[Comparison in of physical activity in fertile and infertile couples Kermanshah, Iran during 2013]

Background and aim: Infertility is a major reproductive health problem that affect 10%-15% of couples. According to the World Health Organization, there are currently 50-80 million infertile couples in the world. Physical activity is a life style factor with possible positive or negative effects on reproductive. The aim of this study was to compare the physical activity of fertile and infertile couples in Kermanshah, Iran during 2013

Materials and Methods: This was a descriptive comparative study. The case group consisted of 118 infertile couples attending Motazedi Infertility Center. One hundred and eight fertile couple attending to six public health centers in Kermanshah, Iran, were the controls. The sampling method was convenience sampling. Data were collected by a questionnaire. The questionnaire was consisted of two section. The first section was demographic and fertility characteristics and the second section was international physical activity questionnaire. The data is presented by descriptive statistics and analyzed with logistic regression, independent t-test, chi-square, and gamma tests using SPSS v16

Results:The result of this study showed that the majority of fertile women[86.1%], infertile women[73.1%], fertile men[87%] and infertile men[96.3%] had moderate level of physical activity. There was a significant difference between fertile and infertile men and women in terms of physical activity. The fertile and infertile couples, also, have significant difference in physical activity[P<0/05]

Conclusions: Given the importance of physical activity on reproductive health and significant difference of physical activity between fertile and infertile couples in this study, it seems that more attention should be paid to lifestyle behaviors, especially in infertile couples

[Comparison of pregnancy self-care, perceived social support and perceived stress of women with gestational diabetes and healthy pregnant women]

Pregnancy complicated by diabetes requires increasing health care resources for controlling sugar levels during pregnancy and reduce the severe perinatal consequences. Now a days changing lifestyle patterns have changed susceptibility to disease. This study was conducted to determine and compare some of the lifestyle factors [pregnancy self-care, perceived social support and perceived stress] of women with gestational diabetes and healthy pregnant women. A comparative- descriptive study was conducted on 100 pregnant women with definite diagnosis of gestational diabetes [diabetic group] and 100 healthy pregnant women [controls] attending teaching health centers affiliated to the Shahid Beheshti University of Medical Sciences in 2013. Data were collected through interviews using a questionnaire related to pregnancy self-care, perceived social support and perceived stress. Data were analyzed using SPSS-18 software. Demographics and obstetrics variables were similar in the diabetes and the controls groups mean pregnancy self-care score was 71.9 and 81.87, respectively [P<0.001], mean perceived social support the was 65.75 and 73.88, respectively [P<0.001], and mean score of perceived stress was 51.57 and 60.27, respectively [P<0.001]. Study results showed that pregnant women with gestational diabetes had less self-care, social support and perceived stress. This study further reveals the importance of women's self-care and perceived social support during pregnancy. The incidence of gestational diabetes can be prevented through increased awareness and education of pregnant women regarding appropriate lifestyles during pregnancy and any interventions that could improve them

[Effects of valerian on bleeding and systemic manifestations of menstruation]

Primary dysmenorrhea, sometimes with one or more systemic symptoms and is associated with severe bleeding. We conducted a double-blind randomized placebo controlled clinical trial to evaluate the impact of Valerian on the bleeding and systemic manifestations of menstruation. A total of 100 students were randomly assigned to treatment [51 subjects] or placebo group [49 subjects]. The treatment was 255 mg of Valerian 3 times a day over 3 days at the onset of menstruation. Bleeding and systemic manifestations were evaluated with a menstrual pictogram and multidimensional verbal scale before and during 2 consecutive menstrual cycles respectively. Statistical tests showed that severity and duration of bleeding between the two groups were not significantly different [p=>0.05].after treatment in two groups the mean total score for intensity of systemic than before treatment can be reduced [p <0.001], but this decreased statistically between valerian and placebo groups was not significant. Except on fainting variable intensity difference between groups was significant [p <0.05]. This study showed that valerian doesn't increase severity of bleeding and systemic manifestations. Valerian and placebo reduce severity of systemic manifestations but the difference between the two groups was not statistically significant. It seems more research is need. Valerian can reduce faint with dysmenorrheal

