Nail Obeidat

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

Abstract 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.

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.

Management of cancer during pregnancy obstetric and neonatal outcomes

Objective: This study aimed to assess the management and the obstetric and neonatal outcomes of pregnancies complicated by cancer. Methods: A retrospective analysis of patients with cancer during pregnancy who were treated at King Hussein Cancer Center and King Abdullah University Hospital in Jordan between January 2002 and December 2009 was conducted. The medical records of patients with invasive cancer diagnosed during pregnancy and their newborns were reviewed to retrieve information on treatment and obstetric and neonatal outcomes. Numerical data were tested for normal distribution using Kolmogorov-Smirnov. Statistical analyses were conducted using SPSS 18.0. Results: A total of 46 patients with a diagnosis of cancer in pregnancy were treated. The most common tumor types were breast cancer, hematologic malignancies, and gastrointestinal malignancies. In 17 patients, a miscarriage or a termination of pregnancy occurred in the first trimester. In 25 of 46 patients, a single or a combination of treatment modalities was commenced. The distribution of therapies was as follows: chemotherapy alone, n = 5; surgery alone, n = 7; surgery and chemotherapy, n = 6; surgery and radiation therapy, n = 1; surgery with chemotherapy and radiation therapy, n = 3; chemotherapy and radiation therapy, n = 1; interferon, n = 1; and hormonal therapy, n = 1. The mean (SD) gestational age at delivery was 35.7 (2.7) weeks. The mean birth weight was 2580 (870) g. Preterm delivery occurred in 17 patients. There were 4 neonatal deaths, 2 of them delivered at 33 weeks, 1 delivered at 34 weeks, and 1 delivered at 35 weeks gestation. There were no congenital malformations. Conclusions: The remarkable finding is a high rate of iatrogenic preterm delivery with a high rate of neonatal mortality. Delivery should be postponed preferably until after a gestational age of 35 weeks.

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

BackgroundMalpresentation 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.ObjectivesTo review the incidence and management of face and brow presentation in north of Jordan.Materials and methodsThis 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.ResultsThe 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.ConclusionThe 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.

Neonatal mortality in Jordan: secondary analysis of Jordan Population and Family Health Survey (JPFHS) data

Abstract Objective: This study aimed to analyze the 2009 Jordan Population and Family Health Survey (JPFHS) data to determine the level, trend, and distribution of neonatal mortality (NNM) in Jordan and determine its associated factors. Methods: Nationally representative data on NNM were extracted from the JPFHS data. Using multivariate analyses, the strength of associations between 12 clinical/sociodemographic variables and neonatal mortality were quantified after controlling for potential confounders. Results: The weighted NNM rate for 2005–2009 period was 16 deaths per 1000 live births, with the early NNM rate and late NNM rates were 10 deaths per 1000 live births and six deaths per 1000 live births, respectively. Fluctuations of NNM according to year of birth and geographic variations were noted. Risk of NNM increased among male newborns, as mother’s education level decreased, in mothers 40–49 years old, in multiple gestations-low birth weight neonates, and as birth interval was <3 years. Conclusions: The NNR rate for 2005–2009 period of 16 deaths per 1000 live births indicates that there are opportunities to decrease it. Risk factors of neonatal mortality with respect to predictors of death during first days of life and variables related to geographic variations require particular focus to improve the quality of obstetric and neonatal health services and to decrease neonatal mortality.

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.

The Impact of fetal Middle Cerebral Artery Doppler on the outcome of congenital hydrocephalus.

Abstract Objectives: The objective of this study is to investigate the impact of abnormal middle cerebral artery (MCA) Doppler on the perinatal mortality in fetuses with congenital hydrocephalus (CH). Methods: A prospective study of all fetuses with CH who delivered at our hospital over a period of 7 years. Data were obtained from the ultrasound, Labor room and intensive neonatal care unit (NICU) database. The Perinatal mortality rates were evaluated in relation to the following measures, associated congenital anomalies, cortical mantle thickness (CMT), and MCA Doppler abnormalities (absent or reversed diastole). The main outcome measure was perinatal mortality rate in relation to MCA Doppler changes. Results: A total of 85 cases of CH were diagnosed and managed. The birth prevalence of CH was 2.44 per 1000 live births. On one hand, the perinatal mortality rate was higher in those fetuses with non-isolated hydrocephalus, (37.25% (19/51) versus (35.29% (12/34, p = 0.854 and in those cases with CMT <10 mm, 38.78% (19/49) versus 33.33% (12/36) in those with CMT >10 mm, p = 0.607. On the other hand, the perinatal mortality rate was significantly higher in those fetuses with abnormal MCA Doppler, (100% (13/13) versus 25% (18/72), OR = 78.0, 95% CI (5.52–44085124.60), p < 0.001. Conclusions: Abnormal fetal MCA Doppler (absent or reversed diastole) appears to be a poor prognostic indicator with significantly high perinatal mortality in fetuses with CH.

Effectiveness of Prophylactic Cervical Cerclage in Prolonging Higher-Order Multiple Pregnancies

OBJECTIVES This study aimed to assess the value of prophylactic cervical cerclage in prolonging higher-order multiple pregnancies. METHODS This retrospective study included all women with higher-order multiple pregnancies beyond 24 gestational weeks treated at the King Abdullah University Hospital in Irbid, Jordan, and King Fahad Medical City in Riyadh, Saudi Arabia, between February 2014 and January 2015. Selected maternal characteristics and obstetric outcomes were compared between women who received prophylactic cervical cerclage and those who did not. RESULTS A total of 146 women with higher-order multiple pregnancies were included in the study; of these, 94 (64.4%) underwent a prophylactic cervical cerclage insertion procedure and 52 (35.6%) women did not. No significant difference was found between the two groups with regards to maternal age, parity or number of fetuses. However, the mean gestational age at delivery was significantly higher for women without compared to those with prophylactic cervical cerclage (32.9 weeks versus 31.7 weeks) according to both univariate and multivariate analyses (P = 0.013 and 0.046, respectively). Additionally, 40.4% of women without and 14.9% of women with prophylactic cervical cerclage gave birth after 34 gestational weeks (P = 0.003). CONCLUSION Overall, prophylactic cervical cerclage was not associated with prolongation of the pregnancy among women with higher-order multiple pregnancies in the current study.

Successful maternal digoxin therapy of supraventricular tachycardia in a fetus with hydrops.

ethambutol outweighed any theoretical risks and concerns with medication safety. Ethambutol is not known to be harmful in pregnancy, but could cause loss of visual acuity, colour blindness and restriction of visual fields (BNF 2007). Fortunately, she had no such side-effects. Safety for the use of rifabutin during pregnancy has not been established, and the manufacturers recommended avoidance during pregnancy and breastfeeding (BNF 2007). However, rifabutin is known to cause liver dysfunction, and monitoring of LFTs during treatment is important (BNF 2007). In this case, her LFTs became abnormal sharply, soon after treatment and improvement of the cutaneous lesions. In addition, she was also complaining of itch in her arms at the same time, making obstetric cholestasis a possible differential diagnosis. Fortunately, her LFTs became normal shortly after stopping the anti-bacterial medication, making rifabutin as the likely culprit for the derangement of liver function. Human-to-human infection is not possible with M. marinum (Petrini 2006). Because the infection is only isolated to the skin surface, systemic infection and transmission to the fetus via the placenta is highly unlikely. The risk of infection from direct contact with open wound is also low. However, as a precaution, we have advised her to be careful and should keep her skin lesions covered with tubigrip when handling her baby.