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Background: Increasing trend in Ceasarean birth is the issue of both demand and supply side. One of the recommended tools to characterize every pregnancy admitted for childbirth is Robson ten-group classification system that may evaluate obstetric practice. The aim of the study was to assess the cesarean section pattern based on Robson's classification in a central referral hospital., Methods: A retrospective census of childbirths at Paropakar Maternity and Women's Hospital in Kathmandu performed from September 2018 to February 2019 based on obstetric record. Robson ten-group classification system was the research tool to collect data and Robson Classification Report Table was used to evaluate the data., Results: There were 10500 births with 34% (32-35%) overall cesarean section rate. Excluding spontaneous and induced labor the supposedly total prelabor CS is 14.5%. Group 1+2+3 size is 81% and 21% CS; 5+10 had 11.3% and 23.3% respectively. Prelabor CS (2b+4b) is 3.54% and additional 11% from malpresentation and preterm. Group CS rate from Class 5 onwards, and ratio of 1 and 2 are as recommended by Robson; 67% of CS were not picked up by Robson class due to indications evolved as the labor progresses and the attributes not pre-classified., Conclusions: The assessed quality of data and the type of obstetric population by Robson reference values prove this study as a representative research. But the indications of cesarean sections can be predicted for only one-third of pregnancy attributes classified by Robson class. To supplement this tool to reduce rising cesarean birth requires audit of indications at decision making level.

Aims: To determine the clinical outcome of rheumatic heart disease in pregnancy. Methods: Retrospective cross-sectional descriptive study from April 2019 to April 2021 in Nobel Medical College, Biratnagar, Nepal. Feto-maternal variables were taken for their health status. Data presented in table with frequency. Results: Out of 13013 deliveries in a year, 49 had cardiac disease (0.37%) and 38 had rheumatic heart disease (0.29%) over 28 weeks of gestation; 95% (n=36) had mitral valve involvement; 12 were primigravida and 7 preterm at the time of delivery. Half of them underwent caesarean section for various indications. Most common maternal complications were cardiac failure, cardiac arrythmia, admission to ICU, obstetric complications, including maternal mortality in 5.2% (n=2) cases. Low birth was in 29% (n=11) of cases, and 34% (n=13) of them needed NICU care at the time of delivery. There was history of rheumatic fever in 9 cases (24%). Conclusions: Rheumatic heart disease is the commonest diagnosis among heart disease in pregnancy and adverse event can be minimized by multidisciplinary intervention. [ABSTRACT FROM AUTHOR]

Aims: To find out the incidence, indications, complication of emergency peripartum hysterectomy in a tertiary care center. Methods: This was a retrospective study conducted over a period of 18 months from April 2017 to October 2018 at Paropakar Maternity and Women’s Hospital in Kathmandu. Data were obtained from the operation theater register and record section. Results: Out of 30917 deliveries in 18 months 18 had lifesaving emergency peripartum hysterectomy (0.58 per 1000 deliveries). The most common indication being morbidly adherent placenta/placenta previa (8; 44%) followed by ruptured uterus (5; 28%), uterine atony (4; 22%). The most common risk factor is attributed to previous cesarean section (11; 61%) followed by abnormal placentation (7; 39%). Most common morbidity was febrile morbidity followed by wound infection and bladder injury. Conclusion: Abnormal placentation and past cesarean section contributed to be the major indication of peripartum hysterectomy. [ABSTRACT FROM AUTHOR]

Aim: To determine the association of Robson ten group classification system (RTGCS) and the fetal distress as an indication of CS among women delivering in Paropakar Maternity and Women’s Hospital. Methods: This was an observational cross-sectional study over a period of 6 months. 410 study sample population undergoing CS were stratified according to RTGCS out of total of 11575 women’s delivering in PMWH and were analysed for indication of CS, fetal distress, maternal and fetal complications and their distribution according to RTGCS. Results: Overall CS rate was 35.08%. Largest group size was of group 1 with 4131 patients (35.69%) followed by group 3 with 2980 patients (25.75%). Highest contribution to CS rate was from group 5 (1070 patients, group CS rate 99.17% and contribution to overall CS rate 26.35%). Group 1 and 2 had low group CS rate in comparison to other groups but it was still higher than the Robson guidelines and MCS reference population as per WHO implementation guidelines. On analysis of sample study population CS rate due to fetal distress was 28.54% and previous CS was 25.85%. Conclusions: High proportion of women gave birth via CS among which high contribution was by low risk groups. The major indication of CS in low risk groups was fetal distress and there was significant rise of fetal distress after admission. Hence RTGCS neither could predict the indication of CS nor could correctly identify the actual high risk group. Hence incorporation of more objective indication of CS like fetal distress or high risk diagnosis which gives rise to fetal distress, in RTGCS criteria is recommended. [ABSTRACT FROM AUTHOR]

