Obstetric Fistula in the Developing World: An Agonising Tragedy

Obstetric fistulae is the most tragic of preventable childbirth complications in the developing world, as affected women are often abandoned by their husbands and family, and forced to live in shame. They occur almost entirely in the developing world and their incidence is poorly studied. Their management requires accurate diagnosis, sufficient pre-operative work-up, fine surgery following standard surgical repair steps and principles by skilled surgeons, specialised post-op care, and follow-up. As obstetric fistula is a serious preventable public health issue in developing countries, national and international organizations should launch a campaign to end fistula by increasing the resources and skilled staff available locally to treat obstetric fistula for improving the lives of women currently living with this condition. Moreover, effective preventive strategies for obstetric fistula such as better education to women and provision of improved obstetric care and searching for the best approaches to both prevention and treatment should be the priority. The materials published in PubMed, Lancet, Medline, WHO and Google Scholar web pages from 1990 to 2013 have been utilized to prepare this paper.Nepal Journal of Obstetrics and Gynaecology / Vol 8 / No. 2 / Issue 16 / July-Dec, 2013 / 5-15 DOI: http://dx.doi.org/10.3126/njog.v8i2.9759

INCIDENCE OF CAESAREAN WOUND INFECTION IN PATAN HOSPITAL, NEPAL

This study aims to find the incidence and outcome of caesarean wound infection in Patan Hospital, duringMarch 2002 to January 2003. We retrospectively analyzed records of patient who developed wound infectionfollowing caesarean section. Incidence of wound infection in Patan Hospital is comparatively low 2.76%.The minor wound infections (56.66%) required conservative management as an OPD basis while majorwound infections required resuturing. The wound infection is more commonly associated with color ofliqour, PROM and frequent number of vaginal examinations and emergency surgery.Key Words: Wound Infection, Caeserean Section, Nepal.

Some fetal and pregnancy parameters in Nepal

In Patan Hospital, Kathmandu, 4600 single live births were analysed concerning birth weight in relation to gestational age. At term, the median birth weight of females was 2900 g and of males 3010 g. Compared with Norwegian newborns, the birthweights of Nepali babies were lower for all corresponding gestational lengths. The differences increased with gestational age. Fundal height was lower in Nepali than in Norwegian pregnant women for all periods of pregnancy. An increase in the differences between Norwegian and Nepali women was also noted. Hematocrit values of Nepali women who did not take supplementary iron, correspond well to findings in Norwegian women without iron supplementation. Only a slight degree of hemoconcentration was noted towards term. For Norwegian women with iron supplementation the hematocrit values were much higher, with a tendency towards hemoconcentration near term. In Nepal the average woman probably has small iron stores, and without iron supplementation the hematocrit values will remain low throughout the pregnancy. The high altitude does not seem to cause hemoconcentration in pregnancy to a greater extent than at lower altitude. Hemoconcentration is therefore not a major causative factor of the lower birth weights.

Prolapse of an ovarian tumor during labor

A case of prolapsed tumor after home delivery is reported. At first a puerperal inversion of the uterus was suspected. At operation a dermoid ovarian tumor was found to be prolapsed through the vaginal fornix.