Browsing by Author "Dangal, Ganesh"
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Publication Broad Ligament Leiomyomata - An Important Differential Diagnosis in Huge Abdominal Mass: A Case Report(Nepal Medical Association, 2025) Basnyat, Amogh; Dangal, Ganesh; Karki, Aruna; Pradhan, Hema; Shrestha, Ranjana; Bhattachan, KabinAbstract Leiomyomas are a common gynaecological condition affecting 20-30% of women over the age of 35, with prevalence decreasing following menopause. Leiomyomas are most commonly found within the uterus. Rarer extra-uterine locations include the broad ligament, cervix, and vagina. We present an unusual case of multiple Left Broad Ligament Leiomyomata that extended from Left Iliac Fossa and Hypogastrium to Epigastric region in a 50- year-old female. Our case highlights the importance for extra-uterine leiomyoma to be considered as a differential diagnosis in patients presenting with huge abdominal mass suspicious of adnexal tumor or malignancy.Publication Clinical Profile of Patients of Pelvic Organ Prolapse and Its Associated Factors(2023) Pudasaini, Sangita; Dangal, GaneshAbstract Background: Prolapse is among the most common indication for gynaecological surgery. It is difficult to estimate prevalence of pelvic organ prolapse even in developed countries due to lack of epidemiological studies. This study was done to find the prevalence, risk factors and common presenting complaints of women with pelvic organ prolapse. Methods: Women with pelvic organ prolapse visiting Paropakar Maternity and Women’s Hospital during 4 months duration in 2021 were approached and after obtaining an informed consent, all the patient information on various risk factors and clinical profile(age,parity,body mass index,smoking etc.) for pelvic organ prolpase were collected in a pre-developed proforma. Pelvic Organ Prolapse was classified by Pelvic Organ Prolapse Quantification system. Data analysis was done using statistical package for the social sciences-25. Ethical approval was taken from Institutional Review Committee- National Academy of Medical Sciences. Results: Out of 58 cases enrolled in the study, prevalence of pelvic organ prolapse was found to be 1.28%. Women belonging to age group ? 49 years was 91.4%. Bulge symptom was the most common presenting complain among the women, 98.3%. 50% of women (n=29) were grand multipara. 53.4% (n=31) of women had delivered their first baby before 20 years of age. Multiparity,vaginal birth and menopausal age were the common risk factors. Conclusions: Menopausal age, multi-parity, vaginal births, age at first vaginal delivery of less than 20 years were significant risk factors for development of prolapse. Bulge symptom was the most common presenting complaint. However,Smoking habit, overweight were not related to pelvic organ prolapse. Keywords: Pelvic organ prolapse; prevalence; risk factorsPublication Correlation of Endometrial Thicknessby Transvaginal Sonography with Histopathological Examination in Abnormal Uterine Bleeding in Perimenopausal Age Group(Nepal Health Research Council, 2023) Sah, Sadhana; Dangal, Ganesh; Jha, MeenaAbstract Background: Transvaginal sonography and endometrial biopsy are the two diagnostic tests, most frequently used to investigate the cause of abnormal uterine bleeding.The aim of this study is to correlate the findings between transvaginal sonography and histopathology for diagnostic evaluation in perimenopausal women with abnormal uterine bleeding. Methods: A descriptive observational study was carried out at Paropakar Maternity and Women’s Hospital, Thapathali, Kathmandu, Nepal during the period of one year (1st January 2019 to 30th December 2019) in 70perimenopausal women with abnormal uterine bleeding. Transvaginal sonography wasdone and endometrial thickness was noted. Endometrial biopsy was done under intravenous anaesthesia. Histopathological reports reviewed and analysis done. Results: The most common age group of women presenting with abnormal uterine bleeding was 40 to 43 years(42.9%) and the commonest clinical feature was menorrhagia (50%) followed by menometrorrhagia (27.1%). The transvaginal sonography showed that majority of women had endometrial thickness of 10-12mm(35.7%) followed by 7-9mm(27.1%). Proliferative endometrium (37.1%) was most common histopathologicalfinding followed by secretory endometrium (30%). 