Sobhraj Maternity Hospital

The article presents a personal observation of the course of pregnancy and childbirth in a patient with spinal muscular atrophy type III. The diagnosis was established at the age of 8 according to clinical data, confirmed by electroneuromyography and the results of a molecular genetic study. During pregnancy planning, a genetic prognosis was made for the birth of a child with SMA in this couple. Pregnancy occurred after further examination of the respiratory system, preparation of the endometrium with gestagen preparations and prevention of thromboembolic complications, proceeded with the phenomena of obstructive sleep apnea, impaired carbohydrate metabolism, cardiac arrhythmias and hypercoagulation. At 37 weeks, she was delivered by caesarean section due to the occurrence of preeclampsia.

Backgroung: Maternal deaths are a major public health issue and serve as a crucial indicator for assessing a country's level of health development.The aim of this study is to describe the epidemiological characteristics of maternal deaths occurring at the Souissi Maternity Hospital in Rabat between 2018 and 2021.Methods: This is a retrospective descriptive study.All cases of maternal death occurring at the Souissi Maternity Hospital in Rabat between January 2018 and December 2021 were included in this study.Data were collected from medical records.We divided the study into two phases (2018-2019 and 2020-2021), to be able to compare the mortality rate before and after COVID-19.Causes of death were also compared between these two phases using Khi 2 test or fisher's exact test. Results:During the entire study period (2018 -2021), the Maternal Mortality Rate was 156.03 deaths per 100,000 live births.This rate rose from 88.84 to 261.49 per 100,000 live births between the two study phases (p < 0.001).Sixty-eight cases were linked to a direct cause (73.9 %).Preeclampsia and eclampsia was the leading cause of maternal mortality by direct cause (30.9 %), and hemorrhage was the second leading cause (25.0 %). Conclusion:The study identified preeclampsia and postpartum hemorrhage as the leading causes of death, both of which are highly preventable.Recognizing risk factors through a case-control study is essential, and targeted interventions could help reduce maternal mortality.

Borderline personality disorder is a chronic psychiatric disorder characterized by pervasive patterns of affective instability, self-image disturbances, interpersonal relationship instability, marked impulsivity and suicidal behaviour. Impulsive trait is a major component of BPD. Another major risk factor for the development of borderline personality disorder is childhood trauma. The objective of this study was to compare childhood trauma and impulsivity in borderline personality disorder and healthy controls. This is a hospital based cross sectional comparative study. Patients seeking treatment in inpatient and outpatient in Department of psychiatry, Patan Hospital, Lalitpur, Nepal who fulfilled the inclusion and exclusion criteria were taken. Patients were divided into two groups: BPD (n=21) and HC (n=42). Childhood trauma questionnaire-28 and Barratt Impulsivity score-11 were filled. The mean Barratt Impulsivity score-11 for borderline personality disorder was 76.95±11.06 and 66.42±8.92 in health controls. The observed difference was statistically significant (p=<0.001). Childhood trauma questionnaire-28 score for borderline personality disorder was 69.05±21.37 and that for healthy control was 46.43±9.27. The observed difference was statistically significant (p-value<0.05). In this study higher impulsivity and childhood trauma experience was observed with BPD than HC.

