مجله زنان مامائی و نازائی ایران
سال شانزدهم شماره 90 (هفته چهارم اسفند 1392)

The extreme reduction in breast milk intake during the first days of life leads to weight loss، kidney failure and hypernatremia. The aim of this study was to examine the relationship between hypernatremia in neonates and the mode of maternal breastfeeding.

This cross-sectional study was conducted on 670 infants who referred to the neonatal ward and clinic of Ghaem hospital of Mashhad، Iran during 2006 to 2012. First، complete history of the mother and baby were obtained regarding pregnancy and delivery problems، mode of breastfeeding، and the first time of lactation beginning. Then neonates were divided into two groups according to the amount of blood sodium، isonatremic and hypernatremic (sodium ≥ 150 mg/dl). Data were analyzed using t-test and chi-square tests with SPSS software (version 11. 5). P value less than 0. 05 was considered significant.

The average age (p=0. 911)، Apgar scores (p=0. 192)، time of the first lactation (p=0. 081) and breast feeding duration (p=0. 108) showed no statistically significant differences between isonatremic and hypernatremic groups. But the admission weight (p=0. 021)، times of lactation (p<0. 001)، breast-feeding status (p<0. 001)، let down reflex in mother’s breast (p<0. 001)، kind of nutrition (p<0. 001)، breast filling after childbirth and lactation (p<0. 001)، and breast softening after breast-feeding (p<0. 001)، urination frequency (p<0. 001)، defecation frequency (p<0. 001) and duration of maternal hospitalization (p=0. 007) showed statistically significant differences between two groups.

Neonatal weight control، times of lactation، lactation status، breast changes during breast feeding and frequency of urination and defecation may be effective in early detection of reduced breast milk intake and control of related complications.

There are many techniques for cesarean sections that each of them has different outcomes. Some clinicians advocate close and some advocate open the visceral and parietal peritoneum. There was different idea about this subject and decided to compare some short term outcomes of two different techniques، closure versus non closure visceral and parietal peritoneum during cesarean section. This randomized double- blind controlled trial was conducted on 80 term pregnant women who underwent for first elective cesarean section in Amir-Almomenin hospital in semnan، Iran from October 2011 to December 2012. Patients were randomly divided into two groups. In one group parietal and visceral peritoneum were closed (control group) and in second group both layers were left open (study group). All cases underwent cesarean section with spinal anesthesia and the surgery was performed by the same surgeon. The severity of pain was measured over the first 24 hours after operation by visual analogous scale and the dosage of analgesic use، the bowel transit time and wound infection during first week after operation were assessed and compared in both groups. Data were analyzed using SPSS software version 16 and chi-square، Mann-Whitney، Wilkinson، t-test and repeated measures ANOVA tests. P value less than 0. 05 was considered significant. The pain score (p<0. 001)، the mean usage of analgesic over 24 hours (p=0. 012) and bowel transit time (p= 0. 001) in non-closure group was significantly less than closure group. But wound infection was similar in both groups (p= 1). The technique of non-closure of peritoneums has some short term postpartum benefits such as less post operation pain، less amount of analgesic use and more rapid bowel transit time.

Breast cancer is the most common cancers in women all around the world. Mastectomy is one of the initial treatments in breast cancer that causes physical defect. Breast reconstruction has increased significantly to reduce psychological effects of mastectomy. The purpose of this study was to develop a valid and reliable questionnaire to assess attitudes of mastectomy patients about breast reconstruction. This cross sectional study was conducted on 110 mastectomy patients referred to public and private health centers in Mashhad، Iran in 2013 for follow-up. Questionnaire was developed according to patients'' opinion in three stages: item generation، item reduction، validity and reliability. Superficial، content and construct validity were evaluated. Construct validity was examined by exploratory factor analysis. The reliability of the questionnaire was evaluated by Cronbach''s alpha and the Split-Half method. SPSS software version 11. 5 was used for data analysis. Superficial validity was confirmed. The amount of content validity using Lawshe method was more than 0. 99. Four hidden factors were found through exploratory factor analysis. Cronbach''s alpha and Split-Half coefficient of the questionnaire were 0. 80 and 0. 79 respectively. This questionnaire is a valid and reliable one. It can be used to determine associated factors with reconstruction and lack of it in mastectomy patients، in order to provide appropriate solutions and enabling patient to do the reconstruction.