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Introduction: Down syndrome (DS) is the most common cause of intellectual disability among live born children which can be detected prenatally. This study aims to assess the knowledge attitude and practice of pregnant women about Down syndrome and its available prenatal diagnosis. Method: A study was conducted in Department of Obstetrics and Gynecology of Patan Academy of Health Sciences in 2021.All pregnant ladies who attended the antenatal clinic received a self-administered validated questionnaire to determine their knowledge of Down syndrome, its screening test and willingness to do prenatal testing. Result: Majority of the participants (88%) belonged to age group of 18 to 35 years.59% were primigravidas. Almost 90% were Hindus and 55% had graduate level education. More than half of the participants had poor knowledge of DS and 60 % had no idea regarding the screening tests. However, more than half (56%) of them were willing to undergo screening for DS. One fifth of the women did not want to continue the pregnancy if baby had DS. Higher income is significantly associated with good knowledge in both domain (knowledge about DS, and knowledge about its screening). Illiterates are found to have better knowledge than educated group which seems a bit contradictory, but this might have been due to our smaller sample size. Conclusion: There is a significant gap between women’s knowledge and their attitudes and practice, which has to be addressed with local and national policies and protocols. Informed decision making should be the norm after empowering pregnant women with knowledge.

Introduction: This study aims to analyze all the women delivering in our institute according to the Robson’s classification. Robson’s ten group classification system (TGCS) endorsed by WHO, is a global standard tool for assessing, monitoring and comparing cesarean section rates at all levels. Method: This cross sectional study was conducted in the department of obstetrics and gynecology, Patan hospital, Patan academy of health sciences (PAHS), Lalitpur, Nepal over 12 months’ period. All women who delivered during this period were classified according to the Robson’s classification (TGCS) into a specific group. Relative size and overall cesarean section rate of each group were calculated. Result: A total of 4,985 cases were analyzed. The cesarean section rate was 57.7%. Group 1+2 represented nearly half (49%) of the obstetric population served during the study period. Group 2A was found to be the highest contributor (27.4%) followed by Group 5 (22.8%) and Group 1 (13.0%). In terms of indication for cesarean section -Fetal distress and previous cesarean section were found to be the most common indications. Similarly, nulliparous women were three to four times more likely to be delivered by cesarean section when labor was induced. Conclusion: From this study, we can conclude that for an effective reduction in the overall high cesarean section rate in our Institution, we need to focus on a more stringent protocol for inducing labor especially among nulliparous women and to practice evidence based guidelines. Redefining failed induction needs to be considered critically as well.

Introduction: Suicide during the antenatal period is one of the major indirect causes of maternal death. This study aims to determine the prevalence of suicidal risk and its related factors among the patients attending the antenatal clinic of a tertiary care center. Method: This is a cross-sectional study conducted in the antenatal clinic Patan Hospital, Lalitpur, Nepal among 124 pregnant patients using purposive sampling and face-to-face interviews applying a semi-structured proforma and P4 suicide screener. Ethical approval was obtained. The percentage of patients with suicide risk was calculated and stratified into minimal, lower, and higher risk of suicide. The association between suicide risk and different sociodemographic and clinical variables was done using the Chi-square test. A p-values ≤0.05 was considered statistically significant. Result: The prevalence of suicide risk was 32 out of 124 patients (25.8%). When risk stratification was done a maximum of 22(17.7%) had a higher risk for suicide. The risk was associated the employment status (p=0.039), history of previous suicide attempts (p=0.04), and diagnosed mental disorder (p=0.027). Conclusion: Our study shows the suicide risk among antenatal females was 25.8% reaffirming the need for proper screening and referral.

Introduction: Maternity services were disrupted during nationwide COVID-19 lock down period. This study aimed to evaluate the impact of nationwide COVID-19 lock down on antenatal visits and obstetric outcomes in a tertiary hospital of Nepal. Method: A study was conducted at Patan hospital, Nepal with regard to antenatal visits and obstetric outcomes during COVID-19 lockdown period (24th March to 14th June 2020) and was compared to non COVID-19 period (24th March to 14th June 2019). A Chi-square test was used to determine the association between the outcome variables. The data was taken as statistically significant when the p-value was