Postpartum hemorrhage is an emergency, condition encountered in obstetric cases. It is an acute life-threatening situation and needs an immediate and rapid management. Postpartum hemorrhage is leading cause of maternal mortality and morbidity worldwide, with more commonly affecting women of developing countries. Accurate assessment of blood loss, identification of risk factors and timely recognition of postpartum hemorrhage remain major challenge in obstetrics. Different risk factors like hypertensive disorder in pregnancy, antepartum hemorrhage, anemia, big baby, polyhydramnios, multiple pregnancy, obesity, augmented/prolonged labor are risk factors for primary postpartum hemorrhage. The objective of this study was to identify the various risk factors associated with primary postpartum hemorrhage, in Paropakar Maternity and Women’s Hospital (PMWH), which is biggest institute in country for holding records of maximum number of deliveries. A cross sectional study was conducted over a period of 3 months between March 2023 to May 2023 on 72 patients. Women with term pregnancy who experienced primary PPH were analyzed for different risk factors. Similarly, incidence of postpartum hemorrhage according to age, parity, gestational age, types of labor, types of vaginal delivery and causes of postpartum hemorrhage were studied. The results were then analyzed. The incidence of primary PPH during the study was 3%. Majority of cases of PPH were in age group of 20-24 (44.4%), followed by age group (25-29). Most of cases (50%) were of gravidity 2 to 3, followed by primigravida (45.8%). There was equal distribution of PPH in gestation age (37-39+6) WOG to (40-41+6) WOG. There were no risk factors associated with occurrence of PPH in 56%. Hypertensive disorder of pregnancy, anemia, APH, multiple pregnancy, fetal macrosomia, polyhydramnios and obesity are associated risk factors for PPH. Among risk factors associated with PPH, hypertensive disorder of pregnancy was most common risk factors (40.6%), followed by maternal anemia (25%), multiple pregnancy (12.5%), APH (6.3%) fetal macrosomia (6.3%), maternal obesity (6.3%), polyhydramnios (3.1%). PPH was more common in augmented labor (43%), followed by induced labor (29.2%) and spontaneous labor (27.8%). In this study most women ( 72.2%) experienced blood loss of 500-1000 ml. And most common cause of PPH was atony (83.3%) followed by genital tract injury (14%) and retained tissues (2.7%). In many cases, PPH can’t be predicted fully as many cases of PPH occur without vivid risk factors, as in this study 56% women experiencing PPH had no associated antenatal risk factors. Antenatal risk factors like hypertensive disorder of pregnancy, maternal anemia, twin pregnancy, APH, macrosomia, obesity are common risk factors for PPH. Similarly induced and augmented labor and instrumental delivery can lead to PPH.

Objective: To compare the causes and rate of caesarean section in primigravida and multigravida. Study Design: Cross-sectional study. Setting: Government Maternity Hospital, Peshawar. Period: January 2021 to January 2022. Methods: The study included all primigravida with 37-42 weeks period of gestation, and multigravida (gravida 2-12) with the same gestational period. Similarly, all the multigravida who delivered previously by C-section or had normal vaginal delivery with the viable fetus and currently delivered by C-section, were also included. Cases having history of ruptured uterus, nonviable pregnancy and ectopic pregnancy were excluded from the study. Results: Overall, the frequency of C-sections in the present study was 30% in primigravida and 70% in multigravida. Majority of the patients (65%) went through elective C-sections while 35% delivered through emergency C-sections, difference between the two is statistically significant (p-value &lt;0.0001). The commonest cause for performing elective C-sections was previous C-sections. Fetal distress was the commonest indication 27.27% for emergency C-sections. Most of the C-sections performed in primigravida were because of fetal distress 23.3% while previous C-sections were the topmost cause in multigravida. Maternal wish is another new indication that accounted for 7.6% of C-sections. Conclusion: The results showed that the incidence of C-sections was higher in multigravida than primigravida. Similarly, the rate of elective C-sections was more than emergency ones. Maternal wish is another rising new indication for C-sections.

The vulva and vagina are a unique anatomical region, which anatomy and physiology changes throughout a woman's life. The most noticeable changes are hormone-mediated and are associated with the onset of puberty, menstrual cycle, pregnancy and menopause. The microbiome changes over time due to various factors, such as hormones, which leads to a change in pH. Various hygiene practices and habits also have a huge impact on the microflora of the vulva and vagina, and therefore on a woman’s health. Today, the market offers a huge number of care and hygiene products designed for the genital area of women. But, unfortunately, information about their correct use and safety of use is limited. For example, various health behaviours, such as vaginal douching and pubic hair removal are still widely used, although there is some evidence of their negative impacts on the health of the vulva and vagina. Despite the abundance of specialized intimate hygiene products, the use of general care products that are not intended for the genital area and therefore can cause irritation, itching and other unpleasant effects is reported. Foreign guidelines for intimate female hygiene practices resolve itself to recommendations of daily vulva cleansing with a gentle hypoallergenic liquid wash. There is a need to increase women's awareness about rational choice of feminine hygiene products and disorders of the vulva and vagina to improve their intimate health.

Objective. To analyze the authors’ published works and their own experience in the application of the transvaginal transluminal endoscopic surgery (v-NOTES) in gynecology. Material and methods. 14 patients were operated on using the vaginal-vaginal transluminal endoscopic surgery (v-NOTES) technique; among them 3 patients with benign ovarian neoplasms after vaginal hysterectomy and 11 patients with pelvic apical prolapse. The operative technique is described in more detail using two obese patients with pelvic apical prolapse as examples. After vaginal hysterectomy we identified sacroiliac ligaments and sutured them with non-absorbable sutures, followed by fixation of the vaginal stump. Results. Transluminal transvaginal endoscopy (v-NOTES) is preferred in obese patients with apical pelvic organ prolapse and in patients who reject traditional laparoscopy for a cosmetic effect. This type of residual limb fixation serves as an alternative to the mesh prosthesis application due to the reduced risk of implant-specific complications and the development of post-hysterectomy prolapse. Conclusion. The advantages of the transluminal endoscopic surgery will allow it to take its place in the routine practice of gynecological surgeries.

