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 The indication for EPH in recent years has changed from outdated uterine atony to abnormal placentation.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.

The prevalence of overactive bladder and its impact on the quality of life: A cross-sectional study.

Objective: Overactive bladder (OAB) is a common condition affecting both men and women and has been shown to affect the quality of life. We conducted this study to estimate the prevalence of OAB, and to incorporate symptom severity, symptom bother and health-related quality of life (HRQL) in the assessment of OAB and evaluate associated factors. Methodology: A total of 940 participants were categorized into non-OAB and OAB using the Overactive Bladder Symptom Score (OABSS). HRQL and symptom bother were measured using the Overactive Bladder Questionnaire - Short Form (OAB-q SF). Descriptive analyses and multivariable regression analyses were performed. Results: The prevalence of OAB among our population was 27.4%. Patients with older age (Odd ratio [OR] = 2.26, 95% confidence interval [CI]: 1.6-3), higher body mass index (BMI) (OR = 2.6, 95% CI: 1.8-3.8), comorbidities (OR = 2.6, 95% CI: 1.9-3.5) and history of recurrent urinary tract infection (UTI) s (OR = 1.9, 95% CI: 1.4-2.6) were significantly associated with increased risk of OAB (p < 0.001). The mean OAB symptom bothers score was 35.7 + 22.9 and increased significantly across OAB severity groups (p < 0.001). The mean HRQL score was 73.3 + 22 and a significant decreased across OAB severity groups (p < 0.001). All OAB symptoms showed significant positive correlation with increased symptom bother (p < 0.001) in addition to significant inverse correlation with HRQL (p < 0.001). Conclusion: OAB is a prevalent condition in our population and the associated symptoms negatively affect HRQL. In this study, the detrimental effect is not exclusive to UUI and can be attributed to the other elements in the symptom spectrum of OAB. Screening for OAB should be considered during routine clinical visits using validated and reliable measures for early detection of symptoms and possible modification of risk factors to improve the outcome.

Risk factors of surgical failure following sacrospinous colpopexy for the treatment of uterovaginal prolapse.

PURPOSE: Trans-vaginal sacrospinous colpopexy is one of the surgical procedures used to repair varying degrees of vaginal vault and uterovaginal prolapse. The purpose of this study is to analyse the potential risk factors of surgical failure following sacrospinous colpopexy. METHODS: A retrospective study of 114 women who underwent unilateral sacrospinous colpopexy at Jordan University Hospital from January 2005 to January 2008 were included. Patient demographics, clinical characteristics and concomitant pelvic organ prolapse surgery were assessed. The patients were evaluated at 6 weeks, and every 6 months thereafter. Twelve (11 %) had recurrent apical (vaginal cuff) prolapse, 26 (23 %) had recurrent prolapse at any compartment were compared with those who had successful surgery. Univariate and logistic regression analyses were used to assess the independent prognostic values of the variables associated with surgical failure. RESULTS: After a mean follow-up of 40 months, the statistically significant predictors of surgical failure included the presence of advanced pre-operative stages of prolapse (stages III and IV), the more distally located points Ba, Bp and C and a lack of mesh augmentation of the anterior vaginal wall during surgery (P = 0.01, 0.027, 0.024, 0.034 and 0.006, respectively). However, a history of prior vaginal repair, the more distally located point Ba and a lack of anterior vaginal wall mesh augmentation were defined as independent predictive variables based on logistic regression analyses (P = 0.04, 0.005 and 0.046, respectively). CONCLUSIONS: The presence of advanced anterior vaginal wall prolapse, prior vaginal repair and a lack of mesh augmentation of the anterior compartment are significant risk factors for the surgical failure of sacrospinous suspension surgery.

Impact of COVID-19 Self-Isolation on Medical Students' Education and Adherence to Protective Measures.

This study aims to evaluate the impact of self-isolation on the level of adherence to health protective measures among medical students in Jordan and on their clinical education. Because of being suspected of having or testing positive for COVID-19, 336 students were self-isolated . A questionnaire was sent to study the clinical adherence of students to COVID-19 protective measures after their self-isolation period, the student's satisfaction about the policy followed during the pandemic, the impact of these measures on their clinical training, and the level of vaccine acceptance among them. The study included 283 participants, with a mean age of 22.5 (±1.50) years; 49.5% males and 50.5% females. We found that students' adherence to protective measures generally increased after their self-isolation. Gender, age, and having an infection from the hospital were the most important predictors for better adherence to health safety measures. Most students (83%) have registered to take the vaccine. 97.5% of self-isolated students reported that they are aware and satisfied of the School of Medicine instructions and policies. The findings suggest the need to ensure that medical students' clinical training should not be negatively affected by COVID-19 and COVID-19 self-isolation, as medical students are adherent to COVID-19 precautionary measures and willing to take the vaccine.

Early Pregnancy Glycemic Levels in Non-Diabetic Women and Pregnancy Outcome: A Retrospective Cross-Sectional Study.

