Geeta Gurung

Induced septic abortion: A major factor in maternal mortality and morbidity

Background:  Septic abortion is an infection of the uterus and its appendages following any abortion especially, illegally performed induced abortions. It is characterized by a rise of temperature to at least 100.4°F, associated offensive or purulent vaginal discharge and lower abdominal pain and tenderness.

Hysterectomy for hematometra in a 15‐year‐old mentally handicapped girl with congenital cervicovaginal agenesis and concomitant ovarian adenoma

We report a case of hematometra and bilateral hematosalphinx in a 15‐year‐old mentally handicapped adolescent girl, complicated by vaginal agenesis over cervical atresia in the presence of an ovarian adenoma. The case was managed by abdominal hysterectomy and bilateral salphingectomy of the hematosalphinx, which had formed a tubo‐ovarian mass. One ovary was preserved. This case also considers the management of the mentally handicapped patient unable to comprehend pain arising from cryptomenorrhea.

Diagnostic Dilemma in cases of Ectopic Pregnancy: a five year prospective study at Tribhuvan University Teaching Hospital

Objective: To determine the incidence of ectopic pregnancy in TUTH and to find out the atypical presentations of ectopic pregnancy that had lead difficulties in diagnosing the cases of ectopic pregnancy leading to increase morbidity. Study design: It is a prospective, descriptive study done in Dept. of Obs/Gyn, TUTH, during the period of Baisakh 2057 – Chaitra 2061 (April 2001- April 2005). Results: There were total of 174 cases of ectopic pregnancy during the period of five years accounting 1.15 % of all deliveries. Majority of them were multipara (P 2-3 )39.5%. Among the 174 women 48.9% carried the risk factors. The commonest risk factor being secondary subfertility (25.9%) followed by h/o D&C (18.5%) and reversal of tuballigation (17.6%). Not all the patients had the classic triad of ectopic pregnancy (98.9% had pain, 70.7% had amenorrhea and only 58% had bleeding). Only 20% presented with syncope (the typical symptom of ruptured ectopic pregnancy). The condition was confirmed by USG in 82%. Urinary hCG was present in 97.1%. Mild anaemia (8-10gm% Hb) was present in 46.6% cases where as only 4% had severe anaemia <6gm. Among these anaemic patients 60% needed blood transfusion. Twenty five (14.3%) out of 174 cases had presented with atypical symptoms resulting difficulty in diagnosis (8 cases confused with GI disorders and 17 cases with gynecological disorders). Conclusion: USG and urinary hCG are not confirmatory diagnostic tools in all cases of ectopic pregnancies. For that serum hCG and diagnostic laparoscopy should be included to improve in the management of ectopic pregnancy. Journal of Institute of Medicine Vol.28(1) 2006

Utero-vaginal prolapse due to portio vaginal fibroma.

Utero‐vaginal prolapse can be caused by traction on to the cervix by heavy myoma. Here we present a unique case of huge, compressed, pedunculated fibromyoma of the cervix, which led to cervical elongation and third‐degree utero‐vaginal prolapse.