Browsing by Author "Thapa, Meena"
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Publication Abruptio Placenta among Pregnant Women Admitted to the Department of Obstetrics and Gynaecology in a Tertiary Care Centre: A Descriptive Cross-sectional Study(Nepal Medical Association, 2022) Maharjan, Sujata; Thapa, Meena; Chaudhary, Babita; Shakya, SubijAbstract Introduction: Abruptio placenta is the complete or partial separation of the normally implanted placenta before delivery of the foetus. It is one of the commonest causes of antepartum haemorrhage affecting maternal and foetal outcomes. Early detection and timely intervention of abruptio placenta in daily clinical practice are important to improve maternal and perinatal outcomes. The objective of the study was to find out the prevalence of abruptio placenta among the pregnant women admitted to the Department of Obstetrics and Gynaecology in a tertiary care centre. Methods: A descriptive cross-sectional study was done among the pregnant women admitted to the Department of Obstetrics and Gynaecology in a tertiary care centre where data from medical records was taken from 1 January, 2021 to 31 December, 2021 after taking ethical approval from the Institutional Review Committee (Reference number: 1102202208). Demographic details of the patients including age and parity were recorded. Convenience sampling was done. Point estimate and 95% Confidence Interval were calculated. Results: Out of 1514 deliveries, abruptio placenta was seen in 10 (0.66%) (0.25-1.07, 95% Confidence Interval) cases. Conclusions: The prevalence of abruptio placenta among pregnancies was similar to the studies done in similar settings.Publication Down Syndrome Screening among Pregnant Women Visiting the Department of Obstetrics and Gynaecology of a Tertiary Care Centre(Nepal Medical Association, 2023) Sharma, Jyotshna; Thapa, Meena; Yadav, Ranjana; Shrestha, DiptyAbstract Introduction: The screening of Down’s syndrome by the measurement of serum markers using dual and quadruple tests in the second trimester is done among obstetric patients between 13 to 22 weeks of gestation. The test readings are signified in terms of low-risk or high-risk. The aim of this study was to find out the prevalence of Downs syndrome screening among pregnant women visiting the Department of Obstetrics and Gynaecology of a tertiary care centre. Methods: A descriptive cross-sectional study was conducted from 15 April 2022 to 15 December 2022 among patients visiting the Department of Obstetrics and Gynecology of a tertiary care centre. Ethical approval was taken from the Institutional Review Committee. Women with a singleton pregnancy who underwent dual and quadruple screening tests at 11 to 22 weeks of gestation were taken and analysed as per reports. Convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Results: Among 268 women, Down syndrome screening was done in 200 (74.63%) (69.42-79.84, 95% Confidence Interval). Among them, 168 (84%) had a low risk for Down syndrome, and 32 (16%) had a high risk for Down syndrome. Conclusions: The prevalence of Downs syndrome screening among pregnant women visiting the Department of Obstetrics and Gynecology of a tertiary care centre was found to be similar to other studies done in similar settings.Publication Dysmenorrhea among Nursing Staff in a Tertiary Care Center: A Descriptive Cross-sectional Study Authors(Nepal Medical Association, 2021) Pokhrel, Manoj; Thapa, MeenaAbstract: Introduction: Menstrual disorders are problems faced by women in their reproductive period, which affects their day-to-day activities and the quality of life and sometimes can be an indicator of serious pathology. There are various types of menstrual disorders with dysmenorrhea being the commonest and most distressing. Health, sense of wellbeing and quality of life can be improved because of early detection and treatment for these disorders. The study aimed to find out the prevalence of dysmenorrhea among the nursing staff of a tertiary care center. Methods: A descriptive cross-sectional study was carried out from September 2020 to November 2020 among the nursing staff of a tertiary care hospital. Ethical approval was taken from the Institutional review committee of Kathmandu Medical College and Teaching Hospital (reference number: 1709202003). A convenient sampling technique was used. A pre-structured questionnaire was used for data collection. The subjects were asked to fill the questionnaire anonymously after taking consent. Statistical analysis was done using the Statistical Package for the Social Sciences. Point estimate at 95% Confidence Interval was calculated along with frequency and percentage for binary data. Results: Out of 212 participants, 165 (77.8%) (95% Confidence Interval = 72.21-83.39) participants reported pain during menstruation. Of which, 61 (36.97%) participants reported abdominal