Effectiveness of Dry Heat Versus Moist Heat Modalities on Pain Intensity and Wound Healing of Episiotomies Among Postnatal Women: A Systematic Review and Meta-Analysis.

OBJECTIVES: Comparison of the effects of dry heat versus moist heat therapy modalities on the intensity of pain and wound healing of episiotomies among postnatal women. DESIGN: A Systematic review and meta-analysis of controlled trials. DATA SOURCES: Six databases searched for original articles using relevant keywords until September 10, 2023, without time or language restrictions. REVIEW/ANALYSIS METHODS: All analyses employed Comprehensive Meta-Analysis (CMA) V.2. The measure of heterogeneity was computed using Cochran's Q-value. The I2 index was employed to quantitatively demonstrate heterogeneity. Statistical significance was reported for P-values <0.05 and I2>50%. RESULTS: Four quasi-experimental and three randomized controlled trials (RCTs) studies with moderate-to-good quality evidence met inclusion criteria. On the third to fifth day after the intervention in the dry heat group, the amount of pain was significantly lower than in the group that used moist heat [MD (95% CI) =-1.395 (-2.374, -0.416), P=0.005]. The use of a hair dryer significantly reduced pain (P=0.029), but an infrared lamp did not significantly reduce pain compared to moist heat (P=0.064). As compared to the moist heat group, the women using dry heat experienced better wound healing to the extent of 2.002 units of the REEDA (Redness, Edema, Ecchymosis, Discharge, Approximation) scale, which was statistically significant [MD (95% CI) = -2.002 (-2.785, -1.219), P<0.001]. CONCLUSION: Compared to sitz baths, dry heat reduced pain and improved episiotomy site healing in postnatal women. Therefore, dry heat, especially hair dryers, is suggested as a non-pharmacological strategy inside maternity hospitals, but additional targeted, high-quality trials are needed.

Efficient administration of a combination of nifedipine and sildenafil citrate versus only nifedipine on clinical outcomes in women with threatened preterm labor: a systematic review and meta-analysis.

BACKGROUND: Preterm labor (PTL) is a common and serious pregnancy disorder that can cause long-term neurological issues in the infant. There are conflicting studies concerning whether sildenafil citrate (SC) reduces preterm labor complications. Therefore, the meta-analysis aimed to examine the clinical outcomes in women with threatened PTL who received nifedipine plus SC therapy versus only nifedipine. METHODS: For the original articles, six databases were searched using relevant keywords without restriction on time or language until January 13, 2024. The Cochrane risk-of-bias tool for randomized trials (RoB) and the Risk of Bias Assessment Tool for Nonrandomized Studies (RoBANS) were both used to assess the risk of bias in randomized and non-randomized studies, and GRADE determined the quality of our evidence. Meta-analysis of all data was carried out using Review Manager (RevMan) version 5.1. RESULTS: Seven studies with mixed quality were included in the meta-analysis. The study found that combining nifedipine and SC resulted in more prolongation of pregnancy (MD = 6.99, 95% CI: 5.32, 8.65, p < 0.00001), a lower rate of delivery in the 1st to 3rd days after hospitalization (RR = 0.62, 95% CI: 0.50, 0.76, p < 0.00001), a higher birth weight (252.48 g vs. nifedipine alone, p = 0.02), and the risk ratio of admission to the neonatal intensive care unit (NICU) was significantly lower (RR = 0.62, 95% CI: 0.50, 0.76, p < 0.00001) compared to nifidepine alone. The evidence was high for prolongation of pregnancy, delivery rate 24-72 h after admission, and NICU admission, but low for newborn birth weight. CONCLUSIONS: Given the effectiveness of SC plus nifedipine in increased prolongation of pregnancy and birth weight, lower delivery in the 1st to 3rd days after hospitalization, and NICU admission, Gynecologists and obstetricians are suggested to consider this strategy for PTL management, although additional article rigor is required to improve the quality of the evidence.

Exploring the understanding and experience of women with rheumatic diseases regarding fertility intention- a qualitative content analysis.

BACKGROUND: Patients with rheumatic diseases (RDs) have a lower desire to have children, fewer children, and a longer interval between their pregnancies, which can be due to the patient's personal choice, the physician's advice, changes in sexual activity, changes in fertility, and pregnancy failure. This study aimed to explore the understanding and experience of women with RDs regarding pregnancy intention. METHOD: In Mashhad, Northeast Iran, between December 2022 and March 2023, this qualitative inquiry was carried out. Purposive sampling was used to select thirty women with RDs. Semi-structured interviews were used to collect the data. Graneheim and Lundman's conventional content analysis method was used to analyze the data. The data organization was done using MAXQDA 12 software. Credibility, dependability, confirmability, and transferability have been considered as elements of trustworthiness. RESULTS: The participants' data analysis revealed the following main theme: "duality of desire and fear in childbearing". Five main categories were identified, including "Individual health concerns following pregnancy", "motherhood and womanhood perceptions", "concerns about child harm", "contradictory beliefs and attitudes of significant family members and clinicians about pregnancy", and "lack of social support for fertility". CONCLUSION: In order to improve the outcomes of pregnancy for women with RDs, the medical professionals who manage them must actively and frequently inquire about their intentions to childbearing and offer them individualized guidance on how to be in the best possible health at the time of conception. Rheumatologists, gynecologists, and reproductive health specialists can better address the sexual and reproductive health needs of this population by enhancing their collaboration in the care of women with RDs.

