Developing of a new guideline for improving birth experiences among Iranian women: a mixed method study protocol.

BACKGROUND: The childbirth experience has significant effects on the life of the mother and family. However, there are no Iranian studies which evaluate and measure women's childbirth experiences to provide accurate data on this important matter. The aim of this study is to develop a new guideline to improve women's childbirth experiences by meeting their needs and expectations. METHODS/DESIGN: The present study will use the mixed method with the explanatory sequential approach. Phase one is a cross-sectional survey with random cluster sampling of the health centers in Tabriz. Eight hundred primiparous women will be selected to measure their childbirth experiences and predictors factors. Phase two is a qualitative study to explore women's perceptions of the aspects and determinants of the childbirth experience. Phase two participants will be selected using purposive sampling from the women who participated in phase one. Phase three involves developing a new guideline to improve women's childbirth experiences. The new guideline will be developed based on the following elements: a) the results of the qualitative and quantitative data from phase one and two, b) a review of the related literature, and c) expert opinions that have been collected using the Delphi technique. DISCUSSION: By exploring women's childbirth experiences and the influencing factors, a culturally sensitive evidence-based guideline can be developed. The provision of the evidence-based guideline resulting from this study might be effective in improving the quality care of the services for pregnant women. ETHICAL CODE: IR.TBZMED.REC.1396.786.

Validation of the Iranian version of the childbirth experience questionnaire 2.0.

BACKGROUND: Assessing women's childbirth experiences is a crucial indicator in maternity services because negative childbirth experiences are associated with maternal mortalities and morbidities. Due to the high caesarean birth rate in Iran, measuring childbirth experience is a top priority, however, there is no standard tool to measure this key indicator in Iran. The aim of present study is to adapt the "Childbirth Experience Questionnaire 2.0" to the Iranian context and determine its psychometric characteristics. METHODS: Childbirth Experience Questionnaire 2.0 was translated into Farsi. A total of 500 primiparous women, at 4 to 16 weeks postpartum, were randomly selected from 54 healthcare centres in Tabriz. Internal consistency and reliability was calculated using the Cronbach's Coefficient alpha and Intraclass Correlation Coefficient, respectively. Construct validity was assessed using exploratory and confirmatory factor analysis and discriminant validity using the known-group method and the Mann-Whitney U-test. RESULTS: The internal consistency and reliability for the total tool were high (Cronbach's alpha = 0.93; Intraclass Correlation Coefficient = 0.97). Explanatory factor analysis demonstrated the adequacy of the sampling (Kaiser-Meyer-Olkin = 0.923) and significant factorable sphericity (p < 0.001). Confirmation factor analysis demonstrated acceptable values of fitness (RMSEA = 0.07, SRMSEA = 0.06, TLI = 0.97, CFI > 0.91, x 2/ df = 4.23). Discriminatory validity of the tool was confirmed where the CEQ score and its subdomains were significantly higher in women who reported having control over their childbirth than women who did not. CONCLUSION: The Farsi version of the Childbirth Experience Questionnaire 2.0 tool is a valid and reliable tool and can be used to measure the childbirth experience in Iranian women.

Predictors of traumatic birth experience among a group of Iranian primipara women: a cross sectional study.

BACKGROUND: Traumatic birth experience has undesirable effects on the life of the mother, child, family, and society. The identification of predictive factors can be useful in improving birth experiences among women. This study aimed to assess the prevalence of a traumatic birth experience and identify its predictors among a group primiparous women. METHODS: A cross-sectional study was conducted among 64 health centres in Tabriz, the second largest city in Iran. Cluster sampling was used to recruit 800 eligible women at one to 4 months postpartum. The Persian version of the Childbirth Experience Questionnaire was used to measure the womens' birth experiences. Data were collected through face to face interviews and analysed mainly by multivariable logistic regression. RESULTS: The prevalence of traumatic birth experience was 37% in the study group. The independent predictors of the traumatic birth experience were related to antenatal and intrapartum factors. The antenatal predictor was the lack of exercise during pregnancy (OR = 2.81, CI 1.40-5.63, P = .003) and the intrapartum predictors were the absence of pain relief during labour and birth (OR = 4.24, CI 2.12-8.50, P < .001), and the fear of childbirth (OR = 3.47, CI 1.68-7.19, P < .001). CONCLUSIONS: The findings revealed the high rate of traumatic birth experience among the primimarous women and identified the importance of a woman-centered care where a woman can actively make decision about the care she receives receive during labour and birth.

