Search

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 analyzed 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. [ABSTRACT FROM AUTHOR]

Aims: To determine the clinical outcome of rheumatic heart disease in pregnancy. Methods: Retrospective cross-sectional descriptive study from April 2019 to April 2021 in Nobel Medical College, Biratnagar, Nepal. Feto-maternal variables were taken for their health status. Data presented in table with frequency. Results: Out of 13013 deliveries in a year, 49 had cardiac disease (0.37%) and 38 had rheumatic heart disease (0.29%) over 28 weeks of gestation; 95% (n=36) had mitral valve involvement; 12 were primigravida and 7 preterm at the time of delivery. Half of them underwent caesarean section for various indications. Most common maternal complications were cardiac failure, cardiac arrythmia, admission to ICU, obstetric complications, including maternal mortality in 5.2% (n=2) cases. Low birth was in 29% (n=11) of cases, and 34% (n=13) of them needed NICU care at the time of delivery. There was history of rheumatic fever in 9 cases (24%). Conclusions: Rheumatic heart disease is the commonest diagnosis among heart disease in pregnancy and adverse event can be minimized by multidisciplinary intervention. [ABSTRACT FROM AUTHOR]

Introduction: Acute kidney injury  is a rare complication of pregnancy and is associated with high maternal morbidity and mortality. Obstetric factors associated with it are preeclampsia/eclampsia, sepsis, hemorrhage and dehydration. Here, we aim to find out the prevalence of complete recovery of renal function among obstetric patients with acute kidney injury., Methods: This is a descriptive cross-sectional study conducted in a tertiary care hospital from 1st July 2020 to 30th June 2021 where obstetric patients who had developed acute kidney injury were included and followed till 6 weeks of diagnosis. Ethical approval was obtained from Institutional Review Committee of Nobel Medical College and Teaching Hospital (IRC- NMCTH 437/2020). The convenience sampling method was used. Data entry and analysis were done using Statistical Package for Social Sciences version 21. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data., Results: Out of total 66 obstetric patients with acute kidney injury, 45 (68.2%) (57-79.3 at 95% Confidence Interval) had complete recovery of renal function. Rate of renal function recovery in Stage 1, Stage 2 and Stage 3 acute kidney injury were 19 (90%), 19 (86%) and 7 (58%) respectively. The most common causes of acute kidney injury were Preeclampsia/eclampsia 18 (40%), sepsis 23 (28.8%) and hemorrhage 10 (22.2%)., Conclusions:  The prevalence of complete recovery in obstetric patients with acute kidney injury was similar to findings from other studies done in similar settings.

Introduction: Thyroid hormone is known to affect reproductive biology. Abnormal uterine bleeding is one of the common presentations in gynaecology outpatient departments and thyroid dysfunction is known to affect its progression. This study aims to find the prevalence of thyroid dysfunction in diagnosed cases of abnormal uterine bleeding in patients in a tertiary hospital of eastern Nepal., Methods: A descriptive cross-sectional study was conducted in patients diagnosed with abnormal uterine bleeding in a tertiary care hospital of eastern Nepal from April 2019-March 2020 after taking ethical clearance from the Institutional Review Committee. On basis of inclusion and exclusion criteria, 95 cases of abnormal uterine bleeding were included in the study. A blood sample was taken and a thyroid function test was done by chemiluminescence assay on an automated analyzer. Convenient sampling method was used for sample collection. Statistical analysis was done using Statistical Package for the Social Sciences version 16. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data., Results: Out of the total cases of abnormal uterine bleeding, 15 (15.79%) (8.46-23.12 at 95% Confidence Interval) had thyroid dysfunction. Among total cases, 80 (84.21%) were euthyroid. The mean age of the patients was 33±8 years. Among thyroid dysfunction, 9 (60.0%) were hypothyroid, 4 (26.66 %) were subclinical hypothyroid, and 2 (13.33 %) were hyperthyroid., Conclusions: Thyroid dysfunction was common among patients with abnormal uterine bleeding, with hypothyroidism being the most common type.

