فهرست مطالب fatemeh tara

Human papillomavirus (HPV) is the most common sexual transmitted infection. The persistence of HPV infection causes different types of anogenital and oropharyngeal cancer. HPV infection during pregnancy may be associated with several adverse consequences, such as preterm birth and miscarriage. The present study was performed with aim to investigate the relationship between HPV infection and adverse pregnancy outcomes in different studies.

In this narrative review, to find relevant articles, PubMed and Google Scholar databases were searched using the keywords HPV, Papillomavirus, HPV in Pregnancy, HPV Transmission and Adverse outcomes from 2000 to 2022. For this purpose, original research articles, clinical trials, reviews and case reports related to the subject of this review were included in the study and unrelated studies were excluded. The review of the articles was done by reading the title, abstract and content, respectively. The language on the admission papers was English.

The results of the different studies have shown that the risk of HPV infection in pregnant women is higher than in non-pregnant women. Also, the risk of preterm birth and preterm premature rupture of the membranes is reported to be higher in HPV positive pregnant women in comparison with HPV negative women. Some studies have also pointed to the relationship between HPV infection and spontaneous fetal death.

Considering many complications of HPV infection in pregnant women, it is better to ensure about non-infection with this virus before pregnancy.

Due to the increase in the frequency of cesarean section over the past few decades, the Ministry of Health and Medical Education of Iran compiled the guideline to promote natural childbirth within the framework of the health reform plans and communicated it to the country's medical science centers. The present study was conducted with aim to determine the epidemiological characteristics and changes trend of the frequency of cesarean section performed in the three educational hospitals of Mashhad University of Medical Sciences.

In this cross-sectional study, the information of all mothers admitted to the three educational hospitals of Mashhad University of Medical Sciences (Imam Reza, Ghaem and Omol-Banin hospitals) due to pregnancy termination during 12 years period (2007-2018) was extracted from the hospital information system. The analyzed information included age, hospitalization center, type of admission (elective or emergency), number of babies, need to transfer mother to ICU, total hospitalization cost, duration of hospitalization, and mother's insurance coverage status. Data was analyzed by SPSS software (version 26). P<0.05 was considered statistically significant.

Overall, 163070 pregnant women have been admitted for pregnancy termination, of which, 68258 mothers (41.9%) had cesarean section. The median of duration of hospitalization was 1 and 2 days for vaginal and cesarean section, respectively. Also, 150089 (92%) of hospitalized mothers were covered by insurance and median hospitalization cost considering inflation rate (until 2018) was 2.6 and 1.35 million Toman for cesarean section and vaginal delivery, respectively. In elective and emergency admission, the frequency of cesarean delivery was 76% and 365, respectively. In general, the rate of performing cesarean section during this period has been increasing from 36% in 2017 to 44.2% in 2018.

Despite the guidelines for promoting natural childbirth within the framework of the Health reform plans in 2014, cesarean delivery rate is still increasing.

One of the major problems of the fetus is the excretion of the contents of the fetal intestine in the amniotic fluid sac or the amniotic fluid stained with meconium. If the time of stained with meconium is long or if the meconium is thick, it leads to serious risks for the mother and the fetus. The present study was conducted with aim to investigate the prevalence of babies born with meconial stained amniotic fluid and the associated maternal and fetal complications.

This cross-sectional study was conducted in a period of 6 months (Dec 2014 to June 2015) on 1383 women with a singleton pregnancy and a gestational age of more than 28 weeks who had referred to Omolbanian Hospital in Mashhad due to the onset of labor pains. The investigated information included: mother's age, gestational age, number of pregnancies, mode of delivery, amniotic fluid condition, baby's gender, baby's Apgar, ABG (arterial blood gas), birth weight and the need for baby resuscitation. Data analysis was done using SPSS statistical software (version 22) and t-test and chi-square statistical tests. P< 0.05 was considered statistically significant.

In the present study, out of 1383 cases of normal delivery, 114 cases had meconium-stained amniotic fluid (prevalence of 8.2%). The number of cesarean section was higher in the thick meconial group (26 cases (%43.3)) compared to thin meconial group (9 cases (16.7%)) (p=0.002). The amount of abnormal ABG was 10 cases (8.7%) in the meconial group, of which 6 cases (5.2%) were in the fetal distress group. The amount of abnormal ABG was 8%, which was significantly higher in the thick meconial group (p=0.002). First minute Apgar less than 7 was more in the thick meconial group (p=0.01) and 5th minute Apgar had no difference between the two groups. There were no cases of convulsions or death of infant in the two groups.

