Browsing by Author "Poonam"
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Publication Ectopic pregnancy – Two years review from BPKIHS, Nepal(Kathmandu University, 2005) Poonam; D, Uprety; B, BanerjeeEctopic pregnancy remains an important cause of morbidity and mortality in early pregnancy. The incidence has increased worldwide with an increase in pelvic infections and improvements in the diagnostic techniques. The objective of this study was to analyse the various aspects of ectopic pregnancy with a view to suggest interventions which would decrease the incidence. Material and methods: The study was carried out in the department of Obstetrics and Gynaecology, B.P Koirala Institute of Health Sciences, Dharan (Nepal). Data were analysed retrospectively using the case sheets and operative notes from the past two years (April 02-April 04). The gynaecological admissions and records of the total births within the period of study were also used in the analysis. Result: The incidence of ectopic pregnancy during this study period was 0.93 of total births and 2.92% of the total gynaecological admissions. The peak age of incidence was in the range of 26-30 years. Majority of patients were in the lower socioeconomic group. Pelvic inflammatory disease and induced abortions were the major risk factors. Their contribution was 61.3% and 38.6% respectively. 70.6% of patients did not use any contraception. 16% used depo provera. Abdominal pain (69.3%), vaginal bleeding (45.3%) and syncopal attacks (21.3%) were the most frequent presenting complaints. 58.6% had amenorrhea of 6-10 weeks. Only 1.3% presented with amenorrhea of greater than 10 weeks. Ampulla (62.6%) followed by isthmus (21.3) were the commonest sites of ectopic implantation. Ovarian and abdominal pregnancies contributed to only 1.3% each. There was no significant difference between the side of the tube involved.82.6% had come with ruptured ectopic but only 12% were in shock. Majority of patients underwent salpingectomy (69.3%) followed by salpingo-oophorectomy (17.3%). Only 2.6% received methotrexate. 70.6% required blood transfusion. Conclusion: Majority of patients attending BPKIHS for ectopic pregnancy were between 26-30 years and had history of PID & induced abortions. Surgery (salpingectomy/salpingo-oophorectomy) was the main stay of treatment.Publication The Misgav Ladach method: A step forward in the operative technique of caesarean section(Kathmandu University, 2006) Poonam; B, Banerjee; SN, Singh; A, RainaIntroduction: Caesarean delivery remains the most common intraperitoneal surgical procedure in obstetric and gynaecologic practice. Since time immemorial there have been countless efforts to improve the technique of caesarean section. One such innovative breakthrough technique is the Misgav Ladach method of caesarean of section. The objective of this trial was to compare the intraoperative and short-term postoperative outcomes between the conventional and the Misgav-Ladach technique for caesarean section. Materials and method: The randomized prospective comparative study was carried out in the department of Obstetrics and Gynaecology, B.P Koirala Institute of Health Sciences, Dharan Nepal. Four hundred patients were randomized to either Misgav Ladach or the Conventional method of caesarean section. Only term pregnancies with singleton foetuses’ were included whereas pregnancies with previous caesarean section were excluded from the study. The study period was from September 2001 to September 2004. Result: There was not much difference in the demographic variables between the two groups. The age of the patients ranged between 18-40 years. The mean age of patients in Misgav Ladach and conventional group was 24.5 and 23.6years respectively. Foetal distress was the commonest indication for caesarean section followed by non progress of labour. The mean incision to delivery interval, operating time and blood loss in the Misgav Ladach group was 1 minute 30 seconds, 16 minutes and 350ml as compared to 3 minutes, 28 minutes and 600ml in the conventional group respectively. 3.5%of patients in the Misgav Ladach group showed febrile morbidity as compared to 7% in the conventional group.19% from conventional group and only 4%from Misgav Ladach group required added analgesia. Almost equal number of patients (10-12) in each group experienced significant headache.).0.1%in the Misgav group and 5% in the Conventional group required post operative blood transfusion. Four patients from the conventional group had their wound gaped. The number of neonates requiring intensive care was sixteen (8% ) in the conventional group and 3 ( 1.5%) in the Misgav group.6.5% from conventional group and 2% from Misgav Ladach group required maternal intensive care admissions. Conclusion: Misgav-Ladach technique has been be associated with shorter operative time, quicker recovery, and lesser need for postoperative medications, when compared with traditional caesarean section (12,13) It has also been shown to be more cost-effective (12) A further advantage of the technique may be the shorter time taken for the delivery of the child.Publication The role of hysterosalpingography in cases of subfertility(Kathmandu University, 2007) PoonamAbstract Introduction: Subfertility is the inability of a couple to conceive even after one year of regular unprotected coitus. The desire of woman for children is great, sometimes greater than self-interest in beauty and figure and may be stronger than the claims of a career. Considering the social stigma attached to subfertility, a sympathetic and a carefully balanced therapeutic approach to their problem is required. Aims and objectives: The present work has been undertaken with a view to asses the role of HSG in the evaluation of subfertility. Material and method: For the present study, a total of 105 infertile patients were selected from the outpatient department of Obstetrics and Gynaecology, Darbhanga Medical College and Hospital, Darbhanga. Only those cases were selected where the couples were in the fertile age group of and were living together for two or more years. The patients were advised to take 600mg ibuprofen, an hour before the procedure to ease the cramps. A catheter was inserted through the cervical canal, and radio-opaque dye (urograffin 76%) was passed through it. A radiograph was taken after injection of two ml. of medium to ensure that there was no filling defect in the uterine cavity which, otherwise, would be concealed by overdistending the uterus. Further injection outlined the Cornua, isthmus and ampullary portions of the tube and evaluated the degree of spillage. Results: Of the total number of cases, abnormal HSG findings were seen in 55 patients. Majority of the patients were between 26-30years age group with 6-10 years duration of subfertility. The tubes were occluded in 34.28% of cases in the ratio of 1:8, proximal occlusion being the commonest. 5.71% showed hydrosalpinx. Beaded & wiry appearances of tubes were seen in 2.85% of cases. Amongst the uterine anomalies, which accounted for 20% of cases, only five patients had acquired abnormality. In the congenital group maximum number of patients had hypoplastic uterus (52.38%) followed by bicornuate uterus. Unicornuate and arcuate uterus accounted for 9.52% each. Intravasation of contrast occurred in two patients. Conclusion: Hysterosalpingography plays an important role in the initial diagnostic assessment of female subfertility. Other than being diagnostic, it can prove to be therapeutic also10. An accurate interpretation of the hysterosalpingogram is necessary for the initial subfertility workup. Knowledge of these entities is important to avoid the practice of unnecessary and sometimes more aggressive procedures Key words: Hysterosalpingography, Subfertility