Background: The aim of this study was to evaluate the effect of health sector evolution plan (HSEP) on the prevalence of cesarean section and vaginal delivery in public hospitals in Kermanshah province. Methods: In the present study, cesarean section (C-Section) and vaginal delivery data were collected and evaluated in 17 public hospitals from 2009 to 2019. The main variables of this study included the prevalence of C-Section and the prevalence of vaginal delivery for 121 months, both were obtained by dividing the number of deliveries by C-Section and vaginal delivery by the total number. Interrupted time series analysis was used to examine the effect of HSEP on the prevalence of cesarean and vaginal delivery rates. Results: The prevalence of C-Section before and after the HSEP was 42. 5% and 43. 2%, respectively. Months before the intervention, the rate of C-Section was increasing by 0. 13%, which was statistically significant. In the first month after the intervention, the prevalence of C-Section decreased by 3. 6% that was statistically significant. The share of C-Section in the months after the implementation of the HSEP showed a monthly increase of 0. 12% compared to before the intervention, which was statistically significant. Conclusions: The results of the study showed that the HSEP has led to a significant reduction in Csection in short term, but in the months after the implementation of the plan, the prevalence of Csection has increased again.

Background: Cesarean section (C-Section) not only is associated with health risks for both mother and child, but also is costly. Csection rates are on the rise worldwide. In Iran, it is becoming a major challenge for current population policies. Objectives: The current study aimed to investigate the main factors of the tendency to C-Section in Iran. Methods: In this cross-sectional study 320 pregnant women admitted to health centers in Lorestan province (west of Iran) in 2019 are included. Participants were selected using the multi-stage cluster sampling technique. Data were collected using a demographic form, the Fear of Pain Questionnaire, and the Knowledge and Attitude about Delivery Methods scale. Descriptive statistics and multivariate logistic regression model were employed to analyze the data using the Stata version 14. Results: 48. 44% of participants preferred cesarean delivery. The mean scores of fear of pain in the C-Section and vaginal delivery groups were 39. 98  8. 21 and 36  8. 62, respectively, indicating a signifi cant diff erence (P < 0. 001). Level of education of the husband (OR = 2. 79), income (OR = 5. 9), fear of labor pain (OR = 1. 04), history of C-Section, and improved attitude toward C-Section (P < 0. 001) were directly associated with increased tendency to C-Section (OR = 0. 36); in contrast, female gender of the fetus (OR = 0. 36), increased BMI (OR = 0. 75), and improved attitude toward vaginal delivery were indirectly associated with women’ s tendency to C-Section. Conclusions: This study showed that while many pregnant women prefer vaginal delivery, the tendency to C-Section in Lorestan province is high, which reveals the need to design and implement eff ective interventions and programs to reduce unnecessary Csection and promote vaginal delivery. Educating families, especially pregnant women, about the advantages and disadvantages of delivery modes, promoting and using new low pain techniques of vaginal delivery, and increasing women’ s participation in childbirth preparation programs are eff ective measures that can reduce the rate of unnecessary C-Section.

Wilson’, s disease is a rare autosomal recessive condition, that affects the liver and brain mainly. Pregnancy in these patients is of high risk due to involvement of liver and high incidence of abortion, preeclampsia, HELLP syndrome. We report a case of a 24year old G2A1 (35+2 weeks) diagnosed with wilson’, s disease 6 years ago, currently on tab zinc. She presented with thrombocytopenia, anemia, extrahepatic portal vein occlusion with splenomegaly and mild ascites. She was taken up for elective section at 35+2 weeks, under general anesthesia. With intramyometrial injection of carboprost, there was sudden desaturation and bronchospasm. However, we managed the case successfully with safe outcome of both the mother and child. There are only very few case reports of Wilson’, s disease in pregnancy undergoing Csection under general anesthesia in the presence of hepatic dysfunction.

Background & Objective: This study aimed to investigate the relationship between the level of high-sensitivity C-reactive protein (hs-CRP,as an indicator of inflammatory response) and shoulder tip pain (STP) following cesarean section (Csection). Materials & Methods: In this cohort study, a total of 120 pregnant women who were candidates for elective C-Section at Imam Reza Hospital were included. The level of hs-CRP was measured perioperatively. STP was measured after the operation. Results: Mean hs-CRP was significantly higher in females with STP compared to counterparts (19±, 13. 1 vs. 7. 2±, 4. 5,P<0. 001). There was a positive and strong correlation between STP and postoperative hs-CRP (P<0. 001). Conclusion: The release of acute-phase proteins (such as hs-CRP) plays a significant role in STP after C-Section,the intensity of STP is associated with the level of hsCRP.

Background and purpose: Anxiety before Cesarean section (C-Section) is one of the common disorders that is caused by different reasons. According to Iranian traditional medicine, temperament indicates the specific characteristics of each person and its understanding is of great benefit in prevention and treatment of diseases and implementing interventions. The present study was conducted to determine the relationship between temperament and anxiety before C-Section. Materials and methods: This descriptive analytical study was conducted in 327 pregnant women candidates for C-Section in Kerman, Iran 2020-2021. Spielberger State-Trait Anxiety Inventory and Salmannezhad Temperament (Mizaj) Questionnaire were completed at gynecology ward before Csection. Analysis of quantitative data was done applying ANOVA and T-test and analysis of qualitative variables was done using Chi-square test in SPSS V21. Results: The average age of pregnant women was 29. 24±, 6. 33 years and 37. 3% were experiencing their second pregnancy. The mean scores for latent anxiety before C-Section in cold-tempered mothers and warm-tempered mothers were 54. 43±, 8. 29 and 34. 44±, 9. 81, respectively, (P=0. 001). Conclusion: The level of latent anxiety before C-Section was higher in cold-tempered mothers than warm-tempered and moderate-tempered mothers. Therefore, necessary measures considering traditional medicine are recommended for cold-tempered mothers before surgery.

Introduction: Anesthesia is always accompanied with operation. In cesarean, general or local anesthesia is used to decrease pain during Csection. Local anesthesia has many benefits comparing to the general anesthesia for example: absent newborn hypoxia if blood pressure is not decreased, an awake mother, needs no painless drugs after anesthesia, facility and the relaxation of pelvic and delivery canal. General anesthesia is done when defect of coagulation, hypovolemia or emergency problem occurs. In this study, we compared the effect of general and spinal anesthesia upon neonatal Apgar score at 1 and 5 minutes in elective cesarean section in Zahedan Ali Ebn Abitaleb Hospital.Materials and Methods: In one randomized clinical traial study, 142 pregnant women were classified into two groups with 71 persons. Pregnant women elected randomly the kind of the anesthesia. All of them had term pregnancy. They had abnormal anesthesia or newborns had anomaly outcome from this study. We needed information from maternal age and weight, gestational age, cause of cesarean section and after delivery Apgar scores at 1 and 5 minutes was also recorded.Results: There were significant differences between the two groups for 1 and 5 minute Apgar scores (p<0.05) and spinal anesthesia group had higher apgar scores in 1 and 5 min. Maternal age, weight, mean gestational age, baby weight and reason for cesarean section did not differ significantly between the two groups. First cause to cesarean section in two groups was previous cesarean section and second cause was fetal position.Conclusion: Our findings indicated that there is statistical difference in two groups in general anesthesia and spinal anesthesia for 1 and 5 minute Apgar scores. Many studies, similar to our study, establish our finding. We suggest that the performance of this study and the experience of anesthesiologist for spinal anesthesia must be increased.