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Cerebral venous sinus thrombosis (CVST) during pregnancy and puerperium is an uncommon diagnosis. CVST can present with wide range of symptoms and signs, and most of the time it is left undiagnosed. Here, three cases of CVST in early pregnancy and puerperium in young women who presented with seizure attacks, altered sensorium and severe headache, respectively, are reported. Subsequent imaging with MRI and magnetic resonance venography (MRV) showed CVST in the first two cases, whereas in the third case it showed a venous infarction. All were treated with low molecular weight heparin followed by warfarin. They all made excellent recoveries and are in regular follow-up. [ABSTRACT FROM AUTHOR]

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Endometrioma is the localization of endometriosis in ovary which often develops as cyst. The condition can be complicated with infection, torsion and rupture leading to significant hemoperitoneum and ascites. We present here a 28-year female P2 L1 presented with the features of acute abdomen and severe anemia referred from other hospital where pain management was done. She had raised Ca-125 level, negative Urine Beta HCG and USG findings of left endometrioma with degenerating subserosal fibroid. The improvement of her general condition with analgesics was misleading however a static hematocrit level despite blood transfusion raised suspicion of ongoing pathology leading to blood loss and diagnostic paracentesis confirmed the hemoperitoneum while awaiting of CT report. She underwent Emergency Laparotomy which revealed hemoperitoneum of 2000ml and right ruptured ovarian endometrioma measuring and left ovarian cyst measuring 6x6 cm was noted. The postoperative period was uneventful. Keywords: Acute abdomen; case report; endometriosis; hemoperitoneum; ruptured endometrioma.

Mayer-Rokitansky-Kuster-Hauser syndrome also known as mullerian agenesis is a rare congenital condition in which there is absence of uterus along with upper vagina. Patient usually presents with primary amenorrhea with or without cyclical lower abdominal pain but have normal secondary sexual characters. Modified McIndoe Vaginoplasty with amnion graft is the commonest surgery performed worldwide. A 23 year old girl with normal secondary sexual characters presented with primary amenorrhea with cyclical lower abdominal pain; on examination blind vagina was present. Vaginoplasty with amnion graft was done and vaginal mould was placed. Vaginal dilatation with Hegar's dilator was done weekly until 6 weeks. She is under regular follow-up at present and advised for regular manual dilation at home. McIndoe Vaginoplasty with amnion graft is a simple yet rewarding procedure especially in low resource countries like ours, with good success rate and with minimal postoperative complications. Keywords: Amnion graft; Mayer-Rokitansky-Kuster-Hauser Syndrome; Modified McIndoe Vaginoplasty; Primary amenorrhea; Secondary sexual characters.

Introduction: Cesarean Section is the most common obstetrics surgery done for both maternal and fetal indications. There is a rising trend of cesarean section rates which is associated with increased maternal morbidities. This study aims to find out the prevalence of repeat Cesarean Section among women with previous cesarean sections done in a tertiary centre., Methods: This was a descriptive cross-sectional study conducted in a tertiary care hospital of Nepal from August 2020 to January 2021. Pregnant women with previous Cesarean Section status without other pelvic surgery and medical comorbidities were included and data were collected regarding intraoperative findings. Ethical approval was taken from the Institutional Review Committee (Reference Number: 14). A convenience sampling technique was used. Data were analysed using Statistical Package for the Social Sciences version 22. Point estimate at 95% Confidence Interval was calculated, with frequency and percentage., Results: Out of 1315 patients undergoing Cesarean Section, the prevalence of Repeat Cesarean Section was found to be 184 (13.99%) (12.11-15.86 at 95% Confidence Interval)., Conclusions: The prevalence of Repeat Cesarean Cection from our study was similar to other studies done in similar settings. Repeat Cesarean Cection confers peri-operative morbidities which adversely affect postoperative recovery. Repeat Cesarean Cection continues to contribute to morbidity over subsequent pregnancies and serious maternal morbidity.

Successful pregnancy along with prevention of obstetric fistula in a subsequent pregnancy is possible if proper antenatal care and timely elective caesarean delivery are ensured. Keywords: Fistula recurrence; obstetric fistula.

