Nepal Journal of Obstetrics and Gynaecology

Management of Rhesus Isoimmunised Pregnancy

Vatsla Dadhwal — 2024-01-24

Rhesus (Rh) isoimmunization remains a leading cause of fetal anemia/fetal hydrops and subsequently haemolytic disease of the fetus and newborn in low-income and middle-income countries. Rh isoimmunization can be easily prevented by simple and effective prophylaxis. Fetal anemia can be treated successfully in utero by intrauterine blood transfusion. However, if fetal anemia is not optimally and appropriately treated in time, it can result in hydrops fetalis and even intrauterine death. Serious neonatal complications such as kernicterus can also develop due to severe jaundice in neonates.

Idiopathic Non-puerperal Uterine Inversion in a Young Female: A Rare Case Report

Amit Kumar — 2024-01-24

Non-puerperal uterine inversion is extremely unusual among adolescent females. To our knowledge this is the first case to be reported in such a young patient without an identifiable cause. Chronic menorrhagia, abdominal pain, and episodes of acute urinary retention were the patient’s primary symptoms. Most recorded cases of uterine inversion have recognised causes, but the aetiology in this case was idiopathic, contributing to its rarity. The clinical and radiological evaluations first showed a cervical polyp, but magnetic resonance imaging of the pelvis was critical in verifying the uterine inversion. This case report emphasizes the diagnostic challenges of uterine inversion, which become considerably more difficult when dealing with young patients. Manual repositioning is the most common treatment for uterine inversion, and surgery is considered if manual repositioning is not possible.

Paradigm shift in Endometrial Cancer Surgery

Rama Joshi — 2024-01-24

N/A

The Effectiveness of Information, Education and Communication (IEC) on Awareness Regarding Polycystic Ovarian Syndrome (PCOS) Among Undergraduates at A Selected Nursing College, South India

Monisha U — 2024-01-24

Aims: Polycystic Ovarian Syndrome is the most common endocrine disorder among women between the ages of 18 and 44 years. The signs and symptoms of polycystic ovarian syndrome include menstrual irregularities, excess body and facial hair, acne, pelvic pain, difficulty getting pregnant, and patches of thicker, darker, velvety skin. The primary objective was to evaluate the effectiveness of information, education, and communication on awareness regarding polycystic ovarian syndrome among undergraduates.

Methods: A quantitative pre-experimental approach was adopted and the research design used was a one-group pre-test-post-test design. The study was conducted at a selected nursing college in South Kerala. A total of 104 samples were selected by total enumerative sampling. The socio-demographic variables were gathered by selfreporting. The awareness was assessed by a structured questionnaire. The sample was
provided with an education session using video and leaflets, and the post-test was conducted 45 days after the pretest.

Results: The pretest mean + SD score of awareness was 12.91 + 3.16, the posttest mean score was 14.79 + 2.74. The mean difference was statistically highly significant (p 0.001). It showed there was a significant difference in awareness among undergraduates after the implementation of Information, Education and Communication.

Conclusions: Information, education and communication had a significant effect in improving the awareness regarding polycystic ovarian syndrome among undergraduates.

Factors affecting acceptance of immediate postpartum contraception at a tertiary hospital in northern Nigeria

Amina Mohammed-Durosinlorun — 2024-01-24

Background: Postpartum contraception is a simple measure that can potentially impact positively on quality of life of mothers and their families, and reduce overall maternal mortality and morbidity, especially in low resource settings.

Aims: To determine factors affecting acceptance of contraception in the immediate post-partum period.

Methodology: This was a cross sectional study carried out between January 2019 to December 2021. A convenient sample of women in the immediate postpartum period had exit interviews, using a semi-structured interviewer administered questionnaire and information was obtained on sociodemographic and reproductive characteristics, pregnancy and delivery history, and reasons for accepting or refusing contraception. Data analysis was done using simple descriptive and inferential statistics. A p-value of < 0.05 was considered statistically significant.

Results: A total of 455 women participated in the study. The mean age of respondents was 29.32 ± 6.31 years, and most women were parous with 1-4 children (313,68.8%). Only 199 women (43.7%) accepted immediate postpartum contraception, mostly implants (166 women) and intra-uterine devices (18 women). Reasons for accepting contraception was to rest, heal and regain strength while reasons for refusing were husband – related factors and the perception that it was too early to initiate contraception. Several factors were significantly associated with uptake of contraception (P- value < 0.05) including age, ethnicity, duration of marriage, parity, number and sex of children alive, desire for more children, previous unplanned pregnancy, accoucheur, time and mode of delivery, outcome of index pregnancy, previous use of contraception and timing of contraceptive counselling.

Conclusion: Acceptance of immediate postpartum can be increased by educating women about their need and safety, greater male involvement and creating opportunities for multiple counselling sessions antenatally.

