Nepal Journal of Obstetrics and Gynaecology 2022-02-01T14:51:14+00:00 Prof Gehanath Baral Open Journal Systems <p>Nepal Journal of Obstetrics and Gynaecology (NJOG) is an open access peer reviewed Journal published by Nepal Society of Obstetricians and Gynaecologists to provide academic platform for its members and to ensure their scientific involvement in establishing scientific culture by promoting sharing newer development in different areas of obstetrics and gynaecology.</p> Cover and Table of Content for Print Purpose 2022-02-01T14:51:14+00:00 Editor <p>N/A</p> 2022-01-01T00:00:00+00:00 Copyright (c) 2022 Effect of different intensities of glycemic control on maternal and fetal outcome in women with diabetes in pregnancy 2022-01-05T06:42:04+00:00 Laxmi Devi M Madhav Prasad Lubna Mukhtar <p><strong>Aims: </strong>To compare the feto-maternal outcomes between patients who have achieved different glucose target values after intervention for hyperglycemia in pregnancy.</p> <p><strong>Methods: </strong>A prospective comparative observational study was conducted in the Obstetrics Department of a Teaching Hospital. The main outcome parameters were the values of the fasting blood sugar (FBS) and the postprandial blood sugars (PPBS) obtained from the self-monitoring tests. The patients were grouped into two groups – the tight control group-I and less tight control group-II. maternal and neonatal parameters are compared. Pearson’s chi-square test was used for proportions and unpaired t-test was used for numbers after checking for normality of distribution and p-value of &lt;0.05 was taken as statistically significant.</p> <p><strong>Results: </strong>Average values of&nbsp; FBS/PPBS values were lesser in group I (84/120) compared to group II (93/142).The proportion of maternal and fetal complications (hypertensive disorders, polyhydramnios, macrosomia, neonatal hypoglycemia, hyperbilirubinemia, NICU admission) were similar between the two groups. The average gestational age at delivery (38.2 weeks vs 37.7 weeks), the proportion of LSCS (50% vs 66.7%) and neonatal birth weight (2.88 kg vs 2.98 kg) were similar in both groups.&nbsp;</p> <p><strong>Conclusion: </strong>There is no difference in feto-maternal outcome in between well controlled lesser control of blood sugar</p> 2022-01-01T00:00:00+00:00 Copyright (c) 2022 Laxmi Devi M, Madhav Prasad, Lubna Mukhtar Obstetric outcome in patients with rheumatic heart disease: experience in a tertiary hospital 2022-01-05T07:39:10+00:00 Amar Nath Chaudhary Gehanath Baral Shanti Subedi Sita Ghimire Rakina Bhansakarya <p><strong>Aims</strong>: To determine the clinical outcome of rheumatic heart disease in pregnancy.</p> <p><strong>Methods</strong>: Retrospective cross-sectional descriptive study from April 2019 to April 2021 in Nobel Medical College, Biratnagar, Nepal. Feto-maternal variables were taken for their health status. Data presented in table with frequency.</p> <p><strong>Results</strong>: Out of 13013 deliveries in a year, 49 had cardiac disease (0.37%) and 38 had rheumatic heart disease (0.29%) over 28 weeks of gestation; 95% (n=36) had mitral valve involvement; 12 were primigravida and 7 preterm at the time of delivery. Half of them underwent caesarean section for various indications. Most common maternal complications were cardiac failure, cardiac arrythmia, admission to ICU, obstetric complications, including maternal mortality in 5.2% (n=2) cases. Low birth was in 29% (n=11) of cases, and 34% (n=13) of them needed NICU care at the time of delivery. There was history of rheumatic fever in 9 cases (24%).