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OBJECTIVE: The purpose of this study was to investigate obstetric outcomes of nulliparous teenagers and to compare selected variables of their course and outcome of pregnancy with controls. METHODS: A review of hospital records from 1997-1999 was done to compare the obstetric outcome in 760 teenage first pregnancies (study group) with that in control group i.e. 20 years to 29 years selected from the first women in the birth registry who delivered after each study case and satisfying the criteria for controls. RESULTS: Revealed that incidence of complications of pregnancy like anemia, pregnancy induced hypertension and antepartum hemorrhage were similar in study and control groups. Pregnancy weight gain, prelabour rupture of membranes and gestational diabetes were significantly lower among teenage mothers. The normal mode of delivery was commoner in teenagers (89.5%) in comparison to control group (72%), probably because of higher number of low birthweight babies. Although in study group the mean birthweight was lower and the incidence of preterm labour and small for gestational age infants higher, there was also increased incidence of large for gestational age infants. While there was no difference in the types of labour, there were lower caesarean and instrumental deliveries. A statistically non-significant higher incidence of perinatal deaths was observed in teenagers. CONCLUSIONS: These results indicated that the course and outcome of pregnancy in teenage mothers had in most respects better obstetric outcomes, despite the higher incidence of preterm labour.

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OBJECTIVE: Our purpose was to examine pregnancy outcomes among women age 40 or older. METHODS: Between January, 1997 and December 1999, we performed a case-control study compared pregnancy outcomes of 468 patients delivered at our hospital at > Or = 40 years old with outcomes in a control group consisting of the next two deliveries of women with ages 20 to 29 years. Retrospective analysis of the antepartum and intrapartum records was done to compare clinical outcome. RESULTS: Approximately 25,356 women delivered during the study period, and 468 (1.8%). Of these women were at age 40 or older. Of this latter group, 50 (10.7%) were nulliparous. Mean birthweight of infants delivered by older nulliparous women was significantly lower than that among nulliparous controls (3,210 +/- 5 vs. 3,320 +/- 1 g), whereas mean birth weight in the group of older multiparous was not different than that among younger multiparous controls (3,370 +/- 1 vs. 3,365 +/- 4 g). Gestational age at delivery was significantly lower among older nulliparous, and multiparous compared with nulliparous and multiparous younger controls. Older women were at increased risk for cesarean delivery (nulliparous 18%; multiparous 14%) compared with nulliparous and multiparous younger control groups (nulliparous 8%; multiparous 6%). In the study group, the operative vaginal delivery rate was higher than that of the control group. The study groups were more likely to develop gestational diabetes, preeclampsia, and placenta praevia. Older nulliparous had an increased incidence of malpresentation, abnormal labour patterns, special care baby unit admission (SCBU), and low 1-minute Apgar score. Older multiparous were more likely to experience birth asphyxia, premature rupture of membranes, and antepartum vaginal bleeding. CONCLUSION: Nulliparous women age 40 or over have a higher risk of operative delivery than do younger nulliparous women. This increase occurs in spite of lower birth weight and gestational age and may be explained by the increase incidence of obstetric complications. Although maternal morbidity was increased in the older women, the overall neonatal outcome did not appear to be affected.

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OBJECTIVE: The purpose of this study was to review the outcome of preterm singleton neonatal morality based on birthweight and gestational age at delivery. METHODS: A retrospective review of hospital case notes of maternity data and neonatal mortality data was carried out on all singleton preterm deliveries from 26 to < 37 completed weeks between 1996 and 1999 to investigate neonatal death. RESULTS: There were 20,758 live-born singleton deliveries over the study period, of which 638 were preterm (3%). The overall neonatal mortality in the preterm group was 42/1000. The neonatal mortality rate fell with advancing gestational age from 174/1000 live births at 28 weeks to 37/1000 live births at < 37 completed weeks of gestation. The neonatal mortality rate also fell with increasing birth-weight from 285/1000 live births of 1000g to 14/1000 live births at 2500g. There was a significant increase in the proportion of babies delivered spontaneously. CONCLUSION: This study has demonstrated neonatal mortality using gestational age and birth weight. The results will be of use in obstetric management when elective preterm delivery is considered, and for providing prognostic guidance following preterm delivery.