Background: Persistent nausea and vomiting (hyperemesis gravidarum) in early pregnancy remains a significant health problem that result in negative side effects on women and their pregnancy. Design: A descriptive research design was utilized. Sample: A purposive sample composed of 150 of pregnant women from first trimester to13 weeks and confirmed diagnosis with hyperemesis gravidarium. Tools: Three tools were utilized to collect data; (1) A structured Interviewing Sheet, (2) Assessment the pregnant women health needs developed often occurring of the hyperemesis gravidarium, (3) Assessment the pregnant women health problems developed often occurring of the hyperemesis gravidarium. Results: It was found that, 71.3% of the studied women have unsatisfactory level of knowledge. Also, 60.7% of them have incorrect practices. Moreover, 55.3%of the studied women their health needs unsatisfied achieved. Furthermore, 62% of them have health problems related to hyperemesis gravidarium. Conclusion: Based on the study finding it concluded that, there was a relation between socio- demographic data of pregnant women and their knowledge and reported practices about hyperemesis gravidarium. Also, there was statistically significant positive correlation between total practices of the studied women and their total knowledge. Recommendations: The study recommended that, Increase awareness of pregnant women about hyperemesis gravidarum hazards and the importance of prompt medical care-seeking to avoid complications, organizing of training programs for pregnant women about self-care to improve their behavioral and life style.

Introduction: The onset of pregnancy till its culmination is a critical care period for the mother because any negligence during the nine months can have dire consequences both for the mother and the child.&#x0D; Objective: The objective of this study is to document the reasons for which women at the time of delivery are referred and their outcome for both mother and new born.&#x0D; Methodology: A cross-sectional study was conducted in the Obstetrics and Gynaecology Unit 1, Department of a tertiary care teaching hospital in Sukkur, Sindh. Full-term pregnant females who were referred in the period of May 2018 to April 2019 were included. Total referrals accounted for n=99. Data was analysed on SPSS version 23. Frequencies and percentages were calculated for the reasons and the outcome. Kruskal Wallis test was applied for finding differences in mean gestational age among maternal and foetal outcomes. P-value less than 0.05 was taken as significant.&#x0D; Results: Total n=99 females were referred during one-year period. The most prevalent medical reason for referral was postpartum haemorrhage (19%) and Eclampsia (18%). Anaemia as an indirect cause was seen in (41%) referrals. For the majority, the mode of delivery was Caesarean Section (49.5%). Maternal deaths were (12%) whereas Intra Uterine Deaths accounted for (41%).&#x0D; Conclusion: The most common reason for referral was postpartum haemorrhage and eclampsia. Increase maternal mortality and intrauterine deaths are observed.&#x0D; Keywords: Maternal outcome, foetal outcome, referrals, high-risk pregnancies, Anaemia.&#x0D;

Aim: To assess the role of intermittent cardiotocographic monitoring of induction of labor while using misoprostol in pregnancy of 41 weeks or more.&#x0D; Methods: This is hospital based descriptive study conducted from December 2017 to March 2018. CTG was done before each transvaginal administration of misoprostol in 113 primigravida patients at Paropakar Maternity Women’s Hospital in Kathmandu. Variables studied were indications of induction, mode of delivery, Apgar score and neonatal admissions.&#x0D; Results: 11.5% of CTGs were non-reassuring who underwent Cesarean Section and had significantly low Apgar at 1 minute but only 46% of neonates required resuscitation. Liquor was thick meconium in 61.5% of non-reassuring CTGs. Total twelve (10.6%) of neonate needed resuscitation of which six (6%) neonate in reassuring CTG where as 46.1% of neonate needed resuscitation in non-reassuring. NICU admission rate was 7.96% in total and 33.3% of neonate with non-reassuring CTG who needed resuscitation. However there was no neonatal mortality during this period.&#x0D; Conclusions: Intrapartum cardiotocography can prevent fetal compromise early.&#x0D; Keywords: Apgar score, caesarean section, cardiotocography, induction, resuscitation