Trans-abdominal fetal reduction in higher order multiple pregnancies: a pioneer cohort retrospective study in Nepal.

Objective: To share the initial experience of trans-abdominal multifetal pregnancy reduction (MFPR) in Nepal. Method: The procedure was performed in 108 patients in a private hospital over a period of 3 years. Under ultrasound guidance, intracardiac injection of 0.2-3.0 ml of 15% w/v (2 mEq/ml) potassium chloride (KCl) was administered via trans-abdominal route. Results: A total of 108 fetal reduction procedures were carried out at the seventh to fifteenth weeks of gestation, a maximum of 44 (40.7%) of which were done at the ninth to tenth weeks of gestation. A total of 123 fetuses were reduced. Out of total 108 multifetal pregnancies, 96 (88.8%) were due to in-vitro fertilization (IVF). Eighty-five pregnancies (78.7%) underwent reduction from triplet to twin. The second-time reduction was needed in five cases. Two attempts (in the same sitting) were required in three cases. The inadvertent demise of the second fetus was noted in three cases of dichorionic tri-amniotic triplet pregnancy. Conclusion: Ultrasound-guided trans-abdominal fetal reduction performed between the seventh and twelfth weeks of gestation is safe and effective.

Proteinuria among Pregnant Women Admitted to the Department of Obstetrics and Gynaecology of a Tertiary Care Centre.

Introduction: Proteinuria is usually related with preeclampsia during pregnancy, although it can also be caused by other conditions such as renal disease or isolated proteinuria. Proteinuria during pregnancy can result in adverse fetomaternal outcomes. The study aimed to find the prevalence of proteinuria among pregnant women admitted to the Department of Obstetrics and Gynaecology of a tertiary care centre. Methods: A descriptive cross-sectional study was carried out among pregnant women in the Department of Obstetrics and Gynaecology after obtaining ethical approval from the Institutional Review Committee. Data of 14 April 2022 to 13 April 2023 was collected from 9 June 2023 to 9 September 2023 from medical records. The study included pregnant women aged 18-45 years, who were past 28 weeks of gestation and had a 24-hour urine protein measurement. Pregnant women who had insufficient medical records were excluded from the study. A convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Results: Among 3,914 pregnant women, proteinuria was seen in 61 (1.56%) (1.17-1.95, 95% Confidence Interval). The mean proteinuria in the study group was 1.5±2.75 gm/24 hr. In pregnant women with proteinuria, maternal complications were seen in 51 (83.60%) and foetal complications in 34 (55.73%) cases. A total of 47 (77.05%) underwent emergency lower-section caesarean section. Conclusions: The prevalence of proteinuria among pregnant women was found to be similar as compared to studies done in similar settings. Keywords: preeclampsia; pregnancy complications; proteinuria.

Hypothyroidism among Pregnant Women Attending the Outpatient Department of Obstetrics in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Hypothyroidism is a common endocrine disorder occurring in pregnancy. Maternal and fetal complications are present in these patients. Timely identification and treatment help in the prevention of complications. The aim of this study was to find out the prevalence of hypothyroidism among pregnant women attending the Outpatient Department of Obstetrics in a tertiary care centre. Methods: A descriptive cross-sectional study was conducted in a tertiary care centre after taking ethical approval from the Institutional Review Committee (Reference number: 08/2021). Data from 1 January 2016 to 31 December 2020 were collected between 1 November 2021 to 31 November 2021. All pregnant women who had undergone thyroid level assessment in each trimester (first, second and third) and had delivered in the same centre were included in the study. However, pregnant women with comorbidities like hypertension, overt diabetes mellitus, hyperthyroidism, renal disease, cardiac disease, and neurological disorder were excluded. Convenience sampling method was used. Point estimate and 95% Confidence Interval were calculated. Results: Among 216 pregnant patients, the prevalence of hypothyroidism was 74 (34.25%) (27.92-40.57, 95% Confidence Interval). Maternal complications were seen in 33 (44.59%). The commonest complication was oligohydramnios 10 (13.51%) followed by preterm delivery 8 (10.81%). Conclusions: The prevalence of hypothyroidism among pregnant women was found to be higher than other studies done in similar settings. Keywords: complications; hypothyroidism; miscarriage; pregnancy; thyroid.

