The Effect of Auriculotherapy on Nausea, Vomiting, and Anxiety in Patients Undergoing Elective Cesarean Section with Spinal Anesthesia: A Clinical Trial Study.

Background: Nausea, vomiting, and anxiety are common complications during and after spinal anesthesia. Auriculotherapy as a complementary medicine can be useful for reducing nausea, vomiting, or anxiety. This study was performed to evaluate the effects of auriculotherapy on nausea, vomiting, and anxiety in patients undergoing elective Cesarean Section (CS) with spinal anesthesia. Materials and Methods: The present study was a clinical trial study that was performed on 56 pregnant women selected as CS candidates in Ommolbanin Hospital in Mashhad during the years 2016-2017. In the intervention group, 1 h before spinal anesthesia, auricular acupoint stimulation was performed at four points bilaterally, for 20-30 seconds at each point. Evaluations were done by the following questionnaires: State-Trait Anxiety Inventory (STAI), Visual Analog Scale (VAS), and Vomiting Assessment Form. Results: The mean anxiety (SD) before the intervention in the intervention group and the control group was 47.88 (8.67) and 47.84 (10.49), respectively, and 4 h after the intervention, it was 40.23 (10.19) and 42.88 (12.18) in the intervention and control groups, respectively. These results were significant in the intervention group (p = 0.008). 30-40 min before and 4 h after the surgery, the severity of nausea and vomiting was low in both groups and no significant difference was observed between the two groups during the surgery and in the recovery room (p > 0.05). Conclusions: According to the results, auriculotherapy could reduce anxiety in CS patients with spinal analgesia. The results also showed that auriculotherapy reduced the severity of nausea and vomiting, but these changes were not significant.

Comparison of two methods of complementary medicine on postoperative pain and anxiety: A randomized clinical trial.

BACKGROUND: Postoperative pain and anxiety are unpleasant situations that are often experienced by women undergoing cesarean section. Since the routine methods of pain relief after surgery is still inadequate, the need for complementary treatments is felt. Foot Reflexology (FR) and Auricular Acupressure (AA) are two of the most popular and safe procedures of complementary and alternative medicine therapies. So, this study aimed to determine and compare the effectiveness of reflexology and AA on postoperative pain and anxiety. MATERIALS AND METHODS: This three-group randomized clinical trial study was performed on 101 pregnant women, admitted to Mashhad Omolbanin hospital, for a cesarean section, in 2015. In the intervention groups, 2-3 h after the operation, AA or FR was performed for 20 min. Routine care was provided for the control group. Pain and anxiety were evaluated by VAS and Spielberger anxiety questionnaire before and 1 and 2 h after the intervention. RESULTS: The results showed that immediately after the intervention, pain intensity was significantly lower in both AA and FR groups (P < 0.001) compared with the control group. In addition, 2 h after the interventions, pain intensity was significantly lower in the AA group compared with the control group (P = 0.006). However, no significant differences were observed between the FR and the control groups (P = 0.095). In addition, 1 and 2 h after the intervention, anxiety was significantly different between the three groups (P = 0.033 and P = 0.018), respectively. The results of the Tukey test showed that this difference was only between FR and control groups (P = 0.025 and P = 0.017), respectively. CONCLUSION: AA is more effective in reducing post-cesarean pain while FR effectively reduces post-cesarean anxiety. Therefore, these complementary medicine treatments as easy and noninvasive methods are recommended to be used during labor for improving maternal outcomes.

Investigating the relationship between the dimensions of mindfulness and maternal attachment to the fetus during pregnancy.

