The prevalence of suicidal behavior and ideation during pregnancy and postpartum period, its variation in the COVID-19 pandemic, and the related factors: A systematic review and meta-analysis of observational studies

Bacground Pregnancy and postpartum are sensitive periods for mental health problems due to increased stressors and demands, and the prevalence of intentional self-harming behaviors such as suicidal behavior and ideation may increase. Changes in the provision of prenatal care services and utilization of health services and adverse living conditions during the COVID-19 epidemic may also trigger or exacerbate mental illnesses. Aims To investigate the prevalence of suicidal behavior and ideation encountered during pregnancy and postpartum period, its change in the COVID-19 pandemic, and the related factors. Methods A systematic review and meta-analysis of observational studies was conducted. A search was conducted in April 2021 and updated in April 2023 on Web of Science, PubMed, PsycINFO, EBSCO, Turk Medline, Turkish Clinics, and ULAKBIM databases. Two authors independently conducted the search, selection of articles, data extraction, and quality assessment procedures, and an experienced researcher controlled all these steps. Joanna Briggs Institute's Critical Appraisal Checklists were used to assess the quality of the studies. Results The meta-analysis included 38 studies and the total sample size of the studies was 9 044 991. In this meta-analysis, the prevalence of suicidal behavior in women during pregnancy and postpartum periods was 5.1 % (95 % CI, 0.01–1.53), suicidal ideation 7.2 % (95 % CI, 0.03–0.18), suicide attampt 1 % (95 % CI, 0.00–0.07) and suicidal plan 7.8 % (95 % CI, 0.06–0.11). Rate of suicidal behavior, ideation/thought increased and attempts in the pandemic process (2.5% vs 19.7 %; 6.3% vs 11.3 %; 3.6% vs 1.4 %, respectively). Prevalences of suicidal behavior, ideation, attempts, and plan in the postpartum period was higher than during pregnancy (1.1% vs 23.4 %; 6.1% vs 9.2 %; 0.5% vs 0.7 %; 7.5% vs 8.8 %, respectively). ... (AU)

The use of hydrotherapy in the first stage of labour: A systematic review and meta-analysis.

AIM: To explore the effect of hydrotherapy applied in the first stage of labour on the health of mother and newborn. METHODS: This systematic review and meta-analysis was carried out by following PRISMA. The studies were obtained by scanning EBSCO, PubMed, Science Direct, Ovid, Web of Science and Scopus electronic databases. Twenty studies published between 2013 and 2023 were included. RESULTS: The total sample size of the studies was 8254 (hydrotherapy: 2953, control: 5301). Meta-analyses showed that the perception of pain decreased, comfort level and vaginal birth rate were higher and assisted vaginal birth rate and APGAR scores in the first minute were lower in women who underwent hydrotherapy. There was no difference between groups in terms of the duration of the first and second stage of labour, episiotomy, perineal trauma, intrapartum and postpartum bleeding amounts, use of pain medication and labour augmentations, APGAR scores in the fifth minute, positive neonatal bacterial culture and neonatal intensive care unit need. CONCLUSION: This study revealed that the results that hydrotherapy decreased the perception of pain and assisted birth, increased the rate of vaginal birth and comfort level and did not adversely affect the health of the mother and baby during the birth process.

Effectiveness of structured education and follow-up in the management of perceived breastmilk insufficiency: A randomized control trial.

In this study, we examine the effectiveness of structured education and follow-up in the management of perceived milk insufficiency and in increasing the baby's amount of milk intake in breastfeeding mothers. We conducted a randomized controlled trial over the period December 2018-June 2019 at Family Health Centers in Turkey with 64 mothers (intervention group: 33 and control group: 31). We provided the intervention group with education using structured educational material. A Descriptive Information Form, a Breastfeeding Follow-up Form, and the Scoring System for Measuring a Baby's Intake of Breast Milk were the instruments we used in the data collection. Mothers in the intervention group started breastfeeding their babies in the first one hour after birth. We observed at each monitoring that a significantly greater percentage of the mothers in the intervention group believed their milk to be sufficient and that they fed their babies exclusively with breast milk in the three follow-ups. We found from the data we obtained that all three tracking times indicated that the baby's amount of milk intake in the intervention group was better than in the control group; the differences were statistically significant. We concluded that structured education and follow-ups increased the exclusive breastfeeding of 0-2-month-old babies, improved perceptions of sufficient milk intake, diminishing the perception of breast milk deficiency.Supplemental data for this article is available online at https://doi.org/10.1080/07399332.2021.2007249.