10 cases of proliferative endometrium was seen at ET 7-9mm and 1 case of endometrial carcinoma was seen at ET 13-15 mm with P-value <0.13. Conclusions: Transvaginal sonography and histopathological examination are the standard diagnostic procedures for the assessment of abnormal uterine bleeding and for early detection of precancerous lesion like endometrial hyperplasiaand endometrial cancer. Keywords: Abnormal uterine bleeding; histopathology; transvaginal sonographyPublication Degenerated Subserosal Uterine Leiomyoma Mimicking Carcinoma Ovary(Nepal Health Research Council, 2024) Ranabhat, Bijay Kumar; Dangal, GaneshUterine leiomyomas are the most common entities encountered in routine gynaecological practice. They are usually easily identifiable on routine imaging. However, there is increasing difficulty with diagnosing leiomyoma following hyaline degeneration as it might mimic ovarian pathology. A stepwise and a multidisciplinary approach in management of these cases is preferred to achieve optimal results. We report a case of 40-year-old female presented to outpatient department with radiological diagnosis of complex adnexal mass and Ca-125 value 122 U/ml. Physical examination and radiological investigations suggested giant abdominopelvic mass, probably aggressive uterine or ovarian tumor preoperatively. Postoperative findings revealed hyaline degeneration of fibroid arising from anterior wall of uterus. Keywords: Degeneration; ovarian tumor; uterine leiomyoma.Publication Fetomaternal Outcome in Antepartum Hemorrhage After 34 Weeks of Gestation(Nepal Health Research Council, 2024) Ranabhat, Bijay Kumar; Dangal, Ganesh; Poudel, Sandesh; Adhikari, Shreeprasad; Khadka, ChiranjiviBackground: Antepartum hemorrhage is defined as any bleeding from or into the genital tract during pregnancy, after the period of viability until delivery of the fetus. APH complicates 2-5% of pregnancies and is a primary cause of perinatal and maternal mortality globally. Aim of this study is to evaluate maternal and perinatal outcome in patients with APH at a tertiary care hospital. Methods: The present study was a cross sectional study conducted in Obstetrics and Gynaecology department of Paropakar Maternity and Women’s Hospital, during a period of 5 months from December 2022 to April 2023. 50 cases of APH were enrolled with gestational age ? 34 weeks of gestation. Results: Incidence of APH after 34 weeks of gestation was 0.51%. The most common type of APH was abruption placenta (44%) followed by placenta previa (32%) and undetermined (24%). The age range of 26 to 30 years old accounted for the highest number of APH patients i.e., 21(42%). In placenta previa, 75% and in abruption placenta 63.64% were multigravida. APH was presented mostly between 37-40 weeks. Around 26% of the patients had anemia at the time of admission. Most common mode of delivery was cesarean section (82%). Most common maternal complications were PPH (40%), blood transfusion (28%), DIC (4%), cesarean hysterectomy (4%). Low birth weight and preterm were the most common causes of fetal complications. Maternal mortality was 2% and perinatal mortality was 18% overall. Conclusions: APH is primary cause of maternal and perinatal morbidity and mortality. In our study, an abruption placenta was the most frequent cause of APH. Cesarean section was the most commonly used mode of delivery. PPH with blood transfusion was the most prevalent maternal complication, while fetal complications included low birth weight and preterm.. Keywords: Abruptio placenta; antepartum haemorrhage; placenta previa.Publication Fetomaternal Outcome of Pregnant Women at Term Undergoing Cesarean Section(Nepal Health Research Council, 2024) Bharati, Sonu; Dangal, Ganesh; Tiwari, Kenusha