Iranian Journal Of Nursing and Midwifery Research
Volume:29 Issue: 1, Jan-Feb 2024

Bacterial infections are among the most serious infections worldwide. They can cause miscarriage, premature birth, stillbirth, and ectopic pregnancy in pregnant women. The aim of this study was to investigate the relationship between bacterial infections and pregnancy outcomes through a systematic review and meta‑analysis.

PubMed, Scopus, Web of Science, and Embase databases were searched from January 2000 to December 2018 using appropriate keywords to identify related articles. The final related studies were selected and evaluated using the Newcastle‑Ottawa Scale (NOS).

Results of this meta‑analysis based on combining case‑control studies showed that the presence of bacterial infections could lead increase in the odds of all pregnancy outcomes like premature infant birth (odd ratio [OR]: 1.50; 95% Confidence Interval [CI], 1.39–1.61), preterm delivery (OR: 1.54; 95% CI, 1.39–1.70), abortion (OR: 1.16; 95% CI, 1.04–1.29), stillbirth (OR, 1.29; 95% CI, 1.12–1.49), and ectopic pregnancy (OR: 1.12; 95% CI, 1.05–‑1.19). The results showed that the Risk Ratio (RR) of preterm delivery in pregnant women with vaginal infections was 1.57 (95% CI, 1.46–1.67), whereas the RR of abortion was 2.02 (95% CI, 1.72–2.38).

Based on the results of this meta‑analysis, the presence of bacterial infections in pregnant women can lead increase in the risk of pregnancy outcomes especially, preterm delivery, abortion, stillbirth, and ectopic pregnancy. Therefore, it is necessary for obstetricians and gynecologists to pay attention to the diagnosis of these infections in women before pregnancy and during pregnancy in order to prevent the consequences of these infections.

Obesity is a significant health problem worldwide and an alarming problem in the developed world including the United States of America and European populations. Subsequently, obesity can lead to different health problems, such as non‑communicable diseases. However, it can be prevented through a healthy diet, exercise, and lifestyle modification. The study’s purpose was to analyze the published literature on community‑based obesity interventions and to present a comprehensive summary of how to reduce the body weight, Body Mass Index (BMI), and Waist Circumference (WC) among overweight and obese individuals in the community through health education and behavior interventions.

The meta‑analysis was conducted in February–July 2021, searching CINAHL, Cochrane Library, Google Scholar, PubMed, and Science Direct databases. Studies published during the prior 12 years on community‑based obesity intervention for weight, BMI, and WC were included in this review. Cochrane Revman software was used for meta‑analysis.

Seventeen studies met the selection criteria for the review. A meta‑analysis of the studies on health education and behavioral intervention studies resulted in a statistically significant reduction at 95% confidence intervals in the mean differences of BMI ‑1.19 (‑1.77, ‑0.62) and WC ‑1.11 (‑1.54, ‑0.68).

Community‑based obesity interventions through health education and behavior interventions effectively reduce the body weight, BMI, and WC. Implementing community‑based health education and behavioral interventions effectively prevents and treats obesity in communities.

Patient handover (handoff in America) is the transfer of information and accountability among nurses assigned to patient care. Introduction, Situation, Background, Assessment, and Recommendation (ISBAR) is currently the most popular framework for framing handovers. However, research shows that incomplete handovers and information transfers among healthcare providers and nurses exist and are responsible for adverse patient events.

The current systematic review aims to view contemporary literature on handover, especially but not exclusively in psychiatric settings, and to extract current conditions from Electronic Patient Records (EPRs) using the ISBAR framework. A total of fifty‑five scientific papers were selected to support the scoping review. Eligibility criteria included structured research to analyze outcomes, completed by reviewing policy papers and professional organization guidelines on I/SBAR handovers.

Our systematic review shows that the application of ISBAR increases interprofessional communication skills and confidence and the quality of the transfer of clinical information about patients, resulting in increased patient safety and quality of care.

Implementing the knowledge and application of structured patient handover will respond to current recommendations for service improvement and quality of care. Furthermore, nurses who use ISBAR also reported its benefits as they feel they can deliver what is required for patient care information in a structured, fast, and efficient way. A further increase in the efficacy of handovers is reported by using EPR.

Knowledge of COVID‑19 preventive measures, in addition to appropriate practices of such measures, remains a necessity for the prevention of contracting COVID‑19 by nurses. This study assessed nurses’ knowledge and practice of COVID‑19 preventive strategies. It also determined the influence of sociodemographic variables on the knowledge of preventive measures for COVID‑19 among nurses.

