The effect of a midwifery continuity of care program on clinical competence of midwifery students and delivery outcomes: a mixed-methods protocol

BACKGROUND

The midwifery continuity of care model is one of the care models that have not been evaluated well in some countries including Iran. We aimed to assess the effect of a program based on this model on the clinical competence of midwifery students and delivery outcomes in Ahvaz, Iran.

METHODS

This sequential embedded mixed-methods study will include a quantitative and a qualitative phase. In the first stage, based on the Iranian midwifery curriculum and review of seminal midwifery texts, a questionnaire will be developed to assess midwifery students' clinical competence. Then, in the second stage, the quantitative phase (randomized clinical trial) will be conducted to see the effect of continuity of care provided by students on maternal and neonatal outcomes. In the third stage, a qualitative study (conventional content analysis) will be carried out to investigate the students' and mothers' perception of continuity of care. Finally, the results of the quantitative and qualitative phases will be integrated.

DISCUSSION

According to the nature of the study, the findings of this research can be effectively used in providing conventional midwifery services in public centers and in midwifery education.

TRIAL REGISTRATION

This study was approved by the Ethics Committee of Ahvaz Jundishapur University of Medical Sciences (IR.AJUMS.REC.1401.460). Also, the study protocol was registered in the Iranian Registry for Randomized Controlled Trials (IRCT20221227056938N1).

Prioritizing the Psychosocial Support Needs of Mothers with Gestational Diabetes: A Delphi Study

Background

Gestational diabetes is the most common medical complication in pregnancy, and the psychosocial health of women suffering from this condition affects their adherence to treatment and self-efficacy. However, since it is not possible to design interventions dealing with all of these needs, the aim of this study was to prioritize the psychosocial supportive needs of women with gestational diabetes.

Materials and Methods

This was a modified Delphi design study involving 22 experts who were selected using purposive and snowball sampling methods. The study was conducted between April 2021 and June 2021. First, the psychosocial needs of diabetic pregnant women were extracted through a qualitative study involving interviews with multidisciplinary specialists and diabetic pregnant mothers (22 participants) and a systematic review of reputable scientific databases. Throughout the two Delphi stages, the questionnaire was classified, quantified, and analyzed.

Results

Based on the results of this study, the following are the top priorities when addressing the psychosocial needs of mothers with gestational diabetes: paying attention to and identifying the mother's worries and anxiety, husband and family support for diabetic pregnant women, the inclusion of specialized nutrition counseling services in mothers' treatment plan, timely education of mothers about diabetes and its complications, and proper nutrition for diabetic mothers.

Conclusions

The priorities of the supportive needs obtained in this study can be used to design interventions aimed at promoting psychosocial health, reducing stress and anxiety, and improving medication adherence in women with gestational diabetes.

Functional Roles of lncRNAs in Recurrent Pregnancy Loss: A Review Study

Recurrent pregnancy loss (RPL) or recurrent miscarriage is the failure of pregnancy before 20-24 weeks that influences around 2-5% of couples. Several genetic, immunological, environmental and physical factors may influence RPL. Although various traditional methods have been used to treat post-implantation failures, identifying the mechanisms underlying RPL may improve an effective treatment. Recent evidence suggested that gene expression alterations presented essential roles in the occurrence of RPL. It has been found that long non-coding RNAs (lncRNAs) play functional roles in pregnancy pathologies, such as recurrent miscarriage. lncRNAs can function as dynamic scaffolds, modulate chromatin function, guide and bind to microRNAs (miRNAs) or transcription factors. lncRNAs, by targeting various miRNAs and mRNAs, play essential roles in the progression or suppression of RPL. Therefore, targeting lncRNAs and their downstream targets might be a suitable strategy for diagnosis and treatment of RPL. In this review, we summarized emerging roles of several lncRNAs in stimulation or suppression of RPL.

Evaluation of the effectiveness of a postnatal support education program for husbands in promotion of their primiparous wives' perceived social support: a randomized controlled trial

BACKGROUND

Primiparous women experience various challenges if not provided with social support in the early postpartum period. Support in form of postpartum education programs is needed to improve mental well-being in primiparous women. The aim of this study was to determine the effect of a postnatal supportive education program for husbands on the perceived social support (primary outcome), and stress and maternal self-efficacy (secondary outcome) of their primiparous wives.

METHODS

This randomized clinical trial was performed on pregnant women referring to healthcare centers for routine care from September to November 2021 in Kermanshah, Iran. One hundred pregnant women were randomly divided in to intervention and control groups. Four 45-90 min online training sessions were held weekly for the husbands of the intervention group. The primiparous women completed the Postpartum Partner Support Scale, Perceived Stress Scale, and Postpartum Parental Expectations Survey before (third day after delivery, immediately and one month after completing the intervention. Data were analyzed using Fisher's exact test, Chi-square test, independent t-test, and repeated measures analysis of variance in SPSS version 24, and p < 0.05 was considered statistically significant.

RESULTS

In the control and intervention groups before the intervention, socio-demographic characteristics (P > 0.05), the mean scores of perceived social support (P = 0.11), maternal self-efficacy (p = 0.37) and perceived stress (p = 0.19) were not statistically significant. However, in the intervention group compared to the control group the mean scores of perceived social support (79.42 ± 7.17 vs. 37.26 ± 7.99, P < 0.001), maternal self-efficacy (186.22 ± 39.53 vs. 106.3 ± 32.88, P < 0.001) and perceived stress (16.36 ± 6.65 vs. 43.3 ± 7.39, P < 0.001) immediately after the intervention and the mean scores of perceived social support (84.4 ± 5.91 vs. 37.14 ± 6.63, P < 0.001), maternal self-efficacy (191.24 ± 38.92 vs. 112.34 ± 37.12, P < 0.001) and perceived stress (13.98 ± 4.84 vs. 39.06 ± 7.25, P < 0.001) one month after the intervention changed significantly.

CONCLUSION

The postpartum supportive education program for husbands was effective in promoting social support for primiparous women. Thus it can be introduced as routine care in the postpartum period.

TRIAL REGISTRATION

Clinical trial registration Iranian Registry of Clinical Trials; https://en.irct.ir/user/trial/56451/view (IRCT20160427027633N8), registered (15/06/2021).

