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.

Polycystic ovarian syndrome - association and risk factors between endometrial polyp and infertility. A retrospective study.

Introduction: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder and is one of the most common causes of infertility. The study aimed to investigate the association between endometrial polyp and infertility in PCOS in a high-incidence region such as the Middle East. Also, to identify the most common risk factors for endometrial polyp(s) in PCOS patients with infertility. Material and methods: We conducted a retrospective cohort study on a total of 250 patients with a confirmed diagnosis of a PCOS. Eighty patients out of the 250 were finally included in the study after a high suspicion of endometrial polyp by 2-D transvaginal ultrasound at the early follicular phase, and they underwent an office hysteroscopy at the late follicular phase after proper counselling. Results: Out of 80 patients enrolled in the study, 62 were confirmed to have endometrial polyp(s) by office hysteroscopy; 6 patients had a polypoid endometrium, 10 patients had an isolated increased endometrial thickness, and 2 patients had a small submucosal fibroid (less than 1.5 cm). The most observed co-factors in patients with PCOS and endometrial polyps are obesity, followed by oligomenorrhoea and amenorrhoea (hyperoestrogenic status). Conclusions: Our study found that there is an association between PCOS with infertility and endometrial polyp(s). The most common associated factor is obesity, followed by oligomenorrhoea and amenorrhoea (hyperoestrogenic status). We hope that our study will raise global awareness about the unwanted effects of obesity in PCOS on general and reproductive health. A large study in the future is needed to confirm our results.

Ondansetron versus metoclopramide for managing hyperemesis gravidarum: A systematic review and meta-analysis of randomized controlled trials.

This investigation examined the efficacy of ondansetron (intervention) versus metoclopramide (control) in managing parturient females with hyperemesis gravidarum (HG), by pooling data from randomized controlled trials (RCTs) using a meta-analysis approach. From inception until January 2022, five information sources were screened: Cochrane Central Register of Controlled Trials, Google Scholar, Scopus, PubMed and Web of Science. Quality assessment was done through the Cochrane Risk of Bias (version 2) assessment tool. The mean difference (MD) with 95% confidence interval (CI) was used to summarize the continuous data in a fixed- or random-effects model, depending on the extent of between-study heterogeneity. Five RCTs were included, comprising a total of 695 patients (355 and 340 females were assigned to ondansetron and metoclopramide, respectively). Four RCTs had an overall "low" risk of bias, whereas one RCT had an overall "some concerns" due to lack of sufficient information about randomization. There was no significant difference between both groups regarding the pregnancy-unique quantification of emesis and nausea score [MD=0.23, 95% CI (-0.42, 0.88), p=0.49], length of hospital stay [MD=-0.17 days, 95% CI (-0.35, 0.02), p=0.08], the number of doses of drug received [MD=0.45, 95% CI (-0.08, 0.98), p=0.10], and duration of intravenous fluids [MD=-1.73 hours, 95% CI (-5.79, 2.33), p=0.40]. Among parturient females with HG, there was no substantial difference in efficacy between both agents. Nevertheless, ondansetron is favored over metoclopramide in view of its trending therapeutic efficacy and better safety profile.

Menstrual changes following COVID-19 infection: A cross-sectional study from Jordan and Iraq.

PURPOSE: COVID-19 infection is normally followed by several post-COVID effects. This study aimed to investigate to evaluate menstrual changes in females following COVID-19 infection, and to evaluate female perception about the effect of COVID-19 on their menstrual cycles. METHODS: During this cross-sectional survey-based study, a convenience sample of 483 women from Jordan and from Iraq, who had infected with COVID-19 were invited to fill-out the study questionnaire. RESULTS: The study was conducted on the females, with a median age 31 years old. Results showed that 47.2% of them (n = 228) suffered from a change in the number of days between two consecutive periods, as well as from a change in the amount of blood loss. Also, more than 50% of them believed that COVID-19 infection may cause changes in the amount of blood loss during the cycle (n = 375, 56.9%), and changes in the number of days between the two consecutive periods (n = 362, 54.2%). Regression analysis showed that participants with higher educational level (bachelor or higher) (Beta = -0.114, P = 0.011), and those living in Iraq (Beta = -0.166, P<0.001) believed that COVID-19 has lower tendency to cause menstrual changes. In addition, non-married females (Beta = 0.109, P = 0.017), and those who are current smokers (Beta = 0.091, P = 0.048) believed that COVID-19 has higher tendency to cause menstrual changes. CONCLUSION: his study revealed that COVID-19 infection could affect the menstrual cycle for the females. Further prospective studies should be done to confirm these findings and evaluate how long these menstrual irregularities lasted.

