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  • 1
    In: Obstetrics and Gynecology International, Hindawi Limited, Vol. 2020 ( 2020-11-16), p. 1-8
    Abstract: Background. Breech presentation is associated with increased rates of maternal and perinatal morbidity regardless of mode of delivery. After the results of Term Breech Trial, most of the countries adopted the protocol of cesarean section for term breech delivery because of which breech vaginal delivery is becoming rare. The aim of this study is to evaluate short-term maternal and perinatal outcomes of breech vaginal delivery at a tertiary care hospital in Nepal. Methods. A retrospective review of case records of all women who had vaginal breech delivery from April 13, 2016, to April 12, 2018, was conducted, over a period of two years. Available demographic variables, obstetric characteristics, details of labor, postpartum complications, and perinatal complications were recorded and analyzed. Results. Out of 21,768 cases of deliveries during the study period, the incidence of term breech deliveries was 528 (2.4%) among which the mode of only 84 (17.8%) deliveries was vaginal. Most of the deliveries were unplanned and were conducted because emergency cesarean section could not be performed. Three (3.6%) women had postpartum hemorrhage, and four (4.8%) had entrapment of aftercoming head, two of them requiring Dührssen incisions. Adverse perinatal outcomes were seen in 23.8% of such deliveries with 〈 7 APGAR score at 5 minutes in 20.2%, neonatal admission in 17.7%, and perinatal mortality in 8.3%. The perinatal mortality was significantly associated with birthweight less than 2500 grams as compared to birthweight ≥2500 grams (21.1% versus 4.6%; P = 0.043 ). Conclusion. The perinatal outcomes for vaginal breech delivery are grave with our existing health facilities, especially when the deliveries are not well planned.
    Type of Medium: Online Resource
    ISSN: 1687-9597 , 1687-9589
    Language: English
    Publisher: Hindawi Limited
    Publication Date: 2020
    detail.hit.zdb_id: 2495157-2
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  • 2
    Online Resource
    Online Resource
    Nepal Journals Online (JOL) ; 2018
    In:  Nepal Journal of Obstetrics and Gynaecology Vol. 13, No. 1 ( 2018-11-12), p. 30-33
    In: Nepal Journal of Obstetrics and Gynaecology, Nepal Journals Online (JOL), Vol. 13, No. 1 ( 2018-11-12), p. 30-33
    Abstract: Aims: The aim of the study was to assess the risk factors for adverse outcomes in pregnancy with obstructed labor.Methods: It was a prospective descriptive study conducted at BP Koirala Institute of Health sciences (BPKIHS).The patients with obstructed labour were managed and followed up until delivery and six weeks postpartum from Jan to Dec 2012.Results: There were 57 (0.6%) cases of obstructed labour out of 9500 deliveries. The main cause was cephalopelvic disproportion in 36 (63.2%). The majority of the cases were from rural areas, low socioeconomic status, non salaried and illiterate. Risk for maternal mortality, peripartum hysterectomy and perinatal mortality as adverse outcomes was significantly associated with low socioeconomic status (AOR 12.5, P=0.02) and literacy status (AOR 21.9, P=0.001). If only the risk of perinatal mortality is taken as an adverse outcome, it is significantly associated with booking status (AOR 7, P=0.001), low socioeconomic status (AOR 9.62, P=0.037) and literacy of the patient (AOR 15, P=0.001). Perinatal mortality rate was 100 per 1000 live births in women with obstructed labour. The case fatality rate was 1.2%.
