Journal of Midwifery & Reproductive health
Volume:5 Issue: 3, Jul 2017

Recently, the use of mifepristone followed by misoprostol after 36-48 h has been demonstrated to be an effective and safe method for the second trimester medical abortion. However, this regimen entails long total abortion time, and consequently increases the financial burden and anxiety in the patients. We hypothesize that one day interval would be also effective and can be used to provide the abortion care. Regarding this, the present study aimed to compare the effectiveness and safety of 24- and 36-hour intervals between the administration of mifepristone and misoprstol for second trimester abortion.
This prospective comparative study was conducted on 70 females who opted for second trimester medical abortion between 12-20 weeks. Mifepristone (200 mg) was followed by sublingual misoprostol (800 mcg) after one and two days in the first and second groups, respectively. Four hours after the administration of 800 mcg misoprostol, all patients received 400 mcg sublingual misoprostol every 4 h (maximum of four doses in 24 h). For the purpose of the study, such parameters as the rate of successful abortion 24 h after the first dose of misoprostol, abortion duration, and the associated side effect profile were examined.
According to the results of the present study, the two-day interval (100%) was more effective than the one-day interval (91.4%) (P=0.021). Furthermore, the mean induction abortion duration was significantly less in the two-day regimen. However, the side effect profiles were comparable in both groups.
As the findings of the present study indicated, both schedules of mifepristone and misoprostol were safe and effective in second trimester abortion. The 36-hour interval between mifepristone and misoprostol was more effective than the 24-hour interval. Furthermore, it had shorter abortion duration. We can individualize the patient care by offering a one-day interval regimen since it is more effective and has less duration for total abortion.

Low birth weight (LBW) is the center of focus as a cause of many social, emotional, and mental deficiencies. The identification of the probable causes of LBW is considered as an important measure in reducing the prevalence of this health problem. Regarding this, the present study was carried out to compare some of the mental and social traits in the mothers of normal weight newborns and those with LBW neonates.
This cross-sectional study was conducted on the parents of 400 neonates selected by the proportional sampling technique in Isfahan, Iran. The participants were assigned into two groups of mothers including 200 subjects with LBW neonate and 200 cases with normal birth weight newborns. The data were collected using the Depression, Anxiety, and Stress Scale (DASS-42) developed by Lavibond and Lavibond in 1995 and the couple satisfaction index.
According to the results of the study, there was a significant difference between the two groups of mothers in terms of depression, stress, anxiety, age, medicine consumption, level of education, and marital satisfaction (P As the findings of this study revealed, different aspects of maternal mental health can affect the pregnancy outcome through many pathways. Regarding this, the implementation of the interventions improving the maternal mental health might be useful in the reduction of the neonatal and pediatric mortality and morbidity.

Pre-pregnancy period is like a window of hope during which the doctors and midwives can help the mothers to solve or adjust the problems needing special care before pregnancy. Therefore, this study was carried out to determine the risk factors for pregnancy health among the females seeking planned pregnancy.
This descriptive study was conducted on 350 females of childbearing age who referred to health centers of Mashhad, Iran to receive preconception care in 2013. The sampling was performed using the multistage sampling technique. The data were collected by a researcher-made questionnaire enquiring the patients’ demographic and obstetric data. Data analysis was performed through the SPSS version 16 using mean and standard deviation (for quantitative variables), frequency (for qualitative variables), and Chi-square test (to assess the relationship between the variables). P-value less than 0.05 was considered statistically significant.
According to the results, the age of 2% and 4.9% of the participants were 35 years, respectively. The most frequent risk factors for pregnancy health were related to gestational diabetes (32%), preeclampsia (22%), abortion (19.1%), history of vaginal bleeding in the second half of pregnancy, and preterm delivery (13%). In addition, the most frequent underlying diseases were diabetes mellitus (22%), thyroid disorders (22%), heart disease, as well as asthma and allergies (13%).
As the findings of the present study indicated, most of the risk factors in the pre-pregnancy period were related to diabetes mellitus and gestational diabetes.