The Effect of Hyoscine N-Butyl Bromide Rectal on the Duration of Labour and Rate of Cervical Dilatation: A Systematic Review and Meta-Analysis.

OBJECTIVE: The current meta-analysis was designed to investigate the impact of Hyoscine N-butyl bromide (HBB) rectal on labour duration and the rate of cervical dilatation by consolidating the available data. METHODS: The search of Medline through the PubMed interface, Scopus, ScienceDirect, and the Cochrane Central Register of Controlled Trials (CENTRAL) was performed for original articles concerning the effects of HBB rectal on the duration of labour published prior to 26 June 2023. Search terms were based on Medical Subject Headings without time and language restrictions. They included: Hyoscine, Scopolamine, HBB, Buscopan, Buscolysin, Buscapine, rectal, suppository, childbirth, delivery, active phase, second stage, cervical dilatation, labour, labour, and duration of labour. The Comprehensive Meta-Analysis V3 software was used for all analyses. RESULTS: Five randomized control trials and 1 non-randomized study involving 1310 women were included in the systematic review. Two studies were excluded from the meta-analysis because of heterogeneous interventions and a lack of mean and SD results. The results determined that HBB rectal administration significantly decreased the duration of the active phase (pooled mean difference -193.893; 95% CI -229.173 to -158.613, P < 0.001; I2 squares = 90.097%) and second stage of labour (pooled mean difference -2.911; 95% CI -5.486 to -0.336, P = 0.027; I2 squares = 90.097%). Also, the cervical dilatation rate in the active phase of labour was 0.981 cm/h higher than in the control group (I2 = 0.0%; P < 0.001). CONCLUSION: This meta-analysis found that HBB rectal administration shortened the active labour phase and second stage and increased the rate of cervix dilatation; consequently, it can be used as a cost-effective intervention for low-risk pregnant women during labour. However, our findings also suggest that more robust clinical trials are required to generate evidence and confirm the use of HBB during labour for clinical practice guidelines.

Domestic violence experienced by women with multiple sclerosis: a study from the North-East of Iran.

INTRODUCTION: Violence against women is a significant health and legal problem and has been declared as a health priority by the World Health Organization. The most common type of violence against women is domestic violence, more prevalent against women with disabilities than other women. Multiple sclerosis (MS) is a debilitating neurological disease and has experienced sudden growth in Iran. This study aimed to investigate the prevalence of domestic violence and its various types (psychological, economic, physical, and sexual) experienced by women with MS. METHODS: In this cross-sectional study, 275 married women with MS were selected using convenience sampling. After obtaining informed consent and reviewing the inclusion and exclusion criteria, the Domestic Violence against Women Questionnaire developed by Mohseni Tabrizi et al. was completed by the participants on a self-report basis. The results were analyzed using SPSS software version 16. To analyze data, statistical tests including chi-square and Fisher exact tests for univariate analysis and logistic regression, were employed. RESULTS: The mean age of participants was 37.12 ± 8.48 years. Domestic violence in different forms of psychological, economic, physical, and sexual violence was present in 53.1%, 63%, 33.6%, and 20.4% of participants, respectively. Economic violence (33.8%) was the highest, and sexual violence (5.1%) was the lowest rate of severe violence among participants. There was a significant relationship between the overall rate of domestic violence and the variables including income (P = 0.013), spouse's income (P = 0.001), participant's job (P = 0.036) and participant's education (P = 0.001). In logistic regression, the overall rate of domestic violence was higher in participants with education less than a diploma than in participants with a diploma (P = 0.014) and participants with a university education (P = 0.016). CONCLUSION: According to the results, providing opportunities such as promoting the social status of women, fulfilling the rights of women with disabilities and debilitating diseases such as MS in society is recommended. Additionally, educating men about the negative impact of domestic violence on the current and future status of the family seems necessary. Providing counseling facilities on various forms of violence, especially domestic violence, for women with MS, is also recommended.

The Relationship Between Menstrual Patterns and Menstrual Attitude Dimensions among Women of Reproductive Age: Cross-sectional survey.

