Comparison of two methods of complementary medicine on postoperative pain and anxiety: A randomized clinical trial

BACKGROUND

Postoperative pain and anxiety are unpleasant situations that are often experienced by women undergoing cesarean section. Since the routine methods of pain relief after surgery is still inadequate, the need for complementary treatments is felt. Foot Reflexology (FR) and Auricular Acupressure (AA) are two of the most popular and safe procedures of complementary and alternative medicine therapies. So, this study aimed to determine and compare the effectiveness of reflexology and AA on postoperative pain and anxiety.

MATERIALS AND METHODS

This three-group randomized clinical trial study was performed on 101 pregnant women, admitted to Mashhad Omolbanin hospital, for a cesarean section, in 2015. In the intervention groups, 2-3 h after the operation, AA or FR was performed for 20 min. Routine care was provided for the control group. Pain and anxiety were evaluated by VAS and Spielberger anxiety questionnaire before and 1 and 2 h after the intervention.

RESULTS

The results showed that immediately after the intervention, pain intensity was significantly lower in both AA and FR groups (P < 0.001) compared with the control group. In addition, 2 h after the interventions, pain intensity was significantly lower in the AA group compared with the control group (P = 0.006). However, no significant differences were observed between the FR and the control groups (P = 0.095). In addition, 1 and 2 h after the intervention, anxiety was significantly different between the three groups (P = 0.033 and P = 0.018), respectively. The results of the Tukey test showed that this difference was only between FR and control groups (P = 0.025 and P = 0.017), respectively.

CONCLUSION

AA is more effective in reducing post-cesarean pain while FR effectively reduces post-cesarean anxiety. Therefore, these complementary medicine treatments as easy and noninvasive methods are recommended to be used during labor for improving maternal outcomes.

The Effect of Auriculotherapy on Nausea, Vomiting, and Anxiety in Patients Undergoing Elective Cesarean Section with Spinal Anesthesia: A Clinical Trial Study

Background

Nausea, vomiting, and anxiety are common complications during and after spinal anesthesia. Auriculotherapy as a complementary medicine can be useful for reducing nausea, vomiting, or anxiety. This study was performed to evaluate the effects of auriculotherapy on nausea, vomiting, and anxiety in patients undergoing elective Cesarean Section (CS) with spinal anesthesia.

Materials and Methods

The present study was a clinical trial study that was performed on 56 pregnant women selected as CS candidates in Ommolbanin Hospital in Mashhad during the years 2016-2017. In the intervention group, 1 h before spinal anesthesia, auricular acupoint stimulation was performed at four points bilaterally, for 20-30 seconds at each point. Evaluations were done by the following questionnaires: State-Trait Anxiety Inventory (STAI), Visual Analog Scale (VAS), and Vomiting Assessment Form.

Results

The mean anxiety (SD) before the intervention in the intervention group and the control group was 47.88 (8.67) and 47.84 (10.49), respectively, and 4 h after the intervention, it was 40.23 (10.19) and 42.88 (12.18) in the intervention and control groups, respectively. These results were significant in the intervention group (p = 0.008). 30-40 min before and 4 h after the surgery, the severity of nausea and vomiting was low in both groups and no significant difference was observed between the two groups during the surgery and in the recovery room (p > 0.05).

Conclusions

According to the results, auriculotherapy could reduce anxiety in CS patients with spinal analgesia. The results also showed that auriculotherapy reduced the severity of nausea and vomiting, but these changes were not significant.

Investigating the relationship between the dimensions of mindfulness and maternal attachment to the fetus during pregnancy

BACKGROUND

Maternal attachment to the fetus is a term used to describe the emotional relationship between mother and fetus. This emotional connection increases during pregnancy and is reflected in her feelings, perceptions, and behaviors. Mindfulness is important as one of the factors affecting the mental health of people during pregnancy. Therefore, the present study was conducted to determine the relationship between the dimensions of mindfulness and maternal attachment to the fetus during pregnancy.

MATERIALS AND METHODS

The present study was performed on 500 pregnant mothers referred to health centers affiliated to Isfahan University of Medical Sciences. The samples were entered into the study by available sampling method and if they had inclusion criteria and no exclusion criteria. The research instruments were the Fetal Attachment Questionnaire and the Bauer Mindfulness Questionnaire. The collected data were analyzed by SPSS software version 22.

