فهرست مطالب شیرین زرگرشوشتری

Menopause is one of the natural transition stages of growth that could be the cause of physical, mental, social, and psychological changes. Both premenopausal and postmenopausal women's attitudes towards this phenomenon are important issues. The aim of this study was to investigate attitudes towards menopause in women aged 40 to 60 and some influencing factors. Subjects and This is a cross sectional study was conducted on 400, 40 to 60 years old women in Ahvaz city in 2012. Tools for data collection were demographic and attitude questionnaires that were completed by interview. Attitude scores were transformed to 0-20 range. Highest scores were related to better attitudes towards the menopause. Attitude scores less than 10 was considered as a bad attitude, and attitude scores greater than 10 was considered as a good attitude. Data were analyzed in SPSS 16.0 using descriptive statistics, t-tests and ANOVA at a significant level of 5%. Mean of attitude score was 14.4±3.3. Negative attitude was recorded in 14.5% (n=58) of women, and 85.5% (n=342) had a positive attitude toward menopause. There was a significant relationship between attitude score and income (P<0.0001) and education level (P=0.02). Although the majority of women in this study had a good attitude toward menopause, but it is necessary to make more efforts for its improvement.

Postpartum hemorrhage is one of the important causes of maternal mortality and morbidity in developing countries. Management of the third stage of labor including the use of uncomplicated methods could be effective in reduction of postpartum hemorrhage and maternal mortality and morbidity. This study was done aimed to assess the effect of placental cord drainage on the length of the third stage of labor. This clinical trial was conducted on 90 primiparous women who had vaginal delivery in Razi hospital of Ahvaz، Iran in 2012. In first group placental cord drainage was performed immediately after delivery and women in second group received no intervention. In all cases the placenta was delivered by Brandt Andrew maneuver. Immediately after that، the length of the third stage of labor، mechanism of placental delivery، number of placental retention and need for manual removal of placenta were recorded. Data were analyzed using SPSS software version 16 and Kolmogorov–Smirnov، independent t-test and chi-square. P value less than 0. 05 was considered significant. The two groups were similar in maternal and neonatal characteristics. Mean length of the third stage of labor in case group (3. 51±0. 93 minutes) was significantly shorter than control group (6. 05±0. 96 minutes) (p<0. 0001). There was no placental retention or need for manual removal of placenta in both groups. Placental cord drainage as a simple and non invasive method can reduce the length of the third stage of labor.

Nulliparous women often are extremely anxious because of fear of labor pain and this anxiety will decrease their chances of normal vaginal delivery. The aim of this study was to investigate the effects of chewing sugar-free gum on labor anxiety in nulliparous women. This study was a randomized clinical trial and performed on 66 nulliparous pregnant women with spontaneous labor pains in Ahvaz Razi hospital in 2011. Samples were randomized to case group (n=34) and control group (n=32) based on the inclusion and exclusion criteria. Maternal anxiety was measured at baseline using Spielberger anxiety scale. Then an Orbit sugar-free chewing gum was given to case group. The women in the control group did not receive any intervention. After 30 minutes of chewing gum anxiety was measured in all subjects again. Also labor stages duration، type of birth and the need for oxytocin in both groups were recorded. Data were analyzed using descriptive statistics، t-tests and chi-square in SPSS version 15. A p-value less than 0. 05 was considered statistically significant. Findings of this study showed that after 30 minutes of chewing gum، mean and standard deviation of active phase anxiety of women in case group (42. 85±5. 46) was significantly lower than control group (49. 82±7. 68). In the case group، active phase duration were significantly less than control group (177±89. 03 min in case group VS. 229. 03±59. 68 min in control group; p=0. 001). Also second stage of labor duration in the case group (43. 91±10. 96) was less than control group (52. 65±18. 27) with p-value of 0. 021. Type of delivery and the need for oxytocin were not significantly different between the two groups. Based on the findings of this study it seems that chewing a gum can be used to reduce anxiety of labor as a non-invasive and effective method.

Quality of life is considered as one of the important health outcomes that plays an important role in evaluation of health interventions. The aim of this study was assessing the various dimensions of postmenopausal quality of life and effect of some demographic variables on it. This analytical descriptive study was conducted on 400 women aged 40–65 years referred to Ahvaz east health center، Iran in 2012. Demographic and menopausal quality of life questionnaires were completed for all subjects via face to face interview. The score of quality of life and its different domains were changed into the 0-20 range. Higher scores indicated worse quality of and lower scores indicated better quality of life. Data were analyzed using SPSS software version 17، descriptive statistics tests، t-test and ANOVA. P value less than 0. 05 was considered significant. The mean score of quality of life in postmenopausal women was 9. 72±3. 27. The worst score was related to vasomotor dimension (10. 90±5. 27) especially hot flash symptom. Employed women had a better quality of life in physical (p=0. 002) and psychological (p=0. 01) dimensions than housewives. Quality of life in smoker women was significantly lower in vasomotor (p=0. 04) and psychological (p=0. 002) dimensions than non-smokers. No significant relationship was found between quality of life and age، education، sport، income and health situation. The worst score of postmenopausal quality of life was related to vasomotor dimension. Smoking and being housewife reduced quality of life in some of its dimensions.

