Background. Breech presentation is associated with increased rates of maternal and perinatal morbidity regardless of mode of delivery. After the results of Term Breech Trial, most of the countries adopted the protocol of cesarean section for term breech delivery because of which breech vaginal delivery is becoming rare. The aim of this study is to evaluate short-term maternal and perinatal outcomes of breech vaginal delivery at a tertiary care hospital in Nepal. Methods. A retrospective review of case records of all women who had vaginal breech delivery from April 13, 2016, to April 12, 2018, was conducted, over a period of two years. Available demographic variables, obstetric characteristics, details of labor, postpartum complications, and perinatal complications were recorded and analyzed. Results. Out of 21,768 cases of deliveries during the study period, the incidence of term breech deliveries was 528 (2.4%) among which the mode of only 84 (17.8%) deliveries was vaginal. Most of the deliveries were unplanned and were conducted because emergency cesarean section could not be performed. Three (3.6%) women had postpartum hemorrhage, and four (4.8%) had entrapment of aftercoming head, two of them requiring Dührssen incisions. Adverse perinatal outcomes were seen in 23.8% of such deliveries with <7 APGAR score at 5 minutes in 20.2%, neonatal admission in 17.7%, and perinatal mortality in 8.3%. The perinatal mortality was significantly associated with birthweight less than 2500 grams as compared to birthweight ≥2500 grams (21.1% versus 4.6%; P = 0.043 ). Conclusion. The perinatal outcomes for vaginal breech delivery are grave with our existing health facilities, especially when the deliveries are not well planned.

Background: Gestational Diabetes Mellitus (GDM) is associated with several adverse maternal and perinatal outcomes. Thus, screening for early detection of GDM and its treatment is important.Methods: This was hospital based descriptive study done over one year in department of Obstetrics and Gynecology, TUTH, Nepal. Six hundred ninety-seven women fulfilling the inclusion criteria were enrolled at 18-22 weeks of gestation. High risk factors were assessed and GCT was performed in women with risk factors during enrollment. Diagnostic OGTT was performed in women who screened positive (GCT ≥130mg/dl). Screen negative high-risk women were re-screened at 24-28 weeks. In women without known risk factors, GCT was performed at 24-28 weeks and OGTT was performed when screen positive. The diagnosis of GDM was made according to Carpenter and Coustan criteria.Results: Out of 697 enrolled women, 12 were excluded for various reasons and 685 women were analyzed. Women having risk of GDM were 28.9%. The prevalence of GDM was 2.92% and 2.48% with GCT cut off 130 mg/dl and 140 mg/dl respectively. Lowering the threshold to 130 mg/dl identified three extra cases (p=0.010). The prevalence among high risk group was 8.58% and 7.07% with the cut off value 130 mg/dl and 140 mg/dl respectively with three extra cases detected on taking cut off value 130 mg/dl (p=0.014). Among low risk women the prevalence of GDM was same i.e. 0.61% with both the cut off values.Conclusions: Lowering threshold of GCT to 130 mg/dl could identify significant percentage of extra cases of GDM especially in high risk women.

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.

Background: Menopause poses a big challenge during middle age and to the healthy aging of woman. Majority of women face various problems and disturbances in daily living leading to decrease in quality of life. This study focuses on menopause related symptoms and quality of life in relation to the symptoms. Method: This descriptive cross-sectional study was conducted among 200 women of age 40-60 years at Dharan Sub-metropolitan City of Nepal selected through snowball sampling technique. The data were collected over the period of four weeks. Semi- structured questionnaire for demographic variables and menopause specific quality of life (MENQOL) questionnaire were used to collect data. Interview technique was adapted. Descriptive and inferential statistics were used to interpret data. Result: Mean menopausal age of the study group was 47.14 years. The most common symptoms of vasomotor, psychosocial, physical and sexual domains were hot flushes, experiencing poor memory, feeling tired or worn out and change in sexual desire respectively. The overall score of menopausal quality of life for each domain reported that highest the mean score in sexual domain (3.58 ± 1.62) and least score in vasomotor domain (2.08 ± 1.67). The score of physical domain was significantly high in late postmenopausal group than early postmenopausal group. Significant association was obtained with age, ethnicity, menopause status, physical activity and marital status in relation to the domains of quality of life. Conclusions: The results conclude that all the menopausal women were having at least one menopausal symptom from each domain. The menopausal women scored highest in sexual domain and least in vasomotor domain suggesting decrease quality of life in relation to sexual domain. Menopausal symptoms were associated with decrease in quality of life. Thus awareness regarding the menopausal changes should be focused in premenopausal age group of women

