Nepal Journal of Obstetrics and Gynaecology <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> en-US <p>Copyright on any research article in the Nepal Journal of Obstetrics and Gynaecology is retained by the author(s).</p><p>The authors grant the Nepal Journal of Obstetrics and Gynaecology a license to publish the article and identify itself as the original publisher.</p><p>Articles in the Nepal Journal of Obstetrics and Gynaecology are Open Access articles published under the Creative Commons CC BY-NC License (<a href="" target="_blank"></a>)</p>This license permits use, distribution and reproduction in any medium, provided the original work is properly cited, and it is not used for commercial purposes. (Prof Gehanath Baral) (Sioux Cumming) Wed, 30 Jun 2021 00:00:00 +0000 OJS 60 Robson Classification and quality audit <p>World Health Organization has recommended Robson Classification from baseline obstetric characters to assess, monitor and compare Cesarean Section rates by the quantity analysis. Incorporation of real time labor related factors requires quality audit for both maternal and perinatal outcome.</p> Gehanath Baral Copyright (c) 2021 Gehanath Baral Wed, 02 Jun 2021 00:00:00 +0000 Classification of Caesarean Section: A Scoping Review of the Robson classification <p>Caesarean section (CS) rate is rising dramatically worldwide. WHO recommended CS rate of 10-15% at populational level would not be the ideal rate at the hospitals level due to the differences on population they have been serving. At the hospital level, a perfectly effective system is necessary to understand the trends and causes of rising trends of CS as well as to implement effective measures where necessary to control the same. Hence, WHO recommended the Robson classification, which is also called the 10-group classification of CS (TGCS) as a global standard tool to assess, monitor and compare CS rates within healthcare facilities over time, and between health facilities. The Robson classification, proposed by Dr Michael Robson in 2001, is a system that classifies all women at admission at a specific health facility for childbirth into 10 groups based on five basic obstetric characteristics (parity, gestational age, onset of labour, foetal presentation and number of foetuses). This classification is easy and simple and mutually exclusive, highly reproducible, easily applicable, and useful to change clinical practice. It has many strengths such as simplicity, flexibility (further subdivisions can be made to increase homogeneity within groups). This classification helps to identify and analyse the contribution of each group to overall CS rates. It also allows distinguishing the main group of women who contributes most and least to the overall CS rates; so that the CS rates can be monitored in a meaningful, reliable, and action-oriented manner in each health facilities for optimal use of CS.</p> Sulochana Dhakal Rai, Edwin van Teijlingen, Pramod Regmi, Juliet Wood, Ganesh Dangal, Keshar Bahadur Dhakal Copyright (c) 2021 Wed, 02 Jun 2021 00:00:00 +0000 High Grade Endometrial Stromal Sarcoma: a rare case report <p>High grade endometrial stromal sarcoma (HG-ESS) is a very rare entity with poor outcome in compared to other endometrial stromal sarcoma as it is usually diagnosed in late stage. The stage of the disease, age and complete surgery are most important prognostic factors. Surgical management of a 40 years old lady with menometrorrhagia and high grade endometrial stromal sarcoma is presented.</p> Snigdha Rai Copyright (c) 2021 Snigdha Rai Mon, 07 Jun 2021 00:00:00 +0000 Quintuplet Pregnancy in a women with HIV positive status <p>Quintuplets are a rare occurrence and even rarer if they are born to a woman without fertility treatment. It is associated with not only high rates of obstetric complications but also increased perinatal morbidity and mortality. We here report a case of a woman with HIV positive status under ART with Quintuplets who delivered on her second trimester.</p> Bibhushan Neupane, Babita Chaudhary, Shiba Bam Copyright (c) 2021 Bibhushan Neupane, Babita Chaudhary, Shiba Bam Mon, 07 Jun 2021 00:00:00 +0000 “Sack of marble” appearance in mature cystic teratoma: an unusual finding <p>Mature cystic teratoma (Dermoid) of ovary is a benign germ cell tumor consisting predominantly of ectodermal derivatives. In rare occasion sebaceous material may get aggregated to form marble like appearance because of continuous mobility of Dermoid and its content. Such a case in a menopausal woman has been presented in this report.</p> Prajmi Shrestha, Gehanath Baral, Rakina Bhansakarya, Amar Nath Chaudhary Copyright (c) 2021 Prajmi Shrestha, Gehanath Baral, Rakina Bhansakarya, Amar Nath Chaudhary Mon, 07 Jun 2021 00:00:00 +0000 Recurrent Puerperal Uterine Inversion <p>Uterine inversion is rare and life threatening obstetric complication. This is a case of recurrent uterine inversion managed successfully with Johnson’s Maneuver followed by condom tamponade placement.</p> Monica Gurung, Gehanath Baral Copyright (c) 2021 Monica Gurung, Gehanath Baral Mon, 07 Jun 2021 00:00:00 +0000 Bladder Injury: A complication of Transobturator Tape Surgery <p>Minimally invasive vaginal surgeries are often a preferred mode of surgical treatment of stress urinary incontinence. It is associated with fewer complications. However, complications including hemorrhage, voiding dysfunction, infection, pain, skin infection and erosion, and bladder injuries are observed. We encountered intraoperative bladder injury in a 40-year-old female patient with stress urinary incontinence who underwent transobturator tape (TOT) surgery. Cystoscopy demonstrated a small defect post procedure. She was managed conservatively with foley catheterization for 2 weeks following TOT procedure. She was dry and continent upon follow up.