ObjectivesStillbirth is one of the vital indicators of quality care. This study aimed to determine maternal-fetal characteristics and causes of stillbirth in Nepal.DesignSecondary analysis of single-centred registry-based surveillance data.SettingThe study was conducted at the Department of Obstetrics and Gynecology, Chitwan Medical College Teaching Hospital, a tertiary care hospital located in Bharatpur, Nepal.ParticipantsAll deliveries of intrauterine fetal death, at or beyond 22 weeks’ period of gestation and/or birth weight of 500 g or more, conducted between 16 July 2017 and 15 July 2019 were included in the study.Main outcome measuresThe primary outcome measure of this study was stillbirth, and the secondary outcome measures were maternal and fetal characteristics and cause of stillbirth.ResultsOut of 5282 institutional deliveries conducted over 2 years, 79 (1.5%) were stillbirths, which gives the stillbirth rate of 15 per 1000 births. Of them, the majority (75; 94.9%) were vaginal delivery and only four (5.1%) were caesarean section (p<0.0001). The proportion of the macerated type of stillbirth was more than that of the fresh type (58.2% vs 41.8%; p=0.13). Only half of the mothers who experienced stillbirth had received antenatal care. While the cause of fetal death was unknown in one-third of cases (31.6%; 25/79), among likely causes, the most common was maternal hypertension (29.1%), followed by intrauterine infection (8.9%) and fetal malpresentation (7.6%). Four out of 79 stillbirths (5%) had a birth defect.ConclusionHigh rate of stillbirths in Nepal could be due to the lack of quality antenatal care. The country’s health systems should be strengthened so that pregnancy-related risks such as maternal hypertension and infections are identified early on. Upgrading mothers’ hygiene and health awareness is equally crucial in reducing fetal deaths in low-resource settings.
Background: Caesarean section rates have globally risen above the levels that can be considered medically necessary. The aim of the study is to analyze the rate and indications of caesarean sections for primigravidae in the period 2016 to 2018 at a tertiary care hospital in Delhi.Methods: It is a retrospective observational study conducted in the Department of Obstetrics and Gynaecology at PGIMER and Dr RML Hospital, New Delhi. A total of 552 caesarean deliveries in primigravidae were studied.Results: The total deliveries during the study period were 3346 and the total caesarean section rate observed was 30.66%. The caesarean section rate among primigravidae was 29.1%. The rate of caesarean section in primigravidae rose from 22.7% in 2016 to 39.3% in 2018 with 17% increase. Majority of them belonged to the age group 20-30 years (79.34%) and 2.53% were elderly primigravidae. Out of the total number of primigravidae caesarean deliveries, 67.2% were performed in emergency and 32.7% were performed electively. Among the emergency caesarean sections performed, 64% of patients had induced labor and 22% had spontaneous labor. The most common indication of caesarean section was fetal distress (19.77%) followed by arrest of labor (17.87%) and malpresentations (8.9%). The short-term caesarean morbidity rate was 25.4% including one mortality. Wound infection was the most common complication.Conclusions: Various reasons like changing maternal risk profile increased IVF pregnancies, scientific advances, personal choice and medico legal considerations have been cited for increased caesarean rate. Following evidence-based labor protocols, judicious use of cardiotocography, proper patient selection for labor induction and patient education will contribute in reduction of caesarean sections and related complications.
The imperforated hymen is one of the commonest genital tract malformations usually present with cyclic abdominal pain and an obstructive pelvic mass at post-pubertal age. The unusual presentations are delayed menarche with obstructive symptoms rarely acute retention of urine, tenesmus, and constipation. We report an unusual case of 12- year old girl with a huge mass in the lower abdomen examination revealed imperforate hymen at early pubertal age. Further investigation of Magnetic Resonance Imaging (MRI) confirmed hematocolpometra. Then, she underwent simple hymenotomy and drainage of collected menstrual blood from the genital tract. She recovered well during the postoperative periods. We conformed normal menstrual flow at her first follow-up. In conclusion, Imperforate hymen at peripubertal age with an unusual huge abdominopelvic mass concerns further imaging to assure the best outcome.
Background: There is no general consensus about the role of routine HPE of the obtained tissue at the time of uterine evacuation. However, it is understood clinically that it is of utmost importance to prove the presence of intrauterine gestation and to exclude gestational trophoblastic disease in the form of partial or complete mole. This study aimed to assess the role of histopathology in cases of first trimester miscarriages and to determine clinical relevance of histopathological examination following surgical evacuation. Methods: This was a retrospective study of collected data over 12 months (January 2018- December 2018) in an agency for reproductive health setup with predefined inclusion criteria. We included 60 consecutive patients attended with history of first trimester bleeding. Patient’s record and the histopathological examination report of products of conception following uterine evacuation were observed. The data was analyzed descriptive statistics including percentage, stander deviation, mean, and range in Microsoft Excel software. Results: Missed abortion was the most common type and constituted 55% of the studied group. The histopathological reports confirmed the pregnancy in all patients and revealed partial mole in 6(10%) patients and complete mole in 2(3.33%) patients. Conclusions: Histopathological examination of products of conception detects under diagnosed molar pregnancies that necessitates special follow up and is a key step to do further management.
Background: Labor induction is one of the most common Obstetrics interventions worldwide. It has got significant risks and benefits. Careful selection of cases for induction improves the fetomaternal outcomes. So, the study was designed to assess the fetomaternal outcome and factors associated with mode of delivery following the induction of labor. Methods: It was a descriptive observational study conducted in the department of Obstetrics and Gynecology from July 17, 2018, to July 16, 2019. The study comprised of 264 mothers admitted in the labor ward subjected to labor induction as clinical management of labor and delivery. Data analyzed with chi-square test and one-way analysis of variance (ANOVA) wherever appropriate. Results: Of 2950 deliveries, the induction rate was 8.94%. Out of them, 264 mothers undergone labor induction. A caesarean was the highly associated mode of deliveries 168(63.63%) due to induction failure 94(55.97%) followed by fetal distress 37(22%). The mean birth weight of neonates was 3.09±0.41 kg. Apgar score in one minute and hospital stay showed a significant difference (p-value .002), in modes of deliveries. No significant association was observed in maternal and fetal complications like PPH, endometritis, and low Apgar score <7 in five minutes. The majority of neonates admitted for observation at the care unit. The neonatal mortality was two. Conclusions: Caesarean mode of delivery highly was associated with labor induction due to induction failure and fetal distress. Carefully selected cases improve morbidity and fetomaternal outcomes following labor induction.
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