Coronavirus disease 2019 (COVID-19) adds more challenges to the perioperative management of parturients. The aim of this study is to examine perioperative adverse events and hemodynamic stability among COVID-19 positive parturients undergoing spinal anesthesia. This prospective observational investigation was conducted at a tertiary teaching hospital in Jordan between January and June 2021, during which 31 COVID-19 positive parturients were identified. Each COVID-19 positive parturient was matched with a COVID-19 negative parturient who received anesthesia under similar operating conditions as a control group. Of the 31 COVID-19 patients, 22 (71%) were otherwise medically free, 8 (25.8%) were emergency cesarean sections. The sensory level of spinal block after 10 min was T8 (T6–T10) among COVID-19 positive group, compared to T4 (T4–T6) among control group (p = 0.001). There were no significant differences in heart rate, SBP, DBP, and MAP intraoperatively (p > 0.05). Twelve (36.4%) neonates born to COVID-19 positive patients were admitted to NICU, compared to four (11.8%) among control group (p = 0.018). There was no statistically significant difference in postoperative complications. In conclusion, spinal anesthesia is considered a safe anesthetic technique in COVID-19 parturients, and therefore it is the anesthetic method of choice for cesarean deliveries among COVID-19 patients.

Background: Stress urinary incontinence (SUI) is a common condition that can significantly impact a patient’s quality of life. Although multiple diagnostic and treatment options exist, significant variability in SUI management exists between countries. Since women’s SUI prevalence in Jordan is high, and Jordan is a lower-middle-income country, this study aimed to investigate how obstetricians and gynecologists (OBGYNs) across Jordan manage and treat women with SUI. Method: A Google Forms survey was prepared and sent out to Jordanian OBGYNs via WhatsApp. The results were collected and arranged in Microsoft Excel and then transferred to SPSS for statistical analysis. Results: Out of the 804 Jordanian registered OBGYNs, 497 could be reached, 240 conduct gynecological surgeries, and 94 completed the survey, providing a response rate of 39.2%. Most of the respondents were females between 41 and 55 years old. More than 70% of the OBGYNs worked in the private sector, and 88.3% operated in the capital of Jordan. Most of the respondents favored lifestyle and behavior therapy (43.6%) or pelvic floor physiotherapy (40.4%) as the first-line management for SUI. The transobturator mid-urethral sling (MUS) was the most common initial surgical treatment option. The physicians preferred two-staged procedures for the repair of pelvic organ prolapse alongside concomitant SUI. In the case of recurrent SUI following surgery, 77% of the respondents chose to refer to a urologist or urogynecologist. Conclusions: The Jordanian OBGYNs preferred using lifestyle/behavioral therapy and pelvic floor muscle physiotherapy as the first-line treatment to manage SUI. Secondly, the MUS would be the most frequently preferred surgical choice. To effectively manage SUI, adequate training in urogynecology and referral resources are essential in lower-middle-income countries.

Background: Pelvic organ prolapse (POP) is a common gynecological problem. Several risk factors have been identified to contribute to the main pathophysiological mechanism of prolapse development. However, the POP data in the Eastern Mediterranean region, including Jordan, are limited, and the risk factors associated with POP were mainly obesity and high number of vaginal deliveries. Since Jordan has a high prevalence of obesity, parity, and type 2 diabetes, the present study aimed primarily to identify the modifiable and non-modifiable factors associated with POP in Jordanian women, and secondly, to evaluate the impact of POP stages on their quality of life. Methods: This study was an age-matched case-control study conducted at the gynecology outpatient clinics at Jordan University Hospital from March 1, 2022, to December 15, 2022. The POP quantification system was used as a standardized method to identify the cases and controls. Sociodemographic, obstetrics, and gynecological characteristics were obtained and correlated with POP. Multivariable logistic regression was performed to determine the independent predictive factors of prolapse occurrence. The Prolapse Quality of Life questionnaire was employed to assess the impact of prolapse across the stages of prolapse. Results: One hundred fifty cases and 150 controls were enrolled in this study, with a median age of 44.5 years. Cystocele and rectocele were the most identified types of prolapse. Nearly 65% of women reported that they had an episiotomy during their deliveries, and 14% reported that there was a family history of prolapse. Multivariable logistic regression revealed that obesity (AOR = 2.31, 95% CI 1.07– 5.84, p = 0.03), episiotomy (AOR = 2.88, 95% CI 1.41– 5.89, p = 0.004) and family history of prolapse (AOR = 3.45, 95% CI 1.3– 9.2, p = 0.013) were associated with POP. Impairment in the quality of life was significantly higher across prolapse severity stages. Conclusion: In Jordan, obesity, episiotomy, and a family history were associated with POP. Quality of life for women with POP was notably impaired as the severity of the prolapse increased.

