Smoking cessation care can translate to lower hazard of death in the short-run in cancer patients - a retrospective cohort study to demonstrate the value of smoking cessation services within the treatment phase of cancer.

BACKGROUND: Smoking cessation is a key step towards improving cancer care and outcomes. However, smoking cessation interventions are underprovided in oncology settings. Within Jordan's only comprehensive oncology center, we sought to evaluate receipt of care at a smoking cessation clinic and the effect of assisted abstinence through the smoking cessation clinic on short-term (two-year) survival after a cancer diagnosis. METHODS: We employed a retrospective cohort study design. Cancer registry and smoking cessation clinic data for adult Jordanian cancer patients diagnosed between 2009 and 2016, who also were cigarette smokers, and who received full treatment at King Hussein Cancer Center, were analyzed. Specifically, descriptive statistics of patients who visited the smoking cessation clinic were generated, and short-term (two-year) hazard of death of patients based on whether or not smoking cessation clinic-assisted abstinence occurred, were evaluated. RESULTS: There were 3403 patients who met our inclusion criteria. Approximately 21% of cancer patients were seen at the smoking cessation clinic, and significant demographic and clinical disparities in who was being seen [at the smoking cessation clinic] existed. In 2387 patients with available survival data, smokers who never went to the smoking cessation clinic (or were seen only once, or seen a year or more from diagnosis) had a hazard of death 2.8 times higher than smokers who had visited the smoking cessation clinic and who also confirmed they had not smoked on atleast two of their 3-, 6- or 12-month follow-up visits (95% confidence interval [CI] = 1.7-4.6). Non-abstainers at the smoking cessation clinic exhibited a similar disadvantage (HR 2.7, 95% CI 1.4-5.0). CONCLUSIONS: Although evidence-based smoking cessation interventions increase the likelihood of abstinence and can lower the short-term hazard of death during cancer treatment, there is a deprioritization of smoking cessation interventions during cancer care, as indicated by low proportions of patients seen at the smoking cessation clinic. Our findings emphasize the importance of promoting interventions to avail smoking cessation interventions in oncology settings within the cancer treatment phase.

Educational Needs of Oncology Practitioners in a Regional Cancer Center in the Middle East-Improving the Content of Smoking Cessation Training Programs.

Little is known with regard to perceptions and information needs of oncology practitioners in the Middle East as they pertain to smoking cessation (SC) support for cancer patients. We sought to assess these in a regional cancer center. A survey was distributed to oncology practitioners (physicians, nurses, pharmacists, and physio- and respiratory therapists) at King Hussein Cancer Center (Amman, Jordan) for self-completion. The survey included SC-related measures of perceptions, knowledge, and practices. Descriptive statistics and cross tabulations were performed to identify misperceptions and knowledge gaps that could be corrected through continuing education. Findings revealed, among 254 practitioners surveyed, low referral rates to the SC clinic. Negative perceptions about cancer patients who smoke existed (e.g., patients needing smoking to control anxiety; patients' willpower sufficient for quitting; patients not wanting to quit and not needing more information). Substantial knowledge gaps were prevalent with regard to the detrimental outcomes associated with continued tobacco use after a cancer diagnosis and with regard to approved SC medication choices. Our results are useful in identifying topics that need to be highlighted during training and educational efforts in the region and also reinforce the need to avail such efforts in order to improve SC-related knowledge and perceptions.

Isolated subdiaphragmatic extralobar pulmonary sequestration: masquerading as suprarenal mass with spontaneous resolution.

Sub-diaphragmatic extralobar pulmonary sequestration (PS) is an extremely rare malformation defined as a portion of lung tissue that is totally discontinuous from the tracheobronchial tree and usually has its own pleural covering with an anomalous systemic blood supply. It is usually associated with other congenital malformations. The authors present an extremely rare case of isolated sub-diaphragmatic PS which was antenatally detected and followed up with postnatal ultrasound, where it masqueraded as a suprarenal mass; it was totally asymptomatic with spontaneous resolution at age of two years. This case emphasizes to add a differential diagnosis of malformation in congenital supra-renal masses, which remain stable in size and appearance, with possible spontaneous resolution and hence avoid immediate intervention and surgery.

Jordan tobacco dependence treatment guidelines: rationale and development.