The study adopted a descriptive cross‑sectional survey design using multi‑stage sampling to recruit 344 nurses.

The results showed that 92% of the nurses had adequate knowledge of COVID‑19 preventive measures. The practice of COVID‑19 preventive measures among nurses showed that 98.80% had sufficient knowledge of the infection preventive measures. Nurses with Registered Nurse/Registered Midwife (RN/RM‑AOR 12.30; CI 4.79–31.63; p = 0.001) and Bachelor of science in nursing (BScN‑AOR 37.60; CI 7.644‑184.95; p = 0.001) were more knowledgeable about the COVID‑19 preventive compared to other nurses with higher degree qualifications.

The nurses in the study had good knowledge of the preventive measures for COVID‑19 despite not being trained as frontline staff. It is essential to transform theory into practice by ensuring that the preventive measures they know are implemented to halt the spread of the disease in the face of minimal vaccine coverage.

This study aims to observe how auriculotherapy acts as a nonpharmacological treatment for pregnant women’s gestational hypertension.

This study was a randomized controlled trial. Eighty patients were with gestational hypertension recruited and divided into control (n = 40) and intervention (n = 40) groups. The control group just received the usual perinatal care. The intervention group received one month of auriculotherapy in addition to the usual care. Blood pressure was measured before and 15 minutes after rest in both groups twice a week. The data were analyzed using descriptive statistics and inferential tests.

The mean systolic blood pressure, based on the Mann‑Whitney test, was not statistically significant between the two groups before the intervention and in the first two weeks after the intervention (p >0.05); however, after the third week of intervention, the mean systolic blood pressure in the intervention group was significantly lower than that in the control group (p <0.001). As per the Mann‑Whitney test, the mean diastolic blood pressure was not statistically significant between the two groups before the intervention and the first week after the intervention (p <0.05). However, after the second week of intervention, the mean diastolic blood pressure in the intervention group was significantly lower than that in the control group, and this decrease was highest in the fourth week of the intervention (p <0.001).

This study demonstrated that auriculotherapy would reduce blood pressure in pregnant women suffering from hypertension.

Non‑adherence to treatments increases the rates of hemodialysis complications, hospitalization, and mortality. One strategy for adherence improvement is peer education. This study aimed to investigate the effects of peer education on treatment adherence among patients receiving hemodialysis.

This was a randomized controlled trial. Patients in the control group were provided just with routine care, and the intervention group received peer education. Treatment adherence was assessed both before and after the intervention via the End‑Stage Renal Disease (ESRD) Adherence Questionnaire. Data analysis was conducted by the Chi‑square, the Mann‑Whitney U, the paired‑sample t, and the independent‑sample t tests.

There were no significant between‑group differences in terms of the pre‑test mean scores of Adherence to regular attendance at hemodialysis sessions (t = 0.19, p = 0.85), Adherence to the prescribed medications (t = 0.46, p = 0.64), and Adherence to fluid restrictions (t = 0.24, p = 0.81). The same finding was observed after the intervention, except for the mean score of the adherence to fluid restrictions dimension which was significantly greater in the intervention group (t = 2.86, p = 0.006). Moreover, no significant changes were observed in the mean scores of treatment adherence dimensions in the control group. However, in the intervention group, the mean scores of the adherence to regular attendance at hemodialysis sessions (t = 3.79, p < 0.001) and the adherence to fluid restrictions dimensions were significantly greater than their pre‑test values (t = 4.47, p < 0.001).

Education by peer groups improves the compliance of patients with regard to the consumption of fluids in the interval between two dialysis sessions.

The risk factors for recurrence are poorly understood. The purpose of study is to investigate the risk factors that contribute to the recurrence of diabetic foot ulcers.

This is a cross‑sectional study, and the two‑phase Delphi method was used. A category was developed to investigate the risk factors of recurrent diabetic foot ulcers by experts. The recurrent items with risk factors were analyzed. Furthermore, the risk factor variables were clinically tested for inter‑rater reliability agreement. Fourteen experts and two patients were included from February 15 to September 28, 2020, Indonesia.

There were 13 risk factors for recurrent diabetic foot ulcers. The mean authority coefficient was 0.71. The positive coefficients were 100% and 78%, respectively. The Kendall coordination coefficient was statistically significant (p < 0.01), and inter‑rater reliability agreement was perfect (1.00).

