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Background: The healthcare system of the Islamic Republic of Iran provides special maternal health care services for mothers, regardless of their nationality., Aim: This study, supported by the United Nations Population Fund, was conducted to review available data associated with health indicators of Afghan mothers living in Islamic Republic of Iran., Methods: This descriptive study used data from the electronic registration system of the Maternal Health Office of the Ministry of Health and Medical Education on characteristics, morbidity and mortality among Afghan mothers in the Islamic Republic of Iran from 2017 to 2019. The data were analysed using SPSS version 23.0. Based on the results, we propose interventions to improve health services for vulnerable Afghan mothers., Results: There were 168 488 deliveries over the 3 years of the study (2017-2019). Deliveries by Afghan women increased from 3.4% in 2017 to 5.2% in 2019, and more than 70% of these Afghan women were vulnerable. Ten percent of deliveries among Afghan mothers were performed by traditional birth attendants. The rate of caesarean section among Afghan mothers was 30%. Maternal mortality ratio among the Afghan mothers was 43 per 100 000 for the 3 years., Conclusion: Afghan mothers in the Islamic Republic of Iran use primary health care services provided for mothers in the country. However, healthcare delivery to these mothers is inadequate, although considered better than the care provided to Afghan mothers living in Afghanistan. We recommend targeted interventions to improve the health status of Afghan women living in the Islamic Republic of Iran., (Copyright © Authors 2023; Licensee: World Health Organization. EMHJ is an open access journal. This paper is available under the Creative Commons Attribution Non-Commercial ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo).)

Introduction: Caesarean section (C/S) rates have significantly increased across the world over the past decades. In the present population-based study, we sought to evaluate the association between C/S and neonatal mortality rates., Material and Methods: This retrospective ecological study included longitudinal data of 166 countries from 2000 to 2015. We evaluated the association between C/S rates and neonatal mortality rate (NMR), adjusting for total fertility rate, human development index (HDI), gross domestic product (GDP) percentage, and maternal age at first childbearing. The examinations were also performed considering different geographical regions as well as regions with different income levels., Results: The C/S rate and NMR in the 166 included countries were 19.97% ± 10.56% and 10 ± 10.27 per 1000 live birth, respectively. After adjustment for confounding variables, C/S rate and NMR were found correlated (r = -1.1, p < 0.001). Examination of the relationship between C/S rate and NMR in each WHO region resulted in an inverse correlation in Africa (r = -0.75, p = 0.005), Europe (r = -0.12, p < 0.001), South-East Asia (r = -0.41, p = 0.01), and Western Pacific (r = -0.13, p = 0.02), a direct correlation in America (r = 0.06, p = 0.04), and no correlation in Eastern Mediterranean (r = 0.01, p = 0.88). Meanwhile, C/S rate and NMR were inversely associated in regions with upper-middle (r = -0.15, p < 0.001) and lower-middle (r = -0.24, p < 0.001) income levels, directly associated in high-income regions (r = 0.02, p = 0.001), and not associated in low-income regions (p = 0.13). In countries with HDI below the centralized value of 1 (the real value of 0.9), the correlation between C/S rate and NMR was negative while it was found positive in countries with HDI higher than the mentioned cut-off., Conclusions: This study indicated that NMR associated with C/S is dependent on various socioeconomic factors such as total fertility rate, HDI, GDP percentage, and maternal age at first childbearing. Further attentions to the socioeconomic status are warranted to minimize the NMR by modifying the C/S rate to the optimum cut-off., (© 2022. The Author(s).)

Background: Previous studies have indicated that the majority of cases with "failed" results related to transient evoked otoacoustic emissions (OAE) test have the normal hearing. The present study aimed to assess the possible relationships between perinatal factors and the false-positive OAE results., Methods: A case-control study was carried out in an Iranian Hospital in 2020. Based on the OAE results on the first day of life, newborns were divided into 2 groups; Control group included subjects with "Pass" OAE results. Every neonate with "Fail" OAE result was referred for auditory brainstem response (ABR). Neonates with bilateral fail OAE but normal ABR results (false-positive OAE) were considered as the case group. All recorded data were analyzed to assess the possible correlations between maternal/neonatal factors and the false-positive OAE results., Results: One hundred and eighty-one neonates entered the study. Of all included neonates, 87 (48.1%) cases showed bilateral fail OAE and 94 (51.9%) subjects passed the OAE test. Normal ABR results (false-positive OAE) were observed in all cases with bilateral fail OAE. Comparisons of variables affecting the OAE results showed that of all perinatal factors, neonate's sex (p = 0.046) and cesarean section (p = 0.003) were the only influencing factors that increased the risk of false-positive OAE results., Conclusion: Based on the results, the cesarean section delivery and neonate's male sex increased the risk of false-positive results related to OAE test. Implementing other screening tests such as ABR or Automated ABR as the initial screening test could be suggested for such cases.

