جستجوی مقالات مرتبط با کلیدواژه « سزارین » در نشریات گروه « پزشکی »

The health system transformation plan has been implemented since 2014, and one of its goals is the reduction of cesarean rate to 25%-30%. The present study aimed to assess the rate of cesarean delivery and vaginal delivery before and after the implementation of the health system reform plan in Lorestan, Iran.

This descriptive study was conducted in 2020. The research population included all the women who had given birth in one of the public hospitals of Lorestan province during 2011-2016. The sampling method was the census, which was based on the statistics of the vice-chancellor of treatment at Lorestan University of Medical Sciences. After data collection, they were analyzed using descriptive statistics.

The results of the study demonstrated that contrary to expectations, the cesarean section overall rate increased by about 3.4% after the implementation of the health system transformation plan, compared to before the implementation of this plan. It is worth noting that in some hospitals, including Khorramabad Asali Hospital, Khorramabad Social Security Hospital, and Broujerd Kowsar Hospital, the rate of cesarean section increased by 4.6%, 6.5%, and 5.9%, respectively, after the implementation of the health system transformation plan.

It seems that according to the rate of cesarean delivery in this province that is higher than standard and the ineffectiveness of the health system transformation plan in this field, more efforts should be made with the use of extensive programs in order to increase the awareness and culturalization of the society.

Anxiety is a common problem in caesarean section patients that can have adverse consequences. Benson relaxation can be useful as a complementary medicine method to reduce anxiety. The aim of this study was to determine the effect of Benson's relaxation on the anxiety level of primiparous pregnant women applying for cesarean section.

This semi-experimental interventional study was conducted among 132 primiparous pregnant women who had beeb referred to the Shahada Qain Medical Training Center for elective cesarean section in 2021. The participants in the study were selected by available sampling method and were randomly divided into two intervention and control groups. In the intervention group, the samples were given relaxation training through headphones. The Spielberger questionnaire was used to determine anxiety. Data were analyzed using SPSS software (version 16) and paired t-test, independent t-test and chi-square . The significance level of P<0.05 was considered.

Before the intervention, there was no significant difference between the demographic and background variables, the mean variables, overt, hidden, and total anxiety in the two groups (P>0.05). After the intervention, the comparison of the two groups showed that the mean scores of overt, hidden and total anxiety in the intervention group significantly decreased compared to the control group (P<0.05).

Despite the reduction of anxiety in the intervention group, the results indicated that the total and obvious anxiety in the control group also decreased significantly after the intervention. It seems that factors other than Benson's relaxation technique in this research, such as studying mothers, participating in pregnancy classes have been able to reduce anxiety among the research samples.

The term gossypiboma is used to describe surgical sponges or gauzes that remain in the patient's body after a surgery. The present study reports a case of a large multiloculated cyst following the retention of a long gas in an emergency cesarean section.

A 37-year-old female patient underwent a cesarean section at a gestational age of 38 weeks due to labor pains and rupture of the membranes, and the baby was delivered and the patient was discharged without any complications. About 5 months later, the patient referred because of right flank pain. In the ultrasound, a large multiloculate cyst was reported on the right side of the pelvis and slightly above it. The general surgeon requested a CT scan, which revealed a cyst-like mass on the right side of the abdominal cavity with fluid and gas accumulation. Finally, after months of waiting for various imaging, the X-ray image diagnosed the foreign body of long gauze after 11 months. For this reason, the patient was hospitalized and underwent surgery, and then the cyst, which consisted of long gas and a thick wall of ammentum around it, was released and removed. A week later, the patient had a general condition without problems.

Failure to prevent the occurrence of Gossypiboma is one of the most important issues that causes serious complications such as large cysts in patients. Therefore, all scrub and circular personnel in the operating room should use all their attention when performing instrument counts.

Considering the high prevalence of cesarean section and the methods of conducting it, this study was performed with aim to determine the relationship between rectus ablation in cesarean section and postoperative pain, thickness and distance of abdominal wall muscles.

This randomized controlled clinical trial study was conducted in 2022 80 pregnant women candidates for caesarean section referred to the Ayatollah Taleghani hospital in Tehran. The subjects were randomly divided into two groups of intervention (n=40, rectus muscle repair) and control (n=40). Pain, thickness and distance of abdominal wall muscles were evaluated. Patients' pain in the first 72 hours after entering recovery (12, 24 and 72 hours after surgery) as well as pain when leaving the bed and pain in the interval of one week after surgery was measured using the visual pain index (VAS). Data were analyzed using SPSS software (version 23) and Shipro-Wilk, t-test, Mann-Whitney and Chi-square tests. P<0.05 was considered statistically significant.

