"Living in a vacuum": Lived experiences of maternal near-miss among women with placenta accreta spectrum.

BACKGROUND: Placenta accreta spectrum (PAS) is one of the life-threatening complications of pregnancy, the prevalence of which has increased in parallel with the caesarean section rate. OBJECTIVE: The purpose of this study was to investigate the experiences of mothers with PAS who have also experienced maternal near miss. METHODS: The participants of this study included 8 mothers who had experienced near miss due to placenta accreta during the past year, as well as two husbands and two health care professionals. Data collection was done using face-to-face, in-depth virtual and in-person interviews. In this qualitative study, the interpretive phenomenological analysis approach was used to analyse the data. RESULTS: The superordinate theme that emerged from the lived experiences of the studied mothers is 'Living in a vacuum', which was derived from 3 main themes. The theme of 'distorted identity' is related to the mothers' experience of losing the uterus as a symbol of femininity and nostalgia for the former self. The theme of 'exacerbated exhaustion' indicates the burnout and fatigue perceived by these mothers and has dimensions far beyond the exhaustion caused by performing parenting duties. The third theme, 'a threatened future', reflects these mothers' vague image of the future in terms of health, preservation of life, and the continuation of living together with the husband. CONCLUSIONS: It seems that mothers with PAS need to be covered by integrated and well-organised psycho-social support from the time they are diagnosed with the complication until long after delivery due to the high potentiality of maternal near miss.

Frequency, Risk Factors, and Pregnancy Outcomes in Cases with Placenta Accreta Spectrum Disorder: A Case-Control Study.

Background: Placenta accreta spectrum (PAS) disorder is an important life-threatening problem. The purpose of the current study was to determine the frequency, risk factors, and pregnancy outcomes of PAS in our population. Methods: This is a case-control study using the data from a main tertiary referral university hospital in Ahvaz, southwest of Iran. The sample included 187 cases diagnosed with placenta accreta spectrum from 2015 to 2019 and 552 controls without PAS. A multivariable logistic regression model was used to find independent risk factors with 95% confidence interval. Pregnancy outcomes were evaluated using chi-square, t-test, and Mann-Whitney U test and p<0.05 were considered statistically significant. Results: The frequency of PAS during the study period was 3.7/1000 deliveries (0.37%). It was found that multiparity (≥3 deliveries, OR=2.05: 95%CI:1.21-3.47) and multigravidity (≥3 deliveries, OR=2.98: 95%CI:1.55-5.72), prior cesarean delivery (OR=52.55: 95%CI:19.73-139.96), and placenta previa (OR=27.48: 95%CI: 9.62-78.5) are the independent risk factors of PAS. Complications and morbidity associated with PAS included hysterectomy (60.4% vs. 0.7%, p<0.001), cystostomy (24.1% vs. 0.2%, p<0.001), the need for blood transfusion (73.7% vs. 1.4%, p<0.001), intensive care unit admission of mother (42.8% vs. 0.2%, p<0.001), duration of hospitalization (7.52±6.34 vs. 1.97±1.83, p<0.001), preterm birth <37 weeks (61.4% vs. 16.8%, p<0.001), and perinatal mortality (7.4% vs. 1.8%, p<0.001) which manifested statistically significant values. Conclusion: The frequency of PAS is similar to other populations. Prior cesarean delivery, placenta previa, multigravidity, and multiparity were independent risk factors and also perinatal hysterectomy and preterm birth were the most important complications.

Comparison of pre- and intra-COVID-19 postpartum depression among reproductive aged women: A comparative cross-sectional study in Ahvaz, Iran.