RESULTS

The results of the data showed that there was no significant relationship between the overall score of mindfulness and the overall score of maternal attachment to the fetus (P = 0.62). While from the dimensions of mindfulness such as "action with awareness" there was a significant negative relationship (P = 0.03) with maternal attachment to the fetus and a significant positive relationship "observation" with maternal attachment to the fetus (P = 0.03).

CONCLUSION

According to the results of this study, there is a relationship between maternal attachment to the fetus during pregnancy and a number of dimensions of mindfulness. For this purpose, since mindfulness can increase the mother's interactions with the fetus, and this interaction begins during pregnancy and with the mother's attachment to the fetus, it is important to pay attention to this.

Investigating the relationship between social support and self-compassion by improving the adequacy of prenatal care

INTRODUCTION

Getting pregnant care is different due to the psychological problems of pregnant mothers. Self-compassion and social support are the important components of mental health. Women with higher self-compassion and social support can take full care of their pregnancies. The aim of this study was to determine the relationship between social support and self-compassion with adequate prenatal care.

METHODS

The present study is a cross-sectional descriptive study that was performed in 2018 using the available sampling method on 500 pregnant mothers referred to Isfahan health centers. Individuals entered the study if they had entry criteria and no exit criteria, and completed social support, self-compassion, and adequacy of pregnancy care questionnaires. The data were coded and analyzed by SPSS software version 22 and Pearson's correlation statistical test.

RESULTS

The results of data analysis with Pearson's correlation test showed a positive and statistically significant relationship with pregnancy care between the overall score of social support (P < 0.001) and the dimensions of social support such as family support (P < 0.002), support of friends (P < 0.004), and the support of other people (P < 0.001). The results also showed a positive and statistically significant relationship between self-compassion and prenatal care (P < 0.001). There was a significant positive relationship between the subscales of the self-empathy questionnaire, including kindness to oneself, human commonalities, mindfulness and increasing replication, and pregnancy care, but there was a significant negative relationship between subscales of isolation and self-judgment with pregnancy care.

CONCLUSION

According to the results of the present study, social support and self-compassion as two components of mental health can affect the quality of services during pregnancy. For this reason, it is recommended that health-care providers pay attention to these two issues in order to increase the level of care during pregnancy and thus ensure maternal health during pregnancy and childbirth and the health of the fetus and baby.

Relationship between fear of childbirth and the sense of cohesion with the attachment of pregnant mothers to the fetus

INTRODUCTION

Maternal-fetal attachment is a term used to describe the emotional relationship that a pregnant woman has with her developing fetus. Mental care for pregnant women (fear of childbirth and a sense of cohesion of pregnant women) is one of the most important aspects of prenatal care that affects the mother's attachment to the fetus. If fear and anxiety are relieved, psychological and physical relaxation will be replaced. Therefore, the present study was conducted with the aim of determining the relationship between fear of childbirth and the sense of cohesion with the attachment of pregnant mothers to the fetus.

METHODS

The present study is a descriptive study that was performed by multi-stage sampling method on 500 pregnant mothers who referred to health centers in Isfahan in 2017. The study participants completed the following questionnaires: fear of childbirth, sense of cohesion, and mother's attachment to the fetus. The data were analyzed by descriptive and analytical statistical methods (Pearson correlation) using SPSS software version 22.

RESULTS

The results showed that there was a significant negative relationship between the overall score of maternal attachment to the fetus and fear of childbirth (r = -0.153, P = 0.001). However, there is a significant positive relationship between the overall score of maternal attachment to the fetus and the sense of cohesion (r = 0.112, P = 0.01). The results also showed a significant negative relationship between the fear of childbirth and the dimensions of maternal attachment to the fetus, including interaction with the fetus (P = 0.04), self-sacrifice (P = 0.04), and attributing characteristics to the fetus (P = 0.05). There was a positive and significant relationship between the sense of coherence and the subsequent acceptance of the maternal role of maternal attachment to the fetus (P = 0.004).

CONCLUSION

More attention of prenatal care provider to the psychological issues of the pregnant mother and their fears and worries can lead to appropriate interventions in this field, and as a result, mothers' attachment to their fetus has increased so that they can take proper care during and after pregnancy.