The intensity of pain in the control group compared to the intervention, when getting out of bed (P<0.001) and at 12 hours (P<0.001), 24 hours (P<0.001), 72 hours (P<0.001) and one week later (P<0.001) was lower. In the intervention group compared to the control, the need for painkillers was more (P=0.001) and diastasis recti in the epigastric area (P<0.001) and hypogaster (P<0.001) were lower.

The re-approximation of rectus abdominis muscle during cesarean section reduces the thickness of the abdominal wall muscles and diastasis recti, but on the other hand, it increases the amount of pain and the need for painkillers.

The high prevalence of caesarean section is a global health concern, especially in Iran. Considering the possibility of complications caused by cesarean section and the importance of identifying the development process of this delivery method, the present research was conducted with the aim of determining the factors influencing the behavioral intention and the choice of the type of delivery by pregnant women of Bojnord city based on the theory of planned behavior.

The current cross-sectional study was conducted in 2021 on 369 pregnant women first abdomen who referred to comprehensive health centers in Bojnurd city. The sampling method was multi-stage. The data collection tool was a questionnaire based on the theory of planned behavior. The data were analyzed by SPSS 21 software by using t-test, Mann-Whitney, and Chi-square tests. 

72.6% of the participants wanted to give birth naturally and 27.4% had a cesarean birth. People who intended to have a natural birth significantly had better knowledge, a more positive attitude towards natural birth, and a better perceived behavioral control (P<0.001). The two constructs of attitude (β=-0.234) and perceived behavioral control (β=-0.215) had the most negative and significant predictors of the behavioral intention to perform cesarean delivery (P<0.001). The results of the subjective norms showed that the doctor's opinion and the mass media had the greatest and least influence on the choice of the type of delivery in pregnant women, respectively. The constructs of the theory of planned behavior together predicted 17.2 of the variance of natural childbirth intention in pregnant women.

The theory of planned behavior can be effective by identifying the factors of pregnant women's intention in choosing natural delivery. It is suitable with training and interventions to reduce the rate of cesarean section for pregnant women using this theory.

Previous cesarean sections are the most common cause of increased cesarean section in many parts of the world, although it is not always necessary. Considering the high statistics of cesarean section in Iran and especially the high rate of repeat cesarean section and creating motivation for vaginal birth after cesarean section, this study was conducted in order to investigate the maternal and neonatal outcomes of vaginal birth after one cesarean section.

This cross-sectional study was conducted on 104 pregnant women with a previous caesarean section and transverse incision on the lower segment in Ayatollah Rouhani Hospital of Babol in two groups; 50 people in the first group who underwent repeat emergency cesarean section and 54 people in the second group who consented to vaginal birth after cesarean section (VBAC). Demographic characteristics and maternal and neonatal complications were investigated and compared between the two groups.

In this study, there were no significant differences between the two groups in terms of demographic characteristics. Infant mortality rate was reported in 6 cases (12%) in the first group and 2 cases (3.7%) in the second group. Furthermore, 3 babies (6%) in the repeat cesarean section group and 9 babies (16.7%) in the vaginal birth group after cesarean section were admitted to the neonatal intensive care unit. The 5-minute Apgar was also significantly higher in the babies of the vaginal birth group after cesarean section (p=0.04). The duration of mother's hospitalization was 3.98±5.53 and 2.11±0.31 days in the repeat cesarean and vaginal birth groups, respectively (p=0.02).

According to the results of this study, maternal and neonatal complications did not increase in vaginal birth after cesarean section, and if the mother wishes, vaginal birth can be performed after one cesarean section.

Endometritis and wound infection after caesarean section is the most common complication of caesarean section and is associated with many problems and complications. The present study was conducted with aim to determining the effect of vaginal washing with chlorhexidine before cesarean section on endometritis and wound infection after cesarean section.

This randomized clinical trial study with a control group was conducted in 2021-2022 on 320 patients with indications for cesarean section referred to the Kowsar Hospital in Qazvin, Iran. Before cesarean section, the patients were divided into two groups of test (vaginal prep with chlorhexidine) and control (vaginal prep with normal saline serum). During the first 10 days after cesarean section, the patients were examined for symptoms of endometritis and abdominal incision site infection. Data analysis was done using SPSS statistical software (version 25) and independent t-tests, Mann-Whitney, Chi-square and Fisher's exact test. P<0.05 was considered significant.

Vaginal preparation with chlorhexidine has reduced the incidence of infection in the test group (P<0.05). Although the vaginal preparation with chlorhexidine in the case group decreased the incidence of endometritis compared to the control group, this difference was not significant (P>0.05).

