19 pneumonia causes negative maternal and neonatal outcomes in pregnant women infected with Covid-19.

Abstinence can be a healthy approach for adolescents to prevent risky sexual behaviors. Understanding the pattern of sexual behaviors and the related factors of sexual decision-making is essential for an effective educational program for college students. This study was performed to determine the prevalence of sexual abstinence and its associated factors among American university students.

In this study, 808 university students from different countries attending Central Michigan University (CMU) in the United States of America were recruited in 2018-2019. In this cross-sectional survey, the students were randomly selected and invited by email to participate in the study. A self-administered questionnaire extracted from World Health Organization (WHO) questionnaire on sexual health was used for data collection through Qualtrics software. Statistical analysis was done using IBM SPSS software.

The mean age of the participants was 23.87±7.56 years. The prevalence of sexual abstinence was 14.9%. The prevalence of sexual abstinence was significantly different among females and males (P<0.05). Fears of pregnancy (37.5%) and HIV/AIDS or other sexually transmitted diseases (32.8%) were the common reasons for not having sex. Income was also significantly associated with sexual abstinence in university students (P<0.01).

Overall, the prevalence of sexual abstinence was low in American university students. Comprehensive sex education should be considered as precedence in this population, particularly among the younger university students.

Gaining health behaviors suitable for women during pregnancy is important for the pregnant woman to complete it in a healthy way.This study was carried out to examine the relationship between spousal support and health behaviors of women during pregnancy.

This cross-sectional study was carried out on 230 pregnant women who attended a hospital in Adıyaman province, Turkey for routine care between 2019 and 2020 and were selected by random sampling method. A demographic questionnaire, Spousal Support Scale (SSS), and Health Practices in Pregnancy Questionnaire-II (HPQ-II) were used as data collection tools, which were completed through structured interviews. The Mann-Whitney U test, Kruskal-Wallis, Pearson Correlation, and Logistic Regression analysis were used to analyze the data.

In terms of scale overall scores, pregnant women took 73.84±11.22 and 121.42±13.37 from SSS and HPQ-II, respectively, besides, a moderately significant positive correlation was found between the overall scores of the two scales (r=0.577, p= <0.001). As a result of Logistic Regression Analysis, pregnant woman’s age (OR:0.050), years of education (OR:0.102), spouse’s years of education (OR:0.081), marriage duration, number of pregnancies (OR:0.116), previous live births (OR:0.157), and prior miscarriage (OR:0.025) were found to be important risk factors for health behavior.

Spousal support during pregnancy is related to health behaviors and women with more spousal support exhibit high-quality health behaviors. Therefore, it is recommended that women during pregnancy be questioned about their spousal support and to be counseled in this regard to experience a safe pregnancy.

Throughout the world, majority of individuals who are affected by sexuallytransmitted disease (STIs) are youths and about one in every twenty adolescents will develop STIs other than Human Immune Deficiency Virus (HIV) each year. Thus, the aim of the study was to assess the prevalence and associated factors of self-reported STIs among college students.

This cross sectional study was conducted in Motta town,Northwest EthiopiainJanuary 2020. Using multistage stratified sampling technique 616 sample were randomly selected from randomly selected 45 sections. Data was collected using semi-open ended and researcher-made self-administered questionnaire from randomly selected students. In multivariable logistic regression, P-value less than 0.05 and Odds ratios at 95% confidence intervals was used to determine presence of association between dependent and independent variables by using STATA version 14.1 windows program.

Overall, a total of 571 students participated in the study and made the response rate 93%.Of respondents, 405(71%) initiated sexual intercourse and 82(14.4%) students reported at least one syndrome. Age >24 years [AOR=8.05;95%CI:2.80-23.12] and 20-24years [AOR=2.7;95%CI:1.18-6.17], being 3rd [AOR=5.23;95%CI:2.23-12.28] and 2nd year student [AOR=2.45;95%CI:1.20-5.01], having multiple sexual partners [AOR=9.38;95%CI:4.46-19.73], having poor knowledge [AOR=2.93;95%CI:1.49-5.77] and inconsistent condom use [AOR=3.10;95%CI:1.40-6.90] were factors associated with sexually transmitted diseases.

