Tubal ectopic pregnancy in the north of Jordan: presentation and management.

OBJECTIVE: To evaluate and compare the current approach to the management of ectopic pregnancy between the main two civil hospitals in the north of Jordan. DESIGN: A retrospective study. MATERIAL AND METHODS: A retrospective review was made of the records of all patients with confirmed ectopic pregnancy admitted to Princess Badea Teaching Hospital (PBTH), and King Abdullah University Hospital (KAUH) between January 1, 2005 and December 31, 2005. The total number of deliveries for the same period was obtained from the labor ward records of hospitals. Information regarding demographic data, presenting symptoms, methods of diagnosis and treatment were extracted from individual patient records. RESULTS: There were 50 cases of confirmed ectopic pregnancy in PBTH compared with 20 cases in KAUH. The total number of deliveries at PBTH was 9,000 (1 ectopic/180 deliveries) while at KAUH, the number of deliveries was 3,000 so the ratio was 1: 150. The majority of patients (82%) had ruptured ectopic pregnancy at presentation. All cases at PBTH were managed by laparotomy. Of the 20 cases at KAUH, five cases were managed laparoscopically and three received medical treatment for their ectopics. There was no maternal mortality from ectopic pregnancy or its management at either hospital. CONCLUSION: The management of ectopic pregnancy in our community is still suboptimal. We recommend the development of clinical protocols for early diagnosis and referral, training in transvaginal scanning and an increase in the use of laparoscopy for the management of ectopic pregnancy.

Umbilical cord prolapse: a 10-year retrospective study in two civil hospitals, North Jordan.

Umbilical cord prolapse (UCP) is an obstetric emergency. The objective of our study was to determine the frequency of cord prolapse, its aetiological factors and to evaluate fetal prognosis. This was a retrospective review of cord prolapse deliveries in the main two civil hospitals in North Jordan between 1995 and 2005, at Princess Badeea Hospital and at King Abdullah University Hospital (KAUH) in Irbid, North Jordan. There were 146 patients identified with UCP among a total of 64,192 consecutive births. The incidence of cord prolapse was one in 440 cases (146/64,192). It occurred mostly in women over 25 years, and significantly more in pre-term births, low birth weight babies, multigravida, and only a few were associated with induced cases. It was not associated with higher rates of perinatal mortality and this supports the benefit of clinical management of UCP by emergency (crash) delivery.

Obstetric uterine rupture: a four-year clinical analysis.

OBJECTIVE: The purpose of our study was to identify the risk factors of uterine rupture during labour, to report maternal and neonatal outcome, and to propose preventive measures. STUDY DESIGN: A retrospective study with review of patients' files and monitor strips was performed. RESULTS: Between January 1, 1994 and November 30, 1998, there were 21 cases of uterine rupture at our institution. Of these, 6 patients had complete rupture, and 15 had incomplete rupture. The risk of uterine rupture was increased in patients who had a history of one or more Caesarean sections, obstructed labour, dysfunctional labour, and those who had injudicious use of uterine stimulants. There was no maternal death and fetal loss was 7 (33.3%). CONCLUSIONS: The high incidence of uterine rupture is attributed to lack of prenatal care, labour in high-risk patients outside hospital because of declining economy, and more patients with two or more previously scarred uterus. The maternal and neonatal complications have remained very high in the developing countries. We recommend that all patients with a history of Caesarean delivery should be delivered in hospital and observed closely for progression of labour, recognition of an active phase arrest requires operative delivery.

Placental praevia and accreta: an analysis of two-years' experience.

This retrospective review of the case records was designed to determine the relationship between previous caesarean section and subsequent development of placenta praevia and placenta praevia with accreta. All women delivered with the diagnosis of placenta praevia at Princess Badeea Teaching Hospital from 1 January 1995 to 31 December 1996 were analysed. There were 18 651 deliveries in the study period. Sixty-five had placenta praevia, 21 of whom had a history of previous caesarean. The incidence of placenta praevia was significantly increased in those with a previous caesarean section (1.87%) compared with those with an unscarred uterus (0.25%) (P<0.0001). The risk increased as the number of previous caesarean sections increased. We also conclude that there is a high association between anterior placenta praevia, placenta accreta and previous caesarean section. This was enhanced with the increasing number of previous caesarean sections.

Placenta praevia and accreta: analysis of a two-year experience.

