Management of Quadruplet Pregnancy: A Case Report.

Quadruplet pregnancy is a pregnancy state where four fetuses grow simultaneously inside a mother's womb. Four fetuses developing in a womb is a challenge not only to the mother but to the obstetrician who has to calculate every risk associated with such pregnancy. High order pregnancy is considered a high risk pregnancy due to increase in maternal, fetal and neonatal morbidity and mortality. So a multidisciplinary approach with early involvement of neonatologists and anesthesiologists for the assessment of such case is essential for a successful obstetric outcome. Here we present a case report of 27 years G3P1L1A1 at 33 weeks 2 days of gestation with quadruplet pregnancy with previous lower segment Cesarian section with history of ovulation induction, delivered successfully via cesarean section with successful outcome of all 1 female and 3 male babies. Keywords: case report; cesarean section; fertility agent; multiple pregnancy; pregnancy; quadruplets.

Medical Induction for Mid trimester Abortion: A Hospital-based Descriptive Cross-sectional Study.

INTRODUCTION: Second trimester abortion is known as termination of pregnancy from 13- 28 weeks of gestation which can be further divided into early second trimester as 13-22 weeks and late as 23-28 weeks. In our study we have limited up to early second trimester. We intend to see the success rate of combination of mifepristone and misoprostol for medical induction, median time required for expulsion, complication and need of dilation and evacuation in some cases. This study also aims to give a review of current literature in mid trimester abortion with respect to efficacy, complication and also to provide evidencebase recommendation for safe regimens for mid trimester pregnancy termination. METHODS: This was hospital-based descriptive cross-sectional study conducted among 40 pregnant women at second trimester admitted for termination of pregnancy in Kathmandu medical collage teaching hospital for the period of six month. Ethical approval was taken from the Institutional Review Committee of Kathmandu Medical College (Ref: 2207202002). Convenient sampling was done. All the pregnant women who need to terminate their pregnancy at second trimester (13-22 weeks) were admitted at Kathmandu Medical College Teaching hospital for termination of pregnancy were included in the study. RESULTS: Among the 40 women, who had termination of pregnancy at second trimester 37 (92.5%) had successful medical termination whereas 3 (7.5%) needed dilatation and evacuation. CONCLUSIONS: The combination of Mifepristone and Misoprostol have excellent result for termination of pregnancy if appropriately used after evaluating the patient with minimal complications.

Translation, cross-cultural adaptation and validation of Nepali version of Health Assessment Questionnaire-Disability Index in rheumatoid arthritis patients from Nepal.

OBJECTIVE: To translate, cross-culturally adapt and validate the Health Assessment Questionnaire-Disability Index (HAQ-DI) in Nepali language (Nepali HAQ). METHODS: Translation was done fulfilling the methodological standards described by Beaton. Comprehensibility testing of the preliminary version was done in 50 rheumatoid arthritis (RA) patients, and a prefinal version was prepared after making changes in the original version to maintain the equivalence with the target version. Psychometric testing was done in another group of 127 rheumatoid patients to test for content validity and reliability. Construct validity was tested with visual analog score (VAS) and numeric rating scales (NRS) for pain and stiffness. RESULTS: Nepali HAQ was comprehensible in >95% of patients. Reliability testing showed an intraclass coefficient for overall Nepali HAQ of 0.76, ranging from 0.71 to 0.95. The internal consistency was acceptable with a Cronbach's alpha of .92. Construct validity was also acceptable with a moderate correlation between Nepali HAQ and VAS and NRS. CONCLUSIONS: Nepali HAQ is a comprehensible, reliable and valid tool for evaluation of the functional status of Nepalese patients with RA and should be implemented in clinical care and research settings.