The prevalence of self-reported sexually transmitted infections among college students in Motta town was high. Thus, building up students’ knowledge and encourage them to abstain from having multiple sexual partners and using condom consistently are important issues.

One of the major problems related to maternal and neonatal health in adolescent pregnant mothers is the low level of pregnancy empowerment. It seems that using cognitive-behavioral counseling approaches can help women to further strengthen their empowerment. The aim of this study was to determine the effect of cognitive-behavioral counseling on empowerment of pregnant women under 18 years old.

This randomized controlled trial was performed in 2020-2021 on 64 pregnant women aged under 18 years referred to health care centers of Khaf, Iran. Participants were randomly allocated to two groups of intervention (n=32) and control (n=32). In the intervention group, cognitive-behavioral counseling was performed in the groups with seven members during 6 sessions (two 120-minute sessions per week for three weeks). The control group received the routine care. The research tool was Kameda and Shimada Empowerment Scale for Pregnant Women (ESPW). Data were analyzed using SPSS software version 25.

In the pre-intervention stage, there was no significant difference between the mean empowerment scores in the two groups of intervention (73.87 ± 8.95) and control (72.78 ± 7.36) (P = 0.59). However, in the post-intervention stage, the mean empowerment score in the intervention group (84.25 ± 6.13) was significantly higher compared to the control group (74.44 ± 9.24) (P= 0.001).

Cognitive-behavioral counseling was effective in improving the empowerment of pregnant women under 18 years of age participating in the present study.

The care plan of women with perineal injury during labor does not differ with women without perineal trauma in the health system of Iran, while they are encounter more physical problems after childbirth. The present study was designed to explore the experiences of Iranian postpartum women regarding physical recovery of perineal trauma after child birth.

This qualitative content analysis was conducted on 22 postnatal women with perineal trauma during childbirth delivered in Ommol-banin hospital, Mashhad, Iran, between 20th of April to 25th of December 2017.  Participants were selected purposively until data saturation was achieved. To collect data face-to-face semi-structured interviews were conducted between 10 days to one year after childbirth. Data analysis was carried out using conventional content analysis recommended by Elo and Kyngas (2008) with MAXQDA software.

Physical recovery after perineal trauma was conceptualized as a journey toward normalization of body function to reach physical recovery. Two generic categories emerged from the data including (1) experience of illness and (2) physical rehabilitation. In the first phase, participants confronted many complications such as mobile restrictions, sexual disorders and symptoms of illness. Recovery was achieved by alleviating of these disorders and getting better. Improving physical functions helped to restore emotional recovery as well, when participants recaptured pervious sense of self (normalization), and regained their daily activities.

Women, especially women with severe perineal trauma, in addition to the routine six-week post-partum care, need longer time of receiving care until completing the natural physical recovery process.

Vocation perception of midwives is important in terms of their sense and level of professionalism. The  purpose of this study was to develop and validate Midwifery Vocational Perception Scale.

This validation study was carried out at five public hospitals located in Istanbul, Turkey from October 1st to December 30th, 2019. In the first stage, 68 items draft form was prepared. After receiving the opinion of seven experts, the face validity of the scale was tested with 20 midwives. In the second stage, the 5-point 52-item Likert scale was administered to 282 midwives. However, since the outliers were deleted before the factor analysis, the analysis was performed for only the data of 232 people. Factor and confirmatory analyses and the Cronbach’s alpha coefficient were used to analyze the scale validity and reliability.

According to the exploratory factor analysis, the scale consisted of 16 items and three factors that explained 53.085% of the the scale variance.  Confirmatory factor analysis fit index results were found as CMIN=175,427, DF=97, p<0.001, CMIN/DF=1.809, RMSEA=0.059, CFI=0.933, GFI= 0.916. The Cronbach’s alpha value of scale was determined to be 0.865. The lowest anyone scored was 16, the highest was 80, while  the mean score was 87.71 ±7.46 (min: 67, max: 95).

