Diagnosis of intracavitary uterine diseases in postmenopausal women by hysteroscopy

To reveal the hysteroscopic findings among postmenopausal women who were subjected to diagnostic hysteroscopy method. This is a descriptive study which was conducted at King Hussein Medical Center within the period from January 2008 to January 2010, on a total of 215 postmenopausal women. Mean age of the study group was 58 years [range 46-70]. Hysteroscopy was carried out to detect intracavitary disease, either by hysteroscopic view or using histopathological biopsies for other diseases. Simple descriptive statistics [frequency, mean age and percentage] were used to describe the study variables. The histopathological and hysteroscopic findings were as follows: polyps in 122 [56.7%] patients, atrophic endometrium in 44 [20.5%] patients, synechia in 22 [10.2%] patients, fibroid in 13 [4.6%] patients, endometrial hyperplasia in seven [3.3%] patients, focal thickening seven [3.3%] patients. The most frequent findings at hysteroscopy for postmenopausal women with bleeding were benign lesions. Hysteroscopy using biopsy is a selective method for detecting intracavitary uterine disease

Prostaglandin E2 versus foley catheter balloon for induction of labor at term: a randomized controlled study

The aim of this study is to evaluate the efficacy, safety and side effects of intracervical Foley catheter balloon in comparison with intra vaginal prostaglandin pessaries in preinduction cervical ripening at term. This randomized prospective study was conducted in the maternity department at King Hussein Medical Centre and Prince Ali Bin Al-Hussein Hospital between July 2009 and July 2010. Four hundred and fourteen women who required induction of labor, with a Bishop score of less than or equal to 5 and met the inclusion criteria, were randomized into two groups: 204 women received prostaglandin E2 vaginal tablets [group I] and 210 women had an intracervical Foley catheter inserted, and the balloon inflated with 60 ml N/Saline [Group II]. The outcome measures were: mode of delivery, time interval between induction to delivery and maternal and neonatal adverse reactions. Age, parity and indications for induction of labor, were similar in both groups. In Group I, 63% achieved normal vaginal delivery compared to 61% in Group II [p= 0.8]. Cesarean section rate was 34% in both groups. The rest had instrumental delivery. The time interval between induction to delivery was longer in the Foley catheter group than PGE2, but not statistically significant [mean 22.6 h vs. 21.4 h; P= 0.3101]. The rate of oxytocin administration was more in Foley catheter group than Prostaglandin E2 [78.6% vs.65.7%; P= 0.018]. Uterine hyper stimulation was more in PGE2 group than Foley catheter 6 [3%] vs.1 [0.5%]; P= 0.0013]. The Apgar scores, neonatal birth weight and admission to neonatal intensive care unit showed no difference between the two groups. PGE2 vaginal tablets and Foley catheter are comparable in efficacy for induction of labor in women at term. However, Foley catheter has the advantage of being safe, simple, reversible and associated with fewer side effects

Intrauterine balloon tamponade in the management of postpartum hemorrhage: experience at the royal medical services in Jordan

To describe the practice and efficacy of intrauterine balloon tamponade catheter in two obstetric units and to highlight uterine tamponade as an integral part of the management options of severe post partum hemorrhage in labour ward. Fourteen cases of severe post partum hemorrhage had persistent bleeding despite the available conservative measures. At this point, the Bakri balloon [Cook Medical] was inserted into the uterine cavity. The balloon was inflated with 300-500 ml of normal saline and left for a maximum of 24 hours, when it was gradually deflated. The procedure was covered by cefoxitin [Mefoxin] 1g three times daily for 48 hours. Simple descriptive statistics [mean, frequency and percentage] were used to describe the study variables. The mean age was 28 [21-35] years. Six patients were primigravidas [43%]. The causes of post partum hemorrhage were as follows: Six cases of uterine atony, six cases of placenta praevia accreta and two cases of fibroids. Eight cases followed cesarean section and six cases followed vaginal delivery. The average blood loss was 1.9 L [1.5-3.5 L]. In total, 59 units of whole blood, 45 units of FFP and 22 units of platelets were given. On average each patient received 4.2 units of blood, 3.2 units of Fresh frozen plasma and 1.6 units of platelets. Two cases had evidence of disseminated intravascular coagulation and received Factor VII [two doses each]. The balloon was inflated to an average of 420 ml of Normal Saline [300-500 ml] according to uterine capacity. In 12 cases [86%], the trial was successful and no further surgery was required. In two cases [14%] the trial failed and both of these women underwent hysterectomy. No cases of endometritis were reported in hospitalized patients or on follow up one week after discharge. Intrauterine balloon tamponade is a valid alternative to less conservative surgical procedures in managing women with post partum hemorrhage. It is easy, safe, and effective and preserves fertility. It should be an integral part of labour ward protocols for management of post partum hemorrhage. Suitable catheters should be available on the labour ward theatres