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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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OBJECTIVE: The purpose of this retrospective study was to evaluate. The mode of delivery on neonatal outcome of twins weighing <1500 g. METHODS: We reviewed the effect of birth order, presentation, and method of delivery on neonatal outcome in twin gestation under 1500 g at Princess Badeea' Teaching Hospital in North Jordan over the 6-years from 1994 to 1999. RESULTS: During the study period, there were 51475 deliveries of which 695 were twin gestations. One hundred and eight (108) sets of twins weighing <1500 g were included in the study (15.5%), of which 41 were in vertex-vertex presentation, 40 in vertex-nonvertex, and 27 with first twin in nonvertex presentation. The second twin pregnancies characterized by a higher incidence of respiratory distress syndrome (82 vs. 70%; p=0.02) more neonatal mortality (23 vs. 17.6%), and lower Apgar score at 1 and 5 min. Cesarean delivery for vertex-vertex presentation did not improve the neonatal outcome. Rather, the incidence of RDS was significantly greater in this group delivered by cesarean section (65.6 vs. 42%, p=0.012). For nonvertex presentation, those delivered by cesarean section had a lower incidence of neonatal mortality. CONCLUSION: We concluded there was no advantage for cesarean delivery that could be demonstrated after multivariate analysis to correct the differences in birthweight between the groups. Therefore, the differences in the neonatal outcome of non vertex twins presentation accounted for the differences in birthweight, rather than in mode of delivery.

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The purpose of this study was to evaluate the meconium staining of amniotic fluid (AF) in term of fetal distress, meconium aspiration syndrome, and perinatal morbidity and mortality. In a prospective study at Princess Badeea Teaching Hospital from April to November 1999, women with a singleton cephalic pregnancy of completed 37-42 weeks and with no pre-defined risk factor were recruited into the study. Study patients comprised 390 (10%) patients with meconium and 400 patients as controls but with clear amniotic fluid. Virtually meconium staining of the amniotic fluid was significantly associated with poor neonatal outcome in all outcomes measures assessed. Perinatal mortality increased from 2 per 1000 births with clear AF to 10 per 1000 with meconium (P<0.001). Other adverse outcomes also increased; e. g., severe fetal acidemia, Apgar score < or = 3 at 1 min and 5 min, and meconium aspiration syndrome. Delivery by cesarean section also increased with meconium from 7-14% (P<0.001). We concluded that meconium in the amniotic fluids associated with an obstetric hazard and significantly increase risks of adverse neonatal outcomes. Women with thin meconium in the presence of normal fetal heart rate can be safely managed at the clinical level. Mod-thick meconium alone should alert the obstetrician to a high risk fetal condition. Continuous fetal heart rate monitoring during labour and reassurance of fetal well-being by acid-base assessment were most significant factors in the reduction of meconium aspiration syndrome.

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OBJECTIVE: To determine the perinatal outcome associated with triplet pregnancies and to compare abdominal delivery with vaginal delivery. METHODS: Retrospective analysis of maternal and neonatal medical records of 41 triplets. 21 were delivered vaginally and 20 were delivered by cesarean section. MAIN OUTCOME: To measure perinatal mortality and early neonatal complications. RESULTS: Between January 1, 1994, and June 30, 1999, there were 41 triplets delivered at our institution. Of these 21 triplets were delivered vaginally and 20 triplets were delivered abdominally. The perinatal mortality rate was 32/123 (26.0%), primarily due to the respiratory distress syndrome. The perinatal deaths are mainly at a birth weight of 500-1,500 g (29/32; 90.6%). Breech presentation was associated with a significantly higher perinatal mortality rate than vertex presentation (62.5 vs. 37.5%). Cesarean delivery was associated with a higher perinatal mortality rate than vaginal delivery (30.0 vs. 22. 2%). CONCLUSIONS: Abdominal delivery in triplets is not superior to vaginal delivery in terms of fetal and early neonatal outcome. The perinatal deaths are increased with low birth weight (500-1,500 g) and with breech presentation. The main cause of neonatal mortality is the respiratory distress syndrome.