The effect of transcutaneous auricular stimulation on anxiety before colposcopy: A randomized clinical trial

Women experience a high level of anxiety and negative emotional responses during colposcopy, which results in women's' unwillingness to return for follow-up. Transcutaneous auricular stimulation may be useful in reducing anxiety. Therefore, the aim of this study was to determine the effect of transcutaneous auricular stimulation on anxiety before colposcopy. This randomized controlled clinical trial study was performed on 65 female candidates for colposcopy who were referred to Ghaem Hospital, Mashhad, Iran, in 2017. Women were randomized into one of the two groups. In the intervention group, a pointer Excel device was used for forty minutes before colposcopy; electrical stimulation at 4 points (Shenmen, relaxation, tranquillizer and endocrine) was performed on ears, with the frequency of 2 Hz for 30 seconds at each point. Women received routine care in the control group. The anxiety level was assessed by Spielberger Questionnaire before intervention and also 40 minutes after intervention. Data analysis was performed using the t-test, paired t-test, and MannWhitney test in SPSS software, version16. P value less than 0.05 was considered significant. After intervention, the state anxiety score was 43.9 ± 9.19 in the control group and 54.3 ± 9.07 in the intervention group, and the difference between the two groups was statistically significant (P = 0.00), while there was no significant difference in the level of trait anxiety in the two groups (P = 0.21). Regarding the reduction of state anxiety level after intervention, transcutaneous auricular stimulation is recommended as a suitable method to reduce anxiety of patients who are candidates for colposcopy.

The Effect of Sexual Education based on Sexual Health Model on the Sexual Function of Women with Infertility

Background

Infertility has deep psychological impacts on the sexual function of women such as a sense of fear, failure, and incompetence. It can also result in reduced sexual desire, unattained orgasm, and other sexual disorders. However, sexual education is assumed to improve the sexual function in these cases. Therefore, we study the effect of sexual education based on Sexual Health Model (SHM) on sexual function disorders in women with infertility.

Materials and Methods

A singleblind, randomized controlled trial was conducted on 108 women with infertility (54 intervention group and 54 control group) aged between 18 and 40 years at the Milad Infertility Center of Mashhad in 2016. The intervention comprised three 90-min sessions administered during 1 week. At first, a pretest (Female Sexual Function Index [FSFI]) was completed, and 1 month after the end of the intervention, the posttest (FSFI) was completed. To analyze the data, independent t-test, Mann-Whitney test, and Wilcoxon test were run.

Results

The mean (Standard Deviation [SD]) age of women and their spouses was 30.61 (5.42) and 34.42 (5.73)years, respectively. Results of Mann-Whitney test showed that after 1 month of intervention, there was a significant difference between intervention and control groups (Z = -4.87, p < 0.001). Moreover, results of Wilcoxon test showed a significant difference in the sexual function in the intervention group before and after the intervention (Z = 2.81, p < 0.001).

Conclusions

Given the positive effects of SHM-based sexual education, this method could be considered as a subset of sexual education materials used for women with infertility suffering from sexual disorders.

Determination of the Effect of Sexual Assertiveness Training on Sexual Health in Married Women: A Randomized Clinical Trial

Background

Sexual health is a state of physical, mental, and social well-being in relation to sexuality. Sexual assertiveness is a person's ability to meet sexual needs. Considering limited sexual information of women and the taboo nature of talking about sexual needs, the purpose of this study is to evaluate the effectiveness of the sexual assertiveness training on sexual health.

Materials and Methods

This randomized clinical trial assignment parallel study with a control group was performed in September and October 2016 on 60 married women referred to Imam Reza Health Center in Mashhad. The sample size was estimated to be 30 subjects per group. Instruments included demographic characteristics, sexual assertiveness, and sexual health questionnaire. The pretest was completed in two groups at the beginning of the study and post-test was done for both groups 1 week after educating the experimental group. Descriptive statistic tests included Chi-square, t-test, and paired t-test, and one-way analysis of variance. A p value less than 0.05 was considered to be statistically significant.

Results

The two intervention and control groups showed no significant difference in terms of sexual health level before starting the study (t ₅₈ = 0.854, p > 0.05). After the study, based on the independent t-test, the two groups showed significant differences (t ₅₈ = -4.077, p < 0.001).

Conclusions

Sexual assertiveness training can improve women's sexual health. Considering the lack of research in this area and due to the effect of mutual understanding of couples on emotional and sexual issues, further research is necessary for this field.

