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.

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

Aims: To assess safety and feasibility of non-descent vaginal hysterectomy. Methods: A hospital based prospective study was conducted at the department of obstetrics and gynecology of Kathmandu Medical College Teaching Hospital from 1st January 2010 to 31st December 2011. All the patients undergoing non -descent vaginal hysterectomy for benign indication, without suspected adnexal pathology were included in the study. Vaginal hysterectomy was done in usual manner. In bigger size uterus morcellation techniques like bisection, debulking, myomectomy, slicing, or combination of these were used to remove the uterus. Data regarding age, parity, uterine size ,estimated blood loss, length of operation, complication and hospital stay were recorded. Results: A total of 50 cases were selected for non-descent vaginal hysterectomy. Among them 43 cases successfully underwent non-descent vaginal hysterectomy. Commonest age group was (41-45 years) i.e. 40%. All patients were parous. Uterus size was <10 weeks in 27 cases and >10 weeks in 23 cases. Commonest indication was leiomyoma of uterus (63%). Mean duration of surgery was two hours. Mean blood loss was 205.26ml. Reasons for failure to perform NDVH was difficulty in opening pouch of Douglas in three cases. In rest of four cases there was difficulty in reaching the myoma and transverse diameter was too large so as to prevent descent of the uterus. The most common complication was post –operative pain in 23% of cases. Febrile morbidity was present in 4.6% of cases. Blood transfusion was required in seven cases. Average duration of hospital stay was three days. Conclusions: Vaginal hysterectomy for benign gynecological causes other than prolapse is safe and feasible. For successful outcome size of uterus, size in all dimensions and location of fibroid should be taken into consideration.Today in the era of minimally invasive surgery, non descent vaginal hysterectomy needs to be considered and seems to be a safe option. DOI: http://www.dx.doi.org/10.3126/njog.v7i2.11134   Nepal Journal of Obstetrics and Gynaecology / Vol 7 / No. 2 / Issue 14 / July-Dec, 2012 / 14-16

Background: Chronic pelvic pain is a common problem in reproductive age group women. Diagnosis of chronic pelvic pain needs multidisciplinary approach. Diagnostic laparoscopy is one of the investigations which can help in reaching the diagnosis. Objective: To know the etiology in chronic pelvic pain. Methods: This was a descriptive study done in the Department of Obstetrics and Gynaecology of Kathmandu medical college teaching hospital from January 2010 to June 2012 (30 months). All the cases of laparoscopic surgery done for chronic pelvic pain were noted and details of these cases were analyzed regarding age, parity and laparoscopic fi ndings. Results: Total 48 cases of Chronic Pelvic Pain underwent diagnostic laparoscopy during the study period. Mean age of cases were 33 years, ranging from 20-46yrs. Almost half of the cases 43.75% were of parity two. Laparoscopic fi nding was negative in 29.17% and pelvic pathology was present in 70.83% of the cases. Out of the pelvic pathology endometriosis was present in 55.88% followed by pelvic adhesions, pelvic congestion and pelvic infl ammatory disease, chronic ectopic in 20.58%, 14.70%, 5.88%, 2.94% respectively. Conclusion: Diagnostic laparoscopy is a useful modality in the diagnosis of etiology and management of Chronic pelvic pain. In our study, Pelvic endometriosis was the most common pelvic pathology in cases of Chronic pelvic pain.

DOI: 10.3126/kumj.v8i2.3548Kathmandu University Medical Journal (2010), Vol. 8, No. 2, Issue 30, 153

A cross sectional study has been done over a period of one year to find out the total number of youngpeople, adolescents and youth attending at general gynaecological OPD and special adolescent clinic andto analyse them in terms of their sex, ethnicity, address, marital status, education, occupation and theirhealth problems in a teaching hospital at Kathmandu.Of the total 2480 patients 31.29% were young people, 18.34% of them were adolescents and 30.52% ofthem were youth. Male attendance was insignificant. Majority (91%) of the young people were Brahmins,Newars and Chhetriyas. Most (91%) of them were from Kathmandu valley, 73% were already married and60% had experienced pregnancy. Approximately 12% of these people were illiterate, 24.85% of them hadnot completed the primary level education. Only 19%of them had completed the SLC examination Lackof education, trend of early marriage has been reflected on to their occupation. 64% of them are engagedin routine household work as housewives. Few (4.3%) of these young people were not doing anything at all.Majority (59%) of them presented with pregnancy related problems and rest of them came for problemslike Pelvic infection, urinary tract infection, sub fertility, breast problems and others.This study conclude that good number of young people from different parts of the country attend specialadolescent clinic with different needs. Therefore adolescent friendly services in the hospital need to bestrengthened to provide special care for them.Key words: Young people, adolescents, youth, substance abuse, illiterate