The shift in COVID-19 vaccination policy for pregnant women, from restricted to required, and the confusion that ensued.

Introduction: The aim was to investigate the response of pregnant women when the COVID-19 vaccination policy shifted from restricted to required, and the confusion that ensued during pregnancy, bearing in mind that women undergo unique physiological and immunological changes during pregnancy, making them at risk of developing a more severe course of COVID-19 infection compared to their non-pregnant peers. Material and methods: A cross-sectional study was carried out at the outpatient clinics at Jordan University Hospital for all pregnant women during the period of the survey from 1st October 2021 to 31st December 2021, focusing on the source of information about the vaccine, receiving the vaccine, and the reasons for rejecting the vaccine, especially during pregnancy. Results: In total, 468 pregnant women were interviewed. The single primary source of information about the COVID-19 vaccine was the traditional media, audio-visual and print media being the most important as reported by 191 women (40.81%), while possible harm to the fetus was the single main reason for refusal of vaccination during pregnancy as reported by 111 women (23.72%). Conclusions: Reluctance toward vaccination is primarily driven by the fierce media campaign that portrayed its initially ambiguous effects on the pregnancy and fetus in a negative light, in conjunction with the open media platforms that enabled semi-experts to issue medically inaccurate statements and information and further complicated the matter by planting the seed of fear and mistrust of the public in the health care system and providers. More public healthcare awareness regarding the safety of the COVID-19 vaccine is needed.

Cervical cancer screening in Jordan; a review of the past and an outlook to the future - facts and figures.

Introduction: This study aims to assess the attitude, knowledge, and behaviour of Jordanian women toward cervical cancer screening and its phenomenal role in preventing the disease, and to identify the defects and obstacles in the national screening programs for early detection of this manageable kind of malignancy.Material and methods: A prospective study via a questionnaire that included the demographic data, knowledge, behaviour, and attitude among Jordanian women about the cervical screening program using face-to-face interviews. Results: Among 655 women who responded to the questionnaire, 340 (51.9%) reported having no idea about the smear, 350 (53.4%) had completed higher education, 84 (12.84%) were not happy to be screened, and 53 (8.09%) were afraid of the result being positive for malignancy. The shocking and scandalous upshots reported that 600 women (91.6%) had no idea about the role of vaccination against this threatening disease. Conclusions: Screening programs occupy a limited space among the health care provider's priorities. The health education and national awareness strategy regarding cervical cancer should be adopted and implemented in primary health care units. The media with its different facets and platforms must take responsibility and share this national cancer education battle. The once-in-a-lifetime screening test should be adopted urgently, being the most important step, because it represents the minimum correct starting point to lessen the future burden on the national healthcare system and benefit the health of the target groups.

Plasma drop and thin-film revealed distinguished molecular structure in pre-eclampsia: An investigation using synchrotron Fourier-transform infrared microspectroscopy.

Pre-eclampsia (PE) is a serious pregnancy-related disorder and the leading cause of maternal and fetal mortality and morbidity worldwide. The etiology of PE is poorly understood and a definitive diagnosis is still lacking. Herein, we used synchrotron-FTIR microspectroscopy as a new analytical tool to investigate the molecular changes in the structure and intensity of lipids (spectral range 3050-2800 cm-1) and protein-carbonyl (spectral range 1855-1485 cm-1) components of the plasma and link them to the pathogenesis of the disease. In the lipid region, an increase in the CH2 and CH3 peaks intensity was noticed in PE group compared to normotensive pregnancy reflecting abnormalities in the lipid profile and a high level of LDL. Increased CH2/CH3 ratio and red shifts were observed in the lipid region in PE highlighting structural variations of lipids and transformation of conformation of lipid tails. In the protein-carbonyl region, a decrease in the amide I and II absorption signals in the plasma of PE compared to normotensive controls was evident, and a red shift was noticed in the amide I region reflecting conformational changes and rearrangement in the α-helix secondary structure of the protein. Moreover, malondialdehyde level and lipid carbonyl peak at 1743 cm-1 were higher and more intense in PE due to the oxidative stress condition in PE. Spectral analysis of plasma drop from PE revealed that lipid and protein components tend to concentrate more in the central region of the drop, and that the most intense wavenumber values for the lipid and amide I region in the plasma drop were very comparable to their analogous in plasma film. Taken together, the current work provides evidence of the promising role of synchrotron-FTIR microspectroscopy in providing a better understanding of the pathophysiology of PE.

