Peripartum Hysterectomy among Patients Admitted to the Department of Obstetrics and Gynaecology in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Emergency peripartum hysterectomy is a life-saving procedure performed as an emergency procedure to control torrential bleeding and it is associated with significant maternal morbidity and mortality. There are only a few studies regarding this topic so this study guides us to monitor the trend and start appropriate policies to reduce unnecessary caesarean deliveries. The aim of this study was to find out the prevalence of peripartum hysterectomy among patients admitted to the Department of Obstetrics and Gynaecology in a tertiary care centre. Methods: A descriptive cross-sectional study was conducted in the Department of Obstetrics and Gynaecology of the tertiary care centre. Data from 1 January 2015 to 31 December 2022 were collected between 25 January 2023 and 28 February 2023 from the hospital records. Ethical approval was obtained from the Institutional Review Committee of the same institute (Reference number: 2301241700). Convenience sampling was done. Point estimate and 95% Confidence Interval were calculated. Results: Among 54,045 deliveries, peripartum hysterectomy was seen in 40 (0.074%) (0.05-0.10, 95% Confidence Interval). The major indication of emergency peripartum hysterectomy was abnormal placentation (placenta accreta spectrum) which was 25 (62.50%) followed by uterine atony in 13 (32.50%) of patients and uterine rupture in 2 (5%). Conclusions: The prevalence of peripartum hysterectomy was lower than in other studies done in similar settings. The indication for Emergency peripartum hysterectomy has changed in recent years from uterine atonicity to the morbidly adherent placenta which is due to a rise in the caesarean section rate. Keywords: caesarean section; hysterectomy; placenta accreta.

Pregnancy Induced Hypertensive Disorders among Patients Admitted to the Department of Obstetric and Gynecology in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Hypertensive disorder of pregnancy is among the leading causes of maternal and perinatal mortality in developing countries. There are only few studies regarding this topic so this study helps us to improve our management protocol thereby reducing maternal and foetal morbidity and mortality. The aim of this study was to find out the prevalence of pregnancy induced hypertensive disorder among patient admitted to the Department of Obstertric and Gynecology in a tertiary care centre. Methods: A descriptive cross sectional study was conducted in the Department of Obstetrics and Gynaecology of tertiary care centre from 30 July 2020 to 30 July 2021 after obtaining ethical approval from the Institutional Review Committee (Reference number: 2007211399). Convenience sampling method was used among patients who met the eligibility criteria. Point estimate and 95% Confidence Interval were calculated. Results: Among 4,303 deliveries, hypertensive disorder in pregnancy was seen in 110 (2.55%) (2.08-3.03, 95% Confidence Interval) Among 110 (2.55%) patients, preeclampsia was seen in the majority of the patients 69 (62.72%). Conclusions: The prevalence of hypertensive disorder among pregnancies was similar to the other studies done in similar settings. Hypertensive disorder poses a major issue in pregnant women so should be taken into a serious matter as it causes major problems in maternal and foetal outcomes. Keywords: preeclampsia; pregnancy induced hypertension; prevalence.

Caesarean Section During Second Stage of Labor in a Tertiary Centre.

BACKGROUND: There is an alarming rise in caesarean section leading to increased adverse outcomes for both the mother and fetus when compared with vaginal delivery. Within this increasing caesarean section rate, there is a concerning increase in the rate of second stage caesarean section. This study highlight the feto-maternal outcome of caesarean section in second stage of labour. METHODS: This was a retrospective cohort review of all women with a singleton, cephalic fetus at term delivered by caesarean section in the second stage of labor between April 1, 2013 and March 30, 2017 at Patan Academy of Health Sciences. The main outcome measures were second stage caesarean section, indications and its maternal and fetal morbidity. RESULTS: During the study period, there were 40,860 deliveries. A total of 18,011 (44%) babies were born by caesarean section, 10484 emergency and 7527 elective. Out of the emergency caesarean section, 200 (1.9 %) were performed in second stage of labor. In this study, the most common indication was cephalopelvic disproportion. (92.4%) were delivered without a trial of instrumental delivery. In terms of maternal complications, atonic post partum haemorrhage uterine incision extension 18 (12.5%), postoperative fever 27(18.8%), wound infection 7 (4.8%) were observed. In perinatal complications, meconium stained amniotic fluid 49(34.2%), neonatal hyperbilirubinemia 14(9.7%) and increased nursery admission 2(15.3%) and 2(1.3%) perinatal mortality were seen. CONCLUSIONS: Cesarean sections done in second stage of labor are associated with several intra-operative maternal complications and neonatal morbidity.