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Objectives: The purpose of this study was to isolate and identify microorganisms of food packaging papers of Kathmandu valley and determine antibiotic susceptibility of the isolates. Methods: A total of 34 food packaging paper samples were collected aseptically from hotels, bakeries and sweet shops (considered as closed shop) and open street vendors and were transported to microbiology laboratory of Golden Gate International College for processing. The isolates were identified by standard microbiological procedures and subjected to antimicrobial susceptibility testing by modified Kirby-Bauer disk diffusion method following CLSI guidelines. The rate of Extended Spectrum Beta- lactamase (ESBL) producing and multiple drug resistant (MDR) isolates were also determined. Results: All 34 samples yielded microbial growth with average microbial count of 4.145×105 CFU/g. Among 103 microbial isolates, 78 were bacteria, 15 molds and 10 yeasts. The predominant bacterial and mold isolates were Bacillus spp (43.59%) and Cladosporium spp (46.67%) respectively. Ciprofloxacin (42/43) and Amikacin (42/43) were the most effective and ampicillin (39/43) was most resistant antibiotics for Gram negative bacteria. A total of 9.30% Gram negative isolates were identified as ESBL producing and MDR strains. Conclusion: This result indicates that potential pathogens are found in food packaging papers which can be threat to health of consumers as they may act as a source of food borne infection.

Newborn weight exceeding 4000 g or 4500 g is considered as macrosomia, incidence of which varies from 6 to 10% of all deliveries. Maternal diabetes, obesity, age >35 years, male baby, history of previous macrosomia, multiparity are few risk factors. It is associated with several maternal and neonatal complications and presents an obstetric challenge as there is no consensus regarding the most appropriate route of delivery for macrosomic baby. We report a rare case of fetal macrosomia with birth weight of 6.25 kg delivered by cesarean section to 39 years old woman at 38 weeks 6 days period of gestation.

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Neoplastic as well as non-neoplastic lesions commonly involve oral mucosa. It had been observed that benign lesions were more common than malignant ones. The present study was done to evaluate the pattern of distribution of various oral mucosal lesions in a tertiary care hospital.This retrospective cross-sectional study reviewed the archival records in the Department of Pathology, Gandaki Medical College, Nepal from January 2017 to December 2020. The records of patients with histopathologic diagnosis of oral mucosal lesions were obtained. The histopathological diagnosis, age, gender, and the site of involvement were collected using a prepared form. Descriptive statistics was applied using SPSS 20 software.Oral mucosal lesions included 3.7% (180 out of total 4895) of cases diagnosed histopathologically. The cases were common among females (101cases/56.1%). Most of the oral mucosal lesions were diagnosed in more than 45 years old patients (75cases/41.7%). The non-neoplastic oral lesions (106cases/58.9%) were the most common lesions followed by neoplastic oral lesions (52cases/28.9%). Among non-neoplastic oral lesions, reactive hyperplastic oral lesions were the most common (50cases/27.8%). Reactive hyperplastic oral lesions frequently affected gingiva (18cases/36%). Neoplastic lesions (Benign neoplasm: 12cases/44.4%; Malignant lesions; 10cases/40%) frequently affected the tongue.Oral lesions were mostly non-neoplastic and reactive hyperplasia being the most commonest presentation Keywords: Neoplastic; non-neoplastic; oral mucosal lesions; reactive.

Aims: To compare the effectiveness of mifepristone plus misoprostol in pre-induction cervical ripening and induction of labour in uncomplicated post-dated primigravidae. Methods: It is a hospital based prospective comparative study enrolling 50 uncomplicated post-dated pregnancies in each group to determine the efficacy and safety of mifepristone and misoprostol with misoprostol alone for induction. It was conducted in Institute of Medicine. Computer software SPSS 20 was used for processing and analysis of the data. Chi-square test and paired sample t-test was used. Results: Comparing change in Bishops score among the two groups, no any statistically significant difference was seen. Sixty-six percent delivered vaginally in mifepristone group as compared to 42% in misoprostol group (p≤0.01). Rest delivered by caesarean section. No significant maternal side effects and complications were seen. Twenty-six percent in mifepristone group and 50% babies in misoprostol group developed fetal side effects (p=0.01). Conclusions: Mifepristone and misoprostol both bring favourable change in the Bishop’s score. Regarding success rate and fetal complications mifepristone seems to be effective and safe. Keywords: induction of labour, mifepristone, misoprostol, post-dated pregnancy