Introduction: The COVID-19 pandemic is a major challenge for health care services including safe and effective surgery. This study aims to analyze gynecological surgery delivery during COVID-19 pandemic. Method: Data on gynecologic surgeries performed at Patan Hospital from 01 Jan to 31 Dec,2020 during pre-lockdown , lockdown and post-lockdown period of the COVID-19 pandemic were analyzed from medical record for surgical procedures, blood transfusion, ICU stay, length of hospital stay, mortality, COVID-19 PCR positive cases. Chi-square and Anova tests were used to compare between three periods, p value

Introductions: Stillbirth (SB) is one of the most common adverse outcomes of pregnancy. The aim of this study was to determine the SB rate and to identify the likely causes contributing to SB. Methods: This cross-sectional study was conducted at Patan Hospital from 15 th June 2014 to 14 th June 2017 for all the cases of SBs, at or after 22 weeks, birth weight of 500 gm or more. The perinatal outcome, demographic profile, fetal characteristics, causes and contributing factors were analyzed. Results: There were 262 SB out of total 23069 deliveries, (11.24 per 1000) and 119 (46.12%) had antenatal check-up (ANC) at Patan Hospital. The 214 (82.95%) SB were among 20-34 years mothers, 133 (51.55%) being multigravida. Antepartum SB were 234 (89.31%), macerated 213 (81.30%), birth weight

Introductions: Relaparotomy after caesarean section is rare and literature are scanty. The decision requires a good clinical judgment to save mother’s life. Our objective was to analyse the outcome of relaparotomy after caesarean section at Patan Hospital.Methods: This was a cross sectional study done at the department of obstetrics and gynaecology, Patan Hospital, Lalitpur, Nepal. Charts of the caesarean section from January 2010 to December 2014 were reviewed to analyze the cases of relaparotomy for incidence, indication, management and outcome. Descriptive analysis was done using SPSS.Results: During 5 years, there were 17,538 caesarean deliveries, 39.15% of total 44,788 deliveries. Relaparotomy was done in 15 cases, 0.085% of 17,538 caesarean. Mean age was 26.6±4.7 years, 14 (93.3%) were between 25-35 years, 12 (80%) were primigravida. Indications for relaparotomy were pyoperitoneum (40%), hemoperitoneum (33.3%) and rectus sheath hematoma (26.7%). Out of 15 relaparotomies, 14 were conservative surgery and one required hysterectomy. There was no maternal mortality.Conclusions: Relaparotomy rate in our study was eight in 10,000. Those requiring relaparotomy had fetal distress as indication for first caesarean.Journal of Patan Academy of Health Sciences. 28 2016 Dec;3(2):28-31

Introductions: Obstetricians have long debated the role of caesarean section as a potentially safer mode of delivery for the fetus with breech presentation. However, the experience of the health care provider remains a critical element in the decision to pursue a vaginal breech delivery, and it may still be a viable option. The aim of this study is to determine the incidence of breech delivery at Patan Hospital and compare maternal and neonatal outcomes subjected to either vaginal or caesarean section.Methods: This was a five-year retrospective study of breech deliveries covering the year 2010 to 2014. Patient’s charts were retrieved from the medical record section and reviewed.Results: There were 896 breech deliveries out of a total 44,842 deliveries giving an incidence of 1.99%. One hundred thirteen (12.61%) of breech deliveries were through vaginal route while 431 (48.10%) and 352 (39.28%) were through emergency and elective caesarean sections respectively. There were 154 (17.18%) preterm breech deliveries including 27 (17.5%) preterm intrauterine death. Among term pregnancy, there were 3 neonatal deaths not associated with mode of delivery. None of the term infant had neurological morbidity comprising neonatal seizures, brachial plexus injury, chephalohematoma. Maternal blood loss was significantly higher in caesarean section group. Conclusions: In well-selected cases, the neonatal outcome following assisted vaginal breech delivery and caesarean section may not be different.Journal of Patan Academy of Health Sciences, Vol. 3, No. 1, 2016. page: 4-9

Aims: This study aims to review obstetric and neonatal outcome and risk factors in adolescent pregnant women and to compare perinatal outcomes with the adult group.Methods: This is a retrospective comparative study in between primiparous pregnant teenager women aged 15-19 years and 20-24 years from April 2012 to April 2013 in Patan Hospital Lalitpur, Nepal. The data was retrieved from the hospital records. Frequency of prenatal care, perinatal outcome (newborn’s weight and gestational age at delivery), mode of delivery and maternal complications if any were recorded. Results: Neonates with normal birth weight (>2.5-4 kg) was seen in 70% (n=248) of the adolescent age group and 85% (n=1797) of adult age group. Neonates with low birth weight (

