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Background: Breech presentation has been associated with higher rates of perinatal morbidity irrespective of mode of delivery. The aim of this study was to determine the prevalence and perinatal outcomes of singleton breech deliveries at Chitwan Medical College, a tertiary level hospital in Nepal. Methods: A retrospective review of records of all women who delivered at Chitwan Medical College with breech presentation from September 2018 to October 2020 was conducted. Information on demographic variables, obstetric characteristics and perinatal outcomes were obtained, recorded and analyzed. Results: Out of 6712 cases of deliveries during the study period, 226 had breech presentation with prevalence of 3.37%. One hundred ninety-one (84.5%) of them had undergone Caesarean delivery with 125 (65.4%) emergency and 66 (34.6%) elective Caesarean delivery. More than two third (70.4%) of breech deliveries were term deliveries while 28.8% were preterm. There were 2 cases of still births and 1 neonatal death with Perinatal Mortality Rate of 13.27 per 1000 breech deliveries. Vaginal breech delivery was associated with higher perinatal mortality, low Apgar score and low birth weight. Caesarean breech delivery was associated with increased rates of Neonatal Intensive Care Unit admission. Conclusions: The neonatal mortality and morbidity were higher with the vaginal breech deliveries. However further studies with larger sample size and greater statistical power is necessary to draw definitive conclusion.

Background: Hysterectomy is an effective treatment for a wide range of gynaecological diseases, both benign and malignant. There must be a pe­riodic audit for the appropriate indication of the surgery and its complica­tion rate. Histopathological analysis is mandatory for definitive diagnosis and further management. This study aims to review the clinical profile, indications of hysterectomy and to assess the correlation between the clinical diagnosis and histopathological report. Methods: A retrospective study of all the patients undergoing abdominal hysterectomy was conducted in the Department of Obstetrics and Gyne­cology, Chitwan Medical College Teaching Hospital, Nepal from January to December 2018. Demographic and clinical informations were retrieved from the medical record section. Datas were entered in the pre-designed proforma. Statistical analysis was done in terms of percentages, standard deviation, correlation and mean. Results: During the study period, 111 patients underwent abdominal hys­terectomy. The mean age of the patients was 46 years. The mean dura­tion of hospital stay was 8.7 days. Abnormal menstrual flow and pain ab­domen were the commonest presenting symptoms. The most common preoperative diagnosis was fibroid followed by ovarian tumor. Leiomyoma was the commonest lesion on histopathological examination. The correla­tion between clinical diagnosis and histopathology was 96.07% for fibroid, 80.95% for ovarian tumor, 66.67% for adenomyosis and 38.46% for DUB. Conclusions: Fibroid uterus and ovarian mass are the common indications for abdominal hysterectomy. Histopathology is mandatory for confirming the diagnosis, proper counseling and holistic management of the patient.

Background: Cervical cancer ranks the most common cancer among Nepalese women. Cervical and vaginal infections constitute the most common gynecological problems. Through Pap smear screening, early diagnosis, follow up and treatment, morbidity and mortality can be reduced by 70% and 80% respectively. Methods: This retrospective study was conducted to know the incidence of abnormal cervical epithelial lesions and cervico-vaginal infections. It was carried out in the Outpatient Department of Gynecology at Chitwan Medical College from April 2018 to March 2019. The data were collected and standard statistical analysis done using Microsoft Excel 2007. Results: The most prevalent cervical epithelial cell abnormality was atypical squamous cells of undetermined significance (3.43%) whereas the least common was low grade squamous intraepithelial lesion (0.21%). The most prevalent cervical vaginal infection was Bacterial vaginosis (12.30%) whereas the least prevalent was Trichomoniasis (0.29%). The majority of the women with epithelial cell abnormality were in the age group of 31-40 years whereas the lowest number in the age group less than 20 years. The highest prevalence of cervical vaginal infection was in the reproductive age group (31-50 years) and the lowest in the age above 51 years. Most of the patients had multiple symptoms like vaginal discharge, genital itching, whereas only (20.17%) visited for routine screening. Conclusion: Atypical squamous cells of undetermined significance and Bacterial vaginosis were the most common finding in Pap smear test representing abnormal cytology of cervix and cervicovaginal infection respectively.

