scholarly journals Intrauterine Foetal Death and Its Probable Causes: Two Years Experience in Dhulikhel Hospital – Kathmandu University Hospital

2014 ◽  
Vol 10 (4) ◽  
pp. 44-48 ◽  
Author(s):  
SR Tamrakar ◽  
CD Chawla
Keyword(s):  
Antenatal Care ◽  
Gestational Age ◽  
Care Center ◽  
Tertiary Care ◽  
Multiple Pregnancy ◽  
University Hospital ◽  
World Health ◽  
Control Group ◽  
P Value ◽  
Health Care Center

Background World health Organization definition of intrauterine foetal demise encompasses any abortion or fetal demise prior to expulsion from its mother, and recommends different protocols according to gestational age. However, conventionally and also in our institution, foetal demise prior to 28 weeks of gestation is managed as abortion in a manner different from foetal demise post 28 weeks of gestation. Objective To find the incidence and characteristics of pregnancies that resulted in stillbirths. Methods A retrospective study, done in Dhulikhel Hospital, Kathmandu University Hospital in the year 2010 and 2011, among 4219 deliveries and 97 fetal deaths. Cases of multiple pregnancy and fetal death diagnosed by ultrasound before the 28th week of gestation were excluded. The included intrauterine foetal demise cases (n=90) were compared with a control group of randomly selected pregnancies (n = 537) delivered during the same time period. Assumed predictors of stillbirth were examined through inferential ways (Chi square, t test) using SPSS Version 13.0 for Windows. Results Incidence of intrauterine foetal demise was 2.13% in the year 2010 and 2011. Mothers in the stillbirth group were slightly older than mothers of live-born infants (25.47±5.64 years vs 23.62±4.31 years, p value=0.000). A slightly higher proportion of women in the stillbirth group were of Tamang ethnic origin and primiparous (p = 0.011, 0.000) . Foetus expelled after IUFD had lower weight compared to live births, (2925.14±444.14gram vs 2182.78±821.04gram, p=0.000) for gestational age. The stillborn babies were generally born at an earlier gestational age, as would be expected (p=0.000). Incidence of intrauterine foetal demise gradually decreases as parity advances. The incidence was higher in patients receiving antenatal care outside Dhulikhel Hospital, Kathmandu University Hospital. Conclusions While comparing the subject with the theme of the national conference of Nepal Society of Obstetricians and Gynaecologist, most of the cases were mother not receiving antenatal care or those receiving antenatal care in the periphery, There is no denying that there would be a massive improvement in women’s health if the co-ordination between the peripheral health care center and tertiary care center was to be improved. DOI: http://dx.doi.org/10.3126/kumj.v10i4.10994 Kathmandu Univ Med J 2012;10(4):44-48

Histopathological Study of Cystoscopic Bladder Biopsies in a Tertiary Care Center

2021 ◽  
Vol 6 (1) ◽  
pp. 1310-1314
Author(s):  
Rachana Dhakal ◽  
Hem Nath Joshi ◽  
Ramesh Makaju ◽  
Shailendra Sigdel
Keyword(s):  
Urinary Bladder ◽  
Urothelial Carcinoma ◽  
Pathological Condition ◽  
Care Center ◽  
Tertiary Care ◽  
University Hospital ◽  
World Health ◽  
Histopathological Study ◽  
Neoplastic Lesion ◽  
Neoplastic Lesions

