Introduction: High risk pregnancy is a major cause of morbidity and mortality in a developing country. These patients are recognized in the initial prenatal office visit as they have a poor obstetrical history or a well recognized medical complication however; pregnancy becomes high risk because they develop unexpected complications in the course of otherwise normal pregnancies. The objective of this study is to identify various type of high risk pregnancy and fetal outcome. Methods: This was a descriptive study conducted in Shree Birendra military hospital over a period of 9 months. Patients were recognized as high risk during antenatal visit and during admission. They were followed till delivery. The case records of all high risk pregnancy with their fetal outcome were analyzed. Statistical analysis was done using simple percentage. Results: Total deliveries during study period was 626. High risk pregnancy identified were 99 (15.81%). Previous lower segment cesarean section was the most common identified high risk pregnancy 34 (5.43%) followed by young primigravida 3.19%, breech 2.23%. There were total 13 low birth weight baby (13.13%) and 2 stillbirth (2%) as fetal outcome. Conclusion: Identification of high risk pregnancy during antenatal period will reduce adverse perinatal outcome.

Introduction: The management of gynecological emergencies is essential for the preservation of the life of affected woman, her sexual functions and fertility particularly in disease conditions that threaten her life. The main objective of the study is to determine the proportion of the surgical emergencies among gynecological surgeries in a tertiary care center. Methods: This is a descriptive cross-sectional study conducted in the department of gynecology and obstetrics in Shree Birendra Hospital, Kathmandu, Nepal from April 2013 till March 2017. Ethical approval was taken from the Institutional Review Committee (IRC) in November 2019. This study was conducted among 515 gynecological surgeries by using convenience sampling methods. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Data were analyzed using EXCEL software. Results: In our study, the proportion of surgical emergencies among total gynecological surgeries performed in the department of gynecology and obstetrics in Shree Birendra Hospital was 120 (23.30%). The highest number of surgical emergencies was observed in the age group of 20-29 years old, followed by less than 19 years of old age group. Ectopic pregnancy accounting for 85 (70.83%) is found to be the most common surgical emergencies in our study. Out of all surgical emergency cases, most of them underwent salpingectomy 65 (54.16%) followed by salpingectomy with tubal ligation 20 (16.16%). Conclusions: Surgical emergencies among gynecological surgeries are found to be in greater proportion in the department of gynecology and obstetrics in Shree Birendra Hospital. Ectopic pregnancy accounted for more than half of the diagnoses in this study.

Introduction: The rate of primary cesarean section is on the rising trend. Vaginal birth after cesarean section can be an alternative to reduce cesarean section worldwide. Antenatal examination and intrapartum monitoring are the most important factors for a vaginal birth after a cesarean section. This study aims to determine the acceptance of vaginal birth after cesarean section trial in a tertiary care hospital in Nepal. Methods: This is a descriptive cross-sectional study carried out in Shree Birendra Hospital, Kathmandu, Nepal, from March 2019 to March 2020. All pregnant women with a previous history of cesarean section meeting Royal College of Obstetrics and Gynecology criteria were included. A trial of labor was conducted on the patients who accepted vaginal birth after cesarean section. Results: A total of 85 cases with previous lower section cesarean section were included in the study. Out of which, 75 (88.2%) refused vaginal birth after cesarean section, and only 10 cases (11.8%) accepted to undergo a trial of labor. Five women (50%) had a successful vaginal birth. Complications were less among the vaginal birth after cesarean section group than the repeat cesarean section group. There was no maternal and neonatal mortality. Conclusions: The acceptance of vaginal birth after cesarean section is very low in this study. No complications were observed among vaginal birth after cesarean section in our study.

Aim: To determine the prevalence of anxiety in pregnancy during COVID19 pandemic in Shree Birendra Hospital, Chhauni Method: It is a cross sectional study conducted at Shree Birendra Hospital Chhauni from July to October 2020 following the ethical approval from IRC. All the pregnant women from first to last trimester attending outdoor visit were included; they were asked to fill up Beck Anxiety Index form. The level of anxiety was compared with demographic data like age, race, parity, and period of gestation, education and occupation. Data were analyzed by using SPSS 20 software. Results: A total of 385 presumably uninfected pregnant women were surveyed in 20-40 (28.45±3.95) years age group from 4 to 41 (27.15±9.4) weeks of pregnancy and 55.6% were multipara. Low-grade anxiety was found 99.5% (BAI= 3.06±3.66). Conclusions: Low-grade anxiety was found in almost all pregnant women during covid pandemic and there was no significant difference by demographic variables.