</p> <p><strong>Conclusions:</strong> Rheumatic heart disease is the commonest diagnosis among heart disease in pregnancy and adverse event can be minimized by multidisciplinary intervention</p> 2022-01-01T00:00:00+00:00 Copyright (c) 2022 Amar Nath Chaudhary, Gehanath Baral, Shanti Subedi, Sita Ghimire, Rakina Bhansakarya Psychological correlates in women with infertility 2022-01-05T06:52:51+00:00 Madhva Prasad Shreedhar Venkatesh Sampath Kumar Amrutha Pentakota Vijaylakshmi <p><strong>ABSTRACT</strong></p> <p><strong>Aims: </strong>To assess the psychological status of infertile women using the Fertility Problem Inventory and to identify any relationship between characteristics of infertility and the psychological problems.</p> <p><strong>Methods: </strong>A prospective, quantitative, descriptive, questionnaire- based study with institutional ethics committee clearance was conducted for two months, on women undergoing infertility treatment. Fertility Problem Inventory Questionnaire was applied and stress levels analyzed. Data were tabulated into Microsoft Excel and statistical analysis was performed in terms of percentages and students t tests for categorical variables.</p> <p><strong>Results: </strong>Thirty-two patients were studied in the time period with an average of 30.15 years. Seventy-five percent of the patients were found to be suffering from a moderately severe level of infertility-related stress. The remaining were suffering from a moderate level of infertility-related stress. The duration of marriage was found to have a significant correlation with the stress.</p> <p><strong>Conclusions: </strong>Majority (two-thirds) of the study group were suffering from a serious psychological morbidity. Psychological evaluation of people seeking infertility treatment could be considered</p> 2022-01-01T00:00:00+00:00 Copyright (c) 2022 Madhva Prasad, Shreedhar Venkatesh, Sampath Kumar, Amrutha Pentakota, Vijaylakshmi Gestational Weight Gain among women with different pre-pregnancy BMI and its relation with Birth Weight of Neonates 2022-01-05T07:01:20+00:00 Rupa Paneru Meena Thapa <p><strong>Aim: </strong>To find out the relationship between gestational weight gain among women with different&nbsp; early pregnancy Body Mass Index and birth weight of neonates.</p> <p><strong>Methods: </strong>This is an analytical observational hospital based study. Singleton pregnancy within 10 weeks of gestation were included in the study and they were followed at term. First trimester Body Mass Index was calculated and the women were divided in to underweight, normal weight, overweight and obese according to World Health Organization classification. Total gestational weight gain was calculated and compared according to the American College of Obstetrics guideline. The birth weight of neonate was recorded soon after the delivery and the relation between gestational weight gain and birth weight of the neonate was studied.</p> <p><strong>Results: </strong>Total 228 women were analyzed. Most of the women (69%) had normal Body Mass Index with the mean gestational weight gain of 10.59±4.317 kg and the mean birth weight 3.03±0.487 kg. Underweight and normal weight women had less pregnancy weight gain; overweight women had slightly higher weight gain whereas obese women had weight gain as per the recommendation. The birth weight of neonate was higher in overweight and obese women (p=0.004) but without positive correlation.</p> <p><strong>Conclusions: </strong>The gestational weight gain is not related to the birth weight of neonates but related to the early pregnancy BMI.</p> 2022-01-01T00:00:00+00:00 Copyright (c) 2022 Rupa Paneru, Meena Thapa Maternal and Fetal Outcomes in Active versus Expectant Management of prelabor rupture of membrane 2022-01-05T07:05:04+00:00 Rosy Vaidya Malla Shailaja Khadka Sumana Thapa Sumit Bidari Indira Acharya Bibhusan Neupane Kopila Rai <p><strong>Aim</strong>: To assess the effects of planned early birth (active treatment within 24hrs) compared to expectant management (without active treatment within 24hrs) for women at term with Prelabor Rupture of Membrane (PROM) on maternal and fetal outcomes.