The relationship between Cormic Index and uterine contractions' pattern in the active phase of the first stage of labour

Uterine contractions are indicators of labour progress. The relationship between anthropometric indices and types of childbirth has been investigated. One of these indices is referred to as the Cormic Index, which provides an estimation of the sitting height and leg length. This cross-sectional study was performed to determine the relationship between the Cormic Index and the uterine contractions' pattern in the active phase of the first stage of labour. The standing and sitting heights of 150 pregnant women were measured to calculate the Cormic Index. Then, two Cardiotocographic traces were recorded during the 3 to 5 and 6 to 8 centimetres' dilations, by which the uterine contractions' pattern were determined. The mean Cormic Index was 51.84 ± 2.62. The results indicated that the Cormic Index had a positive linear correlation with MTIME (frequency of contractions) in the first monitoring episode and SDTIME (regularity of contractions) in the first and the second monitoring episode, which was significant (p < .05). However, there was no significant correlation between the Cormic Index and F:R ratio (shape of contractions) in both monitoring episodes. With the rise of the mother's Cormic Index, the frequency of contractions in the acceleration phase, and also their regularity in the acceleration phase and the phase of the maximum slope, were decreased during the active phase of labour.IMPACT STATEMENTWhat is already known on this subject? Uterine Contraction as an indicator of labour progress enforces cervical dilation. If uterine activity is analysed through electronic methods, one could assess labour outcome through some patterns of the contractions. Anthropometry provides a quick determination of the body proportions. The Cormic Index provides an estimation of the upper and lower body length. Several studies have investigated the relationship between the anthropometric indices and the types of childbirth. Despite the various approaches available, there is no objective means of precisely distinguishing the fact that whether labour can be successful in effecting vaginal delivery or not and diagnosis of dystocia still relies on the trial of labour.What do the results of this study add? The results of this study add to the growing body of research on the progression of labour that Cormic Index has a positive linear correlation with the frequency of contractions in acceleration phase, and with the regularity of contractions in the acceleration phase and the phase of maximum slope.What are the implications of these findings for clinical practice and/or further research? The results can help professionals to evaluate the progress of labour based on the type of uterine contractions in the latent phase or the early active phase of labour using the Cormic Index.

The relationship of the psychological coping and adjustment strategies of infertile women with the success of assisted reproductive technology

Background

The success of assisted reproductive techniques plays a very important role in the quality of life of infertile couples and decreases the negative behavior states of infertility.

Objective

This study aimed at determining the relationship between psychological coping and adjustment strategies with the success of assisted reproductive technology (ART).

Materials and Methods

This correlational study was conducted on 204 women visiting Milad Infertility Center in Mashhad during 2015-2016. The research instruments included Fertility Adjustment Scale and Infertility Coping Strategies Scale. The positive result of two pregnancy tests within 48 hours was considered as the success of ART.

Results

The mean and standard division score of adjustment in the group achieved treatment success (34.3±8.2) exceeded the group failed (33.6±8.8), the difference was not statistically significant (p= 0.381). Also, there was no significant difference between groups in the median and interquartile range of total coping strategies 81 (13) vs. 79.5 (12.25), (p= 0.369). Based on the logistic regression model for one increased transferred embryo, the chance of getting pregnant is 1.3 times, and for each unit increase in FSH level, the chance of ART success decreases 18%.

Conclusion

The results of this study showed that there is no relationship between psychological coping and adjustment strategies with ART success. However, the number of transferred fetus and tirthday FSH are introduced as factors that are related to the success of ART.

Relationship between behavioral indices of pain during labor pain with pain intensity and duration of delivery

Background

Certain behaviors can be adopted by women to cope with labor pain according to their individual characteristics, which are currently called behavioral indicators during labor pain, and include facial expressions, verbal expressions, tone of voice, body movements, degree of relaxation, and respiratory system functioning during delivery. Moreover, severity of pain and duration of labor can vary due to several factors including individual characteristics.

Objective

The purpose of the present study was to determine the relationship between behavioral indicators during labor pain, severity of pain, and delivery duration.

Methods

In this cross-sectional study, 120 low risk pregnant women who referred to Omolbanin (AS) Hospital in the city of Mashhad (Iran) for delivery in 2014, were selected via convenience sampling method, which was then followed by completion of demographic information forms. From cervical dilatation of 3–5 centimeters until delivery, the Labor Pain Coping Behavior Observation Form (comprised of 6 sub-groups of facial expressions, verbal expressions, tone of voice, body movements, degree of relaxation, and respiratory function and severity and duration of pain) was completed during uterine contractions and every half an hour. Using the Inventory of Labor Information; vital signs, frequency of contractions, and duration of the first and second stages of labor were measured. Furthermore, the content validity of the questionnaire was determined and its reliability was confirmed by Cronbach’s alpha method. Then, the data were analyzed using the SPSS version 16, through Pearson Product-Moment Correlation and Spearman’s Rank-Order Correlation, Kruskal-Wallis test, and ANOVA.

