Cervical cancer is the fourth most common cancer among women worldwide. According to the World Health Organization (WHO), about 291 million women are estimated to be infected with HPV globally with an average prevalence of cervical Human Papilloma Virus (HPV) infection of around 10% in healthy women, but even higher (20-30%) in some regions of Latin America and Sub-Saharan Africa (1).

Fear of hospitalization in addition to uncertainties about appropriate treatment at the beginning of COVID -19 pandemic may have affected the health and outcome of pregnant women. Lack of transportation closed out -patient services, and lack of employment has directly linked to poor maternal and perinatal outcomes during nationwide lockdown. This study was aimed to find out the poor perinatal outcome during the first COVID-19 pandemic lockdown at BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal. This was a descriptive cross-sectional study conducted in BPKIHS from 24th March 2020 to 23rd July 2020 during the first COVID- 19 lockdown for the duration of 4 months. The data were collected between 1st February to 15th February 2021 from the hospital records. Convenience sampling was done. Data analysis was done by SPSS version 24. Poor perinatal outcomes: perinatal death, preterm delivery, intrauterine growth restriction, newborn admission, and different reasons for admission were analyzed using descriptive statistics. There were a total of 2685 obstetric admissions and 2442 deliveries during the study period of 4 months. Mean age and gestational age of women with poor perinatal outcome were 27.16 ± 6.02 years and 36.38± 4.54 weeks respectively. The perinatal death rate was 26.2 per 1000 births. 128 newborns required neonatal admission and prematurity was the most common cause. The prevalence of poor perinatal outcome was like other studies done in similar settings. However, larger, comparative studies are needed to identify a definite association of COVID 19 pandemic lockdown with poor perinatal outcomes.

Anemia in pregnancy is a major health concern all over the world. Daily iron supplementation is used to prevent and correct iron deficiency anemia during pregnancy. Intermittent iron supplementation is proposed as an alternative to daily supplementation. This study was undertaken to compare the efficacy of Intermittent versus Continuous oral iron supplementation in non-anemic pregnant women presenting for routine antenatal care. A Prospective cross sectional study was conducted among one hundred and two non-anemic pregnant women at BP Koirala Institute of Health Sciences for one year. They were allocated alternatively to continuous oral iron and intermittent (4 days in a week) iron supplementation group. Baseline hemoglobin and serum ferritin was done and women having more than 10.5gm/dl hemoglobin were recruited in the study at 14-16 weeks period of gestation. Repeat hemoglobin and ferritin was done at 28 weeks period of gestation and hemoglobin at the time of delivery was noted. Maternal and perinatal outcome were analyzed among the two groups by appropriate statistical analysis. The repeat hemoglobin done at 28 weeks period of gestation and at the time of delivery was comparable between the groups. Though more women in the intermittent group developed anemia in 3rd trimester (11.46%), it was not statistically significant and none of the women in either group required blood transfusion intermittent iron supplementation is a good alternative to continuous oral iron supplementation as a prophylaxis in non-anemic pregnant women with similar efficacy

Background: Infertility is a global problem. Male factors are estimated to be the cause of up to 50% of infertility cases. A variety of identifiable and reversible etiological factors are involved in male factor infertility. This study aimed to compare the risk factors in men who have abnormal semen parameters with those with normal parameters. Methodology: This was a case-control study. The male partners of the infertile couples presenting for infertility evaluation were advised for semen analysis and based on the report they were divided into control (normal parameters) and case (abnormal parameters) groups. A detailed interview of each subject was conducted focusing on risk factors causing different semen parameter abnormalities and the risk factors in both groups were compared. Results: There were 50 subjects in each group. The mean age was 31.02 ± 5.183 years and the mean BMI was 24.824 ± 2.438 kg/m2. The mean duration of infertility for those in the case group was significantly higher (p-value 0.006). Mean sperm concentration and sperm motility were 33.492 ± 30.306 million/ml and 38.1% ± 18.893 respectively. 40 subjects had oligozoospermia and 36 had asthenozoospermia. Age (OR1.464), the habit of cigarette smoking (OR 37.946), and the presence of past medical conditions (0R 534.82) were significantly associated with abnormal semen parameters. Service-holder men were significantly less likely to develop semen abnormalities (OR 0.087). Conclusion: Age, cigarette smoking, and presence of past medical history are associated with abnormal semen parameters thus contributing to male factor infertility. Key words: male infertility, risk factors, oligozoospermia, asthenozoospermia.

