Vaginal birth after cesarean section prediction model for Jordanian population.

The rate of cesarean section has increased significantly worldwide, creating a group of women with one lower segment cesarean section concerned about the mode of delivery in their future pregnancies. This group of mothers will face a complex discussion because the likelihood for a successful vaginal birth after cesarean section provided to them is a general one. The probability of having a successful vaginal birth is the cornerstone factor of the mothers' decision. Therefore, providing a case-specific likelihood that respects the characteristics of each pregnancy will refine counseling, lower the decision conflict, and improve the success rate of vaginal birth trials eventually improving maternal and fetal outcomes. This paper aims to develop a clinical decision support system to evaluate the individualized likelihood mode of delivery for pregnant women with a previous lower segment cesarean section based on their unique characteristics. The study included six hundred fifty-nine pregnant women, where three hundred twenty-seven records had missing values. Various pre-processing steps, including missing data imputation and feature selection, were applied to the original dataset before model development to improve the data quality. Missing values were handled first, then a feature selection process using a genetic algorithm was applied to select the relevant features and to exclude features that may have been affected negatively by missing data imputation. After that, four machine learning classifiers, namely Decision Tree, Random Forest, K-Nearest Neighbors (KNN), and Logistic Regression, were used to build the prediction model. The results showed that imputing missing values followed by feature selection was more efficient than deleting them since the Area Under the Curve (AUC) has increased from 0.655 to 0.812 using the KNN classifier.

Validation of the Grobman model for successful vaginal birth after cesarean section in Jordanian women.

BACKGROUND: To validate both models of Grobman nomogram (The antenatal and the intrapartum model) for predicting successful intended Vaginal Birth After Caesarean delivery (VBAC) in a Jordanian population. METHODS: A retrospective study has identified all live, singleton, term, cephalic pregnancies with a previous lower segment cesarean section who opted for a Trial Of Labour After Caesarean Section (TOLAC) between January 2014 to December 2020. Five variables were used for the antenatal model, while ten variables were used for the intrapartum model. Two sets of patients were created: one for the antenatal model and the other for the intrapartum model. The predicted probability for each woman was calculated and compared with the successful VBAC for each category. The predictive ability was assessed with a receiver operating characteristic, and the area under the curve (AUC) was determined. RESULTS: There were seven hundred and fourteen complete cases for the antenatal model and six hundred ninety-seven for the intrapartum model. Our population's overall number of VBAC is 83.89% for the antenatal group and 82.92% for the intrapartum group. The mean predicted probability for a successful intended VBAC using the antenatal and intrapartum models were 79.53 ± 13.47 and 78.64 ± 14.03, respectively. The antenatal and intrapartum predictive models ROC had an AUC of 65% (95% CI: 60%-71%) and 64% (95% CI: 58%-69%), respectively. CONCLUSIONS: Both models are validated in the Jordanian population. Adapting the antenatal model as supporting evidence can lead to a higher rate of TOLAC.

Good maternal and fetal outcomes of three consecutive pregnancies in a Mediterranean woman with Alport syndrome: a case report.

BACKGROUND: Alport syndrome is a rare inherited disorder affecting the glomerular basement membrane, manifested by hematuria and proteinuria that is commonly associated with ocular and hearing defects. There is limited information about the maternal and fetal outcomes of Alport syndrome in pregnancy. CASE PRESENTATION: We describe a smooth course of pregnancy, a good maternal outcome, and a good fetal outcome in three consecutive pregnancies for a 35-year-old Mediterranean woman with Alport syndrome over a 10-year duration. Although there was a nephrotic range of progressive proteinuria in all her pregnancies, there was a prompt drop in proteinuria within 2 weeks of her deliveries. She has constantly shown a normal serum creatinine level and a normal serum protein level in all her pregnancies. Apart from a single episode of asymptomatic hypertension in her second pregnancy at 34 weeks of gestation that returned to a normal range immediately after delivery, she was normotensive antenatally and postnatally. She gave birth by cesarean section to three healthy newborns. CONCLUSIONS: A normal prepregnancy creatinine level and a mild range of proteinuria in a patient with normotension, who is not on any medication, are associated with good maternal and fetal outcomes. Furthermore, successful pregnancy that is followed by a normal renal function test might suggest a favorable outcome for any future pregnancy.

The Association between Late Third-Trimester Oxytocin Level and Early-Onset Postpartum Depression Symptoms among Jordanian Mothers: A Cross-sectional Study.