Leiomyoma is considered the most common benign tumor of genital tract with variable presentation and diverse operative findings. We are presenting a case of asymptomatic huge subserosal pedunculated leiomyoma in a 37 years unmarried nullipara lady diagnosed as highly vascular abdominopelvic mass preoperatively as suggested by imaging studies but of uncertain origin, imposing surgical challenge due to diagnostic dilemma and its vascularity. Laparotomy revealed solid mass of 26 x 24 cm occupying whole abdomen covered with torturous dilated serpentine vessels derived from omentum. The mass was arising from the fundus of bulky uterus with small pedicle suggesting suserosal pedunculated leiomyoma. Myomectomy with infracolic omentectomy with round ligament plication was done and her post operative recovery was smooth. Histological examination confirmed it as leiomyoma. Keywords: Omentum, Pedunculated Leiomyoma, Serpentine

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.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.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).The present study strengthened previous findings regarding the uptake of EIs following joint promotion by HCPAs in low-income settings.

Aims: This study was performed to review the places, indications, maternal-perinatal outcomes requiring emergency air transfer to a tertiary level referral center.Methods: A hospital based descriptive study of one year duration, conducted in Tribhuvan University Teaching Hospital (TUTH), over a period of twelve months. All the women who were air transferred for pregnancy complications were enrolled.Results: There were total 19 airlifted obstetric emergencies to TUTH over one year period: majority (68%) from hilly areas and others (32%) from mountain region. Out of them, referred cases were 11 [district hospital (5), healthpost (4); Primary Health Center (PHC) (2)]; and rest were from home (8). Two cases were abortion related; septic abortion (1) and incomplete abortion (1). There were three antepartum cases: pregnancy with meningoencephalitis (1), eclampsia (1) and bleeding placenta previa (1); maximum, eleven intrapartum cases, obstructed labor (6),labor dystocia (3), breech in labor (1) and undelivered second twin (1). Rest three were postpartum cases, one each of eclampsia, puerperal sepsis and retained placenta. Maternal morbidities were one each case of uterine rupture, acute kidney injury, retained placenta with PPH and vesicovaginal fistula that developed in the case of shoulder dystocia. Maternal mortality occurred in 2 cases, first women with antepartum eclampsia who had intracerebral bleed and second was a case of pregnancy with meningoencephalitis who later developed brain death. Regarding perinatal outcome 12/14 (86%) had live birth and 2/14 (14%) had IUFD upon arrival.Conclusion: Air lift on personal expenditure, despite economic constraints has proven beneficial in our country’s context with difficult geographical terrain and inadequate health services, whereas anticipation of any critical condition right in the beginning and timely transfer however could have been more advantageous.