Introduction: Non-neoplastic urinary bladder lesions are not life threatening, but are an important source to cause clinical symptoms and signs. However, neoplasms of the bladder are a source of morbidity, mortality, and exhibit more clinical challenges. Cystoscopy provides overall information about an anatomical/pathological condition of the urinary bladder which will be helpful for patients' management. A cystoscopic biopsy is a primary diagnostic tool for diagnosing urinary bladder cancer. Objectives: The objective of the study was to find the frequency and histomorphological characteristics of urinary bladder lesions in Dhulikhel Hospital, to find the clinical presentation of urinary bladder lesions and to grade the urothelial tumors based on the World Health Organization (WHO)/ International Society of Urological Pathology (ISUP) classification 2004. Methodology: This was a retrospective, cross-sectional, observational study carried out in the Department of Pathology, Dhulikhel Hospital-Kathmandu University Hospital. Convenient sampling was done. All cystoscopy biopsies received from January 2014 to December 2018 were studied. All tissue blocks were retrieved, cut, and stained with Hematoxylin and Eosin. The stained slides were examined under a light microscope by the primary investigator. Result: A total of 70 cystoscopic biopsies were analyzed. The majority of patients 20 (28.6%) were in the age group between 60 and 69 years and males were predominant 43 (61.4%). The neoplastic lesions constituted 40 (57.1%) of all bladder lesions, among them urothelial carcinoma accounted for 38 (54.2%). Similarly, chronic cystitis 27(38.6%) was the most common non-neoplastic lesion. Conclusion: The study found that the neoplastic lesions were commonly encountered in urinary bladder lesions. Among them, lowgrade urothelial carcinoma was the most common bladder tumor. However, most of the non-neoplastic lesions were inflammatory in origin. Cystoscopy combined with histomorphological examination helps in the early detection of bladder lesions. 

A study on perception about antenatal care among primigravida attending a tertiary care hospital

2019 ◽  
Vol 9 (1) ◽  
pp. 56
Author(s):  
Priya Somu ◽  
Sakthi Narmatha D.
Keyword(s):  
Mortality Rate ◽  
Antenatal Care ◽  
Care Center ◽  
Tertiary Care ◽  
Infant Mortality Rate ◽  
Care Hospital ◽  
College Hospital ◽  
Cross Sectional ◽  
Health Care Center ◽  
Basic Care

Background: Maternal mortality rate and Infant mortality rate remains high in India when compared to several other countries. Understanding and being aware about the basic care provided during pregnancy is an important factor to make the pregnant woman to utilize the antenatal care. Hence this study was planned to assess the existing knowledge of primi gravid mothers attending the tertiary health care center about the various antenatal care services provided.Methods: This cross-sectional study was conducted among the primi gravid females attending the outpatient department of Obstetrics and Gynecology in Sri Muthukumaran Medical College Hospital and Research Institute, Chennai during months of June 2018 to May 2019. A total of 280 primi gravid mothers were included in the study. Data was collected through one to one interview and analyzed using statistical package for social sciences (SPSS) version 17.Results: In this study 82.9%, 70.4%, 80.7% of the mothers were aware about consumption of IFA tablets, TT injection and adequate ANC visits, respectively. PNDT act was known to 76.1% of the participants. Only 12.5% of the primi mothers were aware about Janani Suraksha Yojna (JSY) scheme and 91.8% of the mothers were aware about Dr. Muthulakshmi Maternity Benefit scheme.Conclusions: Knowledge about ANC services was found to be fair among the primi mothers but not sufficient, which shows the need for the healthcare professionals to educate young woman even from adolescent age itself.

scholarly journals Assessment of indications of caesarean section among high risk women by Robson criteria: a prospective study

2018 ◽  
Vol 7 (7) ◽  
pp. 2623
Author(s):  
Kaveri Shaw Patel ◽  
Roma S. Nag
Keyword(s):  
High Risk ◽  
Caesarean Section ◽  
Care Center ◽  
Tertiary Care ◽  
Multiple Pregnancy ◽  
Group Classification ◽  
Classification Systems ◽  
World Health ◽  
Qualitative Assessment ◽  
Safe Delivery