Background: The association between PPD and COVID-19 pandemic has been studied in some countries. This study aimed to compare postpartum depression before and during the COVID-19 pandemic among reproductive-aged women in Ahvaz, Iran. Methods: This comparative cross-sectional study involved 600 women of reproductive age in Ahvaz, Iran during the COVID-19 pandemic who were compared with 504 of their counterparts before the pandemic. Literate women who had given birth 1-6 months prior to the study, were aged 18-35, and were willing to participate in this study were recruited. A demographic questionnaire and Edinburgh Postnatal Depression Scale were used to collect the data. Independent t-test, Chi-square, and Logistic regression were used to analyze the data. Results: Before the pandemic, only 123 (24.9%) of the women had PPD, while during the pandemic, this number rose to 409 (68.2%). During the COVID-19 pandemic, the women were 8.727 times more likely to have PPD (95% CI: 5.919-12.868). During the pandemic, women with high school education and those having a high school diploma were 2.454 and 2.054 times more likely to have PPD compared to women with a university degree (95% CI: 1.508-3.996 and 1.302-3.241, respectively). Conclusion: The prevalence of PPD among Iranian reproductive-aged women increased during the COVID-19 pandemic. Policymakers should seek some strategies to support women during pregnancy and postpartum in times of crises such as the COVID-19 pandemic.

Does Infertility Stress Impair Sexual Function in Infertile Women and Men? A Cross-Sectional Study in Iran.

Background: The issue of infertility is a worldwide challenge, estimated to affect around 50 million couples. This study aimed to evaluate the relationship between infertility stress and sexual function in men and women with infertility. Methods: In this cross-sectional study, 300 men and women with infertility were recruited. A demographic questionnaire, the Fertility Problem Inventory, the Female Sexual Function Scale (FSFI), and the International Index of Erectile Function (IIEF) were used to collect data. Independent t-test, Chi-square, and linear and logistic regressions were used to assess the data. Results: The total score of sexual function in women and men was 22.18 ± 7.86 and 57.7 ± 17.8, respectively. Infertility duration and the ability to pay for the costs of infertility treatment had a significant relationship with sexual function in women. A significant association was found between communication concerns and sexual function scores in men with infertility. Infertile women had more sexual concerns, while infertile men had more communication concerns. Conclusion: This study showed that women with infertility had more infertility stress than men with infertility. Women with higher infertility duration and the inability to pay for the infertility treatment costs impaired sexual function. Women with infertility had more sexual concerns, while Men with infertility had more communication concerns. Policymakers need to consider strategies such as counseling for men and women with infertility to help them cope with their problems, especially their psychological problems. The lack of random enrollment of participants and lack of control group were the limitations of this study.

Prevalence and related factors of postpartum depression among reproductive aged women in Ahvaz, Iran.

In this study authors aimed to identify the prevalence and related factors of postpartum depression in Ahvaz, Iran. A total of 505 women enrolled in this study from six public health centers in Ahvaz city, Republic of Iran. This study started in February and completed in September 2014. Data was gathered using a socio-demographic and Edinburgh Postnatal Depression Scale Persian version. Authors screened women from 14 days to 6 months postpartum. Mothers with a score of >12 were classified as a postpartum depression (PPD). Our results revealed that 196 individuals (38.8%) had PPD. Women with PPD had significantly more of the following characteristics: undesired pregnancy, neonatal hospitalization, congenital abnormalities, history of postpartum depression, history of lifetime episode of depression, stressful events during pregnancy and an experience of domestic violence during pregnancy (p < 0.05). Our results showed that congenital abnormalities (OR = 2.99, 95% CI: 1.44-5.90), history of PPD (OR = 2.61, 95% CI:1.53-4.44), a lifetime episode of depression (OR = 3.26, 95% CI: 1.63-6.49) and having stressful events in the last year (OR = 4.1, CI: 2.19-7.80) were significantly contributed to the PPD. PPD is a common health problem among mothers and screening should be performed after childbearing to identify mothers at the risk.

The relationship between sleep quality and lifestyle in postmenopausal Iranian women: a cross-sectional study.

One of the most frequent symptoms in postmenopausal women is sleep disturbance. This study aimed to determine the relationship between sleep quality and lifestyle factors in postmenopausal women. Postmenopausal women (n = 252) in Ahvaz, Iran with an age range of 45-55 years, were enrolled from April to December 2015. The study tools included the Lifestyle Questionnaire (LSQ) and Pittsburgh Sleep Quality Index. The LSQ contains 10 lifestyle factors: physical health, physical activity, weight control and nutrition, psychological health, spiritual health, social health, medications and narcotics avoidance, illness prevention, accident prevention, and environmental health. Data were analyzed using, chi-square, Pearson correlation coefficients, analysis of variance, and multiple linear regressions. In unadjusted analyses, physical health, physical activity, nutrition, mental health, spiritual health, social health, and medication and narcotics avoidance scores were significantly higher in women without sleep disruption than in those with light and moderate sleep disruption (p < .001). Adjusting for confounding factors, sleep disruption was directly related to duration since the final menstrual period (p < .001), and inversely related to physical health (p = .04) and spiritual health (p = .028). Lifestyle factors were related to sleep disruption in postmenopausal women. Policymakers should consider education on healthy lifestyles for women.

