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

Cesarean section (CS) is one of the most important pregnancy concerns in the world. Increased inflammation is associated with increased risk factors for cesarean section. Diet plays a major role in reducing inflammation. This study aimed to investigate the relationship between dietary inflammatory index (DII) and the risk of Cesarean section in Tehranian women.

This case-control study included 390 pregnant women in Tehran, Iran between 2020 and 2021 at their initial visit to pregnancy clinics, selected by a cluster sampling method. Dietary intakes were determined using valid reliable questionnaires and DII was calculated. Weight, height, and waist circumference were also measured.

The mean age of the subjects was 28.5 yr (± 5.02) and weight, body mass index (BMI) and waist circumference (WC) in the case group with a higher DII were higher. Odds ratio (OR) of cesarean section in DII quartiles was statistically significant. Confounding factors including age, BMI and total energy intake were adjusted in the first model and weight, waist circumference, physical activity and supplements in the second model and the relationship remained significant (P<0.001).

High scores of dietary inflammatory index, possibly through an increase in inflammatory factors, can increase the chances of having a cesarean section.

 Pelvic inflammatory disease (PID) is defined as an acute and subclinical infection of the upper genital system, including the uterus, fallopian tubes, ovaries, and ligaments. It can lead to various complications, such as salpingitis, endometritis, oophoritis, perihepatitis, peritonitis, and tubo-ovarian abscess (TOA).

 In our case, a 22-year-old Afghan woman presented with generalized pain in the abdomen and pelvis, accompanied by vaginal discharge and fever, following 17 days of normal vaginal delivery (NVD) and septic shock. She had no previous history of PID. Abdominal ultrasonography revealed a significant amount of free fluid in the paracolic grooves and pelvis, along with a perforated mass on the right adnexa. As a result, she underwent laparotomy and right adnexectomy. A 10-day course of meropenem and vancomycin was prescribed, and the woman was discharged with oral antibiotics.

 Tubo-ovarian abscess following NVD is a rare condition that can occur in patients with preterm premature rupture of membranes (PPROM) and episiotomy. Therefore, it is essential to prescribe antibiotics in cases involving episiotomy and rupture of the membranous.

Pregnancy after a heart transplant is a concern for many female recipients, and it remains a medical challenge that raises many questions. A 24-year-old woman, gravida 3, para 0, contacted us for obstetric care in the first trimester of gestation, about 3 years after an orthotopic cardiac transplant. She was a known case of dextrocardia with congenitally corrected transposition of the great arteries. The transplant had been performed for severe retractable heart failure, manifesting during her previous lost pregnancy. The course of the current gestation was uneventful. The patient’s cardiovascular function was good throughout the pregnancy. She was admitted to the hospital for dyspnea at 35 weeks and 4 days of gestational age. A cardiovascular consult and echocardiography were performed. The results were within the normal range, and labor pains explained the patient’s dyspnea. Because of labor pain, a repeat Cesarean section was performed at 35 weeks and 4 days of gestational age. A male baby weighing 2700 g, with an Apgar score of 7/9, was delivered. The patient was discharged after delivery with enoxaparin (40 mg), prednisolone (5 mg), levothyroxine, and mycophenolate mofetil (500 mg) without any complications. Follow-up was carried out at 1 month, and no abnormality was found. Here, we report a case of a successful pregnancy in a young woman after a heart transplant.

Cupping therapy is a long-standing traditional therapy that its application has re-emerged, recently. Due to the lack of a review on the applications of this method specifically in obstetrics and gynecology, the present study was performed to evaluate and summarize data from clinical trials on dry and wet cupping applications in obstetrics and gynecology.

In this narrative review, Web of Science, PubMed, Scopus, Science Direct, ProQuest, databases and Google Scholar search engine, as well as Persian databases including SID, Magiran, and Iranmedex were searched without time limit until the end of November 2022. Keywords included cupping, women, pregnancy, obstetrics, gynecology, treatment, dry and wet cupping, clinical trial and their persian equivalents. All clinical trials that examined the effect of different cupping therapy applications for obstetric and gynecological conditions were evaluated by two independent reviewers using the Jadad scale and studies with the scores of 3 or more were included in the review. Nine eligible clinical trials were included in this review.

