Nepal Medical College Teaching Hospital Research Articles

Efficacy and Safety of Spinal Anaesthesia in Paediatric Age Group between 3 to 14 Years for Infraumblicus Surgery

Spinal anaesthesia (SA) in paediatric patients was first introduced by August Bier in 1899. But this technique did not gain wide spread popularity in paediatric age group because of the introduction of various muscle relaxants and inhalational agents for general anaesthesia. SA in paediatric population has been gradually reintroduced as an alternate to general anaesthesia. The study was performed at the Nepal Medical College Teaching Hospital to evaluate the efficacy and safety of SA in paediatric age groups, compare the change in vital parameters such as heart rate, blood pressure and oxygen saturation during preoperative and intraoperative period, the complications of SA and time of demand for first rescue analgesia in postoperative ward. Sixty-seven patients aged between 3 years to 14 years of ASA I and ASA II were selected after screening for anaesthesia fitness. The duration of surgery ranged from 49.85 ± 11.55 to 56.30 ± 9.68 minutes and the blood loss was less than 10% of total blood volume, thus there was no need to transfuse during operation. The duration of analgesia ranged between 107.69 ± 7.25 to 115.00 ± 7.07 minutes in different age groups. Sixty patients (89.55%) achieved Bromage Scale Score (BSS) 3 with interpretation of complete block; seven patients (10.45 %) achieved Bromage Scale Score 2 (partial block) and were operated after supplemental intravenous sedation. None of the patients needed conversion to general anaesthesia. Successful CSF drain with placement of spinal needle in 1st attempt was achieved among 55 patients (82.1%) and in 2nd attempt among 12 patients (17.9%). No unsuccessful attempt was recorded. SA in children appears to be a relatively safe technique with few complications and may be considered as an alternative for general anaesthesia. It is cost effective in comparison to general anaesthesia as the drugs and equipment required are less and cheaper and the length of hospital stay is usually shorter.

Study of Children with Recurrent Pneumonia Admitted in a Tertiary Hospital

Recurrent pneumonia usually occurs due to an underlying disorder that negatively affects local or systemic defence mechanisms. The aim of this study was to find out the prevalence and risk factors associated with recurrent pneumonia in children and to determine possible strategic plan needed for better clinical outcome. Children between 2 months to 15 years old who had a history of 2 or more episodes of pneumonia per year, or 3 or more episodes in a life time were investigated prospectively at Nepal Medical College Teaching Hospital. Out of 653 children admitted for pneumonia, 74 (11.3 %%) met the criteria for recurrent pneumonia. Among 74 children with recurrent pneumonia, underlying risk factors was demonstrated in 65 patients (87.8%). Most common underlying diseases were aspiration syndrome in 21.6% patients, congenital heart disease in 13.5% patients and bronchial asthma in 12.1% children. No predisposing illness could be demonstrated in 12.1% patients. Approximately 1 in 9 children with pneumonia in our hospital had recurrent pneumonia. Aspiration syndrome was the most common underlying illnesses for undiagnosed recurrent pneumonia in children.

Clinico-epidemiological Profile of Women with Non-venereal Vulval Diseases: A Hospital-based Observational Study

Intorduction: Vulval disorders can be of venereal and non-venereal etiology. Establishing non-venereal causation of vulval disorder helps in alleviating fears in patients with the condition. These patients are better dealt in a multidisciplinary clinic as patients with these disorders frequently visit dermatologists and gynecologists for the treatment.
 Objectives: To study the clinico-demographic profile of women with non-venereal vulval disorders and to determine their relative frequency.
 Materials and Methods: This is an observational, descriptive study done at the Departments of Dermatology and Venereology and Gynecology and Obstetrics, Nepal Medical College Teaching Hospital. All consenting female patients with problems pertaining to female external genitalia were recruited for the study after excluding venereal diseases. Details of the patients were obtained and entered in a predesigned proforma.
 Results: Seventy-five females were recruited during a period of 20 months with a mean age of 34.79±17.90 years. Majority were married, uneducated and homemakers. Duration of disease ranged from 3 days to 35 years. Itching was the commonest presenting complaint (82.67%) followed by redness (32.00%), burning sensation (26.67%), white lesions (24.00%) and pain (24.00%). Commonest diagnosis was lichen sclerosus (17.33%), followed by candidiasis (14.67%). Patients presenting with vulval symptoms without lesions were diagnosed with non-specific vulval pruritus (9.33%) and vulvodynia (2.67%).
 Conclusion: Itching is the most common presenting complaint and contrary to the popular belief, inflammatory disorders especially lichen sclerosus, rather than infections were common diagnoses in females with non-venereal vulval disorders.