Menopause is a natural event in women life، but some of its symptoms are severe enough to affect negatively on normal daily activities of women. There are different tools to measure and evaluate the symptoms of menopause. One of these tools is Menopause Rating Scale (MRS). The aim of this study was to determine the frequency and severity of menopausal symptoms in pre-and postmenopausal women using MRS and its relationship with demographic factors. This descriptive، analytical and cross sectional study was carried out on 512 pre-and postmenopausal women in Ahvaz، Iran، 2012. Data gathering tools were demographic and MRS questionnaires. MRS questionnaire consisted of 11 symptoms of menopause in three domains (somatic، psychological، urogenital) that scored on a 5 point Likert scale. The questionnaires were completed by face to face interviews for all samples. Data were analyzed using SPSS software version 16، t-test and ANOVA. P value less than 0. 05 was considered significant. 344 cases (67. 2%) were postmenopausal and 168 cases (32. 8%) were premenopausal. Total MRS score was 23. 12±8. 96 which showed significant difference between premenopausal and postmenopausal groups (p<0. 0001). The most prevalent symptom in premenopausal (62. 5%) and postmenopausal (71. 6%) women was muscle and joint pain. Worst complain was related to joint and muscular pain in premenopausal (2. 30±1. 29) and postmenopausal (2. 79±1. 47) groups. There was a significant difference between total MRS score and education (p=0. 01 in postmenopausal and p The most prevalent symptom in pre-and postmenopausal women was muscle and joint pain. Athletes and non-smokers women and those who had higher education and income had better MRS score.

Postpartum hemorrhage is an important cause of maternal morbidity and mortality. Active management of third stage of labor including the use of uterotonic agents could be effective in reduction of postpartum hemorrhage and peripartum mortality and morbidity. This study aimed to compare the efficacy of intraumbilical injection of diluted oxytocin with intravenous infusion of oxytocin in the active management of third stage of labor. Subjects and This randomized clinical trial was done on 102 vaginal delivery primiparous pregnant women. Women in first group (n=51) received 20 units of diluted oxytocin in 20 ml of 0. 9% N/S injected in the umbilical vein. Women in second group (n=51) received 20 units of diluted oxytocin intra-venously. The primary outcome measurement was the mean duration of third stage of labor and mean changes in post-delivery hemoglobin. Data were analyzed using SPSS Ver. 15. 0، descriptive statistics، t test and Chi square with 95% of confidence interval. Mean duration of third stage of labor in intraumbilical group (3. 50±0. 97 min) was significantly shorter than intravenous group (5. 16±1. 13 min) (P=0. 001). Also women in intravenous group had lower amount of post-delivery hemoglobin (9. 66±0. 91 g/dl) than women in intraumbilical group (10. 42±0. 70 g/dl) (P=0. 001). It seems that active management of the third stage of labor using intraumbilical oxytocin compared with intravenous infusion of oxytocin can reduce the length of third stage of labor and، after delivery، less in hemoglobin level.

Knowledge of herbal medicine by the physicians and medical students is essential for patients’ consultation. Due to the increasing use of herbal medicine in obstetric and considering that according to studies almost half of the users of traditional medicine are women of reproductive age, assessing the knowledge and attitudes of midwives and midwifery students in this field is essential. This study was done in the second academic semester to determine the attitude of midwifery students of Ahvaz university of Medical Sciences about herbal medicine and its application in obstetric in 2012. The results of this study showed the interest in learning herbal medicine and a lack of academic training in this field. It was also found that a quarter of students did not know the application of herbal medicine in obstetrics. It seems that inadequate academic training and no access to a reliable source for herbal medicines can effect on the ability of midwifery students in the use of herbal medicine for treatment of patients.

Episiotomy is the most common operation performed in obstetrics. Since midline episiotomy has been shown to significantly increase the risk of anal sphincter injuries followed by fecal and gas incontinence, mediolateral episiotomy has become common. Despite the use of mediolateral episiotomy a large proportion of women still develop anal sphincter injuries. The aim of this study was to compare the extent of mediolateral episiotomies by doctors and midwives in Ahvaz maternity hospitals. This descriptive-analytic study was carried out on nuliparous women who referred to Imam Khomeini, Razi and Sina maternity hospitals of Ahvaz city in 2010. The perineal length, episiotomy length, distance from the midline, shortest distance from the midpoint of the anal canal and episiotomy angle were measured using a tape in the lithotomy position immediately after episiotomy repair. Data were analyzed using descriptive statistic t-test and chi square tests in SPSS software version 15. Of 120 assessed episiotomies, 76 (%63.3) were performed by midwives and 44(%36.7) were performed by doctors and %16.6 of episiotomies had been performed with true angles. In the other hand, %13.2 of midwives and %22.7 of doctors had performed truly mediolateral episiotomies and there was no statistical difference between the 2 groups (p value=0/12) These results show that the majority of episiotomies are not truly mediolateral, so more intensive training of doctors and midwives is clearly required.