Predictive value of pregnancy-associated plasma protein-A in relation to fetal loss: A systematic review and meta-analysis

Background: For a woman with bleeding and threatened abortion, ultrasound scan is done to confirm the viability of the fetus; however, 10-15% of the embryos are eventually aborted. Distinguishing between women with good and poor prognosis can be a helpful approach. Objective: This study aimed to review the predictive value of Pregnancy-associated Plasma Protein A (PAPP-A) in relation to the diagnosis of fetal loss. Materials and Methods: The articles published in multiple databases including Web of Science, PubMed, MEDLINE, Scopus, and Persian databases such as ISC, Magiran, and IranMedx were searched for articles published until May 2019. MeSH terms was used for searching the databases including fetal loss OR pregnancy loss OR abortion OR miscarriage with the following word using AND; Pregnancy-Associated Plasma Protein- A OR PAPP-A. Two reviewers extracted data and recorded them in a pre-defined form and assessed the quality of articles using the Newcastle-Ottawa tool. Meta-analysis was done using the Comprehensive Meta-Analysis/2.0 software and MetaDisc. Results: A total number of 16 studies were eligible for the qualitative data synthesis, out of which 8 studies were included in the meta-analysis. All studies had high and medium quality. The forest plot analysis showed a sensitivity of 57% (95% CI: 53-63%), a specificity of 83% (95% CI: 80-85%), a positive likelihood ratio of 3.52 (95% CI: 2.44- 5.07), a negative likelihood ratio of 0.54 (95% CI: 0.37-0.79), and a diagnostic odds ratio of 6.95 (95% CI: 3.58-13.50). Conclusion: PAPP-A cannot be recommended on a routine basis for predicting fetal loss and still further research with a combination of other biomarkers is required. Key words: Pregnancy-associated plasma protein-A, Fetal loss, Pregnancy, Systematic review

The Effect of Cognitive-Behavioral Counseling on Maternal-Fetal Attachment among Pregnant Women with Unwanted Pregnancy: A Randomized Clinical Trial

Background: Unwanted pregnancy is an event bringing about adverse effects on the mother, the baby and, ultimately, on the whole family. The establishment and enhancement of maternal-fetal attachment play a role in the promotion of emotional communication between the mother and the child in the future. This study aimed at investigating the effect of cognitive-behavioral counseling on maternal-fetal attachment among pregnant women with unwanted pregnancy. Methods: In this randomized clinical trial, 60 eligible pregnant women with unwanted pregnancy and gestational age of 22-28 weeks who had referred to healthcare centers in Mashhad, a city in the northeast of Iran, were selected and they were through random block  assignment divided into two groups of counseling with the cognitive-behavioral approach (n = 30) and the control group (n = 30). In addition to the routine pregnancy care, the cognitive-behavioral counseling group received 4 group counseling sessions on a weekly basis, while the control group only received the routine pregnancy care from healthcare providers. Maternal-fetal attachment before and after intervention in the two groups was assessed through Cranley’s Maternal-Fetal Attachment Scale. Comparison of mean scores within and between the two groups was performed using SPSS 21 through independent and paired t-tests. Results:  At the end of the study and after the intervention, the mean scores of maternal-fetal attachment in the intervention and control groups were  94.06±11.73 and 80.16 ± 10.09, respectively, and the difference between the groups was significant. Although the difference between the mean scores of each group at the beginning and the end of the study was significant, this difference between the two groups was also noticeable (21.56 ± 12.16 versus 7.40 ± 12.39) and statistically significant . Conclusion: Cognitive-behavioral counseling can be effective in enhancing the maternal-fetal attachment in unwanted pregnancies; therefore, it is recommended to be integrated into pregnant women's healthcare programs

Effect of sexual enrichment program on the sexual satisfaction of pregnant women in Iran: A randomized clinical trial

Background: To improve the sexual satisfaction of pregnant women, there needs to be a culturally appropriate sex education program. This study aimed at determining the effectiveness of a sexual enrichment program on the sexual satisfaction of pregnant women. Methods: This single-blind randomized clinical trial was conducted on 61 pregnant women aged 18 to 35 years old with low-risk pregnancies and gestational ages of 14 to 32 weeks, who had referred to three healthcare centers in Mashhad. The participants were randomly assigned to two groups of control (n = 31) and intervention (n = 30) based on a table of blocks of four. The intervention group, in addition to receiving routine pregnancy training, participated in six one-hour sessions of a sexual enrichment program held on a weekly basis, while the control group received only the routine pregnancy healthcare. Larson's sexual satisfaction questionnaire was used to assess the sexual satisfaction of pregnant women prior to the study and two weeks after the intervention. Comparison of mean scores between and within the two groups was performed using SPSS software (version 21) using independent and paired t-tests. Results: After the intervention, there was a significant difference between the mean sexual satisfaction scores of the two groups (p = 0.02). Comparison of the differences between the mean sexual satisfaction scores of the intervention group before and after the intervention indicated a significant change (p = 0.009), while in case of the control group this change was not significant (p = 0.46). Conclusion: A sexual enrichment program can be effective in improving the sexual satisfaction of pregnant mothers. Keywords: Sexual satisfaction, Pregnant women, Sexual enrichment program, Clinical tria