Introduction: Urinary incontinence is an involuntary passage of urine. The aim of the study was to find the prevalence of urinary incontinence among pregnant women in the third trimester of pregnancy at a tertiary care center., Methods: This descriptive cross-sectional study was conducted in a tertiary care center from March 2021 to May 2021. Ethical approval was obtained from the Institutional Review Board (reference number: 854/2077/78). Convenience sampling method was used. A descriptive analysis of socio-demographic profile and urinary incontinence symptoms were recorded on International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form questionnaire and analysis were done using Statistical Package for Social Sciences 27. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data., Results: Among 277 pregnant women admitted in the antenatal ward, urinary incontinence was present in 26 (9.4%) (95% Confidence Interval= 5.96-12.84). Among them, stress urinary incontinence 16 (61%) was most common followed by mixed incontinence 6 (23%). Majority of them 18 (69.3%) had small leaks with almost all 25 (96.2%) having only a mild to moderate impact on the quality of life. Majority 197 (71.2%) had features of lower urinary tract syndrome., Conclusions: Our study showed similar prevalence of urinary incontinence compared to other international studies.

Introduction: Cervical cancer is the leading gynaecological cancer in Nepal. Most of the time, it is diagnosed in the late stage with its associated morbidity and mortality. This study aimed to find out the prevalence of late-stage presentation of cervical cancer among confirmed cases of cervical cancer in a tertiary care centre., Methods: A descriptive cross-sectional study was conducted at a tertiary care centre of Nepal from March 2021 to May 2021 after obtaining ethical clearance from the Institutional Review Board (Reference no.805). A convenient sampling method was used. A descriptive analysis was done of all cases of cervical cancer who were diagnosed within the last 36 months and attended hospital during the study period. The information was collected by interview and hospital record was checked. Analysis was done using Statistical Package for Social Sciences version 20. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data., Results: Among the 142 confirmed cervical cancer cases, the prevalence of late-stage presentation of cervical cancer was 93 (65.5%) (57.7-73.3 at 95% Confidence Interval). The mean age at diagnosis was 50.6±10.9 years. More than two-thirds of the women were from outside Kathmandu valley 102 (71.8%) and came from >50km distance. The majority of the women 83 (58.5%) were illiterate., Conclusions: The study showed that two-thirds of the women presented in advanced stage and the factors leading to the late stage. This highlights the fact, that the focus should be on the provision of organized screening programs and early diagnosis and treatment of cervical cancer.

Background: Amniotic fluid provides necessary fluid and growth factors for normal development of fetal lungs, cushions the umbilical cord from compression and protects the fetus. This study aims to compare the perinatal outcome between pregnancy with borderline and normal Amniotic Fluid Index that provide greatest chance for appropriate safe delivery with least maternal fetal and neonatal risk., Methods: A total of 94 singleton full term pregnant women were included in the study-at Kathmandu Model Hospital from February to August 2020. Forty Seven women each with Amniotic Fluid Index 5-8 cm was taken as borderline oligohydramnios group and Amniotic Fluid Index 8.1-24 cm was taken as normal group. Ultrasonography was taken as the medium for measuring Amniotic Fluid Index., Results: The rate of intra-partum fetal distress, meconium-stained amniotic fluid, low birth weight and neonatal intensive care unit admission were not statistically significant between the two groups while rate of cesarean section was noted to be 76.6% in exposed groups as compared to 44.7% among women with non-exposed normal group [RR=1.71; 95%CI: 1.2-2.44 p=0.006]., Conclusions: We concluded that in cases of borderline oligohydramnios there was higher risk of operative delivery.

