A profile of ectopic pregnancy at nepal medical college teaching hospital.

A retrospective study of ectopic pregnancy at Nepal Medical College Teaching Hospital between January 2001 to June 2006 was carried out to determine incidence, demographic features, clinical presentation, duration at presentation and treatment, and the management protocol. A total of 36 cases of ectopic pregnancy were treated giving the incidence of ectopic pregnancy of 10.2/1000 deliveries and 7.3 /1000 pregnancies. The mean age is 30.1 years (range 23-45 years) and the mean parity is 1.2 with nulliparous at 49%. The mean gestational age is 6.9 weeks (range 5-11 weeks). Among the ethnicity, Mongolians constituted at 54.6%. The commonest risk factors present were infertility (33.3%), previous ectopic pregnancy (16.7%), pelvic inflammatory disease (13.9%) and tubal surgery (13.9%). The commonest symptoms at presentation are abdominal pain (94.4%), amenorrhea (72.2%) and abnormal vaginal bleeding (58.3%); and commonest signs were abdominal tenderness (91.7%), adnexal tenderness (72.2%) and cervical excitation (50.0%). The mean time from symptom to treatment was 176.58 hours and mean time from admission to treatment was 12.88 hours. Ectopic pregnancy was correctly diagnosed clinically in 85.0% patients including 42.5% (12/36) of ruptured ectopic pregnancy. Abdominal ultrasound and urinary â-hCG tests (ELISA test) were additional diagnostic tools. Sixty one percent (22/36) presented in subacute condition. Two cases (5.6%) were presented late causing diagnostic problem and more morbidity like anaemia, blood transfusion, adhesion needing major operations. Salpingectomy is the mainstay of treatment. Only one case has conservative surgery. Late presentation and ruptured ectopic pregnancy is associated with increased morbidity and mortality. High index of suspicion and early recourse to laparotomy save the life from this obstetric disaster.

Making unsafe abortion safe: medical method.

WHO reported 13.0% of maternal deaths are related to unsafe abortion in developing world. To improve this, medical method of abortion has been in clinical use for over a decade. The antiprogestogen mifepristone followed two days later by a prostaglandin analogue is registered as a medical alternative to surgical termination of early intra uterine pregnancy. Since registration of medical method, research has continued to improve the medical abortion. Multicentre trials have shown that 200 mg of mifepristone orally and 800 ug of misoprostol vaginally results in a higher complete abortion percentage (95.0%). The gold standard method at present is 200 mg mifepristone orally followed by 800 ug ofmisoprostol vaginally 48 hrs later gives 95.0 to 97.0% success rate. With much improvement and efficacy more women accept medical method for abortion with higher satisfaction and provide more privacy to women especially where social stigmas are attached to induced abortion. Use of drug is safe and non-invasive and training is simple and complications are minimal. This is important in developing world where limited trained personnels are available to perform surgical evacuation. The disadvantage of medical abortion is the longer duration of bleeding compared with surgical abortion and fear of uncertainty and side effects. The termination of pregnancy is legalised in Nepal now, these medicines could be made available in market.

Prevention of carcinoma cervix: role of Pap smear screening.

This study was undertaken to evaluate the prevalence of Cervical precancerous and Cancer pick up by single pap smear test. A prospective study of pap smear test of three years duration 2000-2002 in Obstetrics and Gynecology department, NMCTH, Kathmandu. A total 800 cases were included Maximum number of patients are in the age group of active reproductive period (21-40 yr) with higher rate of an abnormal smear in Brahmin ethnic group. The main complaints are of lower abdominal pain and white discharge per vaginum. The main cervical pathology is cervicitis, cervical erosion and cervical hypertrophied with bleeding on touch. 4.8% of the patients had abnormal smear including three patients with invasive cervical squamous cell carcinoma detected on pap smear test. This study shows that routine pap smear screening in patients attending gynecological OPD is the good method of detecting precancerous cervical intraepithelial neoplasia (CIN) lesion and early cervical cancer, which would go undiagnosed otherwise with worst morbidity and mortality. We should try to cover 100% screening if possible in an institution at least to begin with.