Background-Chlorhexidine skin cleansing might substantially reduce neonatal infection and mortali... more Background-Chlorhexidine skin cleansing might substantially reduce neonatal infection and mortality in developing countries. Few data exist on the impact of chlorhexidine cleansing on skin colonization of infants during the first day of life or on the absorption potential of chlorhexidine during newborn skin cleansing. Methods-Hospital born newborns in Kathmandu, Nepal were randomly allocated to full-body skin cleansing with 0.25%, 0.50%, or 1.00% chlorhexidine solution. Skin swabs were collected from the axilla, inguinal and peri-umbilical areas before cleansing (baseline), and at 2 and 24 hours after treatment. Skin flora was quantified and organisms identified. In a sub-sample, heel prick blood was collected 24 hours after the cleansing and percutaneous absorption of chlorhexidine was assessed. Results-Among 286 enrolled newborns, no adverse effects on skin were reported and body temperature was minimally reduced (mean reduction 0.33°C). In all groups, positive skin culture rates were significantly reduced at 2 hours but generally not at 24 hours; greater reductions were observed with higher concentrations of chlorhexidine. Effect at 24 hours was highest in the 1.00% group (37% lower positive skin culture rate). For 15 of 75 infants with heel pricks, chlorhexidine was detected at trace concentrations (< 8 ng/ml, n=14; 25.8 ng/ml, n=1). Conclusions-Chlorhexidine skin cleansing appeared safe and reduced skin flora in newborns in a dose-dependent manner 2 hours after treatment. Greater residual effect at the highest concentration (1%) might provide broader benefit and may simplify combined maternal and neonatal regimens by matching the concentration used for vaginal cleansing during labor.
Aims: To find out the uterovaginal anomalies associated with congenital genital tract obstruction... more Aims: To find out the uterovaginal anomalies associated with congenital genital tract obstruction and successes achieved in its management. Methods: This was a descriptive study done at department of Obs/Gyn at Tribhuvan University Teaching Hospital from April 2014 to April 2018. Types of genital tract obstruction, surgical treatment, success of management and surgical complications were studied. Results: Of 35 cases 16 (46%) consisted of adolescents aged 11-15 yrs. Majority cases of GTO was due to vaginal septum 12(34%): longitudinal 4(33%), mostly transverse vaginal septum (TVS) 8(67%): upper TVS 4 and lower TVS 4,one among each associated with concurrent Imperforate hymen (IH). Other GTO consisted of only IH cases 9 (26%), vaginal agenesis 7 (21%), non- communicating rudimentary horn 4 , non-communicating right cornua 1and cervical stenosis 1(3%). Resection of septum performed in 12 cases of vaginal septum. hymenectomy in 8 and rudimentary horn excision in 4 cases. Restenosis was...
Journal of South Asian Federation of Obstetrics and Gynaecology
Background: Hemolysis, elevated liver enzymes, and low platelet (HELLP) syndrome is a serious obs... more Background: Hemolysis, elevated liver enzymes, and low platelet (HELLP) syndrome is a serious obstetric complication with high risk of adverse maternal and perinatal outcomes. The aim of the study was to find the prevalence of HELLP syndrome and to analyze the maternal and perinatal outcomes. Methods: This was a descriptive cross-sectional study conducted in a tertiary care center from April 13, 2016, to April 12, 2020, after obtaining ethical clearance from the Institutional Review Committee. All the women with HELLP syndrome who delivered in the hospital during the study period were enrolled. A convenience sampling technique was used. Data were analyzed using the Statistical Package for the Social Sciences version 24 software. Descriptive analysis was done and frequency and proportion were calculated for binary data. Results: Prevalence of HELLP syndrome was 0.23%. The majority of the cases were in the 25-29 years age-group and the mean maternal age was 28.05 years. Twenty-seven (61.36%) were primigravida. Of 44, 27 (61.36%) delivered through lower segment cesarean section. Nineteen (43.18%) women were admitted to the high dependency unit. There were four (9.1%) maternal deaths. Most (68.18%) of the babies were preterm and 62.5% of the live-born babies were admitted to the neonatal intensive care unit. There were 20 perinatal deaths with a perinatal mortality of 45.45%. Conclusion: HELLP syndrome is a dreadful complication with high morbidity and mortality. Timely termination of pregnancy is warranted to arrest further progress of pathophysiology. Clinical significance: Outcomes in HELLP syndrome can be improved with early diagnosis and timely intervention.