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Novel coronavirus disease 2019 (COVID-19) is a growing public health crisis. Despite initial focus on the elderly population with comorbidities, it seems that large studies from the worst affected countries follow a sex-disaggregation pattern. Analysis of available data showed marked variations in reported cases between males and females among different countries with higher mortality in males.  At this early stage of the pandemic, medical datasets at the individual level are not available; therefore, it is challenging to conclude how different factors have impacted COVID-19 susceptibility. Thus, in the absence of patients' level data, we attempted to provide a theoretical description of how other determinants have affected COVID-19 susceptibility in males compared to females.  In this article, we have identified and discussed possible biological and behavioral factors that could be responsible for the increased male susceptibility. Biological factors include - an absence of X-chromosomes (a powerhouse for immune-related genes), a high level of testosterone that inhibits antibody production, and the presence of Angiotensin-converting enzyme 2 (ACE2) receptors that facilitate viral replication. Similarly, behavioral factors constitute - higher smoking and alcohol consumptions, low level of handwashing practices, and high-risk behavior like non-adherence to health services and reluctance to follow public health measures in males. Keywords: COVID-19; gender; males; sex disaggregation; susceptibility.

Background: High risk pregnant women have increased risk of maternal and neonatal morbidity and mortality. Antepartum surveillance is important and should be effective in such conditions. Modified biophysical profile is the method of antepartum surveillance which comprises of cardiotocography and amniotic fluid index., Methods: A cross-sectional study was carried out in Paropakar Maternity and Women's Hospital from February 2019 to January 2020 to determine the effectiveness of modified biophysical profile. Cardiotocography was interpreted as reactive, equivocal and non-reactive. AFI was considered normal if it was 5 to 24 cm. In the study 172 high risk cases at term and not in labor were included. Each case was subjected to cardiotocography then amniotic fluid index was obtained using real time sonography where it was measured from all four quadrants. Modified biophysical results were obtained and then were divided into 2 arms as normal modified biophysical profile and abnormal modified biophysical profile then analysis was done., Results: Of 172 cases, there were 97 (56.4%) cases in normal modified biophysical profile and remaining 75 (43.6%) in abnormal modified biophysical profile group. The rate of cesarean section increased when there was abnormal modified biophysical profile.  Neonatal resuscitation and admission was increased in abnormal modified biophysical profile., Conclusions: Normal modified biophysical profile in high risk pregnancy had more cases of vaginal delivery and less adverse fetal outcome like low APGAR score, neonatal resuscitation and neonatal intensive care admission.

Health research activities have advanced considerably in Nepal over the past several years. However, stakeholders' confidence on scientific community is shaken as the latter failed occasionally in adhering to ethical principles. Nepal Health Research Council has exercised regulatory authority to control and support research works. However, much more is needed given the scale at which studies are being carried out. It is high time to conduct an analysis of the current situation followed by the development of an overarching framework to strengthen health research that facilitates a range of actions along the continuum of identifying information needs to translation of knowledge into policies and practices for ultimately improving people's health. Keywords: Ethics; health research systems; knowledge management; research regulation.

Medical induction is an alternative to dilatation and evacuation (D and E) in second trimester abortion, though it has higher risk of minor complications compared to D and E. Combination of mifepristone and misoprostol is commonly used for the medical abortion. A 32 years G3P2L2 with previous two cesarean delivery was referred to our center at sixteen weeks of gestation for termination of her pregnancy. After 63 doses of misoprostol, she had to undergo unintended major intra-abdominal surgery for partial uterine rupture. Keywords: Dilatation and evacuation; medical induction; second trimester abortion; uterine rupture.