Antimicrobial Susceptibility Pattern of Enterococcus Species Isolated from Various Clinical Specimens in a Tertiary Care Hospital, Kathmandu, Nepal

Resistance to vancomycin and high level aminoglycosides are common among Enterococcus spp. and are being increasingly reported from different parts of the world. These resistance phenomena in enterococci have limited the therapeutic options to treat the infections caused by them. The objective of our study was to determine the antimicrobial resistance patterns of Enterococcus spp. (n=60) isolated over a year from clinical specimens received from patients visiting Nepal Medical College Teaching Hospital, Kathmandu, Nepal. All enterococci were subjected to antimicrobial susceptibility testing, high level gentamicin resistance testing by disc diffusion method and minimum inhibitory concentration of vancomycin by agar dilution method. Prevalence of high level gentamicin resistance among enterococci was 55%. None of the isolates were resistant to vancomycin by both disc diffusion and agar dilution method. However 8.3% of them were intermediate to vancomycin. All of these vancomycin intermediate isolates were from samples from hospital admitted patients and resistant to ampicillin, ciprofloxacin, erythromycin and high level gentamicin. Present findings were suggestive of possible emergence of vancomycin resistant enterococci in the hospital if immediate and adequate control measures are not implemented.

Antimicrobial Resistance Patterns in Clinical Isolates of Enterobacteriaceae from a Tertiary Care Hospital, Kathmandu, Nepal

Introduction: Multidrug resistance among Enterobacteriaceae is in increasing trend these days. The objective of this study was to determine the antibiogram of clinical isolates of Enterobacteriaceae with special reference to multidrug resistance and extended spectrum beta-lactamases production.Materials and Methods: A descriptive cross sectional study was conducted over a period of six months (February -July, 2017) in the microbiology laboratory of Nepal Medical College Teaching Hospital, Kathmandu, Nepal. A total of 936 bacterial isolates of Enterobacteriaceae from clinical specimens were processed for antimicrobial susceptibility testing and screened for multidrug resistance. ESBL production was detected among potential isolates by combination disk diffusion test.Results: The rate of multidrug resistance and extended spectrum beta-lactamases production was 54.2% and 23.8% respectively. Of the total ESBL producers 92.4% were multidrug resistance. The rate of multidrug resistance and extended spectrum beta-lactamases production were higher in organisms isolated from clinical samples collected from inpatients. High rate of multidrug resistance and extended spectrum beta-lactamases production was seen in E. coli (54.4% & 27.7%), Klebsiella spp. (67.1% & 28.2%) and Citrobacter spp. (70.3% & 10.9%). The antimicrobial resistance rate was highest against ampicillin (76.7%) followed by cefixime (54. 0%), ceftazidime (51.5%), ceftriaxone (51.0%), cotrimoxazole (48.7%), ciprofloxacin (43.9%) and ofloxacin (41.1%).Conclusions: Multidrug resistance is common among Enterobacteriaceae. These bacteria have high rate of resistance against commonly used groups of antibiotics like cephalosporins and quinolones. Continuous monitoring, surveillance of antimicrobial resistance, proper infection control and practices are important to combat with these issues.

