Introduction: Postpartum depression is a mood disorder that depends on several factors and weakens the mother-child relationship, has a negative impact on mental health, quality of married life and family members. The aim of this study was to achieve postpartum depression and neonatal Apgar score in Normal delivery with and without pain. Materials and Methods: The method of the present study is quantitative and applied, using the method of correlation and structural equations. In terms of time, this study was conducted in the spring of 1400, and during this study, 120 women who referred to health centers in Qom who had passed one month to forty days after delivery were examined. The research instruments were Edinburgh Depression Inventory and Demographic Information. Spss-25 software was used for analysis and Smart Pls was used for path analysis. Results: The mean and standard deviation of depression in this sample was 12. 7. 7. 05. Moderate to moderate postpartum depression was reported. Neonatal Apgar score, neonatal sex, Normal delivery with and without analgesia do not play a significant role in depression. Conclusion: In order to prevent this disorder, it is recommended to implement educational and support programs for mothers and wives during pregnancy and after delivery, and to prevent the complications of this disorder by timely referral of mothers.

2Background and Objective: Women’s satisfaction with the experience and process of childbirth is a decisive factor in the mental health of the family and society and also affects fertility intentions in that many women with bitter memories of a previous birth do not want to have children again. Accordingly, this study aimed to compare childbirth satisfaction based on the type of delivery performed at Fatemieh Hospital in Hamadan, Iran. Materials and Methods: This cross-sectional study was conducted on 242 pregnant women referred to Fatemieh Educational and Medical Center in Hamadan, Iran. Sampling was performed through available sampling among individuals who met the inclusion criteria. Written informed consent was obtained from the participants. Data collection tools were the demographic characteristics questionnaire and the McKay Childbirth Satisfaction Rating Scale, which were completed two hours after delivery until the mother was discharged from the hospital. Study data were collected according to the objectives of the study and analyzed using the SPSS statistical software (version 23). The significance level was set at 0. 05. Results: The results of this study showed that there was no significant difference between the two groups in terms of demographic variables. Out of 120 deliveries with spinal analgesia, 93 (77. 5%) were dissatisfied with the delivery, and 27 (22. 5%) were satisfied. In the routine delivery group, out of 122 patients, 98 (80. 3%) were dissatisfied with the delivery, and 24 (19. 7%) were satisfied. There was no statistically significant difference between the two groups in terms of women’s satisfaction with childbirth (P=0. 6). Conclusion: The findings show no statistically significant difference in women’s satisfaction with childbirth between the two methods of delivery, including spinal analgesia and routine delivery without analgesia

Introduction: Labor pain is the main reason preventing pregnant women from having natural vaginal delivery (NVD).In order to reduce the labor pain, several ways have been introduced, among which spinal analgesia with Fentanyl is considered the most effective.Fentanyl is a lipophilic opioid with the degree of 75-125 times more potent than morphine.This study aims at evaluating the analgesic effects of fentanyl on the process of NVD as well as the possible risks involved for the neonate after spinal injection in pregnant women.Materials and Methods: This is a single blinded clinical trial on 100 pregnant women having their first or second pregnancy who referred to Mashhad Islamic Azad University hospitals for NVD in 1389 HS. This study benefited from using the accessible method of sampling and considering he ethical issues as well applying the inclusion / exclusion criteria. Having informed the patients and their spouses about the analgesic methods, the researchers received the patients’ consent and divided them into two groups of “case” and “control” with 50 patients, each. The case group received 75 µg of Fentanyl with the concentration of 0.05 mg/ml added  to sodium chloride and distilled water. These patients used the drug after getting into the cervical dilatation of 5 or 6 centimeters . The control group received no analgesic drug and experienced the natural process of labor and delivery. Systolic & Diastolic blood pressures, heart rate, SP02, the degree of cervical dilatation and effacement, fetal heart rate (FHR) and Apgar rate were evaluated during the intervals of 1 and 5 minutes after birth. Finally, these data were compared and analyzed with the statistical methods of T-test, Chi-square, Fisher and Man-Whitney, using SPSS.Results: There was no significant difference between the two study groups in terms of maternal systolic & diastolic blood pressure, SP02 and FHR. Shortly after the injection of Fentanyl, the patients in the case group started complaining about itching in the upper part of their abdomen and chest that automatically subsided after about 20-30 minutes. There was a statistically significant difference of the pain rate between the two groups (Pearson Chi-square=62.95, df=2, p=0.0001). Mild pain was seen in 82%, moderate pain in 16% and sever pain in 2% of the patients in the case group. On the other hand, only 4% of the patients in the control group were reported to have mild pain, 22% had moderate pain and the other 74% suffered from severe pain. Duration of labor was longer for the case group and the number of cases resulting in cesarean section was not statistically different between the two groups.Conclusion: Spinal injection of 75µg Fentanyl provides appropriate analgesia without any considerable side effects for the pregnant women who apply for NVD.

