Introduction: Eclampsia is a preventable and treatable cause of maternal morbidity and mortality with poor feto-maternal outcome in developing countries. Despite development in the level of health education expertise in human resources and institutional obstetric care in our country, the delay in early recognition of the problem, transportation to proper health facility and getting proper expert care are major hurdles to reduce complications. Therefore we decided to study feto-maternal outcomes in our setting.Methods: A retrospective cross-sectional hospital based study carried out in Nobel Medical College, Biratnagar, from 17th June 2014 to 16th June 2015. Details and data obtained from Medical Record Section were analysed. All patients with eclampsia were included and fetomaternal outcomes measured in terms of complications. Simple descriptive statistical method was applied for analysis.Results: Among 8,066 deliveries, 112 had eclampsia with incidence of 13.8/1000 deliveries. Majority (41%) were of <19 years of age. Above 90% were unbooked. Aoubt 63.4% were primiparas and 83% had antepartum eclampsia. Eclamptic fits were more common (41.6%) in 37-40 weeks period of gestation. Fits to delivery interval was more than six hours in 89.1% women and 69.3% women underwent caesarean delivery. About 18.9% women developed eclampsia related complications. Common causes of maternal deaths (5.36%) were pulmonary edema, aspiration pneumonia, cerebrovascular accidents and HELLP syndrome. Perinatal death was nine percent.Conclusions: Although the obstetric care facilities are improving with time, the feto-maternal outcomes are still poor in our country. Therefore early recognition and proper management are vital to tackle this challenge. Keywords: eclampsia; fetomaternal outcomes; retrospective analysis. | PubMed

Abstract:Background: anaemia is a major contributor to maternal death in developing countries. Since it reduces resistance to blood loss, death may occur from bleeding associated with normal delivery.

No abstract

An isolated neurovascular variation is common but multiple vascular anomalies on same upper limb is a very rare case. We observed an unusual variations in right upper limb during routine dissection of a Nepali cadaver. The variations were observed in Axilla, Forearm and Palm. In axilla, first part of axillary artery did not give any branch, the second part of axillary artery gave off only two branches - (a) thoracoacromial artery and (b) a large common trunk which later gave off lateral thoracic, thoracodorsal, subscapular, posterior circumflex scapular and then continued as posterior circumfl ex humeral artery. The third part of axillary artery gave off only anterior circumflex humeral artery. In forearm, the ulnar artery runs downward superficial to flexor muscles. Here, radial artery gave off common interosseous artery. In palm radial artery did not give any contribution to superficial palmar arch which is solely formed by the continuation of ulnar artery. This type of anomalies are very rare and is not reported in Nepalese cadaver at all. These anomalies are described in detail and their clinical relevance is highlighted. Key words: Axillary artery; Brachial artery; Radial artery; Ulnar artery; Palmar arch; Variations DOI: 10.3126/kumj.v7i3.2740 Kathmandu University Medical Journal (2009) Vol.7, No.3 Issue 27, 293-297

BackgroundHysterosalpingography (HSG) is a routinely performed radiological investigation for evaluation of uterine cavity morphology and fallopian tube patency in infertile women. This study was undertaken to describe patterns of HSG findings and to assess any significant difference in uterine and fallopian tube findings in women with primary and secondary infertility in eastern part of Nepal. Material and MethodsHospital based cross sectional descriptive study was conducted by retrospectively analyzing HSG records of 216 infertile women (both primary and secondary infertility) done from April 2014 to August 2016. Radiological findings in uterus and fallopian tubes were recorded and analyzed. Association between two categorical variables was examined by Chi-square test. ResultsMajority of infertile women (53.2%) had primary infertility. Abnormal HSG was seen in 44.9% infertile women and higher in secondary infertility (57.4%) than with primary infertility (33.9%) (OR = 2.63, 95% CI = 1.51 -4.57, P value = 0.001). Tubal abnormality was common than uterine abnormality (36.1% versus 8.8%, P value= 0.001). Tubal abnormalities were higher in women with secondary infertility than with primary infertility (52.5% versus 21.7%), whereas uterine abnormalities were common with primary infertility compared to secondary infertility (12.2% versus 5.0%) (P value= 0.001). ConclusionAbnormal HSG was more associated with secondary infertility. Infertility was significantly associated with tubal abnormality than with uterine abnormality. Tubal abnormalities are common in women with secondary infertility whereas uterine abnormalities are common in women with primary infertility and are statistically significant.