Results

According to the results, 16.2% of the individuals had undesirable behavioral indicators during labor pain, 50% of them were endowed with acceptable behaviors, and 33.8% of these women had desirable behaviors. The findings also revealed that the duration of the active phase of the first stage of labor (p<0.001 and r=−0.453), the duration of the second stage of labor (p<0.012 and r=−0.146), and the severity of pain (p<0.001 and r=−0.450) were significantly and inversely correlated with behavioral indicators during labor pain; i.e. an increase in the mean score of behavioral indicators during labor pain could lead to a decline in the duration of stages of labor and severity of pain.

Conclusion

It was concluded that behaviors demonstrated by women in labor had effects on their pains in the course of delivery, and there was also a relationship between the duration of stages of labor and its severity of pain. Therefore, it was recommended to turn attention to behaviors by women in labor in order to achieve a desirable clinical management.

Comparison of Sexual Problems in Fertile and Infertile Couples

Introduction: Infertility is known to have a negative effect on couple's life and in most cases it has a profound impact on sexual relations. Sexual problems may be the cause of infertility or may arise as a result of infertility. The aim of this study was to compare the sexual problems in fertile and infertile couples. Methods: This cross-sectional study was performed on 110 infertile and 110 fertile couples referring to Montaserieh infertility center and five health centers in Mashhad which were selected as class clustering method and easy method. Data collection tools included demographic questionnaires and Golombok-Rust Inventory. The collected information was analyzed by SPSS software and descriptive and inferential statistics. Results: No significant difference was found between fertile 26 (17, 37) and infertile 26(18, 37) women in terms of total score of sexual problems and other aspects of sexual problems (except infrequency). The women in the fertile group had higher infrequency than infertile women. Total score of sexual problems in fertile men was 18.5 (13, 27) and in infertile men 25 (19, 31) and the difference was statistically significant. Infertile men reported more problems in no relation, impotency and premature ejaculation compared to fertile men. Men in both fertile and infertile group reported more sexual problems than women. Conclusion: In view of the more frequent sexual problems in infertile men than infertile women, it seems that it is necessary to pay more attention to sexual aspects of infertility in men and design the training programs for sexual and marital skills in infertility centers.

Sexual dysfunction in infertile women

BACKGROUND

Sexual problems have different effects on the life of people by influencing their interpersonal and marital relationships and satisfaction. Relationship between sexual dysfunctions and infertility can be mutual. Sexual dysfunction may cause difficulty conceiving but also attempts to conceive, may cause sexual dysfunction.

OBJECTIVE

This paper compares sexual dysfunction in fertile and infertile women.

MATERIALS AND METHODS

In this cross-sectional study, 110 infertile couples referring to Montasarieh Infertility Clinic and 110 fertile couples referring to five healthcare centers in Mashhad were selected by class cluster sampling method. Data collection tools included demographic questionnaire and Glombok-Rust Inventory of Sexual Satisfaction. Data were analyzed through descriptive and analytical statistical methods by SPSS.

RESULTS

There was no significant difference in total score of sexual problems and other dimensions of sexual problems (except infrequency) in fertile 28.9 (15.5) and infertile 29.0 (15.4) women. Fertile women had more infrequency than infertile women (p=0.002).

CONCLUSION

There was no significant difference between fertile and infertile women in terms of sexual problems. Paying attention to sexual aspects of infertility and presence of programs for training of sexual skills seems necessary for couples.

A survey of the therapeutic effects of Vitamin E suppositories on vaginal atrophy in postmenopausal women

Background:

Menopause is associated with various complications such as depression, sleep disorders, and genitourinary atrophy. Vaginal atrophy occurs due to the loss of steroid hormones, and its major symptoms include vaginal dryness, itching, dyspareunia, and bleeding after intercourse. According to the literature, vitamin E plays a key role in estrogen stability. The aim of this study was to compare the effects of vitamin E suppositories and conjugated estrogen vaginal cream on vaginal atrophy.

