Interleukin-6 in Spontaneous and Induced Vaginal Birth and Neonatal Outcomes: A Cross-Sectional Study

Introduction: The detailed mechanisms fundamentally the onset of spontaneous labor at term remain obscure. Delayed labor means slower progress of the birth process and is associated with childbirth problems and negative birth feelings, resulting in subsequent pregnancy and labor. Inflammatory mechanisms are thought to play a vital role in the physiology of parturition and labor in pre-term and spontaneous term birth. Studies indicated that the mode of birth and labor change interleukin-6 concentrations in maternal and fetal sections. The immunobiological role of inflammatory cytokines in parturition and the onset of spontaneous labor at term, especially without exogenic motivation, remain unspecified yet. The specific role of Interleukin - 6 (IL - 6) in the biosynthesis of prostaglandins, myometrium contractions, cervix ripening, and finally, its role in the process of labor is reported in studies. According to the changes in the physiology of normal birth in induced labor, this study aimed to compare the mean level of IL-6 in pregnancies terminated by selective induction or spontaneous vaginal birth and neonatal outcome. Methods: This cross-sectional study was conducted on two groups of 40 women with spontaneous and induced birth. All pregnancies were term without clinical or obstetric complications. The enzyme-connected immunosorbent assay measured the level of IL - 6 in the umbilical cord. The obtained data were analyzed by SPSS 22 software. Results: The mean level of IL-6 in the umbilical cord was not significantly different in spontaneous (250.20 ± 39.36 pg./ml) and induced labor (240.97 ± 39.06 pg./ml) (P = 0.847). In the spontaneous birth group, the first and fifth minute Apgar scores were higher than the induced labor group (P = 0.021). None of the infants required resuscitation or NICU hospitalization in the neonatal unit. Approximately 97.5% of infants were breastfed in the induced birth group. Only one of the newborns in the induced birth group had jaundice and underwent phototherapy for 8 hours at home. In this study, there was found no association between IL - 6 and pregnancy/infant variables. Conclusions: Our results indicate that the birth method (induced and spontaneous) had no effect on the level of IL-6 in the umbilical cord blood, but the birth method had just a significant effect on the Apgar score. Induction of labor is associated with adverse birth outcomes. This study investigated interleukin-6 in cord blood in term newborns depending on the mode of delivery and labor. Delayed labor means slower progress of the birth process and is associated with childbirth problems and negative birth feelings, which can have consequences on subsequent pregnancy and labor. We determined whether normal spontaneous birth and induced birth at term was associated with poor newborns outcomes. Current study was a different view helping future studies to investigate other aspects of post term pregnancy and supporting physiological parturitio

Scale Development and Psychometrics for Parents’ Satisfaction with Developmental Care in Neonatal Intensive Care Unit

How to Cite This Article: Rafiey H, Soleimani F, Torkzahrani Sh, Salavati M, NASIRI M. Scale Development and Psychometrics for Parents’Satisfaction with Developmental Care in Neonatal Intensive Care Unit. Iran J Child Neurol. Autumn 2016; 10(4):16-24.AbstractObjectiveDevelopmental care comprises a wide range of medical and nursing interventions used in the neonatal intensive care unit (NICU) to mitigate and reduce stressors affecting preterm or ill neonates. Because patient satisfaction survey is a valuable quality improvement tool, we aimed to develop and test the psychometric properties of a tool for measuring parent satisfaction of developmental care in the NICU. Materials &MethodsIn this psychometric methodological study, the item pool and initial questionnaire were designed based on a comprehensive literature review and exploring NICU parent satisfaction questionnaires. The validity of the designed questionnaire was determined using face, content (qualitative and quantitative), and construct validity. Exploratory factor analysis was performed using responses from 400 parents of infants hospitalized in the NICUs of 34 hospitals in 2015 in Tehran, Iran. The reliability of the questionnaire was identified using Cronbach’s alpha and stability measures. ResultsThe initial questionnaire was designed with 72 items in five domains. After testing the face validity, 3 items were omitted. The results of validity testing were acceptable. The exploratory factor analysis was performed on 69 items, and 5 factors (care and treatment with 20 items, information with 15 items, hospital facilities with 9 items, parental education with 7 items, and parental participation with 8 items) were extracted. The reliability was supported by high internal consistency (α = 0.92). ConclusionThis questionnaire could be valid and reliable tool for measuring parents’ satisfaction. References1. Prakash B. Patient satisfaction. J Cutan Aesthet Surg 2010;3(3):151-5.2. Ware JE, Snyder MK, Wright WR, Davies AR. Defining and measuring patient satisfaction with medical care. Eval Program Plann 1983;6(3):247-63.3. Miles MS, Burchinal P, Holditch-Davis D, Brunssen S, Wilson SM. Perceptions of stress, worry, and support in Black and White mothers of hospitalized, medically fragile infants.J Pediatr Nurs 2002;17(2):82-8.4. Pinelli J. Effects of family coping and resources on family adjustment and parental stress in the acute phase of the NICU experience. Neonatal Netw 2000;19(6):27-37.5. Butt ML, McGrath JM, Samra HA, Gupta R. An integrative review of parent satisfaction with care provided in the neonatal intensive care unit. J Obstet Gynecol Neonatal Nurs 2013;42(1):105-20.6. 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Spiritual Well-Being in Women with Breast Cancer Receiving Palliative Care