Aim:To identify the incidence, clinical risk factors, and clinical course of women with de novo postpartum hypertensive disorder without prior antepartum or chronic hypertensive disorders.Methods: This is a retrospective cross-sectional study.Postpartum records of all pregnant women normotensive in the antepartum and prepregnancy period, delivered in this institute and women (within 6 weeks postpartum period) admitted with the diagnosis of new-onset postpartum hypertension in the reference time period (March 2020-May 2020) were evaluated.Women with an antenatal diagnosis of preeclampsia or chronic hypertension were excluded.Relevant information regarding demographic characteristics, history, pregnancy course, postpartum course, and significant morbidity was collected.The incidence of de novo postpartum hypertension (dPPHTN) was calculated.The medians were compared using the Wilcoxon rank-sum tests.The association between outcome variables and epidemiological and clinical variables was assessed using the Chi-square test.For follow-up of the course of HTN, patients with dPPHTN were inquired via telephone conversation regarding duration of treatment, adherence to home BP charting, and complications.Results: Among 1,080 women who were normotensive 54 women developed dPPHTN giving us the incidence of 4.9%.Cesarean delivery was found to have a statistically significant association with dPPHTN.No statistically significant association was found in terms of parity, family history of HTN in first-degree relatives, and multiple gestations in the development of dPPHTN.No statistically significant difference was found between the medians of maternal age, gestational age at delivery, and that of birth weight among the two groups.The median postpartum day of presentation was 1st postpartum day with range of 0-7th postpartum day.The majority (92%) of cases were asymptomatic and were detected upon routine inpatient blood pressure monitoring, 5% patients had headache as the presenting symptom, and 1 patient presented with seizure.Median (range) peak systolic and diastolic blood pressures were 140 (120-170) mm Hg and 100 (70-110) mm Hg, respectively.The median length of hospital stay was 2 days with range of 2-7 days.About 19 (35%) patients were discharged with daily home blood pressure charting instructions, and 35 (65%) were discharged on oral medications.Regarding follow-up, 17 (31.48%)patients could not be contacted, 15 (27.77%) patients complied with home BP charting and discontinued antihypertensive therapy after physician consultation with duration of use of antihypertensive ranging from 7 to 14 days, 21 (38.88%) were noncompliant and lost to follow-up, 1 (1.8%) patient developed chronic hypertension. Conclusion:De novo postpartum hypertension is an underrecognized disorder with potential serious maternal morbidity.Our study elucidates the need for the development and implementation of stringent postpartum surveillance and follow-up protocols in order to detect, manage, and prevent morbidity due to this disorder.

Aims: To identify the different phenotypic variant of PCOS in women of reproductive age group and to assess the hormonal and metabolic profile of women with PCOS. Methods: This Prospective descriptive study was conducted in the Department of Obstetrics and Gynecology, BPKIHS, Dharan for a period of one year from July 2020 to June 2021. All Women presenting to Gynecology OPD with complaints of menstrual irregularity and clinical features of hyperandrogenism were assessed and evaluated for polycystic ovarian syndrome. BMI was calculated. Hormonal Profile (serum LH, FSH and testosterone) and metabolic parameters (fasting blood sugar and lipid profile) were studied; and then further categorized into different phenotypic variants. All data were stored in Microsoft excel format and analyzed using SPSS version 11.5. using descriptive statistics. Results: Total of 80 cases of PCOS were enrolled during the study period. The most common phenotypic variant was Type B (60%) followed by Type D (30%). The mean BMI was 22.4± 4.2kg/m2 . All PCOS cases presented with menstrual irregularity as the primary complaint. Conclusions: Anovulatory PCOS was the most common phenotypic variant in our study population. This study did not find obese PCOS hence emphasizing the need of evaluation in lean women with or without hyperandrogenism presenting with menstrual irregularities.