Health Maintenance Practices Among Nurses of a Tertiary Level Hospital of Nepal

ABSTRACTBackground: Health maintenance practices are those activities that preserve a person’s current state of health and that prevents future diseases or injuries from occurring. Nurses represent an important part of the hospital workforce and serve as role models when caring for patients. A healthy nurse can deliver quality care to the patients to the optimal level. However, there are no studies that explored the health maintenance practices among nurses, here in Nepal. This study was therefore conducted to assess the health maintenancepractices among nurses. Materials and Methods: A total of 197 out of 208 nurses from Nepal MedicalCollege Teaching Hospital (NMCTH) were enrolled in the study using purposive sampling method. Pretested questionnaire was used as a tool for data collection. SPSS version 16 was applied for data entry and analysis. Descriptive statistics (Percentage, frequency, mean, standard deviation) were used for data analysis. Results: Among 208 nurses only 197 responded yielding a response rate of 94.7%. The findings suggest that nurses did not have a good screening, dietary, exercise and vaccination practices. Lack of time, work overload, psychological stress from work were the main barriers pointed out by the nurses that hinder them to maintain their health status. Conclusion: Nurses did not have good health maintenance practices which could directly influence on the quality of care they provided. Thus it is very necessary to initiate program that promotes health of nurses.Keywords: health maintenance practice; Nepal; nurses; self care.

Prevalence of Methicillin Resistant Staphylococcus aureus and Antibiotic Susceptibility Pattern in a Tertiary Hospital in Nepal

Methicillin resistant Staphylococcus aureus is a global health challenge nowadays creating problem in antibiotic therapy. This study was aimed to generate resistance pattern of Methicillin resistant Staphylococcus aureus to various antibiotics in order to formulate antibiotic policy for control of Methicillin resistant Staphylococcus aureus in Nepal. This was a cross-sectional study conducted at the department of Clinical Microbiology, Nepal Medical College Teaching Hospital, from April 2015 to March 2016. A total of 142 S. aureus isolated from various clinical specimens. were screened for Methicillin resistant Staphylococcus aureus by cefoxitin disc method according to Clinical and Laboratory Standards Institute guidelines. Out of 142 S. aureus isolates, 30 (21.1%) were detected as Methicillin resistant Staphylococcus aureus by cefoxitin disc method. Most of the Methicillin resistant Staphylococcus aureus (25/30) were isolated from pus which were collected from OPD patients. Antibiotic sensitivity pattern showed all Methicillin resistant Staphylococcus aureus isolates were sensitive to vancomycin. Prevalence of Methicillin resistant Staphylococcus aureus was found to be 21.1%, and all Methicillin resistant Staphylococcus aureus appear 100% sensitive to vancomycin.

Laparoscopic Herniotomy for congenital inguinal hernia: prospective assessment of feasibility and outcome analysis in tertiary center in Nepal

Introduction: Congenital Inguinal hernia (CIH) repair is frequently performed surgical procedures in children. Open herniotomy is standard treatment for CIH. However, in developed countries laparoscopic repair is gaining popularity. The benefits of laparoscopic hernia repair are its safety, cosmetic results, opportunity to repair contralateral patent processus vaginalis (CPPV). The aim of this study was to assess feasibility and outcome of Laparoscopic herniotomy (LH) in tertiary center in Nepal.
 Methods: This is prospective observational study conducted at Nepal Medical College Teaching Hospital, Pediatric Surgery Unit from 1st November 2015 to 30th October 2016. All children of age greater than six months with CIH were included in this study after consent from parents. Demographic profile, operative findings, postoperative results, complications and recurrences were recorded.
 Results: We had 60 children, 45 males and 15 females who underwent laparoscopic herniotomy. 33 of them had right, 24 had left and 3 had bilateral hernias. The mean operating time was 30.12 minutes and 35 minutes for unilateral and bilateral hernias respectively. 14 were associated with CPPV and were repaired in same setting. We had one recurrence on right side and were repaired with open herniotomy.
 Conclusion: Laparoscopic herniotomy is feasible and safe in CIH. It provides better opportunity to diagnose CPPV and repair it. LH has got minimal complication and better cosmetic outcome. Larger studies and longer follow ups are needed to support our results.