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OBJECTIVE: The purpose of this study was to examine and to determine whether triplet pregnancies are associated with a significantly greater risk of adverse outcome than are twin pregnancies. METHODS: Maternal and perinatal outcomes were evaluated retrospectively in 41 sets of triplets and twin pregnancies that were matched for maternal age, parity, mode of delivery, preterm delivery, mode of conception, and antepartum complications. MAIN OUTCOME MEASURES: Perinatal outcome in triplet versus twin gestation. RESULTS: Triplets had a significantly lower mean average birth weight than in twin gestation (1,596 vs. 2,317 g, p<0.018) and gestational age at delivery (32.9 vs. 35.9 weeks; p< 0.03). Preterm labour occurred significantly more often in triplet than in twin gestation (80.5 vs. 41.5%) as did preterm delivery (87.8 vs. 46.2%). Triplets required a longer hospital stay than did twins (25 vs. 9 days; p<0.04). There were no significant differences between the groups in number of administrations to the Special Care Baby Unit (32.5 vs. 30.5%). Apgar score <7 at 5 min was significantly more in triplet as compared with twin gestation (17 vs. 6%; p<0.0015). Neonatal deaths occurred significantly more in triplets than in twins (26 vs. 8.5%; p< 0.0001). There were no significant differences between the groups in maternal antepartum or neonatal complications such as anaemia, pregnancy-induced hypertension, placental abruption, respiratory distress syndrome or intraventricular haemorrhage. Preterm labour was the only complication that occurred significantly more often in the triplet than in the twin gestation. CONCLUSIONS: We concluded that this information could be useful in counseling patients with respect to the anticipated perinatal outcome of triplet pregnancies.

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The purpose of this retrospective study was to evaluate the mode of delivery on neonatal outcome of twins weighing <1500 grams. We reviewed the effect of birth order, presentation, and method of delivery on neonatal outcome in twin gestation under 1500 grams at Princess Badeea' Teaching Hospital in North Jordan over the 6 years from 1994 to 1999. During the study period, there were 51 475 deliveries of which 695 were twin. One hundred and eight (108) sets of twins weighing <1500 grams were included in the study (15.5%), of which 41 were in vertex-vertex presentation, 40 in vertex-nonvertex, and 27 with first twin in nonvertex presentation. The second twin was characterised by a higher incidence of respiratory distress syndrome (82% vs. 70%; P = 0.02), more neonatal mortality (23% vs. 17.6%), and lower Apgar scores at 1 and 5 minutes. Cesarean delivery for vertex-vertex presentation did not improve the neonatal outcome. Rather, the incidence of RDS was significantly greater in this group delivered by caesarean section (65.6% vs. 42%; P = 0.012). For nonvertex presentation, those delivered by caesarean section had a lower incidence of neonatal mortality. We conclude that there was no advantage in caesarean delivery after multivariate analysis to correct for differences in birthweight between the groups. The differences in the neonatal outcome of nonvertex twin presentation was accounted for by the differences in birthweight, rather than in mode of delivery.

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In a retrospective study we examined the outcome of twins delivered at Princess Badee'a Teaching Hospital from 1 January 1996 to 30 June 1999. The incidence of twin pregnancy was 1/86 with a gross perinatal mortality rate of 178 per 1000. Breech presentation was associated with the highest perinatal mortality rate (278 per 1000). One hundred and eighty-four out of the 386 twin pregnancies were preterm with the highest perinatal mortality rate (184 per 1000). The neonatal Mortality rate fell with increasing birthweight from 532 per 1000 at 1500 g to 16 per 1000 at 2500 g. Our results showed that the risk factors were mainly prematurity, low birthweight, pregnancy-induced hypertension, lack of proper antenatal care, birth asphyxia, and malpresentation.

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BACKGROUND: Triplet births, which have increased greatly throughout the world in recent years, have a much greater risk of poor birth outcome than singleton births. The purpose of this study was to determine the perinatal outcome associated with triplet pregnancies and to compare abdominal delivery with vaginal delivery. METHODS: We conducted a retrospective study of 41 sets of triplets born between January 1, 1994, and June 30, 1999, at the Princess Badee'a Teaching Hospital in Amman, Jordan. The primary outcome measures were perinatal mortality and early neonatal complications. RESULTS: Of these sets, 21 triplets were delivered vaginally and 20 triplets were delivered by cesarean section. The perinatal mortality rate was 260 per 1000 live births in this series, primarily due to respiratory distress syndrome. The perinatal deaths occurred to infants whose birthweights were primarily 500 to 1500 g (90.6%). Breech presentation was associated with a significantly higher perinatal mortality rate than vertex presentation (62.5% vs 37.5%). Cesarean delivery was associated with a higher perinatal mortality rate than vaginal delivery (30.0% vs 22.2%). CONCLUSIONS: These results suggested that cesarean delivery in triplets is not superior to vaginal delivery in terms of fetal and early neonatal outcome. The perinatal mortality rate was significantly higher than that in other recent series due to limited resources in Jordan.