The Effect of Probiotic Yogurt on Constipation in Pregnant Women: A Randomized Controlled Clinical Trial.

BACKGROUND: Probiotics can alter the colonic microbiota and might improve bowel function. OBJECTIVES: The aim of this study was to evaluate the effect of the consumption of yogurt, enriched with Bifidobacterium and Lactobacillus 4.8 × 1010 (CFU) on the symptoms of constipated pregnant women. MATERIALS AND METHODS: This triple-blind randomized controlled trial was conducted on 60 constipated pregnant women who were diagnosed by the ROME III criteria in Tabriz, Iran from December 2014 to July 2015. Participants were randomly put into two groups including the treatment and the control group through block randomization. The treatment group received 300 g of yogurt enriched with Bifidobacterium and Lactobacillus 4.8 × 1010 colony forming units (CFU) (n = 30) while the control group received conventional yogurt (n = 30) for 4 weeks. The defecation frequency, stool consistency, straining during defecation, sensation of anorectal obstruction, sensation of incomplete evacuation and manual manoeuvres to facilitate defecation were primary outcomes while the amount of defecation, stool colure, and quality of life were secondary outcomes. RESULTS: The frequency of defecation was increased from 2.1 (0.8) at baseline to 8.3 (4.4) in the probiotic yogurt group vs. 2.3 (0.7) at baseline to 8.1 (4.3) in the conventional yogurt group at the end of 4th week. These results were based on the repeated measure ANOVA test and there was no statistically significant difference between the two groups (mean difference: 0.1; Confidence Interval 95%: -1.4 to 1.7; P = 0.872). Constipation symptoms including straining, anorectal obstruction, manipulation to facilitate defecation, consistency of stool and color of stool were improved significantly (P < 0.05) in both groups. In addition, the amount of defecation was significantly increased in both groups (P < 0.05), while incomplete evacuation was significantly reduced in the treatment group (P = 0.01). There was no statistically significant difference between the groups in the mean scores of physical (P = 0.726) and mental (P = 0.678) aspects of quality of life after the intervention with the adjusting of baseline scores. CONCLUSIONS: Consumption of 300 g/day probiotic and conventional yogurt can play a role in improving the symptoms of constipation during pregnancy.

Thromboembolism and Thrombosis during Pregnancy and After Delivery between 2009 and 2012 in Al-Zahra Educational Center.

Venous thromboembolism (VTE) is considered as one of the leading causes of maternal mortality during pregnancy and postpartum period. In this retrospective study the medical records of 81 women diagnosed with Pulmonary thromboembolism (PTE) and Deep venous thrombosis (DVT) between 2009 and 2012 in Tabriz Al-Zahra hospital was participated. These cases were evaluated regarding frequency, maternal and fetus risk factors associated with VTE. During 3 years 33 patients were diagnosed as PTE; 7 women were diagnosed as DVT and PTE; and 41 women were diagnosed as DVT. Most frequent underlying disease was hypertension (13.5%) and most frequent symptoms of PTE and DVT were dyspnea (100%) and swelling of lower limb (100%) respectively. 93% of PTE and 79% of DVT incidences occurred during and after the third trimester of pregnancy. Additionally, 38% of PTE occurred during or after childbirth (33% following cesarean and 5% following vaginal delivery). Therefore, it seems that vaginal delivery is safer than cesarean surgery. In addition, the importance of third trimester of pregnancy and postpartum period is obvious.

Effects of cinnamon on perineal pain and healing of episiotomy: a randomized placebo-controlled trial.