Objectives: Women's attitudes towards menstruation play a critical role in shaping their bodies and psychosocial integrity. Menstruation is affected by certain bio-psychosocial factors, necessitating an in-depth understanding of the phenomenon to cope better with the consequent difficulties. This study aimed to investigate the relationship between menstrual patterns and menstrual attitude dimensions in women of reproductive-age. Methods: An observational cross-sectional study was conducted between January and December 2019 on women referred to various urban health centres of Torbat Heydariyeh, Iran. The Menstrual Attitudes Questionnaire and Verbal Multidimensional Scoring systems were used to collect the required data. The features of the menstrual cycle were also recorded. Results: A total of 164 women (response rate: 96.74%) were included in this study. Women with dysmenorrhea perceived menstruation as a more debilitating, bothersome and predictable event and they were less likely to deny any menstrual effect (P = 0.001). The results also revealed that subjective menstrual blood loss was associated with higher levels of perceiving menstruation as a natural (P = 0.008), bothersome (P = 0.026) and anticipatory event (P = 0.021) and reporting less denial of any menstrual effect (P = 0.001). Moreover, women rated menstruation as a more bothersome event with an increase in the duration of menstrual bleeding (P = 0.014). There was no significant relationship between the other features of the menstrual cycle and menstrual dimensions (P >0.05). Conclusion: The findings of this study suggest that women's attitudes towards menstruation were associated with menstrual pain, duration of the menstrual cycle and subjective volume of menstrual flow. These factors could be used to modify women's attitudes towards the natural phenomenon of menstruation.

Domestic Violence against Infertile Women: A systematic review and meta-analysis.

Domestic violence (DV) against infertile women is an important health concern affecting their well-being. This systematic review and meta-analysis investigated the prevalence of DV against infertile women. The study was done based on the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guideline. Various international electronic databases were utilised in order to retrieve the necessary data. Articles were included if they were cross-sectional studies published in English and in Persian journals and investigated the prevalence of DV against infertile women up to May 2020. Out of 630 studies, 26 cross-sectional studies were systematically reviewed, from which 15 studies were included in the meta-analysis. The experiences of DV varied widely among the infertile women (14.987-88.918%). The results of meta-analysis showed that the prevalence of DV stood at 47.163% (95% Confidence Interval: 34.660-59.850). Psychological and emotional violence were among the most common types of violence. Considering the high rate of DV, it is recommended that policymakers address the issue by providing supportive care to such vulnerable populations, including educational and counselling services.

Life loaded with threat and vulnerability: a qualitative inquiry into the experiences of HIV negative married women in serodiscordant heterosexual relationships.

BACKGROUND: Violence against women is a major, complex, multidimensional and widespread public health concern worldwide. The current qualitative study was conducted to understand the experience of violence among HIV negative married women in heterosexual serodiscordant relationships. METHODS: A qualitative description (QD) was conducted from October 2018 to January 2020 in Mashhad, Iran. The participants were 15 HIV negative women, who married and lived with HIV positive men, through purposive sampling method. The data were collected using semi-structured interviews. Data analyzed using conventional content analysis adopted by Graneheim and Lundman. RESULTS: The main overarching theme emerged entitled: life loaded with threat and vulnerability. This theme consisted of four categories of self-directed violence, intimate partner violence, cultural violence and structural violence. The violence began soon after awareness of husband's infection with acts such as suicide attempts and a sense of abhorrence for living with an infected person, and continued with confrontation with various types of violence in the family and society, which put women in constant threat and vulnerability. CONCLUSIONS: This study provided an insight into different aspects of violence in Iranian women in HIV serodiscordant relationships. Considering the role of men in the occurrence of violence, policymakers must create and execute family-centered interventions to address attitudes and behaviors that lead to marital conflicts and spousal abuse in order to prevent violence. Health care professionals should also be trained to screen women for violence and refer those who require care to specialists to reduce vulnerability.

Responding to the Essential Sexual and Reproductive Health Needs for Women During the COVID-19 Pandemic: A Literature Review.

The pandemic and its consequences have been shown to have a negative impact on the availability and accessibility of the basic services, including sexual and reproductive health (SRH) needs. The aim of this study was to investigate the responses to the essential SRH needs for women during the COVID-19 pandemic. This narrative review was conducted based on the Scale for Assessing Narrative Review Articles (SANRA), in order to present key activities for responding to the important SRH needs of women in the current COVID-19 pandemic. The literature search was performed through English databases of Cochrane Library, PubMed, Scopus and ScienceDirect, as well as Persian databases including Magiran and Scientific Information Database (SID). In addition, the World Health Organization (WHO), the Joint United Nations Programme on HIV and AIDS (UNAIDS) and the reports of Center for Disease Control and Prevention (CDC) were searched. The search was carried out from December 2019 up to 10 January 2021. Essential reproductive healthcare services for women during the COVID-19 pandemic were divided into six categories including access to contraception, safe abortion and post-abortion care, sexual health and sexually transmitted disease (STD) prevention, cervical cancer screening and prevention, maternity services and also addressing violence against women and girls. These essential needs should be considered as a priority by governments as well as public and private stakeholders. It seems that the implementation of the shifted strategies, active participation of public and private stakeholders, consideration of human rights and ethical issues, ensuring access to vulnerable populations, regular contact with individuals and the increased cooperation of individuals for responding to the SRH needs during the COVID-19 outbreak, are necessary.

