Nepal Journal of Obstetrics and Gynaecology

Issues on Quality Research to Publish

Gehanath Baral — Mon, 20 May 2019 07:37:06 +0000

DOI: https://doi.org/10.3126/njog.v13i3.23421

Aims: To sensitize authors and new researchers to produce a quality research manuscript.

Methods: Review of experiences and challenges faced by scientifi c journal editors and new authors; and scientifi c writing guidelines and workshops.

Results: Impatient submission of manuscript with inadequate understanding of authors’ guidelines. Strength of own research and scope of journal not matching; lack of minimum training on writing and submission; journal publication from professional organizations not in primary priority list because of its voluntary nature of work.

Conclusions: Publishing depends on professional commitment, academic interest and need, personal career and institutional interest, and availability of specifi c biomedical publishers.

Keywords: authors’ guideline, biomedical journal, publication

Genetic Testing for Hereditary Gynaecological Cancer: An important and a New Avenue for developing CountriesGenetic Testing for Hereditary Gynaecological Cancer: An important and a New Avenue for developing Countries

Hanoon P Pokharel — Mon, 20 May 2019 07:36:39 +0000

DOI: https://doi.org/10.3126/njog.v13i3.23422

Aims: To explore the scope of genetic testing for gynecological cancer in Nepal.

Methods: Review of genetic testing methods and assessment of facilities and barriers within the country.

Results: Country’s resources are still limited but the genetic testing cost is decreasing substantially. Gynecological service providers are increasing to provide services who can be the appropriate candidates to acquire training on genetic testing.

Conclusions: Hereditary cancer diagnosis using stable buccal swab would be feasible with appropriate training.

Keywords: BRCA, developing countries, genetic testing, hereditary gynecological cancern

Outcome of Instrumental Vaginal Delivery at Patan Hospital

Basant Lamichhane — Mon, 20 May 2019 07:35:11 +0000

DOI: https://doi.org/10.3126/njog.v13i3.23507

Aim: To estimate the severity of neonatal and maternal morbidity associated with instrumental vaginal delivery (IVD).

Methods: Record based cross-sectional retrospective study of 80 instrumental vaginal deliveries during two years from 2013 to 2015 were performed. Variables studied were neonatal and maternal complications.

Results: Out of 80 IVD, 19(23.8%) were forceps deliveries and 61(76.2%) were vacuum deliveries. The mean one minute Apgar score was 6 and 7 for forceps and vacuum delivery respectively. The five minute Apgar score for the both IVD was 8. Regarding maternal complications 7(8.75%) cases had extended episiotomy with deep vaginal tears. In forceps delivery 5 had deep vaginal tear and one each for primary post-partum hemorrhage and urinary retention but among the vacuum deliveries two had deep vaginal tear only. Regarding neonatal complications, one had subgaleal bleed in forceps delivery and one had cephalhematoma with Erbs palsy in vacuum delivery.

Conclusions: The neonatal and maternal complications between both types of IVD were comparable. Forceps and repeated vacuum application resulted in low one minute Apgar score; and extended episiotomy and deep vaginal tear were associated with use of forceps.

Keywords: instrumental vaginal delivery, maternal morbidity, neonatal morbidity, outcome

Medical and Psychological Morbidity of Patients with Urogenital Fistula

Pushpa Srichand, Nabila Hassan, Sher Shah Syed, Gul Farheen — Mon, 20 May 2019 07:36:01 +0000

DOI: https://doi.org/10.3126/njog.v13i3.23424

Aim: This study aimed to determine the frequency of medical and psychological morbidity of patients with urogenital fi stulae.

Methods: It was a descriptive study carried out at Liaquat University Hospital and Isra University Hospital, Hyderabad, Pakistan from 01/06/2007 to 30/06/2018, where 520 patients with urogenital fi stulae were managed. A pre-designed proforma was used to record the details about medical and psycho-social consequences. Data was analyzed, and results were described as frequency and percentages.

Results: Among 16759 gynecological admissions, 520 (3.1%) were confi rmed cases of urinary fi stulae. Average age of patients was 31±2.8 years and average parity was 3±2.4. Regarding health consequences, all patients had major degree depression. Majority (88%) of the patients were malnourished. Severe excoriation of vulva and inner thighs was seen in 338 (65%) patients. Vaginal stenosis, vaginal and vesical calculi were other medical problems. Almost all (n= 511, 98%) patients were found to be socially isolated. 62% patients kept themselves restricted to home, with avoidance of family gatherings and travelling. Marital breakdown seen in 81% (n=241). 90% of patients quit their job. Majority of them suff ered social, verbal or physical abuse.

Conclusions: Patients with urogenital fi stulae not only havesurgical morbidity, they also do suff er from signifi cant medical and psychosocial morbidity. There is a defi nite need to address these under-looked miseriesby a devoted fi stulae team working in collaboration with social workers, religious leaders and healthcare providers.

