Nepal Journal of Obstetrics and Gynaecology 2020-01-17T18:02:45+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> Medical professionalism 2020-01-17T17:40:49+00:00 Gehanath Baral <p>Medical profession is a social contract between doctor and society in medical practice. It follows the business principle with human touch for a dignified medical profession. Proficiency, competency, evidences and set standards in education, training and practice are the key features of medical profession.</p> <p><strong>Keywords:</strong> business principle, doctor, medical profession, regulation, society</p> 2019-12-09T00:00:00+00:00 ##submission.copyrightStatement## Postpartum Depression: Prevention strategies in South East Asia and its possibility of replication in Nepal 2020-01-17T17:39:59+00:00 Manisha Singh Ishwar Tiwari Dinesh Bhandari Basanta Katwal <p><strong>Aims:</strong> To identify existing interventions in South East Asian countries implemented to prevent postpartum depression (PPD) and explore the possibility of replication of such interventions in Nepal to reduce it.</p> <p><strong>Methods: </strong>The paper reviewed the risk factors and preventive strategies implemented in South East Asian countries to prevent PPD.</p> <p><strong>Results: </strong>Enough actions have not been taken to address PPD despite of high prevalence in the reviewed countries (Bangladesh, India, Pakistan, Srilanka and Nepal). However, some of the interventions used such as cognitive behavior therapy, education for girls, poverty alleviation program, participatory approach for empowerment and involvement of community health workers have shown positive impact on reducing PPD.</p> <p><strong>Conclusions: </strong>The interventions used in South East Asian countries were simple in design intervention and mostly conducted through community health workers; it showed a possibility of replication in Nepal as it already has sufficient community workforces working in maternal and child health.</p> <p>&nbsp;</p> <p><strong>Keywords: </strong>interventions, maternal depression, maternal mental health, post–partum depression, prevention, south asia, strategies</p> 2019-12-09T00:00:00+00:00 ##submission.copyrightStatement## Genital fistula: Successes, challenges, and way forward in a facility specialization in fistula management in Bangladesh 2020-01-17T17:42:04+00:00 Nrinmoy Biswas Iftikher Mahmood Sathyanarayan Doraiswamy Animesh Biswas <p><strong>Aims: </strong>To explore the prevalence, types of genital fistulas as well as their success, challenges, and way forward on genital fistula in Bangladesh.</p> <p><strong>Methods:</strong> Between October 2017 and September 2018, Hope Hospital identified a total number of 101 genital fistula cases though a community network system in Cox’s Bazar. For each of the patients, detailed case histories and clinical management reports documented, and the data were interpreted using descriptive analysis.</p> <p><strong>Results:</strong> Out of 101 genital fistula cases admitted to the facility, 95.3% (n=96) of cases were obstetric; three cases iatrogenic, and one each traumatic and congenital. The median age of the women was 28 years (range: 18 -73) and the median duration of two years (range: 1 month-53 years). Most of the cases had urinary incontinence (86.1 %, n=85) and 12 and two cases were fecal and mixed type respectively. Vesicovaginal fistula (VVF) repair was performed in most of the cases (78.2%, n=79) while 21.8% (n=22) received recto vaginal fistula (RVF) repair. 90% (n=91) were discharged without complication. The median duration of hospital stay was 16 days (range: 4 -29). The success rate was 86.1% (n=85), and 16 cases advised for repeat surgery. Pre-and post-surgery counselling was provided without rehabilitation or reintegration support.</p> <p><strong>Conclusions: </strong>Facility data in a particular geographic location represents high prevalence of obstetric fistula and lacks rehabilitation and social reintegration support. Further study is essential to draw a complete geographical map for genital fistula in Bangladesh.