Multiple transvaginal ascitic fluid aspirations improves the clinical and reproductive outcome in patients undergoing in vitro fertilisation treatment complicated by severe early ovarian hyperstimulation syndrome.

The objective of this study is to examine the effect of repeated transvaginal ascitic fluid aspiration on the reproductive outcome in patients undergoing in vitro fertilisation treatment complicated with severe ovarian hyperstimulation syndrome. A total of 65 women with severe early OHSS were hospitalised and managed with transvaginal ascitic fluid aspiration either in < 3 occasions (control group; n = 29) or ≥ 3 occasions (multiple aspirations) (study group; n = 36). All patients in both groups received intravenous fluid, human albumin and thromboprophylaxis. Patients in the study group received significantly lower amounts of parenteral fluid (p < 0.05), human albumin (p < 0.01), and LMWH (p < 0.001). In addition, they had significantly lower days of hospitalisation (p < 0.01) as compared with the control group. There was no significant difference in the cancellation rate between the two groups, but patients who underwent multiple aspiration had a significantly higher pregnancy rate (82.8% vs 41.7%, p < 001) and significantly lower abortion rate (10.3% vs 40%, p < 0.05) compared with the control group. Repeated transvaginal asitic fluid aspiration even with large amounts is safe and effective in the treatment of symptomatic patients with severe OHSS. The pregnancy rate increased significantly along with a significant decrease in the abortion rate was observed after multiple aspirations compared with < 3 aspirations.

Intravaginal prostaglandin-E2 for cervical priming and induction of labour.

A prospective study examined the safety, efficacy and labour outcome in 436 women undergoing labour induction using intravaginal prostaglandin E2. Women with singleton pregnancies (235 nulliparas and 201 multiparas) were recruited if they had a clinically unfavourable cervix, and indications for induction. The mean (standard deviation) interval from initiation to delivery was statistically significantly shorter in multiparas than nulliparas: 13.5 hours (SD 1.8) versus 15.5 hours (SD 2.4). No more than 2 x 3 mg tablets were needed to achieve a clinically feasible cervix for amniotomy. The overall need for oxytocin augmentation of labour was 42%, significantly higher in nulliparas (47%) than multiparas (35%). Intrapartum complications, caesarean section and perinatal deaths showed no statistically significant differences between the groups.

Intravaginal prostaglandin-E2 for cervical priming and induction of labour

A prospective study examined the safety, efficacy and labour outcome in 436 women undergoing labour induction using intravaginal prostaglandin E2. Women with singleton pregnancies [235 nulliparas and 201 multiparas] were recruited if they had a clinically unfavourable cervix, and indications for induction. The mean [standard deviation] interval from initiation to delivery was statistically significantly shorter in multiparas than nulliparas: 13.5 hours [SD 1.8] versus 15.5 hours [SD 2.4]. No more than 2 x 3 mg tablets were needed to achieve a clinically feasible cervix for amniotomy. The overall need for oxytocin augmentation of labour was 42%, significantly higher in nulliparas [47%] than multiparas [35%]. Intrapartum complications, caesarean section and perinatal deaths showed no statistically significant differences between the groups

Termination of second trimester, complicated gestation.

To assess the effectiveness of intravaginal misoprostol for second trimester uterine evacuation, we studied 70 women with singleton pregnancies complicated by fetal malformation or dead fetuses. Participants received 200 microg misoprostol administered at 4-hour intervals. Gestations with dead fetuses had a shorter induction-abortion interval [14.2 hours, standard deviation (SD) 4.3] than those with live, malformed fetuses (20.2 hours, SD 7.3) (P< 0.001). The abortion rate was significantly higher for gestations with dead fetuses (92.1%) than those with live, malformed fetuses (68.8%) (P< 0.05). There were no major complications and no significant difference in the incidence of side-effects. All women aborted within 38 hours. Administration of misoprostol is an effective clinical method to terminate second trimester, complicated pregnancy.

Termination of second trimester, complicated gestation

To assess the effectiveness of intravaginal misoprostol for second trimester uterine evacuation, we studied 70 women with singleton pregnancies complicated by fetal malformation or dead fetuses. Participants received 200 microgram misoprostol administered at 4-hour intervals. Gestations with dead fetuses had a shorter induction-abortion interval [14.2 hours, st and ard deviation [SD] 4.3] than those with live, malformed fetuses [20.2 hours, SD 7.3] [P< 0.001]. The abortion rate was significantly higher for gestations with dead fetuses [92.1%] than those with live, malformed fetuses [68.8%] [P< 0.05]. There were no major complications and no significant difference in the incidence of side-effects. All women aborted within 38 hours. Administration of misoprostol is an effective clinical method to terminate second trimester, complicated pregnancy

Comparison of prostaglandin E2 tablets or Foley catheter for labour induction in grand multiparas.