Background: Caesarean section (CS) is a surgical intervention for safe delivery other than natural vaginal route. World Health Organization (WHO) has recommended ten group classification systems of Robson criteria which we have used to analyse CS at our center. The objective of the study to analyse the lower section caesarian section (LSCS) data under Robson criteria for implementation in regular practice in tertiary care center and to understand the need of it for future practice.Methods: A prospective analysis done for deliveries in Obstetric Department of Shalby Multispecialty Hospital of central India by Robson ten group classification criteria. The study was carried out for the period of two year from April 2016 to April 2018 including antenatal women attending labour room with high risks or referred cases from other centers.Results: The study reflected overall 196 live birth of high risk cases which were having other co morbidities like pre-eclampsia, eclampsia, hypothyroidism, diabetes, acute viral hepatitis. The data compared with Robsons guidelines and reflected that the centre is dealing with high risk primigravida (47.51%, 35-42% Robson criteria) cases with high CS rate (16.8%, group 5). There was multiple pregnancy, group 8, (2.32 %, >1.5-2% Robson Criteria) and preterm births as in group 10, 18.02 % (5% in Robson Criteria), exclusively high.Conclusions: The Robson criteria help to classify the population handled by the canter to develop the strategies for betterment of services. It has limitation in view of qualitative assessment of the data for comorbidities and severity of the disease.

scholarly journals 375. Cryptococcal Antigenemia in Advanced HIV Infection

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S196-S196
Author(s):  
Jatin Ahuja ◽  
Manish Soneja ◽  
Naveet Wig ◽  
Immaculata Xess ◽  
Ashutosh Biswas ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Care Center ◽  
Tertiary Care ◽  
Latex Agglutination ◽  
Cd4 Count ◽  
North India ◽  
World Health ◽  
P Value ◽  
The Mean

Abstract Background Diagnostic importance of asymptomatic cryptococcal antigenemia is being increasingly recognized in the last few years. Recently, WHO (World Health Organization) has recommended routine screening of CrAg (cryptococcal antigen) among PLHA with CD4 ≤100/mm3, albeit this procedure is not yet adopted by many developing countries including India. Methods We conducted a prospective observational study in a large tertiary care center of North India, upon ethical clearance. Latex agglutination test was performed to assess serum CrAg levels, followed by the lumbar puncture for detection of CrAg levels in the CSF. We analyzed the prevalence and treatment outcomes of cryptococcal antigenemia among PLHA with CD4 ≤ 100 cells/mm3. Detailed clinical examination was conducted, with follow-up of upto 3 months. Multivariate analysis was performed for the estimation of risk factors. Results The mean age (years) and BMI (kg/m2) of all the participants were 41.4 ± 11.2 and 22.1 ± 2.6, respectively. Notably, the mean CD4 count (cu.mm) at the time of recruitment was 62.3 ± 20.5. Noteworthy, 62 (60.8%) of the patients were ART naïve. We found 9.8% (n = 10) of the patients were positive for serum CrAg, and only 2.9% (n = 3) had clinical features of meningitis and 6.8% (n = 7) were asymptomatic (subclinical) CrAg positive. Strikingly, 3.9% (n = 4) of the asymptomatic cryptococcal antigenemia patients were also positive for CrAg in CSF, with 1.9% (n = 2) were only serum CrAg positive, and 1 patient was lost to follow-up (Graph 1). Multivariate analysis revealed that patients with long duration of HIV (P = 0.04), headache symptoms (P = 0.004) and possessing features of meningismus (P value=0.08) are more likely to be CrAg positive. Conversely, patients on fluconazole were protective against cryptococcal antigenemia (P = 0.1) as shown in Table 1. Overall mortality observed was 11.3% among advanced HIV patients. Moreover, mortality in CrAg-positive patients was 33.3% in comparison to CrAg-negative patients who had 9% (P = 0.06) in 3-months follow-up. Conclusion Cryptococcal antigenemia is common (9.8%) among patients with CD4 count ≤100/mm3 in India. Screening for CrAg should be made routine for PLHA with CD4 count ≤100/mm3 and if required preemptive treatment to be given in this regard. Disclosures All authors: No reported disclosures.

scholarly journals Knowledge and Awareness among mothers regarding exclusive breastfeeding in holy Karbala city / Iraq