In this study, the prevalence of amniotic fluid stained with meconium was 8.2%. Although the rate of cesarean delivery was higher in the thick meconial group, there was no significant difference in fetal distress in the thick and thin meconial groups. Considering the complications of cesarean section for the mother, natural delivery can be a choice method in these mothers and cesarean section is limited to cases of fetal distress or thick meconium far from delivery.

Down syndrome is considered as one of the most important causes of abortion. Considering to the high prevalence of this syndrome, it is necessary to study the frequency of non-abortion and awareness of the reasons and motivations of parents who do not attempt abortion and finally how these types of pregnancies result. This study was performed with aim to evaluate the outcomes of pregnancy and delivery in the infants with positive karyotype test results for Down syndrome.

This retrospective study was conducted in 2019 on 330 women with a positive fetal karyotype test results for Down syndrome between 2013-2018. Demographic information, parents’ decision and final outcome of pregnancy were recorded in a researcher-developed checklist. Data were analyzed by SPSS software (version 16). P<0.05 was considered statistically significant.

The results showed that 97% of parents with positive karyotype test result for Down syndrome decided to terminate the pregnancy, and 3% kept the fetus that Down syndrome occurred in them. Before the initiation of the study, 30% of these infants had died and 70% of them had survived up to mean of two years. Most of the parents who kept the babies showed feelings of regrets due to the economic problems and treatment challenges.

Given the incidence and sensitivity of the current plan of medical abortion, these results can confirm the validity of this approach and eliminate social sensitivities.

 Hemolysis, elevated liver enzymes, and low platelets syndrome (HELLP) was mimicked by several infectious conditions. It is critically important to distinguish these two, since their management and course differs, substantially.

Case report:

 The case was a 27-year-old gravid patient with gestational age of 30 weeks who initially presented with headache and lower limb pain as well as leukopenia (and lymphopenia), normochromic normocytic anemia, thrombocytopenia, abnormal liver enzymes, increased lactate dehydrogenase enzyme and C-reactive protein. The patient was initially managed for HELLP syndrome, but due to the atypical presentation (low blood pressure and an episode of delirium when admitted), the novel coronavirus disease 2019 (COVID-19), real-time reverse transcription polymerase chain reaction (rRT-PCR) was requested for the patient that was positive. The spiral lung high-resolution computed tomography scan revealed changes compatible with COVID-19 diagnosis. Finally, the patient underwent uncomplicated normal vaginal delivery at 39th gestational week.

 It is important to consider the COVID-19 in differential diagnosis of patients suspected to HELLP syndrome, as the isolation and treatment of the patient is different and time-sensitive.

In the present study, we evaluated the 4-year antimicrobial resistance trends of several nosocomial pathogens during 2018-2021 in a reffereal Mashhad hospital, Mashhad, Iran.
In this study, we reviewed the data of 70,234 clinical isolates were registred Infection Control Data of Ghaem Hospital, Mashhad, Iran. The antimicrobial susceptibility testing was performed using Kirby-Bauer disk diffusion method according to clinical and laboratory standard institute (CLSI) instructions to evaluate trends of antimicrobial resistance over the times.
There were identified (A. baumannii: n = 19,374; K. pneumonia n = 17,206; E. coli n = 23,777; S. epidermidis: n = 9,877). We did not find any significant difference in changes of antimicrobial trends over the time except in minor cases . However, The pattern of antimicrobial drug resistance was gradually differed except E. coli.
our results suggested the overall antimicrobial resistance trends was remins the same level during 2018-2021. It seems that in accessibility and stop prescribing of antibiotics can lead to decreasing antibiotic resistance rate.

Risk perception in high‑risk pregnancies influences the mothers’ adherence to medical treatments and recommendations. Because of the lack of information about the women’s perception of risk, the aim of this study was to explain perception of risk in high‑risk pregnancies. 

This qualitative study was conducted on 25 women with a high‑risk pregnancy in educational hospitals of Mashhad, Iran, from August 2017 to August 2018. Data were collected through semi‑structured interviews and data saturation was reached after 29 interviews. Data collection and analysis were simultaneously carried out using the qualitative content analysis method adopted by Elo and Kyngäs in MAXQDA software.

