Butorphanol in Labour Analgesia

Introduction: Labour is the process where uterine contractions lead to expulsion of product of conception through the vagina into the outer world. Labour pain is one of the most severe pains which has ever been evaluated and its fear is one of the reasons women wouldn’t go for natural delivery. Delivery is a painful experience for all of the women except a few of them. The labor pain results from some physiological-psychological causes. Different pharmacological and non-pharmacological methods have been tried for pain relief in labour. The objective of this study is to see the effect of butorphanol injection in labour pain. Methods: It is a descriptive cross-sectional study conducted in B.P. Koirala institute of health sciences. We observed 200 pregnant women meeting the inclusion criteria and giving the informed consent who were on 1 mg butorphanol i.m. at the onset of active stage of labour every 4 hourly and on demand. Pain assessment was done by Numerical Pain analogue scale measured from 1 to 10. Fetal heart rate monitoring was done according to the hospital protocol. Caesarean section was performed for obstetrical indication. Neonatal outcome was evaluated by on duty pediatrician and APGAR score were noted at 1 and 5 min. Results: The pain scores in first, second, third, fourth hour were (8.83±0.773), (9.84±0.544), (9.94±0.338), (9.6±0.298) respectively, where 1st and 2nd hour is statistically significant. Conclusions: Butorphanol is an effective labour analgesia without significant adverse effects on women and the neonatal outcome

Cystatin-C as a Marker for Renal Impairment in Preeclampsia

Preeclampsia is a devastating pregnancy-associated disorder characterized by the onset of hypertension, proteinuria, and edema with limited plausible pathophysiology known. Cystatin-C, a novel marker for the detection of renal impairment, is increased in preeclampsia at an early stage. This study was aimed to evaluate the diagnostic efficiency of Cystatin-C as an early marker of renal function in preeclampsia comparing it to the traditional renal markers. A hospital based comparative cross-sectional study was performed on 104 women (52 diagnosed cases of preeclampsia and 52 healthy pregnant women). Concentrations of Cystatin-C, creatinine, urea, and uric acid were measured in both the study groups. Mean serum Cystatin-C and uric acid levels were elevated in preeclampsia cases compared to controls (1.15 ± 0.37 versus 0.55 ± 0.12; 5.40 ± 1.44 versus 3.97 ± 0.68, resp.). ROC curve depicted that Cystatin-C had the highest diagnostic efficiency (sensitivity, 88.24%; specificity, 98.04%) compared to creatinine and uric acid. Serum Cystatin-C consequently seemed to closely reflect the renal functional changes, which are believed to lead to increased blood pressure levels and urinary excretion of albumin and may thus function as a marker for the stage of the transition between normal adaptive renal changes at term and preeclampsia.</jats:p

Risk Factors Associated with Abnormal Semen Parameters: Case-Control Study at a Tertiary Hospital in Eastern Nepal

Background: Infertility is a global problem. Male factors are estimated to be the cause of up to 50% of infertility cases. A variety of identifiable and reversible etiological factors are involved in male factor infertility. This study aimed to compare the risk factors in men who have abnormal semen parameters with those with normal parameters. Methodology: This was a case-control study. The male partners of the infertile couples presenting for infertility evaluation were advised for semen analysis and based on the report they were divided into control (normal parameters) and case (abnormal parameters) groups. A detailed interview of each subject was conducted focusing on risk factors causing different semen parameter abnormalities and the risk factors in both groups were compared. Results: There were 50 subjects in each group. The mean age was 31.02 ± 5.183 years and the mean BMI was 24.824 ± 2.438 kg/m2. The mean duration of infertility for those in the case group was significantly higher (p-value 0.006). Mean sperm concentration and sperm motility were 33.492 ± 30.306 million/ml and 38.1% ± 18.893 respectively. 40 subjects had oligozoospermia and 36 had asthenozoospermia. Age (OR1.464), the habit of cigarette smoking (OR 37.946), and the presence of past medical conditions (0R 534.82) were significantly associated with abnormal semen parameters. Service-holder men were significantly less likely to develop semen abnormalities (OR 0.087). Conclusion: Age, cigarette smoking, and presence of past medical history are associated with abnormal semen parameters thus contributing to male factor infertility. Key words: male infertility, risk factors, oligozoospermia, asthenozoospermia.</jats:p