2019 ◽  
Author(s):  
maytham salim Al-Nasrawii ◽  
Ali Neamah Al-Aaragi ◽  
Ali Abd Al-Latif G Mohammed
Keyword(s):  
Exclusive Breastfeeding ◽  
Care Center ◽  
Education Level ◽  
Environmental Benefits ◽  
World Health ◽  
Good Knowledge ◽  
P Value ◽  
Cross Sectional ◽  
Health Care Center ◽  
Significant Difference

Abstract Background: World Health Organization (WHO) and United Nations Children’s Fund (UNICEF) “Exclusive breastfeeding (EBF)” is explained as “the infant receives only breast milk, no other liquids or solids. Its recommended for the first 6 months of life, and then complementary feeding should be started. EBF helps to reduce child morbidity and mortality from several diseases such as diarrhea, respiratory and /or ear infections and other infectious diseases, shielding lactation women from breast and ovarian cancer. In addition to offers societal economic and environmental benefits, The objective of this study was to assess the knowledge and awareness of exclusive breast feeding among mothers with a child < 2 years of age. Methods : A descriptive cross-sectional study was carried out in Health Directorate of Holy Karbala city. The study consist of (487) mothers how attendant to six Primary Health Care center (PHC). The collected data was done by direct interview with mothers and using a questionnaire form that designed based on the study objectives according to WHO criteria. Data were analyzed by SPSS, descriptive statistics included numbers (N) and percentage (%), and the inferential statistical test was done by using Chi-Square test , P-value was equal or less than 0.05 considered as statistically significant to find for any association between the results variables. Result : A total of 487 participants were included in the study, the rate of response was 92.7%. The highest percentage (66.3%) of study sample were full in the age group (21-30) years, and more than three quarters were lived in urban area. Nearly half of the study sample 47% had primary education and 60% those housewives, and the main source of information being family and friends (84.4%). As an overall assessment, 61.8% of the study sample had good knowledge and awareness about exclusive Breastfeeding, with highly significant differences to education level ,occupation residence of the mother. Conclusion: Over half of the subjects had good knowledge and awareness of exclusive Breastfeeding. And, on the other hand, there was a very significant difference between education level, occupation and mother's residence with a level of knowledge.

scholarly journals Intrauterine fetal demise: a retrospective study in tertiary care center in India

2018 ◽  
Vol 7 (8) ◽  
pp. 3069
Author(s):  
Anand Karale ◽  
Kunaal K. Shinde ◽  
Hemant Damle
Keyword(s):  
Gestational Age ◽  
Maternal Age ◽  
Care Center ◽  
Tertiary Care ◽  
Mode Of Delivery ◽  
P Value ◽  
Maternal Complications ◽  
Fetal Demise ◽  
Maternal Risk ◽  
Intrauterine Fetal Demise

Background: An Intrauterine Fetal Demise (IUFD) is a major obstetrical catastrophe at any gestational age but the emotional pain and distress caused by this event increases in direct relation to the duration of pregnancy. The objective of the present study was to determine the incidence and possible causes of Intrauterine Fetal Demise (IUFD), and to determine preventive measures.Methods: Retrospective observational study was done from Jan 2015 to Dec 2017 at Smt. Kashibai Navale Medical College and General Hospital, Narhe, Pune. Inclusion criteria were all the pregnant women with IUFD delivered at the centre, at or above 24 weeks of gestation. The methodology followed were parameters of assessment for analysis were maternal age, parity, probable causes for IUFD, booked or unbooked cases, mode of delivery, maternal complications, and placental histopathology. Statistical data were analyzed using SPSS version 25.Results: The incidence of IUFD at authors’ hospital was 27/1000 live births. The IUFD rate was similar in maternal age <20years and >30years (p value 0.26). The incidence of IUFD increased with decreasing gestational age which was statistically significant (p value 0.001). IUFD incidence was higher in multiparous women compared to primiparous women (p value 0.036 with OR of 1.6 and 95% CI 1.02 to 2.54). The rate of IUFD was similar when sex of the baby was analyzed. 49.4% of fetuses had signs of maceration. The major cause of IUFD was severe preeclampsia (48.1%) which included HELLP syndrome, IUGR, Abruption. Maternal anemia (20.4%), GDM (3.8%), SLE (2.5%), APLA positive (2.5%), anhydramnios (6.3%) were some of the other important causes of IUFD.Conclusions: This study was conducted to determine the incidence of IUFD and associated maternal risk factors. By understanding the contributing factors, we can seek ways of avoiding recurrence of IUFD by proper antenatal care and early diagnosis of obstetric complications and its appropriate management.