</p> <p><strong>Keywords:</strong> genital fistula, management, rehabilitation, Bangladesh</p> 2019-12-09T00:00:00+00:00 ##submission.copyrightStatement## Depression common in early pregnancy and correlates with poor quality of life 2020-01-17T17:43:01+00:00 Gurmeet Singh <p><strong>Aims</strong>: To look for prevalence of depression in patients with early pregnancy and see the effect of depression on quality of life (QOL).</p> <p><strong>Methods</strong>: Patients in early pregnancy with gestational age &lt;12 weeks were enrolled into the study. Depression was assessed with Center for epidemiologic studies depression (CES-D) scale. QOL was measured using the World Health Organization QOL‑BREF (WHOQOL‑BREF).</p> <p><strong>Results: </strong>Out of 74 patients were enrolled in the study 51(68%) patients had depression, 52 (70%) had vomiting and 15(20.2%) had unplanned pregnancy. Patients with depression had higher prevalence of vomiting (78% versus 52%, P =0.022) and lower prevalence of unplanned pregnancy (13% versus 34% P=0.037) as compared to patients without depression. Patients with depression had significantly lower scores for physical , psychological and environmental domains of QOL. There was no difference in the age, gestational age, previous preterm delivery, previous miscarriage, previous pregnancies and social domain of QOL between patients with and without depression. Depression score had significant negative correlation with physical (r= -0.588,p&lt;0.001),&nbsp; psychological (r= -0.561, p &lt;0.001) and environmental (r= -0.313, p=0.007) domains of&nbsp; WHOQOL-BREF.</p> <p><strong>Conclusions: </strong>Depression is common in patients with early pregnancy and correlates with lower QOL of life. Depressed patients were more likely to have vomiting and poor QOL.</p> <p><strong>Key Words:</strong> depression, early pregnancy, quality of life, vomiting.&nbsp;</p> 2019-12-09T00:00:00+00:00 ##submission.copyrightStatement## Analysis of Uterine Rupture in Pregnancy at a Tertiary Care Hospital 2020-01-17T17:45:00+00:00 Beemba Shakya <p><strong>Aims:</strong> To analyze patients with uterine rupture in pregnancy.</p> <p><strong>Methods:</strong> This was a cross-sectional retrospective study undertaken at Paropakar Maternity and Women’s Hospital. Two years’ medical records of uterine rupture between 14 April 2017 and 13 April 2019 were reviewed. Information on patient characteristics, age, parity, mode of previous deliveries, onset of labour spontaneous or induced, type and site of rupture, maternal and perinatal outcome, management and complications associated with it were retrieved and was analyzed using SPSS version 16.0.</p> <p><strong>Results:</strong> Among 29 uterine rupture cases, majority of cases occurred in 25-29 years (48.3%), para1 (79.3%) and unbooked cases (72.4%). Most of them occurred in previous scar 23(79.3%); rupture was complete in 13 and incomplete in 10 cases. Six (20.6%) were unscarred uterine rupture. Rupture repair was done in 24(82.7%) and peripartum hysterectomy (subtotal hysterectomy) in 5(17.2%) cases. The most common complications were postpartun hemorrhage (55.2%), hospital stay &gt;7 days (55.2%), blood transfusion (48.3%) and ICU admission (41.3%). There was no maternal mortality. Perinatal death was 15 (51.7%)-13 stillbirths and 2 neonatal deaths.</p> <p><strong>Conclusions:&nbsp; </strong>Majority of the uterine rupture occurred in previous scar (79.3%). Most of the cases underwent repair of the uterus (82.7%) and remaining were peripartum hysterectomy (17.2%). There was no maternal mortality. However, perinatal mortality occurred in 51.7%.</p> <p><strong>Keywords:</strong> peripartum hysterectomies, previous scar, repair of uterus, uterine rupture.</p> 2019-12-09T00:00:00+00:00 ##submission.copyrightStatement## Invasive cervical cancer in HIV-infected women in low-income countries: experience from Côte d'Ivoire 2020-01-17T17:48:18+00:00 Edouard N’guessan Moctar Toure Jean-Marc Dia Franck Gbeli Privat Guie <p><strong>Aims:</strong> To assess experience in the management of invasive cervical cancer in HIV- infected women in a sub-medical setting.