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Background: Coronavirus disease (COVID-19) can vary in presentation, women present with a spectrum of clinical manifestations that range from mild symptoms and signs to severe illness, may require immediate advanced critical care support. Therefore, a hospital-based study was conducted to evaluate the effect of COVID-19 on maternal and perinatal outcomes of COVID-19 infected pregnant women. Methods: This was prospective descriptive study conducted at B. P. Koirala institute of health science. Total duration of study was one year from September 2020 to August 2021. This study was done in 70 pregnant ladies with confirmed SARS CoV2 infection. Different clinical presentation, mode of delivery, treatment given, need of oxygen, need of ICU admission, maternal outcomes, neonatal outcomes were observed. Result: The most common symptom was fever in 38 (54.2%) patients, followed by cough in 22 (31.5%) patients. Eighteen (25.71%) had mild degree of pneumonia with fall in oxygen saturation below 95% and required oxygen via face mask. Three patients (4.28%) develop sever pneumonia and required mechanical ventilation two (2.85%) had maternal mortality due to covid pneumonia. Most common mode of delivery was LSCS 21(61.76%). Seven (10%) patients had preterm delivery. Conclusions: Most of the COVID-19 positive pregnant women remained asymptomatic or had mild infections. COVID-19 infections in late pregnancy might lead to an increased incidence of caesarean deliveries as observed in the present study. Adverse perinatal outcomes are mostly due to delayed presentation of patient to the hospital during COVID pandemic. High maternal mortality rate has been seen in present study. So proper intensive care is must for the management of such patient during pandemics. Also, efforts to limit exposure to COVID-19 of pregnant women should be strengthened for saving mother and child.

Introduction: Evolution of laparoscopy has revolutionised the field of gynaecological surgery for more than 40 years.Owing to the long learning curve, added expenses and lack of awareness among patients and surgeons, its introduction and development in Nepal is not upto the timeline. Gynaecologic laparoscopy (GL) seems to be introduced at BP Koirala institute of Health Sciences, Dharan,Nepal (BPKIHS) since 2002. It remained in latency because of widespread lack of equipment and skilled personnel. Some laparoscopic procedures like diagnostic laparoscopy, laparoscopic tubal ligation and very few laparoscopic assisted vaginal hysterectomy (LAVH) were done from 2002 - 2012 (10 years). Since then more gynecologists have been trained in GL which has contributed to expansion of GL. Objective: The objective of this study is to study and share trends of gynaecological laparoscopic surgeries performed at BPKIHS. Methodology: All the patients undergoing GL surgeries have been analyzed for the indication, type of procedure, conversion and its complications. We took data from operation theatre register and patient case sheet from July 2004 to May 2018. We divided this period into two phase viz Phase 1: July 2004-June 2013 and Phase 2: July 2013- till May 2018. Results: Total number of GL done in this period was 427. Out of which 102 cases were from phase one and rest of the cases were done in five years of phase II. Number of operative laparoscopy has increased in phase 2 compared to phase 1. In last five years there was155 (47.6%) cases of adnexal surgery, 77 (23.6%) cases of diagnostic laparoscopy.Total laparoscopic hysterectomy was done in 25 (7.6%) cases. Conversion to laparotomy was done in4.6% (n=15) cases. Overall 12(3.7%) patient had major complications. Oral diet started at 4-6th hour post-operatively, and mobilization started after 24 hours. Seventy percent of patient had a hospital stay of 2days and rest stayed for 3 days. Conclusions: There is rising trend in operative GL at BPKIHS. We are facing less complication with expanding experience. There has been good learning from each case. GL has well demonstrated its advantages of reducing postoperative pain and morbidity, short hospital stay, and less postoperative recovery time. We have plans to get new gadgets and expand services in GL.

Uterine inversion is a rare entity but poses a serious threat if not diagnosed and managed timely. Here we present a case of chronic uterine inversion in a 30-year-old lady who presented in emergency with a mass coming out per vagina, blood mixed vaginal discharge, and lower pain abdomen for the last 15 days. She underwent laparotomy and was found to have uterine inversion. The patient was attempted for repositioning of uterus with the Huntington’s approach, but it was unsuccessful, hence Haultain’s operation was done with a total abdominal hysterectomy and bilateral salpingectomy with right-sided ovarian cystectomy for a dermoid cyst. Our case emphasizes the importance of keeping chronic uterine inversion as a differential diagnosis in women presenting with pain abdomen, mass, and bleeding per vagina, and with a recent history of second-trimester abortion. Timely recognition, especially in chronic inversion, will decrease the morbidity and mortality associated with this rare but life-threatening condition.