OBJECTIVE: Our purpose was to determine the relationship between previous caesarean section and subsequent development of placenta praevia and placenta praevia with accreta. METHOD: A retrospective review of the case records of all women delivered with the diagnosis of placenta praevia during the 2-year period from January 1, 1995, to December 31, 1996, at the tertiary referral centre, Princess Badeea Teaching Hospital, in north Jordan. RESULTS: There were 18, 651 deliveries in the study period. 65 (0.35%) had placenta praevia, 21 (32.3%) of whom had a history of previous caesarean section. The incidence of placenta praevia was significantly increased in those with a previous caesarean section (1.87%) compared with those with an unscarred uterus (0.25%); p < 0.0001). This risk increased as the number of previous caesarean sections increased: 1.78% for one previous section; 2.4% for two, and 2.8% for three or more. The incidence of anterior placenta praevia and placenta accreta was significantly increased in those with previous caesarean scars. In the group without antecedent of caesarean section, accretism risk was 9%, with one section or more 40.8% (p < 0.005). CONCLUSION: There is a high association between anterior placenta praevia, placenta accreta and previous caesarean section. This was enhanced with the increasing number of previous caesarean sections. Patients with an antepartum diagnosis of placenta praevia who have had a previous caesarean section should be considered at high risk of developing placenta praevia and accreta.

PIP: The association between previous cesarean section delivery and subsequent development of placenta praevia and placenta praevia with accreta was investigated in a retrospective review of the records of all women delivered at Princess Badeea Teaching Hospital (Irbid, Jordan) in 1995-96 with a diagnosis of placenta praevia. The 65 women with placenta praevia represented 0.35% of total deliveries during the 2-year study period; 21 of these women (32.3%) had a history of previous cesarean section. The incidence of placenta praevia was significantly greater in women with a history of cesarean section than in those without such a history (1.87% and 0.25%, respectively; p 0.0001). This risk increased with increases in the number of previous surgical deliveries: 1.78% for 1, 2.4% for 2, and 2.8% for 3 or more. The incidence of placenta accreta also was significantly increased in women with previous cesarean section compared to those without a prior surgical delivery (40.8% and 9.0%, respectively; p 0.005).

Effect of mode of delivery on perinatal results in singleton breech presentation weighing >/= 1500 g.

The object of this retrospective study was to evaluate the mode of delivery and perinatal outcome of singleton fetuses with breech presentation weighing >/= 1500 g. Consecutive cases of all singleton pregnancies at the Princess Badeea Teaching Hospital in North Jordan in the years 1994 and 1995 were compared for crude and corrected perinatal mortality and effect of mode of delivery by weight after correction for non-preventable causes. There were no differences in the 1 and 5 minutes Apgar scores and corrected perinatal mortality between those delivered vaginally and abdominally. It is concluded that poor perinatal outcome are primarily related to factors other than breech presentation. The mode of delivery for infants weighing >/= 1500 g does not influence neonatal outcome and therefore caesarean section for breech presentation in this group is not justified.

Preterm singleton breech in North Jordan: vaginal versus abdominal delivery.

The safety of vaginal birth for singleton preterm breech has not often been addressed before. We retrospectively compared the perinatal outcome of two groups of preterm breech delivery. Sixty-six patients delivered vaginally and 32 delivered abdominally between 26 and 36 completed weeks. Vaginal delivery was allowed under the same protocol for singleton breech delivery at term. Both groups had similar maternal characteristics. Intergroup differences in early neonatal outcome, as measured by Apgar score, were not significant. Intrapartum and early neonatal deaths in vaginal and cesarean delivery were compared. There was no significant difference in intrapartum death and early neonatal mortality between those who delivered vaginally and those who delivered by cesarean section (16.6 vs. 15.6%). So even with optimum neonatal care facilities, cesarean section does not offer any advantage over vaginal delivery in a developing country. This study does not advocate the routine use of cesarean section for delivering preterm breech fetuses.

Is the second-born twin at high risk?

OBJECTIVE: To compare the outcome of the second-born twin with that of the first twin and to find out whether there were any differences and the reason for such differences, if any, and how to improve those differences. METHOD: We retrospectively reviewed twin deliveries from the 15th of April, 1994 to the 14th of April, 1996. Excluded were twins weighing < 500 gm, either twin with a lethal malformation, and either twin who died before the onset of labour. After this exclusion 246 twin pairs remained in the study. We compared perinatal mortality and 5-minute Apgar scores for both twins. RESULTS: Perinatal mortality was similar for both twins as well as 5-minute Apgar scores. The twins < 1500 gm appeared at special risk. The mode of delivery had no influence on the perinatal outcome of either twin. CONCLUSIONS: The second-born twin may not be at increased risk of complications compared with the first-born twin and caesarean delivery may not improve this outcome.