Intravenous iron sucrose ersus blood transfusion in the management of symptomatic post partum iron deficiency anaemia

To compare the efficacy and safety of intravenous iron with blood transfusion in post partum women with symptomatic iron deficiency anaemia. Ninety women were included in the study. The inclusion criteria were: hemoglobin <9g/dl and/or haematocrit <28%, mean corpuscular volume <80fl, ferritin level <15ng/ml, and symptoms of anaemia within 48 hours of delivery. Women with postpartum haemorrhage and haemodynamic instability were excluded. Women were divided into two groups, group B received blood transfusion and group I received intravenous iron sucrose [400mg infusion in 250ml Normal Saline over half an hour] [Venofer, Vifor St Gallen's, Switzerland]. The outcome measures were relief of symptoms of anaemia. Hemoglobin, haematocrit, mean corpuscular volume and ferritin levels were measured before and one week after the treatment. The two groups were comparable in terms of age, mode of delivery and symptoms. Group B had a mean age of 31.1 years [22-39] vs. 32.3 years [20-43]. Twenty four women from group B had C/S vs. 23 women in group I. However, women in group B had a lower baseline mean hemoglobin [6.8 g/dl [4-8] vs. 7.7g/dl [6.1-9 g/dl] and lower haematocrit [23.2%[18-26] vs. 25.3%[18-28]. At one week post treatment the mean rise in hemoglobin was 2.35 g/dl [34%] in group B vs. 2.15g/dl [27%] in group I. The mean rise in haematocrit was 7.0% and 6.3% respectively. The mean rise in ferritin level was higher in group I [220%] vs. 150% in group B. Symptoms relief occurred in 29 cases in group B and in 28 cases in group I. No serious side effects occurred in either group. Intravenous iron sucrose is an effective and safe treatment for postpartum iron deficiency anaemia. It is hoped that this treatment will reduce the need for blood transfusion

Acute primary tuberculous mastitis: a case report

This is a report of a 28-year-old female patient neither pregnant, nor lactating and was previously healthy, not known to be immunocompromized who presented with a two month history of a painful lump in her right breast associated with low-grade fever. A thorough physical examination, laboratory and radiological investigations were done including breast mammogram, breast ultrasound and excisional biopsy from breast mass for histopathological study; that showed caseating epithelioid granulomas with giant cell and the Ziehl-Neelsen stain was negative

Prospective study of delivery after previous one caesarean section at king Hussein medical center

To evaluate the mode of delivery and safety of vaginal delivery in women with previous caesarean section at King Hussein Medical Centre. Three hundred thirty women with previous caesarean sections were enrolled into the study. Age, parity and indication for the previous caesarean sections were recorded. All events of labour were also recorded [mode of delivery, apgar scores, birth weight, and duration of oxytocin and prostaglandin use]. Intrapartum and postpartum complications were recorded Analysis of the rate of vaginal delivery was made in relation to parity and the indication for the previous caesarean section. The mean age of women was 29.2 years [19-45]. One hundred and twenty six [38%] were Para 1. Overall, the vaginal delivery rate was 71% Among women who had one previous caesarean section 62% achieved vaginal delivery. Overall 11.8% of women had an elective caesarean section. The highest vaginal delivery rate was in patients who had caesarean section for breech presentation [74%], followed by fetal distress [68%]. Even in women, where the previous caesarean section was due to failed progress, 55% achieved vaginal delivery. There was one case of ruptured uterus in the vaginal delivery group, which resulted in a perinatal mortality. The mean birth weight was 3.168 for the vaginal delivery group and 3.4 kg for the caesarean section group. Trial of labour alter previous caesarean section can be very successful with vaginal delivery rate reaching 62%. Even when the previous caesarean section was due to failed progress, vaginal delivery was achieved in 55% of cases. Although the risks of vaginal delivery were small in our series, these should not be overlooked when making decisions regarding mode of delivery after previous caesarean section

case of visual loss after delivery in a woman with pituitary microadenoma

Hyperprolactinaemia in pregnancy is difficult to monitor due to the physiological rise in prolactin levels. Pre-existing pituitary macroadenomas can undergo significant enlargement and therefore have neurological sequelae. Microadenomas, on the other hand, very rarely cause such problems. We report on a 24 year old woman who had hyperprolactinaemia secondary to pituitary microadenoma. She was asymptomatic during most of the antenatal period, but she experienced symptoms two days prior to delivery at Queen Alia Hospital and was found to have enlargement of her adenoma. This unfortunately resulted in significant loss of her vision