This study found some risk variables related with recurrent diabetic foot ulcers, which might serve as guidance to prevent future recurrences.

Some studies have reported that mouthwashes can decrease the viral load in the mouth, but there is not much information about the effectiveness of mouthwashes on coronavirus disease 2019 (COVID‑19). This study was conducted to compare the impact of using two types of mouthwash, chlorhexidine and sodium bicarbonate, on COVID‑19 symptoms and infection.

The present three‑group, double‑blind clinical trial examined 116 operating room nurses and anesthesia personnel of certain hospitals of Isfahan University of Medical Sciences, Isfahan, Iran. The participants were randomly assigned to three groups: intervention group 1 (chlorhexidine mouthwash), intervention group 2 (sodium bicarbonate mouthwash), and the control group (placebo). Mouthwash was used twice a day (morning and night) for 2 weeks. The participants were monitored in terms of COVID‑19–related symptoms for 4 weeks, from the first day of mouthwash use.

Fisher’s exact test indicated a significant difference between the chlorhexidine and control groups in terms of the onset of COVID‑19–related symptoms (p = 0.02). There was no significant difference in the symptoms of COVID‑19 between the groups, but the groups were significantly different in terms of all symptoms at a 4‑week interval (p = 0.04). Furthermore, headache was less observed in the chlorhexidine (p = 0.007) and sodium bicarbonate (p = 0.03) groups compared to the control group.

The use of 0.2% chlorhexidine mouthwash can decrease the onset of COVID‑19–related symptoms in health‑care workers. In addition, this mouthwash can partially reduce the symptoms of this disease in comparison to the control and sodium bicarbonate groups.

Coronavirus Disease (COVID‑19) is a viral disease that has become an international public health concern. Thus, the present study aimed to evaluate pregnant women’s perception of COVID‑19 based on the health belief model in Isfahan.

This cross‑sectional study includes 100 pregnant women selected by random sampling. Data were collected using an online questionnaire on the Porsline website. This questionnaire examines the knowledge and structures of the health belief model, including perceived susceptibility and severity, perceived barriers and benefits, and self‑efficacy regarding the prevention of COVID‑19. Data were analyzed using analytical tests such as independent t‑test and Pearson’s correlation coefficient. The significance level was considered to be <0.05.

The results showed that the knowledge of COVID‑19 and preventative methods was at a reasonable level among most women (77%). Also, there was a significant correlation between education and self‑efficacy. Based on the findings, the mean score of knowledge (F1,99 = 0.116, p = 0.04) and the mean score of perceived susceptibility (F1,99 = 0.02, p < 0.001) of mothers who were pregnant for the first time were significantly higher than mothers who were pregnant for the second time or more.

The perceived severity and susceptibility scores were higher than other constructs, indicating women’s proper understanding of the risks of COVID‑19. However, half of them stated that they do not go to receive services, and this issue can have adverse consequences. The researchers recommend planning to improve other model constructs, such as self‑efficacy, for improving women’s performance in receiving care.

There are insufficient and contradictory reports regarding the effect of delivery method on the rate of umbilical cord Nucleated Red Blood Cell (NRBC). Therefore, the present study aimed to compare the percentages of umbilical cord NRBC in vaginal delivery and emergency cesarean section (C‑section) in preterm neonates.

The present cross‑sectional study was performed on mothers with vaginal delivery and C‑section, from 2020 to 2021. The samples (n = 221) were preterm neonates selected using the convenience sampling method. The percentages of NRBC in neonates born by natural childbirth and by emergency C‑section were measured and compared in this research. A researcher‑made checklist, which included maternal and neonatal characteristics and laboratory evaluation, was used as a data collection tool.

The statistical population of thisresearch included 93 (42.10%) and 128 (57.90%) neonates born by vaginal delivery and by C‑section, respectively.The mean (SD) score of gestational ages at birth was 30.75 (2.81) weeks. The mean (SD) score of umbilical cord NRBC level were estimated at 8.01 (5.93) and 25.64 (22.61) for the neonates born by natural childbirth and by emergency C‑section, respectively (t=-8.43, df = 150, p<0.001). Statistically significant differences were observed in the gestational age (t=-3.36, df = 218, p = 0.001), fifth‑minute Apgar score (t=-2.32, df = 200, p = 0.021), umbilical cord NRBC (t=-8.43, df = 160, p<0.001), and short‑term prognosis (p = 0.032) between the two groups. It was also revealed that the number of NRBCs in the dead neonates was about 1.5 times higher than that in the discharged neonates.

