Worldwide Prevalence of Pelvic Organ Prolapse: A Systematic Review and Meta-Analysis.

Background: The prevalence of pelvic organ prolapse is varied in different countries. For validating the results of numerous studies on the prevalence of Pelvic organ prolapse in the world, a meta-analysis study seems necessary to provide an accurate and valid prevalence for planners and researchers in this field. Therefore, we aimed to investigate the worldwide prevalence of pelvic organ prolapse using the meta-analysis method. Methods: By using valid keywords, searching was done in ISI Web of Science, PubMed, Scopus, and Medline databases, and 22 articles were selected based on inclusion criteria between 2009 and 2021. The quality of articles was checked using The Joanna Briggs Institute (JBI) checklist. Meta-analysis was performed on collected data using Comprehensive Meta-Analysis Software (CMA, Version 2). Meta-analysis of data was done with a random-effects model. The heterogeneity of the study was checked using the I2 index. Publication bias was assessed by the Egger test and funnel graph. Results: The overall prevalence of included studies was 30.9% (95% confidence interval: 24.4-38.2%), (P<0.001, heterogeneity I2=99.8%). Meta-analysis of subgroups in studies that used a questionnaire to estimate the prevalence rate showed the prevalence was 25.0% and, in the studies, used the physical examination was 41.8%. Conclusion: Studies carried out in different parts of the world have examined the prevalence of pelvic organ prolapse using different tools. Since some cases are asymptomatic, especially in the low stage of prolapse, physical examination of pelvic organ prolapse should be considered an essential tool in evaluating pelvic organ prolapse.

Pregnant Women's Experiences of the Conditions Affecting Marital Well-Being in High-Risk Pregnancy: A Qualitative Study.

BACKGROUND: High-risk pregnancy is associated with many problems which can affect marital well-being as well as maternal and fetal health. Yet, there is limited information about the conditions which affect marital well-being in high-risk pregnancy. This study aimed to explore the pregnant women's experiences of the conditions affecting marital well-being in high-risk pregnancy. METHODS: This qualitative study was conducted from October 2018 to December 2019. Participants were 24 women with high-risk pregnancy who were purposively selected from three public and two private hospitals as well as a primary healthcare center in Mashhad, Iran. Face-to-face semi-structured interviews were conducted for data collection. Data were analyzed concurrently with data collection through Graneheim and Lundman's content analysis (2004). The MAXQDA program (v. 10) was used for data management. RESULTS: Conditions affecting marital well-being in high-risk pregnancy were categorized into eleven subcategories and three main categories, namely emotional spousal intimacy in the midst of danger, husband's commitment to manage the difficult conditions of pregnancy and sexual relationship during high-risk pregnancy. CONCLUSION: Several conditions can affect marital well-being in high-risk pregnancy. Healthcare providers can develop and use strategies for the effective management of these conditions, thereby improving marital well-being among women with high-risk pregnancy.

Well-being in high-risk pregnancy: an integrative review.

BACKGROUND: A prerequisite to the interventions for well-being improvement in high-risk pregnancy (HRP) is to make the concept clear, objective, and measurable. Despite the wealth of studies into the concept of well-being in HRP, there is no clear definition for it. This study aimed to explore the concept of well-being in HRP. METHODS: This integrative review was conducted using the Whittemore and Knafl's approach. A literature search was done without any data limitation in dictionaries, thesauruses, encyclopedias, well-being-related textbooks, midwifery, psychology, and mental health journals, and Iranian and international databases. The most primary inclusion criterion was relevance to well-being in HRP. The full-texts of all these articles were assessed using the checklists of the Joanna Briggs Institute. Data were analyzed through the constant comparison method and were managed using the MAXQDA 10 software. Meaning units were identified and coded. The codes were grouped into subcategories and categories according to the attributes, antecedents, and consequences of well-being in HRP. RESULTS: Thirty articles were included in the review, from which 540 codes were extracted. The codes were grouped into seven main attributes, eight main antecedents, and five main consequences of well-being in HRP. The four unique dimensions of well-being in HRP are physical, mental-emotional, social, and spiritual well-being. These dimensions differentiate well-being in HRP from well-being in low-risk pregnancy and in non-pregnancy conditions. CONCLUSION: As a complex and multidimensional concept, well-being in HRP refers to the pregnant woman's evaluation of her life during HRP. It includes physical, hedonic, and eudaimonic components. The assessment of well-being in HRP should include all these components.