</p> <p><strong>Methods</strong>: This is an observational comparative study carried out in all the pregnant women who present in maternity ward of Shree Birendra Hospital with PROM at 37-41 weeks of gestation with vertex presentation during the study period between 13 April 2020 to 13 April 2021.They were randomly placed into (A) active treatment group and (B) expectant treatment group. Group (A) was induced with 25mcg of PGE1 (Misoprostol) depending on cervical score, whereas group (B) was expectantly managed for 24 hrs. PROM to delivery interval, maternal and fetal outcomes were then evaluated in both the groups.</p> <p><strong>Results</strong>: 79.5% of group A and 71.8% in group B delivered through vaginal route. 20.5% patients in group A and 28.2% patients in group B underwent Cesarean section. The average PROM to delivery interval was 15.6 hours in group A, as compared to 16.8 hours in group B. Only 2 babies in group B had an Apgar score of less than 7 at five minutes. Subsequently, in both the groups, two babies required NICU admission for respiratory distress syndrome with no neonatal mortality in both the groups.</p> <p><strong>Conclusion</strong>: Expectant management up to 24 hours can be safely offered to a woman with term PROM.</p> 2022-01-01T00:00:00+00:00 Copyright (c) 2022 Rosy Vaidya Malla, Shailaja Khadka, Sumana Thapa, Sumit Bidari, Indira Acharya, Bibhusan Neupane, Kopila Rai Pregnancy Outcome in Early versus Late Onset Preeclampsia 2022-01-05T07:15:20+00:00 Junu Shrestha Anjali Subedi Eva Gauchan Aashika Shrestha Chandani Pandey <p><strong>Aims: </strong>To determine the pregnancy outcome of early and late onset preeclampsia.</p> <p><strong>Methods:&nbsp; </strong>This was a cross sectional analytical study conducted in the department of Obstetrics and Gynaecology, Manipal Teaching Hospital from July to October 2021. All cases of preeclampsia diagnosed according to International Society of Study of Hypertension in Pregnancy 2018, were included. Early and late onset preeclampsia cut-off used was 34 weeks. Preeclampsia diagnosed before 34 were classified as early onset and after 34 weeks as late onset preeclampsia. Maternal and perinatal outcomes were analyzed using Statistical Package for Social Sciences version 21.</p> <p><strong>Results: </strong>The prevalence of early onset and late onset preeclampsia were 4.3% and 8.3% of all deliveries. Early to late onset preeclampsia were 1:2. Renal involvement, placental abruption, IUGR, low birth weight, low Apgar and perinatal morbidity were significantly more in early onset; pre-term labor&nbsp; and use of MgSO<sub>4</sub> and antihypertensives were also more in early onset.</p> <p><strong>Conclusion: </strong>Late onset preeclampsia was more common than early onset preeclampsia but the maternal and perinatal outcome were poor for early onset as compared to late onset preeclampsia.</p> 2022-01-01T00:00:00+00:00 Copyright (c) 2022 Junu Shrestha, Anjali Subedi, Eva Gauchan, Aashika Shrestha, Chandani Pandey Incidence and risk factors of perineal tears of pregnant women delivering at a midwife obstetric unit South Africa 2022-01-05T07:23:41+00:00 Akm Monjurul Hoque Somaya Buckus <p><strong>Aim: </strong>To estimate the incidence and risk factors for perineal tears of low-risk pregnant women delivering at a midwife obstetric unit.</p> <p><strong>Methods: </strong>&nbsp;A retrospective study performed on perineal tear during childbirth from birth register at midwife run unit in Durban municipality, South Africa between January 2018 and October 2019. Risk factors were studied and bivariate and logistic regression done. Results are expressed with adjusted odds ratios (OR) and p-values &lt;0.05 are considered significant.