&nbsp;</p> Alka Shrestha, Ganesh Dangal, Kenusha Devi Tiwari Copyright (c) 2021 Sat, 19 Jun 2021 00:00:00 +0000 Awareness and perception of epidural labor analgesia among pregnant women visiting antenatal clinic in National Referral Hospital <p><strong>Aims:</strong> To assess the awareness and perception of labour epidural analgesia among pregnant women visiting the antenatal clinic.</p> <p><strong>Methods:</strong> This was an observational cross-sectional study. Study participants included pregnant women visiting the antenatal clinic during 2nd and 3 rd trimester conducted from 21 st September 2018 till 20 th September 2019. Data were collected by using an interviewer-administered questionnaire. Ethics approval was granted by the research Ethics Board of health, Bhutan.</p> <p><strong>Results:</strong> Total 450 parturients participated in this study; 61.4% of the participants knew that labour epidural services were available and 37.5% got information through media. A total of 57.3% of respondents had severe fear about labour pain; 62.4% had severe fear about delivery complication; 85.2% thought that epidural labour analgesia was a good method of pain relief; and 67% were willing to accept it for their current pregnancy. However, 86.6% would recommend epidural labour analgesia as an option of pain relief to other pregnant women.</p> <p><strong>Conclusion:</strong> Awareness about the availability of labour epidural analgesia services needs to be improved, as a majority of the parturient was keen to avail epidural analgesia after the information about its availability was provided.</p> Tandin Tshomo, Karma Tenzin, Jamphel Tshering Copyright (c) 2021 Wed, 02 Jun 2021 00:00:00 +0000 Prevalence of Anxiety in Pregnancy during COVID 19 pandemic in Shree Birendra Hospital, Chhauni <p><strong>Aim:</strong> To determine the prevalence of anxiety in pregnancy during COVID19 pandemic in Shree Birendra Hospital, Chhauni</p> <p><strong> Method:</strong> It is a cross sectional study conducted at Shree Birendra Hospital Chhauni from July to October 2020 following the ethical approval from IRC. All the pregnant women from first to last trimester attending outdoor visit were included; they were asked to fill up Beck Anxiety Index form. The level of anxiety was compared with demographic data like age, race, parity, and period of gestation, education and occupation. Data were analyzed by using SPSS 20 software.</p> <p><strong> Results:</strong> A total of 385 presumably uninfected pregnant women were surveyed in 20-40 (28.45±3.95) years age group from 4 to 41 (27.15±9.4) weeks of pregnancy and 55.6% were multipara. Low-grade anxiety was found 99.5% (BAI= 3.06±3.66).</p> <p><strong> Conclusions:</strong> Low-grade anxiety was found in almost all pregnant women during covid pandemic and there was no significant difference by demographic variables.</p> Shailaja Khadka, Ratna Khatri, Rosy Malla, Sumana Thapa, Arju Chand, Indira Acharya, Bibhusan Neupane, Sumit Bidari, Kopila Rai, Kanti Prabha Giri, Lokendra Bata Copyright (c) 2021 Shailaja Khadka, Sumana Thapa, Ratna Khatri, Rosy Malla, Sumana Thapa, Arju Chand, Indira Acharya, Bibhusan Neupane, Sumit Bidari, Kopila v, Kanti Prabha Giri, Lokendra Bata Mon, 07 Jun 2021 00:00:00 +0000 Robson Ten Group Classification System and fetal distress as the indication for cesarean section <p><strong>Aim:</strong> To determine the association of Robson ten group classification system (RTGCS) and the fetal distress as an indication of CS among women delivering in Paropakar Maternity and Women’s Hospital.</p> <p><strong> Methods:</strong> This was an observational cross-sectional study over a period of 6 months. 410 study sample population undergoing CS were stratified according to RTGCS out of total of 11575 women’s delivering in PMWH and were analysed for indication of CS, fetal distress, maternal and fetal complications and their distribution according to RTGCS.</p> <p><strong> Results:</strong> Overall CS rate was 35.08%. Largest group size was of group 1 with 4131 patients (35.69%) followed by group 3 with 2980 patients (25.75%). Highest contribution to CS rate was from group 5 (1070 patients, group CS rate 99.17% and contribution to overall CS rate 26.35%). Group 1 and 2 had low group CS rate in comparison to other groups but it was still higher than the Robson guidelines and MCS reference population as per WHO implementation guidelines. On analysis of sample study population CS rate due to fetal distress was 28.54% and previous CS was 25.85%.</p> <p><strong> Conclusions:</strong> High proportion of women gave birth via CS among which high contribution was by low risk groups. The major indication of CS in low risk groups was fetal distress and there was significant rise of fetal distress after admission. Hence RTGCS neither could predict the indication of CS nor could correctly identify the actual high risk group. Hence incorporation of more objective indication of CS like fetal distress or high risk diagnosis which gives rise to fetal distress, in RTGCS criteria is recommended.</p> Alish Shrestha, Gehanath Baral Copyright (c) 2021 Alish Shrestha, Gehanath Baral Mon, 07 Jun 2021 00:00:00 +0000 Histological analysis of the products of conception in first trimester spontaneous abortions <p><strong>Aims:</strong> To evaluate the histopathological findings of products of conception in the first trimester spontaneous abortions.</p> <p><strong> Methods:</strong> A hospital based descriptive cross sectional study conducted from March 2018 to March 2019, among the women admitted with diagnosis of first trimester spontaneous abortion at Paropakar Maternity and Women’s Hospital.