Prevalence and Predictors of Cesarean Section in Zanjan-Iran during 2014-2016

Background: The increased prevalence of cesarean section (C–section) is a global epidemic. Objectives: The aim of this study was to determine the prevalence and demographic, fertility, and childbirth-related factors of C–section in Zanjan province, Iran,-from 21 March 2014 to 19 March 2016. Methods: This study was a descriptive analytic study, carried out in 2014–2016, which gathered 41, 265 registered childbirth data in Zanjan province hospitals and from country electronic childbirth register system. Data were analyzed using descriptive, univariate and multivariate logistic binominal regression. Results: according to the findings, the prevalence of C–section was 40.1%. The odds of having C–section went up with increasing maternal age (OR=1.026), gravidity (OR=0.670), and gestational age (OR=0.093), while it decreased with an increased parity, end educational level up to high school graduate. In contrast, higher educational (OR=3.064) level increased the odds of having C–section. Living in the urban areas (OR=1.855) also increased the oddsof C–section. Diabetes (OR=1.990), preeclampsia or eclampsia (OR=2.350), hypertension (OR=1.983), and thyroid disorders (OR=2.289) increased the odds of having C–section. Newborns with low birth weight (OR=1) and macrosomia (OR=2.663), and boys (OR=1.107) were delivered more via C–section. Among the interventions during labor, induction (OR=1.131) and stimulation of labor (OR=0.269) reduced the odds of C–section (P<0.05). Conclusion: C–section rate is very high in Iran and its association with different variables can be a basis for planning and policymaking in order to reduce the C–section rate, particularly in Zanjan province

Prevalence of unplanned pregnancy and factors related to maternal-fetal attachment in Zanjan, 2017

Background: Despite the progress of family planning programs, a significant proportion of pregnancies are still unplanned which threatens the different dimensions of community health. Unplanned pregnancy affects parent's-child association. Maternal-fetal attachment provides a model for the child's mental-social function at present and in the future. Objectives: This study was conducted to determine the prevalence of unplanned pregnancy and related factors of maternal-fetal attachment in pregnant women referring to Zanjan health centers in 2017. Methods: This descriptive correlational study was part of a clinical trial that was performed on 184 pregnant women who referred to health centers for routine prenatal care from October to February 2017 in Zanjan, Iran. Using multi-stage sampling method, health centers of Zanjan were divided into three categories based on social and economic situation. Then, from each category, three centers were selected, randomly. The inclusion criteria comprised being pregnant, satisfaction to participate in the study, have at least reading and writing skills, lack of the history of obstetric complications, psychological disease and medicine use, lack of known psychological disease, lack of narcotic substances abuse, and living in Zanjan City. Data collection tool included demographic checklists and maternal-fetal attachment questionnaire, which completed in self-report method. The data of this study were analyzed by appropriate statistical tests by SPSS v.16 software. Results: Among the participants 58.2% of women had planned pregnancy, 36.4% had unplanned pregnancy, and 5.4% had unwanted pregnancy. Maternal-fetal attachment scores were significantly higher in the planned pregnancy group 84(75-93) than the unplanned pregnancy group 57(54-60) and unwanted pregnancy group 56(48-64) (P˂0.001). The highest sub-scale in the planned pregnancy group was related to the attributing characteristics and intentions. Also, the most subscale in unplanned and unwanted pregnancies related to giving of self. There was a significant relationship between age, education, socioeconomic level, number of pregnancies, number of children and contraceptive method with type of pregnancy (P˂0.001). Conclusion: Based on the results of the study, it seems that reduction in unplanned pregnancy will enhance the maternal-fetal attachment and will improve the mother role and social-psychological health of the chil

The Effect of Vitamin E on Ameliorating Primary Dysmenorrhea: A Systematic Review and Meta‑analysis

Dysmenorrhea or painful menstruation is one of the most common problems of women. Using systematic review and meta‑analysis, this study aimed to determine the effect of vitamin E on ameliorating the intensity of pain of primary dysmenorrhea. Available databases comprising PubMed, Google Scholar, ISI, Science Direct, SID, Iran Medex, and Magiran were searched to find relevant papers. Clinical trials with the aim of the effect of vitamin E on pain reduction of primary dysmenorrhea were selected. Two independent reviewers assessed the quality of studies and extracted the necessary data. Three studies were eligible for meta‑analysis. The meta‑analysis of these studies showed that vitamin E (with or without mefenamic acid), could reduce the intensity of pain about 7% (95% CI: 2-30%). Based on these studies, vitamin E can reduce the intensity of primary dysmenorrhea.Keywords: Complimentary medicine, dysmenorrhea, vitamin

Effect of Couples Counseling Based on the Problem-Solving Approach on the Fear of Delivery, Self-Efficacy, and Choice of Delivery Mode in the Primigravid Women

Background: Fear is an important factor that causes pregnant women to opt for cesarean section. Women with the fear of childbirth consider labor pain to be beyond their power. Basically, these women request cesarean section only to avoid normal vaginal delivery, which indicates their low self-efficacy in normal vaginal delivery. Objectives: The present study aimed to investigate the effects of couples counseling based on the problem-solving approach on the fear of delivery, self-efficacy, and choice of delivery mode in the primigravid women requesting elective cesarean section in Zanjan, Iran. Methods: This quasi-experimental study was conducted on 76 pregnant women in the second trimester of pregnancy and their spouses. The women were eligible for elective cesarean section and met the inclusion criteria. The intervention was based on the problem-solving counseling approach with the couples, which was performed in three weekly sessions at the clinic of Shahid Beheshti Hospital in Zanjan, Iran. Data were collected using the questionnaires of knowledge and attitude, Wijma delivery expectancy/experience questionnaire, and Louis’ self-efficacy scale at the baseline and after one month of the final session. Data analysis was performed using independent t-test, Chi-square, and one-way analysis of variance (ANOVA). Results: Significant differences were observed in the mean scores of knowledge and attitude of women and men, and fear of delivery and self-efficacy of women between the intervention and control groups after counseling (P<0.001). The women in the intervention group were significantly more likely to do normal delivery compared to the control group (P<0.001). Conclusion: According to the results, couples counseling based on the problem-solving approach could be effective in reducing the fear of delivery and increasing the self-efficacy of primigravid women. Furthermore, it could improve the knowledge and attitude of couples, thereby decreasing the rate of cesarean section and tendency toward this mode of delivery