Browsing by Author "Rayamajhi, R"
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Publication A comparative study between nifedipine and isoxsuprine in the suppression of preterm labour(Kathmandu University, 2003) Rayamajhi, R; Pratap, KPreterm labour and delivery remains a major cause of perinatal morbidity and mortality. Numerous drugs and interventions have been used to prevent and inhibit preterm labour but none have been found to be completely effective with the choice being further limited by troublesome side effects. This study compares in a prospective and randomised design the efficacy and safety of the calcium antagonist Nifedipine with the ?mimetic Isoxsuprine. 81.25% of patients receiving Nifedipine and 70% of those receiving Isoxsuprine achieved successful tocolysis. The mean prolongation of pregnancy with Nifedipine was 25?19.85 days and with Isoxsuprine it was 19.18?17.82 days. Maternal side effects were similar in both groups with hypotension and tachycardia being the commonest. Discontinuation rates were also similar with pulmonary oedema and severe hypotension being the reasons for foregoing tocolysis. It can be concluded that Nifedipine is a safe and effective alternative to Isoxsuprine for suppressing preterm labour. Key words: Nifedipine, Isoxsuprine, tocolysis, efficacy.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.