Materials and Methods:

In this clinical trial, 52 postmenopausal women, who were referred to a gynecology clinic in 2013, were recruited and randomly divided into two groups (26 cases per group). One group received 100 IU of vitamin E suppositories (n = 26), whereas the other group applied 0.5 g of conjugated estrogen cream for 12 weeks. Vaginal maturation value (VMV) was compared between the two groups before and after the intervention. VMV ≤ 55 was regarded as a cut-off point for vaginal atrophy. Treatment success was defined as a 10-unit increase in VMV, compared to the baseline value. Data were analyzed by Friedman test and Mann-Whitney test. P value less than 0.05 was considered statistically significant.

Results:

The mean VMV in the vitamin E group before the treatment and after 4, 8, and 12 weeks of treatment was 43.78 ± 13.75, 69.07 ± 22.75, 77.86 ± 21.79, and 80.59 ± 19.23, respectively. The corresponding values in the estrogen cream group were 42.86 ± 14.40, 86.98 ± 12.58, 92.65 ± 15, and 91.57 ± 14.10, respectively. VMV significantly improved in both the treatment groups after the intervention, compared to the preintervention period (P < 0.001). Treatment success was reported in both groups, although estrogen cream (100%) appeared to be more effective after 4 weeks of treatment, compared to vitamin E suppositories (76.9%) (P = 0.01).

Conclusions:

Based on the findings, use of vitamin E suppositories could improve the laboratory criteria for vaginal atrophy and treatment success. Therefore, vitamin E suppositories are suggested for relieving the symptoms of vaginal atrophy, especially in women who are unable to use hormone therapy or cope with the associated side effects.

Comparing the estimation of postpartum hemorrhage using the weighting method and National Guideline with the postpartum hemorrhage estimation by midwives

INTRODUCTION

In developing countries, hemorrhage accounts for 30% of the maternal deaths. Postpartum hemorrhage has been defined as blood loss of around 500 ml or more, after completing the third phase of labor. Most cases of postpartum hemorrhage occur during the first hour after birth. The most common reason for bleeding in the early hours after childbirth is uterine atony. Bleeding during delivery is usually a visual estimate that is measured by the midwife. It has a high error rate. However, studies have shown that the use of a standard can improve the estimation. The aim of the research is to compare the estimation of postpartum hemorrhage using the weighting method and the National Guideline for postpartum hemorrhage estimation.

MATERIALS AND METHODS

This descriptive study was conducted on 112 females in the Omolbanin Maternity Department of Mashhad, for a six-month period, from November 2012 to May 2013. The accessible method was used for sampling. The data collection tools were case selection, observation and interview forms. For postpartum hemorrhage estimation, after the third section of labor was complete, the quantity of bleeding was estimated in the first and second hours after delivery, by the midwife in charge, using the National Guideline for vaginal delivery, provided by the Maternal Health Office. Also, after visual estimation by using the National Guideline, the sheets under parturient in first and second hours after delivery were exchanged and weighted. The data were analyzed using descriptive statistics and the t-test.

RESULTS

According to the results, a significant difference was found between the estimated blood loss based on the weighting methods and that using the National Guideline (weighting method 62.68 ± 16.858 cc vs. National Guideline 45.31 ± 13.484 cc in the first hour after delivery) (P = 0.000) and (weighting method 41.26 ± 10.518 vs. National Guideline 30.24 ± 8.439 in second hour after delivery) (P = 0.000).

CONCLUSIONS

Natural child birth education by using the National Guideline can increase the accuracy of estimated blood loss. Therefore, training the personnel to use this guideline is recommended. However, It has less accuracy than 'sheet weighing'. Consequently, usage of symptoms and the weighing method is recommended in cases of postpartum bleeding.

The Effect of Virtual Reality on Pain in Primiparity Women during Episiotomy Repair: A Randomize Clinical Trial

BACKGROUND

Pain is one of the side effects of episiotomy. The virtual reality (VR) is a non-pharmacological method for pain relief. The purpose of this study was to determine the effect of using video glasses on pain reduction in primiparity women during episiotomy repair.

METHODS

This clinical trial was conducted on 30 primiparous parturient women having labor at Omolbanin Hospital (Mashhad, Iran) during May-July 2012. Samples during episiotomy repair were randomly divided into two equal groups. The intervention group received the usual treatment with VR (video glasses and local infiltration 5 ml solution of lidocaine 2%) and the control group only received local infiltration (5 ml solution of lidocaine 2%). Pain was measured using the Numeric Pain Rating Scale (0-100 scale) before, during and after the episiotomy repair. Data were analyzed using Fisher's exact test, Chi-square, Mann-Whitney and repeated measures ANOVA tests by SPSS 11.5 software.

