Patient profile of gestational trophoblastic disease at Patan Hospital, Nepal

Introductions: This study was designed to determine the demographic pattern, incidence, clinical features and management outcome of gestational trophoblastic disease (GTD) in Patan Hospital. Methods: This is a cross sectional study conducted at Patan Hospital from April 13, 2008 to April 12, 2013. Medical record of cases diagnosed as GTD were retrieved from the record section for review. The age, parity, estimated gestational age at the time of evacuation, presence or absence of vaginal bleeding, uterine size in relation to gestational age, ultrasonogram report and urinary beta human chorionic gonadotropin level, histopathology findings, modalities of treatment and outcomes were analyzed. Results: There was total of 41,543 deliveries during five year study period and 54 GTD on histopathology. Among the 54 GTD, 40 (74%) were molar pregnancy, 8 (14.4%) invasive mole and 6 (11%) choriocarcinoma. The frequency of GTD was 1 per 769 pregnancies. The age of the women with GTD ranged from 15 -50 years. Half of the cases were below 25 years.  Most of the women presented between 8-12 weeks of gestation and below third gravida. Amenorrhea with vaginal bleeding was seen in 49 (90%) patients. Conclusions: The most common GTD observed in this study was molar pregnancy. Vaginal bleeding and lower abdominal pain were the most common complaints at presentation. Keywords: choriocarcinoma, gestational trophoblastic disease, molar pregnancy, persistent trophoblastic diseaseÂ

Stillbirth at Patan Hospital, Nepal

Introductions:  Stillbirth (SB) is one of the most common adverse outcomes of pregnancy.  The aim of this study was to determine the SB rate and to identify the likely causes contributing to SB. Methods: This cross-sectional study was conducted at Patan Hospital from 15th June 2014 to 14th June 2017 for all the cases of SBs, at or after 22 weeks, birth weight of 500 gm or more. The perinatal outcome, demographic profile, fetal characteristics, causes and contributing factors were analyzed. Results: There were 262 SB out of total 23069 deliveries, (11.24 per 1000) and 119 (46.12%) had antenatal check-up (ANC) at Patan Hospital. The 214 (82.95%) SB were among 20-34 years mothers, 133 (51.55%) being multigravida. Antepartum SB were 234 (89.31%), macerated 213 (81.30%), birth weight <1000gm 86 (32.82%) and male 156 (59.54%).  The intrauterine growth restriction (IUGR) was present in 60 (22.90%), unexplained casue in 43 (16.41%), prematurity 28 (10.69%), congenital anomalies 26 (9.92%), pre-eclampsia 19 (7.25%), gestational diabetes, and abruptio placenta each 13 (4.96%). Delay in seeking care in 202 (78.30%) was a potential contributing factor. Conclusions:  The SB was 11.24/1000 births. The causes in descending order were IUGR, unexplained, prematurity, congenital anomalies, pre-eclampsia, gestational diabetes and abruptio placenta. Delay in seeking care was found as a potential contributing factor. Keywords:  antenatal check-up (ANC), birth weight, intrauterine growth restriction (IUGR), stillbirt

Investigations on the Phenomena of Accumulation and Mobilization of Heavy Metals and Arsenic at the Sediment-Water Interface by Electrochemically Initiated Processes

Metals occur naturally and are commonly found as contaminants in areas where industrial and municipal effluents are discharged. Aquatic sediments/environments are often polluted by heavy metals due to the temporal variations in anthropogenic input of contaminants via atmospheric deposition, catchment runoff, effluent inflow and dumping from industrial transportation, mining, agricultural and waste disposal sources [EPA, 1989]. The transfer of contaminants associated with settling inorganic particulates and/or biotic detritus from the water column to the sediments, no disturbance of sediments by physical mixing, slumping or bioturbation after deposition, no post-depositional degradation or mobility of the contaminants and the establishment of a reliable time axis. Therefore, metal contamination in aquatic environment is one of the problems. Rivers, coastal waters, sediments, soils, etc. were mostly contaminated by industrial and mining activities. Recently, the metal discharged from the industries have been controlled in the most developed countries. Even so, till the heavy metals dispersed in river sediments still need to be dealt with. Mainly, characterization, transformation, transport and fate of metal contaminants in the sediment to the aquatic environment need to be studied, because the sediment has great capacity to accumulate the contaminants. Exploitation and utilization of mines discharges heavy metals into the environment and contaminates neighboring aquatic ecosystem..