Introduction: Over the last few decades, the rise in the rates of Caesarean Sections (CS) has become a global phenomenon. The objective of this study was to follow the CS rates over the last 10 years and to compute the various indications of CS in an attempt to analyze the possible reasons for this changing trend in the institute. Methods: All deliveries that took place between April 13, 2004 to April 14, 2014 (Baisakh 2061 BS and Chaitra 2070 BS) in TUTH were retrospectively collected. Annual total number of deliveries, rates of CS, instrumental deliveries and Vaginal Birth after Caesarian Section (VBAC) along with indications for CS were computed and analyzed. Result: A total of 38,770 deliveries were conducted over ten years with 26,791 (69.10%) vaginal deliveries and 11,979 (24.80%) CS. There was a steep rise in the rates of CS from 21.04% in 2004 to 39.23% in 2014. Rates of instrumental deliveries and VBAC remained low at 0.86% to 3.35% and 0.15% to 0.7 % respectively. Fetal distress was the commonest indication of emergency CS while previous CS was the commonest indication for elective CS. Conclusion: Over the last decade, the global trend of rising CS rates was also found to be mirrored at TUTH. The causes for rise in CS rates were- increased diagnosis of fetal distress and oligohydramnios, delivery of most breech by Caesarean sections, low rates of VBAC and instrumental deliveries, complicated referrals from all over the country and last but not the least, threat of malpractice litigations. Journal of Society of Surgeons of Nepal Vol. 17, No. 2, 2014, Page: 7-11

Background Foreign bodies are less common in uterine cavity than vagina, and are less frequently seen in older women than prepubertal or premenarchal girls. When found in the uterus, these foreign bodies are usually forgotten intrauterine contraceptive device or retained fetal bones, objects which were introduced in the former case or the remnants of conceptus parts that was inadvertently retained as in the latter circumstances. Here, we are going to concentrate in foreign body that made its way into the uterine cavity unaided. Aim To study rice grain as retained intrauterine foreign body in women with prolapsed uterus. Methods Collection of series of cases of rice grain in the uterine cavity of women exposed to vaginal hysterectomy and pelvic floor repair for uterine prolapse from the year 2004 till date, from the Department of Obstetrics and Gynecology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal. Results The rice grains as foreign body were entirely seen in postmenopausal multiparous women with the long standing cases of major degree of uterovaginal prolapse, chronicity affirmed by cervical hypertrophy and keratinization. These intrauterine rice grains, 1 to 3 in numbers were found at various level within the uterine cavity with resultant pyometra formation and urinary retention posing surgical difficulties in two cases. Conclusion Possibilities of rice grain as foreign body must be kept in mind in the complicated cases of uterovaginal prolapse posted for hysterectomy. How to cite this article Baral J, Rana A, Gurung G. Rice Grain in Uterine Cavity: Rare Presentations in Rural Nepalese Postmenopausal Farmer with Uterovaginal Prolapse. J South Asian Feder Menopause Soc 2014;2(2):79-82.

Two cases of Papillary carcinoma of thyroid and pregnancy were managed, one with the existing disease diagnosed during pregnancy and the other with a history of near total thyroidectomy. A multidisciplinary approach in the management of both the mothers lead to an uneventful pregnancy, caesarean section with good outcome and were discharged in good health. DOI: http://dx.doi.org/10.3126/joim.v34i3.8919 Journal of Institute of Medicine, December, 2012; 34:54-57

A pregnant woman, gravida 3 with two living children, who frequently experienced syncope from 23(+5) weeks of pregnancy onwards and recurring every week for a period of 3 weeks, was repeatedly treated in line for a case of acid peptic disease/appendicitis in various peripheral hospitals of Nepal, until ultrasonogram/magnetic resonance imaging diagnosis of an (undisturbed) live 27(+5) weeks abdominal pregnancy was made at our hospital. On laparotomy, this materialized to be secondary to the rupture of a left rudimentary horn pregnancy (evidenced from its sealed margin) which still retained a complete placenta, from where an umbilical cord was seen, traversing across towards the right side of the abdominal cavity just below the liver, securing its attachment to the surviving fetus and enclosed in an intact amniotic sac. Excision of the rudimentary horn containing the placenta was accomplished, after the delivery of a live baby weighing 650 g who unfortunately died on the third day of life.