effect of reflexology on pain intensity and duration of labor on primiparas

Reflexology is an ancient, mild and non-invasive technique, used widely as one of the nonpharmacological methods for pain relief. The aim of this research was to determine the effect of reflexology on pain intensity as well as to determine the duration of labor in primiparas. In 2008, a randomized clinical trial study was conducted randomly enrolling 120 parturient women with low risk pregnancy into three groups in Shahid Akbarabadi Hospital, Tehran, Iran. The first group received 40 minutes of reflexology at the beginning of active phase [4-5 cm cervical dilatation]. Emotional support was offered for the second group in the same stage of pregnancy and with the same duration. The third group received only routine care during labor. Pain severity was evaluated with visual analogue scale [0 to 10 cm]. In all groups, pregnant women were asked to evaluate the severity of pain experienced before and after intervention and also at cervical dilatations of 6-7 cm and 8-10 cm respectively. Data were collected through the numerical pain scale. Pain intensity at all the three stages of cervical dilatation was significantly lower in the reflexology group. During the 4-5 cm dilatation stage, women in the supported group reported less severe pain compared to those receiving routine care, but no significant differences at the later stages of labor. This indicates that reflexology could decrease the duration of first, second and third stages of labor. Our findings showed that reflexology can be useful to decrease the pain intensity as well as duration of labor

Relationship between violence during pregnancy and postpartum depression

Due to the lack of evidence in relation to violence against pregnant women, particularly in developing countries, this study was conducted to determine the relationship between violence during pregnancy and postpartum depression in Marivan, western Iran. 240 women between 15 and 40 years at the last month of their pregnancy were selected and divided into two groups: those experiencing violence and those without and matched for age, education, occupation of their own and their husbands', income, marital status, parity and desired or unwanted pregnancy. They were followed 2 to 6 weeks after delivery. Participants were Iranian Kurd, literate and singleton with no known pregnancy complications and depressive disorder in their lifespan. Demographic and obstetrical characteristics, Edinburg's postpartum depression, violence in three domains of physical, sexual, and emotional were recorded in a questionnaire. Mean age of subjects was 26.02 +/- 5.53 years mostly in primary educational level and were housewives. The scores of Edinburg's questionnaire ranged from 0 to 27 [8.25 +/- 6.82] and 34.2% [82 women] of them obtained score 10 or more. The frequency of postpartum depression was 52.5% and 15.8% in women experiencing violence and those without, respectively. A significant relationship was found between domestic violence and postpartum depression [p<0.001] and the estimation of relative risk of depression with 95% confidence interval was between 2.1 and 5.1 [RR=3.3]. Based on adverse effects of violence during pregnancy in this study, a routine screening at perinatal clinics is suggested to identify at-risk cases and provide necessary health services

[Relationship between gestational as well as neonatal disorders and baby bottle syndrome]

Dental caries is a fundamental problem affecting children's health. In spite of extensive preventive programs from dental disorders, baby bottle syndrome is still one of the most common chronic childhood diseases. Since this syndrome is caused by many factors, no consensus exists regarding its etiology. The aim of this analytical retrospective study was to determine the relationship between gestational as well as neonatal disorders and baby bottle syndrome in children referring to health centers affiliated to Shahid Beheshti University of Medical Sciences in 2008. 101 children in two case and control groups were selected by purposive sampling method. Researchers described the purpose of the study for mothers of children of age 3 to 4 at the settings. In case of having their agreement and required qualifications to take part in the study, children were examined by a dentist for the diagnosis of baby bottle syndrome. A perinatal questionnaire was completed by mothers. Content and test-retest methods were used for validity and reliability of the questionnaire respectively. Data analysis was performed by SPSS package [ver 16]. Mean ages of healthy-teeth and baby-bottle-syndrome children were 3.67 +/- 046 and 3.75 +/- 0.35 respectively. No significant difference was found between the groups in terms of relative factors. 12% and 5.9% of mothers had gestational bleeding in the case and control groups respectively. In addition, during their pregnancy, 14% and 5.9% of mothers were hospitalized due to medical conditions, 4% and 2% had gestational diabetes, and 58% as well as 41.2% had caesarian delivery in the case and control groups respectively with no statistical difference. No significant difference was also found between gestational disorders, e.g. chronic hypertension, preeclampsia as well as multiple pregnancy and neonatal disorders, e.g. preterm delivery and low birth weight in the groups. Some of the disorders such as gestational bleeding in the first and second trimester, hospital stay due to medical conditions, gestational diabetes and delivery type were more frequent in the case