Based on the results of the present study, emergency C‑section increased the mean of umbilical cord NRBC by three times, compared to that of normal delivery. Since an increase in the NRBC raises the risk of infant death, it is advisable to take steps to maintain the health of children by identifying high‑risk neonates through umbilical cord NRBC measurement immediately after delivery and special care.

Older adults encounter serious psychological challenges in addition to physical problems. Reducing stress and anxiety, along with promoting happiness, is critical to maintaining the mental health of the elderly. Jacobson’s Progressive Muscle Relaxation (JPMR) will lead to peace of mind by relieving physical stress. The present study aimed to investigate the effect of JPMR on the anxiety and happiness of older adults.

A single‑group pretest‑posttest design as a type of quasi‑experimental study was conducted on 34 older adults living in a nursing home in Rasht, the north of Iran, in 2021. The intervention was performed one session per week, for 8 weeks. The research instruments included the Geriatric Anxiety Inventory (GAI) and the Oxford Happiness Inventory (OHI). Descriptive statistics and the Wilcoxon test were used for data analysis.

After the intervention, the Mean (Standard Deviation [SD](of anxiety was 4.91 (1.96), and the Mean (SD) (of happiness was 37.18 (7.92). The mean score of anxiety among older adults after the intervention was significantly lower compared to the before intervention (Z = −4.73, p < 0.001). In addition, the mean score of happiness of the samples after the intervention was significantly higher compared to the before intervention (Z = −5.09, p < 0.001).

JPMR has a positive effect on reducing anxiety and promoting happiness in the elderly. Developing training programs and allocating time to non‑pharmacological treatments such as JPMR for the elderly living in nursing homes will help make them happier and healthier.

Infection Prevention and Control (IPC) practices during nursing students’ clinical training are based on standardized precautions. However, the spread of COVID‑19 raised the need to revise these practices. We aimed in this study to assess nurse educators’ agreement on items that represent precautionary guidelines, which enhance safety during clinical training of students. It aimed to reach an agreement among nurse educators on IPC practices to ensure safe clinical training.

This descriptive explorative, cross‑sectional study included 243 Jordanian and Omani educators. The study questionnaire was based mainly on evidence reported in the literature. The study questionnaire comprised items for trainers to practice and items to supervise students. It was developed based on available evidence and recommended training practices during COVID‑19 suggested by the WHO and the literature. Both the face and content validity processes were adopted to validate the study questionnaire. The final version was composed of 26 items for trainers and 20 items for students subsumed in the following themes: protecting self, protecting others, and essential training needs.

All questionnaire items were rated above the midpoint indicating agreement among participants on including the new IPC practices. All suggested practices (26 items for the trainers and 20 items for the students) were supported by the study participants.

Clinical training is an important component of nursing students’ preparation. Findings suggest the importance of adding new IPC practices to improve student IPC practices, protect themselves and others, minimize cross‑infections, and enhance students’ training within a safe clinical environment.

One of the high‑risk groups exposed to the coronavirus disease 2019 (COVID‑19) pandemic was pregnant women at risk of pregnancy complications due to a weakened immune system and inability to use various drugs to treat COVID‑19. Accordingly, this study was conducted to investigate the complications in pregnancy before and during the COVID‑19 pandemic.

This cross‑sectional study was performed on all pregnant women in Shahroud, Iran. The time interval from February 18, 2019, to February 17, 2020, was considered before the COVID‑19 pandemic and from February 18, 2020, to February 17, 2021, was considered the COVID‑19 pandemic. Sampling was conducted by census and included 6851 pregnant women. The required information was extracted from hospitals’ health deputy registration system and high‑risk pregnancy registration program.

Based on the findings, hypertension disorder, gestational diabetes, placental abruption, pre‑eclampsia, cesarean section, hospitalization in neonatal intensive care unit (NICU), preterm birth, and hospitalization in other hospital wards increased by 1.88%, 1.93%, 0.12%, 0.45%, 5.45%, 1.00%, 1.20%, and 1.40%, respectively, in 2020 compared to 2019. A statistically significant difference was also observed between them (p < 0.05). Also, the regression results showed that the chances of high blood pressure, Gestational Diabetes Mellitus (GDM), placental abruption, and cesarean section were increased by 10.91, 1.53, 5.51, and 2.83 times, respectively.

