Browsing by Author "Karki, C"
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Publication A profile of menstrual disorders in a private set up(2003) Padhye, S; Karki, C; Padhye, S BMenstruation and its disorders are still considered unholy & impure and are not yet recognised as significant reproductive health morbidity. Therefore a prospective study was carried out at a private clinic for a period of three months where total number of patients coming with current or past menstrual problems are 525. This number did not include pregnant women or those on any hormonal medications or having dysfunctional uterine bleeding. This study aimed to find out the incidence of Menstrual Morbidity and their mode of presentation. It has also tried to find out these women's age, parity, age of menarche and number, following discriminating traditional rituals during their 1st and regular menses, their family planning status and the districts from where they came to Kathmandu for their treatment. In this study, menstrual morbidity was found to be 43.75%. Approximately 60% of women having menstrual complaints had absolutely normal menstrual cycle; whereas 13% of them had irregular, 17% of them had prolonged and 6% had short menstrual cycle. A significant number (46%) of women although suffering from menstrual problems presented with other symptoms like vaginal discharge, pain lower abdomen, subfertility, urinary problems, abdominal lumps and for cuT check-ups. 3% of the women who presented with vague, non-specific complaints asking for a general check up had one or the other menstrual problem. Although approximately 69% of these women were from the age group of 20 - 39 years, 4% of them were adolescents and 27% above 40 years. It was observed that although approximately 78% of these women were primi and multiparous ladies, 22% were unmarried and nulliparous suffering from various menstrual morbidities. More than 55% of these women had their menarche at the age of 12-14 years. It was not surprising to note that more than 90% of women had to follow the traditional unhealthy and unsociable rituals during their first menstruation. More than 75% of them had to follow the discriminating traditional rituals which consider a menstruating woman “untouchable” for 5 days of every month throughout their active reproductive lives. 20% of these women were using non-hormonal contraceptive methods, out of which >50% had undergone permanent sterilisation. It was a matter of pride to note that this clinic was providing the health care services to the adolescents and women of 13 zones and more than 52 districts of the country. Key words: Menstrual morbidity, traditional rituals, Menarche, subfertility, nulliparousPublication A profile of menstrual disorders in a private set up(2003) Padhye, S; Karki, C; Padhye, S BMenstruation and its disorders are still considered unholy & impure and are not yet recognised as significant reproductive health morbidity. Therefore a prospective study was carried out at a private clinic for a period of three months where total number of patients coming with current or past menstrual problems are 525. This number did not include pregnant women or those on any hormonal medications or having dysfunctional uterine bleeding. This study aimed to find out the incidence of Menstrual Morbidity and their mode of presentation. It has also tried to find out these women's age, parity, age of menarche and number, following discriminating traditional rituals during their 1st and regular menses, their family planning status and the districts from where they came to Kathmandu for their treatment. In this study, menstrual morbidity was found to be 43.75%. Approximately 60% of women having menstrual complaints had absolutely normal menstrual cycle; whereas 13% of them had irregular, 17% of them had prolonged and 6% had short menstrual cycle. A significant number (46%) of women although suffering from menstrual problems presented with other symptoms like vaginal discharge, pain lower abdomen, subfertility, urinary problems, abdominal lumps and for cuT check-ups. 3% of the women who presented with vague, non-specific complaints asking for a general check up had one or the other menstrual problem. Although approximately 69% of these women were from the age group of 20 - 39 years, 4% of them were adolescents and 27% above 40 years. It was observed that although approximately 78% of these women were primi and multiparous ladies, 22% were unmarried and nulliparous suffering from various menstrual morbidities. More than 55% of these women had their menarche at the age of 12-14 years. It was not surprising to note that more than 90% of women had to follow the traditional unhealthy and unsociable rituals during their first menstruation. More than 75% of them had to follow the discriminating traditional rituals which consider a menstruating woman “untouchable” for 5 days of every month throughout their active reproductive lives. 20% of these women were using non-hormonal contraceptive methods, out of which >50% had undergone permanent sterilisation. It was a matter of pride to note that this clinic was providing the health care services to the adolescents and women of 13 zones and more than 52 districts of the country. Key words: Menstrual morbidity, traditional rituals, Menarche, subfertility, nulliparousPublication Accuracy of Prediction of Birth Weight by Fetal Ultrasound(Kathmandu university, 2012) Bajracharya, J; Shrestha, NS; Karki, CABSTRACT Background Accurate determination of fetal weight prior to delivery can have a significant bearing on the management decision in labour, thereby markedly improving perinatal outcome. Objective To determine the accuracy of prediction of birth weight by fetal ultrasound. Methods This is the retrospective observational hospital based study done at Kathmandu medical college teaching hospital, Sinamangal, Kathmandu from January 2010 to February 2012. Total 150 women with full term singleton pregnancy leading to live