BackgroundBacterial vaginosis (BV), the etiology of which is still uncertain, increases the risk of preterm birth. Recent PCR-based studies suggested that BV is associated with complex vaginal bacterial communities, including many newly recognized bacterial species in non-pregnant women.MethodsTo examine whether these bacteria are also involved in BV in pregnant Japanese women, vaginal fluid samples were taken from 132 women, classified as normal (n = 98), intermediate (n = 21), or BV (n = 13) using the Nugent gram stain criteria, and studied. DNA extracted from these samples was analyzed for bacterial sequences of any Lactobacillus, four Lactobacillus species, and four BV-related bacteria by PCR with primers for 16S ribosomal DNA including a universal Lactobacillus primer, Lactobacillus species-specific primers for L. crispatus, L. jensenii, L. gasseri, and L. iners, and BV-related bacterium-specific primers for BVAB2, Megasphaera, Leptotrichia, and Eggerthella-like bacterium.ResultsThe prevalences of L. crispatus, L. jensenii, and L. gasseri were significantly higher, while those of BVAB2, Megasphaera, Leptotrichia, and Eggerthella-like bacterium were significantly lower in the normal group than in the BV group. Unlike other Lactobacillus species, the prevalence of L. iners did not differ between the three groups and women with L. iners were significantly more likely to have BVAB2, Megasphaera, Leptotrichia, and Eggerthella-like bacterium. Linear regression analysis revealed associations of BVAB2 and Megasphaera with Nugent score, and multivariate regression analyses suggested a close relationship between Eggerthella-like bacterium and BV.ConclusionThe BV-related bacteria, including BVAB2, Megasphaera, Leptotrichia, and Eggerthella-like bacterium, are common in the vagina of pregnant Japanese women with BV. The presence of L. iners may be correlated with vaginal colonization by these BV-related bacteria.

ObjectivesStillbirth is one of the vital indicators of quality care. This study aimed to determine maternal-fetal characteristics and causes of stillbirth in Nepal.DesignSecondary analysis of single-centred registry-based surveillance data.SettingThe study was conducted at the Department of Obstetrics and Gynecology, Chitwan Medical College Teaching Hospital, a tertiary care hospital located in Bharatpur, Nepal.ParticipantsAll deliveries of intrauterine fetal death, at or beyond 22 weeks’ period of gestation and/or birth weight of 500 g or more, conducted between 16 July 2017 and 15 July 2019 were included in the study.Main outcome measuresThe primary outcome measure of this study was stillbirth, and the secondary outcome measures were maternal and fetal characteristics and cause of stillbirth.ResultsOut of 5282 institutional deliveries conducted over 2 years, 79 (1.5%) were stillbirths, which gives the stillbirth rate of 15 per 1000 births. Of them, the majority (75; 94.9%) were vaginal delivery and only four (5.1%) were caesarean section (p<0.0001). The proportion of the macerated type of stillbirth was more than that of the fresh type (58.2% vs 41.8%; p=0.13). Only half of the mothers who experienced stillbirth had received antenatal care. While the cause of fetal death was unknown in one-third of cases (31.6%; 25/79), among likely causes, the most common was maternal hypertension (29.1%), followed by intrauterine infection (8.9%) and fetal malpresentation (7.6%). Four out of 79 stillbirths (5%) had a birth defect.ConclusionHigh rate of stillbirths in Nepal could be due to the lack of quality antenatal care. The country’s health systems should be strengthened so that pregnancy-related risks such as maternal hypertension and infections are identified early on. Upgrading mothers’ hygiene and health awareness is equally crucial in reducing fetal deaths in low-resource settings.

Background: Hysterectomy is an effective treatment for a wide range of gynaecological diseases, both benign and malignant. There must be a pe­riodic audit for the appropriate indication of the surgery and its complica­tion rate. Histopathological analysis is mandatory for definitive diagnosis and further management. This study aims to review the clinical profile, indications of hysterectomy and to assess the correlation between the clinical diagnosis and histopathological report. Methods: A retrospective study of all the patients undergoing abdominal hysterectomy was conducted in the Department of Obstetrics and Gyne­cology, Chitwan Medical College Teaching Hospital, Nepal from January to December 2018. Demographic and clinical informations were retrieved from the medical record section. Datas were entered in the pre-designed proforma. Statistical analysis was done in terms of percentages, standard deviation, correlation and mean. Results: During the study period, 111 patients underwent abdominal hys­terectomy. The mean age of the patients was 46 years. The mean dura­tion of hospital stay was 8.7 days. Abnormal menstrual flow and pain ab­domen were the commonest presenting symptoms. The most common preoperative diagnosis was fibroid followed by ovarian tumor. Leiomyoma was the commonest lesion on histopathological examination. The correla­tion between clinical diagnosis and histopathology was 96.07% for fibroid, 80.95% for ovarian tumor, 66.67% for adenomyosis and 38.46% for DUB. Conclusions: Fibroid uterus and ovarian mass are the common indications for abdominal hysterectomy. Histopathology is mandatory for confirming the diagnosis, proper counseling and holistic management of the patient.

Background: Emergency Peripartum Hysterectomy (EPH) is an important lifesaving surgical procedure considered in cases of severe hemorrhage unresponsive to medical and conservative management. The objective is to review incidence, identification, intervention and impact of emergency peripartum hysterectomy. Methods: The retrospective, cross-sectional study designed was to used. EPH data were collected from January 2014 to December 2018.Descriptive statistics was used to analyzed data and presented in tables and charts. Results: Incidence of Emergency Peripartum Hysterectomies was 2.3% out of 252(2.6%) cases of obstetrical emergencies and 0.06% that is 1 in 1600 deliveries. Most common indications for EPH were uterine rupture (33.3%); placenta accreta (33.3%) followed by retained placenta (16.6%) and endometritis with pyometritis (16.6%). Estimated blood loss 1916 ml., timeliness from delivery to hysterectomy was 140 minutes; most common post-operative complication was surgical site infection (33.3%) and length of hospital stay 11.7 days. Maternal morbidity rate was 33.3%. There was no maternal mortality recorded. Conclusions: The timely intervention improves the outcome in Peripar­tum Hysterectomy, which is frequently associated with abnormal placen­tation as a consequence of increasing caesarean deliveries rate.

The imperforated hymen is one of the commonest genital tract malformations usually present with cyclic abdominal pain and an obstructive pelvic mass at post-pubertal age. The unusual pre­sentations are delayed menarche with obstructive symptoms rarely acute retention of urine, te­nesmus, and constipation. We report an unusual case of 12- year old girl with a huge mass in the lower abdomen examination revealed imperforate hymen at early pubertal age. Further investigation of Magnetic Resonance Imaging (MRI) confirmed hematocolpometra. Then, she underwent simple hymenotomy and drainage of collected menstrual blood from the genital tract. She recovered well during the postoperative periods. We conformed normal menstrual flow at her first follow-up. In conclusion, Imperforate hymen at peripubertal age with an unusual huge abdominopelvic mass concerns further imaging to assure the best outcome.