Pregnancy complications have increased during the COVID‑19 pandemic. As a result, there is a need to take appropriate health and medical measures to reduce the risks associated with the COVID‑19 epidemic for pregnant women and neonates.

It seems that improving the spiritual dimension of cancer patients can play an effective role in their mental and emotional peace. Meanwhile, oncology ward nurses are one of the most important healthcare providers that can help improve patients’ relationship with God due to their more interaction and communication with patients. For this reason, this study aimed at explaining nurses’ spiritual needs in an oncology ward.

This study was conducted based on the qualitative content analysis method. The participants included 11 nurses from the oncology ward of Seyed Al Shahada Hospital in Isfahan from 2021 to 2022. A semi‑structured interview was administered to determine nurses’ spiritual needs.

Analysis of 11 interviews conducted with nurses revealed a total of four main codes, 13 sub‑codes, and four sub‑sub‑codes. According to nurses’ point of view, their spiritual needs can be classified into four dimensions as follows: communication with God, communication with oneself (intrapersonal communication), communication with others (interpersonal communication), and communication with environment. Administered interviews revealed the role of communication with God with six sub‑codes as nurses’ most important point of attention.

According to nurses’ point of view, nurses’ spiritual needs were divided into the dimensions of communication with God, communication with oneself, communication with others, and communication with environment. Therefore, it is necessary to simultaneously pay attention to oncology nurses’ personal and social aspects to increase their spirituality.

Because nurse prescription has numerous benefits for the health systems, in many countries around the world, nurses are given the right to prescribe medication. In Iran, the role of nurses in prescription drugs is not well understood, and nurses face various challenges in this regard.

A qualitative content analysis methodology based on the Graneheim and Lundman model was used. Thirteen nurses working in medical wards of hospitals affiliated with the Tehran University of Medical Science were selected to participate in this study by purposeful sampling. Participants were interviewed via telephone using a semi‑structured tool. After thirteen interviews, data saturation was reached. Data collection was undertaken between April 2020 and April 2021.

The results of this study are summarized in one theme, four categories, and ten subcategories. The theme extracted from the data analysis was “the practical challenges of nurse prescription,” which included four main categories: structure challenges, personnel‑related barriers, interprofessional separation, and society’s attitudes.

The results of this study explain the barriers and practical challenges of nurse prescription in Iran. Identifying these challenges and barriers provides the necessary evidence for policymakers to remove and adjust these challenges and barriers. Moreover, the elimination of identified challenges will help nurses better perform their new roles and develop the nursing scope and profession.

Infertility is one of the most common problems in the world; there is a growing demand for herbal medicines to treat infertility‑related problems.

A randomized controlled trial with three groups was conducted, each with 30 participants. The first group was administered 1.5 grams of Carob daily, the second group was administered 1.5 grams of Ginseng daily, and the third group received a placebo. The treatment was administered for 12 weeks, and before and after the intervention, semen parameters, testosterone, prolactin, luteinizing hormone, follicle‑stimulating hormone, thyroid hormones, and sexual function were evaluated. Sexual function was assessed using the International Index of Erectile Function Questionnaire.

The mean (SD) age of participants was 34.83 (6.22), 34.60 (5.78), and 33.67 (5.82) years in Carob, Ginseng, and Placebo groups, respectively. The results showed that in the Carob group, the normal volume of semen (Z 133 = 3.05, p = 0.02) and the normal shape of sperm (Z 134 = 2.97, p = 0.01) increased significantly compared to the control group. In the Ginseng group, the normal volume (Z 133 = 3.90, p = 0.001) and the normal viscosity of semen (Z 133 = 2.36, p = 0.01) increased significantly compared to the control group.The Carob group showed a significant increase in normal sperm counts and testosterone hormone levels (Z 131 = 2.81, p = 0.05). The Ginseng group demonstrated a significant improvement in orgasm function (H2 = 6.14, p = 0.04) and the total score of the International Index of Erectile Function (IIEF) (H2 = 5.8, p = 0.05).

Carob supplements are suggested to enhance some semen parameters and male sex hormones. For infertile men, Ginseng can be beneficial in improving sexual function.

With an increase in elderly people, it is essential to address the issue of cognitive impairment and support healthy aging. This study aimed to assess cognitive impairment and factors associated with it among older adults.

