title: Challenges in the Caesarean Section of a Severely Kyphotic Parturient.
abstract: Caesarean section in a severely kyphotic patient presents with unique challenges. We report a case of obstructed labor in case of a pregnant lady with severe kyphosis of spine that was managed by caesarean section. Lateral recumbent position with adequate assistance and paramedian or vertical skin incision was used and found to provide good exposure. Baby was delivered by lower segment uterine incision by reverse breech extraction. Postpartum hemorrhage was managed with uterotonics and bilateral uterine artery ligation. Tubal ligation though advised was refused by the patient. Prolonged catheterization was done in view of obstructed labor. Postoperative period was uneventful.
authors.affiliation: Department of Obstetrics and Gynecology, Nobel Medical College and Teaching Hospital, Kanchanbari, Biratnagar 5, Morang Eastern Region of Nepal, Biratnagar 56700, Nepal.
authors.forename: Manisha
authors.initials: M
authors.lastname: Chhetry
authors.affiliation: Department of Obstetrics and Gynecology, Nobel Medical College and Teaching Hospital, Kanchanbari, Biratnagar 5, Morang Eastern Region of Nepal, Biratnagar 56700, Nepal.
authors.forename: Basudeb
authors.initials: B
authors.lastname: Banerjee
authors.affiliation: Department of Obstetrics and Gynecology, Nobel Medical College and Teaching Hospital, Kanchanbari, Biratnagar 5, Morang Eastern Region of Nepal, Biratnagar 56700, Nepal.
authors.forename: Shanti
authors.initials: S
authors.lastname: Subedi
authors.affiliation: Department of Obstetrics and Gynecology, Nobel Medical College and Teaching Hospital, Kanchanbari, Biratnagar 5, Morang Eastern Region of Nepal, Biratnagar 56700, Nepal.
authors.forename: Narayan Bahadur
authors.initials: NB
authors.lastname: Gharti Chhetri
authors.affiliation: Department of Orthopedics and Trauma, Nobel Medical College and Teaching Hospital, Kanchanbari, Biratnagar 5, Morang Eastern Region of Nepal, Biratnagar 56700, Nepal.
authors.forename: Yogendra
authors.initials: Y
authors.lastname: Gupta