A high score indicates positive vocational perception and occupational opinions in midwifery, while a low score indicates negative vocational perception and occupational opinions. The Midwifery vocational Perception Scale was prepared in Turkish and a validity study in other cultures is recommended.

Utilization of postnatal care (PNC) services has not been optimal in many low- and medium-income countries despite the importance and benefits associated with it. Hence, this study was conducted to determine the prevalence of PNC non-utilization and its related factors among women in Osun State, Nigeria.

This study adopted a descriptive cross-sectional design involving 380 women attending antenatal clinic at the primary health centers, using a multistage sampling technique. A structured questionnaire was used to obtain data which was analyzed using descriptive and inferential statistics. The IBM SPSS statistics version 20 was used.

About three-quarter (75.8%) of the respondents did not attend PNC services and 62.4% did not know the importance of attending PNC services. From multivariate analysis, six variables emerged as predictors of PNC non-utilization i.e. women with no health issues (OR: 7.57, 95% CI: 3.02–18.98), being in the age group 31 years and above (OR: 2.35, 95% CI: 1.21–4.58), no formal PNC clinic appointment (OR: 2.09, 95% CI: 1.13–3.87), lower income (OR: 1.97, 95% CI: 1.10–3.56), lower parity (OR: 1.96, 95% CI: 1.04–3.71) and lack of knowledge of importance of PNC (OR:1.94, 95% CI: 1.06 – 3.56).

There is a high level of non-utilization of PNC services among respondents. To increase the uptake of PNC services in Nigeria and improve mother and child health outcomes, public health programs should focus on educating women and significant others on the importance of PNC for mother and newborn.

Pregnancy is one of the most important stages in a women's life. Occurance of unintended first pregnancy due to changes in women's life-style following COVID-19 pandemic has led to more stress, anxiety, and uncertainty pregnant women. Therefore, the current research aspires to examine how progressive muscle relaxation intervention and imagery-based relaxation technique can affect the psychological characteristics of women with unintended first pregnancy during COVID-19 pandemic.

This single-blind, parallel groups, pretest-posttest randomized controlled trial was conducted on 60 women with first unwanted pregnancy  who attended the urban clinics in Semnan, Iran in 2020, and were assigned to experimental and control groups. Tools for measurement included a demographic questionnaire as well as Depression, Anxiety, Stress Scale (DASS-21). In the experimental group, women were given 8 weeks of progressive muscle relaxation and imagery-based relaxation intervention; while women in the control group only received the routine care. One day before and one day after the intervention, DASS-21 was completed by the subjects.

The results of the multivariate analysis of covariance (MANCOVA) showed that after 8 weeks of intervention, the level of anxiety (P=0.0001), depression (P=0.0001) and stress (P=0.0001) decreased in the experimental group in comparison with the control group (P≤0.016).

According to the results, it can be concluded that in order to improve the psychological status of women with unintended pregnancy, especially in the stressful conditions of COVID-19 disease, the relaxation techniques can be used as cost-effective and non-pharmacological approaches to build more emotional stability.

In developing countries, such as Ethiopia, neonatal morbidity and mortality, which is usually associated with low birth weight, are still high. Therefore, the aim of this study was to determine the extent and predictors of low birth weight among newborns delivered at a referral hospital in Hadiya Zone, Southern Ethiopia.

A hospital-based cross-sectional study was conducted from 1st to 28th April, 2019. A structured questionnaire and chart review were used to collect data. A systematic sampling technique was used to recruit 363 study participants. The relationship of independent variables with the dependent variable was determined using bivariate and multivariable logistic regression analyses. The odds ratios were calculated with their 95% confidence intervals, and statistical significance was accepted at a p -value of < 0.05. SPSS software (version 23) was used to enter and analyze the data.

The prevalence of low birth weight was found to be 12.7%. The predictors of low birth weight comprised of not receiving antenatal care visit (AOR =7.6; 95 % CI: 1.23-6.24), preterm delivery (AOR=4.99, 95% CI: 2.22-11.18), anemia (AOR =4.99; 95% CI: 2.22-11.18) and smoking of cigarette (AOR=5.85; 95% CI: 1.18-28.92).

