Abstract Vol.33(2)

2019

All articles which are published, including editorials, letters and book reviews represent the opinion of the authors and are not necessarily those of the Malaysian Medical Association unless otherwise expressed.

Social and Cultural Issues of Menstruation and Abnormal Uterine Bleeding in Nepal, 2023

Practice difficulties during menstruation and abnormal uterine bleeding (AUB) are major global concerns. So, this review will explore the issues of cultural and social for menstruation and AUB in Nepal. Nearly one-third of menstruating girls and women were facing abnormal menstruation and uterine bleeding worldwide. All religions have negative views and enforce prohibitions on menstruation and abnormal uterine bleeding except Sikhism. AUB impacts women's living quality, sexuality, social engagement and participation, mental well-being, access to education and employment prospects, experiences of stigma and shame, as well as economic challenges. Menstruation restrictions are a routed problem in some parts, some religions, and castes, and very few menstruating women use disposable sanitary pads in Nepal. Awareness programs, educational intervention programs, and education on menstrual health help to rule out the causes of AUB, and legal implementation of these should be applied to the effort to overcome the issues.

Letter submitted to the British Journal of Obstetrics and Gynaecology in response to five Danish papers published in 2012. My letter was not accepted for publication

Backgound: Jaundice is the excess accumulation of bile pigments in the bloodstream and bodily tissues that causes a yellow to orange and sometimes even greenish discoloration of the skin, the whites of the eyes, and the mucous membranes. Jaundice in pregnancy causes significant maternal as well as perinatal mortality and morbidity like DIC, Thrombocytopenia, Renal failure, PPH and maternal mortality rates are high with the disease. It is responsible for about 60% of perinatal mortality and about 14% of maternal mortality. The present study analyses the cause and feto-maternal outcome in pregnancies in lower and middle socioeconomic classes which are affected with jaundice. Materials and methods: All the indore patients in the department of obstetrics and gynecology, civil hospital, Ahmedabad with pregnancy with jaundice with bilirubin>3mg% were included in this study. The study period was January 2019 to December 2019. All such patients were prospectively followed throughout the pregnancy and intrapartum period and their outcomes were studied. All the patients underwent clinical examination, complete blood count, liver function tests, viral hepatitis markers, coagulation profile, hepatobiliary, abdominal and foetal ultrasonography. Apart from these when required additional investigation to know exact etiology of liver disease were carried out. Results: Jaundice in pregnancy is rare medical disorder affecting maternal and perinatal outcome. The most common cause of jaundice was viral hepatitis. Viral hepatitis due to Hepatitis E has grave prognosis with high maternal mortality. There is a high risk of preterm delivery, fetal distress, intra uterine death and meconium aspiration leading to high perinatal mortality. Conclusion: Jaundice and pregnancy is a fatal combination. Both maternal and fetal complications are high with jaundice in pregnancy. Early diagnosis and timely management of pregnancy with jaundice at tertiary care centre helps in reducing maternal and perinatal morbidity and mortality.

Sultan Qaboos University Medical Journal, 2014

(NHS), as a share of national income, has more than doubled, rising by an average of 4% a year in real terms. This period of rapid growth has now ended, but funding pressures on the NHS continue to rise igniting a debate on the most cost-effective way of offering treatment. In this context, we audited subtotal abdominal hysterectomy (STAH) and laparoscopic-assisted supra-cervical hysterectomy (LASH) for benign gynaecological indications in a large district general hospital. A retrospective audit was undertaken of records of patients who had STAH or LASH for benign conditions at Wishaw General Hospital between August and July 2012. Twenty-five patients for each procedure were identified from the theatre information system. As three sets of notes could not be traced, there were 22 patients in the STAH group and 25 in LASH group. The mean operating time for STAH was 61 min (34-85 min) and 145 min (75-237 min) for the LASH group. There was one major complication in the STAH group (1,000 ml blood loss) compared to five in the LASH group (a pelvic infection, two wound infections and two patients with neuropathic pain at port sites). The mean hospital stay in the STAH group was 2.5 nights (2-4 nights) and 2 nights for patients undergoing LASH (1-4 nights). Costs were £2,213.40 (= OMR 1420) for STAH and £2,613.80 (= OMR 1677) for LASH. In this study, complication rates and apparent costs seemed comparable. Shorter hospital stays and possibly quicker recovery are areas where the laparoscopic approach scores over open surgery. In days of austerity for the NHS, surgery options need careful consideration. Open surgery's shorter operating times will help tackle long waiting lists but, if the impact on post-operative recovery and time off work are considered, the laparoscopic approach might be better.

