مجله زنان مامائی و نازائی ایران
سال هفدهم شماره 99 (هفته اول خرداد 1393)

Lack of knowledge in primiparous women about the process of vaginal delivery usually causes anxiety. This anxiety can have negative impacts on fetus، mother and childbirth process. Therefore، supporting the mother can reduce her anxiety and help her to cope better with labor. We aimed to determine the effect of listening to the Quran on reducing anxiety and serum cortisol levels in primiparous women during the first stage of labor. This clinical trial study was conducted in 2013 on 60 pregnant women who had vaginal delivery in Zainab hospital of Shiraz، Iran. Parturients were randomly allocated into interventional and control groups. In the interventional group، parturients listened to the Quran for 45 minutes using headphone during the active phase of labor. However، in the control group no audio was played through the headphone. Women''s anxiety was measured with Spielberger questionnaire before and after using the headphone and cortisol levels were also evaluated. Data were analyzed using SPSS software (version 21) and chi-square، paired t-test، Fisher and Kruskal-Wallis tests. P value less than 0. 05 was considered significant. Hearing the Quran was effective in reducing anxiety in the interventional group and this effect was statistically significant between two groups (p<0. 001) The serum cortisol levels was 101. 47±48. 00 µg/l in the intervention group and 226. 53±105. 77 µg/l in the control group after hearing the Quran and the difference was statistically significant (p<0. 001). In the intervention group، anxiety was reduced more effectively in parturients with high familiarity with the Quran (p<0. 05). Listening to the Quran during the labor، especially in women who are much more familiar with the Quran has positive effects in reducing anxiety. This method is a valuable technique with high quality effects on normal vaginal delivery process that may reduce cesarean delivery without indication.

Shoulder pain is one of the most common complaints after cesarean section that sometimes may be serious and cause malfunction of mothers in breastfeeding and neonatal care. As one of the causes of shoulder pain is referred pain caused by diaphragm irritation due to existence of blood and amniotic fluid in the peritoneal cavity after surgery، we decided to investigate the comparison between placing surgical sponges on both sides of uterus and reverse trendelenburg position of 30 degree to reduce the incidence of shoulder pain after cesarean section with spinal anesthesia. This three blind clinical trial was conducted on 201 women undergoing cesarean section in Niknafas hospital of Rafsanjan، Iran in 2011. Women were randomly divided into three groups. Surgeries were performed by two surgeons equally in each group. In group A، spinal anesthesia was performed and 2 surgical sponges with a radio opaque line impregnated with normal saline were placed on both sides of uterus and operation continued in supine position with no angle with horizon line. In group B، patients were operated in reverse trendelenburg position of 30 degree to horizon line without placing surgical sponges. In group C، cesarean was performed without any surgical sponges and in supine position. Severity of shoulder pain was assessed 24 hours after surgery in right، left or both shoulders in all patients. Data were analyzed using SPSS software (version 18) and one way ANOVA، chi-square، Post-hoc tests and t-test. P value less than 0. 05 was considered significant. Mean of pain severity had no significant differences between the three sites of pain (p=0. 728). No significant differences were observed in pain severity between the three groups (p=0. 111) and between the operations were performed by the two surgeons (p=0. 430). According to no statistically significant difference between groups in pain severity، there might be another agent exclusive of blood and amniotic fluid that irritates diaphragm and cause shoulder pain.

Midwives continually are known as the first custodians of mothers and fetus care. This item causes midwifes problems in their work and irreparable faults. This study investigated the frequency and reasons of midwifes malpractices in cases referred to general office of legal medicine of Isfahan، Iran during 2005-2009. This descriptive-cross sectional study was conducted on all cases referred to general office of legal medicine of Isfahan، Iran during 2005-2009 with claims from midwifery staffs occupied in hospitals، clinics and other healthcare centers. Data were gathered by a checklist. Data collection methods were resource review and observation. Data were analyzed by SPSS software (version 11). 41 claims (5. 8%) of 708 claims were from midwifes. 18 midwives from 41 (43. 9%) were convicted. Negligence (38. 9%) and carelessness of governmental rules (44. 4%) were the main reasons of midwives malpractices. 13 midwives (31. 7%) allocated the most frequency of claims. They were in the age range of 35 to 65 years. 35 midwives (85. 4%) of 41 gave services in hospitals and 6 cases (12. 2%) in home-health. With attention to importance of midwifery، the practitioners of this occupation should be informed about medical laws and regulations، crimes and infractions، blood money law، abortion laws and other legal materials.