Jordan, a high tobacco-burden country, has been working to expand its tobacco dependence treatment services and has completed development of its first customized treatment guidelines. Our paper presents the development process for these guidelines. A group of national and international experts was formed and a national situation analysis for tobacco dependence treatment practices and a detailed review of international evidence were conducted. The guidelines were then drafted and reviewed by national, regional and international experts and were official endorsed by the Jordanian Ministry of Health before being launched. The guidelines comprise concise descriptions and practical supplementary flowcharts covering the major elements of general tobacco dependence treatment. These are the first comprehensive Arabic-language guidelines, including a section focusing on waterpipe use, and we believe they are a reliable and useful resource for neighbouring countries seeking to develop similar guidelines.

A survey of Jordanian obstetricians and gynecologists' knowledge and attitudes toward human papillomavirus infection and vaccination.

OBJECTIVE: To assess the knowledge and attitudes of Jordanian obstetricians and gynecologists toward human papillomavirus (HPV) infection and its vaccine. MATERIALS AND METHODS: A self-administered, anonymous questionnaire was distributed to 400 participants attending scientific meetings. The survey focused on three areas: knowledge of HPV infection, vaccine, and attitude toward vaccination of female adolescents. RESULTS: Survey response rate was of 72.3%. The vast majority knew most of the statements related to knowledge of HPV infection, 66% thought that conventional screening Pap test have a sensitivity of > 75%, and only 44% of them knew that there are 13 to 17 HPV types that cause cervical cancer. The majority of the respondents (79%) knew that the vaccine would lead to long lasting immunity and 45% of the respondents thought that the vaccination would eliminate the need for regular Pap test. The majority (78%) indicated that the vaccine should be given to girls before the beginning of sexually active life. Overall, 67.5% of respondents intend to prescribe HPV vaccines and 79.6% of the respondents intend to recommend the vaccine if it is publicly funded. CONCLUSION: Most of the gynecologists in Jordan have the intention to recommend HPV vaccine, the deficit in their knowledge of HPV infection and vaccine must be corrected to assure acceptability of the vaccine.

Vaginal birth after caesarean section (VBAC) in women with spontaneous labour: predictors of success.

We evaluated the predictors of VBAC success in Jordanian women with a single previous low transverse caesarean section of a gestational age of at least 28 weeks, followed by a trial of spontaneous labour at two tertiary hospitals between January 2008 and February 2010. Among 207 women, 117 (57%) women achieved a successful VBAC. Multivariate analysis showed that a cervical dilatation of ≥ 7 cm at the time of previous caesarean section was an independent predictor of successful VBAC (with a success rate of 80%). Parity of ≥ 2 was significantly associated with increased odds of success (OR = 2.7, 95% CI: 1.2, 6.2). Compared with women who had no previous VBAC, those with previous VBAC had higher odds of success (OR = 3.8 (95% CI: 1.5, 9.5). We concluded that women with a previous caesarean section who achieved a cervical dilatation of ≥ 7 cm before caesarean, had a previous history of successful VBAC and had parity of ≥ 2, have the greatest likelihood of successful VBAC.

Cancer-related knowledge, attitudes, and risk perception among 6 grade students in Jordan.

UNLABELLED: Elementary schools in Jordan have included health education material in curricula to promote healthy lifestyles among younger school children. However, the relation between healthy lifestyles and the prevention of chronic diseases such as cancer has not been an explicit component in school curricula of younger age groups. We sought to explore the level of knowledge among 6th grade students as well as their attitudes with respect to cancer. This comes as part of a pilot project to develop an educational series on cancer prevention that aims to meet knowledge gaps specific to the community of students in this age group in Jordan. METHODS: A questionnaire composed of items measuring knowledge about cancer and cancer prevention through healthy practices, attitudes towards cancer, and intentions to engage in healthy behaviors was developed. Questionnaires previously used in similar age groups elsewhere were used as a reference. Our questionnaire was reviewed and approved by the Ministry of Education - School Health & Nutrition Department. Sixth graders in a convenience sample of four schools selected by the Ministry of Education completed the self-administered questionnaire. RESULTS: Ninety-six 6th graders from four schools answered the baseline survey, but 28% of the surveys were excluded from the analysis (data quality problems) leaving 69 student participants. In the original sample of 96 students, 48 (69.6%) were girls. Among the 69 student participants, 67 (97.1%) had heard of cancer, but fewer than 44 (63.8% knew it was not a contagious disease. Regarding fear, 29 (42%) would not play with a cancer patient. Concerning prevention of the most prevalent cancers in Jordan as research has shown that certain risk factors increase the chance that a person will develop cancer. The most common risk factors are smoking, Poor diet, lack of physical activity, or being overweight, 25 (36.2%) knew breast cancer was preventable, and 28 (40.6%) and 24 (34.8%) knew this regarding lung and colorectal cancers, respectively. About 40 (57.8%) students identified healthy dietary behaviors (e.g., low fat, low sugar), but only six could identify the ideal frequency for exercise (60 minutes daily). Fifty-eight (84.1%) agreed that cigarettes harmed the health. However, only 21 (30.4%) found it easy to avoid exposure to secondhand smoke. Nine (13%) reported smoking water pipes, but only one reported smoking cigarettes. Forty-eight (69.6%) and 47 (68.1%) agreed that daily physical activity and healthy eating were important, respectively. Fifty-two (75.4%) students found it easy to eat healthy at home, but only 37 (53.6%) found it easy to do so at school. Finally, 63 (91.3%) students wanted to learn more about cancer. CONCLUSION: Although a significant number of our sample of students has heard about cancer and students exhibit some knowledge regarding healthy practices, our results show that knowledge gaps exist with regard to the nature of cancer as a noncontagious disease, the preventability of specific cancers, and the link between specific risk factors and cancer.