Primary malignant melanoma of cervix (PMMC) is rare and aggressive cancer of uterine cervix. It presented as vaginal discharge, post coital bleding and blackish cervical growth that was biopsied and radical hysterectomy performed immediately after getting the histopathological diagnosis at stage-1B2 (FIGO staging, 2018). Post-treatment, she was recurrence free at nine months of regular follow up visit. Keywords: cervix, malignant, melanoma, primary

Introduction: Assessment of POP by POP-Q gives anatomical site-specific measurement, which helps in surgery, follow-up and reduces inter-observer variation. The Pelvic Floor Distress Inventory (PFDI) is condition-specific health-related quality of life questionnaires for women with pelvic floor disorders. Objective: To assess pelvic organ prolapse by POP-Q technique and to correlate pelvic floor distress inventory questionnaire with POP-Q segments. Methodology A prospective study was done from March 2014 to February 2015 after ethical approval from IRC, B.P. Koirala Institute of Health Sciences. All patients with pelvic organ prolapse were included after informed verbal consent. The patients were then asked questions as in pelvic floor distress inventory questionnaire (PFDI) and noted in performa. The patients were then examined by POP-Q technique and noted. The informations were entered in the MS excel chart and statistical analysis done using SPSS 11.5. Results: There were 72 patients enrolled. The mean age of patients was 53.65 years. Majority of patients were found to have stage 4 prolapse (43.1%). POP-Q examination showed majority of patients had anterior and apical compartment defect. Correlation between POP-Q points and urinary symptoms showed significant relation with points in anterior compartment, genital hiatus and perineal bodies. Correlation with POP-Q points with colorectal symptoms showed involvement of genital hiatus significantly with strain stool and incomplete bowel movement. Correlation with pelvic distress symptoms with POP-Q sites showed significant relation with bulging, push up vagina for urination and defecation. Conclusion: POP-Q site specific points showed significant correlation with symptoms from Pelvic Floor Distress Inventry (PFDI) questionnaires.

Survivors of domestic and family violence (DFV) report poorer quality of life and worsening mental health. This study evaluated the effect of a counseling and education intervention on the mental health and help-seeking behaviors among pregnant women living with DFV. A parallel pilot randomized controlled trial was performed among 140 pregnant women attending an antenatal clinic of a tertiary hospital of Nepal. Using computer-generated random numbers, participants were randomized to the intervention group (a counseling session, an information booklet about DFV, and contact details of the counselor) or a control group (usual care plus a booklet containing contact details of local DFV support services). Outcome measures included mental health, quality of life (QOL), self-efficacy, social support, and safety planning behaviors. Analyses followed intention-to-treat, using the generalized estimating equation model. Intervention participants showed significant improvements in anxiety (β = −3.24, p < .001) and depression (β = −3.16, p < .001) at postintervention. Such improvements were also sustained at follow-up assessment ( p < .001). Significant group and time interaction for QOL, social support, use of safety behaviors, and self-efficacy ( p < .05) revealed a greater increase in these outcome measures among intervention participants at both follow-up assessments compared with the control group. This pilot integrated intervention showed promising outcomes in improving the mental health, social support, and the use of safety behaviors among women with DFV. This intervention could be incorporated into regular antenatal care as a strategy to identify and support victims of DFV. Larger controlled trials with longer follow-up are needed to support and expand on the current findings regarding the effectiveness of a psychosocial intervention targeting victims of DFV in resource-constrained settings.

