The shift in COVID-19 vaccination policy for pregnant women, from restricted to required, and the confusion that ensued.

Introduction: The aim was to investigate the response of pregnant women when the COVID-19 vaccination policy shifted from restricted to required, and the confusion that ensued during pregnancy, bearing in mind that women undergo unique physiological and immunological changes during pregnancy, making them at risk of developing a more severe course of COVID-19 infection compared to their non-pregnant peers. Material and methods: A cross-sectional study was carried out at the outpatient clinics at Jordan University Hospital for all pregnant women during the period of the survey from 1st October 2021 to 31st December 2021, focusing on the source of information about the vaccine, receiving the vaccine, and the reasons for rejecting the vaccine, especially during pregnancy. Results: In total, 468 pregnant women were interviewed. The single primary source of information about the COVID-19 vaccine was the traditional media, audio-visual and print media being the most important as reported by 191 women (40.81%), while possible harm to the fetus was the single main reason for refusal of vaccination during pregnancy as reported by 111 women (23.72%). Conclusions: Reluctance toward vaccination is primarily driven by the fierce media campaign that portrayed its initially ambiguous effects on the pregnancy and fetus in a negative light, in conjunction with the open media platforms that enabled semi-experts to issue medically inaccurate statements and information and further complicated the matter by planting the seed of fear and mistrust of the public in the health care system and providers. More public healthcare awareness regarding the safety of the COVID-19 vaccine is needed.

Cervical cancer screening in Jordan; a review of the past and an outlook to the future - facts and figures.

Introduction: This study aims to assess the attitude, knowledge, and behaviour of Jordanian women toward cervical cancer screening and its phenomenal role in preventing the disease, and to identify the defects and obstacles in the national screening programs for early detection of this manageable kind of malignancy.Material and methods: A prospective study via a questionnaire that included the demographic data, knowledge, behaviour, and attitude among Jordanian women about the cervical screening program using face-to-face interviews. Results: Among 655 women who responded to the questionnaire, 340 (51.9%) reported having no idea about the smear, 350 (53.4%) had completed higher education, 84 (12.84%) were not happy to be screened, and 53 (8.09%) were afraid of the result being positive for malignancy. The shocking and scandalous upshots reported that 600 women (91.6%) had no idea about the role of vaccination against this threatening disease. Conclusions: Screening programs occupy a limited space among the health care provider's priorities. The health education and national awareness strategy regarding cervical cancer should be adopted and implemented in primary health care units. The media with its different facets and platforms must take responsibility and share this national cancer education battle. The once-in-a-lifetime screening test should be adopted urgently, being the most important step, because it represents the minimum correct starting point to lessen the future burden on the national healthcare system and benefit the health of the target groups.

Cervical Cancer Screening among Female Refugees in Jordan: A Cross-Sectional Study.

BACKGROUND: Cervical cancer (CC) is mainly linked to infection with a high-risk oncogenic human papillomavirus (HPV), with 85% of deaths occurring in developing countries. Refugees are less likely to be aware of screening methods and to have routine gynecological examinations. METHODS: This is a cross-sectional study involving a total of 359 women aged 19-64 living in the Jerash camp in Jordan. Data were collected using a carefully developed and validated questionnaire. RESULTS: A total of 359 participants were included in the study, with a mean age of 38.99 ± 10.53. Participants demonstrated fair knowledge of CC risk factors (4.77 ± 2.85 out of 11). Among the participants, 73.5% had heard of the cervical smear test; however, only 12.8% had actually undergone the test, with a mean total number of smear tests performed of 1.48 ± 0.79 and the mean age at the time of the first test was 32.5 ± 7.89. CONCLUSIONS: Refugee women have a fair level of knowledge of CC risk factors but are unmotivated to have a Pap smear test to screen for CC. Efforts should be made to raise awareness about the issue and promote testing for underrepresented women in refugee camps.

Subtotal hysterectomy reviewed: a stable or aperture for stump cervical malignancy. A referral hospital experience.