Sarcoidosis in Nepal: Epidemiology, Clinical Presentation and Ethnic Differences

Background & Objectives:Sarcoidosis is a multi-system granulomatous disorder of unknown origin.The frequency and the clinical presentation of sarcoidosis vary among the geographical regions. This study is a retrospective analysis of the sarcoidosis patients diagnosed in Nepalese population. The aim of this study was to find the prevalence of sarcoidosis in Nepalese population which has high prevalence of tuberculosis and to understand the clinical profiles and ethnic differences.Materials & Methods:A retrospective chart analysis was done in all the patients from January first, 2005 to December 31st, 2010 who had abnormal chest radiograph and who were diagnosed with sarcoidosis. The study was done at Nepal Medical College Teaching Hospital and Everest Nursing Home.Results:A Forty two patients were diagnosed to have sarcoidosis over a five year period, of which 23/42 (55.0%) were females and 19/42 (45%) were males. The mean age was 36 years with minimum age being 18 years and maximum 72 years. As far as Ethnicity is concerned, 15/42 (36.0%)were Brahmins,08/42(19.0%) were Marwadi, and 07/42(17.0%) were Chhetri. The most common presenting symptom was cough 19/42 (45.0%).Out of the 42 patients, eight were being treated for pulmonary tuberculosis. Most common radiographic findings were bilateral hilar lymphadenopathy 15/42 (36.0%).Conclusion:Sarcoidosis is common in Nepal and should be considered in the differential diagnosis before treating the patient empirically for tuberculosis.

Spectrum of glomerular diseases in native kidneys in patients attending Nepal Medical College Teaching Hospital

Background and Aims: Glomerular disease is the one of the major cause of end stage kidney disease in Nepal. We have undertaken this study to know the spectrum of glomerular disease in native kidneys in patients attending department of nephrology of Nepal Medical College Teaching Hospital.Methods: This is a retrospective analysis of patients who have undergone native kidney biopsy from July 2013 to June 2014. Seventy five cases were included. We reviewed the biopsy requisition and where available admission forms for symptoms, indications and complications of the biopsy, urine analysis report and final biopsy report. Kidney biopsy was done under USG guidance or assistance. Automated biopsy gun of 16 or 18G was used. Kidney tissues were sent for light microscopy and immune fluorescence examinations. After 24 hrs of biopsy, USG-KUB and urine RME were repeated for complicationsResults: Majority of our study population (62%) was from age group of 13 to 30 years. Sixty five percent of the patients (n= 49) were admitted with a diagnosis of nephrotic syndrome. Most frequent histopathological finding was Minimal Change Disease (26.7%) followed by LN (21.3%), Membranous Nephropathy (18.6%), Focal Segmental Glomerulosclerosis (13.4%) and IgA nephropathy (9.3%). Patients with the histopathological diagnosis of LN and IgAN presented with hematuria in 81.2% and 71.4% respectively. MCD patients presented with proteinuria only. Total no. of glomeruli in the sample was 23.41±11.55.Conclusion: Nephrotic syndrome was the most common indication for the renal biopsy. MCD was the most common histological finding in our series and Lupus nephritis is not uncommon in our series.Journal of Advances in Internal Medicine Vol.5(2) 2016: 24-28

Mortality in Emergency Department of Nepal Medical College Teaching Hospital, a tertiary care centre in Kathmandu, Nepal

Introduction: There are limited literatures regarding mortality studies in emergency department of different hospitals of Nepal. The objectives of this study were to review and highlight the demographic patterns of mortality and to determine the frequency and causes of accident and emergency deaths. Methods: This was a retrospective study carried out in emergency department of Nepal Medical College Teaching Hospital, Kathmandu for a period of 3 years from April 2013 to 14th April 2016. The study variables were analyzed with descriptive statistics using software SPSS 16. Results: A total of 35,734 cases attended the emergency department during this period with mortality rates of 0.19%, 0.21% to 0.35% on consecutive 1st, 2nd, and 3rd year of study. There were 51(56%) males and 40(44%) females. The age of the cases ranged from 1month 23days to 86years old. Highest number of mortality (30.8%) was seen in the age group of more than 70 years old. Medical causes for death was far more common than surgical causes (83.5% versus 16.5%), Cardiac arrest being the commonest (n=19, 20.9%). Maximum number of cases (n=44, 48.4%) died within 1 to 6 hours of arrival to the emergency department. Conclusions: This study on mortality patterns highlights the causes of common mortalities in one of the emergency department of tertiary care centre in Nepal. This study will provide a basic data to develop competent manpower and good infrastructure with latest equipments in order to optimize positive outcome and to strengthen the emergency setting.