Journal of College of Medical Sciences-Nepal, 2021
Introduction Maternal mortality reflects reproductive health status and availability of good heal... more Introduction Maternal mortality reflects reproductive health status and availability of good health care facilities at different levels of the healthcare system at a given period, influenced by globally adopted safe motherhood policies. The leading causes of maternal death in Nepal mainly comprise of hemorrhage, eclampsia, abortion-related complications, gastroenteritis and anemia. Although a declining trend has been noted in Nepal it has yet to meet the target set by the Sustainable Development Goal (SDG) 3.1 of reducing the global MMR to less than 70 maternal deaths per 100,000 live births by 2030. MethodsA cross-sectional study was conducted in the Department of Obstetrics and Gynaecology, Tribhuvan University Teaching Hospital (TUTH) from 1st Baisakh 2055- 30th Chaitra 2069 (15th April 1998- 14th April 2013). The study period of 15 years was divided into three parts, five years each: 2055-59 (14th April 1998-April 13th 2003) ; 2060-64 (14th April 2003- April 12th 2008) and 2065...
Introduction: Hemoperitoneum resulting from the rupture of pancreatic tumors is a rare condition,... more Introduction: Hemoperitoneum resulting from the rupture of pancreatic tumors is a rare condition, especially during pregnancy. Case Presentation: We report a case of a 21-year-old gravida 2, para 1, at 25+5 weeks of gestation, who presented to the hospital with severe epigastric pain and decreased fetal movement. Ultrasonography showed intrauterine fetal death, a retroperitoneal mass in the epigastric region, and hemoperitoneum. Computed tomography scan revealed a heterogeneously enhancing pancreatic mass suggestive of pancreatic neoplasm. However, the late diagnosis and the delay in treatment resulted in a deterioration of maternal status with eventual mortality. Conclusion: Diagnostic difficulties occur because of the rarity of the condition and vague clinical presentations. In case of a pregnancy complicated by hemoperitoneum, prompt effort to stop the intraperitoneal bleeding is imperative.
An 18 year old girl was subjected to emergency hysterectomy and unilateral salpingo-oophorectomy ... more An 18 year old girl was subjected to emergency hysterectomy and unilateral salpingo-oophorectomy for uterine perforation because of repeated dilatation and curettagefor persisting vaginal bleeding following molar evacuation.As significant proportion of molar do progress into Gestational trophoblastic Neoplasiawhich in this case was choriocarcinoma; directs our attention to the fact that properfollow up of post molar cases using at least urinary beta HCG and institutingchemotherapy whenever necessary should be advocated in order to avoid such adrastic management.Key Words: Uterine perforation, molar, Gestational Trophoblastic Neoplasia (GTN)
Aims: This study aimed at comparing the efficacy of oral misoprostol 600 mcg with intramuscular o... more Aims: This study aimed at comparing the efficacy of oral misoprostol 600 mcg with intramuscular oxytocin 10 IU in the active management of third stage of labour. Methods: This prospective comparative study was performed in Tribhuvan University Teaching Hospital to compare the efficacy of oral misoprostol with intramuscular oxytocin in the third stage of labour for the prevention of postpartum hemorrhage. One hundred and twenty women without risk of PPH were randomly allocated to receive either 600 mcg misoprostol orally (Group A) or 10 unit of oxytocin intramuscularly (Group B) within 1 minute of delivery. The efficacy and the safety of these two drugs were analyzed on the basis of percentages fall in hemoglobin (Hb) and hematocrit (Hct) level from before delivery to 8 completed hours after delivery, need for additional uterotonic agents, need for exploration and uterine evacuation, need for blood transfusion, duration of third stage of labour and the numbers of retained placenta an...
The Journal of South Asian Federation of Menopause Societies, 2014
Background Foreign bodies are less common in uterine cavity than vagina, and are less frequently ... more Background Foreign bodies are less common in uterine cavity than vagina, and are less frequently seen in older women than prepubertal or premenarchal girls. When found in the uterus, these foreign bodies are usually forgotten intrauterine contraceptive device or retained fetal bones, objects which were introduced in the former case or the remnants of conceptus parts that was inadvertently retained as in the latter circumstances. Here, we are going to concentrate in foreign body that made its way into the uterine cavity unaided. Aim To study rice grain as retained intrauterine foreign body in women with prolapsed uterus. Methods Collection of series of cases of rice grain in the uterine cavity of women exposed to vaginal hysterectomy and pelvic floor repair for uterine prolapse from the year 2004 till date, from the Department of Obstetrics and Gynecology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal. Results The rice grains as foreign body were entirely seen in postmenop...
