Browsing by Author "Saha, R"
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Publication B-Lynch brace suture simple surgical technique for managing post- partum haemorrhage - Report of three cases(Kathmandu University, 2005) Saha, R; Sharma, M; Karki, C; Pande, SPost-partum haemorrhage is a major contributor to maternal morbidity and mortality. Numerous medical and surgical therapies have been used but none has been uniformly successful. Three cases which were managed successfully with brace suture following failure of medical management for post-partum haemorrhage are being presented. The ease and usefulness of this procedure as a life saving measure, its relative safety and its capacity for preserving the uterus and thus fertility is high lighted. Keywords: post-partum haemorrhage, B – Lynch Brace Suture & maternal mortality.Publication Comprehensive abortion care service at Kathmandu Medical College – An experience(Kathmandu University, 2005) Pande, S; Sharma, M; Saha, R; Thapa, M; Shrestha, N; Regmi, DIntroduction: His Majesty’s Government amended the Nepal Criminal Code (Muluki Ain) – for Liberalising abortion law in the month of Chaitra 2058 (March 2002) and Royal Assent was given on 10th Asoj 2059 (27 th September 2002). Accordingly Comprehensive Abortion Care (CAC) Services was initiated in the country. Kathmandu Medical College after enlisting with Ministry of Health started this service from June 2004. Objective: This study was carried out to know- 1. Reasons for undergoing CAC service. 2. The complications after the CAC services. 3. The various contraceptive methods adopted by the client following CAC Methodology: Hospital based prospective study was carried out in Department of Obstetrics & Gynaecology at KMCTH from the period July 2004 to April 2005. Total 160 patients who asked for CAC were enrolled in the study. Counselling, history taking and general examination and per vaginal examination was carried out at the visit. CAC was performed with premedication with Doxycycline 100 mg and Ibuprofen 400 mg half an hour before the procedure. Paracervical block was also given with 1% xylocaine. MVA was performed as described in standard techniques. Patient was discharged after 1 – 2 hours of observation and with contraception opted by the clients. Results: • Main reason for performing CAC was unwanted pregnancy in 66.75%. • Complication following CAC was 1.25%. • Post CAC contraception was adopted by 93%. Most preferred method was Inj. Depoprovera Conclusion: The reason for CAC service asked by the patients was unwanted pregnancy. CAC service performed had minimal complication and also gave the opportunity for contraception. Key words: Comprehensive Abortion Care, Contraception, Safe Abortion.Publication Correlation of cervical cytology with cervical histology(Kathmandu University, 2005) Saha, R; Thapa, MObjective: To correlate cervical cytology with Cervical histology. Methodology: A hospital based prospective study was carried out in consecutive total forty-three patient attending oncology clinic of Kathmandu Medical College Teaching Hospital, Sinamangal, Nepal from 1st Bhadra 2061 to end of Falgun 2061 (18 th August 2004 - 12 th February 2005) during authors posting in this clinic. All patients who underwent cervical biopsy on either indication of clinically suspected lesions or abnormal cytology were correlated with Pap smear report. Pap smear was carried out in conventional technique using Ayre’s spatula. Cervical biopsy was carried out with help of punch biopsy forceps in operation Theatre without the guidance of colposcopy. All pertinent information regarding patient profile in terms of their age, parity, age at marriage, age at 1 st child birth, smoking habit, contraceptive use, and symptom of vaginal discharge was taken. Reports of Pap smear and cervical biopsy of these patients were collected from oncology clinic during their follow up visit and all these information and finding were entered in structured questionnaire. The reporting of Pap smear was done in Bethesda system. The average duration between performing Pap smear and biopsy was of one month. Statistical analysis was carried out by EPI – INFOS6 system. Result: Of forty three patients who underwent cervical cytology 22 cases were of Benign lesion, 8 cases of LSIL, 9 cases of HSIL, 3 cases of invasive carcinoma and 1 of ASCUS. Sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy and p-value in benign grade was 76%, 83.3%, 86.4%, 71.4%, 79.1%, 0.0004 respectively. Similarly sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy and p-value in LSIL was 60%, 93.9%, 75%, 88.6%, 86%,0 .0008 respectively. For HSIL it was 100%, 89.5%, 55.6%, 100%, 90.7 0.0001 respectively. Respectively for carcinoma it was 100% for sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy p-value was0 .00008. Conclusion: Pap smear significantly correlated with cervical histology. Key Words: Pap Smear, Histology, Correlation.Publication Hysterectomy: an analysis of perioperative and post operative complication(Kathmandu University, 2003) Saha, R; Sharma, M; Padhye, S; Karki, U; Pandey, S; Thapa, JObjective : To document peri operative and post operative complication observed after hysterectomy, regardless of route on the operator. Material and methods: A hospital based prospective study was carried out in department of obstetrics and gynaecology, KMCTH Sinamangal for six months. The study was carried out in patients undergoing hysterectomy who were followed from the time of admission to the time of discharge and two weeks thereafter. And followings were noted-Indication; route of hysterectomy, intraoperative and postoperative morbidities during hospital stay and after two weeks of discharge was noted. Result: Total number of hysterectomy carried out was 50. 