</p> <p><strong>Methods: </strong>Retrospective cohort study of patients with cervical cancer at the University Hospital of Treichville between 2012 and 2016. The association between HIV infection and epidemiological data was investigated using the chi-square test. Survival data were calculated according to the Kaplan-Meier method.</p> <p><strong>Results: </strong>A total of 99 women with cervical cancer were included in the study; 49 (49.5%) of whom were HIV positive. The average age of patients was 51.5 years. HIV testing was performed in 53.1% after the diagnosis of cancer. Virtually all (98%) of women living with HIV had received antiretroviral therapy. Their median CD4 was 382 elements / ml. HIV infected Women were significantly younger than HIV-negative women. The median survival rate for patients living with HIV was 9.6 months Versus 15 months for HIV-negative patients. HIV infection was associated with a significant increase in deaths and a shorter survival among patients with cervical cancer.</p> <p><strong>Conclusions:</strong> Cervical cancer is more aggressive in HIV infected women. Overall survival was significantly shorter when the patients were infected with HIV.</p> 2019-12-09T00:00:00+00:00 ##submission.copyrightStatement## Correlation of colposcopy with biopsy in cases of abnormal cervical cytology 2020-01-17T17:49:49+00:00 Kirtipal Subedi <p><strong>Aims: </strong>This study aims to find out the role of colposcopy and its correlation with cervical biopsy in detection of pre malignant cervical lesion.</p> <p><strong>Methodology: </strong>This is hospital based prospective observational study on 60 cases with abnormal cervical cytology reports conducted in the Department of Obstetrics and Gynecology, PMWH, Thapathali, Kathmandu. Colposcopy guided biopsies were done and findings noted.</p> <p><strong>Results: </strong>Among 60 cases enrolled in the study the most common cervical cytology finding was ASCUS, LSIL, HSIL and ASC-H present in 46.6%, 31.6%, 15% and 6.6% respectively.&nbsp; The colposcopy finding among these cases was normal, CIN1, CIN 2 and CIN 3 in 45%, 23.3%, 16.7% and 9% respectively. Among these cases the most common biopsy finding was normal, CIN 1, CIN 2, CIN 3 and squamous cell carcinoma in 55%, 18.3%, 8.3%, 15% and 3.3% respectively. The sensitivity, specificity, positive predictive value and negative predictive value of colposcopy with CIN 1 as disease threshold was calculated to be 80.6%, 93.1%, 81.8% and 92.6% respectively. While evaluating the validity of colposcopy with histopathology, colposcopy seems to make an accurate diagnosis in 75% of cases, overestimating in 15% and underestimating in 8% of cases.</p> <p><strong>Conclusions: </strong>There is a good correlation of colposcopy with histopathological diagnosis of cervical cancer.</p> <p><strong>Keywords: </strong>colposcopy, cytology, diagnosis, premalignant</p> <p>&nbsp;</p> 2019-12-09T00:00:00+00:00 ##submission.copyrightStatement## Usefulness of Anti-Müllerian Hormone in Polycystic Ovarian Syndrome in Infertile Women 2020-01-17T17:52:31+00:00 Hima Rijal <p><strong>Aims:</strong> To correlate the AMH level with various clinical and biochemical parameters in patients presenting to infertility clinic with diagnosis of PCOS.</p> <p><strong>Methods: </strong>This is a hospital based prospective study carried out in the Department of Obstetrics and Gynecology, Tribhuvan University Teaching Hospital from January 2018 to December 2018. Women of reproductive age (21– 35 years) who presented to infertility clinic were recruited for study after taking informed consent. PCOS patients were selected by the Rotterdam criteria. Data regarding menstrual history, clinical manifestations of hyperandrogenism, transvaginal ultrasound (TVS) assessments for ovarian follicles, and the levels of AMH, LH, FSH, testosterone and Estradiol were collected.</p> <p>Blood sampling for hormone measurement (LH, FSH, Testosterone, Estradiol) was performed in the second day of menstrual cycle. Serum AMH was measured in any day of menstrual cycle. TVS was performed for morphology of ovaries during follicular phase.