Induction of Labour in Prelabour Rupture of Membranes with or without Cervical Ripening with Prostaglandin E2

Objective: To compare the outcome of induction of labour with titrated dose of oxytocin with or without pre induction cervical ripening using prostaglandin E2. Methods: This is a prospective study. Sixty women with prelabour rupture of membranes (PROM) and Bishops score of less than six were randomly assigned to either immediate induction with intravenous oxytocin drip or induction with intravenous oxytocin drip preceded by cervical priming with prostaglandin E2 (PGE2) gel 0.5mg instilled intracervically. These two groups were compared regarding the mode of delivery, induction to delivery interval and maternal and neonatal morbidities. Results: Cervical priming with PGE2 resulted in lesser number of caesarean section (5 Vs. 12) and lower incidence of meconium stained liquor (n=6 Vs. n=2). Induction to vaginal delivery interval was shorter when cervical priming was done (5.4 hrs Vs 7.9 hrs). The maternal morbidity was negligible (<1%) in both the groups. The number of neonates with birth asphyxia (n=2) and the need for their resuscitation (n=2) was more in the oxytocin group but the need of antibiotics for the neonates was more in PGE2 group (5% Vs. 3%). Conclusion: Induction of labor with oxytocin, with or without cervical priming with vaginal PGE2 gel, are both reasonable options in cases of PROM, since they result in statistically non significant rates of maternal and neonatal morbidities and caesarean section. Cervical priming with prostaglandin results in higher rate of vaginal delivery and shorter induction to vaginal delivery interval and this is viewed as an advantage to the mother

Chapter 13 Household waste management and the role of gender in Nepal

Solid waste management has become one of the most important issues in urban centres of developing countries where population growth puts pressure on public services. Nepal is struggling to manage municipal solid waste in urban centres due to a lack of segregation at the source, recycling, and proper disposal. This chapter examines whether women and men manage household waste differently at the household level, especially at source segregation, managing recyclable waste (paper and plastic), and composting degradable waste. Using household survey data from the Bharatpur Metropolitan City of Nepal, we find that women are more likely to segregate waste at the source and also manage degradable waste at home better. Still, there is no gender difference in selling plastic and paper waste. In contrast, women are more likely to give paper or plastic waste either to the waste collectors (free) or throw away, suggesting a heterogeneity across gender when it comes to managing household waste. In most cases, women waste managers perform well (segregating at source and composting degradable waste), but they do not seem to do well in all areas of plastic or paper waste management where some sort of sensitization may be helpful

Chapter 13 Household waste management and the role of gender in Nepal

Solid waste management has become one of the most important issues in urban centres of developing countries where population growth puts pressure on public services. Nepal is struggling to manage municipal solid waste in urban centres due to a lack of segregation at the source, recycling, and proper disposal. This chapter examines whether women and men manage household waste differently at the household level, especially at source segregation, managing recyclable waste (paper and plastic), and composting degradable waste. Using household survey data from the Bharatpur Metropolitan City of Nepal, we find that women are more likely to segregate waste at the source and also manage degradable waste at home better. Still, there is no gender difference in selling plastic and paper waste. In contrast, women are more likely to give paper or plastic waste either to the waste collectors (free) or throw away, suggesting a heterogeneity across gender when it comes to managing household waste. In most cases, women waste managers perform well (segregating at source and composting degradable waste), but they do not seem to do well in all areas of plastic or paper waste management where some sort of sensitization may be helpful

A comparative study of serum uric acid, glucose, calcium and magnesium in pre-eclampsia and normal pregnancy

Background: Preeclampsia is associated with liver function abnormalities and renal function impairment. The objective of this study is to compare serum uric acid, glucose, calcium and magnesium in pre-eclampsia with normal pregnancy. Materials and Methods: Normal pregnant women and pre eclamptic women of age group 20-40 years were included. Serum magnesium, calcium, glucose, uric acid were analyzed.Results: Mean serum magnesium level in preeclampsia (1.83 ± 0.21mg/dl) was lesser in comparison to normal pregnant women (2.03 ± 0.16 mg/dl). Serum calcium level was lower (8.10 ±0.56mg/dl) than control (9.59 ±0.62 mg/dl) with p&lt;0.001. Uric acid, glucose and lactate dehydrogenase in preeclamptic women was significantly higher than that in normal pregnant women (6.14 ± 0.85 vs.4.01 ± 0.62, p=&lt;0.001), (94.17± 18.65 vs.86.34 ± 10.19, p=0.033) and ( 466.80 ± 97.29 vs. 194.22 ± 39.76, p=&lt;0.001) respectively.Conclusion: There were significant changes in serum magnesium, uric acid, calcium, glucose, lactate dehydrogenase and total protein in pregnant women.</p

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

Abdominal Cocoon Syndrome following Primary Subfertility Management with IVF-ET

Abdominal cocoon syndrome is a rarely encountered surgical emergency first described by Foo et al. in 1978. This condition is characterised by a thick fibrous membrane which encases the small bowel partially or completely. Diagnosis of this condition is usually made per operatively and the treatment of choice is surgical release of entrapped bowel. This is a case report of abdominal cocoon syndrome diagnosed during laparotomy done with the provisional diagnosis of abdominal pregnancy following In vitro fertilization- embryo transfer. A 30 Years lady was admitted at Kathmandu Medical College for suspected ovarian hyper stimulation syndrome following IVF-ET.  Sub fertility is a common gynecological problem. Its management may sometimes produce challenging health hazards. Thorough screening for medical and surgical illness is very important before proceeding to any kind of assisted reproductive technologies. A multidisciplinary approach is very important to manage such cases

Facing north or south: Does slope aspect impact forest stand characteristics and soil properties in a semiarid trans-Himalayan valley?

An understanding of the differences in vegetation and soil characteristics between slope aspects in high altitude semiarid environments is fundamentally important for efficient management of these semi-natural systems; however, few studies have quantified these differences. Here, we analyzed forest stand characteristics, carbon stocks and soil properties of north- and south-facing slopes in a trans-Himalayan semiarid valley. Pinus wallichiana was the dominant and Juniperus indica the co-dominant species in both aspects, whereas Betula utilis and Abies spectabilis were only recorded in north-facing forests. Pinus regenerated in both aspects, whereas Juniperus did not. Carbon stocks did not differ between aspects; 33 t/ha in north-facing and 31 t/ha in south-facing forests. Similarly, soil properties did not vary between slope aspects, expect for potassium (highest in south-facing slopes). These results suggest that topographic factors affect mountain forests through their direct influence on radiation and moisture, but that human disturbance also plays a significant role affecting vegetation and soil characteristics in a semiarid environment. These natural and anthropogenic factors may play in harmony or in discord with each other. Here, the aridity of the region, parent material and land use history led to less pronounced differences between slope aspects, than commonly found in moister habitats

Randomised controlled trial of nurse-led breathlessness intervention to improve the management of breathlessness in patients with chronic obstructive pulmonary disease : a pilot study

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