Home-Based Care, the Missing Link in Caring of Patients Living with HIV/AIDS and Their Family Members: A Narrative Review.

Inconsistencies between the number of patients, qualified caregivers and lack of adequate services and resources in the healthcare systems for people living with HIV/AIDS have led to the idea of providing healthcare services for this vulnerable population at home. This study aimed to review the evidence related to the Home-Based Care (HBC) programs in the context of HIV. Literature search was carried out without publication date limit through English databases of Cochrane Library, PubMed, EBSCO, Scopus, Google Scholar, Science Direct, as well as Persian databases including Magiran and SID by the end of July 2019. Out of 1312 studies retrieved from the search of databases, six guidelines and 50 articles met the eligible criteria. The results showed that the overall purpose of HBC is to create hope through providing appropriate care to help the patients and their families to maintain their independence and have the best possible quality of life. The potential benefits of HBC could be discussed in three main categories: 1) patients, including patients' satisfaction, quality of life, adherence to antiretroviral therapy, preventing mother-to-child transmission, as well as biochemical, social and psychological outcomes, 2) families, consisted of promotinon of family members' participation, enhancement of family members' awareness and provision of voluntary counseling and testing, and 3) healthcare systems, containing health care costs, workload at healthcare centers and time spent on services. Given the lessons learnt from the existing HBC programs, developing an alternative approach for providing healthcare at home in the context of HIV seems necessary and could be an agenda for action in health policy making in Iran.

Living with Discordance: A Qualitative Description of the Challenges Faced by HIV Negative Married Women.

BACKGROUND: Serodiscordant couples are faced with many social, sexual and relationship challenges in all aspects of their lives. The sources of conflicts could be disease acquisition, transfer of HIV to the uninfected partner, and fertility decisions. The current qualitative study was designed to explore the challenges faced by HIV negative women in serodiscordant relationships. METHODS: This qualitative description was conducted in Mashhad, Northeast of Iran, between October 2018 and June 2019. 15 HIV-negative women who were living with their HIV-positive husbands were selected through purposive sampling method. The data were collected using semi-structured interviews. Data were analyzed using conventional content analysis adopted by Graneheim and Lundman. MAXQDA version 12, was used for data organization. Components of rigor including credibility, dependability, confirmability and transferability were considered. RESULTS: The main overarching theme which emerged from the qualitative study was "threats to family life", consisting of five categories along with their subcategories. These categories included stigmatic reactions followed by disclosure of the status, social misconceptions and limitation of information sources, psychological disruptions, hard decision making for fertility, and role conflict in the family. CONCLUSION: This study provides an insight into different aspects of challenges faced by Iranian women in HIV-serodiscordant relationships. Also, our study supports the view of other investigators who believe that there is an urgent need for provision of counseling and empowerment interventions for HIV- serodiscordant couples.

Depression Following Hysterectomy and the Influencing Factors.

BACKGROUND: Hysterectomy is one of the most common gynecological surgeries performed worldwide. However, women undergoing this surgery often experience negative emotional reactions. OBJECTIVES: This study was done with the aim of investigating the relationship between hysterectomy and postoperative depression, three months after the procedure. MATERIALS AND METHODS: This longitudinal study was conducted in the province of Khorasan-Razavi in Iran, using multistage sampling. At first, three cities were selected from the province by cluster sampling; then, five hospitals were randomly selected from these cities. The participants included 53 women who were hysterectomy candidates in one of the five selected hospitals. The participants' demographics and hysterectomy procedure information were entered into two separate questionnaires, and the Beck depression inventory (BDI) was employed to measure their severity of depression before and three months after the surgery. The statistical package for the social sciences (SPSS) version 16 was used for the statistical analysis, and a P value of < 0.05 was considered to be statistically significant. RESULTS: The means and standard deviations of the participants' depression scores before and three months after their hysterectomies were 13.01 ± 10.1 and 11.02 ± 10.3, respectively. Although the mean score of depression decreased three months after the hysterectomy, the difference was not statistically significant. However, a significant relationship was found between the satisfaction with the outcome of the hysterectomy and the postoperative depression score (P = 0.04). CONCLUSIONS: In this study, undergoing a hysterectomy did not show a relationship with postoperative depression three months after the surgery. Moreover, the only factor related to depression following a hysterectomy was satisfaction with the surgery.