Elderly Gravida with Bombay Blood Group and Placenta Previa Managed with Autologous Blood Transfusion

The Bombay blood group is a rare blood type with an incidence of around one in a million. There is no known reported case of an obstetric patient with the Bombay blood group from Nepal. People with this rare blood group can receive blood only from those with the same blood type. We report an elderly gravida with the Bombay blood group who had a pregnancy complicated by diabetes, placenta previa, and transverse lie (back up) following an in vitro fertilization. Placenta previa posed a greater risk of hemorrhage and hence the need for transfusion. The main challenge was arranging blood for transfusion, and as the Bombay blood group was unavailable, she was managed with autologous blood transfusion which was performed for the first time in a pregnant lady in our institute. She underwent Cesarean section for placenta previa with transverse lie, and both mother and baby were sent home in good health

A case report

vaginal delivery in a case reverted by Dobbins operation for acute uterine inversion

this happen or why is it mistaken?

A second gravida with normal antenatal period delivered a baby within an hour of admission and also expelled placenta which appeared at vagina. This placenta was adhererent to the fundus of uterus which was inverted but was persistently pulled out as uterine inversion was unrecognized. This case report will be of help to many of us who may mistake such condition. A habit to palpate the fundus of uterus and make sure it is contracted before controlled cord traction will help making the diagnosis in time

Towards uterine inversion: Illustration of a gradual process through three cases of submucous myoma

How the largest of the large (> 10 x 8 cms) sub mucous myoma arising from the fundus uteri successively promotes the occurrence of non puerperal uterine inversion over the years as depicted through 3 different illustrations imitating a gradual process; first by forming an indentation in the uterine fundus then progressively causing more dimpling in the verge of uterine inversion until finally giving rise to a full blown picture of complete uterine inversion where the uterine fundus is driven beyond the level of introitus with the consequences of prolapsed incarcerated myoma in a post menopausal woman. A total abdominal hysterectomy and bilateral salpingoophorectomy were performed on all of these 3 women 2 perimenopausal and a postmenopausal; the latter was first facilitated by vaginal myomectomy further supplemented by division of the inversion ring posteriorly as described by Haultain. Key ey words: Non puerperal uterine inversion, submucous fundal myoma, vaginal myomectomy

Myomectomy: TU Teaching Hospital experiences

Aim: To study, open myomectomy operation for uterine myoma/s as of present day practices in women of reproductive age attending TU Teaching Hospital. Methods: This is a retrospective study where we reviewed the medical records of myomectomy cases fro

Intraperitoneal haemorrhage- A call for laparotomy as second

interventio

Pelvic organ prolapse in rural Nepalese women of reproductive age groups: What makes it so common?

Aim: To find out the prevalence, aetiopathogenesis and the magnitude of problems of pelvic organ prolapse (POP) among married women of reproductive age (MWEA) in the rural Nepalese community. Methods: A cross-sectional descriptive study conducted in eight selected districts (mountain / hills to terai region) of Nepal linking community to health services. Proportionate samples of MWRA (15-49 years) in total samples of 2849 were interviewed using questionnaires and clinical examinations were made in health facililities. Results: Among 2849 women who agreed to take part on the study when interviewed (by enumerators with pretested questioners) 2070 (72.6%) came for assessment. POP was diagnosed in 207/2070 giving the incidence as 10 % being commoner in the planes (8:1) than mountains. POP formed 2.8 % of adolescent due to early marriage d ” 15 years in (50%) and unsupported delivery by skilled birth attendant (SBA) out of health facilities (99.2%). Resumption of manual labor after delivery less than a month was (83.8%) and parity was responsible to some extent as P occupied by T!. (1-3) Mean duration of suffering being 7.8 years (e ” 10 years in .) having II°/III ° or procidentia rectovaginal/ vesicovaginal fistula, urinary incontinence (stress/urge), bleeding, discharge from sore and ulceration, coital problem, urination / defecation problem walking, sitting, back ache and chronic abdominal pain S!. Conclusion: In this large reproductive morbidity study including women in the rural community of varied ethenic groups from diverse ecology, basic community survey linked to clinical assessment in the health facility found the incidence of POP to be much higher in planes than hills giving unusually lower prevalence rate for POP as 10 % than other clinic based studies

Maternal hemoglobin and risk of low birth weight: A hospital-based cross-sectional study in Nepal

Background: Maternal hemoglobin during pregnancy is an important predictor of neonatal outcomes such as birth weight. The newborn weight of an infant is considered a crucial factor for morbidity and mortality. This study aimed to assess the association between maternal hemoglobin concentration and newborn weight at term pregnancy. Methods: A hospital-based cross-sectional study was conducted at Tribhuvan University Teaching Hospital (TUTH), Kathmandu, Nepal from 14th April 2018 to 13th April 2019. Term singleton pregnant women who were admitted for delivery in the labor room of TUTH were included in this study. Maternal characteristics such as age, parity, birth space, ethnicity, education level, dietary habit, body mass index (BMI), and hemoglobin level were recorded. The newborn weight was taken immediately after delivery. The main outcome of this study was the birth weight. The association between hemoglobin level and newborn weight was analyzed using bivariate and multivariable logistic regression analysis. Results: Of 2,418 term pregnant women, the prevalence of low hemoglobin and high hemoglobin levels were 24% (95% CI: 22–25.4), and 17% (95% CI: 15.7–18.7), respectively. The prevalence of low birth weight (LBW) was 12.9% (95% CI: 11.7–14.4). Multivariable logistic regression analysis showed that those mothers who had low hemoglobin concentration (adjusted Odds Ratio/aOR = 3.77, 95% CI: 2.84–5.01), and high hemoglobin concentration (aOR = 3.07, 95% CI: 2.23–4.24) had higher odds of having LBW compared to mothers having normal hemoglobin level. Mothers with both young age pregnancy (aged 16–20 years) and older pregnancy (aged ≥31 years) (aOR = 1.60, 95% CI: 1.01–2.52) and (aOR = 1.60, 95% CI: 1.06–2.41), respectively had higher odds of LBW compared to mothers aged 21–25 years. Those mothers who attended a primary level of education had higher odds of (aOR = 1.93, 95% CI: 1.05–3.55) LBW compared to those mothers with a higher level of education. Moreover, mothers who belonged to Janajati ethnic group (aOR = 0.47, 95% CI: 0.34–0.65) compared to the Brahmin/Chhetri ethnic group, and mothers with a birth space of more than three years (aOR = 0.63, 95% CI: 0.41–0.97) compared to those who had less than three years of birth spacing and mothers who were overweight/obese (aOR = 0.74, 95% CI: 0.55–0.99) compared to normal nutritional status had lower odds of having LBW. Conclusions: Our study concludes that both low and high hemoglobin had an increased risk of having low birth weight. Policies and programs can benefit by adopting the findings of this study. More empirical research is critical to understanding the impact of hemoglobin levels on birth weight