Introduction: To review the malignant potential of the stump after subtotal abdominal hysterectomy. Material and methods: Thirty-three patients with stump malignancy were diagnosed and treated between January 2018 and January 2022. All patients primarily underwent subtotal hysterectomy (STH) outside our hospital due to different indications, most of which seemed non-convincing. Upon presentation, they were evaluated properly and offered the best management plan. Results: The presenting symptoms were abnormal histopathology report in 8 patients (24.24%), abnormal bleeding in 7 patients (21.21%), and postcoital bleeding and abnormal Pap smear in 6 patients (18.18%). The primary site of malignancy was endometrial in 17 patients (51.51%), on top of fibroid in 6 patients (18.18%), and cervical in 5 patients (15.15%). Eighteen patients (54.54%) underwent proper surgery, 9 patients (27.277%) were referred for chemoradiation, and 6 patients (18.18%) were candidates for palliative therapy. Conclusions: Stump cancer cases show a worse stage silhouette compared with cancer cases in intact uteruses. The high prevalence of cervical stump problems should be taken into account before a change in surgical approach from total to STH is deemed possible. Further prospective studies with prolonged follow-up periods are needed to evaluate the risks and benefits of retaining the cervix at hysterectomy. Subtotal hysterectomy is easier, does not require distinct skills that lead to experience and follow-up, and must be limited to the narrowest limits of practice, provided that the woman knows that there are no health benefits to keeping the cervix in place.

Prevalence of endometriosis in women undergoing laparoscopic surgery for various gynaecological indications at a Jordanian referral centre: gaining insight into the epidemiology of an important women's health problem.

BACKGROUND: Endometriosis is a considerable health challenge for women of reproductive age. Information about its prevalence in the Jordanian population is sparse. The objective of this research was to evaluate the presence of endometriosis in gynaecological patients undergoing laparoscopic surgery for various indications and to correlate the finding of endometriosis with variables, including patient demographics, obstetric history, type, and indication of laparoscopic procedure. METHODS: A retrospective cohort study involving 460 women who underwent different laparoscopic procedures for a variety of indications was conducted in the Department of Obstetrics and Gynaecology in Jordan University Hospital, a tertiary referral hospital in Jordan, between January 2015 and September 2020. RESULTS: The prevalence of endometriosis in this patient group was higher than that of the general population (13.7% vs. 2.5%), and the mean age at diagnosis (31.9 years) was younger than the general population's age of peak incidence (35-45 years). It was significantly higher in women with lower numbers of pregnancies (p = 0.01) and a lower number of Caesarean sections (p = 0.05) and in those where the indication for surgery was related to decreased fertility or pelvic pain (p = 0.02). Women with high parity or where the surgery's indication suggested normal fertility, such as family planning, were less likely to have endometriosis. CONCLUSION: To our knowledge, this is the first Jordanian study to assess the prevalence of endometriosis in women undergoing gynaecological laparoscopy. This study suggests that the epidemiology of endometriosis in this region follows similar trends to what has been previously documented in international literature, while emphasizing the need for further research into this important women's health issue in this part of the world.

Effects of early umbilical cord clamping versus delayed clamping on maternal and neonatal outcomes: a Jordanian study.

Objective: To compare the effects of early versus delayed cord clamping of term births on maternal and neonatal outcomes.Method: A quasi-experimental study was conducted at the Jordan University Hospital in Amman. One hundred twenty-eight mothers expecting a full-term singleton baby were assigned to delayed cord clamping (90 seconds) or early cord clamping (<30 seconds).Results: Delayed cord clamping was associated with higher hemoglobin levels among newborns after 12 hours. On the other hand, early cord clamping was associated with an increased need for oxygen therapy among newborns and occurrence of postpartum hemorrhage among mothers. There were no differences between the groups on any other variable (Apgar score at 1 and 5 minutes, admission to NICU, baby bilirubin levels after 12 hours and day 3 of birth, and mothers' Hb levels after 12 hours of childbirth).Conclusion: Term babies receiving delayed cord clamping had improved hemoglobin levels with no adverse effect on other maternal and neonatal variables. Creating evidence-based practice guidelines for umbilical cord clamping in Jordanian hospitals is essential to improve neonatal and maternal health.

Pregnancy During COVID-19 Outbreak: The Impact of Lockdown in a Middle-Income Country on Antenatal Healthcare and Wellbeing.

