Prediction of Neonatal Outcome by Umbilical Artery Velocimetry in Intrauterine Growth Restriction: A Study in Western Nepal

Abstract The introduction of Doppler velocimetry to obstetrics offered a noninvasive and safe imaging modality of indirectly assessing the fetal and uteroplacental circulation. Obstetric Doppler ultrasound plays an important role in detecting Intra Uterine Growth Restriction (IUGR). The early diagnosis of IUGR with the help of abnormal flow patterns in umbilical, uterine and middle cerebral arteries using Doppler ultrasound may help in reducing perinatal and neonatal mortality and morbidity as well as reducing perinatal complications. This provides for timely interventions to prevent progression from IUGR to Intrauterine death (IUD).The study was carried out in 140 patients in Manipal Teaching Hospital, Pokhara for a period of twenty months from October 2013 to June 2015. All the cases presented to Radiology department for obstetric Doppler with clinical suspicion of IUGR were taken up for the study and obstetric doppler of umbilical artery was performed. Seventy two out of 140 (51.50%) had abnormal umbilical artery Doppler velocimetry. Fifty seven out of these 72 subjects (positive predictive value -79.2%) with abnormal umbilical artery Doppler were later born with small for gestational age (SGA). The S/D ratio of umbilical artery of 3 or greater was considered abnormal in predicting IUGR and it showed sensitivity, specificity, positive predictive value, and negative predictive value of 76%, 76.9%, 79.2% and 73.5% respectively. Admission to the Neonatal Intensive Care Unit (NICU) and incidence of perinatal and neonatal mortality increased with the worsening of Doppler velocimetry. Twenty seven out of one hundred and forty neonates developed perinatal asphyxia, out of which 26 (96.3%) had abnormal umbilical artery velocimetry. NICU admissions comprised of a total of 30 neonates, out of which 27(90%) had abnormal umbilical artery Doppler velocimetry prenatally. Fifteen out of thirty didn't survive, all of whom had abnormal umbilical artery Doppler velocimetry prenatally. There were 3 still born and all of them had abnormal umbilical artery velocimetry prenatally. The study could underline that abnormal Doppler velocimetry has a fairly good sensitivity and specificity for predicting IUGR and it is related with poor neonatal outcomes

Demographic and Clinical Profile in Patients with Liver Cirrhosis in a Tertiary Care Hospital in Central Nepal

Introduction: Liver cirrhosis is an important health problem worldwide and is a common disease in Nepal. The profile of cirrhosis may vary due to different factors. This study was undertaken to see the demographic and clinical profiles of patients with cirrhosis of liver attending a tertiary care hospital in Central Nepal. Methods: Six hundred patients with clinical features, laboratory and sonological findings suggestive of chronic liver dysfunction and endoscopic evidence of portal hypertension were included in the study. Their demographic and clinical profile, endoscopic findings, outcomes during hospitalization were studied. Ethical approval was taken from Institutional Review Committee of College of Medical Sciences. SPSS 20 was used for statistical analysis. Results: The mean age of subjects was 54±11.84 years with 435 males (72.5%) and 165 (27.5%) females. Majority of 203 (33.8%) patients were from Mongol ethnicity followed by 127 (21.2%) Khas. Two hundred and twenty (36.6%) were farmers followed by 169 (28.2%) retired personnel. A total of 338 (56.4 %) patients were from rural areas. The commonest aetiology of cirrhosis was chronic alcohol consumption and seen in 552 (92%) patients. Abdominal distension was commonest presenting sign and observed in 561 (93.5%) patients. Ascites seen in 555 (92.5%) patients was the commonest complication followed by UGI bleed in 326(54.3%) patients. Gastro-oesophageal varices observed in 345 (57.5%) patients, was the most common endoscopic finding followed by portal gastropathy, peptic ulcer and erosive mucosal diseases. In patient mortality was noted in 92 (15.3 %) patients. Conclusions: This study highlights the burden of cirrhosis, usually caused by chronic alcohol consumption in Central Nepal. Majority of subjects were male, middle aged, farmers, from rural areas and predominantly observed in some ethnicity like Mongols. Cirrhotic patients usually present late with varied complications and have high mortality.   Keywords: cirrhosis of liver; complications; endoscopy