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Infection Prevention Control (IPC), Hospital acquired infection (HAI) and Obstetrics practice 感染预防控制(IPC)、医院获得性感染(HAI)和产科实践
Pub Date : 2023-02-11 DOI: 10.3126/njog.v17i1.49685
R. Baral
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.
感染预防控制规划对预防传染性疾病的发生具有重要意义。在临床实践中,建议采用简单易行的洗手等有效的灭菌方法。免疫功能低下的孕妇和新生儿更易感染;由于产科护理的外科性质,医院获得性感染是一个真正的挑战。
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引用次数: 0
Smooth muscle tumor of uncertain malignant potential (STUMP) of Vulva 外阴不确定恶性潜能的平滑肌瘤
Pub Date : 2022-12-31 DOI: 10.3126/njog.v17i2.52383
M. Yadav, G. Baral
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. 
一位30岁未生育的女性,以外阴平滑肌瘤复发及多次切除的病史为主诉。她有坚实的双叶无压痛的外阴肿块并行部分外阴切除术。组织病理学显示为恶性潜能不确定的平滑肌肿瘤(STUMP)。结论:外阴平滑肌瘤是一种罕见的疾病,极易误诊。手术切除和组织病理学分析对外阴残端的最终诊断有帮助/推荐。
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引用次数: 0
Two syringes technique for spinal anesthesia to prevent hypotension in patients undergoing elective cesarean section 选择性剖宫产术中预防低血压的双针管麻醉技术
Pub Date : 2022-12-31 DOI: 10.3126/njog.v17i2.52370
S. Shrestha, Jeju Nath Pokhrel, T. Gurung, Sagar Devkota, Apurb Sharma
Aims: To compare the incidence of hypotension after intrathecal administration of hyperbaric bupivacaine and fentanyl in two different syringes against standard injection of mixed fentanyl with hyperbaric bupivacaine. Methods: This was a prospective comparative study conducted in 174 parturients undergoing elective caesarean section at Paropakar Maternity & Women’s Hospital. Hemodynamic effects and characteristics of block were monitored and recorded and compared between the two groups, group S (single syringe) and group D (double syringe). Results: The incidence of hypotension was almost similar in the two groups but the drop in systolic blood pressure and mean arterial pressure at 5 minutes and 7.5 minutes after subarachnoid block was significant in group S as compared to group D (p<0.005 and p<0.005 respectively). Conclusion: Hyperbaric bupivacaine with fentanyl, which when injected separately without mixing, is associated with lesser incidence of hypotension following subarachnoid block.
目的:比较两种不同注射器鞘内注射高压布比卡因和芬太尼与标准混合注射高压布比卡因后低血压的发生率。方法:对Paropakar妇产医院174例择期剖宫产患者进行前瞻性比较研究。监测并记录S组(单针注射)和D组(双针注射)的血流动力学效果和阻滞特性,并进行比较。结果:两组低血压发生率基本相同,但S组蛛网膜下腔阻滞后5 min和7.5 min收缩压和平均动脉压下降量显著高于D组(p<0.005和p<0.005)。结论:高压布比卡因与芬太尼单独注射时,蛛网膜下腔阻滞后低血压的发生率较低。
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引用次数: 0
Abortion Legislation and its Reform: A Cross Sectional Study on the Views of Obstetricians and Gynecologists in Nepal 堕胎立法及其改革:尼泊尔妇产科医生观点的横断面研究
Pub Date : 2022-12-31 DOI: 10.3126/njog.v17i2.52372
S. Aryal, D. Shrestha
Aims: To assess the knowledge of obstetrician and gynaecologists in Nepal about abortion legislation and to know their perception on its reform. Methods: A cross-sectional survey design was adopted. An online questionnaire was sent to all members of the Nepal Society of Obstetrician and Gynaecologists and response was collected. Profile of the respondents, their knowledge on the 2002 abortion legislation and their attitude on its reform were noted. Results: The response rate was 10.1%. There was a fair knowledge of previous abortion legislation amongst the 43 respondents. The mean score for the knowledge on previous abortion law and its reform was 3.85±0.35 and 3.0±1.14 respectively. Twenty-seven (62.8%) respondents felt the need for reform was necessary. In regards to the reform, 44.25% (19) stood for it and 46.5% (20) were against it. More (55%) obstetrician and gynaecologists practicing in the Bagmati province were against the reform. Conclusions: Obstetrician and gynaecologists practitioners in Nepal have a good knowledge of abortion legislation and are aware of its reform. The need for reform is also perceived well but there is a divided opinion amongst practitioners, with half of them positive about the reform and half standing against it.  