Introduction Given the relative recency of Domestic and Family Violence (DFV) management as a field of endeavour, it is not surprising that interventions for addressing DFV is still in its infancy in developing countries. In order to maximise the success of an intervention, it is important to know which aspects of the intervention are considered important and helpful by service providers and service users. This study, therefore, examined the acceptability of an antenatal-based psychosocial intervention targeting DFV in Nepal and explored suggestions for improving the program in future. Materials and methods Intervention participants and health care providers (HCPs) were interviewed using semi-structured interviews. Data were audio-recorded and thematic analysis was used to analyse the data. Final codes and themes were identified using an iterative review process among the research team. Results Themes emerging from the data were grouped into domains including perceptions towards DFV, impact of the intervention on women’s lives and recommendations for improving the program. DFV was recognised as a significant problem requiring urgent attention for its prevention and control. Intervention participants expressed that they felt safe to share their feelings during the counselling session and got opportunity to learn new skills to cope with DFV. The majority of the participants recommended multiple counselling sessions and a continued provision of the service ensuring the intervention’s accessibility by a large number of women. Discussion This is the first study to document the perspectives of women and HCPs regarding an antenatal-based intervention targeting psychosocial consequences of DFV in Nepal. There was a clear consensus around the need to engage, support and empower victims of DFV and the intervention was well received by the participants. Ensuring good mental health and wellbeing among victims of DFV requires work across individual, organisational and community levels.

Aims: To estimate the VIA positivity rate and to see the efficacy of the treatment with cryotherapy during follow up.Methods: A retrospective analysis of all VIA test from March 2012 to April 2015 were analyzed to estimate the VIA positivity rate of the screened population. Guideline for screening, treatment and follow up was as per the national guideline for cervical cancer screening and treatment 2010 of Nepal.Results: A total of 12,444 clients were screened, the VIA positivity rate was 5.9%, repeat VIA positivity rate at the end of one year during follow up was 1.2%, more than 98% had been screened for cervical cancer for the first time and the complication following cryotherapy was low.Conclusions: The VIA positivity rate of our population is comparable to the global magnitude. Screening for cervical cancer with VIA and treatment with cryotherapy is a feasible and acceptable form of screening in our setup. The recommendation would be scaling up of the facility up to grass root level that is linked to appropriate referral system.

IntroductionThe strong correlation between domestic and family violence (DFV) and mental health has been well documented in studies. Pregnancy is a period when both DFV and mental distress tend to occur and/or accentuate. Although limited, available evidence from developed countries has shown continual support and education as psychological first aid that can reduce DFV and improve mental health. However, there is significantly less number of studies from resource-constrained countries; thus, there continues to be a substantial gap in knowledge and awareness regarding effective interventions for DFV.Methods and analysisA two-arm randomised trial with a nested qualitative study has been planned to assess feasibility and treatment effect estimates of a counselling-based psychosocial intervention among pregnant women with a history of abuse. A total of 140 pregnant women who meet the inclusion criteria will be recruited into the study. Block randomisation will be used to allocate women equally into two groups. The intervention group will receive a counselling session, an information booklet and continuous support by a researcher, while women in the control group will receive contact information of local support services. Feasibility measures, such as rates of recruitment, consent and retention, will be calculated. Qualitative interviews with participants and healthcare providers will explore the acceptability and usability of the intervention. Outcome measures, such as psychological distress, quality of life, social support and self-efficacy, will be measured at baseline, 4 weeks postintervention and 6 weeks postpartum.Ethics and disseminationThis study has obtained ethical approval from the Griffith University Human Research Ethics Committee, the Nepal Health Research Council and the Institutional Review Board of a tertiary hospital in Dharan, Nepal. The findings will be disseminated via peer-reviewed publications and conference presentations and will be used to inform a future multicentre trial.Trial registration number12618000307202; Pre-results.

Aims – To assess feasibility of visual inspection with acetic acid and treatment with cryotherapy for cervical cancer screening and prevention and assess risk factors for cervical cancer in the screened population.Methods – A prospective analysis of all patients enrolled for cervical cancer screening by visual inspection, meeting the eligibility criteria for screening and treatment as per national guidelines 2011 was analyzed form March 2012 to April 2013.Results – A total of 4138 met the eligibility criteria and were counseled for screening, 33 rejected for screening. Out of 4105 screened 241 were visual inspection with acetic acid positive, 211 were treated with cryotherapy, 25 treated with LEEP, 5 rejected to treatment. Mean age of patient in year’s ± SD 41.48 ± 9.72. The visual inspection with acetic acidpositivity rate was 5.9 %Conclusion – Single visit approach is a feasible and acceptable form of cervical cancer screening strategy in our population.