Devi; Maharjan, Sunita; Bhandari, Srijana; Karki, Aruna; Pradhan, Hema Kumari; Shrestha, Ranjana; Bhattachan, KabinBackground: Cesarean section is one of the most common procedures performed in obstetric practice today and is a lifesaving surgery for mother and fetus. Cesarean sections are classified traditionally, as elective cesarean section or emergency cesarean. The purpose of this study is to compare the maternal and neonatal outcomes in elective and emergency cesarean section so that measures can be taken to reduce maternal and neonatal morbidity and mortality. Methods: A descriptive study including 400 pregnant women who underwent caesarean section were included in this study. Patients were subjected to elective or emergency cesarean section as per the indication and protocol of institute. were included in the study. Results: During the study period there were total 1080 deliveries. The average age of the women was 29.21±4.07 years. Of the 400 cesarean section cases, only 2.8% had wound infection, 3.8% had fever, 4.8% urinary tract infection (UTI) whereas no women had observed with post-partum hemorrhages (PPH) and maternal death. Regarding fetal outcome, neonatal intensive care unit (NICU) admission was observed in 16%, birth asphyxia was 2.3% poor Apgar score 2.5% and neonatal death was not observed. Rate of fever, UTI, wound infection, need of resuscitation and poor Apgar score was significantly high in emergency section than elective caesarean section whereas NICU admission was not statistically significant. The most common indication of emergency cesarean section were fetal dress and for previous LSCS. Conclusions: Emergency cesarean was associated with increased maternal and perinatal complications than in elective cesarean section. Keywords: Caesarean section; elective caesarean section; emergency caesarean section; neonatal morbidity and mortality.Publication Perinatal Transmission of Dengue in a Neonate: A Case Report(Nepal Medical Association, 2024) Chemjong, Binita; Amatya, Luna; Ghimire, Binaya Raj; Dangal, Ganesh; Bharati, Sonu; Maharjan, SunitaAbstract Vertical transmission of dengue is rare. However, the rapid rise of dengue infection is a risk in pregnancy which can lead to preterm delivery, low birth weight, stillbirth, miscarriage, neonatal morbidity and mortality. Here, we present a case of perinatal transmission of dengue in a term neonate who presented with fever on second day of life and desaturation without respiratory distress. Laboratory findings showed thrombocytopenia, dengue Ag NS1/IgM positive and treatment was started. There was positive maternal history of dengue 10 days prior to delivery. Hence, early investigations with prompt interventions was done leading to uneventful recovery.Publication Post-partum Symphysis Pubis diastasis(Nepal Health Research Council, 2024) Rai, Sangam; Pradhan, Peru; Dangal, Ganesh; Shrestha, Sona; Rajbhandari, Subrina; Yadav, Ranjana; Shah, Ranjana; Sherpa, Sona; Ansari, RawabPubic symphysis is a non-synovial joint, made up of a fibrous cartilage disc connecting the two sides of pubic rami in the midline. During pregnancy under the influence of hormones particularly relaxin, the gap increases by 2 to3mm. When the diameter is more than 10 mm, it is considered as pubic symphysis diastasis. Pregnancy and childbirth are the most common causes of pubic symphysis diastasis followed by traumatic causes. Women with post-partum symphysis diastasis present during puerperium with inability to bear weight owing to severe supra-pubic and groin pain. They have complaint of severe excruciating pain while standing up or to perform any movement involving hip abduction. For the diagnosis, proper history regarding delivery should be sought followed by physical examination and radiological imaging. Most cases can be treated with conservative management which includes- use of analgesia and anti-inflammatory medicines for the pain management and stabilization of pelvis using brace/pelvic belt. Some may benefit from physiotherapy. In extreme cases, operative fixation may be required with the involvement