BACKGROUND: Maternal attachment to the fetus is a term used to describe the emotional relationship between mother and fetus. This emotional connection increases during pregnancy and is reflected in her feelings, perceptions, and behaviors. Mindfulness is important as one of the factors affecting the mental health of people during pregnancy. Therefore, the present study was conducted to determine the relationship between the dimensions of mindfulness and maternal attachment to the fetus during pregnancy. MATERIALS AND METHODS: The present study was performed on 500 pregnant mothers referred to health centers affiliated to Isfahan University of Medical Sciences. The samples were entered into the study by available sampling method and if they had inclusion criteria and no exclusion criteria. The research instruments were the Fetal Attachment Questionnaire and the Bauer Mindfulness Questionnaire. The collected data were analyzed by SPSS software version 22. RESULTS: The results of the data showed that there was no significant relationship between the overall score of mindfulness and the overall score of maternal attachment to the fetus (P = 0.62). While from the dimensions of mindfulness such as "action with awareness" there was a significant negative relationship (P = 0.03) with maternal attachment to the fetus and a significant positive relationship "observation" with maternal attachment to the fetus (P = 0.03). CONCLUSION: According to the results of this study, there is a relationship between maternal attachment to the fetus during pregnancy and a number of dimensions of mindfulness. For this purpose, since mindfulness can increase the mother's interactions with the fetus, and this interaction begins during pregnancy and with the mother's attachment to the fetus, it is important to pay attention to this.

Relationship between fear of childbirth and the sense of cohesion with the attachment of pregnant mothers to the fetus.

INTRODUCTION: Maternal-fetal attachment is a term used to describe the emotional relationship that a pregnant woman has with her developing fetus. Mental care for pregnant women (fear of childbirth and a sense of cohesion of pregnant women) is one of the most important aspects of prenatal care that affects the mother's attachment to the fetus. If fear and anxiety are relieved, psychological and physical relaxation will be replaced. Therefore, the present study was conducted with the aim of determining the relationship between fear of childbirth and the sense of cohesion with the attachment of pregnant mothers to the fetus. METHODS: The present study is a descriptive study that was performed by multi-stage sampling method on 500 pregnant mothers who referred to health centers in Isfahan in 2017. The study participants completed the following questionnaires: fear of childbirth, sense of cohesion, and mother's attachment to the fetus. The data were analyzed by descriptive and analytical statistical methods (Pearson correlation) using SPSS software version 22. RESULTS: The results showed that there was a significant negative relationship between the overall score of maternal attachment to the fetus and fear of childbirth (r = -0.153, P = 0.001). However, there is a significant positive relationship between the overall score of maternal attachment to the fetus and the sense of cohesion (r = 0.112, P = 0.01). The results also showed a significant negative relationship between the fear of childbirth and the dimensions of maternal attachment to the fetus, including interaction with the fetus (P = 0.04), self-sacrifice (P = 0.04), and attributing characteristics to the fetus (P = 0.05). There was a positive and significant relationship between the sense of coherence and the subsequent acceptance of the maternal role of maternal attachment to the fetus (P = 0.004). CONCLUSION: More attention of prenatal care provider to the psychological issues of the pregnant mother and their fears and worries can lead to appropriate interventions in this field, and as a result, mothers' attachment to their fetus has increased so that they can take proper care during and after pregnancy.

Investigating the relationship between social support and self-compassion by improving the adequacy of prenatal care.

INTRODUCTION: Getting pregnant care is different due to the psychological problems of pregnant mothers. Self-compassion and social support are the important components of mental health. Women with higher self-compassion and social support can take full care of their pregnancies. The aim of this study was to determine the relationship between social support and self-compassion with adequate prenatal care. METHODS: The present study is a cross-sectional descriptive study that was performed in 2018 using the available sampling method on 500 pregnant mothers referred to Isfahan health centers. Individuals entered the study if they had entry criteria and no exit criteria, and completed social support, self-compassion, and adequacy of pregnancy care questionnaires. The data were coded and analyzed by SPSS software version 22 and Pearson's correlation statistical test. RESULTS: The results of data analysis with Pearson's correlation test showed a positive and statistically significant relationship with pregnancy care between the overall score of social support (P < 0.001) and the dimensions of social support such as family support (P < 0.002), support of friends (P < 0.004), and the support of other people (P < 0.001). The results also showed a positive and statistically significant relationship between self-compassion and prenatal care (P < 0.001). There was a significant positive relationship between the subscales of the self-empathy questionnaire, including kindness to oneself, human commonalities, mindfulness and increasing replication, and pregnancy care, but there was a significant negative relationship between subscales of isolation and self-judgment with pregnancy care. CONCLUSION: According to the results of the present study, social support and self-compassion as two components of mental health can affect the quality of services during pregnancy. For this reason, it is recommended that health-care providers pay attention to these two issues in order to increase the level of care during pregnancy and thus ensure maternal health during pregnancy and childbirth and the health of the fetus and baby.