Factors associated with the success of external cephalic version (ECV) of breech presentation at term.

OBJECTIVE: To evaluate the predictors of success of ECV for breech presentation at term. METHODS: A retrospective study was conducted over a 3-year period from 2005-2007, where 101 patients who had singleton breech presentation at term were undergoing external cephalic version (ECV) after 37 weeks of gestation at two major teaching hospitals in the North of Jordan. Comparative analysis was made between the successful ECV and unsuccessful ECV groups. The collected data were analysed by using statistical analysis Sudent's t-test and Mann-Whitney test as appropriate and on discrete results chi square or Fisher's exact test when appropriate. The differences were considered significant at a p value of < 0.05. RESULTS: The ECV success rate was 72.3%. Favourable factors for success were multiparity (95.5% vs 4.1%, p = 0.0001), flexed breeches (74% vs 26%, p = 0.002), posterior placenta (38.6% vs 16.4%, p = 0.0001) and anterior fetal back (53.4% vs 34.8%, p = 0.03). Once turned the babies remained cephalic until delivery. All the 28 cases who had failed ECV had caesarean section. Among those who had a successful external cephalic version, the incidence of intrapartum caesarean section was only 8.2% which was lower than that of the average of both units caesarean rate (28%). There were no complications related to the ECV procedure in the study. CONCLUSION: Multiparity, flexed breech, posterior placenta, and anterior foetal back were the most favourable factors for successful ECV in our study. Moreover, with careful evaluation of individual predictors patient selection and success rates can be optimised.

Umbilical cord prolapse: a 10-year retrospective study in two civil hospitals, North Jordan.

Umbilical cord prolapse (UCP) is an obstetric emergency. The objective of our study was to determine the frequency of cord prolapse, its aetiological factors and to evaluate fetal prognosis. This was a retrospective review of cord prolapse deliveries in the main two civil hospitals in North Jordan between 1995 and 2005, at Princess Badeea Hospital and at King Abdullah University Hospital (KAUH) in Irbid, North Jordan. There were 146 patients identified with UCP among a total of 64,192 consecutive births. The incidence of cord prolapse was one in 440 cases (146/64,192). It occurred mostly in women over 25 years, and significantly more in pre-term births, low birth weight babies, multigravida, and only a few were associated with induced cases. It was not associated with higher rates of perinatal mortality and this supports the benefit of clinical management of UCP by emergency (crash) delivery.

Tubal ectopic pregnancy in the north of Jordan: presentation and management.

OBJECTIVE: To evaluate and compare the current approach to the management of ectopic pregnancy between the main two civil hospitals in the north of Jordan. DESIGN: A retrospective study. MATERIAL AND METHODS: A retrospective review was made of the records of all patients with confirmed ectopic pregnancy admitted to Princess Badea Teaching Hospital (PBTH), and King Abdullah University Hospital (KAUH) between January 1, 2005 and December 31, 2005. The total number of deliveries for the same period was obtained from the labor ward records of hospitals. Information regarding demographic data, presenting symptoms, methods of diagnosis and treatment were extracted from individual patient records. RESULTS: There were 50 cases of confirmed ectopic pregnancy in PBTH compared with 20 cases in KAUH. The total number of deliveries at PBTH was 9,000 (1 ectopic/180 deliveries) while at KAUH, the number of deliveries was 3,000 so the ratio was 1: 150. The majority of patients (82%) had ruptured ectopic pregnancy at presentation. All cases at PBTH were managed by laparotomy. Of the 20 cases at KAUH, five cases were managed laparoscopically and three received medical treatment for their ectopics. There was no maternal mortality from ectopic pregnancy or its management at either hospital. CONCLUSION: The management of ectopic pregnancy in our community is still suboptimal. We recommend the development of clinical protocols for early diagnosis and referral, training in transvaginal scanning and an increase in the use of laparoscopy for the management of ectopic pregnancy.