of orthopedic surgeon. Keywords: post-partum symphysis diastasis; pubic symphysis; rare presentation.Publication Putting Patient Safety First for the Quality Care: An Essential Component at all Healthcare Settings(Nepal Health Research Council, 2023) Dangal, Ganesh; Dangal, OjashNAPublication Risk Factors for Primary Postpartum Hemorrhage in Vaginal Delivery(Nepal Health Research Council, 2024) Rai, Subash; Dangal, Ganesh; Jaiswal. EktaBackground: Postpartum hemorrhage is an emergency, condition encountered in obstetric cases. It is an acute life-threatening situation and needs an immediate and rapid management. Postpartum hemorrhage is leading cause of maternal mortality and morbidity worldwide, with more commonly affecting women of developing countries. Accurate assessment of blood loss, identification of risk factors and timely recognition of postpartum hemorrhage remain major challenge in obstetrics. Different risk factors like hypertensive disorder in pregnancy, antepartum hemorrhage, anemia, big baby, polyhydramnios, multiple pregnancy, obesity, augmented/prolonged labor are risk factors for primary postpartum hemorrhage. The objective of this study was to identify the various risk factors associated with primary postpartum hemorrhage, in Paropakar Maternity and Women’s Hospital (PMWH), which is biggest institute in country for holding records of maximum number of deliveries. Methods: A cross sectional study was conducted over a period of 3 months between March 2023 to May 2023 on 72 patients. Women with term pregnancy who experienced primary PPH were analyzed for different risk factors. Similarly, incidence of postpartum hemorrhage according to age, parity, gestational age, types of labor, types of vaginal delivery and causes of postpartum hemorrhage were studied. The results were then analyzed. Results: The incidence of primary PPH during the study was 3%. Majority of cases of PPH were in age group of 20-24 (44.4%), followed by age group (25-29). Most of cases (50%) were of gravidity 2 to 3, followed by primigravida (45.8%). There was equal distribution of PPH in gestation age (37-39+6) WOG to (40-41+6) WOG. There were no risk factors associated with occurrence of PPH in 56%. Hypertensive disorder of pregnancy, anemia, APH, multiple pregnancy, fetal macrosomia, polyhydramnios and obesity are associated risk factors for PPH. Among risk factors associated with PPH, hypertensive disorder of pregnancy was most common risk factors (40.6%), followed by maternal anemia (25%), multiple pregnancy (12.5%), APH (6.3%) fetal macrosomia (6.3%), maternal obesity (6.3%), polyhydramnios (3.1%). PPH was more common in augmented labor (43%), followed by induced labor (29.2%) and spontaneous labor (27.8%). In this study most women ( 72.2%) experienced blood loss of 500-1000 ml. And most common cause of PPH was atony (83.3%) followed by genital tract injury (14%) and retained tissues (2.7%). Conclusions: In many cases, PPH can’t be predicted fully as many cases of PPH occur without vivid risk factors, as in this study 56% women experiencing PPH had no associated antenatal risk factors. Antenatal risk factors like hypertensive disorder of pregnancy, maternal anemia, twin pregnancy, APH, macrosomia, obesity are common risk factors for PPH. Similarly induced and augmented labor and instrumental delivery can lead to PPH. Keywords: Postpartum haemorrhage, risk factors, vaginal deliveryPublication Ruptured Endometrioma with Hemoperitoneum Requiring Emergency Laparotomy: A Case Report(Nepal Health Research Council, 2023) Rai, Sangam; Dangal, Ganesh; Karki, Aruna; Pradhan, Peru; Shrestha, Ranjana; Bhattachan, Kabin; Maharajan, Sunita; Bhandari, Srijana; Basnyat, AmogAbstract Endometrioma is the localization of endometriosis in ovary which often develops as cyst. The condition can be complicated with infection, torsion and rupture leading to significant hemoperitoneum and ascites. We present here a 28-year female P2 L1 presented with the features of acute abdomen and severe anemia referred from other hospital where pain management