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Background: Caesarean section is one of the most performed surgical procedures all over the world. It is associated with high morbidity and mortality as compared to vaginal delivery. The present study was carried out to evaluate the maternal and neonatal outcome and complications in two groups of pregnant women who underwent elective and emergency cesarean section, so that measures can be taken to reduce morbidity and mortality in near future., Methods: It was hospital based descriptive cross-sectional study carried out at Paropakar Maternity and Women's Hospital from October to December 2018. There were 340 patients enrolled in the study 170 in elective and 170 in emergency caesareans selected randomly. Ethical approval was obtained from the Institutional Review Board and informed consent was taken from the patients and patients' guardians. Data were collected daily from the Operation Theater., Results: The rate of caesarean section in the hospital was 30.7%. Proportion of emergency caesarean section was 1324 (74.4%) and elective caesarean section was 456 (25.6%). Emergency Caesarean section was more common in younger age group and in primigravida while elective Caesarean section was more common in advanced age group and in multigravida. The most common indication for emergency Caesarean section was Fetal Distress and the most common indication for elective Caesarean section was previous cesarean with refused vaginal delivery after cesarean section. The maternal outcome in terms of post-operative wound infection, (post-partum hemorrhage, urinary tract infection need for blood transfusion, fever and need for maternal intensive care unit admission was significantly (p- value 0.05) higher in emergency Caesarean section than in elective Caesarean section .The fetal outcome in terms of birth asphyxia, meconium stained liquor and need for Neonatal ICU admission were significantly (p - value 0.05) higher in emergency Caesarean section than in elective Caesarean section., Conclusions: Maternal and fetal complications were significantly higher in the emergency caesarean section as compared to elective caesarean section group.

Background: To determine the causes of fistula and to share our experience in treating urogenital fistula and its surgical outcome., Methods: This was a retrospective study done at Kathmandu Model Hospital from January 2014 to June 2019 including 261 patients operated for fistula. The patients were analyzed for age, type of fistula, cause, treatment and surgical outcome., Results: Out of 261 patients operated, 59.38% cases had obstetric fistula, 38.69% had iatrogenic and 1.92% had traumatic fistula. Most of the patients with obstetric fistula were between 21 to 25 years of age whereas iatrogenic fistulae were between 46-50 years of age. The majority (54.84%) of obstetric fistulae were vesicovaginal fistula (54.84%) while the commonest type (77.36%) of iatrogenic fistula was vault fistula after abdominal hysterectomy., Conclusions: This study showed that obstructed and neglected labor was still the major cause of genitourinary fistula in Nepal nevertheless iatrogenic fistula following pelvic surgery is increasing. The surgical outcome of repair of fistula was good.

Background: Abnormal uterine bleeding is defined as any bleeding outside of normal menstruation pattern with excessive duration, frequency, and amount and it is a common problem among women of reproductive age group with varied presentations. The aim of the study was to correlate the histopathological finding in patients with abnormal dysfunctional uterine bleeding with the presenting clinical feature., Methods: A prospective cross sectional study was carried out at Paropakar Maternity and Women's Hospital, Thapathali, Kathmandu during the period of one year (February 2019 to January 2020). It included 77 perimenopausal women with abnormal uterine bleeding who presented in gynecology outpatient department and planned for dilatation and curettage. Then the participants were counselled and informed consent was taken. Histopathological reports reviewed and analysis done., Results: The most common age group of women presenting with abnormal uterine bleeding was 40 to 44 years and the commonest clinical feature was menorrhagia (31/77, 40.3%) followed by menometrorrhagia (18/77, 23.4%). Majority of women were multiparous, parity 3 to 4 (38/77, 49.4%). Proliferative endometrium (29/77, 37.7%) was most common histopathological findings followed by secretory endometrium (24/77, 31.2%). Proliferative endometrium was more commonly associated with menorrhagia and menometrorrhagia whereas secretory endometrium with metrorrhagia (P-value 0.000)., Conclusions: Menorrhagia and Menometrorrhagia are the most common clinical presentation among perimenopausal women with AUB, whereas proliferative endometrium and secretory endometrium were the common histopathological findings respectively.Accurate diagnosis is crucial for a selection of relevant treatment and avoidance of unnecessary major surgical procedure.