The rate of unintended pregnancy has decreased from 24% to 16% in the last four to five years in Pakistan. However, this rate stills varies among the women living in the rural and urban areas of Pakistan. The females residing in the rural areas are less likely to have many contraceptive choices and receive no/low-quality family planning services; as a result, they end up with birth control failure and unintended pregnancy. Regarding this, more studies are needed to investigate the association between the unintended pregnancy and contraceptive use, particularly in the rural areas of Pakistan.Therefore, the aim of the present study was to determine the relationship between contraceptive use and unintended pregnancy among the women at reproductive age living in Thatta district, Sindh, Pakistan.
This nested case-control study was conducted on the women living in Thatta district during June 2011-July 2012. The pregnant women who did not want more children were considered as cases, and those who intended to have more children were considered as controls. The categorical and continuous variables were analyzed using the Chi-square test and independent t-tests, respectively.
According o the results of the present study, the use of contraceptive methods was significantly associated with increased risk of unintended pregnancy among the women living in Thatta district [OR: 2.77 (1.46-5.25)]. Moreover, there was 14% increased risk of unintended pregnancy with one year increase in the age of the women [OR: 1.14 (1.10-1.19)]. The age at marriage showed negative association with unintended pregnancy [OR: 0.92 (0.87-0.97)]. The women having at least one son (alive) were almost three times more likely to report their recent pregnancies as unintended, compared to those with no living son [OR: 2.97 (1.82-4.84)]. In addition, the husband’s education and their opposition with the use of family planning methods [OR 2.16 (1.06-4.39)] were found to be associated with unintended pregnancy.
As the findings of the present study indicted, the unintended pregnancy is likely to occur when the women have achieved their desired family size as evidenced by the higher mean age and presence of at least one living son. We recommend to improve the quality of care and family planning services to deal with issues of birth control failure by taking such measures as the provision of emergency contraception and support.

Sexually transmitted infections (STIs) present a serious public health burden, which are considered as the factors contributing to acute illnesses, infertility, long-term disability, and mortality. The aim of the present study was to provide an in-depth understanding of the participant's perceptions about the integration of gender-sensitive approach to safe motherhood program for the prevention of STIs/human immunodeficiency virus (HIV) in Iran.
This qualitative exploratory study was conducted on 32 male and female key informants, including health managers, health policy makers, and reproductive health providers. The participants were selected through the purposive sampling method, followed by the snowball sampling technique. The data collection was performed using the semi-structured interviews. The data were analyzed through the content analysis.
Based on the results, the participants’ perceptions were categorized into two categories, namely the STIs/HIV prevention among males in safe motherhood and gender-sensitivity in primary maternal STIs/HIV prevention. Each of the patients was further divided into codes. The first category includes accountability to men's own sexual health needs’ and prevention of ill-health effects of men on women’s STIs/HIV status and the second category includes (1) condom negotiation skills in women (2) mandatory pre-marital HIV test policy, (3) partner notification guidelines, (4) STI/HIV risk assessment in safe motherhood services, and (5) women’s right-based instruction for prenatal HIV screening in private services.
As the findings of the present study indicated, the health policy makers were not adequately sensitive to gender sensitivity, which is particularly crucial for STIs/HIV prevention in the safe motherhood programs.

The preservation and enhancement of the sexual function are the key elements of sexual health. One of the most important predictive factors of sexual behavior and function is sexual self-concept. This construct is defined as the individuals’ understanding and evaluation of their own sexual desires and orientations. The aim of the present study was to determine the correlation between the dimensions of sexual self-concept and sexual function in the women of reproductive age.
This correlational descriptive study was conducted on 79 married women of reproductive age referred to the health centers in Gorgan, Iran. The sample size was determined using the sample size formula with a power of 90% and a confidence interval of 95%. The data collection tools included the Persian multidimensional sexual self-concept questionnaire included 23 items covering five dimensions (i.e., sexual anxiety, sexual fear, sexual self-efficacy, sexual self-esteem, and sexual satisfaction) and the Persian Female Sexual Function Index consisted of 19 items in six dimensions. Data analysis was performed using the Mann-Whitney U test and Spearman's rank correlation coefficient through the SPSS software (version 16).
The Spearman correlation test revealed a significant direct correlation between the sexual self-esteem and the positive dimensions of sexual function, including desire (P=0.002, r=0.3), arousal (P The enhancement of the positive dimensions of the sexual self-concept (i.e., self-esteem and sexual satisfaction) and reduction of its negative dimensions (i.e., sexual anxiety) could strengthen the positive sexual function in the women of reproductive age. The findings of the present study can be useful in designing the sexual counseling methods, preserving or enhancing the sexual health and function, and consequently improving the stability of the family system.

In the midwifery profession, observing legal and ethical issues in professional practices should be emphasized. Legal and ethical advancements in the realm of midwifery have raised the need for midwives’ awareness as to patient rights. This study was performed to evaluate midwifery students’ knowledge and attitude towards observing the ethical and legal standards of patient rights in 2015.
This descriptive study was conducted on 85 midwifery students in the 5th and 7th semesters of Bachelor of Midwifery program, the 1st and 3rd semesters of Master of Midwifery program, and 1st and 3rd semesters of Counselling in Midwifery master’s program at Mashhad University of Medical Sciences. Data collection tool was a researcher-made questionnaire consisting of three domains of demographics, knowledge (30 questions), and attitude (35 items) towards observing the legal and ethical standards of patient rights. To analyze the data, descriptive statistics, analysis of variance, Student’s t-test, and correlation coefficient tests were used in SPSS, version 16.
The means of overall knowledge and attitude towards ethical and legal standards were 17.55±3.15 (moderate knowledge) and 145.40±12.33 (good attitude), respectively. No significant association was found between knowledge score of the subjects and observing the patient rights and midwifery ethical codes (P Most students had good attitude, but moderate knowledge about ethical and legal standards of patient rights. Given the importance of observing these principles in providing obstetric care, we recommend holding workshops on this issue.