Does kinesio taping have an effect on kinetics and kinematics after lower limb musculoskeletal injuries? Systematic review and meta-analysis.

PURPOSE: The systematic review aimed to investigate the effects of kinesio taping on the lower extremity kinetics and kinematics after a musculoskeletal disorder. METHOD: Randomized controlled studies reported kinetic or kinematic outcomes (such as joint moment force or angular displacement) in the lower extremity with musculoskeletal disorders were included. A systematic literature search of Web of Science, Scopus, PubMed, EBSCO, and PEDro databases was performed up to 28 February 2021. Meta-analysis was performed, when possible, by using mean difference (MD) and standard mean difference (SMD). RESULTS: Ten randomized controlled trials met the inclusion criteria. The results of a meta-analysis based on included studies show that the use of kinesio taping has similar effects on the kinetics of the lower extremities with musculoskeletal disorders or the control group. These effects do not change between 0 and 24 h, 1 and 15 days, and 15 and 30 days (SMD = 0.01, 95% CI -0.30 to 0.31, p = 0.21). CONCLUSION: This study provides insufficient evidence to prove the effect of kinesio taping on lower extremity kinetics and kinematics on patients with musculoskeletal disorders in shorter and longer terms. Methodologically well-designed studies are needed to show the effectiveness of kinesio tape on lower extremity kinetics and kinematics after a musculoskeletal disorder in short and longer terms.IMPLICATIONS FOR REHABILITATIONThe present evidence does not support the effects of Kinesio tape on lower extremity kinetics in patients with a musculoskeletal pathologyMore evidenced based studies are still needed to show the effects of kinesio taping on lower extremity kinetics in patients with a musculoskeletal pathologyThis meta-analysis demonstrated that kinesio taping had no effect for up to 30 days within the scope of the results obtained from the studies, except for the immediate effect of the application.

Effects of the Covid-19 Pandemic on the Prevalence of Insomnia, Anxiety, and Depression During Pregnancy: A Systematic Review and Meta-Analysis.

This systematic review and meta-analysis study aims to determine the effects of the Covid-19 pandemic on the prevalence of insomnia, anxiety, and depression symptoms during pregnancy. Reviews were done through PubMed, EBSCO (Medline, CINAHL), Embase (OVID), Web of Science, PsycINFO, TR Index, Turkish Thesis Center databases using (pregnancy OR pregnant) and (sleep OR sleep disorders OR insomnia), and (anxiety OR depression) keywords between April and May 2021. The meta-analysis included 48 articles (sample: 77,299). It was found that the Covid-19 pandemic did not affect the prevalence of depression symptoms and anxiety during pregnancy, but it increased insomnia. While insomnia ratio was reported 39.6% (95% CI: 0.253-0.560) in the studies conducted before the pandemic, it was reported 88.8% (95% CI: 0.821-0.921) in the studies conducted during the pandemic. This study found that the Covid-19 pandemic did not have effects on depression symptoms and anxiety, but it increased insomnia complaints.

Maternal and perinatal outcomes of pregnancy associated with COVID-19: Systematic review and meta-analysis.

INTRODUCTION: This study explored maternal and infant outcomes in the periods of pregnancy, birth and the postpartum, in women with COVID-19. METHODS: After PROSPERO registration (CRD42020191106), scanning for the studies was carried out over the period 5-15 May 2020 in the PubMed, Science Direct, EBSCO and Web of Science databases with the search string: ['COVID-19' AND ('pregnancy' OR 'pregnant' OR 'maternal outcomes' OR 'infant outcomes' OR 'fetal outcomes' OR 'birth')]. Studies reporting maternal and perinatal outcomes of pregnant women with COVID-19 were included. Data were extracted independently by two researchers and combined with meta-analysis and pooled analysis. RESULTS: The 54 studies included in this analysis contained data on 517 pregnant women diagnosed with COVID-19 and 385 infants. Of the pregnant women, 18% had gone into preterm labor and 77% had given birth by caesarean. Of the newborns, 19% had low birth weight, 14% had fetal distress, and 24% were admitted into the neonatal intensive care unit. Nine maternal and eight baby mortalities were reported in the studies. CONCLUSIONS: The study revealed that COVID-19 in pregnant women appeared to be negative maternal and infant outcomes, with mortalities as well.

