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Aims: The study was aimed to compare the maternal and perinatal outcomes among pregnancies with isolated oligohydramnios compared to normal amniotic fluid volume between 37-42 weeks.Methods: It was a prospective cohort study done among the singleton pregnancies between 37-42 weeks with isolated oligohydramnios taken as cases (n=100) and pregnancies with normal levels of amniotic fluid matched to cases by gestational age and parity in 2:1 ratio fulfilling the inclusion criteria were taken as controls (n=200). Both the mother and baby were followed up till discharge for outcomes.Results: Majority of the patients (n=300) were of age group 20-30 years (79.0%). Most of them (n=300) were primigravida (74.0%). The overall caesarean section rate was 24.66% (n=300). In the oligohydramnios group, 43.0% had undergone induction of labour (p value

Aims:The aim of this study was to evaluate the effect of preoperative administration of rectal misoprostol onblood loss during and after elective cesarean delivery.Methods:It was a randomized trial including 200 women, divided into two groups (group A and group B), who were planned for elective cesarean delivery and didn’t have risk of postpartum hemorrhage (PPH). Group A received 400μg misoprostol per-rectal preoperatively and intravenous infusion of oxytocin after delivery as hospital protocol.Group B received only intravenous infusion of oxytocin. Primary outcome measureswere the estimated amount of intraoperative and postoperative (24 hours) blood loss and changes in hemoglobin levels 48 hours after delivery.Results:Intraoperative and postoperative blood loss in rectal misoprostol and oxytocin group were significantly reducedin comparison to oxytocin only group. Mean blood loss in groupA was 326.9±116.2 mlwhereas; in group B was 397.7±110.1 ml with p value of < 0.001 which was significant.The difference between preoperative and postoperative hemoglobin level after 48 hours was also significant (1.10±0.51 vs 1.35± 0.49 g/dl with p value

Chlamydia trachomatis is an important agent of pelvic inflammatory disease (PID) globally. Laboratory diagnosis, which is vital for early and appropriate treatment, remains a challenge in resource-limited settings. Our study was undertaken to detect C. trachomatis in women with clinical features of PID. Three endocervical swabs, each obtained from 100 women clinically diagnosed with PID, were subjected to C. trachomatis antigen detection, microscopy and bacteriological culture. Logistic regression was used to assess the risk factors associated with PID. C. trachomatis antigen was present in 6%. The use of hormonal contraception, previous history of PID and a smoking habit were found to have statistically significant association in those who tested positive. Adjunctive use of rapid Chlamydia antigen test with a routinely practiced syndromic approach is beneficial for timely and appropriate antimicrobial therapy in women with PID.

Background: Hypotension during spinal anesthesia is a well known problem. Traditionally prehydration before the spinal block is one of the strategies used to prevent hypotension. Recently the efficacy of prehydration has been questioned. Objective: To compare the incidence of hypotension and vasopressor requirement with crystalloid prehydration and cohydration in women undergoing elective caesarean section. Methods : The prospective randomized study was carried out in 120 patients undergoing elective lower segment caesarian section under spinal anaesthesia. They were allocated to receive either 20ml/kg of lactated ringer’s solution during 20 minutes prior to induction of spinal anaesthesia (prehydration group) or equivalent volume by rapid infusion immediately after administration of the local anaesthetic intrathecally (cohydration group). Vitals, incidence of hypotension, dose of mephenteramine used and complications were recorded. Results: Hypotension occurred in 19 of 60 patients (31.6%) in prehydration group whereas in 15 of 60 patients (25.0%) in cohydration group, but the difference was not significant (P>0.05). But significantly less patients in the cohydration group (2 of 60 vs 18 of 60) developed hypotension and required vasopressor therapy before delivery of baby (P

Aims: This study was done to determine the incidence, modes of presentation and prognosis of molar pregnancy at B. P. Koirala Institute of Health Sciences.Methods: This was a prospective study done among patients with molar pregnancy admitted at BPKIHS from January 2010 to January 2011. The study was conducted after ethical clearance from Institutional Ethical Review Board of BPKIHS. Written informed consent was taken for enrollment in the study. Baseline information like age, address, race and patient’s presenting complaints, period of gestation and serial serum beta human chorionic gonadotropin (βhCG) were collected and analyzed after entering in excel sheet.Results: Total 48 cases of molar pregnancy were diagnosed during the study period. The incidence of molar pregnancy was found to be 5.58 per 1000 deliveries. The most common mode of presentation was per vaginal bleeding i.e. in 64.58% of cases. Majority of the patients were in the age group of 20-34 years (62.5%). Mean time for normalization of βhCG after suction evacuation was 10.19 weeks.Conclusions: Molar pregnancy is a pregnancy related problem which most commonly presents with per vaginal bleeding during first and second trimester. Most of the patients are treated with suction and evacuation but some develop persistent gestational trophoblastic disease.

