Background: Bangladesh recently became a middle income country and despite of its relatively low skilled birth attendance (26.5%) nevertheless experience a rise in caesarean section (CS) rate. But now the rate of CS increased almost seven fold from 3.5% in 2004 to 23% in 2016. Objective: To find out the cause and incidence of caesarean section among the primigravid mother in Rajshahi medical college hospital performed in between January 2017 to December 2017. Methods: This prospective type of observational study was performed in Rajshahi Medical College Hospital (RMCH) over a period of one year from January 2017 to December 2017. All primigravida who underwent caesarean section in RMCH were included. Result: During the study period there were 11018 deliveries. Overall CS rate was 40.98%. The rate in primi was 30.70% and last year it was 25.58%. Conclusion: The vast majority of CS was not medically indicated. A number of policies and program had been launched to counteract this increasing rate of CS but virtually there was no impact. TAJ 2018; 31(2): 54-58
Maternal education is significantly related to early childhood morbidity and mortality. In Bangladesh, most mothers do not have a correct knowledge on exclusive breastfeeding and the appropriate time for introduction of weaning foods; and only 3% of them know how to prepare proper weaning foods 1 . Another study conducted in the rural population reported that according to Gomez classification, 96% of children had varying degrees of protein energy malnutrition (PEM) (28.4% mild, 58.2% moderate and 9.2% severe) 2 . Timely weaning, education and promotion of essential vaccination may reduce childhood malnutrition, especially severe PEM. It has also been reported that the prevalence of breastfeeding in Bangladesh is one of the highest in the world where diarrheal diseases are hyper-endemic and issues of breastfeeding in several diarrheal diseases have been well documented 3 . We undertook this study to determine knowledge, attitude and feeding behavior of the mothers in a rural community. This cross sectional study was conducted in Sreepur Thana. Four villages were purposively selected. All women having children below 5 years were interviewed face to face. Structured questionnaire was used. Each participant was informed about the objectives of the interviewing. After taking her consent the interview session was started. The interviewing included socio-demographic information like housing, sanitation, education, water-supply and family-income. As regards feeding practices, each mother was interviewed for information related to nutrition during pregnancy and lactation. The questionnaire also included information about breast feeding like colostrum, exclusive breastfeeding, weaning and feeding during diarrhea and fever. The collected information were entered into computer using SPSS 11.5 version. The prevalence rates of feeding and weaning practices were expressed in percentages. Chi-sq was used to determine association of feeding practices with education and social class.A total of 500 families were visited in four villages. Of these families, 409 (81.1%) women were selected. Of the 91 non-participants, 85 women had no children below 5 years and only 6 women refused to participate. The mean age of the participants was 25 years (16-45y). The average family size was 4 (4-11) and the average monthly expenditure was 3751 (500-15000) taka. About 25% were illiterate and 95% were housewives. Most of the families had access to tube well water for drinking and domestic purposes. Of them, 94% had living rooms with corrugated tin sheet.The study revealed that 68% of mothers took extra food during pregnancy, 80% took extra food during lactation, 54% mothers gave exclusive breast feeding for 6 months. More than one third (36%) mothers started weaning at 6 th month and only 62% mothers chose khichuri made of rice and pulse as supplementary food. About twothirds used to provide balanced diet to their children; 70% used to serve normal diet during fever, 71% during diarrhea and 88% during recovery from illness. The prevalence of taki...