Data analysis resulted in the four main categories of perception of risk control ability (risk controlling through experience, risk tolerance through relying on a higher power, and risk tolerance to reach family goals), wrong estimation of risk (wrong calculation of possible risks based on wrong beliefs and knowledge, and incorrect risk estimation caused by misunderstanding), possibility of mutual vulnerability of pregnancy and risk condition (possibility of vulnerability of the fetus to risk factors, and possibility of the mother’s vulnerability to risk factors), and induced risk (risk induced by negative experiences, induced threat of unknown pregnancy outcome, and fear of ambiguous medical terms).

The results of this study promoted our understanding of risk perception in women with high‑risk pregnancies. Therefore, it will help to establish a‎ better link between women with a high‑risk pregnancy and the health team, enhance and improve maternal and fetal care.

Background & The complications of cesarean section (CS) are greater than vaginal delivery in most cases and will be increased in repeat cesarean section. Therefore, women are not keen to choose vaginal birth after cesarean section (VBAC). The present study was conducted to explore why women with previous cesarean section do not choose VBAC. This qualitative content analysis was performed on 13 women with previous cesarean section as well as 12 health care providers, who were selected from Om-Albanin hospital in Mashhad, Iran. Data was collected through semi-structured individual interviews and two focus group with women and health care providers. The interviews were recorded, transcribed and analyzed using Graneheim and Lundman’s conventional method of content analysis (2004). The trustworthiness of data was verified by Lincoln and Guba’s criteria. The main category of "feeling of loneliness, inability and fear of VBAC" was emerged from three sub-categories including "non-supportive sociological perspectives", "inefficient care” and "psychological fear of childbirth". The mothers had conflict in choosing VBAC due to emotional, social, and care system issues. Therefore, comprehensive supports including cultural interventions for vaginal birth in order to correct women’s beliefs and enhance their knowledge as well as planning a supportive and special care system for women with previous CS will help them in decision making for VBAC. Planning for these strategies and evaluating their effectiveness are suggested.

Since the outbreak of Coronavirus worldwide, working conditions of medical personnel, specifically nurses, have changed dramatically. Therefore, medical staff have undergone more physical and psychological distress than before. The main purpose of this study was investigating symptoms of stress, anxiety and depression and coping strategies in nurses who worked during COVID-19 pandemic. T This cross-sectional descriptive analytical study was conducted during April and May 2020. Through convenience sampling method, 76 nurses who involved in caring of COVID-19 patients at Ghaem Hospital in Mashhad were selected. They were evaluated by DASS-21 and Billings and Moos coping responses inventories. Mann-Whitney test, Spearman correlation coefficient and multiple regression analysis was used by means of SPSS 16.0.  The findings demonstrated that nurses suffered high mental problems. Symptoms of stress were discovered in 48.7%, anxiety in 77.6%, and depression in 60.5% of the nurses; and the main strategy applied by them was emotion-focused types. Regression analysis revealed a positive correlation between psychological distresses and emotion based approaches as well as negative correlation between problem-focused skills and incidence of depression. The COVID-19 outbreak has caused critical conditions and as a result, psychological pressures on nursing staff. Training on problem-solving strategies in nursing community would help to cope with such health related crisis.

High rate of repeat cesarean section and its complications are the results of cesarean tsunami in the last two decades in Iran. Vaginal birth after cesarean (VBAC) is an important alternative for repeat cesarean. However, the rate of VBAC in Iran is very low subject to some organizational and individual barriers. This study explored the clinician’s and women's perceptions of individual barriers to achieve VBAC.

In this conventional content analysis, 28 semi-structured interviews and one focus group discussion was conducted with health care providers including gynecologists, midwives and family physicians as well as  prior  cesarean section mothers in Mashhad in 2017. Participants were selected through purposive sampling considering the strategy of maximum variation. Data analyzed according to Graneheim and Lundman (2004) method using MAXQDA.10 software.

The theme of “obstacles to acceptance and committed actions” emerged from two categories of “psychological barriers” and “operational barriers and five sub-categories labeled as: 'sense of danger”, “financial displeasure",  "negative attitude", "barriers to decision making" and "indolence".

Attitude improvement by maternity care promotion and create supportive environment, informing mothers about choice of birth mode and empowering them in shared decision making, organization of VBAC care team and create motivation in persons and hospitals through report of research projects outcomes on safety and benefits of VBAC will be affected the VBAC rate and cesarean section rate.

