Infection prevention and control program is important to prevent infectious morbidity. Simple method like hand washing to effective sterilization methods are recommended in clinical practice. Immunocompromised state of pregnancy and newborn are more vulnerable to acquire infection; and there is a real challenge from hospital acquired infection because of surgical nature of obstetric care.
Aims: To determine prevalence, causes and factors leading to severe acute maternal morbidity and mortality during COVID 19 pandemic. Methods: The was a cross sectional observational study conducted in the department of Obstetrics and Gynaecology of Manipal teaching hospital from March 2020 to February 2022 amid COVID 19 pandemic. Women who sustained severe acute maternal morbidity (according to World health organization organ system criteria) and maternal deaths during pregnancy, labour and six weeks postpartum were included. Maternal characteristics, total live births, pregnancy outcome, causes and factors leading to morbidity and mortality were noted. The acquisitioned data was analyzed using Statistical Package for Social Sciences version 21. Results: There were 37 cases of severe acute maternal morbidity and 2 cases of maternal deaths. The severe acute maternal morbidity ratio was 9.4 per 1000 live births and maternal mortality ratio was 51 per 100,000 live births. Therefore, severe acute maternal morbidity mortality ratio was 18.5:1 and mortality index 5.1%. Haematological and coagulation system (45.9%) and neurological system (29.7%) were the common organ systems involved. Hypertensive disorders (40.5%) and haemorrhage (32.4%) were the main causes of severe acute morbidity. Both maternal deaths occurred due to eclampsia. There was no severe acute maternal morbidity or mortality due to COVID infection in pregnancy. Delay in seeking and reaching to the health centre (65%) was major delay leading to severe morbidity and mortality. Conclusions: Indices and causes of severe acute maternal morbidity and mortality during COVID 19 pandemic was not worse compared to those prior to COVID 19 pandemic. Primary delay in seeking and reaching health care was the main factor leading to severe morbidity and mortality.
Aims: To review the experience of women and girls treated for ectopic ureter in Surkhet through the fistula camps and Fistula Treatment Centre and analyse the diagnostic method, management and outcome. Methods: This was a retrospective study of the patients with ectopic ureter who received treatment in Surkhet since 2009. Data were analysed from patient records and interviews. Results: Seven patients were diagnosed with ectopic ureter over a period of 12 years. Five patients were prepubertal with age range of 7 - 15 years. History of continuous incontinence with normal voiding was suggestive of ureteric fistula in six out of seven cases. The seventh case had massive ureterocele in the distal end of the duplex right ureter. Ultrasound suggested a diagnosis of duplex collecting system in five cases. IVU or CT IVU suggested duplex ureter in only three cases. Diagnosis was confirmed by examination under anaesthesia after i.v. frusemide in six cases. All cases were managed by implantation of the ectopic ureter into the bladder. In the case with ureterocele heminephrectomy was performed. All seven patients are well at follow-up between 6 months and five years after presentation. Conclusion: Ectopic ureter is a treatable cause of urinary incontinence and the diagnosis may be overlooked. A lifelong history of continuous urinary leakage with normal voiding, in absence of trauma or surgical procedure should raise the suspicion. Examination under anaesthetic and ultrasound proved most effective in confirming the diagnosis
A 30-years old nulliparous lady presented with apparently recurrent leiomyoma of vulva and past history of repeated resections. She had firm bilobed non-tender vulval lump and underwent partial vulvectomy. Histopathology revealed Smooth muscle tumor of uncertain malignant potential (STUMP). Conclusion: Vulvar leiomyoma is fairly uncommon and can often be misdiagnosed. Surgical excision and histopathological analysis is helpful/ recommended for final diagnosis of Vulvar STUMP.
Aims: To assess the tubal pathology contributing to primary and secondary infertility by laparoscopic examination. Methods: The study was carried out in the department of Obstetrics and gynecology, Grande International Hospital. This is a retrospective study conducted in tertiary care hospital over a period of 2 yrs. From 2020 February to 2022 January. All patients with complaints of infertility (primary and secondary) who were admitted, evaluated and operated for infertility in Obstetrics and Gynaecology department of Grande international Hospital. Results: Of the 52 patients minimum age was 20 and maximum was 46 with mean age of 30.52±4.885. Thirty eight patients had primary infertility and 14 had secondary. Forty patients had normal uterus while 12 had enlarged uterus. Hydrosalpinx was found in 11.5 % and 30.8% in right and left tube respectively. Pyosalpinx was found in 9.6% and 7.7% in right and left tube respectively. Bilateral tubes were patent in 22 cases while bilateral blocked tube was found in 13 cases so rest 17 cases had unilateral tubal block. Pelvic adhesions were found in 44.2 % cases. Most of them were associated with endometriosis (15.4%) followed by ovarian cyst (11.5%) and fibroid uterus (11.5%). Conclusions: Majority had normal tubal pathology followed by edematous tube, hydrosalpinx and pyosalpinx. Endometriosis, fibroid and ovarian cyst were commonly associated conditions.
