Age specific clinicopathological profile of ovarian mass

Introductions: Ovarian cancer is seventh leading cause of cancer death among women. Ovarian mass has age specific occurrence and may may help in screening and management plans. This study was conducted to determine the age-wise clinical profile of the ovarian mass. Methods: This review done to analyse the histologically diagnosed ovarian masses in cases operated during three years at Patan Hospital, Patan Academy of Health Sciences, Nepal. Clinical profile of the patients and age-wise distribution of histological types of ovarian mass were analyzed descriptively using Microsoft Excel. Results: Peak incidence of ovarian tumor was in age group of 20-29 years with 93 (36%) cases out of 258 ovarian masses. All eight malignant tumors were in age group of ≥40 years. Neoplastic masses were 188 (72.9%), 95 (50.5%) germ cell tumor. In 70 (27.1%) non-neoplastic lesion, corpus luteal cyst were 24 (34.3%). Conclusions: Peak incidence of ovarian tumor was seen in age group of 20-29 years. Germ cell tumors accounted for half of the neoplastic lesions. All malignant ovarian tumors were in found in age group ≥40 years. Keywords: germ cell tumor, ovarian cancer, ovarian mas

Viable baby from a couvelaire uterus

A 20 years primi gravida of 32 weeks pregnancy by date was admittedin the labor room with diagnosis of preterm labor with preeclampsia.Ultrasonography revealed 36 weeks pregnancy with normal liquorvolume and fundal placenta. Lower segment caesarean section was donefor cephalopelvic disproportion with preeclampsia. A female baby wasdelivered weighing 2.4 kg, with apgar score of 6/10 – 8/10. The placentawas delivered by control cord traction. On the fundus 25% of placenta wasalready separated and 500 ml of old retro placental clots were found. Itwas abruption placentae (concealed type), the uterus was bluish/purplishcolor, which was diffuse on fundal area and effusions of blood were alsoseen beneath the tubal serosa. After delivery of the baby uterus was wellcontracted 20 weeks size, bilateral ovaries were normal

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

Misoprostol for Termination of Second Trimester Pregnancy

Introductions: The termination of second trimester pregnancy is challenging due unfavorable cervix. This study evaluate the efficacy and maternal side effects of intravaginal misoprostol for termination of second trimester pregnancy.Methods: During one year period from 15th June 2011 to 14th June 2012,Department of Obstetrics and Gynaecology of Patan Hospital, women admitted for second trimester termination of pregnancy for fetal congenital anomalies and intrauterine fetal demise were studied using the International Federation of Gynaecology and Obstetrics recommended doses of vaginal misoprostol. For congenital anomalies, 400 mcg 3 hourly to a maximum of 5 doses were used. For fetal demise, gestational age of 13-17 weeks received 200 mcg every 6 hourly to a maximum of 4 doses, and 18-26 weeks dose was adjusted to 100 mcg. Main outcome measures included success rate of abortion within 48 hours, induction to delivery interval and maternal side effects.Results: There were 40 patients during study period. Success rate for termination of 2nd trimester pregnancy within 48 hours was 88.8% for congenital anomalies. For fetal demise, success of termination was 90.9% at 13-17 weeks and 100% at 18-26 weeks. Median time from induction to delivery was 26.8 hours for congenital anomalies. For fetal demise, it was 18 hours for 13-17 weeks was and 24 hours at 18 to 26 weeks respectively. Abdominal pain was seen in all doses of misoprostol.Conclusions: Vaginal misoprostol is an effective method for termination ofsecond trimester pregnancy.Keywords: misoprostol, pregnancy, second trimester terminatio

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

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

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

A minimal descriptor of an ancestral recombinations graph

<p>Abstract</p> <p>Background</p> <p>Ancestral Recombinations Graph (ARG) is a phylogenetic structure that encodes both duplication events, such as mutations, as well as genetic exchange events, such as recombinations: this captures the (genetic) dynamics of a population evolving over generations.</p> <p>Results</p> <p>In this paper, we identify structure-preserving and samples-preserving core of an ARG <it>G</it> and call it the minimal descriptor ARG of <it>G</it>. Its structure-preserving characteristic ensures that all the branch lengths of the marginal trees of the minimal descriptor ARG are identical to that of <it>G</it> and the samples-preserving property asserts that the patterns of genetic variation in the samples of the minimal descriptor ARG are exactly the same as that of <it>G</it>. We also prove that even an unbounded <it>G</it> has a finite minimal descriptor, that continues to preserve certain (graph-theoretic) properties of <it>G</it> and for an appropriate class of ARGs, our estimate (Eqn 8) as well as empirical observation is that the expected reduction in the number of vertices is exponential.</p> <p>Conclusions</p> <p>Based on the definition of this lossless and bounded structure, we derive local properties of the vertices of a minimal descriptor ARG, which lend itself very naturally to the design of efficient sampling algorithms. We further show that a class of minimal descriptors, that of binary ARGs, models the standard coalescent exactly (Thm 6).</p