Chronic vaginal discharge in children and adolescents is a common gynaecological complaint which ... more Chronic vaginal discharge in children and adolescents is a common gynaecological complaint which is often resistant to antibiotic treatment. We present a 14 years old, premenarcheal girl who presented to us with the complaints of recurrent, foul smelling purulent occasionally blood stained vaginal discharge for eight years, where a foreign body in the upper vagina was found after releasing a dense adhesion of the lower vagina which was unable to detect by pelvic ultrasound.
Removing a degenerated myoma located around the uterine cornu by an innovative technique shelling... more Removing a degenerated myoma located around the uterine cornu by an innovative technique shelling the myoma a little away from the base by choice of a low placed incision, advantageous in terms of no requirement of blood transfusion because of the reduction in the surgical time is described in a 24 years old lady demanding a fertility conserving surgery.
Introduction: Concurrent occurrence of rectal and uterovaginal prolapse in many women living in t... more Introduction: Concurrent occurrence of rectal and uterovaginal prolapse in many women living in the community with misery should be made aware that there is possible solution to this dual debilitating condition by surgical correction which can be acquired at the same sitting to bring changes in their quality of life. Case Report: We report here two ceses of concomitant rectal and uterovaginal prolapse. Fig 1. Uterovaginal prolapse associated with rectal prolapse
Aim: To study, open myomectomy operation for uterine myoma/s as of present day practices in women... more Aim: To study, open myomectomy operation for uterine myoma/s as of present day practices in women ofreproductive age attending TU Teaching Hospital.Methods: This is a retrospective study where we reviewed the medical records of myomectomy cases from2060-2065(2003 April-2009 April).Result: Total 40 cases of myomectomy performed in TU Teaching hospital for myoma size varying from ≥ 10weeks (5), 12-16 weeks (15), 17-22 weeks (5), 23-28 weeks (5) and unknown (2) in women of reproductiveage [ 30-34(16), ≥ 29 (13), 35-39 (9), 40- 44 (1) and ≥ 45 (1)] in 13 (unmarried); nullipara (17); P1-2 (15)P3-4 (1) for reasons of infertility(12), dysmenorrhea (12), menorrhagia (8), urinary problems( 7) abdominalpain (3).At caesarean, myomectomy has been done in special circumstances for subbersous pedunculated myomaand broad ligament myoma, one each.Solitary myomas were 29 and multiple myomas were 8; a case each of broad ligament and cervical myoma(1), was later removed vaginally. Rests had abdominal ...
A seventy two year old postmenopausal multiparous lady who presented with III° uterovaginal prola... more A seventy two year old postmenopausal multiparous lady who presented with III° uterovaginal prolapse was found to have a solid mass palpable through the vaginal fornices for which the vaginal procedure was deferred for abdominal hysterectomy. A solid mass resembling fibrothecoma was discovered which after histopathological examination was reported to be thecoma pointing out the importance of preoperative evaluation. Key words: post menopausal ovarian tumor, thecoma, uterovaginal prolapse with ovarian tumor doi:10.3126/njog.v1i2.2404 N. J. Obstet. Gynaecol Vol. 1, No. 2, p. 69-70 Nov-Dec 2006
How the largest of the large (> 10 x 8 cms) sub mucous myoma arising from the fundus uteri suc... more How the largest of the large (> 10 x 8 cms) sub mucous myoma arising from the fundus uteri successively promotes the occurrence of non puerperal uterine inversion over the years as depicted through 3 different illustrations imitating a gradual process; first by forming an indentation in the uterine fundus then progressively causing more dimpling in the verge of uterine inversion until finally giving rise to a full blown picture of complete uterine inversion where the uterine fundus is driven beyond the level of introitus with the consequences of prolapsed incarcerated myoma in a post menopausal woman. A total abdominal hysterectomy and bilateral salpingoophorectomy were performed on all of these 3 women 2 perimenopausal and a postmenopausal; the latter was first facilitated by vaginal myomectomy further supplemented by division of the inversion ring posteriorly as described by Haultain. Key words: Non puerperal uterine inversion, submucous fundal myoma, vaginal myomectomy. doi:10...
