مجله زنان مامائی و نازائی ایران
سال بیستم شماره 2 (اردیبهشت 1396)

Due to the high prevalence of infertility and its impact on public health, it is needed to seriously plan for its issues. Therefore this study was performed was performed with aim to investigate the utilization of infertility services by infertile couples referred to the public and private infertility centers.
This descriptive and analytic study was performed on 682 couples referred to the public and private infertility centers in 2012-2014. The subjects from 15 infertility centers of 9 provinces were selected through non-probability sampling method and were studied. Data collection tools were the researcher-made questionnaires to determine the utilization of infertility services by infertile couples and economic-social problems in the use of diagnostic or theraputic procedures. Data analysis was performed by SPSS software (version 21) and Chi-square and t-tests. P 515 infertile couples (75.5%) reffered to a gynecologist for the first visit. 363 (53.2%) had a history of stopping therapy that economic factor was the most important reason for stopping treatment in 230 (61%). The second most common factor for stopping treatment was inaccessibility to the infertility centers in 113 (28.6%).
Many diagnostic procedures and treatments suggested to the infertile couples are repeated as unnecessary. Also, regarding to the high rate of treatment discontinuation, attempts to access to full coverage insurance of infertility services and the standardization of infertility services can help to solve these problems.

Pica is an eating disorder characterized by persistent ingestion of non-nutrition substances including: soil or clay (Geophagia), corn or laundry starch (Amylophagia) and ice or freezer frost (Pagophagia). Ingestion of some non-food substances during pregnancy may lead to serious implications for mother and fetus health. Therefore, this study was performed with aim to investigate the association between pica during pregnancy and household food security.
This cross-sectional study was performed on 300 women who had delivered and referred to the health centers in the west of Tehran in 2014. The subjects were selected by stratified sampling method and the number of samples for each center was determined according to the referees. In addition to the checklist of demographic characteristics and pica data, the USDA questionnaire was also used. Data was analyzed by SPSS software (version 16) and descriptive and analytic analyses of Chi-square, T- test and logistic regression. P
The prevalence of pica in this study was 8.33% and there was no significant association between pica during pregnancy and household food security status. Also, no association was found between pica during pregnancy and paternal and maternal employment status and regular iron and folic acid supplementation before pregnancy. But, there was significant association between pica and regular iron supplementation during pregnancy (P=0.001) and educational status of mothers (P=0.011).
In this study, no significant association was observed between pica during pregnancy and household food security; performing more studies are recommended.

Spouse abuse refers to violence which is occurred or is being occurred from the partner. Gender role schemas is a set of one's beliefs about male or female identity, so it can affect the people's relationships. This study was performed with aim to compare the gender schemas couples in women with and without spouse abuse referred to health care centers in Mashhad.
This analytical-comparative study was performed on 257 couples referred to Mashhad health care centers in 2015. The tools included: Bem`s Sex-Role Inventory and ISA questionnaire (Index Spouse Abuse). By using ISA questionnaire, the couples were divided into two groups of with and without Spouse abuse, and using Bem questionnaire, the scores of femininity, masculinity and undifferentiated in women and men were determined. Data were analyzed by SPSS software (version 16), and Chi-square, Fisher, independent-t and Mann-Whitney tests. P Mean scores of femininity and masculinity in men without spouse abuse were significantly higher than other group (P=0.015) (P=0.013). Mean score of undifferentiated in men without spouse abuse was significantly lower than other group (P=0.024).
Femininity attributes along with masculinity attributes in men decrease spouse abuse. But undifferentiated attributes in men are considered as risk factor for spouse abuse.

Breast cancer is the most common malignancy in women which is potentially fatal in the case of no early diagnosed and no effective treatment. The role of beliefs in screening behavior is very useful to control disease. Therefore, this study was performed with aim to determine the relationship between personal characteristics and health beliefs with anxiety before mammographyin women referred to mammography centers.
This descriptive study was performed in 2010 on 120 women referred to two mammography centers in Ahvaz. The subjects were selected by convenience sampling and they asked to three questionnaires of demographic and clinical characteristics, health beliefs and situational anxiety. Data was analyzed by SPSS software (version 18), and descriptive statistics (mean, standard deviation, absolute and relative frequency) and inferential statistics of Pearson correlation and linear regression. P In this study, 64 cases (53.3%) had mild anxiety. Significant relationship was found between age and anxiety (p=0.001) and also between monthly income and anxiety (p=0.031). There was significant relationship between the numbers of mammography and anxiety (p=0.000). No significant relationship was observed between the total scores of health beliefs about barriers to perform mammography and perceived susceptibility toward breast cancer and anxiety (p=0.55).
Designing and implementation of extensive training programs at the community level can have a significant impact in correcting and promoting of women's attitudes and knowledgeTop of Formþ about health behaviors of prevention and screening for breast cancer.