Effect of birth plans integrated into childbirth preparation classes on maternal and neonatal outcomes of Iranian women: A randomized controlled trial

Background

Involvement of women in the decision-making process during childbirth plays an important role in their physical and psychosocial preparation. A birth plan allows the woman to express her expectations and facilitates her participation in her own care. The present study is the first to assess the implementation of birth plans integrated into childbirth preparation classes in Tehran, Iran.

Methods

This study is a randomized controlled clinical trial performed on 300 pregnant women at 32-33 weeks of gestation referring to four public health centers in Tehran, Iran. The participants were randomly allocated into intervention and control groups using block randomization method. A training session on the items of the birth plan checklist was held in the fifth session of childbirth preparation classes for the participants in the intervention group. Accordingly, a birth plan was prepared according to the requests of mothers. The birth plan was implemented after the women were admitted to the maternity ward. The primary outcomes were frequency of vaginal birth, mean duration of labor stages, and mean score of childbirth satisfaction. We used a checklist of maternal and neonatal outcomes, Mackey's childbirth satisfaction questionnaire, and a partogram form for data collection. Independent t-test, Mann-Whitney U-test, Chi-square test, Fisher's exact test, and logistic regression were used for data analysis.

Results

Vaginal birth rates were significantly higher in women who had birth plans compared with those without (81.9% vs. 48.7%, p < 0.001). Also, the lengths of the first and the second stages of labor were significantly shorter in women having a birth plan (p = 0.02). Women in the birth plan group were significantly more satisfied with the process of labor and childbearing (p < 0.001), and started breastfeeding after birth earlier than those in the control group (p < 0.001).

Conclusion

Having a birth plan and attending childbirth preparation classes can increase the rate of normal vaginal birth. Also, according to our results, women's participation in the decision- making process and fulfilling their preferences during birth can improve maternal and neonatal outcomes and childbirth satisfaction.Trial registration: IRCT20190415043283N2. 2020-12-07.

Continuous non-locking vs. interrupted suturing techniques for the repair of episiotomy or second-degree perineal tears: A single-blind randomized controlled trial

Objective

Perineal trauma is a serious and frequent problem after childbirth which is experienced by millions of women worldwide. The technique used for perineal repair may have an impact on pain and wound healing. The aim of the present study was to compare the continuous non-locking technique with interrupted suturing for the repair of episiotomy or second-degree perineal tears.

Methods

A single-blind randomized-controlled trial was conducted from October 2021 to August 2022 in Sina Hospital, Ahvaz, Iran. Three hundred women were selected and randomly assigned into control and intervention groups using block randomization technique. The main outcomes included pain and wound healing that were assessed using visual analog scale (VAS), as well as redness, edema, ecchymosis/bruising, discharge, and approximation scale (REEDA). The secondary outcomes were the use of analgesics, duration of perineal repair, material used for suturing, pain during urination and defecation, and resumption of sexual intercourse. The participants were followed up on the first and seventh days and in the 6th week postpartum. Mann-Whitney, Chi-square, and Generalized Estimating Equations (GEE) model were used for data analysis.

Results

Wound healing was significantly better in the continuous non-locking suture technique compared to the interrupted technique (β = -1.98; P > 0.0001). Women also experienced less pain in the continuous non-locking suture technique (β = -2.46; P > 0.0001). There was a reduction in the use of analgesics, the duration of perineal repair, and the material used for suturing in the continuous non-locking suturing technique as opposed to the interrupted method (P < 0.0001).The odds of pain during urination and defecation significantly reduced in women who underwent the continuous non-locking method (P < 0.001). Also, women in the continuous non-locking group resumed their sexual intercourse earlier (P < 0.0001).

Conclusion

The findings of this study revealed that use of continuous non-locking technique for suturing was associated with reduced perineal pain and improved wound healing. Furthermore, it was associated with a shorter duration of perineal repair, less suture material used, and less need for analgesics compared with the interrupted method. There is, however, need for more studies to confirm the results of the present study.Iranian registry for randomized controlled trials (Ref. ID: IRCT20190415043283N1).

Implementation of birth plans integrated into childbirth preparation classes for vaginal birth: a qualitative study of women, their husbands and clinicians' perspectives in Iran

BACKGROUND

Understanding women's experience of birth planning is necessary for introducing and implementing this process in the Iranian maternity services. This study aims to explore perceptions of birth plan implementation in Iran from the perspective of women, their husbands, and clinicians.

METHODS

This qualitative study was conducted in Iran. Qualitative data were collected from November 2020 to March 2021 by conducting semi-structured in-depth interviews with ten mothers who prepared a birth plan, and 15 key informants (obstetricians, midwives, and husbands) who were involved in the implementation process of birth plans. Data were analyzed using conventional qualitative content analysis.

RESULTS

Data reduction process resulted in 380 codes that were categorized in 16 subcategories and five main categories. The main categories were "Guide and pattern of preparing for childbirth pathway", "Maternal empowerment and sense of triumph", "Facilitating and enhancing communication", "Successful transition to parenthood and women's satisfaction", and "Challenges associated with implementation of the birth plan". The overarching theme "Birth plan: The missing link in promotion of vaginal birth in Iran" was constructed from these categories.

CONCLUSION

Findings of this study highlight the effectiveness of the implementation of birth plan along with childbirth preparation classes for increasing the likelihood of a successful vaginal birth and promoting empowerment and satisfaction in women during the childbirth process. The findings of this study could pave the way for developing, introducing, and implementing of birth plan in Iran.

Comparison of uterine preservation versus hysterectomy in women with placenta accreta: A cross-sectional study

BACKGROUND

Placenta accreta spectrum (PAS) is a major cause of obstetric bleeding in third trimester of pregnancy.

OBJECTIVE

This study aimed to compare the outcomes of uterine preservation surgery vs. hysterectomy in women with PAS.

MATERIALS AND METHODS

In this retrospective cross-sectional study, the records of 68 women with PAS referred to the Imam Khomeini hospital in Ahvaz, Iran, between March 2015 and February 2020 were included. The women were divided into 2 groups according to surgical approach: hysterectomy vs. uterine preservation (including just removing the lower segment, removing the lower segment with uterine artery ligation, or removing the lower segment with hypogastric artery ligation during cesarean section). The need for blood components transfusion (whole blood, packed cells, and fresh frozen plasma), maternal mortality, duration of surgery, and length of hospitalization were compared between groups.