PURPOSE: Oxytocin has been suggested to play a vital role in modulating maternal behavior and stress-related disorders. However, the relationship between antenatal oxytocin and postpartum depression is not well established. We aim to investigate the association between serum oxytocin level in the late third-trimester and early-onset postpartum depression symptoms. MATERIALS AND METHODS: A total of 172 healthy pregnant women participated in this cross-sectional descriptive study. The serum oxytocin level was measured between 34 and 37 weeks. A validated Edinburgh Postnatal Depression Scale (EPDS) was used to assess symptoms of depression four to six weeks postpartum. Participants who scored more than 12 on the EPDS were considered having depressive symptoms. Independent sample t-test and Pearson r were used to examine differences in depression scores. The level of significance was set at α = 0.05. RESULTS: 30.8% of the participants experienced depressive symptoms. There was no association between EPDS scores and oxytocin level r(170) = 0.10, p = 0.23. The association also did not exist even among women with a lifetime history of depression r(43) = -0.13, p = 0.37. Participants with low education, low income, previous history of depression, positive family history of depression, positive family issues, and absent emotional family support have scored significantly higher on EPDS scores than their counterparts. The strongest association was with previous lifetime history of depression t(170) = -4.40, p < 0.001. CONCLUSIONS: Postpartum depression is a major public health problem in Jordan. Late trimester serum oxytocin level has no association with early-onset postpartum depression.

Clinical predictive factors for vaginal delivery following induction of labour among pregnant women in Jordan.

BACKGROUND: Induction of labour (IOL) is an important and common clinical procedure in obstetrics. In the current study, we evaluate predictors of vaginal delivery in both nulliparous and multiparous women in north Jordan who were induced with vaginal prostaglandins. METHOD: A prospective study was conducted on 530 pregnant women at King Abdullah University Hospital (KAUH) in north Jordan. All pregnant mothers with singleton live fetuses, who had induction of labour (IOL) between July 2017 and June 2019, were included in the study. Mode of delivery, whether vaginal or caesarean, was the primary outcome. Several maternal and fetal variables were investigated. The safety and benefit of repeated dosage of vaginal prostaglandin E2 (PGE2) tablets, neonatal outcomes and factors that affect duration of labour were also evaluated. Pearson χ2 test was used to investigate the significance of association between categorical variables, while student's t-test and ANOVA were applied to examine the mean differences between categorical and numerical variables. Linear regression analysis was utilized to study the relation between two continuous variables. A multivariate regression analysis was then performed. Significance level was considered at alpha less than 0.05. RESULTS: Nulliparous women (N = 254) had significantly higher cesarean delivery rate (58.7% vs. 17.8%, p < 0.001) and longer duration of labour (16.1 ± 0.74 h vs. 11.0 ± 0.43 h, p < 0.001) than multiparous women (N = 276). In nulliparous women, the rate of vaginal delivery was significantly higher in women with higher Bishop score; the mean Bishop score was 3.47 ± 0.12 in nulliparous women who had vaginal delivery vs. 3.06 ± 0.10 in women who had cesarean delivery (Adjusted odds ratio (AOR) = 1.2, 95% CI: 1.03-1.28, p = 0.03). In multiparous women, the rate of vaginal delivery was significantly higher in women with higher Bishop scores and lower in women with higher body mass index (BMI). The mean Bishop score was 3.97 ± 0.07 in multiparous women who had vaginal delivery vs. 3.56 ± 0.16 in women who had cesarean delivery (AOR = 1.5, 95% CI: 1.1-2.1, p = 0.01). The mean BMI was 30.24 ± 0.28 kg/m2 in multiparous women who had vaginal delivery vs. 32.36 ± 0.73 kg/m2 in women who had cesarean delivery (AOR = 0.89, 95% CI: 0.84-0.96, p = 0.005). 27% of nulliparous women who received more than two PGE2 tablets and 50% of multiparous women who received more than two PGE2 tablets had vaginal delivery with no significant increase in neonatal morbidity. CONCLUSION: Parity and cervical status are the main predictors of successful labour induction. Further studies are required to investigate the benefit of the use of additional doses of vaginal PGE2 above the recommended dose for IOL.

Pre-Implantation Gender Selection: Family Balancing in Jordan.

PURPOSE: To find out whether couples with predominant female offspring have more chances to produce more female embryos during non-medical pre-implantation genetic diagnosis (PGD) for male sex selection. METHODS: A total of 125 couples who had three or more female offspring and underwent non-medical PGD for male sex selection between 2015 and 2019 were included. Nuclear DNA was analyzed by fluorescent in situ hybridization (FISH). Two-chromosome (X, Y), 3-chromosome (21, X, Y), and 5-chromosome (13, 18, 21, X, Y) probes were used for FISH. The standard protocol was followed for sperm processing and embryo culture for IVF and PGD. RESULTS: In 83.2% of the couples, the ratio of female embryos was higher than male embryos. Independent sample t-test showed that there is no significant difference between equal and unequal embryonic groups in patients' age, husbands' age, sperm count, sperm motility, total male embryos, total female embryos, normal male embryos, and normal female embryos. For patients with positive pregnancy outcome, 84.6% had unequal embryonic ratio while 15.4% had equal embryonic ratio. Similarly, patients who were treated by short protocol had 85% of unequal embryonic ratio and 15% had equal ratio. CONCLUSION: A greater variability in the female to male embryonic ratio is produced in couples having predominantly female offspring and seeking non-medical PGD for male sex selection.

