Diffuse peritoneal deciduosis in pregnancy.

Ectopic decidua is a rare benign condition, believed to be associated with excessive progesterone stimulation such as in multiple gestations as in our case, it's usually asymptomatic and found incidentally during caesarean section. The lesions involute spontaneously in the postpartum period; therefore it usually doesn't require any therapeutic interventions. This condition could induce anxiety to surgeons intra-operatively, because of resemblance of more sinister lesions such as: carcinomatosis and granulomas. We report a clinical case of diffuse peritoneal deciduosis, identified during an emergency caesarean section, performed at 33 weeks of gestation, for a transverse lie, twins DCDA pregnancy in active labor.

Negative histology in surgically managed tubal ectopic pregnancy.

OBJECTIVE: To determine the rate of negative histology following salpingectomy for suspected ectopic pregnancy. METHODS: A retrospective case series in a university hospital in the southwest of England was carried out. The records of all patients who had a salpingectomy for suspected ectopic pregnancy between January 2007 and December 2012 were reviewed. The primary outcome was the histology result. RESULTS: In total, 359 salpingectomies were performed for suspected ectopic pregnancy over 6 years. On histologic examination, 4.7% of fallopian tubes did not have evidence of an implantation site or trophoblastic tissue. When the macroscopic appearance of the fallopian tube was correlated with the surgical findings (e.g., rupture with large hemoperitoneum) and follow-up notes were reviewed thoroughly, the histology of 0.84% of all salpingectomies was not consistent with a tubal ectopic pregnancy. CONCLUSIONS: True negative histology for surgically managed ectopic pregnancy is less than 1%.

Correlation of Sperm Mitochondrial DNA 7345 bp and 7599 bp Deletions with Asthenozoospermia in Jordanian Population.

BACKGROUND: Alterations in sperm mitochondrial DNA (mtDNA) affect the functions of some OXPHOS proteins which will affect sperm motility and may be associated with asthenozoospermia. The purpose of this study was to investigate the correlation between 7599-bp and 7345-bp sperm mtDNA deletions and asthenozoospermia in Jordan. METHODS: Semen specimens from 200 men including 121 infertile and 79 healthy individuals were collected at the Royal Jordanian Medical Services In-vitro fertilization (IVF) units. The mtDNA was extracted followed by mtDNA amplification. Polymerase chain reaction (PCR) was conducted for the target sequences, then DNA sequencing was performed for the PCR products. Chi-square, Fisher's and Spearman's tests were used to calculate the correlation. RESULTS: The results showed a significant correlation between the presence of 7599-bp mtDNA deletion and infertility where the frequency of the 7599-bp deletion was 63.6% in the infertile group compared to the fertile 34.2% (p<0.001, (OR=3.37, 95% CI=1.860 to 6.108)). Additionally, the sperm motility showed a significant association with the frequency of the 7599-bp deletion (p=0.001, r=-0.887). The 7345-bp mtDNA deletion showed no assoctiation with the infertility (p=0.65, (OR=0.837, 95% CI= 0.464-1.51)) or asthenozoospermia (p=0.98, r=0.008). CONCLUSION: We demonstrated a significant correlation between asthenozoospermia and the 7599-bp mtDNA deletion but not the 7345-bp mtDNA deletion in the infertile men in Jordan. Screening for deletions in sperm mtDNA can be used as a pre-diagnostic molecular marker for male infertility.

Unplanned Reoperation Following Gynaecological Surgeries: A report from Jordan.

OBJECTIVES: Unplanned return to the operating theatre refers to an unplanned reoperation following a primary surgical procedure and can result in serious complications. The rate of unplanned reoperations is often used as a measure of in-hospital quality monitoring and improvement. This study aimed to review the prevalence rate and features of unplanned gynaecological reoperations at a major general hospital in Jordan. METHODS: This retrospective study took place between January 2011 and January 2018 at The Specialty Hospital in Amman, Jordan. The medical records of all women who underwent unplanned reoperations following a primary gynaecological procedure during this period were reviewed. RESULTS: A total of 4,895 primary gynaecological procedures were performed during the study period, of which 4,175 (85.3%) were elective and 720 (14.7%) were emergency operations. There were 15 unplanned reoperations (0.3%); of these, 14 (93.3%) followed elective procedures and one (6.7%) followed an emergency surgery. Most reoperations were performed following hysterectomies (53.3%). Bleeding was the predominant reason for reoperation (93.3%), with the source of the bleeding successfully identified in 71.3% of cases. In terms of outcome, none of the cases required a subsequent reoperation and there were no mortalities. CONCLUSION: The rate of unplanned reoperation at a hospital in Jordan was 0.3%. Unplanned reoperations occurred primarily as a result of bleeding following hysterectomies. Development of care pathways may reduce surgical complications and rates of unplanned reoperation.

The effect of intravesical instillations with Hyaluronic Acid on sexual dysfunction in women with recurrent urinary tract infections (RUTI).

OBJECTIVE: To determine whether sexual dysfunction in women with recurrent urinary tract infections (RUTI) improved following treatment with intravesical Hyaluronic Acid (HA) instillations. STUDY DESIGN: Ethical approval was obtained for a prospective study to be performed. Patients referred for bladder instillations to treat RUTI, and who were sexually active, were recruited to the study. A selection of validated questionnaires (ICIQ-UI, ICIQ-VS, FSDS-R, ICIQ-FLUTS, O'Leary/Sant and PGI-I) were completed at baseline, three, six and 12 months after initiation of treatment with bladder instillations. Treatment consisted of weekly bladder instillations with a preparation containing HA for four weeks then monthly for two further treatments. Results were populated in SPSS for statistical analysis and statistical significance was powered for 22 patients. RESULTS: Thirty women were included in the study. FSDS-R was used to determine sexual dysfunction and showed that 57% patients with RUTI had significant sexual distress. There was a significant improvement in FSDS-R at three, six and 12 months when compared to baseline (Friedman two-way analysis p < 0.001). ICIQ FLUTS F and I scores, O'Leary/Sant, ICIQ VS and PGI-I also showed a statistically significant improvement throughout the period of follow up. A statistically significant, negative correlation was found between FSDS-R and PGI-I at 12 months (r = -0.468, p = 0.009). CONCLUSION: We have reinforced previous work showing the association between RUTI and sexual dysfunction, and an improvement in bladder symptoms following treatment with HA. To our knowledge, this is the first study to prove an improvement in sexual dysfunction following intravesical treatment with HA which is sustained for up to 12 months.