Morbidly adherent placenta previa in current practice: prediction and maternal morbidity in a series of 23 women who underwent hysterectomy.

OBJECTIVE: To assess the prediction and maternal morbidity of morbidly adherent placenta previa (PP) when currently available management options are used. MATERIALS AND METHODS: This is a retrospective study of all women with PP/morbidly adherent placenta previa (MAPP) delivered at our hospital over a period of 9 years. Data were obtained through hospital registry and medical records search. RESULTS: A total of 81 PP were identified, 23 (28.4%) of them had MAPP. All MAPP had previous lower segment cesarean section (LSCS). The following are associated with increased odds of MAPP versus PP, LSCS (OR for each additional LSCS was 2.9 (95% confidence interval: 1.8, 4.5, p ≤ 0.005), age ≥35 years (OR 4.3 (95% CI: 1.4, 12.7, p = 0.008). Anterior or central placenta (OR = 11.6; p = 0.028). Women with previous PP were at risk. Fifteen women were diagnosed by ultrasound [sensitivity 0.65 (0.43, 0.83) and PPV 0.79 (0.54, 0.93)]. MAPP was associated with risk of massive transfusion, bladder injury, DIC and admission to intensive care unit (ICU) (p < 0.005, 0.008, 0.036 and 0.008, respectively). One maternal death was reported in the MAPP group. CONCLUSION: MAPP is associated with high morbidity and mortality. As the diagnosis is often not certain before delivery, we recommend that all PP and previous LSCS are assumed to be morbidly adherent, and should be managed in properly equipped centers.

Prediction of preterm and low birth weight delivery by maternal periodontal parameters: receiver operating characteristic (ROC) curve analysis.

In this study we used receiver-operating characteristic (ROC) analysis to comparatively evaluate maternal periodontal parameters to predict preterm (PB) delivery and low birth weight (LBW) delivery among Jordanian women. A total of 277 pregnant women (20 weeks of gestation or less) had periodontal examination at baseline and followed up until delivery. Gestational age and birth weight were retrieved from their medical records. ROC curve analyses were used to examine the overall discriminatory power of the studied periodontal parameters to predict PB, LBW, and PB or LBW. For the three outcome variables, the area under curve (AUC) ranged from 0.84 to 0.87 for average clinical attachment level (CAL), 0.78-0.86 for percent of sites with CAL ≥ 5 mm, 0.63-0.74 for percent of sites with CAL ≥ 6 mm, and 0.71-0.82 for number of missing teeth indicating that they had high discriminating power to predict adverse pregnancy outcomes. All other parameters had AUC less than 0.60 and thus had low discriminating power. Average CAL performed the best in predicting the studied adverse pregnancy outcomes because it has the highest AUC. The severity and extent of periodontal disease as measured by CAL can be used to predict the occurrence of adverse pregnancy outcomes.

Premenstrual symptoms in dysmenorrheic college students: prevalence and relation to vitamin D and parathyroid hormone levels.

OBJECTIVES: To determine the prevalence of premenstrual symptoms (PMS) due to primary dysmenorrhea among a sample of university female students, and to explore possible association with vitamin D and parathyroid (PTH) levels, as well as frequency of consumption of dairy products. DESIGN: A cross-sectional study. SETTING: One Jordanian university. SUBJECTS: A total of 177 female students aged between 18 and 24 years who experienced primary dysmenorrhea participated in the study and completed a self administered questionnaire to collect information concerning demographics, menstruation-related information, associated specified premenstrual symptoms, and consumption of dairy products. Plasma 25-hydroxyvitamin vitamin D level and intact parathyroid hormone level were measured. RESULTS: Of the 177 participants 91.5% had two or more symptoms among which fatigue, mood swings, anxiety, abdominal bloating, and depression were the most prevalent symptoms. There was no evident association between presence of symptoms and vitamin D status, PTH level or dairy products consumption. Headaches and social withdrawal were significantly lower in those women who consumed high amounts of dairy products. CONCLUSION: Premenstrual symptoms are very common in young women with primary dysmenorrhea. PMS has no relation to levels of vitamin D, parathyroid hormone or dairy products consumption. Headache and social withdrawal may be affected by dairy product consumption.

Association between periodontal disease and osteoporosis in postmenopausal women in jordan.

BACKGROUND: Some studies suggest that females with osteoporosis are at an increased risk of periodontal attachment loss and tooth loss; however, results have varied. The aim of this study is to determine the relationship between periodontitis and osteoporosis among postmenopausal Jordanian women. METHODS: This cross-sectional study includes 400 Jordanian postmenopausal women with a mean age of 62.5 years (SD ± 6.4 years). These subjects were recruited from patients who had received a routine dual-energy x-ray absorptiometry examination in the Radiology Department, King Abdullah Hospital, Jordan University of Science and Technology, between June 2008 and February 2009. The relationship between skeletal bone mineral density (BMD) and radiographic and clinical parameters of periodontal status, including the loss of alveolar crestal height (ACH), clinical attachment level, probing depth, and percentage of sites with bleeding on probing, was evaluated after controlling for known confounders. RESULTS: Bivariate analyses revealed no significant differences in the severity and extent of clinical attachment and ACH loss among women with normal BMD, osteopenia, and osteoporosis. However, in the multivariate analysis, women with osteoporosis were more likely to have severe ACH loss (odds ratio [OR]: 4.20; 95% confidence interval [CI]: 1.57 to 11.22) and periodontitis (OR: 2.45; 95% CI: 1.38 to 4.34). CONCLUSION: Osteoporosis was significantly associated with severe alveolar crestal bone loss and the prevalence of periodontitis cases in postmenopausal Jordanian women.

Induction of labor and perinatal outcome: the impact of the amniotic fluid index.

OBJECTIVE: The purpose was to determine the impact of the amniotic fluid index on the perinatal outcome of patients admitted for induction of labor at term. STUDY DESIGN: Patients (n=180) included in the study were those admitted for induction of labor at 37-42 weeks' gestation, with unfavorable cervix and intact membranes. The amniotic fluid index (AFI) was determined in all patients using the four-quadrant technique within 24 h of the induction of labor. Patients were divided into two groups based on their AFI: the oligohydramnios group with AFI < or = 5 cm (n = 66) and a normal group with AFI > 5 cm (n = 114). The perinatal outcomes of the two groups were compared. RESULTS: The two groups were similar with regard to maternal age, gestational age, and birth weight. Meconium staining of the amniotic fluid was significantly higher in the group with AFI < or = 5 cm (p = 0.040). The number of cesarean deliveries due to fetal distress was significantly higher even after adjusting for other confounding factors in the group with AFI < or = 5 cm (adjusted OR 6.52 [95% CI 1.82, 23.2]; p < or = 0.0001). There was no significant difference between the two groups with regard to Apgar scores or neonatal admission. CONCLUSION: Induction of labor at term in patients with oligohydramnios is associated with an increased risk of cesarean delivery due to fetal distress.