The relationship between coping strategies and infertility self-efficacy with pregnancy outcomes of women undergoing in vitro fertilization: A prospective cohort study

Background: Assisted reproductive technology treatments are stressful procedures, but there are individual differences in the emotional response to them. Differences in response to this stress may be related to the outcome of infertility treatment. Objective: This study aimed to investigate the relationship between coping strategies and infertility self-efficacy with pregnancy outcomes of women undergoing in vitro fertilization/intracytoplasmic sperm injection treatment. Materials and Methods: This was a prospective cohort study and the 154 infertile women were psychologically evaluated in 2 stages: once before ovarian stimulation and again during embryo transfer. The research measurements used were the Revised COPE, the Depression Anxiety Stress Scale (DASS-21) and the Infertility Self-Efficacy Scale. Results: There was no significant difference between the group of non-pregnant women and the positive pregnancy group in terms of coping strategies (mental rumination, self-blame, active confronting, goal replacement, avoidance) or self-efficacy in either of the 2 stages of ovarian stimulation and embryo transfer. The Mann-Whitney test did not show any statistical difference between the clinically pregnant women and the only laboratory positive pregnant group. Moreover, the self-blame and mental rumination strategies were positively related with anxiety and depression. Conversely, active confronting, goal replacement, avoidance and self-efficacy were associated with decreased depression, anxiety and stress levels. Conclusion: It can be concluded that there is no relationship between coping strategies and infertility self-efficacy with in vitro fertilization/intracytoplasmic sperm injection outcomes. Further research is needed to clarify the effects of other psychological factors on the pregnancy outcomes of assisted reproductive treatment. Key words: Coping strategy, Self-efficacy, Infertility, In vitro fertilization, Depression, Anxiety

Comparison of Efficacy and Side Effects of Different Administration Routes of Misoprostol (Oral, Vaginal, and Sublingual) for Second-Trimester Abortion

Background The current study was designed to compare the effectiveness and side effects of oral, vaginal, and sublingual misoprostol in termination of second-trimester pregnancy. Materials and Methods: In this clinical trial (2014 to 2015), 85 pregnant women in the second trimester of pregnancy were included in Imam Reza hospital, Kermanshah, Iran. They were randomly divided into three groups as follows: oral misoprostol (n=28), vaginal misoprostol (n=30), and sublingual misoprostol (n=27). Misoprostol was administered orally (oral misoprostol group), vaginally (vaginal misoprostol group), or sublingually (sublingual misoprostol group). The dosage was similar in three groups (400 micrograms every four hours up to a maximum of five doses). The mothers were followed and induction-abortion interval time, number of dosages required, and misoprostol side effects were documented. The data were analyzed by SPSS version 20.0 software. Results: The mean (standard deviation) age of the sample was 28.27 (±4.97) years. Mean gestational age was 16.58 weeks and mean gravidity was 1.99. Mean number of administered misoprostol doses was 3.89 and most patients responded to three doses of misoprostol. Mean abortion time was 20.08 hours. No side effects were reported in 60% of the subjects. Others experienced side effects such as nausea (16.5%), fever and chills (12.9%), and vaginal bleeding (9.4%). The abortion duration in 35.3% of the subjects was within 18 hours. The most successful method was oral route (82.1%), followed by vaginal route (80%), and sublingual route (70.4%). The abortion duration was statistically different between the three groups (P= 0.001). Conclusion: Finding of the presented study showed that misoprostol is a safe medication to be used for medical abortion in the second trimester of pregnancy. Oral route of administration was superior to vaginal or rectal use of misoprostol

