Background: Cesarean section is a widely performed surgery. Objective: To compare anesthetic types regarding feto-maternal outcomes. Materials and Methods: Retrospective comparative study of 3599 cesarean sections (emergency and elective categories). Results: Mean APGAR score was statistically higher in the spinal than general anesthesia among the emergency category, P = 0.000 and 0.026, respectively, with no significant difference in the elective category. Estimated blood loss among the elective category was statistically significantly higher in the spinal than general anesthesia, P = 0.001. However, among the emergency category, it was significantly higher in the general than in spinal or epidural anesthesia, P = 0.000. Diclofenac sodium was used more after spinal than general anesthesia (P = 0.000), with no significant difference between epidural and general or between epidural and spinal anesthesia. Pethidine hydrochloride (HCL) was used more after general than after spinal anesthesia (P = 0.000). However, pethidine HCL use was not statistically significantly different between spinal and epidural anesthesia. In the elective category, paracetamol was requested more after spinal than epidural or general anesthesia, P = 0.000. No significant difference was seen between epidural and general anesthesia, P = 1.000. No statistically significant difference was found among the anesthetic types in both categories regarding tramadol HCL. Length of hospital stay, operative time and neonatal intensive care unit admission were not statistically different between anesthetic modes. In the emergency category, significantly higher percentage of patients were satisfied with and would recommend epidural anesthesia. Conclusion: There was no statistically significant difference among the three types of anesthesia regarding neonatal intensive care admission and length of hospital stay for emergency and elective categories. APGAR score was higher with spinal than with general anesthesia in the emergency category with no significant difference in the elective category. More diclofenac sodium and paracetamol and less opioids were used after regional than after general anesthesia. Satisfaction was higher with epidural anesthesia. Limitations: Retrospective and single centered.

Incidences of immune thrombocytopenic purpura occur in 1 in every 1000–10,000 pregnancies accounting for 3% of all thrombocytopenic pregnancies. A pre-existing immune thrombocytopenic purpura is known to be a risk factor for developing thrombocytopenia during pregnancy. We present here the treatment regime and management of a patient with known immune thrombocytopenic purpura who developed postpartum thrombotic thrombocytopenia with atypical response to traditional therapy. Pregnant women are more vulnerable to immune thrombocytopenic purpura or thrombotic thrombocytopenia. Pregnancy or postpartum thrombotic thrombocytopenia accounts for 10–25% of all thrombotic thrombocytopenia. This case report deals with the treatment regime and management of a patient with known immune thrombocytopenic purpura who developed postpartum thrombotic thrombocytopenia. A 30-year-old Middle Eastern woman, with a prior diagnosis of chronic immune thrombocytopenic purpura had remained off-the-treatment for many years. After primary unexplained infertility for 8 years, for which she underwent six failed trials of in vitro fertilization, she delivered a healthy baby through caesarean section. Two days post-surgery, she had persistent thrombocytopenia, ecchymoses, bruises, and hemolysis. Her blood film revealed leukoerythroblastic anemia. Her blood tests also revealed a very low level of haptoglobin, and low level of ADAMTS13. A diagnosis of thrombotic thrombocytopenia was suspected. Plasma exchange therapy was started with partial response. We showed that rituximab in conjunction with mycophenolate mofetil following plasma exchange therapy was effective in controlling the low platelet count in our patient. Rituximab in conjunction with mycophenolate mofetil following plasma exchange therapy was effective in controlling the low platelet count in our patient. Only two doses of rituximab were sufficient to normalize our patient. We present here a case of safe and effective use of rituximab in pregnancy-induced thrombotic thrombocytopenia.

Background: Primary dysmenorrhea is a common and often debilitating, gynaecological condition. Objective: To investigate the effects of specific lifestyle variables on the prevalence and severity of primary dysmenorrhea. Materials and Methods: A cross-sectional study of Jordanian women aged between 18– 25 years old utilized a questionnaire as the main instrument of the study. Results: Primary dysmenorrhea was reported by 660 women out of 1988. It was found that approximately two thirds of them were students. Overall, 54.5% of the participants reported severe dysmenorrhea. A statistically significant correlation was found between severe dysmenorrhea and smoking at p value ˂0.001, sleeping less than 7 hours per 24 hours at p = 0.005, holding a university degree at p = 0.032, non-alcohol consumption at p = 0.044, frequent energy, fizzy, tea, coffee drinks and sugar intake. Interestingly, we found that severe dysmenorrhea was statistically significantly associated with women who never eat meat at p ˂0.001, cereals and fish consumers and with those who take less than 3 servings of fruit or none at all per week at p = 0.006. In addition to the previous variables, water intake of less than 1.0 litre a day, irregular cycles, non-OCP use and positive family history were found significantly associated with severe dysmenorrhea. Severe dysmenorrhea was significantly related to working less hours per week, higher stress level and longer bleeding duration at p = 0.021, 0.017 and 0.008, respectively. On the other hand, there was no statistically significant difference found between severe dysmenorrhea and the following variables: age, body mass index (BMI), weekly studying hours and age of menarche. Conclusion: Primary dysmenorrhea is prevalent in the Jordanian population. To overcome severe dysmenorrhea, women should increase their intake of fish and fresh fruits, drinking water and use of oral contraceptive pills. The study concluded that smoking, frequent sugar intake, fizzy drinks, coffee, tea and energy drinks were associated with severe dysmenorrhea. It is also worth mentioning that alcohol consumption had a positive impact on dysmenorrhea. Trial Registration: Registered in Clinicaltrial.gov (ID: NCT04583943).