</p> <p><strong> Results:</strong> Among 80 cases of spontaneous abortions, incomplete abortion was the commonest type constituting 42.5% of the studied group. The majority of participants belonged to age group of 21-30 years (61.2%) with a mean age of 26.8±6.1 years. Histopathologic examination confirmed products of conception in 60 (75%) patients, partial molar pregnancy in 9 (11.25%) patients, decidual reaction in 9 (11.25%) patients and hydropic abortus in only 2 (2.5%) patients. The molar pregnancy was more prevalent among women of Tibeto-Nepalese ethnic group 26.5% (n=9). Partial hydatidiform mole was more common in primiparous (19.3%) than in multiparous (14.2%).</p> <p><strong> Conclusions:</strong> The histopathological examination of the products of conception proved to be an important tool in detecting undiagnosed pathology like molar pregnancy and hydropic changes that necessitate special follow-up protocol and further management.</p> Poonam Lama, Jitendra Pariyar Copyright (c) 2021 Poonam Lama, Jitendra Pariyar Mon, 07 Jun 2021 00:00:00 +0000 Study of Caesarean Section using Robson’s Classification at Provincial Public Hospital <p><strong>Aims:</strong> To categorize all pregnant women admitted for delivery at Provincial Public Hospital Janakpurdham according to Robson’s ten group classification and to assess the caesarean section rate and identify the indications contributing to the same.</p> <p><strong>Methods:</strong> This is a prospective study conducted at Provincial Public Hospital Janakpurdham for 3 months from 15 th April to 15 th July 2020 .Total of 1536 participants admitted for delivery including 257 undergoing caesarean section were included in the study and were classified according to the Robson’s classification. For each group, demographic and obstetric profile, relative size and its contribution to the overall caesarean rate was calculated.</p> <p><strong> Results:</strong> The overall caesarean section rate was 16.7% (257 among 1536 total deliveries). Robson’s Group 5(Previous caesarean section, singleton cephalic, ≥37 weeks) was the major contributor (46%) to the overall caesarean section rate followed by Group 2b (nullipara, singleton cephalic, ≥37 weeks, caesarean section before labor) (15.6%).</p> <p><strong>Conclusion:</strong> Induction of labor for Group 2a and 4a should be done and trial for vaginal delivery in previous Cesarean section for Group 5 should be promoted to reduce the caesarean section rate. Study result is limited by lack of labor induction facility at the study site.</p> Murari Thakur Copyright (c) 2021 Murari Thakur Mon, 07 Jun 2021 00:00:00 +0000 Diagnosis of abnormal uterine bleeding using PALM COEIN classification and its management: An institutional experience <p><strong>Aims:</strong> Categorization and treatment of abnormal uterine bleeding based on FIGO - PALM COEIN classification system</p> <p><strong>Methods:</strong> A prospective cross-sectional observational study was conducted in the Department of Obstetrics and Gynaecology, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru for a period of 1year from January 2019 to December 2019. All cases with abnormal uterine bleeding in 20 - 50 years of age were taken. Clinical details and imaging tests recorded, and categorized by FIGO- PALM COEIN classification for diagnosis and treatment. Statistical Package for Social Sciences version 21 was used to analyse the data and presented as frequencies and percentages.</p> <p><strong> Results:</strong> Out of 300 women of AUB, 190 had structural (PALM) and 110 women had nonstructural (COEIN) aetiology; 138 women among 300 underwent hysterectomy and 20 patients underwent hysteroscopic polypectomy. Levonorgestrel intrauterine device inserted in 40 patients, 85 women were managed medically and 17 women lost to follow-up for further management.</p> <p><strong>Conclusion:</strong> FIGO PALM-COEIN classification system for the diagnosis and treatment of abnormal uterine bleeding was adopted for the uniform standard.</p> Chandana Chandregowda, Swathi Aswath Reddy, Sujatha Datti, Shreedhar Venkatesh Copyright (c) 2021 Chandana chandregowda, Swathi Aswath Reddy, Sujatha Datti, Shreedhar Venkatesh Mon, 07 Jun 2021 00:00:00 +0000 Obstetric profile during and before COVID 19 period pandemic at a teaching hospital in Eastern Nepal <p><strong>Aim:</strong> To compare fetomaternal outcomes among pregnant patients in COVID and non-COVID period in tertiary centre in eastern Nepal.</p> <p><strong>Methods:</strong> All women who delivered at Nobel Medical College Teaching Hospital during non- COVID period between April to June 2019 and COVID period between April to June 2020 were compared. Data were collected from medical records.</p> <p><strong>Results:</strong> Significant number of women had cesarean deliveries in COVID period (36.5% vs 32.6%). There were no significant differences in period of gestation at the time of delivery, birth weight of baby, intrauterine fetal death and neonatal intensive care unit admission as well as no difference in obstetric outcomes, labor complications, maternal intensive care unit stay, near miss and peripartum hysterectomy.</p> <p><strong> Conclusion:</strong> There were more cesarean sections, vaginal birth after cesarean section and vaginal breech delivery in COVID period and no other significant differences in maternal and fetal outcomes during COVID period and Non-COVID period.</p> Rakina Bhansakarya, Gehanath Baral, Shanti Subedi, Sita Ghimire, Prajmi Shrestha, Amar Nath Chaudhary Copyright (c) 2021 Rakina Bhansakarya, Gehanath Baral, Shanti Subedi, Sita Ghimire, Prajmi Shrestha, Amar Nath Chaudhary Mon, 07 Jun 2021 00:00:00 +0000 Effect of Hypopressive exercise in women with Pelvic Organ Prolapse <p><strong>Aim:</strong> To study the effect of Hypopressive exercises to improve pelvic floor muscle strength in women with Pelvic Organ Prolapse.