Browsing by Author "Pande, S"
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Publication 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 Comprehensive abortion care service at Kathmandu Medical College – An experience(Kathmandu University, 2005) Pande, S; Sharma, M; Saha, R; Thapa, M; Shrestha, N; Regmi, DIntroduction: His Majesty’s Government amended the Nepal Criminal Code (Muluki Ain) – for Liberalising abortion law in the month of Chaitra 2058 (March 2002) and Royal Assent was given on 10th Asoj 2059 (27 th September 2002). Accordingly Comprehensive Abortion Care (CAC) Services was initiated in the country. Kathmandu Medical College after enlisting with Ministry of Health started this service from June 2004. Objective: This study was carried out to know- 1. Reasons for undergoing CAC service. 2. The complications after the CAC services. 3. The various contraceptive methods adopted by the client following CAC Methodology: Hospital based prospective study was carried out in Department of Obstetrics & Gynaecology at KMCTH from the period July 2004 to April 2005. Total 160 patients who asked for CAC were enrolled in the study. Counselling, history taking and general examination and per vaginal examination was carried out at the visit. CAC was performed with premedication with Doxycycline 100 mg and Ibuprofen 400 mg half an hour before the procedure. Paracervical block was also given with 1% xylocaine. MVA was performed as described in standard techniques. Patient was discharged after 1 – 2 hours of observation and with contraception opted by the clients. Results: • Main reason for performing CAC was unwanted pregnancy in 66.75%. • Complication following CAC was 1.25%. • Post CAC contraception was adopted by 93%. Most preferred method was Inj. Depoprovera Conclusion: The reason for CAC service asked by the patients was unwanted pregnancy. CAC service performed had minimal complication and also gave the opportunity for contraception. Key words: Comprehensive Abortion Care, Contraception, Safe Abortion.Publication The challenge of grandmultiparity in obstetric practice(Kathmandu University, 2006) Rayamajhi, R; Thapa, M; Pande, SIntroduction: Traditionally grandmultiparity has been considered to be an obstetric hazard both to the mother and foetus. Compounding factors are low socioeconomic status, poor female literacy and social deprivation. In developed populations with improved and optimal obstetric services, parity per se is no longer considered a significant risk for adverse obstetric and perinatal outcome. Objectives: To compare the obstetric and perinatal outcome between grandmultiparas and second gravidas with previous one delivery as well as analyse certain socio demographic features in the two groups. Methodology: Case records from Maternity Hospital, Kathmandu, an inner city tertiary care centre were retrospectively studied. 106 cases of grandmultiparous patients were compared with 110 cases of second gravidas who had previously delivered once which was taken as the control group. Biosocial features as well as obstetric and perinatal outcome were analyzed. Results: Rural residents comprised 60.4% of the grandmultiparous group versus 27.7% of the control group. A predominance of early marriage as well as an older age profile was noted in the grandmultipara. ANC attendance was documented to be much lower among grandmultipara with 26.4% having absolutely no antenatal care. A higher frequency of hypertensive disorders in pregnancy, preterm birth, anaemia, malpresentations, multiple pregnancy and premature rupture of membranes, postpartum haemorrhage and retained placenta was noted in the grandmultipara which also had a slightly higher caesarean delivery rate. The salient adverse perinatal outcome was found to be intrauterine foetal death, preterm birth and neonatal sepsis. Conclusion: In our set up grandmultiparity continues to challenge our obstetric practice with its associated increased likelihood of maternal and perinatal complications. Concerted effort should be directed to reducing high parity in the community through effective family planning initiatives and specialized antepartum and intrapartum supervision of this group should be available.