RESUMEN
The objective of this study was to examine awareness of Jordanian married women and men of preconception care. A total of 763 (537 women and 226 men) Jordanians who attended maternal and child healthcare centres in a city, in the centre of Jordan, were included in the current study. The Health before Pregnancy Questionnaire was used to collect the data from participants, while they waited to be seen by the healthcare provider in the health centres. Family history of chronic disorders, 1st-degree consanguineous marriages and planning pregnancy were associated with awareness of preconception care. Around 50% of participants were aware of the serious impact that a woman's and man's family history can have on the health of their babies. The majority of participants were aware of changes that should be made prior to conception.
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Conocimientos, Actitudes y Práctica en Salud , Atención Preconceptiva , Adulto , Salud de la Familia , Femenino , Conductas Relacionadas con la Salud , Humanos , Jordania , Masculino , Encuestas y Cuestionarios , Adulto JovenRESUMEN
INTRODUCTION: Fallopian tube recanalisation (FTR) for proximal fallopian tube obstruction (PFTO) is considered a good treatment option for tubal infertility. The aim of this study was to assess the safety and the technical and clinical success rates of FTR using a dedicated radiographic tubal assessment set (FluoroSet(®) ) in the angiography suite. METHODS: This study is a retrospective analysis of data prospectively collected between February 2007 and June 2011 at King Abdullah University Hospital, Irbid, Jordan. During this period, 61 patients affected by PFTO underwent FTR using FluoroSet(®) at our institution. The mean age of patients was 34 years (range 20-45 years), and the mean duration of infertility was 4 years (range 2-14 years). The procedure was performed with conscious sedation under fluoroscopic guidance in the angiography suite. The obstructed tube was accessed with a 5-Fr multipurpose catheter, and the obstruction was crossed with a 0.35-Fr hydrophilic guide wire until the wire coiled freely into the peritoneal cavity. Patency of the tube was then confirmed by selective salpingiogram. Technical success rate was recorded, and patients were followed up for evidence of pregnancy over 12 months. RESULTS: The procedure was technically successful in all patients. Minor bleeding and postprocedural pain occurred in most patients; however, there were no major complications encountered. Twenty-five patients (41%) became pregnant. Successful deliveries of full-term infants were reported in 21 patients (84%). Miscarriage was reported in four patients (16%). No ectopic pregnancies were detected, and all deliveries were full-term. The technical success rate was 100% and the clinical success rate was 41%. CONCLUSION: Selective salpingography and FTR using FluoroSet(®) is a safe and effective method. FTR is recommended as the first intervention in patients with PFTO. In experienced hands with dedicated equipment and in an appropriate setting, the success rate is high, and this treatment should be offered to infertile women with PFTO before other, more complex techniques are attempted.
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Angiografía/instrumentación , Enfermedades de las Trompas Uterinas/diagnóstico por imagen , Enfermedades de las Trompas Uterinas/cirugía , Histerosalpingografía/instrumentación , Infertilidad Femenina/diagnóstico por imagen , Infertilidad Femenina/cirugía , Cirugía Asistida por Computador/instrumentación , Adulto , Angiografía/métodos , Diseño de Equipo , Análisis de Falla de Equipo , Enfermedades de las Trompas Uterinas/complicaciones , Trompas Uterinas , Femenino , Humanos , Histerosalpingografía/métodos , Infertilidad Femenina/etiología , Persona de Mediana Edad , Embarazo , Resultado del Embarazo , Estudios Retrospectivos , Cirugía Asistida por Computador/métodos , Resultado del Tratamiento , Adulto JovenRESUMEN
We evaluated the predictors of VBAC success in Jordanian women with a single previous low transverse caesarean section of a gestational age of at least 28 weeks, followed by a trial of spontaneous labour at two tertiary hospitals between January 2008 and February 2010. Among 207 women, 117 (57%) women achieved a successful VBAC. Multivariate analysis showed that a cervical dilatation of ≥ 7 cm at the time of previous caesarean section was an independent predictor of successful VBAC (with a success rate of 80%). Parity of ≥ 2 was significantly associated with increased odds of success (OR = 2.7, 95% CI: 1.2, 6.2). Compared with women who had no previous VBAC, those with previous VBAC had higher odds of success (OR = 3.8 (95% CI: 1.5, 9.5). We concluded that women with a previous caesarean section who achieved a cervical dilatation of ≥ 7 cm before caesarean, had a previous history of successful VBAC and had parity of ≥ 2, have the greatest likelihood of successful VBAC.
