Analysis of cesarean section using Robson’s criteria in tertiary care center

Introduction: This study aims to analyze all the women delivering in our institute according to the Robson’s classification. Robson’s ten group classification system (TGCS) endorsed by WHO, is a global standard tool for assessing, monitoring and comparing cesarean section rates at all levels. Method: This cross sectional study was conducted in the department of obstetrics and gynecology, Patan hospital, Patan academy of health sciences (PAHS), Lalitpur, Nepal over 12 months’ period. All women who delivered during this period were classified according to the Robson’s classification (TGCS) into a specific group. Relative size and overall cesarean section rate of each group were calculated. Result: A total of 4,985 cases were analyzed. The cesarean section rate was 57.7%. Group 1+2 represented nearly half (49%) of the obstetric population served during the study period. Group 2A was found to be the highest contributor (27.4%) followed by Group 5 (22.8%) and Group 1 (13.0%). In terms of indication for cesarean section -Fetal distress and previous cesarean section were found to be the most common indications. Similarly, nulliparous women were three to four times more likely to be delivered by cesarean section when labor was induced. Conclusion:  From this study, we can conclude that for an effective reduction in the overall high cesarean section rate in our Institution, we need to focus on a more stringent protocol for inducing labor especially among nulliparous women and to practice evidence based guidelines. Redefining failed induction needs to be considered critically as well

Antepartum hemorrhage at a tertiary care teaching hospital in Nepal

Introductions: Antepartum hemorrhage (APH) is a serious obstetrical emergency and is a leading cause of maternal and perinatal morbidity and mortality. Incidence varies from 2-5% of all deliveries. The maternal and perinatal complications of APH are anemia, postpartum hemorrhage, shock, low birth weight, intrauterine fetal death and birth asphyxia. Methods: This descriptive study was conducted at Department of Obstetrics and Gynaecology of Patan Hospital, a tertiary care teaching hospital of Patan Academy of Health Sciences (PAHS), Lalitpur, Nepal. All patients who were admitted after 22 weeks of gestation with diagnosis of antepartum hemorrhage from April 2012 to April 2016 were included. Results: The incidence of APH was 0.23% in the present study. Out of 84 patients, 39.3% were in age group of 25-29 years, 63% were multigravidae, 63% had placenta previa, 92.3% lower segment caesarean section done in new onset APH and 53.1% done in previous admitted cases of APH, 23.8% developed hypovolemic shock, 14.3% needed blood transfusion, 9.5% had postpartum hemorrhage, 1.2% had caesarean hysterectomy, 54.8% had preterm delivery, 9.5% were admitted in neonatal intensive care unit and perinatal mortality was 10.7%. Conclusions: APH is a major cause of maternal and perinatal morbidity and mortality. In our study, the most common cause of APH was placenta previa. The commonest mode of delivery was caesarean section. The major maternal complication was hypovolemic shock with consequent high blood transfusion rate and fetal complication in prematurity. Keywords: antepartum hemorrhage, placenta previa, perinatal mortality Nepa

A Outcome of breech delivery: caesarean section versus vaginal delivery at Patan Academy of Health Sciences, Patan

Introductions: Obstetricians have long debated the role of caesarean section as a potentially safer mode of delivery for the fetus with breech presentation. However, the experience of the health care provider remains a critical element in the decision to pursue a vaginal breech delivery, and it may still be a viable option. The aim of this study is to determine the incidence of breech delivery at Patan Hospital and compare maternal and neonatal outcomes subjected to either vaginal or caesarean section. Methods: A five-year retrospective study of breech deliveries covering the year 2010 to 2014. Patient’s charts were retrieved from the medical record section and reviewed.Results: There were 896 breech deliveries out of a total 44,842 deliveries giving an incidence of 1.99%. One hundred thirteen (12.61%) of breech deliveries were through vaginal route while 431 (48.10%) and 352 (39.28%) were through emergency and elective caesarean sections respectively. There were 154(17.18% preterm intrauterine death. Among term pregnancy, there were 3-neonate deaths not associated with mode of delivery. There were 154(17.18%) preterm breech deliveries including 27(17.5%) preterm intrauterine death. Among term pregnancy, there were 3 neonatal deaths not associated with mode of delivery. None of the term infant had neurological morbidity comprising neonatal seizures, brachial plexus injury, chephalohematoma. Maternal blood loss was significantly higher is caesarean section group. Conclusions: In well-selected cases, the neonatal outcome following assisted vaginal breech delivery and caesarean section may not be different.Keywords: Breech delivery; Maternal and perinatal outcom