INTRODUCTION: Since the emergence of coronavirus disease 2019 (COVID-19) as a major worldwide health threat, countries have implemented preventative measures to limit the spread of the disease and reduce the strain on their health services. The Hashemite Kingdom of Jordan is one of the countries where relatively strict lockdown measures were enforced. This study aims to evaluate the impact of the lockdown circumstances in Jordan on antenatal care services and health circumstances of pregnant women during this period. PARTICIPANTS AND METHODS: This study involved a cross-sectional survey of Jordanian women who are currently pregnant. An electronic survey was distributed among pregnant women in Jordan. A total of 944 completed responses were returned and analyzed. The sample size was statistically determined to be representative of the population. RESULTS: The results revealed a significant increase in the percentage of pregnant women not receiving antenatal care from 4% to 59.53% (p<0.001) during the lockdown period, despite the fact that some of these women were suffering from significant underlying medical conditions or serious pregnancy complications that require close antenatal surveillance. The survey also demonstrated that the lockdown circumstances impacted the physical, social, and mental wellbeing of the participants. CONCLUSION: Although the lockdown measures in Jordan have succeeded so far in relative containment of COVID-19, this research suggests that significant disruption to antenatal services has occurred and that the lockdown has affected the wellbeing of pregnant women in a number of aspects, which has the potential to cause antenatal health issues that are not directly related to the spread of COVID-19, but rather are a side effect of the way in which the outbreak is managed.

Emergency peripartum hysterectomy at Jordan University hospital - a teaching hospital experience.

INTRODUCTION: Emergency peripartum hysterectomy (EPH) is a foremost operation and is perpetually implemented in the presence of life intimidating hemorrhage during or immediately after abdominal or vaginal deliveries. The aim of this study was to review cases managed at the Department of Gynecology and Obstetrics at Jordan University Hospital (JUH). MATERIAL AND METHODS: All women who underwent EPH due to any cause in the period from January 2010, to December 2017 were included in the study. Data were collected retrospectively using the patients' files namelessly. Main measures: age, gravidity, parity, number of previous cesarean sections, previous uterine surgeries, indication for hysterectomy, complications, antepartum bleeding and the need for blood transfusion. RESULTS: In total, 74 cases of EPH were managed during the study period. The incidence of EPH ranged from 0.24 to 8.7 per 1000 deliveries. EPH was found to be more common following cesarean sections than vaginal deliveries. The prime indication was abnormal placentation, uterine atony, and uterine rupture. The risk factors included previous cesarean sections, scarred uteruses, multiparity, older age group. Maternal morbidity ranged from 26.5 to 31.5% and mortality from 0 to 12.5% with a mean of 4.8%. CONCLUSIONS: EPH is the most demanding obstetric surgery performed in very tiresome circumstances of life threatening hemorrhage. The indication for EPH in recent years has changed from outdated uterine atony to abnormal placentation. Antenatal eagerness of the risk factors, engrossment of proficient obstetricians at an early stage of management and a prompt hysterectomy after adequate resuscitation would go a long way in tumbling morbidity and mortality.

Abandoning the blind legacy passed on horde of routine intra-abdominal drain insertion in cesarean section.

INTRODUCTION: Cesarean section (CS) delivery is the most common major obstetrical surgical operation carried out in and is increasing in incidence throughout the world. The major involves some risks that might include: infection, coagulation problem, loss of blood, bowel or bladder injury, abnormalities of the placenta in subsequent pregnancies. AIM OF THE STUDY: To evaluate the clinical effectiveness of postoperative CS intra-abdominal drain insertion. MATERIAL AND METHODS: A prospective study was conducted on 245 patients in labor, at the Department of Obstetrics and Gynecology, Jordan University Hospital, between January 2017 and January 2018. Participants were divided into two groups: group I including those who had abdominal drains insertion during surgery and group II including women who had no abdominal drain inserted before closure. All patients on both groups were term pregnancies, underwent elective vs. emergency CS, and had no subcutaneous drains inserted. RESULTS: Clinical and surgical parameters were comparable in both groups. Postoperative hospital stay was significantly shorter in group II, whereas specific postoperative complication rate was significantly higher in group I. Drain site infection was noted in 2 (1.6%), organ herniation in 2 (1.6%), drain avulsion in 2 (1.6%), severe pain at the site of insertion in 2 (1.6%) patients. CONCLUSIONS: Routine prophylactic intra-abdominal drain insertion post CS has no benefits and therefore should be stopped.

Setting priorities in the conventional approaches in managing ectopic pregnancy; is it time to reform? A teaching hospital experience.

