Journal of Midwifery & Reproductive health
Volume:2 Issue: 1, Jan 2014

Improving patient health status is the primary goal of healthcare system. and planning to improve the health care services without taking into account the views of care receivers is not possible. In this regard, Donabedian Model as an appropriate framework in assessing the quality of health care, has particular attention to the issue of «outcomes», which are sometimes seen as the most important indicators of quality. This study therefore aimed to assess the outcomes of preconception care including changes to health knowledge as well as patient satisfaction in urban health centers, Mashhad, Iran in 2012. In this descriptive study, 350 women of reproductive age who received preconception care in urban health centers of Mashhad, Iran, were selected using a two stage sampling design. Demographic and obstetric data were collected through a self-structured questionnaire. Outcomes of preconception care including health knowledge as well as patient satisfaction were measured using a questionnaire adopted from Donabedian Model. Data were analyzed with SPSS Software version 16 and statistical tests such as ANOVA, Chi-square and Pearson correlation coefficient. The mean age of women was 22. 5 ± 26. 93 and the mean score of their marriage years was 6. 32±4. 77. 67. 4% of subjects experienced between one and six pregnancies. The mean score of health knowledge of preconception care was 53. 4 ± 8. 14 and the highest score of its subdomains was related to the personal hygiene. The mean score of patients'' satisfaction of preconception care was 84. 11 ± 56. 75 and its highest score was in relation to counseling and provided care. According to the results, planning to provide better education services for clients, raising public awareness regarding preconception care and more emphasis on preconception care importance in continuous education of health care providers are recommended.

Afterpain is a common phenomenon after vaginal delivery. Any factor that causes a delay in the process of uterus sub involution and consequently returning its size to pre-pregnancy status could affect the severity of afterpain. This study aimed to investigate the factors related to afterpain in multiparous women delivered in 17-Shahrivar Hospital, Mashhad, Iran. In this descriptive study 210 multiparous women during 2-4 hours after uncomplicated spontaneous vaginal delivery with moderate or severe afterpain were conveniently selected and included in the study. Afterpain was measured each hour during the first 12 hours of postpartum period using Visual Analogue Scale (0-100 mm). The duration of lactation and ambulation, the need for any medication to relieve afterpain and also vital signs were recorded during this period. Data were analyzed with SPSS Version 14, using t Student and correlation test. The mean score of afterpain severity was 55.1±16.7. There was a positive correlation between the number of pregnancies and the duration of breastfeeding with mean score of afterpain. Also the length of ambulation decreased the afterpain intensity. However, the intensity of afterpain had no significant relationship with stimulation with oxytocin in labor, prescription of methyl ergonowin and also oxytocin after delivery. Considering that longer duration of breast feeding and ambulation in early postpartum period could decrease afterpain, it is suggested to encourage postpartum mothers to begin breast feeding and ambulation as soon as possible after birth.

The third stage of labour is one of the most troublesome stages of child delivery. The basic principle of the third stage management is administrating prophylactic uterotonics. However, the time of its administration varies in different hospitals. This study aimed to determine the effect of intramuscular oxytocin injection after emergence of the fetal anterior shoulder or placental expulsion on bleeding in the third stage of labour. This clinical trial was conducted on 100 pregnant women with gestational age of 38-42 weeks, and singleton pregnancies. Subjects were selected using convenience sampling and were then randomly assigned to intervention (injection of 10 IU intramuscular oxytocin after emergence of the fetal anterior shoulder) and control (injection of 10 IU intramuscular oxytocin after placental expulsion) groups. Blood was collected in containers and weighed with a weighing scale. A checklist was used to record labor and delivery related data. Data were analyzed by SPSS version 11.5, using Chi-square and t-test. The mean amount of bleeding during the third stage of labour was 183.4 ± 145.8 and 202.2 ±208.8 ml in intervention and control group, respectively. No significant difference was found between two groups in terms of maternal bleeding. Injection of intramuscular oxytocin either after emergence of the fetal anterior shoulder or placental expulsion does not affect the amount of maternal bleeding during the third stage of labour.

Postpartum period is an exclusive period after birth which can act as a potential stressor and could be accompanied with psychological disorders. Social support could play an important role in maternal mental health. Considering various stressors and different levels of social support for women, this study aimed to compare postpartum stressors as well as social support level between primiparous and multiparous women. This descriptive comparative study was conducted on 400 primiparous and multiparous mothers who referred to urban health centers, Mashhad, Iran in 2011. They had no history of medical or psychological problems and had healthy term neonates who were 8-25 days old. The sampling was carried out through a multistage cluster sampling. Data were collected using modified Hung questionnaire of postpartum stressors, Helen questionnaire of anxiety and Hopkins social support questionnaire. Data were analyzed using descriptive analytic statistics by SPSS version 11. The mean stress scores were 242.5±157.1 in primiparous and 28.8±179.8 in multiparous women. The main stressor of primiparous and multiparous women was neonate bathing and lower-back pain, respectively. The mean score of social support was 108.3±8.25 in the primiparous and 102.0±26.6 in multiparous women, which showed a significant difference between two groups (P=0.000). Various care programs are essential to support primiparous and multiparous mothers from different stressors that they face in postpartum period. It is also recommended to provid more information regarding the social support for the families.

