Oqba Al-Kuran

The effect of late pregnancy consumption of date fruit on labour and delivery

We set out to investigate the effect of date fruit (Phoenix dactylifera) consumption on labour parameters and delivery outcomes. Between 1 February 2007 and 31 January 2008 at Jordan University of Science and Technology, a prospective study was carried out on 69 women who consumed six date fruits per day for 4 weeks prior to their estimated date of delivery, compared with 45 women who consumed none. There was no significant difference in gestational age, age and parity between the two groups. The women who consumed date fruit had significantly higher mean cervical dilatation upon admission compared with the non-date fruit consumers (3.52 cm vs 2.02 cm, p < 0.0005), and a significantly higher proportion of intact membranes (83% vs 60%, p = 0.007). Spontaneous labour occurred in 96% of those who consumed dates, compared with 79% women in the non-date fruit consumers (p = 0.024). Use of prostin/oxytocin was significantly lower in women who consumed dates (28%), compared with the non-date fruit consumers (47%) (p = 0.036). The mean latent phase of the first stage of labour was shorter in women who consumed date fruit compared with the non-date fruit consumers (510 min vs 906 min, p = 0.044). It is concluded that the consumption of date fruit in the last 4 weeks before labour significantly reduced the need for induction and augmentation of labour, and produced a more favourable, but non-significant, delivery outcome. The results warrant a randomised controlled trial.

Gestational nutrition improves outcomes of vaginal deliveries in Jordan: an epidemiologic screening.

Adequate and balanced nutrition during gestation is essential for achieving healthy pregnancy outcomes. This retrospective survey tested the hypothesis that maternal nutrition (macronutrients intake, micronutrients intake, and weight gain) during gestation will impact gestational outcomes (gestational age, birth weight, and labor spontaneity). The objectives of this study were to test the impact of macronutrients and micronutrients consumed during gestation, pregestational weight and weight gain during gestation on gestational age, birth weight, and labor spontaneity among Jordanian women. Study participants (n = 700) were recruited from a womens hospital in northern Jordan. Data were collected using structured interviews. Dietary determinants examined in the study included daily intake of macronutrients (energy, carbohydrate, protein, fat, and n-3 and n-6 fatty acids) and micronutrients (zinc, calcium, folate, vitamin C, vitamin A, and vitamin B6), pregestational body mass index, total weight gain, and weight gain pattern during pregnancy. Dietary data were obtained from a semiquantitative food frequency questionnaire. Mean (SEM) daily intakes of energy, carbohydrate, and protein were 10894 (138) Kj, 320 (3.8) g, and 90 (0.95) g, respectively; with fat contributing 36% of total energy. Average daily energy and carbohydrate intake during pregnancy were related negatively to gestational age (P < .05). Pregestational body mass index was associated positively with gestational age and birth weight (P < .05). Intakes of vitamin A and calcium had significant relationships with birth weight. Daily intakes of zinc, calcium, vitamin B6, and n-3 and n-6 fatty acids were associated with labor spontaneity. Dietary factors consumed during pregnancy are associated with pregnancy outcomes.

Maternal Anemia in Rural Jordan: Room for Improvement

The objectives of this cross-sectional study were to estimate the prevalence and determine factors associated with anemia among pregnant women in rural Jordan. A cohort of 700 pregnant women from a National Health Service hospital and ten health centers completed a questionnaire. Of the total, 243 (34.7%) had anemia. The prevalence was the highest for women in their 3rd trimester (42.5%) compared to those in 2nd trimester (32.7%) and 1st trimester (18.9%). Gestational age, body mass index, history of previous surgery, and multivitamin intake during pregnancy were significantly associated with anemia. Women in the 2nd and 3rd trimesters had higher odds of anemia (OR = 2.2 and 3.3, resp.). Underweight women had higher odds of anemia (OR = 2.9). History of previous surgery and multivitamin intake during pregnancy were associated with higher odds of anemia (OR = 1.6 and 1.9, resp.).

Prevalence and frequency of severity of urinary incontinence symptoms in late pregnancy: a prospective study in the north of Jordan

ObjectiveTo determine the frequency of urinary urge, stress incontinence and bothersome urinary symptoms in late pregnancy in Jordan.MethodWomen admitted in spontaneous labor to labor suite at three covering hospitals in the north of Jordan and at least 36 weeks gestational age were eligible for survey to ascertain data on current pregnancies and past pregnancy. Data analyzed for 181 women.ResultMean gestational age was 39.5 weeks. 85% had normal vaginal delivery. 35% of women reported symptoms of urgency, 30% of whom described symptoms frequency as moderate or severe, and 45% reported stress incontinence, 29% of whom described symptoms frequency as moderate or severe during the current pregnancy. Symptoms in previous pregnancies were reported by 20 and 30% of women for urge and stress incontinence, respectively. Urgency and urge incontinence increased in relation to parity.ConclusionThe frequency of urinary incontinence and bothersome symptoms was relatively similar compared to other countries.