A cross‑sectional study was carried out in different catchment areas within the Jerash governorate in the north of Jordan. The Elderly Cognitive Assessment Questionnaire (ECAQ) and a household face‑to‑face interview were used to collect data from 220 older adult participants aged 60 years and more. Descriptive statistics were conducted to describe the study variables. Correlation tests were applied to find associations between them. Logistic regression analysis was applied, with a minimum significance level (p < 0.05).

About 9.10% of the older adults had cognitive impairment. Cognitive impairment was correlated with age, self‑perceived health, hypertension, stroke, and mental illness. The primary predictors of cognitive impairment were age [odds ratio (OR) =1.07 (1.01–1.14), p = 0.001] and stroke [OR = 10.92 (1.44–82.85), p = 0.001].

While many factors were correlated with cognitive impairment, the strongest predictors of cognitive impairment were age and stroke.

Although breakfast skipping among university students is a significant concern, its prevalence and the contributing factors among university students have received little attention in the literature. This study aims to determine the prevalence of skipping breakfast among Jordanian university students and examine the associated factors and variations in rates of skipping breakfast by day of the week.

A cross‑sectional study was conducted among undergraduate students between March and May 2022 through a self‑questionnaire. A convenience sample of 891 students was chosen at four Jordanian public universities. The data were analyzed using descriptive and inferential statistics.

The prevalence of skipping breakfast among university students was 66%. The reasons for skipping breakfast were having no time due to oversleeping and having no feeling of hunger (59% for both), followed by having no energy to prepare the breakfast and making no difference (49% and 48%), and not being able to afford to eat or buy breakfast (19%). There is a strong correlation between eating fast food and skipping breakfast. With whom the student eats breakfast is significantly associated with breakfast skipping, revealing that the highest percentages of skipping occur with friends. About 63% of students skipped breakfast through university days compared with 37% on the weekend, while 37% of them had breakfast through university days compared with 67% on the weekend.

A high percentage of university students in Jordan skip breakfast. More attention should be paid to correlating factors and developing interventions to help students adhere to the breakfast.

Cardiovascular care units are among the most crucial departments in any healthcare system. In these units, nurses play the most pivotal roles, and the quality of nursing care is essential; missing certain aspects of care can have irreversible adverse effects on patient health. This qualitative study aims to investigate the factors influencing Missed Nursing Care (MNCs) based on the experiences of nurses and patients in cardiovascular care units.

This qualitative study utilized the conventional content analysis approach to explore the factors affecting MNCs in cardiovascular care units. Data were collected between December 2021 and September 2022 through in‑depth, semi‑structured individual interviews with 11 participants selected through purposive sampling. Data analysis followed the five‑step method proposed by Graneheim and Lundman.

The analysis revealed five main themes: nurse’s job characteristics, work–life conflict, nurse’s professional competence, the cardiac work environment atmosphere, and organizational management.

The findings of this study suggest that authorities should consider factors such as understanding the occupational characteristics of nurses when assigning them to cardiovascular care units, providing solutions to mitigate work–life conflicts for nurses, enhancing nurses’ professional competence, improving the working environment for nurses, and enhancing the performance and skills of organizational managers.

Virtual Reality (VR) can provide more interruption as it inundates the patient in a different universe and connects with numerous faculties. VR has been utilized to deal with the pain and stress associated with various painful medical procedures.

This multi‑method study was conducted on 60 women in an Intrauterine Device (IUD) acceptor. This research occurred in the independent practice of midwifery in the great region of Yogyakarta, Indonesia, in 2020.

The study found that the things that make respondents anxious in the face of this IUD insertion are experience, information, knowledge, and family support. The quantitative analysis found different pain levels in the VR and non‑VR groups (t118 = 1,65, p < 0,001).

VR can be used as a method to distract clients during IUD insertion.

Dear Editor,
Human beings have always expected good news upon the pregnancy of a dear member of their family, together with both midwives and physicians. Unfortunately, not all pregnancies lead to good news, such as a normal childbirth or the birth of a healthy baby. Stillbirth gives rise to social, psychological, and physical challenges.[1] Both parents often experience grief, anxiety, fear, and suffering. Tolerance of bad news may be less agonizing if, thanks to ultrasound technology, fetal abnormalities are detected before childbirth and even during the early phases of gestation; timely interventions and treatment can then be conducted.[2] Among the undesirable news such as genetic defects, abnormalities, and abortion, the most painful and unexpected news may be the stillbirth, particularly a late stillbirth or a term stillbirth. Therefore, breaking the news of fetal death requires a sensitive approach and empathetic communication toward the affected parents.[3]