Keywords: fistula, psycho-social morbidity, urinary fistula

Factors Associated with Obstetric Fistula Repair Failure among Women Admitted at Gynocare Women’s and Fistula Hospital in Kenya, 2012-2016: A Case Control Study

Mon, 20 May 2019 07:35:37 +0000

DOI: https://doi.org/10.3126/njog.v13i3.23425

Aim: To determine factors associated with obstetric fistula repair failure at Gynocare Women’s & Fistula Hospital in Kenya.

Methods: This is a case-control study of patients who underwent fistula repair at Gynocare from January 2012 to December 2016. Total of 357 patients (119 cases and 238 controls) were taken by simple random sampling.

Results: Study participants were mostly married (62.2%) with low or no formal education (90.1%). Delivery that led to fistula development occurred in the hospital for 85.2% of the study participants and 66.7% had Cesarean Section. Only one-third (120) had previous repair(s). Patients classified to have VVF IIA were 20.5%, class IIB were 35.0% and class III were 9.2%, and the rest (35.3%) were classified as class I. The odds of repair failure were 2.9 times more among those with previous repair attempts compared to those with no previous repair attempts. Women with VVF IIB were 4 times more likely to develop failure. While women who attained at least secondary education were 77% less likely to have fi stula repair failure.

Conclusion: After controlling the eff ects of age, marital status, comorbidities, parity, time to repair, post-operative complications, having not attained at least secondary education level, having previous repair attempts, and VVF IIB were found to be independent predictors of repair failure.

Key words: Failure, Kees Waaldjik, Obstetric Fistula, Obstetric Fistula Classifi cation, Repair

Situation of Obstetric Fistula in a Marginalized Teagarden Community of Bangladesh: A Qualitative Study

Animesh Biswas, Sathyanarayanan Doraiswamy, Abdul Halim, Abu Sayeed Md. Abdullah — Mon, 20 May 2019 07:34:45 +0000

DOI: https://doi.org/10.3126/njog.v13i3.23426

Aims: This study aims to explore why and how difficult it is for obstetric fistula patients living in the underprivileged teagardens community of Bangladesh.

Methods: It was a qualitative study conducted in 10 teagardens with approximately fifty thousand population. Five case studies followed by five Focus Group Discussions (FDG) were conducted in places where obstetric fistulas were identified.

Results: The mean age of the women was 41 years and the mean duration of suffering was 19 years. All of them got married before the age of 15 and became pregnant in the following year. One woman was divorced, two were separated and two were living with their husband. Only one of them received treatment from a tertiary center but did not continue due to economic constraints; rest of them were never exposed to any treatment or care. They believed that it would be recovered over time. All of them were neglected in their society and were deprived from all social and religious activities in the community. FGDs findings represent that poverty, lack of knowledge and perception are the significant barriers.

Conclusions: Underprivileged communities in the teagardens in Bangladesh are far behind in terms of access to quality health care services. Obstetric fistula is particularly still being under reported and undermined and focused intervention is required to eliminate fistula among them.

Keywords: barriers, community, obstetric fistula, referral, teagarden

Learning Curve for Laparoscopic Hysterectomy: An Experience from Kathmandu University Hospital

Suman Raj Tamrakar, N. Pradhan, Suresh Kayastha — Mon, 20 May 2019 07:34:19 +0000

DOI: https://doi.org/10.3126/njog.v13i3.23427

Aims: The aim of this study is to assess learning curves for laparoscopic hysterectomies, compare the performance of surgeons and review demographic parameters of the patients, varieties of complications experienced and indications of the procedures.

Methods: A retrospective study was conducted in Kathmandu University Hospital, Kavre of January 1, 2011 to June 30, 2018.

Results: A total of 1849 cases were already performed by mid 2018. Of them, 261 (14.12%) cases were LAVH and TLH cases. Mean duration for laparoscopic hysterectomies (for both LAVH and TLH) was 142.21±43.46 minutes (range 55 to 310 minutes) and one third of the cases performed in a range of 121 to 150 minutes. There is difference in mean duration of operation between surgeons which is statistically significant (p <0.001). Beside one of four surgeons (surgeon B) had significant reduction in mean duration for LAVH surgery (p=0.004). Same surgeon has significant reduction in mean duration for performing TLH (p=0.0047). Of the 261 laparoscopic hysterectomies, 8 cases (3.07%) turned into laparotomy.

Conclusions: Laparoscopic hysterectomies are feasible with reducing mean operating time across the period. These minimal invasive surgeries are safe with low rate of complications and less conversion to open even in our set up.