Dermatologic aspects and cutaneous manifestations of sarcoidosis.

Sarcoidosis is a multisystem disease that may involve any organ or system. Cutaneous manifestations occur in 25- 30% of patients with sarcoidosis. Recognition of cutaneous lesions is important because they provide a clue about the diagnosis and provide an easily accessible source of tissue for histopathologic examination. Sarcoidosis can present with reactive non- specific lesions like erythema nodosum or specific manifestations showing granulomatous microscopic pathology including papules, plaques, lupus pernio, scar sarcoidosis, and rare morphologies such as alopecia, hypopigmented patches and ichthyosiform lesions. Treatment of cutaneous lesions can sometimes be difficult. For patients with widespread or severe lesions systemic glucocorticoids might be warranted. This article provides a comprehensive review of the dermatologic aspects of sarcoidosis and discusses the clinical manifestations, pathology and treatment of cutaneous manifestations of sarcoidosis.

Respiratory health and quality of life in young exclusive, habitual smokers - a comparison of waterpipe smokers, cigarette smokers and non-smokers.

Purpose: Waterpipe (WP) use has become a global trend in young populations. However, there are few well-controlled studies focusing specifically on the chronic effects of exclusive WP use on young adults' respiratory health. We sought to compare in young adults the burden of respiratory symptoms in regular WP smokers (WPS) relative to regular cigarette smokers (CS, positive controls) and non-smokers (negative controls); and to evaluate differences in health-related quality of life between the three groups. Method: We implemented a cross-sectional survey in college campuses across four countries (Egypt, Jordan, Morocco and Oman). Purposive sampling was employed to identify habitual (regular) healthy WPS (smoked 3 or more WP per week for 3 or more years); CS (smoked 5 or more cigarettes daily for 3 or more years); and non-smokers. Respiratory symptoms were assessed using the European Community Respiratory Health Survey and the American Thoracic Society and the Division of Lung Diseases Questionnaire. Health-related quality of life was measured using the Short-Form 12. Demographic, environmental and lifestyle factors also were measured. Result: The analytic sample included 135 WPS, 303 CS, and 300 non-smokers. Either tobacco group had significantly greater proportions of males than the non-smoker group. A significantly lower proportion of non-smokers (than either tobacco group) was overweight or obese. Average numbers of reported respiratory symptoms were 5.1, 5.8, and 2.9 in WPS, CS, and non-smokers, respectively. In multivariable regressions controlling for environmental exposures, body mass index, and physical activity, WPS and CS exhibited significantly higher rates of respiratory symptoms than non-smokers (1.6 times greater and 1.9 times greater rate of respiratory symptoms than non-smokers, respectively). Non-smokers reported significantly higher scores for general health relative to either WPS or CS. Conclusion: Relative to their young non-smoking counterparts, young habitual WPS exhibit a significant burden of respiratory symptoms that is comparable to that observed with CS. Young WPS (and CS), despite their age, may be well on their way to developing respiratory disease.

Comparing REM- and NREM-Related Obstructive Sleep Apnea in Jordan: A Cross-Sectional Study.