THE AIM OF THE STUDY: To review the management approaches of ectopic pregnancy (EP) at the Department of Obstetrics and Gynecology at Jordan University Hospital (JUH). MATERIAL AND METHODS: All patients admitted to our department with the diagnosis of EP treated during the study period extending from January 2017 to June 2019. Data were collected retrospectively using the patients' files anonymously. Main outcome measures: age, parity, ectopic site, presentation, the main risk factor/s and the management plan. RESULTS: In total, 65 cases of EP were managed during the study period. Overall, the mean age was 30 years. EP was located in the right tube in 23 cases, and in the left tube in 14 cases. Eleven patients presented with acute abdomen due to rupture of the EP and underwent urgent laparotomy; 7 of these cases were located on the right side. Conservative surgery (laparoscopy versus laparotomy) was the main line of management with attention to preserving the tube patency, followed by medical therapy when the patient fulfilled the criteria or those with pregnancy of unknown location. CONCLUSIONS: EP is a life-threatening condition. It is time to reform the priorities in the conventional approach to management. Every effort ought to be applied to preserve the reproductivity of women who are diagnosed with EP at the JUH. We would suggest that salpingostomy needs to be considered the surgical treatment of choice for the majority of these cases.

Noncompliance with surgical antimicrobial prophylaxis guidelines: A Jordanian experience in cesarean deliveries.

BACKGROUND: Surgical site infections are common, especially in developing countries. Nevertheless, up to 60% of surgical site infections can be prevented with appropriate perioperative care, which includes among other measures using suitable surgical antimicrobial prophylaxis (SAP). METHODS: After a short interview with patients and retrospective review of medical charts, compliance with 6 SAP parameters was assessed for appropriateness; those parameters are indication, choice, dose, time of administration, intraoperative redosing interval, and duration of prophylaxis in 1,173 operations. RESULTS: Overall compliance was poor; nevertheless, certain components showed high compliance rates, such as indication and choice of antibiotics. The most frequent error noted was extended administration of prophylactic antibiotics, which was observed in 88.2% of the study population. Emergency operations were associated with a lower risk of noncompliance in administering the correct dose at the correct time (odds ratio, 0.63; 95% confidence interval, 0.47-0.83 and odds ratio, 0.21; 95% confidence interval, 0.14-0.3, respectively). On the other hand, women who underwent an emergency operation were associated with a 6-fold higher risk of receiving prophylactic therapy following surgery. CONCLUSIONS: The present study demonstrated the existence of a surprisingly low level of overall compliance with the hospital-adapted SAP guidelines. Factors implicated in noncompliance were investigated, and the present results create a starting point to improve the current practice.

Surgical site infections following caesarean operations at a Jordanian teaching hospital: Frequency and implicated factors.

Surgical site infections (SSIs) following caesarean surgeries are common. The present study aimed to evaluate the frequency of SSIs following caesareans at Jordan University Hospital during the 30 postoperative days and to identify factors associated with increased SSIs risk. Data regarding the occurrence of SSIs were collected both prospectively via follow-up phone calls and retrospectively via reviewing wound culture results and clinical notes. SSI cases were subsequently determined utilizing predefined criteria. Data relating to possible risk factors of SSIs were collected from patient interviews and hospital records. Risk factors for SSIs were identified via logistic regression. A high rate of SSIs (14.4%) was detected; implicated factors included body mass index ≥36 kg/m2 prior to pregnancy odds ratio (OR) 3.8, 95% confidence interval (95% CI) 1.6-9.4, hospital stay longer than 3.5 days OR 2.3, 95% CI 1.4-3.6, having the operation at a gestational age greater than 40 weeks OR 2.2, 95% CI 1.3-3.9. Receiving a higher weight-adjusted dose of the prophylactic antibiotic cefazolin was associated with lower SSIs risk OR 0.967, 95% CI 0.94-0.99.In conclusion, a high rate of SSIs following caesareans was detected, and modifiable risk factors of SSIs should be incorporated into targeted policies aiming to reduce the rate of SSIs.

Gastric perforation secondary to metastasis from ovarian cancer: Case report.