Introduction: Acute appendicitis is the most common acute condition of the abdomen requiring surgery in both adults 1,2 and children. 3.5 The overall frequency of appendicitis for symptomatic patients younger than 20 years is 41%; the frequency for those older than 20 years is 59%. Methods: This was a prospective cross sectional study involving 104 patients aged between 8 and 68 years with clinical suspicion of acute appendicitis. Patients with suspected acute appendicitis were evaluated with high frequency linear transducer using graded compression technique. Peroperative findings were noted and histopathological examination were carried out in all the cases for confirmation of acute appendicitis. Sensitivity, specificity, negative predictive value, positive predictive value and accuracy of ultrasonography were calculated by using statistical method. Results: Among 104 patients (61 males and 43 females) with clinical diagnosis of acute appendicitis, ultrasonography was positive for acute appendicitis in 79 patients (75.96%). On histopathological examination, 94 appendices (90.38%) were acutely inflamed. The sensitivity of ultrasonography for the diagnosis of acute appendicitis was 78.72% with specificity of 60%. Positive predictive value, negative predictive value and accuracy of ultrasonography were 94.87%, 23.07% and 76.92% respectively. Conclusion: Ultrasonography is a useful method of diagnosing clinically suspected acute appendicitis especially in doubtful cases. DOI: http://dx.doi.org/10.3126/joim.v34i3.8908 Journal of Institute of Medicine, December, 2012; 34:8-11

A 17-year-old girl had a large abdominopelvic mass (12 x 8cm) extending from vagina, due to the presence of a complete transverse vaginal septum in its middle third which on resection facilitated the drainage and disappearance of the mass finally diagnosed as a case of mucocolpos.

Introduction: Breast cancer is one of the major health problem for all countries. . In Nepal , breast cancer is the second most common cancer in female. Early detecting tools like mammography can able to detect location , size, morphology, and nature of breast lesions that can help to reduced mortality and morbidity from breast cancer significantly. Methods: This prospective study was carried out at the department of Radiology, Surgery and Pathology for a period of one year. A total of 100 patients with clinically palpable breast lump were subjected to mammography and subsequently to FNA or biopsy. The mammograms were reviewed by two senior consultant radiologists and pathology by a senior pathologist. Results: Out of 100 patients, 65% had mammographic features of benign lesion and 35% had features of malignancy. Pathology revealed 64% of lesion to be benign and 36% of lesion to be malignant. There were four false negative (6.2%) and three false positive (8.6%) cases. The sensitivity and specificity of mammography were 88.9% and 95.53% respectively. The mean age of patient with malignant lesion was 46.3 years (SD=11.5) and 34.7 years (SD=10.6) for benign lesions. Among malignant lesion 37.1% had lobulated, 14.3% had oval, 31.4% round and 17.1% had irregular shape with spiculated margin in 60% and indistinct margins in 34.3%. Among benign 7.7% showed lobulated shape, 41.5% oval and 50.8% round shape. Circumscribed margin was found in 93.9% of benign and 5.7% of malignant lesions. Punctuate and polymorphic calcification was found in malignant lesions (25.7% and 5.7%). Secondary changes were found in only in the malignant cases. Halo sign was found only in benign cases and most common in fibroadenoma (38.4%). Conclusions: Mammography is an effective diagnostic tool for benign and malignant characteristic of palpable breast mass. Keywords : Breast lump; mammography; micro calcification DOI: http://dx.doi.org/10.3126/joim.v32i2.4940 Journal of Institute of Medicine , August, 2010; 32: 21-25

We report a case of hematometra and bilateral hematosalphinx in a 15-year-old mentally handicapped adolescent girl, complicated by vaginal agenesis over cervical atresia in the presence of an ovarian adenoma. The case was managed by abdominal hysterectomy and bilateral salphingectomy of the hematosalphinx, which had formed a tubo-ovarian mass. One ovary was preserved. This case also considers the management of the mentally handicapped patient unable to comprehend pain arising from cryptomenorrhea.

Chronic vaginal discharge in children and adolescents is a common gynaecological complaint which is often resistant to antibiotic treatment. We present a 14 years old, premenarcheal girl who presented to us with the complaints of recurrent, foul smelling purulent occasionally blood stained vaginal discharge for eight years, where a foreign body in the upper vagina was found after releasing a dense adhesion of the lower vagina which was unable to detect by pelvic ultrasound.