birth were included in this study. Prenatal fetal ultrasound database was reviewed for fetal weight estimation. Delivery records were reviewed for actual birth weight. Error in estimation was calculated. Results Our study showed that fetal ultrasound using Hadlock’s formula has error in estimation of fetal weight by about 290 gm ± 250 gm. In 40% of the cases, there is an error of estimation by more than 10% compared to actual weight. Conclusion Significant error was seen while estimating fetal weight by ultrasound. Depending only on the fetal ultrasound for the estimation of fetal weight can lead to unnecessary obstetrical intervention. It is thus necessary to correlate the ultrasound findings with clinical examination. KEY WORDS fetal weight, Hadlock’s formula, ultrasoundPublication B-Lynch brace suture simple surgical technique for managing post- partum haemorrhage - Report of three cases(Kathmandu University, 2005) Saha, R; Sharma, M; Karki, C; Pande, SPost-partum haemorrhage is a major contributor to maternal morbidity and mortality. Numerous medical and surgical therapies have been used but none has been uniformly successful. Three cases which were managed successfully with brace suture following failure of medical management for post-partum haemorrhage are being presented. The ease and usefulness of this procedure as a life saving measure, its relative safety and its capacity for preserving the uterus and thus fertility is high lighted. Keywords: post-partum haemorrhage, B – Lynch Brace Suture & maternal mortality.Publication Baseline survey on functioning of abortion services in government approved CAC centres in three pilot districts of Nepal(Kathmandu University, 2009) Karki, C; Ojha, M; Rayamajhi, RTAbstract Background: Abortion has been legalized in Nepal since September 2002 and under this law, Comprehensive Abortion Care (CAC) service is being provided through listed service providers and listed health facilities from 2004. Nepal Government has prioritized the national safe abortion program and is working with many government and non government partners for providing this service. Till date medical abortion services are not made available at any of the health facility. Government is now preparing to introduce this service in six selected pilot districts. Objective: This survey was carried out to assess the functioning of existing abortion services in 12 Government approved CAC sites of three districts. Materials and methods: Direct observation of the functioning of these centers, assessment of physical facilities and service provider’s skill was done. At the same time service provider’s attitude and knowledge on CAC service and other abortion services were also assessed through semi structured interviews. Quality of record keeping and the feasibility of initiating the medical abortion service in these sites were also studied. Result: Number of listed centers in six pilot districts was twenty nine. Study districts have 16 listed centers. Visited sites were twelve; four managed by Government and eight by non government organizations. Thirty three thousand nine hundred and twenty women have availed this service so far: only 4.76% of them received service from Government facilities. Marie Stopes International (MSI) topped the list in providing service to the maximum number of clients (75.64%) and Family planning association of Nepal (FPAN) was the second. MSI centre was also first to initiate the service. Government facilities provide 24 hours service unlike private facilities which are open only up to 5.00 pm. Cost for the service varies from rupees 900/- to rupees 1365/- and is cheaper at Government facilities. Private sectors have separate setups and Government have allocated some space within their already existing infrastructure for CAC service. Private sectors were better in providing the information to public about the availability of service. There were total 20 trained service providers for first trimester abortion service. They are more at Government facilities. They seem to be positive to CAC service and had good knowledge and skill of service delivery. Complications were not recorded at most of the sites. Pain management and infection prevention practice needs improvement at the Government sites. All the sites had identified their referral sites and had one or the other arrangement for referral. Conclusion: CAC service has become accessible and affordable to Nepalese women even at peripheral level. CAC sites are functioning well. Initiation of medical abortion and second trimester abortion services at these sites are feasible and would expand the option and choices available. Key words: Comprehensive abortion care (CAC), medical abortion, unsafe abortion,Publication Indications for labour induction and predictors for failed induction at KMCTH(Kathmandu university, 2009) Rayamajhi, RT; Karki, C; Shrestha, N; Padhye, SMAbstract Objective: To study the incidence and indications for labour induction and study the predictors of failed induction. Materials and methods: A hospital based prospective study done over a 12 month period between 1st November 2007 to 30th October 2008. Selection criteria: Singleton pregnancies beyond 37 weeks with vertex presentation and unscarred uterus requiring induction of labour. Results: The incidence of labour induction was 19.7%. Operative delivery was 34.6% in the study group and 27.4% in those with spontaneous onset of labour. 74.07% of the induction group required operative delivery for failed induction and 25.03% for foetal distress. The predominant indication for induction was post term pregnancy (51.28%) followed by PROM (17.3%), isolated oligohydramnios (8.97%), hypertensive disorders of pregnancy (8.33%), maternal perception of decreased foetal movements (7.69%) and others. Failed induction was higher in nulliparas (41.2%) as compared to multiparas (23.7%). Failure rate was 53.8% when maternal age >30y and 28.2% in those <30y. Women with normal BMI had a failure rate of 25.6% compared to 36% for overweight and 44.4% for obese women. 