Nepal Journal of Obstetrics and Gynaecology

Serum lipid profile in pregnancy and its correlation with preeclampsia and its impact on severity of preeclampsia

Sujatha Datti, Swathi Aswath Reddy, Naga Tejaswi — Wed, 28 Dec 2022 00:00:00 +0000

Aims: To compare the changes in the lipid profile in pre-eclampsia, eclampsia and normal pregnancy and to know the severity of preeclampsia depending on the lipid derangement.

Methods: This is the hospital based observational analytical study with 30 pregnant women in each study and comparison group at Vydehi Institute of Medical Sciences. India. Lipid profile was run in each participant and statistical analysis was performed by STATA 11.2.

Results: The mean value of serum total cholesterol, serum triglycerides, low density lipoprotein and very low-density lipoprotein in the study group were significantly raised compared to comparison group. The mean high density lipoprotein levels were lower in study group compared to comparison group which was statistically significant. Total cholesterol, LDL and VLDL was increased in eclampsia group and severe preeclampsia group. No significant difference was found between serum triglyceride levels, HDL and severity of preeclampsia.

Conclusions: LDL and VLDL were significantly higher in severe preeclampsia and eclampsia; but no significant difference found between serum triglyceride levels and HDL levels.

Keywords: dyslipidemia, lipoprotein, preeclampsia

Clinical and Hormonal Profile of Oligomenorrhea in Bhaktapur Hospital

Benju Pandit — Wed, 28 Dec 2022 00:00:00 +0000

Aims: To analyze the clinical and hormonal profile of patients presenting with oligomenorrhoea in outdoor consultation.

Methods: This is an observational descriptive study conducted between January to April 2022 in Bhaktapur Hospital. Data were collected in outpatient clinic of Department of Obstetrics and Gynecology. Descriptive parameters were analyzed.

Results: There were 80 patients enrolled in the study. Cause of oligomenorrhoea was identified in only one-third of cases. Common diagnosed cause of oligomenorrhea was Polycystic Ovary Syndrome (16;20%) followed by thyroid disorder (8;10%) and hyperprolactinemia (2;2.5%).

Conclusions: The most common identified causes of oligomenorrhea were polycystic ovarian syndrome and thyroid disorder but two-third of cases had no any identifiable cause.

Keywords: hyperprolactinemia, oligomenorrhea, PCOS, thyroid disorder

Patient Perceptions and fetal outcome of Cesarean delivery on Maternal request at Birat Medical College Teaching Hospital

Tarun Pradhan, Raj Deb Mahato, Jiba Nath Dhamala, Prerana Dahal — Wed, 28 Dec 2022 00:00:00 +0000

Aims: To explore the patient profile and perceptions of patient for choosing cesarean delivery on request over vaginal delivery. Methods: The study is a prospective cross-sectional observational study from Jan 2021 to Dec 2021 in the Department of Obstetrics and gynecology, BMCTH. The data were entered in an excel sheet. Statistical analysis was done for frequency and percentage for categorical variables.

Results: Out of 1413 cesarean sections 106 underwent on their request without obstetrical indications. requested for cesarean delivery by maternal request. Prevalence of CDMR of total number of delivery in our institute was found to be 3.3. Fear of labor pain (53.8%) was the most common reason for CDMR followed by 39.6% of the lady choose because of concern of fetal injury during labor. Despite CDMR, 10 fetus required NICU admission.

Conclusions: The perception of pregnant women for choosing CDMR showed to be influenced by multiple factors; the most important is to avoid pain during labour and fera of fetal injury during vaginal delivery.

Keywords: cesarean delivery; maternal request; neonatal outcome

Safety and feasibility of Myomectomy during cesarean delivery

Wed, 28 Dec 2022 00:00:00 +0000

Aims: To assess the safety and feasibility of myomectomy during cesarean delivery.

Methods: This was a retrospective descriptive study conducted at Kathmandu Model Hospital. Data on cesarean myomectomy were obtained from hospital records and analyzed in terms of demographic profile, number, size and location of fibroids, intraoperative blood loss, and drop in hemoglobin level, blood transfusion, birthweight and duration of hospital stay.