The Relationship between Critical Thinking Disposition and Self-Esteem

Introduction: Critical Thinking Disposition indicates individual’s inclination to Critical Thinking, which is one of the domains of personality. Individual characteristics are important and influential factors in the growth and development of students’ Critical Thinking. One of these influential characteristics might be self-esteem, thus this study was to determine the correlation between Critical Thinking Disposition and self-esteem in medical students. Methods: In an analytical cross-sectional study, 289 medical students were selected through stratified random sampling method in Kermanshah University of Medical Sciences in 2011. The instrument for data collection was a questionnaire containing 3 parts: demographic data, California Critical Thinking Disposition Inventory, and Cooper-Smith Self-Esteem Inventory. The results were analyzed by SPSS-16 using descriptive statistics, Pearson and Spearman Correlation Coefficient, ANOVA, Chi-Square and Fisher exact test. Results: Results showed that 98.6% (285) of students had deficiency, 1.4% (4) ambivalence and nobody had positive critical thinking disposition. There was a significantly negative correlation between Critical Thinking Disposition and self-esteem (r=-0.462, P<0.001). Also, there was no a significant relationship between two groups of low self-esteem , high self-esteem , negative and ambivalent Critical Thinking Disposition. Conclusion: It seems that Critical Thinking Disposition, like other psychological variables, is influenced by social factors and social environment plays a role in promoting or undermining it. So, similar studies are recommended to investigate the factors affecting Critical Thinking in medical students

Objective assessment of obstructive sleep apnea in normal pregnant and preeclamptic women

Objective: Obstructive sleep apnea (OSA) is a risk factor for adverse pregnancy outcomes. The aim of this study was to evaluate the association between OSA and preeclampsia. Methods: Between 30 and 39 weeks gestation, objective sleep apnea were evaluated in 38 normal pregnant and 40 preeclamptic women. Preeclampsia was defined by having a blood pressure (BP) > 140/90 mmHg on two occasions after the 20th week of pregnancy with excess protein in the urine (> 300 mg in 24 h) or 30 mg persistent proteinuria (+ 1 in dipsticks) in random samples. Objective sleep apnea was evaluated using an overnight in-hospital sleep evaluation using the SOMNOwatch plus Respiratory Screener. OSA was defined as an apnea–hypopnea index (AHI) ≥ 5, and further grouped into severity categories: mild (5–14.9), moderate (15–29.9), and severe (≥ 30). Results: Mean AHI was 33.3 ± 12.1 in preeclamptic women and was 23.8 ± 15.8 in normal pregnant women (p = 0.008). There was significant difference in prevalence of OSA severity (none, mild, moderate, or severe) between groups. Out of 33 preeclamptic women, 11 women had moderate and 22 women had severe OSA. Whereas, among 33 normal pregnant women, 8, 13, and10 women had mild, moderate, and severe OSA, respectively. Two normal pregnant women had no OSA (AHI< 5). Conclusion: Our study suggests women are susceptible to developing OSA during pregnancy that is associated with an increased risk of preeclampsia

Critical Thinking Disposition among Medical Students of Kermanshah University of Medical Sciences

Introduction: Critical thinking as a process of purposeful self-regulatory judgment leads to problem solving and correct decision making in individuals. In the modern world, health care faces rapid change and burgeoning amount of knowledge. Possessing critical thinking is essential for individuals in health care centers, specially when they are forced to solve clinical problems. The aim of this study was to evaluate critical thinking disposition among medical students in various levels of education.Methods: In this descriptive, cross-sectional study, we determined critical thinking disposition among 289 medical students of Kermanshah University of Medical Sciences. The students were studying at different levels of general physician education. In Iran general physician education divided into four levels; basic sciences, physiopathology courses, clerkship and internship. They were selected using stratified sampling. Data were collected using a questionnaire that consisted of two parts; demographic information of the participants and California Critical Thinking Disposition. To analysis the data, both descriptive and inferential statistics (One-way ANOVA) were employed using SPSS-16 software.Results: Our findings indicated that 98.6% of the students lacked critical thinking disposition, 1.4% were ambivalent disposition and no one had positive disposition to critical thinking. The highest acquired score of critical thinking was for truth-seeking (20.4%) and the lowest score acquired for analyticity (4.8%). The results revealed that there was no statistically significant difference between mean score of participants with regards to their critical thinking disposition in various educational levels. Conclusion: The findings of this study indicated that medical students lacked appropriate critical thinking disposition

Both melatonin and meloxicam improved sleep and pain in females with primary dysmenorrhea - results from a double-blind cross-over intervention pilot study