Introduction: Post cesarean surgical site infection (SSI) is one of the common complications diagnosed in 2.5%-16% of the cases and is associated with significant increase in maternal morbidity, hospital stay, costs, and psychological stress to the new parents. This study was designed to study the incidence of SSI and the antimicrobial resistance pattern in our hospital.   Methods: This was a prospective observational study conducted from July 2015 to December 2015, in which all patients who were admitted with post cesarean SSI or developed SSI during their stay were included.  Wound specimens were collected and susceptibility testing was carried out using disc diffusion technique.   Results: The incidence of post cesarean SSI was 6.07% (47/774). Out of the 47 patients who had SSI, 35 (74.75%) had positive swab culture. The most important organism isolated was Staphylococcus aureus (82.85%) out of which 17 (58.62%) were MRSA strain. The resistance of Staphylococcus to penicillin was 84.6% whereas amikacin was found to be highly sensitive (>96%). Among the MRSA strain, resistance to ciprofloxacin, which is the currently used drug for prophylaxis, was 94%. Resistance to penicillins, cephalosporins, and clavulanate was also high. Resistance to vancomycin was also high (53%). Amikacin and chloramphenicol were found to be highly sensitive  (94% and 90% respectively) in the MRSA group.   Conclusion: MRSA is the leading cause of post cesarean SSI and is a matter of great concern. Amikacin and chloramphenicol were found to be highly sensitive in this group but unlike other studies, resistance of vancomycin was showing an increasing trend.

Background: Malnutrition is a major public health & nutrition problem in Nepal. It is associated with many risk factors like low birth weight, multiple birth, short spaced birth, extra diet, and iron supplementation in pregnancy etc. Objectives: This study aims at finding out the nutritional status of under-five Nepalese children of Borbote village, Ilam and risk factors associated with malnutrition. Methods: A cross sectional study was conducted in Borbote village, Ilam. A total of 186 under-five children was selected by purposive sampling. Non parametric test was applied to find out statistical significance. Logistic regression method was used to identify the factors influencing the malnutrion. Results: According to WHO, 20% children were malnourished . of which 14% were moderately undernourished and 6% were severely undernourished. Mothers exclusively breast feeding for 6 months had only 20.0% low weight for age children and those who didn.t had 34.8% (P=0.041). Pregnant ladies who took iron supplements had 20.5% of low weight for age children compared to 37.1% (P =0.037) in those who didn.t take supplements. Malnutrition was found more in those who were below poverty line 27.94% (P=0.023) compared to those above poverty line 12.00%. Conclusion: Significant number of under-five children of Bortbote village was malnourished. Maternal factors have significant association with nutritional status of the children which include extra diet in pregnancy and lactation, iron supplements in pregnancy, exclusive breast feeding for six months. Extra attention should be provided by the Ministry of Health towards maternal and child health. Health Renaissance, January-April 2013; Vol. 11 No.1; 111-118 DOI: http://dx.doi.org/10.3126/hren.v11i2.8217

Background: Ectopic pregnancy can be managed expectantly, medically or surgically. Laparoscopic surgery is considered gold standard. The aim of this study was to find incidence, risk factors, clinical presentation and mode of management of ectopic pregnancy.Methods: Prospective descriptive study was conducted at Nobel Medical College and Teaching Hospital, Biratnagar. All the cases of diagnosed ectopic pregnancy were enrolled in the study. All the relevant data of the patients were recorded in pre-designed Performa. The collected data were entered in MS Excel and exported into SPSS 21 version for statistical analysis.Results: The incidence of ectopic pregnancy was 0.8%. Most of the patients (35 ;( 58.3%) belonged to 20-30 age group. The classic triad of pain abdomen, amenorrhea and per vaginal bleeding was present in 41 (68.3%) cases. The most common risk factor associated was PID (39 ;-( 65%) followed by abortion 98 ;-( 13.3%). USG findings were suggestive of ruptured ectopic pregnancy, which was seen in 52(86.7%) cases and. 93.3% of the cases were managed surgically. The most common site of ectopic pregnancy was found to be ampulla 35(58.3%) followed by isthmus 11(18.3%). There was no mortality.Conclusions: Pelvic inflammatory disease was the commonest risk factor, laparotomy was the commonest modality of surgical management and ampulla was the commonest site of ectopic pregnancy. Early diagnosis, referral and treatment in the tertiary care center prevents morbidity and mortality related to ectopic pregnancy.Keywords: Ectopic pregnancy; methotrexate; ultrasonography