Comparision of ultrasonographic diagnosis with ‘Tzanakis’ Score in acute appendicitis

Introduction: Acute appendicitis is one of the most common acute surgical abdominal conditions requiring surgery. Ever since the inflamed appendix was demonstrated in the 1980’s by Ultrasonography, it has been used as an aid to clinically diagnose acute appendicitis. Tzanakis scoring system is a combination of clinical examination, Ultrasonography and inflammatory markers.
 Methods: A retrospective non-randomized observational study was conducted from April 2014 to March 2015 on all cases of acute appendicitis, which underwent preoperative ultrasound before appendectomy (open/laparoscopic) at the Department of surgery, Nepal Medical College Teaching Hospital. Ultrasound findings and Tzanaki score were compared in the cases. No studies could be found in literature comparing ultrasound diagnosis with Tzanaki score in appendicitis.
 Results: The sensitivity, specificity, positive predictive value and negative predictive value of ultrasound were 73%, 50%, 95% and 12% respectively. The sensitivity, specificity, positive predictive value and negative predictive value of Tzanaki were 87%, 50%, 96% and 23% respectively. Tzanaki score is better than ultrasound alone as a diagnostic test for acute appendicitis.
 Conclusion: Tzanaki score is better than ultrasound in diagnosis of acute appendicitis.

Clinico-Radiological Study of Polycentric Knee Brace in Osteoarthritis of Knee

Introduction: Osteoarthritis (OA) of knee causes considerable pain and disability. It has been observed that symptomatic pain relief and cartilage regeneration are possible in OA joints that have been pulled apart or distracted for prolonged periods of time. The knee brace is used to modify joint loading during rest and activities. Material and methods: The study included total of 310 patients, at Nepal Medical College Teaching Hospital, Kathmandu, Nepal from September 2009 to August 2012, with osteoarthritis of the knee of different grades (II, III and IV). The patients were followed up at 6 weeks, 3 months, 6 months and 1 year after the use of polycentric knee brace. The clinical and radiological findings were recorded, tabulated and analysed by WOMAC scoring for symptomatic improvement and deformity correction. Results: After one year 263 (84.83%) patients were still using the brace but 37 (15.17%) patients had discontinued the use of brace after some months. There was 54% improvement in WOMAC score. It showed symptomatic relief of pain, stiffness and improved physical function in grade II and III whereas prevented further radiological deterioration in all grades of osteoarthritis knees. Conclusion: The polycentric knee brace can be a cost effective alternative to the treatment of osteoarthritis of the knees. The treatment with a knee brace can provide significant improvement in pain, stiffness and increased physical activity levels and no radiological deterioration in early stages. But the knee bracing should not be used alone, but in addition to other therapeutic modalities for better results.

Relationship between Amniotic Fluid Index and Perinatal Outcome

Aims: This study was done to evaluate the predictive value of low amniotic fluid index (AFI) of < 5 cm for adverse perinatal outcome in term of caesarean section for fetal distress, birth weight, meconium stained liquor and APGAR scores. Methods: This was a prospective study of 200 antenatal women booked at Nepal Medical College Teaching Hospital during the year 2013-2014 with gestational age between 34 and 41 weeks. Patients history and clinical examination were recorded and AFI was measured and the perinatal outcome was compared between two groups i.e AFI <5 cm and >5 cm. Results: The caesarean section (C/S) rate for fetal distress and low birth weight babies (<2.5 kg) was higher in patients with low AFI (p=0.048, 0.001 respectively). There was no significant difference in meconium staining, APGAR score at 5 minutes between the two groups (p=0.881, 0.884 respectively). Conclusions: Caesarean section for fetal distress and low birth weight babies was significantly associated with low amniotic fluid index. There was no significant difference in meconium staining liquor, APGAR score at 5 minutes between the two groups.