Introduction and Hypothesis: Pelvic floor muscle training (PFMT) and lifestyle advice are effective at improving the symptoms and severity of pelvic organ prolapse (POP) in a range of populations; however, the impact of these interventions in Nepali women is unknown. We aimed to evaluate the impact of an informational flipchart on PFMT and lifestyle advice on the quality of life (QOL) for Nepali women with a POP., Methods: This prospective randomized controlled trial recruited 140 women with a stage I-III POP from Kathmandu Valley. The intervention group were instructed on PFMT and lifestyle advice through an informational flipchart and the control group were provided usual care. The primary outcome measure was the Prolapse Quality of Life questionnaire (P-QOL) and was completed at baseline, 6 weeks, 12 weeks and 6 months. The secondary outcome measure was the Pelvic Organ Prolapse Quantification (POP-Q) system and Modified Oxford Scale (MOS) assessed by clinical examination at baseline and 6 months. Differences in mean P-QOL scores for each domain were evaluated using analysis of covariance., Results: Compared with usual care, the women in the informational flipchart group experienced significant improvement in six of the nine P-QOL domains and for the prolapse, bladder and bowel symptoms. Only a small percentage (20%) of women were able to attend the 6-month clinical assessment so we were unable to assess the secondary outcomes., Conclusions: A one-time intervention of an informational flipchart on PFMT and lifestyle advice is effective at improving QOL and symptoms for Nepali women with a stage I-III POP.

Background: Nepal government has legalized abortion and approved both medical abortion and manual vacuum aspiration for first trimester pregnancy. However, there is inadequate evidence in our setup to comment on the acceptability and complications of medical abortion and manual vacuum aspiration for termination of pregnancy up to nine weeks of gestation. The objective of this study is to compare the reasons for termination of pregnancy, effectiveness and complications between medical abortion and manual vacuum aspiration in termination of pregnancy up to nine weeks., Methods: A comparative study was conducted among women requesting termination of pregnancy up to nine weeks of gestation in Comprehensive Abortion Care unit of Paropakar Maternity and Women's Hospital. Women were kept in medical abortion and manual vacuum aspiration groups after they chose the method. They were advised for follow up in two weeks. Reasons for termination, effectiveness and complications of medical abortion and manual vacuum aspiration were compared using Chi square test., Results: In a total of 160 women, the most common reason for termination of pregnancy was completion of the family. In manual vacuum aspiration group 43 (58.9%) women had minimal per vaginal bleeding while 30 (40.54%) women in medical abortion group had per vaginal bleeding for 6-10 days(p less than 0.001). Rate of complete abortion in medical abortion group was 85.14% (n=63) and in manual vacuum aspiration group was 93.15% (n=68)., Conclusions: The complications following medical abortion were higher than manual vacuum aspiration in termination of pregnancy up to nine weeks. Rate of completeness of abortion following manual vacuum aspiration is superior over medical abortion.

Background: Despite continuous efforts to increase the utilization of institutional delivery care services nearly two-fifths women deliver their babies at home without the assistance of skilled birth attendants (SBA) in Nepal. The skilled care at birth can reduce the high maternal and neonatal mortality. This study explored childbirth practices and women's perceptions of childbirth and its associated factors., Methods: An exploratory study was conducted in three purposively selected remote villages of Kapilvastu district, from March to May 2017. Face-to-face in-depth interviews were conducted with women who had an under-one year child. We performed a thematic analysis to draw the findings of the study., Results: Women sought institutional delivery care either for long labor-pain or obstructed-delivery. Despite various incentives, people still preferred home for normal deliveries. There was also practiced skilled birth attendant (SBA) assisted home delivery care. Some of the local health workers also advised pregnant-women for assisted home delivery care. People considered childbirth as a normal process. Due to cultural beliefs and norms, people were also reluctant to pursue institutional delivery care services. Financial constraints, poor access to services and expensive transportation services were other underlining causes of home delivery practices., Conclusions: Despite various incentives for institutional delivery care; the study did not spectacle an encouraging reaction. It pointed to the very basic and strong relationship between women's position in the household and the society and education with childbirth practices. There were limits to how far financial incentives can overcome these obstacles. So, the improvement of the socio-economic conditions of the women would be the viable way-out of the problem.