目的:评估尼泊尔妇产科医生对堕胎立法的了解,了解他们对堕胎立法改革的看法。方法:采用横断面调查设计。一份在线调查问卷被发送给尼泊尔妇产科医师协会的所有成员,并收集了他们的回复。受访者的个人资料、对2002年堕胎法的了解程度及对堕胎法改革的态度。结果:有效率为10.1%。在43名受访者中,对以往的堕胎立法有相当的了解。对既往堕胎法及其改革知识的平均得分分别为3.85±0.35分和3.0±1.14分。有27人(62.8%)认为有必要进行改革。对于改革,赞成的占44.25%(19人),反对的占46.5%(20人)。在巴格马提省执业的更多(55%)产科医生和妇科医生反对改革。结论:尼泊尔的产科医生和妇科医生对堕胎立法有很好的了解,并意识到其改革。改革的必要性也被认为是好的,但从业者之间的意见分歧,一半的人支持改革,一半的人反对改革。
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引用次数: 0
Clinical analysis of ectopic pregnancy in a tertiary center in rural Telangana 特伦甘纳邦农村某三级中心异位妊娠的临床分析
Pub Date : 2022-12-31 DOI: 10.3126/njog.v17i2.52373
N. Anusha, B. M. Hota, N. Movva
Aims: To find the incidence, risk factors, morbidity and mortality in ectopic pregnancy in a tertiary center in rural Telangana.Methods: This retrospective observational study was conducted in the Department of Obstetrics and Gynecology, Mamata Medical College, Khammam, Telangana State, India, over 5 years from 2017 to 2021. Detailed informative data of all admitted and treated cases of ectopic pregnancy were collected, analyzed and discussed.Result: The incidence of ectopic pregnancy was 1.3 per 100 pregnancies and 2.5% case fatality. The majority of cases were in the 20-30 years of age group (82.5%); multipara (50%) and gestational age of ≤ 8 weeks (62.5%). History of abortion was the most common risk factor (67.5%). The classical triad of amenorrhoea, pain abdomen and bleeding per vagina was present in 45% of cases; and amenorrhea (97.5%), pain abdomen (87.5%) and vaginal bleeding (42.5%), abdominal tenderness (85%) and unstable hemodynamic (22.5%) were reported. The fallopian tube was the commonest site and operative management was required in 97.2% of cases.Conclusion: Prevention of known risk factors, early reporting and referral in need, diagnosis and effective management is the way to a better outcome in ectopic pregnancy.
目的:了解特伦甘纳邦农村某三级中心异位妊娠的发生率、危险因素、发病率和死亡率。方法:回顾性观察研究于2017 - 2021年在印度特伦甘纳邦Khammam Mamata医学院妇产科进行,为期5年。对所有收治和治疗的异位妊娠病例的详细资料进行收集、分析和讨论。结果:异位妊娠发生率为1.3 / 100例,病死率为2.5%。以20 ~ 30岁年龄组居多(82.5%);多产(50%)和胎龄≤8周(62.5%)。流产史是最常见的危险因素(67.5%)。45%的病例存在闭经、腹痛和单阴道出血的经典三联征;闭经(97.5%)、腹痛(87.5%)、阴道出血(42.5%)、腹部压痛(85%)、血流动力学不稳定(22.5%)。输卵管是最常见的部位,97.2%的病例需要手术治疗。结论:预防已知的危险因素,及早报告和转诊,及时诊断和有效管理是异位妊娠获得较好结局的途径。
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引用次数: 0
Analysis of the phenotypic variants of polycystic ovarian syndrome in women of reproductive age group 育龄妇女多囊卵巢综合征表型变异分析
Pub Date : 2022-12-31 DOI: 10.3126/njog.v17i2.52379
P. Basnet, M. Chhetry, D. Shah, Tulasa Basnet, Sarita Sitaula, M. Dahal
Aims: To identify the different phenotypic variant of PCOS in women of reproductive age group and to assess the hormonal and metabolic profile of women with PCOS.Methods: This Prospective descriptive study was conducted in the Department of Obstetrics and Gynecology, BPKIHS, Dharan for a period of one year from July 2020 to June 2021. All Women presenting to Gynecology OPD with complaints of menstrual irregularity and clinical features of hyperandrogenism were assessed and evaluated for polycystic ovarian syndrome. BMI was calculated. Hormonal Profile (serum LH, FSH and testosterone) and metabolic parameters (fasting blood sugar and lipid profile) were studied; and then further categorized into different phenotypic variants. All data were stored in Microsoft excel format and analyzed using SPSS version 11.5. using descriptive statistics.Results: Total of 80 cases of PCOS were enrolled during the study period. The most common phenotypic variant was Type B (60%) followed by Type D (30%). The mean BMI was 22.4± 4.2kg/m2 . All PCOS cases presented with menstrual irregularity as the primary complaint.Conclusions: Anovulatory PCOS was the most common phenotypic variant in our study population. This study did not find obese PCOS hence emphasizing the need of evaluation in lean women with or without hyperandrogenism presenting with menstrual irregularities. 