Up to 25% of ovulating women suffer from primary dysmenorrhea, a condition associated with pain and transient reduced quality of life, along with greater irritability and impaired sleep. In the present study, we asked whether and if so to what extent melatonin and meloxicam can improve subjective and objective sleep and reduce pain among women with primary dysmenorrhea. To this end we conducted a double-blind cross-over clinical trial lasting for three menstrual cycles. Method: A total of 14 women (mean age: M = 27.5 years) with primary dysmenorrhea took part in the study. At baseline, that is, during the first menstruation, they completed a visual analogue scale to rate pain; sleep continuity was assessed via actigraphs, and overall sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI). Next, participants were randomly assigned to one of two conditions, either melatonin during the second, and meloxicam during the third menstruation, or meloxicam during the second, and melatonin during the third menstruation. Neither participants nor investigators were aware of participants' study assignment. During the second and third menstruations, the assessments described above were repeated. Results: At baseline, sleep assessed both objectively and subjectively was impaired, and pain was high. Subjective sleep improved and pain decreased during the second and third menstruations irrespective of whether melatonin or meloxicam was administered first or second. Likewise, objective sleep efficiency increased and objective sleep latency shortened. The efficacy of melatonin was superior to that of meloxicam. Conclusions: The present pattern of results suggests that both melatonin and meloxicam are suitable to treat pain and PD-related sleep complaints among women with primary dysmenorrhea

Effect of maternal anxiety on maternal serum and fetal cord blood cortisol

Prenatal exposure to maternal anxiety and inappropriate levels of glucocorticoids may influence intrauterine growth and affect later health outcomes. We examined the relationship between maternal anxiety, maternal serum, and fetal cord blood cortisol.; Eighty-four pregnant women with gestational age above 37 weeks admitted for elective caesarian section were studied. The Spielberger State-Trait Anxiety Inventory was used to assess maternal anxiety. Maternal blood was sampled immediately before caesarean section. Cord blood sample was taken immediately after birth. Multiple regression analysis was performed.; Maternal trait anxiety score, maternal serum cortisol, and neonatal weight were associated with the fetal cord blood cortisol (r = 0.21, P = 0.04). Bivariate correlation analysis revealed a positive correlation between maternal trait anxiety and fetal cord blood cortisol (r = 0.21, P = 0.03).; These data suggested that high maternal trait anxiety increases fetus cord blood cortisol and may regulate fetal growth

Comparison of Extra-Amniotic Normal Saline Infusion plus Hydrocortisone versus Prostaglandin E2 Suppository for Pregnancy Termination

Background and Aim: Pregnancy termination before onset of labor is one of the midwifery problems. The aim of the present study was to compare extra-amniotic normal saline infusion plus hydrocortisone effect versus prostaglandin E2 suppository for cervical ripening and second- trimester pregnancy termination.   Materials and Methods: This randomized clinical-trial study was performed on 50 pregnant women with gestation age of 14 to 28 weeks and Bishops Score ≤ 2 who required pregnancy termination for fetal indications. Half of the cases received extra-amniotic normal saline infusion plus 100 mg hydrocortisone (EASI+ H) and the other half received two doses of 3mg prostaglandin E2 suppository every 4 hours. Six hours later, induction of labor was started by means of a high dose of Oxytocin according to of Alabama University Protocol for Mid-trimester Abortion. The obtained data was analyzed by using statistical softwares Chi-square, Fisher and T-test.   Results: There were no differences between the two groups regarding maternal age, parity, gestational age, Primary Bishops Score and indication of pregnancy termination. In the EASI+H group, the mean interval between initiation of labor induction and fetal expulsion was 23.04 ± 4.47 hours and in PGE2 group was 28.65 ± 2.87 hours (P=0.001). The success rate in the EASI+H group was 100% and in PGE2 group 80 % (P =0.04). Complications such as fever, nausea, vomiting, diarrhea, increase of blood pressure and need to curettage in PGE2 group were statistically and significantly more abundant.   Conclusion: Extra-amniotic normal saline infusion plus hydrocortisone is an effective and safe method that is suggested for cervical ripening and second- trimester pregnancy termination