Browsing by Author "Rana, A"
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Publication A simple new technique of performing myomectomy for a predominantly subserosal myoma quickly within few minutes(Kathmandu University, 2007) Rana, A; Gurung, G; Amatya, A; Khatri, RRemoving a degenerated myoma located around the uterine cornu by an innovative technique shelling the myoma a little away from the base by choice of a low placed incision, advantageous in terms of no requirement of blood transfusion because of the reduction in the surgical time is described in a 24 years old lady demanding a fertility conserving surgery.Publication Endometrioma: A Concern for fertility(Institute of Medicine, 2014) Baral, J; Acharya, P; Rana, A; Gurung, GAbstract Introduction: Endometriosis is a complex disease of young women in reproductive age, responsible for endometriosis-associated pelvic pain (EAPP) because of the deeply infiltrating endometriosis (DIE). There has been significant successful revolution in the diagnosis and the management both surgical and medical where medical treatment both pre and post-operatively has been documented as gain for pain relieve and fertility promotion. Methods: Retrospective study was done for a period of 4 years, April 2009 - 2013, in Department of Gynecology and Obstetrics, TU Teaching Hospital, using Operation Register obtaining files from Medical Record Section. All the cases exposed to operative management endometrioma were noted for size, adhesions and association with other gynecological condition and the type of surgical approach used for future fertility preservation. Results: There were 77 cases of chocolate cysts, representing 3.2% of major gynecological surgery, in age up to 30 years being 21 (27%) as compared to those above the age of 30. Adhesion were omnipresent in all cases [mild 20 (26%) and dense adhesions and 57 (74%). Irrespective of the size of chocolate cysts; 3-5 cm (27); >5-10 cm (40); 10-15 cm (9), 15-20cm (1); associated was myoma in 14 (18%). Confined to 36% infertility were total 28 [Primary infertility (14); Secondary infertility (14)]. Adhesion was dense in all cases of primary infertility and in 12/14 cases of secondary infertility, yet forward anticipation in primary (9) and cases of secondary (6) infertility cases [after deducting, 13: hysterectomy (11) and bilateral ovarian removal (2)] along with 8/9 cases in unmarried [expecting, hysterectomy (1)] but may not be rewarding in cent percent. Conclusion: Endometrioma noted to create adhesion in one and all cases, expected to enhance on operative exposure, need coverage by favorable medication before and after semiconservative surgical approach to overcome associated adverse fertility prognosis. Keywords: Chocolate cyst, dense adhesion, endometrioma and fertilityPublication Heterotopic pregnancy with spontaneous intrauterine conception: A rare clinical entity with diagnostic dilemma(Kathmandu University, 2008) Rawal, S; Koirala, P; Singh, M; Rana, AAbstract Twenty-one years old primigravida presented to emergency with amenorrhoea for 2 months and complaints of severe abdominal pain for few hours. The pain was associated with 2 episodes of fainting attacks in emergency during the period of observation. Viable intrauterine pregnancy of 8-9 weeks along with collection of fluid in the Pouch of Douglas was detected by ultrasound examination and on laparotomy ectopic pregnancy was confirmed with haemoperitoneum of 2 litres with 500gms of clots. Histopathology report confirmed the tubal ectopic pregnancy and postlaparotomy, transvaginal sonography confirmed the salvage of the intrauterine pregnancy. Despite massive haemoperitoneum, the pregnancy continued till 40+6 weeks with uneventful antenatal period. She underwent emergency caesarean section for meconium stained liquor with foetal distress and delivered of an alive healthy female of 2.5 kg with good Apgar score. Key words: Ectopic, Heterotopic pregnancyPublication Hysterectomy in the Present Day for Dysfunctional Uterine Bleeding: a finding from Tertiary Care Hospital Nepal(Institute of Medicine, 2014) Baral, J; Gurung, G; Kaudel, S; Paudyal, P; Chudal, D; Shrestha, P; Rana, AAbstract Introduction: Hysterectomy is a an operative procedure in gynecology, performed for benign or malignant indication, accomplished via abdominal or vaginal routes, technically as open or endoscopic surgery by various approaches; laparoscopic, laparoscopic assisted vagina hysterectomy or robotic surgery. This study was undertaken to analyze the indications of hysterectomies for benign condition with main focus on dysfunctional uterine bleeding (DUB). Method: This study was conducted between 2009 April and 2014 March in the Department of Obstetrics and Gynaecology Tribhuvan University Teaching Hospital. Data were obtained from Operation Theater. Results were precisely reevaluated to find out the indication of hysterectomy done for benign etiology, routes of surgery. Results: Fibroid, utrovaginal prolapsed (UVP), adenomyosis, endometriosis, dysfunctional uterine bleeding (DUB) and adnexal mass were the main indication in total hysterectomy (n1644) performed for benign aetiopathologies, most surgery being performed abdominally (n1126). DUB which were principally treated by hysterectomy and occupied the fifth position as an indication had the postoperative diagnosis other than DUB on histopathological examination in more than 50%. The endometrial pathologies in the operated cases showed endometrial hyperplasia in three cases and adenocarcinoma in one. Conclusion: Presently, abdominal hysterectomy is seen as the only available surgical option for DUB, indicating a need for a change in practices favoring organ preservation. Keywords: endometrial hyperplasia, hysterectomy, dysfunctional uterine bleeding(DUB)Publication Manual Vaginal Reversion of Acute Puerperal Uterine Inversion: Learning by Doing(Institute of Medicine, 2016) Katuwal, N; Pokharel, M; Subedi, K; Baniya, J; Sherchan, K; Rawal, S; Baral, J; Gurung, G; Rana, AAbstract Uterine inversion is the folding of the fundus into the uterine cavity in varying degrees. Acute uterine inversion is a rare and unpredictable obstetric emergency. Here we report a case of a woman who had vaginal delivery complicated by postpartum hemorrhage. Diagnosed as acute puerperal uterine inversion; reposition was tried in the labor room which failed ensuing shock. Simultaneous fluid resuscitation and manual vaginal reversion under general anesthesia was done in Operation Theater, also needing blood transfusion, 5 units in total. Therefore, this case is described herein to illustrate the importance of early recognition and prompt reversion of inverted uterus vaginally,as delay can render replacement progressively more difficult and also increase the risk of hemorrhage.