(grade 1and 2).</p> <p><strong> Methods:</strong> This is an experimental study conducted on women of urban and rural areas of Kamothe and Kalamboli in India who presented with grade 1 and grade 2 Pelvic Organ Prolapse. 20 women (35 years and above) were recruited after taking their consent. The outcome measures assessed during pre and post evaluation were pelvic floor muscle strength as measured by modified oxford scale and perinometer whereas Pelvic Organ Prolapse symptoms by pelvic floor distress inventory scale-20. Intervention consisted of 6-weeks of Hypopressive exercises with a physiotherapist. The protocol consisted of three sessions weekly with progression in each week. Precautions to be taken during the study were explained to the participants each time.</p> <p><strong> Results:</strong> Hypopressive exercises presented positive results with statistically significant difference in pre and post evaluation of outcome measures. Wilcoxon Signed Rank Test analysis reported p-value of 0.00 for modified oxford scale. For perinometer, p-value for peak, average, duration and gradient was 0.00, 0.00, 0.01 and 0.04 respectively. Pelvic Floor Distress Inventory Scale reported p-value of 0.00.</p> <p><strong> Conclusion:</strong> Hypopressive exercises exhibited improvements in pelvic floor muscle strength and reducing the symptoms of Pelvic Organ Prolapse.&nbsp;</p> Jyoti Parle, Sana Shahmalak, Divya Irkar Copyright (c) 2021 Jyoti Parle, Sana Shahmalak, Divya Irkar Mon, 07 Jun 2021 00:00:00 +0000 Analysis of Ectopic Pregnancy at Paropakar Maternity and Women’s Hospital <p><strong>Aims:</strong> To analyze the patients with ectopic pregnancy.</p> <p><strong> Methods:</strong> The medical records of 88 ectopic pregnancies at Paropakar Maternity and Women’s Hospital were reviewed from January to July 2020. Data pertaining patient characteristics, age, gravida, risk factors, clinical presentation, diagnostic modality, site of ectopic pregnancy, management and morbidity associated with it were retrieved and was analyzed using SPSS version 16.0.</p> <p><strong>Results:</strong> Among 88 ectopic pregnancies, 28% occurred in 30-34 years,65% were multipara, presented abdominal pain (72%), vaginal bleeding (60%) and amenorrhoea (57%); 72% had ampullary ectopic, 60% had ruptured ectopic, 99% underwent surgical management and 41% required blood transfusion. There was no any mortality.</p> <p><strong> Conclusions:</strong> Abdominal pain, vaginal bleeding and amenorrhoea were the common presentation. Only 60% had ruptured ectopic pregnancy. Almost all had surgical management.</p> Beemba Shakya Copyright (c) 2021 Beemba Shakya Mon, 07 Jun 2021 00:00:00 +0000 Study of Semen Analysis Patterns in Male Partner of Infertile Couple Attending Tertiary Level Hospital of Nepal <p><strong>Aims:</strong> The aim of this study is to analyze the pattern of semen abnormality in male partner of infertile couple in Nepal.</p> <p><strong> Methods:</strong> A retrospective study of semen sample of male partner of infertile couple analyzed in Department of pathology, Dhulikhel Hospital from January 2014 to December 2018. All semen samples were processed and analyzed according to methods and standards outlined by World Health Organization laboratory manual for the examination and processing of human semen 2010.</p> <p><strong> Results:</strong> A total of 520 semen samples were analyzed. Our study shows 221 (44%) abnormal for different semen parameters and asthenozoospermia (39.3%) is the most common abnormality followed by azoospermia (28.8 %), Oligoasthenozoospermia (17.9 %), Oligozoospermia (8.7 %), Oligoasthenoteratozoospermia (3.5 %) and teratozoospermia (1.8 %).</p> <p><strong> Conclusions:</strong> Abnormal semen parameters remain significant causes in overall infertility in our set up with asthenozoospermia and azoospermia were common abnormalities in male partner. Semen analysis is an inevitable tool for evaluation of infertility in male partner. Further study is required to find out the possible etiologies of male infertility for holistic management of infertility.</p> Surendra Koju, Suman Raj Tamrakar, Ramita Shankhadev Copyright (c) 2021 Surendra Koju, Suman Raj Tamrakar, Ramita Shankhadev Mon, 07 Jun 2021 00:00:00 +0000 Correlation of Cardiotocography with Intraoperative findings and neonatal outcome in caesarean section for non-reassuring fetal status <p><strong>Aims:</strong> To demonstrate the correlation of cardiotocography with intraoperative findings and neonatal outcome undergoing emergency cesarean section for non-reassuring fetal status.</p> <p><strong> Methods:</strong> It is a hospital based cross sectional study at maternity ward of Shree Birendra Hospital in Kathmandu with non-reassuring CTG who underwent cesarean section in a period of one year. Their CTG were correlated with their intraoperative findings and neonatal outcome such as meconium stained liquor, nuchal cord, Apgar score at birth, NICU admission, perinatal mortality and stillbirth.</p> <p><strong> Results:</strong> Fifty four patients were recruited. Most common operative finding was meconium stained liquor (35.2%); and cardiotocographic abnormality was variable Deceleration (37%). Variable deceleration and late deceleration had significant correlation with meconium stain liquor and nuchal cord. Apgar score ≤ 7 at 5 minute was 7.4%. NICU admission was 13% with common abnormality as late Deceleration.</p> <p><strong> Conclusion:</strong> CTG pattern of variable and late deceleration had correlated with the meconium stained liquor and nuchal cord only. There was no relation with neonatal outcome in terms of Apgar score and admission rate.