Background: Perinatal mortality includes both deaths in the first week of life and fetal deaths (stillbirths). Over 130 million babies are born every year, and more than 10 million infants die before their fifth birthday and almost 8 million before their first birthday.Objectives: To make an effort to find out impact of birth interval on fetal outcomes like, low birth weight (weight less than 2500 grams regardless of gestational age), perinatal death (death within 28 weeks of gestation to 7 days of birth) in subsequent pregnancies.Methods: This was a cross-sectional study conducted in BPKIHS, Dharan in 2011. Patients included were women of second gravida between age group 20 -35 years .The consecutive convenience sampling method was used to collect the data. Study population was divided into three birth interval groups of 59 months respectively and fetal outcomes (low birth weight, gestational age, early neonatal death, Apgar score) were compared.Results: Out of included population majority (55.63%) of the women had age range of 20-25 years with the mean age of 25.30. Among the total 168 who were included 20(11.91%) were belongs to birth interval 59 months group.Conclusion: There was increased risk of preterm and low birth weight and perinatal death in women with birth interval 59 months. Health Renaissance 2015;13(3): 169-176

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.

Introduction: During the last decade, medical methods for second trimester abortion have considerably improved and become safe and more accessible. The combination of mifepristone and misoprostol is now an established and highly effective method for second trimester abortion. But where mifepristone is not available or affordable, misoprostol alone has also been shown to be effective. The objective of this study is to compare the efficacy of mifepristone with misoprostol and misoprostol alone for second trimester termination of pregnancy. Methods: It is a comparative study conducted on 60 patients from 13 to 18 weeks of gestation admitted for second trimester termination on legal indications. Results: Mean induction abortion interval was comparable in both the groups. Of the 30 cases in each group, nine cases in each Group A and six cases in Group B had incomplete/failed expulsion. Among these 15 cases, only nine required check curettage for complete evacuation while others received oxytocics only for completion. The distribution of these cases was also comparable in both the groups. Only one patient in Group B had complete failure of expulsion and underwent surgical evacuation. However, the difference in dosage of misoprostol required for complete expulsion and incidence of side effects were significantly higher in the group B. Conclusions: Mifepristone and misoprostol combined together is now an established, highly effective and safe method for medical method of second trimester termination. However, when mifepristone is not available or affordable, misoprostol alone can also be used effectively, although a higher total dose is needed and side effects are higher than with the combined regimen.

Introduction: Magnesium sulfate is the drug of choice for prevention of seizures in the pre-eclamptic woman. There is no agreement in the published randomized trials regarding the optimal time to initiate magnesium sulfate, the dose to use (both loading and maintenance) as well as the duration of therapy. The objective of this study is to determine whether magnesium sulfate (MgSO4) prophylaxis is needed for up to 24 hours postpartum in all patients with severe pre-eclampsia for the prevention of seizure. Methods: It is a randomized controlled trial done on 60 pregnant women with severe preeclampsia randomized into standard dose regimen and loading dose only regimen. Results: Out of 30 cases in each group 1 (3.3%) patient in standard regimen and 2 (6.7%) patients in loading dose only developed seizure. The occurrence of seizure is not significant statistically. In both regimens there was no maternal mortality. Total of 3 patients needed MICU care and 12 patient developed maternal complications. MgSO4 toxicities were seen only in standard dose regimen that is in 17 (56.7%) of the patients. The median number of IM injections of MgSO4 received in standard dose regimen was 8±2.176. In standard dose regimen 73.3 percent baby were alive whereas in case of loading dose only regimen 93.3 percent of baby were alive after 48 hours of delivery. Conclusions: Single dose of magnesium sulfate is equally effective as standard dose regimen in terms of seizure prophylaxis in severe pre eclamptic women, with added advantage of reduced maternal toxicity and better neonatal outcome. Keywords: severe preeclampsia; MgSO4; magnesium sulfate; loading dose; eclampsia.

