Amniotic fluid embolism: A rare cause of maternal collapse-A case report.

High index of suspicion of amniotic fluid embolism should be considered in any intrapartum or postpartum collapse where the obvious cause of collapse is not identified.

Selected Risk Factors and Pattern of Semen Abnormality in Male Partners of Infertile Couples in Eastern Nepal: A Descriptive Cross-sectional Study.

INTRODUCTION: Semen analysis is an initial basic step in evaluating and diagnosing male infertility. Multiple risks factors in combination or alone are responsible for abnormal semen parameters. The present study aimed to study certain risk factors and semen parameters of infertile male. METHODS: It was a descriptive cross-sectional study. We consecutively enrolled 186 male partners of infertile couple who underwent certain risk factors evaluation and semen analysis according to WHO guideline. RESULTS: Multiple risk factors were present like Gulf country migration, smoking, chemical exposure and heat exposure in infertile male partners. Forty six percent of our patients were gulf workers. Eleven percent patients had azoospermia, 27% had abnormal sperm morphology and 23% had <25% motile spermatozoa. CONCLUSIONS: Surprisingly 46% of our patients were Gulf country workers and abnormal semen analysis is very important factor for infertility. Large prospective studies need to be carried out involving Gulf migrant workers only.

Term Delivery of a Complete Molar Pregnancy with a Coexistent Normal Pregnancy.

Twin pregnancy with a complete mole and a coexistent normal fetus reaching term is a rare occurrence. We report a case of a 21-yrs G2P1L0 un-booked patient at 39 weeks who was referred for the same condition diagnosed incidentally on ultrasound scan which showed a singleton pregnancy in breech presentation with a normal placenta and a heterogeneous cystic lesion seen anteriorly, suggesting a coexistent molar pregnancy. Cesarean section was done, and a healthy male baby was delivered with a grossly normal placenta and a second placenta with grape like vesicles. Histopathology confirmed the diagnosis of complete mole and normal placenta. Postoperative period was uneventful, and the patient was kept on beta hcg follow-up to monitor progression to gestational trophoblastic neoplasia, but it normalized by 12 weeks.

Knowledge and Practices of Pregnant Women regarding Oral Health in a Tertiary Care Hospital in Nepal.

INTRODUCTION: Poor dental hygiene has been associated with various perinatal complications in studies done worldwide but few studies in Nepal have explored the knowledge of pregnant ladies regarding dental hygiene. The aim of the study was to know the knowledge and practices of pregnant women regarding oral health in a tertiary care center in Nepal. METHODS: A qualitative study was carried out in Nobel Medical College and Teaching Hospital from January 15, 2018 to June 15, 2018 after approval from the Institutional Review Committee of Nobel Medical College. Convenience sampling was done. Fifty pregnant women admitted in antenatal ward were interviewed regarding their knowledge of dental care in pregnancy, the common dental problems they faced and the treatment taken. A predesigned proforma was used and results were analyzed using SPSS version 17. RESULTS: Twenty two (44%) patients reported dental problems during pregnancy. Bleeding gums was seen in 7 (14%) and toothache in 7 (14%) were commonly reported dental problems. Forty seven (94%) patients acknowledged that routine dental care was needed for health, only 6 (12%) were aware that poor dental health could affect baby weight. Oral health not seen as priority in 24 (48%) was the main barrier to seeking dental care in pregnancy followed by costs of treatment in 18 (36%) and safety concerns in pregnancy in 8 (16%) cases. CONCLUSIONS: Though dental problems were a common occurrence in pregnancy, utilization of services was low for the same. The participants reported significant barriers to obtaining dental care including lack of knowledge about the importance of maternal oral health and the treatment costs.

Necrotizing fasciitis of anterior abdominal wall following cesarean section in a low-risk patient.

We report a case of a mono-microbial post-cesarean necrotizing fasciitis caused by methicillin resistant Staphylococcus aureus, in a low-risk healthy woman who presented with acute fulminant infection, sepsis and features of multi-organ dysfunction syndrome on sixth post-operative day. Aggressive management with multiple surgical debridement and supportive therapy was the key to favorable outcome in this case.

HYPEREMESIS GRAVIDARUM IN A TERTIARY CARE CENTRE IN EASTERN NEPAL: A PROSPECTIVE OBSERVATIONAL STUDY.

BACKGROUND: Hyperemesis gravidarum (HG) is the most severe form of nausea and vomiting of pregnancy which can have potentially dangerous complications if untreated. Its treatment is basically supportive as the condition itself is self-limiting. The aim of our study was to evaluate maternal characteristics in patients with HG including risk factors and treatment outcome with respect to improvement in Pregnancy Unique Quantification of Emesis (PUQE) scores, number of doses of antiemetics used, weight gain during treatment and duration of intravenous fluid therapy METHODS: A cross-sectional study where all women admitted to B.P. Koirala Institute of Health Sciences with a diagnosis of HG during a period of one year were studied for different maternal characteristics. The severity of disease was quantified using Modified PUQE score and the various treatment outcomes considered. RESULTS: The admission for hyperemesis gravidarum (n=81, including 13 readmissions) was 10.64% of total early pregnancy admissions (n = 735).The condition was more common in nulliparous patients (56%) at a mean period of gestation of 8.93 ± 2.33 wks. Most patients suffered from moderate to severe disease at presentation, mean PUQE scores being 12.29 ± 1.59. The median number of doses of intravenous antiemetics used was three (IQR 3-6), median weight gain was one kg (IQR 0-1 kg), median duration of intravenous fluid therapy was 24 hrs (IQR 24-48 hrs) and mean length of hospital stay was 3.2 ± 1.48 days. CONCLUSIONS: Hyperemesis is one of the common causes of hospitalization in early pregnancy. Treatment has favourable outcome with early recovery.

Challenges in the Caesarean Section of a Severely Kyphotic Parturient.

Caesarean section in a severely kyphotic patient presents with unique challenges. We report a case of obstructed labor in case of a pregnant lady with severe kyphosis of spine that was managed by caesarean section. Lateral recumbent position with adequate assistance and paramedian or vertical skin incision was used and found to provide good exposure. Baby was delivered by lower segment uterine incision by reverse breech extraction. Postpartum hemorrhage was managed with uterotonics and bilateral uterine artery ligation. Tubal ligation though advised was refused by the patient. Prolonged catheterization was done in view of obstructed labor. Postoperative period was uneventful.

Risk Factors For Necrotizing Fasciitis And Its Outcome At A Tertiary Care Centre.

BACKGROUND: Necrotizing fasciitis (NF) is a serious and potentially fatal condition where there is rapid progression of inflammation of skin, subcutaneous tissue, and superficial fascia and can be mono-microbial or poly-microbial. The disease is rapidly progressive in nature and if not promptly treated leads to significant morbidity or even mortality. This study was designed to explore the various risk factors commonly present and study the outcome of the disease. METHODS: This was a cross sectional study done in tertiary centre over period of one year from April 2014 to March 2015. Patient admitted with soft tissue infection were presumptively made diagnosis of NF based on clinical features and final diagnosis was made after pre-operative surgical findings. RESULTS: Forty two (40.38%) patients had final diagnosis of NF out of 102 soft tissue infections. Twentynine (69%) of 42 patients with NF fully recovered with surgical and medical management. Eleven (26.2%) of these patients succumbed to their illness and two (4.8%) needed amputation of limb to control the infection. The most common co-morbid condition was alcoholism, followed by diabetes mellitus. CONCLUSIONS: The incidence of necrotizing fasciitis in patients admitted with soft tissue infection was 40.38%. Mortality and morbidity due to this condition was found to be high.