Human embryology science: which theoretical information do clinical embryologists need to know more about? A survey / Ciencia de la embriología humana: ¿Qué información teórica necesitan saber más los embriólogos clínicos? Una encuesta

SUMMARY: For the past decades, it has been apparent that assisted reproductive technologies along with clinical embryology have both propounded themselves triumphantly in the field of medicine. Although high-tech equipment and staff skills are crucial to the success of these breakthrough implementations, the pivot of these practices is updated, knowledgeable and competent technicians who excel in the field of human embryology. Crucially, the advancement of clinical embryology and its related fields depends on the meticulous training of clinical embryologists in practical skills as well as theoretical knowledge. Unfortunately, most aspects of reproductive medicine have no obligatory assembled curriculum. A lot more emphasis has been put on the clinical aspect of these sciences and training than its theoretical counterpart. Consequently, clinical embryologists continue to face difficulty in unifying the needed theoretical knowledge in these fields. Not only that, but they also struggle to shed a light on the advanced knowledge required to stand out as professionals. This study aimed to explore which theoretical information in the science of human embryology that embryologists need to know thoroughly about. The survey was conducted online (July 2021).

RESUMEN: Durante las últimas décadas, ha sido evidente que las tecnologías de reproducción asistida junto con la embriología clínica han demostrado un éxito importante en el area de la medicina. Si bien los equipos de alta tecnología y las habilidades del personal son cruciales para el éxito de estas implementaciones, el eje de estas prácticas son los técnicos actualizados, competentes y expertos en el campo de la embriología humana. Fundamentalmente, el avance de la embriología clínica y sus campos relacionados dependen de la formación meticulosa de los embriólogos clínicos en las habilidades prácticas y los conocimientos teóricos. Desafortunadamente, la mayoría de los aspectos de la medicina reproductiva no cuenta con un plan de estudios obligatorio. El énfasis se ha concentrado en el aspecto clínico y en el entrenamiento de estas ciencias más que en la contraparte teórica. En consecuencia, los embriólogos clínicos continúan enfrentando dificultades para unificar el conocimiento teórico necesario en estos campos. Este estudio tuvo como objetivo explorar qué información teórica importante en la ciencia de la embriología humana requieren los embriólogos. La encuesta de este trabajo se realizó en línea (julio de 2021).

Platelet-rich plasma for the management of intrauterine adhesions: A systematic review and meta-analysis of randomized controlled trials.

OBJECTIVE: To conduct a systematic review and meta-analysis to assess the efficacy of platelet-rich plasma (PRP) infusion after adhesiolysis in patients with intrauterine adhesions (IUAs) by establishing the evidence from published randomized controlled trials (RCTs). METHODS: PubMed, Scopus, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar databases were screened from inception till June 2021. Risk of bias of included studies was evaluated according to the Cochrane's Collaboration tool. The efficacy endpoints were summarized as risk ratio (RR) or mean difference (MD) with 95% confidence interval (CI) under the fixed-effects model. RESULTS: Three RCTs met the inclusion criteria, comprising a total of 260 patients (132 and 128 patients were allocated to PRP and control groups, respectively). The RCTs revealed an overall low risk of bias. Compared with the control group, the PRP group had a statistically significant higher rate of patients with IUAs grade I-II after intervention (n = 3 RCTs, RR=1.23, 95% CI [1.11 to 1.36], p<0.001), higher duration of menstrual menses after intervention (n = 3 RCTs, MD=1.13 days, 95% CI [0.86 to 1.41], p<0.001), and higher amount of menstrual menses after intervention (n = 3 RCTs, MD=2.96 pads, 95% CI [0.31 to 3.61], p<0.001). All pooled analyses were homogeneous. CONCLUSION: PRP treatment after hysteroscopic adhesiolysis is effective in decreasing the IUA grade and improving the duration and amount of menstrual menses. Nonetheless, additional RCTs are warranted to validate these conclusions.

The Use and Efficacy of Mobile Fertility-tracking Applications as a Method of Contraception: a Survey.