    Type of Medium: Online Resource
    ISSN: 1999-8546 , 1999-9623
    Language: Unknown
    Publisher: Nepal Journals Online (JOL)
    Publication Date: 2018
    detail.hit.zdb_id: 2430134-6
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  • 3
    Online Resource
    Online Resource
    Nepal Health Research Council ; 2019
    In:  Journal of Nepal Health Research Council Vol. 16, No. 41 ( 2019-01-28), p. 425-427
    In: Journal of Nepal Health Research Council, Nepal Health Research Council, Vol. 16, No. 41 ( 2019-01-28), p. 425-427
    Abstract: Background: Eclampsia is a multisystem disorder that may lead to deterioration of maternal condition, hypoxia and acidosis of fetus. Objective was to evaluate the risk factors associated with adverse maternal and fetal outcome in patients with eclampsia. Methods: All patients with eclampsia were enrolled after informed consent from February 2013 to February 2014. Questions as per per-forma were asked to the patients and attendants about antenatal visits, parity, number of episodes of seizures, duration from onset of seizure to magnesium sulfate, then the patients were followed as per the hospital protocol, the mode of delivery, outcome of baby, post partum maternal condition and mortality were then noted. Results: Fifty-two patients with eclampsia were admitted in the study period. Thirty-one patients required mechanical ventilator support. Twenty-five (48.07%) patients were delivered by emergency cesarean section and 30(57.6%) babies were low birth weight and there were 11(21.1%) stillbirths. There was one maternal mortality and 45(86.5%) patients were discharged with improvement but 6(11.5%) patients had neurological impairment. Mortality was significantly related with number of seizure episodes and time interval between seizure onset and administration of magnesium sulphate. Conclusions: Early detection of hypertension and management with magnesium sulphate for eclampsia can help to minimize the maternal and fetal adverse outcomes. Keywords: Eclampsia; maternal mortality; risk factors.
    Type of Medium: Online Resource
    ISSN: 1999-6217 , 1727-5482
    URL: Issue
    Language: Unknown
    Publisher: Nepal Health Research Council
    Publication Date: 2019
    detail.hit.zdb_id: 2551251-1
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  • 4
    In: Gynecologic Oncology Reports, Elsevier BV, Vol. 47 ( 2023-06), p. 101206-
    Type of Medium: Online Resource
    ISSN: 2352-5789
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2023
    detail.hit.zdb_id: 2818505-5
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  • 5
    Online Resource
    Online Resource
    Nepal Journals Online (JOL) ; 2020
    In:  Journal of BP Koirala Institute of Health Sciences Vol. 3, No. 1 ( 2020-07-27), p. 105-112
    In: Journal of BP Koirala Institute of Health Sciences, Nepal Journals Online (JOL), Vol. 3, No. 1 ( 2020-07-27), p. 105-112
    Abstract: Introduction: Induction of labor is done with the aim of normal vaginal delivery. There are different methods; mechanical like intra-cervical Foley’s or pharmacological agents like misoprostol ordinoprostone. Objectives: To compare sequential use of Foley’s catheter and vaginal misoprostol in comparison with vaginal misoprostol only. Methods: Patients with period of gestation more than or equal to 41 weeks without any complications were assigned randomly according to computer generated randomization into sequential use ofintracervical Foley followed by vaginal misoprostol after 24 hours (sequential group) or vaginalmisoprostol only. Primary outcome was rate of normal vaginal delivery. Secondary outcomes were induction to delivery interval, maternal and fetal morbidity. Results: Rate of normal vaginal delivery in sequential group (n= 353) and misoprostol alone group(n= 356) was 71.6% and 53.3% (p 〈 0.001) but the time to delivery from induction is statistically more in sequential group (30.3 vs. 11.2 hours, p 〈 0.001). Maternal outcomes like postpartum hemorrhage, hyper-stimulation syndrome, chorioamnitis and neonatal outcomes like low Apgar score, meconium stained baby and stillbirth are similar in both the groups. Conclusions: The priming of cervix using intracervical Foley catheter before giving vaginalmisoprostol was beneficial in increasing the rate of normal vaginal delivery but it increased the induction to delivery interval.