Extensive torsion of umbilical cord, a rare complication, shown by 2 fetuses with too frequent changes in their lie and presentation with subsequent development of fetal growth restriction (FGR), culminating intrauterine fetal death of one with transverse lie and survival of the other with decreased fetal movement worsened by impending eclampsia both managed by caesarean section is reported.

Aims: To study the distribution of different types of ovarian tumors seen in adolescents and children and evaluate the commonest tumor during this period. Methods: A prospective study conducted at Dept of Ob/Gyn, Tribhuvan University Teaching Hospital form January 1999 - January 2008. Results: There were a total of 80 cases of ovarian tumors in childhood and adolescents. Most of the cases had presented to the outpatient department of Ob/Gyn (54%), Medicine (10%), Surgery (21%) and Emergency Unit (15%). Majority of the cases were between the ages of 15 to 19 and tumors in childhood age up to 14 represented 21% of the total ( < 10year being 4). The most frequently occurring tumor was Germ cell tumors accounting for 59 (73.7%) of the total. Out of which dermoid was the most frequently occurring in 45(76.2%). Nineteen (23.71 %) of the total tumor were malignant. All of them underwent laparatomy followed by enucleation (14); Unilateral ophoorectomy (28), unilateral salphingooophorectomy (36) and TAHBSO (2). Conclusion: This study shows the preponderance of germ cell tumor and high percentages of malignancies within germ cell tumor in young children and adolescents. Keywords: childhood, adolescent, ovarian tumors, malignancy doi:10.3126/njog.v3i1.1438 NJOG 2008 May-June; 3(1): 39 - 42

Aim: To study laparotomy as second intervention for hemoperitoneum following primary surgery in obstetric and gynecology. Method: Eleven years retrospective study going back from Dec 2006 embracing all the cases of re/laparotomy for intraperitoneal bleeding were carried out in TUTH, Nepal. Results: Of the 24 cases complicated by intraperitoneal hemorrhage for which relaparotomy had been done 12 each were formed by gynaecologic and obstetric cases: 11 were caesareans (CS) and a laparotomy following vaginal birth after caesarean (VBAC). In gynecology the preceding surgeries undertaken were [diagnostic laparoscopy (1), laparotomy (3), hysterectomies 8 (3 being vaginal)] Massive hemoperitoneum occurred in ¼ cases; extensive hematoma in a third having altogether with associated risks factor in 9(37.5%).Source of bleeding were disligated/abraded infundibulopelvic vessel (3), cuff bleeding (4), cardinal ligaments (1), uterine cornua (1), uterine angles (6), vagina (1) and placental bed (1) which were duly managed by 5 obstetrics hysterectomy. Laparotomy >2 times were repeated 4: obstetric 2 [(1) for vault bleeding following hysterectomy done for scar rupture after VBAC and other for slippage of ovarian vessel following hysterectomy and internal iliac ligation] and same number in Gynecology 2 [(1) after vaginal hysterectomy first for laceration of infundibulopelvic vessel and then for generalized ooze and hematoma]. Next was following a diagnostic laparoscopy, complicated by unexplainable intraperitoneal bleeding first devised by internal iliac ligation, then finally by hysterectomy that died. Conclusions: Careful tying of the blood vessel, choosing right technique and appropriate ligature in the first place is as important as proper closure of all the surgical incision/ inflicted cut taking note of the rise in the pulse rate and fall in the blood pressure in overall postoperative cases such that related morbidity and mortality from late diagnosis leading to delayed second surgical intervention can be obviated or minimized. Key Words: Intraperitoneal bleeding, hemoperitoneum, relaparotomy doi:10.3126/njog.v2i2.1458 N. J. Obstet. Gynaecol 2007 Nov-Dec; 2 (2): 63 - 68

