مجله زنان مامائی و نازائی ایران
سال شانزدهم شماره 66 (هفته چهارم شهریور 1392)

Hypotension is the most complication of spinal anesthesia in cesarean delivery, which cause various side effects such as nausea, vomiting, drowsiness and increased risk of aspiration is mother. Opioids have synergistic effects on local anesthetics drugs and increase sensory block duration without increase sympathetic block and also may reduce hypotension episodes. The aim of this study was evaluating the application of different dosage of bupivacaine in combination with intrathecal sufentanil in cesarean delivery and its effects on maternal hemodynamic during cesarean section, level of sympathetic block, block duration and neonatal Apgar. This double blind clinical trial was conducted on 45 patients between 18-40 years old who were candidate for cesarean section and set in class 1 of Anesthesia Society of America classification (ASA1). Patients were divided into three groups (A, B, C). Each group received 3µg sufentanil in combination with 6, 8 and 10 mg bupivacaine. Hypotension, nausea, vomiting, level and duration of block and 1 and 5 minutes Apgar scores, satisfaction level and maximum sedation level were assessed. After normalized controlling, ANOVA or Kruskal-Wallis tests were used to compare 3 groups. P value less than 0.05 was considered significant. The time to reach peak block level and latest block level had not significant differences in three groups (p<0.05). Hypotension (p=0.005), ephedrine consumption total dose (p=0.002) and nausea (p=0.001) had statistically significant differences among groups. Motor block degree, intraoperative pain, patient's satisfaction and 1 and 5 minutes Apgar scores had not statistically significant differences among groups (p>0.05). Application of 3µg sufentanil in combination with bupivacaine in spinal anesthesia for cesarean delivery reduces bupivacaine dose for satisfactory sensory block to 6 mg with less hypotension, nausea, vomiting without any adverse effect on Apgar scores.

There is an obvious difference in cesarean section rate between the world and Iran. Cesarean section rate is included 50-60% of the delivery modes in Iran and 10-20% in the world. This study was done to survey cesarean sections base on their causes and type of hospital that the delivery has been done.

This cross sectional study was conducted on data collected about delivery modes has been done in hospitals affiliated to Mashhad university of medical science, Iran in 2011. Data were collected based on a single form that was notified by obstetric department of deputy of treatment affairs of Mashhad university of medical science to all hospitals. Data were analyzed using SPSS software version 16 and central measures (mean) and dispersion (standard deviation).

Total deliveries in hospitals affiliated to Mashhad university of medical sciences were 103348 during 2011 that 45% of them were performed in academic centers and 55% in other places. Of total deliveries were performed, 37% of the deliveries in academic hospitals, 72% in private hospitals, 64% in charity hospitals, 44% in social affairs hospitals, 55% in other hospitals and 75% in Azad university hospitals have been done by cesarean section.

Total deliveries and cesarean section in other hospitals were higher than university hospitals. The most important cause of cesarean section was repeated cesarean after first cesarean and number of elective cesarean section was significantly higher in non academic hospitals than university hospitals.

Many reasons have been mentioned for fear of childbirth that one of the most important of them is personality characteristics of mother. According to classification of Friedman and Rosenman, people set in two personality types of A and B. Each of these two types has properties that make people vulnerable or resistance against different situations. So this study was done to recognize which personality type is related to fear of childbirth in pregnant women. This study was conducted on 159 pregnant women who referred to Fatemieh hospitale of Hamedan, Iran in 2012. Cases were selected by available sampling method. Data gathering tools were Childbirth Attitudes Questionnaire (CAQ) and Friedman and Rosenman personality type questionnaire. Data were analyzed using SPSS software version 19, descriptive statistics and linear regression tests. P value less than 0.01 was considered significant. Result of linear regression represented that personality type with R2= 0.51 and significant level of p value less than 0.01 has significant relationship with fear of childbirth (p=0.01) and with increasing point of personality type (tendency to type A personality), point of fear of childbirth increased too. Results of this study show the predictor role of personality type in fear of childbirth and there is significant positive relationship between type A personality and fear of childbirth.