Anatomy of Internal Iliac Artery and Its Ligation to Control Pelvic Hemorrhage

Pelvic hemorrhage is a major cause of maternal morbidity and mortality in developing countries. A sound clinical judgment, adequate assessment, and preparation of the patient are the best preoperative means to avoid its occurrence. Bilateral internal iliac artery ligation is a life-saving procedure to control massive obstetric and gynecological hemorrhage when other measures fail. This procedure significantly reduces the pulse pressure and rate of blood flow abolishing the‘triphammer effect’ of arterial pulsation and subsequently resulting in sluggish blood flow allowing effective thrombosis within the small bleeding vessels. This has helped to save many lives and uteruses for more than a century. No tissue necrosis occurs due to ample collateral circulation in the pelvis from the major pelvic anastomoses. An increased understanding of retroperitoneal anatomy and regional variations of the internal iliac artery is needed to reduce the risk of intraoperative andpostoperative complications.</jats:p

Analysis of Perinatal Outcome During COVID- 19 Pandemic Lockdown: a cross sectional study

Background: Fear of hospitalization in addition to uncertainties about appropriate treatment at the beginning of COVID -19 pandemic may have affected the health and outcome of pregnant women. Lack of transportation, closed out -patient services, and lack of employment has directly linked to poor maternal and perinatal outcomes during nationwide lockdown. This study aimed to assess perinatal outcome during the first COVID-19 pandemic lockdown at BPKIHS. Methods: This is a Descriptive Cross- Sectional Study conducted in a tertiary care center in Eastern Nepal from 24th march 2020 to 23rd July 2020 during the first COVID- 19 lockdown. Poor perinatal outcomes: perinatal death, preterm delivery, intrauterine growth restriction, newborn admission, and different reasons for admission were analyzed using descriptive statistics. Results: There were a total of 2685 obstetric admissions and 2442 deliveries during the study period of 4 months. The perinatal death rate was 26.2 per 1000 births. One hundred and twenty- eight newborns required neonatal admission and prematurity was the most common cause. Mean age and gestational age of women with poor perinatal outcome were 27.16 ± 6.02 years and 36.38± 4.54 weeks respectively. Conclusions: Despite the availability of comprehensive Emergency Obstetric Care (CEOC) at our center, poor perinatal outcome is still high. Which was directly or indirectly affected by COVID-19 pandemic lockdown as there was closure of OPD services, elective surgery, and most importantly lack of transportation.</jats:p

Risk Factors Related to Intrauterine Fetal Death

Background: Intrauterine fetal death is a traumatic event. Stillbirth rate is an important indicator to assess the quality of antenatal care. The objective of the study was to identify the risk factors related to intrauterine fetal death in patients admitted with intrauterine fetal death.Methods: It was a descriptive study conducted in the department of Obstetrics and Gynaecology at B. P. Koirala Institute of Health Sciences from January to December 2014. Patients admitted with singleton pregnancy with intrauterine fetal death after 28 weeks gestation were included. Results: There were 11,006 obstetric admissions. Of them, 152 women had intrauterine fetal death. There were 128(84.2%) women between 20-35 years of age. Out of 152, 81(53.3%) women were preterm and 39(2.1%) women were postterm. Primigravida were 77(50.7%) followed by 35(23%) of second gravida. Hypertension was the commonest identified risk factor in 30(26.78%) women. Out of 152 women, 49(32.2%) had not received formal education. Ten (6.6%) women had a past history of fetal death. Four (2.6%) women had medical disorder before pregnancy. One hundred and twenty five (82.2%) women had vaginal delivery, 21(13.8%) had caesarean section and 6(3.9%) had laparotomy for rupture uterus. The commonest indication for caesarean section was placenta previa for 7(33.33%) women. Four (2.6%) women had diabetes. Ninety five (62.5%) were male and 57(37.5%) were female babies. Five (3.3%) babies had malformations. Conclusions: Hypertension in pregnancy was found to be the most common identified risk factor for intrauterine fetal death. Keywords: Fetal death; pregnancy; risk factors.</jats:p