RESULTS

In total, we investigated 68 women between the ages of 24-45 yr (mean age of 32.88 ± 5.08 yr). All participants were multiparous and underwent cesarean section. Furthermore, 28 women (41.2%) had a history of curettage. In total, 24 women (35.3%) underwent a hysterectomy, and 44 (64.7%) underwent uterine preservative surgeries. There were no significant differences between groups of hysterectomy and uterine preservative surgeries in terms of the need for blood components transfusion, maternal mortality, duration of surgery, and length of hospitalization.

CONCLUSION

The results of this study showed no significant difference between groups regarding the studied outcomes. Therefore, conservative surgeries could be used to preserve the uterus instead of hysterectomy in women with PAS.

Interventions to improve social support among postpartum mothers: A systematic review

Background: Poor and insufficient social support to the mother in the post-partum period impairs the effective functioning of her new role as a mother, and it is an important risk factor for the maternal depression and stress after childbirth. Thus, interventions to improve social support to mothers in their postpartum period are required. The present review aimed to investigate the effectiveness of the existing interventions aimed at improving social support among postpartum women.

Methods: In this systematic review, PubMed, Scopus, Science Direct, Cochrane Library, Web of Science, EMBASE, Google Scholar, IranDoc, IranMedex, MagIran and SID were searched until January 2022. Full-text articles on the social support outcome, published in English or Persian, which used the design of randomized controlled trials (RCTs) or comparison groups and involved postpartum or pregnant women as participants were included. The quality of the studies was assessed based on the seven criteria offered by Cochrane guidelines.

Results: Our review included 10 studies involving 3328 women. According to our results, the following interventions were successful in increasing social support compared to the controlled conditions: counseling with men in the prenatal period, interventions based on interpersonal psychotherapy (IPT), advanced practice nurse (APN), internet support, and home visiting in the postpartum period.

Conclusion: These interventions could be provided to mothers during their prenatal or postpartum care. However, which one of these interventions is the most effective in improving social support among postpartum mothers was not identified in the present study.

Psychosocial needs of inpatient women with gestational diabetes mellitus: a qualitative study

BACKGROUND

Gestational diabetes mellitus (GDM) is one of the most common medical complications associated with pregnancy. Its treatment requires multidisciplinary cooperation, and identifying the psychosocial needs of patients is important in the management of their condition.

OBJECTIVE

This study investigates the psychosocial needs of inpatient mothers with GDM from the joint perspectives of future mothers and healthcare providers.

METHODS

This qualitative study used a content analysis approach. Semi-structured individual interviews focusing on the psychosocial needs of women with GDM were conducted with twelve women suffering from GDM and eight medical staff. Sampling continued until data saturation.

RESULTS

According to the findings of this study, the psychosocial needs of these mothers were classified into the following categories: Support for worries related to the consequences of the disease, Interpersonal support, Infrastructural support, educational support.

CONCLUSION

The psychosocial needs of inpatient mothers with GDM were identified in this study. Attention to these needs can help enhance the mother's satisfaction and treatment adherence, and reduce worries and anxiety during hospitalisation.

ABBREVIATIONS

GDM: Gestational Diabetes Mellitus; hPGH: human placental growth hormone; COREQ: Consolidated criteria for reporting qualitative research; WHO: World Health Organization; HCP: healthcare provider.

Severe SARS‐CoV ‐2 infection in a 32‐week pregnant woman treated with Remdesivir‐Dexamethasone combination therapy: A case report

This study shows that remdesivir and dexamethasone combination therapy can be considered as a suitable treatment choice for pregnant women infected with COVID‐19. It is worth mentioning that more studies are required to evaluate the efficacy and side effects of remdesivir monotherapy and its combination with dexamethasone during pregnancy.

Factors causing timely referral for fetal echocardiography in the final diagnosis of congenital heart malformations: A crosssectional study

Background

Congenital heart disease (CHD) is one of the most frequently inherited illnesses associated with adverse outcomes.

Objective

This study aimed to determine the referral cause for fetal echocardiography in the final diagnosis of major CHD.

Materials and Methods

In this cross-sectional study, the data of 1772 pregnant women, referred to a diagnostic clinic during 2017-2020, were reviewed. Data were collected from participants on maternal age, gestational age, history of previous child's heart disease, body mass, the order of birth of children (baby birth rank), type of woman's disease, history of poor midwifery, and nuchal translucency (NT).

Results

Of the 1772 pregnant women, only 33 women (1.8%) had a fetus with CHD major. Abnormality in ultrasound (57.6%), history of abortion (36.4%), increased NT and gestational diabetes (18.2%) and gestational diabetes (18.2%) were identified as the most common referral reasons for fetal echocardiography in these women. Other reasons included a previous child with Down syndrome (12.1%), a previous child with heart disease (12.1%), a history of stillbirth (12.1%), hypothyroidism (12.1%), taking medication during the pregnancy period (9.0%), no underlying disease (9.0%), multiple pregnancies (6.0%), diagnosis with high-risk fetal heart disease (3.0%), high-risk combined aneuploidy screening test in the first trimester (3.0%), in vitro fertilizationpregnancy (3.0%), and having a child with an intellectual disability (3.0%).

Conclusion

According to the results, it can be concluded that ultrasound abnormality, abortion, increased NT and gestational diabetes are the most important factors for referring pregnant women for fetal echocardiography.

The psychosocial challenges associated with gestational diabetes mellitus: A systematic review of qualitative studies

BACKGROUND

Gestational diabetes is a disease with complex management that requires multidisciplinary collaboration. To achieve treatment goals, in addition to using medications and paying attention to exercise and diet, it is also important to take into account the mental health and psychosocial aspects of diabetes management. This study aimed to highlight these challenges associated with gestational diabetes.

METHOD

This qualitative systematic review involved a search of the following databases: CINAHL, EMBASE, MEDLINE, and PsycINFO. Title, abstract, and full-text screening was done using Covidence software, and quality assessment of the included papers was conducted using the Critical Appraisal Skills Programme Checklist. Enhancing transparency in reporting the synthesis of the qualitative research statement (ENTREQ) was used in the design of this paper. Data synthesis was done using meta-aggregation method.

RESULTS

Out of the 2440 articles searched, 24 were qualitatively analyzed. The CASP score of the included papers was optimal. The 514 findings extracted from the 24 studies were aggregated into five broad conceptual categories: psychological challenges, socio-cultural challenges, information-communication challenges, challenges associated with a lifestyle change, and challenges related to health care.