Objectives: Evaluation of uterine factors is an essential step in the diagnostic workup of subfertile couple. Intrauterine pathologies can impair implantation and hence reduce the endometrial receptivity. The advantage of hysteroscopy is that it not only allows direct observation and accurate localization of pathology but also provides therapeutic treatment for some pathologies in a single setting. This study aims to evaluate the intra uterine condition of the subfertile couple presenting to our centre using hysteroscopy. Materials and Methods: This was a Prospective descriptive study and sixty three cases of subfertility were enrolled during the study period. Hysteroscopy was scheduled in the follicular phase of the menstrual cycle. The detailed hysteroscopic findings were noted. Data was entered in Microsoft excel format and appropriate statistical test was applied. Results: Sixty three patients underwent hysteroscopy, among them forty-eight patients (72.2%) had primary subfertility and fifteen patients (23.8%) had secondary subfertility. Thirty-nine (61.9%) patients had normal hysteroscopic findings whereas twenty-four (38.1%) patients showed abnormal hysteroscopic findings. Common abnormal pathologies were stromal oedema1(n=3,54.16%) followed by intrauterine adhesions (n=8,19%).Twenty-two (45.8%) patients with primary subfertility showed abnormal hysteroscopic findings as compared to only two (13.3%) patients of secondary subfertility which was statistically significant (p value= 0.03). Conclusion: Stromal oedema was the most common hysteroscopic finding followed by intrauterine adhesions which could have been missed during routine diagnostic investigations for subfertility workup.

Management of a pregnant woman with complete heart block presenting during pregnancy and without pacing remains debatable. To bear up against any hemodynamic variations in peripartum period, temporary pacemakers have been advocated by some authors. Herein, we report a case of successful management of a 24 year old, pregnant woman with CHB who had an uneventful emergency caesarean delivery under spinal anesthesia after temporary pacing. She was an unbooked patient detected with CHB first time during active stage of labour. She delivered a healthy male baby and was discharged from the hospital in a stable and satisfactory condition on seventh postoperative day.

Primary malignant melanoma of cervix (PMMC) is rare and aggressive cancer of uterine cervix. It presented as vaginal discharge, post coital bleding and blackish cervical growth that was biopsied and radical hysterectomy performed immediately after getting the histopathological diagnosis at stage-1B2 (FIGO staging, 2018). Post-treatment, she was recurrence free at nine months of regular follow up visit. Keywords: cervix, malignant, melanoma, primary

Pelvic hemorrhage is a major cause of maternal morbidity and mortality in developing countries. A sound clinical judgment, adequate assessment, and preparation of the patient are the best preoperative means to avoid its occurrence. Bilateral internal iliac artery ligation is a life-saving procedure to control massive obstetric and gynecological hemorrhage when other measures fail. This procedure significantly reduces the pulse pressure and rate of blood flow abolishing the‘triphammer effect’ of arterial pulsation and subsequently resulting in sluggish blood flow allowing effective thrombosis within the small bleeding vessels. This has helped to save many lives and uteruses for more than a century. No tissue necrosis occurs due to ample collateral circulation in the pelvis from the major pelvic anastomoses. An increased understanding of retroperitoneal anatomy and regional variations of the internal iliac artery is needed to reduce the risk of intraoperative andpostoperative complications.