</p> Arju Chand Singh, Ratna Khatri, Pradyuman Chauhan, Sumana Thapa Copyright (c) 2021 Arju Chand Singh, Ratna Khatri, Pradyuman Chauhan, Sumana Thapa Mon, 07 Jun 2021 00:00:00 +0000 Laparoscopic pelvic adnexal surgery in Nobel Medical College <p><strong>Aim:</strong> To share early experience of gynaecological laparoscopic surgeries for adnexal masses in Nobel Medical College and Teaching Hospital (NMCTH).</p> <p><strong> Methods:</strong> This is a observational descriptive study in the Department of Obstetrics and Gynaecology of Nobel Medical College, Biratnagar for one year in 2019-2020. All the patients undergoing laparoscopic pelvic surgeries for adnexal masses were analysed for indication, type of procedure, complications and histopathological diagnosis.</p> <p><strong>Results:</strong> A total of 123 laparoscopic surgeries were performed. Preoperative diagnosis in most of the cases was adnexal mass followed by adnexal evaluation for subfertility. The common surgical procedure was cystectomy followed by salpingo-oophorectomy in 80% of cases. The most common histopathological diagnosis was mature cystic teratoma (42; 34%) followed by endometriosis (29; 23.8%) and cystadenoma (25; 20.3%).</p> <p><strong> Conclusions:</strong> Adnexal evaluation and surgical treatment were performed with laparoscopy. The common pathologies were mature cystic teratoma, endometriosis and ovarian cystadenomas.</p> Amar Nath Chaudhary, Gehanath Baral, Prajmi Shrestha, Rakina Bhanshakarya Copyright (c) 2021 Amar Nath Chaudhary, Gehanath Baral, Prajmi Shrestha, Rakina Bhanshakarya Mon, 07 Jun 2021 00:00:00 +0000 Pattern of Lower Urinary Tract Symptoms (LUTS) and satisfaction among patients having diagnostic cystoscopy <p><strong>Aims:</strong> To study the pattern of LUTS during diagnostic cystoscopy and to evaluate patient’s satisfaction using rigid cystoscopy with intra-urethral lignocaine gel.</p> <p><strong>Methods:</strong> Hospital based cross-sectional observational study done in all patients attending Department of Obstetrics and Gynecology with LUTS. Diagnostic cystoscopy was performed after using intra-urethral lignocaine gel. Patients profile and indications for cystoscopy were recorded; and VAS (Visual Analogue Scale) was used to assess procedure related pain. Data stored in MS Excel and descriptive analysis performed using SPSS 21.</p> <p><strong> Result:</strong> Forty-three patients were included in the study. The mean age of presentation was 45.77 years. Majority of the patients were pre-menstrual and with symptoms less than 5 year duration. Twenty-seven (62.8%) patients had urgency as indication for cystoscopy followed by cystitis and recurrent urinary infection each (16.3%). Only 2 patients had mixed urinary incontinence. Thirty- one (72.1%) had mild discomfort, seven (18.7%) moderate and 5(9.2%)severe in visual analogue scale.</p> <p><strong> Conclusions:</strong> Urgency was found to be a frequent indication for diagnostic cystoscopy and use of rigid cystoscope using inra-urethral gel showed only mild discomfort to majority of patients.</p> Tarun Pradhan, Amit Deo, Raj Deb Mahato, Tulasa Basnet Copyright (c) 2021 Tarun Pradhan, Amit Deo, Raj Deb Mahato R, Tulasha Basnet Mon, 07 Jun 2021 00:00:00 +0000 Correlation of palpation versus ultrasound-assisted approach for locating the level of lumbar puncture used for subarachnoid block in elective cesarean delivery <p><strong>Aims:</strong> To correlate the level of lumbar puncture used for subarachnoid block in parturient undergoing elective cesarean delivery between palpation and ultrasound method; and to find its accuracy.</p> <p><strong>Methods:</strong> This is an observational study, conducted in 314 parturient undergoing elective caesarean delivery under spinal anesthesia over the period of three months at Paropakar Maternity and Women's Hospital Kathmandu. The interspinous space identified by palpation method on lateral position for subarachnoid block and later the site confirmed by ultrasound.</p> <p><strong>Results:</strong> In this study, intervertebral space identified by palpation was matched in 38.1% (i.e. 107 in 281 patients) when assessed with ultrasound (USG). In 166 (59.1%) patients, skin puncture level was determined by palpation was found to be one intervertebral space cephalic. In eight (2.8%) patients, one intervertebral space caudal while assed with USG. The correlation between intervertebral space determined by palpation and by ultrasonography was poor (correlation coefficient r=0.288).The kappa was 0.293±0.015.</p> <p><strong>Conclusions:</strong> The level of lumbar puncture used for subarachnoid block in elective cesarean delivery by palpation method is poorly correlated (38.1%) with ultrasonographic identification of corresponding interspinous level.</p> Arjun Prasad Tiwari, Amir Babu Shrestha, Ritu Pradhan, Bidur Kumar Baral, Tara Gurung, Sangeeta Shrestha Copyright (c) 2021 Arjun Prasad Tiwari, Amir Babu Shrestha, Ritu Pradhan, Bidur Kumar Baral, Tara Gurung, Sangeeta Shrestha Mon, 07 Jun 2021 00:00:00 +0000 Histomorphological spectrum of Leiomyoma – a one year retrospective study <p><strong>Aims:</strong> To analyze the histomorphology of leiomyoma in specimens received in Pathology.</p> <p><strong> Methods:</strong> This is a retrospective descriptive study of histopathology database of histomorphologic spectrum of leiomyoma at Pathology Laboratory of Nobel Medical College Teaching Hospital, Biratnagar, Nepal from April 2020 to April 2021. Data for the leiomyoma were analyzed descriptively. Ethical approval was obtained from the Institutional review committee.