[Satisfaction rate of normal vaginal delivery and its relative factors among childbearing women in [Mahdiye, Tehran] and [Shaheed Chamran, Boroujerd] Hospitals, 1385]

Patient's satisfaction is one of the most important health indicators in health care system which is used for care qualification and providing health services. Hence, a descriptive correlative study is carried out to determine the satisfaction degree of normal delivery and its relative factors in childbearing women at [Shaheed Chamran, Borujerd] and [Madiye, Tehran] Hospitals in 1385. In this study, 360 literate Iranian childbearing mothers were chosen via a non-probable quar to sampling. Data gathered by a questionnaire consisting of 4 parts [pain severity, personal control, environmental satisfaction, childbirth satisfaction] and two checklists of demographic features and past obstetric records. Respectively, the pain ruler was used to estimate the pain severity, the questionnaire of labors Agentry Scale to personal control, 17-question Likert scale to environmental contentment and 18 questions derived from 34-item questionnaire of Mackey Childbirth satisfaction to childbirth content. Using SPSS 13, Mann-Whitney and Cruskal- Wallis non-parametric tests, Spearman's Correlation coefficiency, one-way Anova [variance Analysis] and regression test were applied to analyze the information. Among the studied women, 72.2% were contented with their childbirth, whereas 8.4% of them were unsatisfied with their childbirth. There was a meaningful relationship among pain severity, environmental satisfaction, personal control, childbirth factor, reserved length of the first phase of labor, pregnancy age, the conformity of newborn's gender with father's and with mother's will [P<0.001], lack of problem in their second and third delivery [P=0.01],mother's degree of education [P=0.009], economical situation [P=0.02], and spouse's occupation [P=0.03] with childbirth gratification in [Shaheed Chamran] hospital. There was a significant relationship between pain severity, personal control, the reserved length of the first and second phase[P<0.001] in [Mahdiye] hospital. Based on regression test, the personal control variables [P<0.001] and environmental content [P=0.005] were achieved to be the predictors of childbirth gratification. It is outstanding that the contentment with childbirth is multi-dimensinal issue and in order to increase the mothers' positive experiences and prevent them from side-effects of their negative experiences, all the espects must be comprehensively, simultaneously, considered.

Evaluation of the relationship between domestic violence in pregnancy and postnatal depression

Domestic violence against women is now widely recognized as an important public health problem. Research works are necessary to clarify the relationship between the different forms of domestic violence and mental health outcomes, especially in the developing countries where relatively little research is available. The aim of this study was to evaluate the relationship between domestic violence in pregnancy and postnatal depression in pregnant women referring to the health care centers in Marivan, in 1386. This study was a prospective cohort study. Sample size included 251 women at the last month of pregnancy who were questioned about domestic violence during pregnancy and assigned into 2 groups: abused and non-abused groups. Each group included 120 patients. 11 patients were lost to follow up. Then the subjects filled out the Edinburg Postnatal Depression Scale questionnaire within 4-6 weeks after delivery. P<0/05 considered statistically significant. The mean age of the subjects was 26.02 +/- 5.53 years and most of them had elementary education. The prevalence rate of depression among the patients was 34.2%.%15.8 of the women in the abused group and%52.5 of the women in the non-abused group had scores of more than 10 on the basis of Edinburg Postnatal Depression Scale. There was a significant relationship between domestic violence and postnatal depression [p<0.001]. The relative risk of depression RR=3.3 with a confidenc interval of 95% was between 2.1 and 5.1. Since the detrimental impacts of domestic violence during pregnancy have been clarified in this research and other studies, it is recommended to screen such cases routinely in order to recognize abused cases for counseling

Effects of intermittent and continuous oxytocin infusion on outcomes of pregnancy