The relationship between Cormic Index and uterine contractions' pattern in the active phase of the first stage of labour.

Uterine contractions are indicators of labour progress. The relationship between anthropometric indices and types of childbirth has been investigated. One of these indices is referred to as the Cormic Index, which provides an estimation of the sitting height and leg length. This cross-sectional study was performed to determine the relationship between the Cormic Index and the uterine contractions' pattern in the active phase of the first stage of labour. The standing and sitting heights of 150 pregnant women were measured to calculate the Cormic Index. Then, two Cardiotocographic traces were recorded during the 3 to 5 and 6 to 8 centimetres' dilations, by which the uterine contractions' pattern were determined. The mean Cormic Index was 51.84 ± 2.62. The results indicated that the Cormic Index had a positive linear correlation with MTIME (frequency of contractions) in the first monitoring episode and SDTIME (regularity of contractions) in the first and the second monitoring episode, which was significant (p < .05). However, there was no significant correlation between the Cormic Index and F:R ratio (shape of contractions) in both monitoring episodes. With the rise of the mother's Cormic Index, the frequency of contractions in the acceleration phase, and also their regularity in the acceleration phase and the phase of the maximum slope, were decreased during the active phase of labour.IMPACT STATEMENTWhat is already known on this subject? Uterine Contraction as an indicator of labour progress enforces cervical dilation. If uterine activity is analysed through electronic methods, one could assess labour outcome through some patterns of the contractions. Anthropometry provides a quick determination of the body proportions. The Cormic Index provides an estimation of the upper and lower body length. Several studies have investigated the relationship between the anthropometric indices and the types of childbirth. Despite the various approaches available, there is no objective means of precisely distinguishing the fact that whether labour can be successful in effecting vaginal delivery or not and diagnosis of dystocia still relies on the trial of labour.What do the results of this study add? The results of this study add to the growing body of research on the progression of labour that Cormic Index has a positive linear correlation with the frequency of contractions in acceleration phase, and with the regularity of contractions in the acceleration phase and the phase of maximum slope.What are the implications of these findings for clinical practice and/or further research? The results can help professionals to evaluate the progress of labour based on the type of uterine contractions in the latent phase or the early active phase of labour using the Cormic Index.

The Effect of Sexual Education based on Sexual Health Model on the Sexual Function of Women with Infertility.

BACKGROUND: Infertility has deep psychological impacts on the sexual function of women such as a sense of fear, failure, and incompetence. It can also result in reduced sexual desire, unattained orgasm, and other sexual disorders. However, sexual education is assumed to improve the sexual function in these cases. Therefore, we study the effect of sexual education based on Sexual Health Model (SHM) on sexual function disorders in women with infertility. MATERIALS AND METHODS: A singleblind, randomized controlled trial was conducted on 108 women with infertility (54 intervention group and 54 control group) aged between 18 and 40 years at the Milad Infertility Center of Mashhad in 2016. The intervention comprised three 90-min sessions administered during 1 week. At first, a pretest (Female Sexual Function Index [FSFI]) was completed, and 1 month after the end of the intervention, the posttest (FSFI) was completed. To analyze the data, independent t-test, Mann-Whitney test, and Wilcoxon test were run. RESULTS: The mean (Standard Deviation [SD]) age of women and their spouses was 30.61 (5.42) and 34.42 (5.73)years, respectively. Results of Mann-Whitney test showed that after 1 month of intervention, there was a significant difference between intervention and control groups (Z = -4.87, p < 0.001). Moreover, results of Wilcoxon test showed a significant difference in the sexual function in the intervention group before and after the intervention (Z = 2.81, p < 0.001). CONCLUSIONS: Given the positive effects of SHM-based sexual education, this method could be considered as a subset of sexual education materials used for women with infertility suffering from sexual disorders.

The relationship of the psychological coping and adjustment strategies of infertile women with the success of assisted reproductive technology.