BACKGROUND: Maternal fasting blood sugar (FBS) variations within normal range and lower than that in diabetes mellitus (DM) may be associated with adverse feto-maternal outcomes. OBJECTIVE: To find out if a rise of maternal FBS level above 80 but still below 120 mg/dL (group 2) has an influence on feto-maternal outcomes compared with a maternal FBS below 80 mg/dL (group 1). METHODS: Retrospective cross-sectional study. FBS was measured at the booking visit. Subjects whose FBS was measured before 20 weeks were categorized according to their FBS (>80 mg/dL or ≤80 mg/dL) and correlation between FBS levels in the two groups with several parameters were tested. RESULTS: Group 1 (130 healthy pregnant women) and group 2 (88 healthy pregnant women) did not show a statistical difference in age or BMI. More statistically significant cases were diagnosed with GDM in group 2 than in group 1 (39.8% vs 16.9%, P value 0.000). More cases that needed pharmacological intervention in the form of metformin or insulin or both were seen in group 2 than in group 1 (p value 0.007 and 0.061, respectively). More but not statistically significant polyhydramnios was seen more in group 2 than in group 1 (9.1% vs 3.1%, p value 0.056). There was no statistically significant difference between the 2 groups in relation to all other fetomaternal outcome parameters that were studied. CONCLUSION: Raised maternal fasting blood glucose level (80-120 mg/dL) in healthy primigravid women in early pregnancy was associated with significant diagnosis of gestational diabetes mellitus and need for pharmacological intervention. An association was found with polyhydramnios but this was not statistically significant. No influence was found on preterm birth, fetal weight, mode of delivery or APGAR score. More attention should be given to FBS levels early in pregnancy to reduce the risk for later complications.

Perioperative Outcomes in COVID-19 Obstetric Patients Undergoing Spinal Anesthesia for Cesarean Section: A Prospective Observational Study.

Coronavirus disease 2019 (COVID-19) adds more challenges to the perioperative management of parturients. The aim of this study is to examine perioperative adverse events and hemodynamic stability among COVID-19 positive parturients undergoing spinal anesthesia. This prospective observational investigation was conducted at a tertiary teaching hospital in Jordan between January and June 2021, during which 31 COVID-19 positive parturients were identified. Each COVID-19 positive parturient was matched with a COVID-19 negative parturient who received anesthesia under similar operating conditions as a control group. Of the 31 COVID-19 patients, 22 (71%) were otherwise medically free, 8 (25.8%) were emergency cesarean sections. The sensory level of spinal block after 10 min was T8 (T6-T10) among COVID-19 positive group, compared to T4 (T4-T6) among control group (p = 0.001). There were no significant differences in heart rate, SBP, DBP, and MAP intraoperatively (p > 0.05). Twelve (36.4%) neonates born to COVID-19 positive patients were admitted to NICU, compared to four (11.8%) among control group (p = 0.018). There was no statistically significant difference in postoperative complications. In conclusion, spinal anesthesia is considered a safe anesthetic technique in COVID-19 parturients, and therefore it is the anesthetic method of choice for cesarean deliveries among COVID-19 patients.

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.

Bupivacaine with meperidine versus bupivacaine with fentanyl for continuous epidural labor analgesia.

OBJECTIVE: To compare the efficacy of bupivacaine-meperidine and bupivacaine-fentanyl mixtures when continuously infused epidurally to relief the labor pain. METHODS: We performed this prospective double-blinded study at Jordan University Hospital, Amman, Jordan between October 2005 and April 2006. Sixty-seven American Society of Anesthesia physical status I parturients were randomly divided into 2 groups, Group M (n=34) received a continuous infusion of 1 mg/ml of bupivacaine mixed with 1 mg/ml meperidine, and Group F (n=33) received a continuous infusion of 1 mg/ml bupivacaine mixed with 2 micrometer/ml fentanyl. Efficacy of analgesia, degree of motor block, hemodynamic variability, incidence of nausea and vomiting, pruritus, sedation, and the neonatal outcome were all compared between the 2 groups. A p value <0.05 was considered to be significant. RESULTS: Highly effective analgesia was achieved in both groups with a similar incidence of motor block, sedation, pruritus, and neonatal outcome. The only significant difference was in the incidence of nausea and vomiting. Group M had 8 parturients with nausea, compared with only 2 parturients in Group F (p=0.003). CONCLUSION: Bupivacaine-meperidine in a continuous epidural infusion is as efficient as bupivacaine-fentanyl for pain relief during labor, but associated with a higher incidence of nausea and vomiting.

Intrasplenic Arterial Aneurysms during Pregnancy.

Splenic artery aneurysms account for about 60% of all visceral aneurysms. Pregnancy is a risk factor for splenic artery aneurysms rupture with high maternal mortality and fetal loss. Intrasplenic arterial aneurysms are extremely rare and have not been reported to be associated with pregnancy. This report presents a 34-year-old woman during the second trimester, admitted with severe left upper quadrant and left shoulder pain. She had two uncomplicated intrasplenic aneurysms. Splenectomy was done. She delivered a full term healthy girl. This is the first report of acute abdomen during pregnancy caused by intrasplenic artery aneurysms with maternal and fetal survival.