Vesicouterine fistula (VUF) is a very rare occurrence and is estimated to occur in only (1-4%) of all genitourinary fistulas. It is an abnormal pathway between the bladder and the uterus. The most common cause is lower segment caesarean section. Patients usually present in the early post operative period with the problem of continuous urinary incontinence. On the rare occasion, recurrent urinary tract infection, recurrent gross painless haematuria, or secondary infertility associated with secondary amenorrhoea would be the presenting complaint. Among all vesicouterine fistula 90% are Youseef’s Syndrome the least common of the urogynaecological fistulas. Youseef’s syndrome is characterized by cyclic haematuria (menouria), absence of vaginal bleeding (amenorrhea) and urinary incontinence due to vesicouterine fistula (VUF).TAJ 2017; 30(1): 70-72
Background: A molar pregnancy is also known as hydatidiform mole which is a benign tumour that develops in the uterus. It begins when an egg is fertilized but normal viable pregnancy not occurs, rather than the placenta develops into an abnormal mass of cyst. In all cases of molar pregnancy observation is essential to detect the reawakening of chorionic activity.Objectives: The aim of the study was to explore the incidence, clinical presentation, management and outcome of the molar pregnancy in our hospital.Materials & Methods: This prospective study was conducted in Rajshahi Medical College Hospital, Rajshahi, Bangladesh over a period of one year from July 2016 to June 2017. All pregnant women who were diagnosed as molar pregnancy were included in the study.Results: In this study the incidence of molar pregnancy was 5.3 per 1,000 deliveries that was 1 in 188 deliveries. Among the patients 54.7% were between (23 - 27 years) age group, 81.2% cases were multiparous and 58.4% patients belonged to low socioeconomic status. The prevalent blood group was A and constitute 56.6%. About 62.2% patient presented with amenorrhoea and abnormal vaginal bleeding. 45.3% admitted between (12-16) weeks of gestation. Most of the patients 58.4% were managed by suction and evacuation. Among all the cases 92.4% were complete mole and only 16.9% came for follow up.Conclusion: Results from this study showed that a small portion of patient of molar pregnancy came for routine follow up. To achieve high cure rate and low chemotherapy rate an effective registration programme and treatment protocol should be established.KYAMC Journal Vol. 9, No.-1, April 2018, Page 24-27
Objective: To review the management and outcome of postoperative complications after common obstetric and gynecologic surgeries performed in outside nonacademic private hospitals (clinics) and peripheral public hospitals (districts hospitals) and later admitted in Department of Obstetrics and Gynecology of Rajshahi Medical College Hospital (RMCH). RMCH is a tertiary referral hospital where all complicated patients were referred for better management from surrounding hospital.Methodology: This Quasi-experimental study was carried out in the Department of Obstetrics and Gynecology at Rajshahi Medical College Hospital, Rajshahi, Bangladesh between July 1, 2015 and June 30, 2017. All patients admitted with post operative complications following common obstetric and gynecologic surgeries during this period were included. Patients admitted with post operative complications, where primary surgery was done in this hospital were excluded. The common obstetric and gynaecological surgeries were caesarean sections (LUCS), total abdominal hysterectomy (TAH) and vaginal hysterectomy (VH) performed outside Rajshahi Medical College Hospital.Result: During this period a total of 39,929 patients were admitted through emergency way in obstetrics and gynecology department of Rajshahi Medical College Hospital. Among them 675 patients were admitted with the complaints of post operative complications following common obstetric and gynecologic surgeries with rate being 1.7%. In 560(83%) cases surgery was done in clinics and 115(17%) cases surgery was done in district hospitals. Among the patients 580(85.9%) cases primary operation was done by non-gynaecologic surgeon and 95(14.1%) cases by gynaecologic surgeon. Caesarean section was the primary obstetric surgery in 405(60%) cases .Gynecologic surgeries included TAH in 185(27.4%) cases and VH in 85(12.6%) cases. We found 25(3.7%) patients died from these complications. Repeat surgery was done in 90(13.33%) cases. Genitourinary fistula repair was done in 41 cases (45.55%). Rests were improved by conservative management.Conclusion: Any surgical procedure carries risk of complications. Careful selection of patients with suitable indications for operations, expertise of the surgeon, good surgical technique, proper knowledge of pelvic anatomy and careful postoperative follow up can minimize recognized complications.TAJ 2017; 30(2): 7-12
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