scholarly journals Retrospective study of cases of rupture uterus at tertiary care center in Egypt

2018 ◽  
Vol 7 (8) ◽  
pp. 2993
Author(s):  
Laila Ezzat ◽  
Mohamed Salah
Keyword(s):  
Risk Factors ◽  
Retrospective Study ◽  
Antenatal Care ◽  
Uterine Rupture ◽  
Care Center ◽  
Tertiary Care ◽  
University Hospital ◽  
Bladder Rupture ◽  
Fetal Life ◽  
Primary Care Center

Background: Uterine rupture (UR)is one of the most serious obstetrical emergencies necessitating prompt diagnosis and management, as it en-dangers the maternal and fetal life. Uterine rupture (scarred/ unscarred) may occur at any stage of pregnancy. In developed countries, with good antenatal care and good supervision during labour, (UR) has become rare except by dehiscence of a caesarean scar. The objective of present study was to find out risk factors, management, related complications and associated maternal and fetal outcomes with rupture uterus.Methods: A retrospective study, data files and the case notes was retrieved from the medical records department at Aswan university hospital from January 1 2013 to December 31 2013 in the form of data relating to the age, parity, gestational age, method of termination, perinatal outcomes, and related maternal complications.Results: There were 4284 deliveries during the period under review among them 5 cases of uterine rupture. Thus, the incidence of uterine rupture was 1.1/1000 deliveries.3 cases (60%) of them had no antenatal care at any hospital or primary care center. The risk factors in these cases are in majority 4 (80%) of cases uterine rupture occurred in women with previous scar, 1case (20%) of cases uterine rupture occurred in women with none scarred uterus. As regard surgical management 3 cases (60%) managed by hysterectomy and 2cases (40%) managed by repair. As regard maternal and fetal outcome all women required blood transfusion. Associated bladder rupture was repaired in two cases (40%). After excluding fetal wastage before the age of viability, perinatal mortality was 100% (5/5).Conclusions: Present retrospective analytical study has concluded that rupture uterus is a life-threatening complication. Proper antenatal and intrapartum care, identification of high risk factors, promotion of skilled attendance at birth and institutional delivery are key factors in reduction and early diagnosis.

scholarly journals Impact of Brief Interactive Psycho-Education Intervention on Caregiver toward Family Care Burden for Schizophrenic Patients at Puskesmas Kasihan II, Bantul

2018 ◽  
Vol 1 (2) ◽  
pp. 38
Author(s):  
Triatmi Dyah Wahyuning ◽  
Adi Heru Sutomo ◽  
Carla R. Marchira
Keyword(s):  
Care Center ◽  
Family Care ◽  
Essential Medicines ◽  
Control Group ◽  
P Value ◽  
Education Intervention ◽  
Care Burden ◽  
Health Care Center ◽  
Quasi Experimental ◽  
Schizophrenic Patients

Background: Schizophrenia is a chronic severe mental disorder which causes a substantial burden of care for family caregivers.Objective: This study aimed to identify the effect of a brief interactive psycho-education intervention on caregivers towards family care burden for schizophrenic patients.Method: This study was a quasi-experimental design with one control group. Data were obtained from a random sample of patients who came to Puskesmas Kasihan II (Community and Primary Health Care Center). The participants in this research were 68 caregivers, who were divided into treatment and control groups. Both groups were administered a pre and post-test with the Burden Assessment Schedule questionnaire early in the first week and in the end or fourth week. The treatment group received a brief interactive psycho-education of schizophrenic patient care over one week for 4 sessions, while the control group received the prescribed essential medicines as usual.Results: This study showed that the average scores of the pre-test for the two groups were not significantly different (p value 0.77), while the averages of the post-tests were significantly different (p value 0.001).Conclusion: It was concluded that a brief interactive psycho-education for caregivers of schizophrenic patients was effective to decrease family care burden.