Introduction: Hysteroscopic surgery and assisted reproduction technology are feasible ways to improve the reproductive outcome. Our aim was to study hysteroscopic septoplasty and myomectomy’s effect on infertility and reproductive performance. Methods: Retrospective cohort of patients who had unexplained infertility and/or recurrent miscarriages and had myomectomy or septoplasty in the period September 2016-october 2021 with a total of 18 months’ follow up. The main outcome measures were spontaneous pregnancy, term pregnancy and miscarriage. For analysis, we used Statistical Package for Social Sciences (SPSS) version 20. Results: One hundred and sixty-five patients were included. The mean age of patients was 39 years. 40 patients had septum resection and 125 patients had hysteroscopic myomectomy. A spontaneous pregnancy rate after surgery was achieved in 46 patients (27.9%). Out of the 64 patients who had failed IVF preoperatively, 32 patients (50%) had a successful IVF post-hysteroscopic surgery and there were more successful cases in the patients who had fibroid resection but this difference did not reach a statistical significance (P value 0.055). In the 79 pregnancies after surgery, preterm birth and miscarriage were seen in 10 patients (12.7%), similarly, respectively after septal or fibroid resection. Miscarriages were less post-operatively. Hysteroscopic myomectomy, compared with hysteroscopic metroplasty, was significantly associated with higher spontaneous pregnancy rate (63.0% Vs 37.0%, P value 0.018), more term pregnancies (87.5% vs. 12.5%, P value 0.001) and less miscarriage rate (40%vs 60%, P value 0.003). Pregnancy post-operatively in patients with primary infertility was more statistically significantly associated with hysteroscopic myomectomy than with hysteroscopic septoplasty (95.8% vs. 4.2%, p value 0.030). In patients who got pregnant postoperatively there was no statistically significant difference in the mode of delivery. Conclusion: In carefully selected patients with unexplained infertility and recurrent miscarriage, hysteroscopic myomectomy, compared with hysteroscopic metroplasty, was significantly associated with higher spontaneous pregnancy, more term pregnancies and less miscarriage rates. More than metroplasty, hysteroscopic myomectomy led to higher spontaneous pregnancies in patients with primary infertility. Trial registration: NCT05560295.

Urinary tract infections (UTI) are common during pregnancy. Identification of antimicrobial susceptibility patterns of microorganisms in pregnant women is important to select the most appropriate antimicrobial. We assessed common uropathogens in pregnant women with UTI and antimicrobial susceptibility, to guide empirical antibiotic selection. In this retrospective study, we analyzed mid-stream urine culture and antibiotic susceptibility data from pregnant women who attended Jordan University Hospital during 2014 to 2018. Data were collected from patients’ charts and urine cultures, and sensitivity results were extracted from the laboratory electronic system. We calculated descriptive statistics and determined correlations among pathogens and antibiotics. We examined 612 positive urine cultures from 559 pregnant women, including 163 (29.2%) inpatients. Escherichia coli (29.4%) was the most frequently identified microorganism, followed by coagulase-negative staphylococci (CoNS) (21.6%). All bacterial isolates were sensitive to aztreonam, chloramphenicol, fosfomycin, ofloxacin, pefloxacin, piperacillin, and colistin sulfate; 87.5% were sensitive to amikacin. Only 15.79%, 18.93%, and 17.91% were sensitive to oxacillin, nalidixic acid, and erythromycin, respectively. E. coli and CoNS were the most commonly identified microorganisms in this study. We found increased antibiotic resistance in Enterobacter species. The chosen antimicrobial therapy in pregnancy should be determined by sensitivity/resistance and fetomaternal safety.

Background and Objective: H1N1 infection carries an increased risk in pregnancy. Our aim was to study the fetomaternal outcome and the effect of early initiation of therapy. Methods: This is a retrospective descriptive study. Confirmed infected cases were included. Maternal age, parity, gestational age at diagnosis, presenting symptoms, time between presentation and starting therapy, ICU admission, and maternal and perinatal outcome were evaluated. Results: Nineteen confirmed patients were included. Most patients are 31 years old or more. Multiparous patients were 73.68% and 57.89% were in the third trimester. Most of our patients presented with cough, fever, and chills. Two patients were admitted to the ICU. One of them was a case of maternal mortality. 42.10% of patients were started on therapy only one day after clinical onset of symptoms. 26.31% delivered before 37 completed weeks. 73.68% delivered beyond term. Around one third delivered vaginally. 45% of babies weighed more than 3 kg. Four babies weighed less than 2 kg. Ninety percent had APGAR scores more than 8 at 1 and 5 minutes after delivery. Twenty five percent were admitted to the NICU with no neonatal mortalities. Conclusions: H1N1 influenza A infection in pregnancy is associated with adverse maternal and perinatal outcomes. Medical and public awareness, low threshold for testing suspected pregnant patients, very early initiation of antiviral therapy, and multidisciplinary approach in our series decreased the overall adverse effects of this infection.