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Aims: To observe the maternal and fetal outcome among those having elevated Glucose Challenge Test (GCT) level and gestational diabetes mellitus (GDM). Methods: Medical record of 15,413 pregnant women booked and delivered between June 2012 and January 2018 were evaluated. GCT was performed by using 50gm glucose and diagnosis of gestational diabetes performed by using the Carpenter Coustan Criteria. Pregnancy outcomes were assessed by the antenatal events, gestation and mode of delivery. Similarly, neonatal outcomes assessed in terms of birth weights, Apgar score, congenital abnormalities, hyperbilirubinaemia, hypoglycaemia and respiratory distress syndrome. Results: The detected incidence of gestational diabetes was 2.35%. With the threshold plasma glucose level at 140 mg/ dl, 1843 women needed to undergo 100g oral glucose tolerance test and 363 women had gestational diabetes. Conclusions: It is very important to find out GDM in pregnancy as it has adverse outcomes which are preventable; it is worthwhile to detect GDM by screening in pregnancy. The 50g GCT is feasible and 100gm OGTT to find out GDM. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study was to analyze the non-reproductive risk factors associated with uterovaginal prolapse (UVP) which is a major health concern of women. Methods: This was a hospital-based case control study, carried out in the Gynaecology Department of Tribhuvan University Teaching Hospital (TUTH) over one year from 13th April 2011 to 12th April 2012). Cases comprised of 116 women with UVP, second degree or more and controls were women without prolapse of the same age group within five years admitted subsequently after the cases. The variables studied were medical disorders like chronic obstructive pulmonary disease (COPD)/chronic cough, constipation; smoking, family history of prolapse and body mass index (BMT). The p-value and Odds Ratio (OR) for each risk factor were calculated. Multivariate analysis was done for those risk factors found to be significant from the univariate analysis. Results: Smoking, family history of prolapse and low BMI were found to be significant risk factors from univariate analysis. Only two risk factors-family history of prolapse with OR 5.52 (2.11-14.49) and being underweight with OR 15.38 (1.88-125), were found to be significant by multivariate analysis. Conclusions: Providing good nutrition and preventing malnourishment in postmenopausal women, imparting awareness about increased risk in women with history of prolapse in first degree relatives and educating about the perils of smoking could contribute in reducing morbidity due to prolapse. [ABSTRACT FROM AUTHOR]

Aims: This was performed to study the characteristics of Pregnancy Related Acute Kidney Injury (PRAKI), its management and outcome in patients at a tertiary level referral centre. Methods: A hospital based prospective observational study was conducted in Tribhuvan University Teaching Hospital (TUTH) over a period of 18 months. All patients diagnosed with PRAKI were included in the study. Patient profiles in terms of age, parity, gestational age were studied along with time of occurrence of PRAKI, preceding event, etiology, management and maternal outcome. Descriptive and univariate analyses were conducted and qualitative variables were expressed as percentages while quantitative variables as means. Results: There were fifteen cases of PRAKI during the study period with incidence of 2.1 per 1000 deliveries. The average age was 25.23± 3.8 years and 9(60%) were primipara. Fourteen (93.3%) developed PRAKI in the postpartum period with 10(66.6%) cases following Lower Segment Caesarian Section (LSCS). The commonest etiology of PRAKI was severe preeclampsia/Hemolysis, Elevated Liver enzymes, Low Platelet (HELLP) syndrome and pregnancy hemorrhages each consisting 4(26.6%) cases. The stage of Acute Kidney Injury (AKI) according to RIFLE (Risk, Injury, Failure, Loss, ESRD-End Stage Renal Disease) criteria was as follows: risk in 1(6.6%), injury in 3(20%) and failure in 11(73.3%) cases. Hemodialysis was necessary in 12(80%) cases while 3 cases (20%) improved with medical management only. The average duration of hospital stay was 25.2±14.7 days and 7(46.6%) needed ICU admission. Twelve (80%) cases recovered completely while two patients were dialysis dependent at the time of evaluation. There was one death. Conclusions: PRAKI occurred mainly in the postpartum period with severe preeclampsia/HELLP syndrome and hemorrhages as the most common causes. It is associated with high maternal morbidity, prolonged hospital stay and even mortality. Multidisciplinary team management is essential. [ABSTRACT FROM AUTHOR]

Aims: This study was done to analyze the cases of obstetric hysterectomy and maternal complications and survival after that. Methods: A retrospective study was carried out from the review of records of the near miss, maternal mortality, cesarean audit and operation theater record of the Department of Obstetrics and Gynaecology, Tribhuvan University Teaching Hospital (TUTH), Kathmandu from 2057-2071 BS. Results: Fourteen maternal survival resulted following total of 19 obstetric hysterectomy, subtotal hysterectomy being the procedure of choice in 11 cases, emergency peripartum hysterectomy (EPH) being performed in abundance (18/19) in comparison to an elective peripartum hysterectomy, which was undertaken in a single case of placenta percreta, and inclusive of latter were four cases of morbid placental adhesion, a placenta increta and two placenta accreta. Eight out of 19 cases had vaginal delivery and rest had cesarean section. Among seven cases of cesarean hysterectomy 3 were done for placenta previa with accreta one case each done for abruptio placentae and placenta accreta and two cases were done for extra placental causes. Among four cases of emergency peripartum hysterectomy (EPH), which were relaparotomy followed by hysterectomy, three cases were done for complication of cesarean section and one done for uterine atonicity. Four cases of spontaneous vaginal deliveries needed peripartum hysterectomy two of them were complicated by morbid placental adhesion placenta increta (1), placental percreta (1), two cases were vaginal birth after cesarean (VBAC). Seven cases of uterine rupture had undergone peripartum hysterectomy. Conclusions: Obstetric hysterectomy is a lifesaving surgical procedure for maternal survival whenever necessary and mandates a quick decision making process, however in consideration of younger age and low parity or nulliparity, the best obstetric governance and services must foresee not to let mothers meet such situation necessitating organ removal and to enjoy potential reproductive life cycle. [ABSTRACT FROM AUTHOR]

Aims: This study was done to understand the severity of labor pain in parturients of Kathmandu and to determine factors affecting it. Methods: A descriptive study was conducted in Tribhuvan University Teaching Hospital (TUTH), Kathmandu, Nepal where 300 term parturientsin active labor (cervical dilatation of 3-5 cm with three uterine contractions in 10 minutes each lasting for ≥ 30 seconds) were analysed for socio-demographic data, clinical profile and pain assessment. Visual analog scale was used for pain assessment. Results: The intensity of labor pain was graded as severe by 32%, moderateby 57% and mild by 11% of parturients. Almost half of the parturients in the age group of ≤ 19 years described labor pain as severe as compared to women between 20-34years (30.4%) and ≥ 35 years (20%). Among the nulliparous parturients, 37% described it as severe compared to only 20.7% in ≥ Para 1. In those with ≥ higher secondary leveleducation, 35.9% described labor pain as severe as compared to those women who had education of ≤ primary level(26.9%) and upto secondary level (27.1%). Labor pain was seen to be more severe in advanced labor withmore than half describingit as severe when the cervix was dilated to 5 cm, as compared to only 25.9% and 29.4% of the parturients at 3 and 4cm cervical dilatation respectively. Conclusions: This study concluded that the labor pain was moderate to severe for majority of the parturients. Adolescents, nullipara, patients with higher education and those in advanced laborwere more likely to perceive labor pain of higher intensity. [ABSTRACT FROM AUTHOR]