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Background The COVID-19 pandemic and its impact on healthcare services is likely to affect birth outcomes including the delivery mode. However, recent evidence has been conflicting in this regard. The study aimed to assess changes to C-section rate during the COVID-19 pandemic in Iran. Methods This is a retrospective analysis of electronic medical records of women delivered in the maternity department of hospitals in all provinces of Iran before the COVID-19 pandemic (February-August 30, 2019) and during the pandemic (February-August 30, 2020). Data were collected through the Iranian Maternal and Neonatal Network (IMAN), a country-wide electronic health record database management system for maternal and neonatal information. A total of 1,208,671 medical records were analyzed using the SPSS software version 22. The differences in C-section rates according to the studied variables were tested using the χ2 test. A logistic regression analysis was conducted to determine the factors associated with C-section. Results A significant rise was observed in the rates of C-section during the pandemic compared to the pre-pandemic (52.9% vs 50.8%; p  = .001). The rates for preeclampsia (3.0% vs 1.3%), gestational diabetes (6.1% vs 3.0%), preterm birth (11.6% vs 6.9%), IUGR (1.2% vs 0.4%), LBW (11.2% vs 7.8%), and low Apgar score at first minute (4.2% vs 3.2%) were higher in women who delivered by C-section compared to those with normal delivery ( P  = .001). Conclusions The overall C-section rate during the first wave of COVID-19 pandemic was significantly higher than the pre-pandemic period. C-section was associated with adverse maternal and neonatal outcomes. Thus, preventing the overuse of C-section especially during pandemic becomes an urgent need for maternal and neonatal health in Iran.

Background Abortion and its complications have always been associated with challenges such as the lack of awareness, high cost of receiving in-person services, lack of access to the skilled healthcare workers, distance from healthcare centers in remote areas, and cultural sensitivities. Therefore, the use of mobile health technology in post-abortion care has been suggested. This study aimed to investigate factors influencing the acceptance and use of mhealth technology in post-abortion care. Method A mixed-methods study was completed in 2023. Initially, a literature review was conducted. Then, a five-point Likert-scale questionnaire was designed based on the results of the literature review. The research participants were gynecologists ( n  = 24), midwives ( n  = 38), and women who had experience of abortion ( n  = 183). Data were analyzed using descriptive and inferential statistics. Results The findings revealed that the participants had different opinions about the importance of motivating and inhibiting factors which included individual, technical, economic, organizational, and ethico-legal aspects. It seems that the individual, organizational, economic, and ethico-legal motivating factors as well as the ethico-legal inhibiting factors were more important than other factors and had higher mean values. In addition, there was a statistically significant difference between the mean values of gynecologists and patients regarding the individual motivating ( P  = 0.014) and technical inhibiting factors ( P  = 0.016). The gynecologists’ opinions regarding the technical motivating factors were also significantly different from midwives ( P  = 0.044) and patients ( P  = 0.010). Conclusion Multiple factors may influence the acceptance and use of mhealth technology in post-abortion care. Therefore, mhealth service developers must consider these factors to improve the quality of services and increase technology adoption. This will lead to saving costs, improving health, reducing abortion complications, and ultimately improving quality of life for women. However, further research in patient engagement and health interventions tailored to diverse cultural contexts are recommended.

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Background Abortion and its complications are challenges that endanger women's health, especially in developing countries. It seems that the application of mhealth technology can be useful as a safe and affordable strategy in post-abortion care. The purpose of this study was to identify factors influencing the use of mhealth technology in post-abortion care. Methods This was a review study conducted in 2023 and articles published in English between 2010 and 1st November 2023 were searched in PubMed, Scopus, ProQuest, Web of Science, and Embase databases as well as Google Scholar. Data were collected using a data extraction form and were analyzed narratively. Results The influencing factors could be divided into the motivating and inhibiting factors. The motivating factors included the subgroups of the individual factors (e.g., saving time), technical factors (e.g., usability), economic factors (e.g., saving costs), and ethico-legal factors (e.g., improving security and confidentiality of the information). Similarly, the inhibiting factors consisted of individual factors (e.g., fear of expressing abortion), technical factors (e.g., a lack of access to the network and the Internet), economic factors (e.g., inappropriate patient financial status), and ethico-legal (e.g., concerns over the security and confidentiality of information). Conclusion This study underscores the importance of considering various technical and non-technical factors influencing the design and implementation of mHealth technology in post-abortion care. Developers need to address these factors to ensure successful technology adoption and mitigate risks. The findings contribute to the enhancement of women's health and offer insights for future technology acceptance models in the mHealth field.

