Background: The osteitis pubis is an inflammatory-noninfectious disease of the pubic symphysis, which is rarely reported in the postpartum period after Normal Vaginal Delivery. Misdiagnosis of this disease can leave the patient disabled with a poor quality of life Case report: The case in the present study was a 35-year-old woman, admitted two days after giving birth, due to severe pain in the hypogastric and groin regions. Movement aggravated the pain in a way that disabled the patient. The pelvic radiograph showed pubic symphysis dislocation, and osteitis pubis was clinically diagnosed. Therefore, conservative treatment was prescribed for her, including relative bed rest, nonsteroidal anti-inflammatory drugs (PRN, maximum TDS), physiotherapy, and pelvic binder, for two weeks. After this period, her pain decreased gradually and in the next follow-up, which was one month later, she had no limitation of motion. Conclusion: Though it seems to be a simple disease, osteitis pubis can cause profound motion disability. Early diagnosis and treatment can prevent complications, such as joint stiffness and chronic pain.

Injuries to the genitourinary organs are complications of Vaginal Delivery. We report a patient with no history of surgery presented 4 days postpartum with distended tender abdomen and peritoneal sign and renal failure. Abdominal X-Ray showed a large amount of ascites. In laparotomy 3.5 liter of urine was in cavity and laceration of 3 cm in the dome of bladder was seen. Repair was done. By reviewing the record, this is the fourth case of bladder rupture after Normal Vaginal Delivery without previous history of cesarean section. In the postpartum patient presenting with ascites and azotemia, intraperitoneal bladder rupture should be suspected.

Background: A variety of endocrine disorders can complicate pregnancy. Diabetes insipidus although uncommon, may have devastating effect on pregnancy outcome, if unrecognized and untreated. The etiology of diabetes insipidus is often unknown, many cases are likely autoimmune, with lymphocytic infiltration of the posterior Pituitary gland. Massive polyuria, caused by failure of the renal tubular concentrating mechanism, and dilute urine, with a specific gravity 1.005, are characteristic of diabetes insipidus. The diagnosis of diabetes insipidus relies on the finding of continued polyuria and relative urinary hyposmolarity when water is restricted. Most Women require increased doses Desmopressin Acetate during pregnancy because of an increased metabolic clearance rate stimulated by placental Vasopressinase. By this same mechanism, subclinical diabetes insipidus may become symptomatic during pregnancy. Transient diabetes insipidus is associated with acute fatty liver and HELLP syndrome as well as twin gestation. Increased placental Vasopressinase activity, along with insufficient liver degradation in HELLP syndrome and acute fatty liver, may unmask this condition. Diabetes insipidus in pregnancy is rare. The disease results from inadequate or absent antidiuretic hormone (vasopressin) production by the posterior pituitary gland. The increased glomerular filtration rate seen in pregnancy may increase the requirement for antidiuretic hormone. Case presentation: We present a 39 years old woman, gravida3 para3, was admitted to Akbarabadi Teaching Hospital in September 2013. She was admitted due to polyuria, malaise, thirst with slight fever, six days after Normal Vaginal Delivery. The urine volume was 8 lit/day and the specific gravity (S.G.) of the urine was 1.010. The urine osmolarity was lower than the plasma osmolarity. Electrolyte serum examination showed hypernatremia. The patient received 5 µg/day of synthetic vasopressin, in the form of l- deamino-8-Darginine vasopressin (DDAVP). This drug was given as intranasal spray in doses 0.25 mg twice daily. Plasma electrolytes and fluid status monitored carefully with initiation of therapy. DDAVP was used because it was not degraded by vasopressinase. Treatment was continuing, when the symptoms of central Diabetes insipidus resolve and urinary concentrating ability was preferred. Maximum urinary osmolality over the next 11 hours was assessed, 730 mosm/kg was considered Normal.Conclusion: Close attention to electrolyte and fluid balance is important in the postpartum period. The symptoms of transient vasopressin-resistant diabetes insipidus resolve in few days to a few weeks after Vaginal Delivery or when hepatic function returns to Normal.

