Zouhair Amarin

Low-molecular-weight heparin in the treatment of recurrent IVF–ET failure and thrombophilia: A prospective randomized placebo-controlled trial

Background Introduction: Recently, thrombophilia (acquired and inherited) has been implicated in recurrent IVF–ET failure. The objective of this study was to determine the effect and safety of thromboprophylaxis using low-molecular-weight heparin (LMWH) in women with recurrent in vitro fertilization (IVF)–embryo transfer (ET) failure and thrombophilia. Methods: Eighty-three women with history of three or more previous IVF failures and who had at least one thrombophilic defect were eligible for this study. Patients were randomly allocated into two groups: Group A (n = 42) received enoxaparin 40 mg/day, and group B (n = 41) received placebo (NaCl 0.9%). Both treatments started on the day of ET and continued until delivery or foetal demise was diagnosed. The primary outcomes were the implantation, pregnancy and live birth rates. Results: Patients who received LMWH for thromboprophylaxis had a significant increase in the implantation and pregnancy rates compared with the placebo group (20.9% vs. 6.1% and 31% vs. 9.6%, respectively; p < 0.001 and p < 0.05, respectively). A significant increase in the live birth rate was observed in the heparin-treated group compared with placebo (23.8% vs. 2.8%, respectively; p < 0.05). The abortion rate was significantly higher in the placebo-treated group compared to the heparin-treated group (p < 0.05). The frequency of treatment complications did not differ between the two study groups. Conclusions: LMWH is a safe and effective thromboprophylactic treatment for women with thrombophilia and recurrent IVF–ET failures. The implantation rate, pregnancy and live birth rates are significantly increased with such treatment.

Risk of malignancy index in the preoperative evaluation of pelvic masses

Objectives: To assess the ability of a risk malignancy index (RMI) based on serum levels of CA 125, ultrasound findings, and menopausal status to discriminate between benign and malignant pelvic masses in a particular population. Methods: A retrospective study was conducted of 100 women with pelvic masses admitted for laparotomy. The sensitivity and specificity of serum levels of CA 125, ultrasound findings, and menopausal status were calculated both separately and combined into a RMI to diagnose malignancy. Results: The RMI was more accurate than any single criterion in diagnosing malignancy. Using a cut‐off level of 200 to indicate malignancy, the RMI gave a sensitivity of 90%, specificity of 89%, positive predictive value of 96%, and negative predictive value of 78%. Conclusion: The RMI is able to correctly discriminate between malignant and benign pelvic masses. It is a simple scoring system that can be introduced easily into clinical practice to facilitate the selection of patients who would benefit from primary surgery.

Diagnostic Markers for Neonatal Sepsis: Comparing C‐reactive Protein, Interleukin‐6 and Immunoglobulin M

This clinical study was conducted to evaluate the diagnostic value of C‐reactive protein (CRP), interlekin‐6 (IL‐6) and immunoglobulin M (IgM) in the early diagnosis of neonatal sepsis. The diagnostic values of each marker separately or in combinations were evaluated. The optimal cut‐off values of each marker in the diagnosis of neonatal sepsis were defined. Between December 2004 and March 2005, a total of 78 neonates at different ages with different diagnoses in a neonatal intensive care unit in North Jordan were enrolled. Patients were classified into ‘sepsis’ group, ‘probable sepsis’ group and ‘no sepsis’ group. Blood samples were collected for CRP, IL‐6 and IgM determination. A CRP value of 5 mg/l was the best among the three parameters with 95% sensitivity and 98% negative predictive value. Combination between parameters was helpful in enhancing the ability to diagnose sepsis. The best combination was CRP ≥ 5 mg/l and/or IgM of ≥20 mg/dl. We conclude that CRP, IL‐6 and IgM are helpful in the early diagnosis of Gram‐negative neonatal sepsis. However, CRP continues to be the best single test. The use of both CRP and IgM in combination was the most helpful in predicting Gram‐negative neonatal sepsis. We speculate a significant role of this combination in making decisions regarding antibiotics treatment and upgrading the level of medical care and observation in a setting where Gram‐negative micro‐organisms are causing the majority of neonatal infections.

The use of intrapartum defibulation in women with female genital mutilation

Objective To assess the use of intrapartum defibulation for women who have had female genital mutilation.

Full-term viable abdominal pregnancy: a case report and review

Abstract. A full-term abdominal pregnancy culminating in the birth of a live healthy baby by laparotomy is described.

Effect of folic acid fortification on the incidence of neural tube defects

In a few countries enriched cereal grains have been fortified with folic acid to reduce the incidence of neural tube defects. The objective of this study was to analyse the effect of folic acid fortified foods on the incidence of neural tube defects in live newborns at Princess Badea Teaching Hospital, in the north of Jordan, before and after the national food fortification with folic acid was implemented. For the 7-year period from 1 January 2000 to 31 December 2006, we retrospectively extracted the total number of births at Princess Badea Hospital, as well as the number of pregnancies affected by spina bifida and anencephaly, per 1000 births during the periods before (2000-01), during (2002-04) and after (2005-06) folic acid fortification of grain products, was implemented. Neural tube defects were defined in accordance with the International Classification of Diseases, 10th revision (ICD-10): anencephaly, encephalocele and spina bifida. A total of 78 subjects with neural tube defects were recorded among 61 447 births during the study period. The incidence of neural tube defects decreased from 1.85 per 1000 births before fortification [95% confidence interval (CI) 1.2, 2.4] to 1.07 per 1000 births during the fortification period [95% CI 0.7, 1.5], and 0.95 after full fortification [95% CI 0.5, 1.5], a 49% reduction. The difference between incidence of neural tube defects in the periods before and after food fortification with folic acid was statistically significant. We conclude that food fortification with folic acid was associated with a significant reduction in the rate of neural tube defects in north Jordan.

Luteal phase support with GnRH-a improves implantation and pregnancy rates in IVF cycles with endometrium of ≤7 mm on day of egg retrieval

Background Objective: The objective of this study was to examine the use of gonadotrophin-releasing hormone agonist (GnRH-a) for luteal phase in a group of patients with thin endometrium (≤7 mm) after IVF treatment. Methods: One-hundred-and-twenty women were eligible for this study. Patients were randomly allocated into two groups: group A (n = 60) received triptorelin 0.1 mg on the day of ovum pickup (OPU), on the day of embryo transfer (ET) and three days thereafter, and group B (n = 60) received placebo. The primary outcomes were implantation and pregnancy rates. Results: Although there was no significant difference in the number of good quality embryos transferred in both groups, the implantation and pregnancy rate were significantly higher in the GnRH-a – treated group compared with placebo controls. Furthermore, Estradiol (E2), progesterone (P) levels and endometrial thickness were significantly more elevated in patients who received GnRH-a for luteal phase support. Conclusions: The administration of GnRH-a at the time of OPU significantly improves the implantation and pregnancy rates in patients with thin endometrium (≤7 mm).

Bed rest versus free mobilisation following embryo transfer: a prospective randomised study

Objective  To evaluate the efficacy of two clinical methods of post‐embryo transfer protocols in patients undergoing in vitro fertilisation.

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.

A survey of uterine perforation following dilatation and curettage or evacuation of retained products of conception

StudyOf 11,914 women who underwent dilatation and curettage over a 7-year period (1995–2002) at Princess Badea Teaching Hospital in Irbid, North Jordan, 23 patients sustained a uterine perforation. In 22 cases, the operator was a trainee. Previous gynaecological surgery had been performed in only 2 of these 23 women.ConclusionOperator inexperience seemed to be the only risk factor in this very common operation.