The Relationship between Gestational Weight Gain and Postpartum Depression in Normal and Overweight Pregnant Women.

OBJECTIVE: To investigate the relationship between weight gain in pregnancy and postpartum depression (PPD) in normal and overweight pregnant women. METHODS: The participants of this prospective cohort study were 223 healthy pregnant women with the first trimester body mass index (BMI) between 18.5 and 30 and the gestational age of 10-14 weeks and depressed women were excluded with Beck questionnaire in the first trimester. The evaluation included weight gain at the end of the second and third trimesters and the screening of PPD in 6-8 weeks after delivery by Edinburgh scale. RESULTS: 49 participants were excluded from the study and data from 174 people were analyzed. 32.2% of mothers were scored above 12 in the Edinburgh scale. The only variable associated with depression was the third trimester weight gain (OR 1.17, 95%CI 1.04-1.32). CONCLUSION: In addition to considering other risk factors for postpartum depression, health care providers should consider the higher probability of PPD in prepregnancy normal and overweight women who have excessive weight gain especially in the third trimester of pregnancy.

Investigating the relationship between psychological hardiness and resilience with depression in women with breast cancer.

INTRODUCTION: Considering the fact that depression in patients with breast cancer increases the severity and complications of medical treatments such as chemotherapy (including fatigue, nausea, and cognitive problems), the identification of its related factors can be one of the important steps in reducing the complications of this disease. Therefore, the purpose of this study was to determine the relationship between psychological hardiness and resilience with depression in women with breast cancer. MATERIALS AND METHODS: The present study was a descriptive-analytic study, the population of which included all women with breast cancer under chemotherapy referred to Oncology Center of Imam Hassan Mojtaba Hospital in Dezful city from July 2015 to December 2016. A sample size of 114 people was selected. Data collection instruments included demographic information form, Ahvaz Psychological Hardiness Scale, Connor-Davidson Resilience Scale (CD-RISC), and Beck Depression Inventory. Data were analyzed using SPSS ver.21. FINDINGS: Findings showed that 61.4% of respondents had depressive symptoms. Mild, moderate and severe depression symptoms were prevalent among 37.7%, 20.2% and 3.5% of the participants, respectively. Also, there is a significant relationship between resiliency and hardiness with depression in women with breast cancer (P<0.05). DISCUSSION AND CONCLUSION: The depression rate in women with breast cancer decreased if hardiness and resiliency against the disease has been increased. This means that there is a need for training courses and counseling services for women with breast cancer in order to improve their mental health status.

Impact of green tea extract on serum lipid of postmenopausal women: A randomized controlled trial.

BACKGROUND: This study aimed to evaluate the impact of green tea extract on serum lipid level in postmenopausal women. METHOD: In this randomized controlled trial 100 postmenopausal women with an abnormality in at least one lipid profile were recruited and randomly assigned to one of the two groups: green tea extract (n = 50) and control group (n = 50). The intervention group received two capsules (400 mg) of green tea extract two times daily; the control group received a placebo for 4 weeks. The serum level of the lipid profile (total cholesterol, low density lipoprotein (LDL), high density lipoprotein (HDL), triglyceride, and fasting blood sugar) was measured at baseline and 4 weeks after intervention. RESULTS: In total, 79 women completed the study. The mean total cholesterol in the green tea group was significantly decreased after 4 weeks of intervention (mean difference -18.1 vs. -5 mg/dL in the green tea and placebo groups, p < 0.04). The triglyceride and LDL also decreased significantly in the green tea group compared to the control group (p = 0.002 and p = 0.04 respectively). The level of HDL and fasting blood sugar did not change within the group and between groups. CONCLUSION: Green tea extract is cost-effective way to decrease lipid profile in postmenopausal women without major side effects. Using this herb is recommended in women who have slight lipid profile abnormalities.