Aim: To determine whether short term bladder catheterisation for 24 hrs after vaginal hysterectom... more Aim: To determine whether short term bladder catheterisation for 24 hrs after vaginal hysterectomy for prolapse would be more advantageous to routinely practiced 3 days catheterisation. Method: Randomized comparative study was done as thesis topic in Gynaecological Ward of TU Teaching Hospital, Maharajgunj, Kathmandu from 30th October 2004 to 2nd November 2005. A total of 100 women were included in this study. Prior to surgery at OT table, and before giving prophylactic antibiotics urine samples were collected from metal catheter for routine analysis. They were randomized into two groups. In groups 1 (n=50) transurethral catheter was removed after 24 hrs of surgery. In group 2 (n=50) catheter was removed on 3rd post operative day. Urine culture was taken before removal of the catheter. Residual volume of urine after the first voiding was measured by transabdominal ultrasound. Recatheterisation for three more days was considered whenever residual volume exceeded 200ml. Result: Recath...
Aims: To study the distribution of different types of ovarian tumors seen in adolescents and chil... more Aims: To study the distribution of different types of ovarian tumors seen in adolescents and children and evaluate the commonest tumor during this period. Methods: A prospective study conducted at Dept of Ob/Gyn, Tribhuvan University Teaching Hospital form January 1999 - January 2008. Results: There were a total of 80 cases of ovarian tumors in childhood and adolescents. Most of the cases had presented to the outpatient department of Ob/Gyn (54%), Medicine (10%), Surgery (21%) and Emergency Unit (15%). Majority of the cases were between the ages of 15 to 19 and tumors in childhood age up to 14 represented 21% of the total ( < 10year being 4). The most frequently occurring tumor was Germ cell tumors accounting for 59 (73.7%) of the total. Out of which dermoid was the most frequently occurring in 45(76.2%). Nineteen (23.71 %) of the total tumor were malignant. All of them underwent laparatomy followed by enucleation (14); Unilateral ophoorectomy (28), unilateral salphingooophorecto...
Background-Chlorhexidine skin cleansing might substantially reduce neonatal infection and mortali... more Background-Chlorhexidine skin cleansing might substantially reduce neonatal infection and mortality in developing countries. Few data exist on the impact of chlorhexidine cleansing on skin colonization of infants during the first day of life or on the absorption potential of chlorhexidine during newborn skin cleansing. Methods-Hospital born newborns in Kathmandu, Nepal were randomly allocated to full-body skin cleansing with 0.25%, 0.50%, or 1.00% chlorhexidine solution. Skin swabs were collected from the axilla, inguinal and peri-umbilical areas before cleansing (baseline), and at 2 and 24 hours after treatment. Skin flora was quantified and organisms identified. In a sub-sample, heel prick blood was collected 24 hours after the cleansing and percutaneous absorption of chlorhexidine was assessed. Results-Among 286 enrolled newborns, no adverse effects on skin were reported and body temperature was minimally reduced (mean reduction 0.33°C). In all groups, positive skin culture rates were significantly reduced at 2 hours but generally not at 24 hours; greater reductions were observed with higher concentrations of chlorhexidine. Effect at 24 hours was highest in the 1.00% group (37% lower positive skin culture rate). For 15 of 75 infants with heel pricks, chlorhexidine was detected at trace concentrations (< 8 ng/ml, n=14; 25.8 ng/ml, n=1). Conclusions-Chlorhexidine skin cleansing appeared safe and reduced skin flora in newborns in a dose-dependent manner 2 hours after treatment. Greater residual effect at the highest concentration (1%) might provide broader benefit and may simplify combined maternal and neonatal regimens by matching the concentration used for vaginal cleansing during labor.