目的:探讨育龄妇女多囊卵巢综合征(PCOS)的不同表型变异,评价PCOS患者的激素和代谢特征。方法:本前瞻性描述性研究于2020年7月至2021年6月在达兰BPKIHS妇产科进行,为期一年。所有以月经不规律和高雄激素症的临床特征向妇科门诊就诊的妇女都被评估和评估多囊卵巢综合征。计算BMI。研究激素谱(血清LH、FSH和睾酮)和代谢参数(空腹血糖和血脂);然后进一步分为不同的表型变异。所有数据以Microsoft excel格式保存,使用SPSS 11.5版本进行分析。使用描述性统计。结果:研究期间共纳入80例PCOS患者。最常见的表型变异是B型(60%),其次是D型(30%)。平均BMI为22.4±4.2kg/m2。所有PCOS病例均以月经不调为主诉。结论:无排卵型多囊卵巢综合征是我们研究人群中最常见的表型变异。本研究未发现肥胖型多囊卵巢综合征,因此强调有必要对伴有或不伴有月经不规律的高雄激素症的消瘦女性进行评估。
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引用次数: 0
Analysis of the Factors leading to Severe Acute Maternal Morbidity and Maternal Mortality during COVID 19 Pandemic COVID - 19大流行期间孕产妇严重急性发病和死亡因素分析
Pub Date : 2022-12-31 DOI: 10.3126/njog.v17i2.52384
J. Shrestha, Sudiksha Thapa, Nidhish Sharma
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.  
目的:了解2019冠状病毒病(COVID - 19)大流行期间孕产妇严重急性发病率和死亡率的流行情况、原因和因素。方法:采用横断面观察研究方法,于2020年3月至2022年2月在新冠肺炎大流行期间在马尼帕尔教学医院妇产科进行。包括在怀孕、分娩和产后六周期间患有严重急性产妇发病率(根据世界卫生组织器官系统标准)和产妇死亡的妇女。记录了产妇特征、总活产、妊娠结局、导致发病率和死亡率的原因和因素。获取的数据使用社会科学统计软件包第21版进行分析。结果:重症急性产妇发病37例,产妇死亡2例。严重急性产妇发病率为每1000例活产9.4例,产妇死亡率为每10万例活产51例。因此,重症急性产妇发病率死亡率为18.5:1,死亡率指数为5.1%。血液学和凝血系统(45.9%)和神经系统(29.7%)是常见的受累器官系统。高血压疾病(40.5%)和出血(32.4%)是严重急性发病的主要原因。两名产妇的死亡都是由于子痫。妊娠期未见因COVID感染引起的严重急性孕产妇发病或死亡。在寻求和到达保健中心方面的延误(65%)是导致严重发病率和死亡率的主要延误。结论:2019冠状病毒病大流行期间孕产妇严重急性发病率和死亡率的指标和原因与前无明显差异。在寻求和获得保健方面的初级延迟是导致严重发病率和死亡率的主要因素。
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引用次数: 0
Stillbirths In Nepal: A Scoping Review 尼泊尔的死产:一项范围审查
Pub Date : 2022-12-31 DOI: 10.3126/njog.v17i2.52368
Keshar Bahadur Dhakal, D. Khadka, A. Dhakal, Sulochana Dhakal-Rai
Stillbirth is the term to describe a foetal demise in utero either prior to, or during the process of labour. It is one of the most burning issues in obstetrics research in recent years. Stillbirth is one of the most heart-wrenching events which can occur unexpectedly during the course of a pregnancy. It causes immense distress to the mother and the health professionals involved. This study aims to explore the incidence, sociodemographic characters, risk factors and obstetrical outcomes related to stillbirths among various studies in Nepal. We searched various electronic databases such as MEDLINE, CINAHL, PubMed, Nepal Journals on-line (NepJOL) and Bangladesh Journals on-line (BanglaJOL) from 2014 to 2021, especially for articles reporting hospital-based stillbirths. We included studies with primary studies on stillbirth conducted in a hospital setting in Nepal and published in English language. The incidence of stillbirths in Nepal varied widely. In this study, the incidence varied from 8 to 23.87 per 1000 births. The majority of stillbirths were preterm, occurring among women aged 20 - 35 years. Many stillborn babies were low birth weight. The categorisation of maternal age and weight of baby, lower limit of gestational week was not similar across the studies. Hypertensive disorders in pregnancy and unexplained factors were the leading risk factors. Limited number of studies available and the lack of uniformity among studies was the main limitation of this review.
