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Rising cesarean section (CS) rates are a global public health problem. The systematic review investigates key indications for performing CS and factors significantly associated with the rising rate of CS in South Asia. Primary studies in South Asia published between January 2010 and December 2018 were searched using relevant electronic databases: MEDLINE, Scopus, PubMed, Web of Science, CINAHL, NepJOL, and BanglaJOL. A narrative synthesis of the indications for performing CS and factors significantly associated with the rising CS rates was performed using content analysis. A total of 68 studies were included in this review. The most common medical indication for CS was fetal distress, followed by previous CS, antepartum hemorrhage (including placenta previa/abruption), cephalopelvic disproportion, failed induction, hypertensive disorders in pregnancy, oligohydramnios, and non-progress of labor. Maternal request was the most common non-medical indication for conducting CS. Higher maternal age was the most common significant factor associated with the rising CS rate followed by higher maternal education, urban residency, higher economic status, previous CS, pregnancy/childbirth complications, and lower parity/nulliparity. Preference for CS and increasing private number hospital were also factors contributing to the rising rate. Several key indicators and factors significantly associated with rising CS rate are revealed. These key indicators and significant factors reflect the global trend. Reduction in the use of primary CS, unless medically warranted, would help stem rates of CS. Realistic and candid explanation to pregnant women and their families regarding the benefits of vaginal birth for women and babies should form an integral part of maternity care as these are issues of public health.

Introduction: Stillbirth is often defined as the death of a foetus in the uterus prior to its birth or during the process of birth. Most of the stillbirths are preventable global health problem. The aim of this study was to find out the prevalence of stillbirths among pregnant women admitted to the Department of Obstetrics and Gynaecology in a tertiary care centre. Methods: A descriptive cross-sectional study was conducted in the Department of Obstetrics and Gynaecology of a tertiary care centre among pregnant women admitted between 14 April 2021 to 13 April 2022. Ethical approval was taken from the Institutional Review Committee (Reference number: 43). Convenience sampling method was used. The data was collected from the medical record section using a proforma. Point estimate and 95% Confidence Interval were calculated. Results: Among 5118 pregnant women, stillbirths were found in 126 (2.46%) (2.04-2.88, 95% Confidence Interval). Conclusions: The prevalence of stillbirth among pregnant women was higher than in the other studies done in similar settings.

Background: Ectopic pregnancy (EP) is one of the major causes of preventable maternal death in first trimester of pregnancy. The incidence of EP varies between 1 – 2 % worldwide. The main objective of this study is to explore the incidence, predisposing factors, clinical presentations and approaches for management of EP in Karnali Province Hospital (KPH), Nepal. Methods: This is a retrospective study carried out in KPH between 14 April 2013 to 13 April 2018. Data were extracted from patients’ admission files, discharge registers and operation theatre (OT) notes. Data were then analysed by SPSS version 26. Percentage, frequency and interquartile range (IQR) were calculated and displayed in the tables and figures. Ethical approval was granted from hospital authority prior to the study. Results: The incidence of ectopic pregnancy is found to be 0.33% in our study. The median age of the patient was 28 years and the median gestational age for ectopic was 8 weeks. Majority of patients were from Surkhet (70%) and Brahmin/Chhetri ethnicity (52.6%). Most cases were multigravida (80.7%). In this study, most of patients presented with abdominal pain (96.4%), amenorrhoea (96.4%) and vaginal bleeding (87.7%). The main predisposing factors of EP were history of previous abortion (35.10%) and pelvic inflammatory diseases (PID) (21.10%). Most of patients (87.7%) had undergone surgery for the treatment of EP. Conclusion: In our study, the incidence of ectopic pregnancy is comparatively very low (0.33%). EP is found most common in multigravida and up to 10 weeks gestation of pregnancy. Previous abortion and PID were the most common predisposing factors. The main clinical presentations of EP were abdominal pain, amenorrhoea and vaginal bleeding. Laparotomy was the main mode of treatment for EP in KPH.