Introduction: Infertility is a global health issue and a socially destabilizing condition for couples with several stigmas including medical, social, psychological burdens and a marital disharmony. The aim was to study the outcome of laparoscopy in infertile females attending Nobel Medical College as laparoscopy is considered as a gold standard in investigation and treatment of infertility., Methods: A descriptive cross-sectional study was carried out in the department of Obstetrics and Gynaecology over a period of May 2018-April 2020, where the outcomes of laparoscopy in infertile females were studied. All the patients with abnormal HSG, unexplained infertility and adnexal mass in the background of infertility were enrolled., Results: Of the 100 infertile patients who underwent laparoscopy, 62 (62%) had evidence of tubal disease as documented by unilateral or bilateral block, 63 (63%) had peritubal adhesions and hydrosalpinx in 15 (15%). Associated pelvic pathology like endometriosis in 50 (50%) in the form of cyst, adhesions and complete and partial obliteration of Pouch of Douglas., Conclusion: Laparoscopy is definitely an effective diagnostic tool of tubal and pelvic pathology. Laparoscopy is recommended for all infertile females with suspected tubal factor and moreover it provides opportunity to correct the condition in possible cases.

Paratubal cysts are generally small but there are rare cases of large paratubal cyst and this case is one of them. Here we report a case of a young female with complains of abdominal fullness since 3 months. On examination, a huge mass (25 x 25 cm) extending from symphysis pubis upto xiphisternum was noted. Ultrasongraphy showed a cystic mass of 27 x 27 cm. Intraoperatively, the cyst was paratubal. It was drained with the help of veress needle and laparoscopic cystectomy was done. A large adnexal cyst extending above umbilicus is traditionally managed by laparotomy. But with the advent of laparoscopy, even a huge cyst can be managed by laparoscopy.

Introduction: Nepal Society of Obstetricians and Gynecologists jointly with the Nepalese government and with the support from the International Federation of Obstetrics and Gynecology has implemented an initiative to institutionalize postpartum family planning services in selected major referral facilities of Nepal to address the gap of low uptake of postpartum family planning in Nepal. The aim of the study is to find the prevalence of the service coverage of postpartum contraception in the selected facilities., Methods: A descriptive cross-sectional study was conducted in seven major referral facilities across Nepal. Data were collected from the hospital records of all women who delivered in these facilities between October 2018 and March 2019. Ethical approval for this study was obtained from Nepal Health Research Council. Data analysis was done with SPSS version 23., Results: Among the 29,072 deliveries from all the facilities, postpartum family planning counseling coverage was 27,301 (93.9%). The prevalence of uptake of Postpartum Intrauterine Device is 1581 (5.4%) and female sterilization is 1830 (6.3%). In total 11387 mothers (52.2%) had the intention to choose a postpartum family planning method. However, 36% of mothers neither used nor had the intention to choose a postpartum family planning method., Conclusions: The coverage of Postpartum Intrauterine Device counseling service coverage in Nepal is higher in 2018 as compared to 2016-2017 and in other countries implementing Postpartum Intrauterine Device initiatives. However, the prevalence of service coverage of immediate Postpartum Family Planning methods, mainly Postpartum Intrauterine Device in 2018 is lower in Nepal as compared to 2016-2017, and other countries implementing Postpartum Intrauterine Device initiative. More efforts are needed to encourage mothers delivering in the facilities to use the postpartum family planning method.

Introduction: WHO defines adolescent pregnancy as any pregnancy from a girl who is 10-19 years of age, the age being defined as her age at the time the baby is born. Globally, adolescent birth rate is 44 per 1000 women aged 15-19 years whereas 33 per 1000 in South East Asian region. The main objective of the study is to find the prevalence of adolescent pregnancy in a tertiary care hospital., Methods: A descriptive cross-sectional study was conducted in Department of Obstetrics and Gynecology, Nobel Medical College and Teaching Hospital, Biratnagar over a period of six months from 1st January 2018 to 30th June 2018. Using the convenient sampling technique, 2688 samples were studied and the descriptive statistical analysis was done., Results: The prevalence of teenage pregnancy was found to be among 143 (5.3%) [5.3%±0.85% at 95% Confidence Interval]. Maximum adolescents of 95 (66.4%) presented at gestational age between 37 to 40 weeks. Regarding contraception, only 2 (1.4%) of teenage mothers had used Injectable Depo Provera., Conclusions: Adolescent pregnancy in developed countries is usually outside of marriage and carries a social stigma but in the context of developing countries it usually happens within marriage and half of them are planned reflecting educational status and contraception knowledge. Effective interventions need to be developed like strict enforcement of laws prohibiting teenage marriage.