Cupping therapy was identified as an effective method for improving primary dysmenorrhea, chronic pelvic pain, hypercholesterolemia in menopausal women, oligomenorrhea, idiopathic menorrhagia, low back pain due to pregnancy and delivery, perineal pain due to the childbirth and postpartum anxiety.

The widespread use of cupping in obstetrics and gynecology has had a positive effect on mitigating a wide range of conditions. Knowledge of the various applications of this method could help specialists to employ this branch of complementary medicine along with other conventional medicine methods of treatment.

Labor is an experience that requires confidence but can induce a feeling of fear. Women's readiness and self-efficacy for pregnancy and childbirth are issues in preventing long labor. The husband's support can increase the mother's childbirth self-efficacy. To determine the effect of husband education in childbirth support on women's childbirth self-efficacy and labor outcomes. A quasi-experimental study with pretest-posttest design was conducted from June to October 2022 at the Independent Midwifery Practice Centers of Pringsewu Regency, Indonesia. The participants were 138 pregnant women who were randomly allocated into two groups. The data collection instrument included the Childbirth Self-Efficacy Inventory (CBSEI), a questionnaire for assessing the husbands’ childbirth support knowledge and skills, and two questionnaires developed by the researchers to record respondents' characteristics and current pregnancy outcomes. Data analysis was performed using the chi-square test, the independent samples t-test, and the Multivariate analysis of variance. There was a significant increase in the husband's knowledge and skills in childbirth support, four domains of childbirth self-efficacy, pain, duration of the first and second stages of labor, and success of initiating breastfeeding (P <0.001). Multivariate analysis showed that of all variables, the variable most influenced by the intervention was first-stage self-efficacy expectancy, which was 0.746 (74.6%), while the variable least influenced was the duration of the first stage of labor, which was 0.199 (19.9%). Husband education in childbirth support can increase the mother's childbirth self-efficacy and birth outcomes.

 Cervical ripening is the process of initiating labor in women with an unripe cervix. Vaginally administered prostaglandin E1 analog (misoprostol) has been promising in cervical ripening and labor induction. However, optimal dosage and dose-dependent adverse effects in this administration route need further clarification.

 This trial aimed to compare the efficacy and adverse effects of 50 mcg vs. 25 mcg of vaginal misoprostol in low-risk term pregnant women.

 This double-blind, single-center, randomized clinical trial included 200 low-risk term pregnancies undergoing labor induction with a Bishop score of 2 or less. Patients were assigned randomly to receive 25 mcg or 50 mcg of vaginal misoprostol every six hours up to four times until the active phase of labor was reached. The primary outcome included time to vaginal delivery (latent and active phase of labor), and secondary outcomes included the total dosage of prescribed misoprostol, the need for oxytocin for labor augmentation, and the cesarean section rate.

 Misoprostol 50 micrograms resulted in a significantly shorter time in the first phase of labor (P-value = 0.002), the second phase of labor (P-value = 0.030), and the third phase of labor (P-value = 0.020). The number of administered misoprostol, the need for additional oxytocin, uterine hyperstimulation, cesarean delivery rate, Apgar score, umbilical artery pH, and neonatal intensive care unit (NICU) administration were statistically similar between the two groups.

 This study showed that 50 mcg of vaginal misoprostol (vs. 25 mcg) for cervical ripening could reduce labor phase duration without significantly increasing adverse maternal and neonatal outcomes.

Assessing the progress of labor is a primary step in intrapartum care. This study was performed to assess comparison of the effects of date syrup with saffron–honey syrup on the progress of labor in nulliparous women.

A randomized single‑blind clinical trial study was conducted on 189 women who were referred to Bea’sat Hospital of Sanandaj from October 2019 to March 2020. Patients were randomly divided into three groups saffron–honey syrup, date syrup, and placebo syrup each including 63 cases. Each participant in the intervention and control groups received a maximum volume of 150 ml of saffron–honey syrup, date syrup, or placebo syrup. The syrups were given at the 4 cm dilation, and every 30–60 min until the end of the active phase of the first stage of labor. Data collection tools included a two‑part questionnaire and a partograph form. The results were analyzed by Statistical Package for the Social Sciences (SPSS) 24 using Chi‑squared test, analysis of variance, and last significant difference as a post hoc test, the significance level was set at 0.05.