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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.

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OBJECTIVE: To study the effect of maternal age, gravidity, parity, previous abortion and previous caesarean section on placenta previa. METHODS: We reviewed records of 95 women with placenta previa and compared with 190 women delivered during the same period, all delivering between 16 April 1994 and 15 May 1997. We compared maternal age, parity, gravidity, previous abortion, and previous caesarean section. RESULTS: Placenta previa is higher among women gravida > 4 (p < 0.002), para > 3 (p < 0.01) and previous caesarean section (p < 0.02). There is no increase in the incidence of placenta previa with increasing maternal age and previous abortion. CONCLUSION: The risk of placenta previa is increased with higher gravidity, higher parity, previous lower segment caesarean section, while increasing maternal age and previous abortion had no significant effect.

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This randomised prospective study was designed to evaluate the use of transvaginal (TVS) and transabdominal (TAS) ultrasound in the diagnosis of placenta praevia and its effect on length of stay in hospital. One hundred and thirty patients with antepartum haemorrhage (APH) and/or malpresentation with a suspicion of placenta praevia were referred to the scanning department of Aberdeen Maternity Hospital and Princess Badee'a Teaching Hospital from July 1993 to December 1996. Fifty-eight patients had an ultrasound because of antepartum haemorrhage and 72 had a malpresentation and/or unstable lie. All examinations were performed by the same authors. Placenta praevia was diagnosed in 13 (22.4%) out of 58 cases presenting with APH and in five (7%) out of 72 cases presenting with malpresentation. There was a high false positive rate in the detection rate of placenta praevia using TAS (23%) compared with TVS (11.5%) which is higher than other reported figures (2-6%). The mean length of stay in hospital of the group in whom the results were released was 9.2 days compared with those not released where it was 15.7 days. The difference was significant (P <0.05). This study suggests that the traditional transabdominal approach to the diagnosis of placenta praevia can be improved upon. TVS is a safe method and with improved accuracy over TAS can reduce the length of stay in hospital.

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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.

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OBJECTIVE: To find out the indications for caesarean sections, the contribution of "dystocia" to the overall caesarean section rates, and to find ways to reduce dystocia-induced caesarean sections. METHOD: This was a retrospective study where all caesarean sections performed in 1995 at the Princess Badeea Teaching Hospital in North Jordan (the main teaching and referral hospital in the area) were reviewed. RESULTS: The caesarean section rate for 1995 was 8.4%. Dystocia was the main indication in 13.4% of all caesarean sections in that year. In 80.2% of patients who delivered because of dystocia labour started spontaneously. Thus if we advocate active management of labour, especially in nulliparous women who start labour spontaneously due to dystocia, we may reduce caesarean section and many repeat caesarean sections could be avoided. CONCLUSIONS: Applying a policy of active management of labour in nulliparous women may be the most useful approach to reduce caesarean section rates in modern obstetric practice.

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We retrospectively reviewed the perinatal outcome of twin pregnancies cohere the first baby was presenting by the breech. 21 were delivered vaginally and 37 abdominally. Differences in perinatal outcome, as measured by Apgar score and mortality, were not apparently different.

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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.

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To evaluate the safety of vaginal delivery for breech first twin we reviewed retrospectively and compared the perinatal outcome of breech first twin: 42 delivered vaginally and 87 delivered abdominally. Vaginal delivery was allowed under the same criteria for singleton breech presentation. Both groups had similar maternal and neonatal characteristics. Intergroup differences in perinatal outcome, as measured by Apgar score, and mortality cases, were not significant. Our results showed that vaginal delivery is a safe mode of delivery and this route is not associated with higher mortality and morbidity.