Evaluation of Lower Urinary Tract Symptoms (LUTS): Severity Score and Symptom Association

Introduction: Lower urinary tract symptoms (LUTS) is a group of symptoms relating to stages of micturation such as storage symptoms, voiding dysfunction and post micturation dysfunction. Overactive bladder symptom score (OABSS) is a questionnaires with scores which helps in evaluating the severity of symptoms.&#x0D; Objectives To find the incidence of women visiting with LUTS and to evaluate storage symptoms in LUTS (urgency, urge incontinence, frequency) using OABSS (overactive bladder symptom score) questionnaires.&#x0D; Methodology This is a prospective study done from February 2016 to February 2017. Patients visiting Department of Obstetrics and Gynaecology with lower urinary tract symptoms (LUTS) were enrolled in the study after informed consent. Patients were assessed for types of LUTS and data were filled in the performa. If patients had urgency, urge incontinence, increased day time frequency, then the patients were explained and asked overactive bladder symptom score questionnaire (OABSS) and noted. Patients were then examined for pelvic floor dysfunction and neurological abnormalities for identifying association with the symptoms. Statistical analysis was done using SPSS 11.5.&#x0D; Results Fifty-seven patients were enrolled with lower urinary tract symptoms (LUTS) during study period. Forty-six patients had overactive bladder symptoms (OABS). LUTS were found in age ranging from 21 to 80 years. Majority of patients visiting out-patient department with LUTS were found to have urgency, urge incontinence, increased day time frequency, nocturia. Patients with urgency and urge incontinence showed significant correlation with increasing likert score of OABSS (p&lt;0.05). But the increased day time frequency did not show any correlation with increasing score. The score showed significant correlation with combination of symptoms (urgency, urge incontinence and increased frequency) than patients presenting with single symptom.&#x0D; Conclusion Diagnosis of LUTS with valid assessment tools and treatment benefits patients with chronic urinary symptoms and also helps clinicians to further re-assess the treatment.</jats:p

Induction of Labor Using Misoprostol With or Without Mifepristone in Intrauterine Deat

Introduction: Rapid expulsion of fetus in intrauterine fetal death is usually requested without any medical grounds for it. So an efficient, safe method for induction of labor is required. The objective of this study is to determine if pre-treatment with mifepristone followed by induction of labor with misoprostol in late intrauterine fetal death is more efficacious. &#13; Methods: We conducted a randomized controlled trial in 100 patients in B.P.Koirala Institute of Health Sciences, Nepal from June 2011 to May 2013. Group A women received single oral dose of 200 mg mifepristone, followed by induction with vaginal misoprostol after 24 hours. Group B women were induced only with vaginal misoprostol. In each group, five doses of misoprostol was used four hourly. If first cycle was unsuccessful, after break of 12 hour, second course of misoprostol was started. The primary outcome was a measure of induction to delivery time and vaginal delivery within 24 hours. Secondary outcome was to measure need of oxytocin and complications. &#13; Results: Maternal age, parity and period of gestation were comparable between groups. Number of misoprostol dose needed in group A was significantly less than group B. Mann Whitney U test showed, women in group A had significantly earlier onset of labor, however total induction to delivery interval was not significant. In group A, 85.7% delivered within 24 hours of first dose of misoprostol while in group B 70% delivered within 24 hours (p=0.07). More women in Group B required oxytocin. &#13; Conclusions: Pretreatment with mifepristone before induction of labor following late intrauterine fetal death is an effective and safe regimen. It appears to shorten the duration of induction to onset of labor. &#13; Keywords: induction of labor; intrauterine fetal death; mifepristone; misoprostol