This study revealed that a significant proportion of newborns are delivered with low birth weight. Consumption of iron-rich foods and abstinence from smoking should be encouraged to help prevent low birth weight. Additionally, increasing the uptake of antenatal care visits and prompt diagnosis and treatment of obstetric complications such as preterm delivery are important.

The burden of congenital malformation can be decreased through two major approaches- primary prevention of those at risk through antenatal screening and improving survival for those affected. This study was conducted to investigate the knowledge and readiness of midwives to practice antenatal screening and genetic testing for congenital abnormalities.

A cross-sectional study among randomly selected 245 midwives across five maternal and child health government hospitals within Lagos metropolis in 2017. The validated self-administered questionnaire having 3-section; midwife’s demographic-characteristics, knowledge and readiness of antenatal screening and genetic testing, with 0.74 reliability coefficient, was used to obtain information within five weeks after obtaining ethical approval. The obtained information was analysed using SPSS version 22.

The study findings revealed that 62.9% of the midwives had inadequate knowledge of antenatal screening and genetic testing for congenital abnormalities. Up to 82.4% were ready to practice antenatal screening and genetic testing for congenital abnormalities. The midwives’ level of knowledge was not significantly associated with their readiness to practice antenatal screening and genetic testing for congenital abnormalities (p=0.74), meanwhile, professional qualification (p = 0.003) and years of experience (p < 0.001) were significantly associated with readiness to practice antenatal screening and genetic testing.

The study recommends that midwives should improve their knowledge and skills in genetic testing by attending both local and international training workshops/seminars. Midwives should be provided with the screening devices to facilitate the practice of antenatal screening and genetic testing for congenital abnormalities.

Family planning has pivotal role in the improvement of various aspects of community health. Owing to the incomplete previously performed studies, the present research was carried out to measure the prevalence of contraceptive use and its key influencing factors among the women residing in Tehran.

An analytical and observational cross-sectional study was performed on 395 women (18-40 years old) whom attended private clinics in three strict of Tehran determined through clustering sampling, during January to July 2019. A questionnaire including 24 questions was completed for all the participants. The questions were designed to determine the type of contraception and its influencing factors including demographic characteristics, attitude of women and their husbands as well as social, economic and cultural factors. The collected data were analyzed using SPSS software (version 22).

The overall rate of using contraception was 75.2% and traditional methods were the most prevalent contraception (55.9%). Frequency of the different contraceptive methods was meaningfully different among women with various age categories (P=0.01[l1] ). Housing location was meaningfully associated with no contraception (P=0.04), and except for withdrawal, house size (p <0.0001) and family income (P=0.007) were significantly associated with the type of contraception. Moreover, it was shown that the attitude of women and their husbands as well as the number of children significantly affected the contraception choice (p <0.0001).

  High prevalence of withdrawal method even among highly educated women is relying on the demand for education programs, especially among couples who are seeking the least successful contraceptive methods.

Infertility, as a crisis in marital life, has multiple psychological and social consequences for couples, especially women. Infertile women are more vulnerable to violence than fertile women. The purpose of this study was to examine violence and its related factors in infertile women referring to infertility centers of Rasht, Iran.

This cross-sectional study was conducted on 245 women with primary infertility who referred to infertility canters in Rasht, Iran in 2017, using sequential sampling method. The data collection tool was a self-structured questionnaire to examine the demographic characteristics of the couples and Onat's violence standard questionnaire for assessing the exposure of infertile women to violence. The data were analyzed using Kolmogorov-Smirnov, Friedman, Mann-Whitney and Kruskal-Wallis tests as well as Spearman correlation and logistic regression.

The results showed that the mean total score of violence was 50.93 ± 18.76. Also, there were significant relationships between the total score of violence and the variables of the duration of marriage, the duration of awareness and treatment of infertility, the age of married couples, occupation/education of the  couples, the family relationship between couples, unwillingly marriage and the number of infertility treatment attempts (P<0.05).