Effect of pelvic floor muscle training on postpartum sexual function and quality of life: A systematic review and meta-analysis of clinical trials.

There are a weakness and laxity in pubourethral and external urethral ligaments during postpartum which has an important role in the females' sexual function and quality of life. Some evidences showed that pelvic floor muscle training can strength pelvic muscles and prevent sexual dysfunction. Therefore, current study aimed to review the effect of pelvic floor exercise on female sexual function and quality of life in the postpartum period. PubMed, CINAHL, Medline, Scopus, Google scholar citations, Persian databases including SID and Iran Medex were searched using MeSH-based keywords to find published articles. Experimental and quasi-experimental studies in Persian and English were included. Data extracted was done in pre-defined checklist by two independent researchers. Risk of bias was assessed using the Cochrane Risk of Bias tool. Meta-Analysis of the data was carried out by "Comprehensive Meta-analysis Version 2" (CAM). The search resulted in 347 titles and abstracts, which were narrowed down to 12 potentially eligible articles. Pooled standardized differences in means (SMD) of sexual function in both pelvic floor exercise and control group were 0.462 [0.117 to 0.806], p = 0.009. The pooled SMD was 1.294 [0.926 to 1.663], p < 0001 for sexual quality of life. The pooled SMD was 0.232 [0.038-0.426], p = 0.019 for general quality of life. Evidences showed that pelvic floor muscle training in primi or multi-parous women can boost sexual function and quality of life in postpartum. Although the majority of studies and the result of meta-analysis reported positive results, more high-quality RCTs are needed in this area. One limitation of our study is significant heterogeneity because of different intervention method.

Comparison of the effect of standardized patient-based training with team-based learning on the knowledge of midwifery students in providing services to victims of rape.

BACKGROUND: Rape is a widespread and important issue in the field of public health, and its victims require comprehensive and gender-sensitive health services. Healthcare providers, especially midwives, play an important role in the diagnosis and treatment of rape, and improving their knowledge has been an essential factor in enhancing the quality of service provided. OBJECTIVE: The objective of the study is to compare the impact of standardized patient-based training and team-based learning on midwifery students' knowledge for providing services to rape victims. MATERIALS AND METHODS: In this randomized quasiexperimental study, 75 midwifery students of Mashhad School of Nursing and Midwifery were selected using available sampling method and were assigned to two groups of standardized patient-based training (n = 38) and team-based learning (n = 37). After performing pretest, standardized patient-based training group and team-based learning group were trained separately for 6 h. One week after intervention, posttest was performed. Data were collected and analyzed using the Academic Specifications Questionnaire and the Knowledge Assessment Questionnaire. Significance level was considered at P < 0.05. RESULTS: The two groups were homogeneous in terms of demographic characteristics. There was no statistically significant difference between the two groups in the posttest in terms of knowledge score (P = 0.079). However, there was a statistically significant difference in the level of knowledge between the two groups (P = 0.037). CONCLUSIONS: Given the effectiveness of both standardized patient-based training method and team-based learning method on enhancing midwifery students' knowledge for providing services to rape victims, these methods can be used in students' education.

Comparison of the effect of web-based, simulation-based, and conventional training on the accuracy of visual estimation of postpartum hemorrhage volume on midwifery students: A randomized clinical trial.

INTRODUCTION: Delay in diagnosis of bleeding can be due to underestimation of the actual amount of blood loss during delivery. Therefore, this research aimed to compare the efficacy of web-based, simulation-based, and conventional training on the accuracy of visual estimation of postpartum hemorrhage volume. MATERIALS AND METHODS: This three-group randomized clinical trial study was performed on 105 midwifery students in Mashhad School of Nursing and Midwifery in 2013. The samples were selected by the convenience method and were randomly divided into three groups of web-based, simulation-based, and conventional training. The three groups participated before and 1 week after the training course in eight station practical tests, then, the students of the web-based group were trained on-line for 1 week, the students of the simulation-based group were trained in the Clinical Skills Centre for 4 h, and the students of the conventional group were trained for 4 h presentation by researchers. The data gathering tool was a demographic questionnaire designed by the researchers and objective structured clinical examination. Data were analyzed by software version 11.5. RESULTS: The accuracy of visual estimation of postpartum hemorrhage volume after training increased significantly in the three groups at all stations (1, 2, 4, 5, 6 and 7 (P = 0.001), 8 (P = 0.027)) except station 3 (blood loss of 20 cc, P = 0.095), but the mean score of blood loss estimation after training did not significantly different between the three groups (P = 0.95). CONCLUSION: Training increased the accuracy of estimation of postpartum hemorrhage, but no significant difference was found among the three training groups. We can use web-based training as a substitute or supplement of training along with two other more common simulation and conventional methods.

