Aims: To determine the pregnancy outcome of early and late onset preeclampsia. Methods: This was a cross sectional analytical study conducted in the department of Obstetrics and Gynaecology, Manipal Teaching Hospital from July to October 2021. All cases of preeclampsia diagnosed according to International Society of Study of Hypertension in Pregnancy 2018, were included. Early and late onset preeclampsia cut-off used was 34 weeks. Preeclampsia diagnosed before 34 were classified as early onset and after 34 weeks as late onset preeclampsia. Maternal and perinatal outcomes were analyzed using Statistical Package for Social Sciences version 21. Results: The prevalence of early onset and late onset preeclampsia were 4.3% and 8.3% of all deliveries. Early to late onset preeclampsia were 1:2. Renal involvement, placental abruption, IUGR, low birth weight, low Apgar and perinatal morbidity were significantly more in early onset; pre-term labor and use of MgSO4 and antihypertensives were also more in early onset. Conclusion: Late onset preeclampsia was more common than early onset preeclampsia but the maternal and perinatal outcome were poor for early onset as compared to late onset preeclampsia.
Introduction: Identification of high risk pregnancy can be done by using various scoring systems which is highly predictive in determining maternal and perinatal outcome. Objectives: The objectives of the study were to identify high- risk pregnancy and to compare the maternal and perinatal outcome of high-risk with low-risk pregnancies. Methodology: This study was conducted in the department of obstetrics and gynaecology, Manipal Teaching Hospital, Pokhara, from 1st August 2020 to 31st January 2021. Study included pregnant women coming for delivery after 28 weeks of gestation. Antenatal scoring system involving various risk factors, was used to stratify women as low-risk (score 0-3), high-risk (score 4-6) and extremely high-risk group ( score ≥7). All women were followed up in intrapartum and postpartum period and complications noted. Neonates were also followed up. Maternal and perinatal outcome of three groups were compared. Results: There were 67.3% women in low-risk, 20% in high-risk and 12.7% in extremely high-risk groups. Operative deliveries were 89.9% in extremely high- risk, 77.9% in high- risk as compared to 51% in low- risk group. Maternal complications, total amount of blood loss and duration of hospital stay was more in extremely high-risk and high-risk pregnancies. Low birth weight was more common in extremely high risk (60%) and high-risk (26%) pregnancies compared to low- risk pregnancies (15%). Neonates with low Apgar scores at 1 and 5 minutes were more in high-risk pregnancies. Thirty-two percent neonates in extremely high-risk pregnancy required neonatal intensive care admission which was significantly higher as compared to high-risk and low-risk pregnancies. Perinatal deaths were more frequent in extremely high-risk pregnancies. Conclusions: Identifying high risk pregnancy using scoring system is useful to identify women at risk of developing maternal and perinatal complications.
Introduction: Persistent inflammatory smear is a benign finding on pap test but is associated with premalignant lesion of the cervix. Further evaluation is therefore necessary. This study was done to determine the prevalence of cervical intraepithelial lesions in women with persistent inflammatory smear. Methods: This is descriptive observational study conducted in Department of Obstetrics and Gynaecology of tertiary care centre of Nepal from 15th May 2020 to 14th May 2021 after obtaining ethical clearance from Institutional Review Board (Reference no MEMG/IRC/338/GA). Women with two consecutive pap smear reports showing inflammatory findings were enrolled. Colposcopy was performed and Modified Reid’s colposcopic index was used to grade the lesions. Colposcopic guided biopsy was taken and tissue sent for histopathology for abnormal colposcopic lesions. Data analysis was done using Statistical Package for Social Sciences version 21 and frequency and percentages were used to present data. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Among 115 women, 57 (49.5%) at 95% Confidence Interval (40.37-58.63) had Cervical Intraepithelial lesions. Among them 48 (41.7%) had low grade intraepithelial lesions and 9 (7.8%) had high grade lesions on colposcopy. Conclusions: The prevalence of cervical intraepithelial lesions in women with persistent inflammatory smear on pap was higher in our study compared to other studies.
Liver haematoma complicating pregnancy with HELLP syndrome is a rare but life-threatening condition. Diagnosis requires a high index of suspicion. Here a case of liver haematoma is presented in a 29 years multigravida at 34 weeks of pregnancy. Initially hypertension was not revealed since she had presented in shock. She had presented with on and off epigastric pain for many days. In context of haemoperitoneum in ultrasound, emergency laparotomy was done and liver haematoma diagnosed intraoperatively. Haematoma was managed with packing and second look laparotomy was done to remove the packs. Haematoma gradually resolved over period of months.
Endometriosis is defined as the presence of the endometrium outside the uterine cavity. Around 8- 15 % of women of the reproductive age group have been affected by it. Abdominal scar endometriosis is a rare complication of the cesarean section and can be often misdiagnosed. We present a 39-year-old woman who has been complaining of pain and edema at the location of her cesarean incision for the past two years. The pain began on the first day of the menstrual cycle and only continued for the duration of the cycle. Swelling, which started as tiny but grew in size over time, was linked to pain. She had a similar background four years ago. Her vitals were stable during examination, as were her general and systemic examinations. There was a scar mark over the hypogastric region, as well as a 5 x 3 cm swelling in the left lateral angle of that scar. The swelling was tender. Scar endometriosis was seen on USG. Scar endometriosis was removed, and tissue was sent for histopathological examination. Now she is on injection Leuprolide 3.75mg intramuscular every monthly for a period of six months.We present this case as it is very rare complication and being underestimated by patient.
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