Browsing by Author "Baral, J"
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Publication An Adolescent with innumerable myomas(Institute of Medicine, 2012) Baral, J; Rai, N; Gurung, G; Mishra, S; Rai, N; Paudyal, P; Shrestha, B; Rana, AAbstract Myoma is rare in younger age group, so tends to be mistaken for adnexal tumour. A 19 year old adolescent who was taken for laparotomy for ovarian germ cell tumour instead was found to have uterus studded with innumerable myomas, which were surgically removed through tedious yet successful myomectomy of 40 myomas, thus deserving description. Keywords: Adolescents, myoma, myomectomyPublication Comparison of Outcome of Borderline and Normal Amniotic Fluid Index in Term Pregnancy(Kathmandu University, 2021) Ansari, SN; Baral, J; Gurung, G; Jha, AABSTRACT Background Determination of Amniotic Fluid Index (AFI) is an important component of antepartum assessment of all normal pregnancies. Objective To compare the obstetric interventions and neonatal outcomes in term pregnancies with borderline Amniotic Fluid Index versus normal Amniotic Fluid Index. Method This hospital based prospective study was conducted at Tribhuwan University Teaching Hospital over 1 year between 2017 and 2018 in 128 women having uncomplicated term pregnancy admitted in labor ward. Of the 128 women, 64 women had borderline Amniotic Fluid Index (5.1-8 cm) and 64 normal AFI (8.1 - 24 cm). Parameters studied were induction of labor, cesarean section, instrumental delivery, intrapartum abnormal fetal heart rate, meconium staining of liquor, APGAR score at 5 and 7 minutes, birth weight, neonatal intensive care unit (NICU) admission and neonatal death. Data was analyzed using software OpenEpi. Result Statistically significant difference in result was obtained in the two groups in terms of rate of induction of labor (73.4% vs 35.9%, p = 0.0001, OR = 4.9), rate of cesarean section (42.1% vs 28 .1%, p = 0.04, OR = 1.8), tachypnea (50% vs 11.1%, p = 0.01) and low birth weight (9.1% vs 4.5%, p = 0.04). No statistical significance was found in meconium staining of liquor (33% vs 38.3%, p = 0.3) and APGAR score of <7 at 5 minutes (3.1% vs 1.5%, p = 0.06). There were no neonatal intensive care unit admissions and neonatal mortality in any of the babies. Conclusion Detection of amniotic fluid volume at term is important for timely maternal interventions to improve the overall fetal outcome. KEY WORDS Borderline amniotic fluid index, Cesarean section, Induction of labor, Meconium stained liquor, TachypnoeaPublication Endometrioma: A Concern for fertility(Institute of Medicine, 2014) Baral, J; Acharya, P; Rana, A; Gurung, GAbstract Introduction: Endometriosis is a complex disease of young women in reproductive age, responsible for endometriosis-associated pelvic pain (EAPP) because of the deeply infiltrating endometriosis (DIE). There has been significant successful revolution in the diagnosis and the management both surgical and medical where medical treatment both pre and post-operatively has been documented as gain for pain relieve and fertility promotion. Methods: Retrospective study was done for a period of 4 years, April 2009 - 2013, in Department of Gynecology and Obstetrics, TU Teaching Hospital, using Operation Register obtaining files from Medical Record Section. All the cases exposed to operative management endometrioma were noted for size, adhesions and association with other gynecological condition and the type of surgical approach used for future fertility preservation. Results: There were 77 cases of chocolate cysts, representing 3.2% of major gynecological surgery, in age up to 30 years being 21 (27%) as compared to those above the age of 30. Adhesion were omnipresent in all cases [mild 20 (26%) and dense adhesions and 57 (74%). Irrespective of the size of chocolate cysts; 3-5 cm (27); >5-10 cm (40); 10-15 cm (9), 15-20cm (1); associated was myoma in 14 (18%). Confined to 36% infertility were total 28 [Primary infertility (14); Secondary infertility (14)]. Adhesion was dense in all cases of primary infertility and in 12/14 cases of secondary infertility, yet forward anticipation in primary (9) and cases of secondary (6) infertility cases [after deducting, 13: hysterectomy (11) and bilateral ovarian removal (2)] along with 8/9 cases in unmarried [expecting, hysterectomy (1)] but may not be rewarding in cent percent. Conclusion: Endometrioma noted to create adhesion in one and all cases, expected to enhance on operative exposure, need coverage by favorable medication before and after semiconservative surgical approach to overcome associated adverse fertility prognosis. Keywords: Chocolate cyst, dense adhesion, endometrioma and fertilityPublication Hysterectomy in the Present Day for Dysfunctional Uterine Bleeding: a finding from Tertiary Care Hospital Nepal(Institute of Medicine, 2014) Baral, J; Gurung, G; Kaudel, S; Paudyal, P; Chudal, D; Shrestha, P; Rana, AAbstract Introduction: Hysterectomy is a an operative procedure in gynecology, performed for benign or malignant indication, accomplished via abdominal or vaginal routes, technically as open or endoscopic surgery by various approaches; laparoscopic, laparoscopic assisted vagina hysterectomy or robotic surgery. This study was undertaken to analyze the indications of hysterectomies for benign condition with main focus on dysfunctional uterine bleeding (DUB). Method: This study was conducted between 2009 April and 2014 March in the Department of Obstetrics