INTRODUCTION: Metastasis from ovarian cancer occurs frequently through the peritoneal cavity in the form of peritoneal carcinomatosis; isolated gastric metastasis is rarely reported in literature. PRESENTATION OF CASE: We present a case of 43-year-old infertile lady, who developed a picture of acute abdomen four days post total abdominal hysterectomy and salpingoopherectomy for ovarian cancer. Further contrast-enhanced CT scan demonstrated massive free gas and fluid in the abdomen. She underwent antrectomy with truncal vagotomy due to 3cm×4cm prepyloric gastric ulcer. Final pathology proved the presence of metastatic serous cystadenocarcinoma of ovarian origin. DISCUSSION: Our patient had a gastric perforation secondary to ovarian metastasis. Being isolated, the absence of ascites and the transmural nature of the gastric metastasis suggest haematogenous spread .To the best of our knowledge perforated gastric metastasis secondary to ovarian cancer was not reported in literature before. CONCLUSION: Gastric metastasis should be kept in mind in patients with a well-known ovarian cancer who present with gastric lesions, ulcers, bleeding or perforation.

Laparoscopic versus abdominal hysterectomy in the treatment of endometrial cancer.

Up until 20 years ago, laparotomy was the single method of surgical treatment for endometrial cancer. Wider acceptance for the laparoscopic approach has been gained by gynecologic surgeons as an alternative surgical method. Clinical application of laparoscopic surgery has grown rapidly, yet it remains to be proven if this technique has brought great benefits. The location of minimal-access surgery in gynecologic oncology has proven effective particularly with the growth of exchanged experience among surgeons. As operative laparoscopy in gynecologic oncology remains novel, the potentiality of the procedure is underscored. In this review, we survey the literature on this technique and critically evaluate the indications, limitations, as well as the benefits and risks of this approach to hysterectomy. Due regard should be given certain patients with indications for an abdominal hysterectomy to the benefits that laparoscopic hysterectomy may offer.

Sexuality after hysterectomy at University of Jordan Hospital: a teaching hospital experience.

PURPOSE: This research concentrates on evaluating the sexual activity of the patients after having hysterectomy for benign disorders. SETTING: This analysis took place at the University of Jordan hospital. MATERIAL AND METHODS: The retrospective record was reviewed for over 2 years (from January 2008 to January 2010). The sample of study included a total number of 124 patients with benign disorders who underwent hysterectomy. The sexual life parameters indicate that 93 patients (75 %) felt general improvement in their performance, while 14 patients (11.3 %) complained of having suffered bad performance, 6 patients (4.8 %) noticed no changes, and 11 patients (8.9 %) did not provide any comment. As for the partner's sexual function (as relayed by the patients themselves), 69 patients (55.6 %) felt improvements in their performance and 23 (18.5 %) commented that their partners had bad performance, while 18 patients (14.5 %) noticed no changes and 14 (11.3 %) did not provide any comment. Patients were interviewed by the operating physician each of whom was subjected to an average of half an hour verbal interview after obtaining the prior written consent of the patient. Questionnaire forms were used to record the answers given by each patient. The interview data recorded in the questionnaires were analyzed. CONCLUSION: The result of these analyses significantly indicated that sexual function is a major cause of women's concern for scheduled hysterectomy. That is because they were influenced by both physiological and psychological factors. Even though the analysis results implied that there was a sizeable minority who evidently suffered a considerably worse outcome, it was recognized that hysterectomy leads to improvement in sexual function and health for the majority of women. Therefore, it is important to spread awareness among women and let them know that most probably they will neither lose their sexual desire after hysterectomy, nor they will lose their feminine shape or style.

Histological analysis of the products of conception following first trimester abortion at Jordan University Hospital.

OBJECTIVE: To evaluate the value of histopathological examination of products of conception in first trimester abortion. SETTINGS: University hospital. DESIGN: Retrospective record review over 2 years, from January 1999 to January 2001. PATIENTS: A total number of 293 patients with the diagnosis of first trimester abortion were admitted and their abnormal pregnancy evacuated. RESULTS: The highest type of abortion among the studied group was incomplete abortion, 140 patients (48%), and surgical evacuation was the most common method of termination, 202 patients (69%). The histopathology reports confirmed the pregnancy in all patients and revealed partial mole in 51 patients (17%), undiagnosed abnormality in 8 patients (2.7%), suggesting the possible cause for recurrent pregnancy loss in 4 patients (1.4%). CONCLUSION: Histopathological assessment for the products of conception proved to be an important tool in detecting molar pregnancy and hydropic changes that necessitate special follow-up protocol and unmasking ectopic pregnancies for further management.