Aim: To compare fetomaternal outcomes among pregnant patients in COVID and non-COVID period in tertiary centre in eastern Nepal. Methods: All women who delivered at Nobel Medical College Teaching Hospital during non-COVID period between April to June 2019 and COVID period between April to June 2020 were compared. Data were collected from medical records. Results: Significant number of women had cesarean deliveries in COVID period (36.5% vs 32.6%). There were no significant differences in period of gestation at the time of delivery, birth weight of baby, intrauterine fetal death and neonatal intensive care unit admission as well as no difference in obstetric outcomes, labor complications, maternal intensive care unit stay, near miss and peripartum hysterectomy. Conclusion: There were more cesarean sections, vaginal birth after cesarean section and vaginal breech delivery in COVID period and no other significant differences in maternal and fetal outcomes during COVID period and NonCOVID period. [ABSTRACT FROM AUTHOR]

Aim: To assess the role of intermittent cardiotocographic monitoring of induction of labor while using misoprostol in pregnancy of 41 weeks or more. Methods: This is hospital based descriptive study conducted from December 2017 to March 2018. CTG was done before each transvaginal administration of misoprostol in 113 primigravida patients at Paropakar Maternity Women's Hospital in Kathmandu. Variables studied were indications of induction, mode of delivery, Apgar score and neonatal admissions. Results: 11.5% of CTGs were non-reassuring who underwent Cesarean Section and had significantly low Apgar at 1 minute but only 46% of neonates required resuscitation. Liquor was thick meconium in 61.5% of non-reassuring CTGs. Total twelve (10.6%) of neonate needed resuscitation of which six (6%) neonate in reassuring CTG where as 46.1% of neonate needed resuscitation in non-reassuring. NICU admission rate was 7.96% in total and 33.3% of neonate with non-reassuring CTG who needed resuscitation. However there was no neonatal mortality during this period. Conclusions: Intrapartum cardiotocography can prevent fetal compromise early. [ABSTRACT FROM AUTHOR]

Aim: To find out the Maternal and perinatal outcomes in Rh-Negative mothers. Methods: This is a cross sectional study of all Rhesus negative mothers giving childbirth at Department of Obstetrics and Gynecology, Nobel Medical College Teaching Hospital from March 2020 to February 2021. Maternal variables like age, parity, mode of delivery, and complications were recorded. Fetal variables like period of gestation, fetal outcomes, hemoglobin, indirect bilirubin, fetal weight were noted. Results: There were 108 cases of Rh negative pregnancy and 95 of them delivered Rh positive fetuses. Prevalence of Rh negative pregnancy was 1.68%. Half of them (51; 53.6%) underwent caesarean section due to obstetric indications with 20 repeat cesarean sections and 9 (17.7%) cases for fetal distress. Gross perinatal death was 9; none of the patients received antepartum immunoprophylaxis; and 86 received postpartum Anti-D Rh IgG. There was only one case of proven isoimmunisation presented as hydrops fetalis in a grand multiparous woman with positive Indirect Coomb Test; and two newborn received exchanged transfusion. Conclusion: Rhesus negative rate was 1.68% and proven isoimmunization rate was 1%. [ABSTRACT FROM AUTHOR]

Aims: To analyze the maternal and fetal outcome in teenage pregnancy (≤ 19years) with that of pregnancy at optimal childbearing age group (20- 34 years). Methodology: This was a hospital based observational analytical study conducted at Paropakar Maternity and Women's Hospital in Kathmandu from August 2016 to February 2017.Results were analyzed using SPSS 21 taking p-value≤ 0.05 as statistically significant. Results: There were 200 cases in each group (≤19 and 20-34 years). Anemia (p=0.001), hypertensive disorder of pregnancy (p=0.001), preterm delivery (p=0.001), Cesarean Section rate (p=0.006), 5-minute Apgar score (p=0.035), low birth weight (p=0.017) and neonatal admission rates (p=0.018) were significantly high in teenage pregnancy. Conclusions: Both maternal and neonatal complications are increased in teenage pregnancy in comparison to the optimal reproductive age group. Key words: complications, pregnancy, teenage. [ABSTRACT FROM AUTHOR]

World Health Organization has recommended Robson Classification from baseline obstetric characters to assess, monitor and compare Cesarean Section rates by the quantity analysis. Incorporation of real time labor related factors requires quality audit for both maternal and perinatal outcome. [ABSTRACT FROM AUTHOR]

Objective: To assess whether the implementation of a package of activities through the joint action of three international healthcare professional associations (HCPAs) increased the use of essential interventions (EIs) for delivery and neonatal care.Methods: A noncontrolled pre-intervention versus post-intervention study was conducted from June 13 to December 13, 2016, among women older than 18 years of age, who had delivered at one of two urban tertiary hospitals in Nepal.Results: The study included 9252 women. Minimal change was found after the implementation of EIs that were used frequently at baseline (e.g. social support during delivery in the emergency room, and promotion and support for early initiation of breastfeeding). By contrast, an increase was recorded for some EIs that had not been used regularly at baseline. For example, the rate of timely administration of prophylactic antibiotics before cesarean delivery increased from 0.0% (0/496) to 94.0% (409/435) at one hospital. Nonetheless, some EIs with low use at baseline did not show improvement after implementation (e.g. kangaroo mother care).Conclusion: The present study strengthened previous findings regarding the uptake of EIs following joint promotion by HCPAs in low-income settings. [ABSTRACT FROM AUTHOR]