Nepal Journal of Obstetrics and Gynaecology

Stillbirths In Nepal: A Scoping Review

Keshar Bahadur Dhakal, Damber Khadka, Astha Dhakal, Sulochana Dhakal-Rai — Sat, 31 Dec 2022 00:00:00 +0000

Stillbirth is the term to describe a foetal demise in utero either prior to, or during the process of labour. It is one of the most burning issues in obstetrics research in recent years. Stillbirth is one of the most heart-wrenching events which can occur unexpectedly during the course of a pregnancy. It causes immense distress to the mother and the health professionals involved. This study aims to explore the incidence, sociodemographic characters, risk factors and obstetrical outcomes related to stillbirths among various studies in Nepal. We searched various electronic databases such as MEDLINE, CINAHL, PubMed, Nepal Journals on-line (NepJOL) and Bangladesh Journals on-line (BanglaJOL) from 2014 to 2021, especially for articles reporting hospital-based stillbirths. We included studies with primary studies on stillbirth conducted in a hospital setting in Nepal and published in English language. The incidence of stillbirths in Nepal varied widely. In this study, the incidence varied from 8 to 23.87 per 1000 births. The majority of stillbirths were preterm, occurring among women aged 20 - 35 years. Many stillborn babies were low birth weight. The categorisation of maternal age and weight of baby, lower limit of gestational week was not similar across the studies. Hypertensive disorders in pregnancy and unexplained factors were the leading risk factors. Limited number of studies available and the lack of uniformity among studies was the main limitation of this review.

Ultrasound measurement of fetal kidney length in the second and third trimester of pregnancy and its correlation with gestational age

Mahesh Gautam, Bipin Khanal, Amita Dhakal, Manish Raj Pathak, Sagar Tiwari — Sat, 31 Dec 2022 00:00:00 +0000

Aims: To measure the fetal kidney length in the second and third trimesters of pregnancy and correlate it with the gestational age and other routine fetal parameters.

Methods: This prospective cross-sectional study includes 250 pregnant women presented in the Nobel Medical College for ultrasound examination from the period of July 2021 to June 2022. Gestational age was estimated based on the last menstrual date and ultrasonogram. Routine fetal parameters and mean fetal kidney length were measured. The correlation between gestational age, fetal kidney length, and routine fetal parameters was studied.

Results: The mean gestational age according to ultrasound and last menstrual period were 35.5 ± 3.4 weeks and 35.2 ± 3.2 weeks respectively. The mean fetal kidney length was 36.8 ± 4.02mm. There was a very strong positive correlation between gestational age and fetal kidney length (r=0.921, p =0.001). Compared to the routine fetal parameters, adding fetal kidney length improved the effectiveness in predicting gestational age. (R² =0.918 vs. R² =0.936)

Conclusion: Fetal kidney length can be added to the other standard parameters to improve the prediction of gestational age.

Two syringes technique for spinal anesthesia to prevent hypotension in patients undergoing elective cesarean section

Saurav Shrestha, Jeju Nath Pokhrel, Tara Gurung, Sagar Devkota, Apurb Sharma — Sat, 31 Dec 2022 00:00:00 +0000

Aims: To compare the incidence of hypotension after intrathecal administration of hyperbaric bupivacaine and fentanyl in two different syringes against standard injection of mixed fentanyl with hyperbaric bupivacaine.

Methods: This was a prospective comparative study conducted in 174 parturients undergoing elective caesarean section at Paropakar Maternity & Women’s Hospital. Hemodynamic effects and characteristics of block were monitored and recorded and compared between the two groups, group S (single syringe) and group D (double syringe).

Results: The incidence of hypotension was almost similar in the two groups but the drop in systolic blood pressure and mean arterial pressure at 5 minutes and 7.5 minutes after subarachnoid block was significant in group S as compared to group D (p<0.005 and p<0.005 respectively).

Conclusion: Hyperbaric bupivacaine with fentanyl, which when injected separately without mixing, is associated with lesser incidence of hypotension following subarachnoid block.

Diagnostic Laparoscopy to assess tubal and pelvic pathology in patients of subfertility: A retrospective analysis

Nilam Subedi, Asmita Ghimire, Padam Raj Pant — Sat, 31 Dec 2022 00:00:00 +0000

Aims: To assess the tubal pathology contributing to primary and secondary infertility by laparoscopic examination.

