Intra-abdominal Adhesions among Patients Undergoing Repeat Caesarean Section in Department of Obstetrics and Gynaecology of a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Adhesions are one of the common complications encountered after caesarean section whose risk increases with the number of caesarean deliveries. This study aimed to find out the prevalence of intra-abdominal adhesions among patients undergoing repeat caesarean section in a tertiary care centre. Methods: A descriptive cross-sectional study was conducted on 74 pregnant women undergoing repeat caesarean section in the Department of Obstetrics and Gynaecology of a tertiary care centre from July, 2021 to December, 2021 after receiving the ethical approval from the Institutional Review Committee (Reference number: 2107202103). Pregnant women who met the eligibility criteria were included in the study. Convenience sampling was done. The severity of the adhesions was classified using the Tulandi and Lyell classification. Data were analysed using the Statistical Package for the Social Sciences version 26.0 software. Point estimate at 90% Confidence Interval was calculated along with frequency and percentage for binary data along with mean and standard deviation for continuous data. Results: Out of 74 women undergoing repeat caesarean section, 55 (74.32%) (65.99-82.65 at 90% Confidence Interval) had developed intra-abdominal adhesions. Conclusions: Our study showed that the prevalence of intra-abdominal adhesions among patients undergoing repeat caesarean section was higher when compared to similar studies conducted in similar settings. Keywords: postoperative complications; repeat caesarean section; surgical adhesions.

Nulligravida with Large Uterine Leiomyoma: A Case Report.

Uterine leiomyoma is the most common benign tumour of the female reproductive tract originating from the uterine smooth muscle causing morbidity and impairing their quality of life. It is common among women in the age group 30 to 50 years of age. Women are usually asymptomatic or may present with various symptoms such as abnormal uterine bleeding, pelvic pain, dysmenorrhea, and change in bowel and bladder habits due to pressure symptoms. It is one of the leading causes of hysterectomy. Women with uterine leiomyoma can be managed medically and surgically. Gonadotropin-releasing hormone analogue is one of the modalities used preoperatively to reduce the size of large uterine fibroid. We present the case report of a 36-year-old nulligravida who underwent total abdominal hysterectomy with bilateral salpingectomy for large uterine leiomyoma weighing 5.61 kg without compression symptoms. She received a gonadotropin-releasing hormone agonist (injection leuprolide) preoperatively for reduction of the size of uterine myoma. Keywords: case reports; gonadotropin-releasing hormone; hysterectomy; leiomyoma.

Neonates Born Through Meconium-stained Amniotic Fluid among Deliveries in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: The mortality and morbidity of meconium aspiration syndrome in neonates born with meconium-stained amniotic fluid in developing countries are still high. In Nepal, few studies have estimated the prevalence of meconium-stained amniotic fluid among newborns. The study aimed to find out the prevalence of neonates born through meconium-stained amniotic fluid among deliveries in a tertiary care centre. Methods: This descriptive cross-sectional study was conducted among neonates born in a tertiary care centre from November 2021 to March 2022. Neonates born during the study period with meconium-stained amniotic fluid were studied. Ethical approval was obtained from the Institutional Review Committee. Convenience sampling method was used. With permission from the Department of the Neonatal Intensive Care Unit, the data were collected and entered in a Microsoft Excel sheet. Point estimate and 95% Confidence Interval were calculated. Results: Among 576 neonates, the prevalence of neonates born through meconium-stained amniotic fluid was 77 (13.37%) (10.59-16.15, 95% Confidence Interval). Conclusions: The prevalence of neonates born through meconium-stained amniotic fluid was found to be similar to other studies done in similar settings. Keywords: meconium; neonate; Nepal.

Scar Pregnancy a Diagnostic Conundrum: A Case Report.

Cesarean scar pregnancy is a rare form of ectopic pregnancy which may lead to uterine rupture and catastrophic hemorrhage. We report a case of cesarean scar pregnancy in a 35-year-old female with the past history of cesarean section presented with complaints of amenorrhoea for 6 weeks and non-specific  pain. Two Transvaginal sonography was done 48 hours apart which suggested a cesarean scar pregnancy in one and cervical pregnancy on the other. Magnetic Resonace Imaging showed a well-defined cystic lesion of (21x19)mm2 embedded within the previous cesarean scar which confirmed the diagnosis of cesarean scar pregnancy. Laparotomy unveiled uterus around 6 weeks size and a (3x3)cm2 bulge was noted at the site of previous scar in lower uterine segment, where a small incision was given and the gestational sac was removed following which the uterine incision was closed with 2-0 polyglactin suture. High index of suspicion and prompt diagnosis is ofparamount for reducing morbidity and mortality.

Dysmenorrhea among Nursing Staff in a Tertiary Care Center: A Descriptive Cross-sectional Study.

INTRODUCTION: Menstrual disorders are problems faced by women in their reproductive period, which affects their day-to-day activities and the quality of life and sometimes can be an indicator of serious pathology. There are various types of menstrual disorders with dysmenorrhea being the commonest and most distressing. Health, sense of wellbeing and quality of life can be improved because of early detection and treatment for these disorders. The study aimed to find out the prevalence of dysmenorrhea among the nursing staff of a tertiary care center. METHODS: A descriptive cross-sectional study was carried out from September 2020 to November 2020 among the nursing staff of a tertiary care hospital. Ethical approval was taken from the Institutional review committee of Kathmandu Medical College and Teaching Hospital (reference number: 1709202003). A convenient sampling technique was used. A pre-structured questionnaire was used for data collection. The subjects were asked to fill the questionnaire anonymously after taking consent. Statistical analysis was done using the Statistical Package for the Social Sciences. Point estimate at 95% Confidence Interval was calculated along with frequency and percentage for binary data. RESULTS: Out of 212 participants, 165 (77.8%) (95% Confidence Interval = 72.21-83.39) participants reported pain during menstruation. Of which, 61 (36.97%) participants reported abdominal pain. CONCLUSIONS: The prevalence of dysmenorrhea was high among the nursing staff of a tertiary care centre which was similar to the findings of other studies done in similar settings.

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.

Knowledge, Attitude and Practices among Mothers of Children 6 to 24 months of Age Regarding Complementary Feeding.

INTRODUCTION: Complementary foods fill the gap between the total nutritional needs of the child and the amounts provided by breast milk. Inappropriate feeding practices are a major cause of the onset of malnutrition in young children. The objective of this study was to assess the knowledge, attitude, and practices of mothers of children between 6 to 24 months of age regarding complementary feeding. METHODS: This Knowledge, Attitude, and Practice Study was conducted among 250 mothers in Kathmandu Medical College and Teaching Hospital from June 2019 to November 2019 after obtaining ethical approval from the institutional review committee (Ref no. 150320199). Convenient sampling method was applied. The mothers of children between 6 to 24 months were interviewed using a structured questionnaire to ascertain the knowledge, attitude, and practices regarding complementary feeding. Statistical analysis was done using SPSS version 20. RESULTS: Two hundred and fifty mothers were interviewed. 151 (60.4%) mothers knew initiation of breastfeeding soon after birth and 179 (71.6%) were knowledgeable about exclusive breastfeeding for 6 months. 161 (64.4%) mothers knew the proper age of initiating complementary feeding but only 139 (55.6%) mothers practiced it. Early initiation of complementary feeding was done by 87 (34.8%) mothers while 24 (9.6%) mothers delayed it beyond 6 months. CONCLUSIONS: There was a gap in knowledge and practice among mothers regarding adequate age of initiation of complementary feeding, complementary foods, preparation, and practices.