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

Interstitial pregnancy is a rare type of ectopic pregnancy with a high risk of massive hemorrhage on rupture as compared to ectopic on other sites. The mortality rate for the ruptured interstitial pregnancy is high. Therefore, early diagnosis of such pregnancy before the rupture occurs facilitates appropriate management and avoids life-threatening complications. With the advancement in diagnostic imaging modalities, early diagnosis and more conservative management for interstitial pregnancy have become possible. Here, we report a case of primigravida diagnosed with interstitial pregnancy with ultrasonography and successfully managed with a single dose of methotrexate.

Obstructed Hemivagina and Ipsilateral Renal Anomaly syndrome is a rare obstructive uterovaginal anomaly involving both mesonephric and paramesonephric ducts. It usually presents after menarche with non-specific symptoms like pelvic pain, dysmenorrhea, or paravaginal mass and examination findings of paravaginal or pelvic mass. Because of non-specific symptoms and signs, the diagnosis is usually overlooked, which leads to complications like endometriosis, tubo-ovarian abscess compromising patient’s fertility, and quality of life. Therefore, in presence of these nonspecific clinical features along with imaging findings of uterine didelphys and unilateral renal agenesis, this syndrome should be considered in the diagnosis. We present a case of a 17-year-old lady with Obstructed Hemivagina and Ipsilateral Renal Anomaly syndrome, diagnosed by finding of paravaginal mass on examination and uterine didelphys with ipsilateral renal agenesis in USG and managed successfully by resection of vaginal septum.  

Background: Anal incontinence is an embarrassing condition that is largely underreported. Obstetric anal sphincter injuries are the most important etiological factors. Anal sphincter injury during delivery is considered to be one of the major risk factors for fecal incontinence in women. After anal sphincter injury at the time of delivery, up to 50% women have complaints of fecal incontinence, mainly because of persisting sphincter defects.Objectives: To evaluate the risk factors for the occurrence of obstetric anal sphincter injuries during vaginal delivery. To evaluate the outcome of patients with obstetric anal sphincter injuries.Methodology: A retrospective descriptive study was conducted from 2014 to 2016. Data of all patients with Obstetric Anal Sphincter Injuries (OASIS) over 3 years was collected from the medical record section after ethical clearance from Institutional Review Committee (IRC), BPKIHS. The data was entered in the excel sheet and analyzed using SPSS 17. Results:The Most important risk factor of OASIS was operative vaginal delivery (vacuum assisted vaginal delivery), followed by birth weight of the baby greater than 3.5 Kg and primigravida. Conclusion:Patients undergoing operative vaginal delivery, primigravida and birth weight greater than 3 kg are the important risk factors for OASIS. So, patients with these conditions should be handled carefully during second stage of labor to prevent the occurrence of OASIS.