Seeking consultation for urinary incontinence: Behaviours and barriers among Jordanian women.

INTRODUCTION: The rates of seeking consultation for urinary incontinence (UI) and the barriers against consultations vary among countries and study populations and are influenced by various factors such as embarrassment, perception of illness, resources and culture. OBJECTIVES: To study healthcare-seeking behaviours and barriers among Jordanian women. METHODS: Between 1 March 2020 and 15 April 2020, we conducted a cross-sectional online survey among women 18 years of age or more who have UI and have access to the internet. We collected women's characteristics, UI types, severity, bother, seeking consultation behaviours and barriers. Logistic regression analyses were used to study the variables associated with seeking consultation. RESULTS: The data of 1454 women with a mean age (SD) of 41.5 (11.5) years were analysed. Mixed UI was the most common type (56.3%), while 43.8% of the participants sought consultation, and 33.8% waited 1 year before seeking consultation. The most common barriers were embarrassment (52.2%), considering UI as a normal occurrence with ageing (41.5%), and limited expectations of improvement from treatment (42.0%). The most common barriers vary according to UI type. Embarrassment was the most commonly reported barrier by women with mixed UI (29.4%), UI as normal with ageing was mostly considered by women with stress UI (11.5%) and treatment for UI is going to be expensive was expressed by women with mixed UI (19.4%). Seeking consultation decreased among women with more educational achievement (adjusted odds ratio [aOR]: 0.62; 95% confidence interval [CI]: 0.44-0.87) with university graduates doing so less than women with high school or less educational achievement. Additionally, seeking consultation was more among women who were aware of a family member with UI (aOR: 1.44; 95% CI: 1.03-2.01) compared to women who were not. Also, multiparous women (aOR: 1.8; 95% CI: 1.19-2.77) sought consultation more than nulliparous women. Seeking a consultation was more among women who were bothered by the impact of UI on various daily activities, namely, household activities (aOR: 1.42; 95% CI: 0.85-2.37), prayers (aOR: 1.7; 95% CI: 1.07-2.71) and sex life (aOR: 2.48; 95% CI: 1.45-4.21) compared to women who were not bothered. Seeking a consultation was less among women who reported embarrassment as a barrier (aOR: 0.534; 95% CI: 0.34-0.84) compared to women who were not embarrassed. CONCLUSION: Four in 10 women with UI sought care, but with a considerable delay between the onset of symptoms and actual care seeking. These outcomes could be explained by the impact of various barriers. Additionally, barriers might vary in different cultures and countries, so culture-sensitive questionnaires should be considered when healthcare-seeking consultations and barriers are studied.

Omental mature cystic teratoma mimicking a mesenteric cyst: A case report.

Mature cystic teratomas (MCTs) arise from totipotent cells. While the ovaries are the most common sites, extragonadal teratomas are very rare. This case report describes the clinical details of a 20-year-old woman who was found to have a large pelvi-abdominal mass on clinical and imaging studies and elevated levels of CA-125. Because of the uncertainties of the origin of the mass, a multidisciplinary team suggested exploratory laparotomy with a mesenteric cyst as a differential diagnosis. Laparotomy showed both ovaries to be normal and revealed a large omental MCT, which was excised. Histopathology confirmed the diagnosis.

Mid-trimester spontaneous rupture of a bicornuate uterus: A case report.

Bicornuate uterus (BU) is a rare congenital anomaly that may present with various obstetric complications, and very rarely may be a risk factor for uterine rupture, even of an unscarred uterus. A 21-year-old primigravida woman, at 19 weeks and 5 days of gestation, presented with severe abdominal pain and features of hypovolemic shock. Urgent laparotomy showed a large hemoperitoneum, a ruptured left horn of a BU and a dead fetus in the abdominal cavity. Excision of the ruptured left horn was performed and the uterine defect was sutured. Postoperative recovery was uneventful. Bicornuate uterus is a rare uterine anomaly and is associated with various obstetric complications at different gestational ages. Ruptured uterus should be considered in the differential diagnoses of acute abdominal pain and a picture of hypovolemia in women with mid-trimester pregnancies.

Enema Administration During Labor: Pregnant Women's Perspective and Knowledge.

Introduction: Current evidence does not support the routine use of rectal enemas (REs) because they have not been associated with reduced rates of puerperal infection, degree of perineal tear, or duration of labor. A recent literature review recognized knowledge gaps regarding the uses of RE during labor including women's perceptions, pain, and satisfaction. Objectives: To report pregnant women's knowledge, attitudes, perceptions, pain, and satisfaction associated with the use of RE during labor. Methods: A prospective study was conducted between 20 October 2019 and 20 October 2020. Women were included if they were 37 weeks or more pregnant, had a viable pregnancy, were admitted in labor, and had an RE. Characteristic data and data about knowledge, perceptions, attitudes, pain, and satisfaction associated with its use were recorded. Women were regrouped based on their level of knowledge into low- and high-level groups. Attitudes, perceptions, inconveniences, pain, and satisfaction were regrouped into two categories: low and high on the Likert scale. Results: A total of 300 women were recruited, with means (SD) for age and gestational age of 27.8 (4.8) years, and 40 (1.1) weeks, respectively, and 45.7% were knowledgeable or very knowledgeable, 76% had a positive attitude, and 88.7% perceived enemas as important. The mean scores (SD) for pain and satisfaction as measured on visual analogue scales were 1.5 (1.8) and 5.4 (1.8), respectively. Women with high knowledge about RE were older and multiparous. Recruited women were more likely to report lower inconvenience and pain scores and higher satisfaction scores (all P<.05). Conclusion: Most recruited women were knowledgeable about REs, perceived them as important, and expressed a positive attitude toward their administration. The low levels of inconvenience, pain, and complications and the high satisfaction rates may be used when counseling women about when an RE is required during labor.