Introduction: Spinal analgesia with Opioids is the most effective way for reducing labor Pain. Sufentanil, a Lipophilic Opioid, has the pain-reducing power of 500-1000 times more than Morphine. This study intends to evaluate the effect of Sufentanil in reducing labor pain as well as its effect on Normal delivery (ND) and new-born fetal during the process of spinal analgesia.Materials and Methods: This is a prospective, randomized study of the type of single blinded control-trial design which was carried out on 100 pregnant women with ASA class 1&2 who were candidate for Normal delivery. Using accessible method of sampling, criteria for including and excluding samples were established and ethic principles were observed. The participants were divided into two groups of 50 persons. One group (case) received spinal analgesia of 7.5 mcg Sufentanil while the second group (control) did not use any kind of Opioid drugs. The data gathered about Systolic and Diastolic blood pressure, pulse rate, SPO2, cervix dilatation, effacement and fetal heart rate were recorded in a questionnaire. Pain rates were assessed with VAS. Spinal analgesia for the case group was done with spinal needle No: 27, labeled Dr j using paramedian approach based on sterilized condition. After the deliveries, an intern, under the supervision of a gynecologist, recorded the Apgar every one and every five minutes. Finally, conclusions were made by comparing the statistical results.Results: There weren’t any significant differences in age, weight, ASA and education between the two groups of the study. Also, the findings suggest no significant difference between the two groups in Systolic and Diastolic blood pressure, SPO2 and FHR Itching occurred in the upper chest and abdomen of the case group shortly after injecting spinal Sufentanil. However, it was over in 20-30 minutes. There was a significant difference in the rate of pain between the two groups. In the case group, 80% expressed mild pain while the control group reported 8% mild pain and 52% of severe pain. There weren’t any significant differences between the case and control groups in terms of duration of labor and cesarean section.Conclusion: Spinal analgesia with 7.5 mcg sufentanil provides appropriate analgesia without any considerable side effect for women who apply for ND.

In recent years, much more attentions have been focused on siRNA-based gene therapy. This approach is based on PTGS (Post-transcriptional gene silencing). Due to some defects in viral vectors, non-viral vectors have been used to deliver nucleic acids into target cells. Although, transfection efficiency in non-viral vectors is less than viral ones, but safety of non-viral vectors is much more. Characteristic features of siRNA, such as high compatibility, application in low doses and its versatility make it suitable in the gene therapy field. However, some challenges, such as stimulating immune system and Off-target silencing will be remain. In this review article, we express bottlenecks existing in siRNA delivery into target cells. According to the information, with further development of siRNA delivery in the future, it could be a promising approach in treatment for a variety of genetic diseases.

Background: The maternal health is one of the priorities of the World Health Organization and countries around the world. In this regard, promoting physiological childbirth has always been important for health care policy makers. However, fear of pain is one of the main reasons for pregnant women to refuse a natural childbirth, while this pain can be reduced by various analgesic methods. This study is a report of our experiences in painless delivery and the related problems and complications. Materials and Methods: In this retrospective cross-sectional study, all cases of painless delivery performed over a period of seven years in Taleghani Hospital affiliated to the Shahid Beheshti University of Medical Sciences in Tehran were investigated. The data was collected from the maternity ward by a questionnaire. Conclusion: Most cases underwent spinal anesthesia. The results showed that despite a wellequipped center and appropriate facilities, a significant number of pregnant mothers did not agree with neuraxial analgesia.

Introduction: Conversion disorder or functional neurologic symptom disorder is a diagnosis of exclusion in situations which the patients' symptoms and clinical findings(signs) are not consistent with a wellestablished organic reason and is not fully justifiable to make the diagnosis. Conversion disorder can present by very diverse manifestations such as: Aphonia, Motor and sensory loss, Ataxia, Psudoseizure, Dystonia, myoclonus, etc. almost always there is a psychologic trigger for conversion and in fact conversion or somatization is a way of dealing with stress for the human body. On one hand childbirth is a stressor of great magnitude and can act as a trigger for conversion disorder and on the other hand neurologic symptoms may being referred to anesthesia side effects (regional, neuraxial and general) and mislead the true diagnosis and appropriate treatment. Patient Presentation: A 33 years old woman gave birth to a healthy and vigorous newborn by vaginal delivery under epidural analgesia. immediately after entering to the recovery unit the mother presented aphonia and motor function loss of the limbs while being conscious and oriented. The mother was not agitated due to her symptom and could fully understand conversations and answer our questions with head movements. Her symptoms went away within 2 hours of being under observe in the recovery unit and she got fully recovered and symptom free. After thorough assessment of the patient we were led to the diagnosis of conversion disorder which was proven correct after neurologic and psychiatric consultations. Conclusion: Although conversion disorder is diagnosed after having other possible diagnoses ruled out, it is important to consider conversion disorder as a possible diagnosis when we are facing neurologic symptoms inconsistent with clinical findings, especially in young women after a psychologic stressful situation like childbirth. considering the obstetric patients’ properties, we expect obstetric anesthesiologists to visit greater number of conversion patients in the perioperative time in comparison with other anesthesia fields.

Introduction: Usage of different types of pain relief during labor is the best method for relief of pain during labor. Spinal analgesia belongs to a long history in midwifery. This study was designed to evaluate the effect of spinal analgesia during stages of labor and delivery. Material and Methods: This study was a randomized clinical trial done in 2005 in 17 Shahrivar Hospital of Mashhad. Two groups (62 patients) selected from pregnant term women. Patients were divided into two similar groups (case and control). The patients in the case group received spinal analgesia with 50 mg fentanyl (in prime gravid 15 mg petedine was added). Characteristics of patients such as length of labor, fetal heart rate, and demographic data was collected in a questionnaire and analyzed by SPSS software, Q square, and T. students test.Results: Age, gravidity, condition of anemia, fetal heart rate before using spinal analgesia did not have significant difference in the two groups. The length of first stage of labor was 143.7 minutes for the case group and 311.45 in the control group (p<0/05). Apgar, length of the second and the third stages of labor were similar in both groups. Headaches in the forth stage of labor had significant difference in the two groups (p=0.5).Conclusion: The use of spinal analgesia provides a satisfactory result for labor and decreases the length of the first stage of labor without disrupting the Normal course of labor. It can be recommended as a suitable method for pain reduction in labor.