Post-cesarean pain relief in an effective way without danger so that not to disturb mother’s ability to take care of her child is required. Post-cesarean pain is associated with reduced resistance against infections, increased use of analgesics and delayed wound healing. This study was performed with aim to compare the effect of Citrus arantium and Salvia officinalis aroma on post-cesarean section pain.
This three-group randomized clinical trial was performed on 120 pregnant women who had referred to Kermanshah Motazedi Hospital for cesarean in 2014. Aromatherapy with 3 drops of essence was fulfilled on two intervention groups immediately after the onset of pain, 4, 8 and 12 hours after it. Aromatherapy using normal saline was fulfilled on the control group in the same way. Severity of pain was evaluated using Visual Analogue Scale before and half an hour after each four interventions. Data was analyzed using SPSS software (version 18) and Chi-square, ANOVA, Kruskal-Wallis, Friedman and Mann Whitney tests. P
Mean of pain severity before the intervention was not significantly different between the three groups (P=0.15). After the intervention, mean of pain in the intervention groups of Citrus arantium and Salvia officinalis was significantly reduced in the first, second, third and fourth stage of intervention compared with control group (P There was no significant difference between Citrus arantium aroma and Salvia officinalis aroma groups in reducing post-cesarean section pain, therefore, the use of both aromas is recommended as simple, noninvasive and inexpensive technique to reduce post-cesarean pain.

Alleviating labor pain has always been one of the most important issues in midwifery practice. Nowadays, non-pharmacological pain relief methods such as aromatherapy are considered due to low side effects. This study was performed with aim to review the studies which evaluated the effect of aromatherapy on relief of labor pain.
In this review study, electronic databases including: SID, Iranmedex, Magiran, IranDoc, Cochrane Library, MEDLINE/PubMed, Scopus and Google Scholar were searched with the keywords of aromatherapy, labor pain and clinical trial up to November 9, 2016. Search was limited based on English or/and Persian articles. The quality of studies was assessed using the Cochrane "risk of bias" tool. The results were reported qualitatively.
Of 456 articles which were found in the initial search, 24 randomized trials (3414 participants) were selected for systematic review. The studies were conducted in Iran, India, Egypt, Korea, Italy and New Zealand. The used essence were lavender in 11 articles, rose in 6 articles, common sage in 3 articles, geranium in 3 articles, jasmine in 3 articles, chamomile in 2 articles, peppermint in 2 articles, bitter orange in 1 article, mandarin in 1 article, orange in 1 article, pink in 1 article, ginger in 1 article, lemongrass in 1 article and frankincense in 1 article. Most of the studies showed the positive effects of aromatherapy on labor pain relief.
Available data demonstrate that aromatherapy can be an effective intervention for alleviation of labor pain, but more studies with strong methodology are needed to achieve more rigorous evidence.

Diabetes Mellitus includes a group of prevalent metabolic (metabolism) disorders which may occur in fat and protein metabolism. According to the research of specialists, regular exercise is essential to control and improve diabetes. Therefore, this study was performed with aim to evaluate the effect of circadian rhythm during 12 weeks of aerobic exercise on protein catabolism of type 2 diabetic women.
This semi-experimental study was conducted on 45 women with diabetes in Behbahan at 20116. They were randomly divided into two experimental groups (n=15 in each group) of aerobic training in morning and afternoon and control group. The experimental group underwent selective aerobic exercise with the intensity of 55-70%, the maximum heart beat and the increasing time of 35-50 minutes per session. The activity intensity was added up to 5% every four weeks. After 15 minutes of walking briskly, the exercise included aerobics and coordinated movements of hands and feet. The control group didn’t have exercise during 12 weeks. 24 hour urine urea test was measured and assessed in the first and 12th week. Data was analyzed by SPSS Software (version 16) and ANOVA and LSD tests. P The selective aerobic exercise for 12 weeks in the morning and afternoon significantly reduced 24 hour urine urea level of the subjects compared with control group (P≥0.05). No significant difference was observed in 24 hour urine urea level of the subjects between aerobic exercise in the morning and the afternoon (P≤0.05).
Exercise both in the morning and the afternoon was almost equally effective on diabetic women’s protein catabolism.