Obstructive sleep apnea (OSA) is a common disorder that includes an intermittent mechanical obstruction of the upper airway during sleep, which can occur either during rapid eye movement (REM) phase or non-REM (NREM) phase. In this study, we aim to evaluate the differences in demographic and polysomnographic features between REM- and NREM-related OSA in a Jordanian sample, using both the broad and the restricted definitions of REM-related OSA. All patients who were referred due to clinical suspicion of OSA and underwent sleep study were screened. We included patients with a diagnosis of OSA who had Apnea-Hypopnea Index (AHI) greater than or equal to five. We classified patients into REM-related OSA according to either the broad definition (AHIREM/AHINREM ≥ 2) or the strict definition (AHIREM > 5 and AHINREM < 5 with a total REM sleep duration of at least 30 minutes), and patients with AHIREM/AHINREM less than two were classified as NREM-related OSA. A total of 478 patients were included in this study with a mean age of 55.3 years (±12.6). According to the broad definition of REM-related OSA, 86 (18%) of OSA patients were classified as having REM-related OSA compared to only 13 (2.7%) patients according to the strict definition. Significant differences were found between both NREM-related OSA and REM-related OSA according to the broad and to the strict definitions for arousal index (p < 0.001 and p < 0.032), respectively, duration of saturation below 90% (p < 0.001 for both), and saturation nadir (p < 0.036 and p < 0.013), respectively. No significant differences were found between this group and other OSA patients regarding age, BMI, ESS, and snoring. Our study showed that the stricter the definition for REM-related OSA, the milder the associated clinical changes.

Are Jordanian primary healthcare practitioners fulfilling their potential in cancer prevention and community health? Findings from a cross-sectional survey.

INTRODUCTION: Primary healthcare practitioners (PHCPs) can contribute to the control of cancer by promoting healthy lifestyles to patients. Given the scarcity of data in the Middle East on this subject, we sought to determine, through a cross-sectional survey, the status of healthy lifestyle promotion by PHCPs (physicians, nurses, midwives, nurse aids) in Jordan. METHODS: Building on published studies, an Arabic questionnaire was developed to measure knowledge, perceptions and practices of Jordanian PHCPs with regard to healthy lifestyle counselling. A purposive sample of 20 clinics covering the main regions of Jordan was selected and all PHCPs were asked to complete the questionnaire. RESULTS: 322 practitioners (32.3% physicians) responded (a 75.1% response rate). 24.4% of PHCPs were current cigarette smokers (physicians 44.2%). Roughly 58% of physicians and 50% of non-physicians reported advising the majority of patients to quit tobacco, but proportions were lower for providing other services (eg, asking about frequency of tobacco use, inquiring about diet and exercise, providing evidence-based guidance on quitting tobacco or improving diet and activity). Only 8% of the sample reported collectively asking the majority of patients about smoking status, exercise and diet; and providing evidence-based tips to improve these. Among physicians and non-physicians, 14.2% and 40.4% were able to identify the lifestyle-related risk factors associated with breast, colorectal and lung cancer. In multivariable analyses, confidence was the only significant variable associated with provision of counselling on healthy lifestyles. CONCLUSIONS: Among Jordanian PHCPs, primary prevention services are underprovided, and data suggest ample room to improve PHCPs' skills and practices.

The effect of habitual waterpipe tobacco smoking on pulmonary function and exercise capacity in young healthy males: A pilot study.

BACKGROUND: Evidence regarding the health effects of habitual waterpipe smoking is limited, particularly in young smokers. Respiratory health and cardiopulmonary exercise tests were compared in young male habitual waterpipe smokers (WPS) versus non-smokers. METHODS: 69 WPS (≥3 times/week for three years) and 69 non-smokers were studied. Respiratory health was assessed through the American Thoracic Society and the Division of Lung Diseases (ATS-DLD-78) adult questionnaire. Pulmonary function and cardiopulmonary exercise tests were performed. Self-reported respiratory symptoms, forced expiratory volume in first second (FEV1), forced vital capacity (FVC), FEV1/FVC ratio, forced expiratory flow between 25 and 75% of FVC (FEF25-75%), peak expiratory flow (PEF), exercise time, peak end-tidal CO2 tension (PetCO2), subject-reported leg fatigue and dyspnea; peak O2 uptake (VO2 max), and end-expiratory lung volume (EELV) change from baseline (at peak exercise) were measured. RESULTS: WPS were more likely than non-smokers to report respiratory symptoms. WPS also demonstrated: shorter exercise time; lower peak VO2; higher perceived dyspnea at mid-exercise; lower values of the following: FEV1, FVC, PEF, and EELV change. CONCLUSION: Habitual waterpipe tobacco smoking in young seemingly healthy individuals is associated with a greater burden of respiratory symptoms and impaired exercise capacity.

Associations between inhaler technique and asthma control among asthma patients using pressurised MDIs and DPIs.

