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Methods:A hospital based prospective observational study was conducted in Tribhuvan University Teaching Hospital (TUTH) over a period of 18 months. All patients diagnosed with PRAKI were included in the study. Patient profiles in terms of age, parity, gestational age were studied along with time of occurrence of PRAKI, preceding event, etiology, management and maternal outcome. Descriptive and univariate analyses were conducted and qualitative variables were expressed as percentages while quantitative variables as means.Results: There were fifteen cases of PRAKI during the study period with incidence of 2.1 per 1000 deliveries. The average age was 25.23± 3.8 years and 9(60%) were primipara. Fourteen (93.3%) developed PRAKI in the postpartum period with 10(66.6%) cases following Lower Segment Caesarian Section (LSCS). The commonest etiology of PRAKI was severe preeclampsia/ Hemolysis, Elevated Liver enzymes, Low Platelet (HELLP) syndrome and pregnancy hemorrhages each consisting 4(26.6%) cases. The stage of Acute Kidney Injury (AKI) according to RIFLE (Risk, Injury, Failure, Loss, ESRD-End Stage Renal Disease) criteria was as follows: risk in 1(6.6%), injury in 3(20%) and failure in 11(73.3%) cases. Hemodialysis was necessary in 12(80%) cases while 3 cases (20%) improved with medical management only. The average duration of hospital stay was 25.2±14.7 days and 7(46.6%) needed ICU admission. Twelve (80%) cases recovered completely while two patients were dialysis dependent at the time of evaluation. There was one death.Conclusions: PRAKI occurred mainly in the postpartum period with severe preeclampsia/HELLP syndrome and hemorrhages as the most common causes. It is associated with high maternal morbidity, prolonged hospital stay and even mortality. Multidisciplinary team management is essential.
The Bombay blood group is a rare blood type with an incidence of around one in a million. There is no known reported case of an obstetric patient with the Bombay blood group from Nepal. People with this rare blood group can receive blood only from those with the same blood type. We report an elderly gravida with the Bombay blood group who had a pregnancy complicated by diabetes, placenta previa, and transverse lie (back up) following an in vitro fertilization. Placenta previa posed a greater risk of hemorrhage and hence the need for transfusion. The main challenge was arranging blood for transfusion, and as the Bombay blood group was unavailable, she was managed with autologous blood transfusion which was performed for the first time in a pregnant lady in our institute. She underwent Cesarean section for placenta previa with transverse lie, and both mother and baby were sent home in good health.
Aims: The aim of this study was to analyze the non-reproductive risk factors associated with uterovaginal prolapse (UVP) which is a major health concern of women.Methods: This was a hospital-based case control study, carried out in the Gynaecology Department of Tribhuvan University Teaching Hospital (TUTH) over one year from 13th April 2011 to 12th April 2012). Cases comprised of 116 women with UVP, second degree or more and controls were women without prolapse of the same age group within five years admitted subsequently after the cases. The variables studied were medical disorders like chronic obstructive pulmonary disease (COPD)/chronic cough, constipation; smoking, family history of prolapse and body mass index (BMI). The p-value and odds ratio (OR) for each risk factor were calculated. Multivariate analysis was done for those risk factors found to be significant from the univariate analysis. Results: Smoking, family history of prolapse and low BMI were found to be significant risk factors from univariate analysis. Only two risk factors- family history of prolapse with OR 5.52 (2.11-14.49) and being underweight with OR 15.38 (1.88-125), were found to be significant by multivariate analysis.Conclusion: Providing good nutrition and preventing malnourishment in postmenopausal women, imparting awareness about increased risk in women with history of prolapse in first degree relatives and educating about the perils of smoking could contribute in reducing morbidity due to prolapse.
Introduction: Over the last few decades, the rise in the rates of Caesarean Sections (CS) has become a global phenomenon. The objective of this study was to follow the CS rates over the last 10 years and to compute the various indications of CS in an attempt to analyze the possible reasons for this changing trend in the institute. Result: A total of 38,770 deliveries were conducted over ten years with 26,791 (69.10%) vaginal deliveries and 11,979 (24.80%) CS. There was a steep rise in the rates of CS from 21.04% in 2004 to 39.23% in 2014. Rates of instrumental deliveries and VBAC remained low at 0.86% to 3.35% and 0.15% to 0.7 % respectively. Fetal distress was the commonest indication of emergency CS while previous CS was the commonest indication for elective CS. Conclusion:Over the last decade, the global trend of rising CS rates was also found to be mirrored at TUTH. The causes for rise in CS rates were-increased diagnosis of fetal distress and oligohydramnios, delivery of most breech by Caesarean sections, low rates of VBAC and instrumental deliveries, complicated referrals from all over the country and last but not the least, threat of malpractice litigations.
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