Aim: To find out the incidence and correlation of preoperative hemoglobin level (Hb %) with hemoperitoneum in cases of ectopic pregnancy (EP). Methods: This was a prospective study carried out in Tribhuvan University Teaching Hospital (TUTH), Nepal during the period of 5 years; 15 April 2002-14 April 2007 (Baisakh 2059 - Chaitra 2063). All the cases of hemoperitoneum from rupture of EP confirmed at laparotomy were analyzed. Unruptured ectopic EP undergoing medical management or ruptured organized EP forming tubo-ovarian mass and ruptured rudimentary horn pregnancy without hemoperitoneum were all excluded. Datas were collected from patient's interview, reviewing the operation record and record file. Result: Of the total 167 EP constituting 0.963 % of all deliveries, managed during the five years period, 150 (90%) cases with hemoperitoneum were analyzed. Further excluding five cases not mentioning the amount of hemoperitoneum 145 [ < 1500ml (98) or >1500ml ->3000ml (47)] was categorized to have different degrees of anaemia was ascertained in 90 (62.1%): Severe (13), moderate (55) and mild (22). Results depicted a negative (inverse) correlation between pre operative Hb level and hemoperitoneum. Conclusion: In conclusion there is negative (inverse) correlation between pre-operative Hb percentage and hemoperitoneum which is statistically significant. Keywords: Ruptured ectopic, hemoperitoneum, hemoglobin level doi:10.3126/njog.v2i1.1475 N. J. Obstet. Gynaecol Vol. 2, No. 1, p. 39 - 43 May -June 2007

Aim: To determine whether short term bladder catheterisation for 24 hrs after vaginal hysterectomy for prolapse would be more advantageous to routinely practiced 3 days catheterisation. Method: Randomized comparative study was done as thesis topic in Gynaecological Ward of TU Teaching Hospital, Maharajgunj, Kathmandu from 30th October 2004 to 2nd November 2005. A total of 100 women were included in this study. Prior to surgery at OT table, and before giving prophylactic antibiotics urine samples were collected from metal catheter for routine analysis. They were randomized into two groups. In groups 1 (n=50) transurethral catheter was removed after 24 hrs of surgery. In group 2 (n=50) catheter was removed on 3rd post operative day. Urine culture was taken before removal of the catheter. Residual volume of urine after the first voiding was measured by transabdominal ultrasound. Recatheterisation for three more days was considered whenever residual volume exceeded 200ml. Result: Recatheterisation was not needed in either groups for residual volume >200ml. Regarding recatheterisation 4 needed them after 2-3 hrs of first voiding. Among these 4 women, cause of urinary retention was accountable for pelvic haematoma leading to pelvic abscess in one case, which belonged to group 1 where as urinary tract infection was responsible for urinary retention in group 2. There were no explainable causes in two cases. But urinary tract infection was seen in two cases in group 1 and 11 cases in group 2 (P value 0.017). Conclusion: This study has shown that short term catheterisation is more beneficial in terms of lower incidence of urinary tract infection (2 Vs 11) and related febrile morbidity as compared to long term catheterisation. Key words: Uterovaginal prolapse, pelvic floor repair with vaginal hysterectomy, catheterisation. doi:10.3126/njog.v2i1.1473 N. J. Obstet. Gynaecol Vol. 2, No. 1, p. 29 - 34 May -June 2007

How the largest of the large (> 10 x 8 cms) sub mucous myoma arising from the fundus uteri successively promotes the occurrence of non puerperal uterine inversion over the years as depicted through 3 different illustrations imitating a gradual process; first by forming an indentation in the uterine fundus then progressively causing more dimpling in the verge of uterine inversion until finally giving rise to a full blown picture of complete uterine inversion where the uterine fundus is driven beyond the level of introitus with the consequences of prolapsed incarcerated myoma in a post menopausal woman. A total abdominal hysterectomy and bilateral salpingoophorectomy were performed on all of these 3 women 2 perimenopausal and a postmenopausal; the latter was first facilitated by vaginal myomectomy further supplemented by division of the inversion ring posteriorly as described by Haultain. Key words: Non puerperal uterine inversion, submucous fundal myoma, vaginal myomectomy. doi:10.3126/njog.v1i2.2398 N. J. Obstet. Gynaecol Vol. 1, No. 2, p. 51-54 Nov-Dec 2006