    Type of Medium: Online Resource
    ISSN: 2616-0390 , 2616-0323
    Language: Unknown
    Publisher: Nepal Journals Online (JOL)
    Publication Date: 2020
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  • 6
    Online Resource
    Online Resource
    Birat Medical College and Teaching Hospital ; 2019
    In:  Birat Journal of Health Sciences Vol. 4, No. 2 ( 2019-09-04), p. 684-687
    In: Birat Journal of Health Sciences, Birat Medical College and Teaching Hospital, Vol. 4, No. 2 ( 2019-09-04), p. 684-687
    Abstract: Introduction: Lower urinary tract symptoms (LUTS) is a group of symptoms relating to stages of micturation such as storage symptoms, voiding dysfunction and post micturation dysfunction. Overactive bladder symptom score (OABSS) is a questionnaires with scores which helps in evaluating the severity of symptoms. Objectives To find the incidence of women visiting with LUTS and to evaluate storage symptoms in LUTS (urgency, urge incontinence, frequency) using OABSS (overactive bladder symptom score) questionnaires. Methodology This is a prospective study done from February 2016 to February 2017. Patients visiting Department of Obstetrics and Gynaecology with lower urinary tract symptoms (LUTS) were enrolled in the study after informed consent. Patients were assessed for types of LUTS and data were filled in the performa. If patients had urgency, urge incontinence, increased day time frequency, then the patients were explained and asked overactive bladder symptom score questionnaire (OABSS) and noted. Patients were then examined for pelvic floor dysfunction and neurological abnormalities for identifying association with the symptoms. Statistical analysis was done using SPSS 11.5. Results Fifty-seven patients were enrolled with lower urinary tract symptoms (LUTS) during study period. Forty-six patients had overactive bladder symptoms (OABS). LUTS were found in age ranging from 21 to 80 years. Majority of patients visiting out-patient department with LUTS were found to have urgency, urge incontinence, increased day time frequency, nocturia. Patients with urgency and urge incontinence showed significant correlation with increasing likert score of OABSS (p 〈 0.05). But the increased day time frequency did not show any correlation with increasing score. The score showed significant correlation with combination of symptoms (urgency, urge incontinence and increased frequency) than patients presenting with single symptom. Conclusion Diagnosis of LUTS with valid assessment tools and treatment benefits patients with chronic urinary symptoms and also helps clinicians to further re-assess the treatment.
    Type of Medium: Online Resource
    ISSN: 2542-2804 , 2542-2758
    Language: Unknown
    Publisher: Birat Medical College and Teaching Hospital
    Publication Date: 2019
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  • 7
    Online Resource
    Online Resource
    Birat Medical College and Teaching Hospital ; 2020
    In:  Birat Journal of Health Sciences Vol. 5, No. 1 ( 2020-06-26), p. 911-915
    In: Birat Journal of Health Sciences, Birat Medical College and Teaching Hospital, Vol. 5, No. 1 ( 2020-06-26), p. 911-915
    Abstract: Introduction: Small-for-gestational-age (SGA) is defined by a birth weight below the 10th percentile for mean weight corrected for gestational age. It is associated with adverse health events throughout life, including substantial perinatal morbidity and mortality rates. Objectives: The aims of the study was to estimate the prevalence of the SGA newborns, attributable factors for SGA and perinatal outcomes of SGA. Methodology: A hospital based prospective cohort study was conducted among pregnant women after 28 weeks' gestational age in the Department of Obstetrics and Gynaecology, BPKIHS, Dharan from October, 2016 to June, 2017.A total of 150 study population was sampled using purposive sampling technique whose symphysio-fundal height lags the gestational age by four cms. The association for risk factors between the various socio-demographic parameters and SGA was analysed using chi-square test for categorical data and t-Test for continuous data with p value 〈 0.05 considered as significant. The mothers and babies were followed up till discharge from the hospital for outcomes. Result: There was a total of 140 SGA with 10 appropriate for gestational age (AGA) fetuses among 6,500 hospital deliveries above 28 weeks' gestation, hence the prevalence was 2.15%. The risk factors for very small for gestational age were history of birth of SGA fetus (OR, 1.25; 95% CI, 1.15-1.35); history of recurrent pregnancy loss (OR, 1.25; 95% CI, 1.15-1.35); personal history of substances abuse in the index pregnancy (OR, 1.68; 95% CI, 1.47-1.92); adverse obstetrics or medical events in the index pregnancy (OR, 2.21; 95% CI, 1.10-4.45); high blood pressure at admission (OR, 1.58; 95% CI, 1.96- 2.59) and significant urinary proteinuria (OR, 2.26; 95% CI, 1.00-5.09).SGA newborns correlated with increased risk of operative delivery and adverse perinatal outcomes, including oligohydramnios, low Apgar scores, resuscitation at birth, admission to the neonatal intensive care unit or nursery, metabolic complications and fetal death. Conclusions: SGA have distinct modifiable risk factors and mortality patterns suggesting potential implications for public health and urgent need to intervene with effective interventions.
