Browsing by Author "Thapa, Jwala"
Now showing 1 - 4 of 4
Results Per Page
Sort Options
Publication Diagnostic Hystero-Laparoscopy for Evaluation of Female Infertility: A Cross-sectional Study(Institute of Medicine, 2025) Maskey, Suvana; Thapa, Jwala; Adhikari, ShreePrasad; Sedhain, Nesuma; Silpakar, BhawaniAbstract Introduction Diagnostic hystero-laparoscopy has additional advantage of direct visualization of pelvic pathology along with performing therapeutic surgery at same setting, compared to other diagnostic modalities. This study aims to determine the role of diagnostic hystero-laparoscopy in evaluation of infertile women. Methods This descriptive study was conducted from April to July 2025 including women presenting with infertility and planned for diagnostic hystero-laparoscopy in department of infertility at Paropakar Maternity and Women’s Hospital. Any abnormalities detected during laparoscopy and hysteroscopy were recorded. If any therapeutic procedure was done, that was also noted. A structured proforma was used to collect data and descriptive analysis was done. Results During the study period 36 underwent diagnostic hystero-laparoscopy among which, 20 (55.55%) had primary infertility and 16 (44.44%) had secondary infertility. The mean age was 30.44±4.70 years and the mean duration of infertility was 3.76±3.71 years. The most common pathologies determined on hysteroscopy were uterine polyp and septate uterus, both being 6 in number (16.66%). On laparoscopy tubal block was noted in 22 (61.11%) women followed by pelvic adhesions which was seen in 19 (52.77%) cases. Most frequent therapeutic intervention done during laparoscopy was adhesiolysis (16, 44.44%) and during hysteroscopy were polypectomy and septal resection (6 each, 16.66%). Eleven women (30.55%) had undergone multiple procedures. Conclusion Tubal and peritoneal abnormalities were the two main factors determined on laparoscopy and most prevalent finding on hysteroscopy were uterine polyp and septate uterus. Adhesiolysis, polypectomy and septal resection were the main procedures performed.Publication Shock Index and Modified Shock Index as Predictors of Adverse Maternal Outcomes in Primary Postpartum Hemorrhage(Nepal Health Research Council, 2025) Vaidya, Sapana Amatya; Shakya, Madhu; Maharjan, Anita; Khadka, Shree Ram; Yadav, Manisha; Thapa, Jwala; Shrestha, Tripti; Sah, Aswini Kumar; Newa, Soni; Dangal, GaneshAbstract: Background: Postpartum hemorrhage is a leading cause of maternal morbidity and mortality, particularly in developing countries like Nepal. Early identification of women at risk is vital but traditional methods are sometimes subjective. Simple objective tools are of high importance in times of need. This study aimed to evaluate and compare the predictive performance of the Shock Index and Modified Shock Index for adverse maternal outcomes after primary postpartum hemorrhage. Methods: A hospital based cross sectional study was conducted at a tertiary maternity hospital in Nepal. The study included 281 women diagnosed with primary postpartum hemorrhage. Heart rate, systolic blood pressure and mean arterial pressure were recorded at 1 and 2 hours postpartum. Shock Index and MSI were calculated. The adverse maternal outcomes such as including blood transfusion, surgical interventions or intensive care unit admissions were analyzed. The predictive ability of Shock Index and Modified Shock Index was analyzed using Receiver Operating Characteristic curve analysis. Results: Both Shock Index and Modified Shock Index were significant predictors of adverse maternal outcomes. The single best predictor was identified as Shock Index as measured at 1 hour in women who underwent cesarean delivery, with an Area Under the Curve of 0.811 (95% CI: 0.754–0.868). For vaginal deliveries at 1 hour, Shock Index and Modified Shock Index performed similarly (Area Under Curve 0.777 and 0.776, respectively). Predictive ability decreased at the 2 hour mark, especially for patients post-cesarean delivery. Logistic regression confirmed that cesarean delivery and Shock Index at 1 hour were strong and independent predictors of the adverse outcomes. Conclusions: The Shock Index is a simple and effective tool for the early detection of increased risk of adverse outcomes from postpartum hemorrhage. Modified Shock Index in particular showed greater overall predictability. Its routine implementation in postpartum monitoring, primarily in low-resource settings can significantly aid the triage and facilitate early life saving interventions.Publication The Impact of Body Mass Index on Semen Parameters: A cross sectional study(Rapti Academy of Health Sciences (RAHS), 2024) Sedhain, Nesuma; Adhikari, Shree Prasad; Pradhan, Hema Kumari; Thapa, Jwala; Parajuli, RakshyaAbstract Introduction: Infertility is an emerging health issue across the world/. Obesity is another growing health concern, which is seen associated with adverse health outcomes. Several people had investigated the effects of obesity on male infertility, with inconclusive findings. Hence the present study aimed to assess the relationship between Body Mass Index (BMI) and the various parameters of semen (volume, sperm count, vitality, motility and morphology). Methods: This was a cross-sectional study involving 272 men aged 20 – 52 years. The participants were categorized into four BMI groups as underweight, normal weight, overweight, and obese. Semen samples were analyzed. In the correlation study, Spearman’s correlation was used. Independent variables were tested on the dependent variables using Analysis of Variance (ANOVA) and Multivariate Analysis of Variance (MANOVA) to find out the effects of BMI on semen parameters while controlling effects of various covariates (age, smoking and alcohol consumption, occupation, ethnicity and education). Results: Correlation analysis showed no statistically significant correlations between BMI and semen parameters. However, comparing the BMI groups revealed statistically significant differences in semen parameter (p<0.05). The normal weight, overweight and obese groups had better semen quality than underweight. Underweight men had sperm count(16±20.78 million/ml), vitality(13.6±7.09%), progressive motility(4.33±4.93%) and morphology(1.33±0.57%). The effect of BMI on semen parameters was further confirmed by MANOVA study with Wilks’ Lambda=0.802, F=3.273, p<0.05. Conclusions: Semen quality was adversely affected in underweight groups compared to other groups. Thus emphasizing importance of keeping healthy BMI in order to have a better reproductive health. Keywords: BMI, Semen parameters, Underweight.Publication Uterine Didelphys and Spontaneous Conception: A Rare Occurence(Rapti Academy of Health Sciences (RAHS), 2024) Adhikari, Shreeprasad; Thapa, JwalaAbstract: Mullerian duct anomalies refer to a set of congenital structural malformations which result from abnormal development of the paramesonephric or Mullerian ducts in utero. Mullerian abnormalities are estimated to affect 0.5-5% of the general population. A didelphys uterus, commonly known as “double uterus”, is an infrequent type of Mullerian duct anomaly. This report describes a rare case of a 25 years old primigravida who had a spontaneous conception followed by successful delivery of a healthy baby via cesarean section at 37 weeks of gestation.