BACKGROUND: The success of assisted reproductive techniques plays a very important role in the quality of life of infertile couples and decreases the negative behavior states of infertility. OBJECTIVE: This study aimed at determining the relationship between psychological coping and adjustment strategies with the success of assisted reproductive technology (ART). MATERIALS AND METHODS: This correlational study was conducted on 204 women visiting Milad Infertility Center in Mashhad during 2015-2016. The research instruments included Fertility Adjustment Scale and Infertility Coping Strategies Scale. The positive result of two pregnancy tests within 48 hours was considered as the success of ART. RESULTS: The mean and standard division score of adjustment in the group achieved treatment success (34.3 ± 8.2) exceeded the group failed (33.6 ± 8.8), the difference was not statistically significant (p= 0.381). Also, there was no significant difference between groups in the median and interquartile range of total coping strategies 81 (13) vs. 79.5 (12.25), (p= 0.369). Based on the logistic regression model for one increased transferred embryo, the chance of getting pregnant is 1.3 times, and for each unit increase in FSH level, the chance of ART success decreases 18%. CONCLUSION: The results of this study showed that there is no relationship between psychological coping and adjustment strategies with ART success. However, the number of transferred fetus and tirthday FSH are introduced as factors that are related to the success of ART.

Determination of the Effect of Sexual Assertiveness Training on Sexual Health in Married Women: A Randomized Clinical Trial.

BACKGROUND: Sexual health is a state of physical, mental, and social well-being in relation to sexuality. Sexual assertiveness is a person's ability to meet sexual needs. Considering limited sexual information of women and the taboo nature of talking about sexual needs, the purpose of this study is to evaluate the effectiveness of the sexual assertiveness training on sexual health. MATERIALS AND METHODS: This randomized clinical trial assignment parallel study with a control group was performed in September and October 2016 on 60 married women referred to Imam Reza Health Center in Mashhad. The sample size was estimated to be 30 subjects per group. Instruments included demographic characteristics, sexual assertiveness, and sexual health questionnaire. The pretest was completed in two groups at the beginning of the study and post-test was done for both groups 1 week after educating the experimental group. Descriptive statistic tests included Chi-square, t-test, and paired t-test, and one-way analysis of variance. A p value less than 0.05 was considered to be statistically significant. RESULTS: The two intervention and control groups showed no significant difference in terms of sexual health level before starting the study (t 58 = 0.854, p > 0.05). After the study, based on the independent t-test, the two groups showed significant differences (t 58 = -4.077, p < 0.001). CONCLUSIONS: Sexual assertiveness training can improve women's sexual health. Considering the lack of research in this area and due to the effect of mutual understanding of couples on emotional and sexual issues, further research is necessary for this field.

Vitamin E as alternative local treatment in genitourinary syndrome of menopause: a randomized controlled trial.

INTRODUCTION AND HYPOTHESIS: Genitourinary syndrome of menopause is a major health concern in postmenopausal women. This study was aimed at comparing the effect of a vitamin E vaginal suppository with that of conjugated estrogen vaginal cream on sexual function in postmenopausal women with genitourinary syndrome of menopause. METHODS: This survey was carried out on 52 postmenopausal women aged 40-65 years who had been referred to gynecology clinics in Mashhad city, during 2013-2014. Keeping ß = 0.1, the power was calculated to be 90%. The patients were randomly divided into two groups: vitamin E vaginal suppository and conjugated estrogen vaginal cream. Participants used the medications for 12 weeks. They were visited at the 4th, 8th, and 12th weeks. Validated Abbreviated Sexual Function Questionnaire (ASFQ), as the primary outcome measure, and a demographic information questionnaire, were used to collect data at each visit. Data were analyzed using SPSS and p < 0.05 was considered statistically significant. RESULTS: Mean overall scores of the ASFQ were increased significantly in both groups during the course of the study, compared with baseline (p < 0.001). However, the mean ASFQ scores of the two treatments did not differ significantly. CONCLUSION: Improved scores of ASFQ after the 12th week showed that the treatment was successful in both groups. Therefore, a vitamin E vaginal suppository may be an alternative to vaginal estrogen in relieving the symptoms of vaginal atrophy in postmenopausal women, especially those not able to use hormone therapy or have low compliance.