Obstetric Outcome of Teenage Pregnancy

Aims: To assess the prevalence of teenage pregnancies and to compare the obstetric performance of teenage pregnant woman with that of adult pregnant woman. Methods: A prospective study was conducted in Nepal Medical College Teaching Hospital from August, 2010 to February, 2012 (one and half year duration). All the teenage pregnancies were included and outcomes were compared with adult (20-24 years) pregnancies, selected randomly who had delivered during the same period of time. The patient characteristics (age, gravidity, parity, gestation age) and obstetric outcome (medical and obstetrical complications, mode of delivery, complications during delivery, fetal outcome, birth weight) were compared between the two groups. Statistical analysis was preformed using PHSTATZ and Z test for proportion. Results: There were total 2708 deliveries during the study period, out of which teenage pregnancy was 264 (9.7%). There were 69(26.1%0) teenage mothers of age 16 to 17 years and 195(73.9%) of age group 18 to 19 years. As expected, maximum patients in the test group i.e. teenagers were primigravida as compared to control group. (90.1% vs. 68.5%). As for mode of delivery, normal delivery in test and control was 82.9% vs 81.1% (p=0.56) and rate of cesarean delivery was similar 10.2% and 10.7%, (p=0.84) in both the groups. The incidence of instrumental delivery was more in control group although it was not statistically significant( 0.7% vs 2.2%, p=0.16). Preterm delivery was 3.0% in teenage as compared to control which is 2.2%. The percentage of intrauterine fetal death was 0.7% vs 0% in test and control group (p=0.15). Proportion of low birth weight babies in test and control group was 7.2% vs 5.9% (p=0.55). Similarly pregnancy related complications were also compared in teenage and control groups. It was found that postpartum hemorrhage occurred more in teenage pregnancy 1.8% vs 0.7% (p=0.84) but statistically not significant. Incidence of hypertensive disorders was 6.4% and 5.6% (p=0.66) in test and control group. Proportion of babies with intrauterine growth restriction was 3.0% in test and 1.1% (p=0.009) in control, the only parameter that is statistically significant. Fetal congenital anomaly was 0.7% vs 0.4% (p=0.54) Conclusions: Teenage pregnancy can have an equally good outcome if we give good obstetric care and encourage institutional delivery. DOI: http://www.dx.doi.org/10.3126/njog.v7i2.11139 Nepal Journal of Obstetrics and Gynaecology / Vol 7 / No. 2 / Issue 14 / July-Dec, 2012 / 29-32

Management of giant ovarian teratoma

The management of ovarian teratoma in normal condition is well established but in rare giant tumour (diameter over 15 cm) management approaches such as laparoscopy or laparotomy are controversial and may be therapeutically challenging for surgeons. Laparotomic resection is the preferred method for the en-block mass removal, adequate abdominal cavity irrigation, and avoidance of accidental mass rupture during management of giant ovarian teratoma. Here we discuss a case of a 43 year old multiparous lady suffering from a huge ovarian tumour of size 40 cm, admitted in Nepal Medical College Teaching Hospital on 15th May 2013. This patient underwent laparotomy on 21st May 2013 and left sided huge multiloculated ovarian cystic teratoma was removed en-bloc with no complications. DOI: http://dx.doi.org/10.3126/jkmc.v2i2.10632Journal of Kathmandu Medical College, Vol. 2, No. 2, Issue 4, Apr.-Jun., 2013, page: 89-93

Use of Oral Misoprostol for the Treatment of Incomplete Abortion

Aims: This study was done to assess the feasibility and acceptability of use of Misoprostol 600 mcg orally for treatment of incomplete abortion. Methods: A hospital based prospective study was carried out in the Department of Obstetrics and Gynaecology of Nepal Medical College Teaching Hospital from 1st November 2010 to 30th May 2013. All cases of first trimester incomplete abortion diagnosed clinically or by ultrasonogram were included in the study. They were given 600 mcg of Misoprostol orally. They were sent home, with advice to come for follow up after one week. Routine Ultrasound was carried out on follow up visit to confirm complete abortion. The side effects, complications and patient satisfaction was assessed and recorded. Results: Out of 86 patients, 8.1% (7) had to undergo surgical evacuation. So the success rate was 91.9% (79 cases). All the cases which needed evacuation were of higher gestation, that is, nine weeks or more. The commonest side effect was severe abdominal pain (81.4%). Three cases required emergency surgical evacuation within 24 hours due heavy bleeding.Conclusions: It is feasible and acceptable to use Misoprostol orally for medical evacuation, especially in earlier gestation of first trimester incomplete abortion. Side effects were common but were acceptable and tolerable by the patients. Nepal Journal of Obstetrics and Gynaecology / Vol 8 / No. 2 / Issue 16 / July-Dec, 2013 / 30-33 DOI: http://dx.doi.org/10.3126/njog.v8i2.9766