Induction of the labor is one of challenging therapies in midwifery. Synthetic oxytocin has been used for many years in obstetric practice for the induction and augmentation of labor. Common side effects of oxytocin are overstimulation, fetal distress and emergency Caesarian section. Despite its extensive use, there is no consensus regarding the initial dose, dosage increments and/or the maximal dose. In addition, there is not enough data to know whether induction or argumentation of labor with oxytocin should be continued or stopped after the onset of active labor. Prolonged oxytocin infusion causes desensitization of oxytocin receptors and reduction of oxytocin receptors MRNA. This study was accomplished to compare the effects of intermittent and continuous oxytocin infusion on outcome of pregnancy in those referring to hospital in Maraghe in 2006. 102 pregnant women were randomly selected and divided into two groups of intermittent and continuous oxytocin infusion. The groups were then matched in terms of parity, age, BMI before pregnancy, gestational age, indication of induction and Bishop score for initiation of oxytocin infusion. Induction of labor in the groups was started by oxytocin infusion of 2mu/min [10 IU of oxytocin was dilated in 1000cc of 0.9% normal saline] and the dosage in the continuous group was increased every 15 minutes by 2mu/min until 3 regular contractions at least 45-60 seconds with moderate severity over 10 minutes. Infusion of oxytocin in intermittent group was discontinued when cervical dilation reached to 5-6 cm but, in the continuous group, infusion of oxytocin was continued at the same level until delivery. Data were collected by a questionnaire, observation of vagina and physical examination. No significant difference was found between the groups regarding the quality of contractions in terms of frequency, duration and severity of contractions [p>0/05]. The rate of overstimulation in the continuous group was more. The lengths of active phase in intermittent group were less and the rate of fetal distress in continuous group was more. The rate of Cesarean section in continuous group was less than intermittent group. Further studies in this regard are warranted

Relation between Helicobacter pylori and nausea and vomiting in pregnant women

Gestational nausea and vomiting in pregnant women have a high prevalence. The disorder will usually be better after the third trimester but, in some cases, it persists throughout pregnancy and makes the life of pregnant women disturbed. This case-control retrospective study was conducted to determine the relation between Helicobacter pylori and nausea as well as vomiting in pregnant women referring to the healthcare centers affiliated to Mashhad University of Medica Sciences in 2006. 187 pregnant women at the third trimester of their pregnancy were selected. According to the experience of nausea and vomiting from the first trimester, they were divided into two groups: 89 women with the disorder and 98 women without it. A questionnaire in three parts was used for data collection: demographic information, history of nausea and vomiting, and socioeconomic status. The questionnaire was validated by context validity and reliability by test-retes method. Anti-Hp immunolobin G [IgG] serum antibody wastested by ELISA it determine seropositivity [r=0/89]. The result showed a significant relation between helicobacter pylori and nausea and vomiting during pregnancy. The subjects did not have significant differences in terms of height, job, education of spouse, husbands' job, pregnancy and BMI except for age and socioeconomic status [P=0.037 and P<0.001 respectively]. The results may show that nausea and vomiting during pregnancy can be prevented by diagnosing helicobacter pylori infection in women. Also, it seems that there should be a training program in knowing Helicobacter pylori infection and its complications. Considering the results of this research, studying women with nausea and vomiting during pregnancy for helicobacter pylori infection is advisable

[ relationship between Helicobacter pylori infection and anemia in pregnant women]

Iron deficiency anemia has a high prevalence in women of reproductive age, especially in pregnant women [50%], with serious consequences on the mother and the fetus. Anemia is responsible for about 10-15% of all maternal deaths worldwide. There are different and sometimes contradicting reports on the role of Helicobacter pylori in causing anemia. On the other hand, Helicobacter pylori infection and its well-known complications are of high prevalence in developing countries. Therefore, the present study was conducted to determine the relationship between Helicobacter pylori and anemia. This study was retrospectively conducted on 187 pregnant women who were at their third trimester and attended the Health Centers affiliated with Mashad University of Medical Sciences for prenatal care during 2006. Based on hemoglobin assessment done in the first trimester and kept in their health records, the participants were divided into two groups: anemic [94 women] and healthy [93 women] groups. Demographic information and nutrition questionnaires were completed. Tests for hemoglobin, ferritin, and Helicobacter pylori infection, using Elisa method for the detection of IgA and IgG, and antibody titration were conducted. The data from this study were analyzed by SPSS software, version 13, using descriptive [Mean, standard deviation and odds ratio] and inferential statistics [Independent t-test, chi-squared, Mann-Whitney test, analysis of variance and logistic regression]. P-values less than 0.05 were considered significant. The subjects in the two groups did not have significant differences in terms of age, job, education, husband and #101;s education, husband and #101;s job, number of pregnancies and economic status. The rate of Helicobacter pylori infection showed a significant difference between the two anemic and non-anemic groups [p=0.01]. It was also shown that hemoglobin concentration and ferritin, during the third trimester of pregnancy in Helicobacter pylori infected cases were lower compared to that of the healthy ones [p<0.001]. On the other hand, the changes of hemoglobin during the first and the third trimesters of pregnancy in the two groups showed a significant difference [p<0.001]. The amount of hemoglobin during the third trimester of pregnancy in the Helicobacter pylori infected group had no significant increases in comparison to theirs at the first trimester, despite iron supplementation. It seems that there is a relationship between Helicobacter pylori infection and anemia in pregnant women, therefore it is suggested that tests for Helicobacter pylori infection be included in preconceptional consultations, especially for women who have a history of anemia or persistent anemia, as this will be both wise and economic

