Background. Cesarean section (CS) is one of the most performed surgeries in obstetrics. Surgical site infection is the major cause of morbidity and mortality causing an increase in the duration of hospitalization as well as the cost of admission for the patient. Objective. To determine incidence of surgical site infection following cesarean section, classify them according to CDC criteria, and identify the different risk factors. Methodology. This is a case-control study conducted at the Department of Obstetrics and Gynecology at Tribhuvan University Teaching Hospital (TUTH), main campus of Institute of Medicine (IOM), Kathmandu, Nepal. Surgical site infections (SSI) in patients who underwent cesarean sections from February 2019 to August 2019 were taken as cases, while the patients who underwent cesarean section before or after the procedure and did not develop SSI comprised the controls. Visual inspection during ward rounds, reports from laboratory, and postprocedure follow-ups for up to 30 days formed the basis of identifying infections on the patients. Risk factors were identified by bivariate and multivariate logistic regression. Results. Out of 1135 cases of cesarean sections, 97 of them developed SSI with incidence rate of 8.54%. Among them, 94.85% were superficial incisional and 5.15% were deep incisional type of SSI with no organ space type. Cases had higher mean age 26.88 ± 4.38 years compared to 24.81 ± 5.08 years in controls. Host-related risk factors which led to higher odds of developing surgical site infection (SSI) were obesity with adjusted odds ratio (AOR) 15.72 (confidence interval (CI): 4.60-53.67), diabetes/hypertension in pregnancy with AOR 4.75(CI 1.69-13.32), and other medical diseases with AOR 9.38 (CI 2.89-30.46). Duration of the rupture of membrane for more than 18 hours with AOR 8.38 (CI 1.48-47.35), more than five per vaginal (PV) examination with AOR 1.93 (95% CI 1.03-3.64), and in labor status with AOR 6.52 (CI 1.17-36.38) were some procedure-related factors resulting into higher odds of infection. Conclusion. Multiple risk factors like age, obesity, medical complications during pregnancy, occurrence of labor status during cesarean section, prolonged duration of rupture of membrane for more than 18 hours, and more than five vaginal examinations before the procedure increases the chance of surgical site infection (SSI) following cesarean section.

Gossypiboma, a retained foreign body after surgery, is a rare complication. It appears years after surgery, has nonspecific symptoms, and is usually identified on imaging sequences. We present here an asymptomatic case of a 32 years old lady with a history of laparotomy done two years earlier. She was initially misdiagnosed clinically and radiologically as hydatid cyst of pelvis. During re-surgery, foreign body was detected. Postoperative period was uneventful. To prevent these types of complications, we have to follow the main principle of surgery in all procedures i.e. ensuring a proper count of surgical materials before and after surgery.

Aims. Adnexal torsion commonly affects reproductive age group females. Prompt diagnosis and early management help in the preservation of fertility. However, its diagnosis is challenging. Preoperative diagnosis can be suspected in only 23–66% of the cases and half of the patients operated for adnexal torsion have different diagnosis. This article thus aims to identify the diagnostic value of preoperative neutrophil lymphocyte ratio in adnexal torsion in comparison with other untwisted unruptured ovarian cysts. Methods. This was a retrospective study conducted in the duration of five years from 1st January 2016 to 1st January 2020. The data about demographic parameters, hematological parameters, operative approach, operative technique, and histopathological reports were derived from an electronic database and documented on proforma. SPSS was used for statistical analysis. Logistic regression analysis and influence of each factor on preoperative diagnosis of Adnexal torsion was evaluated. Results. A total of 125 patients were included in the article (adnexal torsion group n = 25, untwisted unruptured ovarian cyst group n = 100). There was no statistically significant difference in comparison to age, parity, and abortion between both groups. Most patients had undergone laparoscopic surgery which was based on surgeon’s skill and preference. Nineteen (78%) patients in the adnexal torsion group underwent oophorectomy while infarcted ovary was seen in only 4 cases. Among the blood parameters, only neutrophil-lymphocyte ratio (NLR) >3 was found to be statistically significant under logistic regression analysis. Most common adnexal pathology to undergo torsion was serous cyst. Conclusion. Preoperative neutrophil-lymphocyte ratio can be a predictive marker for diagnosis of adnexal torsion and can differentiate it from untwisted unruptured ovarian cysts.

Ovarian vein thrombosis is one of the rare causes for acute abdomen. Occult presentation of this disease may lead to diagnostic dilemma. A sixteen years female who was operated as a case of ectopic pregnancy was finally diagnosed as having ovarian vein thrombosis. She was successfully treated with anticoagulant.

Introduction: Postpartum haemorrhage is the most life-threatening complication during pregnancy and atonic postpartum haemorrhage being the commonest one, often poses difficulties in management. B-Lynch suture with a high success rate has emerged as a life-saving measure in uncontrolled atonic postpartum haemorrhage refractory to uterotonics. The objective of this study was to find out the prevalence of B-Lynch suture management among patients with post-partum haemorrhage in a tertiary care centre. Methods: This descriptive cross-sectional study was conducted in the Department of Obstetrics and Gynecology of a tertiary care centre from 1 April 2017 to 1 April 2021 after taking ethical approval from the Institutional Review Committee of the same institution [Reference number: 497(6-11)C-2077/078]. All patients with post-partum haemorrhage during the study period were included in the study. Patients with traumatic post-partum haemorrhage, congenital malformations, complete placenta previa/accreta, bleeding disorders, disseminated intravascular coagulation, and retained bits of placenta were excluded from the study. A convenience sampling method was used. Point estimate and 90% Confidence Interval were calculated. Results: Out of 72 patients, 19 (26.39%) (17.85-34.93, 90% Confidence Interval) underwent B-Lynch suture management for atonic post-partum haemorrhage. Uterus salvage was done in 18 (94.74%) whereas 1 (5.26%) underwent a cesarean hysterectomy. Conclusions: The prevalence of the use of B-Lynch suture was similar to other studies done in similar settings. B-Lynch suture is a valuable addition for controlling intractable atonic primary postpartum haemorrhage refractory to uterotonics, thus saving the life as well as preserving the future fertility of the woman.