Background and purpose: Perineal lacerations are common complications of normal vaginal delivery which influence maternal health and quality of life of mothers. This study aimed at comparing perineal protection using hands on and hands off techniques on perineal lacerations during delivery.Material and Methods: This clinical trial included 600 nulliparous women who were randomly divided into hands on and hands off groups (n=300 per group). In hands on technique when the head was crowning, a midwife placed her index, middle, ring and little fingers on the infant’s occiput, simultaneously she placed her other hand (index finger and thumb) in a “u” shape exerting pressure on the posterior region of the perineum. In hands off technique during expulsive period the midwife’s conduct was expectant, as she only observed the successive movement of external rotation, delivery of shoulder and remainder of the body. The data was analyzed using chi –square and independent T-Test in SPSSV.16Results: The rate of Perineal lacerations was not different between the two groups (P=0.7). In both groups first degree lacerations were more dominant. Three degree lacerations (P=0.01) and episiotomy (P=0.003) were significantly lower in hands off group but the rate of periurethral lacerations was significantly higher in hands-off group (P=0.01). Second stage of labor and neonatal outcomes were similar in both groups.Conclusion: In present study the use of hands off technique reduced the rate of episiotomy and three degree lacerations of birth canal, therefore, it could be recommended as a safe method during labor.

Background: Given the fact that the carpal tunnel syndrome (CTS) happens as a consequence of the median nerve entrapment, besides other known factors, the shape and anthropometric characteristics of the carpal tunnel, wrist, and hand could be considered as a predisposing risk factor for idiopathic CTS. The aim of this study was to evaluate the morphology and radiologic scales in CTS hands. Methods: In this prospective study, patients who underwent upper extremity electrodiagnostic studies were enrolled for hand morphologic and radiographic indexes. Patients were divided into CTS suffering and CTS symptom-free groups according to nerve conduction velocity (NCV) findings. A true posteroanterior radiograph of the hands was pas performed for each participant. Metacarpal length to wrist length index (carpal ratio), metacarpal length to metacarpal width index, third to first metacarpal length, hand length index, and hand volume index were measured in both groups. Results: Significant differences were seen between the two groups regarding the body mass index (P< 0. 001), metacarpal length divided by metacarpal width index (P=0. 08), first metacarpal length divided by third metacarpal length (P=0. 002), wrist circumference divided by distal flexor wrist crease to the tip of the third finger (P< 0. 001), distal flexor wrist crease to the tip of the third finger divided by hand volume (P=0. 05), and distal flexor wrist crease to the tip of the third finger divided by wrist circumference (P< 0. 001). Multivariable analysis of hand indices were statically significant for the first metacarpal length divided by third metacarpal length (P=0. 00), wrist circumference divided by distal flexor wrist crease to the tip of the third finger (P=0. 138), and distal flexor wrist crease to the tip of the third finger divided by wrist circumference (P=0. 117). However, first metacarpal length divided by third metacarpal length and third metacarpal length divided by palm height were associated with higher CTS occurrences. Receiver operating characteristic curve analysis demonstrated cutoff points which were possible to estimate only for first metacarpal length divided by third metacarpal length and wrist circumference divided by distal flexor wrist crease to the tip of the third finger. Conclusion: Based on our findings, CTS hand is characterized by shorter fingers compared to thumb and wrist (metacarpal length to wrist length and hand length indexes), wider (metacarpal length to metacarpal width index), and bulkier (hand volume index) compared to non-CTS hands. The severity of CTS was correlated with a higher carpal ratio. In conclusion, CTS hands are bulkier with wider palms and shorter fingers compared to thumb. In this study, the thumb to the third metacarpal length was proved to be the best index for diagnosis of "CTS hand".