relationship between mode of delivery and postpartum depression

Postpartum period is the most vulnerable time for the onset of mood disorders including the blues, depression and psychosis. Depression is the most important mood disorder in the postpartum period that can be associated with mother-baby and family conflictual interactions and may lead to irreparable consequences if not addresses well. Regarding different etiologies of postpartum depression, among them mode of delivery, and the existence of numerous controversies about this matter, the present study was conducted to determine the relationship between mode of delivery and postpartum depression in pregnant women attending some selected Health Centers affiliated to Shahid Beheshti University of Medical Sciences in 2005. In this prospective analytical study, 258 pregnant women in their 3[rd] trimester of pregnancy were evaluated for signs of depression within 8 months and about 50 people were excluded from the study because of depression [Getting more than 12 from Edinburgh Postnatal Depression Scale, EPDS] and those not suffering from depression were included in the study. Subjects who had histories of quitting parents before the age of 15, abortion, infertility, complications during pregnancy, prolonged pregnancy, postpartum complications, chronic diseases, nervous diseases in the family, hospitalization of the mother or the neonate and those with fetal demise were excluded from the study too. During 2 to 6 weeks from delivery, study subjects completed EPDS, marital satisfaction and social support questionnaires, were divided into NVD [73 women] and CS [75 women] groups and were matched for confounding factors before statistical analysis. Data analysis was performed by SPSS software, version 13, and the significance level was considered 0.05. The mean age of subjects was 22.71 +/- 3.15 years. Most of them had high school diplomas and were housewives. The prevalence of postpartum depression was 20.3%. 13.6%of the cases in NVD and 27.6% in CS groups scored more than 12 on EPDS and they were at risk for postpartum depression. There was a significant relationships between mode of delivery and postpartum depression [p<0.05] and a two fold risk for depression was seen in CS group [OR=2]. According to the findings of this study that postpartum depression has been twice as much prevalent in the CS group compared to that of NVD group, it can be concluded that CS should be performed in women who meet the criteria for this procedure. Implementing this strategy can have an effective role in preventing postpartum depression and help reduce expenses from its proper practice

[Prevalence of menopausal symptoms at perimenopausal period in Kermanshah city]

With respect to increased life expectancy and increased number of middle-age and old population, recognizing the problems and needs of people at these ages can help in promoting the health level of them particularly women. One of the problems of middle-age women is menopause. This descriptive study was conducted to determine the prevalence of menopausal symptoms in perimenopausal women in Kermanshah city. 460 women between 40 - 60 referring to 9 healthcare centers in Kermanshah city were randomly selected. Data were collocted by a questionnaire consisted of items regarding demographic characteristics, menstrual status, menopausal symptoms and Beck depression inventoiy scale Analysis of data showed that 39% of subjects were perimenopausal with mean age of 45.4 +/- 3.7. The majority of subjects was married [86%] and most of them [46%] had school diploma. The mean number of their children was 4 +/- 2. The prevalence of menopausal symptoms was as follows: hot flush [25.3%], night sweats [20.2%], sleep disturbance [36%], palpitation [18%], headache [30.9%], vaginal diyness [6.3%], joint pain [39.3%], vertigo [18%] and depression [39.3%]. Some demographic characteristics of women had correlation with menopausal symptoms such as age, number of children, level of education, educational level of husband, job and sport activities. The prevalence of menopausal symptoms at perimenopausal period was more than other studies in Asian countries and was similar to studies on Caucasian women in European countries. With respect to the prevalence of these symptoms and vulnerability of women, researchers recommend consultation for recognizing and treating these symptoms in middle-age women

[Knowledge and attitude toward family planning in non-medical female students at selected governmental universities in Tehran, 2003]