Aims: To find out the uterovaginal anomalies associated with congenital genital tract obstruction... more Aims: To find out the uterovaginal anomalies associated with congenital genital tract obstruction and successes achieved in its management. Methods: This was a descriptive study done at department of Obs/Gyn at Tribhuvan University Teaching Hospital from April 2014 to April 2018. Types of genital tract obstruction, surgical treatment, success of management and surgical complications were studied. Results: Of 35 cases 16 (46%) consisted of adolescents aged 11-15 yrs. Majority cases of GTO was due to vaginal septum 12(34%): longitudinal 4(33%), mostly transverse vaginal septum (TVS) 8(67%): upper TVS 4 and lower TVS 4,one among each associated with concurrent Imperforate hymen (IH). Other GTO consisted of only IH cases 9 (26%), vaginal agenesis 7 (21%), non- communicating rudimentary horn 4 , non-communicating right cornua 1and cervical stenosis 1(3%). Resection of septum performed in 12 cases of vaginal septum. hymenectomy in 8 and rudimentary horn excision in 4 cases. Restenosis was...
Journal of South Asian Federation of Obstetrics and Gynaecology
Background: Hemolysis, elevated liver enzymes, and low platelet (HELLP) syndrome is a serious obs... more Background: Hemolysis, elevated liver enzymes, and low platelet (HELLP) syndrome is a serious obstetric complication with high risk of adverse maternal and perinatal outcomes. The aim of the study was to find the prevalence of HELLP syndrome and to analyze the maternal and perinatal outcomes. Methods: This was a descriptive cross-sectional study conducted in a tertiary care center from April 13, 2016, to April 12, 2020, after obtaining ethical clearance from the Institutional Review Committee. All the women with HELLP syndrome who delivered in the hospital during the study period were enrolled. A convenience sampling technique was used. Data were analyzed using the Statistical Package for the Social Sciences version 24 software. Descriptive analysis was done and frequency and proportion were calculated for binary data. Results: Prevalence of HELLP syndrome was 0.23%. The majority of the cases were in the 25-29 years age-group and the mean maternal age was 28.05 years. Twenty-seven (61.36%) were primigravida. Of 44, 27 (61.36%) delivered through lower segment cesarean section. Nineteen (43.18%) women were admitted to the high dependency unit. There were four (9.1%) maternal deaths. Most (68.18%) of the babies were preterm and 62.5% of the live-born babies were admitted to the neonatal intensive care unit. There were 20 perinatal deaths with a perinatal mortality of 45.45%. Conclusion: HELLP syndrome is a dreadful complication with high morbidity and mortality. Timely termination of pregnancy is warranted to arrest further progress of pathophysiology. Clinical significance: Outcomes in HELLP syndrome can be improved with early diagnosis and timely intervention.
Journal of College of Medical Sciences-Nepal, 2021
Introduction Maternal mortality reflects reproductive health status and availability of good heal... more Introduction Maternal mortality reflects reproductive health status and availability of good health care facilities at different levels of the healthcare system at a given period, influenced by globally adopted safe motherhood policies. The leading causes of maternal death in Nepal mainly comprise of hemorrhage, eclampsia, abortion-related complications, gastroenteritis and anemia. Although a declining trend has been noted in Nepal it has yet to meet the target set by the Sustainable Development Goal (SDG) 3.1 of reducing the global MMR to less than 70 maternal deaths per 100,000 live births by 2030. MethodsA cross-sectional study was conducted in the Department of Obstetrics and Gynaecology, Tribhuvan University Teaching Hospital (TUTH) from 1st Baisakh 2055- 30th Chaitra 2069 (15th April 1998- 14th April 2013). The study period of 15 years was divided into three parts, five years each: 2055-59 (14th April 1998-April 13th 2003) ; 2060-64 (14th April 2003- April 12th 2008) and 2065...
Introduction: Hemoperitoneum resulting from the rupture of pancreatic tumors is a rare condition,... more Introduction: Hemoperitoneum resulting from the rupture of pancreatic tumors is a rare condition, especially during pregnancy. Case Presentation: We report a case of a 21-year-old gravida 2, para 1, at 25+5 weeks of gestation, who presented to the hospital with severe epigastric pain and decreased fetal movement. Ultrasonography showed intrauterine fetal death, a retroperitoneal mass in the epigastric region, and hemoperitoneum. Computed tomography scan revealed a heterogeneously enhancing pancreatic mass suggestive of pancreatic neoplasm. However, the late diagnosis and the delay in treatment resulted in a deterioration of maternal status with eventual mortality. Conclusion: Diagnostic difficulties occur because of the rarity of the condition and vague clinical presentations. In case of a pregnancy complicated by hemoperitoneum, prompt effort to stop the intraperitoneal bleeding is imperative.