</p> <p><strong>Results:</strong> A total of 1578 women had singleton vaginal childbirths. Half (50.6%) of them have perineal tears. The incidences of episiotomy, combined first-and second, and third-and fourth- degree (OASI) tears are 24.3%, 25.1% and 1.1% respectively. Risk factors for any perineal tears are younger mothers (teenage OR=2.9, 20-24 years OR=2.2), primipara (OR= 15.8), received antenatal care (OR=.47) and gestational age (GA) (&lt;32 weeks OR=.05). The risk factors for episiotomy are; teenage (OR=5.4), ages 20-24 years (OR=4.2), ages 25-29 years (OR=3.0), primipara (OR=12.4), GA (£32 weeks OR=.16), GA 33-36 weeks (OR=.6) and having antenatal care (OR=.41). Birth weight &lt;2.5 kg and between 2.5-3.0 kgs (OR=.014) and (OR=.09) are protective for OASI.</p> <p><strong>Conclusions: </strong>Risk factors for the perineal injuries are similar to those previously reported in other studies. Training of midwives on perineal care and selection for undertaking episiotomy is urgently needed to improve maternity services at the midwife obstetric unit. Identification of those at risk may reduce obstetric perineal injury.</p> 2022-01-01T00:00:00+00:00 Copyright (c) 2022 Akm Monjurul Hoque, Somaya Buckus Maternal and fetal outcome of severe pre-eclampsia and eclampsia in cesarean section and normal delivery 2022-01-05T07:28:13+00:00 Lokeshwari K Sreenivasa B <p><strong>Aims:</strong> To evaluate the maternal and fetal outcomes in severe preeclampsia and eclampsia in Cesarean Section&nbsp; and normal delivery .</p> <p><strong>Methods:</strong> An observational descriptive study of severe pre-eclampsia-eclampsia conducted in the Department of Obstetrics and Gynaecology, Basaveshwara Medical College Hospital. Gestational age 32-42 weeks were included and imminent deliveries were excluded from the study. Primary outcome variables were mode of delivery, maternal morbidity-mortality, and perinatal morbidity-mortality.</p> <p>&nbsp;<strong>Results:</strong> 63.2% in severe pre-eclampsia, 50% in eclampsia group delivered vaginally; 15.1%&nbsp; in severe preeclampsia and 25% in eclampsia group underwent elective LSCS; 21.7% in severe preeclampsia and 25% in eclampsia group underwent&nbsp; emergency LSCS. Incidence of cesarean deliveries in severe pre-eclampsia was 36.8% and in eclampsia it was 50%. No maternal death was observed in elective LSCS. Maternal death in vaginal delivery cases was 0.94% in severe preeclampsia and 4.76% in eclampsia. In emergency LSCS cases maternal mortality was 1.4% in severe preeclampsia and 4.76% in eclampsia group. No perinatal mortality was observed in elective LSCS group; 4.7% perinatal mortality occurred in normal delivery, 20.5% in emergency LSCS in severe preeclampsia and 7.1% in eclampsia who were delivered&nbsp; vaginally.</p> <p><strong>Conclusion:</strong> In eclampsia, feto-maternal outcome is better in the cesarean deliveries than in the vaginal deliveries</p> 2022-01-01T00:00:00+00:00 Copyright (c) 2022 Lokeshwari K, Sreenivasa B Awareness and Attitude Regarding Teenage Pregnancy among Adolescent Girls of Chandannath Municipality, Jumla 2022-01-05T07:32:19+00:00 Sharmila Shrestha Sarita Shrestha Monika Lama Sujata Ojha Savina Thapa <p><strong>Objectives:</strong> To assess the awareness and attitude regarding teenage pregnancy among adolescent girls.</p> <p><strong>Methods:</strong> A descriptive cross- sectional design was carried out among 334 adolescent girls of school students of Chandannath Municipality, Jumla.</p> <p><strong>Results:</strong> Awareness of teenage pregnancy was inadequate in 68% of adolescent&nbsp;girls, moderate in 26% and adequate in only 6%. Attitude to denounce teenage pregnancy was good in 58.1%, neutral in 34.4% and unfavorable in7.5%. There was no relation between awareness and attitude regarding teenage pregnancy and types of family, level of education of father and mother.</p> <p><strong>Conclusion:</strong> Despite of favourable attitude against teenage pregnancy, the awareness level is low in adolescent girls. There was no significant difference between demographic variables with awareness and attitude regarding teenage pregnancy.