The impact of telehealth applications on pregnancy outcomes and costs in high-risk pregnancy: A systematic review and meta-analysis.

INTRODUCTION: Telehealth is an applicable, acceptable, cost-effective, easily accessible, and speedy method for pregnant women. This study aimed to examine the impact of telehealth applications on pregnancy outcomes and costs in high-risk pregnancies. METHODS: Studies were selected from PubMed, Science Direct, Web of Science, EBSCO, Scopus, and Clinical Key databases according to the inclusion and exclusion criteria from January to February 2021. Cochrane risk-of-bias tools were used in the quality assessment of the studies. RESULTS: Four observational and eight randomized controlled studies were included in this meta-analysis (telehealth: 135,875, control: 94,275). It was seen that the number of ultrasound (p < 0.01) and face-to-face visits (p < 0.01), fasting insulin (p < 0.01), hemoglobin A1C before delivery (p < 0.01), and emergency cesarean section rates (p = 0.05) were lower in the telehealth group. In the telehealth group, the women's use of antenatal corticosteroids (p = 0.03) and hypoglycemic medication at delivery (p = 0.03), the total of nursing interventions (p < 0.01), compliance with actual blood glucose measurements (p < 0.01), induction intervention at delivery (p = 0.003), and maternal mortality (p < 0.001) rates were higher. Two groups were similar in terms of the use of medical therapy, total gestational weight gain, health problems related to pregnancy, mode and complications of delivery, maternal intensive care unit admission, fetal-neonatal growth and development, neonatal health problems and mortality, follow-up, and care costs. DISCUSSION: Telehealth and routine care yielded similar maternal/neonatal health and cost outcomes. It can be said that telehealth is a safe technique to work with in the management of high-risk pregnancies.

The impact of adolescent pregnancy on maternal and infant health in Turkey: Systematic review and meta-analysis.

OBJECTIVES: To examine the impact of adolescent pregnancy on maternal and infant health on the basis of studies conducted in Turkey. MATERIAL AND METHODS: Systematic reviews and meta-analyses of cross-sectional and case-control. A systematic scan was performed in January 2020 based on the keywords "adolescent pregnancy or teenage pregnancy and Turkey" in the electronic databases PubMed, Clinical Key, Science Direct, Web of Science, Google Scholar, National Thesis Center, DergiPark, Ulakbim, Turkish Medline and Turkish Clinics. Two of the authors carried out a scan independently of each other, making a selection of articles, performing data extraction and quality assessment procedures under the supervision of the senior researcher. RESULTS: The results of a total of 38 studies, of which twenty-three were cross-sectional and 15 were case-control, were compiled for the meta-analysis (adolescents: 20,768; control: 59,481). The results of the meta-analysis showed that the more common effects of adolescent pregnancies were preterm birth (OR: 2.12, p < 0.001), early membrane rupture (OR: 1.49, p < 0.001), anemia (OR: 2.60, p < 0.001), low birthweight/intrauterine growth retardation (OR: 2.06, p < 0.001), and fetal distress (OR: 1.78, p = 0.003). On the other hand, it was observed in the meta-analysis that childbirth by cesarean section (OR: 0.70, p < 0.001), gestational diabetes (OR: 0.35, p < 0.001), placenta previa (OR: 0.52, p = 0.01), polyhydramnios (OR: 0.52, p = 0.04) and macrosomia (OR: 0.54, p < 0.001) were less common among adolescents compared to adults. CONCLUSION: Our review revealed that adolescent pregnancy had an adverse impact on maternal and infant health in terms of preterm childbirth, early membrane rupture, anemia, low birthweight/intrauterine growth retardation, low Apgar scores and fetal distress.

The prevalence and risk factors of gestational diabetes mellitus in Turkey: a systematic review and meta-analysis.