Hysteroscopy among Patients Attending the Outpatient Department of Gynaecology in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Hysteroscopy is a procedure used widely for diagnostic and therapeutic purposes. Hysteroscopy enables visualisation of the endometrial cavity and if possible treatment in the same setting avoiding invasive procedure. The objective of the study was to find out the prevalence of hysteroscopy among gynaecological patients attending the outpatient department of Obstetrics and Gynaecology in a tertiary care centre. Methods: A descriptive cross-sectional study was done among gynaecological patients from 1 January 2016 to 1 January 2020 visiting the outpatient Department of Obstetrics and Gynaecology in a tertiary care centre after ethical approval from the Institutional Review Committee (Registration number: 029/2021). Convenience sampling was used. Data regarding demographic parameters, hysteroscopy findings, procedures performed, histopathological findings and complications were retrieved from the electronic database of the hospital. Point estimate and 95% Confidence Interval were calculated. Results: Among 319 gynaecological patients, hysteroscopy was done in 72 (22.57%) (17.98-27.16, 95% Confidence Interval) patients. Conclusions: The prevalence of hysteroscopy among gynaecological patients was higher to the studies done in similar settings. Keywords: hysteroscopy; infertility; leiomyoma; polyps.

Preoperative Neutrophil Lymphocyte Ratio in Prediction of Adnexal Mass Torsion.

Aims: Adnexal torsion commonly affects reproductive age group females. Prompt diagnosis and early management help in the preservation of fertility. However, its diagnosis is challenging. Preoperative diagnosis can be suspected in only 23-66% of the cases and half of the patients operated for adnexal torsion have different diagnosis. This article thus aims to identify the diagnostic value of preoperative neutrophil lymphocyte ratio in adnexal torsion in comparison with other untwisted unruptured ovarian cysts. Methods: This was a retrospective study conducted in the duration of five years from 1st January 2016 to 1st January 2020. The data about demographic parameters, hematological parameters, operative approach, operative technique, and histopathological reports were derived from an electronic database and documented on proforma. SPSS was used for statistical analysis. Logistic regression analysis and influence of each factor on preoperative diagnosis of Adnexal torsion was evaluated. Results: A total of 125 patients were included in the article (adnexal torsion group n = 25, untwisted unruptured ovarian cyst group n = 100). There was no statistically significant difference in comparison to age, parity, and abortion between both groups. Most patients had undergone laparoscopic surgery which was based on surgeon's skill and preference. Nineteen (78%) patients in the adnexal torsion group underwent oophorectomy while infarcted ovary was seen in only 4 cases. Among the blood parameters, only neutrophil-lymphocyte ratio (NLR) >3 was found to be statistically significant under logistic regression analysis. Most common adnexal pathology to undergo torsion was serous cyst. Conclusion: Preoperative neutrophil-lymphocyte ratio can be a predictive marker for diagnosis of adnexal torsion and can differentiate it from untwisted unruptured ovarian cysts.

Rectal Perforation: A Rare Complication Following Uncomplicated Vaginal Delivery.

Rectal perforation during vaginal delivery is an uncommon event. It can cause complications including pelvic abscess and other life threatening illnesses, if not treated early. We here report a 24 years lady presented with a week long history of abdominal pain and fever associated with rectal discharge three weeks after uncomplicated vaginal delivery. Abdominal computed tomography findings suggestive of rectal perforation and revealed a huge pelvic abscess. A pigtail catheter was inserted into the pelvic abscess under transrectal ultrasound guidance and drained successfully. The patient recovered uneventfully and discharged 5 days after admission. Keywords: Pelvic abscess; rectal perforation; uncomplicated vaginal delivery.