</p> 2022-01-01T00:00:00+00:00 Copyright (c) 2022 Sharmila Shrestha, Sarita Shrestha, Monika Lama, Sujata Ojha, Savina Thapa Diagnostic laparoscopy findings in pelvic pain among the women attending Gynecology OPD at Dhulikhel Hospital 2022-01-05T07:47:21+00:00 Arun Yadav Suman Raj Tamrakar <p><strong>Aims: </strong>To evaluate the laparoscopic findings in women with pelvic pain.</p> <p><strong>Methods: </strong>A prospective study conducted in Department of Obstetrics and Gynecology at Dhulikhel Hospital from March 2017 to December 2018. All women with pelvic pain, ultrasound evaluation and laparoscopic procedure at the hospital were taken. Data entered in SPSS 23 and analyzed using descriptive parameters.</p> <p><strong>Results: </strong>Maximum number of cases of pelvic pain belonged to 21-30 years, most of them were parous with mean duration of pain of 16.48±4 months. The mean age and parity of the patients was 34±5 years and 1.74 respectively. The most common complaint was dysmenorrhea (33.3%) followed by abnormal vaginal discharge (31.7%). On clinical examination, pelvic tenderness was observed in majority (21.7%) of cases.</p> <p>On laparoscopic examination, normal finding were seen in 41.7% cases followed by pelvic inflammatory disease (19.2%), endometriosis (17.5%), pelvic adhesion (12.5%), retroverted uterus (2.5%). PCOS, pelvic congestion and fimbrial cyst were seen in 1.7% each. Pyosalphinx and twisted ovary were seen in 0.8% each.</p> <p><strong>Conclusions: </strong>Laparoscopy serves as diagnostic as well as a therapeutic modality of management in chronic pelvic pain.</p> 2022-01-01T00:00:00+00:00 Copyright (c) 2022 Arun Yadav, Suman Raj Tamrakar Choosing Research Title 2022-01-05T03:56:59+00:00 Gehanath Baral <p>Biomedical research title should represent the main idea or message of research content and catchy to the readers. The main idea would be the purpose, finding and method of research, and there should be searchable keywords within it. Catchy title in simple words or phrase creates interest to the readers, can be easily remembered and communicated to all. Shortest possible length of title disregarding syntaxes is a good title and should always follow the instruction from the academic authority.</p> 2022-01-01T00:00:00+00:00 Copyright (c) 2022 Gehanath Baral Electrical Cardioversion in Pregnancy: A Case Report 2022-01-05T08:06:19+00:00 Hima Rijal S Thapa Pooja Jha <p>A case of 28 years primigravida with refractory tachycardia at term is reported. She was refractory to medical cardioversion. Electrical cardioversion was applied before and after the delivery of baby. With several cycles of variable joules of electrical cardioversion, the normal rhythm was not obtained. However, patient’s rhythm reverted to sinus with anti-arrhythmic medication after third week of cesearean delivery.</p> 2022-01-01T00:00:00+00:00 Copyright (c) 2022 Hima Rijal, S Thapa, Pooja Jha Juvenile nulliparous uterine prolapse in an unmarried 17-year-old adolescent 2022-01-05T08:03:06+00:00 Apariharya Rana Ashma Rana <p>In a peripheral health camp, a 17-year-old juvenile nullipara who presented with the history of something coming out per vagina was clinically diagnosed as third-degree pelvic organ prolapse (POP) Stage III, acknowledged as a rarity concerning patient wellbeing and reproductive future.</p> 2022-01-01T00:00:00+00:00 Copyright (c) 2022 Apariharya Rana, Ashma Rana Unusual occurrence of tuberculosis in mature cystic teratoma 2022-01-05T08:21:27+00:00 Sanjib Pariyar Shovana Karki <p>Mature cystic teratoma is a common benign germ cell tumor of ovary. Unusual presentation can be seen in mature cystic teratoma like struma ovarii, carcinoid tumor, and malignant transformation. Detection of tuberculosis in mature cystic teratoma is uncommon. Here, a 57-years-female who presented with abdominal mass and pain abdomen who had tuberculosis in mature cystic teratoma</p> 2022-01-01T00:00:00+00:00 Copyright (c) 2022 Sanjib Pariyar, Shovana Karki Types of plagiarism and how to avoid misconduct: Pros and cons of plagiarism detection tools in research writing and publication 