The Quality of Maternity Services in Mashhad Educational Hospitals, Using SERVUSE Model

Introduction: Reducing maternal and neonatal mortality requires improved care quality; the aim of this study was to determine various dimensions of the quality of services in maternity wards in Iran from the patient’s perspective. Methods: In this cross-sectional study which was conducted from April to October 2017, 363 patients were selected from maternity wards of five hospitals affiliated to Mashhad University of Medical Sciences by convenience sampling method. Data collection tools consisted of the SERVUSE (Service Usability questionnaire), including 51 items in 6 dimensions of services quality; its validity and reliability were determined in previous studies. Data analysis was performed using SPSS, version 20. The analysis was performed using descriptive and inferential statistical methods including Wilcoxon, Kruskal Wallis and Mann-Whitney tests. The significance level in all the tests was considered 5%. Results: The total mean scores of the patients’ expectation and perception were 19.10±2.14 and 15.11±4.25, respectively. The highest expectation and perception were related to the usability dimension, and the lowest expectation and perception were related to reliability dimension. The differences between the median score of perception and expectation for all dimensions and total median score of perceptions and expectations were statistically significant (P<0.05, using Wilcoxon test). There were no statistically significant differences in the median score of the gap between the patient’s expectations and perceptions at the levels of demographic variables (P>0.05, using Mann-Whitney and Kruskal Wallis tests). Conclusion: It seems that the service quality of maternity ward of hospitals was approximately unsatisfactory from the patients’ perspective, and they had high expectations in maternity wards of hospitals. Since maternity service quality is critically important, improvement of quality requires management, concordant participation, and efforts of the hospital and staff at all levels of the medical facilities and convenience

Assessing the quality of published clinical trials regarding the effect of conservative methods in women with pelvic floor disorders using CONSORT tool

Introduction: When designing an evidence-based treatment program to help patients with pelvic floor disorders through conservative methods, it is necessary to select studies that, in addition to focusing on the desired subject, also have a suitable quality. Therefore, the present study was performed with aim to assess the quality of published clinical trials regarding the effect of conservative methods in women with pelvic floor disorders using CONSORT tool. Methods: In this critical review, published RCTs which are indexed in PubMed, Scopus, Medline, Cochrane، Web of Science as well as Persian databases such as SID and Magiran from 2001 to 2021 were searched using Persian and English keywords. Out of 416 articles, 64 RCTs were assessed using CONSORT 2017 checklist. Data were analyzed using SPSS (version 16) and descriptive statistical tests. Results: In the complete assessment of the articles, the mean overall score of articles quality based om CONSORT criteria was 28.85 ± 7.5 (minimum and maximum range of 12-41). Title, introduction, objectives and discussion had the highest mean score; whereas method and results section had the lowest mean score. Also, 33.9% of the articles had not point out the type of the article in the title. In the abstract section, 75% of the articles did not report the study type, 87.5% did not describe the method of randomization, and more than 73.2% did not report blinding. Conclusion: The appraised articles in the present study had a moderate quality. Improving the quality of clinical trials, especially in the method section, is essential for more use at the bedside and providing better care. Getting help from experts in the statistics and methodology as well as using standard tools for critical appraisal, the quality of articles could be improved

The Relationship Between Job Satisfaction and Job Performance Among Midwives Working in Healthcare Centers of Mashhad, Iran

Background and Aim: Job satisfaction represents individuals' positive or negative attitude towards their occupation. Job satisfaction is of high significance in health care field and could affects the quality of patients' health care and satisfaction. Every organization should pay considerable attention to job satisfaction and performance and continually monitor these indices. Therefore, we aimed to determine the relationship between job satisfaction and job performance of midwives, employed in health care centers of Mashhad, Iran. Methods: This descriptive correlational study was performed on 90 midwives, working in healthcare centers of Mashhad, Iran, in 2014 who were selected through multistage sampling from five healthcare centers. Data collection tools included a questionnaire to record demographic, personal and occupational data, Minnesota Job Satisfaction Questionnaire (MSQ) as well as a self-structured observational checklist to measure the quality of educational, care, and communicative job performance of midwives. SPSS version 19 was used to analyze data through descriptive statistics, and also Spearman and Kruskal-Wallis tests. Results: The mean age of the participants was 39.63±6.92 years. Spearman correlation test showed a direct correlation between job satisfaction and the total score of job performance (

Exploring the Process of Women\'s Confrontation with Symptoms of Pelvic Floor Disorders

