Implementation of birth plans integrated into childbirth preparation classes for vaginal birth: a qualitative study of women, their husbands and clinicians' perspectives in Iran.

BACKGROUND: Understanding women's experience of birth planning is necessary for introducing and implementing this process in the Iranian maternity services. This study aims to explore perceptions of birth plan implementation in Iran from the perspective of women, their husbands, and clinicians. METHODS: This qualitative study was conducted in Iran. Qualitative data were collected from November 2020 to March 2021 by conducting semi-structured in-depth interviews with ten mothers who prepared a birth plan, and 15 key informants (obstetricians, midwives, and husbands) who were involved in the implementation process of birth plans. Data were analyzed using conventional qualitative content analysis. RESULTS: Data reduction process resulted in 380 codes that were categorized in 16 subcategories and five main categories. The main categories were "Guide and pattern of preparing for childbirth pathway", "Maternal empowerment and sense of triumph", "Facilitating and enhancing communication", "Successful transition to parenthood and women's satisfaction", and "Challenges associated with implementation of the birth plan". The overarching theme "Birth plan: The missing link in promotion of vaginal birth in Iran" was constructed from these categories. CONCLUSION: Findings of this study highlight the effectiveness of the implementation of birth plan along with childbirth preparation classes for increasing the likelihood of a successful vaginal birth and promoting empowerment and satisfaction in women during the childbirth process. The findings of this study could pave the way for developing, introducing, and implementing of birth plan in Iran.

The effect of dexamethasone on labor induction: a systematic review.

BACKGROUND: To evaluate the effect of dexamethasone administration on the interval between initiation of labor induction and active phase of labor. METHODS: The databases including PubMed, Cochrane Library, Embase, Scopus and Web of Science were searched for studies published up to June 27, 2021. Two types of articles were included: a) full-text articles published in English or any other languages, and b) Randomized Controlled Trials (RCTs). Participants were primi- or multigravida women with term or post-term pregnancy. The intervention group received parenteral or extra-amniotic dexamethasone whereas the control group received normal saline or no treatment before initiation of labor induction. All data were analyzed using Review Manager 5.3. RESULTS: Seventeen studies involving 1879 patients were included in the meta-analysis. Administration of dexamethasone reduced the interval between the initiation of labor induction and the beginning of active phase by about 70 min [MD: - 1.17 (- 1.37, - 1.00); P < 0.00001]. Duration of the first stage of labor in the dexamethasone group was about 88 min shorter than that in the control. There were no maternal and fetal adverse effects. CONCLUSIONS: Dexamethasone could significantly reduce the length of induction-active phase interval, and length of the first stage of labor, with no difference in maternal or fetal adverse effects.

Study the relationship between medical sciences students' self-esteem and academic achievement of Guilan university of medical sciences.

BACKGROUND: Achievement of productivity and improvement of quality in the educational system is the effective, influential factors for countries development. Academic achievement is the main objective of the training program and the most important concerns of teachers, education officials, and university Student's families. Self-esteem is one of the factors affecting student academic achievement. This study is aimed to investigate the relationship between self-esteem and academic achievement in Medical Sciences students of in 2014-2015. SUBJECTS AND METHODS: This is a descriptive-correlational study. In this study, 537 university students were selected using random stratified sampling method from Guilan University of Medical Sciences in 2014-2015. Data were collected using the standard self-esteem questionnaire of Cooper Smith consisting of four elements (general, social, familial, and educational) and a demographic questionnaire. Data were analyzed using SPSS software version 21 and descriptive statistics such as Spearman correlation and Logistic Regression. RESULTS: The results indicated a significant relationship between grade point average and educational self-esteem (P = 0.002, r = 0.135) and global self-esteem (P = 0.02, r = 0.102). There was also a significant relationship between composite Index educational status and general self-esteem (P = 0.019, r = 0.102) and academic achievement (P = 0.007, r = 0.116) and global self-esteem (P = 0.020, r = 0.102). CONCLUSIONS: According to the results, the highest mean score of self-esteem was related to the familial element, and the lowest average was in terms of social self-esteem, therefore, given the importance and necessity of self-esteem in academic achievement, strengthening of all aspects of self-esteem is suggested.

Salivary calcium concentration as a screening tool for postmenopausal osteoporosis.

AIM: Measurements of salivary calcium level may be a useful screening tool for osteoporosis in postmenopausal women. The purpose of this study was to clarify whether this measure is valid compared with dual-energy X-ray (Bone Mineral Density) screening tools in osteoporosis. METHODS: A case-control study was carried out in 40 postmenopausal women with osteoporosis (T-score ≤ -2.5) and 40 women without osteoporosis (T-score > -1 bone mineral density). Salivary samples were collected and calcium concentrations were measured and expressed as mg/dL. Receiver operating characteristic curve analyses was used to determine the optimal cut-off thresholds for salivary calcium in healthy postmenopausal women. RESULTS: The cut-off point for salivary calcium was 6.1 mg/dL. The sensitivity and specificity, respectively, for identifying women with osteoporosis, were 67.5 (95%CI 52.33-82.67) and 60% (95%CI 44.62-75.38). The area under curve (AUC) was 0.678 (95%CI 0.56-0.79), the positive predictive value (PPV) was 62.79 (95%CI 47.74-77.84) and negative predictive value (NPV) was 64.86% (95%CI 49.27-80.46). The positive likelihood ratio was 1.688 and the negative likelihood ratio was 0.542. CONCLUSIONS: Salivary calcium concentration discriminates between women with and without osteoporosis and constitutes a useful tool for screening for osteoporosis.