死产是描述胎儿在分娩前或分娩过程中在子宫内死亡的术语。这是近年来产科研究中最亟待解决的问题之一。死产是最令人心痛的事件之一,它可能在怀孕过程中意外发生。这给母亲和相关的卫生专业人员带来了巨大的痛苦。本研究旨在探讨尼泊尔各种研究中死产的发生率、社会人口学特征、危险因素和产科结局。我们检索了2014年至2021年的各种电子数据库,如MEDLINE、CINAHL、PubMed、尼泊尔在线期刊(NepJOL)和孟加拉国在线期刊(BanglaJOL),特别是报道医院死产的文章。我们纳入了在尼泊尔一家医院进行的死胎初步研究,并以英语发表。尼泊尔的死产发生率差别很大。在这项研究中,每1000个新生儿的发病率从8到23.87不等。大多数死产是早产,发生在20 - 35岁的妇女中。许多死产婴儿出生时体重过低。各研究对产妇年龄、婴儿体重、孕周下限的分类不一致。妊娠期高血压疾病及不明原因因素是主要危险因素。研究数量有限,研究之间缺乏一致性是本综述的主要局限性。
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引用次数: 0
Smooth muscle tumor of uncertain malignant potential (STUMP) 恶性潜能不确定的平滑肌瘤(STUMP)
Pub Date : 2022-12-31 DOI: 10.3126/njog.v17i2.52380
R. Yadav, S. Ansari, Kanika Chopra, K. Agrawal, M. Osama, S. Dhar
Uterine smooth muscle tumor of uncertain malignant potential (STUMP) is a rare tumor belonging to a group of smooth muscle tumor that possess both benign and malignant features, complicating the diagnosis. STUMP is a rare uterine tumor with a paucity of literature available regarding management and subsequent malignant potential. A 22-year-old unmarried lady presented as uterine fibroids with 24 weeks size uterus. There was one intramural and another subserosal mass both of which revealed smooth muscle tumor of uncertain malignant potential in histopathology.
子宫平滑肌不确定恶性潜能瘤(STUMP)是一种罕见的肿瘤,属于一组平滑肌肿瘤,兼具良恶性特征,诊断较为复杂。STUMP是一种罕见的子宫肿瘤,缺乏关于治疗和随后恶性潜能的文献。22岁未婚女性,子宫肌瘤24周大小。有一个壁内肿块和另一个浆膜下肿块,在组织病理学上都表现为平滑肌肿瘤,恶性潜能不确定。
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引用次数: 0
Diagnostic Laparoscopy to assess tubal and pelvic pathology in patients of subfertility: A retrospective analysis 诊断腹腔镜评估输卵管和盆腔病理在不孕患者:回顾性分析
Pub Date : 2022-12-31 DOI: 10.3126/njog.v17i2.52371
Nilam Subedi, A. Ghimire, P. Pant
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.
目的:通过腹腔镜检查评估原发性和继发性不孕症的输卵管病理。方法:本研究在格兰德国际医院妇产科进行。这是一项在三级医院进行的为期2年的回顾性研究。从2020年2月到2022年1月。所有在格兰德国际医院妇产科收治、评估和手术的不孕症(原发性和继发性)患者。结果:52例患者年龄最小20岁,最大46岁,平均年龄30.52±4.885岁。38例为原发性不孕症,14例为继发性不孕症。子宫正常40例,子宫肿大12例。右侧输卵管积水占11.5%,左侧输卵管积水占30.8%。右、左管脓输卵管炎分别占9.6%和7.7%。双侧输卵管通畅22例,双侧输卵管阻塞13例,其余17例为单侧输卵管阻塞。盆腔粘连发生率为44.2%。其中以子宫内膜异位症最多(15.4%),其次为卵巢囊肿(11.5%)和子宫肌瘤(11.5%)。结论:多数患者输卵管病理正常,其次为输卵管水肿、输卵管积液和输卵管脓。子宫内膜异位症、肌瘤和卵巢囊肿是常见的相关疾病。
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引用次数: 0
期刊
Nepal Journal of Obstetrics and Gynaecology
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