Gaining adequate knowledge about high-risk pregnancy (HRP) and correctunderstanding of the condition, empowers women to improve the use of prenatal care, practice betterself-care, and reduce the risk of pregnancy complications. The present study aimed to assess thevaluation of knowledge by Iranian women with HRP. The present qualitative study was conducted on 25 women with HRP from August 2017to August 2018 at various educational hospitals in Mashhad, Iran. The data were collected throughin-depth semi-structured interviews. The data collection process continued until data saturation.The data were analyzed using the conventional content analysis method and MAXQDA software(version10.0). Data collection and data analysis were conducted concurrently. Based on the analysis of the interviews, two main categories and eight sub-categories wereextracted. The main categories were “Positive valuation of credible problem-relevant knowledge” and“Avoidance of misleading and stressful information”. The results showed that various factors had apositive impact on knowledge gathering, namely personal and other people’s experiences, obtainingneed-based information, sympathetic advice from others, and faith-based health recommendations.On the other hand, factors that had a negative impact were related to the type of information thatcaused stress, was unreliable, inefficient or incompatible with personal goals. The findings of the present study would help health care providers to offer suitable andempathetic counseling to women with HRP. Providing valid and accessible sources of information willlead to faster and timely referrals of such patients.

Approximately half of mothers give birth by cesarean section in Iran and two‑thirds of them are repeated cesareans. Repeated cesarean is threatening for the mothers and newborns and not compatible with fertility policies in Iran. Vaginal Birth After Cesarean(VBAC) is a reasonable strategy but its prevalence is very low due to some barriers. The aim of this study was to explore barriers to VBAC in health care system.

In this qualitative study, 26 semi‑structured individual interviews with maternity care providers and mothers with prior cesarean section as well as one focus group discussion with maternity care providers were conducted. Interviews and focus group discussions were tape‑recorded, transcribed verbatim and analyzed with conventional content analysis developed by Graneheim and Lundman using MXQDA10 software.

Barriers to VBAC in health care system identified in the main category of “the climate of restriction, fear and discourage” and eight subcategories including: “defective access to specialized services,” “insufficient encouragement system,” “modeling in cesarean section,” “physician‑centeredness in VBAC,” “fear of legal responsibilities,” “imposed policies,” “marginalization of midwives,” and “unsupportive birth team.”

To remove barriers of VBAC in health care system, appropriate strategies including establishment of specialized VBAC counseling centers, performance‑based incentive policies, cultural development and promotion of natural childbirth, promoting of teamwork culture, shared decision making, improvement of knowledge and skills of maternal care providers and implementation of clinical guidelines, should be considered. Future research could be focused on the effect of implementing these strategies to decrease repeat cesarean section rate.

The purpose of this study is to construct and validate a measurement model of women’s preferences in Obstetrician and Gynecologist (OB/GYN) selection in the private sector of non-clinical parameters. This methodological study included 462 respondents in OB/GYN’s offices to a researchermade questionnaire. The patients visited 57 offices of OB/GYNs in the city of Mashhad in Iran and completed women’s preferences in OB/GYN selection questionnaire over a 2-month period from January to February 2018. Exploratory Factor Analysis (EFA) was conducted to verify the instrument’s construct validity. Confirmatory Factor Analysis (CFA) was used to test whether the data fit our hypothesized model obtained from EFA model. The first draft of the questionnaire was prepared with 118 items based on literature review. The outcome of content validity assessment was a 51-item questionnaire. Scale-Content Validity Index (S-CVI) turned out to be 0.80. The results of EFA yielded an instrument with 33 items in six domains, which explained 52.657% of the total variance of the questionnaire. With performing CFA, the 6-factor model with 29 items demonstrated a good fit with the data (CFI=0.952, CMIN/DF=1.613, RMSEA=0.036). Availability and Accessibility, Communicational Skills, Office Environment, Recommendation by Others, Special Services, and Cost and Insurance were found to define the women’s preferences in OB/ GYN selection in private sector, Iran. The developed measurement model considers the patient’s preferences that influence decisionmaking process on OB/GYN selection. It can provide useful knowledge for OB/GYNs and policymakers to design appropriate and efficient marketing strategies according to the consumer preferences priority.

Vasomotor symptoms such as hot flashes and night sweats occur in the near-menopausal stage and thereafter and affect women's quality of life. This study was performed with aim to determine the factors related to the severity of vasomotor symptoms using structural equation modeling in women of Mashhad.