</p> <p><strong>Results:</strong> A total of 1705 histopathology specimens were received in one year from April 2020 to April 2021 out of which 620 (37%) were from the Department of Gynecology and Obstetrics for histopathological analysis of various specimens. Total of 106 specimens of hysterectomy and myomectomy were included. Maximum number of leiomyoma was seen in the body 48 (45%) followed by fundus 34 (32%) and one from the lateral wall of the vagina 1 (0.9%). Mean age was 42 (24-70) years. Maximum size was 35 cm and minimum was 0.5 cm in diameter. Out of the rare ones one case of STUMP, Lipoleiomyoma and Mitotically active leiomyoma each were seen. Degenerative change was in 40 cases with hyaline type as the commonest one (33%); 61% were intramural; and 12% were multiple. Presentation was lower abdominal pain and abnormal uterine bleeding in 39.6%.</p> <p><strong> Conclusions:</strong> Cases of leiomyoma may present with abdominal mass, pain and bleeding but the degenerative changes and malignant transformation can't be identified without histopathological examination.</p> Reetu Sharma Baral, Oshan Shrestha Copyright (c) 2021 Reetu Sharma Baral, Oshan Shrestha Mon, 07 Jun 2021 00:00:00 +0000 Clinical outcome of sacrospinous fixation following pelvic organ prolapse surgery <p><strong>Aims:</strong> To evaluate the midterm outcome of sacrospinous fixation done during surgical management of pelvic organ prolapse.</p> <p><strong>Methods:</strong> This was an interview based cross sectional follow up study done among the patients who underwent sacrospinous fixation procedure along with pelvic organ prolapse surgery in Kathmandu Model Hospital and Paropakar Maternity Hospital. This was conducted between 15 th February 2021 and 15 th April 2021. Post-operative cases 22 to 30 months (average 2 years) from the day of surgery were included.</p> <p><strong> Results:</strong> Out of 321 eligible SSF patients from both the hospital, 156 agreed to participate. Among them, 77 (48%) were in 60-69 years of age and 82% were postmenopausal; 33% were more than para 3; 20% had right gluteal pain that was decreased to 1.9% by 2 years; and 20% had some degree of urgency and stress incontinence.</p> <p><strong> Conclusion:</strong> Sacrospinous fixation is safe and effective procedure which can be done during pelvic organ prolapse surgery with good success rate and minimal post-operative complications.</p> Sandesh Poudel, Ganesh Dangal Copyright (c) 2021 Sandesh Poudel, Ganesh Dangal Mon, 07 Jun 2021 00:00:00 +0000 Choice of temporary contraception based on client’s demographic status and parity <p><strong>Aim:</strong> To analyse the demographic factors and parity in women influencing choice of contraceptive methods.</p> <p><strong> Methods:</strong> This is a hospital record based retrospective study at Bhaktapur hospital, a tertiary hospital in a span of 6 months from October 2020 to March 2021. Data were collected from medical record and descriptive analysis was done.</p> <p><strong> Results:</strong> There were 142 women taking contraceptive service in six months.Implant was the most commonly used method of contraception (48%), followed by the IUCD (26%), Injectable (16%) and OCP (10%). Age group of 20-39 had more acceptance of contraception as compared to adolescent and women above 40. More the parity more usage of long acting reversible contraception was found.</p> <p><strong> Conclusion:</strong> The most common contraceptive method used among women was implant. Client having two or more children are more to receive long acting contraception.</p> Benju Pandit Copyright (c) 2021 Benju Pandit Mon, 07 Jun 2021 00:00:00 +0000 Peripartum hysterectomy at a tertiary center <p><strong>Aims:</strong> To find out the incidence, indications, complication of emergency peripartum hysterectomy in a tertiary care center.</p> <p><strong> Methods:</strong> This was a retrospective study conducted over a period of 18 months from April 2017 to October 2018 at Paropakar Maternity and Women’s Hospital in Kathmandu. Data were obtained from the operation theater register and record section.</p> <p><strong> Results:</strong> Out of 30917 deliveries in 18 months 18 had lifesaving emergency peripartum hysterectomy (0.58 per 1000 deliveries). The most common indication being morbidly adherent placenta/placenta previa (8; 44%) followed by ruptured uterus (5; 28%), uterine atony (4; 22%). The most common risk factor is attributed to previous cesarean section (11; 61%) followed by abnormal placentation (7; 39%). Most common morbidity was febrile morbidity followed by wound infection and bladder injury.</p> <p><strong>Conclusion:</strong> Abnormal placentation and past cesarean section contributed to be the major indication of peripartum hysterectomy.</p> Monica Gurung, Gehanath Baral Copyright (c) 2021 Monica Gurung, Gehanath Baral Mon, 07 Jun 2021 00:00:00 +0000 Quality of life and sexual dysfunction in cervical cancer survivors <p><strong>Aim:</strong> To evaluate the quality of life and sexual dysfunction in cervical cancer survivors.</p> <p><strong> Methods:</strong> This is a cross sectional study conducted in Bhaktapur Cancer Hospital from 14 th January to 13 th April 2021. Total 136 patients treated for cervical cancer without other coexisting cancers and psychological disorders were interviewed. Independent t test was used to compare means in two categories while ANOVA to compare mean in more than two categories like treatment.</p> <p><strong> Result:</strong> Out of 136 cervical cancer survivors 80% were from hilly region, 75% were diagnosed in late stage of disease and average age was 50 years. Total mean FACT-Cx score was 61.1±14.8, with lowest score in physical wellbeing (8.4±5.5) and highest in social and family wellbeing (18.5±6.2); and 94.8% of the patients had sexual dysfunction.