Background and Objective: Pelvic floor disorders (PFDs) are defined as defects in the muscle and ligamentous plates that cause disorders in the anterior, medial, and posterior walls. Symptoms of these disorders can affect various aspects of a woman's life. The results of the studies show that there is a lack of knowledge regarding this process. Therefore, the present study aimed to explain the process of women 's confrontation with the symptoms of PFDs . Materials and Methods: This qualitative study was conducted between 2017 and 2020. A total of 38 participants were included using a purposive and theoretical sampling method. To answer the research question, data were collected using semi-structured in-depth interviews. To find out how women coped with the symptoms of PFDs, Corbin and Strauss’ (2015) grounded theory was used. The data were analyzed in four phases, namely 1- analysis of data for concepts, 2- analysis for context, 3- analysis for process, and 4- integration of categories. MAXQDA10 software was used to manage and analyze the qualitative data. Results: In the present study, the main concern of the participants was "deprivation of normal life" and the theory extracted from the data was "symptom management to normalize the situation". This theory was the result of five actions/responses that included mental exploration by observing symptoms and attempting to find reassurance, attempting to hide the illness, trying to resolve marital conflicts, adopting self-management strategies, and actively following up on treatment. Finally, there was a spectrum of consequences ranging from adjustments to the disease to partial recovery. Participants' concerns were related to the "dominance of symptoms in the dimensions of individual and interpersonal life", which included seven sub-concepts. Conclusion: The main finding of this study was the presentation of the theory of "symptom management to normalize the situation", which explained the process in which women faced the symptoms of PFDs. According to this theory, women sought strategies in various contexts in response to their worries and tried to normalize their lives through management

First trimesters Pregnancy-Associated Plasma Protein-A levels value to Predict Gestational diabetes Mellitus: A systematic review and meta-analysis of the literature

Detecting pregnant women at risk of diabetes in first months can help them by early intervention for delaying or preventing onset of GDM. In this study, we aimed to assess the Predictive value of first trimester Pregnancy related plasma protein-A (PAPP-A) levels for detecting Gestational diabetes Mellitus (GDM). This systematic review and meta-analysis was conducted through probing in databases. PubMed, Scopus, Medline and Google scholar citations were searched to find the published papers from 1974 to 2017. Studies were considered eligible if they were cohorts, case–control studies, reported GDM result, not other types, conducted on singleton pregnancy, measured Serum pregnancy associated plasma protein A in the first trimester and evaluated the relation of first trimester pregnancy associated plasma protein–A and GDM. Two reviewers independently assessed the quality with Newcastle–Ottawa and extracted data in the Pre-defined checklist. Analysis of the data was carried out by “Comprehensive Meta-analysis Version 2 (CAM)” and Metadisc software. 17 articles have our inclusion criteria and were considered in our systematic review, 5 studies included in Meta-analysis. Meta-analysis of these articles showed that the predictive value of PAPP-A for GDM has 55% sensitivity (53–58), 90% (89–90) specificity, LR + 2.48 (0.83–7.36) and LR − 0.70 (0.45–1.09) with 95% confidence intervals. In our study PAPP-A has low predictive accuracy overall, but it may be useful when combined with other tests, and this is an active part for future research. One limitation of our study is significant heterogeneity because of different adjusted variables and varied diagnostic criteria. Keywords: Gestational diabetes Mellitus, Pregnancy-Associated Plasma Protein-A, First trimesters, Systematic revie

Predictive Value of Pregnancy-associated Plasma Protein-A in Relation to Fetal Loss: A Systematic Review and Meta-analysis

Background: For a woman with bleeding and threatened abortion, ultrasound scan is done to confirm the viability of the fetus; however, 10-15% of the embryos are eventually aborted. Distinguishing between women with good and poor prognosis can be a helpful approach. Objective: This study aimed to review the predictive value of Pregnancy-associated Plasma Protein A (PAPP-A) in relation to the diagnosis of fetal loss. Materials and Methods: The articles published in multiple databases including Web of Science, PubMed, MEDLINE, Scopus, and Persian databases such as ISC, Magiran, and IranMedx were searched for articles published until May 2019. MeSH terms was used for searching the databases including fetal loss OR pregnancy loss OR abortion OR miscarriage with the following word using AND; Pregnancy-Associated Plasma Protein- A OR PAPP-A. Two reviewers extracted data and recorded them in a pre-defined form and assessed the quality of articles using the Newcastle-Ottawa tool. Meta-analysis was done using the Comprehensive Meta-Analysis/2.0 software and MetaDisc. Results: A total number of 16 studies were eligible for the qualitative data synthesis, out of which 8 studies were included in the meta-analysis. All studies had high and medium quality. The forest plot analysis showed a sensitivity of 57% (95% CI: 53-63%), a specificity of 83% (95% CI: 80-85%), a positive likelihood ratio of 3.52 (95% CI: 2.44- 5.07), a negative likelihood ratio of 0.54 (95% CI: 0.37-0.79), and a diagnostic odds ratio of 6.95 (95% CI: 3.58-13.50). Conclusion: PAPP-A cannot be recommended on a routine basis for predicting fetal loss and still further research with a combination of other biomarkers is required. Key words: Pregnancy-associated plasma protein-A, Fetal loss, Pregnancy, Systematic review