Keywords: Hysterectomy, laparoscopy, learning curve

Demographic Study of Female Victims of Sexual Violence Referred to Forensic Medicine in Fars Province

F. Vaziri, F. Ghodrati, N. Saadatmand, M. Zarenezhad, S. Foruhari, M. Akbarzadeh — Mon, 20 May 2019 07:33:50 +0000

DOI: https://doi.org/10.3126/njog.v13i3.23428

Aims: To determine the clients’ profile of referred in female victims of sexual violence.

Methods: In a period of 7 years (2006-2012), 2113 cases of plaintiffs complaining about women sexual violence were investigated by a questionnaire after receiving permission from Shiraz University of Medical Sciences and Forensic Medicine Organization. Data were analyzed after entering SPSS software, version 16, using descriptive statistics and chi-square.

Results: The prevalence of rape has decreased in different ages. In 1668 cases, the plaintiffs were female (78.93 %) and most of the victims (36.5%) aged between 16 and 25 years old. According to Fisher test, there was a significant relationship between the age of the victims and different years of examination (p≤0.001). The highest frequency of 30% is reported at elementary education level. The highest frequency of sexual violence against women (18.3%) was reported in 2006 followed by 18.2% in 2011. In terms of occupation, the highest frequency of victims was related to students estimated as 40.52%.

Conclusions: Because of the unpleasant nature of sexual violence, there is a serious need for urgent and necessary consideration of its harmful effects and root out this social dilemma by policy makers. Sexual abuse must be prevented especially using religious achievements or by developing effective control strategies detected and by experience female health care users treated.

Keywords: sexual violence, victims, female forensic medicine

Incidence of Post-spinal Hypotension during Cesarean Section in Paropakar Maternity and Women’s Hospital

Sangeeta Shrestha, Tara Gurung, Ritu Pradhan, Amir Babu Shrestha — Mon, 20 May 2019 07:33:19 +0000

DOI: https://doi.org/10.3126/njog.v13i3.23508

Aims: Spinal anesthesia is the choice of anesthesia in parturient for cesarean section. This procedure is frequently associated with hypotension and the incidence varies from 70% to 80%. Maternal hypotension causes very unpleasant sign and symptoms such as nausea, vomiting, dyspnoea and sense of impending doom. Prolonged episodes of hypotension lead to organ ischemia, loss of consciousness, cardiovascular collapse and uteroplacental hypoperfusion. The aim of this study is to find out the proper data of the incidence of hypotension in parturient undergoing cesarean section in our hospital as only the estimated data is present.

Methods: We retrospectively reviewed the intraoperative anesthesia record form of all the patients who underwent cesarean section under spinal anesthesia from the hospital record section from 13th April 2016 to 12th April 2017. The detailed parameters of patient’s demographic data were collected and recorded.

Results: A total of 3814 parturients were included in this study. The mean age was 25.76 ± 4.74 years and mean gestational age was 39.23 ± 1.54 weeks. Post spinal hypotension was seen in 947 patients out of 3814. Thus the incidence of hypotension was 24.8%.

Conclusions: The incidence of maternal hypotension is very high if prophylactic measures are not taken. The fluid preloading or coloading, left lateral uterine displacement and prophylactic vasopressors have shown to be effective in preventing postspinal hypotension.

Keywords: cesarean section, incidence, post-spinal hypotension, spinal anesthesia

Two Years Trend of Cervical Screening and Precancerous and Cancerous Lesion in Cervical Biopsy in Paropakar Maternity and Women's Hospital

Gehanath Baral, Bigya Shrestha — Mon, 20 May 2019 07:32:54 +0000

DOI: https://doi.org/10.3126/njog.v13i3.23430

Aims: To determine the detection rate of cervical lesion by cervical Pap test and to see the ongoing trend of Pap testing in the hospital.

Methods: The retrospective study was conducted in department of pathology, Paropakar Maternity and Women's Hospital, Thapathali, Kathmandu, Nepal from 2016 to 2018. Pap testing sample received in the department were included in the study. All the data were retrieved from computers and registers at record section and histopathology unit.

Results: There were 5.49% (1688 out of 30725) and 6.12% (1779 out of 29062) of gynecology out-patients had Pap test in first and second year respectively. Epithelial cells abnormalities were seen in 6.1% (104) and 4.83% (86) in first and second year respectively. Cervical biopsy sample in first year and second year had precancer and cancerous lesion in 29.55% (94 out of 318) and 22.01% (59 out of 268) in second year.

Conclusions: Epithelial abnormalities seen in Pap test could detect quite a good proportion of abnormal cervical lesion in biopsy specimen of cervix.

Keywords: cervical biopsy, cervical cancer, cervical intraepithelial neoplasm, cervical screening

Comparison between Sublingual and Vaginal Misoprostol for Induction of Labour in Primigravida

Sailaja Ghimire, Deepanjali Sharma, Samjhana Dhakal, Gehanath Baral — Mon, 20 May 2019 07:31:56 +0000

DOI: https://doi.org/10.3126/njog.v13i3.23509

Aims: To compare the outcome and side effects of administration of sublingual misoprostol with vaginal misoprostol for induction of labour and cervical ripening.