Maternal and Fetal Outcome in Elective versus Emergency Cesarean Section

The complications of cesarean section are seen more commonly in emergency than in elective cases. The aim of this study was to find out the incidence of cesarean section in Nepal Medical College Teaching Hospital and to compare the maternal and fetal outcome in elective and emergency cesarean section. A prospective study of all the cases undergoing cesarean section in Nepal Medical College Teaching Hospital was carried out during the period of six months from Asar 2069 to Mangsir 2069. The incidence of cesarean section was 254 (22.30%) out of which emergency cesarean section accounted for 167 (65.7%) and elective cesarean section for 87 (34.3%). The usual indications of emergency cesarean section were fetal distress, previous cesarean section in labour, non progress of labour and prolonged second stage of labour. The usual indications of elective cesarean section were previous cesarean section, breech, cephalopelvic disproportion and cesarean section on demand. There was found to be no significant difference in age, period of gestation, blood loss and blood transfusion in emergency vs. elective cesarean section. There was significant difference seen in the length of hospital stay, fever, urinary tract infection, wound infection and low APGAR in five minutes indicating that these were more common in emergency cesarean section. Significant difference was also seen in the incidence of postpartum haemorrhage indicating that it was seen more in elective cesarean section. The incidence of cesarean section in Nepal Medical College Teaching Hospital is high and the overall complication rate is higher in emergency cesarean section than in elective cesarean section.

Impact of Antenatal Care on Maternal and Perinatal utcome: A Study at Nepal Medical College Teaching Hospital

Aims: To identify the determinants of antenatal care (ANC) attendance and its impact on maternal / perinatal outcome. Methods: Prospective descriptive study of women delivered at Nepal Medical College Teaching Hospital (NMCTH), a 700 bedded tertiary care hospital situated at periphery of Kathmandu. Results: Among 322 women delivered during period of four months, majority (87%) reported of attending more than 4 antenatal visits, only 21 (6.5%) women had not attended ANC. The most preferred place of ANC was hospital (71.6%). Women with secondary education and above, business/service holders, 20-29 years age group, primigravida and Brahmin / Chhetri caste were more likely to attend ? 4 visits, while those living further than 6 km. from a health facility were less likely to attend. Financial problem (52.4%) followed by ignorance (28.6%) were the most commonly stated reasons for not attending ANC. Women attending more than 4 antenatal visits have more chance of full immunization with tetanus toxoid and iron supplementation. Most of the women started attending ANC from their second trimester (75.8%), only 21.9% had first ANC visit during first trimester. Overall Cesarean section rate was 17.4% and with increased rates in women who had attended ANC, because of the fact that all elective cesarean section were planned in these women only. Also, all inductions of labor (9.3%) were performed among them. Maternal complications like anemia and pregnancy induced hypertension occurred more commonly in women without ANC. The proportion of low birth weight and preterm babies was higher in women with inadequate or no ANC. Special care baby unit (SCBU) admission was also higher among them due to various reasons like neonatal sepsis, birth asphyxia, jaundice etc. While there were no neonatal deaths during the study period, 3 still births have occurred. Perinatal mortality rate was similar in no ANC and inadequate ANC groups; it was 16 times higher than that in the group with more than 4 visits. Maternal and perinatal outcomes were found to be better in women who attended regular ANC. Conclusions: Although attendance of ANC is quite encouraging, the proportion of women attending ANC from first trimester is low. The quality of antenatal care needs to be strengthened. The health system needs to ensure the availability of ANC in primary care level and to establish mobile clinics for those living far from the health facilities.NJOG 2011 Nov-Dec; 6 (2): 37-43 DOI: http://dx.doi.org/10.3126/njog.v6i2.6755

ATTITUDE TOWARDS KIDNEY DONATION AMONG PRIMARY CARE PATIENTS IN DEVELOPING COUNTRY.

1Community Medicine, Nepal Medical College Teaching Hospital, Kathmandu/NEPAL, 2Public Health, Community Health and Environmental Society Nepal, ktm/NEPAL