The vaginal preparation with chlorhexidine had positive effects in reducing the incidence of infection and endometritis. Therefore, it is recommended to do the vaginal preparation with chlorhexidine in addition to routine abdominal washing to prevent infections after cesarean section.

Global reimbursement is a hospital payment method. In some global surgeries, the billing cost of treatment differs from the tariff set by the Supreme Council of Insurance, leading to financial losses for hospitals or insurance companies. This study compares the billing costs of childbirth services with the approved tariffs.

This descriptive-analytical study examined the billing costs of all childbirth cases (natural and cesarean section) covered by health insurance at three specialized maternity hospitals (A, B, C) in Tehran province in 1400. Data were sourced from health insurance company dashboards, compiled in Excel, and analyzed using SPSS software.

The study evaluated 3,742 childbirth cases, with 35% being natural births and 65% cesarean sections. The comparison between billing costs and approved tariffs showed that Hospital A's costs for both natural and cesarean childbirths exceeded the set tariffs. However, the billing costs in the other two hospitals were below the approved tariffs. Additionally, the actual hospitalization days for cesarean sections were shorter than those covered by the tariff in all three hospitals.

This study highlights variations in childbirth billing costs compared to the approved global tariffs across different hospitals. These findings underline the necessity of cost control in hospitals and suggest a need to revise the approved tariffs to align with the actual hospitalization duration for patients.

Assessing maternal satisfaction with spinal anesthesia is important for determining changes that is needed to improve the overall quality of patient care delivery. In this study, the aim of this study was to investigate the main complaints of mothers after cesarean surgery with spinal anesthesia.

This cross-sectional analytical study was performed on pregnant women undergoing caesarean section with spinal anesthesia in 2022 in Alzahra Hospital, Rasht. First, the purpose and method of the research was explained to the patients and informed consent was obtained. Then a questionnaire containing demographic data and patients complaints of spinal anesthesia was filled out.

The results of this study showed that 92 (38.5%) of the total 239 pregnant women mentioned complaints after the anesthesia procedure, while most of them 147 (61.5%) had no complaints. Nausea-vomiting (37.7%), shivering (23.9%) and repeated needling (16.7%) were the most common complaints mentioned by mothers. Based on the results of this study, there was no statistically significant relationship between complaints of spinal anesthesia and the variables of age, education, employment status, place of residency, number of pregnancies, BMI, time of termination of the pregnancy and history of spinal anesthesia (All P < 0.05).

Pregnant women who underwent cesarean section with spinal anesthesia in this center, reported limited and preventable complaints from this procedure. The mentioned complications did not lead to lasting and serious injury in mothers and were often controlled with routine therapeutic interventions without adverse consequences.

Natural childbirth after caesarean section can prevent the recurrence of caesarean section and its many complications, so this study was conducted with the aim of examining the explaining the lived experiences and psychological function of these mothers.

This research was conducted with a qualitative approach of hermeneutic phenomenology. Participants included 17 women with a history of natural childbirth after cesarean section, who were selected purposefully from among women in hospitals and medical centers in Tehran, Karaj, Mashhad, and Qom. The research tool was an unstructured interview, and the process of completing the interviews continued until data saturation was reached. Dikelman et al.'s seven-step model was used to collect and analyze data.

In the data analysis, the main theme was identified as post-traumatic growth, which indicates the improvement of psychological function. This theme was formed by five sub-themes of threat perception and effective coping strategies, replacing successful identity instead of failed identity, understanding experiences and strengthening spiritual beliefs, developing and improving interpersonal emotional relationships, and strengthening self-efficacy beliefs.

Based on the data analysis, it was concluded that women with vaginal delivery after caesarean section were able to cope with it successfully and reach higher levels of psychological performance and positive change in cognition and emotion and then behavior by using personal and social resources to fight against mental barriers and internal and external challenges of natural childbirth after caesarean section.

Background and Objectives Anesthesia is one of the major risks of cesarean surgery, and the decision to choose the type of anesthesia depends on various reasons. This study aimed to identify Reasons for using different methods of anesthesia in cesarean section in selected teaching hospitals located in Khuzestan province. Subjects and Methods The present qualitative research was conducted using the content analysis method. The research population included all doctors and anesthesiologists working in two teaching hospitals located in two cities. The necessary information was obtained through a semi-structured interview with a purposeful sampling method until the theoretical saturation of the data. The data were analyzed using the qualitative content analysis method. Results To choose the type of anesthesia, two main themes of preference from the doctor and preference from the organization were obtained, which preference from the doctor includes the priority of the type of service (patient and surgeon preference) and specialized reasons (fewer side effects, scientific and technical) and priority from the side of the organization, they include hospital routine (majority choice) and time management (better control of operating room time). Conclusion The preferred method of the anesthesiologist for the health of the patient is determined in addition to scientific and technical reasons according to the priorities of the surgeon and the patient as well as the desired priorities of the organization. It is necessary to establish training courses for anesthesiologists and create platforms for informed choice by providing about the complications and benefits of the chosen method for the patient.