Methods: It was a hospital based comparative study which was carried out in 120 patients in each group of sublingual and vaginal route of misoprostol induction from August 2016 to February 2017 at Paropakar Maternity and Women’s Hospital, Thapathali, Kathmandu. Patients with Bishops score <6 were subjected for Misoprostol 25 μg (for maximum 2 doses) 6 hours apart. Results were analyzed using SPSS 21 taking p-value <0.05 as statistically significant.

Results: The mean change in Bishops score after 6 hours of misoprostol was statistically signifi cantly (p=0.001) in sublingual group in comparison to vaginal group. The diff erence in augmentation rate was not statistically signifi cant (p= 0.811). The mean time interval from drug administration to delivery was almost similar in both groups. The indications for cesarean section were similar in both the groups, the most common being fetal distress, (67.33% in sublingual and 58.065% in vaginal group). In terms of maternal and neonatal outcome there was no difference.

Conclusions: Sublingual route results in significant changes of Bishop’s score as compared to vaginal route. It was also significantly better in terms of fetal outcome. However, both routes appeared similar in terms of maternal outcome.

Keywords: misoprostol, sublingual route, vaginal route, induction of labour

Pregnancy after Obstetric Fistula: Should It Be Encouraged?

Mon, 20 May 2019 07:30:18 +0000

DOI: https://doi.org/10.3126/njog.v13i3.23447

Obstetric fistula (OF) is a life-changing morbidity associated with childbirth. It occurs especially after a prolonged obstructed labor and is a major public health problem in the developing countries. The smell of stool and urine leads to the ostracization and rejection of fistula patients by their spouses, families, friends and society in whole. Surgical treatment of fistula is possible. However, this successful outcome of fistula repair surgery is dependent on pre-operative care and the post-operative care such as delaying the commencement of sexual intercourse and delaying conception. Family planning can aid to this. Pregnancy is advised after minimum of 12 months’ post-repair and mode of delivery should be elective cesarean section. Here, we present a case of 23 years’ female, who suffered from obstetric fistula who underwent obstetric fistula repair twice, re-married and conceived after a year with successful elective cesarean delivery.

Keywords: cesarean section, obstetric fistula, pregnancy after fistula

Turner's Syndrome: Approach to Diagnosis and Treatment

Mon, 20 May 2019 07:29:41 +0000

DOI: https://doi.org/10.3126/njog.v13i3.23476

Turner's syndrome is the most common karyotypic abnormality causing gonadal failure and primary amenorrhea. It is characterized by short stature and absence of secondary sexual characteristics. It is diagnosed by increased plasma FSH and LH level with low level of estrogen i.e. hypergonadotrophic hypogonadism. Ultrasound abdomen reveals streak ovaries and atrophic uterus. Karyotype confirms the diagnosis of Turner's syndrome (45XO).

We present here a 15 years girl who presented with primary amenorrhea with short stature with breast development corresponds to Tanner stage I. Her FSH was raised. Ultrasound abdomen showed uterine agenesis and streak ovaries. Karyotype showed 45XO which confirmed the diagnosis of Turner's syndrome. She is now on estrogen therapy and her height has increased and breast development corresponds to Tanner stage II.

Keywords: hypergonadotrophic hypogonadism, primary amenorrhea, Turner's syndrome

Laparoscopic Cystectomy of Huge Ovarian Cyst in Nulliparous Woman

Mon, 20 May 2019 07:29:08 +0000

DOI: https://doi.org/10.3126/njog.v13i3.23478

Mucinous cystadenoma arises from the totipotent surface epithelium of the ovary. Its association with Brenner tumor suggests its origin as mucinous metaplasia of the epithelioid cells. The chance of malignancy is 5–10 percent. Patients usually present with abruptly increasing abdominal mass. Cystectomy is the management of choice in these cases. It was managed by laparoscopy.

Keywords: laparoscopy, mucinouse cystadenoma, nulliparous

Primary Pelvic Hydatid Cyst: a Rare Case

Kirtipal Subedi, Karishma Vaidhya, Bigya Shrestha, Kamana KC — Mon, 20 May 2019 07:28:05 +0000

DOI: https://doi.org/10.3126/njog.v13i3.23510

Hydatid cyst is ecchinococcal disease caused by tapeworm echinococcus, most commonly by metacestode stage of echinococcus granulosus. Liver is the most common organ to be aff ected followed by lungs and spleen. Primary hydatid cyst in the pelvis is rare. We report a case of primary isolated pelvic hydatid cyst diagnosed incidentally during laparotomy performed for adnexal mass.

Key words: adnexae, albendazole, echinococcus, hydatid cyst, laparotomy