Background Menstrual cup is one of the menstrual management products that is available throughout the world and can be effective in improving women's quality of life by empowering women in menstrual management. Although menstrual cups have recently entered the Iranian market, the use of this product is limited among women. The aim of this study was to determine the acceptability and safety of menstrual cups among Iranian women. Methods This is a cross-sectional study conducted in 2020. Iranian women between the ages of 18 and 50 with regular menstrual periods who used the menstrual cup at least for three months were included. Participants were selected through continuous sampling, and they completed a web-based questionnaire including a demographic characteristics form as well as checklists on acceptability and safety through a link sent electronically via social media. Results The mean score of the overall satisfaction with the cup was 6.54 ± 0.76, and the leakage had the lowest mean score among the satisfaction items (5.25 ± 1.63). About 83% of participants reported experiencing menstrual cup leakage. Among the reported health risks, the highest mean score was for vaginal pain during removal (23.9%). Most participants (83.9%) were familiar with the cup via social networks and 98.6% recommended this product to other women. Conclusions The high level of acceptability and safety of the menstrual cup showed that this product is a suitable alternative for menstrual management in Iranian women. The results of the study help healthcare providers to learn more about the potential advantages and disadvantages of using cup and create trust in the menstrual cup use based on the results of local evidence-based research.

Background The Covid-19 pandemic response is influencing maternal and neonatal health care services especially in developing countries. However, the indirect effects of Covid-19 on pregnancy outcomes remain unknown. The aim of the present study was to compare pregnancy outcomes before and after the beginning of the Covid-19 pandemic in Iran. Methods We performed a retrospective analysis of the medical records of 2,503 pregnant women with singleton pregnancies, admitted to the maternity department of a women’s hospital in Tehran, Iran, during the pre-Covid-19 pandemic (February 19 to April 19, 2019) and the intra-Covid- 19 pandemic (February 19 to April 19, 2020) period. Results We included 2,503 women admitted to the hospital; 1,287 (51.4 %) were admitted before the Covid-19 lockdown and 1,216 (48.6 %) during the Covid-19 lockdown. There were no significant differences in stillbirth rates ( p  = 0.584) or pregnancy complications (including preeclampsia, pregnancy-induced hypertension and gestational diabetes) ( p  = 0.115) between pregnant women in the pre- and intra-pandemic periods. However, decreases in preterm births ( p  = 0.001), and low birth weight ( p  = 0.005) were observed in the pandemic period compared to the pre-pandemic period. No significant difference in the mode of delivery, and no maternal deaths were observed during the two time periods. Conclusions In our study we observed a decrease in preterm births and low birth weight, no change in stillbirths, and a rise in the admission rates of mothers to the ICU during the initial Covid-19 lockdown period compared to pre-Covid-19 lockdown period. Further research will be needed to devise plan for immediate post-pandemic care and future health care crises.

Background: Some women experienced alterations in their menstrual cycles during the Coronavirus disease 2019 (COVID-19) pandemic. Objective: This study aimed to evaluate the changes in menstrual cycles among Iranian women during the COVID-19 pandemic. Materials and Methods: This cross-sectional study included 1500 women of childbearing age referred to healthcare centers in Tehran, Iran from April-November 2022. Participants were selected using the stratified sampling method. Data were collected via a questionnaire covering information on menstrual cycle, COVID- 19 infection, and COVID-19 vaccination status. The study’s outcomes focused on menstrual changes by evaluating cycle regularity, duration, and symptoms based on participant-reported observations. Results: The findings revealed that the pattern of menstrual change during the pandemic occurred in the form of a shorter interval in 8.6%, and longer interval in 8.9%, shorter duration in 10.4%, longer duration in 9.4%, heavier bleeding in 12.3%, lighter bleeding in 14.7%. The chance of menstrual changes in women who were infected with COVID-19 was 54% higher than that of women who were not infected, and the chance of menstrual changes in women who received 3 doses of COVID-19 vaccine was 1.5 times higher than women who had not been vaccinated. Conclusion: Our research revealed a high incidence of menstrual changes among Iranian women of childbearing age during the COVID-19 pandemic. Healthcare providers should be knowledgeable about the menstrual changes associated with COVID-19 infection and vaccination to provide information and support to affected women. Key words: Menstrual cycle, Menstrual irregularities, COVID-19, Vaccine.