Introduction: Small-for-gestational-age (SGA) is defined by a birth weight below the 10th percentile for mean weight corrected for gestational age. It is associated with adverse health events throughout life, including substantial perinatal morbidity and mortality rates. Objectives: The aims of the study was to estimate the prevalence of the SGA newborns, attributable factors for SGA and perinatal outcomes of SGA. Methodology: A hospital based prospective cohort study was conducted among pregnant women after 28 weeks' gestational age in the Department of Obstetrics and Gynaecology, BPKIHS, Dharan from October, 2016 to June, 2017.A total of 150 study population was sampled using purposive sampling technique whose symphysio-fundal height lags the gestational age by four cms. The association for risk factors between the various socio-demographic parameters and SGA was analysed using chi-square test for categorical data and t-Test for continuous data with p value<0.05 considered as significant. The mothers and babies were followed up till discharge from the hospital for outcomes. Result: There was a total of 140 SGA with 10 appropriate for gestational age (AGA) fetuses among 6,500 hospital deliveries above 28 weeks' gestation, hence the prevalence was 2.15%. The risk factors for very small for gestational age were history of birth of SGA fetus (OR, 1.25; 95% CI, 1.15-1.35); history of recurrent pregnancy loss (OR, 1.25; 95% CI, 1.15-1.35); personal history of substances abuse in the index pregnancy (OR, 1.68; 95% CI, 1.47-1.92); adverse obstetrics or medical events in the index pregnancy (OR, 2.21; 95% CI, 1.10-4.45); high blood pressure at admission (OR, 1.58; 95% CI, 1.96- 2.59) and significant urinary proteinuria (OR, 2.26; 95% CI, 1.00-5.09).SGA newborns correlated with increased risk of operative delivery and adverse perinatal outcomes, including oligohydramnios, low Apgar scores, resuscitation at birth, admission to the neonatal intensive care unit or nursery, metabolic complications and fetal death. Conclusions: SGA have distinct modifiable risk factors and mortality patterns suggesting potential implications for public health and urgent need to intervene with effective interventions.

Introduction: Evolution of laparoscopy has revolutionised the field of gynaecological surgery for more than 40 years.Owing to the long learning curve, added expenses and lack of awareness among patients and surgeons, its introduction and development in Nepal is not upto the timeline. Gynaecologic laparoscopy (GL) seems to be introduced at BP Koirala institute of Health Sciences, Dharan,Nepal (BPKIHS) since 2002. It remained in latency because of widespread lack of equipment and skilled personnel. Some laparoscopic procedures like diagnostic laparoscopy, laparoscopic tubal ligation and very few laparoscopic assisted vaginal hysterectomy (LAVH) were done from 2002 - 2012 (10 years). Since then more gynecologists have been trained in GL which has contributed to expansion of GL. Objective: The objective of this study is to study and share trends of gynaecological laparoscopic surgeries performed at BPKIHS. Methodology: All the patients undergoing GL surgeries have been analyzed for the indication, type of procedure, conversion and its complications. We took data from operation theatre register and patient case sheet from July 2004 to May 2018. We divided this period into two phase viz Phase 1: July 2004-June 2013 and Phase 2: July 2013- till May 2018. Results: Total number of GL done in this period was 427. Out of which 102 cases were from phase one and rest of the cases were done in five years of phase II. Number of operative laparoscopy has increased in phase 2 compared to phase 1. In last five years there was155 (47.6%) cases of adnexal surgery, 77 (23.6%) cases of diagnostic laparoscopy.Total laparoscopic hysterectomy was done in 25 (7.6%) cases. Conversion to laparotomy was done in4.6% (n=15) cases. Overall 12(3.7%) patient had major complications. Oral diet started at 4-6th hour post-operatively, and mobilization started after 24 hours. Seventy percent of patient had a hospital stay of 2days and rest stayed for 3 days. Conclusions: There is rising trend in operative GL at BPKIHS. We are facing less complication with expanding experience. There has been good learning from each case. GL has well demonstrated its advantages of reducing postoperative pain and morbidity, short hospital stay, and less postoperative recovery time. We have plans to get new gadgets and expand services in GL.