This cross-sectional, descriptive-analytical study was performed in 2017 on 664 women aged 42-60 years old in Mashhad. Information about hot flashes, night sweats, depression, anxiety and cognitive impairment were measured through MSSI-38 questionnaire. Demographic data as well as nutrition and life events questionnaires were completed for participants. Data were analyzed with weighted least squares estimation method in Structural Equation Modeling using SPSS software (version 16) and Mplus (version 6.12). P

The frequency of hot flashes was moderate in 109 women (%16.40), severe in 84 (%12.70) and very severe in 98 (%14.80). The frequency of night sweats was moderate in 88 women (%13.30), severe in 72 women (%10.80) and very severe in 93 women (%14.00). There was significant relationship between life events (p=0.025), anxiety (p=0.013), disease (p=0.005) and menopause status (p<0.001) with vasomotor symptoms.

Participation in training and counseling sessions on reducing stress and increasing women's self-efficacy, controlling underlying diseases by early visiting a specialist, exercising, mobility and improving economic status can be effective in reducing vasomotor symptoms.

We aimed to evaluate the diagnosis of acute toxoplasmosis by IgG avidity test in pregnant women.

In this cross-sectional study, 250 blood samples were collected from pregnant women with the first month of their pregnancy referring to health centers of University in Mashhad during 2016. Samples were centrifuged at 3000 rpm for 5 min for separation of serum and were kept in the -20 until use. To detection of acute and chronic toxoplasmosis, anti-Toxoplasma antibodies (IgG and IgM, and IgG avidity tests were performed using ELISA. Then, data analyzed using SPSS software by Frequency, Pearson Chi-Square, Likelihood Ratio, and Exact tests. And P<0.05 was statistically considered as significant.

Total prevalence of IgG and IgM was 23.2% and 7.2%, respectively. A significant correlation was observed between the mean age and IgG level (P<0.05). It was not found any correlation between the history of raw meat consumption, cats keeping, education, and residency site. Moreover, 16 people (6.4%) had IgM antibody, of which, 10 cases (62.5%) with low avidity for IgG and 1 people (6.2%) with moderate avidity and 5 cases (31.3%) with high avidity for IgG. Moreover, 76% of pregnant women were seronegative.

More than half of the women (62.5%) with positive IgM antibody in their serum had a low avidity for IgG which revealed an acute infection among pregnant women. Toxoplasma infection should be considered as an important factor that affects the pregnancy and IgG avidity as an important test for screening the women who need the treatment.

The purpose of the present study was a survey of venous thromboembolism (VTE) prophylaxis in obstetrics patients in Iran.

A national, multicenter, non-interventional, prospective study was performed on 1000 women at 11 different parts of Iran. Primary outcome was to assess the situation of VTE prophylaxis in pregnant and postpartum women and the secondary outcome was risk stratification in obstetrics patients and to evaluate the guideline adherence in physician’s practice of VTE prophylaxis.

1,036 women entered the final analysis. The three main VTE risk factors before hospitalization were BMI > 30 kg/m2, history of oral contraceptive (OCP) use, and the age over 35.VTE risk factors upon enrollment were detected in 780 (75.28%) patients. 219 women (28.07%) were deemed eligible for drug prophylaxis, however, only 37 women (17%) received it. A total of 113 (10.9%) patients received VTE prophylaxis, of which 76 (67.25%) women had no clear indications. Concordance between theory and practice was detected with a Cohen’s Kappa coefficient to be 0.74 (p < 0.001), which fell within “good agreement”. Multivariate analysis for association between VTE prophylaxis and VTE risk factors showed that history of VTE [OR = 9.06 (CI 95% 1.16 – 70.8) p = 0.036] was the most frequent risk factor for receiving VTE prophylaxis followed by obesity (BMI > 30 Kg/m2); [OR = 3.74 (CI 95% 1.79 – 5.69), p = <0.001], multiple pregnancy [OR= 2.81 (CI 95% 1.70 – 4.64), p = < 0.001] and age > 35 years; [OR =1.09 (CI 95% 0.82 – 1.21), p = 0.026]. Varicose Veins [OR= 0.22 (CI 95% 0.56 – 0.87), p = 0.031], PROM / PPROM [OR= 0.33 (CI 95% 0.12 – 0.91), p = 0.032] and history of using OCP [OR= 0.36 (CI 95% 0.24 – 0.53), p = < 0.001] were the most missed risk factors for receiving VTE prophylaxis respectively.

History of VTE, obesity, multiple pregnancy and age > 35 years were the most frequent risk factors for receiving VTE prophylaxis and varicose veins, PROM / PPROM and history of using OCP were the most missed risk factors for receiving VTE prophylaxis.

