Browsing by Author "Ojha, N"
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Publication Obstetric factors and pregnancy outcome in placenta previa(Institute of Medicine, 2012) Ojha, NAbstract Introduction: Placenta previa is one of the major causes for maternal morbidity and mortality. The aim of this study was to analyze the obstetrical factors associated with placenta previa and to find out the maternal and perinatal outcome of these cases. Methods: This was a retrospective study conducted in the Department of Obstetrics and Gynecology of TUTH. Hospital chart records of four years (1st January 2008 to 31st December 2011) were collected. Chart records of all women who had undergone cesarean section for placenta previa were reviewed. Relevant clinical findings were noted. Results: During the study period, there were 82 cases of cesarean sections done for placenta previa, which is 0.55% of the total deliveries. Of the eighty two cases, charts could be obtained of the 70 patients for the analysis. 21.4% had total placenta previa. Maximum women were in age group 26-30 years. Sixty one percent of the patients were multipara. Sixteen patients had history of cesarean section and 20 cases had abortions in previous pregnancy. Malpresentation was present in more than one fifth (21.4%) of the patient. 45.7% of the babies were preterm and 27% were low birth weight babies. Seven babies had neonatal death. Almost one third (31.4%) of the patient had blood loss ≥500ml. There were four cases with blood loss ≥1000ml. Among them two had loss of more than two liters. Ten patients required blood transfusion. One patient had cesarean hysterectomy. Conclusion: Placenta previa poses danger to both the mother and the baby. There is high maternal morbidity and adverse perinatal outcome. Keywords: maternal and perinatal outcome, placenta previa, risk factorsPublication Post legalisation challenge: minimizing complications of abortion(Kathmandu University, 2004) Ojha, N; Sharma, S; Paudel, JAbortion has been legalized in Nepal since September 2002 by 11th amendment to the Muluki Ain. The present study was conducted in Paropakar Shree Panch Indra Rajya Laxmi Devi Maternity Hospital to assess the magnitude of induced abortion, its causes and the types of complications, in the post legalization phase. Prospective descriptive analyses of the patients who were admitted with history of induced abortion from 16 th Dec 2003 to 13th March 2004 was carried out. A total of 305 cases of abortion complications were admitted during the three-month study period, which is 39.7% of the total gynaecological admissions (768). Of these 31 (10.25%) patients had history of induced abortion. Half of the induced abortion cases (52%) were of age group 21-29 yrs and 42% had three or more children. 39% of the cases had history of induced abortion at more than 12 weeks and almost half of the cases (48%) had history of family planning. The most common reason for seeking abortion was too many children (59%) followed by illegitimate pregnancy (16%). Twenty-one patients gave history of abortion being performed by doctors and the most common method used was D&C (75%). 77% of cases presented as incomplete abortion and one case presented with uterine perforation, bowel injury and peritonitis. Twenty patients had evacuation under sedation while five had manual vacuum aspiration (MVA); one patient required laparatomy. In two third of the patients intravenous fluid and antibiotics were used. Four patients required blood transfusion. Abortion complications constitute almost 40% of the total gynaecological admissions. Ten percent of the abortion cases had history of induced abortion. Medical persons, mainly doctors, performed most of the cases of induced abortion and D&C was the most commonly used method. However the patients had faced various types of complications. Untrained provider, resulting in serious life threatening injuries, performed more than a third of the cases of induced abortion at more than twelve weeks gestation. This points to the need for improved monitoring of the quality of services provided, and adherence to the criteria set by the procedural order.Publication Pregnancy outcome in overweight and obese mothers at a tertiary care Hospital(Institute of Medicine, 2016) Ojha, NAbstract Introduction: Maternal obesity has been associated with increased risk of adverse pregnancy outcomes. The aim of this study was to determine the impact of increased body mass index on pregnancy outcome in women delivering at Tribhuvan University Teaching Hospital. Methods: This was a retrospective comparative study carried out in the Department of Obstetrics and Gynecology of TU Teaching Hospital. The study was carried from 1 April 2016 to 31 July 2016. Women were categorized according to booking BMI into three groups: normal (18.5-24.9kg/m²). overweight (25.0-29.9 kg/m²) and obese (≥30 kg/m²). Obstetrical and neonatal outcomes were evaluated using normal group as reference. The outcome variables were maternal hypertensive disorders, type of labor and delivery, blood loss, hospital stay, birth weight, preterm delivery and NICU admission. Results: During the study period, there were 228 mothers of whom 114 were normal weight, 85 overweight and 29 obese. The mean age and multipara were significantly higher in over weight and obese as compared to normal weight women. The overweight and obese mothers were at an increased risk of hypertensive disorders (OR3.3, 95%CI 1.4-8.1 and OR10.8, 95%CI 3.9-30.0), cesarean section (OR 2.2 95%CI 1.2-3.8 and OR 4.2, 95%CI 1.7-10.2), post partum hemorrhage (OR 3.8 95%CI 1.0- 14.9), longer mean hospital stay and adverse neonatal outcome like macrosomia, preterm birth and NICU admission. Conclusions: Overweight and obese mothers appear to be at an increased risk of hypertensive disorders, cesarean section, postpartum hemorrhage and neonatal problems like macrosomia, preterm birth and NICU admission in comparison to normal weight mothers. Keywords: obesity, overweight, pregnancy outcomePublication Reproductive Risk Factors in Uterovaginal Prolapse: A Case Control Study(Institute of Medicine, 2015) Paudyal, P; Pradhan, N; Ojha, NAbstract Introduction: Uterovaginal prolapse (UVP) is a major women’s health concern throughout the world and contributes a major bulk of reproductive health morbidity in Nepal. The cause of this disorder is likely to be multifactorial. The aim of this study was to analyze the reproductive risk factors associated with UVP. Methods: This was a hospital-based case control study, carried out in the Gynaecology Department of TUTH over one year from 1 st Baisakh 2068 to 30 th Chaitra 2068 (13th April 2011 to 12th April 2012). Cases comprised of 116 women with UVP, second degree or more and controls were women without prolapse of the same age group (± 5 years) admitted subsequently after the cases. The variables studied were; age at first childbirth, number of vaginal births, birth spacing and rest during puerperal period. P value and Odds Ratio (OR) for each risk factor were calculated. Multivariate analysis was done for those risk factors found to be significant from the univariate analysis. Results: Age at first childbirth, number of vaginal births and rest during puerperium were found to be significant risk factors from univariate analysis. Only two risk factors i.e. age at first childbirth<20years; OR 2.24(95% CI 1.18-4.25) and rest during puerperium<15 days; OR 3.87(95% CI 1.9-7.93), were found to be significant by the multivariate analysis. Conclusion: Preventing early marriage and childbirth at a young age along with imparting awareness about the importance of adequate rest during the puerperium could go a long way in reducing morbidity due to prolapse. Keywords: reproductive risk factor, uterovaginal prolapse