</p> <p><strong>Results: </strong>There were 54 patients with PCOS based on Rotterdem criteria. The mean age was 26.6±3.7 year (range=20-35). Among the study population 42 patients (78%) had primary infertility. &nbsp;High AMH with bilateral polycystic ovaries was in 32(59.2%), bilateral PCO with normal AMH was in 13(24%), unilateral polycystic ovaries with high AMH was in 2(3.7%). AMH mean value was 9.8±4.1 ng/ml (range=2.8-19.8), high in 40 women (74%) and normal in 14 women (26%).</p> <p><strong>Conclusions: </strong>Serum AMH can be a useful serum marker of PCOS and it correlates with the clinical and biochemical abnormalities in women with PCOS.</p> <p><strong>Keywords: &nbsp;</strong>anti mullarian hormone, infertility, hyperandrogenism, polycystic ovarian syndrome</p> 2019-12-09T00:00:00+00:00 ##submission.copyrightStatement## Iatrogenic Genitourinary Fistula: Changing Trends 2020-01-17T17:53:51+00:00 T Pradhan T Basnet BD Thapa MC Regmi <p><strong>Aims:</strong> To study the frequency of iatrogenic cause amongst the surgery done for genitourinary fistula and to study the type and cause of iatrogenic genitourinary fistula.</p> <p><strong>Methods:</strong> This is retrospective study of women undergoing surgery for genitourinary fistula repair from year 2013 to 2018. The analysis considers frequency and characteristics of type of fistula.</p> <p><strong>Results:</strong> Out of 223 genitourinary fistula 75 (33.6%) were iatrogenic. Vaginal vault fistula were 25% followed by uretero-vaginal fistula (32.9%), vesico-vaginal fistula (32.9%) and there were 4 iatrogenic recto-vaginal fistula; 81.6% of the iatrogenic fistula had preceding history of hysterectomy followed by emergency caesarean section (17.1%). There is annual increasing trend in iatrogenic fistula repair from 3 to 23.</p> <p><strong>Conclusions:</strong> Women undergoing hysterectomy were under risk for iatrogenic fistula. Optimum work environment is important to reduce surgical error during procedures. Operating training should be emphasised on optimal surgical skills, decision making.</p> <p><strong>Keywords:</strong> genitourinary fistula, ureteric fistula, vault fistula</p> 2019-12-09T00:00:00+00:00 ##submission.copyrightStatement## Histopathological patterns of benign lesions in hysterectomy specimens 2020-01-17T17:55:27+00:00 Ujwal Rai Monasha Vaidya Gehanath Baral Smrity Mool Joshi Sunita Ray <p><strong>Aims: </strong>To audit and evaluate the surgical indications, routes of surgery and types of hysterectomies performed along with histopathological analysis of those hysterectomies in respect to disease of endometrium, myometrium, cervix and fallopian tubes and ovaries for benign conditions.</p> <p><strong>Methods: </strong>This is retrospective cross sectional study of all hysterectomy specimens received in the department of Pathology, B and C teaching hospital and research center, Jhapa, Birtamode, Nepal from May 2017 to May 2019. Clinical details were received from the data provided by gynecologists in histopathological requisition forms. Only specimens received for the benign indication for hysterectomy were taken.</p> <p><strong>Results: </strong>Out of 115 specimens, the number was equal on both abdominal and vaginal route. The common indications were leiomyoma (60%, n=69), abnormal uterine bleeding (24%, n=28) and uterine prolapsed in 11% (n=13). Uterovaginal prolapse was seen commonest indication for hysterectomy in age group of 5<sup>th</sup> and 6<sup>th</sup> decade of life. Myometrial pathology was seen in 74% (n=75) comprising mostly of leiomyoma. Endometrial pathology was present in 14% (n=16) and chronic non-specific cervicitis in 24% (n=28). Abnormal tubo-ovarian pathology was found in 40% (n=51).</p> <p><strong>Conclusions: </strong>Leiomyoma, abnormal uterine bleding and uterovaginal prolapsed are the common benign conditions undergoing hysterectomy.</p> <p><strong>&nbsp;</strong></p> 2019-12-09T00:00:00+00:00 ##submission.copyrightStatement## Teenage Pregnancy Outcome in Rapti Sub Regional Hospital 2020-01-17T17:56:31+00:00 Sandesh Poudel Snigdha Rai Kirtipal Subedi <p><strong>Aim: </strong>To determine the maternal and perinatal outcome in teenage pregnancies.