Subtotal hysterectomy reviewed: a stable or aperture for stump cervical malignancy. A referral hospital experience.

Introduction: To review the malignant potential of the stump after subtotal abdominal hysterectomy. Material and methods: Thirty-three patients with stump malignancy were diagnosed and treated between January 2018 and January 2022. All patients primarily underwent subtotal hysterectomy (STH) outside our hospital due to different indications, most of which seemed non-convincing. Upon presentation, they were evaluated properly and offered the best management plan. Results: The presenting symptoms were abnormal histopathology report in 8 patients (24.24%), abnormal bleeding in 7 patients (21.21%), and postcoital bleeding and abnormal Pap smear in 6 patients (18.18%). The primary site of malignancy was endometrial in 17 patients (51.51%), on top of fibroid in 6 patients (18.18%), and cervical in 5 patients (15.15%). Eighteen patients (54.54%) underwent proper surgery, 9 patients (27.277%) were referred for chemoradiation, and 6 patients (18.18%) were candidates for palliative therapy. Conclusions: Stump cancer cases show a worse stage silhouette compared with cancer cases in intact uteruses. The high prevalence of cervical stump problems should be taken into account before a change in surgical approach from total to STH is deemed possible. Further prospective studies with prolonged follow-up periods are needed to evaluate the risks and benefits of retaining the cervix at hysterectomy. Subtotal hysterectomy is easier, does not require distinct skills that lead to experience and follow-up, and must be limited to the narrowest limits of practice, provided that the woman knows that there are no health benefits to keeping the cervix in place.

Prevalence of endometriosis in women undergoing laparoscopic surgery for various gynaecological indications at a Jordanian referral centre: gaining insight into the epidemiology of an important women's health problem.

BACKGROUND: Endometriosis is a considerable health challenge for women of reproductive age. Information about its prevalence in the Jordanian population is sparse. The objective of this research was to evaluate the presence of endometriosis in gynaecological patients undergoing laparoscopic surgery for various indications and to correlate the finding of endometriosis with variables, including patient demographics, obstetric history, type, and indication of laparoscopic procedure. METHODS: A retrospective cohort study involving 460 women who underwent different laparoscopic procedures for a variety of indications was conducted in the Department of Obstetrics and Gynaecology in Jordan University Hospital, a tertiary referral hospital in Jordan, between January 2015 and September 2020. RESULTS: The prevalence of endometriosis in this patient group was higher than that of the general population (13.7% vs. 2.5%), and the mean age at diagnosis (31.9 years) was younger than the general population's age of peak incidence (35-45 years). It was significantly higher in women with lower numbers of pregnancies (p = 0.01) and a lower number of Caesarean sections (p = 0.05) and in those where the indication for surgery was related to decreased fertility or pelvic pain (p = 0.02). Women with high parity or where the surgery's indication suggested normal fertility, such as family planning, were less likely to have endometriosis. CONCLUSION: To our knowledge, this is the first Jordanian study to assess the prevalence of endometriosis in women undergoing gynaecological laparoscopy. This study suggests that the epidemiology of endometriosis in this region follows similar trends to what has been previously documented in international literature, while emphasizing the need for further research into this important women's health issue in this part of the world.

Abandoning the blind legacy passed on horde of routine intra-abdominal drain insertion in cesarean section.