An 18 year old girl was subjected to emergency hysterectomy and unilateral salpingo-oophorectomy ... more An 18 year old girl was subjected to emergency hysterectomy and unilateral salpingo-oophorectomy for uterine perforation because of repeated dilatation and curettagefor persisting vaginal bleeding following molar evacuation.As significant proportion of molar do progress into Gestational trophoblastic Neoplasiawhich in this case was choriocarcinoma; directs our attention to the fact that properfollow up of post molar cases using at least urinary beta HCG and institutingchemotherapy whenever necessary should be advocated in order to avoid such adrastic management.Key Words: Uterine perforation, molar, Gestational Trophoblastic Neoplasia (GTN)
Aims: This study aimed at comparing the efficacy of oral misoprostol 600 mcg with intramuscular o... more Aims: This study aimed at comparing the efficacy of oral misoprostol 600 mcg with intramuscular oxytocin 10 IU in the active management of third stage of labour. Methods: This prospective comparative study was performed in Tribhuvan University Teaching Hospital to compare the efficacy of oral misoprostol with intramuscular oxytocin in the third stage of labour for the prevention of postpartum hemorrhage. One hundred and twenty women without risk of PPH were randomly allocated to receive either 600 mcg misoprostol orally (Group A) or 10 unit of oxytocin intramuscularly (Group B) within 1 minute of delivery. The efficacy and the safety of these two drugs were analyzed on the basis of percentages fall in hemoglobin (Hb) and hematocrit (Hct) level from before delivery to 8 completed hours after delivery, need for additional uterotonic agents, need for exploration and uterine evacuation, need for blood transfusion, duration of third stage of labour and the numbers of retained placenta an...
The Journal of South Asian Federation of Menopause Societies, 2014
Background Foreign bodies are less common in uterine cavity than vagina, and are less frequently ... more Background Foreign bodies are less common in uterine cavity than vagina, and are less frequently seen in older women than prepubertal or premenarchal girls. When found in the uterus, these foreign bodies are usually forgotten intrauterine contraceptive device or retained fetal bones, objects which were introduced in the former case or the remnants of conceptus parts that was inadvertently retained as in the latter circumstances. Here, we are going to concentrate in foreign body that made its way into the uterine cavity unaided. Aim To study rice grain as retained intrauterine foreign body in women with prolapsed uterus. Methods Collection of series of cases of rice grain in the uterine cavity of women exposed to vaginal hysterectomy and pelvic floor repair for uterine prolapse from the year 2004 till date, from the Department of Obstetrics and Gynecology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal. Results The rice grains as foreign body were entirely seen in postmenop...
Chronic vaginal discharge in children and adolescents is a common gynaecological complaint which ... more Chronic vaginal discharge in children and adolescents is a common gynaecological complaint which is often resistant to antibiotic treatment. We present a 14 years old, premenarcheal girl who presented to us with the complaints of recurrent, foul smelling purulent occasionally blood stained vaginal discharge for eight years, where a foreign body in the upper vagina was found after releasing a dense adhesion of the lower vagina which was unable to detect by pelvic ultrasound.
Removing a degenerated myoma located around the uterine cornu by an innovative technique shelling... more Removing a degenerated myoma located around the uterine cornu by an innovative technique shelling the myoma a little away from the base by choice of a low placed incision, advantageous in terms of no requirement of blood transfusion because of the reduction in the surgical time is described in a 24 years old lady demanding a fertility conserving surgery.
Introduction: Concurrent occurrence of rectal and uterovaginal prolapse in many women living in t... more Introduction: Concurrent occurrence of rectal and uterovaginal prolapse in many women living in the community with misery should be made aware that there is possible solution to this dual debilitating condition by surgical correction which can be acquired at the same sitting to bring changes in their quality of life. Case Report: We report here two ceses of concomitant rectal and uterovaginal prolapse. Fig 1. Uterovaginal prolapse associated with rectal prolapse
Aim: To study, open myomectomy operation for uterine myoma/s as of present day practices in women... more Aim: To study, open myomectomy operation for uterine myoma/s as of present day practices in women ofreproductive age attending TU Teaching Hospital.Methods: This is a retrospective study where we reviewed the medical records of myomectomy cases from2060-2065(2003 April-2009 April).Result: Total 40 cases of myomectomy performed in TU Teaching hospital for myoma size varying from ≥ 10weeks (5), 12-16 weeks (15), 17-22 weeks (5), 23-28 weeks (5) and unknown (2) in women of reproductiveage [ 30-34(16), ≥ 29 (13), 35-39 (9), 40- 44 (1) and ≥ 45 (1)] in 13 (unmarried); nullipara (17); P1-2 (15)P3-4 (1) for reasons of infertility(12), dysmenorrhea (12), menorrhagia (8), urinary problems( 7) abdominalpain (3).At caesarean, myomectomy has been done in special circumstances for subbersous pedunculated myomaand broad ligament myoma, one each.Solitary myomas were 29 and multiple myomas were 8; a case each of broad ligament and cervical myoma(1), was later removed vaginally. Rests had abdominal ...