Methods: The study was carried out in the department of Obstetrics and gynecology, Grande International Hospital. This is a retrospective study conducted in tertiary care hospital over a period of 2 yrs. From 2020 February to 2022 January. All patients with complaints of infertility (primary and secondary) who were admitted, evaluated and operated for infertility in Obstetrics and Gynaecology department of Grande international Hospital.

Results: Of the 52 patients minimum age was 20 and maximum was 46 with mean age of 30.52±4.885. Thirty eight patients had primary infertility and 14 had secondary. Forty patients had normal uterus while 12 had enlarged uterus. Hydrosalpinx was found in 11.5 % and 30.8% in right and left tube respectively. Pyosalpinx was found in 9.6% and 7.7% in right and left tube respectively. Bilateral tubes were patent in 22 cases while bilateral blocked tube was found in 13 cases so rest 17 cases had unilateral tubal block. Pelvic adhesions were found in 44.2 % cases. Most of them were associated with endometriosis (15.4%) followed by ovarian cyst (11.5%) and fibroid uterus (11.5%).

Conclusions: Majority had normal tubal pathology followed by edematous tube, hydrosalpinx and pyosalpinx. Endometriosis, fibroid and ovarian cyst were commonly associated conditions.

Abortion Legislation and its Reform: A Cross Sectional Study on the Views of Obstetricians and Gynecologists in Nepal

Shreyashi Aryal, Deepak Shrestha — Sat, 31 Dec 2022 00:00:00 +0000

Aims: To assess the knowledge of obstetrician and gynaecologists in Nepal about abortion legislation and to know their perception on its reform.

Methods: A cross-sectional survey design was adopted. An online questionnaire was sent to all members of the Nepal Society of Obstetrician and Gynaecologists and response was collected. Profile of the respondents, their knowledge on the 2002 abortion legislation and their attitude on its reform were noted.

Results: The response rate was 10.1%. There was a fair knowledge of previous abortion legislation amongst the 43 respondents. The mean score for the knowledge on previous abortion law and its reform was 3.85±0.35 and 3.0±1.14 respectively. Twenty-seven (62.8%) respondents felt the need for reform was necessary. In regards to the reform, 44.25% (19) stood for it and 46.5% (20) were against it. More (55%) obstetrician and gynaecologists practicing in the Bagmati province were against the reform.

Conclusions: Obstetrician and gynaecologists practitioners in Nepal have a good knowledge of abortion legislation and are aware of its reform. The need for reform is also perceived well but there is a divided opinion amongst practitioners, with half of them positive about the reform and half standing against it.

Clinical analysis of ectopic pregnancy in a tertiary center in rural Telangana

N S Sai Anusha, Basanta Manjari Hota, Naimisha Movva — Sat, 31 Dec 2022 00:00:00 +0000

Aims: To find the incidence, risk factors, morbidity and mortality in ectopic pregnancy in a tertiary center in rural Telangana.

Methods: This retrospective observational study was conducted in the Department of Obstetrics and Gynecology, Mamata Medical College, Khammam, Telangana State, India, over 5 years from 2017 to 2021. Detailed informative data of all admitted and treated cases of ectopic pregnancy were collected, analyzed and discussed.

Result: The incidence of ectopic pregnancy was 1.3 per 100 pregnancies and 2.5% case fatality. The majority of cases were in the 20-30 years of age group (82.5%); multipara (50%) and gestational age of ≤ 8 weeks (62.5%). History of abortion was the most common risk factor (67.5%). The classical triad of amenorrhoea, pain abdomen and bleeding per vagina was present in 45% of cases; and amenorrhea (97.5%), pain abdomen (87.5%) and vaginal bleeding (42.5%), abdominal tenderness (85%) and unstable hemodynamic (22.5%) were reported. The fallopian tube was the commonest site and operative management was required in 97.2% of cases.

Conclusion: Prevention of known risk factors, early reporting and referral in need, diagnosis and effective management is the way to a better outcome in ectopic pregnancy.

Correlation between various biochemical biomarkers and blood pressure in pregnant women

Balwinder Kaur, Renu, Ashok Kumar, Beant Singh, Manjit Kaur — Sat, 31 Dec 2022 00:00:00 +0000

Aims: To find out the correlation of C-reactive protein, serum uric acid and serum LDH with hypertensive antenatal patients.