31(62%) were Total abdominal hysterectomy, and 19(38%) were vaginal hysterectomy. Indication for total abdominal hysterectomy were fibroid uterus 12(24%), DUB 8 (16%), CIN 4(8%), chronic cervicitis 1 (2%). II U-V prolapse with previous LSCS 1 (2%), endometriosis 1(2%). Prophylactic for Ca breast 1(2%), Postmenopausal bleeding 1(2%). All cases of vaginal hysterectomy were performed for 2nd degree U-V prolapse. Intra operative complication during surgery were two cases of haemorrhage (4%) each in both total abdominal hysterectomy and vaginal hysterectomy. There was one case of bladder injury during abdominal hysterectomy. Postoperative complication noted were febrile morbidity 1(2%) in abdominal hysterectomy. Urinary tract infection remains the single most common febrile morbidity. There was one case of secondary haemorrhage in both type of hysterectomy. One was managed conservatively and other required laprotomy. There were three(6%) cases of wound infection in abdominal hysterectomy of two which were sanguineous discharge and one was frank pus which required secondary suture.Publication Near miss maternal morbidity and maternal mortality at Kathmandu Medical College Teaching Hospital(Kathmandu University, 2010) Shrestha, NS; Saha, R; Karki, CAbstract Background: Maternal mortality traditionally has been the indicator of maternal health all over the world. More recently review of the cases with near miss obstetric events has been found to be useful to investigate maternal mortality. Cases of near- miss are those in which women present with potentially fatal complication during pregnancy, delivery or the puerperium, and survives merely by chance or by good hospital care. Objectives: The objective of this study is to determine the prevalence and nature of near miss obstetric cases and maternal deaths at Kathmandu Medical College Teaching Hospital. Material and methods: This was a descriptive study done for the period of 24 months (1 January 2008 to 31 December 2009). Cases of severe obstetric morbidity were identified during daily morning meetings. All the cases were followed during their hospital stay till their discharge or death. Five factor scoring system was used to identify the near miss cases from all the severe obstetric morbidity. For each case of maternal death, data were collected from records of maternal death audit. Results: During the study period, 1562 women delivered at the institution and 36 women were identified as near-miss obstetrical cases. The prevalence of near miss case in this study was 2.3%. Five maternal deaths occurred during this period, resulting in a ratio of maternal death of 324 maternal deaths per 100,000 live births. Of the five maternal deaths three were due to pregnancy complicated with hepatitis E infection, one each due to Eclampsia and amniotic fluid embolism. Fifteen cases of near miss were due to haemorrhage (41.66%) and hypertensive disorder of the pregnancy was the cause in 10 (27.77%). Dystocia was the cause in 1(2.77%) case and infections in 7(19.4%) cases. Rare causes like anaesthetic complications were the cause in one case and dilated cardiomyopathy was the cause in two cases. Conclusion: The major causes of near-miss cases were similar to the causes of maternal mortality of Nepal. Need for the development of an effective audit system for maternal care which includes both near-miss obstetric morbidity and mortality is felt. Key words: Near-miss obstetric morbidity, Maternal mortality, Five factor scoring systemPublication Patients choice for method of early abortion among comprehensive abortion care (CAC) clients at Kathmandu Medical College Teaching Hospital (KMCTH)(Kathmandu University, 2007) Saha, R; Shrestha, NS; Koirala, B; Kandel, P; Shrestha, SObjective: The over all objective of the study was to determine different methods of abortion opted by CAC clients at KMCTH. The specific objective of the study was to know the reasons for pregnancy termination and to know the reasons opted for either medical or surgical method of abortion. Methodology: A hospital based prospective study was carried out for a period of six months at KMCTH from 1 st January 2006 to 31 st June 2006. All the patient undergoing CAC services were included for the study. Clients were provided with written and verbal information regarding the methods of terminating early abortion and its associated complications. After that they were asked to give their informed choice and decision. All the pertinent information was entered on pre-structured questionnaire. Results: During the study period a total of 100 patients underwent CAC services. The commonest reason for termination pregnancy was no desire for additional children (60%) followed by youngest child too small or short spacing (21%). 74% of the patients opted for surgical abortion, 23% patient opted for medical abortion and 3% of the patient remain undecided. Reasons for favouring surgical method of abortion was that surgical abortion is complete (35), repeated visits are avoided (18), quick (10) would be with service provider and feel safe (5), lack of expectancy (2) side effect of medical treatment (1), twin pregnancy (1), easy (1), fear of pain (1). Medical method of abortion was favoured due to fear of surgery (9), easy and less painful (8) and maintains privacy (6). Conclusion: Factors affecting the choice of abortion method appear to be numerous and complex. Providers need to be sensitive to differences in women’s values and life circumstances when counselling them about an abortion method. In particular, providers should incorporate into their counselling sessions what women need to know about the characteristics of abortion methods and help women to identify what is the best option for them. Key words: Early abortion medical methods, surgical methods, choicePublication Perimortem caesarean delivery (PMCD)(Kathmandu University, 2007) Saha, RABSTRACT When a woman in late pregnancy has cardiac arrest and resuscitation fails, should an attempt be made to deliver the baby by Caesarean section? Many obstetricians would hesitate to operate in these circumstances for fear of delivery a baby who survives but shows profound neurological handicap. Obstetricians need to have a clear view on whether and when to operate in such cases. Here we report two cases of PMCD.