was done. She had raised Ca-125 level, negative Urine Beta HCG and USG findings of left endometrioma with degenerating subserosal fibroid. The improvement of her general condition with analgesics was misleading however a static hematocrit level despite blood transfusion raised suspicion of ongoing pathology leading to blood loss and diagnostic paracentesis confirmed the hemoperitoneum while awaiting of CT report. She underwent Emergency Laparotomy which revealed hemoperitoneum of 2000ml and right ruptured ovarian endometrioma measuring and left ovarian cyst measuring 6x6 cm was noted. The postoperative period was uneventful. Keywords: Acute abdomen; case report; endometriosis; hemoperitoneum; ruptured endometrioma.Publication The Burden of Maternal and Neonatal Disorder in Nepal from 1990 to 2019; An Analysis of Data from Global Burden of Disease Study: An Observational Study(Nepal Medical Association, 2025) Rai, Pramila; Ackerman, Ilana N.; O’Connor, Denise A.; Dangal, Ganesh; Buchbinder, RachelleAbstract Introduction: Nepal continues to face significant challenges with high maternal and neonatal mortality. To improve health and achieve the Sustainable Development Goals of reducing maternal and newborn mortality by 2030, Nepal needs to focus on addressing high-burden maternal and neonatal disorders. The objective of the study was to examine the current burden of maternal and neonatal disorders in Nepal and to assess any changes over time. Methods: We examined the annual Global Burden of Disease Study data on prevalence, deaths, Years Lived with Disability, and Disability-Adjusted Life Years for maternal and neonatal disorders in Nepal for the 1990-2019 period. Estimated annual percentage changes were also calculated to assess the trends of the age-standardised rates of these burden metrics. Results: The analysis found that the prevalence of overall maternal disorder in Nepal decreased by 37% from 128,176 in 1990 to 80,724 in 2019 with Age-Standarised Ratio of 432.07 per 100,000 in 2019 and Estimated Annual Percentange Change of -4.34 (CI 95%: -4.49 to -4.18). Similarly, the overall prevalence of neonatal disorder increased by 57% from 303,146 in 1990 to 475,544 in 2019 with Age-Standarised Ratio of 1521.14 per 100,000 in 2019 and Estimated Annual Percentage Change of 0.98 (95% CI: 0.67-1.29). Conclusions: Our findings emphasise the need to address maternal haemorrhage, indirect maternal deaths, maternal abortion and neonatal disorders in Nepal in future national health programs.Publication The Future of Artificial Intelligence in Healthcare(Nepal Health Research Council, 2024) Dangal, Ganesh; Dangal, OjashNAPublication Vaginoplasty with Amnion Graft: Management of Mayer-Rokitansky-Kuster-Hauser Syndrome(Nepal Health Research Council, 2023) Bhandari, Srijana; Dangal, Ganesh; Karki, Aruna; Pradhan, Hema; Shrestha, Ranjana; Bhattachan, Kabin; Tiwari, Kenusha Devi; Bharati, Sonu; Maharjan, SunitaAbstract Mayer-Rokitansky-Kuster-Hauser syndrome also known as mullerian agenesis is a rare congenital condition in which there is absence of uterus along with upper vagina. Patient usually presents with primary amenorrhea with or without cyclical lower abdominal pain but have normal secondary sexual characters. Modified McIndoe Vaginoplasty with amnion graft is the commonest surgery performed worldwide. A 23 year old girl with normal secondary sexual characters presented with primary amenorrhea with cyclical lower abdominal pain; on examination blind vagina was present. Vaginoplasty with amnion graft was done and vaginal mould was placed. Vaginal dilatation with Hegar’s dilator was done weekly until 6 weeks. She is under regular follow-up at present and advised for regular manual dilation at home. McIndoe Vaginoplasty with amnion graft is a simple yet rewarding procedure especially in low resource countries like ours, with good success rate and with minimal postoperative complications. Keywords: Amnion graft; Mayer-Rokitansky-Kuster-Hauser Syndrome; Modified McIndoe Vaginoplasty; Primary amenorrhea; Secondary sexual characters.