Aims : This was performed to examine pelvic organ prolapse using POP-Q technique and correlate pre-existing urinary symptoms with segments of pelvic organ prolapse. Methods : All patients admitted with pelvic organ prolapse were included. Patients were asked regarding any concomitant urinary symptoms and then all patients were examined by POP-Q technique and correlation of urinary symptoms was done with various segments of pelvic organ prolapse. Results : Eighty patients were studied in one year duration. Majority of patients had presented with stage 4 prolapse (58.8%). Majority of patients had urinary symptoms among which 87.5% had increased urinary frequency, 88.8% had dysuria, 65% had stress urinary incontinence (SUI), 72.5% had incomplete evacuation. Dysuria and SUI was found to have significant correlation with anterior segment prolapse (p

Background: Labour is the most perilous journey a woman has to undertake. Painless and short labour is desired by every woman and is a constant aim for obstetrician. Objective: To analyze and compare the efficacy and safety of drotaverine and valethamate with control group on improving cervical dilatation and promoting progress of labour. Method: Three hundred demographically similar women, both primigravida and multigravida with a term pregnancy in established labour were randomly divided into three groups. One hundred women (group 1) were given injection valethamate intramuscularly,100 women (group 2) were given drotaverine and the rest 100 (group 3) were not given any drug. Comparative analysis was carried out as regards to duration of first stage of labour, mode of delivery, maternal side effects and fetal outcome. Results: The mean duration of active phase of labour in group 1, 2 and 3 was 254.29±96.621 min, 178.31±73.412 min and 346.31±123.351 min respectively. The duration of injection to end of first stage of labour in valethamate and Drotaverine group was 228.12±84.626min and 168.89±69.576min respectively (p value

Background Urethral catheterization is done as a routine procedure in cesarean section. It is associated with high incidence of urinary tract infections, discomfort, delayed ambulation and longer hospital stay. Objective To determine the feasibility and safety of cesarean section without urethral catheterization. Methods A prospective, randomized controlled trial was carried out from April 2008 to March 2009, in the Department of Obstetrics and Gynecology, B. P. Koirala Institute of Health Sciences. Among 150 patients who had undergone cesarean section 75 were catheterized and 75 were uncatheterized. Results First void discomfort was significantly associated with the use of indwelling catheter (OR 6.95, CI 95 %, 3.74 to 12.95; P< 0.001).Significant number of patients with indwelling catheter had signs and symptoms of urinary tract infection (OR 6,CI 95%, 2.59 to 13. 86; P < 0.001). Positive urinalysis for urinary tract infection was high in catheterized group (P

Aims: This study was done to evaluate the effectiveness of subcutaneous injection of sterile water compared with placebo in reduction of labor pain. Methods: Two hundred and forty pregnant women at term planned for normal vaginal delivery during the first stage of labor were randomized to receive either subcutaneous injection of sterile water (study group, n=120) or normal saline as placebo (control group, n=120) at painful point in lumbosacral region. Pain score was measured before and 10, 45 and 90 minutes after the injections. Main outcome measured was reduction of low back labor pain using visual analogue scale. Results: The mean pain score was equal in both groups prior to the injection. The pain scores were significantly lower among the intervention group compared to the control group at 10, 45, 90 minutes after injection. There was no difference between the two groups with regard to rate of instrumental delivery, cesarean rate and neonatal outcome.Conclusions: The subcutaneous injection of sterile water administered at painful point in lumbosacral area was effective in reducing low back labor pain during labor. DOI: http://dx.doi.org/10.3126/njog.v8i2.9777

