Knowledge and Attitude about Labor Epidural Analgesia among Pregnant Women Attending Antenatal Clinic.

BACKGROUND: Labour pain is one of the most painful experiences that a woman faces in her lifetime. There are various options for labour pain management. Epidural analgesia is the gold standard method for pain management during labour. In developing and under-developed countries there are many challenges to provide this service, a very important one being knowledge about epidural analgesia among the parturients and the physicians. METHODS: A prospective cross-sectional study was carried out among 384 pregnant women attending Antenatal clinic of a tertiary level teaching hospital using pretested structured questionnaire prepared by a team of anaesthesiologists and obstetricians. Non-probability purposive sampling technique was used. The data was analysed by using SPSS version 20.0. Descriptive and inferential statistical methods were used for analysis. RESULTS: Of the 384 pregnant women, only 29.4% had knowledge about some form of labour analgesia techniques and only 16% of the participants were aware of labour epidural analgesia. Also, only 6.2% were aware that epidural service is available at our hospital. Regarding acceptance, only 42.4% were willing to use epidural analgesia in their present pregnancy. CONCLUSIONS: The present study findings revealed that a significant number of participants had very limited knowledge about labour epidural analgesia and were also unaware of the availability of the service in our hospital. Educational programs need to be provided to all the pregnant women for enhancement of knowledge and awareness about epidural labour analgesia to increase its acceptability among them.

COVID-19 among Pregnant Women Delivering in a Tertiary Care Center: A Descriptive Cross-sectional Study.

INTRODUCTION: Coronavirus Disease 2019 pandemic is raging across the world and has affected pregnant women as well. There is limited information regarding COVID-19 in pregnant women. The study aimed to find the prevalence of COVID-19 among all pregnant women who delivered during the study period in a tertiary care center. METHODS: This was a descriptive cross-sectional study conducted in a tertiary care center from 16th August to 15th November 2020 after obtaining ethical clearance from the Institutional Review Committee of a tertiary care center. All the women who delivered in the hospital during the study period were enrolled and they were subjected to COVID-19 Reverse Transcriptase Polymerase Chain Reaction test. A total of 667 samples were taken using convenience sampling technique. Data were analyzed using the Statistical Package for the Social Sciences version 24 software. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. RESULTS: Among 667 pregnant women, the prevalence of COVID-19 was 47 (7.05%) (5.10-8.99 at 95% Confidence Interval). Though the majority of women were asymptomatic 40 (85.1%), 5 (10.64%) developed mild disease, 1 (2.12%) each had severe and critical COVID-19 pneumonia. CONCLUSIONS: The prevalence of COVID-19 among pregnant women delivering in our center is similar to other studies done in similar settings. In our study, we found that the majority of women had been asymptomatic and were diagnosed on routine testing. Hence, it is important to test all pregnant women before delivery for Coronavirus Disease 2019 irrespective of the presence or absence of symptoms.

Genitourinary Syndrome of Menopause among Postmenopausal Women in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

INTRODUCTION: Genitourinary syndrome of menopause incorporates vulvovaginal and lower urinary tract symptoms related to estrogen deficiency which affects more than half of postmenopausal women. This study aimed to find out the prevalence of genitourinary syndrome of menopause among postmenopausal women attending a tertiary care center. METHODS: A descriptive cross-sectional study was conducted at the Department of Obstetrics and Gynaecology of tertiary care hospital from October 2019 to April 2021 after obtaining ethical approval from the Institutional Review Committee (Reference number: 452 6-11). A convenience sampling method was used among postmenopausal women aged 40-75 years attending gynaecology outpatient departments. The information was obtained by interview and examination. Analysis was done using the Statistical Package for the Social Sciences version 20. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. RESULTS: Among the 385 postmenopausal women, 285 (74.02%) (69.63-78.40 at 95% Confidence Interval) had a diagnosis of genitourinary syndrome of menopause. The mean age of menopause was 48.2±3.6years. The most common symptom and sign were vaginal dryness in 223 (78.2%) and decreased moisture 200 (70.2%). Regarding the impact of genitourinary syndrome of menopause on quality of life, it least affected the activities of daily living and mostly on sexual functioning. CONCLUSIONS: The study showed three-fourth of postmenopausal women suffered from genitourinary syndrome of menopause which is similar to the previous studies done in other countries, in postmenopausal women. Therefore, understanding genitourinary syndrome of menopause is vital, and assuring women those treatments are available to relieve symptoms may improve their quality of life.

Outcome of Pregnant Patients with Cardiac Diseases Delivered in Tribhuvan University Teaching Hospital.