The duration of the active phases of the first (F</em>2 = 92.70, p </em>< 0.01), second (F</em>2 = 66.76, p </em>< 0.01), and third (F</em>2 = 12.34, p </em>< 0.01) stages of labor was shorter in the date syrup and saffron–honey syrup groups than in the control group (p </em>< 0.01). Additionally, both experimental groups exhibited no significant difference in terms of duration between the first (p </em>= 0.312), second (p </em>= 0.724), and third (p </em>= 0.911) stages of labor.

Date syrup and saffron–honey syrup can be used as one of the safe and available herbal methods to facilitate labor. 

For pregnant women who require an emergency cesarean section (CS), extending labor epidural analgesia as quickly as feasible to good quality anesthesia is a critical issue. This indicates the presence of functional labor epidural analgesia and reduces the need for general anesthesia. Addition of magnesium increases anesthetic and analgesic qualities of epidural anesthesia.

The purpose of this trial was to assess the role of adding magnesium sulfate (MgSO4) with levobupivacaine to speed up the conversion of labor epidural analgesia into enough anesthesia for emergency CS.

Fifty parturients were randomly assigned to receive 19.5 mL of levobupivacaine 0.5% with either 0.5 mL of normal saline 0.9% (Group I) or 0.5 mL of MgSO4 10% (Group II) after receiving labor epidural analgesia. We documented the onset of block (loss of pinprick to T6), number of patients needing additional analgesia, the time needed for sensory and motor blockade to recover, and the adverse effects.

The frequency of patients receiving intraoperative supplements was comparable in the study groups (P = 0.491), although the onset of the block was faster in Group II than in Group I (P = 0.000*). Group II took substantially longer to recover from sensory and motor blockade than Group I (P = 0.001* and P = 0.001*, respectively). In both groups, the occurrence of adverse events was similar.

Adding 50 mg of MgSO4 to levobupivacaine 0.5% accelerated the epidural top, and both sensory onset and motor blocks period were prolonged as compared to levobupivacaine alone when extending epidural analgesia for emergency CS.

We designed and implemented a Programmed Learning Simulation (PLS) exercise depicting obstetric scenarios of hemorrhage to train anesthesiologists, ancillary staff, and surgeons to accurately estimate blood loss visually. We then measured the efficacy of this exercise in a clinical setting. We conducted a prospective study to assess the effect of implementing a PLS exercise on quantification of blood loss in an operative setting. The PLS exercise consisted of 13 simulationstations of varying quantities of simulated blood loss paired with standardized objects of known volume. Eighty-eight individuals participated including attending physicians, residents, medicalstudents, and ancillary staff participated in this study. The PLS was part of regularly scheduled continuing medical education activities; thus, the sampling used was non-randomized convenience method. The percent error was calculated for each of the 13 stations. A subgroup analysis was performed to assess the effect of the years of experience, size of hemorrhage, and occupation on accuracy. Univariate analyses for continuous variables were compared using a one-way ANOVA test. For the comparison of the three groups (years of experience and size of hemorrhage), a p-value of determine the effect of PLS in a clinical setting, the percent error of blood loss estimation for cesarean deliveries during the twomonth period after the PLS exercise was compared to the twomonth period immediately prior to using the student’s t-test with p During Part A, the baseline performance of the participants was evaluated during the PLS activity. The PLS data showed no significant difference in absolute value of mean percent error estimation (standard deviation) across professions: student 63.61% (69.74), ob/gyn 56.91% (47.72), ancillary 62.15% (77.90), general/trauma surgeon 66.70% (65.06), anesthesia 61.51% (63.12). (P=0.681), or levels of experience 0-5: 62.21% (60.06), 6-10 years: 56.22% (52.66), greater than 10 years: 61.89% (71.89) (P=0.831). However, mean percent error of estimation was higher when participants estimated smaller samples 77.7% (104.73) compared to either medium 56.8% (49.06) or large 57.9% (46.19) samples (p <0.001). For Part B, 179 cesarean deliveries occurred during the pre-intervention period and 193 occurred during the postintervention period. Mean error in provider estimation of blood loss significantly improved from 47% (68.51) pre-intervention to 31% (32.70) post-intervention (P=0.009). We believe our described PLS activity was effective in teaching techniques for visual blood loss estimation. This was reflected by improved competency in a clinical setting, demonstrated by more accurate visually estimated blood loss during the period immediately following simulation activity compared to a prior time frame. Further research is needed to assess the impact of simulation activities on patient outcomes, such as utilization of blood products and patient morbidity.