BACKGROUND: Analgesic and wound-healing effects of cinnamon, a widely used spice, have been shown in laboratory rats. However, we found no human studies in this area. OBJECTIVE: The aim of this study was to assess the effect of cinnamon on perineal pain and healing of episiotomy incision. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS: In this double-blind, randomized, placebo-controlled trial, 144 postpartum women were allocated into two groups, using stratified block randomization, 1 h after completion of episiotomy repair. They received cinnamon or placebo ointment, 2 mL every 12 h for 10 d. MAIN OUTCOME MEASURES: Perineal pain and wound healing were assessed using visual analogue scale (0-10) and Redness, Edema, Ecchymosis, Discharge, Approximation scale (0-15), respectively. General linear model was used to compare the groups on the outcomes adjusted for baseline values and stratified factors. RESULTS: Follow-up rate was 100% up to the 8 h time point in both groups, and 86% (62 of 72) in the cinnamon group and 85% (61 of 72) in the placebo group at day 10-11 after delivery. Pain score in the cinnamon group was significantly lower than that in the placebo group at (4±1) h (adjusted difference: -0.6, 95% confidence interval: -1.0 to -0.2) and (8±1) h (-0.9, -1.4 to -0.3) after intervention, and on the 10-11th day after delivery (-1.4, -2.0 to -0.7). Also the cinnamon group showed significantly more improvement than the control group in healing score at (8±1) h (-0.2, -0.4 to -0.04) and the 10-11th day after delivery (-1.6, -2.0 to -1.1). CONCLUSION: Cinnamon can be used for reducing perineal pain and improving healing of episiotomy incision.

Maternal-neonatal outcome in pregnancies with non-obstetric laparotomy during pregnancy.

In this study maternal and neonatal outcome evaluated in each trimester of pregnancies with non obstetric laparotomies. In this descriptive-analytic study, 100 pregnant women operated during pregnancy were evaluated. Based on available data a questionnaire comprising general information, kind of surgery as well as the maternal-neonatal outcome was fulfilled. These outcomes were compared in the different gestational ages. In this study, 28 (28%), 48 (48%) and 24 (24%) patients had been operated in the first, second and third trimester, respectively. The patients of these three groups were matched for general characters. Sixty one patients had appendectomy, 30 adnexal mass or torsion, 6% cholecystectomy, 3% abdominal mass. Maternal complications were recorded in 6, 3 and 9% patient in 3rd, 2nd and 1st trimester of pregnancy, respectively. Abortion in first trimester was 8.2%. Low apgar in fifth minute and asphyxia were higher in third trimester. Appendectomy was the most common surgery in the pregnancy. Maternal and fetal complications were higher in third and first trimester. Besides obstetric and pediatric consultation before surgery are necessary for optimal safety of the woman and the fetus.

Service quality of delivered care from the perception of women with caesarean section and normal delivery.

BACKGROUND: Our aim was to determine the service quality of delivered care for people with Caesarean Section and Normal Delivery. METHODS: A cross-sectional study was conducted among 200 people who had caesarean section and normal delivery in Al-Zahra Teaching Hospital in Tabriz, north western Iran. Service quality was calculated using: Service Quality = 10 - (Importance × Performance) based on importance and performance of service quality aspects from the postpartum women's perspective.A hierarchical regression analysis was applied in two steps using the enter method to examine the associations between demographics and SQ scores. Data were analysed using the SPSS-17 software. RESULTS: "Confidentiality", "autonomy", "choice of care provider" and "communication" achieved scores at the highest level of quality; and "support group", "prompt attention", "prevention and early detection", "continuity of care", "dignity", "safety", "accessibility and "basic amenities" got service quality score less than eight. Statistically significant relationship was found between service quality score and continuity of care (P=0.008). CONCLUSION: A notable gap between the participants? expectations and what they have actually received in most aspects of provided care. So, there is an opportunityto improve the quality of delivered care.

Effects of cinnamon on perineal pain and healing of episiotomy: a randomized placebo-controlled trial / 中西医结合学报

Analgesic and wound-healing effects of cinnamon, a widely used spice, have been shown in laboratory rats. However, we found no human studies in this area.

Study of foetal heart rate patterns in pregnancy with intra-uterine growth restriction during antepartum period.