Nowadays, family planning is a fundamental principle in human life. Since about half of Iranian population are younger than 25, it is important to recognize the needs of this group to secure family members' health by devising and revising family planning programs. This descriptive study was conducted by a multi-stage cluster randomized sampling. Subject population consisted of 1100 single female students between 18-24, who were studying one of 4 majors including engineering, basic science, humanity, and arts at 9 governmental universities of Tehran. A questionnaire concerning knowledge and attitude toward family planning, and sources of information and options of contraception education was used. Statistical analysis was performed by SPSS10. Mean age of participants was 20.9. Students had moderate knowledge and uncertain attitude toward family planning. The mean score of knowledge in basic science students was more than the others [p<0.001]. However, there was no significant difference between the mean sources of attitude in the 4 groups. There was a positive but weak relation between the mean scores of attitude in the 4 groups. There was a positive but weak relation between age as well as year of study and knowledge and attitude score [p<0.001]. the main sources of information about contraceptive methods were their friends and relatives. Our results suggest that a more appropriate educational family-planning program in colleges should be used by revising the present education at universities to increase knowledge and improve attitudes toward family planning program in colleges should be used by revising the present education at universities to increase knowledge and improve attitudes toward family planning

[ effect of reflexology on pain intensity of labor]

Background and Objective: labor pain management is one of the difficulties in most countries. Pharmacological methods for pain relief during labor has many side effects whereas reflexology as one of the non-pharmacological methods for pain relief, is an ancient and noninvasive technique, but there is not enough information on its effect on pain intensity of delivery. Therefore, this research was conducted to determine the effect of reflexology on pain intensity of labor on prime parous in Shahid Akbarabadi hospital in 2009

Materials and Methods: a randomized clinical trial study was designed. A total of 120 parturient women with low risk pregnancy were randomly assigned into three groups. Each group received one of the following treatments: reflexology, support or routine care only. In all groups pregnant women asked to evaluate their severity of pain before and after the intervention and also in 6-7 and 8-10 cm of cervical dilatation. Data was collected through numerical pain scale

Results: confounding factors were equal in all three groups. Pain intensity in all three dilatation stages was significantly lower in reflexology group [p< 0.001], but comparison between the supported group and routine care group, severity of pain was lower in supported group just in 4-5 cm dilatation, but during 6-7 and 8- 10cm of dilatation there was no significant difference between these two groups

Conclusion: based on the results of this study, it seems that reflexology can decrease the pain intensity in first stage of labor

Efficacy of syntometrine, syntocinon and the physiologic approach in the management of the third stage of labor

The third stage of labor is of utmost importance. Prior investigators have proposed different approaches to shorten this stage. The present study was aimed at determining the efficacy of syntometrine, syntocinon and the physiologic approach in the management of the third stage of labor. Ninety parturients enrolled for this clinical trial. They were randomly distributed in one of the 3 groups; physiologic, syntometrine, and syntocinon. Along with the anterior shoulder appearance, 10 units of oxytocin, or 5 units of oxytocin plus 0.5mg ergometrin was intramuscularly injected in the syntocinon and syntometrine group, respectively. Then the umbilical cord was clamped and cut immediately and finally the placenta was delivered. On the other hand, patients in the physiologic group were not given oxytocic drugs, and umbilical cord was not cut unless the pulse completely disappeared. The efficacy of these approaches was determined on the duration of the third stage of labor and its complications [bleeding during the first 2 hours, hemoglobin, hematocrit, further requirement of oxytocic drugs]. Drugs-related side effects were also determined.The mean duration of the third stage of labor was 7.4 +/- 2.4, 5.5 +/- 2.5, and 5.1 +/- 2.4 minutes in the physiologic, syntocinon and syntometrine groups, respectively [p < 0.001]. The amount of bleeding during the first 2 hours were 230 +/- 95.2, 217 +/- 113, and 176 +/- 83.2 ml in the groups, respectively [p < 0.05]. Hematocrit was 33.3 +/- 4.1, 34.7 +/- 4, and 36.4 +/- 4% in the groups [p < 0.05]. Further demand for oxytocic drugs was reported in 16.7% of patients in the physiologic group and 13.3% of patients in the syntocinon group, whereas, there was no demand among patients who receive syntometrine [p < 0.05]. Mild pain was reported in 16.7, 20 and 43.3% of patients in the physiologic, syntocinon and syntometrine groups, respectively [p < 0.05]. In order to manage the third stage of labor, syntometrine is better than syntocinon and syntocinon is better than the physiologic approach