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Aims: To assess the safety and feasibility of myomectomy during cesarean delivery. Methods: This was a retrospective descriptive study conducted at Kathmandu Model Hospital. Data on cesarean myomectomy were obtained from hospital records and analyzed in terms of demographic profile, number, size and location of fibroids, intraoperative blood loss, and drop in hemoglobin level, blood transfusion, birthweight and duration of hospital stay. Results: Mean age of mother and gestational age at delivery were 32.6 years and 37.8 weeks respectively. Seventeen cases (58.6%) had multiple fibroids. Seventeen (58.6%) of the fibroids were intramural, 10 (34.4%) sub serosal and 2(6.8%) were submucosal. Nine cases (31.1%) had intraoperative blood loss of 500ml to 1000ml with mean loss of 420 ml. Only One case who had blood loss of 1500ml due to presence of fibroid in lower segment of uterus required 3 unit of blood transfusion. The mean preoperative & postoperative hemoglobin were 12.23 gm/dl and 11.25gm/dl. The mean birthweight & duration of hospital stay were 2.8 kg and 2.3 days. Conclusion: Cesarean myomectomy is a safe and feasible procedure. [ABSTRACT FROM AUTHOR]

Aims: To identify the existing solutions and research gaps globally and in Nepal to provide an overview on the existing solutions and research gaps. Methods: Different databases such as PubMed, Google Scholar, registries, and relevant organizational websites were searched. The study designs included systematic reviews on cervical cancer prevention and screening globally and original studies and program related reports in Nepal. Narrative summary of the findings were performed. Results: Globally, most of the systematic reviews are conducted in low and middle-income countries followed by high-income countries. The cost-effective and common interventions globally and in South Asia includes awareness and educational activities for cervical cancer screening and prevention, early medical interventions such as pap smears, HPV vaccination, and visual inspection with acetic acid. Barriers to cervical cancer screening include lack of education, low socioeconomic status, and lack of knowledge, lack of effective communication, embarrassment, time constraints, and preference of female doctors. In Nepal, the national guidelines on cervical cancer screening and prevention were published more than a decade ago. The published studies indicated a low level of knowledge and attitude related to cervical cancer prevention and screening. Conclusions: Research in cervical cancer prevention and screening has received recognition globally in recent years. In Nepal, research that has explored the implementation and policy gaps at a deeper level through different dimensions remain inadequate. The findings of this review could pave way for designing better studies for sustainable interventions in the long run. [ABSTRACT FROM AUTHOR]

Caesarean section (CS) rate is rising dramatically worldwide. WHO recommended CS rate of 10-15% at populational level would not be the ideal rate at the hospitals level due to the differences on population they have been serving. At the hospital level, a perfectly effective system is necessary to understand the trends and causes of rising trends of CS as well as to implement effective measures where necessary to control the same. Hence, WHO recommended the Robson classification, which is also called the 10-group classification of CS (TGCS) as a global standard tool to assess, monitor and compare CS rates within healthcare facilities over time, and between health facilities. The Robson classification, proposed by Dr Michael Robson in 2001, is a system that classifies all women at admission at a specific health facility for childbirth into 10 groups based on five basic obstetric characteristics (parity, gestational age, onset of labour, foetal presentation and number of foetuses). This classification is easy and simple and mutually exclusive, highly reproducible, easily applicable, and useful to change clinical practice. It has many strengths such as simplicity, flexibility (further subdivisions can be made to increase homogeneity within groups). This classification helps to identify and analyse the contribution of each group to overall CS rates. It also allows distinguishing the main group of women who contributes most and least to the overall CS rates; so that the CS rates can be monitored in a meaningful, reliable, and action-oriented manner in each health facilities for optimal use of CS. [ABSTRACT FROM AUTHOR]

Aims: To evaluate the improvement in the quality of life of women with stress urinary incontinence who were treated with trans-obturator tape procedure. Methods: This is a cross-sectional study of treatment of stress urinary incontinence using trans-obturator tape at Kathmandu Model Hospital from February 2018 to December 2019. The outcome of the procedure in terms of improvement in quality of life and surgical complications were assessed. Results: Out of 16 cases of stress urinary incontinence half of them were post-menopausal. One each had intra-operative bladder injury, urinary retention and urinary tract infection; 14 cases improved completely by a week, one had some improvement and one didn't improve. At six months follow-up one case had no improvement and one developed urge incontinence. Conclusions: Trans-obturator tape has been found a good procedure for the treatment of stress urinary incontinence in our setting and hence led to high rate of improvement in quality of life with minimal and minor complications. [ABSTRACT FROM AUTHOR]

Aims: To explore the knowledge of menstrual hygiene management among adolescent girls in different domains like culture, social learning and belief. Methods: This review paper explored the knowledge of menstrual hygiene management under several domains. Literature published in Pub Med, Medline, Google Scholar and HINARI from 2010 to 2020 was reviewed to prepare this paper. Results: The studies revealed that there is a general silence about menstruation. Adequate and accurate information about menstruation and the need for good menstrual hygiene management is limited. It further revealed that girls are not provided with comprehensive information before menarche while growing up, and therefore the first experience of menstruation is without any preparation and usually comes as a shock. Menstruation is widely regarded as a curse from God or as a disease or as being impure or as a taboo. Schools are doing very little to impart education on Menstrual Hygiene Management to adolescents. A majority of the teachers themselves are least or unprepared to address this issue with the girls, even when it is part of the school curriculum. The studies provide a weal th of information for designing interventions to improve menstrual hygiene management. Conclusions: Young girls are not well aware of the menstrual event and the hygienic measures. They are neither well informed nor properly taught by elders and teachers. Effective interventions must be contextualized, designed, and implemented to generate awareness and change the mindset of people surrounding menstruation. [ABSTRACT FROM AUTHOR]

