Admission Process of Low Risk Women in Labour: Development of an Evidence-based Protocol

Abstract Introduction: To protect normal birth, admission of pregnant women in labour units is one of the most important decisions. This study developed a protocol for admission of women during labour in order to improve the accuracy of the diagnosis of onset of labour. Methods: First the admission processes of 25 pregnant women were observed in the study hospital. Then the multi-disciplinary team searched and reviewed the Iranian database using related key words. Evidence-based medicine resources and other databases were searched using related key words for the most important symptoms in relation to the onset of active labour as well as early labour assessment programs. Results: The results of observation of the admission process in the study hospital and review of the literature indicated that low-risk pregnant women in labour were admitted using different criteria. The evidence-based protocol for admission of women in labour was developed using these criteria to provide a guide, which lists the necessary measures in dealing with women in various situations during the onset of labour. Presence of regular uterine contractions, cervical dilatation ≥ 4 cm and effacement should be considered as signs of starting labour, which may be accompanied by spontaneous rupture of membranes or bloody show. Conclusions: Protocols are appropriate clinical tools for the design and standardization of clinical processes based on the available evidence. This protocol could be used in a multi-center clinical trial to assess its effectiveness

Development and psychometric properties of Midwives' Knowledge and Practice Scale on Respectful Maternity Care (MKP-RMC)

ObjectiveTo develop a scale for evaluating knowledge and practice of midwives on Respectful Maternity Care (RMC).MethodsAn exploratory sequential mixed method study was conducted from January 2018 to July 2019 in two non-teaching public hospitals in Tehran, Iran. In the first part of the study, a literature review and qualitative study were carried out in order to develop the preliminary item pool. Then face, content and construct validity and reliability (internal consistency and test-retest) were assessed.ResultsThe MKP-RMC scale has 23-item in knowledge and 23-item in practice section that loaded in three factors: Giving emotional support, providing safe care and preventing mistreatment. Exploratory factor analysis accounted for 43.47% and 58.62% of observed variance in knowledge and practice sections, respectively. The internal consistency and internal correlation coefficient of both section of MKP-RMC indicated acceptable reliability.ConclusionThe MKP-RMC is a valid and reliable tool for measuring midwives' knowledge and practice of respectful care during labor and childbirth. The MKP-RMC could be used in maternity services to evaluate and improve quality of childbirth care through development of educational interventions for effective behavioral change. Confirmation of validity and reliability of translated version of the scale in other maternity care providers and different contexts is recommended

Effects of Sex Hormones in Combined oral Contraceptives and Cyclofem on Female Sexual Dysfunction Score: A Study on Iranian Females

AbstractIntroduction: Unwanted pregnancy can endanger reproductive health, and its complications could adversely affect quality of life in females, families, and the community. A large number of unwanted pregnancies are terminated with abortion or stillbirth. Sex is an important aspect of quality of life. According to reproductive rights, females have the right to experience a safe and enjoyable sexual relationship. This study aimed at comparing sexual function scores between females taking combined oral contraceptives and Cyclofem at health centers affiliated to Shahid Beheshti University of Medical Sciences of Tehran, Iran, During Year 2013.Methods: This descriptive-comparative study was carried -out on 240 females (each group 120) in Tehran, Iran, by multistage sampling. Data collection tools had 3 parts; General Health Questionnaire (GHQ), demographic variables, and Female Sexual Function Index (FSFI) that were completed by interviews. Descriptive statistics, independent t, Mann-Whitney test, chi-square, and SPPS16 were used for analysis of data. P-values less than 0.05 were considered statistically significant.Results: The difference in sexual function between combined oral contraceptives and cyclofem was insignificant. Scores of desire and arousal dimensions were better in combined oral contraceptive consumers than cyclofem users.Conclusions: It is important for females to choose hormonal contraception methods, which are the most effective, yet, cause the least sexual dysfunction

Psychometric Evaluation of the Persian Version of the Childbirth Experience Questionnaire (CEQ)