24.1% had failed induction when Bishop score was >5 and 40.8% when Bishop score was <5. Between 38-41 weeks pregnancy failed induction occurred in 28-31% while it was higher at <38 weeks and >41 weeks pregnancy. The best outcome was seen when the birth weight was 2500-2900g (22.5% failures) while 72.7% had failed induction when the birth weight was >3500g. The duration of induction was >24 hours in 42.6% of women and 48.2% were in the latent phase of labour when taken for caesarean section. Conclusion: Despite the proven benefit of induction of labour in selected cases, one must keep in mind its impact on increasing the rates of operative delivery. Strategies for developing practice guidelines may help to prevent unwarranted case selection and help to reduce the current high operative delivery rates. Key words: caesarean section rate, failed induction, induction of labour.Publication Near miss maternal morbidity and maternal mortality at Kathmandu Medical College Teaching Hospital(Kathmandu University, 2010) Shrestha, NS; Saha, R; Karki, CAbstract Background: Maternal mortality traditionally has been the indicator of maternal health all over the world. More recently review of the cases with near miss obstetric events has been found to be useful to investigate maternal mortality. Cases of near- miss are those in which women present with potentially fatal complication during pregnancy, delivery or the puerperium, and survives merely by chance or by good hospital care. Objectives: The objective of this study is to determine the prevalence and nature of near miss obstetric cases and maternal deaths at Kathmandu Medical College Teaching Hospital. Material and methods: This was a descriptive study done for the period of 24 months (1 January 2008 to 31 December 2009). Cases of severe obstetric morbidity were identified during daily morning meetings. All the cases were followed during their hospital stay till their discharge or death. Five factor scoring system was used to identify the near miss cases from all the severe obstetric morbidity. For each case of maternal death, data were collected from records of maternal death audit. Results: During the study period, 1562 women delivered at the institution and 36 women were identified as near-miss obstetrical cases. The prevalence of near miss case in this study was 2.3%. Five maternal deaths occurred during this period, resulting in a ratio of maternal death of 324 maternal deaths per 100,000 live births. Of the five maternal deaths three were due to pregnancy complicated with hepatitis E infection, one each due to Eclampsia and amniotic fluid embolism. Fifteen cases of near miss were due to haemorrhage (41.66%) and hypertensive disorder of the pregnancy was the cause in 10 (27.77%). Dystocia was the cause in 1(2.77%) case and infections in 7(19.4%) cases. Rare causes like anaesthetic complications were the cause in one case and dilated cardiomyopathy was the cause in two cases. Conclusion: The major causes of near-miss cases were similar to the causes of maternal mortality of Nepal. Need for the development of an effective audit system for maternal care which includes both near-miss obstetric morbidity and mortality is felt. Key words: Near-miss obstetric morbidity, Maternal mortality, Five factor scoring systemPublication Study of young people attending an adolescent friendly centre(Kathmandu University, 2004) Karki, CAdolescents are the individuals between the ages of 10-19 years and the youth are those between the ages of 15 – 24 years. World Health Organisation has therefore defined young people as individuals between the age group of 10 – 24 years. In our country Adolescents comprise more than one fifth (22%) of the total population. Therefore Family Health Division, Ministry of Health, established an adolescent friendly centre at Bir Hospital on 5th January 2002. This paper has tried to study and analyse the young population attending this centre at a fixed period of time. This study was carried out to a. Find out the total number of adolescents. b. Estimate their male: female ratio. c. Find out their ethnicity, address, marital status, education, and occupation d. Learn what Health and Development problems these young people have. This is a cross sectional study done at Bir Hospital adolescent friendly centre for a period of one year. All young people (adolescents and youths) coming to this centre within the specified period are included in this study. OPD register was used to collect the data, which was obtained and analysed manually. Total of 956 young people were provided healthcare and counselling services from this centre. Out of them, only 9.21 % were males. 887 (92.78%) of this population are adolescents, 69 (7.22%) are from 19 -24 years age group and 880 (92.05%) of them are youth. Majority (28.56%) were Brahmins. 313 (32.74%) of these people were from outside the valley. 9 (10.23%) out of 88 boys and 384 (79.34%) out of 484 girls were married. 1.14% of boys and 14.63% of girls were illiterate. 4.55% of boys’ and 14.17% of girls had not completed the studies of standard five. 17.05% of boys and 47% of girls had not completed their school. 81.82% of boys and 38.36% of girls had joined the college. It also showed that 521 (54.50%) of these young people are students but 35.94% of girls are housewives. 278 (32.03%) girls presented with menstrual problems and 22.12% (192) came with pregnancy related problems and 15.27 % of these young people presented with the symptoms of various infections Twenty-six (3%) girls came with features of anaemia and 22 (2.53%) girls had dropped in for family planning services. 20 (2.09%) of these young people had some psychological problem (mainly anxiety) and 9.62% of them had various types of skin problems. Adolescent friendly centre can play a vital role to support and help a good number of adolescents of the society. Key words: Adolescents, youths, and young peoplePublication