and Gynaecology Tribhuvan University Teaching Hospital. Data were obtained from Operation Theater. Results were precisely reevaluated to find out the indication of hysterectomy done for benign etiology, routes of surgery. Results: Fibroid, utrovaginal prolapsed (UVP), adenomyosis, endometriosis, dysfunctional uterine bleeding (DUB) and adnexal mass were the main indication in total hysterectomy (n1644) performed for benign aetiopathologies, most surgery being performed abdominally (n1126). DUB which were principally treated by hysterectomy and occupied the fifth position as an indication had the postoperative diagnosis other than DUB on histopathological examination in more than 50%. The endometrial pathologies in the operated cases showed endometrial hyperplasia in three cases and adenocarcinoma in one. Conclusion: Presently, abdominal hysterectomy is seen as the only available surgical option for DUB, indicating a need for a change in practices favoring organ preservation. Keywords: endometrial hyperplasia, hysterectomy, dysfunctional uterine bleeding(DUB)Publication Immune thrombocytopenic purpuera in pregnant women(Institute of Medicine, 2007) Rawal, S; Sigdel, MR; Singh, M; Baral, JAbstract Case report: Immune Thrombocytopenic Purpuera (ITP) is the commonest autoimmune disorder occurring in pregnancy. This is a case of asymptomatic ITP diagnosed in a 21 years primigravida by doing platelet count during routine antenatal investigation at 27th week, who remained refractory to treatment with steroid and platelet transfusion, had to undergo emergency LSCS for low lying placenta, but both the intrapartum and the postpartum period remained uneventful. The baby was assumed to have neonatal alloimmune thrombocytopenia (NAIT) due to low platelet count of 10,000/ cumm and with clinical evidence of petechia on the trunk and hard palate, was later treated with platelet transfusion, intravenous immunoglobulin (IVIG) and steroids. Both the baby and the mother had an uneventful recovery following a multidisciplinary approach with the obstetrician, physician, neonatologist and the anaesthesiologist and both were discharged on steroids on the 10th post operative day. Keywords: Platelets, Pregnancy, ITPPublication Manual Vaginal Reversion of Acute Puerperal Uterine Inversion: Learning by Doing(Institute of Medicine, 2016) Katuwal, N; Pokharel, M; Subedi, K; Baniya, J; Sherchan, K; Rawal, S; Baral, J; Gurung, G; Rana, AAbstract Uterine inversion is the folding of the fundus into the uterine cavity in varying degrees. Acute uterine inversion is a rare and unpredictable obstetric emergency. Here we report a case of a woman who had vaginal delivery complicated by postpartum hemorrhage. Diagnosed as acute puerperal uterine inversion; reposition was tried in the labor room which failed ensuing shock. Simultaneous fluid resuscitation and manual vaginal reversion under general anesthesia was done in Operation Theater, also needing blood transfusion, 5 units in total. Therefore, this case is described herein to illustrate the importance of early recognition and prompt reversion of inverted uterus vaginally,as delay can render replacement progressively more difficult and also increase the risk of hemorrhage.Publication Maternal Mortality in Pregnancy with Heart Disease(Institute of Medicine, 2014) Dali, B; Baral, JAbstract Introduction: The incidence of heart disease complicating pregnancy is approximately 1–3% of pregnancies and is responsible for 10 to 15% of maternal mortality. While rheumatic heart disease is on real decline in western world, it is adamantly remaining unchanged here in Nepal and persistently contributing to maternal mortality in cardiac complication in pregnancy. Methods: From the ongoing maternal mortality study since BS 2050 (13th April 1993), data from last 15 years (April 1998 - 2013) were extracted. The data were tabulated and analyzed. Results: There were 14 12.5% deaths accountable to heart disease in a total 112 maternal mortality during the period of 15 years and they were mostly from rheumatic heart disease. Most of them were multivalvular heart disease except for a solitary case of aortic stenosis. MTP (2) Caesarian (3) breech vaginal delivery (1) were performed and spontaneous expulsion was managed along with supportive care delivered in mothers who died shortly after admission. Conclusion: Poor health seeking behavior and careless attitude is a part of blame game played often played whereas mortality from rheumatic heart disease which is obsolete in global scenario is of utmost concern as cardiac conditions pertaining to this etiology can be minimized certainly and the mortality attributed thus can be reduced. Termination of pregnancy should only be allowed for reason more than valvular lesion like coarctation of aorta. Keywords: Heart Disease, maternal mortalityPublication Uterine Perforation following Induced Second trimester Abortion in an Adolescent(Institute of Medicine, 2013) Rijal, H; Baral, J; Gurung, G; Rajbhandari, A; Rana, SAbstract We report a case of a 19 year adolescent, who underwent unsafe induced abortion at 14 weeks of pregnancy followed by continuous pain and fever discovered at laparotomy to be due to uterine perforation with the findings of product of conception along with flat bone popping through a uterine rent in anterior and lower part of the uterus within the vicinity of uterovesical which was repaired with good outcome. Keywords: Unsafe abortion,, septic bortion, uterine perforation