Coronavirus disease 2019 (COVID-19) is a newly emerged disease that has become a global public health concern as it rapidly spread around the world. The etiologic agent responsible for this disease has been named as severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) by the International Committee on Taxonomy of Viruses as it shows similar genomic features to that of SARS-CoV which caused a pandemic in 2002. This disease first appeared in Hubei province of China and it follows human-to-human transmission but the path this virus took to set up human infection remains a mystery. By 17 April 2020, globally there have been 2,074,529 confirmed cases with 139,378 deaths because of COVID-19. SARS-CoV-2 shows several similarities with SARS?CoV, and Middle East Respiratory Syndrome Coronavirus (MERS-CoV) with its clinical presentations. This can vary from asymptomatic infection to severe disease and mortality. Real-time reverse-transcription polymerase chain reaction (rRT-PCR) screening is considered as the standard laboratory test for the diagnosis of COVID-19. There is no proven antiviral agent against SARS-CoV-2 so the treatment for COVID-19 is symptomatic, aiming for the management of the symptoms and prevention of the complications. The outbreak of COVID-19 has led to the implementation of extraordinary public health measures throughout the world. Numerous antiviral compounds used to treat other infections are being clinically researched to find possible treatment. Similarly, the traditional public health outbreak response strategy of isolation, quarantine, social distancing and community containment has been implemented in multiple countries and has played an important role in the prevention of new outbreaks. This review aims to enhance our understanding of COVID 19. Keywords: Coronavirus disease 2019; COVID-19; SARS-CoV-2; novel coronavirus 2019; severe acute respiratory syndrome-2.

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Background: Aims of this study was to assess the caesarean section rate and identify the indications contributing to the same using the Robson's Ten Group Classification System at Kathmandu Model Hospital., Methods: This was a retrospective study conducted at Kathmandu Model Hospital among women who underwent caesarean section from 1 January to 31 December, 2018 and were grouped according to Ten Group Classification System. The overall caesarean section rate and the contribution of each group was calculated., Results: The overall caesarean section rate was 66.1% (494 among 747 total deliveries) in 2018. Nullipara, singleton cephalic, >= 37 weeks, spontaneous labor (Group 1) was the major (24.2%) contributor to the overall caesarean section rate followed by previous caesarean section, singleton cephalic, >=37 weeks (Group 5, 22.6%) and nullipara, singleton cephalic, >=37 weeks, induced or caesarean section before labor (Group 2, 18.8%). Also, the caesarean section rate was 49.5% in nullipara, thus increasing the trend of caesarean section for previous caesarean section in future., Conclusions: Efforts must be focused more on Group 1, 2 and 5 to decrease the increasing trend of caesarean section Promoting vaginal delivery in nullipara and facilitating vaginal birth after caesarean are the most relevant areas of intervention.

Background: A hypertensive disorder in pregnancy comprises one of the deadly triad along with hemorrhage and infection-that contributes greatly to maternal morbidity and mortality. The aim of this study was to compare the feto-maternal outcome in pregnancy induced hypertension with normotensive pregnant women., Methods: A cross sectional prospective study was conducted in Paropakar Maternity and Women's Hospital from 1st February 2018 to 1st May 2018. All pregnant women seeking help for hypertension during this period was included in the study and were followed up to six weeks of postpartum period., Results: Total 40 patients were enrolled in each arm. The highest number of pregnancy induced hypertension cases was seen in age group 20-24years (32.5%) and were mostly primigravidas (60%). The commonest symptom in Pregnancy induced hypertension was headache 47.5 %. The mean hemoglobin value was 11.91 gm/dl, mean SGPT (Gestational hypertension 25.44 IU/L, preeclampsia 55.25 IU/L and eclampsia 32.17 IU/L) and mean platelet count was 1, 95,140 lakh/cumm in pregnancy induced hypertension. Mean prothrombin time in gestational hypertension was 13.78±0.7 seconds. Most common maternal complication was preterm labor and fetal complication was prematurity. The most common mode of delivery was vaginal., Conclusions: Pregnancy induced hypertension was more common in primigravida with young age group of 20-24 years and presented commonly with complain of headache. Preterm labor was the most common maternal complication similarly prematurity was the commonest fetal complication seen in pregnancy induced hypertension. Vaginal delivery was the commonest mode of delivery. Blood investigation showed significant thrombocytopenia in eclampsia and decreased prothrombin time in gestational hypertension.