Relationship between behavioral indices of pain during labor pain with pain intensity and duration of delivery.

BACKGROUND: Certain behaviors can be adopted by women to cope with labor pain according to their individual characteristics, which are currently called behavioral indicators during labor pain, and include facial expressions, verbal expressions, tone of voice, body movements, degree of relaxation, and respiratory system functioning during delivery. Moreover, severity of pain and duration of labor can vary due to several factors including individual characteristics. OBJECTIVE: The purpose of the present study was to determine the relationship between behavioral indicators during labor pain, severity of pain, and delivery duration. METHODS: In this cross-sectional study, 120 low risk pregnant women who referred to Omolbanin (AS) Hospital in the city of Mashhad (Iran) for delivery in 2014, were selected via convenience sampling method, which was then followed by completion of demographic information forms. From cervical dilatation of 3-5 centimeters until delivery, the Labor Pain Coping Behavior Observation Form (comprised of 6 sub-groups of facial expressions, verbal expressions, tone of voice, body movements, degree of relaxation, and respiratory function and severity and duration of pain) was completed during uterine contractions and every half an hour. Using the Inventory of Labor Information; vital signs, frequency of contractions, and duration of the first and second stages of labor were measured. Furthermore, the content validity of the questionnaire was determined and its reliability was confirmed by Cronbach's alpha method. Then, the data were analyzed using the SPSS version 16, through Pearson Product-Moment Correlation and Spearman's Rank-Order Correlation, Kruskal-Wallis test, and ANOVA. RESULTS: According to the results, 16.2% of the individuals had undesirable behavioral indicators during labor pain, 50% of them were endowed with acceptable behaviors, and 33.8% of these women had desirable behaviors. The findings also revealed that the duration of the active phase of the first stage of labor (p<0.001 and r=-0.453), the duration of the second stage of labor (p<0.012 and r=-0.146), and the severity of pain (p<0.001 and r=-0.450) were significantly and inversely correlated with behavioral indicators during labor pain; i.e. an increase in the mean score of behavioral indicators during labor pain could lead to a decline in the duration of stages of labor and severity of pain. CONCLUSION: It was concluded that behaviors demonstrated by women in labor had effects on their pains in the course of delivery, and there was also a relationship between the duration of stages of labor and its severity of pain. Therefore, it was recommended to turn attention to behaviors by women in labor in order to achieve a desirable clinical management.

Comparison of Sexual Problems in Fertile and Infertile Couples.

Introduction: Infertility is known to have a negative effect on couple's life and in most cases it has a profound impact on sexual relations. Sexual problems may be the cause of infertility or may arise as a result of infertility. The aim of this study was to compare the sexual problems in fertile and infertile couples. Methods: This cross-sectional study was performed on 110 infertile and 110 fertile couples referring to Montaserieh infertility center and five health centers in Mashhad which were selected as class clustering method and easy method. Data collection tools included demographic questionnaires and Golombok-Rust Inventory. The collected information was analyzed by SPSS software and descriptive and inferential statistics. Results: No significant difference was found between fertile 26 (17, 37) and infertile 26(18, 37) women in terms of total score of sexual problems and other aspects of sexual problems (except infrequency). The women in the fertile group had higher infrequency than infertile women. Total score of sexual problems in fertile men was 18.5 (13, 27) and in infertile men 25 (19, 31) and the difference was statistically significant. Infertile men reported more problems in no relation, impotency and premature ejaculation compared to fertile men. Men in both fertile and infertile group reported more sexual problems than women. Conclusion: In view of the more frequent sexual problems in infertile men than infertile women, it seems that it is necessary to pay more attention to sexual aspects of infertility in men and design the training programs for sexual and marital skills in infertility centers.

A survey of the therapeutic effects of Vitamin E suppositories on vaginal atrophy in postmenopausal women.