Amniocentesis is the most commonly used method for diagnosis of aneuploid and other genetic disorders of the fetus. Cautious should be taken when entering the amniocentesis needle to avoid entering the placenta. The purpose of this study was to investigate the consequences of needle transposition from the placenta during amniocentesis. In a cohort study, 1000 pregnant women candidates for amniocentesis were selected from Mashhad Perinatology Clinic, 2014-2016. A needle was inserted into the gestational sac and 20cc amniotic fluid was taken, using the ultrasound guidance. Passage or not passage of needle through the placenta was recorded and complications such as abortion, spotting, preterm labor, and rupture of membrane in each group were compared. Data analysis was done in SPSS applying Kolmogorov-Smirnov test, t-test, and Chi-square. The relative risk (RR) was also calculated. The mean age of participants was 33.4 years old (16-48 years of age). Spotting after amniocentesis was recorded in 1.4% nontransplacental amniocentesis and in 6.1% of transplacental amniocentesis (RR; 6.85, p=0.03). There was no significant relationship between needle passage through the placenta and other complications such as abortion, amnionitis, preterm labor, and amniotic fluid leakage following amniocentesis (p=0.08). Current findings showed that transplacental amniocentesis increases the probability of spotting following amniocentesis.

Postpartum hemorrhage (PPH) is considered as one of the major causes of maternal mortality worldwide. The most effective risk factors have been suggested in various studies on risk nomogram for the prediction of PPH. This study aimed to determine the diagnostic value of the risk nomogram for the prediction of PPH. This study was performed prospectively using diagnostic methods on 600 women admitted to Omolbanin Hospital, Mashhad, Iran, from May to October 2017. The researcher measured and recorded the loss of blood volume in mothers using plastic blood collection bags and pads within 4 h after delivery. Subsequently, risk nomogram was completed for each study sample and the probability score for PPH was calculated by the researcher’s assistants. The obtained data were analyzed in SPSS software (Version 25). Ultimately, the receiver operating characteristic (ROC) curve of risk nomogram was plotted in this study. The PPH occurred in 33.3% (n=200) of deliveries in this study. The area under the ROC curve was estimated at 81.2%. The point of 0.1 with 85.5% sensitivity and 51.5% specificity was also selected as the proposed cut-off point for this nomogram.
Implications for practice: According to the results, the risk nomogram was considered as an appropriate method for the prediction of PPH. Therefore, it was recommended as a simple and noninvasive approach in childbirth for the prediction of PPH.

Postpartum hemorrhage is considered as one of the major causes of maternal mortality in the world. Identification of women at risk of postpartum hemorrhage prepares the medical team for faster therapeutic decisions which can reduce maternal complications. This study was performed with aim to identify the risk factors of vaginal delivery postpartum hemorrhage. This cross-sectional analytic study was performed on 600 women referred to Omol-Banin Hospital of Mashhad in 2017. After delivery, the researcher measured and recorded lost blood volume in mothers via plastic blood collection bags and pads within 4 hours after delivery. Data were analyzed by SPSS software (version 25) and Mann-Whitney, independent t, Chi-square, and Fisher Exact tests. P<0.05 was considered statistically significant. PPH occurred in 33.3% of deliveries in this study. The results of the logistic regression test showed significant relationship between PPH and nulliparity (OR:5.987،CI:1.870-8.821)، hemoglobin level (OR:1.849،CI:1.677-2.890)، platelet levels (OR:2.955،CI:1.989-3.001)، Afghan race (OR:3.645،CI:1.141-8.644)، Barbarian race (OR:5.958،CI:3.452-6.645)، history of PPH(OR:4.562، CI:1.570-6.597)، preeclampsia(OR:20.126،CI:3.831-21.114)، duration of the second stage (OR:4.452،CI:2.265-5.674)and third stage(OR:3.620،CI:1.857-6.325) of labor، consumption of Magnesium sulfate(OR:67.107،CI:60.471-69.101)، uterine fundal pressure(OR:4.941،CI:3.305-5.903)، use of vacuum(OR:14.123،CI:10.003-18.831)، episiotomy(OR:2.143،CI:2.136-3.349)، genital tract tears(OR:17.889،CI:14.152-18.950), neonatal birth weight(OR:4.025،CI:3.641-6.850)، placenta weight(OR:3.988،CI:2.980-3.997)، and courage (OR:15.005،CI:13.520-15.224) were each associated with an increased odds of PPH. The most important cause of postpartum hemorrhage is uterine atony and the most important risk factors are nulliparity، Afghan and Barbarian race، history of PPH، preeclampsia، increased duration of the second and third stage of labor، consumption of Magnesium sulfate، uterine fundal pressure، use of vacuum، genital tract tears، placenta weight، neonatal birth weight and courage.

