Scar Rupture in Early Puerperium: A Case Report.

Uterine scar dehiscence or rupture is a rare but potentially life-threatening complication of caesarean delivery. It is the opening of the uterine incision line that can lead to postpartum haemorrhage, pelvic hematoma, pelvic abscess, endomyometritis, generalised or localised peritonitis and sepsis. Here we report a case of a 25 years old female who presented with puerperal pyrexia. Investigations revealed uterine scar rupture with a uterovesical collection. The case was managed conservatively with intravenous antibiotics, an intracervical Foley's catheter and a gonadotropin-releasing hormone agonist. Keywords: caesarean section; case reports; postpartum; rupture; scar.

Multiple Pregnancy among Deliveries in a Tertiary Care Center: A Descriptive Cross-sectional Study.

Introduction: Multiple pregnancy is associated with increased obstetric complications as well as poor perinatal outcomes in developing countries because of the increased risk to both mother and baby. So better understanding of the risk factors is required to improve the quality of perinatal care. The aim of the study was to find out the prevalence of multiple pregnancies among deliveries in a tertiary care centre. Methods: A descriptive cross-sectional study was done among total deliveries in the Department of Obstetrics and Gynaecology of a tertiary care centre from inpatient records starting from 15 August 2020 to 15 February 2021 after obtaining ethical approval from the Institutional Review Committee (Reference number: 1208202005). Convenience sampling was done. Point estimate and 95% Confidence Interval were calculated. Results: Out of 4400 deliveries, multiple pregnancy was seen in 35 (0.79%) (0.53-1.06, 95% Confidence Interval). Conclusions: The prevalence of multiple pregnancies was similar to the studies done in similar settings. Keywords: low birth weight; multiple pregnancy; preterm.

Anxiety among Pregnant Women about Corona Virus Infections during COVID-19 Pandemic at a Tertiary Care Center in Nepal: A Descriptive Cross-sectional Study.

INTRODUCTION: COVID-19 is a beta coronavirus that is transmitted by physical interaction or close contact. This Coronavirus Pandemic has also created stress and anxiety among pregnant women all over the world. The disease was first identified in Wuhan city, China, in late December 2019 and was declared pandemic by the World Health Organization on 11th March 2020. Concern and stress in pregnancy are associated with pre-eclampsia, intrauterine growth restriction, preterm labour, depression etc. Pregnancy is an immune-compromised state and poses a high risk to this risk. This study aims to identify anxiety about the coronavirus infection among pregnant women visiting a tertiary care centre in Kathmandu, Nepal, during this COVID-19 pandemic. METHODS: This is a descriptive cross-sectional study conducted at Kathmandu Medical College and Teaching Hospital from 15th July 2020 to 30th July 2020 after taking the ethical clearance from the Institutional Review Committee of Kathmandu Medical College (reference no. 207202002). Convenient sampling method was used. All the data were entered in Statistical Package for the Social Sciences data 20.0 and analyzed. Data was presented in frequencies, charts and percentage. RESULTS: Among the total 273 cases, only 2 (0.73%) cases had a score between 25-30 corresponding to moderate to severe anxiety, 21 (7.69%) had a score between 18-24, which corresponds to mild to moderate anxiety and 250 (91.57%) had score 0-17 which corresponds mild status. CONCLUSIONS: Most of the participants in the study reported a mild status of anxiety. Very few participants reported moderate to severe anxiety.

Vaginal Leiomyoma: A Case Report.

Leiomyomas are common benign tumors of the uterus, affecting 20-30% of women of reproductive age group. But vaginal leiomyomas remain an uncommon entity with only about 300 reported cases. The first case was described in 1733. Only a few cases have been reported in Nepal to date. Tumors are thought to arise from Mullerian smooth muscle cells in the sub-epithelium of the vagina. Vaginal leiomyomas are usually situated in the anterior vaginal wall. Here, we report a case of a 48-year old multipara who presented the outpatient department with the ultrasonographic report showing multiple uterine fibroids but was asymptomatic. A physical examination showed a mass in the right vaginal wall. Pervaginal removal of the tumor was performed and subsequent histopathology revealed a vaginal leiomyoma. Removal of the tumor by the vaginal route, wherever possible, with the subsequent histopathological examination, appears to be the optimum management plan.

