Background The maternal mortality ratio is a significant public health indicator that reflects the quality of health care services. The prevalence is still high in developing countries than in the developed countries. This study aimed to determine the MMR and identify the various risk factors and causes of maternal mortality. Methods This is a retrospective study conducted in a tertiary care center in Eastern Nepal from 16th July 2015 to 15th July 2020. The maternal mortality ratio was calculated per 100,000 live-births over five year’s study period. The causes of death, delays of maternal mortality and, different sociodemographic profiles were analyzed using descriptive statistics. Results There was a total of 55,667 deliveries conducted during the study period. The calculated maternal mortality ratio is 129.34 per 100,000 live-births in the year 2015 to 2020. The mean age and gestational age of women with maternal deaths were 24.69 ± 5.99 years and 36.15 ± 4.38 weeks of gestation. Obstetric hemorrhage, hypertensive disorder of pregnancy and sepsis were the leading causes of maternal death. The prime contributory factors were delay in seeking health care and reaching health care facility (type I delay:40.9%). Conclusions Despite the availability of comprehensive emergency obstetric care at our center, maternal mortality is still high and almost 75% of deaths were avoidable. The leading contributory factors of maternal mortality are delay in seeking care and delayed referral from other health facilities. The avoidable causes of maternal mortality are preventable through combined safe motherhood strategies, prompt referral, active management of labor and, puerperium.

Backgroun: Intrauterine fetal death (IUFD) is a contributor of perinatal outcome and is an important indicator of the quality of antenatal care. Despite efforts, risk factors cannot be identified in cases of intrauterine fetal deaths. This study aims to identify the maternal, fetal, placental and cord related factors related to it. Methods: It is a retrospective cross-sectional study conducted analyzing patients admitted with IUFDs after 28 weeks of pregnancy at Tribhuwan University Teaching Hospital from April 2019 to March 2020.  It was conducted after taking ethical approval from Institutional Review Committee (IRC) of Institute of Medicine. Data were collected from review of charts of individual patients in MS Excel and was analyzed using SPSS. Results: There were 5496 births and 46 intrauterine fetal deaths during the study period giving stillbirth rate of 8 per 1000 births. It was common in the age group of 26-30 years (34.8%), 62.2% were from inside Kathmandu valley,43.5% were just literate, 13% were illiterate, 84.8% were housewives, 56.5% were primigravida and 69.57% of the babies were preterm. Only four percent had previous history of intra uterine fetal deaths. Hypertensive disorders complicating pregnancy were found in 30.5% followed by heart disease in 10.9% of the mothers. There were no known co-morbidities in 26.1% of the patients. Out of total 46 cases, 62% were female. Two had Rh isoimmunization and four had congenital malformations. Placenta previa was seen in four percent and abruptio placenta in two percent. Twin pregnancy with diamniotic dichorionic placenta was present in four percent. Seventeen percent of the babies had cord around the neck and two percent had thrombosis of the umbilical cord. Conclusion: Low level of maternal education and maternal comorbidities like hypertensive disorders complicating pregnancy were found to be most common factors seen in cases of intrauterine fetal deaths.

No abstract

Anchored fallopian tube through the drain tube is rare. We present a case of a 27-year-old female patient who underwent right salpingectomy with the fenestrated drain tube in the pelvic cavity. Postoperatively, the drain could not be removed. Laparotomy revealed the left fallopian tube entering through the fenestration of the drain tube.

Giant ovarian tumors are rare in the present day due to the early diagnosis and treatment. However, owing to the large size, it can often compress the inferior vena cava and sudden decompression of it during the removal can lead to hemodynamic instability with disastrous outcomes.

Introduction and importance: Hepatitis E virus causes self limiting hepatitis most of the times but, during pregnancy it can lead to severe hepatitis along with various complications thereby increasing the mortality. Case presentation: A 27-year-old woman gravida two, para one at 38 weeks and 6 days of gestation presented with multiple episodes of nonbilious vomiting, severe dehydration, and later developed right upper quadrant abdominal pain. The patient had a positive serological test for the hepatitis E virus, and liver enzymes were severely elevated. Under supportive treatment she delivered a healthy baby, and her liver enzymes returned to normal levels after 2 weeks of delivery. Clinical discussion: Although the hepatitis E virus usually causes self-limiting hepatitis, it can quickly progress to severe hepatitis, liver failure, and even death during pregnancy. Immunological change with a Th2 biased response and increased hormonal levels during pregnancy could possibly facilitate the development of severe liver damage. No particular drug has been approved for the treatment of hepatitis E viral infection in pregnant women, and the commonly used drugs are contraindicated due to the risk of teratogenicity. Supportive therapy and intensive monitoring are the core management techniques for hepatitis E virus infection in pregnant women. Conclusion: Due to the high mortality risk, pregnant women should try to avoid possible exposure to the hepatitis E virus, but once infected, symptomatic therapy is the mainstay.

Stuck drain tube is a rare postoperative complication. We present a case of 27 years female who underwent right salpingectomy with abdominal drain on left side. Postoperatively drain couldn’t be removed and diagnosis of stuck drain was made. Laparotomy revealed Fallopian tube entering through both eyes of the drain tube.

Succenturiate placenta can be associated with vasa previa, retained placenta, post-partum hemorrhage and infection. Prior knowledge of presence of succenturiate placenta can be helpful to take quick and rational decisions during the labor. We present a case of placenta succenturiate suspected at 34+3 weeks of gestation using findings from ultrasonography.