OBJECTIVE: To identify the prevalence and related risk factors of gestational diabetes mellitus (GDM) based on studies on the condition conducted in Turkey. METHODS: The study is a systematic review and meta-analysis and was conducted over the period November-December 2017 by performing a search of the Turkish and English literature. The international databases were accessed using the keywords "gestational diabetes" and "Turkey" and the national databases were scanned using the word groups, "gestational diabetes", "diabetes in pregnancy", "pregnancy and diabetes," and "pregnancy diabetes". Forty-one complete articles on research carried out in Turkey over the period 2004-2016 and published in 2006-2018 on the prevalence of GDM and/or a reported risk factor were included in the study. Combined percentage calculations were employed to determine GDM prevalence. RESULTS: It was found in this systematic review and meta-analysis of the studies examined that out of the total of 50,767 pregnant women included in the studies, 3891 had GDM. Based on these data, combined GDM prevalence was calculated as 7.7% (range: 1.9-27.9%). It was observed that the highest combined GDM prevalence was 17.6% in the black Sea Region and the lowest was 5.1% in the Central Anatolian Region. Fourteen risk factors had been reported as statistically significant in the studies included in the systematic review. The most commonly reported of these was advanced maternal age, being overweight prior to pregnancy, gaining weight in pregnancy, diabetes in the family, a history of GDM or giving birth to a large baby. CONCLUSIONS: It was observed in this meta-analysis that the prevalence of GDM in Turkey is notably high and risk factors are similar to what has been reported in current international literature. The continuation of routine screening tests to detect GDM may contribute to controlling the condition while ensuring that risk groups take special preventive measures and mother-child health is protected. IMPLICATIONS FOR PRACTICE: Results of this study might be used in the organization of prenatal care, especially high-risk pregnant women for GDM. Nursing researchers and health care managers should consider this situation in the implementing of prenatal care serving.

Comparison of blood pressure and pulse readings measured on a bare arm, a clothed arm and on an arm with a rolled-up sleeve.

BACKGROUND: Although there are standards for measuring blood pressure and pulse, nurses and other health professionals implement different practices. It has been observed that these measurements are sometimes taken over sleeves or with rolled-up sleeves due to various cultural factors or as a matter of convenience. There is a need to investigate whether measurements taken in this form can be counted on to be reliable. OBJECTIVE: This study aimed to compare blood pressure and pulse readings measured on a bare arm, a clothed arm and on an arm with a rolled-up sleeve. METHODS: This study, of analytical design, was conducted with 200 individuals at the Adnan Menderes University Research and Practice Hospital in January and December 2017. A questionnaire and a measurement recording form were used in collecting the data. The participants' blood pressure and pulse readings were taken and the circumference of the clothed and bare arm and arm skinfold thickness was measured. The data were analyzed using descriptive statistics, the independent samples t-test, and Pearson's correlation test. RESULTS: The mean age of the individuals participating in the study was 33.38 ±â€¯9.14 (range: 19-51). It was observed that in the measurements taken over a bare and clothed arm, mean systolic (114.48 ±â€¯13.18 and 114.72 ±â€¯12.21, respectively) and diastolic (70.42 ±â€¯8.72 and 70.24 ±â€¯8.63, respectively) blood pressure readings were statistically similar (t = -0.41, p = 0.682; t = 0.45, p = 0.653, respectively). On the other hand, in the measurements taken over an arm with a rolled-up, constricting sleeve, it was observed that mean systolic (116.76 ±â€¯13.00) and diastolic (71.99 ±â€¯9.15) blood pressure readings were statistically higher than measurements taken over a bare arm (t = -3.88, p = 0.000; t = -3.75, p = 0.000, respectively) and a clothed arm (t = -3.43, p = 0.001; t = -4.31, p = 0.000, respectively). Similarly, pulse readings taken from an arm with a rolled-up, constricting sleeve (82.40 ±â€¯12.15) were found to be statistically higher than pulse readings taken from a bare arm (79.68 ±â€¯12.30) and a clothed arm (80.44 ±â€¯11.10) (t = -6.78, p = 0.000; t = -5.50, p = 0.000, respectively). The analysis indicated blood pressure and pulse readings were positively correlated with arm thickness but not correlated with the arm skinfold thickness or the thickness of the clothing. CONCLUSION: The study revealed that constricting rolled-up sleeves and the thickness of the circumference of the arm were factors that produced higher systolic and diastolic blood pressure and pulse readings.

The impact of prenatal education based on the Roy adaptation model on gestational hypertension, adaptation to pregnancy and pregnancy outcomes.