scholarly journals Predictors of very preterm births (born between 23 and 29 weeks’ gestation) at a tertiary care center in Karachi, Pakistan: additional multivariate analyses on data from primary cohort

2019 ◽  
Author(s):  
Mohammad Yakoob
Keyword(s):  
Birth Weight ◽  
Gestational Age ◽  
Multivariate Analyses ◽  
Care Center ◽  
Tertiary Care ◽  
Mode Of Delivery ◽  
University Hospital ◽  
Very Preterm ◽  
Antenatal Steroids ◽  
Univariate Analyses

Abstract Objective: Previously, we have published univariate analyses on a cohort of all singleton, very preterm infants (N=101) born between 23 and 29 weeks of gestation during January 01, 1998 to June 30, 2003 at The Aga Khan University Hospital in Karachi, Pakistan. Our main objective was to extend these analyses to multivariate logistic regression models and report Odds Ratios (ORs) for univariate and multivariate analyses. All variables in univariate were included in multivariate models. Results: The survival incidences were 0% at 23, 16.7% at 24, 40.0% at 25, 30.0% at 26, 33.3% at 27, 68.8% at 28 and 83.9% at 29 weeks of gestation. In univariate analyses, gestational age, birth-weight and mode of delivery (Cesarean-section had higher survival compared to vaginal) were statistically significant predictors of survival (P≤0.001 each). Other variables that also included antenatal steroids did not achieve significance. However, in complete-case multivariate analyses, only gestational age (per week) was associated with survival (OR=2.5, 95% CI: 1.1–5.5, P=0.03); birth-weight (per 100 grams) and C-section were not associated-1.2, 0.88–1.6, P=0.26 and 2.4, 0.48–12.2, P=0.28. Antenatal steroid use, maternal age, year of birth, parity, history of preterm delivery, hemoglobin levels, complications and time of birth remained not associated.

scholarly journals Predictors of very preterm births (born between 23 and 29 weeks’ gestation) at a tertiary care center in Karachi, Pakistan: additional multivariate analyses on data from primary cohort

2019 ◽  
Author(s):  
Mohammad Yakoob
Keyword(s):  
Gestational Age ◽  
Multivariate Analyses ◽  
Care Center ◽  
Tertiary Care ◽  
Mode Of Delivery ◽  
University Hospital ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
Antenatal Steroids ◽  
Univariate Analyses

Abstract Objective: Previously, we have published univariate analyses on a cohort of all singleton very preterm infants (N=101) born between 23 and 29 weeks of gestation during January 01, 1998 to June 30, 2003 at The Aga Khan University Hospital in Karachi, Pakistan. Our main objective was to extend these analyses to multivariate logistic regression models and report Odds Ratios (ORs) for univariate and multivariate analyses. All variables in univariate were included in multivariate models. Results: The survival incidences were 0% at 23, 16.7% at 24, 40.0% at 25, 30.0% at 26, 33.3% at 27, 68.8% at 28 and 83.9% at 29 weeks of gestation. In univariate analyses, gestational age, birth-weight and mode of delivery (Cesarean-section had higher survival compared to vaginal) were statistically significant predictors of survival (P≤0.001 each). Other variables that also included antenatal steroids did not achieve significance. However, in complete case multivariate analyses, only gestational age (per week) was associated with survival (OR=2.5, 95% CI: 1.1–5.5, P=0.03); birthweight and C-section were not associated-1.2, 0.88–1.6, P=0.26 and 2.4, 0.48–12.2, P=0.28. Antenatal steroid use, maternal age, year of birth, parity, history of preterm delivery, hemoglobin levels, complications and time of birth remained not associated.

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