Background: Relaparotomy after cesarean section is associated with significant maternal morbidity and mortality which can be prevented with proper precaution during the primary surgery. The objective of the study was to determine factors associated with relaparotomy after cesarean section. Methods: A hospital based descriptive cross sectional study conducted by analyzing the records of 3 years from 1st July 2017 to 30th June 2020, among the women who underwent relaparotomy after cesarean section at Paropakar Maternity and Women’s Hospital, Kathmandu. Results: There were 21,270 cesarean sections among 64,475 deliveries with the mean incidence of 32.6%. A total of 22 patients underwent relaparotomy out of which 18 had their primary surgery performed at our hospital i.e. 0.08% of the total caesarean section, and 4 cases were referred from peripheries. 60% of primary surgery were done by residents and the commonest indications of primary surgery were previous CS (36.3%) and obstructed labor (27.2%). Primary PPH was the major indication for laparotomy (31.8%) with mean interval from primary surgery of 4.7 hours followed by burst abdomen (22.7%) and secondary PPH (18.1%). Hysterectomy was the commonest operative intervention done during relaparotomy accounting for 45.4% followed by tension suture for burst abdomen (18%). There were 2 maternal death among them which were due to aspiration pneumonia following eclapmsia and DIC. Conclusion: Relaparotomy has increased risk of adverse maternal outcome but still is a lifesaving intervention. Early recognition, timely intervention and multidisciplinary teamwork helps to decrease the complications associated with it.

Background: Operative vaginal delivery is safe and effctive when applied by well-trained personnel. However, it is an underutilized component of obstetric care. We aimed to estimate the frequency of operative vaginal delivery in a tertiary care center and evaluate the immediate maternal and fetal morbidities. Methods: This descriptive retrospective study was carried out in the Department of Obstetrics and Gynecology, Chitwan Medical College and Teaching Hospital. Medical records of all operative vaginal deliveries conducted from May 2019 to April 2020 were retrieved. Data regarding demography, delivery characteristics, maternal and fetal morbidity and mortality associated with operative vaginal deliveries were collected. Results: The frequency of operative vaginal delivery was found to be 2.3% among 3060 deliveries. It was more commonly used in nulliparous women (n = 54, 76.1%); the commonest age group being 20 to 35 years. The commonest indication was fetal distress (n = 32, 45.1%) followed by prolonged second stage of labor (n = 26, 36.6%). The associated maternal morbidities included postpartum hemorrhage (n = 12, 16.9%), need of blood transfusion (n = 9, 12.7%), fever (n = 6, 8.5%), cervical tear (n = 3, 4.2%) and third/fourth degree perineal tears (n = 3, 4.2%). One neonate had cephalhematoma and 14 neonates (19.7%) needed admission in neonatal intensive care unit. Conclusion: Operative vaginal delivery accounted for 2.3% of the total deliveries and was associated with a few maternal and fetal morbidities.

Background: Surgical site infection following Cesarean Section is one of the major potential surgical complications with its incidence ranging from 3-15%. Morbidity and mortality are considerably in­creased after a surgical site infection placing a significant physical, emotional and economic burden on the patient herself. This study is aimed to identify the associated risk factors for postcesarean surgical site infection at a tertiary care hospital in Chitwan. Methods: A descriptive cross-sectional study of 186 women who underwent a cesarean section was carried out in Chitwan Medical College Teaching Hospital, Chitwan, Nepal from 27thDecember 2019 to 19th February 2020. Data were collected from patients using a self-constructed questionnaire and their risk factors were studied. Results: A total of 186 cases were studied and the incidence rate of surgical site infection was 13 (6.99%). The mean age was 26.13±4.94. Among the total cases, 87.10% of cases were literate while 12.90% of cases were illiterate. Out of total surgical site infection cases, infection was more prevalent (84.62%) among those with preoperative hospitalization of ≤ 24 hours and (53.85%) among those who stayed in the hospital for < 5 days. Conclusions: Education level, duration of preoperative hospitalization and total hospital stay were found to be significant risk factors associated with surgical site infection and appropriate measures to address these risk factors help to lower the rate of surgical site infection.

Background: There is no general consensus about the role of routine HPE of the obtained tissue at the time of uterine evacuation. However, it is understood clinically that it is of utmost importance to prove the presence of intrauterine gestation and to exclude gestational trophoblastic disease in the form of partial or complete mole. This study aimed to assess the role of histopathology in cases of first trimester miscarriages and to determine clinical relevance of histopathological examination following surgical evacuation. Methods: This was a retrospective study of collected data over 12 months (January 2018- De­cember 2018) in an agency for reproductive health setup with predefined inclusion criteria. We included 60 consecutive patients attended with history of first trimester bleeding. Patient’s record and the histopathological examination report of products of conception following uterine evacu­ation were observed. The data was analyzed descriptive statistics including percentage, stander deviation, mean, and range in Microsoft Excel software. Results: Missed abortion was the most common type and constituted 55% of the studied group. The histopathological reports confirmed the pregnancy in all patients and revealed partial mole in 6(10%) patients and complete mole in 2(3.33%) patients. Conclusions: Histopathological examination of products of conception detects under diagnosed molar pregnancies that necessitates special follow up and is a key step to do further management.