Background: In 2011, around 273,465 women died worldwide during pregnancy, childbirth or within 42 days after childbirth. Near-miss is recognized as the predictor of level of care and maternal death. The objective of the study was to evaluate the associated risk factors of near miss obstetric cases.Methods: A prospective observational study was done from August 1, 2014 to July 30, 2015 in Department of Obstetrics and Gynecology at BPKIHS hospital, tertiary care hospital in Eastern Nepal, Dharan. Case eligible by 5 factor scoring system and WHO near miss criteria were evaluated. Risk factors included severe hemorrhage, hypertensive disorders, complication of abortion, ruptured uterus, medical/surgical condition and sepsis.Results: A total of 9,727 delivery were attended during the study period from August 2014 to July 2014. There were 6307 (71.5%) vaginal delivery and 2777 (28.5%) caesarean section and 181 perinatal death with total of 9,546 livebirth. 162 near miss and 16 maternal death occurred during the study. Maternal near miss rate of 16.6 per 1000 live birth, Women with life-threatening conditions of 172, Severe maternal outcome ratio of 18.64, Maternal near-miss: mortality ratio: 10.1:1, Mortality index: 8.98%. Risk factors were obstetric hemorrhage 27.8%, abortion/ectopic 27.2%, eclampsia 16%, medical/surgical condition 14.8%, sepsis 13.6%, severe preeclamsia 11.1%, ruptured uterus 3.1%, and molar pregnancy 1.9% and cardiovascular and coagulation dysfunction as a major life-threatening condition and sepsis (25%) was the major cause of mortality.Conclusions: Haemorrhage and hypertensive disorders are the leading causes of near miss event. Evaluation of associated risk factor can be potential tool for reduction of maternal morbity and mortality.

A case of retained placenta following full-term vaginal delivery with an unscarred uterus where surgical management of delivering the placenta was not attempted due to unfavorable cardiac condition is presented. Although she was planned for hysterectomy, she was successfully managed medically with injection methotrexate. Health Renaissance, January-April 2013; Vol. 11 No.1; 83-85 DOI: http://dx.doi.org/10.3126/hren.v11i1.7608

Keywords: Prostaglandin; Foley catheter; cervical ripening; induction of labourDOI: http://dx.doi.org/10.3126/hren.v9i2.4980Health Renaissance 2011: Vol.9 (No.2): 88-90

Vesical calculus associated with uterovaginal prolapse is very rare. We report a case of a 70–year –old multiparous lady with third degree uterovaginal prolapse for twenty years .Presence of multiple vesical calculus in the cystocele was noted on ultrasonography and x-ray pelvis while undergoing investigation for acute urinary retention. Vaginal hysterectomy with pelvic floor repair followed by suprapubic cystolithotomy was done in the patient. Multiple vesicle calculus were removed. Post operative course was uneventful. Bladder outlet obstruction resulting from prolapse is suspected to be the inciting factor in stone formation though the casual relationship between prolapse and vesical calculus is not established.DOI: http://dx.doi.org/10.3126/hren.v12i1.11989Health Renaissance 2014;12(1):55-56

Background: Preterm birth is the major cause of neonatal mortality and morbidity. In developing countries, it’s a major health hazard. But there are very few evidence based interventions to prevent it. This study focus on prevention of preterm birth. Methods: A randomized controlled trial was undertaken in BP Koirala Institute of Health Sciences, where 60 patients were randomized into group 1 (n=29, weekly intramuscular Progesterone) and group 2 (n=31,no treatment) after the arrest of preterm labor with tocolysis. Their latency period till delivery and recurrence of preterm labor and neonatal outcomes were compared. Results: There was significant reduction in recurrence of preterm labor and increase in latency period in progesterone group. However neonatal outcomes were similar. Conclusion: Progesterone is useful in reducing the recurrence of preterm labor in a patient who had preterm labor.

Endometriosis is often seen in gynecology practice and is treated medically. However, intestinal involvement of endometriosis causing acute large bowel obstruction is uncommon and is dif cult to differentiate from malignancy before surgery, owing to its similar colonoscopic and radiologic ndings. We report a successfully-treated case of a 30-year-old woman in which endometrial in ltration of the large bowel caused acute obstruction, requiring emergency surgery to relieve the symptom and conrm the diagnosis. We present this unusual disease in general surgical practice and also review the literature. __________________________________________________________________ Keywords: colorectal malignancy, endometriosis, intestinal obstruction _______________________________________________________

INTRODUCTION: Unsafe abortion is a significant cause of maternal morbidity and mortality in developing countries despite provision of adequate care and legalization of abortion. The aim of this study was to find out the contribution of unsafe abortion in maternal mortality and its other consequences. METHODS: A retrospective study was carried out in the Department of Obstetrics and Gynecology in BPKIHS between 2005 April to 2008 September analyzing all the unsafe abortion related admissions. RESULTS: There were 70 unsafe abortion patients. Majority of them (52.8%) were of high grade. Most of them recovered but there were total 8maternal deaths. CONCLUSIONS: Unsafe abortion is still a significant medical and social problem even in post legalization era of this country. Keywords: abortion, legalization, maternal death, unsafe.