CONCLUSION

Recognizing the psychosocial challenges associated with gestational diabetes and developing support packages tailored to psychosocial needs can help improve the management of these patients.

PCR Detection and Sequencing of Trichomonas vaginalis in Women with Suspected Vaginitis in Southwestern Iran

INTRODUCTION

The human being is considered a natural host for Trichomonas vaginalis (T. vaginalis), which causes trichomoniasis, the most frequent non-viral sexually transmitted infectious disease in the world. The current study aimed to evaluate the prevalence and sequencing of T. vaginalis in women with vaginitis. ; Methods: In the current research, 514 vaginal discharge samples were obtained from women with vaginitis. The specimens were evaluated by the direct wet mount examination, Dorset culture medium, and PCR technique. Primers were designed for the detection of TVK3/TVK7, TVA5/TVA6 genes specific for the identification of T. vaginalis. The PCR-positive samples were sequenced and compared with the sequences registered in the GenBank database. ; Results: Among the collected samples, 30 (5.83%), 45 (8.75%), 90 (17.50%), and 62 (12.06%) cases were positive for T. vaginalis when assayed by the direct wet mount examination, Dorset culture medium, and PCR technique (TVK3/TVK7, TVA5/TVA6 genes), respectively. There was no significant relationship between trichomoniasis and demographic characteristics of women, such as age, occupational status, mode of delivery, number of deliveries, educational level, and contraceptive methods (p˃0.05). The range of vaginal pH was between 5-7 in women with vaginitis, and there was a significant statistical correlation between the pH values and the infection rate (p<0.05). The PCR-positive samples had 100% sequence homology with the reference sequence in the GenBank database (accession number L23861.1). ; Conclusion: This study confirmed a relatively high prevalence of T. vaginalis in the southwestern region of Iran. According to our results, the PCR method, especially detecting TVK3/TVK7 genes, was more sensitive than the direct wet mount examination and Dorset culture medium methods.

Women's perception of continuity of team midwifery care in Iran: a qualitative content analysis

Background

Understanding the pregnant women’s perception of continuity of team midwifery care is necessary for introducing and implementing this model of midwife-led care in the Iranian maternity services. This qualitative study aims to explore women’s perception of continuity of team midwifery care in Iran.

Methods

This research is a qualitative study conducted in Iran to explore women’s perception of continuity of team midwifery care during pregnancy, birth and postpartum from October 2019 to August 2020. Fifteen semi-structured interviews were conducted with women individually in private midwifery clinic through a purposive sampling method. Interviews were digitally recorded and transcribed verbatim in Persian and analyzed using conventional content analysis.

Results

From the data analysis, two themes, four main categories, and nine subcategories emerged. The themes were “Maternal empowerment” and “Mother’s satisfaction during the transition from pregnancy to motherhood”. The first theme included two categories of improving self-efficacy during antenatal education classes and the effective midwife-mother interaction. The second theme composed of two categories of satisfaction with the process of pregnancy, childbirth and postpartum as well as satisfaction with motherhood.

Conclusion

Findings of this qualitative study highlight the effectiveness of continuity of team midwifery model of care for promoting empowerment and satisfaction in women during pregnancy, birth and postpartum. The results of this study could pave the way for developing, introducing and implementing the midwife-led continuity models of care in Iran.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-021-03666-z.

Pregnancy outcomes following in vitro fertilization using fresh or frozen embryo transfer

Objective

The aim of this study was to investigate the pregnancy outcomes in women undergoing IVF using fresh and/or frozen embryo transfer.

Methods

In this retrospective patient record study, we reviewed 2,872 infertile women’s files, who were candidates for IVF. The patients were classified into two groups, including those who underwent fresh embryo transfer (n=1628) and/or frozen embryo transfer (FET) (n=1244).

Results

Fertility was achieved in 313 (19.23%) and 356 (28.62%) patients, who underwent fresh ET and FET, respectively. The rates of clinical pregnancy, ongoing pregnancy, and live births were significantly higher in the FET group than the fresh ET group. The incidence of multiple pregnancies, perinatal mortality, abortion in the first trimester, preterm delivery, and low birth weight were significantly higher among fresh ET group [38 (35.51%), 15 (14.50%), 72 (23.01%), 26 (8.30%), and 33 (10.54%), respectively] than in the FET group [25 (15.33%), 6 (6.87%), 63 (17.69%), 14 (3.93%), and 20 (5.61%); p<0.05]. In addition, the incidence of ectopic pregnancies, abortion in the second trimester, gestational diabetes, preeclampsia, and placenta previa were higher in the fresh ET group, but not significantly so (p>0.05).

Conclusions

Women who underwent IVF via FET showed more successful fertility and pregnancy outcomes compared to those who underwent IVF by fresh ET.

Factors influencing the implementation of obstetric triage: a qualitative study

OBJECTIVE

To identify factors influencing the OB triage implementation in Iran DESIGN: Qualitative study of conventional content analysis SETTING: A teaching tertiary referral hospital in Ahvaz, Khuzestan, Iran PARTICIPANTS: 37 professional midwives, nurses, gynecologists, and specialists of emergency medicine, and 6 patients MEASUREMENTS AND FINDINGS: Semi-structured interviews were conducted individually and face-to-face. Interviews were audio recorded, transcribed, and analyzed using conventional content analysis. Four overarching categories and nine themes emerged from the content analysis of the interviews and observations. Overarching categories were the guideline, individual, cultural and social context, and organization. The development and structure were themes of the guideline. Knowledge, attitudes, and behaviors were related to the category of individuals. The cultural and social context included cultural and social changes. Implementation and monitoring strategies and executive infrastructure were organizational themes. Participants had differences and similarities in understanding influencing factors.

CONCLUSION

The guideline, individual, cultural and social context, and organization were key factors influencing the OB triage implementation in Iran. Some variety was detected between the different occupational groups' perceptions of influencing factors. Providing human resources and training and empowerment of them was the most significant factor influencing, which was acknowledged by almost all participants in all occupational groups.

IMPLICATION FOR PRACTICE

Identifying the influencing factors from the perspective of all stakeholders can improve the process of OB triage implementation by eliminating barriers and enhancing facilitators.

Exploring the concept and structure of obstetric triage: a qualitative content analysis

BACKGROUND

Obstetric triage is a new idea, so the design and implementation of it requires identification of its concept and structure. The aim of this qualitative study was to explore the concept and structure of the obstetric triage in Iran.