  Pregnant women are often ill-prepared for the health of their unborn child in the case of abnormal findings, and experience several difficulties following the detection of fetal anomalies. Therefore, this study was conducted to explore the emotional and cognitive experiences of pregnant women following prenatal diagnosis of fetal anomalies in Mashhad, Iran. This qualitative conventional content analysis study was designed through two referral centers for fetal anomaly. The data were collected from April 2017 to January 2018 in Mashhad (Iran) through individual semi-structured in-depth interviews, from 25 pregnant women with a prenatal diagnosis of fetal anomalies. Four categories and 10 subcategories emerged. Category one, grief reactions during the time of diagnosis, contained two subcategories: shocked and panicked, and distressed and disbelieved.Category two, perinatal loss through a pregnancy termination, contained four subcategories: guilt and shame during pregnancy termination, loss of their expected child, suffering and emotional distress process, and unmet needs by health professionals. Category three, fears of recurrence in future pregnancies, had two subcategories: worried about inadequate prenatal care in the future pregnancies and worried about abnormal fetus in next pregnancies. Finally, Category four, a dilemma between hope and worries contained two subcategories: hope for normality and worried about future. It is important to monitor emotional reactions of women following prenatal anomaly diagnosis. So, training clinicians and health-care professionals for proper response to grief reaction in post therapeutic abortion is essential.  

Trauma averagely affects one per 12 pregnancies and is a major non-obstetric cause of mortality among pregnant women, as well as fetal outcomes. Considering the change in therapeutic approaches base on several studies on the management of trauma in pregnancy, it is necessary to update the provided care. Therefore, this review study was performed with aim to collect the optimal care for pregnant patients with trauma using an evidence-based approach based on the most updated articles and guidelines. In this review study, all articles and guidelines were searched without time limitation in databases such as Irandoc, Magiran, Scopus, Up-to-date, Science direct, Google Scholar, PubMed, Web of science, Cochrane Library, CINAHL, and Medline using the keywords such as “Trauma” and “pregnancy” and their Persian equivalents by two researchers. After searching, the content of all available articles and guidelines was evaluated to find the most relevant evidence. Based on the results of the reviewed studies and guidelines, assessment and management of traumatized pregnant women requires a coordinated approach from a team of professionals. Furthermore, in all reviewed articles, the primary objective of treating victims of trauma in pregnancy was to stabilize the mother's condition and then evaluation of the fetus condition. Primary care of pregnant women similar to that of non-pregnant women is based on the principles of Advanced Cardiac Life Sup port (ACLS). Some of the unique aspects of this procedure include early intubation, resuscitation in the left lateral decubitus position or with manual displacement of uterus, and performing perimortem cesarean section. Routine screening of women for domestic violence, recommending the correct use of a seat belt and not turning off the airbag while driving are from the important strategies to reduce the traumatic effects in pregnancy. According to the evidence, management of trauma in pregnancy should be done as a team and with regard to specific aspects and changes of this period. The use of strategies to prevent trauma also have a significant role in reducing the effects of this complication in pregnancy.

Menopause symptoms severity is different in women, and in addition to the effects on aging process, hormonal changes with inducing the symptoms can affect women's quality of life. There are several tools to assess physical and psychological changes during the climacteric period. The MSSI-38 questioner is one of the new tools for simultaneous assessment of the frequency and intensity of symptoms with five-point Likert scale. This study was performed with aim to assess the validity and reliability of MSSI-38 questionnaire. This cross-sectional study was performed on 676 Iranian women who were resident in Mashhad in 2017. The MSSI-38 questioner was translated into Persian and after calcuating CVR, 6 items were eliminated according to the Lawshe formula and 9 factors were extracted by exploratory factor analyses. The content validity was evaluated with Content Validity Ratio (CVR) and Content Validity Index (CVI), and Construct validity was evaluated with Average Variance Extracted (AVE) and Composite Reliability (CR). Data were analyzed with SPSS software (version 16.0) and MPlus and Smart PLS. P< 0.05 was considered statistically significant. The value of AVE=0.562 was favorable. The CVI=0.87 was obtained and the content reliability was confirmed. The Cronbach alpha and CR in most of the factors were acceptable (>0.7). KMO=0.851 indicates the adequacy of the samples. After CFA, the goodness of fit indices were (χ2/df=1.53, RMSEA=0.039, CFI=0.972, TLI=0.968). 7 factors were extracted by using CFA and WLSM and factors construct validity was confirmed. MSSI-38 is a valid and reliable tool for evaluation of Menopause Severity Symptoms and can be used in research articles on Iranian Persian languages population

Congenital anomalies is one of most important causes of hospitalization, disability and neonatal death; the cost of admission and treatment of these children imposes a heavy burden on the health system and their families. Therefore, the present study was performed with aim to investigate the status of congenital anomalies in Iran through systematic review and meta-analysis.

