A study of Body Mass Index (BMI) of Nepalese women attending gynaecology clinic.

This prospective study was carried out to find out the body mass index (BMI) of all the women attending a gynaecological clinic at Kathmandu Valley. Total of 1450 women attended this clinic over the study period. After excluding few hundreds of women, one thousand women of reproductive age (15-49) were enrolled. Detail history was taken, general, systemic and pelvic examinations were performed and a provisional diagnosis was made on the clinical ground. In this process height and weight of each patient was measured then Body Mass Index (BMI) was calculated. Eight percent (8%) of women were underweight and equal numbers of them were obese too. Forty-four point six percent were healthy and 37.3 were overweight. Most of them were diagnosed vaginitis, urinary tract infection (UTI), pelvic inflammatory disease (PID), subfertility, menstrual disorders, and cervical conditions. In eleven percent no gynaecological abnormalities were detected (NAD). Commonly diagnosed conditions were vaginitis, UTI, PID, primary subfertility and menstrual disorders were the commonly diagnosed conditions.

Rupture uterus in primigravida: morbidity and mortality.

OBJECTIVE: This paper is aimed to present "Rupture of the uterus (RU) in primigravida "- unscarred cases which are supposed to be extremely rare. MATERIAL AND METHOD: The charts of patients labelled as "Rupture Uterus" for the period 1985 - 2005 AD (2042 - 2061 BS), 20 years were taken out and analysed. RESULT: There were 251 cases of rupture uterus during the study period giving the incidence of 0.09% i.e. 1:1100 among live births in a very busy tertiary maternity hospital of capital, Kathmandu of Nepal. There were 60% spontaneous, 29% scar dehiscence and 11% Iatrogenic/traumatic rupture and death due to RU was 7.9%(n=20). Fifteen cases (6%) were primigravid patients -- six were young primi (age 19 and below) and 9 primigravid patients. Five cases were referred from the district hospitals. Ten cases were brought from very far off i.e. more than 50 KM from the city. One case presented at 34, one at 41 and all the others presented between 38 to 40 weeks of gestational age. Only three cases had attended ante-natal clinics. All were having labour pain for more than 48 hours at home. Findings of laparotomy: The lesions found were: ruptured bladder and complete lower segment (CLS) up to the cervix - 1, CLS & cervix -2, complete lower segment (CLS) 1, Complete upper segment (CUS) - 2, Complete upper & lower segment (CULS) - 6, (one had tear at posterior wall of the uterus and the other had tear up to posterior vaginal wall) and Incomplete lower segment (LS) 2. Blood grouping & Rh: six cases had O+, four had A+, four had AB+ and one had B positive. The blood transfusion given was 1 - 4 units. The treatment given was laparotomy and repair in 10; one had LUSCS, repair of bladder and cervical injury. One had repair and bilateral tubal-ligation, one had subtotal hysterectomy and another had hysterectomy & repair of posterior wall of vagina. Four cases were admitted in the state of shock among which 1 had irreversible shock and died before surgical intervention. Another died on the 3rd post-operative day due to convulsions and shock. Maternal mortality (MM) was 13% (2/15) in primips. All cases presented with intrauterine fetal death (IUFD) and had still births (one baby was hydrocephalic). The hospital stay varied from 3 - 170 days. Four cases had vesico-vaginal fistula (VVF) CONCLUSION: Rupture of uterus in primigravida though rare, has been common in developing countries with low socio-economic status.

Rupture of the pregnant uterus--a 20 year review.

Nepal is a land-locked developing country located in between China and India with a population of 2.34 millions. The male: female ratio being 49:51 and very high maternal mortality. (539/100,000 live birth-1996) The geography of the country makes the situation very much divergent and difficult to cater the health services, especially operative procedures in remote places. THE AIMS OF THE STUDY ARE:- 1. To find out the incidence of R.U, distance from where the patients came, age, parity antenatal attendance, type of rupture, type of intervention and foetal outcome. 2. To suggest the concerned authorities to focus their attention to strengthen and expand comprehensive emergency obstetric care service (CEOCS) in remote areas of the country. Material and method: This is a retrospective study of rupture of pregnant uterus (RU) after 28 weeks of pregnancy for the period of 20 years from 1985 to 2005 A.D. (2042-2061 BS) admitted in the very busy tertiary centre for women (Maternity Hospital, Thapathali, Kathmandu.) with approximately 16000 deliveries and 11% Caesarean section rate per year. Available charts from hospital records of cases of R.U. admitted for the period of 20 years were analysed. During the period, 251 cases of R.U. were admitted. RESULT: There were 272245 live births, 25819 Caesarean section, 270 maternal deaths and 11197 perinatal foetal deaths, during the study period. Incidence of rupture of pregnant uterus was (0.09%) 1:1100 live-birth. There were 60% spontaneous, 29% scar rupture and 11% traumatic rupture. Maximum cases were brought from distance of more than 70 kilometres away, between 25-29 years of age, (mean age 28.7), of third and fourth gravida at 36-40 weeks of gestational period with 68% without antenatal attendance. Seventy percent (70%) had complete rupture. Sixty percent (60%) were managed with suture repair with bilateral tubal ligation, 24% had only repair and 15% had hysterectomy. The case mortality of R.U. (n=20) was 7.9%. Two percent (n=5) cases died before intervention due to arrival in moribund condition. Seventy five percent (75%) cases had stillborn babies. Conclusion More cases of RU are coming to the hospital due to better communication and awareness of the people outside the capital, and case- mortality is reduced compared to previous years.

"Brought Dead" - cases of maternal mortality.

Seven cases that were brought dead on the way to the hospital in 2057 BS (2000-2001 AD) have been presented in this study. Among seven, two cases were young primiparas, one was a grand multipara and four were between ages 20-25 years. Of these, one had post abortion complications, two were complicated by non-delivery and four had third stage complications. The information that the patient was dead on arrival to the hospital was received by the attendants in all cases with shock and disbelief so that it was very difficult to take proper history. An important point noted by this study was that only four maternal deaths occurred in the hospital and were recorded in the hospital statistics in that year, so that the number of deaths that occurred in transit to the hospital and were technically excluded from the hospital statistics exceeded the number of maternal deaths recorded in the hospital statistics. Another interesting point was that none of the seven women who expired on the way to the hospital were living at a distance greater than 15 Km from the hospital and yet had not attended antenatal clinic, implying that inadequate use of health services even in areas with relatively easy access to proper heath care is a major contributor to maternal death.