METHODS

The purposive sampling was done and it continued until reaching the theoretical saturation. Thirty-seven semi-structured interviews were conducted individually and face-to-face. Interviews were audio recorded, transcribed, and analyzed using conventional content analysis.

RESULTS

Two themes, 8 main categories, and 16 subcategories emerged from the content analysis of the interviews and observations. The themes were the concept and structure of obstetric triage. The concept of obstetric triage consisted of three categories of nature, process, and philosophy of obstetric triage. The structure of obstetric triage included five categories of assessment criteria, emergency grading, determining the appropriate location for patient guidance, initiation of diagnostic and therapeutic measures, and timeframe for initial assessment and reassessment.

CONCLUSION

Findings highlighted that obstetric triage is a process with a dual and dynamic nature. This process involves clinical decision making to prioritize the pregnant mother and her fetus based on the severity and acuity of the disease in order to allocate medical resources and care for providing appropriate treatment at the right time and place to the right patient. The results of this study could be used for the design and implementation of the obstetric triage system.

A longitudinal study on the relationship between mother's personality trait and eating behaviors, food intake, maternal weight gain during pregnancy and neonatal birth weight

Background

Many factors such as social and behavioral are related to appropriate weight gain during pregnancy, and there is much of importance to find them. The aim of the study was to explore the association of personality traits, with eating behaviors, food intake, maternal weight gain during pregnancy as well as the neonatal birth weight.

Methods

This is a longitudinal and cross-sectional study. Eating behaviors were assessed using the Dutch Eating Behavior Questionnaire (DEBQ), and the NEO personality inventory was used to assess personality in pregnant subjects. A validated food frequency questionnaire was used to determine food intake. Three hundred and sixty pregnant subjects from Ahvaz (the capital city of Khuzestan province, Iran) were followed from the 20th week of pregnancy until delivery.

Results

High neuroticism was associated with higher consumption of highly energetic foods (p < 0.05) and less consumption of vegetables (p < 0.01), also was related with lower weight gain during pregnancy and neonatal birth weight (p < 0.05). Openness to experience, extraversion and agreeableness were linked with higher consumption of vegetables (p < 0.05). Conscientiousness predicted lower neonatal weight (odds ratio: 1.20, confidence interval: 1.07–1.34, p < 0.01).

Conclusions

Identification of personality traits would help to change the lifestyle and improve management guidelines.

The development and validation of an obstetric triage acuity index: a mixed-method study

Background: There is uncertainty about the applicability of developed country triage scales in the developing population.Objective: To develop and validate an obstetric triage scale in Iran.Methods: This exploratory sequential mixed-method study was conducted on experienced gynecologists, emergency medicine, midwives, and nurses as evaluators, and pregnant or parturient women as sample. Development of obstetric triage acuity index was done using qualitative study and literature review. Thirty-two evaluators in two rounds evaluated the clinical impact score, content validity ratio, and content validity index. The tool performance was compared with a standard reference in 415 women. The association of urgency levels with hospitalization, resource utilization, and emergency department length of stay were assessed in 599 women. Five midwives independently double-triaged 234 convenience women to estimate inter-rater reliability.Results: Out of 191 items in the initial draft, 9 (4.7%) items in the face validity, 33 (18.1%) in the first, and 5 (3.2%) in the second content validity round were removed because not meeting the expected thresholds. Nine items added based on evaluators' suggestions. Finally, total items had a kappa above 0.74, and S-CVI/Ave, S-CVI/UA were 0.99 and 0.86, respectively. There was a significant correlation between the two tools (r = 0.661, p < 0). Level 1 mothers had a higher chance of using ≥ 2 resources (OR = 16.4, 95% CI = 2.06-129.98) and hospitalization (OR = 18.0, 95% CI = 3.96-81.51) compared to the level 5, after adjusting for gestational age/postpartum, and referral method. Sensitivity, specificity, and accuracy of the scale in predicting hospitalization were 74.8% (95% CI = 69.73-79.49), 80.8% (95% CI = 73.60-86.74), and 76.7% (72.67-80.48), respectively. The over and under-triage rates were 6.1% and 17.1%, respectively. The absolute agreement inter-raters was 86.8%, and the linear weighted kappa was 0.86 (95% CI = 0.81-0.91).Conclusion: The designed OB triage scale showed good validity and reliability in the tertiary teaching hospital. Studying this tool at lower levels, non-educational, and public hospitals are recommended for external validity testing.

Obstetric triage systems: a systematic review of measurement properties (Clinimetric)

BACKGROUND

Since labor and delivery units often serve as emergency units for pregnant women, the use of obstetric triage systems with poor or inadequate quality can lead to unintended consequences such as over and under-triage and so a waste of humans and financial resources. Therefore, this systematic review was conducted to evaluate the measurement properties of obstetric triage tools.

METHODS

PubMed, EMBASE, and Medline were searched to identify studies in October 2018 and were updated in May 2019. The risk of bias COSMIN checklist was used to evaluate the quality of the studies. The quality of every measurement property was appraised by the update criteria of COSMIN. Evidence quality was judged using the modified GRADE approach.

RESULTS

A total of 444 studies were retrieved in initial search. Six studies evaluating 4 tools were included in this study. All the included studies reported only content validity and reliability. The quality of evidence varied from very low to moderate. The quality of content validity and reliability of the included tools was sufficient except for the reliability of the maternal-fetal triage index. The obstetric triage acuity scale (OTAS) was found to have higher reliability than other tools.

CONCLUSIONS

Due to insufficient evidence, the conclusions about the quality of measurement properties of each obstetric triage tool may be uncertain. This review emphasizes the necessity for further studies with robust methodological quality on the measurement properties of obstetric triage tools.

Scorpion stings in pregnancy: an analysis of outcomes in 66 envenomed pregnant patients in Iran

Background:

Scorpionism is one of the most important health problems in tropical regions, which unfortunately results in thousands of deaths annually. Pregnant women are potential victims in areas with high scorpion-sting prevalence. Limited medical data are available on the effects of scorpion envenomation in pregnant women. This study aimed to examine the effect of scorpion envenomation on pregnancy outcomes in 66 cases.

