Aims:The aim of the study was to evaluate the changing trend of the instrumental vaginal deliveries at Patan hospital over the last 10 years. 0HWKRGVThis was a retrospective study done at Patan hospital. The study included data of 10 years duration (July 15 th , 2004 -July 14 th , 2014). The data included total normal delivery, caesarean section, vacuum delivery, forceps delivery and total delivery of the respective years.Results: Out of 80,149 deliveries over 10 years, 1635 (2.03%) were instrumental vaginal delivery. The study revealed progressive decline in overall trend of instrumental vaginal delivery. The highest percentage of it in the year 2005 was 265 (16.02%) and tangential dropped to 49 (2.9%) by 2014. The study revealed markedly decreased trend in vacuum delivery IURP WR EXW D SRVLWLYH GHÀHFWLRQ ZDV QRWLFHG WLOO DQG DEUXSW IDOO LQ WKH \HDU 5HJDUGLQJ IRUFHSV GHOLYHU\ a gradual fall in trend was noticed over the years. Over the last 10 years the mean percentile value of vacuum delivery was 78.47% while that of forceps was 21.52 %. Conclusions:The trend of instrumental vaginal delivery has markedly declined. On the other hand, it has shown increasing trend in caesarean delivery..H\ZRUGV forceps delivery; instrumental vaginal delivery; vacuum delivery.

Aim: To estimate the severity of neonatal and maternal morbidity associated with instrumental vaginal delivery (IVD). Methods: Record based cross-sectional retrospective study of 80 instrumental vaginal deliveries during two years from 2013 to 2015 were performed. Variables studied were neonatal and maternal complications. Results: Out of 80 IVD, 19(23.8%) were forceps deliveries and 61(76.2%) were vacuum deliveries. The mean one minute Apgar score was 6 and 7 for forceps and vacuum delivery respectively. The five minute Apgar score for the both IVD was 8. Regarding maternal complications 7(8.75%) cases had extended episiotomy with deep vaginal tears. In forceps delivery 5 had deep vaginal tear and one each for primary post-partum hemorrhage and urinary retention but among the vacuum deliveries two had deep vaginal tear only. Regarding neonatal complications, one had subgaleal bleed in forceps delivery and one had cephalhematoma with Erbs palsy in vacuum delivery. Conclusions: The neonatal and maternal complications between both types of IVD were comparable. Forceps and repeated vacuum application resulted in low one minute Apgar score; and extended episiotomy and deep vaginal tear were associated with use of forceps.

Aims:This study was done to analyze the semen parameters of fertile Nepalese men with a known time to pregnancy of less than or equal to 12 months and to compare the values obtained with the newer reference limit of WHO, 2010. Methods:A hospital based prospective cross-sectional study was conducted at Tribhuvan University Teaching Hospital, ,QVWLWXWH RI 0HGLFLQH IURP WK $SULO ± WK $SULO 6L[W\ IHUWLOH PHQ ZLWK D NQRZQ WLPH WR SUHJQDQF\ 773 12 months were included in the study and semen collection and analysis done at the laboratory of Department of Pathology. Results 7KH IROORZLQJ RQHVLGHG UHIHUHQFH OLPLWV WKH ¿IWK FHQWLOH ZLWK WK SHUFHQW FRQ¿GHQFH LQWHUYDO ZHUH JHQHUDWHG VHPHQ YROXPH PO WRWDO VSHUP QXPEHU PLOOLRQ SHU HMDFXODWH VSHUP FRQFHQWUDWLRQ PLOOLRQ SHU PO SURJUHVVLYH PRWLOLW\ WRWDO SURJUHVVLYH SOXV QRQSURJUHVVLYH PRWLOLW\ PRWLOLW\ YLWDOLW\ PRUSKRORJLFDOO\ QRUPDO IRUP Conclusions:The study concluded that only a single semen parameter cannot be conclusive of fertility, therefore combination of all semen parameters is more predictive. In addition the study also concluded that the semen parameters of Nepalese fertile men were found lower as compared to reference limits of WHO. .H\ZRUGV IHUWLOH PHQ VHPHQ SDUDPHWHUV WLPH WR SUHJQDQF\ 773

Aims: To assess the intraoperative and post-operative complications of exteriorization repair with intrabdominal repair of uterus during caesarean delivery. Method: This was a prospective comparative study of 150 caesarean deliveries. Randomization of the cases was irrespective of age, parity, indication and elective or emergency and was performed by two surgeons. Total of 150 cases were considered in the study and 75 cases performed by each surgeon were selected. One surgeon performed the surgery as intrabdominal repair while the other exteriorized the uterus for closure. Descriptive parameter and t-test were used. Results: Intraoperative complications like intraoperative nausea, vomiting, pain were more commonly associated in cases in which uterus was exteriorized. In regards to severity of blood loss in either group there was no significant difference in either group (1.28±1.00, 1.23±0.98). The study revealed no significant difference in febrile morbidity and wound infections in either group. Conclusions: There is no significant difference in the post-operative morbidity between the two groups but intraoperative peritoneal stretching pain was more when uterus was exteriorized. Keywords: caesarean delivery, exteriorization, intrabdominal repair, uterine closure

Introduction:  Health systems all around the globe have greatly been affected by the increasing demand for care of people with COVID-19. A well-prepared health system should have the capacity to maintain equitable essential health services in any pandemic or emergency. In this current scenario, this study aims to study the trends of hospital care services in one of the remote tertiary hospitals of province 5. The aim of the study was to assess the trends of various important health services along with the onset of the COVID-19 pandemic.  Methods: A cross-sectional study was conducted in which data of the number of OPD cases, emergency cases, inpatients, deliveries, number of surgeries (major and minor), and the number of USG services were collected. Data of seven months prior to the onset of pandemic (August 15th, 2019 to March 15th, 2020) were compared with data of seven months following the onset of the pandemic (March 16th to October 16th, 2020) were recorded, compared, and plotted. Results:  In regard to inpatients, there was an increment of 47.57%, the number of emergency cases increment by 41.90%, and the number of delivery increments by 94.70% was detected compared to seven months’ data prior to the onset of the pandemic.  On the other hand, a reduction in total OPD, total number of surgeries, and USG by 32.7 %, 13.04%, 5.26 % respectively were detected. Looking through the trend, there was a decline in the number of OPD visits, inpatient cases, and emergency cases initially for three months (March-May) following the onset of the pandemic but along with an upsurge of the COVID pandemic, there was a marked increase in these services. Conclusions: The depiction of such trends of seeking and use of health services in resource-limited tertiary centers during this pandemic reflects the need of strengthening the overall health system. It also emphasizes the importance of the need of addressing non-COVID services during a pandemic, which was greatly affected by COVID-19.