Background and Purpose: Perineal damage is one of the traumas most frequently suffered by women during delivery. There are several techniques aimed at reducing the perineal damage. The present study is aimed at determining and comparing the frequency and degree of perineal rupture in hands-off and hands-on techniques of protecting perinea during labor. Method and Materials: This blind clinical trial (with the CI of 95% and test power of 80%) involved 187 women who, after signing their informed consent, were divided into the hands-off (n= 98) and hands-on (n=89) groups through random allocation. In the experimental (hands-off) method, the midwife guides the parturient and observes the process of labor without touching the perineum or the head. In the control (hands-on) group, the midwife protects the infant's head using Ringen maneuver. The data were analyzed in SPSS using chi-square and Fisher's exact test. Results: The result showed that the undamaged perinea in the hands-off group were 44.9%, versus 10% in the hands-on group, where the difference was statistically significant (P < 0.0001). Perineal laceration was 51% in the hands-off group and 47.2% in the hands-on group but the difference between the two groups was not significant (p = 0.55). Most ruptures were of the first-degree type (50% in the hands-off and 64.3% in the hands-on group). In the hands-off group, 3.1% underwent episiotomy as compared with 75.3% in the hands-on group. Conclusion: The results suggest that a policy of hands-off technique in protecting perinea can be safe and efficient technique and can be an alternative method in perineal protection during labor.

Background and Purpose: Self-efficacy is a modifiable psychological variable in sustained breastfeeding that is defined as a mother's confidence in her perceived ability for successful and exclusive breastfeeding. Therefore, the present study was conducted in order to compare the effectiveness of “Hands on” and” Hands off” methods on breastfeeding self-efficacy in primiparous mothers.Materials and Methods: In this experimental single-blind study, 124 primiparous women were randomly assigned to one of the three groups. Participants in the experimental group received one of the structured one-on-one educational sessions (i.e., hands-off or hands-on) within the first two hours of giving birth to her child. Mothers in control group received usual postpartum care. Follow-up assessments were conducted one, four, and eight weeks after the birth. Data collection was done through interview forms, examination and observation, checklist of breastfeeding status, breastfeeding self-efficacy and dailyfeeding form. The obtained data were analyzed in SPSS using one-way ANOVA, Kruskal Wallis and correlation coefficient (p<0.05 was considered as significance level and test power of 80% was estimated).Results: Mean score of self efficacy in the first week of handsoff and hands-on groups were 59.9±4.78 and 54.59±7.55 respectively; it was 56.6±8.93 in the routine care participants. In the fourth week, the figure amounted to 63.28±6.63 and 58.78±9.05 respectively; also, in the routine care participants it was 56.1±9.04. But in the eighth week, the figures were 66.7±5.3 and 61.7±8.4 respectively; it was 60.9±6.2 in the routine group. A statistically significant difference was demonstrated the three between treatment durations (p=0.000).Conclusion: The hands-off education increased breastfeeding self efficacy in the first eight weeks after birth.

Background & Objective: Perineal trauma usual1y occurs during childbirth and associates with short and long term complications for women. Blood loss, urinary, faecal and sexual incontinence are effects of after childbirth complications of perinal trauma. These can cause maternal and newborn morbidity. This study wanted to compare the effectiveness of two techniques for perineum protection "hands off' versus "hands on" (Ritgen) during childbirth from view points of frequency, degree and suture of perineal trauma. Methods: This randomized clinical trial study carried out on 70 nulliparous women that expecting normal birth of a singleton. They were randomly selected and divided in hands off and hands on (N = 35) groups. In the 'hands on' method, midwife put pressure on the baby's head and support ('guard') the perineum; then lateral flexion is used to facilitate delivery of the shoulders, and in the 'hands off method, midwife keep her hands poised, not touching the head or perineum, allowing spontaneous delivery of the shoulders. We analyzed data with descriptive statistical methods, t-test, chi-squer, mann whitney and non parametric tests by SPSS.Results: Rates of intact perineum was significantly higher in the 'hands off' group (50%, 40%, P = 0.48). The first and second degree tears were significantly lower in the 'hands off' group (40.6%, 50%, vs, 9.4%, 10%, P = 0.48). We did not observe any significant differences in the rate of lacerations in the anterior regions of the perineum and frequency of suture between the two groups.Conclusions: The hands off technique in the second stage of labour increases the likelihood of an intact perineum.

Health care associated infections (HCAI), lead to significant morbidity and mortality in hospitalized patients. It has been estimated that about 1.5 million patients incur HCAI at any time throughout the world. In industrialized countries up to 15% of patients admitted to the hospitals and up to 37% of those admitted to the intensive care units (ICUs) may contract HCAI, these figures are much higher in developing countries. The risk of infections associated with various devices and procedures, like central venous lines, mechanical ventilations, and urinary catheters rises sharply in the ICU setting (1).