Defensive Medicine: Is It Legitimate or Immoral?

NA.

Conjoined Twins.

Reported here is a case of conjoined twins presented to ante-natal outpatient department of Paropakar Maternity and Women's Hospital on 21st August 2015 on a 20 year "Primigravida at 27 weeks and 6days of gestation not in labor" referred from a polyclinic following ultrasonography diagnosis for better management. After confirming the diagnosis and counseling the patients regarding mode of delivery and possible outcomes, elective caesarean section was performed and delivered male conjoined twins of Parapagusdicephalus type with poor Apgar score. No resuscitation attempted except oxygen supplementation as per wish of parents and early neonatal deaths occurred at one hour of life. Keywords: conjoined twins; monozygotic twins; siamese twins; twinning; twin pregnancy.

Feto-maternal Outcomes of Emergency Caesarean Section following Residential Posting at Dhading District Hospital.

INTRODUCTION: Caesarean section is a commonly performed major obstetric surgery to deliver baby under certain indications which may be maternal or fetal. If performed timely, it is helpful to save the life of mother and fetus and if not, it increases both maternal and fetal risks. METHODS: A hospital based descriptive cross-sectional study was conducted at Dhading district hospital from 17th October 2016 to 17th October 2017. Total of 41 patients undergoing emergency caesarean section meeting the selection criteria were included. RESULTS: The incidence of emergency caesarean section was 41 (5.5%). Most common indication for caesarean delivery was fetal distress in 12 (29.3%) followed by failed induction and cephalopelvic disproportion each accounting 6 (14.6%) cases. The least common causes being chorioamnionitis and cord prolapse in 1 (2.4%). Regarding perinatal outcomes, 33 (80.5%) babies delivered were of normal weight. Low Apgar score (<7) at one minute was noted in 8 (19.5%) cases. Neonatal resuscitation in the form of oxygen supplementation was required in 2 (4.9%) cases whereas bag and mask ventilation was required in 5 (12.2%) cases. Referral for neonatal intensive care unit admission was done in 6 (14.6%) cases. There were three neonatal deaths. CONCLUSIONS: Residential posting was fruitful to decrease feto-maternal morbidities and mortalities. Even to minimize the delay of treatment, government should provide adequate equipments and skilled man-power to run neonatal intensive care unit.

Sirenomelia: A Case Report.

Sirenomelia is primarily a congenital anomaly where a normally paired lower limb is replaced by a single midline limb and is characterized by single umbilical artery. Such cases though considered rare do occur at our set-up and to make health workers aware regarding the condition, so that they can be managed well when encountered, lays the importance of reporting such case. A referred case of Sirenomelia from Dhading district hospital was presented to Emergency department of Paropakar Maternity and Women's Hospital on 6th March 2016 of 18 year "Young Primigravida at 34 week and 5 days of gestation in second stage of labor" following ultrasonography diagnosis for better management. After confirming the diagnosis, preterm vaginal delivery was performed with a live baby of 1250 gm consisting of multiple congenital anomalies and poor Apgar score. Such cases do occur at our set-up so that if anomaly scanning is done routinely, they could be picked up early and management becomes easier. Keywords: case report; ectromelia; fused legs and feet; Mermaid syndrome; Sirenomelia.