Women’s childbirth experience is an outcome indicator for evaluating maternity care. This study evaluated the psychometric properties of the Persian version of the Childbirth Experience Questionnaire (P-CEQ). The study recruited two hundred and fifty primiparous postpartum women in the 1-3 months following birth from one private and three public hospitals in Mazandaran province, Iran. First, face validity and content validity were evaluated. Moreover, confirmatory factor analysis (CFA) was conducted, and discriminant validity was assessed by applying the known-groups method. Intraclass correlation coefficient (ICC) was measured to confirm the stability and Cronbach’s alpha to confirm the internal consistency. CFA also confirmed the values of fit indices (RMSEA = 0.05, SRMSR = 0.06, CFI >0.93, χ2/df = 1.80). ICC was 0.88 and Cronbach’s alpha for all items was 0.85. Furthermore, discriminant validity of the P-CEQ was approved given that it effectively differentiated women whose stay in the labor unit exceeded twelve hours from those with a shorter stay. The P-CEQ questionnaire is a valid and reliable tool for assessing childbirth experiences. It is an easy-to-use questionnaire that can be used for evaluating quality of care in terms of women’s childbirth experience. It can be used in maternity services that aim to improve quality of care during labor and childbirth

Perinatal Outcomes of Idiopathic Polyhydramnios with Normal Ultrasound: A Systematic Review and Meta-Analysis

Background: Incidence of polyhydramnios in various studies has been reported from 0.2 to 3.9%. Approximately, 50-60% of cases are idiopathic with no known etiology. We aimed to investigate perinatal outcomes of idiopathic polyhydramnios with a normal ultrasound. Materials and Methods: In this study, Persian and English databases including Barakatkns, SID, Magiran, Medline, Science Direct, Scopus, Cochran, Embase, and ProQuest were searched for articles published from 1950 to August 2018. The search procedure was conducted with keywords related to "idiopathic polyhydramnios", "perinatal outcomes", "normal ultrasound", and their equivalents in "Mesh" and PICO. In meta-analysis, first we quantified heterogeneity by using I2 statistics and tested using the Cochran’s Q test. Even when a low heterogeneity was detected, a fixed-effects model was applied, and for more than 75% of heterogeneity, random-effects model was used. The Forest Plot chart was drawn up and the relative risk (RR) estimate for each study (ES), the pooled estimate of "RR" by combining all the studies and its 95% CI, and the P-value associated with it, were indicated. Results: In this study, 13 articles involving 325,426 pregnant women were included for the Meta-analysis. The RR and 95% CI of Caesarian Section (C.S), 1.61(1.25-2.07), macrosomia, 1.84(1.40-2.42), preterm delivery, 2.45(1.29-4.64), NICU admission, 2.90(1.77-4.74), Apgar score min

Midwives' perspectives of respectful maternity care during childbirth: A qualitative study.

The adoption of respectful maternity care during labor and birth is a complex process which needs both scientific and interpersonal skills of providers. In this regard, identifying the potential barriers and applying effective strategies for implementing respectful maternity care are essential. This study aimed to explore the perceptions of Iranian midwives regarding respectful maternity care during labor and childbirth. This was a qualitative study which was conducted from September-December 2018 in two non-teaching public hospitals in Tehran, Iran. Twenty-four semi-structured interviews were conducted with midwives, who had more than one year work experience in labor and childbirth units, through a purposive sampling method. A content analysis approach was used to analyze the data and identify themes. Three themes were extracted including "showing empathy", "women-centered care" and "protecting rights". Showing empathy reflects that "establishing a friendly relationship" and "being with women". Women-centered care encompassed "keeping women safe" and "participating in decision making". Protecting rights reflected a need for "safeguarding dignity" as well as "giving equal care" and "preparing appropriate environment". Iranian midwives considered respectful maternity care a broader concept than just preventing mistreatment. Providing supportive care through friendly interaction with women was the first step for providing respectful maternity care. Respectful care is also promoted by providing safe care, implementing evidence-based care and involving women in their care as well as by providing an appropriate environment for women, families and caregivers

Study of Awareness and Performance of Ahvazi Midwives about Physiologic Childbirth in Public Hospitals, 2016

Abstract Introduction: To promote normal childbirth the care during childbirth should be on evidence-based care. Evidence-based care practices promote physiological birth and midwives.  This study studied midwives’ awareness and performance about physiological childbirth in Ahvaz publiv maternity services.Methods: This descriptive study was conducted on maternity units in which 128 midwives were recruited using census sampling. The researcher made questionnaire were used for self-reporting of awareness and performance of midwives.Results: Majority of midwives (86.7%) had Bachelor degree, had (1-7) year’s work experience (64.1). This study showed that the Ahvazi midwives had relatively good awareness of physiologic labour items however the performance of them was not as ideal as their awareness.Conclusions: Iranian midwives are informed about evidence-based practice in childbirth which indicates that attempts to promote physiologic childbirth has been useful, however multifaceted implementation strategies are necessary to promote the use of evidence-based practice in clinical practice and health care decision making during labour childbirth