Results: Mean age of mother and gestational age at delivery were 32.6 years and 37.8 weeks respectively. Seventeen cases (58.6%) had multiple fibroids. Seventeen (58.6%) of the fibroids were intramural, 10 (34.4%) sub serosal and 2(6.8%) were submucosal. Nine cases (31.1%) had intraoperative blood loss of 500ml to 1000ml with mean loss of 420 ml. Only One case who had blood loss of 1500ml due to presence of fibroid in lower segment of uterus required 3 unit of blood transfusion. The mean preoperative & postoperative hemoglobin were 12.23 gm/dl and 11.25gm/dl. The mean birthweight & duration of hospital stay were 2.8 kg and 2.3 days.

Conclusion: Cesarean myomectomy is a safe and feasible procedure.

Keywords: cesarean, myomectomy, safety

Success Rate of Assisted Reproductive Technology Treatment at a Tertiary Fertility Centre in Nepal

Wed, 28 Dec 2022 00:00:00 +0000

Aims: To determine the success rate of various Assisted Reproductive Technology (ART) treatments at a tertiary fertility centre in Nepal.

Methods: This study was a retrospective study conducted at Creator’s IVF Nepal Pvt. Ltd. (CIVF) from November 2015 till April 2020. The success rates of ART treatment were preclinical pregnancy rate, clinical pregnancy rate, and live birth rate. Anonymised information about demographic and clinical characteristics of the patients, ART treatment related variables, and ART outcome related variables were collected from the medical records. Descriptive analysis was performed using SPSS (Statistical Package for the Social Sciences) version 20.

Results: Overall, 768 ART cycles leading up to embryo transfer were analysed. About 69.6% of all ART treatments were autologous cycles followed by oocyte recipient cycles (22.0%), and embryo recipient cycles (8.4%). About 88.7% were fresh embryo transfers whereas 11.3% were frozen embryo transfers. Overall the preclinical pregnancy rate, clinical pregnancy rate and live birth rate were 48.4 %, 43.3%, and 33.3% respectively.

Conclusions: The success rates of ART treatment in this study were comparable to the international estimates. More research on treatment outcomes by all ART service providers in Nepal is needed to provide better evidence on utilization and efficacy of ART treatment in fertility centres across the country.

Keywords: assisted reproductive technology; clinical pregnancy; in-vitro fertilization; live birth; success rate

Women’s Autonomy And Utilization of Maternal Health Services In Rural Tertiary Level Hospital of Karnali Province, Nepal

Wed, 28 Dec 2022 00:00:00 +0000

Aim: To assess the effect of women’s autonomy on utilization of maternal health services in selected tertiary level hospital of Karnali Province.

Methods: Cross sectional descriptive research design was adopted in Karnali Academy of Health Science (KAHS). Nepal. Pregnant women after 22 weeks of gestation to term who came for the delivery in KAHS irrespective of mode of delivery and postnatal women within 6 weeks postpartum irrespective of place and mode of delivery were taken as study population. Probability sampling technique was used. Semi-structured interview schedule was used to collect data after informed consent.

Result: The study found that 52.5 percent of respondents utilized maternal health services and 38.6 percent had full autonomy in their life in regards to movement, financial and decision making autonomy. Significant association was found between utilization of maternal services and women autonomy. Regarding the effect of autonomy on maternal health service utilization, significant association was seen between movement autonomy and utilization of maternal health services (p-value= .002, OR= 0.432, C.I: 0.253-0.735). Income, facilities of transportation and decision making power of husband are the factors affecting utilization of maternal health services.

Conclusions: The study provides more insight between the utilization of maternal health services and autonomy of women, lower the movement autonomy of the women lower the utilization of maternal health services. Actions that increase women’s autonomy at home could be effective in helping assure good maternal health.

Keywords: maternal health services, women’s autonomy, utilization

A clinicopathological patterns in hysterectomies in a medical college in eastern Nepal

Amar Nath Chaudhary, Gehanath Baral, Shanti Subedi , Chandrika Dangol — Wed, 28 Dec 2022 00:00:00 +0000

Aims: Hysterectomy are being performed in regular basis and its aetiology and histopathological findings are watched and co-related in this study.