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Primer Periodo del Trabajo de Parto , Parto Vaginal Después de Cesárea/estadística & datos numéricos , Adulto , Femenino , Humanos , Recién Nacido , Jordania , Embarazo , Estudios Retrospectivos , Adulto JovenRESUMEN
OBJECTIVES: To describe the characteristics of women attending a fertility clinic for infertility treatment and to determine their interest in the use of preconception sex selection and its associated factors. METHODS: A cross-sectional study was conducted among women who presented to the fertility clinic in the IVF center for infertility treatment. A total of 335 women were included in the study and interviewed using the study questionnaire, which included information on patients' demographics, obstetric and infertility history, child gender preference, and interest in preconception sex selection. RESULTS: A total of 155 (46.3%) women had primary infertility and 180 (53.7%) had secondary infertility. While preference for a boy was reported by 50 (14.9%) participants and preference for a girl was reported by seven (2.1%), the majority of women (83.0%) had no preference for gender. A total of 59 (17.6%) women showed an interest in using preconception sex selection. In the multivariate analysis, women who preferred a boy were more likely to be interested in preconception sex selection (OR=3.52) compared to women who had no preference for gender. Trying to conceive for ≥2 years was associated with an 80% increase in the odds of being interested in preconception sex selection. CONCLUSIONS: The majority of women (83.0%) had no gender preference. Less than one fifth of women (17.6%) showed an interest in using assisted method for sex selection. Preference for a boy and trying to conceive for ≥2 years were significantly associated with increased odds of being interested in using preconception sex selection.
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Actitud , Infertilidad Femenina/terapia , Preselección del Sexo , Adulto , Estudios Transversales , Femenino , Humanos , Infertilidad Femenina/psicología , Jordania , Masculino , Persona de Mediana Edad , Técnicas Reproductivas Asistidas , Encuestas y CuestionariosRESUMEN
OBJECTIVE: To evaluate the predictors of success of ECV for breech presentation at term. METHODS: A retrospective study was conducted over a 3-year period from 2005-2007, where 101 patients who had singleton breech presentation at term were undergoing external cephalic version (ECV) after 37 weeks of gestation at two major teaching hospitals in the North of Jordan. Comparative analysis was made between the successful ECV and unsuccessful ECV groups. The collected data were analysed by using statistical analysis Sudent's t-test and Mann-Whitney test as appropriate and on discrete results chi square or Fisher's exact test when appropriate. The differences were considered significant at a p value of < 0.05. RESULTS: The ECV success rate was 72.3%. Favourable factors for success were multiparity (95.5% vs 4.1%, p = 0.0001), flexed breeches (74% vs 26%, p = 0.002), posterior placenta (38.6% vs 16.4%, p = 0.0001) and anterior fetal back (53.4% vs 34.8%, p = 0.03). Once turned the babies remained cephalic until delivery. All the 28 cases who had failed ECV had caesarean section. Among those who had a successful external cephalic version, the incidence of intrapartum caesarean section was only 8.2% which was lower than that of the average of both units caesarean rate (28%). There were no complications related to the ECV procedure in the study. CONCLUSION: Multiparity, flexed breech, posterior placenta, and anterior foetal back were the most favourable factors for successful ECV in our study. Moreover, with careful evaluation of individual predictors patient selection and success rates can be optimised.
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Presentación de Nalgas/epidemiología , Versión Fetal/estadística & datos numéricos , Adulto , Parto Obstétrico , Femenino , Edad Gestacional , Hospitales de Enseñanza , Humanos , Jordania/epidemiología , Paridad , Embarazo , Estudios RetrospectivosRESUMEN
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.
