No abstract

Introduction: Cesarean section (CS) delivery is the most common major obstetrical surgical operation carried out in and is increasing in incidence throughout the world. The major involves some risks that might include: infection, coagulation problem, loss of blood, bowel or bladder injury, abnormalities of the placenta in subsequent pregnancies.Aim of the study: To evaluate the clinical effectiveness of postoperative CS intra-abdominal drain insertion.

Introduction Emergency peripartum hysterectomy (EPH) is a foremost operation and is perpetually implemented in the presence of life intimidating hemorrhage during or immediately after abdominal or vaginal deliveries. The aim of this study was to review cases managed at the Department of Gynecology and Obstetrics at Jordan University Hospital (JUH). Material and methods All women who underwent EPH due to any cause in the period from January 2010, to December 2017 were included in the study. Data were collected retrospectively using the patients’ files namelessly. Main measures: age, gravidity, parity, number of previous cesarean sections, previous uterine surgeries, indication for hysterectomy, complications, antepartum bleeding and the need for blood transfusion. Results In total, 74 cases of EPH were managed during the study period. The incidence of EPH ranged from 0.24 to 8.7 per 1000 deliveries. EPH was found to be more common following cesarean sections than vaginal deliveries. The prime indication was abnormal placentation, uterine atony, and uterine rupture. The risk factors included previous cesarean sections, scarred uteruses, multiparity, older age group. Maternal morbidity ranged from 26.5 to 31.5% and mortality from 0 to 12.5% with a mean of 4.8%. Conclusions EPH is the most demanding obstetric surgery performed in very tiresome circumstances of life threatening hemorrhage. The indication for EPH in recent years has changed from outdated uterine atony to abnormal placentation. Antenatal eagerness of the risk factors, engrossment of proficient obstetricians at an early stage of management and a prompt hysterectomy after adequate resuscitation would go a long way in tumbling morbidity and mortality.

Objective: The purpose of this audit is to analyze the indications, complications, and the final histopathology reports of all hysterectomies done under our care during the study period at Jordan University Hospital. The ultimate goal of the study is to clarify the importance of acquiring brain surgical skills during practice and follow-up. It should be a target present in teaching hospitals that adopt educational residency programs. Methods: This is a retrospective study involving all patients who underwent hysterectomy from January 2017 till January 2020. Results: a total of 245 patients underwent hysterectomy (regardless of the type) during the study period. The most common indication was abnormal vaginal bleeding followed by malignancy. The most common intraoperative complication was bladder injury followed by bleeding. The most common postoperative complication was wound infection followed by hematoma. The most common histopathology was benignly followed by malignancy. Conclusion: hysterectomy is a surgical procedure commonly performed to alleviate health welfare; nevertheless, in some situ, actions it is portrayed as a lifesaving procedure. Unsurprisingly, the significance and consequences of related complications mandate for patients planned for the procedure to be appraised thoroughly and adequately before surgery. The aim and art of refining and improving acquired surgical skills and experience portrayed intraoperatively errors a decline in complications rate. Time and practice aid to the ascending linear curve of gained surgical skills, which mirrors a gradual drop in the complications rate.

Background It has been shown that gout is associated with left atrium remodeling and a pro‐inflammatory state leading to the development of atrial fibrillation (AF). There is limited evidence whether gout increases the risk of stroke in patients with AF. We assessed the incidence of gout and the risk of stroke in patients with AF. Methods This is a retrospective cohort study using the 2016 US National Inpatient Sample (NIS) based on ICD‐10 codes. The outcomes of the study were the risk and severity of new stroke in patients with pre‐existing AF and gout. Results In 2016, we identified 3 844 057 patients admitted to the hospitals in NIS with history of AF, of which 240 875 had history of gout. Patients with AF and gout have higher risk of new stroke (OR 2.07 [1.97‐2.19], P < .001), and this risk remains significantly elevated after adjusting for CHADS2VASC score variables, chronic kidney disease, dyslipidemia, obesity, and race (OR 1.10 [1.01‐1.11], P = .041). However, presence of gout in patients with AF was not associated with all‐cause in‐hospital mortality, need for mechanical ventilation, percutaneous gastrostomy tube insertion, or discharge to skilled nursing facility. Conclusion Subjects with AF and gout compared to AF alone had an increased risk of new stroke, but presence of gout was not associated with stroke severity. There is a potential role of gout as a risk factor or a risk marker for stroke in subjects with AF.