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Background The most common pathological cause of abnormal vaginal discharge in reproductive-aged women is bacterial vaginosis (BV). Amsel’s criteria and Nugent scoring systems are commonly employed approaches for the diagnosis of BV. Despite the Nugent scoring system being the gold standard method for diagnosing BV, Amsel’s criteria are generally preferred in clinical setup owing to the fact Nugent scoring requires considerable time and expert microscopist. This study was conducted to determine the diagnostic value of Amsel’s criteria by comparing it with the Nugent scoring system. Methods This was a descriptive cross-sectional study conducted at Tribhuvan University Teaching Hospital, Nepal from October 2016 to September 2017. Vaginal specimens were collected from a total of 141 women presenting with abnormal vaginal discharge. The sensitivity, specificity, positive predictive value, and negative predictive value of Amsel’s criteria were calculated, and each component of Amsel’s criteria was compared to the Nugent scoring system. Results The sensitivity, specificity, positive predictive value, and negative predictive value of Amsel’s criteria were 50%, 98.2%, 87.5%, and 88.8% respectively. The clue cells showed 100% specificity and vaginal discharge with pH > 4.5 had 89.3% sensitivity while compared with Nugent’s scoring system. Conclusions Amsel’s criteria can be used as an adjunct method to Nugent scoring for the diagnosis of BV in the hands of skilled manpower in resources limited countries. The presence of clue cell and positive whiff test of Amsel’s criteria shows good match with Nugent’s score.

Gestational trophoblastic neoplasia is extremely rare entity accounting 1% of all gynecological malignancies. Invasive mole is a form of Gestational trophoblastic neoplasia which is locally invasive with propensity of metastasis. Association of partial mole with invasive mole and/or theca lutein cysts is a rare occurrence. Large cysts may present with complications. A case with these rare combinations presented at 15+3 weeks period of gestation as acute abdomen due to torsion of bilateral theca lutein cysts is reported. Right salpingo-ophorectomy with untwisting of left cyst was done. Six cycles of chemotherapy was given with regular βhCG monitoring. First trimester dating scan would have helped in early diagnosis, treatment and prevention of complications. Keywords: Invasive mole; theca lutein cysts; torsion.

Objective The physiological challenges of high altitude have led to population-specific patterns of adaptation. These include alterations to child growth and reproduction, including lactation. However, while breastfeeding has been investigated, nothing is known about milk composition in high altitude adapted populations. Materials and Methods Here, we investigate milk macronutrient composition, volume, and energy in a sample of 82 Tibetans living at high and low altitude in rural villages (Nubri Valley, Nepal) and at low altitude in Kathmandu, Nepal. Milk samples were collected in the morning using hand expression, frozen, and assayed for fat, protein, and total sugars. Reproductive histories and health recalls were also collected. Results Milk fat averaged 5.2 ±2.0 g/100 mL, milk sugar 7.37 ± 0.49 g/100 mL, and milk protein 1.26 ± 0.35 g/100 mL for a mean energy density of 81.4 ± 17.4 kcal/100 mL. There were no associations between altitude of residence and milk composition; however, overall milk fat was high compared to reference populations. Within the three groups, milk fat was positively associated with infant age (B = 0.103; p

Aims: The objective of this study was to find the incidence, assess the age and stage of presentation of ovarian malignancy and correlate these features with the histological types. Methods: Retrospective analysis of ovarian tumor cases that underwent primary surgery at our institute between April 2009 - April 2012 was done. Age, histological type, stage of the disease features were analyzed. Statistical analysis was done by Chi square and T test. Results: Out of 451 ovarian tumor cases, 81 cases of borderline and malignant ovarian tumor were seen. Germ cell tumors were the most common type of ovarian tumors. The mean age of presentation of primary malignant tumors was 41.9 years. Serous adenocarcinoma was the most common ovarian cancer occurring in 22.2 % (n =67) cases. In women

A pregnant woman, gravida 3 with two living children, who frequently experienced syncope from 23(+5) weeks of pregnancy onwards and recurring every week for a period of 3 weeks, was repeatedly treated in line for a case of acid peptic disease/appendicitis in various peripheral hospitals of Nepal, until ultrasonogram/magnetic resonance imaging diagnosis of an (undisturbed) live 27(+5) weeks abdominal pregnancy was made at our hospital. On laparotomy, this materialized to be secondary to the rupture of a left rudimentary horn pregnancy (evidenced from its sealed margin) which still retained a complete placenta, from where an umbilical cord was seen, traversing across towards the right side of the abdominal cavity just below the liver, securing its attachment to the surviving fetus and enclosed in an intact amniotic sac. Excision of the rudimentary horn containing the placenta was accomplished, after the delivery of a live baby weighing 650 g who unfortunately died on the third day of life.