OBJECTIVES: To evaluate foetal heart rate pattern during antepartum period in pregnancies suffering from intrauterine growth restriction. METHODS: The case control study was conducted at the Alzahra Hospital, Tabriz, Iran from April 2008 to April 2011. It comprised 100 pregnancies with intra-uterine growth restriction and 92 normal pregnancies. The foetal heart rate pattern including basal heart rate, beat-to-beat variation, non-stress test (NST) result and acceleration and deceleration patterns of the heart rate were determined in both groups during the antepartum period. Findings were compared between the two groups and their relation with pregnancy-foetal outcomes was specified in the case group. SPSS 15 was used for statistical analysis. RESULTS: There was no statistically significant difference between the foetus mean basal heart rate in the two groups (p <0.960). Frequency of cases with non-reactive non-stress test in the Cases was significantly higher than Controls (p <0.005). The difference in heart rate acceleration was also not statistically significant (p <0.618). Frequency of cases with low birth weight and caesarian was non-significantly but borderline higher among the Cases (p <0.081 and 0.060, respectively). CONCLUSION: Abnormal foetal heart rate pattern is more common in pregnancies marked by intra-uterine growth restriction and is directly associated with worse pregnancy/foetal outcomes.

Hyoscine-N-butylbromide versus atropine as labour accelerant and analgesic: a randomized clinical trial.

The aim of this study was to compare the efficacy of atropine and hyoscine-N-butyl bromide in reducing the pain and time length of the first stage of labour. In a single blind randomized clinical trial, 120 term pregnancies were enrolled from July 2009 to March 2011. A parallel design was used to randomly assign subjects into two equal groups including 60 participants in each group. Hyoscine-N-butylbromide was administered 40 mg intravenously in the first group and intravenous atropine was given in second group at a dose of 0.5 mg. The participants of the two trial arms were similar according to the distribution of background variables. The pain trend through the study follow up was found to be different between groups (p < 0.05). Mean length of the first stage of labor was 218.5 min (SD: 81.4) in hyoscine versus 339 min (SD: 83.3) in atropine group (p < 0.001). Mean 1st and 5th min APGAR score was similar in both groups. Drug side effects were less frequent in hyoscine group observed in 13 cases compared to atropine group observed in 56 cases (p < 0.001). Hyoscine appeared to be preferable to atropine specially in reducing the length of first stage of pregnancy.

Complications in premature labor between severe preeclampsia and normal pregnancies.

Severe Preeclampsia may lead to liver and renal failure, Disseminated Intravascular Coagulopathy (DIC) and Central Nervous System (CNS) abnormalities. This study aimed at comparing of infant complication in premature labor between severe preeclampsia and normal pregnancies. In this analytical-descriptive study, one hundred pregnant with severe preeclampsia and premature delivery due to severity of preeclampsia were compared with one hundred cases of premature delivery without preeclampsia to study neonatal fate. The understudy subjects were divided into five age groups of 27-28, 29-30, 31-32, 33-34, 35-36 weeks considering type of delivery, neonate features and neonatal complications related to premature delivery. Mean age of mothers of normal delivery group was 27.28 +/- 5.42 mean age of mothers of the second group was 30.56 +/- 5.86. There was statistically meaningful difference between two groups of delivery regarding patients' systolic blood pressure (p < 0.001). The study made it clear that there was not statistically meaningful difference between two groups of delivery regarding fetus age (in weeks) at the time of delivery (p = 0.456). According to findings of this study, neonatal complications and mortality is high in preeclampsia due to stressful conditions created for the fetus.

Comparison of fetal middle cerebral arteries, umbilical and uterin artery color Doppler ultrasound with blood gas analysis in pregnancy complicated by IUGR.