Infertility is not merely a biomedical disorder and can lead to violence against women, therefore providing counselling services to infertile couples, making them aware of infertility treatments, improving the socio -economic status of women as well as teaching the way of managing marital, cultural and family issues to couples can be effective in reducing violence against infertile women.

Abortion in Iran, like some countries in the world, has long been a culturally, socially, politically and religiously sensitive issue. So the present study was conducted to investigate the causes of abortions in pregnant women referring to Shiraz educational and medical centers.

: In this cross-sectional study, 437 woman who had an abortion, were selected by examining 5176 pregnant women using sequential sampling method during 4 months from educational and forensic medicine centers in Shiraz, Iran, in 2017. A self-structured questionnaire including demographic characteristics and obstetric data was completed for each mother. Data analysis was carried out using descriptive statistics.

Out of 88 abortions with a legal permission from the forensic medicine, 9.1% were due to maternal illness and 90.9% were due to fetal disease, the most common cause of which was fetal cranial and cerebral disorders (17.1%). Out of 105 cases of spontaneous abortion, 8 cases were due to maternal cause (the most common cause of uterine defects (4.8%) and 97 cases were due to fetal cause. Out of 244 induced abortions with obstetric indication, the most common cause was missed abortion (32%).

In all three types of abortion, fetal causes were the most common cause of abortion.  It seems that education, access to information and awareness raising activities involving the whole community will have a significant effect on preventing the occurrence of abnormalities. Emphasis is placed on the importance of conducting prenatal screening before 20 weeks of gestation.

 The quality of sexual life is an important dimension of women's quality of life. Various factors including medication, education and regular exercise modulate menopausal symptoms and improve the quality of life in postmenopausal women. The present study was conducted to compare the effect of exercise training through multimedia and pamphlets on the quality of sexual life in postmenopausal women.

 This experimental study was performed on 70 postmenopausal women referred to the social security clinic in Quchan. A 45-minute training session was held for all individuals and then they were randomly assigned in the pamphlet (n=35) and the multimedia group (n=35). The tools included demographic questionnaire, quality of sexual life questionnaire, pelvic floor exercise checklist, and the criteria of measuring pelvic floor muscle strength (Brink scale).  Data were analyzed using inferential statistics including Chi-square, Friedman, T-student, Wilcoxon and Mann-Whitney tests.

 The mean score of quality of sexual life in the multimedia group before the intervention was 73.15±1.72 that increased to 79.07±11.3 after the intervention (P=0.024). Also, in the pamphlet group, it was 74.3±09.59 before the intervention that increased to 80.52±08.27 after the intervention (P=0.007). However, no significant difference was found between the two groups after the intervention comparing the mean score of quality of sexual life.

 Exercise training through both multimedia and pamphlets had a positive and similar effect on increasing postmenopausal women’s quality of sexual life. Therefore, standard training pamphlets is recommended in providing services to postmenopausal women.

 Hemolysis, elevated liver enzymes, and low platelets syndrome (HELLP) was mimicked by several infectious conditions. It is critically important to distinguish these two, since their management and course differs, substantially.

Case report:

 The case was a 27-year-old gravid patient with gestational age of 30 weeks who initially presented with headache and lower limb pain as well as leukopenia (and lymphopenia), normochromic normocytic anemia, thrombocytopenia, abnormal liver enzymes, increased lactate dehydrogenase enzyme and C-reactive protein. The patient was initially managed for HELLP syndrome, but due to the atypical presentation (low blood pressure and an episode of delirium when admitted), the novel coronavirus disease 2019 (COVID-19), real-time reverse transcription polymerase chain reaction (rRT-PCR) was requested for the patient that was positive. The spiral lung high-resolution computed tomography scan revealed changes compatible with COVID-19 diagnosis. Finally, the patient underwent uncomplicated normal vaginal delivery at 39th gestational week.

 It is important to consider the COVID-19 in differential diagnosis of patients suspected to HELLP syndrome, as the isolation and treatment of the patient is different and time-sensitive.