Evaluation of midwifery students' competency in providing intrauterine device services using objective structured clinical examination.

BACKGROUND: Delivering IUD services is one of the important competencies that midwifery students must obtain during academic period. As Objective Structured Clinical Examination (OSCE) can be reasonably reliable, valid and objective method for clinical skills assessment, this study was conducted to assess midwifery students' skill in delivering intrauterine device (IUD) services using a clinical examination and their satisfaction from the OSCE. METHODS: All of the 62 eligible Bachelor of Science midwifery students of Mashhad University of Medical Sciences participated in a ten-station OSCE about delivering IUD services for 50 minutes in 2006. Students performed technical skills or interacted with standard patients in 6 stations and in 4 stations they answered to the related questions. Students' performance in 6 stations was rated by observer or standard patients using validated checklists. Students' level of satisfaction and also their experience of participating in OSCE examination were gathered. RESULTS: Performance of 98.2% of students was poor. On average, the students gained 49% of total score in counseling and screening, 35.7% in inserting the IUD, 40% in IUD removal and 24.4% in management of IUD side effect. Eighty percent of students rated their satisfaction from the OSCE high and very high. Students reported the OSCE as an enjoying examination experience. CONCLUSIONS: Students' skill in delivering IUD services was lower than expected level that shows the need to change the current teaching methods. OSCE is a valid evaluation method which provides valuable information which cannot be obtained by more traditional assessment modalities. Based on the finding of this study a workshop program on providing IUD services for midwifery students and family planning providers should be prepared.

Differences in episiotomy technique between midwives and midwifery and medical students.

BACKGROUND: Episiotomy is the incision of perineum made to facilitate childbirth. Here are the two types of episiotomy: median and mediolateral. Considering the important role of incision characteristics such as length, angle and distance of initiation point from midperineum line in prevention of perineal rupture and reduction of further complications, this study investigated the comparison episiotomy in midwives and midwifery and medical students in maternity ward of hospitals of Mashhad University of Medical Sciences. METHODS: In this descriptive cross-sectional study, 127 midwives and midwifery and medical students completed the novel validated pictorial questionnaire. The length of episiotomy drawn, the distance from the sagittal plane at which the episiotomy was begun, and the angle of the episiotomy from the sagittal plane were evaluated. RESULTS: Median length of the episiotomy from the midline was 2.89 ± 0.95 cm. Episiotomies drawn by midwives more angled than those drawn by students (P = 0.04) and median distance of the episiotomy from the midline in episiotomies drawn by students were significantly more than those drawn by midwives (P = 0.0001). CONCLUSIONS: This study demonstrated some differences in the episiotomy practice by midwives and midwifery and medical students. The differences demonstrated could predispose mothers to a greater risk of anal sphincter injuries and subsequence complications in child birth.

The intelligence quotient of school aged children delivered by cesarean section and vaginal delivery.

BACKGROUND: There has always been an asking question with physicians and health staff whether delivery mode can effect on child intelligence. This study was conducted to compare the intelligence quotient (IQ) of school aged children delivered by cesarean section and vaginal delivery in Mashhad, Iran. METHODS: This study conducted in two stages; a cross-sectional section in which 5000 randomly selected children, who were 6-7 years old, attended at 10 Cognitive Examination Posts in Mashhad. The examination was performed by the Exceptional Education and Training Institute affiliated to Ministry of Education for all 6-7 years old children at the entry to the primary school. At the second stage, we selected two matched groups of 189 children who delivered by cesarean section or spontaneous vaginal delivery and then compared their IQ scores. RESULTS: The cesarean delivery group had significantly higher IQ test scores. Maternal and paternal educational levels were related to children's IQ scores. After adjusting of maternal and paternal education, maternal age and parity, there was not any significant difference between IQ scores of cesarean delivery and natural vaginal delivery groups 101(3.67) vs. 100.7(4.28). CONCLUSIONS: Based on our findings, the association between cesarean deliveries with better cognitive development in children cannot be supported.