Background: Child birth is one of the most important events in a mother's life. Different factors influence whether a child is delivered by cesarean or normal vaginal delivery. Despite the complications of cesarean, demand for this type of delivery is increasing. The purpose of this study was to examine the influence of personal traits on the choice of the delivery method based on HEXACO personality model., Methods: Two hundred and ten pregnant women in some health centers in Tehran volunteered to participate in this research. To identify their personality dimensions, the pregnant women first filled out HEXACO personality forms. Then, the received data were analyzed through multivariate analysis of variance using a software package called SPSS-23., Results: 104 women selected cesarean and 106 other women preferred normal vaginal delivery. The results of the multivariate analysis of variance showed that there is a significant difference between the two groups of women for six personality factors in HEXACO (P = 0.001). The linear combination of personality characteristics of pregnant women has a significant effect on the choice of delivery method (P < 0.05)., Conclusions: Personality differences of pregnant women can be considered in psychological interventions and antenatal counseling to overcome psychological resistance to vaginal delivery and increase its choice.

Background: In the present study, we evaluated post-natal growth and psychomotor development status of infants at 6 months of age based on their gestational age at elective cesarean sections., Methods: This is a prospective cohort study performed in 2014-2015 in Iran. The study population consisted of 6-month-old infants with gestational ages of 38-40 weeks delivered by elective cesarean section. The subjects were divided into 3 groups: Group A (neonates with gestational age of 380/7 weeks), group B (neonates with gestational age of 390/7 weeks), and group C (neonates with gestational age of 406/7 weeks). At the infant age of 6 months, the mothers were called for follow-up visits. Growth and psychomotor status of all subjects were assessed by expert pediatricians based on the Age and Stage Questionnaires. Recorded data related to outcomes in neonatal period and 6 months later were analyzed to determine associations between groups' variables., Results: A total of 952 subjects were found eligible for study participation. The mean birth weight, length and head circumference were significantly higher in group C compared with the other groups (P=0.005). Regarding growth parameters, a significant association was found between gestational age at birth and all other growth indices at 6 months of age (P=0.005). The mean weight at 6 months of age was higher in group B in comparison with group A (P=0.001) and C (P=0.007). Infants born at 380/7 weeks were shorter in comparison with those born at 390/7 (P=0.002) and 406/7 weeks (P=0.005). Head circumference was significantly lower in group A than group B (P=0.02) and C (P=0.05). Regarding psychomotor indices at 6 months, a significant association was found between gestational age at birth and problem-solving skills (P=0.003). Delays in problem-solving skills were more frequent in neonates born at 380/7 weeks compared with those born at 390/7 (P=0.005) or 406/7 weeks (P=0.003). This difference was also significant between the two groups who were born at 390/7 and 406/7 weeks (P=0.01)., Conclusion: The results from this study demonstrated that postponing the time of planned elective cesareans beyond 39 weeks of gestation may improve infant's growth and psychomotor outcomes., (© 2019 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)

Background: Iodine-containing disinfectants are widely used for skin preparation before caesarean section. Current evidence suggests that maternal exposure to these disinfectants results in thyroid dysfunction in the newborns, but its extent is not known., Objectives: The purpose of this study was to explain the quality of the effect of these disinfectants on the thyroid function of newborns., Methods: This cohort study was performed on all the healthy mothers with a term pregnancy who underwent caesarean section in the obstetrics emergency department of an educational hospital affiliated with Tehran University of Medical Sciences from December 2013 to December 2014. We divided this 12-month period into two consecutive 6 months. Povidone-iodine 10% (PVP-I) and chlorhexidine gluconate 4% (CHX) were used in the first and second 6 months, respectively, for skin preparation before caesarean section and also for umbilical cord disinfection. Cord blood thyroid stimulating hormone (TSH) and thyroxine (T4) were assayed by the ELISA method., Results: We included 326 cases in this study, 153 in the PVP-I group and 173 in the CHX group. The incidence of cord blood TSH ≥ 10 mIU/L and T4 ≤ 7.3 µg/dL was significantly higher in the PVP-I than the CHX group. Cord blood TSH concentration showed a significant positive correlation with cord blood T4 concentration in the CHX group. Through selection of cases with cord blood T4 < 13 µg/dL, we found a negative correlation between cord blood TSH and T4 concentration in the PVP-I group., Conclusions: It seems that PVP-I has the potential to cause false-positive screening-test results and increase recall rates, which should be evaluated in further studies., Trial Registration Number: Iranian Registry of Clinical Trials (IRCT) number IRCT201204289568N1., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

Purpose: Caesarean delivery in the absence of any medical indications has become a major issue of concern among the women's health professionals. The patients' choice of caesarean is influenced by several factors predominating by their physicians' suggestion. Our objective was to examine factors that may affect the physicians' responses to patients consulting the mode of delivery., Methods: Questionnaires were posted to 1,000 female obstetricians and gynaecologists practicing in Tehran in winter 2007. Questionnaires included demographic information of physicians and their history of pregnancy and delivery. Finally, they were asked their preferred mode of delivery and the mode they suggest when being consulted by parturient., Results: From 1,000 physicians, 785 cases (78.5%) responded to the survey. The rate of responses in favour of suggesting normal vaginal delivery, Caesarean Section and painless vaginal delivery was 60.8, 25.6 and 13.6%, respectively. There was a correlation between the suggested and the preferred mode of delivery, it means that the physicians mostly suggested their self-preferred mode of delivery to their patients., Conclusions: Physicians normally suggest to their patients as the safe mode of delivery what they prefer for themselves. This preference and subsequent suggestion is influenced by different factors including their age, marital status, and previous modes of delivery. As conclusion, it is inferred that informing a physician to choose the right mode of delivery for herself leads to better suggestions to the patients.