Introduction: The purpose of this study was to categorize new reference ranges for measurements of commonly used umbilical artery and fetal middle cerebral artery Doppler indices (Pulsatility Index, Resistance Index, and Systolic: Diastolic ratio) in uncomplicated third trimester pregnancy. Methods: This was a prospective cross sectional study involving 101 singleton uncomplicated pregnancies of 30 to 37 weeks of gestation. Umbilical artery indices were obtained from free floating loop and middle cerebral Doppler indices were obtained from the proximal third of the artery with flow towards the probe. Regression equations were used to categorize reference ranges and percentile fitted Normograms were obtained for all the parameters. Results: Among 101 singleton pregnancies between 30 and 37 weeks of gestation, 65 (64.35%) were primigravida women and 36 (34.65%) were multigravida. Mean maternal age was 23.12years (range 16 to 35 years). Maximum number of pregnancies (18.81%) was at 34 weeks of gestation. The established percentiles of Doppler indices showed a continuous reduction of all the measured indices as pregnancy increases (p

Placental site trophoblastic tumor (PSTT) a rare variety of gestational trophobalstic neoplasia described in younger women, usually following term delivery characterized by low serum ß hCG level was met in a 32 year old lactating mother, who resumed normal menstruation after three months of cesarean section up to three cycles followed by amenorrhea for eight months; evacuation for presumed missed abortion prompted the diagnosis of PSTT which at the time of hysterectomy was found invading perimetrium and perforating the uterine cesarean scar. Conclusion: Careful evaluation of lactational amenorrhea is indicated so that the diagnosis of PSST may not be missed in the background of elusive picture such as missed abortion with low serum ß hCG, histological examination of the evacuated material may be relied which may provide the diagnosis at times. Key words: Placental site trophoblastic tumour (PSTT), hysterectomy, low serum ß hCG doi:10.3126/njog.v3i1.1443 NJOG 2008 May-June; 3(1): 55 - 57

A woman with a history of laparotomy and corrective abdominal surgery for acute puerperal uterine inversion reverted by division of the inversion ring anteriorly "Dobbins's operation" subsequently was successful to undergo assisted vaginal breech delivery arriving at second stage of labor warranting, manual removal of placenta which was complied with the management of PPH. This case is reported because of the rarity of uterine inversion itself in the first place. Next because of the conception taking place spontaneously after morbid puerperal period and then the pregnancy advancing to term: all the management beginning from correction of uterine inversion to retained placenta being handled in the same facility a rare event too in our set up. Key words: Uterine inversion and subsequent birth, manual removal of the placenta. doi:10.3126/njog.v2i2.1462 N. J. Obstet. Gynaecol 2007 Nov-Dec; 2 (2): 78 - 80

Degenerative changes in myomas found in the reproductive age group in day to day life is much lower than reported and in this respect we present as unusual case of myoma size 15 x 20 cm with myxoid degeneration in a 23 year old nulliparous lady presenting with menorrhagia, increased frequency of micturition who underwent myomectomy even after cystic changes was seen on USG and CT scan; this case indicating the importances of organ preserving surgery in young women. Key words: cystic changes, lump in lower abdomen, menorrhagia, myoma, myomectomy doi:10.3126/njog.v1i2.2403 N. J. Obstet. Gynaecol Vol. 1, No. 2, p. 66-68 Nov-Dec 2006

DOI: http://dx.doi.org/10.3126/njog.v5i2.5080NJOG 2010 Nov-Dec; 5(2): 48-49

DOI: http://dx.doi.org/10.3126/njog.v6i1.5258NJOG 2011; 6(1): 68