Despite the adverse effects of post-caesarean pain relievers, few studies have compared non-pharmacological methods of pain control. The present study was conducted with aim to compare the effects of foot reflexology and Benson's relaxation on pain levels in women candidates for caesarean section.

This randomized controlled clinical trial study was conducted in 2019-2020 on 135 women candidates for caesarean section in Persian Gulf Martyrs hospital, Bushehr. The participants were selected via convenience sampling and divided into three groups using block randomization: reflexology, Benson's relaxation, and control. In the reflexology and Benson's relaxation groups, the intervention was performed two hours post-operation and six hours after the first time. Pain levels were measured using a visual pain scale immediately, 30 and 60 minutes after the procedure. The amount of pain medication was also recorded. Data were analyzed using SPSS (version 19) and chi-square, Fisher's exact, One-way ANOVA, Kruskal-Wallis, Mann-Whitney, Friedman, and Wilcoxon tests. P<0.05 was considered statistically significant.

Before the intervention, the mean pain ranks were not significantly different among the three groups (P>0.05). Immediately, 30 and 60 min after the intervention, the mean pain ranks were significantly lower in the two intervention groups than the control group (P<0.05). There were no significant differences among the three groups in pethidine intake (P=0.193). However, the control group received significantly higher amounts of ketorolac and diclofenac when compared to the two intervention groups (P<0.05).

Reflexology and Benson's relaxation techniques can reduce post-cesarean pain and analgesics. Therefore, nurses can use these two non- pharmacological pain control methods.

Women with drug use disorder probably need larger amounts of drugs for analgesia during and after childbirth; however, due to the limited number of studies in this field, the present study was conducted with aim to evaluate drug use disorder and how to manage it in women with history of caesarean section.

In this systematic review study which was conducted during 2000 until the first six months of 2022, in order to find related articles (published in both Persian and English), databases of PubMed, EMBASE, Cochrane Library, Web Of Science, Scopus, Mag-Iran and SID were searched using the keywords of pain, pain intensity, acute pain, chronic opioid pain, cesarean section, cesarean delivery, drug abuse disorder, pain management, prevention and analgesia.

Women with a history of caesarean who had drug use disorders faced unique challenges in accessing appropriate treatment and support. The results focused on the importance of integrated care models that addressed both the physical and psychological aspects of drug use disorder management. Additionally, specialized interventions tailored to the needs of this population, such as trauma-informed care and perinatal substance use programs, were found to be effective in improving outcomes.

Optimal control of post-cesarean pain in women with drug abuse disorder includes a multifaceted strategy using intrathecal or epidural drugs, acetaminophen and non-steroidal anti-inflammatory agents as the first line.

Background and

Uterine atony is responsible for 75-90% of postpartum hemorrhage, which will increase the probability of maternal mortality if proper measures are not taken to correct it. The aim of this study was to determine the therapeutic effect of tranexamic acid along with oxytocin in controlling postpartum hemorrhage.

This clinical trial study was performed on 142 pregnant women referring to Imam Sajjad Hospital in Yasouj for delivery in 2019-2020. Patients were randomly divided into two groups. The intervention group (71 people) received an ampoule of oxytocin at the rate of 40 units per liter of Ringer's serum and an ampoule of tranexamic acid at the rate of one gram per 10 cc of normal saline in a slow intravenous manner for 1 minute. The control group (71 people) received 40 units of oxytocin in one liter of serum and 10 cc of normal saline as a slow intravenous infusion for 1 minute. Then, the bleeding volume was evaluated based on the weight of gas consumed, the volume of blood collected, and the number of red blood cells received in both groups. Descriptive statistics of ratio comparison tests (chi-square) and t-test were used for data analysis.

The decrease of hemoglobin in the intervention group was significantly lower than the control group (P=0.007). The average change in gas weight at the end of the operation was higher in the control group (602.7±66.8) compared to the intervention group (571.7±81)(P=0.014). Also, the average bleeding volume and the number of blood bags received in the control group were higher than the intervention group, however, no significant relationship was observed (P>0.05).

Administering tranexamic acid together with oxytocin, in the case of uterine atony, may be more effective than oxytocin alone in controlling postpartum bleeding during cesarean section.