Methods:

The present descriptive/analytical cross-sectional study was performed on 66 scorpion-envenomed pregnant women referred to the clinical toxicology unit of Ahvaz Razi Hospital in Iran during 2015-2017. The variables assessed in all cases, via questionnaire and hospital medical records, were: age, patient residency, gestational week, status of the fetus, laboratory anomalies, clinical severity of envenomation, sting site and scorpion species. Pregnancy outcome (miscarriage, stillbirth, preterm birth, normal delivery) and status of the newborns were also evaluated. Data were analyzed using SPSS ^® software (version 24.0).

Results:

The following pregnancy outcomes were recorded from envenomed pregnant women: miscarriage = 1.5% (n = 1), stillbirth = 4.5% (n = 3), preterm birth = 10.6% (n = 7), normal birth = 83% (n = 55). Among participants whose pregnancy led to birth, 11(17.7%) cases had prenatal-neonatal complications. Neonatal complications, including Apgar score less than 8 points at 5 min, were found in 7 (11.3%) preterm birth cases and in 4 (6.4%) normal birth cases, along with birth weight below 2500 g in normal births. A significant relationship was found between adverse pregnancy outcomes and bite location, as well as scorpion species, but no relationship was found with other variables.

Conclusion:

Envenomation significantly contributes to preterm birth. Moreover, the location of bites and the type of scorpion species have a decisive role in the pregnancy outcome of scorpion-envenomed pregnant women.

Evaluation of Exhausted Regulatory T Cells in Preeclampsia

BACKGROUND

The development of a maternal immune response to fetal antigens and deficiency in regulatory T-cells (Tregs) may lead to preeclampsia. A plausible explanation for the reduced Treg cell function in women with preeclampsia is the presence of exhausted Treg cells which express CD279 or programmed cell death receptor-1 (PD-1), a negative regulatory molecule associated with limited proliferative capacity and reduced immune suppression.

OBJECTIVE

To assess the number of Treg CD4+ CD25 high and exhausted Treg CD4+ CD25 high CD279+ cells in women with preeclampsia (PE group) and healthy pregnant women (HP group) during the third trimester of pregnancy.

METHODS

Three-color flow cytometry was used to determine the proportion of Treg and exhausted Treg cells in 40 women in the PE group and 37 women in the HP group. Participants' blood samples were placed in EDTA blood collection tubes. Peripheral mononuclear cells were separated from the samples and stained with flurochrome-conjugated antibodies against human CD4, CD25 and CD279 markers, and subsequently analyzed by flow cytometry.

RESULTS

The PE group had fewer Tregs compared to the HP group (p=0.011). There was a significant increase in the percentage of exhausted PD-1+(CD279) Tregs (p=0.035) in the PE group comparisons with the HP group.

CONCLUSION

The increased number of PD-1 (CD279) molecules on the Treg cells may play a role in preeclampsia, hence it recommendation as a therapeutic target for the disease.

Association between HLA-G 14bp Gene Polymorphism and Serum sHLA-G Protein Concentrations in Preeclamptic Patients and Normal Pregnant Women

BACKGROUND

Preeclampsia (PE) is a multisystem syndrome that is a primary source of fetal-maternal morbidity and mortality. Human leukocyte antigen-G (HLA-G) is a nonclassical Major histocompatibility complex (MHC) class-Ib molecule expressed on the extravillous trophoblast and seems to have immunomodulatory functions during pregnancy. The purpose of our study was to investigate whether HLA-G may be a vital marker in the modulation of the pregnancy.

METHODS

In this case-control study, a number of 150 healthy pregnant women and 150 patients with PE had been genotyped for the 14 base-pair (bp) insertion/deletion polymorphism in exon 8 of the HLA-G gene, and the serum level of soluble HLA-G (sHLA-G) protein was measured using the enzyme-linked immunosorbent assay.

RESULTS

Data showed that the PE syndrome was not related to the HLA-G 14 bp genotype. But, the serum level of sHLA-G in PE patients was significantly lower than that in healthy pregnant women in the third trimester (11.74 and 24.48 U/ml, respectively, p < 0.001). However, no significant association was observed between the HLA-G 14 bp genotype and serum sHLA-G level.

CONCLUSION

Our results demonstrate that measurement of sHLA-G protein level may be helpful as a primary diagnosis for the pathogenesis of PE. Overall, this study suggests that the association between HLA-G 14 bp polymorphism and serum sHLA-G level in different ethnic populations of PE should be taken into consideration.

Effect of fennel vaginal cream on sexual function in postmenopausal women: A double blind randomized controlled trial

Objective: The aim of this study was to assess the effect of fennel on sexual function in postmenopausal women. It was a randomized controlled trial in 60 postmenopausal women with sexual dysfunction who were randomly assigned to two groups receiving either fennel vaginal cream (n=30) or placebo (n=30). Vaginal atrophy in the women was assessed using symptoms such as pallor, dryness, dyspareunia, itching and burning. The pH of the vagina and cytology of the vaginal mucosa were also measured at baseline and 8 weeks after the intervention. All participants were requested to fill out the Female Sexual Function Index (FSFI) at baseline and after 8 weeks. The intervention group was requested to use fennel vaginal cream (5 grams) every night, while the control group used placebo each night for 8 weeks. The data were analyzed using the independent t-test and Chi-square, Mann-Whitney and Wilcoxon tests. All areas of sexual function including arousal, lubrication, orgasm, sexual satisfaction and pain improved in both fennel and placebo groups after 8 weeks; however, the differences in the fennel group were more evident (p<0.05). The total FSFI score was significantly higher in the fennel group compared to the control group (8.2 ±9.4 and 8.03±10.36 before the intervention and changing to 33.79±0.7 and 18.99±1.09 after the intervention in the fennel and placebo groups, respectively; p<0.001). Discussion: According to our results, fennel vaginal cream is an effective means of improving sexual activity in postmenopausal women. The use of this product in women who have sexual dysfunction and contraindications for hormone therapy is recommended.

In vitro antimicrobial activities of metabolites from vaginal Lactobacillus strains against Clostridium perfringens isolated from a woman's vagina

BACKGROUND

More than 50 different species of bacteria may live in a woman's vagina, with lactobacilli being the predominant microorganism found in healthy adult females. Lactobacilli are relevant as a barrier to infection and are important in the impairment of colonization by pathogens, owing to competitive adherence to adhesion sites in the vaginal epithelium and their capacity to produce antimicrobial compounds.