Introduc onDelivery which is conducted with the help of instruments either vacuum or Forceps is known as instrumental vaginal delivery (IVD). It is done to prevent the pa ent from impending cesarean sec on and uterine scar which has its implica on in the future pregnancy along with maternal and fetal morbidi es as well. Objec veThis study assessed the risk factors and feto-maternal outcome of instrumental vaginal delivery Methodology ORA 116

Background: Fear of hospitalization in addition to uncertainties about appropriate treatment at the beginning of COVID -19 pandemic may have affected the health and outcome of pregnant women. Lack of transportation, closed out -patient services, and lack of employment has directly linked to poor maternal and perinatal outcomes during nationwide lockdown. This study aimed to assess perinatal outcome during the first COVID-19 pandemic lockdown at BPKIHS. Methods: This is a Descriptive Cross- Sectional Study conducted in a tertiary care center in Eastern Nepal from 24th march 2020 to 23rd July 2020 during the first COVID- 19 lockdown. Poor perinatal outcomes: perinatal death, preterm delivery, intrauterine growth restriction, newborn admission, and different reasons for admission were analyzed using descriptive statistics. Results: There were a total of 2685 obstetric admissions and 2442 deliveries during the study period of 4 months. The perinatal death rate was 26.2 per 1000 births. One hundred and twenty- eight newborns required neonatal admission and prematurity was the most common cause. Mean age and gestational age of women with poor perinatal outcome were 27.16 ± 6.02 years and 36.38± 4.54 weeks respectively. Conclusions: Despite the availability of comprehensive Emergency Obstetric Care (CEOC) at our center, poor perinatal outcome is still high. Which was directly or indirectly affected by COVID-19 pandemic lockdown as there was closure of OPD services, elective surgery, and most importantly lack of transportation.

Background: Covid-19 pandemic affected maternal health directly by causing respiratory disease in pregnant women as well as indirectly by affecting health care delivery and caused sharp increase in maternal mortality. Aim: This study aimed to assess causes and contributing factors for maternal mortality during six months of Covid-19 lockdown. Methodology: This was a retrospective review of all maternal mortalities over the period of six months (23rd March - 22nd September 2020) after implementation of lockdown. Information regarding demographic variables, obstetric characteristics, referral, diagnosis, cause of death and any delay present were obtained from the patient records. The data were analyzed using SPSS 11.5 and descriptive statistics was used. Results: There were 19 maternal deaths, of which one was due to accidental cause. The MMR was 419 per 100,000 live births. Mean age was 29.16 ± 9.53 years with age ranging from 16 to 49 years, 44.4% women never had antenatal check-up, mean POG at presentation was 29.7 ± 9.7 weeks. Four patients died during early pregnancy (two (11.1%) due to abortion related complications and two molar pregnancies) and six (33.3%) expired during antenatal period. Three most common causes for maternal mortality were sepsis (27.8%), hypertensive disorder (22.2%) and obstetric hemorrhage (16.7%). Covid pneumonia caused one (5.6%) mortality. Main contributory cause was anemia (50%). Major delay was in providing appropriate care timely. Conclusion: Maternal mortality was very high during lockdown and the leading cause was sepsis contributed by anemia in most cases. Delays in screening high-risk pregnancies as well as delay in appropriate treatment were responsible factors.

Background:Maternal mortality ratio is an important 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 to identify the various risk factors and causes of maternal mortality.Methods: This is a retrospective study conducted in a tertiary care center of Eastern Nepal from 16th July,2015 to 15th July 2020. Maternal mortality ratio per 100,000 live-births over 5 years of study period was calculated. The causes of death, delays of maternal mortality and different sociodemographic profiles were analyzed by descriptive statistics.Results:There were total of 55,667 deliveries conducted during the study period. The calculated maternal mortality ratio is 129.34 per 100,000 live-births in year 2015 to 2020. The mean age and gestational age of women having maternal deaths were 24.69 ±5.99 years and 36.15± 4.38 weeks of gestation respectively. The common causes of maternal deaths were obstetric hemorrhage, hypertensive disorder of pregnancy and sepsis. The leading contributory factors to the death were delay in seeking health care and delay in reaching health care facility (type I delay:40.84%).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 were due to delay in seeking care and delayed referral from other health facilities. Contributory factors related to maternal mortality are preventable through combined safe motherhood strategies, prompt referral, active management of labor and puerperium.