A seventy two year old postmenopausal multiparous lady who presented with III° uterovaginal prola... more A seventy two year old postmenopausal multiparous lady who presented with III° uterovaginal prolapse was found to have a solid mass palpable through the vaginal fornices for which the vaginal procedure was deferred for abdominal hysterectomy. A solid mass resembling fibrothecoma was discovered which after histopathological examination was reported to be thecoma pointing out the importance of preoperative evaluation. Key words: post menopausal ovarian tumor, thecoma, uterovaginal prolapse with ovarian tumor doi:10.3126/njog.v1i2.2404 N. J. Obstet. Gynaecol Vol. 1, No. 2, p. 69-70 Nov-Dec 2006
How the largest of the large (> 10 x 8 cms) sub mucous myoma arising from the fundus uteri suc... more How the largest of the large (> 10 x 8 cms) sub mucous myoma arising from the fundus uteri successively promotes the occurrence of non puerperal uterine inversion over the years as depicted through 3 different illustrations imitating a gradual process; first by forming an indentation in the uterine fundus then progressively causing more dimpling in the verge of uterine inversion until finally giving rise to a full blown picture of complete uterine inversion where the uterine fundus is driven beyond the level of introitus with the consequences of prolapsed incarcerated myoma in a post menopausal woman. A total abdominal hysterectomy and bilateral salpingoophorectomy were performed on all of these 3 women 2 perimenopausal and a postmenopausal; the latter was first facilitated by vaginal myomectomy further supplemented by division of the inversion ring posteriorly as described by Haultain. Key words: Non puerperal uterine inversion, submucous fundal myoma, vaginal myomectomy. doi:10...
Aim: To determine whether short term bladder catheterisation for 24 hrs after vaginal hysterectom... more Aim: To determine whether short term bladder catheterisation for 24 hrs after vaginal hysterectomy for prolapse would be more advantageous to routinely practiced 3 days catheterisation. Method: Randomized comparative study was done as thesis topic in Gynaecological Ward of TU Teaching Hospital, Maharajgunj, Kathmandu from 30th October 2004 to 2nd November 2005. A total of 100 women were included in this study. Prior to surgery at OT table, and before giving prophylactic antibiotics urine samples were collected from metal catheter for routine analysis. They were randomized into two groups. In groups 1 (n=50) transurethral catheter was removed after 24 hrs of surgery. In group 2 (n=50) catheter was removed on 3rd post operative day. Urine culture was taken before removal of the catheter. Residual volume of urine after the first voiding was measured by transabdominal ultrasound. Recatheterisation for three more days was considered whenever residual volume exceeded 200ml. Result: Recath...
Aims: To study the distribution of different types of ovarian tumors seen in adolescents and chil... more Aims: To study the distribution of different types of ovarian tumors seen in adolescents and children and evaluate the commonest tumor during this period. Methods: A prospective study conducted at Dept of Ob/Gyn, Tribhuvan University Teaching Hospital form January 1999 - January 2008. Results: There were a total of 80 cases of ovarian tumors in childhood and adolescents. Most of the cases had presented to the outpatient department of Ob/Gyn (54%), Medicine (10%), Surgery (21%) and Emergency Unit (15%). Majority of the cases were between the ages of 15 to 19 and tumors in childhood age up to 14 represented 21% of the total ( < 10year being 4). The most frequently occurring tumor was Germ cell tumors accounting for 59 (73.7%) of the total. Out of which dermoid was the most frequently occurring in 45(76.2%). Nineteen (23.71 %) of the total tumor were malignant. All of them underwent laparatomy followed by enucleation (14); Unilateral ophoorectomy (28), unilateral salphingooophorecto...
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