PALM-COEIN Classification of Abnormal Uterine Bleeding among Women of Reproductive Age in a Tertiary Care Centre of Eastern Nepal

Jiba Nath Dhamala — 2024-01-24

Aims: Abnormal Uterine Bleeding (AUB) is a highly prevalent condition with complex underlying condition. The absence of standardized definitions and uniform criteria for describing menstrual symptoms has posed challenges in investigation and management of the case. This study was conducted to categorize the causes of AUB among Nepalese women of reproductive age using the PALM-COIEN classification system (provided by FIGO) and to describe the bleeding patterns exhibited by them.

Methods: A descriptive cross-sectional study was conducted among 139 women of reproductive age group visiting out-patient care in a tertiary care hospital with complaints of abnormal uterine bleeding. The causes of AUB were classified before treatment using the PALM-COEIN system.

Results: The mean age of patients was 37.9 ± 10.1 years, with 57.6% of them aged 38 years or more. Structural causes accounted for 31% of the AUB cases, while non-structural causes were present in 69% of them. AUB-O was the most frequent finding 91(65.5%) among the patients, followed by AUB-L in 19 (13.7%) women and AUB-A in 11 (7.9%) women. More than half of the patients (54.7%) were anemic, and hypothyroidism was seen in 14.2% of them.

Conclusion: Non-structural causes of AUB particularly ovulatory dysfunction contributed to major cause of AUB. Evidence of various etiological causes of AUB among Nepalese women based on this PALM-COEIN system can provide uniformity in investigation and management of such cases.

Knowledge and practice regarding Pelvic Floor Disorders among mid-level health providers in eastern Nepal: A cross-sectional study

Tulasa Basnet — 2024-01-24

Aims: Pelvic floor disorders negatively affect the quality of life of women worldwide. Lack of adequate knowledge among women as well as health workers and limited access to health care has deprived women of proper management. This study aimed to assess the knowledge and common practice regarding PFDs among mid-level health providers.

Methods: A descriptive cross-sectional survey was conducted among mid-level health providers attending training on reproductive health morbidity screening at the health training centers of two hilly districts of eastern Nepal after ethical clearance from Institutional Review Committee, BPKIHS. The data were collected using a structured questionnaire, pretested before the use. The participants were requested to complete questionnaire before the training session was started. The data obtained were analyzed using descriptive statistics.

Results: Out of 72 participants, 71 completed the questionnaires. Mean age of participants was 30.56±8.27 years. Among them, 63.4% were nurses and 36.6% ANMs; 81.7% were aware of pelvic floor disorders (PFD), 90.2% identified pelvic organ prolapse (POP) as the commonest PFDs in Nepal, 91.4% were aware of risk factors and 32.4% knew about Urogynecology subspeciality. Majority (53.4%) were not screening for PFDs routinely. Nearly 40% participants would reassure and refer the patients with POP, 53% do so for urinary incontinence and 70% would refer patients with obstetric fistula and fecal incontinence. Only 35% would start treatment for pelvic organ prolapse. Those with experience > 5 years were more likely to screen PFDs (p=0.007) and start treatment for pelvic organ prolapse (p=0.034).

Conclusion: Mid-level health providers are aware of common pelvic floor disorders but are not routinely screening these disorders or practicing simple conservative management strategies. Training these health workers with proper screening guidelines on pelvic floor disorders is imperative.

Pregnancy Outcome In Hypertensive Disorder Of Pregnancy With Low Platelet count

Nitu kumari Jha — 2024-01-24

Aims: To study pregnancy outcome in HDP with low platelet count.

Objectives: This study aimed to assess the frequency of occurrence, identify diverse delivery methods, and investigate the maternal and fetal outcomes associated with Hypertensive Disorders of Pregnancy (HDP) in the presence of low platelet count.

Methodology: This cross-sectional descriptive study took place at Paropakar Maternity and Women’s Hospital (PMWH) in Kathmandu, focusing on hospital-based data. The sample size was 35. Total duration of data collection was 6 months from shrawan 2078 to poush 2078.

Results: A total of 35 cases fulfilling the inclusion criteria were enrolled. Incidence of HDP with low platelet count was 100/810 (12.3%). Majority of cases were primigravida 19/35(54.3%), of age group 20-24 10/35(28.6%). Mostly, pre-eclampsia cases had thrombocytopenia 17/35(48.5%). Majority of cases 21/35 (60%) had LSCS and 14/35 (40 %) had vaginal delivery. Maternal complication included MICU admission, HELLP syndrome, PPH and abruptio placenta and fetal complication were LBW, NICU admission, Perinatal asphyxia, IUFD, IUGR and early NND were noted.