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Embarazo Tubario/epidemiología , Adolescente , Adulto , Femenino , Humanos , Jordania/epidemiología , Embarazo , Embarazo Tubario/diagnóstico , Embarazo Tubario/cirugía , Estudios Retrospectivos , Adulto JovenRESUMEN
The objective of this retrospective study was to investigate the indications, interventions and clinical outcome of pregnant and newly delivered women admitted to the multidisciplinary intensive care unit at the King Abdullah University Hospital in Jordan over a 7-year period from January 2002 to December 2008. The collected data included demographic characteristics of the patients, mode of delivery, pre-existing medical conditions, reason for admission, specific intervention, length of stay and maternal outcome. A total of 43 women required admission to the intensive care unit (ICU), which represented 0.37% of all deliveries. The majority (95.3%) of patients were admitted to the ICU postpartum. The most common reasons for admissions were (pre)eclampsia (48.8%) and obstetric haemorrhage (37.2). The remainder included adult respiratory distress syndrome (6.9%), pulmonary embolism (2.3%) and neurological disorders (4.6%). Mechanical ventilation was required to support 18.6% of patients and transfusion of red blood cells was needed for 48.8% of patients. There were three maternal deaths (6.9%). A multidisciplinary team approach is essential to improve the management of hypertensive disorders and postpartum haemorrhage to achieve significant improvements in maternal outcome. A large, prospective study to know which women are at high risk of admission to the intensive care units and to prevent serious maternal morbidity and mortality is warranted.
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Unidades de Cuidados Intensivos/estadística & datos numéricos , Complicaciones del Trabajo de Parto/mortalidad , Adulto , Femenino , Humanos , Jordania/epidemiología , Persona de Mediana Edad , Complicaciones del Trabajo de Parto/terapia , Admisión del Paciente , Embarazo , Estudios Retrospectivos , Adulto JovenRESUMEN
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.
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Enfermedades Fetales/epidemiología , Cordón Umbilical , Adulto , Estudios de Casos y Controles , Femenino , Hospitales de Enseñanza , Humanos , Jordania/epidemiología , Embarazo , Prolapso , Estudios Retrospectivos , Factores de RiesgoRESUMEN
BACKGROUND: Malpresentation is a deviation from the normal presentation, which occurs in approximately 5% of labours (Seeds and Cefalo in Clin Obstet Gynaecol 25:145-156, 1982). The commonest form of malpresentation at delivery is breech presentation followed by face and brow presentation. OBJECTIVES: To review the incidence and management of face and brow presentation in north of Jordan. MATERIALS AND METHODS: This was a retrospective review of the experience of face and brow presentation deliveries in the two main civil hospitals in north of Jordan between 1995 and 2005. RESULTS: The incidence of face and brow presentation was 1 in 813 and 1 in 1,689 deliveries, respectively. There was no significant increase in the incidence of prematurity nor very low birth weight and no higher incidence of postmaturity among those delivered by face or brow in the same period. All the foetuses presenting by the brow and by face (mentoposterior) and only 16.7 % of foetuses presenting by face (mentoanterior) were delivered by caesarian section. CONCLUSION: The incidence of face and brow presentation was 1 in 813 and 1 in 1,689 deliveries, respectively. All the babies presenting by brow presentation did undergo caesarean section. The management of face and brow presentation is heading towards a safe delivery and not merely to accomplish vaginal delivery.
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Presentación en Trabajo de Parto , Complicaciones del Trabajo de Parto/epidemiología , Complicaciones del Trabajo de Parto/terapia , Adulto , Cesárea/estadística & datos numéricos , Estudios de Cohortes , Cara , Femenino , Humanos , Incidencia , Jordania/epidemiología , Complicaciones del Trabajo de Parto/diagnóstico , Embarazo , Estudios Retrospectivos , Factores de Riesgo , Resultado del TratamientoRESUMEN
We evaluated maternal complications in relation to number of previous caesarean sections in Princess Badea Teaching Hospital, Irbid, Jordan. Analysis of the medical records of 1739 patients delivered by caesarean section was conducted. It revealed a 14-fold increase in the risk of caesarean hysterectomy in patients with placenta praevia and previous caesarean section compared to patients with placenta praevia and no previous caesarean section. The risk of caesarean hysterectomy increased with increasing number of previous caesarean sections. Those with 3 or more previous caesarean sections were at significantly higher risk of blood transfusion. Post-operative pyrexia was commoner in women with 3 or more previous caesarean sections compared to those undergoing their first one.
