Objective:To evaluate the effectiveness of hysteroscopic trans-cervical resection of endometrial polyps in improving pregnancy rates. and 25 patients were included with a diagnosis of primary or secondary infertility for a minimum of 2 years. Endometrial polyps were diagnosed by trans-vaginal Ultrasound scan and confirmed later by hysteroscopy. The inclusion criteria were age under 38 years, menstrual irregularities for at least 6 months, no other cause of infertility was found after diagnostic workup of the couples, minimum 2 years of infertility and 18 months of follow-up with attempts to conceive after hysteroscopic polypectomy. All polyps were larger than 1.5 cm. The effect of the different sizes of the polyps was not evaluated in our study.Results: All 125 Patients had endometrial polyps on transvaginal scans and confirmed at hysteroscopic removal and histological examination. Among patients of the study group, there were no significant differences in age, type or length of infertility, or follow-up period after the procedure. The mean size of the endometrial polyps was 3.0 cm ± 0.5cm. Sixty patients had endometrial polyp ≤ 2.8 cm and 65 patients had bigger or multiple endometrial polyps. Following the procedure, menstrual irregularity was back to normal in 90% of patients. After the procedure, the spontaneous pregnancy rate was 80% (100 patients of the total number of patients) and delivery at term rate was 70% (70 patients out of the 100 patients who conceived). Spontaneous abortion rate in the first trimester of pregnancy was 12% (12 patients) of the total number of pregnant patients. Type of infertility did not affect fertility rates after hysteroscopic polypectomy. There were no complications related to the procedure in the study patients and only 13 patients (10.5%) had recurrence of their menstrual irregularities. Conclusion:Fertility rate in patients with endometrial polyps and menstrual irregularities with no other cause to explain their infertility is significantly improved with trans-cervical polypectomy. The procedure is also safe with low recurrence rate.

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IntroductionCervical cancer is a malignant neoplasm arising from cells originating in the cervix uteri. It is routinely screened by Papanicolaou's (Pap) smear and human papilloma virus (HPV) is considered as one of its etiological agents. Cervical cancer is the second most common cancer in reproductive age and its diagnosis is increasing in young age as a result of effective and widespread screening programs (1). Cervical cancer is the seventh most common cancer in developed countries. In 2004, around 30,750 new cases of invasive cervical cancer were diagnosed in Europe. In 2012, around 12,170 new cases were discovered in USA and the estimated deaths were 4,220. Unfortunately, the incidence of new cases is much more in developing countries due to inefficient screening programs (2). Due to effective and widespread screening programs and the delay in childbearing age, many women are diagnosed at a time which there is a strong demand for fertility sparing surgery (3). Radical hysterectomy and pelvic lymphadenectomy are the conventional treatment for early stage cervical cancer, but this results in loss of fertility (4). Fertility preservation is one of the most important issues to be discussed with the patient. In the last 20 years, laparascopy assisted radical vaginal trachelectomy (RVT) and radical abdominal trachelectomy have developed that have good documented long term oncological and pregnancy outcome. RVT is a fertility-sparing technique first described by Daniel Dargent in 1994 (5), involving the removal of the cervix, the parametrium, and cuff of vagina, while maintaining the patient's uterine fundus and adnexae. This procedure, in combination with a laparoscopic pelvic lymphadenectomy, is the most common and accepted fertility-sparing procedure for early cervical cancer. RVT begins with laparoscopic pelvic lymphadenectomy. The vaginal procedure is started by circumferential incision in the upper vagina. The supracervical ligament is cut, and the bladder base is mobilized. Posteriorly, the pouch of Douglas is opened and the pararectal spaces are exposed. The uterosacral ligaments are then divided. The vesicovaginal ligaments are then identified, and the paravesical spaces are entered laterally. Then the ureters and uterine arteries are identified. The cardinal ligaments are then divided. The cervix is amputated below the cervical isthmus (5,6). Although RVT associated with laparoscopic pelvic lymphadenectomy is the most used surgical procedure, radical trachelectomy (RT) may be performed either abdominally or vaginally (laparoscopic or robotic). It is estimated that around 40% of candidates for radical hysterectomy can undergo RT, but 12% of these cases will AbstractObjectives: To review the role of trachelectomy as a method of fertility preservation instead of traditional radical hysterectomy in early cervical cancer. Materials and Methods: We conducted our original study through research in PubMed for all original studies and reviews published in the last 10 years. We reviewed the data available on trach...

Objectives: To study cervical length measurement by transvaginal ultrasound at 20-28 weeks as predictor for women at risk of preterm delivery. Methods: This study was done over a period of one year between 2012 and 2013 at prince Rashid Bin Al-Hassan Military Hospital-Irbid-Jordan. Cervical assessment by transvaginal sonography was done in 100 women at 20-28 weeks of gestation. The gestation at delivery in woman with cervical length more or equal to 3 cm (group A, n=80) were compared with that in woman with cervical length < 3 cm (group B, n=20) Results: thirty-eight percent of patients were primigravidas and 61.25% were multigravidas in group A, while 35% of them were primigravidas and 65% were multigravidas in group B. The most age group of the women was between 21-30 years in both groups. The incidence of preterm delivery was 13.75% in group A as compared to 90% in group B (p<0.005). In group A of the 80 women 11 delivered preterm (13.75%), 7 of them between 32 and 37 weeks of gestation and 4 women before 32 weeks. While in group B, 18 of the 20 women (90%) delivered preterm (10 before 32 weeks, 8 between 32 and 37 weeks and 2 after 37 weeks). The mean cervical length in group A women was 3.5±0.6 cm, while it was 2.1±0.5 cm in group B women. Conclusion: Transvaginal ultrasound has been shown to be an objective sensitive and reliable method to assess the cervix and predict the risk of preterm delivery.

Objective: To evaluate the association between passive smoking and adverse reproductive effects or pregnancy outcomes among Jordanian pregnant women. Material and Methods: This was a retrospective study which was conducted at Prince Rashid Ben Alhasan hospital between 2011 and 2013. Total samples of 4125 newborns were included in the study. The demographic characteristics of these newborns included: gestational age, gender, birth weight, congenital anomaly, mode of delivery and admission to NICU. Maternal characteristics of Jordanian women according to passive smoking included: age, parity, weight, and income. Results: Pregnancy outcome for Jordanian women according to passive smoking status indicated that passive smoking is related with stillbirth with an incidence of 1.0%, low birth weight in 11.9%, pre-term delivery in 12.5%, congenital anomaly in 1.6%, caesarean delivery in 23.7% and need for admission in NICU in 35.4%. The result indicated that exposure to passive smoking during pregnancy had adverse effects on low birth weight, admission to NICU, and need for antibiotic significantly, p-value <.0005. Conclusion: Exposure to passive smoking during pregnancy had adverse effects on pregnancy outcome. Adverse reproductive effects are serious and costly health problems that have a huge impact on morbidity and mortality rate in all societies.