Determination of fetal head station is an important factor during labor progress. This study evaluated the agreement and correlation between professors and residents of obstetrics and gynecology in the determination of fetal head station based on a vaginal examination during labor. 

In this cross-sectional study, term pregnant women with cephalic presentation in an active phase of labor underwent vaginal examinations simultaneously by residents and professors of obstetrics and gynecology. Their examination findings regarding a fetal head station, cervical dilation and effacement were recorded both by professors and the residents. Data were analyzed by SPSS version 16 using Spearman’s correlation and Intraclass Correlation Coefficient tests between results obtained by two groups of assessors (residents and professors).

Our data analysis showed that the agreement between obstetricians and residents for cervical dilatation, cervical effacement, and a fetal head station was 0.88, 0.9 and 0.67 respectively (p <0.001). The correlation between obstetricians and residents for determination of cervical dilatation, cervical effacement and, a fetal head station was 0.77, 0.79 and 0.52, respectively (p <0.001).

The agreement and correlation between professors and residents in obstetrics and gynecology about the determination of fetal head station are lower than those for cervical dilatation and effacement. Because of the importance of accurate determination of fetal head station in the first stage of labor, a new approach (new invented device for determine fetal head station) should be developed to for determining of fetal station.

Background :

Postpartum depression (PPD) can have serious consequences for both the mother and infant. We aimed to investigate the prevalence of postnatal depression and associated sociocultural, obstetrics and child-related factors among Iranian women.

This is a cross-sectional study carried out in Bushehr, Iran. 290 women from 10 public health centers were selected through stratified random sampling. Data were collected using a self-administered questionnaire from women within 12 weeks postpartum in 2019. PPD was assessed using Edinburgh Post Natal Depression Scale (EPDS), and score of >12 was considered having PPD.

The mean age of the respondents was 28.48 ± 5.50 years. The prevalence of depression was 24.1% in 12 weeks after delivery. Higher social support was associated with lower PPD [OR: 0.92, 95% CI: 0.88, 0.95; p <0.001]. The risk of developing PPD was 4.84 times higher in mothers with cesarean section [OR: 4.84, 95% CI: 1.89, 12.36; p =0.001], 5.19 times higher with preterm birth [OR: 5.19, 95% CI: 1.44, 18.27; p =0.01], 4.47 times higher with a history of depression [OR: 4.47, 95% CI: 1.40, 14.24; p =0.009]. The women who were satisfied with their marital relationship [OR: 0.16, 95% CI: 0.02, 0.96; p=0.04], and the baby's sleep habits [OR: 0.36, 95% CI: 0.15, 0.82; p =0.01] were less likely to suffer from PPD.

Conclusion:

 Postpartum depression was found common among mothers. The poor social support, poor marital relationship, cesarean section, preterm birth, positive history of depression, and adverse baby's sleep habits were associated with PPD. The vulnerable women should monitor their mental status and should be educated about the effective intervention strategies.

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.