Obstetric fistula is a hidden tragedy in the developing world, prevention is important and treatment is by surgical repair. However, failure, broken fistula, stress incontinence often demoralizes surgeons and patients. Keywords: Fistula repair; Obstetric fistula; Obstructed delivery.

Background: Workplace violence among nurses is prevalent worldwide. If nurses become aware of the workplace violence and its risk factors then only they can protect themselves. This study assessed the prevalence of workplace violence and its associated factors among nurses in Pokhara, Nepal., Methods: A hospital-based descriptive cross-sectional study was conducted in Pokhara. The required sample size of the study was 200 nurses. We adopted self-administered questionnaire developed by International Labor Office, International Council of Nurses, World Health Organization (WHO), and Public Services International. Out of 21 hospitals of Pokhara, we selected five hospitals using simple random sampling method. The number of nurses in each hospital was fixed proportionately considering the total number of employed nurses. Individual nurses were selected on the first meet first basis to gain the required number., Results: Two-thirds (64.5%) nurses experienced some type of violence in the last six months at their workplace. The proportion of verbal violence was higher (61.5%) compared to the physical (15.5%) and sexual violence (9%). Most perpetrators of the violence were the relatives of patients and hospital employees. Age of nurses and working stations had statistically significant association with workplace violence (p-value < 0.05)., Conclusions: Workplace violence among nurses is a noteworthy problem in Pokhara whereas nearly two-thirds of nurses faced some type of violence in last six months. It is an urge to widen awareness level of nurses on the violence thus, they can take precaution themselves and ask hospital administration and other stakeholders to address the workplace violence.

Delivery care is regarded as safe when it is attended by a skilled birth attendant either at health facility or home. Childbirth practices differ from place to place and are determined by availability and accessibility of health services. After National Health Policy (1991), Nepal has focused on safe motherhood policies and programmes. Maternal mortality ratio decreased nearly fourfold between the years 1990 to 2011. The country is likely to achieve the Millennium Development Goal (MDG) 5. However, indicators of the MDG 5: skilled care at birth and institutional delivery rates are very far from the targets. From the initial findings of limited studies, safe delivery incentive programme has been successful for increasing the skilled care at birth and institutional delivery and reducing the maternal mortality twofold between the years 1990 to 2011. In spite of numerous efforts there is a wide difference in the utilization of skilled care at birth among the women by area of residence, ecological regions, wealth quintiles, education status, age and parity of women, caste ethnicity and so forth. This difference indicates that current policies and programmes are not enough for addressing the low utilization of safe delivery care throughout the country.

Introduction: Multicenter surveillance has been carried out on maternal near-miss in the hospitals with sentinel units. Near-miss is recognized as the predictor of level of care and maternal death. Reducing Maternal Mortality Ratio is one of the challenges to achieve Millennium Development Goal. The objective was to determine the frequency and the nature of near-miss events and to analyze the near-miss morbidities among pregnant women., Methods: A prospective surveillance was done for a year in 2012 at nine hospitals in Kathmandu valley. Cases eligible by definition were recorded as a census based on WHO near-miss guideline. Similar questionnaires and dummy tables were used to present the results by non-inferential statistics., Results: Out of 157 cases identified with near-miss rate of 3.8 per 1000 live births, severe complications were postpartum hemorrhage 62 (40%) and preeclampsia-eclampsia 25 (17%). Blood transfusion 102 (65%), ICU admission 85 (54%) and surgery 53 (32%) were common critical interventions. Oxytocin was main uterotonic used both prophylactically and therapeutically at health facilities. Total of 30 (19%) cases arrived at health facility after delivery or abortion. MgSO4 was used in all cases of eclampsia. All laparotomies were performed within three hours of arrival. Near-miss to maternal death ratio was 6:1 and MMR was 62., Conclusions: Study result yielded similar pattern amongst developing countries and same near-miss conditions as the causes of maternal death reported by national statistics. Process indicators qualified the recommended standard of care. The near-miss event could be used as a surrogate marker of maternal death and a window for system level intervention.