Methods: The present study was conducted among preeclamptic and eclamptic antenatal patients. Serum was used for estimation of serum levels of CRP, LDH and Uric acid. The data obtained was compiled and analyzed statistically and was expressed in terms of mean±SD and percentage. Student t-test, Chi-square test, Pearson’s Correlation Coefficient were used and p value less than 0.05 was considered significant.

Results: A positive correlation was found between serum CRP level and systolic blood pressure (r = +0.525, P=0.001) & serum CRP level diastolic systolic blood pressure (r= + 0.493, P=0.001). There was a positive correlation between serum uric acid with systolic (r= +0.454, P <0.001) and diastolic blood pressure (r = +0.471, p < 0.001). There was positive correlation between Serum LDH with systolic (r =+0.385, p value of r <0.001) and diastolic BP (r = +0.420, p value of r < 0.001).

Conclusion: Hyperuricemia, increased serum CRP and LDH level can be used as biomarkers for identifying women at risk of preeclampsia and its complications along with adverse effects. We conclude that CRP, serum LDH and Serum Uric acid are reliable and inexpensive markers to predict severity of hypertensive disorders of pregnancy.

Analysis of the Factors leading to Severe Acute Maternal Morbidity and Maternal Mortality during COVID 19 Pandemic

Junu Shrestha, Sudiksha Thapa, Nidhish Sharma — Sat, 31 Dec 2022 00:00:00 +0000

Aims: To determine prevalence, causes and factors leading to severe acute maternal morbidity and mortality during COVID 19 pandemic.

Methods: The was a cross sectional observational study conducted in the department of Obstetrics and Gynaecology of Manipal teaching hospital from March 2020 to February 2022 amid COVID 19 pandemic. Women who sustained severe acute maternal morbidity (according to World health organization organ system criteria) and maternal deaths during pregnancy, labour and six weeks postpartum were included. Maternal characteristics, total live births, pregnancy outcome, causes and factors leading to morbidity and mortality were noted. The acquisitioned data was analyzed using Statistical Package for Social Sciences version 21.

Results: There were 37 cases of severe acute maternal morbidity and 2 cases of maternal deaths. The severe acute maternal morbidity ratio was 9.4 per 1000 live births and maternal mortality ratio was 51 per 100,000 live births. Therefore, severe acute maternal morbidity mortality ratio was 18.5:1 and mortality index 5.1%. Haematological and coagulation system (45.9%) and neurological system (29.7%) were the common organ systems involved. Hypertensive disorders (40.5%) and haemorrhage (32.4%) were the main causes of severe acute morbidity. Both maternal deaths occurred due to eclampsia. There was no severe acute maternal morbidity or mortality due to COVID infection in pregnancy. Delay in seeking and reaching to the health centre (65%) was major delay leading to severe morbidity and mortality.

Conclusions: Indices and causes of severe acute maternal morbidity and mortality during COVID 19 pandemic was not worse compared to those prior to COVID 19 pandemic. Primary delay in seeking and reaching health care was the main factor leading to severe morbidity and mortality.

Clinical and Demographic Profile of Covid-19 Infected Pregnant Women admitted in Obstetric Ward

Meena Thapa, Dilasha Karki, Sujata Maharjan, Lakpa Dolma Lama — Sat, 31 Dec 2022 00:00:00 +0000

Aims: To evaluate the severity of the infection among pregnant women in an urban area of Nepal during the first surge in COVID-19 cases in Nepal in the year 2020.

Methods: This is a retrospective and descriptive study carried out at Department of Obstetrics and Gynecology in Kathmandu Medical College, Kathmandu, Nepal, from August 2020 to January 2021. All the Covid infected pregnant women admitted in Obstetric ward for various presenting symptoms were included.

Results: Among 52 Covid-19 positive pregnant women admitted for various obstetrical and medical complaints, 90.38% were asymptomatic at the time of admission. Those who were symptomatic (9.61%) had mild form of infection. Majority of infected women were admitted in the month of October and November with most common presentation being women in labour (48.07 %).

Conclusions: Pregnant women with SARS Covid-19 infection has no greater threat to their health.

Analysis of the phenotypic variants of polycystic ovarian syndrome in women of reproductive age group

Sat, 31 Dec 2022 00:00:00 +0000

Aims: To identify the different phenotypic variant of PCOS in women of reproductive age group and to assess the hormonal and metabolic profile of women with PCOS.