Introduction: Pelvic inflammatory disease (PID) is defined as an acute and subclinical infection of the upper genital system, including the uterus, fallopian tubes, ovaries, and ligaments. It can lead to various complications, such as salpingitis, endometritis, oophoritis, perihepatitis, peritonitis, and tubo-ovarian abscess (TOA). Case Presentation: In our case, a 22-year-old Afghan woman presented with generalized pain in the abdomen and pelvis, accompanied by Vaginal discharge and fever, following 17 days of Normal Vaginal Delivery (NVD) and septic shock. She had no previous history of PID. Abdominal ultrasonography revealed a significant amount of free fluid in the paracolic grooves and pelvis, along with a perforated mass on the right adnexa. As a result, she underwent laparotomy and right adnexectomy. A 10-day course of meropenem and vancomycin was prescribed, and the woman was discharged with oral antibiotics. Conclusions: Tubo-ovarian abscess following NVD is a rare condition that can occur in patients with preterm premature rupture of membranes (PPROM) and episiotomy. Therefore, it is essential to prescribe antibiotics in cases involving episiotomy and rupture of the membranous.

Puerperal uterine inversion is a rare obstetric emergency that may cause maternal mortality. We describe a multiparous woman with total uterine inversion after a Normal Vaginal Delivery. A 28-years-old, gravid 3, pregnant woman was admitted to the hospital in the first stage of labor. She had a past medical history of curettage due to abNormal Vaginal bleeding following her second Vaginal Delivery and the present pregnancy proceeded without complications. After the Delivery, due to the history of placental adhesion, umbilical cord traction was avoided and after 20 min, the patient was asked to push hard. During a Valsalva maneuver, the uterus and the placenta were suddenly expelled from the vagina. The placenta was completely adherent to the decidua and the patient displayed no signs of shock. Then manual repositioning of the uterus was performed by a closed fist and a subtotal abdominal hysterectomy was performed. Pathological examination revealed placenta accreta and the placenta was found completely adherent at the fundus. Uterine inversion usually occurs unexpectedly and is unpreventable in some cases. Assessment of the possible risk factors before Delivery may help predict its occurrence. Therefore, in women with a positive history, special measures should be taken in the third stage of labor to manage the possibility of inversion.

Background & aim: Warm water immersion during labor is associated with relaxation and pain reduction for pregnant women. This method is not extensively used in Iran, given the fear of infection and other maternal/neonatal complications. Alternative methods are required to increase the safety of Normal Vaginal Delivery. The purpose of this study was to compare maternal and neonatal outcomes, associated with water birth and Normal Vaginal Delivery.Methods: This analytical, cross-sectional study was performed on 43 water birth cases (study group) and 62 subjects with Normal Vaginal Delivery (control group). Random sampling and consensus were applied for Normal Vaginal Delivery and water birth groups, respectively. Data were collected in a data collection form, using hospital records and interviews with mothers. For data analysis, descriptive and analytical tests including t-test and Chi-square were carried out, using SPSS version 15.Results: No significant difference was observed between the two groups in terms of labor and Delivery complications; although three cases of complications during the second stage of labor and four cases of hospitalizations at birth were reported in the control group. The two groups were not significantly different in terms of hospitalization for the reason of neonatal period complications. Regarding maternal complications, there was a significant difference in the rate of episiotomy between the two groups (P=0.032). Postpartum hemorrhage was mostly observed in the control group, although the difference was not significant.Conclusion: In this study, no significant difference was observed in terms of maternal or neonatal complications between the two groups. Therefore, it seems that water birth is a safe method, associated with improved pregnancy outcomes.

Introduction: The postpartum period is a dangerous potential time for postpartum depression. Postpartum depression is the reducer instrument for postpartum support. The purpose of the current study is to determine the effectiveness of postpartum supports on the postnatal women depression after childbirth. Methods: This study a semi experimental study was conducted in Marand hospital. Two hundred sixty mothers agreed to take part and were randomly allocated to an intervention group (n = 130) or control group (n = 130). The intervention group received telephone counseling for 20- minute at the first week twice, second week till 6th weeks once at week plus routine care. The control group received only the routine care. Also for evaluation of the unanticipated mother’s needs, 24-hour telephone access to researcher was provided. The main outcome measure was recording demographics data sheet, postpartum problem’s checklist and the Edinburgh Postnatal Depression Scale (EPDS) administered by presence interview questionnaire at six weeks after Delivery. Control group received general postpartum education. The data were analyzed by χ², Fisher test and T test. Results: At 6 week postpartum, mean of depression was obtained in the intervention group (15/80 ± 5/12) and in the control group (18/43 ± 5/90). On the EPDS scale, in the intervention group was significantly decrease to control group (P < 0.0001). Conclusions: The result of this research showed that Postpartum Fallow Up by midwife could effective to decrease women’s postpartum depression in the pureperium.