Methods: This is an observational descriptive study carried out in the Department of Obstetrics and Gynaecology at Nobel Medical College Teaching Hospital Biratnagar for one year from 15 May 2021 to 15 may 2022. All the patients undergoing hysterectomies were analysed for indication, type of procedure, complications and histopathological diagnosis.

Results: A total of 456 hysterectomies were performed in a year. Preoperative diagnosis in most of the cases was fibroid uterus. The common surgical procedure was total abdominal hysterectomy. The most common histopathological diagnosis was fibroid uterus followed by uterine prolapse, ovarian mass, endometrial disease and adenomyosis.

Conclusions: Fibroid uterus is the leading cause of hysterectomy as well as the commonest pathologic diagnosis followed by prolapsed uterus and ovarian tumor.

Key words: Adenomyosis, AUB, histopathology, hysterectomy, fibroid, uterus

Post-Abortion Contraceptive Acceptance and Choice Among Women Receiving Abortion Care at Tertiary Center In Chitwan District, Nepal

Rubina Shrestha — Wed, 28 Dec 2022 00:00:00 +0000

Aims: To find out the acceptance of contraception after abortion and the factors affecting its use.

Methods: A prospective cross sectional study was carried out from February 2020 to February 2021 on women seeking safe abortion care services in College of Medical Sciences Teaching Hospital, Chitwan, Nepal. A systematic sampling technique was used to reach the sample size.

Results: Out of total 200 women who came for safe abortion 73% participant had induced abortion and 27% had spontaneous abortion. The main reason for induced abortion was completed family (43.3%).The acceptance rate of contraceptive was 78%. Most frequently used contraceptive was oral contraceptive pill (OCP) followed by depo- provera. The age of the patient, high parity, number of living children, reason for abortion and family planning counseling were independent factors that increase the acceptance of contraceptive post abortion. The education, occupation, past history of contraceptive use and abortion although did not affect the use of contraceptives.

Conclusions: This study shows that if we give proper contraceptive counseling post-abortion, acceptance rate of contraceptives can be increased. Therefore, family planning services after abortion need to be strengthened.

Risk factors and clinico-pathological profile of female genital tract malignancies at BPKIHS

Wed, 28 Dec 2022 00:00:00 +0000

Aims: To evaluate the risk factors and clinico-pathological profile of patients with female genital tract malignancy.

Methods: It was a prospective descriptive study of female genital tract malignancy conducted from December 2019 to December 2020 in the Department of Gynaecology, BPKIHS.

Results: Out of 61 cases, cervical cancer was the most common cancer (56.0%) followed by ovarian cancer (21.0%) and gestational trophoblastic neoplasia (13.0%). The mean age of patients was 50.82±12.81 years. 38 (62.3%) were postmenopausal; 59 (96.7%) had good performance status at presentation (ECOG 1 and 2); 41 (67.2%) had early stage disease (stage I and II). 36 (59.0%) were referred outside for further treatment and majority belonged to cervical cancer (n=29;80.5%) for radiotherapy services. Eight (13.1%) patients had disease recurrence and one patient (1.6%) had death during the study duration. Among patients with cervical cancer, the mean age at marriage and at first pregnancy were 17.24±2.32 years and 19.47±2.51 years respectively. Majority of them had poor local hygiene (n=27; 79.4%). The most common presentation was post menopausal bleeding (n=29; 85.3%) and most common histology was squamous cell carcinoma (n=30; 88.3%).

Conclusions: Cervical cancer is the most common female genital tract cancer followed by ovarian and gestational trophoblastic tumor.

Keywords: clinico-pathological, female, genital tract, malignancy, risk factors.

Impact of different waves of COVID-19 on the rate and indications of Caesarean delivery: An Observational Study

Wed, 28 Dec 2022 00:00:00 +0000

Aims: To assess the impact of the COVID-19 pandemic on caesarean section rate, its indications, and related maternal and neonatal mortality rates during the first and second waves in comparison to pre-COVID era.