INTRODUCTION: Cesarean section (CS) delivery is the most common major obstetrical surgical operation carried out in and is increasing in incidence throughout the world. The major involves some risks that might include: infection, coagulation problem, loss of blood, bowel or bladder injury, abnormalities of the placenta in subsequent pregnancies. AIM OF THE STUDY: To evaluate the clinical effectiveness of postoperative CS intra-abdominal drain insertion. MATERIAL AND METHODS: A prospective study was conducted on 245 patients in labor, at the Department of Obstetrics and Gynecology, Jordan University Hospital, between January 2017 and January 2018. Participants were divided into two groups: group I including those who had abdominal drains insertion during surgery and group II including women who had no abdominal drain inserted before closure. All patients on both groups were term pregnancies, underwent elective vs. emergency CS, and had no subcutaneous drains inserted. RESULTS: Clinical and surgical parameters were comparable in both groups. Postoperative hospital stay was significantly shorter in group II, whereas specific postoperative complication rate was significantly higher in group I. Drain site infection was noted in 2 (1.6%), organ herniation in 2 (1.6%), drain avulsion in 2 (1.6%), severe pain at the site of insertion in 2 (1.6%) patients. CONCLUSIONS: Routine prophylactic intra-abdominal drain insertion post CS has no benefits and therefore should be stopped.

Investigating the molecular structure of placenta and plasma in pre-eclampsia by infrared microspectroscopy.

Pre-eclampsia (PE) is a serious hypertensive disorder with unclear etiology and lack of reliable diagnostic tests. In this study, IR microspectroscopy was applied to identify molecular changes associated with the pathogenesis of PE in placental tissues and plasma samples from pre-eclamptic women and normotensive matched controls. The obtained spectra were analyzed by multivariate analysis in the spectral ranges of 3050-2800 cm-1 and 1855-1485 cm-1 corresponding to lipid and protein-carbonyl components, respectively. In the lipid region, an increase in CH2/CH3 ratio was noticed and higher level of unsaturation index in placenta was evident. New lipid species emerged as a consequence of oxidative stress. The more intense peak at 1740 cm-1 in PE reflected higher level of LDL and VLDL. In the protein region, a decrease in the α-helix structure associated with gain in ß-sheet and ß-turn structures was detected. Our results revealed significant conformational changes in the protein secondary structure in PE illustrated by peak shifts and intensity alterations, particularly in amide I component. Variations in lipid order, membrane integrity, fatty acid saturation and plasma lipid profile were also detected in PE. The ROC curve generated from plasma samples yielded AUC values of 98.4% and 99.9% for lipid and protein-carbonyl regions, respectively. The current study shed light on the promising role of IR microspectroscopy as a new analytical tool that can aid in providing better diagnosis and understanding of the pathophysiology of PE.

Setting priorities in the conventional approaches in managing ectopic pregnancy; is it time to reform? A teaching hospital experience.

THE AIM OF THE STUDY: To review the management approaches of ectopic pregnancy (EP) at the Department of Obstetrics and Gynecology at Jordan University Hospital (JUH). MATERIAL AND METHODS: All patients admitted to our department with the diagnosis of EP treated during the study period extending from January 2017 to June 2019. Data were collected retrospectively using the patients' files anonymously. Main outcome measures: age, parity, ectopic site, presentation, the main risk factor/s and the management plan. RESULTS: In total, 65 cases of EP were managed during the study period. Overall, the mean age was 30 years. EP was located in the right tube in 23 cases, and in the left tube in 14 cases. Eleven patients presented with acute abdomen due to rupture of the EP and underwent urgent laparotomy; 7 of these cases were located on the right side. Conservative surgery (laparoscopy versus laparotomy) was the main line of management with attention to preserving the tube patency, followed by medical therapy when the patient fulfilled the criteria or those with pregnancy of unknown location. CONCLUSIONS: EP is a life-threatening condition. It is time to reform the priorities in the conventional approach to management. Every effort ought to be applied to preserve the reproductivity of women who are diagnosed with EP at the JUH. We would suggest that salpingostomy needs to be considered the surgical treatment of choice for the majority of these cases.

Sexuality after hysterectomy at University of Jordan Hospital: a teaching hospital experience.

