Twin pregnancy with a complete mole and a coexistent normal fetus reaching term is a rare occurrence. We report a case of a 21-yrs G2P1L0 un-booked patient at 39 weeks who was referred for the same condition diagnosed incidentally on ultrasound scan which showed a singleton pregnancy in breech presentation with a normal placenta and a heterogeneous cystic lesion seen anteriorly, suggesting a coexistent molar pregnancy. Cesarean section was done, and a healthy male baby was delivered with a grossly normal placenta and a second placenta with grape like vesicles. Histopathology confirmed the diagnosis of complete mole and normal placenta. Postoperative period was uneventful, and the patient was kept on beta hcg follow-up to monitor progression to gestational trophoblastic neoplasia, but it normalized by 12 weeks.

Background: The maternal complications during pregnancy pose very serious challenge requiring multispeciality critical care approach. The objective of the study was to analyse clinical profile and outcome of these patients. Studies regarding above will add on existing knowledge that will help in improving patient outcome. Materials and Methods: This was a prospective observational study conducted over a period of 1 year from April 2017 to March 2018 in the department of obstetrics and gynecology of Nobel Medical College, Biratnagar. All the consecutive patients requiring ICU care were enrolled. Results: Among 7820 deliveries, 122 patients (1.56% of total deliveries) required critical care admission. Among them 61(50%) have causes related to obstetrics problems and 61 (50%) have non obstetric problems. Obstretic hemorrgage (24.59%) and hypertensive disorders (11.47%) of pregnancy were common obstetric complications whereas isolated renal failure 18(14.75%), cardiac disease 16 (13.1%), pulmonary disorders 11(9.1%) and sepsis 10 (8.19%) were common non obstetric complications. Maternal mortality rate was 24.59%.Renal failure 9(30%) was the commonest cause of death. Conclusion: Obstetric hemorrhage and hypertensive disorders of pregnancy were the commonest risk factors requiring critical care support. Other risk factors requiring ICU were renal failure, cardiac disease, pulmonary disorders and sepsis.

Introduction: Acute kidney injury  is a rare complication of pregnancy and is associated with high maternal morbidity and mortality. Obstetric factors associated with it are preeclampsia/eclampsia, sepsis, hemorrhage and dehydration. Here, we aim to find out the prevalence of complete recovery of renal function among obstetric patients with acute kidney injury. Methods: This is a descriptive cross-sectional study conducted in a tertiary care hospital from 1st July 2020 to 30th June 2021 where obstetric patients who had developed acute kidney injury were included and followed till 6 weeks of diagnosis. Ethical approvalwas obtained from Institutional Review Committee of Nobel Medical College and Teaching Hospital (IRC- NMCTH 437/2020). The convenience sampling method was used. Data entry and analysis were done using Statistical Package for Social Sciences version 21. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Out of total 66 obstetric patients with acute kidney injury, 45 (68.2%) (57-79.3 at 95% Confidence Interval) had complete recovery of renal function. Rate of renal function recovery in Stage 1, Stage 2 and Stage 3 acute kidney injury were 19 (90%), 19 (86%) and 7 (58%) respectively. The most common causes of acute kidney injury were Preeclampsia/eclampsia 18 (40%), sepsis 23 (28.8%) and hemorrhage 10 (22.2%). Conclusions: The prevalence of complete recovery in obstetric patients with acute kidney injury was similar to findings from other studies done in similar settings.

Aim: To compare fetomaternal outcomes among pregnant patients in COVID and non-COVID period in tertiary centre in eastern Nepal. Methods: All women who delivered at Nobel Medical College Teaching Hospital during non- COVID period between April to June 2019 and COVID period between April to June 2020 were compared. Data were collected from medical records. Results: Significant number of women had cesarean deliveries in COVID period (36.5% vs 32.6%). There were no significant differences in period of gestation at the time of delivery, birth weight of baby, intrauterine fetal death and neonatal intensive care unit admission as well as no difference in obstetric outcomes, labor complications, maternal intensive care unit stay, near miss and peripartum hysterectomy. Conclusion: There were more cesarean sections, vaginal birth after cesarean section and vaginal breech delivery in COVID period and no other significant differences in maternal and fetal outcomes during COVID period and Non-COVID period.

Aim: To share early experience of gynaecological laparoscopic surgeries for adnexal masses in Nobel Medical College and Teaching Hospital (NMCTH). Methods: This is a observational descriptive study in the Department of Obstetrics and Gynaecology of Nobel Medical College, Biratnagar for one year in 2019-2020. All the patients undergoing laparoscopic pelvic surgeries for adnexal masses were analysed for indication, type of procedure, complications and histopathological diagnosis. Results: A total of 123 laparoscopic surgeries were performed. Preoperative diagnosis in most of the cases was adnexal mass followed by adnexal evaluation for subfertility. The common surgical procedure was cystectomy followed by salpingo-oophorectomy in 80% of cases. The most common histopathological diagnosis was mature cystic teratoma (42; 34%) followed by endometriosis (29; 23.8%) and cystadenoma (25; 20.3%). Conclusions: Adnexal evaluation and surgical treatment were performed with laparoscopy. The common pathologies were mature cystic teratoma, endometriosis and ovarian cystadenomas.