BACKGROUND: Fetal color Doppler is important for evaluation of hypoxia in intrauterine growth restriction (IUGR) fetus. OBJECTIVE: In this study we compare fetal and maternal color Doppler with blood gas analysis to detect fetal acidosis. MATERIALS AND METHODS: In this cross-sectional study we evaluated 100 hospitalized patients with IUGR for comparison of color Doppler results with arterial blood gas analysis. RESULTS of Doppler sonography of fetus middle cerebral arteries, umbilical and uterine artery and umbilical artery ABG were studied in these neonates. RESULTS: Mean maternal age was 28±7 years, mean gestational age was 31.79±2.59 weeks and mean growth restriction was 3±2 weeks. Resistance increasing was observed in right uterine arteries of 37 mothers. It was normal in 60 mothers. Resistance increasing was observed in left uterine arteries of 36 mothers and nuch was seen in four cases. PCO2, PO2, and pH mean were 48.41±9.50 mmHg, 26.00±12.34 mmHg, and 7.28±0.10 in the neonates respectively. CONCLUSION: In this study abnormal color Doppler in IUGR fetuses have no significant correlation with umbilical cord blood gas.

Irrational parenthood cognitions and health-related quality of life among infertile women.

BACKGROUND: The aim of this study was to assess health-related quality of life, irrational parenthood cognitions, and their interrelationship among a group of Iranian women referred to an infertility center in Tehran, the capital of Iran. MATERIALS AND METHODS: Women who visited the infertility center in Imam Khomeini University Hospital in Tehran participated in this cross-sectional study. Each participant filled out a two-part questionnaire. The first part included background questions, and the second part included inventories developed to assess quality of life and irrational parenthood cognition among infertile subjects. RESULTS: The mean age of the participants was 27.8 years (standard deviation, 5.1). Mean standardized quality of life score was 59.4 out of a maximum of 100 (95% confidence interval, 56-62.8). No statistically significant linear correlation was found between quality of life and age, length of marriage, or the time under treatment. There was a weak reverse correlation between length of the time attempting to become pregnant and quality of life (r = -0.25; P < 0.01). There was a strong reverse correlation between irrational parenthood cognitions and quality of life (r = -0.64; P < 0.00). Multivariate regression analysis found several variables to be independent predictors of quality of life score. These included having higher levels of irrational parenthood cognitions, being under high social pressure imposed by relatives, and having spent a long time attempting to become pregnant. CONCLUSION: Knowing about the predictors of low quality of life (including high-level irrational parenthood cognitions, social pressure from relatives, and spending a long time attempting to become pregnant) is assumed to help physicians in identifying the infertile women who are at higher risk of developing a poor health over their infertility experience.

Domestic injuries and suicide among women of reproductive age in Iran.

BACKGROUND: The aim of this study was to map out some epidemiological aspects of intentional and unintentional injuries among Iranian women of reproductive age using a national registry. METHODS: Injury data were taken from a national-based injury surveillance system over the period 2000-2002. The study population comprised 31.5% of the population of Iran. RESULTS: Of all the 307,064 domestic injuries reported during the years 2000-2002, about 152,600 cases (49.7%) involved women. About half of these women (76,474) were in the reproductive age group. The majority (42.7%) of injuries among women of reproductive age were burn wounds followed by lacerations in 32.6%. Eighty-five percent of suicide cases were poisonings, followed by 11% for suicides by burning. However, 45.2% of burn suicides were fatal, compared with a 0.89% fatality rate for poisonings. Of all female suicide victims, 1029 died, 174 victims became disabled, while the remainder improved or were undergoing therapy when reported. CONCLUSION: Injuries, especially burns, are a major public health problem for women of reproductive age.

Study of awareness among pregnant women of the effects of drugs on the fetus and mother in Iran.

OBJECTIVE: The aim of the study was to examine the awareness of Iranian pregnant women about the effects of drugs in pregnancy. METHODS: Awareness of 400 women in postnatal and prenatal wards was assessed using self-completion questionnaire, which included demographic information, medication use, and the level of information regarding the safety of drugs during pregnancy and the most susceptible periods in pregnancy. RESULTS: Out of 400 participants from prenatal and postnatal wards of two hospitals, 19.0% used medications other than vitamins and minerals supplements during pregnancy, and 7% believed in the safety of medications for mother and/or fetus during pregnancy. The first and second trimesters were believed to be the most and the least susceptible periods of pregnancy, respectively. Most information on drugs safety in pregnancy was obtained from physicians and health centers. CONCLUSIONS: Present study indicates weaknesses in the awareness of this population and weak role of pharmacists in informing this vulnerable population. This study shows the requirement of training of this group of people in order to enhance the health of our community.