PURPOSE: This research concentrates on evaluating the sexual activity of the patients after having hysterectomy for benign disorders. SETTING: This analysis took place at the University of Jordan hospital. MATERIAL AND METHODS: The retrospective record was reviewed for over 2 years (from January 2008 to January 2010). The sample of study included a total number of 124 patients with benign disorders who underwent hysterectomy. The sexual life parameters indicate that 93 patients (75 %) felt general improvement in their performance, while 14 patients (11.3 %) complained of having suffered bad performance, 6 patients (4.8 %) noticed no changes, and 11 patients (8.9 %) did not provide any comment. As for the partner's sexual function (as relayed by the patients themselves), 69 patients (55.6 %) felt improvements in their performance and 23 (18.5 %) commented that their partners had bad performance, while 18 patients (14.5 %) noticed no changes and 14 (11.3 %) did not provide any comment. Patients were interviewed by the operating physician each of whom was subjected to an average of half an hour verbal interview after obtaining the prior written consent of the patient. Questionnaire forms were used to record the answers given by each patient. The interview data recorded in the questionnaires were analyzed. CONCLUSION: The result of these analyses significantly indicated that sexual function is a major cause of women's concern for scheduled hysterectomy. That is because they were influenced by both physiological and psychological factors. Even though the analysis results implied that there was a sizeable minority who evidently suffered a considerably worse outcome, it was recognized that hysterectomy leads to improvement in sexual function and health for the majority of women. Therefore, it is important to spread awareness among women and let them know that most probably they will neither lose their sexual desire after hysterectomy, nor they will lose their feminine shape or style.

Bupivacaine with meperidine versus bupivacaine with fentanyl for continuous epidural labor analgesia.

OBJECTIVE: To compare the efficacy of bupivacaine-meperidine and bupivacaine-fentanyl mixtures when continuously infused epidurally to relief the labor pain. METHODS: We performed this prospective double-blinded study at Jordan University Hospital, Amman, Jordan between October 2005 and April 2006. Sixty-seven American Society of Anesthesia physical status I parturients were randomly divided into 2 groups, Group M (n=34) received a continuous infusion of 1 mg/ml of bupivacaine mixed with 1 mg/ml meperidine, and Group F (n=33) received a continuous infusion of 1 mg/ml bupivacaine mixed with 2 micrometer/ml fentanyl. Efficacy of analgesia, degree of motor block, hemodynamic variability, incidence of nausea and vomiting, pruritus, sedation, and the neonatal outcome were all compared between the 2 groups. A p value <0.05 was considered to be significant. RESULTS: Highly effective analgesia was achieved in both groups with a similar incidence of motor block, sedation, pruritus, and neonatal outcome. The only significant difference was in the incidence of nausea and vomiting. Group M had 8 parturients with nausea, compared with only 2 parturients in Group F (p=0.003). CONCLUSION: Bupivacaine-meperidine in a continuous epidural infusion is as efficient as bupivacaine-fentanyl for pain relief during labor, but associated with a higher incidence of nausea and vomiting.

Outcome of adolescent pregnancy at a university hospital in Jordan.

OBJECTIVE: To determine whether adolescent pregnancies are associated with increased risk of adverse obstetrical outcome. MATERIALS AND METHODS: This is a retrospective study comparing the obstetric outcome of 267 adolescent pregnancies to 500 adult women pregnancies during the same period at a university hospital. RESULTS: Medical and obstetric complications including pregnancy-induced hypertension, diabetes mellitus, anemia, placenta praevia, abruptio placenta and multiple pregnancy were not different in both groups, where there was a significant increase of preterm labor in adolescent pregnancies compared to adult pregnancies (14.6 and 8%, respectively). Moreover, adolescent pregnancies when compared to adult pregnancies, were associated with a significantly higher incidence of forceps delivery (4.5 and 1.4%, respectively), neonatal intensive care unit admission (22.7 and 13.5%, respectively) and a lower incidence of caesarean section (7.1 and 16.8%, respectively). CONCLUSION: Adolescent pregnancies are associated with a favorable obstetric outcome apart from the higher incidence of preterm labor.