Aims: To evaluate the outcome of endourological management of iatrogenic ureterovaginal fistula caused by gynecological and obstetric surgeries. Methods: This is a retrospective analysis of uretorovaginal fistula (UVF) patients who underwent UVF management with endourology technique from February 2014 to November 2019. All data were taken from fistula database. All non-obstetric/gynaecological cases and open surgical procedures leading to UVF were excluded. Diagnostic evaluation by cystoscopy and ureterorenoscopy; and use of guide wire, C-arm and DJ stent were recorded. Three to six months post-operative follow up status was also recorded. Results: There were 14 cases managed by retrograde DJ stenting. Both hysterectomy (n=10) and Cesarean Sections (n=4) were the past surgeries. Diagnosis was made by history, methylene blue test, cystoscopy, intravenous urography and CT urogram. Treatment was retrograde DJ stenting. All of them had unilateral distal ureteric injury close to vesicoureteric junction leading to ureterovaginal fistula. All were continent at the end. Conclusions: Endourological approach with retrograde DJ stenting had successful outcome in iatrogenic UVF. Keywords: double J stent, endourological technique, iatrogenic ureterovaginal fistula, ureterorenoscope. [ABSTRACT FROM AUTHOR]

Aims: This review was done to identify the reported prevalence rate of pelvic organ prolapse among the different world populations. Methods: Systematic review of Pelvic Organ Prolapse (POP)usingthe PRISMA checklist; PubMed database was searched on reportingthe prevalence of POP and its management measuresin January 2020. Medical Subject Headings (MeSH) like "Pelvic Organ Prolapse" OR "Uterine Prolapse" OR "Vaginal Wall Prolapse" OR "Cystocele" AND "Prevalence" [key word/s] were used. Additional articles were identified through the reference list of the retrieved articles. Results: Out of 91 screenedarticles, 46 full articles were eligible and only 15 satisfied by selection criteria for the systematic review. The methodological score rated for the quality of studies is 4.5±1.7 (range=2-7) out of 8 points. The mean prevalence of POP diagnosis was 40%; with 42.44% in low and lower-middle-income countries, and 35.56% in upper-middle and high-income countries. Increasing age and parity, body mass indexand fetal macrosomia were found to be the significant risk factors irrespective of the country's economy. Conclusions: The low and lower-income countries have almost twice the burden of prolapse than the countries of the higher economy. The major risk factors associated with prolapse remain common in all countries irrespective of national income or development. [ABSTRACT FROM AUTHOR]

COVID-19 is a pandemic affecting every group of people. Pregnancy itself is a partially immune compromised state, so chance of aggravation of symptom supposed to be more in pregnancy. Prevention is the best way to get away from this disease. Good hygiene, supportive care and possible mechanical ventilation for severe case are required. There is no proven role of antibiotic, antiretroviral and steroids. There is no proven vertical transmission. Baby has to be kept in isolation and breast milk can be expressed and given to newborn. [ABSTRACT FROM AUTHOR]

There is an increasing demand of more and more specialized services and trainings in medical field and Obstetrics and Gynecology is not an exception to it. As a sub-specialty training, Gynecological oncology and Urogynecology fellowships have become a developmental milestone under National Academy of Medical Sciences since 2018. Resource utilization for academic purpose in public-privatepartnership model is beneficial. [ABSTRACT FROM AUTHOR]

Large myoma may show various type of degenerative change and have alteration of radiological view. Subserosal or pedunculated fibroid with cystic degeneration may mimic complex ovarian mass on radiological imaging. A 34 year female, para one, with normal menstrual period presented with radiological diagnosis of complex adnexal mass and CA 125 value 100 μ/ml. Postoperative finding revealed cystic degeneration of pedunculated subserosal fibroid receiving blood supply from adherent omentum. [ABSTRACT FROM AUTHOR]

Minimally invasive vaginal surgeries are often a preferred mode of surgical treatment of stress urinary incontinence. It is associated with fewer complications. However, complications including hemorrhage, voiding dysfunction, infection, pain, skin infection and erosion, and bladder injuries are observed. We encountered intraoperative bladder injury in a 40-year-old female patient with stress urinary incontinence who underwent transobturator tape (TOT) surgery. Cystoscopy demonstrated a small defect post procedure. She was managed conservatively with foley catheterization for 2 weeks following TOT procedure. She was dry and continent upon follow up. [ABSTRACT FROM AUTHOR]

Genitourinary fistula is an abnormal communication between the urinary tract and genital tract, most common being the vesicovaginal fistula. In most of the cases fistula results mainly due to poor obstetric care in developing countries, where as in developed countries most of the urogenital fistulas are iatrogenic. It is mainly diagnosed by clinical examinations and intravesical dye test using methylene blue. Repair can be done via abdominal or vaginal route based on the findings. Here we present a case of 27 years postnatal mother referred to our centre with diagnosis of vesicovaginal fistula post cesarean hysterectomy that was repaired successfully via vaginal approach. [ABSTRACT FROM AUTHOR]

Clear cell carcinoma of cervix is a rare neoplasm accounting for round 4% of all adenocarcinomas. It is usually seen in patients with a histoiy of intrauterine exposure to diethylstilbestrol. We are reporting a case of clear cell carcinoma of cervix in a 50 years old PjLj postmenopausal woman, with no history of exposure to diethylstilbestrol in-utero or synthetic non-steroidal estrogen, and who was managed with neoadjuvant chemotherapy followed by modified radical hysterectomy with pelvic lymphadenectomy and adjuvant chemotherapy. [ABSTRACT FROM AUTHOR]