Background: There is an alarming rise in caesarean section leading to increased adverse outcomes for both the mother and fetus when compared with vaginal delivery. Within this increasing caesarean section rate, there is a concerning increase in the rate of second stage caesarean section. This study highlight the feto-maternal outcome of caesarean section in second stage of labour.Methods: This was a retrospective cohort review of all women with a singleton, cephalic fetus at term delivered by caesarean section in the second stage of labor between April 1, 2013 and March 30, 2017 at Patan Academy of Health Sciences. The main outcome measures were second stage caesarean section, indications and its maternal and fetal morbidity.Results: During the study period, there were 40,860 deliveries. A total of 18,011 (44%) babies were born by caesarean section, 10484 emergency and 7527 elective. Out of the emergency caesarean section, 200 (1.9 %) were performed in second stage of labor. In this study, the most common indication was cephalopelvic disproportion. (92.4%) were delivered without a trial of instrumental delivery. In terms of maternal complications, atonic post partum haemorrhage uterine incision extension 18 (12.5%), postoperative fever 27(18.8%), wound infection 7 (4.8%) were observed. In perinatal complications, meconium stained amniotic fluid 49(34.2%), neonatal hyperbilirubinemia 14(9.7%) and increased nursery admission 2(15.3%) and 2(1.3%) perinatal mortality were seen.Conclusions: Cesarean sections done in second stage of labor are associated with several intra-operative maternal complications and neonatal morbidity.

There is paucity of literature pertaining to association between vitamin D deficiency and preeclampsia from sunshine-rich countries like India. Further none of the studies have reported on relation with severity of preeclampsia. This study was carried out with a purpose of studying relation between vitamin D deficiency and preeclampsia and its complications.Seventy-four nulliparous preeclamptic women with singleton pregnancy and without any known medical disorder and 100 healthy nulliparous controls of same age were enrolled. Serum vitamin D concentration of the two groups was compared. We also compared the vitamin D level of women with mild and severe preeclampsia and with or without various complications of preeclampsia.Eighty-four percent of women were vitamin D deficient. Mean serum vitamin D was significantly lower among cases (9.7 ± 4.95 ng/ml) as compared to controls (14.8 ± 6.68 ng/ml); p = 0.0001. Women with mild preeclampsia (9.44 ± 5.63 ng/ml) had similar vitamin D level as those with severe disease (9.8 ± 4.79 ng/ml) (p = 0.811). There was no difference in vitamin D level of women with eclampsia (p = 0.956) or imminent eclampsia (p = 0.310) and those without these complications.There is high prevalence of vitamin D deficiency among pregnant women in India. Women with preeclampsia had significantly lower vitamin D level as compared to normal women. Severity of the disease was not related to vitamin D level.

Background Chronic Myeloid Leukemia (CML) is caused by the abnormal fusion protein BCR-ABL1, a constitutively active tyrosine kinase and product of the Philadelphia chromosome. Gleevec (Imatinib mesylate) is a selective inhibitor of this kinase. Treatment with this agent is known to result in hematologic, cytogenetic, and molecular responses. Patan hospital (Patan, Nepal) is one of the Gleevec International Patient Assistance Program (GIPAP) centers for patients with CML. Methods A total of 106 Philadelphia positive CML patients were enrolled in our center between Feb 2003 and Jun 2008, and 103 of them were eligible for cytogenetic and/or hematologic response analyses. Results Out of 103 patients, 27% patients underwent cytogenetic analysis. Imatinib induced major cytogenetic responses in 89% and complete hematologic responses in almost 100% of the patients with confirmed CML. After a mean follow up of 27 months, an estimated 90% of the patients on imatinib remained in hematologic remission and more than 90% of the patients are still alive. About 30% of patients developed some form of manageable myelosuppression. A few patients developed non-hematologic toxic side effects such as edema and hepatotoxicity. Conclusions Our study demonstrates that imatinib is safe to use in a developing country. Furthermore, we demonstrate that imatinib is very effective and induced long lasting responses in a high proportion of patients with Ph chromosome/BCR-ABL1 positive CML. Imatinib is well tolerated by our patients. The lack of cytogenetic analysis in the majority of our patients hindered our ability to detect inadequate responses to imatinib and adjust therapy appropriately.