Background: Eclampsia is a multisystem disorder that may lead to deterioration of maternal condition, hypoxia and acidosis of fetus. Objective was to evaluate the risk factors associated with adverse maternal and fetal outcome in patients with eclampsia. Methods: All patients with eclampsia were enrolled after informed consent from February 2013 to February 2014. Questions as per per-forma were asked to the patients and attendants about antenatal visits, parity, number of episodes of seizures, duration from onset of seizure to magnesium sulfate, then the patients were followed as per the hospital protocol, the mode of delivery, outcome of baby, post partum maternal condition and mortality were then noted. Results: Fifty-two patients with eclampsia were admitted in the study period. Thirty-one patients required mechanical ventilator support. Twenty-five (48.07%) patients were delivered by emergency cesarean section and 30(57.6%) babies were low birth weight and there were 11(21.1%) stillbirths. There was one maternal mortality and 45(86.5%) patients were discharged with improvement but 6(11.5%) patients had neurological impairment. Mortality was significantly related with number of seizure episodes and time interval between seizure onset and administration of magnesium sulphate. Conclusions: Early detection of hypertension and management with magnesium sulphate for eclampsia can help to minimize the maternal and fetal adverse outcomes. Keywords: Eclampsia; maternal mortality; risk factors.

Aims: This study was done to assess the main causes of maternal mortality and other co-morbid factors contributing to maternal death at a university teaching hospital. Methods: A retrospective study was carried out in the department of Obstetrics and Gynecology analyzing all case record of maternal deaths from April 2008 to April 2011. Results : Eclampsia, unsafe abortion, puerperal sepsis, hemorrhages were the leading causes of death. Majority of the patients were unbooked. Conclusions : Eclampsia, sepsis and hemorrhage were the main causes of maternal deaths. Elderly ages, illiterate status, rural residence, presence of prior medical disease were statistically significant factors contributing to maternal death. DOI: http://dx.doi.org/10.3126/njog.v9i1.11185 NJOG 2014 Jan-Jun; 2(1):33-36

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: Postpartum hemorrhage is a common and occasionally life-threatening complication of labor. Cesarean section is associated with more blood loss in compared to vaginal delivery. Despite, there is a trend for increasing cesarean section rates in both developed and developing countries thereby increasing the risk of morbidity and mortality, especially among anemic women. The objective of this study was to evaluate the effect of preoperative administration of intravenous Tranexamic acid on blood loss during and after elective cesarean section.Methods: This was a prospective, randomized controlled study with 160 eligible pregnant women of 37 or more period of gestation. They were all planned for elective cesarean section and were randomized into two groups either to receive 10ml (1gm) of Tranexamic acid intravenously or 10ml of normal saline. Blood loss was measured during and for 24 hours after operation.Results: The mean estimated blood loss was significantly lower in women treated with Tranexamic acid compared with women in the placebo group (392.13 ml±10.06 vs 498.69 ml±15.87, respectively; p

Dysgerminoma tends to occur in young women although its incidence in pregnancy is low. Torsion and incarceration occurs in nearly half of the cases. Early diagnosis and appropriate treatment offers the best prognosis to the patient presenting with dysgerminoma. However because of enlarging abdominal size, pregnancy may mask the rapidly growing dysgerminoma often leading to late presentation. This is a case report of a female 30 years of age with stage 3C dysgerminoma which lead to acute surgical abdomen at 33weeks of pregnancy. Nepal Journal of Obstetrics and Gynaecology / Vol 7 / No. 1 / Issue 13 / Jan- June, 2012 / 53-55 DOI: http://dx.doi.org/10.3126/njog.v7i1.8838

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

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.

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.

A case of bilateral fimbrial cyst with torsion of right side is presented, occurring in a 32 year old female. She presented in outpatient department with pain abdomen and feeling of mass in lower abdomen since six months. Initial assessment of ovarian cyst was made. Ultrasound showed cystic structures in left adnexa and complex cyst in right adnexa. Laprotomy was performed and bilateral fimbrial cysts in fallopian tubes were identified with torsion on right side which was subsequently confirmed on histopathology. Although huge fimbrial cysts with torsion of fallopian tube is rare, it should be considered in differential diagnosis of abdominal mass with pain in females.DOI: http://dx.doi.org/10.3126/hren.v10i2.6588 Health Renaissance 2012; Vol 10 (No.2); 153-154

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