Background: Maternal mortality traditionally has been the indicator of maternal health all over the world. More recently review of the cases with near miss obstetric events has been found to be useful to investigate maternal mortality. Cases of near-miss are those in which women present with potentially fatal complication during pregnancy, delivery or the puerperium, and survives merely by chance or by good hospital care. Objectives: The objective of this study is to determine the prevalence and nature of near miss obstetric cases and maternal deaths at Kathmandu Medical College Teaching Hospital. Material and methods:This was a descriptive study done for the period of 24 months (1 January 2008 to 31 December 2009). Cases of severe obstetric morbidity were identifi ed during daily morning meetings. All the cases were followed during their hospital stay till their discharge or death. Five factor scoring system was used to identify the near miss cases from all the severe obstetric morbidity. For each case of maternal death, data were collected from records of maternal death audit. Results: During the study period, 1562 women delivered at the institution and 36 women were identifi ed as near-miss obstetrical cases. The prevalence of near miss case in this study was 2.3%. Five maternal deaths occurred during this period, resulting in a ratio of maternal death of 324 maternal deaths per 100,000 live births. Of the fi ve maternal deaths three were due to pregnancy complicated with hepatitis E infection, one each due to Eclampsia and amniotic fl uid embolism. Fifteen cases of near miss were due to haemorrhage (41.66%) and hypertensive disorder of the pregnancy was the cause in 10 (27.77%). Dystocia was the cause in 1(2.77%) case and infections in 7(19.4%) cases. Rare causes like anaesthetic complications were the cause in one case and dilated cardiomyopathy was the cause in two cases. Conclusion:The major causes of near-miss cases were similar to the causes of maternal mortality of Nepal. Need for the development of an effective audit system for maternal care which includes both near-miss obstetric morbidity and mortality is felt.

Objective: To study the incidence and indications for labour induction and study the predictors of failed induction. Materials and methods: A hospital based prospective study done over a 12 month period between 1 st November 2007 to 30 th October 2008. Selection criteria: Singleton pregnancies beyond 37 weeks with vertex presentation and unscarred uterus requiring induction of labour. Results: The incidence of labour induction was 19.7%. Operative delivery was 34.6% in the study group and 27.4% in those with spontaneous onset of labour. 74.07% of the induction group required operative delivery for failed induction and 25.03% for foetal distress. The predominant indication for induction was post term pregnancy (51.28%) followed by PROM (17.3%), isolated oligohydramnios (8.97%), hypertensive disorders of pregnancy (8.33%), maternal perception of decreased foetal movements (7.69%) and others. Failed induction was higher in nulliparas (41.2%) as compared to multiparas (23.7%). Failure rate was 53.8% when maternal age >30y and 28.2% in those <30y. Women with normal BMI had a failure rate of 25.6% compared to 36% for overweight and 44.4% for obese women. 24.1% had failed induction when Bishop score was >5 and 40.8% when Bishop score was <5. Between 38-41 weeks pregnancy failed induction occurred in 28-31% while it was higher at <38 weeks and >41 weeks pregnancy. The best outcome was seen when the birth weight was 2500-2900g (22.5% failures) while 72.7% had failed induction when the birth weight was >3500g. The duration of induction was >24 hours in 42.6% of women and 48.2% were in the latent phase of labour when taken for caesarean section. Conclusion: Despite the proven bene¿ t of induction of labour in selected cases, one must keep in mind its impact on increasing the rates of operative delivery. Strategies for developing practice guidelines may help to prevent unwarranted case selection and help to reduce the current high operative delivery rates.

Introduction: Estimation of accurate fetal weight is essential in obstetrical management and we aim to see the accuracy of fetal ultrasound in estimating birth weight in our setting. Method: 150 women with full term singleton pregnancy leading to live birth were included in the study. Prenatal fetal ultrasound database was reviewed for the fetal biometry and fetal weight estimation and delivery records were reviewed for actual birth weight. Error in estimation was calculated.Result: The study showed that fetal ultrasound using Hadlock.s formula has error in estimation of fetal weight by about 290 gm ± 250 gm. In 40% of the cases, there is an error of estimation by more than 10% compared to actual weight. Conclusion: There is a significant error in the estimation of the fetal weight. Depending only on the fetal ultrasound for the estimation of fetal weight can lead to unnecessary obstetrical intervention. It is necessary to correlate the ultrasound findings with clinical examination.Health Renaissance; September-December 2012; Vol 10 (No.3);236-238DOI: http://dx.doi.org/10.3126/hren.v10i3.7053

A simplified medical abortion protocol, including home administration of misoprostol, can be successfully integrated into clinical services in Nepal, where abortion services were recently legalized.

Please cite this paper as: Malla DS, Giri K, Karki C, Chaudhary P. Achieving Millennium Development Goals 4 and 5 in Nepal. BJOG 2011;118 (Suppl. 2):60–68. The under 5 child mortality rate in Nepal is on track to achieve the target of 54 per 1000 live births by 2015 compared with 158 per 1000 live births in 1991. The maternal mortality rate also looks set to drop to its target of 134 per 100, 000 live births by 2015 from 539 per 100, 000 live births in 1991. A 3‐year interim plan (2008–11) was established to provide free basic health care for all citizens and the safe delivery incentive programme has proved to help progression towards achieving Millennium Development Goals 4 and 5. The development of a policy targeting women, children and vulnerable populations in hard to reach places is a key feature. The principle of a primary healthcare approach is applied in the development and implementation of strategy plans and programmes. The focus is on ensuring that there are functioning facilities for essential obstetric care at health facilities and provision of trained personnel at delivery.