The relationship between function and sexual satisfaction with sexual violence among women in Ahvaz, Iran.

BACKGROUND: One of the forms of violence that receives less attention due to cultural and social issues is sexual violence against women, which is a hidden and a constant epidemic and impact on their health. AIM: This study aimed to determine the relationship between function and sexual satisfaction in women who have experienced sexual violence in Ahvaz-Iran. METHODS: This study was a case-control study which was conducted on 105 women (cases=35 and control=70) referred to one forensic center and seventeen Shahrivar health centers during 2013-2014 in Ahwaz-Iran. The data collection tools included questionnaires for evaluating demographic characteristics and sexual satisfaction, sexual female function index and sexual violence. The data were analyzed using descriptive and inferential statistics (Chi-square, Fisher's exact, and independent-samples t-test) in SPSS, version 19. P-value < 0.05 was considered significant. RESULTS: Two groups of women were matched according to age and education. Mean ± SD sexual satisfaction was (71.4±15.84) in the case group and (99.44±15.68) in the control group (p<0.001). The mean ± SD of sexual function was (17.1±4.94) in the case group and (26.37±5.27) in the control group. The groups had a statistically significant difference in terms of sexual arousal, sexual orgasm, sexual lubrication, pain and sexual satisfaction (p<0.001). CONCLUSION: Sexual dysfunction and dissatisfaction have a relation with sexual violence, and a major concern is that the sexual violence in most cases is hidden and can seriously affect the general health condition of women.

The effect of hydro-alcohol extract of Tribulus terrestris on sexual satisfaction in postmenopause women: A double-blind randomized placebo-controlled trial.

INTRODUCTION: Increasing life expectancy in women and having menstrual problems and hormone-associated complications have led people to use complementary and alternative medicine. In menopause, the reduction in estrogen and androgen physiologically leads to a decrease in blood flow in the volvuleous and vaginal zone, resulting in a reduction in sexual desire and arousal. Sexual satisfaction plays an important role in mental health. The aim of this study was to investigate the effect of Tribulus terrestris on sexual satisfaction in postmenopausal women. METHODS: This double-blind clinical trial was conducted in 2017 with the aim of investigating the effect of hydro-alcohol extract of T. terrestris on sexual satisfaction of postmenopausal women on 60 women referred to health center number 1 in eastern Ahvaz. A total of 60 postmenopausal women were randomly assigned into two groups of 30 to receive a syrup containing T. terrestris extract at a concentration of 0.9 mg and placebo for 8 weeks. Sexual satisfaction was calculated based on Larsson questionnaire. Data were analyzed by SPSS software (version 22) and t-test was used for comparing two groups in quantitative variables and Chi-square test was used for qualitative variables. P value less than 0.05 was considered significant. FINDINGS: After intervention, the mean of sexual satisfaction in the intervention group was significantly higher than in the preintervention group (P < 0.005), and a significant increase in sexual satisfaction was observed in the tetanus syrup group. RESULTS: Taking T. terrestris syrup increased sexual satisfaction in postmenopausal women.

The effect of vitamin D on vaginal atrophy in postmenopausal women.

BACKGROUND: Most of the women suffer from vaginal atrophy and dryness, and therefore, efficient and safe treatment is needed to improve vaginal lubrication. Vitamin D has several important functions which may be effective in proliferation and repair of the epithelial tissue. This study aimed to evaluate the effect of vitamin D vaginal suppositories on maturation index, pH, and dryness in postmenopausal women. MATERIALS AND METHODS: Women were enrolled in this double-blind clinical trial, in whom menopause occurred at least one year ago. Those women who had an abnormal Papanicolaou smear, had undergone hormonal treatment, or have had vaginal infection in the previous year were excluded. Forty-four women who found eligible were randomized into two equal groups, the treatment and control groups, which received vitamin D and placebo vaginal suppository daily for 8 weeks, respectively. Vaginal pH and maturation value were measured at the beginning and end of the study. Pain, dryness, and paleness were assessed before treatment and at the end of the 2, 4, and 8 weeks of treatment. RESULTS: In the treatment group, the number (Mean ± SD) of superficial cells increased (69.76 ± 12.4) and vaginal pH decreased (1.42 ± 0.67) significantly compared to the control group after 56 days. The mean pain significantly reduced after 8 weeks in the treatment group (1.23 ± 0.53) compared to the control group 1.95 ± 0.74 (P < 0.001). The mean of dryness and paleness reduced significantly in the treatment group versus control at 56 days. CONCLUSIONS: Vitamin D is effective in improving the maturation index and decreased the pH and dryness of the vaginal atrophy due to menopause.