Methods: This Prospective descriptive study was conducted in the Department of Obstetrics and Gynecology, BPKIHS, Dharan for a period of one year from July 2020 to June 2021. All Women presenting to Gynecology OPD with complaints of menstrual irregularity and clinical features of hyperandrogenism were assessed and evaluated for polycystic ovarian syndrome. BMI was calculated. Hormonal Profile (serum LH, FSH and testosterone) and metabolic parameters (fasting blood sugar and lipid profile) were studied; and then further categorized into different phenotypic variants. All data were stored in Microsoft excel format and analyzed using SPSS version 11.5. using descriptive statistics.

Results: Total of 80 cases of PCOS were enrolled during the study period. The most common phenotypic variant was Type B (60%) followed by Type D (30%). The mean BMI was 22.4± 4.2kg/m² . All PCOS cases presented with menstrual irregularity as the primary complaint.

Conclusions: Anovulatory PCOS was the most common phenotypic variant in our study population. This study did not find obese PCOS hence emphasizing the need of evaluation in lean women with or without hyperandrogenism presenting with menstrual irregularities.

Neural tube defects: An Obstetrician’s concern

Gehanath Baral — Sat, 03 Sep 2022 00:00:00 +0000

No abstract available.

Smooth muscle tumor of uncertain malignant potential (STUMP)

Reena Yadav, Sana Ansari, Kanika Chopra, Kiran Agrawal, Md Ali Osama, Swati Dhar — Sat, 31 Dec 2022 00:00:00 +0000

Uterine smooth muscle tumor of uncertain malignant potential (STUMP) is a rare tumor belonging to a group of smooth muscle tumor that possess both benign and malignant features, complicating the diagnosis. STUMP is a rare uterine tumor with a paucity of literature available regarding management and subsequent malignant potential. A 22-year-old unmarried lady presented as uterine fibroids with 24 weeks size uterus. There was one intramural and another subserosal mass both of which revealed smooth muscle tumor of uncertain malignant potential in histopathology.

Late presentation of vesicouterine rupture following vaginal birth after caesarean

Baburam Dixit Thapa, Mohan Chandra Regmi — Sat, 31 Dec 2022 00:00:00 +0000

Vesicouterine rupture is one of the complications of vaginal birth after cesarean section. Late presentation of bladder along with uterine rupture is rarely reported in literature. A case of vaginal birth after cesarean got admitted on seventh postpartum day due to hematuria and urinary retention. On Per abdominal examination bladder was palpable. A large defect was noted in the dome of bladder on cystoscopy. The posterior wall and fundus of uterus was acting as posterior wall of urinary bladder on laparotomy. Total hysterectomy was done and bladder was repaired.

Inversion of uterus due to prolapsed submucous fundal fibroid

Sat, 31 Dec 2022 00:00:00 +0000

Inversion of uterus is rarely encountered by gynecologist during practice; inversion in a non- pregnant uterus is further rarer; only case reports are published in literature on non-puerperal uterine inversion. We present a case of a 40-years multipara who had a history of irregular and excessive vaginal bleeding associated with severe lower abdominal pain during vaginal bleeding for two years. She was referred from general hospital with suspicion of cervical cancer. Being a rare clinical condition diagnosis and management of uterine inversion is challenging. High index of clinical suspicion is necessary which can be aided by radiographic imaging. Our case was diagnosed as a case of complete uterine inversion secondary to fundal fibroid clinically. She underwent abdominal hysterectomy with bilateral salpingectomy with bilateral sacrospinous vault suspension after resuscitation with fluids, blood transfusion and broad-spectrum antibiotics.

Smooth muscle tumor of uncertain malignant potential (STUMP) of Vulva

Munjal Yadav, Gehanath Baral — Sat, 31 Dec 2022 00:00:00 +0000

A 30-years old nulliparous lady presented with apparently recurrent leiomyoma of vulva and past history of repeated resections. She had firm bilobed non-tender vulval lump and underwent partial vulvectomy. Histopathology revealed Smooth muscle tumor of uncertain malignant potential (STUMP).

Conclusion: Vulvar leiomyoma is fairly uncommon and can often be misdiagnosed. Surgical excision and histopathological analysis is helpful/ recommended for final diagnosis of Vulvar STUMP.

Table of Content

Editorial Team — Fri, 26 May 2023 00:00:00 +0000

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