OBJECTIVE: To analyse the impact of prenatal education on gestational hypertension, adaptation to pregnancy and on maternal and neonatal outcomes. METHODS: The quasi-experimental case-control study was conducted at Aydin Maternity and Children's Hospital, Aydin, Turkey, from October 2013 to July 2015, and comprised women with gestational hypertension. The sample was randomised into education and control groups with the former receiving informative education and the latter receiving due medical care alone. Roy Adaptation Model was used to determine the impact of prenatal education. SPSS 20 was used for data analysis. RESULTS: Of the 132 subjects, 68(51.5%) were in the education group and 64(48.5%) in the control group. Postintervention, 11(16.2%) women in the education group and 37(57.8%)in the control group developed severe preeclampsia. Subsequently, 44(64.7%) in the education group had no preeclampsia. The corresponding number in the control group was 15(23.4%). CONCLUSIONS: Education based on Roy Adaptation Model proved to be effective among pregnant women in keeping hypertension under control.

The Cost of Prenatal Care Services in the City of Aydin: A Cross-Sectional Study.

AIM: To determine the cost of prenatal care services provided to pregnant women in the city of Aydin, Turkey. METHOD: This cross-sectional study was conducted over the period of February-December 2016 at the Aydin Maternity and Children's Hospital. The convenience sampling method was used to recruit 403 women who were in weeks 36-42 of pregnancy into the study. Data for the study were collected with the Descriptive Information Form and the Prenatal Care Service Usage Form. Descriptive statistics, Mann-Whitney U and Kruskal-Wallis tests were used to analyse data. RESULTS: It was determined that the pregnant women were followed up an average total number of 10.94±4.30 times and 97.0% received care at the state hospital. It was found that for each pregnant woman, the mean total cost of prenatal care was $138.77±$93.44, the sum paid by general health insurance was $96.12±$46.38, individual contributions stood at $25.05±$10.43 and payments made to the private institutions was $110.32±$142.31. It was observed that the total prenatal care cost was not influenced by some of the characteristics of the pregnant women. CONCLUSION: It was revealed in the study that most pregnant women received prenatal care at the state hospitals and at family health centers and that they had approximately 11 prenatal care follow-ups amounting to a total mean cost of about $139. A contribution can be made to making prenatal care more cost-effective by organizing the number and scope of prenatal care sites on the basis of the individual characteristics of risk factors pregnant women.

Breastfeeding problems and interventions performed on problems: systematic review based on studies made in Turkey.

To determine the breastfeeding problems encountered in the postpartum period and effect of interventions done in relation to the problems based on breastfeeding studies in Turkey. This study is a systematic review and was conducted by performing a scan of the Turkish and English literature over the period October 2016-February 2017. The study included 27 articles and seven theses, which were published in 2000-2015 in Turkey and published in 2008-2017. Data are presented tabulating and the aggregate percentages were calculated for some data showing common characteristics. A total of 6736 parents and 592 babies were included in these studies. As a result of the combined percentage calculation based on the data of cross-sectional and case-control studies, the most frequently reported problems were having breastfeeding problem (24.5%), mother's milk deficiency/worry about milk deficiency/thinking her baby is not satisfied/baby's inadequate weight gain (15.7%), lack of knowledge and experience about breastfeeding/need for education and support (17.8%). Again, these studies showed that women stated the problems about have flat/depressed/small nipple (7.7%), pain/sensitivity (3.9%), swelling/fullness/engorgement (10.8%), redness (28.8%), crack/wound/bleeding (26.1%) and mastitis (5.6%). Methods of prenatal education/counselling/motivation/follow-up, strong motivation, proactive lactation management and social support, moist warm application, using of breast milk and olive oil and using of breast shield and feeding with container and pacifier using have been reported to be effective in the experimental/quasi-experimental and case report studies included in this systematic review. This study showed that women experienced a lot problem with breastfeeding and that more prenatal education/counselling/monitoring was used in reducing problems.

Status of postpartum depression in Turkey: A meta-analysis.