OBJECTIVES: To investigate associations between technique with pressurised metered-dose inhalers (pMDIs) and dry powder inhalers (DPIs) used as controller medication and asthma control variables measured using Asthma Control Test (ACT) scores. DESIGN: In this cross-sectional study, the inhaler technique of asthma patients using pMDIs or DPIs (Turbuhaler® [TH] and Accuhaler Diskus™ [ACC]) were assessed against published inhaler technique checklists. ACT scores (maximum 25, higher score corresponding to better asthma control) were assessed. RESULTS: Of the 130 subjects enrolled in the study (41 TH, 54 ACC and 35 pMDI), inhaler technique scores (out of nine for all devices) were low for TH (4.4 ± 0.9) and ACC (5.4 ± 1.0) compared with pMDI (8.1 ± 0.9) (P < 0.001, one-way analysis of variance). Older age and use of pMDI were associated with better inhaler technique. ACT scores were low, consistent with very poorly controlled asthma (mean TH 13.1 ± SD 3.9, mean ACC 13.3 ± SD 3.9 and mean pMDI 12.8 ± SD 4.2). No significant association between inhaler technique scores and ACT scores was found. More recent asthma diagnosis and a higher level of education were associated with higher ACT scores (better asthma control). CONCLUSION: Asthma control was poor in this population. Lack of a significant association between the inhaler technique score and asthma control may reflect the multiple factors contributing to poor asthma control in the Jordanian population.

Fallopian tube recanalisation using dedicated radiographic tubal assessment set in angiography suite.

INTRODUCTION: Fallopian tube recanalisation (FTR) for proximal fallopian tube obstruction (PFTO) is considered a good treatment option for tubal infertility. The aim of this study was to assess the safety and the technical and clinical success rates of FTR using a dedicated radiographic tubal assessment set (FluoroSet(®) ) in the angiography suite. METHODS: This study is a retrospective analysis of data prospectively collected between February 2007 and June 2011 at King Abdullah University Hospital, Irbid, Jordan. During this period, 61 patients affected by PFTO underwent FTR using FluoroSet(®) at our institution. The mean age of patients was 34 years (range 20-45 years), and the mean duration of infertility was 4 years (range 2-14 years). The procedure was performed with conscious sedation under fluoroscopic guidance in the angiography suite. The obstructed tube was accessed with a 5-Fr multipurpose catheter, and the obstruction was crossed with a 0.35-Fr hydrophilic guide wire until the wire coiled freely into the peritoneal cavity. Patency of the tube was then confirmed by selective salpingiogram. Technical success rate was recorded, and patients were followed up for evidence of pregnancy over 12 months. RESULTS: The procedure was technically successful in all patients. Minor bleeding and postprocedural pain occurred in most patients; however, there were no major complications encountered. Twenty-five patients (41%) became pregnant. Successful deliveries of full-term infants were reported in 21 patients (84%). Miscarriage was reported in four patients (16%). No ectopic pregnancies were detected, and all deliveries were full-term. The technical success rate was 100% and the clinical success rate was 41%. CONCLUSION: Selective salpingography and FTR using FluoroSet(®) is a safe and effective method. FTR is recommended as the first intervention in patients with PFTO. In experienced hands with dedicated equipment and in an appropriate setting, the success rate is high, and this treatment should be offered to infertile women with PFTO before other, more complex techniques are attempted.

Face and brow presentation in northern Jordan, over a decade of experience.

BACKGROUND: Malpresentation is a deviation from the normal presentation, which occurs in approximately 5% of labours (Seeds and Cefalo in Clin Obstet Gynaecol 25:145-156, 1982). The commonest form of malpresentation at delivery is breech presentation followed by face and brow presentation. OBJECTIVES: To review the incidence and management of face and brow presentation in north of Jordan. MATERIALS AND METHODS: This was a retrospective review of the experience of face and brow presentation deliveries in the two main civil hospitals in north of Jordan between 1995 and 2005. RESULTS: The incidence of face and brow presentation was 1 in 813 and 1 in 1,689 deliveries, respectively. There was no significant increase in the incidence of prematurity nor very low birth weight and no higher incidence of postmaturity among those delivered by face or brow in the same period. All the foetuses presenting by the brow and by face (mentoposterior) and only 16.7 % of foetuses presenting by face (mentoanterior) were delivered by caesarian section. CONCLUSION: The incidence of face and brow presentation was 1 in 813 and 1 in 1,689 deliveries, respectively. All the babies presenting by brow presentation did undergo caesarean section. The management of face and brow presentation is heading towards a safe delivery and not merely to accomplish vaginal delivery.