Vaginal pessaries still have role in the management of uterovaginal prolapse especially in elderly women, unfit for surgery and as a temporary relief for women waiting for surgery. Forgotten vaginal pessaries may cause serious complications. We here by present a case with metallic vaginal ring pessary for 16 years without significant symptoms. Key words: Prolapse, Ring pessary, Metallic pessary doi: 10.3126/kumj.v6i4.1745 Kathmandu University Medical Journal (2008), Vol. 6, No. 4, Issue 24, 508-510

Vesicovaginal fistula is physically, socially and psychologically devastating to the women who suffer from it. The aim of this study is to create some awareness about VVF, to describe the profile of the patients, etiology, and success rate of surgery in our institute. A retrospective analysis of a total of 23 cases of vesicovaginal fistula admitted to the Department of Gynecology and Obstetrics, BPKIHS over a period of three years were included in the study. The cause of VVF in all was obstructed labor except in one, which followed abdominal hysterectomy. Twenty-three subjects underwent VVF repair, of which 14 (56.5%) had successful outcome.JNMA J Nepal Med Assoc. 2008 Jul-Sep;47(171):120-122.

Background: Although ruptured uterus is nowadays a rare obstetric emergency in Western countries, it is still alarmingly common in developing countries, where it remains a major cause of maternal mortality and morbidity. Aims: To review the recent experience of uterine rupture at a tertiary obstetric unit in eastern Nepal and to recommend improvements in the current management of labour, especially obstructed labour, in a poorly resourced country. Methods: All cases of uterine rupture managed from March 2002 to March 2006 were identified retrospectively, and details were retrieved from medical records. Results: Fifty-two women suffered from uterine rupture during the four-year period, approximately one woman per month. Most were unbooked multigravidae, with no antenatal care. They nearly all began labour at home in the absence of a skilled birth attendant. After prolonged labour, usually prolonged second stage, various interventions had often been attempted at home or in other health facilities before admission. Most were shocked and required urgent laparotomy and blood transfusion. Many required intensive care and ventilatory support. Forty-six per cent required hysterectomy and 5.8% subsequently suffered from a urogenital fistula. The maternal mortality rate in this series was 13.5%, and the stillbirth rate was 94.2%. Conclusions: Unsafe obstetric practices were identified, especially the injudicious use of oxytocic drugs and fundal pressure in prolonged second stage. Several achievable improvements in obstetric care are recommended, particularly aimed at reducing the delay in women reaching emergency obstetric care when labour is prolonged.

Nonpuerperal uterine inversion is a rare condition. We describe a case report of chronic inversion secondary to submucous fibroid. A 37 years lady presented with acute retention of urine with submucous fibroid. Diagnosis of partial inversion was made intra operatively and she underwent abdominal hysterectomy. Health Renaissance; September-December 2012; Vol 10 (No.3);242-2431DOI: http://dx.doi.org/10.3126/hren.v10i3.7055

This study aimed to find out the maternal mortality rate (MMR) in mothers dying after admission to the gynaecology and obstetrics ward of BP Koirala Institute of Health Sciences, Nepal, and to analyse the most common causative factor. There was a total of 58 mortality cases in 6 years. The MMR in 1997-1998 was 12/100 000 live births, in 1998-1999 144/100 000, in 1999-2000 294/100 000, in 2000-2001 450/100 000, in 2001-2002 546/100 000 and in 2002-2003 400/100 000. The most common cause of death was septic-induced abortion and its complications, followed by eclampsia and puerperal sepsis.