Cesarean Delivery on Maternal Request among Patients Undergoing Cesarean Section in a Tertiary Care Hospital: A Descriptive Cross-sectional Study.

INTRODUCTION: Caesarean delivery on maternal request in absence of any maternal and fetal indications and has become a concerning issue among obstetricians. It seems to be one of the contributory factors of increased cesarean rate all over the world. This study aims to find out the prevalence of cesarean delivery on maternal request among cesarean deliveries in a tertiary care hospital. METHODS: This descriptive cross-sectional study was conducted from November 1st 2019 to February 1st 2020 among women undergoing cesarean section in a tertiary care hospital. The ethical clearance was taken from the Institutional Review Committee of Kathmandu Medical College (reference number: 201120192). Convenient sampling was used. Statistical Package for Social Sciences version 20.0 was used for analysis. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. RESULTS: Out of 386 cesarean sections, maternal request was the indication in 72 (18.65%) (95% Confidence Interval = 14.76-22.54) mothers. Among the 72, 38 (52.7%) chose cesarean section for fear of labor pain, 14 (19.4%) for date-of-birth selection, 10 (13.8%) for anxiety of labor pain, because of cord around the neck in four (5.5%), male baby in three (4.1%), to avoid pelvic trauma in two (2.7%), and to go abroad in one (1.3%). CONCLUSIONS: Our study showed a prevalence of cesarean delivery on maternal request higher than other national studies but was similar to the global prevalence. The commonest reasons were fear of labor followed by date-of-birth selection.

Study of Vitamin-D Deficiency among Pregnant Women in their First Trimester Visiting a Tertiary Care Hospital: A Descriptive Cross-sectional Study.

INTRODUCTION: Vitamin-D deficient pregnant women are more likely to have pregnancy complications like pre-eclampsia, intrauterine growth restriction, diabetes, preterm birth, etc. Associated factors include ethnicity, skin coverall, use of sun protection, overweight, vitamin-D intake, and smoking. The objective of this study is to determine the prevalence of Vitamin-D deficiency among pregnant women in a tertiary level hospital. METHODS: This study descriptive cross-sectional study was conducted at a tertiary care hospital from September 15th, 2020 to November 15th, 2020 where the pregnant women visiting for an antenatal checkup in the first trimester were enrolled. Ethical clearance was taken from the Institutional Review Committee of Kathmandu Medical College (reference no. 1808202003). A convenience sampling method was used. All the data were entered in the Statistical Package of the Social Sciences version 20.0 and analyzed. Point estimate at 90% Confidence Interval was calculated along with frequency and percentage for binary data. RESULTS: Among a total of 47 cases, vitamin-D deficiency was seen in 21 (44.6%) (32.67-56.52 at 90% Confidence Interval). CONCLUSIONS: The prevalence of vitamin-D deficiency was similar to other studies done in similar settings.

Successful Outcome of Uterocutaneous Fistula: A Case Report.

Uterocutaneous fistula is a rare complication that occurs after cesarean section and other pelvic operations. Here we report a case of a 27 years woman presented to our department with a mass and pus-like discharge coming from her previous Pfannenstiel incision for 1 month. The definitive treatment of such cases is hysterectomy but the case was managed by fistulectomy along with gonadotropin-releasing hormone agonist.

Ruptured Cesarean Scar Pregnancy: A Case Report.

Cesarean scar pregnancy is a rare variant of ectopic pregnancy where the fertilized ovum gets implanted in the myometrium of the previous cesarean scar. The incidence of Caesarean Scar Pregnancy among ectopic pregnancies is 6.1% and it is seen in approximately 1 in 2000 normal pregnancies. As trophoblastic invasion of the myometrium can result in uterine rupture and catastrophic hemorrhage termination of pregnancy is the treatment of choice if diagnosed in the first trimester. Expectant treatment has a poor prognosis and may lead to uterine rupture which may require hysterectomy and subsequent loss of fertility. We present a case report of a 24-year-old female G2P1L1with ruptured cesarean scar pregnancy who underwent emergency laparotomy and subsequently hysterectomy. In this case report, we aim to discuss ruptured cesarean scar pregnancy as obstetric emergency and methods by which we can make an early diagnosis that it can be managed appropriately so as to prevent maternal morbidity and mortality. Keywords: cesarean; hysterectomy; maternal mortality; pregnancy; scar; uterine rupture.