Objective: Asymptomatic bacteriuria (ASB) is common in pregnant women and can lead to serious complications. During pregnancy, routine screening for bacteriuria is often not standard in many developing countries, leading to underdiagnosis. In Jordan, there is limited data on ASB in pregnant women. This study aimed to determine the prevalence, causative organisms, antibiotic sensitivity, and associations with maternal conditions and diseases. Methods: This cross-sectional, prospective study conducted at Jordan University Hospital assessed the prevalence of ASB in pregnant women. Pregnant women aged ≥ 18 years at any trimester, without symptoms of urinary tract infection, and who had not utilized antibiotics for two weeks, were included. Midstream urine samples were collected, analyzed, cultured, and tested for antibiotic susceptibility in the hospital’s Microbiology laboratory. Results: Out of 319 women, 23.5% (n=76) showed positive urine culture. The chi-square and logistic regression analysis revealed that gestational age and grand multipara were associated with ASB. Neither diabetes nor hypertension (true or gestational) was associated with ASB. Fifty-one of the bacteriuria cases (68%) were positive for pure culture of Escherichia coli, and 4% were mixed with Gram-positive organisms. ASB due to Gram-negative organisms was significantly associated with older age group (p = 0.025). Furthermore, the antibiotic sensitivities of the isolated E. coli showed high percentages (≥ 90%) to nitrofurantoin, aminoglycosides, and some types of cephalosporins, but low (56%) to amoxicillin-clavulanic acid. Conclusion: The prevalence of ASB among Jordanian women was higher than in developed countries and some low-to-middle-income countries, and ASB was significantly associated with gestational age and parity. These findings emphasized the importance of routine screening for ASB during pregnancy, particularly in the third trimester and in grand multiparous women. Although no significant association was found with maternal age or common comorbidities such as diabetes and hypertension, further extensive studies are needed.

Background: Stress urinary incontinence (SUI) affects around 35% of adult women and has a significant impact on quality of life. A single incision sling (SIS), such as Altis^®, was introduced to improve original slings and avoid complications. The present study aimed to evaluate the SIS Altis^® subjective and objective cure rates of women with SUI, mixed urinary incontinence (MUI), recurrent SUI, and SUI with concomitant prolapse and report its complications from one single medical center. Methodology: A retrospective cohort, unsponsored study was conducted at the Jordan University Hospital. All women patients were treated with the SIS Altis^® procedure, and prolapse procedures were also completed as necessary. The chi square analysis for the cure rates was conducted between the subgroups. Results: From June 2016 to June 2019, 111 women patients with a mean age of 48.0 ± 11.3 years underwent a SIS Altis^® procedure. The overall outcome resulted in 81% and 85% of patients being subjectively and objectively cured. The subjectively cured MUI patients were significantly fewer than SUI patients (70% versus 86%, p < 0.05), and patients with recurrent SUI had significantly lower rates (56% for subjective and objective cure rates; p < 0.01 and 0.001). Of the 44 patients who underwent SIS Altis^® and concomitant vaginal repair surgery, no significant differences in subjective and objective cure rates were observed. Only 2.7% of women had mild pain, 2.7% had vaginal tape erosion, and 9% had to be re-operated on. Conclusions: The Altis^® procedure is effective in women who suffer from SUI for a 19-month follow-up period. However, recurrent SUI patients had lower subjective and objective cure rates than primary SUI patients. Further research is needed with a larger sample size in a prospective study design to determine the effectiveness of single SIS in patients with recurrent SUI.

This study aimed to assess the prevalence of genitourinary syndrome of the menopause (GSM) signs and symptoms and their severity in postmenopausal Jordanian women attending a tertiary care hospital in Jordan. A cross-sectional study was conducted on women with medical records at the University of Jordan Hospital complaining of symptoms related to the GSM. The participants were contacted by phone, briefed about the study, and asked if they would like to enroll. The study included demographic questions and validated assessments of Urinary Distress Inventory-6 (UDI-6) and Vulvar Disease Quality of Life Index (VQLI). Differences in the mean scores were assessed based on data normality and association assessment was performed using Pearson’s chi-square test. GSM was reported by 84.9% of 325 postmenopausal women enrolled in the study with an average of 5.1 symptoms per person. Most of the reported urinary symptoms were stress urinary incontinence (54.8%), followed by urge incontinence (48.6%). Furthermore, most reported genital complaints were vulva itching and/or burning sensations (41.2%) and vaginal discharge (40.3%). GSM interfered with the participants’ sexual activity in 44% of the population studied. Smoking was associated with higher UDI-6 scores (p =0.045), and with stress urinary incontinence (1.74 versus 2.19; p = 0.004) and painful intercourse (1.66 versus 2.27; p = 0.011). Furthermore, high BMI was associated with higher UDI-6 and VQDL1 scores (p = 0.029 and p = 0.043). Dysuria was higher (p = 0.007) in women with shorter years of postmenopause (5 years or less), whereas difficulty in emptying the bladder and GSM interference with sexual activity scores were higher in women who had been postmenopausal for more than 5 years (p = 0.041, p = 0.053). The present study showed that a high percentage of postmenopausal Jordanian women developed GSM, with several symptoms per person. Furthermore, the severity of GSM interfered with sexual activity. Smoking and obesity were associated with overall GSM symptoms in Jordanian women.