Aromatherapy is the art and science of using essential oils extracted from aromatic plants, and is concerned with natural balance, coordination and promotion of health. This study was designed to determine the effect of «rose (Rosa damascena) essential oil» inhalation and foot bath on the improvement of maternal and neonatal health outcomes. This study was a randomized clinical trial, conducted on 80 primiparous women in Shahid Akbar Abadi Maternity Hospital, Tehran, Iran. Subjects were randomly assigned to aromatherapy and control groups. Aromatherapy group received methods of inhalation and foot bath with rose essential oil for 10 minutes at the beginning of the active phase and then at the onset of the transitional phase of labor. Control group received the routine care of the delivery room. The measured variables in this study included episiotomy in the second stages of labor, Apgar score, admission to neonatal intensive care unit (NICU), and maternal satisfaction with the administration of pain relievers. Statistical analysis of the extracted data was performed using SPSS version 16 with Chi-square and t student test. Two groups were significantly different in terms of the second stage of labor duration (P<0. 001). A noticeable decrease in NICU admissions was observed in the aromatherapy group (P<0. 005). Concerning the rates of episiotomy and perineal tears, a significant difference was observed between two groups, i. e. the rates were significantly lower in the aromatherapy group (P=0. 001). Maternal satisfaction with labour pain relief in the experimental group was significantly higher than the control group (p=0. 001). Use of aromatherapy by rose essential oil inhalation and foot bath during delivery improves the quality of maternal and neonatal health.

In people over 50, one out of three women and 12 men experience osteoporosis. Youth lifestyle plays an essential role in increasing bone mass and preventing osteoporosis in old ages. Thus, lifestyle changes during adolescence could cause the prevention of osteoporosis in older age. This study therefore conducted to investigate the lifestyle of female high school students in relation to prevention of osteoporosis. In this cross-sectional study 403 female students recruited from high schools in Iranshar, Iran included in the study. Data were collected using a questionnaire consisted of two parts of demographics and lifestyle issues associated with osteoporosis including nutrition, physical activity and habits. Data analysis was carried out using Chi-square and t test. results showed that 57.1% of the stdents had poor nutrition. In relation to the habits including smoking, alcohol consumption, adherence to medications and weight loss regimens, 78.2% of students had a relatively favorable lifestyle. 48.1% of subjects had a desirable lifestyle in terms of physical activity. The total score of lifestyle in 82.4% of students was relatively favorable. There was a significant relationship between lifestyle and age (P = 0.027), maternal education (P = 0.035) and occupation (P = 0.034). Considering that the lifestyle of more than half of the students were poor in relation to nutrition, it is suggested that in addition to giving awareness to the adolescents regarding risk factors and preventive measures of osteoporosis, families should also be taught to include calcium-rich foods in the food basket of their households.

Iron deficiency anemia is the most common micronutrient deficiency in the world today. It affects the lives of millions of women and children through contributing to poor cognitive development, increased maternal mortality and decreased work capacity. Because of the important role of Iron in the physical and cognitive health, and for the universal consideration of eradication of this problem, this review aimed to compare iron supplementary programs in three countries if India, Iran and England. The design was a comparative review of iron supplementary programs in three countries of India, Iran and England. These countries were selected for review, as they represent the spread of iron deficiency anemia in three different level of low, medium and high. Relevant data were retrieved from databases including PubMed as well as WHO, World Bank Ranking and BMJ Center reports and then were included in comparative tables to provide the basis for detecting similarities and differences. The included countries in this review were different in terms of preventive and treatment strategies to overcome iron deficiency. The reason for this difference was due to health conditions, and availability of healthy drinking water, and also prevalence of various diseases like anemia, parasitic diseases, and malaria. In Iran and India the preventive programs are confined to all groups at risk, however, in England it just encompasses the immigrants and the people who are supported by the government. This review showed that in low income countries, the most economic and cost-effective practice is enriching the nutritionals. Additionally, the treatment and preventive programs and policies for anemia in different countries are related to health conditions and health indicators of that country.

The etiology of male breast cancer is unclear, but hormonal levels may play a role in development of this disease. It seems that the risk of male breast cancer related to increased lifelong exposure to estrogen or reduced androgen. The aim of this study was to investigate the expression of the steroid hormone receptors including estrogen receptor (ER) and progesterone receptor (PR) in Iranian cases with male breast cancer. This is a prospective review of 18 cases of male breast cancer in in Omid Hospital, Mashhad, North East of Iran, between October 2001 and October 2006. ER and PR were measured by immunohistochemistry. Clinicopathologic features and family history were obtained by interview. Data were analyzed with SPSS 13 using descriptive statistics. The median age was 63.2 year. All the cases were infiltrating ductal carcinoma. A high rate of expression of ER (88.8%) and PR (66.6%) was found in the studied cases. Cancers of the male breast are significantly more likely than cancers of the female breast to express hormonal receptors.