The growing demand for high-quality obstetric care and treatment has led to the advent and development of a field known as obstetric triage. The present review study aimed to examine the development of tools and criteria for obstetric triage services. In this narrative review, two authors searched for related articles using the keywords of “obstetric triage, gynecology triage, perinatal Triage, maternity triage, midwifery triage” AND “tool, index, scale, questionnaire, system”. With Persian and English language limitation, searches were performed in Scopus, Google Scholar, Scientific Information Database, ProQuest, Medline, Embase and Web of Science databases for articles published from 2000 to 2018. Out of the 289 articles reviewed in this study, 8 articles met the eligibility criteria. Out of these 8 articles, 6 were dedicated to introducing a tool designed and only 2 introduced an obstetric triage system. The obstetric triage tools and systems covered included Emergency Severity Index (ESI), Obstetric Triage Acuity Scale (OTAS), Birmingham symptom specific obstetric triage system (BSOTS), Maternal Fetal Triage Index (MFTI), Florida Hospital Obstetric Triage Acuity Tool, self-assessment questionnaire for gynecologic emergencies (SAQ-GE) and Perinatal Emergency Team Response Assessment (PETRA). Overall, the validity and reliability of the studied method were investigated and found to be acceptable in only 5 of the reviewed studies. The review showed the lack of consensus on how to devise a single standardized tool or system for obstetric triage. The comparison of different obstetric triage tools and systems demonstrated the need for a standardized and widely-approved system with high validity and reliability and standard definitions for obstetric triage to determine the right priority and waiting times of obstetric care services.

Labor pain is one of the most severe pains that woman may experience during their lifetime. This study aimed to systematically review and meta‑analyze studies into the effects of epinephrine on the duration of analgesia during childbirth and Apgar score. This systematic review was conducted in 2018. Data were collected through searching online databases, namely the PubMed, Scopus, Google scholar, SID, Medlib, Magiran, and Iranmedex. Inclusion criteria were an interventional design, comparison of the effects of epinephrine with other modalities on the duration of analgesia and Apgar score, and publication from January 1990 to October 2018 in English or Persian in peer‑reviewed journals. Meta‑analysis was performed using the fixed and the random effects models with a 95% confidence interval (CI). The Q and the I2 statistics were used to assess heterogeneity, while the funnel plot and the Egger’s test were used to evaluate the possibility of publication bias. The standardized mean difference between the epinephrine and the comparison groups respecting the duration of analgesia was 0.65 (95% CI: 0.32–0.98). This difference was statistically significant (P < 0.05). The between‑group standardized mean differences respecting the total, 1 min, and 5‑min Apgar scores were −0.33 (95% CI: −0.97–0.30), −0.26 (95% CI: −1–0.47), and −0.54 (95% CI: −1.79–0.70), respectively. None of these differences was statistically significant (P > 0.05). Epinephrine increases the duration of analgesia without causing serious side effects.

Hyoscine butylbromide is one of the drugs that is used to shorten prolonged labor and helps to decrease the complications and pain related to prolonged labor. To prescribe this drug, understanding its effect on the duration of labor is important through summarizing the available primary study results. Therefore, the present study aimed to determine the effect of hyoscine butylbromide in shortening the duration of labor through summarizing the available primary evidence. To this end, different electronic databases were searched including the International Scientific Indexing Web of Science, PubMed/Medline, and Scopus in order to find English published articles during 2000-2017. The obtained data were by Stata software. Finally, the effect of hyoscine butylbromide was estimated by the mean difference (MD) and CI as the summary measures using a random-effects meta-analysis model. Based on the results, hyoscine butylbromide significantly reduced the duration of labor in the intervention group when compared to the placebo group in the first (MD = -67.77 minutes, 95% CI, -90.98 to -44.56) and second stages of labor (MD=-2.76 minutes, 95% CI, -4.79 to -0.74). However, it failed to significantly decrease the duration of labor in the third stage (MD = -0.45 minutes, 95% CI, -1.45 to 0.56) in the intervention group. In general, hyoscine butylbromide led to a significant reduction in the duration of labor in the first and second stages while it caused no significant decrease in its duration in the third stage. Thus, hyoscine butylbromide could be used for reducing labor duration in the first and second stages of delivery.

Locked twins is a rare and dangerous multiple pregnancy and generally occurs in about 1 in every 1000 twin births. A 23‑year‑old female with gravida 1, para 0 pregnancy was admitted. The head of the first fetus was locked to the chin of the second fetus (alive) at the top of the symphysis pubis. The uterus was relaxed with isoflurane. The legs and the back of the baby were extended to the symphysis pubis. The head of the second baby was gently positioned to the posterior walls of uterine cavity on the upper side of it. So, the locked head of the first baby was released and both fetuses were delivered vaginally. The second baby was in good condition. By recognizing the probable cases, radiological diagnosis, and punctual cesarean delivery, it is possible to avoid the fetal morbidity and mortality in locked twins.