BACKGROUND: Menopause is associated with various complications such as depression, sleep disorders, and genitourinary atrophy. Vaginal atrophy occurs due to the loss of steroid hormones, and its major symptoms include vaginal dryness, itching, dyspareunia, and bleeding after intercourse. According to the literature, vitamin E plays a key role in estrogen stability. The aim of this study was to compare the effects of vitamin E suppositories and conjugated estrogen vaginal cream on vaginal atrophy. MATERIALS AND METHODS: In this clinical trial, 52 postmenopausal women, who were referred to a gynecology clinic in 2013, were recruited and randomly divided into two groups (26 cases per group). One group received 100 IU of vitamin E suppositories (n = 26), whereas the other group applied 0.5 g of conjugated estrogen cream for 12 weeks. Vaginal maturation value (VMV) was compared between the two groups before and after the intervention. VMV ≤ 55 was regarded as a cut-off point for vaginal atrophy. Treatment success was defined as a 10-unit increase in VMV, compared to the baseline value. Data were analyzed by Friedman test and Mann-Whitney test. P value less than 0.05 was considered statistically significant. RESULTS: The mean VMV in the vitamin E group before the treatment and after 4, 8, and 12 weeks of treatment was 43.78 ± 13.75, 69.07 ± 22.75, 77.86 ± 21.79, and 80.59 ± 19.23, respectively. The corresponding values in the estrogen cream group were 42.86 ± 14.40, 86.98 ± 12.58, 92.65 ± 15, and 91.57 ± 14.10, respectively. VMV significantly improved in both the treatment groups after the intervention, compared to the preintervention period (P < 0.001). Treatment success was reported in both groups, although estrogen cream (100%) appeared to be more effective after 4 weeks of treatment, compared to vitamin E suppositories (76.9%) (P = 0.01). CONCLUSIONS: Based on the findings, use of vitamin E suppositories could improve the laboratory criteria for vaginal atrophy and treatment success. Therefore, vitamin E suppositories are suggested for relieving the symptoms of vaginal atrophy, especially in women who are unable to use hormone therapy or cope with the associated side effects.

Sexual dysfunction in infertile women.

BACKGROUND: Sexual problems have different effects on the life of people by influencing their interpersonal and marital relationships and satisfaction. Relationship between sexual dysfunctions and infertility can be mutual. Sexual dysfunction may cause difficulty conceiving but also attempts to conceive, may cause sexual dysfunction. OBJECTIVE: This paper compares sexual dysfunction in fertile and infertile women. MATERIALS AND METHODS: In this cross-sectional study, 110 infertile couples referring to Montasarieh Infertility Clinic and 110 fertile couples referring to five healthcare centers in Mashhad were selected by class cluster sampling method. Data collection tools included demographic questionnaire and Glombok-Rust Inventory of Sexual Satisfaction. Data were analyzed through descriptive and analytical statistical methods by SPSS. RESULTS: There was no significant difference in total score of sexual problems and other dimensions of sexual problems (except infrequency) in fertile 28.9 (15.5) and infertile 29.0 (15.4) women. Fertile women had more infrequency than infertile women (p=0.002). CONCLUSION: There was no significant difference between fertile and infertile women in terms of sexual problems. Paying attention to sexual aspects of infertility and presence of programs for training of sexual skills seems necessary for couples.

Comparing the estimation of postpartum hemorrhage using the weighting method and National Guideline with the postpartum hemorrhage estimation by midwives.

INTRODUCTION: In developing countries, hemorrhage accounts for 30% of the maternal deaths. Postpartum hemorrhage has been defined as blood loss of around 500 ml or more, after completing the third phase of labor. Most cases of postpartum hemorrhage occur during the first hour after birth. The most common reason for bleeding in the early hours after childbirth is uterine atony. Bleeding during delivery is usually a visual estimate that is measured by the midwife. It has a high error rate. However, studies have shown that the use of a standard can improve the estimation. The aim of the research is to compare the estimation of postpartum hemorrhage using the weighting method and the National Guideline for postpartum hemorrhage estimation. MATERIALS AND METHODS: This descriptive study was conducted on 112 females in the Omolbanin Maternity Department of Mashhad, for a six-month period, from November 2012 to May 2013. The accessible method was used for sampling. The data collection tools were case selection, observation and interview forms. For postpartum hemorrhage estimation, after the third section of labor was complete, the quantity of bleeding was estimated in the first and second hours after delivery, by the midwife in charge, using the National Guideline for vaginal delivery, provided by the Maternal Health Office. Also, after visual estimation by using the National Guideline, the sheets under parturient in first and second hours after delivery were exchanged and weighted. The data were analyzed using descriptive statistics and the t-test. RESULTS: According to the results, a significant difference was found between the estimated blood loss based on the weighting methods and that using the National Guideline (weighting method 62.68 ± 16.858 cc vs. National Guideline 45.31 ± 13.484 cc in the first hour after delivery) (P = 0.000) and (weighting method 41.26 ± 10.518 vs. National Guideline 30.24 ± 8.439 in second hour after delivery) (P = 0.000). CONCLUSIONS: Natural child birth education by using the National Guideline can increase the accuracy of estimated blood loss. Therefore, training the personnel to use this guideline is recommended. However, It has less accuracy than 'sheet weighing'. Consequently, usage of symptoms and the weighing method is recommended in cases of postpartum bleeding.

