Background: Placenta previa is an obstetric life-threatening condition with several maternal and fetal complications. The objective of this study is to compare the maternal and fetal outcome of placenta previa in scarred and unscarred uterus.Methods: A retrospective case control study was carried out on 85 cases of placenta previa in the department of obstetrics and gynecology, Paropakar Maternity and Womens Hospital (PMWH) Kathmandu from April 2019 to May 2020 of which 46 had scarred uterus and 39 cases had unscarred uterus.Results: Sixty-one of patients were less than 30 years of age, 62% presented with gestational age 28 to 37 weeks and 67% had parity between 1 to 5. Frequency of placenta previa in scarred uterus was 54% and that in unscarred uterus was 46%. Eighty percent cases with scarred uterus had anterior placenta compared to 33% of cases of unscarred uterus with p value of 0.009. 42% had grade 4 placenta previa on ultrasonography. 45 percent of patient with scarred uterus had PPH compared to 23% in unscarred group with p value of 0.03. Malpresentation was found in 7 cases in scarred group and in one case in unscarred. Cesarean hysterectomy was performed in 6 cases in scarred category compared to 2 in unscarred. Low birth weight was present in 28 cases in scarred category compared to 15 cases in unscarred category with p value 0.03.Conclusions: This study concluded that fetal and maternal outcome is adverse for cases of placenta previa with scarred uterus compared to unscarred uterus.

INTRODUCTIONWorldwide, more than half a million women between age 15-49 die each year from the complication of pregnancy and childbirth.1 Near misses have emerged as a useful complement to the investigation of maternal deaths. 2Near miss is defined as "A woman who nearly died but survived a complication that occurred during pregnancy, childbirth, or within 42 days of termination pregnancy. 2,3The patient survived either by chance or because of hospital care she received." Currently we have high pregnancy related mortality ratio (247 deaths due to any causes in pregnancy up to six weeks after pregnancy event per 100 thousand live births) and maternal mortality ratio (229 deaths due to pregnancy and childbirth related cause per 100 thousand live births) which constitutes 11% of deaths of women of reproductive age group.Various associated risk factors contribute to near miss events. Commonly seen in our context are: Antepartum/Postpartum hemorrhage, complication of abortion, ruptured ectopic and ruptured uterus, Hypertension complicating pregnancy: severe preeclampsia, eclampsia, sepsis or severe systemic ABSTRACT 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 nearmiss: 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.

Hyperthyroidism is a state of excessive thyroid function. The most common cause of hyperthyroidism is Graves’ disease. Overt hyperthyroidism if not treated can have serious outcome on the mother and the fetus. We present a pregnant women at 31 weeks of gestation presented with shortness of breath and palpitation with previous history of caesarean section and was treated with propyl thiouracil, beta blockers, antihypertensive drug, and during her course of treatment had Preterm Prelabor Rupture of Membrane with subsequent onset of labor and had normal vaginal delivery of 1.7 kg healthy baby. This report emphasize on the timely management of overt symptoms before the onset of labor.

Introduction: Birth defect refers to any abnormality of physical structure or form or function of prenatal origin, whether genetic or not, which is present at birth. Congenital birth defect is one of the causes of perinatal morbidity and mortality especially in developed countries. Studies of congenital birth defects are useful to establish baseline data, document changes over time and identify clues to etiology. This study was aimed to determine the overall prevalence of newborns with congenital birth defects, outcomes of those babies at birth, modes of delivery as well as various organ systems involved. Methods: It is a short term observational study conducted in the Department of Obstetrics and Gynaecology, B.P. Koirala Institute of Health Sciences, Dharan from July, 2016 to December, 2016 after ethical approval. All the intramural deliveries after 22 weeks of gestation in six months were looked for gross congenital birth defects soon after birth through meticulous examination. Antenatal sonographic documentation of fetal anomalies was noted and correlated after birth. The birth defects were categorized according to the ICD10 th Revision of birth defects. Results: During the study duration, there was a total of 6,496 births out of which 26 babies had birth defects. All the babies were delivered to mothers of age less than 35 years with no history of parental consanguinity. 11 (42.3%) babies were born to mothers with no folic acid supplementation and three (11.5%) babies had ambiguous sex. Most of them (22; 84.6%) were alive at birth and majority of them born vaginally (19; 73.0%) and had normal birth weight (18; 69.2%). Majority of them had defects detected incidentally after delivery (19; 73.0%) and were non-lethal. The most common birth defect was related to central nervous system (12; 46.15%). Conclusions: In this study, the prevalence of congenital birth defects was 0.4%. Majority of the birth defects (73.0%) were detected after delivery. Most of the babies with defects (84.6%) were alive at birth and non-lethal. The most common birth defects were related to central nervous system (46.15%). Hence, preconceptional counselling and folic acid supplementation are recommended for prevention, termination for lethal defects and surgical repairs of non-lethal defects for viable newborns after delivery.

Introduction: The incidence of birth defects is 2-3% in the general population but it is increasing. An estimated 303,000 newborns die within 4 weeks of birth every year, worldwide, due to congenital anomalies. The objective of this study was to find out the prevalence of birth defects among newborns in a tertiary care centre. Methods: A descriptive cross-sectional study was done in the Department of Obstetrics and Gynaecology and the Department of Paediatrics from 15 June 2016 and 14 June 2019. Ethical approval was obtained from the Institutional Review Committee (Reference number: 142/077/078-IRC). Data of newborns were collected from the hospital records. Convenience sampling method was used. Point estimate and 99% Confidence Interval were calculated. Results: Among 32,695 newborns, birth defects were seen in 169 (0.51%) (0.41-0.61, 99% Confidence Interval). The most common birth defect was musculoskeletal defects seen in 60 (35.50%) newborns followed by central nervous system defect seen in 30 (17.75%) newborns. Conclusions: The prevalence of birth defects among newborns was lower than in other studies done in a similar setting.