Comparison of Four Tests for Preterm Birth Prediction in Symptomatic Singleton Women: A Prospective Cohort Study.

Background and Purpose: It is challenging to predict preterm births accurately. We sought to compare the diagnostic performance of cervical length in predicting preterm birth to those of contraction recording in cardiotocography (CTG), cervical funneling, and Bishop score. Methods: A total of 371 women with singleton pregnancies and threatened preterm labor admitted to tertiary hospitals of northwestern Iran were included in this prospective cohort study and followed up until childbirth. Transvaginal ultrasound was utilized to assess the cervical length and funneling. Also, a CTG test and digital vaginal examination were performed. The data of 218 women were analyzed in the STATA software. The sensitivity and other diagnostic performances, and 95% confidence intervals, were reported. Results: The CTG uterine contraction recording had the highest sensitivity for predicting birth within the next 2 days, whereas a Bishop score ≥6 revealed the highest specificity, positive predictive value, and positive likelihood ratio. Inadequate cervical length for gestational age exhibited a high negative predictive value and the lowest negative likelihood ratio. Conclusion: The cervical length test has good diagnostic and prognostic performance among the four tests for preterm birth. Cervical funneling and CTG tests have poor predictive value, whereas the Bishop score has a superior diagnostic performance to the other tests.

Validation of a Nomogram for Predicting Preterm Birth in Women With Threatened Preterm Labor: A Prospective Cohort Study in Iranian Tertiary Referral Hospitals.

In this prospective cohort study, we aimed to investigate external validity of the Allouche's nomogram to predict preterm birth in symptomatic women in Iran. We employed six variables of cervical length, uterine contractions, rupture of membranes, vaginal bleeding, gestational age, and multiple pregnancy to draw the nomograms. These variables were examined in the first day of women's hospitalization and participants followed up until giving birth. The concordance index of area under the curve (AUC) was used for validation of the nomograms. Of the participants 10% gave birth within 48 hours and 29% before 34 weeks. The nomogram had sufficient accuracy in predicting birth within 48 hours (AUC 0.89 [95% CI 0.82-0.96]) and birth before 34 weeks (AUC 0.89 [95% CI 0.84-0.94]). The optimal risk threshold for nomogram predicting birth within 48 hours was 0.16. Use of these two nomograms, can improve the health of women and their neonates.

Perceived stress and its predictors in women with threatened preterm labour: A cross-sectional study.

AIM: To determine prevalence and predictors of perceived stress in women with threatened preterm labour. DESIGN: Cross-sectional. METHODS: We recruited 409 women with threatened preterm labour, hospitalized at two tertiary hospitals. We assessed their socio-demographic and obstetrics characteristics, and their perceived stress, perceived social support, experience of violence using validated scales. Multiple linear regression was used to determine the predictors. RESULTS: Data from all recruited women were analysed. Most of them had borderline (36%) or high (42%) level stress. Overall, 17 predictors were identified explaining 89.5% of variation in the stress score. Predictors of the higher stress score included: urban living, experience of sexual and psychological violence, perceived insufficient social support, experience of vaginal bleeding during current pregnancy, abnormal results in initial pregnancy tests, having multiple roles at home, being less than 28 weeks pregnant, being parous, sleep disorders, history of health problems, insufficient income and unwanted pregnancy.

Validity and reliability of the Iranian preterm birth experiences and satisfaction scale: A methodological and cross-sectional study.

Background: Women's experience and satisfaction with childbirth care are increasingly being addressed by health care providers, managers, and policymakers. Due to need for a validated special scale for assessing satisfaction of women with preterm birth, we aimed to translate and adapt the first specific tool, Preterm Birth Experiences and Satisfaction Scale (P-BESS), into Persian language and evaluate its psychometric properties. Methods: A methodological and cross-sectional study was conducted in two tertiary levels of maternal hospitals in Tabriz. The Iranian version of the scale was developed from the original English version using forward-backward translation. After confirmation of its face and content validity, the scale was completed by 201 women who had given birth prematurely. Results: Exploratory factor analysis revealed three factors (staff professionalism and empathy, confidence in Staff, information and explanations) with eigenvalues greater than 1, explaining a total variance of 55.4%. Confirmatory factory analysis showed that the 17-item, three factor model fitted the data well: the root mean square error of approximation 0.060. There were moderate correlations between the total and sub-scales of Iranian P-BESS and overall satisfaction (r = 0.45 to 0.66), as well as need for improvement (r = -0.46 to -0.61), which confirm convergent validity. Internal consistency and test-retest reliability of the scale and its sub-scales were satisfactory (α = 0.852 to 0.922, intraclass correlation coefficient; 0.83 to 0.92). Conclusion: The Iranian version of P-BESS is a valid and reliable scale which can be used by policy makers, managers, health care providers and researchers.

The effect of midwifery continuing care on childbirth outcomes.

BACKGROUND: Continuation of delivery care by a midwife, and establishing a relationship between the midwife and the delivering woman, is so important for women, and preserving such relationship increases woman's calmness and self-confidence. The current research aims at studying the effect of midwifery continuing care during delivery on delivery outcomes. MATERIALS AND METHODS: This study was a quasi-experimental research conducted on childbearing women referring to Tabriz 29 Bahman Hospital. One hundred women were randomly assigned to either experimental (n = 50) or control (n = 50) group. In the experimental group, the women were cared exclusively with a midwife from the active phase continuously, while in the control group, women were cared with several midwifes conventionally. The birth outcomes were recorded in both valid and reliable groups (checklists). Data were analyzed using SPSS version 13.0. RESULTS: Type of delivery was the same in both the groups (P = 0.051). In the experimental group, grade of the perineal lacerations was lower (P = 0.001); also, in this group, less oxytocin was used in the labor stage (P = 0.001). CONCLUSIONS: The results showed that providing one-to-one delivery care and continuous attendance of the midwife on the bedside of delivering woman had positive effect on improvement of birth outcomes. So, providing the choice of one-to-one care for women in delivery rooms must be considered where it is logistically possible.

Effect of continuous midwifery care on length of labor.

INTRODUCTION: The process of pregnancy and labor has a dramatic impact on society's health. Considering the importance of obstetrical cares and the role and presence of midwife at parturient bedside, this study aimed to evaluate the impact of care and conti-nuous presence of midwifery on labor duration. METHODS: This was a semi-experimental study. The study population included parturient women referred to 29 Bahman Hospital in Tabriz who had normal vaginal delivery indication. 100 women were randomly se-lected and divided into experimental and control groups (50 in each group). In the expe-rimental group, obstetrical cares were provided by one midwife since the beginning of active phase of labor with her continuous presence at the bedside of parturient (continu-ing care) whereas in the control group, cares were provided by several midwives and without their continuous presence. Labor consequences (including labor duration) rec-orded for both groups. The data were analyzed through SPSS13 and inferential statistics including independent sample t-test. RESULTS: In the experimental group, the lengths of the first and second stages were shorter (per minute) than those of control group (p = 0.001). However, the length of the third stage of labor had no significant difference between the two groups (p = 0.083). Totally, the lengths of delivery including the first, second and third stages were shorter in the experimental group than in control group (p = 0.001). CONCLUSION: The results showed that low number of midwives and their continuous presence on bedside of parturient had a positive effect on reducing the deli-very duration. Therefore, being with "parturient" not only does promote the quality of obstetric care, also can promote the health of society.