Introduction: Lower urinary tract symptoms (LUTS) is a group of symptoms relating to stages of micturation such as storage symptoms, voiding dysfunction and post micturation dysfunction. Overactive bladder symptom score (OABSS) is a questionnaires with scores which helps in evaluating the severity of symptoms. Objectives To find the incidence of women visiting with LUTS and to evaluate storage symptoms in LUTS (urgency, urge incontinence, frequency) using OABSS (overactive bladder symptom score) questionnaires. Methodology This is a prospective study done from February 2016 to February 2017. Patients visiting Department of Obstetrics and Gynaecology with lower urinary tract symptoms (LUTS) were enrolled in the study after informed consent. Patients were assessed for types of LUTS and data were filled in the performa. If patients had urgency, urge incontinence, increased day time frequency, then the patients were explained and asked overactive bladder symptom score questionnaire (OABSS) and noted. Patients were then examined for pelvic floor dysfunction and neurological abnormalities for identifying association with the symptoms. Statistical analysis was done using SPSS 11.5. Results Fifty-seven patients were enrolled with lower urinary tract symptoms (LUTS) during study period. Forty-six patients had overactive bladder symptoms (OABS). LUTS were found in age ranging from 21 to 80 years. Majority of patients visiting out-patient department with LUTS were found to have urgency, urge incontinence, increased day time frequency, nocturia. Patients with urgency and urge incontinence showed significant correlation with increasing likert score of OABSS (p<0.05). But the increased day time frequency did not show any correlation with increasing score. The score showed significant correlation with combination of symptoms (urgency, urge incontinence and increased frequency) than patients presenting with single symptom. Conclusion Diagnosis of LUTS with valid assessment tools and treatment benefits patients with chronic urinary symptoms and also helps clinicians to further re-assess the treatment.

Background: Intrauterine fetal death is a traumatic event. Stillbirth rate is an important indicator to assess the quality of antenatal care. The objective of the study was to identify the risk factors related to intrauterine fetal death in patients admitted with intrauterine fetal death.Methods: It was a descriptive study conducted in the department of Obstetrics and Gynaecology at B. P. Koirala Institute of Health Sciences from January to December 2014. Patients admitted with singleton pregnancy with intrauterine fetal death after 28 weeks gestation were included. Results: There were 11,006 obstetric admissions. Of them, 152 women had intrauterine fetal death. There were 128(84.2%) women between 20-35 years of age. Out of 152, 81(53.3%) women were preterm and 39(2.1%) women were postterm. Primigravida were 77(50.7%) followed by 35(23%) of second gravida. Hypertension was the commonest identified risk factor in 30(26.78%) women. Out of 152 women, 49(32.2%) had not received formal education. Ten (6.6%) women had a past history of fetal death. Four (2.6%) women had medical disorder before pregnancy. One hundred and twenty five (82.2%) women had vaginal delivery, 21(13.8%) had caesarean section and 6(3.9%) had laparotomy for rupture uterus. The commonest indication for caesarean section was placenta previa for 7(33.33%) women. Four (2.6%) women had diabetes. Ninety five (62.5%) were male and 57(37.5%) were female babies. Five (3.3%) babies had malformations. Conclusions: Hypertension in pregnancy was found to be the most common identified risk factor for intrauterine fetal death. Keywords: Fetal death; pregnancy; risk factors.

Background: Anemia is a common problem in pregnancy particularly in developing countries. In Nepal, the prevalence of anemia in pregnancy is 48%. It is defined by WHO as hemoglobin level less than 11gm/dL in pregnancy. It leads to a number of threats to mother, fetus and newborn. Objectives: The objective of the study was to assess the maternal, fetal and newborn outcome with respect to anemic status of women admitted in maternity ward of BPKIHS, Dharan, Nepal. Methods: A descriptive cross-sectional study was conducted among the 20 to 35 years women admitted in maternity ward of BPKIHS. Total 193 respondents were included in the study by purposive sampling technique. Out of 193 respondents, 78 were anemic and 115 were non-anemic. Maternal, fetal and newborn outcome among all the respondents were assessed by interview and review of records. Pearson Chi-square test was used to find the association between two categorical variables. Results: Maternal outcomes such as preterm delivery, mode of delivery and fetal and newborn outcomes such as abnormal fetal heart rate, IUGR, LBW, low APGAR scores at 1 minute and at 5 minutes, need for resuscitation and need for admission in ward/nursery/NICU were significantly associated with anemic status of women at p value <0.05. The prevalence of anemia among the pregnant women was 40.5%. Conclusion: Maternal outcome such as preterm delivery, cesarean section were associated with anemia. Regarding the fetal and newborn outcome; abnormal fetal heart rate, IUGR, low birth weight, APGAR scores below 7, need for resuscitation, need for admission in ward/ nursery/NICU were associated with anemia.