</p> <p><strong>Conclusion:</strong> This study indicated that the quality of life and sexual function were very low among cervical cancer survivors. Need of counseling regarding the general health and sexual health among cervical cancer is observed.</p> Snigdha Rai Copyright (c) 2021 Snigdha Rai Mon, 07 Jun 2021 00:00:00 +0000 Modified Risk of Malignancy Index (RMI 5) in ovarian tumor <p><strong>Aims:</strong> To evaluate the role of modified RMI (RMI 5) in pre-operative evaluation of ovarian tumor.</p> <p><strong> Methods:</strong> It was a prospective cross sectional study done in Paropakar Maternity and Women’s Hospital from May to August 2018. During the study, 72 women with ovarian tumor were analyzed. RMI5 was calculated using the ultrasound score, Doppler score, menopausal status and CA125. Cut-off of 200 was used for malignancy discrimination. Chi square test was used to calculate the statistical significance which was set at 0.05. Receiver Operator Characteristics curves for RMI and its individual parameters were plotted using SPSS.</p> <p><strong> Results:</strong> There were 72 ovarian tumors operated in four months and mean age was36 years with 10 (14%) at post-menopause. The mean value of RMI 5 was 38 for benign tumors, 80 for borderline tumors and 899 for malignant tumors. The area under curve for RMI 5 was 0.993 for cut-off of 200. The diagnostic accuracy of RMI 5 was 94.4 which was similar to that of Doppler score 2 (94.7) while it was much higher than that of the rest of the parameters (CA-125: 72, ultrasound score: 87 and postmenopausal status: 88.9).</p> <p><strong>Conclusions:</strong> RMI 5 is better for malignancy prediction of ovarian masses instead of individual parameters like menopausal status, CA125 and ultrasound score.</p> Rijuta Joshi, Gehanath Baral Copyright (c) 2021 Rijuta Joshi, Gehanath Baral Mon, 07 Jun 2021 00:00:00 +0000 Histomorphological Spectrum of Ovarian Masses in a Tertiary Centre of Eastern Nepal <p><strong>Aims:</strong> To analyze the trends of ovarian masses in a tertiary centre in eastern Nepal.</p> <p><strong> Methods:</strong> This was a retrospective cross sectional study conducted in Department of Pathology at Nobel Medical College and teaching hospital, Biratnagar, Nepal. Database of two years from April 2019 to April 2021 was searched. Gross and microscopic findings of cases including demographic details of patients with ovarian mass were analyzed and presented by descriptive parameters.</p> <p><strong> Results:</strong> Out of 127 cases of ovarian masses studied, 95 (74.8%) were neoplastic. The common types were Germ cell tumors were (47; 37%), epithelial tumors (43; 33.9%) and endometriotic cyst (23; 18.1%). Mean age was 38.1 (range: 17-77) years in benign, 47.1 (30 – 70) years in malignant and 36.9 (21-53) years in non-neoplastic tumors; 11 cases were malignant and 63.6% were solid; and 23.8% of serous tumors were bilateral.</p> <p><strong>Conclusions:</strong> Benign neoplastic lesions were the most common lesions and presented earlier than borderline and malignant lesions. Endometriotic cysts comprised the most common non- neoplastic lesions. The non-neoplastic lesions were predominantly cystic and the malignant lesions were predominantly solid. Most of the benign lesions were solid-cystic. Most mucinous tumors and all the sex-cord stromal tumors were unilateral while the seromucinous tumor and a significant number of serous tumors were bilateral.</p> Oshan Shrestha, Reetu Baral, Shipra Shrestha Copyright (c) 2021 Oshan Shrestha, Reetu Baral, Shipra Shrestha Mon, 07 Jun 2021 00:00:00 +0000 Maternal and perinatal outcome in Rh-Negative women <p><strong>Aim:</strong> To find out the Maternal and perinatal outcomes in Rh-Negative mothers.</p> <p><strong>Methods:</strong> This is a cross sectional study of all Rhesus negative mothers giving childbirth at Department of Obstetrics and Gynecology, Nobel Medical College Teaching Hospital from March 2020 to February 2021. Maternal variables like age, parity, mode of delivery, and complications were recorded. Fetal vari- ables like period of gestation, fetal outcomes, hemoglobin, indirect bilirubin, fetal weight were noted.</p> <p><strong>Results:</strong> There were 108 cases of Rh negative pregnancy and 95 of them deliv- ered Rh positive fetuses. Prevalence of Rh negative pregnancy was 1.68%. Half of them (51; 53.6%) underwent caesarean section due to obstetric indications with 20 repeat cesarean sections and 9 (17.7%) cases for fetal distress. Gross perinatal death was 9; none of the patients received antepartum im- munoprophylaxis; and 86 received postpartum Anti-D Rh IgG. There was only one case of proven isoimmunisation presented as hydrops fetalis in a grand multiparous woman with positive Indirect Coomb Test; and two newborn re- ceived exchanged transfusion.</p> <p><strong>Conclusion:</strong> Rhesus negative rate was 1.68% and proven isoimmunization rate was 1%.</p> Munjal Yadav, Gehanath Baral Copyright (c) 2021 Munjal Yadav, Gehanath Baral Mon, 07 Jun 2021 00:00:00 +0000 Anti-mullerian hormone as an emerging promising marker in the prognosis of PCOS <p><strong>Aims:</strong> To correlation of AMH with clinical, hormonal and ultrasound findings; and determine the role of AMH as prognostic marker.</p> <p><strong>Methods:</strong> This was a prospective cross sectional study on women attending Gynaecology outpatient department of Medial College and Hospital, Kolkata, from January 2018 to June 2019. Study comprised of 70 newly diagnosed cases of PCOS using Rotterdam criteria 2003. Clinical history included menstrual complaint, hirsutism and weight gain; examination included BMI and Ferriman-Gallwey score; and investigations included FBS, 2hr PPBS, TSH, Prolactin, total testosterone, LH, AMH level and pelvic USG before starting intervention and same parameters were rechecked after 3 months of treatment completion.