Knowledge and attitudes regarding Covid-19 among syrian refugee women in Jordan.

OBJECTIVES: To explore knowledge and attitude about Covid-19, among Syrian refugee mothers in the Governorate of Irbid, where the first outbreak of Covid-19 in Jordan took place. METHODS: This is a cross-section study among Syrian refugee mothers, who were pregnant or having had children. Data was collected through an online questionnaire. The survey link was distributed in April 2020, through the social network's messaging services Facebook and WhatsApp. Contact information was obtained from local community centres and non-governmental organisations in the town of Irbid, the north of Jordan. RESULTS: In total, 389 Syrian refugee mothers participated in the study. It showed that 66% of mother's access information regarding Covid-19. The main sources of information were Facebook 87%, WhatsApp 69%, television 53%, while 21% indicated that they access professional databases or government websites. In general, Syrian refugee mothers were knowledgeable about Covid-19 transmission and prevention. However, they lacked adequate knowledge about transmission of Covid-19 between the mother and the child, and smoking risks associated with Covid-19. CONCLUSIONS: There are gaps in the knowledge and attitude of Syrian refugee mothers in the Governorate of Irbid in relation to the Covid-19 pandemic. There is a need for further health education measures.

The Use of Single Dose Methotrexate in the Management of Ectopic Pregnancy and Pregnancy of Unknown Location: 10 Years' Experience in a Tertiary Center.

OBJECTIVE: To study factors associated with the success of single dose methotrexate (MTX) treatment in women with ectopic pregnancy. METHODS: This is a retrospective study of women (n=110) with ectopic pregnancy and treated with single dose of MTX. The clinical presentations, transvaginal sonography (TVS) findings, pretreatment beta-human chorionic gonadotropin (ß-HCG), and progesterone values were compared between the treatment success (Group S) and treatment failure (Group F) groups. RESULTS: The overall success rate of treatment with single dose of MTX was 75.45%. The majority of patients in both groups presented with pain and bleeding (~55%), and bleeding only was the presenting symptom in about 20% of patients. Only 3 patients (3.61%) in Group S required a repeat dose of MTX. In contrast, 51.8% of the Group F patients required a repeat dose. The mean pretreatment ß-HCG level was 2.3 times higher in Group F than in Group S (1734±1684 vs 4036±2940 IU/L). The data showed a ß-HCG level of 3924IU/L as a suitable cut-off value with 76.19% sensitivity and 62.5% specificity to predict MTX treatment success. History of ectopic pregnancy had no relation with success/treatment failure or a repeat dose. None of the TVS findings were related to the outcome of the treatment, whereas pretreatment HCG level was a significant predictor. CONCLUSION: The single dose MTX treatment was successful in 75.45% (83/110) of cases, with 3.61% (3/83) requiring a repeat dose of the drug. Pretreatment ß-HCG level is a significant predictor of the treatment outcome.

Distance education during the COVID-19 outbreak: A cross-sectional study among medical students in North of Jordan.

INTRODUCTION: In the spot of the new emerging COVID-19 pandemic and its major impact worldwide on day-to-day activities many rules had to be changed in order to fight this pandemic. Lockdown started in Jordan and around the globe affecting several aspects of life including economy, education, entertainment, and government policies. Regarding education, the priority was to ensure the safety and progress of the educational process. Thus, new methods of teaching had to be applied using the online learning at Jordan University of Science and Technology (JUST), Faculty of Medicine. This study was done to assess (1) Class Experience (2) Students and Lecturers' Interaction (3) Online Learning Advantages & Disadvantages (4) Students' Preference. METHODS: A cross sectional study was conducted Convenience sampling technique was used to collect the data from the participants using a survey composed of 18 questions on Google Forms platform. A link was sent to the undergraduate medical students at the Jordan University of Science & Technology via their e-learning accounts (n = 3700). The form was available from May 22nd, 2020 to May 30th, 2020 for 8 days long. Data analysis was done using SPSS V 23. RESULTS: 2212 out of 3700 students responded, (55.8%) of them were in the basic years and (44.2%) of them were in the clinical years. (55.8%) of students started to take online lectures after 3 weeks. (45.7%) used the hybrid teaching method (asynchronous and synchronous), (31.4%) used live classes, and 22.8% recorded classes. Zoom was the most used platform. (48.7%) and (57%) of clinical students and basic students express their interaction as bad, while the others had good and excellent interaction. Maintaining social distance was the most advantage of online teaching, while poor technical setup and no direct contact were the most disadvantage, furthermore inability to have real clinical access was a significant problem for clinical students (p < .001). With reference to students' preferences 75% of students were not pleased with their experience and 42% of students prefer to integrate online learning with traditional learning. CONCLUSION: Most medical students at JUST preferred the traditional face-to-face teaching method over the solo online teaching methods with recommendations to convert to a more integrated educational system. Also, a well-established infrastructure should be done in involving online teaching.