    Type of Medium: Online Resource
    ISSN: 2542-2804 , 2542-2758
    Language: Unknown
    Publisher: Birat Medical College and Teaching Hospital
    Publication Date: 2020
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  • 8
    Online Resource
    Online Resource
    Springer Science and Business Media LLC ; 2022
    In:  BMC Women's Health Vol. 22, No. 1 ( 2022-09-19)
    In: BMC Women's Health, Springer Science and Business Media LLC, Vol. 22, No. 1 ( 2022-09-19)
    Abstract: Aggressive Angiomyxoma is a benign, slowly growing, locally aggressive and recurrent tumour that occurs in the pelvic-perineal region of females in their reproductive years. It presents as a painless, soft, gelatinous mass and metastasizes rarely. Suspicion can be made based on clinical examination and radiological imaging but final diagnosis is confirmed only after histopathology and immunohistochemistry. The choice of treatment is surgical wide local excision. Case presentation We hereby present a case of a 19-year, unmarried lady, with a body mass index of 21 kg/m 2 , who presented with a chief complaint of painless mass in left vulva which progressively increased in size in the past one year. Clinical examination revealed a large, cauliflower like, exophytic mass of 10 cm × 10 cm size. Radiological imaging confirmed involvement of lymph nodes. Wide local excision with adequate tumour free margin and depth was used as a treatment modality. The diagnosis was confirmed via histopathological examination of the excised specimen. There is no recurrence in the patient up to date. Conclusion Aggressive Angiomyxoma is a rare tumour and it is most often misdiagnosed. This report highlights the importance of considering Aggressive Angiomyxoma as a differential diagnosis of vulval masses and the two-step surgical approach for its treatment in low resource setting.
    Type of Medium: Online Resource
    ISSN: 1472-6874
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
    detail.hit.zdb_id: 2050444-5
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  • 9
    Online Resource
    Online Resource
    Journal of Nepal Medical Association (JNMA) ; 2020
    In:  Journal of Nepal Medical Association Vol. 58, No. 232 ( 2020-12-31)
    In: Journal of Nepal Medical Association, Journal of Nepal Medical Association (JNMA), Vol. 58, No. 232 ( 2020-12-31)
    Abstract: Introduction: Hysterectomy is the most common gynecological procedure. Over the last decade, the minimally invasive approach has been practiced more frequently. Fibroid uterus being the most common indication for hysterectomy justifies this minimal approach, however, whenever feasible, vaginal hysterectomy can be the preferred route. The objective of this study was to find out the prevalence and indication of hysterectomy among major gynecological surgeries in a tertiary care hospital. Methods: A descriptive cross-sectional study was done at a tertiary care hospital among 1912 patients who had major gynecological surgeries from January 2017 to December 2019. Ethical clearance was obtained from the institutional review committee (ref. no. ACD 935/076/077). Convenient sampling was used. Statistical analysis was done using Statistical Package for Social Sciences version 21.0. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: During the study period, there were 1,912 major gynecological surgeries and the prevalence of hysterectomy was 1,131 (59.15%) (56.94-61.35 at 95% Confidence Interval). Fibroid uterus was the most common clinical indication for hysterectomy which was done in 397 (35.10%) patients, followed by uterovaginal prolapse in 254 (22.46) patients, adnexal mass in 210 (18.56%), and abnormal uterine bleeding in 117 (10.34%) patients. Conclusions: Hysterectomy, being the most common gynecological surgery, selection of the most appropriate route is of paramount importance. As for any other surgery, it is not without complication and hysterectomy should always be justified. With the advancement in the conservative approaches, these organ-preserving options should be explored rigorously before opting for hysterectomy.
    Type of Medium: Online Resource
    ISSN: 1815-672X , 0028-2715
    Language: Unknown
    Publisher: Journal of Nepal Medical Association (JNMA)
    Publication Date: 2020
    detail.hit.zdb_id: 2209910-4
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  • 10
    Online Resource
    Online Resource
    Nepal Journals Online (JOL) ; 2022
    In:  Nepal Journal of Obstetrics and Gynaecology Vol. 17, No. 2 ( 2022-12-31), p. 75-77
    In: Nepal Journal of Obstetrics and Gynaecology, Nepal Journals Online (JOL), Vol. 17, No. 2 ( 2022-12-31), p. 75-77
    Abstract: 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. 
    Type of Medium: Online Resource
    ISSN: 1999-8546 , 1999-9623
    Language: Unknown
    Publisher: Nepal Journals Online (JOL)
    Publication Date: 2022
    detail.hit.zdb_id: 2430134-6
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