Browsing by Author "Rawal, S"
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Publication Comparison of oral misoprostol with intravenous oxytocin for induction of labour in premature rupture of membranes(Institute of Medicine, 2013) Maskey, S; Singh, M; Rawal, SAbstract Introduction: To compare the effectiveness of oral misoprostol with intravenous oxytocin for induction of labor in premature rupture of membranes (PROM) at term. Methods: This randomized comparative study was carried out in 100 women who were at or beyond 37 weeks of gestation with cephalic presentation, had PROM more than 12 hours with bishop’s score less than six. Out of 100 women 50 were induced with 50 μg of oral misoprostol 4 hours apart (max 6 doses) and other 50 received intravenous oxytocin infusion (max 3 pints). Results: The parity, mean bishop’s score of two groups were comparable. Both misoprostol and oxytocin group showed similar induction to delivery interval (8.68 hrs ± 3.22hours vs. 7.61hours ± 2.84hours, P value was 0.08). Maximum number (52%) of patient’s responded to single dose of misoprostol in misoprostol group. Whereas in oxytocin group 40% of primigravidae required 10 units and 47% of multigravidae required 2.5 units of oxytocin. Majority of women in both the groups delivered vaginally but oxytocin group had slightly increased number of LSCS and one instrumental delivery. Meconium stained liquor was seen more in oxytocin group than misoprostol. Neonatal outcome was comparable in both groups. Conclusion: Oral misoprostol was as effective as oxytocin in induction of labour in term PROM with low bishop’s score. Keywords: premature rupture of membrane, induction of labor, misoprostol, oxytocinPublication Diagnostic Accuracy of Intraoperative Frozen Section in Ovarian Neoplasms: Experience in a Tertiary Oncology Centre(Kathmandu University, 2018) Bajracharya, Shakya A; Jain, V; Sekhon, R; Rawal, S; Mehta, AABSTRACT Background Ovarian cancer is the second most common type of female genital tract malignancy. Treatment planning differs for benign, borderline and malignant subtypes of surface epithelial tumours and depends on accurate histopathological diagnosis. A pre-operative diagnosis of the nature of ovarian tumors is not always reliable. Frozen section is a valuable diagnostic tool in rapid intraoperative categorization of ovarian masses and thereby helps in planning the surgical management. Adequate management and treatment of ovarian carcinoma requires a complete surgical staging supported by frozen-section examination. To achieve this goal it is necessary to have a high level of accuracy. Objective To assess the accuracy of intra-operative frozen section in the diagnosis of various categories of ovarian neoplasm conducted in Rajiv Gandhi Cancer Institute and Research Centre. Method Intra-operative frozen sections for suspected ovarian neoplasm that underwent surgery as primary line of therapy at this institution were analyzed retrospectively from Jan. 2014 - Dec. 2015. The results of frozen section were compared with the final histopathology diagnosis on paraffin sections and the overall accuracy, sensitivity, specificity, positive and negative predictive values were determined. Result The study included 159 cases and the mean age of patients was 44.72±14.28 years (Range 19-75 years). The mean size of tumor was 12.5±5.9 cm. Sensitivity of frozen section for benign, borderline and malignant tumors was 98.53%, 73.33% and 94.74% respectively and the related specificities were 95.60%, 96.53% and 100% respectively. There were 150 concordant cases and 9 discordant cases. Overall diagnostic accuracy of frozen section was 94.33%. Conclusion Intra-operative frozen section diagnosis appeared to be an accurate and comparable technique for the histopathology diagnosis of ovarian tumors. KEY WORDS Accuracy, Frozen section, Ovarian neoplasm, SensitivityPublication 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 Immune thrombocytopenic purpuera in pregnant women(Institute of Medicine, 2007) Rawal, S; Sigdel, MR; Singh, M; Baral, JAbstract Case report: Immune Thrombocytopenic Purpuera (ITP) is the commonest autoimmune disorder occurring in pregnancy. This is a case of asymptomatic ITP diagnosed in a 21 years primigravida by doing platelet count during routine antenatal investigation at 27th week, who remained refractory to treatment with steroid and platelet transfusion, had to undergo emergency LSCS for low lying placenta, but both the intrapartum and the postpartum period remained uneventful. The baby was assumed to have neonatal alloimmune thrombocytopenia (NAIT) due to low platelet count of 10,000/ cumm and with clinical evidence of petechia on the trunk and hard palate, was later treated with platelet transfusion, intravenous immunoglobulin (IVIG) and steroids. Both the baby and the mother had an uneventful recovery following a multidisciplinary approach with the obstetrician, physician, neonatologist and the anaesthesiologist and both were discharged on steroids on the 10th post operative day. Keywords: Platelets, Pregnancy, ITPPublication Lipid Profile and Ultrasonographic Grading in Alcoholic and Non Alcoholic Fatty Liver Patients(Kathmandu University, 2021) Shahi, A; Gautam, N; Rawal, S; Sharma, U; Jayan, AABSTRACT