Empowerment of pregnant mothers promotes their health and pregnancy outcomes. Given the importance of empowerment of women during pregnancy, this study was conducted to determine the level of empowerment during pregnancy and its determinants.
This cross-sectional study was carried out on 161 pregnant mothers who were selected using random cluster sampling in Gorgan, North East of Iran in 2015. To measure the level and determinants of empowerment, Kameda’s prenatal empowerment scale was used. Data analysis was carried out using descriptive and inferential statistical tests including linear regression analysis. P The regression analysis showed that age at first pregnancy (βeta standardized coefficient (β)=0.474), marital satisfaction (β=0.239) and spiritual support (β=0.227) had the highest coefficient in the regression. However, the age of marriage, the size of family as well as experience of violence had negative impact on prenatal empowerment.
Awareness of determinants of maternal empowerments could help policy makers to develop programs for promotion of mother's empowerment during pregnancy. It seems that through developing counseling and educational programs with special focus on reducing domestic violence and enhancing marital satisfaction as well as offering spiritual support could promote prenatal empowerment and as a consequence facilitate moving towards safe motherhood.

Despite the importance of screening for early diagnosis of breast cancer, few women do it. Existence an indigenous educational model to promote health literacy is essential. This study attempted to determine the effect of breast cancer screening education based on SHEP model to Healthy volunteers on women's knowledge covered by Mashhad health centers
Methods & Materials: This was a quasi-experimental study with two groups: Trainers and Audients, done in two urban health centers affiliated to Mashhad district health authority, divided randomly to experimental and control centers. Six health volunteers and sixty women with random selected from each center were the sample of the study. An 8-hour workshop conformity SHEP model was conducted over two days for health volunteers in experimental group. In both centers ten women were allocated for each health volunteer, were taken a pre-test with an assessment test evaluating their knowledge about breast cancer screening, a 2-hour educational session was performed for them by health volunteers, immediately and 4 weeks after educational sessions two post-tests were taken. Research data were processed and analyzed, using Mann Whitney, Friedman, Chi Square, Fisher’s exact test in SPSS statistical software, version 20
The post interventional scores of knowledge were significantly higher in the experiment group (p Results confirm the effectiveness of training based on SHEP model by usage peer Trainers on women’s short and long term knowledge promotion about breast cancer screening.

The enhancement of childbirth self-efficacy to manage the labor pain can help the nulliparous pregnant women to make informed choice about vaginal delivery. Regarding the relationship of the childbirth self-efficacy with psychological antecedents, the present study aimed to explore the meditating role of alexithymia in the relationship of attachment styles and childbirth self-efficacy among the nulliparous pregnant women.
This descriptive correlational study was conducted on 210 nulliparous pregnant women, living in Shiraz in 2016. The samples were selected from the nulliparous women referring to the public and private health and medical centers through the purposive sampling technique. The data were collected using a researcher-made demographic form, Iranian version of Childbirth Self-Efficacy Inventory, Hazan and Shaver’s Adult Attachment Inventory, and Farsi Toronto Alexithymia Scale-20. The data analysis was performed using the descriptive statistics and structural equation modeling through the SPSS version 20 and AMOS version 21, respectively.
Our findings indicated that all aspects of attachment styles (i.e., secure, avoidant, and ambivalent) would be able to predict the childbirth self-efficacy in the nulliparous pregnant women. On the other hand, the secure and insecure attachment styles predicted alexithymia among this population. The results of the path analysis demonstrated that alexithymia had a mediating role in the relationship of the attachment styles and the childbirth self-efficacy.
Based on the findings of the present study, it can be concluded that the attachment styles and childbirth self-efficacy had an indirect relationship mediating through such variables as alexithymia.

Nausea and vomiting manifest in more than 50% of pregnancies; in case of severe nausea and vomiting during pregnancy, or hyperemesis gravidarum, other diagnoses should be considered. This case report details a 34-year-old pregnant woman with diabetes whose primary symptom was nausea and vomiting; she presented with mild abdominal pain without abdominal tenderness. After hospital admission, she was treated as a case of hyperemesis. Sonography revealed acalculous cholecystitis, necessitating laparoscopic cholecystectomy that led to resolution of her condition. As hyperemesis is a diagnosis always arrived at by ruling out other possibilities, a complete physical examination should be performed and other patient symptoms must be considered in pregnant women with this disorder.