Feto-maternal outcome of second stage cesarean section in B. P. Koirala institute of health sciences: a retrospective study

Background: Cesarean section (CS) is a common surgical procedure performed in obstetrics. The rate of rise of CS can be attributed to the increase in safety of the procedure, enhanced surgical techniques, improved    antibiotics, increase in number of women requesting for CS. In general, caesarean delivery is associated with more severe maternal complications compared to vaginal deliveries. The stage of labour at which CS is undertaken has been shown to influence the rate/risk of complication. Methods: It was an observational and retrospective study that depended on some clinical records related to more than 37 weeks’ gestation. The study was conducted in BP Koirala institute of health sciences, Dharan Nepal from 2021 December to 2022 December. The neonatal as well as maternal outcomes have been evaluated for CS among those who were observing the second stage in their labor period. The test statistics used to analyse the data were descriptive statistics chi-square test. Results:  The total delivery was 16131 out of which there were 6748 cesarean deliveries. Out of 6748 CS 65 patients had cesarean in second stage of labour. The most common cause of CS in second stage of labor was arrest of descent and dilatation (40%), followed by meconium-stained liquor (15.38%), occipito-posterior position (12.30%), and obstructed labour (3.07%) Being the least cause. One patient had to undergo peri-partum hysterectomy and the most common complication of second stage CS was prolong foleys catheterization (15 patients), post-partum febrile illness (20 patients out of 65), followed by wound infection, PPH, blood transfusion. The neonatal admission for NICU were birth asphyxia and respiratory distress were 50% each. Conclusions: CS in the second stage of labor is correlated with considerably improved neonatal and maternal rate of morbidity along with expanded neonatal mortality. A proper judgment and skilled obstetrician are required to perform a second-stage CS. CS in the second stage of labor is a technically demanding procedure with an increased risk of maternal and neonatal morbidity compared to the CS in the first stage of labor

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

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

Response of maize (Zea mays L.) hybrids to different levels of nitrogen

Nitrogen is one of the key factors for higher grain production of hybrid maize (Zea mays L.). The use of improved varieties and optimal use of nitrogen (N) fertilizer is important for exploiting yield potential of maize. This work was carried out to evaluate the effects of N rates on grain yield and yield attributing traits of hybrid maize. Two hybrids (RML-86/RML-96 and RML-95/RML-96) and five levels of nitrogen (120, 150, 180, 210 and 240 kg N/ha) were evaluated at research field of National Maize Research Program (NMRP), Rampur, Chitwan, Nepal in spring season of  2017 and 2018. The experiments were conducted in two factorial randomized complete block design (RCBD) with three replications under rainfed condition. The pooled analysis (2017 and 2018) showed that the highest grain yield 10.5 and 10.5 t/ha were given by hybrids RML86/RML96 and RML95/RML96, respectively with the use of 150 kg N/ha in 2017. The hybrids RML-86/RML-96 and RML-95/RML-96 produced the highest grain yield 7.49 and 7.68 t/ha, respectively with the use of 150 kg N/ha in 2018. The mean grain yield (2017 and 2018) showed that both maize hybrids produced the highest grain yield 10.5 t/ha in 2017 and 7.58 t/ha year in 2018 with the application of 150 kg N/ha. The application of nitrogen fertilizer on grain yield was found significant (P<0.05) in both years. Therefore, the application of 150 kg N/ha has significantly increased grain yield of maize, Therefore, this dose of nitrogen can be recommended for higher maize production in Chitwan, Nepal in spring season under rainfed condition

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

Incidence of Impacted Mandibular Third Molars with Their Pattern and Associated Complications in Nepalese Population

INTRODUCTION: Impaction may be defined as the failure of complete eruption into a normal functional position of one tooth within normal time due to lack of space in the dental arch, caused by obstruction by another tooth or development in an abnormal position.MATERIAL AND METHODS: A cross sectional descriptive study was conducted on 945 patients (males=591, females=354) aged between 18- 50 years of age who had mandibular third molars impacted. The difficulty index for mandibular third molar for angulation and depth was based on Winter’s classification (1926).RESULTS: The most common type of impaction seen was Mesio- angular with (32%) followed by horizontal 264 (27.8%), then followed by other types. Data was analyzed using Statistical Package for Social Sciences (SPSS) version 23.0CONCLUSION: Impacted third molars are a common observation in routine dental practice. The impaction rate of third molars is higher as compared to other teeth in the dentition. The high prevalence found in the present study, with more than half of these Nepalese adult patients having at least one impacted third molar

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