Background & Objective: Despite the high efficacy of the Apgar score in finding respiratory distress, a low Apgar score doesn't necessarily indicate fetal hypoxiaasphyxia. Umbilical Artery pH (UApH) is one of the best indicators of fetal hypoxia. Therefore, it's so beneficial to consider these criteria and their relationship with the Apgar score for accurate diagnosis of prenatal respiratory distress retrospectively which reduces the unnecessary cesarean section (CS) rate. Materials & Methods: 162 full-term (=259 days) neonates delivered by CS with the diagnosis of decreased fetal heart rate (FHR) were evaluated. 1-min and 5-min Apgar scores and UApH were measured. The correlation between Apgar scores with UApH and the association between UapH and Apgar with the NICU admission were evaluated. The effect of other variables including mother's age, gravidity, gestational age, birth weight, newborn sex, and causes of decreased FHR on Apgar scores and UApH were studied as well. Results: The most common cause of decreased FHR was fetal distress, boys had higher weight (P=0.033) and lower UApH (P=0.049) than girls. Other parameters were not different significantly between both sexes. There was a positive correlation between UApH and 1-min and 5-min Apgar scores (r=0.464 and r=0.370 respectively) when controlled for birth weight (P<0.0001). The RR for NICU admission in male acidemic neonates with abnormal 1-min Apgar was 14.05 (CI95%: 5.7-34.6) in comparison to females (RR=1.06, CI95%: 1-1.26). Conclusion: Mild acidemia (UApH<7.2) at least in a male fetus would be a good predictor for postnatal complications and need for NICU admission. Future studies with more samples are suggested. [ABSTRACT FROM AUTHOR]

Objective: Despite the declining trend of maternal mortality (MMR) in Iran between 1990 and 2013, direct causes are still the major reasons for maternal death. One of these direct causes is complications of cesarean section (CS). Since the rate of CS in Iran is quite high (47.9%) and the trend continues to rise, there is an alarming threat of the possibility of increasing MMR in the country as a result of cesarean section complications, especially in repeated cases. In this study, we attempted to determine the indications of CS in reported maternal mortality, with special attention to risk factors predisposing to CS and/or to maternal mortality. Materials and methods: A retrospective study was implemented for the period between March 2009 and March 2012. All nationally reported data regarding maternal death during pregnancy, labor and 42 days after parturition during these 3 years was collected and input to software specially designed for this project. Subsequently, cases of maternal death related to pregnancy termination by cesarean section were selected for analysis. Results: There were 393 cases of maternal death with cesarean section as the termination method. Indications of CS were mostly emergency and repeat and the leading causes of death were postpartum hemorrhage and hypertensive disorders. Most of these deaths occurred in academic hospitals and the most common type of delay was brought about by hospital management, specifically personnel issues. Conclusion: Based on this study, acknowledging CS as a serious health threat endangering every achievement in the maternal health program is the most important policy and efforts should be focused on provision of guidelines for realistic CS indications, standardized CS procedures, and post CS care as well as propagation of training courses in risk management and high risk case-finding protocols. [ABSTRACT FROM AUTHOR]

Background: Considering the rarity of umbilical cord prolapse (UCP) and lack of accurate data about the risk factors and health outcomes, we aimed to evaluate cases of cesarean section (CS) due to UCP in order to reduce treatment costs and provide information about the mortality and morbidity associated with this condition. Methods: Of 35,259 cases of CS performed in four hospitals during 2004-2012, 103 cases of UCP were selected as the case group; on the other hand, 318 cases without UCP were classified as the control group. Information was extracted from patients' records and analyzed by SPSS version 18. Results: Prevalence of UCP was estimated at 0.2%. In the case group, cord prolapse in the active phase of labor was reported 1.4 times (81% vs 57%-P<0.00), engagement 8 times (14% vs 2% -P<0.001), transverse presentation 8 times (6% vs 2%-P<0.002), grand multiparity 3.9 times (4% vs 0-P<0.001), oligohydramnios 4.7 times (5% vs. 0-P<0.0001, and polyhydramnios 5.9 times (6% vs 0 - P<0.001). UCP was more prevalent in post-term deliveries (P<0.043). Oneminute Apgar score < 7 was 3 times more prevalent in neonates of the case group (P<0.00). Prepartum vaginal bleeding was 4 times more common in the case group, compared to the control group; also, decreased fetal movement and heart rate drop were more prevalent in the case group. Mortality rate was 5.2% in the case group and 1.7% in the control group. Overall, the control group had a better general health at discharge, compared to the case group. Conclusion: A statistically significant correlation was detected between UCP and gestational age, active phase of labor, fetal presentation, engagement, parity, and amniotic fluid volume. [ABSTRACT FROM AUTHOR]