We determined the prevalence of postpartum depression (PPD) and related risk factors in Turkey based on relevant research. This study is a systematic review and meta-analysis and was conducted by performing a scan of the Turkish and English literature over the period of January-February 2016. Most of the research included in this systematic compilation made use of the Edinburgh Postpartum Depression Scale. The scans executed indicated that 4,740 women out of 18,780 were at risk for PPD. In the computations made based on these data, it was found that the consolidated prevalence of PPD was 24% (21%-27% at a confidence interval of 95%) and that this rate varied between 9% and 51%. The study revealed 54 risk factors related to PPD. Those most commonly reported were mental problems/depression prior to pregnancy, unplanned/unwanted pregnancy, low income/socioeconomic level, bad marital relationship/problems with spouse/dissatisfaction with married life, and being a housewife. In this study, we showed that the prevalence rate of PPD is significantly high, that it varies within a wide range, that the prevalence of depression decreased with the increase of the time passed after childbirth, and that it is related to numerous and different factors.

The correlation between mothers' participation in infant care in the NICU and their anxiety and problem-solving skill levels in caregiving.

OBJECTIVE: To examine the correlation between mothers' participation in infant care in the Neonatal Intensive Care Unit (NICU) and their anxiety and problem-solving skill levels in caregiving. METHODS: The cross-sectional study was conducted with 340 mothers whose babies were in the NICU. Data were collected with a questionnaire, a Participation in Caregiving Observation Form, the State and Trait Anxiety Inventory and the Problem-solving Skills Evaluation Form. Descriptive statistics and correlation analysis were used in the evaluation of the data. RESULTS: The mothers were with their babies an average of 6.28 ± 2.43 (range: 1-20) times a day, participating in many basic procedures of care. A negative correlation was found between the mothers' scores on the Participation in Caregiving Observation Form and their State and Trait Anxiety Inventory scores (respectively, r = -0.48, p < 0.001 and r = -0.12, p < 0.05), but a positive correlation was observed between the Problem-solving Process (r = 0.41, p < 0.001) and the Baby Care Skills (r = 0.24, p < 0.001) Subscale scores. CONCLUSIONS: The study revealed that mothers participated in many basic caregiving procedures in the NICU and this participation resulted in reduced state and trait anxiety levels and an improvement in the mothers' problem-solving skills with respect to baby care and related problems.

Applying fundal pressure in the second stage of labour and its impact on mother and infant health.

We examine the prevalence of the practice of applying fundal pressure in the second stage of labour, the technique used, and its impact on mother and infant health. This analytical cross-sectional study was conducted in a state hospital in the city of Bursa, Turkey with 350 women giving vaginal birth in gestational weeks 37-42. We found that fundal pressure is commonly applied but that this is done without a specific indication, that it is more associated with the performance of an episiotomy, and at the same time, the use of the technique does not have an adverse impact on maternal satisfaction or the health of the mother and infant.

Evaluating the content and quality of intrapartum care in vaginal births: An example of a state hospital.

OBJECTIVE: The purpose of the research was to assess the content and quality of the intrapartum care offered in vaginal births in Turkey, based on the example of a state hospital. MATERIALS AND METHODS: This cross-sectional study was conducted between January 1st, 2013 and December 31st, 2014 at Aydin Maternity and Children's Hospital. The study sample consisted of 303 women giving vaginal birth, who were recruited into the study using the method of convenience sampling. Research data were collected with a questionnaire created by the researchers and assessed using the Bologna score. Numbers and percentages were assessed in the data analysis. RESULTS: The mean age of the women was 25.14±5.37 years and 40.5% had given one live birth. Of the women, 45.2% were admitted to hospital in the latent phase, 76.6% were administered an enema, 3.3% had epidural anesthesia, 2.6% delivered using vacuum extraction, and 54.1% underwent an episiotomy. Some 23.8% of the women experienced spontaneous laceration that needed sutures. The babies of two women exhibited an Apgar score below 7 in the fifth minute. When the quality of the intrapartum care given to the women was assessed with the Bologna score, it was found that 92.7% went into labor spontaneously, 100% of the births were supervised by midwives and doctors, 97.7% of the women had no supporting companion, and the nonsupine position was only used in 0.3% of the women. A partogram was used to follow up on the birth process in 72.6% of the women, and 82.5% achieved contact with their babies within the first hour after birth. Induction was applied in 76.6% of the women and fundal pressure in 27.4%. CONCLUSION: The study revealed that the quality of intrapartum care in vaginal births was inadequate. Reformulating the guidelines regarding intrapartum care in accordance with World Health Organization recommendations and evidence-based practices may contribute to improving mother and infant health.

The feeling of discomfort during vaginal examination, history of abuse and sexual abuse and post-traumatic stress disorder in women.