&nbsp;</p> <p><strong>Methods: </strong>A hospital based descriptive cross sectional study conducted from April 2017 to April 2018, among the pregnant women of age group≤19 years, admitted to the labour ward&nbsp; atRapti Sub regional Hospital, Dang.</p> <p><strong>Results: </strong>The total of 853 pregnant adolescent women were admitted during the study period, most of which belonged to 19 years of age (38.6%) and were primipara (93.3%) and 42.1% belonged to janjati group. 79.6% had normal delivery, while 14.1% of the cases underwent caesarean section, 5.9% had instrumental delivery and in 0.5% had perineal injury. Anaemia complicated 63% of teenage mothers, more in age group of ≤ 18yrs than in &gt; 18years (61.4%vs 38.6%) and 4.6% had maternal complications, the majority being PPH (2.9%) followed by oligohydraminos, eclampsia, wound infection and vulvar haematoma. Preterm delivery occurred in 15.5% of the cases (≤ 18yrs vs&gt;18yrs being 9.8% vs 5.7%), other neonatal complications included respiratory distress (1.5%), intrauterine growth retardation (4.5%), intrauterine foetal death (0.4%) and very low birth weight (1.2%).</p> <p><strong>Conclusions: </strong>Teenage pregnancy has increased risk of adverse pregnancy outcomes leading to various adverse maternal, fetal and neonatal complications.</p> <p><strong>Keywords:</strong> outcome, pregnancy, teenage.</p> 2019-12-09T00:00:00+00:00 ##submission.copyrightStatement## Pedunculated Fibroid Mimicking an Ovarian Cancer 2020-01-17T17:57:49+00:00 Kabin Bhattachan Aruna Karki Ganesh Dangal Hema Kumari Pradhan Ranjana Shrestha <p>Large myoma may show various type of degenerative change and have alteration of radiological view. Subserosal or pedunculated fibroid with cystic degeneration may mimic complex ovarian mass on radiological imaging. A 34 year female, para one, with normal menstrual period presented with radiological diagnosis of complex adnexal mass and CA 125 value&nbsp; 100 u/ml. Postoperative finding revealed cystic degeneration of pedunculated subserosal fibroid receiving blood supply from adherent omentum.</p> <p><strong>Keywords:</strong>&nbsp; Cystic degeneration, pedunculated fibroid, complex ovarian mass.</p> <p>&nbsp;</p> 2019-12-09T00:00:00+00:00 ##submission.copyrightStatement## Spontaneous hematometra: a rare cause of pain lower abdomen 2020-01-17T17:59:08+00:00 Rojina Manandhar Asha Singh Abhimanyu Shrestha Sebak Shrestha <p>Hematometra is a rare condition that is most commonly associated with congenital anomalies and prior surgical procedures. This is an unusual case of spontaneous hematometra occuring in 32 years old healthy woman with no prior medical or surgical history. Till now only five cases of spontaneous hematometra without any risk factors have been reported.</p> <p><strong>Keywords: </strong>abdominal pain, depot medroxyprogesterone acetate, hematometra</p> <p>&nbsp;</p> 2019-12-09T00:00:00+00:00 ##submission.copyrightStatement## Uterine Perforation after Manual Vacuum Aspiration 2020-01-17T18:01:04+00:00 Smrity Mool Joshi <p>Surgical modality of abortion should be backed up by adequate skill and facility in service delivery as well as in detecting and managing complications.</p> <p><strong>Keywords</strong>: abortion, hemoperitoneum, manual vacuum aspiration</p> 2019-12-09T00:00:00+00:00 ##submission.copyrightStatement## Uterine Leiomyosarcoma: A case Report 2020-01-17T18:02:45+00:00 Snigdha Rai Beemba Shakya <p>Leiomyosarcoma is a rare but aggressive tumor with poor clinical outcomes in compared to other uterine cancers regardless of its stage. The preoperative diagnosis of leiomyosarcoma is seldom made as the patients present with the symptoms similar to that leiomyoma following hysterectomy and myomectomy. Herein, we present a case of a 50 years old ladyoperated for broad ligament fibroid whose histopathology and immunohistochemistry report revealed leiomyosarcoma.</p> <p><strong>Keywords: </strong>fibroid, histopathology, leiomyosarcoma.</p> 2019-12-09T00:00:00+00:00 ##submission.copyrightStatement##