Background: Urinary incontinence is a common medical disorder. However, in the developing countries the problem is not accepted as a major health problem. Objectives : To find out the prevalence of urinary incontinence in institutionalized gynecology patients at BPKIHS and to asses the severity of incontinence and to find out its perception as health problem. Methods : All the patients aged more than 20 years and excluding pregnancy related admissions during the study period of one year (February 2005 to February 2006) were questioned with preformed questionnaire and responses were noted . All together 630 patients participated . Results : 50.6% had incontinence. Urge incontinence was more common type (60%) than stress incontinence (40%).Most of the patients did not consider it as a health problem. Conclusion : Urinary leakage is highly prevalent and should be regarded as potential health problem. DOI: http://dx.doi.org/10.3126/hren.v10i1.6001 HREN 2012; 10(1): 16-19

Aim: To observe the trend of malignant diseases of the female genital tract, and to assess pattern amongst the diagnosed cases and its management at BPKIHS. Methods: All the diagnosed cases of female genital malignancies were followed. Cases in advance stages were referred to Oncology Centers. Some patients opted to undergo treatment at BPKIHS. Those case sheets and histopathology reports were analyzed to see the trend and pattern of diseases and its optimum management. Referred cases who came for further follow up in the general gynecology department after consultation and treatment are also included in the study. Setting: Department of obstetrics & Gynecology and Pathology, BPKIHS. Results: Cervical cancer was the commonest malignant disease 216 (67.3%) followed by the ovary (17%), endometrium (10%), choriocarcinoma (3.4%) and vulva and vagina (2.8%). The mean (years in) age of the patients varied with the type of cancer as follows - cervix (30.9), ovary (40.4), endometrium (54.8), choriocarcinoma (25.6) and Vagina & vulva (42.2). Out of the total 216 patients Carcinoma Cervix only 20 patients were admitted for Radical surgery and treatment. 196 patients belonged to the group of advanced carcinoma cervix and were referred to the cancer hospital for radiotherapy and chemotherapy. Conclusion: Cancer cervix is the most common and manageable disease if diagnosed early provided mandatory selective screening program are implemented. The missed opportunity to diagnose the disease in time should be utilized by creating national or regional community - based cervical cancer screening program. General gynecological service provider can also contribute a lot to reduce the burden of disease. Keywords: Female genital malignancies, carcinoma cervix, radiotherapy and chemotherapy. doi:10.3126/njog.v2i1.1474 N. J. Obstet. Gynaecol Vol. 2, No. 1, p. 35 - 38 May -June 2007

Objective: To test the feasibility and acceptability of a simplified mifepristone-misoprostol regimen for early abortion at BPKIHS. Methods: Pregnant women (n=100) with amenorrhea of 56 days or less seeking termination of pregnancy received 200mg of oral mifepristone followed 48hours later by 400 μg of oral misoprostol, administered either at home or at the clinic. Prospective data were collected to determine the women.s experience, abortion outcome, and the operational requirement for providing the method. Result: Most (91%) of the 88 women with known outcomes had successful medical abortions. Given the option, most (95.4%) women elected to administer the misoprostol at home. Conclusion: A simplified medical abortion protocol, including home administration of misoprostol, is highly safe, effective acceptable and feasible in our setting. Keywords: medical abortion; mifepristone; misoprostol DOI: 10.3126/hren.v8i3.4205 Health Renaissance , September-December 2010; Vol 8 (No.3);142-146

Setting: Department of Gynaecology & Obstetrics, B P Koirala Institute of Health Sciences, Dharan, Nepal. Objective : The study was conducted to find out the different indications of induction of labour as well as cesarean delivery rate, fetal and neonatal morbidity associated with induction of labour. Methods: A prospective observational study was conducted at obstetric unit of B.P Koirala Institute of Health Sciences, a tertiary care centre in eastern Nepal .The study enrolled 262 consecutive patients from April2008 to august 2008 recruited to induction of labour according to the standard practiced in the institute. Dinoprostone gel was used as induction agent in all the cases, the patients were monitored in labour according to hospital protocol, cesarean was performed for routine indications. Fetal morbidity was assessed in terms of NICU admissions & 5 min Apgar scores. Results: 62% of patients were unbooked. Prolonged pregnancy (62.8%) and hypertensive disorders (18.7%) were the common indications for induction of labour. Cesarean delivery rate was 47.2% and NICU admission was 5.3%. Conclusion: Prolonged pregnancy and hypertensive disorders are the common indications for induction of labour. Standard labour management protocol has to be followed to avoid unnecessary cesarean delivery and have a better neonatal outcome. Keywords: induction of labour; cesarean delivery; post dated pregnancy DOI: 10.3126/hren.v8i2.4423 Health Renaissance , May-Aug 2010; Vol 8 (No.2):114-116