The effect of pelvic floor muscle exercises program on sexual self-efficacy in primiparous women after delivery.

BACKGROUND: Selection and acceptance of appropriate sexual behavior and sexual function are made difficult by low sexual self-efficacy in the postpartum period. The general purpose of this research is to define the effects of an 8-week pelvic floor muscle exercise program on sexual self-efficacy in primiparous women after childbirth. MATERIALS AND METHODS: This clinical trial was performed on 79 primiparous women who referred to health care centers, Mashhad, Iran in 2013, 8 weeks after delivery, to receive health care services. They were selected by easy sampling. The samples were randomly assigned to either intervention or control group. The intervention group was trained in Kegel exercises for 8 weeks. Both groups were evaluated at 4 and 8 weeks. Data collection tools included: Demographic information, sexual self-efficacy, and Brink scale. Data were analyzed using repeated measures, Friedman test, t-test, and Mann-Whitney test. RESULTS: The results showed significant increase in pelvic floor muscle strength in the intervention group at 4 and 8 weeks after exercises (P < 0.0001), but no significant difference was observed in the control group (P = 0.368). There was a significant increase in sexual self-efficacy in the intervention (P < 0.0001) and control groups (P = 0.001) at 4 and 8 weeks after the start of the study. Comparison of the two groups showed a significant difference in sexual self-efficacy after they performed these exercises (P = 0.001). CONCLUSIONS: The findings showed that 8-week pelvic muscle exercises increase the sexual self-efficacy in women after delivery.

The Effect of Virtual Reality on Pain in Primiparity Women during Episiotomy Repair: A Randomize Clinical Trial.

BACKGROUND: Pain is one of the side effects of episiotomy. The virtual reality (VR) is a non-pharmacological method for pain relief. The purpose of this study was to determine the effect of using video glasses on pain reduction in primiparity women during episiotomy repair. METHODS: This clinical trial was conducted on 30 primiparous parturient women having labor at Omolbanin Hospital (Mashhad, Iran) during May-July 2012. Samples during episiotomy repair were randomly divided into two equal groups. The intervention group received the usual treatment with VR (video glasses and local infiltration 5 ml solution of lidocaine 2%) and the control group only received local infiltration (5 ml solution of lidocaine 2%). Pain was measured using the Numeric Pain Rating Scale (0-100 scale) before, during and after the episiotomy repair. Data were analyzed using Fisher's exact test, Chi-square, Mann-Whitney and repeated measures ANOVA tests by SPSS 11.5 software. RESULTS: There were statistically significant differences between the pain score during episiotomy repair in both groups (P=0.038). CONCLUSION: Virtual reality is an effective complementary non-pharmacological method to reduce pain during episiotomy repair. TRIAL REGISTRATION NUMBER: IRCT138811063185N1.

Relationship between gender role attitude and fertility rate in women referring to health centers in Mashhad in 2013.