2005

A review of publications relating to significant advances in the specialty of Obstetrics and Gynaecology over the past four years will be discussed: topics reviewed will have an important impact on reducing maternal/fetal morbidity and mortality and should improve on woman's health care.

• Determinants of thrombocytopenia • Thrombocytopenia in pregnancy • Haematological disorders of pregnancy MATERIALS AND METHODS This was a cross-sectional study conducted over a period of three months of May 2019 and August 2019. The study was conducted in the maternity unit of Obstetrics and Gynecology department of KIUTH located in Ishaka-Bushenyi district, in southwestern Uganda about 370 kilometers from the center of Kampala city. This unit has a bed capacity of 85 and conducts approximately 200 deliveries per month. Sample size was determined using Keish and Leslie formula (1965), using an

Introduction: Obstetric fistula is an abnormal communication, acquired and direct between the genital and urinary tracts and rectal. It usually occurs after an obstruction and laborious delivery. The aim of this presentation is to determine the rate of obstetric fistula, the factors associated with these fistulas in Butembo, to describe the most frequent anatomical lesion, to establish the responsibilities and to assess the cure rate. Material and methods: A cross-sectional and descriptive study with retrospective data from January 2014 to August 2017. Patients included in this study were admitted and managed in Gynecological ward at the teaching hospital UCG in Butembo. Of the 49 patients with different types of genital fistulas, 37 had obstetric fistula with vesico-vaginal and recto vaginal types and they were all managed. Results: The cesarean section is the mode of delivery much concerned and accounts for 70.27%, the grand multiparous are 70.27%, the more common anatomical lesion is the vesico-vaginal fistula with 54.05%, The responsibility accounted for midwives is in 51.35% of cases, the type of health facility is the referral health center with 64.86%, the age group concerned is that of 25 to 39 years in 67.59%, the patients who came from rural area in 97.29% and the cure rate after surgery was 83.78%. Conclusion: Obstetric fistula is frequent in Butembo, occurring in most cases after cesarean section associated with the health workers inexperience. The common anatomical lesion is vesicovaginal fistula and the cure rate after surgery is encouraging. It is important to consider a proper training of the health workers to improve on the management during labour and delivery in order to prevent these complications Key words: Epidemiology-therapeutical aspects-obstetric fistula-peri urban area-Butembo The physiopathology of the obstetric fistula concerns difficult delivery which is the result of ischemic necrosis part of the pelvic walls secondary to their prolonged compression by the cephalic presentation of the fetus. The risk of fistula is very high if the pelvic bodies (bladder and rectum) compressed by the presentation are in repletion. The iatrogenic obstetric fistula, secondary to a Caesarean or a hysterectomy, result from a technical error or insufficiency of competence [1]. The consequences are the permanent leakage of the urine and/or stool by the vagina. The main causes are however avoidable: the prolonged labour, the insufficient technical support center and unqualified staff. This study aimed to determine the frequency of obstetric fistula and to identify the associated factors in order to contribute to the reduction of the cases of Obstetric fistula in the health centers in peri urban area of Butembo. Methods This study was carried out at the Teaching Hospital of the Catholic University of Graben (UCG) at Butembo, in province of North-Kivu, Democratic Republic of Congo (DRC). It is a descriptive cross-sectional study and with retrospective data during the period from January 2014 to August 2017, meaning over 3 years and 8 months, period which had 2 outreaches of repair of the fistulas. Our study population was all women who presented leakage of urines and/or faeces from the vagina. Coming from different villages, 49 cases were admitted including 37 cases of genital leaking which have occurred after the childbirth. Had been included in this study, the patients admitted and operated in the department of gynaecology and obstetrics at the teaching

Sultan Qaboos University Medical Journal, 2016

This study aimed to determine causes of maternal and neonatal morbidity and mortality at Nizwa Hospital, Nizwa, Oman, in order to improve the quality of healthcare. Methods: A prospective self-audit was conducted by the Maternal Morbidity Working Group to critically analyse secondary healthcare lapses during the management of all obstetric cases at Nizwa Hospital in order to highlight possible strategies to avoid such errors in future. Results: Major obstetric morbidity occurred in 3.97% of cases. Leading causes of death were obstetric haemorrhages caused by placenta accreta and rupture of the uterus, followed by eclampsia, vaginal tears and wound haematomas. Sickle cell disease and H1N1 influenza type A-associated pneumonia were the main indirect causes of maternal mortality. In some cases, uncontrolled diabetes led to birth asphyxia, stillbirths and an increased rate of congenital anomalies. Conclusion: Auditing morbidity and mortality can help in recognising, anticipating and managing risks to maternal and neonatal health.