Background:Uncontrolled hemorrhage still remains a major cause of trauma-associated mortality. The events resulting in acute traumatic coagulopathy, particularly hypofibrinogenemia, make control of bleeding difficult. It is essential to timely predict, diagnose, and manage trauma-induced coagulopathy.Aims:The aim of this study is to determine clinical and easily available laboratory variables that are predictive of hypofibrinogenemia in acute trauma patients.Settings and Design:This 2-year retrospective work examined the data of major trauma patients that were referred to Shahid Rajaee Hospital's emergency room in hemorrhagic shock condition.Materials and Methods:Fibrinogen level was assessed for these patients on their arrival at our facility. Along with clinical and routine paraclinical variables, we evaluated the predictive value of these variables for a fibrinogen level below 100 mg/ml.Results:A total of 855 cases were included (females: 16.4%; and males: 83.6%) in the study. The mean ± SD age was 36 ± 17.9 years, and the mean ± SD injury severity score was 12.2 ± 9. Motor vehicle accident was the most common cause of injury. Three factors, including arterial pH (cut off point = 7.34; area under the curve [AUC]: 0.59), base excess (cutoff point = −4.3; AUC: 0.60), and patients' gender had a significant association with the fibrinogen level under 100 mg/ml. When three factors of pH, BE, and patients' gender are being assessed simultaneously, the AUC became 0.62 (the predictive ability improved).Conclusions:Variables, including arterial pH, BE level, and patients' gender have predictive value for fibrinogen transfusion in trauma.

Background: Caesarean Section means the exiting of the fetus, placenta and membranes by cutting the abdominal wall and uterus. Indications of this operation include previous cesarean, dystocia, fetal distress and presenting of breech. Methods: In this cross-sectional study, 255 pregnant women requesting caesarean Section that referred to the obstetrics and gynecology department of Imam Reza hospital of Larestan were selected as an available sampling as a sample of this study. Three-part structured questionnaire to collect information include: Individual factors, protective factors and indications for cesarean Section was used and finally the data were analyzed by using SPSS software, version 19 and chi-square and Fisher exact tests. Results: The findings 61.57 percent of proper cesarean Section and 38.43 percent had been of inappropriate cesarean. Results showed that there is a significant difference between the mean number of pregnancies, pervious cesarean Section and the age between appropriate and inappropriate cesarean (P <0.05). Supplemental insurance, the type of care during pregnancy, education level, type of insurance, employment status, age at marriage and age of cesarean, there is no significant difference between appropriate and inappropriate. Also repeated cesarean Section 34.5 in the first phase, demand of mom 21.6 and medical advice 16.9 in the second and third rate were the most important of cesarean reasons. Conclusions: Considering the role of repeated cesarean, the mom's demand and doctor's advice in choosing the type of cesarean and significant relationship between the number of pregnancies, pervious cesarean and the age in between the appropriate and inappropriate it is necessary to consider these factors in order to reducing the demand of cesarean by doing essential measures to change attitudes of pregnant woman in this area.

Purpose:To investigate the meaning of spirituality in pregnancy by asking, "How does your faith or spirituality affect your pregnancy?" Background: Despite the emphasis of midwives on the holistic nature of pregnancy, few have described the meaning that spirituality may have for pregnant women. The study was guided by the HOPE Theory (Holistic Obstetrical Problem Evaluation). Methods: Study participants were recruited from a nonrandom convenience sample of 130 pregnant African American and Caucasian women between 16 and 28 weeks' gestational age. Content analysis was conducted, and data were coded and clustered under major themes. Results: Of the study sample, 62% were African American and 38% Caucasian; 76% were Medicaid recipients. Seven themes emerged on how faith or spirituality affected the women's pregnancy, including 1) strength and confidence, 2) guidance and support, 3) protection, 4) blessing or reward, 5) time to communicate with God, 6) help with difficult moral choices, and 7) a generalized positive effect. Of the 62 women who responded that spirituality affected their pregnancy, the overarching theme was a desire for connectedness to oneself, others, or God. Conclusion: The findings from this study emphasize the importance of spirituality within a holistic framework and the need for health care providers to attend to spirituality as a resource in pregnancy for those who value it.

Background: Pain control methods after cesarean section may interfere with infant breast-feeding. The aim of this study was to evaluate the effect of pethidine on breast feeding of infants born via cesarean section with spinal anesthesia. Methods: In this randomized double-blind clinical trial, we evaluated 116 infants born via cesarean section in Gerash Amiralmomenin hospital (Southern Iran) in 2017. The subjects were selected through purposive sampling and randomly by permuted block randomization and assigned to intervention and control groups. The test group received 100 mg of pethidine as intravenous infusion and the control group received only routine cares. Infants’ breast feeding behavior in both groups was recorded within 48 hours of hospitalization, using the standard tool for rapid assessment of infant feeding behavior, which consists of 4 main components of breastfeeding, including readiness to feed, rooting, latching, and sucking with a score range of 0 to 3 for each component evaluated at 1, 6, 12, 24, 36, and 48 hours postnatally. Data were analyzed using independent t tests and chi-square test. Results: The highest score of breast-feeding behavior pertained to sucking reflexes in the control group and the lowest score to breast feeding readiness in the pethidine group. Readiness for feeding in the control group (2.09±0.53) was significantly higher than the pethidine group (1.81±0.61) (95% CI: 0.0552, 0.5092 and P=0.015). Sucking reflex (95% CI: -0.1461, 0.2208 and P=0.687), latching (95% CI: -0.3012, 0.0345 and P=0.118) and rooting reflexes (95% CI: -0.1685, 0.2342 and P=0.747) were almost equal in the control group (2.54±0.49, 2.52±0.38, 2.5±0.48, respectively) and pethidine groups (2.51±0.43, 2.65±0.45, 2.46±0.53, respectively). The total score of feeding behavior in the control group (9.66±1.04) was higher than that of the pethidine group (9.44 ±.69) (95% CI: -0.2032, 0.6412 and P=0.306). There was no significant difference between the infants’ feeding frequency (95% CI: -0.269, 1.930 and P=0.137) and duration of feeding (95% CI: -3.2067, 0.4597 and P=0.14). Conclusion: Evaluation of infants in the first 48 hours after birth showed that those babies whose mothers received pethidine were less willing to start breast-feeding. However, other components of breast-feeding behaviors were similar.