Profile of Caesarean Section at Kathmandu Medical College.

BACKGROUND: There is a world-wide rise in caesarean section rateduring the last three decades and has been a cause of alarm and needs an in-depth study. The objective of this study was to determine the rate and clinical indications of Caesarean Section. METHODS: A hospital based study was carried out from 15th June 2015 to 15th January 2016 in Department of Obstetrics and Gynecology at Kathmandu Medical College, Sinamangal, Nepal. Patients who delivered by caesarean section were included in the study. Basic demographic data and clinical indications were noted. Results: A total of 1172 deliveries were carried out during the study period. Total number of caesarean section was 537 accounting to 45.81%. Most of the patients were of the age group of 25-29 years (42.8%). Most of the patients were primigravida (n=274; 51%). Emergency caesarean section was 411 (76.5%) and elective caesarean section was 126 (23.4%). Multigravida (71%) underwent more elective procedure than primigravida (25. 39%).The most frequent indication was fetal distress19.55% (n=105), failed induction 19.73%(n=106), and previous caesarean section 21.3% (n=115). CONCLUSIONS: The rate of cesarean section is quite high than that recommended by WHO which is (10-15%). Most of the caesarean sections were emergency caesarean section with previous caesarean being the leading cause.

Laparoscopic management of benign ovarian masses.

INTRODUCTION: Laparoscopic surgery is one of the most common procedures performed for benign ovarian masses. The aim of the study was to analyze all benign ovarian masses treated laparoscopically to assess safety, feasibility and outcome. METHODS: A prospective study was carried out at Kathmandu Medical College Teaching Hospital, Sinamangal, Nepal. All the patients undergoing laparoscopic surgery for benign ovarian masses from 1st January 2012 to 31st December 2012 were included in the study. The pre-operative findings, intra-operative findings, operative techniques and post-operative complications were analyzed. RESULTS: Thirty-six patients were taken for the study. Two cases were excluded since intra-operatively they were tubo-ovarian masses. The most common tumor was dermoid cyst (n=13; 38.23%) and endometriotic cyst (n=14; 41.17%). Out of 34 cases, five cases of endometriotic cyst (14.70%) were converted to laparotomy due to severe adhesions and four cases of endometriotic cyst underwent deroofing surgery. Two cases underwent laparoscopic assisted vaginal hysterectomy with bilateral salphingo-oopherectomy. Successful cystectomies were carried out in 22 cases. None were malignant. Major complications were not noted while minor complications like port-site infection (n=3; 8.82%) and subcutaneous emphysema (n=1; 2.9%) were present. CONCLUSIONS: Laproscopic management of benign ovarian masses is safe and feasible.

Comparison of laparoscopy and laparotomy in the surgical management of ectopic pregnancy.

OBJECTIVE: To compare the operative findings, operative procedure and complications, postoperative complications and hospital stay in patients with ectopic pregnancy managed by laparoscopy and conventional laparotomy. STUDY DESIGN: A cross-sectional, observational study. PLACE AND DURATION OF STUDY: Department of Obstetrics and Gynaecology, Kathmandu Medical College Teaching Hospital, Kathmandu, Nepal, from October 2009 to October 2010. METHODOLOGY: All patients with ectopic pregnancy confirmed during surgery, were included in the study. Patients with preoperative diagnosis of ectopic pregnancy but confirmed not to be so during surgery were excluded. Data regarding the studied variables were collected by interviewing patients postoperatively, reviewing the charts and operative notes and by following-up the patients till discharge. RESULTS: There were a total of 32 cases of ectopic pregnancy which was 4.4% of total deliveries during the study period. Twelve patients (37.5%) were managed by laparoscopy and 20 patients (62.5%) by laparotomy. All the patients who underwent laparoscopy and 40% patients who underwent laparotomy were haemodynamically stable pre-operatively. Laparoscopy was mostly performed for tubal abortion (40%) and unruptured ectopic pregnancy (25%) whereas laparotomy mostly for ruptured ectopic pregnancy (70%). Salpingectomy was the commonest procedure in both routes of surgery. One patient in the laparoscopy group and 4 patients (20%) in laparotomy group had complications with two of the latter requiring admission in intensive care unit. CONCLUSION: Laparoscopy is feasible and safer than laparotomy in the surgical management of ectopic pregnancy.