BACKGROUND: Pregnant women with cardiac disease pose a unique challenge to both the anaesthesiologists and obstetrician because of high morbidity affecting the maternal and fetal outcomes. Our research aims to provide an overview of pregnant women with heart disease coming for delivery in Tribhuvan University Teaching Hospital over one year, the occurrence of adverse maternal and neonatal outcome (mortality and morbidity) and correlation of certain maternal factors associated with adverse outcome. METHODS: This is an observational cross-sectional study conducted in Tribhuvan University Teaching Hospital from 2075/11/01 to 2076/10/30 where data of pregnant women beyond 28 wks period of gestation with diagnosed cardiac disease was recorded from secondary sources. RESULTS: The prevalence of pregnant women with cardiac disease presenting for delivery over one-year period was found out to be 120 (2.49%). Among them, almost 85 cases (71%) had valvular heart disease and 27 had mitral stenosis. The mortality was 2.5%. The complication rate among such patients was 30%, the patients requiring ICU admission was 20.7% and requiring mechanical ventilation was 6.7%. The neonatal mortality in such patients was 3.2% and 20.5% were premature, 27% had weight <2.5 kgs at birth and 10.7% required NICU admission. There was statistically significant association between history of prior cardiac event and NYHA with adverse maternal event with p value of <0.001. CONCLUSIONS: History of prior cardiac event and higher NYHA grading in a pregnant patient with cardiac disease are major determinants for adverse maternal outcome.

Ruptured ectopic pregnancy on a tubal stump: A case report.

Tubal stump ectopic pregnancy is a rare event. Early diagnosis and management can spare patients from significant morbidity; however, patients usually present with hemoperitoneum in developing countries. A long tubal stump might increase the risk for tubal stump pregnancy; hence, the length of fallopian tube should be minimized during salpingectomy.

Successful management of postpartum hemorrhage and surgical site infection in a pregnant woman under warfarin for heart valve replacement: A case report.

INTRODUCTION AND IMPORTANCE: Pregnant women under warfarin for mechanical heart valves can pose a variety of challenges which requires fine tuning of various anticoagulants throughout the pregnancy and in the postpartum period as hemorrhage can lead to maternal and fetal morbidity and mortality. CASE PRESENTATION: A 36-year-old woman gravida two, para one at 35 weeks 5 days gestation, with hypothyroidism with mitral valve replacement and tricuspid valve repair due to rheumatic heart disease underwent emergency lower section cesarean section for fetal bradycardia. B-lynch suturing was eventually done to control atonic postpartum hemorrhage. During hospital stay she developed surgical site infection of abdominal skin incision site which was also subsequently managed. Postpartum anticoagulation was started late due to postpartum hemorrhage and finally the patient was discharged on warfarin. CLINICAL DISCUSSION: There is always a risk of both thromboembolic and hemorrhagic manifestations in a pregnant woman with a prosthetic heart valve which requires fine tuning of anticoagulants throughout the pregnancy and in the postpartum period. Hemorrhagic manifestation in the form of postpartum hemorrhage is common which can be difficult to manage and also poses a great dilemma in restarting the anticoagulation after delivery. Excessive blood loss can itself lead to mortality and morbidity, and also via increased risk of surgical site infection. CONCLUSION: Appropriate preconception counseling along with meticulous assessment, management and monitoring of pregnant women with prosthetic heart valves is necessary to decrease fetal and maternal morbidity and mortality.

Pure Sertoli cell tumor of the ovary: A case report.

Pure Sertoli cell tumors are an uncommon variant of rare ovarian Sertoli-Leydig cell tumors. Due to nonspecific clinical and imaging features, diagnosis is often made after histopathological examination. The prognosis is excellent as most are detected in the early stages and surgical resection is often curative in most cases.

Tubal abortion masquerading as an acute appendicitis with a negative urine pregnancy test: A case report.

INTRODUCTION AND IMPORTANCE: Spontaneous expulsion of product of conception through the fimbrial end to the peritoneal cavity is a rare mode of progression of tubal pregnancy. Thus, ectopic pregnancy can present with right-sided iliac fossa pain which can be preoperatively misdiagnosed as acute appendicitis. CASE HISTORY: A 30-year regularly menstruating woman presented with right iliac fossa pain which was diagnosed as acute appendicitis preoperatively with an ultrasound. However, intraoperatively, a product of conception-like material measuring 3 ∗ 3 cm was seen hanging from the right fimbrial end of the fallopian tube with a normal appendix. With an intraoperative diagnosis of spontaneous tubal abortion, histopathology of the resected mass showed chorionic villi lined by trophoblastic cells along with decidualized tissue, fibrinoid material, and blood clot. DISCUSSION: Ectopic pregnancy presenting as a right iliac fossa pain can mimic acute appendicitis. An abnormal ß-hCG pattern/level which doesn't correspond to the gestational age suggests the likely diagnosis of ectopic gestation. Transvaginal ultrasound is the preferred imaging modality for the evaluation of patients with suspected ectopic gestation. A urine pregnancy kit cannot always exclude an underlying ectopic pregnancy because of the associated false-negative results. CONCLUSION: Urgent laparotomy to prevent detrimental complications associated with ectopic gestation should be done. Surgeons should be aware of this suspicion as a false negative UPT can happen and misguide clinicians about the possible occurrence of ectopic pregnancy.

An Unusual Case of Acute Abdomen: Ovarian Vein Thrombosis.

Ovarian vein thrombosis is one of the rare causes for acute abdomen. Occult presentation of this disease may lead to diagnostic dilemma. A sixteen years female who was operated as a case of ectopic pregnancy was finally diagnosed as having ovarian vein thrombosis. She was successfully treated with anticoagulant.