Background: Gestational Diabetes Mellitus (GDM) is associated with several adverse maternal and perinatal outcomes. Thus, screening for early detection of GDM and its treatment is important.Methods: This was hospital based descriptive study done over one year in department of Obstetrics and Gynecology, TUTH, Nepal. Six hundred ninety-seven women fulfilling the inclusion criteria were enrolled at 18-22 weeks of gestation. High risk factors were assessed and GCT was performed in women with risk factors during enrollment. Diagnostic OGTT was performed in women who screened positive (GCT ≥130mg/dl). Screen negative high-risk women were re-screened at 24-28 weeks. In women without known risk factors, GCT was performed at 24-28 weeks and OGTT was performed when screen positive. The diagnosis of GDM was made according to Carpenter and Coustan criteria.Results: Out of 697 enrolled women, 12 were excluded for various reasons and 685 women were analyzed. Women having risk of GDM were 28.9%. The prevalence of GDM was 2.92% and 2.48% with GCT cut off 130 mg/dl and 140 mg/dl respectively. Lowering the threshold to 130 mg/dl identified three extra cases (p=0.010). The prevalence among high risk group was 8.58% and 7.07% with the cut off value 130 mg/dl and 140 mg/dl respectively with three extra cases detected on taking cut off value 130 mg/dl (p=0.014). Among low risk women the prevalence of GDM was same i.e. 0.61% with both the cut off values.Conclusions: Lowering threshold of GCT to 130 mg/dl could identify significant percentage of extra cases of GDM especially in high risk women.

Introduction: In Nepal medical abortion has been approved for use since 2009. There were many cases coming to Tribhuvan University Teaching Hospital coming with problems and complications following medical abortion. Thus the objective of this study was to analyze the cases that came to TUTH following medical abortion with problems and complications. Methods: This is a prospective study conducted in the Department of Obstetrics and Gynecology of TUTH. Study was carried from 1st August 2011 to 30th November 2012. Women who came to TUTH with any complaints following medical abortion were interviewed, examined and treatment provided. Relevant clinical finding were noted. Results: There were a total of 57 cases during the study. Most (66.6%) of the women were in age group 20-29 years age. There were 45 (79%) women who had abortion up to 9 weeks. Medical shop was the main place where most of the women (45.6%) directly come to know about medical abortion. More than 34 (77.2%) received the service from medical shops without any supervision. Most 31 (54.4%) presented with incomplete abortion. There were three cases of continuing pregnancy and four presented with ectopic pregnancy. Eighteen (31.6%) cases needed admission. Fifty six percent of the cases were treated with manual vacuum aspiration, six cases underwent laparotomy and there was one maternal mortality. Conclusions: There is a need for proper dissemination and implementation of guideline for management of these women and adequate supervision to reduce the problems and complications. _______________________________________________________________________________________ Keywords: complications; incomplete abortion; medical abortion; problems.

DOI: http://dx.doi.org/10.3126/njog.v4i2.5033 NJOG 2010 Jan-Feb; 4(2): 12-17

Aim: To study laparotomy as second intervention for hemoperitoneum following primary surgery in obstetric and gynecology. Method: Eleven years retrospective study going back from Dec 2006 embracing all the cases of re/laparotomy for intraperitoneal bleeding were carried out in TUTH, Nepal. Results: Of the 24 cases complicated by intraperitoneal hemorrhage for which relaparotomy had been done 12 each were formed by gynaecologic and obstetric cases: 11 were caesareans (CS) and a laparotomy following vaginal birth after caesarean (VBAC). In gynecology the preceding surgeries undertaken were [diagnostic laparoscopy (1), laparotomy (3), hysterectomies 8 (3 being vaginal)] Massive hemoperitoneum occurred in ¼ cases; extensive hematoma in a third having altogether with associated risks factor in 9(37.5%).Source of bleeding were disligated/abraded infundibulopelvic vessel (3), cuff bleeding (4), cardinal ligaments (1), uterine cornua (1), uterine angles (6), vagina (1) and placental bed (1) which were duly managed by 5 obstetrics hysterectomy. Laparotomy >2 times were repeated 4: obstetric 2 [(1) for vault bleeding following hysterectomy done for scar rupture after VBAC and other for slippage of ovarian vessel following hysterectomy and internal iliac ligation] and same number in Gynecology 2 [(1) after vaginal hysterectomy first for laceration of infundibulopelvic vessel and then for generalized ooze and hematoma]. Next was following a diagnostic laparoscopy, complicated by unexplainable intraperitoneal bleeding first devised by internal iliac ligation, then finally by hysterectomy that died. Conclusions: Careful tying of the blood vessel, choosing right technique and appropriate ligature in the first place is as important as proper closure of all the surgical incision/ inflicted cut taking note of the rise in the pulse rate and fall in the blood pressure in overall postoperative cases such that related morbidity and mortality from late diagnosis leading to delayed second surgical intervention can be obviated or minimized. Key Words: Intraperitoneal bleeding, hemoperitoneum, relaparotomy doi:10.3126/njog.v2i2.1458 N. J. Obstet. Gynaecol 2007 Nov-Dec; 2 (2): 63 - 68