METHODS

The aim of the present study was to demonstrate the inhibitory capability of Lactobacillus metabolites against Clostridium perfringens, an anaerobic Gram-positive bacterium. These bacteria were isolated from vaginal swabs by using culture-dependent approaches, and the bacteriostatic effect of Lactobacillus metabolites, extracted from different isolates, was assessed using a modified E test.

RESULTS

Among the 100 vaginal swabs, 59 (59%) samples showed the presence of Lactobacillus strains and only one sample contained C. perfringens. Lactobacillus metabolites demonstrated the significant potency of in vitro activity against C. perfringens, with minimal inhibitory concentration values ranging from 15.6 μg/mL to 31.2 μg/mL.

CONCLUSION

This study suggests that women without vaginal Lactobacillus strains may be susceptible to nonindigenous and potentially harmful microorganisms.

In vitro adherence of Lactobacillus strains isolated from the vaginas of healthy Iranian women

BACKGROUND

The lactobacilli are a part of the bacterial flora of the human vagina. Detection of normal Lactobacillus species in the vaginas of healthy women in different geographical locations, and evaluation of their specific properties, can aid in the selection of the best species for preventing sexually transmitted diseases in the future. This study was performed to isolate and identify the Lactobacillus species in the vaginas of healthy women and to evaluate the adherence of these lactobacilli to Vero and HeLa cell lines.

METHODS

The study included 100 women. Bacteria were isolated from healthy women and purified. Phenotypic and biochemical tests were performed to identify the lactobacilli. The Lactobacillus species were detected by molecular methods using polymerase chain reaction amplification of the full length of the 16S rDNA of the isolated bacteria. Several isolates of each species were then selected to study their adherence to Vero and HeLa cell lines.

RESULTS

Among the 50 samples taken from healthy women meeting the inclusion criteria, Lactobacillus species were identified in 33 (66%) samples. Of these lactobacilli, 14 isolates were Lactobacillus crispatus, six (18.2%) were Lactobacillus gasseri, nine (27%) were Lactobacillus rhamnosus, and the rest were either Lactobacillus salivarius (6%) or Lactobacillus plantarum (6%). L. rhamnosus showed the greatest adhesion to the cells when compared to the other tested species. All the lactobacilli isolated in this study showed a smaller capacity for cell adherence when compared with control species.

CONCLUSION

L. crispatus, L. rhamnosus, and L. gasseri were the dominant Lactobacillus species in the vaginas of healthy women in Iran. L. rhamnosus attached more readily to the cells than did the other species; therefore, this isolate is a good candidate for further studies on the potential health benefits and application of lactobacilli as probiotics.

Investigation the Effects of Metformin versus Insulin on Neonatal and Maternal Outcomes in Women with Gestational Diabetes Mellitus: A Randomized Clinical Trail

The aim of this study was to evaluate the effectiveness of metformin versus insulin in the glycemic control and to investigate the maternal and neonatal outcomes in in women with gestational diabetes mellitus. Pregnant women with gestational diabetes were randomized to either receive metformin (n=70) or insulin (n=70). Inclusion criteria were singleton pregnancy, following healthy diet and performing exercise for at least one week without satisfactory blood glucose level, no risk factor contributing to lactic acidosis, and no anatomic and/or chromosome anomalies. Two patients were excluded from the study due to lost to follow-up. The mean score of BMI and FBS after treatment was similar between two groups. But, the mean score of 2 hours blood sugar in insulin group (104.38±7.06 mg/dl) was significantly higher than metformin group (97.5±5.98 mg/dl) (P&lt;0.0001). The weight gain in metformin group was slightly lower than insulin group. (P=0.123). The proportion of neonatal hypoglycemia in insulin group was higher than metformin group (20 vs 3, P=0.002). Other neonatal outcomes such as IUGR, IUFD, fetal anomaly, polyhydramnios, macrosomia, oligohydramnios, and NICU stay did not differ significantly between two groups. In conclusion, metformin had compatible effect with insulin in decreasing adverse maternal and neonatal outcomes even in some parameters such as neonatal hypoglycemia it works better. Totally, metformin is safe and effectiveness in controlling the gestational diabetes mellitus.

The Effect of Hemoglobin Correction by Blood Transfusion on Pregnancy Outcomes in Minor and Intermedia Thalassemia Patients: A Single-Blind Controlled Randomized Clinical Trial

<p>To the best of our knowledge, there is no prospective trial study assessing the management of β-thalassemia by blood transfusion in pregnancy. The aim of this study was to investigate the effect of blood transfusion on maternal and neonatal outcomes in pregnant patients with beta thalassemia minor and intermedia. We did this randomized, single –blind, controlled clinical trial on 36 pregnant women with β thalassemia minor and intermedia at two tertiary hospitals of Imam Khomeini and Shafa in Ahvaz, Iran from January 2016 to July 2016. Patients were randomly assigned to receive either packed cell or not (control group) during pregnancy (ratio 1:1). The main outcomes of interest transfusion times, abortion, preterm delivery, type of delivery (cesarean or vaginal), stillbirth, birth weight, low birth weight, very low birth weight, small for gestational age, low Apgar score (≤7) at 1 and 5 minutes, oligohydramnios, fetal anomalies , and NICU admission. The median of blood transfusion in intervention group during pregnancy was two blood units. The cesarean section rate did not significantly differ between the intervention and control groups (72.2% and 44.4%, respectively, P=0.2). Two infants in intervention group experienced with LBW, one with SGA, one with low Apgar score, two with oligohydramnios, and one with NICU admission, while none in control group experienced these complications. The mean birth weight of infants in intervention group was significantly lower than control group (P value 0.002). The comparison between two groups showed that the adverse maternal and neonatal outcomes, especially low birth weight and preterm delivery were higher in intervention group.</p>

Comparison of group B streptococci colonization in vaginal and rectal specimens by culture method and polymerase chain reaction technique

BACKGROUND

Streptococcus agalactiae (group B streptococci, GBS) is a colonizing microorganism in pregnant women and without causing symptoms. Colonization of GBS in the rectovaginal region in late of pregnancy is a risk factor for newborn diseases. GBS infection in newborn babies is acquired by the aspiration of infected amniotic fluid or vertical transmission during delivery through the birth canal. The aim of this study was determination of GBS prevalence among vaginal and anorectal specimens at gestation females by polymerase chain reaction (PCR) and culture-based methods.