Background & objective: One of the objectives of health reform plan in Iran is to reduce the rate of cesarean section Delivery. This needs research and use of results to improve the maternal and neonatal outcomes. The aim of this study was to compare the maternal and neonatal outcomes after Normal Vaginal and cesarean section Delivery in hospitalized low-risk mothers in Arash Hospital in Tehran, Iran.Methods: In this prospective cohort study, 1900 low-risk pregnant women, with 37-40 weeks of gestational age, referring to the emergency department and being hospitalized for Delivery were included. The data were collected from two groups of patients (Normal Vaginal Delivery and cesarean section Delivery). Data on wound infection, abNormal postpartum hemorrhage, decrease of hemoglobin, transfusion requirement, injuries to the genitourinary system, fever until 10 days after Delivery, neonatal respiratory complications, NICU admission, jaundice and obstetric injuries were collected by a questionnaire.Results: From 1900 pregnant women, 62.1% had cesarean Delivery and 37.9% had Normal Vaginal Delivery. The reasons for cesarean Delivery included repeated cesarean (68%), failure to progress (18.1%), and fetal distress (13.9%). Wound infection (p=0.004), abNormal postpartum hemorrhage (p=0.042) and low hemoglobin (p<0.001) were more frequent in cesarean Delivery group than in Normal Vaginal Delivery group. But obstetric injuries were higher in Normal Vaginal Delivery group (p<0.0001). There was no difference between the two groups in terms of fever ten days after Delivery and blood transfusion requirement. For neonatal outcomes, transient neonatal tachypnea (p=0.032), neonatal respiratory distress syndrome (p=0.002), and NICU admission (p<0.0001) were more frequent in cesarean Delivery group than in Normal Vaginal Delivery group. There was no difference between the two groups in neonatal jaundice rate and neonatal injuries.Conclusion: Due to the high rate of cesarean section Delivery in our country and higher rate of maternal and neonatal complications after cesarean section Delivery, appropriate strategies are required to be applied to decrease unnecessary cesarean section Delivery and increase Normal Delivery with minimum maternal and neonatal complications.

Introduction: One of the goals of the health reform program (HRP) which was started in 2014, was Normal Vaginal Delivery (NVD) promotion. Although, HRP has been successful in increasing NVD, it seems medical complaints related to the Delivery have been rising during this program. Therefore, this study examined the complaints related to the NVD and cesarean section in 2011 to 2017. Materials and Methods: In this retrospective study, the complaints registered in the field of obstetrics and gynecology surgery in the sub-branch of midwifery, in the Forensic Medicine Organization and the Police Department of Tehran were investigated (before and after the HRP) randomly. Results: The results of this study showed that in 18 cases (16. 3%) of the investigated medical complaints, malpractice occurred, 14 cases of which (77. 8%) related to before and 4 cases (22. 2%) related to after the implementation of the HRP. Conclusion: The results of this study showed that some medical malpractices are avoidable. Health system managers should pay more attention to avoidable malpractice to improve the quality of the services. The results of this study showed that the implementation of the HRP did not cause an increase in the number of registered complaints related to the Delivery.

Introduction: Cesarean section is growing increasingly in Iran. Therefore, it is necessary to find out an appropriate training method for encouraging pregnant women toward performing Vaginal Delivery. The purpose of this study is to compare the effect of two training methods including educational package plus group discussion, with educational package to encourage pregnant women for performing Vaginal Delivery.Methods: A quasi-experimental study was carried out on a sample of 100 pregnant women who referred to the obstetricians’ offices in Zahedan in 2011-12. Pregnant women included in study if they were in the third trimester of pregnancy with the intention or decision to elective cesarean section. After performing the pretests, they were voluntarily classified in one of the two educational groups including the educational package plus group discussion (group A), or educational package (group B). After a month of waiting time posttest was conducted. Data was analyzed using independent T, paired T and Chi-Square Tests.Results: The Comparison of mean and standard deviation of knowledge scores between pregnant women in two groups showed no significant difference after training. However there was significant difference between attitude (p<0.05), perceived behavior control (p<0.001), behavioral intention (p<0.05), subjective norm and behavior (p<0.001) of women in two groups after training.Conclusion: Both methods increased knowledge of participants. In comparison group discussion method (group A) has more effectively increased other constructs of the model and significantly improved Normal Vaginal Delivery behavior. This might be due to increased motivation, and decision making ability and skills of women experiencing group discussions.