Factors that influenced pregnant women with one previous caesarean section regarding their mode of delivery.

BACKGROUND: During the last decades, the rate of caesarean section is increasing and this can increase the mortality and morbidity. Up to one third of the caesarean sections are attributed to the elective repeat caesarean section (ERCS). This study aims to evaluate attitudes and factors affecting the choice of pregnant women with one previous caesarean section regarding their mode of delivery in their second pregnancy. By assessing these attitudes, this study can help the efforts in developing strategies to increase the rates of vaginal delivery. MATERIAL AND METHODS: A cross-sectional design was conducted by a structured questionnaire on 166 pregnant women who had delivered once by caesarean section for their first pregnancy and were in the third trimester of their second pregnancy. Any women with an absolute indication for caesarean section was excluded. The study comprises women who attend the clinic at our center in Northern of Jordan. Proper statistical tests were performed to assess the association between the choice of delivery and selected demographic and clinical factors. RESULTS: About 55.4% responded that they would choose ERCS (n = 92) and the remaining participants chose trial of labour after caesarean section (TOLAC) (n = 74). Fear of pain was the most common reason for choosing caesarean section, accounting for 55.4%. Interestingly, our study did not show a significant association between the mode of delivery and demographic factors, such as age, educational level and occupation. The single independent significant factor influencing patients' choice that our study revealed was "being informed about the complications of TOLAC". The choice of TOLAC was almost four times higher for those participants who had been informed about the complications, compared to those who had not been informed. CONCLUSION: Proper counselling is a main factor that affected the patients' choice toward the mode of delivery. Proper pain management may encourage patients to choose TOLAC because fear of pain was a main reason that patients requested ERCS instead of TOLAC.

Challenges and solutions for maternity and gynecology services during the COVID-19 crisis in Jordan.

OBJECTIVE: To describe regional experiences and measures implemented to safely maintain obstetrics and gynecology services during the COVID-19 pandemic at King Abdullah University Hospital in Jordan. METHODS: All policies and measures were implemented in keeping with World Health Organization and other international recommendations and guidelines. RESULTS: With concerted effort and a multidisciplinary approach, most maternity and gynecology services were provided and all other training and educating responsibilities were maintained. CONCLUSION: COVID-19 caused an unprecedented global healthcare crisis. Our institution addressed the challenges and implemented several measures at different levels to maintain services and facilitate the training and teaching of trainees and medical students.

Intelligent system based on data mining techniques for prediction of preterm birth for women with cervical cerclage.

Preterm birth, defined as a delivery before 37 weeks' gestation, continues to affect 8-15% of all pregnancies and is associated with significant neonatal morbidity and mortality. Effective prediction of timing of delivery among women identified to be at significant risk for preterm birth would allow proper implementation of prophylactic therapeutic interventions. This paper aims first to develop a model that acts as a decision support system for pregnant women at high risk of delivering prematurely before having cervical cerclage. The model will predict whether the pregnancy will continue beyond 26 weeks' gestation and the potential value of adding the cerclage in prolonging the pregnancy. The second aim is to develop a model that predicts the timing of spontaneous delivery in this high risk cohort after cerclage. The model will help treating physicians to define the chronology of management in relation to the risk of preterm birth, reducing the neonatal complications associated with it. Data from 274 pregnancies managed with cervical cerclage were included. 29 of the procedures involved multiple pregnancies. To build the first model, a data balancing technique called SMOTE was applied to overcome the problem of highly imbalanced class distribution in the dataset. After that, four classification models, namely Decision Tree, Random Forest, K-Nearest Neighbors (K-NN), and Neural Network (NN) were used to build the prediction model. The results showed that Random Forest classifier gave the best results in terms of G-mean and sensitivity with values of 0.96 and 1.00, respectively. These results were achieved at an oversampling ratio of 200%. For the second prediction model, five classification models were used to predict the time of spontaneous delivery; linear regression, Gaussian process, Random Forest, K-star, and LWL classifier. The Random Forest classifier performed best, with 0.752 correlation value. In conclusion, computational models can be developed to predict the need for cerclage and the gestation of delivery after this procedure. These models have moderate/high sensitivity for clinical application.