Methods: This is retrospective observational analytical study conducted at a tertiary hospital from Northern India. Case records of 3196 women who underwent caesarean delivery (CD) during pre-Covid, Covid first wave and covid second wave periods from April to September each year in 2019, 2020 and 2021 respectively were reviewed. Results: Institutional delivery rate reduced by 45% and 38% during first and second waves respectively. The overall CD rate in the study groups 1 (29.34%) and 2 (30.09%) was comparable with control group (28.70%). Difference in CD rate in COVID-19 positive and negative women was comparable. The most common indication for CD was foetal distress followed by labour dystocia in all groups. Caesarean delivery for failed induction was significantly reduced in both waves. However, CD for previous two or more caesarean sections and non-reassuring FHR were significantly increased in first wave and for deranged doppler in second wave. Maternal mortality ratio and neonatal mortality rate were comparable in all groups.

Conclusions: Institutional delivery rate significantly reduced in COVID-19 pandemic with non-significant change in caesarean section rate and significant difference in few indications

Keywords: cesarean delivery, cesarean section, COVID-19, maternal mortality, neonatal mortality

Knowledge, attitude and practices regarding HPV vaccination among medical and paramedical students in North India

Himanshi Gupta, Priya Sharma, Swati Dubey, Uma Gupta, Aditya Vikram — Wed, 28 Dec 2022 00:00:00 +0000

Aims: To assess the knowledge, attitude and practices regarding HPV vaccination among medical and para medical students in North India.

Results: A total of 391 respondents were enrolled in the study with mean age of 24.39±4.27 years. The overall knowledge level of respondents in the study was satisfactory around 69%. Majority of respondents favours need for more awareness programmes regarding HPV vaccination, implementation of education on HPV infection at schools and colleges, inclusion of HPV vaccination in National Immunisation Schedule and provision to provide vaccination at schools and colleges. In regard to practice, 78.5% respondents either underwent or were willing to undergo vaccination. Reason for non-vaccination were mainly fear of side effect (23.2%), cost (18.8%), doubts about efficacy (10.4%) and others.

Methods: This study is Cross sectional study conducted among 391 medical and nursing students after obtaining ethical approval from the Institute’s Ethics committee. Data was analyzed using Statistical Package for Social Sciences 21.0. Independent samples t-test and ANOVA were used to compare the data. Correlation between knowledge, attitude and practice scores was assessed using Pearson correlation coefficient.

Conclusions: The study concludes, not only the students but a health care professional lacks appropriate knowledge regarding HPV and cervical cancer.

Companionship during childbirth: As experienced and perceived in rural Nepal, Sindhupalchowk

Rujina Joshi, Wanapa Naravage — Wed, 28 Dec 2022 00:00:00 +0000

Aims: To explore the experiences and the perceptions of reproductive-aged women and their main influencers, including husbands or mothers-in-law during their most recent institutional delivery regarding companionship during childbirth. To identify the experiences and perceptions of nursing staff regarding companionship during childbirth.

Methods: A qualitative approach was adopted to interview chosen eleven reproductive-aged women, five main influencers (three husbands and two mothers-in-law) and three nursing staff of Melamchi Primary Health Care Center by purposive sampling, in a community setting.

Results: Overall, almost all the women were not allowed to be accompanied by their relatives during childbirth in the Primary Health Care Center, when majority of them wanted company of their husbands, followed by female relatives. The nursing staff also concurred to the need of companionship during childbirth for support. On the contrary, a few interviewed women and all the husbands did not find any importance of companionship to the women in labor. Main reasons expressed were the ignorance among husbands to support their partners during childbirth and a feeling of shyness or discomfort among women in presence of known person during the process.

Conclusion: The practice regarding the provision of companionship during childbirth is not congruent to the felt need for and importance of it by majority of women and nursing staff. Privacy, infection control and institutional policy were the concern for companionship during childbirth.

Key words: childbirth, companionship, experience, perception, Respectful Maternity Care

Thrombocytopenia in pregnancy and its correlation with fetomaternal outcome in a tertiary care hospital

Mandira Roy, vAmit Kyal, Parth Donga, Indrani Das — Wed, 28 Dec 2022 00:00:00 +0000

Aims: To study thrombocytopenia in pregnancy and its correlation with fetomaternal outcome in a tertiary care centre.