Aims: To determine the incidence and risk factors of women undergoing peripartum hysterectomy at BPKIHS, Dharan.Methods: A descriptive study was conducted for all women undergoing peripartum hysterectomy in two years from July 2012 to June 2014.Various maternal characteristics including demographic data, previous obstetric details, antepartum, intrapartum and postpartum data were collected and analysed.Results: There were 29 cases of peripartum hysterectomy among 19,539 births in 2 yrs (1.48 per 1000 births). Indications for peripartum hysterectomy were uterine rupture (65.5%), morbid adherence of the placenta (13.8%) and uterine atony (12.9%). Previous caesarean section was identified as independent risk factor with relative risk of 1.8 (95% CI 1.3-2.5, p< 0.003). Maternal morbidity was significant with febrile morbidity and urinary tract injury among the most common complications.Conclusions: Uterine rupture causing severe haemorrhage was the commonest indication for peripartum hysterectomy. Timely intervention reduces the peripartum maternal and perinatal morbidity and mortality.

Ectopia cordis is a rare congenital malformation and only few cases have been reported in literature previously. It is defined as the complete or partial evisceration of heart outside the thoracic cavity through the sternal defect. Most cases are sporadic. The classical presentation for the antenatal diagnosis on ultrasonography is a pulsating heart out of the thoracic cavity with absent chest wall.We reported three cases of ectopia cordis in the last one and half year in our institute. Two of them were diagnosed on ultrasound and the third case terminated for meningocele with severe oligohydramnios had associated ectopia cordis detected after delivery. All three were admitted via out patient department for termination. The first case live at birth had isolated thoracic ectopia cordis with birth weight of 2.4 kilograms, Apgar score of 7,8,9 and was delivered by caesarean section for failed induction while the other two were still birth and had thoraco-abdominal ectopia cordis. The live baby was taken to Sahid Gangalal hospital in Kathmandu by the visitors after two days of delivery and the baby underwent surgical intervention but had an unsuccessful outcome. Regarding the management of this condition, parental counseling for pregnancy termination is advised. Though few cases of surgical interventions for ectopia cordis have been reported, mortality rate is still very high.

Introduction: Abnormal uterine bleeding (AUB) is one of the common presenting symptoms in women attending gynaecology outpatient department and has remained one of the most frequent indications for hysterectomy in developing countries. Endometrial sampling is used as the first diagnostic step in AUB.Objectives: To correlate the clinical presentations with endometrial pathologies in women presenting with abnormal uterine bleeding.Methodology: This was a hospital based descriptive study carried out on one hundred and nineteen women who presented with AUB and planned for endometrial biopsy. Clinical profile of the patient was recorded and the histopathology of the sampled endometrial tissue was retrieved. Correlation of abnormal uterine bleeding with histopathology report was done using appropriate statistical test.Results: The mean age of presentation of women with abnormal uterine bleeding was 46.56 yrs ± 9.525. Irregular menstrual cycle was the commonest reason seeking treatment for AUB. The commonest histopathology among women who underwent endometrial biopsy was secretory endometrium (39.5%). Other causes identified were proliferative endometrium (21.8%), mucus flakes with hemorrhage (16%), disordered proliferative endometrium (10%), pill endometrium (5%) ,endometritis (5.9%), endometrial carcinoma (1.7%),endometrial hyperplasia without atypia (1.7%).Conclusion: The nature of endometrial pathology is varied across the entire spectrum of women presenting with abnormal uterine bleeding. Knowledge of endometrial pathology helps in directing specific management and can provide better care to women presenting with abnormal uterine bleeding. BJHS 2018;3(1)5 : 354-356