Necrotizing fasciitis following episiotomy in a woman with Hailey-Hailey disease: A case report.

A healthy 25-year-old primiparous woman had an uncomplicated pregnancy and spontaneous vaginal delivery with mediolateral episiotomy. Twenty-four hours postpartum, she developed increasing perineal pain and swelling. Initial examination showed a localized erythema and tissue oedema at the episiotomy site. The woman was admitted to hospital for management of the infected hematoma at the site of the episiotomy. Thereafter, she was started on intravenous antibiotics, and exploration under anaesthesia was planned. The woman's medical condition deteriorated rapidly, and necrotizing fasciitis (NF) was strongly suspected. Therefore, aggressive medical and surgical management was undertaken, including broader-spectrum antibiotics and multiple surgical debridement. A biopsy of the debrided tissue showed acantholysis and dyskeratosis, which are features of Hailey-Hailey disease of the skin (familial benign chronic pemphigus), a rare condition. The woman eventually had a V-Y advancement fascial flap and made a complete recovery. In this case report, the details of the development of NF in a woman who was found to have Hailey-Hailey disease are discussed.

The impact of the coronavirus pandemic curfew on the psychosocial lives of pregnant women in Jordan.

OBJECTIVES: Worldwide the COVID-19 pandemic has negatively affected the health and psychosocial lives of people. International guidelines recommend special attention to pregnant women during pandemics and national emergencies. This study aimed to report the impact of the COVID-19 pandemic curfew on the psychosocial lives of pregnant women in Jordan. DESIGN: A cross-sectional study was conducted and included women who were pregnant during the COVID-19 curfew in Jordan, which took place between mid-March and mid-June of 2020. SETTINGS: A web-based survey that was posted on various social media platforms. PARTICIPANTS: Women who at the time of the study were 18 years of age or more, were living in Jordan, and were pregnant during the curfew. MEASUREMENTS AND FINDINGS: Data collected included women's characteristics, the impact of the curfew on the pregnancy, physical activity, and psychosocial lives and the barriers to seeking healthcare, in addition to pregnancy and delivery details, and changes in nutrition and supplements intake. A total of 877 women responded to the survey. The results showed that 21.1% of the respondents did not receive any antenatal care (ANC) during the curfew. The respondents also reported that the main barriers for seeking ANC included healthcare facilities being closed (85.2%), the need for travel permits (76.8%), financial difficulties (63.9%), and fear of catching the COVID-19 virus (60.1%). Furthermore, 93.3% reported that they had psychological stress, and 29.9% reported that they had at least one form of domestic violence. Statistically significant associations existed between various women's characteristics, obstetric, psychosocial factors, and the level of psychological stress. KEY CONCLUSIONS: The COVID-19 pandemic curfew, which was applied in Jordan, resulted in a negative impact on the psychosocial lives of pregnant women. As a result, pregnant women did not receive optimal antenatal care and experienced higher degrees of psychological stress and domestic violence. IMPLICATIONS FOR PRACTICE: The findings of our study may encourage national healthcare policymakers to ensure the provision of appropriate psychosocial support of pregnant women during large scale emergencies.

Food Group Intake of Pregnant Jordanian Women Based on the Three Pregnancy Trimesters.

Inadequate diets have adverse effects on maternal, fetal, and, possibly, childhood health. This cross-sectional study aimed to examine daily food group intake of pregnant Jordanian women during the three pregnancy trimesters and to compare these to the recommended servings of the five food groups reported by The United States Department of Agriculture and My Plate Plan. A total of 283 pregnant Jordanian women were recruited during their antenatal visits. Data were obtained by interviewer-administered structured questionnaires. Our results showed that 1.1% of participants consumed the recommended number of servings for all five food groups during pregnancy and 10.2% did not consume the minimum number of servings of the five food groups. Nearly half of the participants in the first trimester met the recommended daily servings for three food groups but only approximately two-third of participants met the minimum recommended daily servings for one or two food groups in the second and third trimesters. Consumption of grains and sweets was significantly higher in the third trimester compared with the first and second trimesters. Overall, the majority of pregnant Jordanian women in this study did not consume the recommended number of servings for all five food groups during pregnancy.

Unplanned Reoperation Following Gynaecological Surgeries: A report from Jordan.

OBJECTIVES: Unplanned return to the operating theatre refers to an unplanned reoperation following a primary surgical procedure and can result in serious complications. The rate of unplanned reoperations is often used as a measure of in-hospital quality monitoring and improvement. This study aimed to review the prevalence rate and features of unplanned gynaecological reoperations at a major general hospital in Jordan. METHODS: This retrospective study took place between January 2011 and January 2018 at The Specialty Hospital in Amman, Jordan. The medical records of all women who underwent unplanned reoperations following a primary gynaecological procedure during this period were reviewed. RESULTS: A total of 4,895 primary gynaecological procedures were performed during the study period, of which 4,175 (85.3%) were elective and 720 (14.7%) were emergency operations. There were 15 unplanned reoperations (0.3%); of these, 14 (93.3%) followed elective procedures and one (6.7%) followed an emergency surgery. Most reoperations were performed following hysterectomies (53.3%). Bleeding was the predominant reason for reoperation (93.3%), with the source of the bleeding successfully identified in 71.3% of cases. In terms of outcome, none of the cases required a subsequent reoperation and there were no mortalities. CONCLUSION: The rate of unplanned reoperation at a hospital in Jordan was 0.3%. Unplanned reoperations occurred primarily as a result of bleeding following hysterectomies. Development of care pathways may reduce surgical complications and rates of unplanned reoperation.