Background With the increasing number of young women surviving cancer and a growing trend among highly educated women to postpone childbearing for educational or professional pursuits, there is a rising demand for egg freezing services to ensure a successful pregnancy. This study aims to assess the knowledge and beliefs surrounding oocyte cryopreservation, both for medical and social reasons, among female students in Tehran, Iran. Methods An online cross-sectional survey was carried out from March to August of 2022, involving a total of 1279 childless students pursuing master’s and doctoral degrees at universities in Tehran. The participants were between the ages of 18 and 38. Knowledge and beliefs about medical and social oocyte cryopreservation were assessed through Fertility Preservation Survey (FPS) instrument. Results The mean age of the participants was 26.38 ± 4.9. The majority of students expected to be “30–34 years” when they become pregnant with their first child (41.1%, M: 30.3 ± 4.13 years) and “35–39 years” when they give birth to their last child (46.7%, M: 35.28 ± 4.18 years). The students agreed with preserving fertility with medical (93.3%) and social (86.9%) indications and believed the medical (95.1%) and social (87.4%) costs of cryopreservation should be covered by the healthcare system. Among the participants, 75.6% considered cost to be a definite or probable factor in their decision to pursue fertility preservation. The oncology team’s recommendation was identified as the most important factor in deciding on medical egg freezing (92.6%, M: 3.46 ± 0.71). The overall correct response rate for the knowledge questions was 57.7%. The majority of participants (95.5%) agreed that physicians should routinely provide information about egg freezing to women of childbearing age during their regular healthcare visits. Conclusions The research results revealed that female students in Tehran universities have a positive attitude towards medical and social egg freezing, but lack sufficient knowledge about the ideal timing of childbearing. Health professionals could provide detailed information about fertility preservation and age-related infertility as part of routine healthcare visits or reproductive health planning. Additionally, expanding supportive policies and incentives for childbearing established by the government to cover the costs of fertility preservation would be beneficial.

Background Infertility as a distressing condition, is associated with numerous psychological and social consequences for couples. In addition, there is evidence to suggest that infertility may contribute to the occurrence of violence against women. The aim of the study is to determine the prevalence and factors associated with violence against Iranian women with infertility. Methods A cross-sectional study was carried out in 2020, involving 310 infertile women who sought treatment at an infertility clinic in a referral women’s hospital in Tehran. The eligible participants were selected using the consecutive sampling method. The Infertile Women’s Exposure to Violence Determination Scale (IWEVDS) was used to collect data on violence. Data were analyzed using descriptive (Mean, frequency) and inferential statistics (Independent sample t-test, Chi-square, regression logistic) through the SPSS version 25. Results The average score on the IWEVDS was found to be 43.89 ± 18.23, indicating a moderate level of violence. Out of the 310 participating infertile women, 84.2% reported experiencing violence. Among abused women, 67% experienced domestic violence, 76.2% encountered social pressure, 85.4% faced punishment, 88.9% were exposed to traditional practice, and 57.5% experienced exclusion. The main risk factors associated with violence were a low number of children, low economic status, and an increased duration of infertility. Conclusions This study’s findings underline a high rate of violence experienced by infertile women. Therefore, it is crucial to screen women with infertility for violence and provide them with adequate support.

Background Recent evidence shows that men and women have inadequate fertility knowledge which may negatively affect their childbearing decisions in future. Given the fact that decision making for fertility needs accurate information, targeted educational interventions especially through media are needed to improve knowledge regarding the best age of fertility, factors affecting fertility potential and fertility options available for sub-fertile couples. Aim of the study is to evaluate whether a fertility educational program can be effective in increasing fertility knowledge, childbearing intention and the planned pregnancy rate among couples referring to premarital counselling centers. Methods This study is a parallel randomised clinical trial with pre-test/post-test design. We will recruit 1240 marrying couples referring for compulsory premarital counselling in public health centers through stratified sampling in five metropolitan cities of Iran. The intervention group will receive both the typical premarital counselling training and a fertility knowledge package containing verbal and virtual educational package at five time episodes (one verbal session and four virtual sessions) within 4 weeks. The primary outcomes are fertility knowledge, childbearing intention and the first planned pregnancy rate (positive pregnancy test) and the secondary outcomes include contraception method use, miscarriage and unplanned pregnancy. Participants will respond to a self-administered demographic/reproductive characteristics questionnaire, the Cardiff Fertility Knowledge Scale (CFKS) and the childbearing intention questionnaire. Data will be collected through online questionnaires at baseline and 3, 12 and 18 months after the intervention. Data will be analyzed using Chi-square or Fisher-exact test for categorical variables, Independent sample t-test for normally distributed quantitative variables and Mann–Whitney U test for non-normally distributed quantitative variables. To compare the outcomes between the two groups over the time, repeated measures ANOVA will be used. We hypothesize that the positive impact of increasing the fertility knowledge is the reduced involuntarily childlessness. Discussion The findings are proposed to inform government policies and public education strategies aiming at supporting childbearing among young couples who postpone their first pregnancy while they might not have any important social and economic obstacles. Trial registration This study was approved by Iranian Registry of Clinical Trials (IRCT), Number: IRCT20201005048925N1 , Date of registration: 2020-10-12.