In this review for finding the related articles, the databases of SID, Iranmedx , Irandoc, Magiran ,Scopus, Pubmed and Google scholar were searched using the keywords such as Prevalence, Iran, Congenital anomalies in Persian and English journals from 1986 to 2018. Data were analyzed by meta-analysis method using random effects model. The heterogeneity of the studies was calculated by I2 Index.

Of 2306 studies, 35 studies which met the inclusion criteria from 1986 to 2018 entered to the meta-analysis. The results of this meta-analysis showed that the total prevalence of congenital anomalies in Iran is 2.6%. The prevalence of abnormalities in boys is 2.8% and in girls is 2%. Also, the most common congenital anomalies were skeletal abnormalities (29.1%) and genitourinary system abnormalities (23.2%), respectively.

The results of this study indicate a high prevalence of congenital anomalies in Iran. Further studies are needed to more identify this issue and plan to prevent congenital anomalies.

Amniocentesis is usually performed to genetically assess the fetus before birth. The most common complications associated with amniocentesis include the rupture of membrane (ROM), miscarriage, amniocentesis, as well as direct and indirect harm to fetus. The study aimed to evaluate the early and late complications of amniocentesis.
This cohort study was conducted on 1,000 pregnant women, who referred to the Perinatology Clinic of Ommolbanin Hospital in Mashhad, Iran during 2014-2016 to undergo amniocentesis by a perinatologist. To obtain 20 cc amniotic fluid, a needle was inserted into the gestational sac through the skin of the abdominal area of mothers using the ultrasound guidance. Subsequently, the researchers collected the data related to the early and late complications, pregnancy termination date, and neonatal complications through phone calls. Data analysis was performed in SPSS version 20 using Kolmogorov-Smirnov test.
From the evaluated neonates, 887 newborns (88.7%) were healthy. According to the results, spontaneous abortion, amniotic fluid leakage, spotting, amnionitis, and childbirth before 37 weeks of gestation were reported in 10 (1%), 16 (1.6%), 16 (1.6%), 2 (0.2%), and 173 (17.3%) of the cases, respectively. Furthermore, there were no reports of ocular, dermatologic and orthopedic complications in the study.
According to the results of the study, the most common early complications of amniocentesis were spotting and amniotic fluid leakage. Furthermore, preterm birth was the most common late complication of this procedure.

The most important intervention to prevent the prolongation of the third stage of labor is the prescription of chemical drugs that have adverse effects despite their efficacy. Therefore, it seems necessary to seek for alternative methods with higher safety. Regarding this, the aim of the present study was to investigate the effects of immediate and continuous mother-neonate skin-to-skin contact (SSC) on the duration of the third stage of labor.
This randomized clinical trial was conducted on 92 primiparous women who referred to Omolbanin Hospital in Mashhad, Iran. The participants were divided into two groups of SSC and routine care (RC). In the SSC group, at the end of the second stage of labor, the neonate was placed naked against his/her mothers’ skin in a prone position. In the RC group, the newborns were kept under a radiant heater, and after the repairing of the perineum, they were transferred to their mothers in a blanket. The data were analyzed in SPSS (version 14) using the Chi-square test and independent t-test test. The P-value less than 0.05 was considered statistically significant.
The duration of the third stage of labor was less than 5 min in 11 (23.4%) and 3 (6.7%) participants in the SSC and RC groups, respectively. Additionally, this duration was within 10-20 min in 6 (12.8%) and 13 (28.9%) subjects of the SSC and RC groups, respectively. Accordingly, there was a significant difference between the two groups in this regard (P=0.02). Furthermore, the SSC group had a significantly lower need for synthetic oxytocin after delivery as compared to the RC group (P=0.03).
As the findings indicated, early mother-neonate SSC can shorten the length of the third stage of labor and reduce the need for a high dose of synthetic oxytocin and its complications. Therefore, this approach can be used a simple, cost-effective, efficient, and uncomplicated method to accelerate the third stage of labor and decrease the rate of postpartum hemorrhage, which is one of the main causes of maternal mortality and morbidity.