Browsing by Author "Rijal, H"
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Publication Evaluation of clinical profile, management and outcomes of molar pregnancy(Institute of Medicine, 2018) Rijal, HAbstract Introduction: Hydatidiform mole is benign form of gestational trophoblastic disease characterized by hydropic swelling of the chorionic villi and proliferation of the trophoblasts. The majority of Hydatidiform mole is cured by simple surgical intervention. The disease can re-occur. The patients are followed up with serial serum BhCG till the normal level is acheived.With raised, plaetue level of serum β-hCG values, persistant GTD is diagnosed. So the proper monitoring and follow up of gestational trophoblastic disease is a must. It reduces both the morbidity and mortality of the women. This study details the clinical profiles and outcome of molar pregnancy. Methods: This is an observational study conducted in Department of Obstretics and Gynaecology at Tribhuvan University Teaching Hospital from 1st May 2015 to 30th April 2017(2 years). Patients with the provisional diagnosis of molar pregnancy during the study period were included. After all required investigations, cases were managed according to the diagnosis. And were followed up with serial serum B- hCG. Further required treatment was given according the histopathological diagnosis. Results: Total 46 cases of gestational trophoblastic disease (GTD) were diagnosed and it accounted for 4.9 per 1000 deliveries. Majority of patients belonged to age group of 20-40 years, presented during second trimester with amenorrhoea and per vaginal bleeding. Among these patients 93% (n=43) had suction evacuation, 5 % (n=2) had total abdominal hystrectomy with bilateral salphingo ophorectomy (TAH BSO), 2 % (n=1) had suction evacuation and laparotomy with untwisting of twisted theca luteal cyst. Thirteen patients developed persistent gestational trohphoblastic tumour (PGTT) and six patients were diagnosed as gestational trophoblastic neoplasia (GTN) and managed with multiagent chemotherapy. Conclusions Any deviation from normal norms in pregnancy or post delivery, gestational trophoblastic disease has to be thought of. Along with proper diagnosis and management, counseling regarding follow up should also be emphasized, which not only reduces morbidity but also reduces the mortality. Keywords: Beta hCG, GTD, Choriocarcinoma, PGTTPublication Outcome Analysis of Termination of Pregnancy in Second Trimester(Kathmandu University, 2023) Rijal, H; Koirala, PABSTRACT Background Second-trimester abortions, constitute 10-15% of global annual abortions, leading to two-thirds of major abortion-related complications. Recognizing the elevated risk, the WHO recommends diverse methods for safe termination. Surgical and medical approaches, particularly using drugs like Mifepristone and Misoprostol, show promising success rates. Objective To analyze the outcomes of second-trimester termination using Mifepristone or PG analogues alone or in combination. Method This is a one-year retrospective study at Tribhuvan University Teaching Hospital analyzing second-trimester terminations, collecting data on demographics, medical history, period of gestation, doses of abotificient drugs, complications, and management. Result In a study of 66 second-trimester abortions, mean age was 28.8±4.96 years, gestational age 20.07±4.3 weeks. Mifepristone and Misoprostol combination succeeded in 66.7% of cases, while 42.2% required repeated Mifepristone doses. Misoprostol use was significantly higher in patients without medical comorbidities (p=0.018), but Mifepristone requirement didn’t differ significantly based on medical conditions. Combined Mifepristone and Misoprostol were used more for fetal indications. Notably, the use of Mifepristone and Misoprostol didn’t significantly differ for live and intrauterine fetal death cases. Conclusion Mifepristone and Misoprostol effectively terminate second-trimester pregnancies. In high-risk cases, cautious Prostaglandin use is crucial and Mifepristone alone, in divided doses, reduces complications with high success. KEY WORDS Abortion, Mifepristone, Misoprostrol, Second trimester, Termination