BACKGROUND: Fertility rate apparently is a non-interventional behavior, but in practice, it is influenced by social values and norms in which culture and traditional beliefs play a significant role. In this regard, some studies have shown that gender roles can be associated with reproductive behaviors. With regard to the importance of annual reduction of population growth rate and its outcomes, the present study was performed to determine the relationship between gender role attitude and fertility rate in women referring to Mashhad health centers in 2013. MATERIALS AND METHODS: The present study is an analytical cross-sectional and multistage sampling study performed on 712 women. Data were collected by a questionnaire consisting of two sections: Personal information and gender role attitude questionnaire that contained two dimensions, i.e. gender stereotypes and gender egalitarianism. Its validity was determined by content validity and its reliability by internal consistency (r = 0.77). Data were analyzed by SPSS software version 16. RESULTS: Initial analysis of the data indicated that there was a significant relationship between acceptance of gender stereotypes (P = 0.008) and gender egalitarianism (P < 0.001), and fertility. There was also a direct association between acceptance of gender stereotypes and fertility rate (r = 0.13) and an indirect association between egalitarianism and fertility rate (r = -0.15). CONCLUSIONS: The results of the present study indicate that there is an association between gender role attitude and fertility. Paying attention to women's attitude is very important for successful planning in the improvement of fertility rate and population policy.

The shape of uterine contractions and labor progress in the spontaneous active labor.

BACKGROUND: Dystocia is the most common indication of primary cesarean section. The most common cause of dystocia is uterine dysfunction. In prolonged labor, more attention is usually paid to the fetus and pelvis rather than to the role of uterine contractions in a delivery. Therefore, we decided to determine the relationship between the labor progress and uterine contractions shapes. METHODS: In this cross-sectional study, 200 primiparous women participated having a single pregnancy and cephalic presentation. Uterus contractions were recorded using electronic fetal monitoring at the beginning of the active phase of labor (dilatation 3-5 cm) for 30 min. Fall to rise (F:R) ratio was calculated by determining the duration of returning from a contraction peak to its baseline (fall) and the duration of the rise time from baseline to peak (rise) in two groups. The data were analyzed using t-test and Chi-square test. RESULTS: In this study, 162 women had a normal delivery and 38 women had a cesarean (CS) delivery due to the lack of labor progress. The average F:R ratio was 1.13±0.193 seconds in the vaginal delivery group and 1.64±0.301 seconds in the CS group. This difference was statistically significant (P<0.001). The frequency of contractions in the vaginal delivery group was more than the CS group (P=0.008). CONCLUSION: Our findings demonstrated that uterine contractions shapes change; and F:R ratio was higher in the group that lacked labor progress. Therefore, contraction shapes can be used to predict the labor progress.

Behavioral Intervention Program versus Vaginal Cones on Stress Urinary Incontinence and Related Quality of Life: A Randomized Clinical Trial.

OBJECTIVE: To compare the efficacy of behavioral intervention program and vaginal cones on stress urinary incontinence. METHODS: In this randomized clinical trial, 60 women aged 25-65 years with stress urinary incontinence were randomly divided into two groups, those who participated in a behavioral intervention program (n=30) and those who used vaginal cones (n=30). The women in the behavioral intervention group were instructed on pelvic floor exercise and bladder control strategies. In the other group, pelvic floor exercises were performed using the vaginal cones. All participants were treated for 12 weeks and followed-up every 2 weeks. The subjective changes in severity of stress urinary incontinence were measured using a detection stress urinary incontinence severity questionnaire, leakage index, and a 3-day urinary diary. The objective changes were measured by pad test. For better evaluation of the effects, two questionnaires were used: Incontinence Quality of Life and King's Health Questionnaire. RESULTS: Among the 51 women who completed the study, 25 subjects were in the vaginal cones group and 26 participated in the behavioral intervention program. The changes in leakage rate on pad test and leakage index in the behavioral intervention program group were significantly higher than in the vaginal cones group (p=0.001 and p=0.008, respectively), but the severity of stress urinary incontinence was not significantly different between the two groups (p=0.2). The changes in strength of the pelvic floor, Incontinence Quality of Life, and King's Health Questionnaire scores showed no significant differences between the two groups after 12 weeks of intervention. CONCLUSION: Vaginal cones and behavioral intervention programs are both effective methods of treatment for mild to moderate stress urinary incontinence, but the behavioral intervention program is superior to vaginal cones in terms of cost-effectiveness and side effects.