PURPOSE OF REVIEW: The purpose of this review is to investigate the use and efficacy of fertility tracking applications as a natural contraceptive method since there has been a worldwide increase in the development and use of applications that monitor the menstrual cycle and fertility window. An anonymous online survey had been conducted in order to achieve this goal, and a total of 375 married women from Jordan responded to our survey. RECENT FINDINGS: Topics discussed include fertility awareness-based methods (FAM) of contraception in which mobile applications fall into, and their efficacy and failure rates, comparing them with other methods of contraception while taking into account the typical and perfect use of each method. Motivation has also been looked at as a factor affecting the efficacy of FAM and advantages/disadvantages of this method were discussed. The prevalence of mobile applications that monitor fertility signs and their expected increased use over the next years was also discussed. SUMMARY: The use of fertility tracking applications is not uncommon amongst sexually active women in reproductive age, and the majority of users rely on them to track their fertility window. However, the efficacy of such applications as a method of contraception is not high and there is a significant failure rate especially if used alone. It is worth noting that 50% of women who reported failure relied solely on mobile applications and fertility window assessment without using other methods of contraception, and thus we advise women to use more reliable methods of contraception and not rely solely on such applications.

The Effect of Endometrial Polyp Resection by Office Hysteroscopy during In Vitro Fertilization/Intracytoplasmic Sperm Injection Treatment Cycle on Pregnancy Rate A Series of 25 Cases.

AIM: This study aims to evaluate the effect of endometrial polyp resection by office hysteroscopy during in vitro fertilisation/intracytoplasmic sperm injection (IVF/ICSI) treatment cycle on pregnancy rate. SETTING AND DESIGN: A retrospective observational study (case series). MATERIALS AND METHODS: Twenty-five patients from a total of 346 patients that started IVF/ICSI treatment due to different causes of infertility over the period from January 2018 to December 2019 underwent an office hysteroscopy during ovarian stimulation (day 7-8) due to suspected endometrial polyp by transvaginal ultrasound and confirmed at day 7 of ovarian stimulation were retrospectively investigated. RESULTS: Eighteen patients from the 25 patients that started IVF/ICSI treatment; endometrial polyp was confirmed by office hysteroscopy and resected, egg collection performed after 4-5 days after the hysteroscopy, embryo transfer done Double ET) at Day 3 and 5, the clinical Pregnancy rate was 56% (10 from the 18). No hysteroscopy-related adverse events were reported. CONCLUSION: Office hysteroscopy during ovarian stimulation in the IVF/ICSI treatment cycle may be useful in confirming the diagnosis and resection of endometrial polyp suspected by transvaginal ultrasound and is safe on the endometrium in terms of receptivity and improvement of the pregnancy rate. As the sample size of our study is relatively small, a well-designed large RCT is required to confirm our results before clinical advice is released.

Hydrosalpinx and pregnancy loss: a systematic review and meta-analysis.

RESEARCH QUESTION: What is the association between hydrosalpinx and pregnancy loss and the effects of treatment for hydrosalpinx? DESIGN: A systematic review and meta-analysis was conducted to investigate the risk of pregnancy loss, and the benefit of treatment in women with hydrosalpinx. Searches were conducted on MEDLINE, Embase, the Cochrane Library and Web of Science. RESULTS: A meta-analysis of 14 observational studies showed a 74% relative increase in the risk of pregnancy loss in women with hydrosalpinx compared with women without hydrosalpinx (relative risk [RR] = 1.74, 95% confidence interval [CI]: 1.43, 2.12, P< 0.00001, I2 = 31%). Pooling of risk ratios from seven randomized trials and six observational studies of treatment of hydrosalpinx showed a reduction in pregnancy loss of approximately half when compared with no treatment (RR = 0.46, 95% CI: 0.34, 0.63, P <0.00001, I2 = 0%). CONCLUSIONS: This evidence suggests that the presence of hydrosalpinx increases the risk of pregnancy loss and that treatment can reduce this risk. However, in all studies apart from one, participants conceived through IVF so the evidence is less certain for women conceiving naturally. Further research should consider whether women with recurrent miscarriages should have routine screening for hydrosalpinx.

A Rare Case of Rectovaginal Fistula Due to Consensual Sexual Intercourse.

Rectovaginal fistulae after sexual intercourse are rare. We report a healthy recently married 21-year-old woman who presented to the Jordan Healthcare Centre, Amman, Jordan in 2014 with a five-week history of passing flatus and stool from the vagina. Six weeks prior, she had sustained a rectovaginal injury during initial consensual sexual intercourse, leading to the development of a distal rectovaginal fistula. A successful transvaginal repair was performed nine weeks after presentation which resulted in the complete resolution of her symptoms.