Secondary postpartum hemorrhage following placental site vessel subinvolution: a case report

Postpartum hemorrhage (PPH) is an obstetric emergencythat can follow vaginal or cesarean delivery. It is a majorcause of shock, renal failure, acute respiratory distress syn-drome, coagulopathy and Sheehan’s syndrome. PPH is oneof the top Wve causes of maternal mortality in both high-income and low-income countries, with a much lower abso-lute risk of death in the former [1].The true incidence of PPH is unknown, but a reasonableestimate is 1–5% of deliveries. Figures vary according tothe criteria used to deWne the disorder [1]. The most com-mon deWnition of PPH is an estimated blood loss of 500 mlafter vaginal birth or 1,000 ml after cesarean delivery [2],yet accurate measurement of blood loss is rarely possible orpracticable. PPH can also be de Wned as 10% change in hae-matocrit from admission assessment to postpartum data, orthe need to administer a transfusion of red blood cells [3].PPH is classiWed as primary or secondary. Primary PPHoccurs within 24 h after delivery, and secondary PPHoccurs 24 h to 6 weeks after delivery.Bleeding after delivery is controlled by a combination ofcontraction of the myometrium, which constricts the bloodvessels supplying the placental bed, and local decidual hae-mostatic factors, including tissue factor, type-1 plasmino-gen activator inhibitor and systemic coagulation factors [ 4].DeWcient contraction of the myometrium is manifestedclinically as uterine atony. Defective decidual homeostasisis associated with inadequate decidualization or bleedingdiatheses.

Jordanian obstetricians’ personal preference regarding mode of delivery

The personal preference of Jordanian obstetricians regarding mode of delivery in uncomplicated pregnancy with singleton cephalic presentation at term was surveyed by an anonymous structured questionnaire distributed at five conferences/scientific meetings on obstetrics and gynecology held in Jordan in 2007. The response rate was 70% (n = 315), and 22 (7%) of the respondents chose elective cesarean section (CS). Respondents <45 years seemed to be more in favor of elective CS than those ≥55 years (14.1% vs. 3.7%). In multivariate analysis, increased age was inversely associated with the odds of choosing elective CS (OR = 0.93, 95% CI: 0.88–0.99, p = 0.024) after adjusting for gender, sector, and duration of practice. The main reasons for preferring abdominal delivery were the fear of long‐term sequel (stress incontinence and anal sphincter damage) and the wish to preserve sexual function (86.4 and 50.0%, respectively). The majority of Jordanian obstetricians and gynecologists preferred vaginal delivery in uncomplicated pregnancy for themselves or their wives.

Validation of reportable indices of haematology, liver and renal function in pregnancy for the Middle Eastern population

The objective of this study was to describe normative values of complete blood counts, kidney and liver function tests for Jordanian women. A prospective study of 797 healthy pregnant women, seen at the antenatal clinics of the Jordan University of Science and Technology, in Irbid, north Jordan, was conducted between January 2005 and December 2009. Differences by trimester were analysed using one-way ANOVA. The mean age of the women was 31.0 years. The mean gestational age at delivery was 38.2 weeks. It was concluded that complete blood counts, kidney and liver function values by trimester, of healthy pregnant population of Jordanian women, were consistent with data reported for other populations.

Effect of abdominal hysterectomy on developing urinary and faecal incontinence later in life

Summary The objective of this retrospective longitudinal study was to investigate the incidence and severity of urinary and faecal incontinence in women after either total abdominal hysterectomy or comparable abdominal surgery. Age-matched and postoperative time-matched control groups were drawn from women attending for operation at a Scottish District General Hospital, during the early 1990s (59 women in the hysterectomy group and 33 women in the control group, with a mean preoperative age 40.4 years and 38.1 years, respectively). Within-group and between-group analyses were conducted using t and Fishers exact tests. Within each group, changes in all urinary and faecal variables during the 10-year period were extremely significant (p < 0003). With the exception of urinary urgency (p = 0.028), there was no statistical difference between the groups.

Is age of menarche related to urinary symptoms in young Jordanian girls? A prospective cross-sectional study

Objectives Urinary incontinence (UI) is highly prevalent worldwide, especially in women. This study hypothesized that the age of menarche, a developmental landmark, may be a risk factor for the development of UI. Methods This prospective, cross-sectional study was conducted on girls presenting to the gynaecology outpatient clinic at King Abdullah University Hospital, Jordan, from 2013 to 2014. Medical history and demographic data were collected, and associations between age of menarche and urinary problems were examined. Results The study enrolled 360 girls (mean age 17.60 ± 4.01 years). Of the participants, 101 (28.9%) reported experiencing urgency in urination, 23 (6.6%) had UI, 17 (4.9%) reported using urine pads at night, 23 (6.6%) had recurrent urinary infections, 61 (12.3%) had received treatment for UI, and 43 (12.3%) had been treated for urinary infections. Nocturia was significantly more frequently reported in younger girls at their first period (p = 0.02). Other urinary problems during menstruation, such as urge incontinence, were significantly associated with older age at first period (p = 0.05). Conclusion Age of menarche represents an important risk indicator for later development of UI in women.