Background Fatty liver disease (FLD) is a common and major chronic liver disease. It has been implicated that patients have disorders of lipid metabolism and are involved in the pathogenesis of fatty liver. Hence, it was designed to observe the association between lipid profile and fatty liver disease. Objective This study was undertaken to evaluate the association of lipid profile status, hemoglobin and albumin levels with fatty liver disease patients diagnosed based on ultrasonography (USG). Method This Cross-sectional study was undertaken in the Department of Internal Medicine with the collaboration of the Department of Radiology and Department of Biochemistry, Universal College of Medical Sciences-Teaching Hospital (UCMS-TH), Bhairahawa, Nepal from March 2019 to February 2020 in a total of 100 patients diagnosed with fatty liver disease by ultrasonography. The fasting blood was collected for lipid profile and carried out in the automated analyzer following standard protocol. Result In 100 cases, the male to female ratio was 1.8:1. Fifty six percent of the total cases presented with alcoholic fatty liver disease (AFLD) while the remaining 44% with nonalcoholic fatty liver disease (NAFLD). The spectrum of lipid abnormality was observed with increased total cholesterol (TC), Low Density Lipoprotein (LDL), increased triglycerides (TG), Very Low Density Lipoprotein (VLDL) in alcoholic fatty liver disease cases as compared to nonalcoholic fatty liver disease cases. However, it has been observed that TG/HDL and Non-HDL/HDL were higher in nonalcoholic fatty liver disease as compared to alcoholic fatty liver disease. Moreover, a statistically significant difference was observed in HDL between AFLG2 and NAFLG2 (p-value: 0.012). Conclusion Dyslipidemia and decreased HDL have been implicated in fatty liver diseases. USG in conjunction with Non-HDL/HDL, TG/HDL, hemoglobin, and albumin can be useful in early screening and monitoring of dyslipidemia in fatty liver patients. KEY WORDS Alcoholic fatty liver, Dyslipidemia, Non-alcoholic fatty liverPublication 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.Publication Mortality in a second gravida following dissecting aortic aneurysm due to Takayasu’s Arteritis(Institute of Medicine, 2007) Rawal, SAbstract Takayasu’s arteritis is a vasculitis involving the aorta and its branches. This is a case of undiagnosed Takayasu’s arteritis in a 32 weeks pregnant lady, who presented to the emergency department with complaints of severe chest and epigastric pain and signs consistent with aortic aneurysm. The woman died of aortic dissection two days later. Keywords: Pregnancy, Takayasu’s arteritis, aortic aneurysm, dissectionPublication Papillary carcinoma of thyroid and pregnancy(Institute of Medicine, 2012) Rawal, S; Gurung, GAbstract Two cases of Papillary carcinoma of thyroid and pregnancy were managed, one with the existing disease diagnosed during pregnancy and the other with a history of near total thyroidectomy. A multidisciplinary approach in the management of both the mothers lead to an uneventful pregnancy, caesarean section with good outcome and were discharged in good health.Publication Second Intervention in Obstetric Hemorrhage(Institute of Medicine, 2012) Rawal, S; Rana, AAbstract Introduction: Obstetric hemorrhage is still one of the dreaded complications that contribute to a maximum number of maternal morbidity and mortality till date. The management of obstetric hemorrhage involves early recognition, assessment and resuscitation. Though dealt with appropriate use of oxytocic agents, it may seldom require surgical techniques, including uterine tamponade, major vessel ligation, compression sutures, and even hysterectomy. Method: Prospective study of 20 cases of laparotomy for obstetrical hemorrhage carried out at Tribhuvan University Teaching Hospital, Kathmandu, Nepal, between Jan 2003 to Nov 2011. Results:Out of 20 cases,massive hemoperitoneum(more than a liter)was noted in 9 and associated risk factors in 10. Source of bleeding in 20 cases were from extensive hematoma (retroperitoneal and broad ligament) in 5, including a rectus sheath hematoma and with colporrhexis, oozing inverted T incision repaired in a single layer (1), placental bed (3) and 1 was from vessels in LUS. There was bleeding from uterine angle (4) and incision (1). Bleeding from tear at various sites were 3, from uterovesicle fold of peritoneum 1 and from the ruptured uterus following vacuum delivery in a case of VBAC (1). Uterine packing was done in 1, B-Lynch in 3 and 1 failed needing the uterine packing; uterine artery ligation in 2 including ovarian vessel ligation in 1, repair of ruptured uterus in 1 and subtotal hysterectomy in 5 cases. There were 3 mortalities due to DIC, pulmonary edema and ARF and rest were discharged in good health. Conclusion: Choosing of the right technique, complete hemostasis and meticulous closure of all surgical incisions will prevent the need for laparotomy following LSCS. Vigilant monitoring of all the post operative patients will lead to early diagnosis of intraperitoneal / pervaginal bleeding and its management, thus preventing morbidity and mortality owing to late diagnosis. Keywords: relaparotomy, hemoperitoneum, Intraperitoneal bleeding