Prevalence of suicide risk and its associated factors in patients presenting in antenatal clinic

Introduction: Suicide during the antenatal period is one of the major indirect causes of maternal death. This study aims to determine the prevalence of suicidal risk and its related factors among the patients attending the antenatal clinic of a tertiary care center. Method: This is a cross-sectional study conducted in the antenatal clinic Patan Hospital, Lalitpur, Nepal among 124 pregnant patients using purposive sampling and face-to-face interviews applying a semi-structured proforma and P4 suicide screener. Ethical approval was obtained. The percentage of patients with suicide risk was calculated and stratified into minimal, lower, and higher risk of suicide. The association between suicide risk and different sociodemographic and clinical variables was done using the Chi-square test. A p-values ≤0.05 was considered statistically significant. Result: The prevalence of suicide risk was 32 out of 124 patients (25.8%). When risk stratification was done a maximum of 22(17.7%) had a higher risk for suicide. The risk was associated the employment status (p=0.039), history of previous suicide attempts (p=0.04), and diagnosed mental disorder (p=0.027). Conclusion: Our study shows the suicide risk among antenatal females was 25.8% reaffirming the need for proper screening and referral

Relaparatomy after caesarean section

Introductions: Relaparotomy after caesarean section is rare and literature are scanty. The decision requires a good clinical judgment to save mother’s life. Our objective was to analyse the outcome of relaparotomy after caesarean section at Patan hospital.Methods: This was a cross sectional study done at the department of obstetrics and gynaecology, Patan Hospital, Nepal. Charts of caesarean section from January 2010 to December 2014 were reviewed to analyze the cases of relaparotomy for incidence, indication, management and outcome. Descriptive analysis was done using SPSS.Results: During 5 years, there were 17,538 caesarean deliveries, 39.15% of total 44,788 deliveries. Relaparotomy was done in 15 cases, 0.085% of 17538 caesarean. Mean age was 26.6±4.7 years, 14 (93.3%) were between 25-35 years, 12 (80%) were primigravida. Indications of relaparotomy were pyoperitonium (40%), hemoperitoneum (33.3%) and rectus sheath hematoma (26.7%). Out of 15 relaparotomy, 14 were conservative surgery and one required hysterectomy. There was no maternal mortality. Conclusions: Relaparotomyin our study the rate was eight in 10,000. Those requiring relaparatomy had fetal distress as indication for first caesarean.Keywords: caesarean section, pyoperitoneum, relaparotom

Yield Evaluation of Nutrient-rich Potato Clones in High Hill of Nepal

A study was conducted to evaluate the yield of nutrient-rich potato clones in high-hill districts: Dolakha and Jumla of Nepal during the years 2013 and 2014, respectively. Fourteen potato clones were tested as on-station and on-farm experiments at both districts, and those fourteen clones were compared to ‘Lady Rosita' and ‘Jumli Local' respectively as the check varieties in the first year experiment, 2013. Eight promising clones were selected from the first year experiment, and were evaluated and compared with same local varieties in the consecutive year, 2014. Two clones namely; CIP 395112.32 (19.3 tha-1) and CIP 393073.179 (17.8 tha-1) exhibited superior marketable tuber yield than that of ‘Lady Rosita'(14.2 tha-1) in Dolakha and five CIP clones namely; 395112.32 (25.5 tha-1), 393073.179 (22.5 tha-1), 394611.112 (20.9 tha-1), 390478.9 (19.9 tha-1) and 395017.229 (17.0 tha-1) showed higher marketable tuber yield than ‘Jumli Local'(14.5 tha-1). Based on two years' phenotypic and tuber yield result, clones CIP 395112.32 and CIP 393073.179 are recommended to potato growers at high hills of Nepal for commercial cultivation.Journal of Nepal Agricultural Research Council Vol.3 2017: 6-1

Gynecologic surgery during the COVID-19 pandemic:patan hospital experience: Gynecologic surgery in COVID-19 pandemic

