Introduction: Shivering is frequently seen after subarachnoid block. Subarachnoid block impairs the thermoregulation system by inhibiting tonic vasoconstriction with redistribution of blood flow and core heat from the trunk to the peripheral tissue. Intraoperative shivering leads to increase in oxygen consumption and carbon dioxide production. This causes an increase in heart rate, blood pressure resulting in exacerbation of ischemic heart disease, increased risk of hypoxemia, intraocular pressure, intracranial pressure, metabolic rate, lactic acidosis, pain at the surgical site and discomfort to the patient. Objective: To assess the effectiveness of Dexamethasone in preventing intraoperative shivering in patients of cesarean delivery under subarachnoid block. Methodology: This was a hospital based prospective, comparative, cross sectional study which was conducted from February 2019 to July 2019 among 88 pregnant patients of age group 18 to 35 years old, American Society of Anesthesiologists (ASA) physical status 1 and 2, posted for elective or emergency caesarean delivery at Birat Medical College and Teaching Hospital (BMCTH). Operation room temperature was recorded by a wall thermometer and maintained during surgery between 20 to 25 degree Celsius and intravenous fluids were kept at this temperature. Patients were divided into two equal groups. Group S (study group) patients received 2 ml or 8mg of dexamethasone IV (As a premedication before giving subarachnoid block) while group C (control group) patients received 2 ml of normal saline. If the patients shivered according to classification of shivering, the prophylaxis was regarded as ineffective. Results: Patients undergoing caesarean delivery under subarachnoid block had significantly reduced (p value = 0.002) intraopera tive shivering who received prophylactic dexamethasone (group S). Conclusion: The prophylactic use of 8mg i.v dexamethasone was significant in prevention of shivering in Nepalese population who underwent caesarean delivery under subarachnoid block.

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Background: Postmenopausal women have various problems that may affect their quality of life. However, published reports from nearby communities of the capital of province 1 of Nepal are lacking. Hence, we aimed to determine the quality of life of postmenopausal women in selected communities of Morang, Nepal. Methods: This cross-sectional study was conducted from August to October 2021 among 200 postmenopausal women of Budhiganga Rural Municipality. Menopause-specific quality of life (MENQoL) that included vasomotor, psychological, physical, and sexual domains was assessed. Factors that may affect it were also assessed. Results: Majority of the participants had sweating (80.5%), accomplishing less than earlier (95.0%), decrease in physical strength, feeling lack of energy (98.1%), and avoiding intimacy (98.5%) in vasomotor, psychosocial, physical, and sexual domains respectively. The highest mean score was found in the sexual (5.02 ± 0.82) followed by physical (3.43 ± 0.51), vasomotor (3.0 ± 1.08), and psychosocial domain (2.74 ± 0.80). The MENQoL score was 3.48 ± 0.53 with a significant association with age and occupation. The psychosocial domain had a significant association with age, marital status, occupation, history of childbirth, current smoking, and current alcohol use. The physical domain had a significant association with age, religion, marital status, occupation, and history of childbirth. The sexual domain had a significant association with age and current alcohol use. Conclusion: Sexual domain was the most affected in postmenopausal women followed by physical, vasomotor, and psychosocial domain. Age, occupation, marital status, history of childbirth, current smoking, and current alcohol use were the factors associated with MENQoL.

Introduction: Transversus abdominis plane (TAP) block is a regional anesthesia that involves the infiltration of local anesthetic in between the internal oblique and transversus abdominis muscle plane. This block provides post-operative analgesia and reduces the requirement of opioids consumption. Objective: To assess the effectiveness of TAP block in providing postoperative analgesia in women undergoing caesarean section. Methodology: This was a hospital based prospective, comparative, cross sectional study conducted in 70 patients from 17th September 2018 to 17th February 2019 undergoing caesarean section under spinal anesthesia. Patients were divided into two groups. Group A patients received TAP block with 0.5% Ropivacaine versus Group B patients received injection paracetamol 1gm intravenous every 8 hourly as a standard and routine analgesic. At the end of the surgery, TAP block was performed by anesthesiologist and assessment of postoperative pain using a visual analogue pain score at every 1 hour, 3 hour, 6 hour, 12 hour and 24 hour by trained staffs at postoperative ward. Then, depending upon the severity of the pain injection fentanyl 1mcg/kg intravenous was given as rescue analgesia. Short assessment of patient satisfaction (SAPS) score was also assessed 24 hours postoperatively. Results: Compared to control group, in women who received TAP block, there was statistically significant reduction in pain at 3 hr, 6 hr, 24 hrs. However at 12 hrs there was no significant difference in the pain score. The cumulative fentanyl requirement was also significantly less in the TAP block group at all the time points.  Conclusion: The TAP block provided highly effective postoperative analgesia following caesarean section and reduces the fentanyl requirement in the first 24 hour.

