Maternal and perinatal outcome among the booked and unbooked pregnancies from catchments area of BP Koirala Institute of Health Sciences, Nepal.

OBJECTIVES: To examine the differences in maternal and perinatal outcome among booked and unbooked pregnant women and their perception for underutilization of services targeted for them. METHODS: Two thousand two hundred and twenty eight pregnant women, booked and unbooked, attending emergency obstetrics care during Jan.-Dec. 2005, were included in the study; Investigators followed cases till discharge. RESULTS: Tendency for mothers to be booked was found to be significantly associated with age. Booked and unbooked mothers differed by distance to the hospital and parity. There was difference between the periods of gestation at which they presented to the hospital among both the groups (p<0.0001). Nearly eighty percent (81.4%) of unbooked mothers did not know the period of gestation. Most of these women conceived during lactational or depo provera-induced amenorrhea. The maternal mortality rate for unbooked mothers was 16 out of 1056 and none among the booked. Perinatal mortality is 3 times less in booked mothers. Higher perinatal mortalities are associated with unbooked mothers and had a higher proportion of maternal intensive care unit admissions and perinatal deaths compared with the booked group. Focus group discussion revealed that the reasons for underutilizations of services are; Distance, cost, disempowerment of women and attitudes of hospital personnel. CONCLUSION: The opportunities to enhance utilizations are based on distance, cost and client friendly environment of hospital personnel. It has been observed, building teaching hospitals alone, will not have much impact to maternal and perinatal outcome, unless peripheral health institutions are equipped with facilities and service provisions.

Evaluation of endometrial changes and p53 expression in tamoxifen treated women: comparison of various methods.

OBJECTIVE: To compare transvaginal sonography (TVS), sonohysterography (SHG), hysteroscopy and endometrial aspiration (EA) and p53 expression in assessing endometrial abnormalities in women on tamoxifen. METHODS: In a cross sectional study of 50 pre- and post-menopausal women receiving tamoxifen for > 2 years, all participants underwent TVS and EA. Those with endometrial thickness > 4 mm on TVS underwent hysteroscopy and SHG. Serum p53 antibody and p53 immunohistochemistry were tested in all women. RESULTS: The sensitivity and specificity when compared with histopathology as the reference standard were as follows: TVS 100% and 33.3%, SHG 85.7% and 50%, hysteroscopy 92.8% and 80.8%, serum p53 50% and 83.3%, and p53 immunohistochemistry 57.1% and 61.1%. Prevalence of endometrial abnormalities was not significantly different in asymptomatic and symptomatic women. CONCLUSION: Tamoxifen-users require routine testing for endometrial evaluation. TVS followed by hysteroscopy and biopsy is an effective option. p53 expression correlates with histological abnormalities.

Prolapsed uterus with huge rectocele and omentocele following cervical amputation: a rare and unusual case presentation.

Pelvic organ prolapse is a common condition whose incidence is increasing. Many cases of prolapse of the posterior vaginal wall occur along with other pelvic support defects. Pelvic surgeons who treat rectocele must have an excellent understanding of the normal anatomy, interactions of the connective tissue and muscular supports of the pelvis, and the relationship between anatomy and function. Pelvic pressure, the need to splint the perineum to defecate, impaired sexual relations, difficult defecation, and faecal incontinence are some of the symptoms that have been described in patients with rectocele.