The efficacy, safety and outcome of prostaglandin (PG)E2 was compared with Foley catheter for labour induction in grand multiparous women. At a hospital in Jordan, 147 women with Bishop score < or = 5 were randomized to receive 3 mg PGE2 vaginal tablets (n = 75) or 50 mL intracervical Foley catheter (n = 72). The change in Bishop score was significantly higher in the PGE2 group than the catheter group, and time from induction to delivery was significantly shorter in the PGE2 group. Significantly more women needed oxytocin for labour augmentation in the catheter than the PGE2 group and fetal distress was significantly more frequent. For grand multiparas, PGE2 vaginal tablets may be preferable for ripening the cervix as well as for labour induction.

Comparison of prostaglandin E2 tablets or Foley catheter for labour induction in grand multiparas

The efficacy, safety and outcome of prostagl and in [PG]E2 was compared with Foley catheter for labour induction in gr and multiparous women. At a hospital in Jordan, 147 women with Bishop score </= 5 were r and omized to receive 3 mg PGE2 vaginal tablets [n = 75] or 50 mL intracervical Foley catheter [n = 72]. The change in Bishop score was significantly higher in the PGE2 group than the catheter group, and time from induction to delivery was significantly shorter in the PGE2 group. Significantly more women needed oxytocin for labour augmentation in the catheter than the PGE2 group and fetal distress was significantly more frequent. For gr and multiparas, PGE2 vaginal tablets may be preferable for ripening the cervix as well as for labour induction

Microbiology of wound infection after caesarean section in a Jordanian hospital.

To determine the microbiology of wound infection following caesarean section and to evaluate the use of Gram stain for the predicton of subsequent microbiological culture results, 1319 surgical wounds were followed up. We did Gram stains and cultures on exudates from open wounds and on aspirates if the wounds had demonstrable fluid collection. Incidence of post-caesarean wound infection was 8.1%. Ninety-three (86.9%) of 107 infected wounds were culture positive, with Staphylococcus aureus the most frequently found organism (42%). Organisms seen by Gram stain yielded a sensitivity of 96.6%, specificity of 88.9%, positive predictive value of 97.7% and negative predictive value of 84.2% when used to predict positive culture results for bacterial wound infection.

Microbiology of wound infection after caesarean section in a Jordanian hospital

To determine the microbiology of wound infection following caesarean section and to evaluate the use of Gram stain for the predicton of subsequent microbiological culture results, 1319 surgical wounds were followed up. We did Gram stains and cultures on exudates from open wounds and on aspirates if the wounds had demonstrable fluid collection. Incidence of post-caesarean wound infection was 8.1%. Ninety-three [86.9%] of 107 infected wounds were culture positive, with Staphylococcus aureus the most frequently found organism [42%]. Organisms seen by Gram stain yielded a sensitivity of 96.6%, specificity of 88.9%, positive predictive value of 97.7% and negative predictive value of 84.2% when used to predict positive culture results for bacterial wound infection

The effect of antenatal corticosteroid therapy on pregnancies complicated by premature rupture of membranes.

UNLABELLED: This study was carried out to examine the effect of antenatal corticosteroid therapy on pregnancies complicated by premature rupture of membranes (PROMs). For this purpose, 139 patients with a singleton pregnancy (27-34 weeks of gestation) complicated by PROMs were evaluated prospectively during the period January 1997 to February 1999 at two Jordanian military hospitals (Prince Rhashed and Prince Zaid). Patients were allocated into two groups; Group 1 included 72 patients treated with dexamethsone (24 mg divided into 4 doses 12 hours apart), and Group 2 which included 67 patients whoreceived no treatment (control group). All women were examined clinically and the diagnosis of PROMs was demonstrated using vaginal speculum, nitrazine paper examination and ultrasonography. All neonates were evaluated clinically, radiologically, and by laboratory investigations. Pearson's Chi-square and Fisher's exact tests were used to assess the significance of differences between the two study groups. Respiratory distress syndrome (RDS), necrotizing enterocolitis (NEC), intraventricular haemorrhage (IVH), and days of hospital stay were significantly reduced in premature infants of the corticosteroid treated women compared with the controls (p<0.04, p<0.04, p<0.04, and p<0.05, respectively). The perinatal mortality was significantly decreased among the corticosteroid treated group in the gestational subgroups 31-32 and 33-34 weeks (p<0.04), and in all birth weight subgroups (p<0.03). RDS was statistically a significant factor which resulted in increased perinatal mortality in the control group (p=0.02). Regarding the occurrence of postpartum endometritis there was a statistically significant increase among the corticosteroid treated group compared with the controls (p<0.04). CONCLUSION: Antenatal corticosteroid therapy in pregnancies complicated by PROMs has a positive influencing effect on premature infants between 31 and 34 weeks of gestation, decreasing significantly the perinatal morbidity and mortality. It should be used with particular relevance to the developing world where surfactant is not available or where neonatal intensive care units are lacking.

Subdermal levonorgestrel implant: Acceptability and user satisfaction.

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