Browsing by Author "Shrestha, NS"
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Publication Accuracy of Prediction of Birth Weight by Fetal Ultrasound(Kathmandu university, 2012) Bajracharya, J; Shrestha, NS; Karki, CABSTRACT Background Accurate determination of fetal weight prior to delivery can have a significant bearing on the management decision in labour, thereby markedly improving perinatal outcome. Objective To determine the accuracy of prediction of birth weight by fetal ultrasound. Methods This is the retrospective observational hospital based study done at Kathmandu medical college teaching hospital, Sinamangal, Kathmandu from January 2010 to February 2012. Total 150 women with full term singleton pregnancy leading to live birth were included in this study. Prenatal fetal ultrasound database was reviewed for fetal weight estimation. Delivery records were reviewed for actual birth weight. Error in estimation was calculated. Results Our study showed that fetal ultrasound using Hadlock’s formula has error in estimation of fetal weight by about 290 gm ± 250 gm. In 40% of the cases, there is an error of estimation by more than 10% compared to actual weight. Conclusion Significant error was seen while estimating fetal weight by ultrasound. Depending only on the fetal ultrasound for the estimation of fetal weight can lead to unnecessary obstetrical intervention. It is thus necessary to correlate the ultrasound findings with clinical examination. KEY WORDS fetal weight, Hadlock’s formula, ultrasoundPublication Publication High risk nonmetastatic persistent gestational trophoblastic tumour following an abortion(Kathmandu University, 2007) Pandey, S; Shrestha, NS; Thapa, MLocally invasive non-metastatic persistent gestational trophoblastic tumours (PGTT) following a non-molar pregnancy occur very rarely. Non-metastatic tumours usually falls in low risk group in WHO scoring system based on prognostic factors. We report a case of high risk non-metastatic PGTT which followed a spontaneous first trimester abortion. Complete remission of the tumour was achieved by chemotherapy EMA-CO regimen. Key words: Persistent gestational trophoblastic tumour, Abortion, ChemotherapyPublication 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 Nuchal cord and perinatal outcome(Kathmandu University, 2007) Shrestha, NS; Singh, NObjective: to find out the incidence of nuchal cord at delivery, intrapartum complication and perinatal outcomes in the cases with nuchal cord. Materials and methods: A prospective, cross-sectional, comparative study done at Kathmandu Medical College Teaching Hospital (KMCTH) between March 2006 to September 2006. Total 512 deliveries occurred during this period that were enrolled in the study and were analyzed for presence of nuchal cord at the time of delivery, number of coils whether loose or tight, intrapartum complications and perinatal outcome. The cases with nuchal cord at the time of delivery were taken as study group and the cases without nuchal cord served as control group. Outcome variables between the two groups were compared. Outcome variables used were meconium staining of liquor, rate of instrumental and caesarean delivery, intrapartum fetal heart rate (FHR) irregularities. As a measure of perinatal outcome Apgar score < 7at 1 minute and 5 minutes and incidence of neonatal unit admission was taken. Results: Incidence of nuchal cord at the time of delivery was 22.85%. Incidence of single nuchal cord was highest (18.95%). Intrapartum complications like FHR irregularities and meconium staining of liquor were increased in nuchal cord group but statistically not significant. Instrumental delivery rate was high in nuchal cord group but statistically not significant (0.108). However, caesarean section rate was high in the group without nuchal cord (p=0.029). Apgar score < 7 at 1 minute was significantly low in nuchal cord group (p=0.010) but apgar score at 5 minutes and admission to neonatal unit was not more common. Conclusion: Nuchal cord is not associated with adverse perinatal outcome.Publication 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, choice