Introduction: The COVID-19 pandemic is a major challenge for health care services. Worldwide health systems were reorganized with the aim to both cope with the new disease and deliver surgical services safely and effectively. This study aims to audit  gynecologic surgeries , complications, suspected , positive covid cases during covid -19 pandemic.   Method:  Data of gynecologic surgeries  performed at patan hospital from 1st January to 31st December,2020 during prelockdown , lockdown and postlockdown  period of the pandemic were collected from medical record . Patients’  surgical  procedures, blood transfusion, ICU stay,  length of hospital stay , mortality, Covid-19 cases  were descriptively analyzed .   Result: There were  total 413 surgeries among which major surgery was 155 (37.5%), minor  249 (60.3%), minimally invasive nine (2.2%) , 61 (14.8%)  blood transfusion, mean length of hospital stay 3.75 with standard deviation of 3.711 ,15 (3.63%) cases stayed in ICU following procedure  and one (0.2%) mortality.  149(36.1%) ,116(28.1%) and 148(28.1%) cases were done during  prelockdown  ,  lockdown   and  postlockdown period respectively . Thirteen patients were suspected with COVID-19 infection and these surgeries were done in COVID operating room with full protective gear and 8 tested positive following a diagnostic PCR test .                                                                                             Conclusion: There was  decrease in  major procedures during lockdown period ,a result of travel restrictions, fear and postponement of elective surgeries prioritising the health care services. All the adequate protective measures taken  in the setting of COVID-19  enabled the continuity of  surgery without significant compromise of the safety of patients and gynecologic surgery units. &nbsp

Clinical Characteristics, Maternal and Fetal Outcomes of Pregnant Women with COVID-19

Background: Pregnant woman are more vulnerable to COVID infection due to physiological changes in the immune and cardiopulmonary system.  The aim of the study is to assess the clinical characteristics, maternal and fetal outcomes of pregnant patients with COVID-19 in Patan hospital. Methods: This was a descriptive cross-sectional study conducted in Patan hospital from 1 August 2020 to 30 July 2021 following approval from ethical committee. The study population comprised of all pregnant women with COVID-19 diagnosed by reverse transcriptase polymerase chain reaction test. There were total of 171 cases. The data were obtained from medical records and hospital database system. The statistical analysis was done by using SPSS version 16. Results: In Patan hospital, there were a total of 171 patients who were COVID-19 positive by PCR test. There were total deliveries of 4,277 during one year period and hence the incidence was 3.99%. There were 101 (59.06%) caesarean section  and   70 (40.93%) vaginal deliveries among which one was vacuum assisted delivery. There were two peripartum hysterectomies. Majority of the patients were asymptomatic, common symptoms were cough 29 (16.95%), fever 27 (15.78%) and shortness of breath 13 (7.6%). Prematurity was the common fetal complication seen in 28 (16.37%) of the cases. Maternal mortality was seen in 7 (4.09%) patients. Conclusions: COVID-19 is associated with increase maternal morbidity and mortality. Symptoms can be from mild form to much more severe course of illness. Proper treatment and timely referral of severe cases to higher center can improve both maternal and fetal outcomes in COVID-19 in pregnancy. Keywords: COVID-19; outcome; pregnancy; reverse transcriptase PC

Yield Evaluation of Nutrient-rich Potato Clones in High Hill of Nepal

A study was conducted to evaluate the yield of nutrient-rich potato clones in high-hill districts: Dolakha and Jumla of Nepal during the years 2013 and 2014, respectively. Fourteen potato clones were tested as on-station and on-farm experiments at both districts, and those fourteen clones were compared to ‘Lady Rosita’ and ‘Jumli Local’ respectively as the check varieties in the first year experiment, 2013. Eight promising clones were selected from the first year experiment, and were evaluated and compared with same local varieties in the consecutive year, 2014. Two clones namely; CIP 395112.32 (19.3 tha-1) and CIP 393073.179 (17.8 tha-1) exhibited superior marketable tuber yield than that of ‘Lady Rosita’(14.2 tha-1) in Dolakha and five CIP clones namely; 395112.32 (25.5 tha-1), 393073.179 (22.5 tha-1), 394611.112 (20.9 tha-1), 390478.9 (19.9 tha-1) and 395017.229 (17.0 tha-1) showed higher marketable tuber yield than ‘Jumli Local’(14.5 tha-1). Based on two years’ phenotypic and tuber yield result, clones CIP 395112.32 and CIP 393073.179 are recommended to potato growers at high hills of Nepal for commercial cultivation