pain. Conclusions: The prevalence of dysmenorrhea was high among the nursing staff of a tertiary care centre which was similar to the findings of other studies done in similar settings.Publication Intra-abdominal Adhesions among Patients Undergoing Repeat Caesarean Section in Department of Obstetrics and Gynaecology of a Tertiary Care Centre: A Descriptive Cross-sectional Study(Nepal Medical Association, 2022) Pokhrel, Manoj; Sherpa, Lakpa Dolma; Thapa, Meena; Sharma, JyotshnaAbstract Introduction: Adhesions are one of the common complications encountered after caesarean section whose risk increases with the number of caesarean deliveries. This study aimed to find out the prevalence of intra-abdominal adhesions among patients undergoing repeat caesarean section in a tertiary care centre. Methods: A descriptive cross-sectional study was conducted on 74 pregnant women undergoing repeat caesarean section in the Department of Obstetrics and Gynaecology of a tertiary care centre from July, 2021 to December, 2021 after receiving the ethical approval from the Institutional Review Committee (Reference number: 2107202103). Pregnant women who met the eligibility criteria were included in the study. Convenience sampling was done. The severity of the adhesions was classified using the Tulandi and Lyell classification. Data were analysed using the Statistical Package for the Social Sciences version 26.0 software. Point estimate at 90% Confidence Interval was calculated along with frequency and percentage for binary data along with mean and standard deviation for continuous data. Results: Out of 74 women undergoing repeat caesarean section, 55 (74.32%) (65.99-82.65 at 90% Confidence Interval) had developed intra-abdominal adhesions. Conclusions: Our study showed that the prevalence of intra-abdominal adhesions among patients undergoing repeat caesarean section was higher when compared to similar studies conducted in similar settings.Publication Nulligravida with Large Uterine Leiomyoma: A Case Report(Nepal Medical Association, 2022) Maharjan, Sujata; Thapa, Meena; Pokhrel, ManojAbstract Uterine leiomyoma is the most common benign tumour of the female reproductive tract originating from the uterine smooth muscle causing morbidity and impairing their quality of life. It is common among women in the age group 30 to 50 years of age. Women are usually asymptomatic or may present with various symptoms such as abnormal uterine bleeding, pelvic pain, dysmenorrhea, and change in bowel and bladder habits due to pressure symptoms. It is one of the leading causes of hysterectomy. Women with uterine leiomyoma can be managed medically and surgically. Gonadotropin-releasing hormone analogue is one of the modalities used preoperatively to reduce the size of large uterine fibroid. We present the case report of a 36-year-old nulligravida who underwent total abdominal hysterectomy with bilateral salpingectomy for large uterine leiomyoma weighing 5.61 kg without compression symptoms. She received a gonadotropin-releasing hormone agonist (injection leuprolide) preoperatively for reduction of the size of uterine myoma.Publication Prevalence of Polycystic Ovarian Syndrome among Medical Students of a Tertiary Care Hospital(Nepal Medical Association, 2020) KC, Shreeyanta; Shah, Rakesh Kumar; Singh, Avilasha; Prasai, Astha; Bhandari, Birat; Aryal, Saman; Khatri, Asmita; Thapa, MeenaAbstract Introduction: Polycystic ovarian syndrome is considered to be one of the most common endocrine disorders among women of reproductive age. Characterized by a triad of androgen excess, anovulation, infertility, and obesity the disease can lead to several complications like infertility, endometrial carcinoma. This study aims to find out its prevalence among female medical undergraduates. Methods: A descriptive cross-sectional study was conducted among female undergraduate medical students in a tertiary care hospital from 1st to 7th February 2018. Ethical approval was taken from the Institutional Review Committee (reference number 10012018). The sample size was calculated. Systematic random sampling was done. Statistical Package for the Social Sciences version 20.0 was used. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Out of 381 participants, the prevalence of polycystic ovarian syndrome was found to be 35 (9.18%) at 95% Confidence Interval (6.28-12.08). Eighty (20.99%) participants were reported to have prolonged menses, 28 (7.34%) tended to grow dark, coarse hair, 79 (20.73%) reported being obese or overweight, and milky discharge from nipple was present in 4 (1.049%). Conclusions: The prevalence of polycystic ovarian syndrome was found to be similar to other studies conducted in similar settings. But still, it is a growing endocrinological problem in the females of the reproductive age group. Early screening is necessary to prevent lifelong complications. Keywords: polycystic ovarian syndrome, medical students, NepalPublication Ruptured Cesarean Scar Pregnancy: A Case Report(Nepal Medical Association, 2019) Shah, Prishita; Manandhar, Rosina; Thapa, Meena; Saha, RachanaAbstract Cesarean scar pregnancy is a rare variant of ectopic pregnancy where the fertilized ovum gets implanted in the myometrium of the previous cesarean scar. The incidence of CSP among ectopic pregnancies is 6.1% and it is seen in approximately 1 in 2000 normal pregnancies.As trophoblastic invasion of the myometrium can result in uterine rupture and catastrophic hemorrhage termination of pregnancy is the treatment of choice if diagnosed in the first trimester. Expectant treatment has a poor prognosis and may lead to uterine rupture which may require hysterectomy and subsequent loss of fertility. We present a case report of a 24year old femaleG2P1L1with ruptured cesarean scar pregnancy who underwent emergency laparotomy and subsequently hysterectomy. In this case report, we aim to discuss ruptured cesarean scar pregnancy as obstetric emergency and methods by which we can make an early diagnosis that can be managed appropriately as to prevent maternal morbidity and mortality. Keywords: Cesarean; Hysterectomy; Maternal mortality; Pregnancy; Scar; Uterine rupture.Publication Scar Pregnancy a Diagnostic Conundrum: A Case Report(Nepal Medical Association, 2021) Pokhrel, Manoj; Acharya, Shreedhar Prasad; Sharma, Jyotshna; Thapa, MeenaAbstract: Cesarean scar pregnancy is a rare form of ectopic pregnancy which may lead to uterine rupture and catastrophic hemorrhage. We report a case of cesarean scar pregnancy in a 35-year-old female with the past history of cesarean section presented with complaints of amenorrhoea for 6 weeks and non-specific pain. Two Transvaginal sonography was done 48 hours apart which suggested a cesarean scar pregnancy in one and cervical pregnancy on the other. Magnetic Resonace Imaging showed a well-defined cystic lesion of (21x19)mm2 embedded within the previous cesarean scar which confirmed the diagnosis of cesarean scar pregnancy. Laparotomy unveiled uterus around 6 weeks size and a (3x3)cm2 bulge was noted at the site of previous scar in lower uterine segment, where a small incision was given and the gestational sac was removed following which the uterine incision was closed with 2-0 polyglactin suture. High index of suspicion and prompt diagnosis is ofparamount for reducing morbidity and mortality.Publication Severe Birth Asphyxia without Sequelae: A Case Report(Nepal Medical Association, 2019) Dahal, Sujata; Lama, Roshan; Lohala, Nita; Simkhada, Prashant; Thapa, Meena; Manandhar, Sunil RajaAbstract Perinatal asphyxia is one of the major causes of neonatal morbidity and mortality. It mainly causes neurodevelopmental delay leading to hypoxic-ischemic encephalopathy. We present here the case of a preterm male baby of 1670 grams born at 31+3 weeks of gestation delivered by 25-year-old primi mother through vaginal delivery with history of umbilical cord prolapse. At birth, the baby had no heart rate and cyanosed following which he was resuscitated according to the Neonatal Advanced Life Support 2015 guidelines protocol. After 5 minutes of neonatal resuscitation, the baby’s heart rate reappeared, but was only upto 20 beats/min and resuscitation thus continued. But heart rate did not improve despite of using all form of resuscitation procedure including intubation and drugs. After 2 hours, baby cried spontaneously and later baby was managed in Neonatal Intensive Care Unit according to the neonatal unit protocol of the hospital. Keywords: birth asphyxia; cord prolapse; hypoxic ischemic encephalopathy.Publication Toxic Epidermal Necrolysis A Diagnostic Dilemma in Puerperium: A Case Report(Nepal Medical Association, 2019) Mahto, Vidya; Thapa, Meena; Padhye, SaraswotiAbstract Toxic epidermal necrolysis is a potentially life threatening dermatologic disorder characterized by widespread erythema, necrosis and bullas, detachment of epidermis and mucous membrane resulting in exfoliation, possible sepsis and even death. This is the first case report in Nepal of toxic epidermal necrolysis in puerperium. We present a case of a 28-years-old, P1L1 on fourth postoperative day following emergency lower segment caesarean section for cephalopelvic disproportion in latent phase of labour with uneventful antenatal period. She developed fever followed by rashes all over the body with hypotension, tachypnea and shortness of breath. Initially, she was diagnosed as a case of septic shock and transferred to intensive care unit from postnatal ward. She was managed with broad spectrum antibiotics and inotropes. Later on, it was found to be the case of Toxic epidermal necrolysis and managed with vancomycin and corticosteroids under the supervision of gynecology, dermatology and medicine team. Keywords: puerperium; toxic epidermal necrolysis; vancomycin.