Conclusions: This study reveals a significant association between HDP accompanied by thrombocytopenia and heightened maternal and fetal morbidity. The primary
maternal complications observed included admission to the Maternal Intensive Care Unit (MICU) for monitoring post the administration of a loading dose of MgSo4, followed by occurrences of HELLP syndrome and PPH. Fetal complications encompassed admissions to the NICU, instances of LBW, perinatal asphyxia, IUGR, and IUFD.

Severity of Menopausal Symptoms and Its Association with Various Sociodemographic Variables: A Hospitalbased Cross-sectional Study

Anjali Subedi — 2024-01-24

Aims: Menopause is a natural process with short term and long term health implications in menopausal women. There is variation in severity of menopausal symptoms among menopausal women and various socio-demographic factors are responsible for the difference of experience of symptoms. This study was conducted to assess the severity of menopausal symptoms and explore its association with various socio-demographic factors.

Methods: This was a cross-sectional analytical study done in a tertiary care hospital for duration of one year. All the menopausal women visiting outpatient department of Obstetrics and Gynecology were enrolled in the study and interviewed using preformed proforma and Nepali version of Menopausal Rating Scale (MRS) about demographic variables and menopausal symptoms severity respectively.

Results: Among 411 menopausal women with symptoms, 373 (90.75%) had nonsevere symptoms (MRS score <16) and 38 (9.25%) had severe symptoms (MRS≥16).
We found that women from Dalit ethnicity (AOR 1.5; 95% CI: 0.51, 4.43), Madhesi ethnicity (AOR 2.62; 95% CI: 0.27, 24.96), , women who smoked (AOR 1.64; 95% CI: 0.68, 3.93) and who had any medical disorders (AOR 1.59; 95% CI: 0.80, 3.17) did not have statistically significant association with severity of symptoms.

Conclusions: Severe menopausal symptoms were not common in our study. No statistically significant association was found between symptoms severity and sociodemographic variables.

A Study on Epidemiology of Severe Acute Maternal Morbidity in a Tertiary Care Center

Lakshmidevi M — 2024-01-24

Aims: Although maternal mortality is a good indicator of maternal health care services, it does not consider the near miss cases which would have otherwise ended in mortality if timely intervention and adequate services were not provided. Hence, the new concept of severe acute maternal morbidity (SAMM) emerged as a promising alternative to maternal mortality reviews.

Methods: It was a retrospective study of all pregnant women or those within 42 days of termination of pregnancy who fulfilled the modified WHO SAMM criteria 2009 and were admitted in the emergency and intensive care unit from January 2019 to June 2021.

Result: A total of 110 SAMM cases were included in the study. The maternal mortality ratio was 2.74 per 100000 live births. The incidence of SAMM was 7.55% and Mortality index was 3.63%. Hypertensive disorders of pregnancy accounted for 49 (44.45%) of SAMM, of which 14 (12.72%) had eclampsia, followed by hemorrhage including both antepartum and postpartum (N=29, 26.35%). Twenty three (20.90%) cases presented with ruptured ectopic pregnancy requiring laparotomy.

Conclusion: Maternal mortality and SAMM share similar spectrum of pathology and circumstances. Timely diagnosis and referral, and with aggressive multidisciplinary team involvement SAMM cases can be prevented to end as maternal mortality.

Health Equity for Women still a challenge

Meeta Singh — 2024-01-24

We are delighted to come out with another issue of NJOG,we are open to your suggestions, feedback and comments. Our goal is to see this journal indexed and attract maximum number of clinicians, researchers, public health experts in obstetrics and gynecology and sub- specialties. To ease communication and encourage new contributors we have made it more user friendly with only online submissions. Guidelines already exist and our technical staff are ready to help you, if any concerns arise.

This issue we have tried to provide fair and insightful content by variety of articles. In order to reduce the gap between research and practiceoriginal research articles, short communications and case reports are featured. Our readers would have access to the latest research in our field, and hopefully it would stimulate all of you to write more, explore and share with our colleagues your scientific work. “Knowledge is power, information is liberating, education is the premise of progress in every society, in every family” Kofi Anan former secretary general United Nations. These powerful words said many years back, have been the foundation of my curiosity. Learning is a life long process, hopefully as the days pass our journal also will become better and better. But this can only be possible with your contribution and feedback. Together we can make a difference in women’s health. Having laws for gender equity is not enough, we all can make a difference together!

We have colleagues through- out the country and abroad who are improving women’s health every single day. So many of us have faced challenges and so many success and failure stories need to be shared too. Research helps us to learn what works and what does not, how best to deliver proven interventions, what barriers exist in our country context, surely, we are unique in so many ways.

We work but we spend very little time to document things. We urge all our colleague please share with us your stories, your cases, your challenges. This is the only way to empower our colleagues as well as share latest evidence- based practices. We are trying to generate excitementand challenges for research ,write , share , reflect and promote women’s health and make a difference for women’s health equity. I look forward hearing from you, your thoughts and ideas. Please feel free to write to me. Enjoy reading the issue...