Introduction: Worldwide there is a tremendous increase in cesarean section rate over the last decades which has been a global public health issue. This study aimed to find out the prevalence of cesarean delivery in a tertiary care center of Nepal. Methods: A descriptive cross-sectional study was conducted among pregnant women at tertiary care centre from 15th September 2019 to 15th October 2020. Ethical clearance was taken from the Institutional Review Committee (Ref: CMC-IRC/077/078-200). Convenience sampling was done to reach the sample size. Basic demographic data, clinical indications and neonatal outcomes were noted. Data entry was done using Statistical Package for the Social Sciences version 20. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Out of 3193 total deliveries, cesarean deliveries were 1412 (44.22%) at 95% Confidence Interval (42.49-45.94). Among caesarean deliveries 1086 (76.9%) were emergency cesarean sections. Most common indication for cesarean section was fetal distress (24.9%). Among 1437 newborns, 1428 (99.4%) were live births, 1387 (98.2%) were singleton and 801 (55.7%) were male. Nearly one third 418 (29.1%) neonates required neonatal intensive care unit admission and transient tachypnoea of newborns (44.28% in emergency and 60.46% in elective cesarean delivery) was the most common indication for admission. Conclusions: The prevalence of cesarean delivery was found to be higher than that recommended by the World Health Organisation. Fetal distress was the leading indication for cesarean deliveries.

Background: Spinal anesthesia with hyperbaric bupivacaine provides a dense neural block in cesarean delivery but associated with side effects like hypotension, bradycardia nausea and vomiting. Addition of low dose fentanyl with low dose of hyperbaric bupivacaine may decrease the in­cidence of these complications. The aims of study was to compare the hemodynamic parameters (blood pressure and heart rate), nausea and vomiting with low dose intrathecal hyperbaric bupivacaine with fentanyl vs a conventional dose of intrathecal hyperbaric bupivacaine in patient undergoing elective cesarean section. Methods: Seventy-four pregnant women aged 20-35 years old which un­derwent elective cesarean section at Chitwan Medical College were ran­domized into two groups. One group received spinal anesthesia with 8mg of0.5% hyperbaric bupivacaine and 25μg fentanyl and another group re­ceived 12mg 0.5% bupivacaine. Results: The mean age, baseline heart rate, systolic and diastolic blood pressure were comparable in both groups. Significant difference in hypo­tension (24.31% vs. 62.16%, p

DOI: https://doi.org/10.3126/jcmc.v9i1.23779 Background: Emergency Peripartum Hysterectomy (EPH) is an important lifesaving surgical procedure considered in cases of severe hemorrhage unresponsive to medical and conservative management. The objective is to review incidence, identification, intervention and impact of emergency peripartum hysterectomy. Methods: The retrospective, cross-sectional study designed was to used. EPH data were collected from January 2014 to December 2018.Descriptive statistics was used to analyzed data and presented in tables and charts. Results: Incidence of Emergency Peripartum Hysterectomies was 2.3% out of 252(2.6%) cases of obstetrical emergencies and 0.06% that is 1 in 1600 deliveries. Most common indications for EPH were uterine rupture (33.3%); placenta accreta (33.3%) followed by retained placenta (16.6%) and endometritis with pyometritis (16.6%). Estimated blood loss 1916 ml., timeliness from delivery to hysterectomy was 140 minutes; most common post-operative complication was surgical site infection (33.3%) and length of hospital stay 11.7 days. Maternal morbidity rate was 33.3%. There was no maternal mortality recorded. Conclusions: The timely intervention improves the outcome in Peripar­tum Hysterectomy, which is frequently associated with abnormal placen­tation as a consequence of increasing caesarean deliveries rate. Keywords: Cesarean hysterectomy, Peripartum hyterectomy, Postpartum hysterectomy

ObjectivesStillbirth is one of the vital indicators of quality care. This study aimed to determine maternal-fetal characteristics and causes of stillbirth in Nepal.DesignSecondary analysis of single-centred registry-based surveillance data.SettingThe study was conducted at the Department of Obstetrics and Gynecology, Chitwan Medical College Teaching Hospital, a tertiary care hospital located in Bharatpur, Nepal.ParticipantsAll deliveries of intrauterine fetal death, at or beyond 22 weeks’ period of gestation and/or birth weight of 500 g or more, conducted between 16 July 2017 and 15 July 2019 were included in the study.Main outcome measuresThe primary outcome measure of this study was stillbirth, and the secondary outcome measures were maternal and fetal characteristics and cause of stillbirth.ResultsOut of 5282 institutional deliveries conducted over 2 years, 79 (1.5%) were stillbirths, which gives the stillbirth rate of 15 per 1000 births. Of them, the majority (75; 94.9%) were vaginal delivery and only four (5.1%) were caesarean section (pConclusionHigh rate of stillbirths in Nepal could be due to the lack of quality antenatal care. The country’s health systems should be strengthened so that pregnancy-related risks such as maternal hypertension and infections are identified early on. Upgrading mothers’ hygiene and health awareness is equally crucial in reducing fetal deaths in low-resource settings.