2022-01-05T03:59:12+00:00 Jay N Shah Jenifei Shah Gehanath Baral Reetu Baral Jesifei Shah <p>The ultimate journey of research and writing is publication. To see one’s name listed in the author's byline is an exciting feeling. This exciting feeling of authorship credit is linked with responsibility. The impact of the published work will depend on the dissemination of evidence-based scientific findings to help the health care workers, scientists, and policymakers for the benefit of society. This requires ethical research, to begin with, and publication without misconduct to maintain the integrity and trust in science. Among various misconducts in research writing and publication, plagiarism is serious scientific misconduct. The issue of plagiarism is a global concern that requires a collective effort from all stakeholders to prevent it and take prompt action if this issue does arise. Adequate teaching and training are necessary to increase awareness right from the early phases of learning; and to develop a culture of ethical research, writing, and publication. Types of plagiarism and its characteristics vary and should be dealt with accordingly, from a warning to definitive punishment for the offense committed. The software available to detect and avoid plagiarism is plenty and should be used taking into consideration their accuracy, usability, and cost.</p> 2022-01-01T00:00:00+00:00 Copyright (c) 2022 Jay N Shah, Jenifei Shah, Gehanath Baral Ovarian Steroid Cell Tumor, Not Otherwise Specified: a case series 2022-01-05T07:58:10+00:00 Sunitha Sankaralingappa Sanjiban Patra Priti Trivedi <p>Case series of Ovarian Steroid Cell Tumor Not Otherwise Specified is being reported in a child and two post-menopausal females. Hormonal symptoms were present in all of them. Two of three had malignant potential. The clinical presentation and histopathologic features and treatment of this extremely rare variety of sex cord stromal tumor has been discussed.</p> 2022-01-01T00:00:00+00:00 Copyright (c) 2022 Sunitha Sankaralingappa, Sanjiban Patra, Priti Trivedi Diagnosis and management of ectopic ureter in a low resource setting – A case series 2022-01-05T07:53:54+00:00 Shirley Heywood Shuvechchha Dewa Shrestha <p><strong>Aims:</strong>&nbsp; To review the experience of women and girls treated for ectopic ureter in Surkhet through the fistula camps and Fistula Treatment Centre and analyse the diagnostic method, management and outcome.</p> <p><strong>Methods:</strong> This was a retrospective study of the patients with ectopic ureter who received treatment in Surkhet since 2009. Data were analysed from patient records and interviews.</p> <p><strong>Results:</strong>&nbsp; Seven patients were diagnosed with ectopic ureter over a period of 12 years. Five patients were prepubertal with age range of &nbsp;7 - 15 years. History of continuous incontinence with normal voiding was suggestive of ureteric fistula in six out of seven cases. The seventh case had massive ureterocele in the distal end of the duplex right ureter. Ultrasound suggested a diagnosis of duplex collecting system in five cases. IVU or CT IVU suggested duplex ureter in only three cases. Diagnosis was confirmed by examination under anaesthesia after i.v. frusemide in six cases. All cases were managed by implantation of the ectopic ureter into the bladder. In the case with ureterocele heminephrectomy was performed. All seven patients are well at follow-up between 6 months and five years after presentation.&nbsp;&nbsp;</p> <p><strong>Conclusion:</strong> Ectopic ureter is a treatable cause of urinary incontinence and the diagnosis may be overlooked. A lifelong history of continuous urinary leakage with normal voiding, in absence of trauma or surgical procedure should raise the suspicion. Examination under anaesthetic and ultrasound proved most effective in confirming the diagnosis</p> 2022-01-01T00:00:00+00:00 Copyright (c) 2022 Shirley Heywood, Shuvechchha Dewa Shrestha