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Cesárea/efectos adversos , Resultado del Embarazo/epidemiología , Trastornos Puerperales , Transfusión Sanguínea/estadística & datos numéricos , Cesárea Repetida/efectos adversos , Femenino , Fiebre/epidemiología , Fiebre/etiología , Edad Gestacional , Hospitales de Enseñanza , Humanos , Histerectomía/estadística & datos numéricos , Jordania/epidemiología , Edad Materna , Mortalidad Materna , Paridad , Placenta Previa/epidemiología , Placenta Previa/etiología , Embarazo , Embarazo de Alto Riesgo , Trastornos Puerperales/epidemiología , Trastornos Puerperales/etiología , Estudios Retrospectivos , Factores de Riesgo , Esterilización Tubaria/estadística & datos numéricos , Dehiscencia de la Herida Operatoria/epidemiología , Dehiscencia de la Herida Operatoria/etiología , Infección de la Herida Quirúrgica/epidemiología , Infección de la Herida Quirúrgica/etiología , Rotura Uterina/epidemiología , Rotura Uterina/etiologíaRESUMEN
We evaluated maternal complications in relation to number of previous caesarean sections in Princess Badea Teaching Hospital, Irbid, Jordan. Analysis of the medical records of 1739 patients delivered by caesarean section was conducted. It revealed a 14-fold increase in the risk of caesarean hysterectomy in patients with placenta praevia and previous caesarean section compared to patients with placenta praevia and no previous caesarean section. The risk of caesarean hysterectomy increased with increasing number of previous caesarean sections. Those with 3 or more previous caesarean sections were at significantly higher risk of blood transfusion. Post-operative pyrexia was commoner in women with 3 or more previous caesarean sections compared to those undergoing their first one
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Cesárea , Mortalidad Materna , Resultado del Embarazo , Complicaciones del Trabajo de PartoRESUMEN
BACKGROUND: Local anesthesia at the trocar site in laparoscopic cholecystectomy is expected to decrease postoperative pain and hence expedite recovery. The aims of this prospective randomized study were to investigate the effect of local anesthesia and to discover whether it is cost effective. METHODS: For this study, 100 patients undergoing laparoscopic cholecystectomy were randomized into two groups. The 43 study patients were injected with 0.5% bupivacaine hydrochloride at the trocar site before the trocars were inserted. They then were compared with 41 control patients who received no local anesthesia. The remaining 16 patients were excluded from the study. The postoperative pain was evaluated at the standard four trocar sites at 4 h and 24 h after surgery on a scale 1 (the mildest pain the patient had ever experienced) to 10 (the most severe pain the patient had ever experienced). Postoperative pain medications and their cost were evaluated. RESULTS: There was no difference between the two groups with regard to gender, age, weight, operative time, estimated operative blood loss, and bile culture. The patients who received bupivacaine at the trocar site clinically had less pain (p < 0.001 for all four sites) both at 4 and 24 h after surgery. The treatment group patients used less mepiridine and promethzine than the control group (p = 0.001 and 0.002, respectively) postoperatively. Overall, the patients who had local anesthesia used less postoperative pain and antiemetic medication than the control patients (p = 0.02). This afforded a significant decrease in the costs and charges of these medications (p = 0.004 and 0.005, respectively). Three patients in the study group were discharged from the hospital the day of surgery. CONCLUSION: Preinsertion of local anesthesia at the trocar site in laparoscopic cholecystectomy significantly reduces postoperative pain and decreases medication usage costs.
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Anestesia Local/métodos , Colecistectomía Laparoscópica/economía , Colecistectomía Laparoscópica/métodos , Colelitiasis/cirugía , Dolor/prevención & control , Atención Perioperativa , Músculos Abdominales/cirugía , Bupivacaína/administración & dosificación , Bupivacaína/uso terapéutico , Colelitiasis/economía , Control de Costos , Costos de la Atención en Salud , Humanos , Meperidina/administración & dosificación , Meperidina/uso terapéutico , Dolor Postoperatorio/prevención & control , Prometazina/administración & dosificación , Prometazina/uso terapéutico , Instrumentos Quirúrgicos , Resultado del TratamientoRESUMEN
OBJECTIVE: This study was designed to evaluate the predictive value of beta-hCG levels in predicting the pregnancy outcome. METHODS: A retrospective analysis was done on 423 pregnant patients following assisted conception (stimulated in vitro fertilization [SIVF] and stimulated intra uterine insemination [SIUI]). These were monitored with plasma beta-hCG on day +18 post hCG injection. Ongoing pregnancy was defined as greater than 20 weeks. RESULTS: Four hundred twenty three patients had a positive serum quantitative beta-hCG level 18 days post hCG injection. Of these 321 (75.9%) were ongoing pregnancies. The spontaneous miscarriages were 98 (23.2%), and four ectopic pregnancies were recorded. Of the successful pregnancies, 279 were single births, and 42 were multiple births (15.1%), that is either twins (31) or triplets (11). Tables were calculated to help predicting the pregnancy outcome. CONCLUSIONS: It can be shown that +18 levels of beta-hCG in cases of assisted conception are useful and provide predictive information concerning pregnancy outcome which should be helpful for the staff and the infertility patients.
