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.

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.

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.

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.

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.