Abstract Introduction: Breast cancer is the most common cancer in women with significant undesirable complications. Due to its life-threatening nature, the diagnosis of this disease increases spiritual needs and the need for palliative care. Palliative care has emerged as care that addresses explicitly gaps inherent in disease-centered approaches to enhance care quality in serious illness, both for patients and families and health care systems. Methods: This descriptive-comparative study was conducted on 200 women with breast cancer selected by convenience sampling from those visiting chosen hospitals of Tehran in 2018. Data were collected using a demographic-histopathologic form and Paloutzian-Ellison’s Spiritual Well-Being Scale, which was filled out in palliative care (n = 100) and routine care (n = 100) groups four weeks after the completion of therapy through interviews. The data obtained were analyzed in SPSS-21 using descriptive and inferential statistics. Results: Compared to those receiving routine care, the women with breast cancer who were receiving palliative care had higher scores in religious well-being (P < 0.509) and total spiritual well-being (P < 0.167), although not in a statistically significant way. Meanwhile, the palliative care group obtained significantly higher scores in existential well-being compared to the routine care group (P < 0.007). Conclusions: Developing programs to improve spiritual well-being in patients with breast cancer by incorporating palliative care into medical interventions can be beneficial

Commentary: Childbirth Education in Iran

With regard to childbirth, the role of every health-care system is to improve maternity care as well as the birth experience of women and their family members. Despite many efforts to improve maternity care in the Islamic Republic of Iran, the nation's childbirth care still faces a tremendous amount of unnecessary intervention and, consequently, a high rate of cesarean births. This article describes the strengths and weaknesses of Iran's maternity-care system and childbirth education in light of evidence-based practice

The examination of quality of pregnancy care based on the World Health Organization’s “Responsiveness” model of selected pregnant women in Tehran

Introduction: The World Health Organization (WHO) Responsiveness model showing the ability of health systems in fulfilling people’s expectations in connection with nonclinical aspects is an appropriate pattern to assess healthcare. The purpose of this study was to determine the status of pregnancy care provisions based on the responsiveness model. Methods: This was a cross-sectional study conducted by randomly sampling 130 women visiting selected hospitals in Tehran in 2015. A researcher-made questionnaire based on the responsiveness model of WHO was used to collect data. We determined the face validity and content validity of the questionnaire, and its reliability was confirmed by Cronbach’s alpha coefficient (0.94) and test-retest analysis (0.96). The obtained data were analyzed by SPSS version 20 descriptive statistics, t-test, one-way ANOVA, Pearson product-moment correlation coefficient, and Spearman correlation. Results: Total responsiveness from the perspective of service recipients was 69.46±14.65 from 100. The obtained scores showed that, in the range of 0 to 100, 73.02 were about basic amenities (the most score), 72.93 about dignity, 70.91 about communication, 70.76 about confidentiality, 66.30 about provision social needs, 65.96 about choice of provider, 65.92 about autonomy, and 52.65 about prompt attention (the lowest score), which are representing the average level of service quality. There were significant relationships between participating in preparation class of labor and dignity (p<0.001), autonomy (p=0.01), provision social needs (p=0.01), and overall responsiveness (p=0.03). It was obtained that there is a significant linear relationship between scores given to hospitals and dimensions of responsiveness (p=0.05). Findings indicated a significant relationship between insurance type and dimensions of choice of provider (p=0.03) and communication (p=0.03). Conclusion: The mean score of service quality in the present investigation illustrated that nonclinical dimensions have been disregarded and it has potential to be better. So some grand plans are needed

Introducing a model for improving the quality of developmental care in the neonatal intensive care unit in Iran

Background and AimDevelopmental care along with medical care controls premature infant's potential stress. Improving thequality of developmental care as well as other healthcare services is very important. In this paper, theexisting quality care improvement models have been reviewed and followed by analysis of their applicationsto the Iranian NICU. Consequently, an appropriate model is proposed.Materials and MethodsIn this review article, Iran Medex، Science direct، Google Scholar، SID, PubMed, Scopus, and EBSCOCINAHLdatabases have been searched by keywords including quality improvement, quality, developmentalcare, health care, NICU, premature infants. The content of articles were analyzed and compared.ResultsThe review of the literature indicates that there are many health care improvement models. Some of macroand micro related models are applicable in NICUs. However, there are some limitations in this regards. Withconsidering the characteristics of developmental care and the attributes of an ideal health care improvementmodel a number of models chose to promote developmental care in Iranian's NICU. The models are "QualityImprovement Collaborative", Clinical Pathways, Plan- DO- Study- Act Cycle, Six Sigma, EFQM and ISO.KeywordsDevelopmental care; Neonatal Intensive Care Units; Healthcare; Quality Improvemen

Effect of breathing technique of blowing on the extent of damage to the perineum at the moment of delivery: A randomized clinical trial

Introduction: One of the important tasks in managing labor is the protection of perineum. An important variable affecting this outcome is maternal pushing during the second stage of labor. This study was done to investigate the effect of breathing technique on perineal damage extention in laboring Iranian women. Materials and Methods: This randomized clinical trial was performed on 166 nulliparous pregnant women who had reached full-term pregnancy, had low risk pregnancy, and were candidates for vaginal delivery in two following groups: using breathing techniques (case group) and valsalva maneuver (control group). In the control group, pushing was done with holding the breath. In the case group, the women were asked to take 2 deep abdominal breaths at the onset of pain, then take another deep breath, and push 4–5 seconds with the open mouth while controlling exhalation. From the crowning stage onward, the women were directed to control their pushing, and do the blowing technique. Results: According to the results, intact perineum was more observed in the case group (P = 0.002). Posterior tears (Grade 1, 2, and 3) was considerably higher in the control group (P = 0.003). Anterior tears (labias) and episiotomy were not significantly different in the two groups. Conclusions: It was concluded that breathing technique of blowing can be a good alternative to Valsalva maneuver in order to reduce perineal damage in laboring women