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Gonadotropina Coriónica Humana de Subunidad beta/sangre , Edad Gestacional , Técnicas Reproductivas , Aborto Espontáneo/sangre , Femenino , Fertilización In Vitro , Humanos , Inseminación Artificial , Embarazo , Resultado del Embarazo , Embarazo Ectópico/sangre , Embarazo Múltiple , Valores de Referencia , Trillizos , GemelosRESUMEN
In this study we tested the hypothesis of an association between consanguinity and pre-eclampsia/eclampsia. This is a case-control study conducted at Princess Badea Teaching Hospital, Irbid-Jordan during the period May 1997-April 1998. The study population were Jordanian women delivered at Princess Badea Teaching Hospital with or without hypertensive disorders of pregnancy. The total number was 208 pre-eclamptic/eclamptic women (76 primiparous and 132 multiparous) and 618 randomly selected non-hypertensive women. In primiparous as well as multiparous women, it was evident that neither consanguinity nor the degree of the relationship to the husband in consanguineous marriages had an impact on the incidence of preeclampsia/eclampsia. However, comparing the incidence of consanguinity between pre-eclamptic/eclamptic and non-hypertensive, multiparous women married to a relative other than first cousin, the P value was 0.0248, which we explained as chance incidence. When we compared the incidence of consanguineous marriages as a whole between pre-eclamptic/eclamptic and non-hypertensive, multiparous women, there was no evidence of any impact of consanguinity on the incidence of pre-eclampsia/eclampsia.
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One hundred and seventeen couples with unexplained infertility who underwent natural cycle in vitro fertilization (NIVF) in the years 1991-1993 at the Sheffield Fertility Centre (SFC) formed the basis of this analysis, where they were followed in the following years. Seventy-six of the 117 patients who did not conceive came back for further treatment and they were offered either stimulated intrauterine insemination (SIUI) or stimulated in vitro fertilization (SIVF). If fertilization was confirmed at NIVF they then received SIUI for three treatment cycles and a change to SIVF treatment. If fertilization was not confirmed at NIVF they were then subjected to SIVF. Only 41 patients out of 117 (35%) did not come back for further treatment. The remaining 76 patients (65%) had 130 cycles of treatment, 58 cycles of SIUI and 72 cycles of SIVF. An implantation rate of 23.4% per cycle completed was achieved in the SIUI group. The rate of implantation for the SIVF group was 19.4% per cycle completed. We conclude that patients with unexplained infertility who failed fertilization at NIVF showed fertilization and implantation at SIVF and SIUI, and the implantation rate was similar in both groups.
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Fertilización In Vitro/métodos , Infertilidad Femenina/terapia , Inseminación Artificial/métodos , Embarazo/estadística & datos numéricos , Adulto , Femenino , Estudios de Seguimiento , Humanos , Infertilidad Femenina/etiología , Probabilidad , Estudios Retrospectivos , Estadísticas no Paramétricas , Insuficiencia del Tratamiento , Resultado del TratamientoRESUMEN
UNLABELLED: Unexplained infertility is a diagnosis made by exclusion after all of the standard investigations have revealed no abnormality (1). The range of the prevalence is from 6 to 60 percent (23), depending on the diagnostic criteria. This article reviews the literature in the management of unexplained infertility; published data suggest no benefit of danazol or bromocriptine. The empirical use of clomiphene citrate suggests that ovarian stimulation using clomiphene citrate can double the spontaneous pregnancy rate (52, 58, 59). Induction of ovulation with human menopausal gonadotrophin (hMG) yields an overall pregnancy rate between 2 and 26 percent per cycle (68, 74). These results seem to be lower than those reported for in vitro fertilization (IVF) or gamete intrafallopian transfer (GIFT) procedures in similar patients (25-30 percent (92, 95)). Based on the literature, a rational treatment plan for treating infertility in couples with unexplained infertility includes up to four cycles of clomiphene citrate with or without intrauterine insemination (IUI). Superovulation with hMG and IUI or stimulated intrauterine insemination (SIUI) is the next step for three-cycle treatments and if unsuccessful, one of the variants of assisted reproductive techniques (ART) should be considered. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader will understand the appropriate tests and work up for unexplained infertility, the various treatment options for the unexplained infertility couple including which drugs are effective and not effective, and to be able to outline an appropriate treatment plan for such patients.