RESULTS

There were statistically significant differences between the pain score during episiotomy repair in both groups (P=0.038).

CONCLUSION

Virtual reality is an effective complementary non-pharmacological method to reduce pain during episiotomy repair.

TRIAL REGISTRATION NUMBER

IRCT138811063185N1.

The shape of uterine contractions and labor progress in the spontaneous active labor

BACKGROUND

Dystocia is the most common indication of primary cesarean section. The most common cause of dystocia is uterine dysfunction. In prolonged labor, more attention is usually paid to the fetus and pelvis rather than to the role of uterine contractions in a delivery. Therefore, we decided to determine the relationship between the labor progress and uterine contractions shapes.

METHODS

In this cross-sectional study, 200 primiparous women participated having a single pregnancy and cephalic presentation. Uterus contractions were recorded using electronic fetal monitoring at the beginning of the active phase of labor (dilatation 3-5 cm) for 30 min. Fall to rise (F:R) ratio was calculated by determining the duration of returning from a contraction peak to its baseline (fall) and the duration of the rise time from baseline to peak (rise) in two groups. The data were analyzed using t-test and Chi-square test.

RESULTS

In this study, 162 women had a normal delivery and 38 women had a cesarean (CS) delivery due to the lack of labor progress. The average F:R ratio was 1.13±0.193 seconds in the vaginal delivery group and 1.64±0.301 seconds in the CS group. This difference was statistically significant (P<0.001). The frequency of contractions in the vaginal delivery group was more than the CS group (P=0.008).

CONCLUSION

Our findings demonstrated that uterine contractions shapes change; and F:R ratio was higher in the group that lacked labor progress. Therefore, contraction shapes can be used to predict the labor progress.

The effect of pelvic floor muscle exercises program on sexual self-efficacy in primiparous women after delivery

BACKGROUND

Selection and acceptance of appropriate sexual behavior and sexual function are made difficult by low sexual self-efficacy in the postpartum period. The general purpose of this research is to define the effects of an 8-week pelvic floor muscle exercise program on sexual self-efficacy in primiparous women after childbirth.

MATERIALS AND METHODS

This clinical trial was performed on 79 primiparous women who referred to health care centers, Mashhad, Iran in 2013, 8 weeks after delivery, to receive health care services. They were selected by easy sampling. The samples were randomly assigned to either intervention or control group. The intervention group was trained in Kegel exercises for 8 weeks. Both groups were evaluated at 4 and 8 weeks. Data collection tools included: Demographic information, sexual self-efficacy, and Brink scale. Data were analyzed using repeated measures, Friedman test, t-test, and Mann-Whitney test.

RESULTS

The results showed significant increase in pelvic floor muscle strength in the intervention group at 4 and 8 weeks after exercises (P < 0.0001), but no significant difference was observed in the control group (P = 0.368). There was a significant increase in sexual self-efficacy in the intervention (P < 0.0001) and control groups (P = 0.001) at 4 and 8 weeks after the start of the study. Comparison of the two groups showed a significant difference in sexual self-efficacy after they performed these exercises (P = 0.001).

CONCLUSIONS

The findings showed that 8-week pelvic muscle exercises increase the sexual self-efficacy in women after delivery.

Behavioral Intervention Program versus Vaginal Cones on Stress Urinary Incontinence and Related Quality of Life: A Randomized Clinical Trial

OBJECTIVE

To compare the efficacy of behavioral intervention program and vaginal cones on stress urinary incontinence.

METHODS

In this randomized clinical trial, 60 women aged 25-65 years with stress urinary incontinence were randomly divided into two groups, those who participated in a behavioral intervention program (n=30) and those who used vaginal cones (n=30). The women in the behavioral intervention group were instructed on pelvic floor exercise and bladder control strategies. In the other group, pelvic floor exercises were performed using the vaginal cones. All participants were treated for 12 weeks and followed-up every 2 weeks. The subjective changes in severity of stress urinary incontinence were measured using a detection stress urinary incontinence severity questionnaire, leakage index, and a 3-day urinary diary. The objective changes were measured by pad test. For better evaluation of the effects, two questionnaires were used: Incontinence Quality of Life and King's Health Questionnaire.