Diastasis recti and structural changes in the abdominal muscles are among the important consequences of C-section delivery. Exercises have been proposed as a safe and pain-free solution to improve these symptoms. Therefore, the purpose of this research was to compare the effects of pilates exercises and core stability on diastasis recti and the structural characteristics of the abdominal muscles in primiparous women.

The current research is semi-experimental. A total of 20 primiparous mothers between the ages of 20 and 30 were included in the research based on the inclusion and exclusion criteria. They were randomly divided into two groups of core stability exercises and pilates exercises. In the pre-examination stage, diastasis recti and the thickness of the rectus abdominis and transvers abdominis muscles were evaluated by ultrasound. After that, the subjects of the training groups performed their respective exercises for 8 weeks. The exercises were 3 sessions a week and each session lasted 45 to 60 minutes. After the end of 8 weeks of exercises, all research variables were examined once again in the post-test phase. Two-way analysis of variance method was used to statistically analyze the research findings at a significance level of p≤0.05.

The results of the two-way analysis of variance test showed that after 8 weeks of exercises, diastasis recti (p=0.001) and the thickness of the rectus abdominis (p=0.001) and transvers abdominis (p=0.021) muscles improved significantly in both training groups. Also, the results showed that in the post-test, there is no significant difference between the average of the study variables in the two training groups (p≥0.05).

Because pilates and core stability exercises have a significant effect on the recruitment the motor units of the central muscles of the body, they can increase the strength and coordination of the rectus and transverse abdominal muscles and, as a result, create stability in this area. Therefore, they can be suggested as suitable options for improving diastasis recti and the thickness of the abdominal muscles of primiparous women.

Researchers have always been investigating the non-narcotic medications for obstetrics and gynecology surgeries. The present study was performed with aim to investigate the efficacy and safety of using anesthesia without narcotics compared to conventional anesthesia with narcotics in the treatment of pain and complications after surgery.

In this systematic review study, according to the PRISMA statement, electronic databases of ‎PubMed, Medline, Embase, Scopus and Cochrane library, as well as the Persian databases of SID and Magiran ‎were searched with the help of Google Scholar between 1990 and the end of 2022. The studies which compared anesthesia with narcotic-based and non-narcotic-based drugs in a clinical trial or observational study design were extracted and qualitative evidence was synthesized from the results of the studies.

In this systematic review, 11 studies including anesthesia induction drugs, anesthesia maintenance and postoperative pain management were examined. For post-surgical pain management, non-opioid drugs such as ketorolac, paracetamol, paracetamol + ketorolac, tenoxicam and diclofenac were used, and in the case of insufficient pain management, opioid rescue drugs such as tramadol, morphine and fentanyl were also used. In general, non-opioid drugs such as paracetamol and non-steroid anti-inflammatory medications are safer than opioids and, in some cases, can be as effective or more effective in providing pain relief and anesthesia; however this pain relief and anesthesia varies depending on the type of drug. The quality of extracted evidence was low according to the Cochrane and Newcastle-Ottawa risk of bias scale.

The use of anesthesia induction and maintenance techniques using non-opioid substances in cesarean and other gynecological surgeries can help to reduce the consumption of opioids and related side effects, such as cardiopulmonary arrest, improve pain control and improve recovery after surgery.

Neuraxial analgesia is the most efficient way to relieve pain during delivery. Hypotension is commonly occurred in cesarean surgery. The vasopressors are used as one of the most important methods of prevention and treatment of hypotension. So the present study was performed with aim to determine the effect of bolus norepinephrine and phenylephrine to prevent hypotension in spinal anesthesia in patients undergoing elective caesarean section.

This clinical trial study was conducted in 2022 on 90 pregnant women of 36-41 weeks who were candidates for elective cesarean section without anesthesia restrictions. Immediately after spinal anesthesia, phenylephrine (50 μg/ml) was injected for the first group and norepinephrine (5 μg/ml) for the second group. Vital signs were non-invasively monitored and recorded. Data analysis was done using SPSS statistical software (version 19) and t-test, Man-Whitney U, Chi-square and Fisher's exact tests. P<0.05 was considered statistically significant.

The mean systolic blood pressure (p=0.001), diastolic blood pressure (p=0.001) and mean arterial blood pressure (p=0.003) in the norepinephrine group in the first 6 minutes were significantly lower than the phenylephrine group. The heart rate (p=0.001) in the first 6 minutes was significantly higher in the norepinephrine group than the phenylephrine group.

Hemodynamic changes following the administration of bolus epinephrine are less compared to phenylephrine. It causes better control of blood pressure and heart rate.