Evaluation of contextual and demographic factors on licorice effects on reducing hot flashes in postmenopause women.

Menopause is an important stage in the life of every woman. Hot flashes are the most common climacteric symptom and a major cause of suffering in postmenopausal women. Licorice is one of the plants that is used to relieve menopausal symptoms. The present study was undertaken to evaluate the effects of licorice on hot flash symptoms in menopausal women. The participants of this randomized, double blind, clinical trial study were 60 menopausal women randomly allocated to licorice or hormone replacement therapy (HRT) groups. The participants in this trial received licorice (1140 mg/day) or HRT (a conjugated estrogen 0.312 mg/day and Medroxyprogesterone 2.5 mg/day) for 90 days. In this study we observed that licorice is not very different from hormones in terms of reducing the number and duration of hot flashes, but that HRT can reduce the severity of hot flashes significantly better than licorice can. In addition, there was no significant difference between age, education level, marital status, occupation, income, number of pregnancies, time from cessation of menstruation, and severity of hot flashes in the two groups. We observed that licorice seems more effective than HRT in improving hot flash duration, but that HRT can reduce the duration and severity of hot flashes more than licorice.

Effectiveness of selective vaginal tightening on sexual function among reproductive aged women in Iran with vaginal laxity: a quasi-experimental study.

AIM: Sexuality is an important part of women's health, quality of life and general well-being. Vaginal laxity may cause sexual dissatisfaction thereby causing some women to demand vaginal tightening surgeries. This study aimed to evaluate the sexual function preoperative and 6 months after selective vaginal tightening in women of reproductive age in Iran with vaginal laxity. METHODS: A quasi-experimental study was carried out on 79 women with vaginal laxity. All the women were requested to complete the questionnaire, which contained sociodemographic and Female Sexual Function Index (FSFI) questions preoperatively and 6 months after vaginal tightening. Data were analyzed using a paired Student's t-test, Wilcoxon rank sum test and Mann-Whitney U-test. RESULTS: The mean age of participants was 34.02 ± 5.30 years. The average total FSFI score increased from 24.19 ± 3.09 to 26.92 ± 3.41 (P < 0.001) after surgery. The scores for libido, arousal, orgasm and satisfaction domain were significantly improved, but a high level of dyspareunia and low vaginal lubrication were noted (P < 0.001). CONCLUSION: Sexual function was improved 6 months after vaginal tightening. This indicates that elective vaginal tightening had a positive effect on the sexual function in women. However, the increase in dyspareunia and decrease in lubrication may limit the application of this type of surgery. Further studies with longer follow-up are required to verify the long-term results of vaginal tightening.

Effect of hyoscine-N-butyl bromide rectal suppository on labor progress in primigravid women: randomized double-blind placebo-controlled clinical trial.

AIM: To determine the effects of hyoscine-N-butyl bromide (HBB) rectal suppository on labor progress in primigravid women. METHODS: A randomized double-blind placebo-controlled clinical trial was carried out on 130 primigravid women admitted for spontaneous labor. The women were recruited based on the inclusion and exclusion criteria and randomized into the experimental (n=65) and control group (n=65). In the beginning of the active phase of labor, 20 mg of HBB rectal suppository was administered to the experimental group, while a placebo suppository was administered to the control group. Cervical dilatation and duration of active phase and second stage of labor were recorded. RESULTS: The rate of cervical dilatation was 2.6 cm/h in the experimental and 1.5 cm/h in the control group (P<0.001). The active phase and the second stage of labor were significantly shorter in the experimental group (P=0.001 and P<0.001, respectively). There was no significant difference between the two groups in the fetal heart rate, maternal pulse rate, blood pressure, and the APGAR score 1 and 5 minutes after birth. CONCLUSION: Use of HBB rectal suppository in the active management of labor can shorten both the active phase and second stage of labor without significant side-effects.