AIMS AND OBJECTIVES: To examine the feeling of discomfort during vaginal examinations, history of abuse and sexual abuse and post-traumatic stress disorder in women to determine the correlation between these variables. BACKGROUND: Women who have experienced abuse or sexual abuse may feel more discomfort during vaginal examinations and may perceive a sensation similar to what they experienced during sexual abuse. DESIGN: Cross-sectional. METHODS: This study included 320 women receiving a vaginal examination. The data were collected using a questionnaire composed of items related to descriptive characteristics, vaginal examinations and violence, a visual analogue scale of discomfort, and the Post-Traumatic Stress Disorder Scale-civilian version. RESULTS: The mean score for the feeling of discomfort during vaginal examinations was 3·92 ± 3·34; 26·3% of the women described discomfort. Thirty-eight (12%) of the 320 women had experienced emotional violence, 25 (8%) had experienced physical violence, and 25 (8%) had been forced into sexual intercourse by their spouses. Of the women, 64·7% suffered from post-traumatic stress disorder, and physical, emotional and sexual violence were found to increase the possibility of this disorder. Exposure to emotional violence increased the possibility of discomfort during vaginal examinations by 4·5 (OR = 4·482; 95% CI = 1·421-14·134). Post-traumatic stress disorder (OR = 1·038; 95% CI = 1·009-1·066) was found to increase the possibility of discomfort during vaginal examinations; however, as the number of live births increases, women reported a reduction in their discomfort with vaginal examinations. CONCLUSION: This study revealed a positive correlation between discomfort during vaginal examinations and emotional violence and post-traumatic stress disorder but a negative correlation between discomfort during vaginal examinations and the number of live births. In addition, having a history of abuse and sexual abuse was found to increase post-traumatic stress disorder. RELEVANCE TO CLINICAL PRACTICE: Considering these findings during vaginal examinations may help change women's experiences for the positive and reduce the trauma, this procedure may cause.

Effectiveness of Structured Education in Reduction of Postpartum Depression Scores: A Quasi-Experimental Study.

The aim of this study was to evaluate effectiveness of structured education in reduction of postpartum depression scores among women. This was a quasi-experimental study with a pre-post tests and a control group. Non-random sampling was used and the study included a total of 103 Turkish women, 52 of whom were in the intervention group and 51 were in the control group. The women in the intervention group were offered structured education for postpartum depression and given structured education material. Effectiveness of the education given was evaluated by comparing scores for Edinburg Postpartum Depression Scale obtained before and after delivery between the intervention and the control groups. Before education, median score (8.0±4.8) for Edinburg Postpartum Depression Scale of the intervention group were significantly higher the than the control group (6.0±6.0, p=0.010), but the groups were statistically similar in terms of having depression (intervention: 17.3%, control: 11.8%, p=0.425). After education, the median score for Edinburg Postpartum Depression Scale and the ratio of the women having depression in the intervention group were significantly lower than in the control group (respectively intervention: 4.0±3.0, control: 10.0±4.0, p=0.000; intervention: 7.7%, control: 25.5%, p=0.015). Besides, the median score (8.0±4.8) of the intervention group before education were significantly higher than the score (4.0±3.0) obtained after education (p=0.000), while the median score (6.0±6.0) of the control group before education were lower than the score (10.0±4.0) obtained after education (p=0.000). This study revealed that structured education offered to women by nurses was effective in reducing the postpartum depression scores and the numbers of women having depression.

Evolving understanding and treatment of labour dystocia.

The objective of the review is to critically review the diagnosis and management of dystocia in the first stage of labour. We conducted a narrative review of research since 1998. Eight studies were identified, four about the onset and duration of active phase of the first stage of labour, one on the diagnosis of dystocia, and three focused on the treatment of dystocia. The review demonstrates that current understandings of dystocia rest on outdated definitions of active first stage of labour, its progress and on treatments with an equivocal evidence base. These include the cervical dilatation threshold for active first stage, uncertainty over whether a reduced rate of dilatation and reduced strength of uterine contractions always represent pathology and the effectiveness of amniotomy/oxytocin for treating dystocia. Prospective studies should evaluate the impact of defining the active phase of the first stage of labour as commencing at 6 cm dilated and should test this definition in combination with Zhang's revised partogram.