METHODS

In this study, 137 rectal and vaginal swabs were separately collected from women with gestational age 35-37 weeks from July 2013 to March 2014 at the teaching hospital of Razi, Ahvaz, Iran. All samples were enrichment in selective culture media Todd-Hewitt broth for 24 hours and recognized by standard culture using blood agar, phenotypic tests, and amplification of the CFB gene.

RESULTS

Age range was 16-45 years (mean, 28.34 ± 0.7 years). Of rectal samples, 42 (30.7%) were positive based on culture method and 57 (41.6%) samples were positive by PCR. Of 137 vaginal samples, 38 (27.7%) were positive by culture and 60 (43.8%) samples were positive by PCR. The chance of colonization with GBS was increased in women with a history of urinary tract infection.

CONCLUSION

The frequency of GBS culture from rectal samples was higher than vaginal samples. However, the detection percentage of GBS using PCR from vaginal samples was higher than rectal samples. By contrast, the culture is a time-consuming method requiring at least 48 hours for GBS fully identification but PCR is a sensitive and rapid technique in detection of GBS, with the result was acquired during 3 hours.

Comparison of Two Different Protocols of Methotrexate Therapy in Medical Management of Ectopic Pregnancy

Background:

Ectopic pregnancy (EP) is one of the most dangerous complications of pregnancy and without prompt diagnosis and treatment, it could become a major cause of maternal morbidity and mortality.

Objectives:

In this randomized controlled study, we compared single and double dose of methotrexate (MTX) therapy in the treatment of ectopic pregnancy.

Patients and Methods:

This study was performed on 76 patients who were admitted to Obstetrics Ward with primary diagnosis of ectopic pregnancy based on their medical history, physical examination, beta subunit (β-HCG) level, and transvaginal ultrasonography. Using random block allocation, the patients were classified in two groups of single dose and double dose administration of MTX. In single dose group, 50 mg/m² of MTX was given at day 0 and in double dose group, the patients received two doses of MTX at day 0 and 4. The level of β-HCG was measured at day 0, 4, 7 in both groups. The successful treatment was defined as 15% reduction in β-HCG level between day 4 and 7. The two groups were compared with each other with regard to their need for operation, or extra dose of MTX; duration of hospitalization; and MTX complications.

Results:

Results showed that the rate of success in double dose method was more than single dose one (79% versus 69%) but the difference was not significant (P = 0.29). Although the need for operation and extra dose of MTX were lower in the double dose group (15.8% vs. 18.8% and 5.26% vs. 13.2%, respectively), these differences were not significant too. Duration of hospitalization was significantly lower in double dose compared to the single dose (11.55 d vs. 14.76 d, P < 0.001).

Conclusions:

Single dose therapy of MTX has sufficient power and efficacy in the treatment of ectopic pregnancy, however in patients with higher serum level of β-HCG, the successful treatment increases by using double dose method. Using double dose also could decrease the necessity of operation, re-administration of MTX, and duration of hospitalization.

Investigation of aerobic training and electrical motivation impacts on body fat decrease

Goals: Study and comparison between the effects of walking and the electrical motivation on body fat burning and weight loss. Methodology: The samples were elected among the volunteer healthy females (20-40 years) with an index rate (20 ≤ BMI ≤ 30) provided that they had no regular active exercise activity and they were classified randomly to 2 teams in this quasi-experimental research. The electrical stimulation was used for one group in 1 year each week up to eight, and the period of 40-60 min per session on intestinal muscles. The plan of the group with aerobic exercise included 40-60 min walking with an intensity of the stored heart rate (50-70%) within the similar period. The parameters of BMI, rate of body fact, and LBM were measured at the start and at terminal of study on weight. The given data are investigated via using of t- independent and correlation t-test at level (p≤ 0.05). The parameters of BMI, rate of body fact, and LBM were measured at the start and at terminal of study on weight. Findings: Weight, Body Mass Index (BMI), and body fat percentage were significantly reduced and also the LBM parameter was enhanced in 2 teams. Conclusion: Walking and electrical stimulation similarly caused to decrease in weight, BMI, body fat percentage, and enhance in lean body mass factor (LBM).

Occurrence of fetal macrosomia rate and its maternal and neonatal complications: a 5-year cohort study

Background. Macrosomia is defined as an infant's birth weight of more than 4000 g at term which is to different maternal and neonatal complications. Several studies have been done on factors influencing risk of macrosomia, but there is lack of information and study in our country regarding macrosomia complications. Objective. The aim of this study was to determine the prevalence of macrosomia and its complications. Method. A cohort study was conducted from 2007 to 2011 at Obstetrics and Gynecology Department, Razi Hospital in Ahvaz city, Iran. All pregnant mothers who were referred to Obstetrics and Gynecology Department for delivery were included in this study. The total number of 201,102 pregnant mothers was recruited and divided into case and control groups after delivery (macrosomia (case) and normal weight infants (control) groups). Results. Out of total deliveries (201,102), there were 1800 macrosomia, (9%). Gestational diabetes, maternal obesity (BMI), maternal aged and positive history of previous macrosomia were the major risk factors for macrosomia which were compared with the normal weight infant groups (P < 0.001 for all parameters). Neonatal complications associated with macrosomia included humerus—clavicle fractures and arm—brachial plexus injury which were significant compared to the control group (P < 0.001 for all parameters). Conclusion. The macrosomia is potentially dangerous for the mother and the neonate. It is important to recognize the suspected fetal macrosomia to prevent its risk factors and complications. There is a need to provide all delivery facilities and care services to prevent and reduce the maternal and neonatal macrosomia complications.

Prevalence of and some factors relating with unwanted pregnancy, in ahwaz city, iran, 2010

We aimed to find the prevalence and some factors relating with unwanted pregnancy. Methods. It was a cross-sectional study on 400 randomly pregnant women, who were referring to different health centers in Ahwaz city during 2010. Data was conducted based on questionnaire, and all the analysis was performed using SPSS (version 17) statistical analysis software. Results. The prevalence of unwanted pregnancy was 26%. The percentage of unwanted pregnancy in ages more than 35 years was approximately three times more than the intended pregnancy. There were significant relationship between unwanted pregnancy and some variables such as age, number of pregnancy, number of childbirth, education status, economic status, husband's occupation, and the relationship with the spouse and contraceptive methods (P < 0.0001). Conclusion. The prevalence of unwanted pregnancy was high. To prevent unwanted pregnancy using consultation services before planning to be pregnancy, it is necessary to identify the factors relating with unwanted pregnancy.