Methods: Observational descriptive study conducted in Medical College Kolkata from 1 st January 2019 to 30 th June 2020 taking pregnant women having platelet count less than 1,50,000/L.

Results: Total 70 cases with mild, moderate and severe thrombocytopenia were seen in 77.1%, 8.6% and 14.3% patients respectively. Gestational thrombocytopenia was the most common cause (58.6%) followed by Pre-eclampsia (21.4%) and ITP (5.7%). Vaginal delivery was the preferred route of delivery (65.7%). Treatment (platelet transfusion/ IVIG / steroids) was required only in 11.42% cases. Maternal complications were postpartum haemorrhage (20%), episiotomy site hematoma (9.8%), placental abruption (8.6% ) and rectus sheath hematoma (4.5%); and there was no maternal mortality. Fetal outcomes were low birth weight (18.6%), IUGR (14.3%), IUFD (1.4%). Apgar score <7 at 5 minutes (13.2%), neonatal thrombocytopenia (1.5%) and ICU admission (19.1%). Early Neonatal death was seen in 2.9% babies.

Conclusions: One-third of cases had hemorrhagic complication and one in ten cases received specific medical treatment for thrombocytopenia.

Keywords: fetal, maternal, outcome, thrombocytopenia

Infection Prevention Control (IPC), Hospital acquired infection (HAI) and Obstetrics practice

Reetu Baral — Sat, 11 Feb 2023 00:00:00 +0000

Infection prevention and control program is important to prevent infectious morbidity. Simple method like hand washing to effective sterilization methods are recommended in clinical practice. Immunocompromised state of pregnancy and newborn are more vulnerable to acquire infection; and there is a real challenge from hospital acquired infection because of surgical nature of obstetric care.

Implementation of cervical cancer prevention and screening at global and national levels: a review of evidence and research gaps

Rolina Dhital — Sat, 11 Feb 2023 00:00:00 +0000

Aims: To identify the existing solutions and research gaps globally and in Nepal to provide an overview on the existing solutions and research gaps.

Methods: Different databases such as PubMed, Google Scholar, registries, and relevant organizational websites were searched. The study designs included systematic reviews on cervical cancer prevention and screening globally and original studies and program related reports in Nepal. Narrative summary of the findings were performed.

Results: Globally, most of the systematic reviews are conducted in low and middle-income countries followed by high-income countries. The cost-effective and common interventions globally and in South Asia includes awareness and educational activities for cervical cancer screening and prevention, early medical interventions such as pap smears, HPV vaccination, and visual inspection with acetic acid. Barriers to cervical cancer screening include lack of education, low socioeconomic status, and lack of knowledge, lack of effective communication, embarrassment, time constraints, and preference of female doctors. In Nepal, the national guidelines on cervical cancer screening and prevention were published more than a decade ago. The published studies indicated a low level of knowledge and attitude related to cervical cancer prevention and screening.

Conclusions: Research in cervical cancer prevention and screening has received recognition globally in recent years. In Nepal, research that has explored the implementation and policy gaps at a deeper level through different dimensions remain inadequate. The findings of this review could pave way for designing better studies for sustainable interventions in the long run.

Perioperative Bilateral Internal Iliac Artery Balloon Occlusion, In the Setting of Placenta Accreta and Its Variants: The Role of the Interventional Radiologist

Sristi Singh, Padma Gurung, Prashant Shrestha — Wed, 28 Dec 2022 00:00:00 +0000

A case of twenty eight year-old, G3P2 with placenta accreta, oligohydramnios, placenta previa and previous LSCS for placenta previa had undergone bilateral internal iliac artery balloon occlusion as a preventative measure to control anticipated intra-operative hemorrhage. Balloons were inserted in cath lab and shifted to operation theater for Cesarean Section. After the delivery of baby and during cord clamping, balloon was inflated and hysterectomy was carried out with minimal blood loss of 400ml.

Keywords: balloon occlusion, cath lab, cesarean delivery, internal iliac artery, placenta accreta