Results: Out of 31,674 obstetric admissions, 45 (0.14%) were eclampsia cases of which 42.2% belonged to 20 -<25 years and 28.8% in 17-<20 years age group occurring mostly in primipara (71.1%). Antepartum and postpartum eclampsia were 77.7% and 22.2% respectively. Majority of them presented at 36-40 weeks'(46.6%), unbooked cases being 80% and 20% had antenatal check-up at this hospital. The diastolic blood pressure on admission recorded was 110-130 mmHg (55.5%), headache being the most common symptom(53.3%), blurred vision (22.2%), HELLP syndrome (4.4%) and urine albumin 3+ (46.6%) at the time of admission. Magnesium sulphate was used as anticonvulsant, loading and maintenance dose (40%) and only as loading dose (33.3%). Though fetal outcome was normal in 44.4% cases, rest were premature (24.4%), intrauterine growth restriction (17.7%) and intrauterine fetal demise (13.3%). Three (6.6%) cases were referred to multidisciplinary center. Maternal mortality occurred in two (4.4%) cases (cardiopulmonary arrest and prolonged hypoxia). Conclusions:When patients with eclampsia presented late, significant morbidity like HELLP syndrome, renal failure and central nervous disorder occurred and muti-organ damage leading to maternal mortality.

Background: This study was to compare the accuracy of hysterosalpingography (HSG) with hysteroscopy (HSC) in detection of uterine pathology in patients with infertility. Methods: This is a prospective comparative study done among 50 new cases of primary and secondary infertility presenting to infertility clinic of Tribhuvan University Teaching Hospital from March 2006 - 2007. HSG was performed in the proliferative phase of menstrual cycle followed by HSC in the proliferative phase of the same or the following cycle. Intra uterine findings on HSG were evaluated and compared with hysteroscopic findings. Results: Out of 50 cases, HSG revealed normal findings in 49 cases (98%) and HSC demonstrated normal uterine cavity in 44 of the cases (88%). There was one abnormality (2%) shown on HSG (subseptate uterus) which was confirmed at HSC. HSC demonstrated six cases (12%) of intrauterine pathologies and these were endometrial polyps, subseptate uterus and submucous myoma. HSG in the detection of intrauterine pathology had a sensitivity (SV) of 16.7% (95% CI 0.9-63.5), specificity (SP) 100% (95% CI 90-100), positive predictive value (PPV) 100% (95% CI 5.5-100), negative predictive value (NPV) 89.8% (95% CI 77-96.2), false negative rate (FNR) 83.3% and accuracy rate (AR) 90%. Conclusion: HSG is a specific, but not sensitive predictor of uterine pathology. However, HSG did not provide any additional finding in comparison to HSC. Therefore, HSG is not advisable in the detection of uterine pathology in infertility patients.Key words: diagnostic hysteroscopy, hysterosalpingography, infertility, uterine cavity.   DOI: 10.3126/jnhrc.v7i1.2271 Journal of Nepal Health Research Council Vol. 7, No. 1, 2009 April 6-9

Leiomyosarcoma is a rare but aggressive tumor with poor clinical outcomes in compared to other uterine cancers regardless of its stage. The preoperative diagnosis of leiomyosarcoma is seldom made as the patients present with the symptoms similar to that leiomyoma following hysterectomy and myomectomy. Herein, we present a case of a 50 years old ladyoperated for broad ligament fibroid whose histopathology and immunohistochemistry report revealed leiomyosarcoma. Keywords: fibroid, histopathology, leiomyosarcoma.

Three cases of cornual pregnancies encountered within three weeks at Paropakar Maternity and Women’s Hospital had diverse presentations. Fortunately, in all three case series, cornual resection was performed successfully. Cornual pregnancy is difficult to diagnose preoperatively with low ultrasonographic sensitivity and is easily confused with tubal ectopic pregnancy or a normal intrauterine pregnancy. Diagnosis before rupture is essential to prevent mortality and potential loss of fertility. The surgical management of diagnosed cornual pregnancy consists of hemostasis, resection, repair and reconstruction.