Profile of Patients Admitted in Maternal Intensive Care Unit at BPKIHS, a Tertiary Hospital in Eastern Nepal.

BACKGROUND: Maternal death is a tragic event. It can be reduced by prompt recognition of critical illness in pregnancy and earlier initiation of intensive care. The physiological changes of pregnancy and the presence of a fetus complicates the assessment and management of critically ill obstetric patients. The objective of this study was to analyse the basic contributing factors for maternal intensive care unit admission and the maternal outcome. METHODS: This was a prospective study conducted in the department of Obstetrics and Gynaecology at B.P. Koirala Institute of Health Sciences, a tertiary hospital in eastern Nepal, for one year duration from January-December 2012. Data like age, diagnosis at admission, intervention, indication for admission, duration of stay and outcome were analysed. RESULTS: One hundred and ninety two patients were admitted in one year. Among them 177 were obstetrics related admission and 15 were non obstetrics. Out of 177 patients, 21(11.8%) were antenatal, 123(69.4%) were postnatal and 33(18.6%) had early pregnancy complications. The mean age in years was 25.67±7.169. One hundred and seventy one patients (96.6%) were unbooked and only 6(3.3%) were booked. Among the postnatal patients, 83(67.4%) had delivered at BPKIHS, 24(19.5%) at other health centres and 16 (13%) at home. Antepartum eclampsia was the commonest diagnosis. Out of 192 patients, 148(78.12%) were improved, 24(12.5%) had expired, 15(7.8%) went against medical advice and 5(1.6%) were referred. The median duration of MICU stay in days (IQR) was 2(1-4). CONCLUSIONS: An intensive care unit often offers the opportunity to improve the patient care.

Cesarean section without urethral catheterization: a randomized control trial.

BACKGROUND: Urethral catheterization is done as a routine procedure in cesarean section. It is associated with high incidence of urinary tract infections, discomfort, delayed ambulation and longer hospital stay. OBJECTIVE: To determine the feasibility and safety of cesarean section without urethral catheterization. METHODS: A prospective, randomized controlled trial was carried out from April 2008 to March 2009, in the Department of Obstetrics and Gynecology, B. P. Koirala Institute of Health Sciences. Among 150 patients who had undergone cesarean section 75 were catheterized and 75 were uncatheterized. RESULTS: First void discomfort was significantly associated with the use of indwelling catheter (OR 6.95, CI 95 %, 3.74 to 12.95; P less than 0.001).Significant number of patients with indwelling catheter had signs and symptoms of urinary tract infection (OR 6,CI 95%, 2.59 to 13. 86; P less than 0.001). Positive urinalysis for urinary tract infection was high in catheterized group (P less than 0.001). Hospital stay was shorter in patients without catheter (p less than 0.05). None of the patients had bladder injury. There were no significant differences in duration of surgery and ambulation time between two groups of patients. CONCLUSIONS: Cesarean section can be done safely without urethral catheterization with reduced morbidities.

Carcinoma of vagina in utero-vaginal prolapse: a rare presentation.

Primary vaginal carcinoma in uterovaginal prolapse is a rare entity. We report a case of an 84-years-old lady, who presented with long standing vaginal ulcer in association with third degree uterovaginal prolapse. Incisional biopsy was taken from the ulcer. Histopathological examination showed a large cell keratinizing squamous cell carcinoma.

Association between pregnancy-induced hypertensive fundus changes and fetal outcomes.

BACKGROUND: Ocular involvement in pregnancy-induced hypertension (PIH) is common. OBJECTIVE: To study the association between pregnancy-induced hypertensive fundus changes and fetal outcomes. SUBJECTS AND METHODS: A prospective cohort study was carried out including 153 subjects with the diagnosis of PIH. The subjects were evaluated for hypertensive fundus changes. Fetal outcomes were assessed in terms of gestational age, birth weight, 1 minute Apgar score, stillbirth and neonatal death. STATISTICS: The chi2 test was used to evaluate the association between the various fundus changes and fetal outcomes using SPSS version 10 software program. RESULTS: Fundus changes were found in 13.7% of the subjects. The means of systolic and diastolic BP of the subjects with hypertensive fundus changes were 182.86 +/- 33.64 and 125.24 +/- 21.36 respectively, whereas those values without fundus changes were 150.72 +/- 12.86 and 100.07 +/- 9.51.Vitreous hemorrhage, serous retinal detachment and macular star were not found in this study. Fetal outcomes in PIH patients with vascular changes alone were similar to those with no fundus changes. Retinal and optic nerve head changes were found to be associated (p = 0.016) with low birth weight (< 2.5 kg). Choroidal changes and optic nerve head changes were associated with low Apgar score. CONCLUSION: Retinal and optic nerve head changes are associated with low birth weight. Choroidal changes and optic nerve head changes are associated with low Apgar score. Fundus evaluation in patients with PIH is an important procedure to predict adverse fetal outcomes.

Vesicovaginal fistula at tertiary care center in eastern Nepal.

Vesicovaginal fistula is physically, socially and psychologically devastating to the women who suffer from it. The aim of this study is to create some awareness about VVF, to describe the profile of the patients, etiology, and success rate of surgery in our institute. A retrospective analysis of a total of 23 cases of vesicovaginal fistula admitted to the Department of Gynecology and Obstetrics, BPKIHS over a period of three years were included in the study. The cause of VVF in all was obstructed labor except in one, which followed abdominal hysterectomy. Twenty-three subjects underwent VVF repair, of which 14 (56.5%) had successful outcome.

Metallic vaginal ring pessary: a rare entity.

Vaginal pessaries still have role in the management of uterovaginal prolapse especially in elderly women, unfit for surgery and as a temporary relief for women waiting for surgery. Forgotten vaginal pessaries may cause serious complications. We here by present a case wtih metallic vaginal ring pessary for 16 years without significant symptoms.

Effectiveness of structured teaching program in improving knowledge and attitude of school going adolescents on reproductive health.

INTRODUCTION: Development of knowledge and attitude takes place during the adolescent period, which can have lifelong effects on the individual, family and society. Proper education in this age group is important for prevention of untoward social and health related problems. OBJECTIVE: To find out the effectiveness of structured teaching program in improving knowledge and attitude of school going adolescents on reproductive health. MATERIALS AND METHODS: An experimental study with pretest - posttest control group design was carried out in four selected schools with similar settings in Dharan town of Nepal. All the subjects were divided into two groups: experimental and control, each comprising of two subgroups of 50 boys and 50 girls. Structured teaching program consisting of information on human reproductive system was used as a tool of investigation for the experimental group, whereas conventional teaching method was used for the control group. RESULTS: A total of 200 Adolescent school students were included in this study. The mean (+/-SD) pretest score of the experimental group on knowledge of reproductive health was 39.83 (+/- 16.89) and of the control group was 39.47(+/- 0.08). The same of experimental group after administration of the structured teaching program (84.60+/-10.60) and of the control group with conventional teaching method (43.93+/-10.08) was statistically significant (p<0.001). Similarly, the post-test scores of knowledge of the groups on responsible sexual behaviour and their attitude towards reproductive health were better in the experimental group than in the control group (p<0.001). CONCLUSION: The knowledge of adolescent school students on reproductive health is inadequate. The use of structured teaching program is effective in improving knowledge and attitude of the adolescents on reproductive health.