Introduction: Menstrual disorder encompasses a major chunk of gynecological outpatient department visits. Among menstrual disorders, dysmenorrhea is the commonest problem during reproductive life. Dysmenorrhea is crampy lower abdominal pain involving lower back, genitalia and upper thigh. Its prevalence varies widely from 40-94% with environment, ethnicity, lifestyle etc. It is a major cause for absenteeism from job/school. Common risk factors include family history, low body mass index (BMI), early menarche, psychological factors, smoking etc. Methods:This non-interventional cross-sectional study was conducted over 427 females of reproductive age group (15-49 years) visiting Gynecology OPD for 6 months' duration. Information was gathered from patients using a semi-structured standardized questionnaire formulated after a pilot study after obtaining written consent. Patients out of the specified age group, not giving consent, or previously interviewed patients coming for follow-up were excluded from the study. Results:This study showed the commonest complaint for visiting hospital as lower abdominal pain (50.6%), followed by menstrual abnormalities and Per-Vaginal (PV) discharge. Among menstrual problems, majority complained of irregularity of cycle (53.3%), followed by menorrhagia. The lifetime prevalence of dysmenorrhea was 86.4%, while point prevalence was 75.6%. Among dysmenorrheic individuals; 36.9%, 26.8% and 36.3% had mild, moderate, and severe pain respectively. Among them only 24.6% were taking medications and 6.5% were using hot water bag. There were significant correlations of severity of dysmenorrhea with its impact on activities (p=.000) and intervention (p=.000) though there was no significant correlation with family history, alcohol and tobacco consumption. Conclusion:Lower abdominal pain is the commonest complaint for gynecological OPD visit.Among menstrual disturbances, dysmenorrhea is a common entity that has significant impact on life and needs proper intervention.

Introduction: Abnormal uterine bleeding (AUB) is a very common gynaecological condition that affects women of all age groups. Majority of the cases are diagnosed by sampling the endometrium by procedure like dilatation and curettage (D and C). The aim of this study was to analyse the different types of endometrial histopathology of patients with the abnormal uterine bleeding and to find the association between various patterns of abnormal uterine bleeding and histopathological findings. Methods: This was a retrospective study carried out in the Department of Obstetrics and Gynaecology of Shree Birendra Hospital, Chhauni, Kathmandu over a period of two years from August 2018 to August 2020. All cases of AUB who underwent D and C procedure were included in the study. Data was entered in Microsoft excel and managed in SPSS Version 21. Analysis was done in the form of percentage and proportion and represented as tables where necessary. Results: Total 192 patients were analysed. Age group ranged from 21 to 75 years and most common age group presenting with AUB was 41 to 50 years. The most common presenting complaint was menorrhagia 47.9% (92/192) followed by metrorrhagia 19.8% (38/192). Most common endometrial histopathology was proliferative endometrium 33.3% (64/192), followed by secretory endometrium  21.9 % (42/192). Endometrial malignancy was found in 1.5% (3/192) cases. Conclusions: Histopathological examination of the endometrium showed a wide spectrum of pathological changes ranging from normal endometrium to malignancy. This emphasises the importance of endometrial sampling like D and C as an important diagnostic tool in the management of abnormal uterine bleeding.

Aim: To assess the effects of planned early birth (active treatment within 24hrs) compared to expectant management (without active treatment within 24hrs) for women at term with Prelabor Rupture of Membrane (PROM) on maternal and fetal outcomes. Methods: This is an observational comparative study carried out in all the pregnant women who present in maternity ward of Shree Birendra Hospital with PROM at 37-41 weeks of gestation with vertex presentation during the study period between 13 April 2020 to 13 April 2021.They were randomly placed into (A) active treatment group and (B) expectant treatment group. Group (A) was induced with 25mcg of PGE1 (Misoprostol) depending on cervical score, whereas group (B) was expectantly managed for 24 hrs. PROM to delivery interval, maternal and fetal outcomes were then evaluated in both the groups. Results: 79.5% of group A and 71.8% in group B delivered through vaginal route. 20.5% patients in group A and 28.2% patients in group B underwent Cesarean section. The average PROM to delivery interval was 15.6 hours in group A, as compared to 16.8 hours in group B. Only 2 babies in group B had an Apgar score of less than 7 at five minutes. Subsequently, in both the groups, two babies required NICU admission for respiratory distress syndrome with no neonatal mortality in both the groups. Conclusion: Expectant management up to 24 hours can be safely offered to a woman with term PROM.

This work is licensed under creative common license: http://creativecommons.org/licenses/by-nc-nd/4.0/ © MJSBH 2018 ABSTRACT Background: Induction of labor is an intervention intended to artificially initiate uterine contractions