</p> <p><strong>Results:</strong> A total of 70 PCOS patients were included in a study conducted within 1 year time period. The most common Phenotype in our study is Phenotype A (O+H+P) which was almost 85.71%, followed by Phenotype B (O+H) 7.14% and the least we got Phenotype C (H+P) that is 2.86%. There was statistically significant (p&lt;0.05) decrease in AMH level following treatment of PCOS (before treatment mean AMH level was 9.634.42 and after treatment the level was 5.812.77).</p> <p><strong>Conclusions:</strong> The most frequent PCOS phenotype in Indian women is A (O+H+P). Therapy in PCOS women with raised AMH reduces the AMH levels. Measurement of serum AMH provides a high specificity and sensitivity by which it can act as a prognostic marker for PCOS.</p> Anu Meena, Amit Kyal, Partha Mukhopadhyay, Pragati Sharma Copyright (c) 2021 Sat, 19 Jun 2021 00:00:00 +0000 Association of laboratory parameters with chest CT findings in COVID-19 patients <p><strong>Aims:</strong> To analyze the Chest CT Scan and association of the severity score with the serum biomarkers D- dimer, C-reactive protein (CRP), Lactate dehydrogenase (LDH) and Ferritin levels.</p> <p><strong>Methods:</strong> This is a retrospective study done from the database of Department of Radiology and Department of Pathology at Nobel medical college and teaching hospital during the peak of the second wave of the pandemic from 1st April 2021 to 31 st May 2021. Data for the Chest CT scan and lab parameters were analyzed and correlated. Ethical approval was obtained from the Institutional review committee of Nobel Medical College and Teaching Hospital. Descriptive statistical analysis was performed.</p> <p><strong>Results:</strong> A total of 263 cases of Chest CT scan were done in 2 months period who were diagnosed as cases of COVID 19. In this study the severity and scores were taken from the database in the Radiology department. The lab parameters like D-dimer, CRP, LDH and Ferritin levels were studied from the database in the lab. Age of the patients ranged from 19 to 89 years with maximum cases 68 (25.8%) seen in the age group of 50-59 years. According to the chest CT Scan the severity score was in between 11-15 in 92 (48.3%) cases. Fifty six cases showed abnormal levels of D-dimer, Ferritin, CRP and LDH. D-dimer was raised in 26 (46.4%), LDH was raised in 48 (87.2%) while Ferritin and CRP was also raised in all 56 cases.</p> <p><strong>Conclusions:</strong> There was a positive correlation between the biomarkers and the Chest CT severity score. The severity of the disease with involvement of the lungs can be estimated by correlating with the lab parameters.</p> Ayeshna Gurung, Reetu Baral, Binit Koirala, Suman Kumar Shrestha Copyright (c) 2021 Sat, 19 Jun 2021 00:00:00 +0000 Clinical profile of Female Urinary Incontinence: A Hospital Based Study <p><strong>Aim:</strong> To determine the prevalence of urinary incontinence of women attending gynae outdoor patient department.</p> <p><strong>Method:</strong> It is a prospective cross sectional study conducted at Paropakar Maternity and Women’s Hospital for three months. Types of incontinence, their presentation, associated factors, age and parity were the variables studied. Data were analyzed by descriptive statistics.</p> <p><strong>Results:</strong> Out of 950 gynaecological out-patients, 97 had urinary incontinence(10.2%); 34.1% were in 50- 59 years and 37.2% were multipara. Stressurinary incontinence (SUI) was the most common incontinence (56.7%) followed by mixed urinary incontinence (22.7%) and urge urinary incontinence (20.6%). Common complaints were leakage during coughing (63.6%) and sneezing(18.2%) in SUI;urgency and frequency were main problem in mixed and urge urinary incontinence. Three-fourth cases had associated medical conditions and rest had gynecological factors.</p> <p><strong>Conclusions:</strong> Urinary incontinence is common in the fifth decade of life of women and more than half had stress incontinence.</p> Alka Shrestha Copyright (c) 2021 Sat, 19 Jun 2021 00:00:00 +0000 Surgical Morbidity and its Associated Factors in Ovarian Carcinoma <p><strong>Aims:</strong> To estimate 30-day surgical morbidity in patients with ovarian carcinoma and identify its associated factors.</p> <p><strong>Methods:</strong> This was an observational study conducted at two cancer hospitals, from October 2020 to March 2021. All women with ovarian carcinoma that underwent surgery were enrolled in the study. Incidence of surgical complications was recorded. Patients were followed up to the 30 th day post- operatively. Logistic regression analyses were used to evaluate the factors affecting surgical complications and their association was determined.</p> <p><strong>Results:</strong> A total of 31 patients were analyzed in this study. The incidence rate of surgical complications was 29%. Total 11 complications occurred in nine patients (one intra-operatively and 10 post-operatively). Post-operative complications were wound infection (n=4; 12.9%), urinary tract infection (n=2; 6.4%); one each had post-op ileus, hemorrhage and deep vein thrombosis; and one mortality. Advancing age, increased Body Mass Index, primary surgery, higher surgical complexity score, increased operative time, increased blood loss, higher American Society of Anesthesiologists (ASA) score, presence of chronic disease were associated with surgical morbidity; and their hospital stay was longer (p=0.04).</p> <p><strong>Conclusion:</strong> The common complications were wound infection and urinary tract infection.</p> Birendra Bhagat Copyright (c) 2021 Sat, 19 Jun 2021 00:00:00 +0000