Journal Issue: No 1, Issue 25, JAN-MARCH, 2009
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Volume
Number
Issue Date
2009
Journal Title
Journal ISSN
1812-2027
Journal Volume
Articles
Partnerships in health research: Experiences from a developing country
(Kathmandu University, 2009) Banjara, MR
NA
Risk of neonatal hyperbilirubinemia in babies born to ‘O’ positive mothers: A prospective cohort study
(Kathmandu University, 2009) Kalakheti, BK; Singh, R; Bhatta, NK; Karki, A; Baral, N
Abstract
Introduction: Hyperbilirubinemia in a neonate is one of the most common problems that may occur in 60-70 % of term
and 80% of preterm babies. It is known to be associated with significant morbidity like neonatal bilirubin encephalopathy
and even death. Clinically, and almost exclusively ABO incompatibility occur in ‘A’ and ‘B’ blood group babies of O
‘+ve’ mothers. These babies are reported to be at high risk of severe hyperbilirubinemia (serum bilirubin level more than
16 mg/dl).
Objectives: To find out the incidence of hyperbilirubinemia in babies born to ‘O’ positive mothers. To estimate the risk of ABO
incompatibility in babies born to ‘O’ positive mothers.
Materials and methods: A prospective cohort study conducted in B. P. Koirala institute of Health Science (Department
of Pediatrics and Dept. of Gynae and Obstetric) from July 2002 to June 2003. A total of 199 women having ‘O’ positive
blood group admitted to the Department of Gynae and Obstetric were included in the study. A piloted proforma was
used to collect information. The blood group of neonates was tested by tile and slide method and serum bilirubin was
estimated by diazo method in the Central Laboratory Services and Emergency laboratory of BPKIHS. The data was
observed and analysis was carried out using statistical software SPSS-10.
Results: Total 37 (18.5%) babies had developed hyperbilirubinemia and among them 14 (38%) were from group of
babies having ‘O’ Positive blood group and 23 (62%) were from group of babies having other than ‘O’ Positive blood
group. There was 2.6 times higher chance of having hyperbilirubinemia in the babies with ABO incompatibility than ‘O’
Positive babies after adjusting other significant variables.
Conclusion: Among different significantly associated variables, ABO incompatibility was found to be a major risk
factor for neonatal hyperbilirubinemia.It was seen that neonate with ABO incompatibility had two times higher chances
of having hyperbilirubinemia than those babies with O ‘+ve’ blood group. This finding in BPKIHS suggests that there
is a need of screening cord blood bilirubin and continuous monitoring of bilirubin level in the hospital especially among
ABO incompatible neonates.
Key words: Hyperbilirubinemia, Neonatal Jaundice, ABO-incompatibility
A comparative study of early vs. delayed laparoscopic cholecystectomy in acute cholecystitis
(Kathmandu University, 2009) Yadav, RP; Adhikary, S; Agrawal, CS; Bhattarai, B; Gupta, RK; Ghimire, A
NA
Indications for labour induction and predictors for failed induction at KMCTH
(Kathmandu university, 2009) Rayamajhi, RT; Karki, C; Shrestha, N; Padhye, SM
Abstract
Objective: To study the incidence and indications for labour induction and study the predictors of failed induction.
Materials and methods: A hospital based prospective study done over a 12 month period between 1st November 2007
to 30th October 2008. Selection criteria: Singleton pregnancies beyond 37 weeks with vertex presentation and unscarred
uterus requiring induction of labour.
Results: The incidence of labour induction was 19.7%. Operative delivery was 34.6% in the study group and 27.4% in
those with spontaneous onset of labour. 74.07% of the induction group required operative delivery for failed induction
and 25.03% for foetal distress. The predominant indication for induction was post term pregnancy (51.28%) followed by
PROM (17.3%), isolated oligohydramnios (8.97%), hypertensive disorders of pregnancy (8.33%), maternal perception
of decreased foetal movements (7.69%) and others. Failed induction was higher in nulliparas (41.2%) as compared to
multiparas (23.7%). Failure rate was 53.8% when maternal age >30y and 28.2% in those <30y. Women with normal
BMI had a failure rate of 25.6% compared to 36% for overweight and 44.4% for obese women. 24.1% had failed
induction when Bishop score was >5 and 40.8% when Bishop score was <5. Between 38-41 weeks pregnancy failed
induction occurred in 28-31% while it was higher at <38 weeks and >41 weeks pregnancy. The best outcome was seen
when the birth weight was 2500-2900g (22.5% failures) while 72.7% had failed induction when the birth weight was
>3500g. The duration of induction was >24 hours in 42.6% of women and 48.2% were in the latent phase of labour when
taken for caesarean section.
Conclusion: Despite the proven benefit of induction of labour in selected cases, one must keep in mind its impact on
increasing the rates of operative delivery. Strategies for developing practice guidelines may help to prevent unwarranted
case selection and help to reduce the current high operative delivery rates.
Key words: caesarean section rate, failed induction, induction of labour.