Browsing by Author "Chawla, CD"
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Publication Ambispective study on Mac Donald suturing in pregnant ladies with cervical incompetence in Dhulikhel Hospital(Kathmandu University, 2010) Tamrakar, SR; Chawla, CDABSTRACT Background Cervical incompetence is one of the main contributors to repeated pregnancy loss, accounting for approximately 25% of the cases. Typically it results in progressive cervical dilatation, leading to a painless second- or early-third-trimester abortion. Objectives The main objective of the study was to explore the benefit from cervical cerclage in pregnant women with anatomical cervical incompetence Methods In a review of the operation and labour registers from January 2006 till January 2010, a total of 38 cervical cerclage procedures were performed at Dhulikhel Hospital (DH). In the study caste, parity, gestational age, diagnostic criteria, postoperative complications and pregnancy outcomes of the cases were analyzed. Results Two of the 38 cases didn’t come for delivery at Dhulikhel Hospital (Kathmandu University Teaching Hospital). Four women haven’t delivered at the time of data analysis. So pregnancy outcomes were analyzed among 32 cases while rests of the variables were analyzed among 38 cases. Of them 18 cases (47%) were Brahmin, 22 cases (58%) were between 20-25 years old and 32 cases (84%) were from Kavre district. All cases were booked cases (they had antenatal care in the hospital) and 14 patients (37%) were third gravida. Most cases had 2 to 4 antenatal visits prior to suturing. Two cases were diagnosed with a bicornuate uterus. 21 cases (55%) had a previous history of at least one dilatation and evacuation. 33 cases (87%) were diagnosed with cervical incompetence clinically and confirmed by ultrasound. The remaining 13% were assessed, in the absence of a history of mid- trimester abortion, of having a high suspicion of cervical incompetence after mid- trimester scan with measurement of cervical length. In 18 cases (47%), cervical cerclage were done at 15 to 20 weeks of gestation. The postoperative period was uneventful in all 38 cases. All cases (32) delivered in DH were assisted by consultant obstetricians. 19 out 32 cases (59%) were delivered vaginally at term. Conclusions 38 cases were included in the study. Pregnancy outcomes were analyzed among 32 cases while rests of the variables were analyzed among 38 cases. 31 out 32 cases were delivered with good foetal weight. It clearly shows pregnant women with anatomical cervical incompetence were benefitted from cervical cerclage. The authors recommend an early trans vaginal scan in any patient with a history of mid trimester abortion or preterm labour. The cervical cerclage procedure therefore should be available more widely to benefit those patients with proven or strongly suspected cervical incompetence. Key Words cervical incompetence, cervical encirclage, trans vaginal scanPublication Post partum haemorrhage: Prevalence, morbidity and management pattern in Dhulikhel Hospital(Kathmandu University, 2010) Dongol, AS; Shrestha, A; Chawla, CDAbstract Background: Post partum haemorrhage (PPH) is the leading cause of maternal death worldwide. PPH occurs in up to 18% of total births. Among different factors, PPH due to uterine atony is the primary and direct cause of maternal mortality comprising about 90%. Objective: The objective of the present study was to assess the prevalence, morbidity and management pattern of PPH in Dhulikhel Hospital. Materials and methods: Hospital based retrospective study was carried out at Kathmandu University School of Medical Science, Dhulikhel Hospital from the period of January 2007 till October 2009. The study group included total of 60 patients. All women who had PPH both primary and secondary were studied. Information regarding total number of deliveries obtained from Obstetrics ward. The cases with PPH were identified and detail records were reviewed using standard format. The main outcome measures used for the analysis were amount of blood loss, cause of PPH and treatment methods. Results: In Dhulikhel hospital, from January 2007 till October 2009 a total of 3805 deliveries took place. Out of which 60 women had PPH. The prevalence was 16/1000 deliveries. There are 41 (68.3%) cases of primary PPH and 19 (31.7%) cases of secondary PPH. PPH was found more in home deliveries, unbooked case and in multiparas. The mean blood loss was 1055ml. As an aetiology, retained placenta and retained placental bits of tissue was found in 37(61.7%) cases, atonic uterus in 10 (16.7%) cases, genital tract trauma in 8(13.3%), sepsis of genital tract in 3(5%), case of ruptured uterus in one case and a case of angle bleeding from previous uterine scar following caesarean section. Among all 15 (25%) cases underwent manual removal of placenta, 5(8.3%) underwent controlled cord traction, 3 (5%) underwent manual removal of placenta followed by check curettage in cases of retained placenta, 16 (26.7%) cases were managed by check curettage for retained bits of placental tissue and membrane. Trauma in genital tract was managed by repair of trauma in 6 (10%) cases. Hysterectomy was required in 3 (5%) cases. Conservative management with uterotonics only required in 12 (20%) cases. Conclusion: Active management of third stage of labour can prevent PPH so delivery by skilled hand in hospital should be promoted. Secondary PPH besides primary can result in significant maternal morbidity. It also deserves similar attention. Key words: Atonic uterus, Postpartum haemorrhage