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Infertilidad/terapia , Técnicas de Diagnóstico Obstétrico y Ginecológico , Femenino , Humanos , Infertilidad/diagnóstico , Infertilidad/etiología , Masculino , Embarazo , Técnicas ReproductivasRESUMEN
Fetal weight prediction by different methods were compared. Those methods were ultrasound fetal weight estimations using Campbell, Warsof and Hadlock equations, and clinical subjective estimation by experienced obstetricians, as well as clinical objective studies (Zayed's equation). We evaluated 523 Jordanian (Arabic) patients in labour. Our results shows that ultrasound equation provides the highest accuracy in predicting fetal weight. In this study Hadlock's equation was more precise than the other equations. There is still a place for clinical fetal weight estimation, especially if objection methods are used.
RESUMEN
The objective of this study was to explore details of the clinical relationship between meconium-stained amniotic fluid (MSAF) in labour, abnormal fetal heart pattern and meconium aspiration (MA). This was a prospective study carried out in Princess Badeea Teaching hospital during a 6-month period from March to September 1997. During the study period 344 (8.5%) of the deliveries had MSAF (344 women). Continuous fetal heart monitoring was routinely used and 36 women with MSAF (10.5%) needed to be delivered by caesarean section because of fetal distress (diagnosed by abnormal fetal heart pattern) in early labour, compared with 0.95% in those with clear amniotic fluid (CAF), (P <0.00001). Many infants in the MSAF group had a low Apgar score and required ventilation at birth. Nineteen infants (5.5%) developed MA, three of whom (15.8%) died. We conclude that there is an association between MSAF, abnormal fetal heart pattern in labour and a low Apgar score and that it should be considered a high risk situation. MA a problem that occurs with particulate meconium was significantly related to abnormal fetal heart pattern and longer length of labour.
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A prospective study was undertaken to evaluate the efficacy of stimulated in vitro fertilization (SIVF) using Clomiphene Citrate and hMG in different infertilities. The analysis was applied to the first 81 cycles over a period of 9 months in the years 1994-1996 in Sheffield Fertility Centre (SFC). The female patients included in this study were under 40 years of age, and their FSH and LH values were < 10IU/L. Mild and moderate male factor infertilities were included. For tubal factor infertility 16 cases were included with an implantation rate of 0%. The unexplained factor infertility included 33 cases with an implantation rate per embryo transfer (ET) of 41%. For male factor infertility there were 18 cases with an implantation rate per ET of 42%. Out of 3 cases in the ovulatory factor group none reached ET with 0% implantation. For multiple factor infertility 11 cases were included with a 0% implantation rate. The overall implantation per embryo transfer was 27%, while the implantation per cycle started was 15%. We conclude that there are certain infertility factors, i.e. unexplained infertility and mild male factor, which can have good results in IVF using CC/hMG only.
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Clomifeno , Fármacos para la Fertilidad Femenina , Fertilización In Vitro , Infertilidad Femenina/terapia , Infertilidad Masculina/terapia , Menotropinas , Adulto , Transferencia de Embrión , Femenino , Humanos , MasculinoRESUMEN
OBJECTIVE: Our aim was to describe the indications of repeat caesarean delivery and to determine modifiable practice patterns that might lead to fewer repeat caesarean deliveries. METHOD: Hospital records of all women with previous caesarean sections who delivered between 15 April, 1994-31 December, 1994 at the Princess Badeea Teaching Hospital in North Jordan were reviewed. Three groups were identified: 1) elective repeat caesarean 2) vaginal birth after caesarean 3) failed vaginal birth after caesarean. RESULTS: In this study there were 388 patients. Of these, 208 had a repeat caesarean delivery for the following reasons: failed vaginal birth after caesarean (39, 10.1%) and repeat elective caesarean section (169, 43.5%). The remaining (180, 46.4%) patients had a vaginal birth after caesarean. CONCLUSIONS: Our vaginal birth rate after one previous caesarean section was 82.2%. If this rate can be maintained in patients with 2 or 3 previous caesarean deliveries, we can reduce repeat caesarean rates by at least 14% by allowing more patients with 2 or even 3 previous caesarean deliveries to have a trial of labour under appropriate conditions and also proper management of dystocia.