RESULTS

Among the 51 women who completed the study, 25 subjects were in the vaginal cones group and 26 participated in the behavioral intervention program. The changes in leakage rate on pad test and leakage index in the behavioral intervention program group were significantly higher than in the vaginal cones group (p=0.001 and p=0.008, respectively), but the severity of stress urinary incontinence was not significantly different between the two groups (p=0.2). The changes in strength of the pelvic floor, Incontinence Quality of Life, and King's Health Questionnaire scores showed no significant differences between the two groups after 12 weeks of intervention.

CONCLUSION

Vaginal cones and behavioral intervention programs are both effective methods of treatment for mild to moderate stress urinary incontinence, but the behavioral intervention program is superior to vaginal cones in terms of cost-effectiveness and side effects.

Evaluating the Relationship between Body Size and Body Shape with the Risk of Breast Cancer

OBJECTIVE

This study aims to determine the relationship between body size and body shape with the risk of breast cancer.

METHODS

In this case control study, 480 women participated (240 women with breast cancer in case group and 240 healthy women in control group). After completing the interview form, the weight, height, waist circumference, hip circumference and breast size, were measured. The data were analyzed using statistical test by SPSS11.5.

RESULTS

The present study showed that the mean of hip circumference were significantly different in both groups (p=0.036). The size of the breast was statistically significant between the two groups. Thyroid type, one of the body shapes, was more seen in the case group than control group (p<0.001).

CONCLUSION

This study revealed that the risk of breast cancer increases with increased hip circumference. In addition, the results indicate that body shape may be a useful predictor in determining the risk of breast cancer. More studies should be designed to address this subject.

Study of correlation between maternal fatigue and uterine contraction pattern in the active phase of labour

AIMS AND OBJECTIVES

To evaluate the correlation between maternal fatigue and uterine contraction pattern at the beginning of the active phase of labour.

BACKGROUND

Fatigue is one of the most common complaints in pregnant women that often continues until delivery. Maternal fatigue prolongs the labour process and increases the rate of cesarian section. Studies on the pattern of uterine contractions have shown that the length of the fall time is longer in prolonged labours than in normal deliveries.

DESIGN

A cross-sectional study.

METHODS

This study was conducted on 100 primiparous women who were referred to Ommolbanin Hospital (Mashhad, Iran) in 2011. Maternal fatigue was assessed at the beginning of the active phase of labour. Then, the pattern of uterine contractions was monitored for 30 minutes by an external tocodynamometer. The F/R ratio was determined by measuring the time for a contraction to return to its baseline from its peak and the time for a contraction to rise to its peak. The data were analysed by chi-square and anova tests.

RESULTS

The results showed that there was a significant relationship between maternal fatigue and uterine contraction pattern. The F/R ratio was increased with increase in fatigue severity.

CONCLUSIONS

Fatigue causes changes in the pattern of uterine contractions. The return time of a contraction from its peak to its baseline (fall) is increased with increase in fatigue severity.

RELEVANCE TO CLINICAL PRACTICE

Offering strategies to prevent tiredness and reduce the related fatigue complications.

Production of a novel camel single-domain antibody specific for the type III mutant EGFR

Camelids have a unique immune system capable of producing single-domain heavy-chain antibodies. The antigen-specific domain of these heavy-chain IgGs (VHH) are the smallest binding units produced by the immune system. In this study, we report the isolation and characterization of several binders against the epidermal growth factor receptor (EGFR) vIII retrieved from immune library of camels (Camelus bactrianus and Camelus dromedarius). The EGFRvIII is a ligand-independent, constitutively active, mutated form of the wild-type EGFR. The expression of EGFRvIII has been demonstrated in a wide range of human malignancies, including gliomas, and breast, prostate, ovarian and lung cancer. Camels were immunized with a synthetic peptide corresponding to a mutated sequence and tissue homogenates. Single-domain antibodies (VHH) were directly selected by panning a phage display library on successively decreasing amounts of synthetic peptide immobilized on magnetic beads. The anti-EGFRvIII camel single-domain antibodies selectively bound to the EGFRvIII peptide and reacted specifically with the immunoaffinity-purified antigen from a non-small cell lung cancer patient. These antibodies with affinities in the nanomolar range recognized the EGFRvIII peptide and affinity-purified mutated receptor. We concluded that using the phage display technique, antigen-specific VHH antibody fragments are readily accessible from the camelids. These antibodies may be good candidates for tumor-diagnostic and therapeutic applications.