Introduction: The study compared spinal anesthesia using intrathecal hyperbaric bupivacaine between height and weight adjusted dose and fi xed dose during caesarean section. Methods: A hundred parturients, who had given their consent and were scheduled for elective caesarean section under spinal anesthesia, were randomly assigned into two groups. We adjusted the intrathecal dose of heavy bupivacaine (0.5 %) according to the height and weight of patients (Group AD) from Harten’s dose chart developed from the Caucasian parturients and the fi xed dose (2.2 ml) was used in Group FD patients. Keeping the observer blinded to the study groups, the onset time to sensory block up to T5, haemodynamic changes, side effects, and fetal outcome were observed. Results: The median onset time of spinal block in Group FD was faster than in Group AD (6 min vs. 4 min; p = 0.01). The spinal block level extended above T3 level in a signifi cantly (p < 0.05) larger number of patients 12 (24 %) in Group FD than in one (2 %) patient in Group AD. A signifi cantly (p < 0.05) larger number of patients, 32, (64 %) in Group FD had hypotension than in 15 (30 %) patients in Group AD. The lowest recorded SAP (101 ± 6 mm Hg) in Group AD was higher than in Group FD (96 ± 6.7 mm Hg). Nausea and vomiting were more pronounced in Group FD patients. Conclusions: The bupivacaine dose was signifi cantly reduced on its dose adjustment for the body weight and height of patients for cesearean section. This adjusted-dose use suitably restricted spinal block level for cesarean section with a distinct advantage of less hypotension and with a similar neonatal outcome as fi xed compared with the dose use. keywords: caesarean section; low-dose hyperbaric bupivacaine; spinal anesthesia.
Aims: This study was done to observe the rate of vaginal cuff dehiscence of one minute technique of laparoscopic vault closure in laparoscopic hysterectomy.Methods: It was a descriptive study performed in Birat Hospital among 1012 patients undergoing total laparoscopic hysterectomy for both benign and malignant gynaecological conditions between 2012 to 2013. Monopolar cautery was used for laparoscopic colpotomy and vault was closed by laparoscopic single running suture, that is, one-minute laparoscopic vault closure technique. Patients were followed up for vaginal cuff dehiscence and the dehiscence rate was compared with other techniques of laparoscopic vault closure in laparoscopic hysterectomy.Results: This study showed that the rate of vaginal cuff dehiscence after one minute technique of laparoscopic vault closure in laparoscopic hysterectomy was 1/1012 patients (0.09%) which was significantly less as compared to other techniques of laparoscopic vault closure in laparoscopic hysterectomy quoted in the literature.Conclusions: One minute technique of laparoscopic vault closure after colpotomy with monopolar cautery using single running suture has encouraging results. It is a noble technique of laparoscopic vault closure with excellent support. It can be practiced in low resource setting also.
Background:Urinary incontinence is a common medical disorder. However, in the developing countries the problem is not accepted as a major health problem. Objectives: To find out the prevalence of urinary incontinence in institutionalized gynecology patients at BPKIHS and to asses the severity of incontinence and to find out its perception as health problem. Methods: All the patients aged more than 20 years and excluding pregnancy related admissions during the study period of one year (February 2005 to February 2006) were questioned with preformed questionnaire and responses were noted. All together 630 patients participated. Results: 50.6% had incontinence. Urge incontinence was more common type (60%) than stress incontinence (40%).Most of the patients did not consider it as a health problem. Conclusion: Urinary leakage is highly prevalent and should be regarded as potential health problem.
Aims: This study was done to assess the main causes of maternal mortality and other co-morbid factors contributing to maternal death at a university teaching hospital.Methods: A retrospective study was carried out in the department of Obstetrics and Gynecology analyzing all case record of maternal deaths from April 2008 to April 2011.Results: Eclampsia, unsafe abortion, puerperal sepsis, hemorrhages were the leading causes of death. Majority of the patients were unbooked. Conclusions:Eclampsia, sepsis and hemorrhage were the main causes of maternal deaths. Elderly ages, illiterate status, rural residence, presence of prior medical disease were statistically significant factors contributing to maternal death.
Ectopia cordis is a rare congenital malformation and only few cases have been reported in literature previously. It is defined as the complete or partial evisceration of heart outside the thoracic cavity through the sternal defect. Most cases are sporadic. The classical presentation for the antenatal diagnosis on ultrasonography is a pulsating heart out of the thoracic cavity with absent chest wall.We reported three cases of ectopia cordis in the last one and half year in our institute. Two of them were diagnosed on ultrasound and the third case terminated for meningocele with severe oligohydramnios had associated ectopia cordis detected after delivery. All three were admitted via out patient department for termination. The first case live at birth had isolated thoracic ectopia cordis with birth weight of 2.4 kilograms, Apgar score of 7,8,9 and was delivered by caesarean section for failed induction while the other two were still birth and had thoraco-abdominal ectopia cordis. The live baby was taken to Sahid Gangalal hospital in Kathmandu by the visitors after two days of delivery and the baby underwent surgical intervention but had an unsuccessful outcome. Regarding the management of this condition, parental counseling for pregnancy termination is advised. Though few cases of surgical interventions for ectopia cordis have been reported, mortality rate is still very high.
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