Obstetric fistulae is the most tragic of preventable childbirth complications in the developing world, as affected women are often abandoned by their husbands and family, and forced to live in shame. They occur almost entirely in the developing world and their incidence is poorly studied. Their management requires accurate diagnosis, sufficient pre-operative workup, fine surgery following standard surgical repair steps and principles by skilled surgeons, specialised post-op care, and follow-up. As obstetric fistula is a serious preventable public health issue in developing countries, national and international organizations should launch a campaign to end fistula by increasing the resources and skilled staff available locally to treat obstetric fistula for improving the lives of women currently living with this condition. Moreover, effective preventive strategies for obstetric fistula such as better education to women and provision of improved obstetric care and searching for the best approaches to both prevention and treatment should be the priority. The materials published in PubMed, Lancet, Medline, WHO and Google Scholar web pages from 1990 to 2013 have been utilized to prepare this paper.
In Patan Hospital, Kathmandu, 4600 single live births were analysed concerning birth weight in relation to gestational age. At term, the median birth weight of females was 2900 g and of males 3010 g. Compared with Norwegian newborns, the birthweights of Nepali babies were lower for all corresponding gestational lengths. The differences increased with gestational age. Fundal height was lower in Nepali than in Norwegian pregnant women for all periods of pregnancy. An increase in the differences between Norwegian and Nepali women was also noted. Hematocrit values of Nepali women who did not take supplementary iron, correspond well to findings in Norwegian women without iron supplementation. Only a slight degree of hemoconcentration was noted towards term. For Norwegian women with iron supplementation the hematocrit values were much higher, with a tendency towards hemoconcentration near term. In Nepal the average woman probably has small iron stores, and without iron supplementation the hematocrit values will remain low throughout the pregnancy. The high altitude does not seem to cause hemoconcentration in pregnancy to a greater extent than at lower altitude. Hemoconcentration is therefore not a major causative factor of the lower birth weights.
Objectives: To review the incidence, risk factors, indications, outcomes, and complications of emergency peripartum hysterectomy performed after cesarean section and vaginal deliveries. Study design: A nine years retrospective study of all those cases who underwent peripartum hysterectomy at Patan Hospital from the year 1997 to 2005. Results: There were total 28 cases of emergency peripartum hysterectomy, 16 caesarean hysterectomies, and 12 postpartum hysterectomies, with the incidence of 1 per 1364 deliveries. The most common indication for hysterectomy was uterine atony (35.7%) followed by uterine rupture (25%). Average estimated blood loss was 1600 ml, average time from delivery to hysterectomy was 130 minutes, the most common post operative complication was unspecified fever and the average length of hospitalization was 11.17 days. There was only one maternal mortality with 32% maternal morbidity and four perinatal mortality. Conclusion: Peripartum hysterectomy is usually associated with significant maternal and fetal morbidity and mortality yet it remains a potentially life saving procedure. Timely decision to intervene is essential for the optimum outcome. Uterine atony is the leading indication for emergency hysterectomy performed followed by rupture uterus and morbid adherent placenta. Key Words: Caesarean hysterectomy; Peripartum hysterectomy; Postpartum hysterectomy doi:10.3126/njog.v1i2.2395 N. J. Obstet. Gynaecol Vol. 1, No. 2, p. 33-36 Nov-Dec 2006
This study aims to find the incidence and outcome of caesarean wound infection in Patan Hospital, duringMarch 2002 to January 2003. We retrospectively analyzed records of patient who developed wound infectionfollowing caesarean section. Incidence of wound infection in Patan Hospital is comparatively low 2.76%.The minor wound infections (56.66%) required conservative management as an OPD basis while majorwound infections required resuturing. The wound infection is more commonly associated with color ofliqour, PROM and frequent number of vaginal examinations and emergency surgery.Key Words: Wound Infection, Caeserean Section, Nepal.
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