One of the most widely used theories in the field of self-care is the Orem's theory. According to this theory, patients can recover more quickly and holistically if they carry out their own self cares to the best of their ability. This study was performed with aim to investigate the application of Orem's theory for promotion of self-care behaviors of pregnant women at risk for preterm delivery.
This clinical trial was done on 176 pregnant women at 24-26 gestational week at risk for preterm delivery who referred to health centers of Mashhad University of Medical Sciences in 2015-2016. The research tools included Holbrook risk-scoring for preterm labor questionnaire, demographic and obstetric questionnaire and Hart prenatal care actions scale. According to Holbrook risk-scoring for preterm labor questionnaire, the women who had inclusion criteria were selected. According to Hart prenatal care actions scale, the educational needs of intervention group and self-care behaviors were evaluated. Data were analyzed by SPSS software (Version16), and repeated measures ANOVA, Chi-square, Fisher exact and Mann–Whitney U tests. P The mean score of prenatal self-care was not significantly different in intervention and control group before educational intervention (P=0.899). But one week (P The educational intervention based on Orem’s theory is recommended to increase the prenatal self-care behaviors of pregnant women at risk for preterm delivery, identifying and training the prenatal self-care based on Orem’s theory for women at risk for preterm birth in health care centers.

The general experience of women from childbirth process is an important outcome. The quality of these experiences affect the mother and her babies’ health and their relationship, sexual activity and desire to having next child in future. Hot shower and intravenous injection of hyoscine are utilized to promote childbirth experience and increased satisfaction of childbirth; however, their effects are not thoroughly investigated. This study was performed with aim to assess the effects of hot shower and intravenous injection of hyoscine on childbirth experience in nulliparous women.
This randomized controlled clinical trial was conducted on 162 nulliparous women who were hospitalized in 29-Bahman hospital of Tabriz in 2015. The participants were assigned into 3 groups of 54 cases (intravenous hyoscine, hot shower, and control) by block randomization. In the intervention groups, hyoscine and hot shower were applied at dilatation of 4 cm and 7 cm. The control group received routine cares. Childbirth experience questionnaire was completed by the participants 12 to 24 hours after childbirth; the higher score showed better experience. Data were analyzed by SPSS software (version 20) and One-way ANOVA and Chi-square, Fisher-Exact, and Kruskal-Wallis tests. P The mean score of childbirth experience was 44.3±5.7 in the hyoscine group, 42.3±11.7 in the hot shower group and 39.0±10.6 in the control group. The mean score of childbirth experience was significantly higher in the hyoscine group (P= 0.014) and the hot shower group (P= 0.046) compared with the control group. However, there was no significant difference between two intervention groups (P=0.401). There was no significant difference between the groups in terms of satisfaction of childbirth and oxytocin consumption (P>0.05).
Using of non-pharmacological method of hot shower can improve childbirth experience similar to hyoscine group; therefore, using of this non-pharmacological supportive method is recommended to the mothers.

Alleviating labor pain has always been one of the most important issues in midwifery practice. Nowadays, non-pharmacological pain relief methods such as aromatherapy are considered due to low side effects. This study was performed with aim to review the studies which evaluated the effect of aromatherapy on relief of labor pain.
In this review study, electronic databases including: SID, Iranmedex, Magiran, IranDoc, Cochrane Library, MEDLINE/PubMed, Scopus and Google Scholar were searched with the keywords of aromatherapy, labor pain and clinical trial up to November 9, 2016. Search was limited based on English or/and Persian articles. The quality of studies was assessed using the Cochrane "risk of bias" tool. The results were reported qualitatively.
Of 456 articles which were found in the initial search, 24 randomized trials (3414 participants) were selected for systematic review. The studies were conducted in Iran, India, Egypt, Korea, Italy and New Zealand. The used essence were lavender in 11 articles, rose in 6 articles, common sage in 3 articles, geranium in 3 articles, jasmine in 3 articles, chamomile in 2 articles, peppermint in 2 articles, bitter orange in 1 article, mandarin in 1 article, orange in 1 article, pink in 1 article, ginger in 1 article, lemongrass in 1 article and frankincense in 1 article. Most of the studies showed the positive effects of aromatherapy on labor pain relief.
Available data demonstrate that aromatherapy can be an effective intervention for alleviation of labor pain, but more studies with strong methodology are needed to achieve more rigorous evidence.