Introduction: Eclampsia is a multisystem disorder with potential life-threatening complications that can result in significant maternal and fetal morbidity and mortality. The case fatality rate of eclampsia is 1.8% in developed countries, 17.7% in India and 13% in Nepal. The incidence of pre-eclampsia and eclampsia is high in developing countries due to hypoproteinemia, malnutrition and poor obstetric facilities. Objective: To assess the maternal and perinatal outcome in patients of eclampsia Methodology: This was a hospital based cross-sectional study where all the patients presenting with eclampsia from June 2019 to November 2020 in the department of Obstetrics & Gynecology, Birat Medical College and Teaching Hospital were enrolled for the study. Data analyzed included various maternal parameters and fetal parameters along with the mode of delivery, outcome of baby, postpartum maternal condition and maternal mortality were noted. Results: Among 6631 deliveries, 50 patients had eclampsia with the incidence of 7.54/1000 deliveries. Thirty four (68%) patients were of 20-30 years of age, 37 (74%) were primigravidas, 36 (72%) from rural areas, 34 (68%) were illiterate, 49 (98%) were low to middle socioeconomic status, 41 (82%) were unbooked and 33 (66%) patients had antepartum eclampsia. Eleven (22%) women developed eclampsia related complications. There were 02 (4%) maternal deaths and the common causes were HELLP Syndrome and pulmonary oedema. Neonatal outcome consisted of live births in 39 (78%) newborns, 03 (6%) were still births, 08 (16%) were birth asphyxia and 15 (30%) were low birth weight. Conclusion: Majority of the patients were young, illiterate, unbooked primi gravidas with poor to average socioeconomic status from rural areas. Majority of the eclamptic women nearly 39 (78%) cases delivered via caesarean section for better neonatal outcome. Two (4%) eclamptic women died as a result of eclamptic complications and three (6%) newborns had neonatal deaths because of low birth weight and prematurity. Adequate antenatal screening, early detection of hypertension, timely referral, and early initiation of treatment and termination of eclamptic patients can help to improve the maternal and perinatal outcomes.

Introduction: The female pelvis is a quite complex anatomical region consisting of uro-genital system as its main part and other structures like blood vessels, gastrointestinal tracts, lymphatics, nerves and a part of musculoskeletal system. Thus, the differential diagnosis of pelvic masses may be of gynecological or non gynecological origin. Gynecological pelvic masses are uterine, ovarian or adnexal masses which may be benign or malignant. Objective: The objective of this study was to evaluate the type of various gynecological pelvic masses and to correlate the preoperative diagnosis with histopathological diagnosis. Methodology: This was a hospital based cross sectional study conducted on 107 patients from September 2018 to September 2019 at Birat Medical College and Teaching Hospital (BMCTH) with presenting complian of lump in the abdomen. These patients underwent clinical examination, routine and specific investigations along with ultrasonographic evaluation and tumour markers to reach a preoperative clinical diagnosis. Patients were admitted and preanesthetic consultation was done. Patients were taken for therapeutic or diagnostic laparoscopy or exploratory laparotomy and diagnosis were confirmed with histopathological diagnosis. Results: Total 107 patients were enrolled in the study with age ranging from 21 to ≥70 years and among them majority (42.1%) were in the age group of 41-50 years. The most common presenting complain of patients were lower abdominopelvic pain (58.87%). The most common clinical diagnosis was leiomyoma in 39.25% patients followed by adenomyosis in 24.29% patients. The most common histopathological diagnosis was fibroid uterus seen in 42.05% patients. There were 2 (1.86%) patients of ovarian malignancies and 1 (0.93%) patient of uterine malignancy.