Aim: Aimed at comparing the efficacy of prophylactic intramuscular methylergometrine with intramuscular oxytocin in reducing blood loss in the third stage of labour (TSL). Methods: This is a randomized, comparative, clinical trial to compare the efficacy of intramuscular methylergometrine with intramuscular oxytocin in the third stage of labour for the prevention of postpartum hemorrhage Two hundred women undergoing normal vaginal delivery were recruited, 100 in each group- Group A receiving .2mg methylergometrine intramuscularly and Group B receiving 10U oxytocin intramuscularly immediately after the delivery of the anterior shoulder of the baby. The efficacy and the safety of these two drugs were analyzed on the basis of percentages fall in haemoglobin (Hb) and haematocrit (Hct) level from before delivery to 24 completed hours after delivery, need for additional uterotonic agents, need for exploration and uterine evacuation, need for blood transfusion, duration of third stage of labour and the numbers of retained placenta and need for MRP. Results: Intramuscular methylergometrine was observed to be equally effective as intramuscular oxytocin in prevention of post partum haemorrhage (PPH) [defined as fall in Hb and /or Hct level³ 10% from before delivery to 24 hours after delivery]. There was no difference in the risk of prolonged third stage, need for additional uterotonic agents, need for exploration and uterine evacuation and need for blood transfusion in the two groups. The side effects were all mild in nature and the overall incidence was too low for statistical significance to be elicited. Conclusion: Intramuscular methylergometrine is as efficacious as intramuscular oxytocin in the prevention of third stage blood loss with comparable side effects. Keywords: Third stage of labour, postpartum hemorrhage, methylergometrine, oxytocin. doi:10.3126/njog.v2i2.1451 N. J. Obstet. Gynaecol 2007 Nov-Dec; 2 (2): 24 - 28

How the largest of the large (> 10 x 8 cms) sub mucous myoma arising from the fundus uteri successively promotes the occurrence of non puerperal uterine inversion over the years as depicted through 3 different illustrations imitating a gradual process; first by forming an indentation in the uterine fundus then progressively causing more dimpling in the verge of uterine inversion until finally giving rise to a full blown picture of complete uterine inversion where the uterine fundus is driven beyond the level of introitus with the consequences of prolapsed incarcerated myoma in a post menopausal woman. A total abdominal hysterectomy and bilateral salpingoophorectomy were performed on all of these 3 women 2 perimenopausal and a postmenopausal; the latter was first facilitated by vaginal myomectomy further supplemented by division of the inversion ring posteriorly as described by Haultain. Key words: Non puerperal uterine inversion, submucous fundal myoma, vaginal myomectomy. doi:10.3126/njog.v1i2.2398 N. J. Obstet. Gynaecol Vol. 1, No. 2, p. 51-54 Nov-Dec 2006

During the interval period, she almost collapsed from heavy vaginal bleeding and therefore admitted and investigated. Complete blood count showed features of pancytopenia (low hemoglobin estimation reported as 5 gm%, low WBC, RBC and also platelets). For this she was transfused with 3 units of packed cell. In oral hormone therapy, medroxy progesterone acetate was substituted by norethisterone acetate and as usual, was sent home with a decision to operate later once there was subsidence of body edema and return in the tissue perfusion. This was also because on the unavailability of attending doctor.

Labial adhesion in adults is rare and usually due to trauma or chronic inflammation. This is a report of a case of labial fusion in an adult. A 36 year old unmarried woman presented with the complaint of discomfort during menstruation and difficulty in micturition since one year. The labial adhesion was produced after hot oil application for the treatment of rashes in childhood. Surgical lysis was possible exposing normal genitalia behind the fused labia is reported. Key words: Labial adhesion, labial fusion, micturition difficulty. doi:10.3126/njog.v1i2.2401 N. J. Obstet. Gynaecol Vol. 1, No. 2, p. 61-62 Nov-Dec 2006