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Stillbirth is the term to describe a foetal demise in utero either prior to, or during the process of labour. It is one of the most burning issues in obstetrics research in recent years. Stillbirth is one of the most heart-wrenching events which can occur unexpectedly during the course of a pregnancy. It causes immense distress to the mother and the health professionals involved. This study aims to explore the incidence, sociodemographic characters, risk factors and obstetrical outcomes related to stillbirths among various studies in Nepal. We searched various electronic databases such as MEDLINE, CINAHL, PubMed, Nepal Journals on-line (NepJOL) and Bangladesh Journals on-line (BanglaJOL) from 2014 to 2021, especially for articles reporting hospital-based stillbirths. We included studies with primary studies on stillbirth conducted in a hospital setting in Nepal and published in English language. The incidence of stillbirths in Nepal varied widely. In this study, the incidence varied from 8 to 23.87 per 1000 births. The majority of stillbirths were preterm, occurring among women aged 20 - 35 years. Many stillborn babies were low birth weight. The categorisation of maternal age and weight of baby, lower limit of gestational week was not similar across the studies. Hypertensive disorders in pregnancy and unexplained factors were the leading risk factors. Limited number of studies available and the lack of uniformity among studies was the main limitation of this review.

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.

IntroductionInduction of labour has been common intervention in modern obstetrics. This study is aimed to determine the distribution of practice and outcomes related to induction of labour in Mid-Western Regional Hospital in Nepal. MethodsThis is a retrospective cross-sectional study conducted at Mid-Western Regional Hospital in Surkhet, Nepal. Secondary data were collected from patients’ records of the hospital dating from 16 July 2016 to 15 July 2017. All women who underwent induction of labour with oral misoprostol were included in this study. For induction of labour, maximum five doses of 50 microgram oral misoprostol was administered in every four hours. Descriptive summary statistics such as frequency and percentages were calculated.ResultsOut of total 3,694 pregnant women who delivered in MWRH, 10.5% (n = 387) were induced by oral misoprostol. Majority of labour induced women were in the age group of 20 – 24 years (52.9%), 37 – 42 weeks of gestation (69.5%), and multi-gravida (49.9%). Majority (77.0%) who underwent induction of labour had vaginal delivery. Among total induction of labour, 88.9% had healthy babies. Majority of new borns had APGAR score of six or more in both one minute (87.9%) and five minutes (93.6%). More than half of the new borns (54.5%) had birth weight of 3000 – 3500 grams. Most of the induced cases (97.4%) were free of complications. Only 1.3% of cases had post-partum haemorrhage. ConclusionsInduction of labour using oral misoprostol is a common practice in Mid-Western Regional hospital in Nepal and majority (77.0%) who underwent induction of labour had vaginal delivery.

Introduction: Cervical ripening is essential for successful induction of labor. The aim of the study is to compare the efficacy, safety and cost-effectiveness of extra-amniotic saline infusion, Foley’s catheter and intra-cervical PGE2 gel for pre-induction cervical ripening. Methods: A total 150 women having indications of labor induction were randomly assigned equally into three groups: EASI, Foley’s catheter and PGE2 gel. Eligible full-term pregnancy with Bishop score 4 or less was recruited for the study. Computer generated randomization method and random numbers were used to allocate cases into three groups. Data were analyzed by SPSS. The induction to cervical ripening interval, induction to delivery time, changes in the Bishop Score, mode of delivery and cost were assessed. Results: Majority of the cases was primigravida (67.3%) and the most common indication of induction was postdated pregnancy (72%). The mean time for induction to cervical ripening interval was shorter in Foley’s catheter and EASI than PGE2 (6.92 & 5.69 vs 11.08 (P

Background: Rising rate of caesarean section since few decades has been a global public health issue.This study is aimed to determine the rate of caesarean section plus examine the indications and complications of caesarean section.Methods: A retrospective cross-sectional study was conducted using secondary data sources at Mid-Western Regional Hospital in Surkhet, Nepal. Data were collected from patients’records ofthe hospital dating from 16 July 2016 to 15 July 2017. All patients who had delivered their baby by caesarean section were included in this study. Data were analyzed by help of SPSS version 21.Ethical approval was obtained from the hospital authority prior to the study.Results: During the study, out of total 3,694 deliveries, 695 (18.8%) were caesarean section. Most of the caesarean section were emergency than elective (83.0% vs 17.0%). Among all women who underwent caesarean section, majority were from 37 to 42 weeks pregnancy (88.5%), age group between 20 and 24 (42.9%) and multiparous (53.5%).Fetal distress (20.1%) was most common among all major indications of caesarean section. Maternal complications due to caesarean section was low (3.7%). Among all complications, Post-partum hemorrhage (30.5%) was the major maternal complication of caesarean section. Most of newborn babies had APGAR score six or more at one minute (94.5%) and five minutes (97.9%).Conclusions: In our study, caesarean section rate was 18.8%, which is higher than WHO recommendation (10 – 15%). Main indication for caesarean section was fetal distress. Maternal and fetal complications were low.

In Nepal, most births take place at home, and many, particularly in rural areas, are not attended by a skilled\ud birth attendant. The main objectives of the study were to assess the use of skilled delivery care and barriers\ud to access such care in a rural community and to assess health problems during delivery and seeking care. \ud This cross-sectional study was carried out in two Village Development Committees in Nepal in 2006. \ud In total, 150 women who had a live birth in the 24 months preceding the survey were interviewed using a structured questionnaire. The sample population included married women aged 15-49 years. Forty-six (31%) women delivered their babies at hospital, and 104 (69%) delivered at home. The cost of delivery at hospital was significantly (p

The rising rate of caesarean section in urban Nepal is alarming as the lack of access for women in rural areas to emergency obstetric care, putting lives at risk. The latter is referred to as ‘Too little too late’. At the same time, the sharp rise in caesarean section rates in cities presents the other extreme: “Too much too soon”. The overuse of caesarean section causes harm, unnecessary costs, and misuse of health resources. Availability of private hospitals and increasing hospital childbirth may contribute to the rising rate of caesarean section. This article highlights the rising rate of caesarean section in urban Nepal.Keywords: Caesarean section; emergency obstetric care; Nepal.