Maternal complications were increased by cesarean delivery but elective section may reduce neonatal complication.

Severe preeclampsia/eclampsia is one of the common cause of maternal and perinatal morbidity and mortality. So the prevention of this severe preeclampsia may prevent these complications. This study was undertaken to assess the association between antenatal care and severe pre-eclampsia/eclampsia, also to examine the role of other risk factors for severe preeclampsia/eclampsia. A case study was conducted during May to Oct 1994 in Kathmandu valley. This study failed to demonstrate that ANC could reduce the risk of severe pre-eclampsia/eclampsia. The incidence rate of ANC visits in third trimester was significantly lower among cases than among controls. Risk independently increased in women with a history of previous PET (OR 6.9, 95% CI 1.0-48.9), history of abortion (OR 4.5, 95% CI 1.1-19.3), late menarche (OR 3.7, 95% CI 1.6-8.4) and primigravidity (OR 2.9, 95% CI 1.2-7.4). Use of modern contraceptive methods decreased the risk (OR 0.21, 95% CI 0.05-0.83). Risk was also higher among the middle-income group (OR 3.6, 95% CI 1.2-10.7), manual workers (OR 13.4, 95% CI 4.5-40.3) and non-Hindu women (OR 9.9, 95% CI 3.0-32.3). This study did not demonstrate that ANC could reduce the risk of severe pre-eclampsia/eclampsia. The history of previous PET, abortion, late menarche and primigravidity status each independently increased risk. Use of modern contraceptive methods decreased the risk. Risk was higher among the middle-income group manual workers and non-Hindu women.

Maternal mortality over a period of a decade in an institutional setting exhibited induced septic abortion as the main cause of maternal death during the first five years of the study period (1997-2001). In the second five years of the study period (2002-2006) an alarming rise in infective hepatitis became the main cause of maternal death.

Introduction: Infertility is defined as inability to conceive after one year of regular unprotected intercourse. Thyroid disorders can lead to infertility arising from different pathophysiological mechanisms. The aim of this study is to determine the prevalence and type of thyroid disorder in infertile women and to compare the prevalence of thyroid disorder in primary and secondary infertility. Methods: A hospital-based descriptive cross-sectional study conducted in the Department of Obstetrics and Gynecology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal from 1st Baishak 2068 to 30th Chaitra 2068 (14th April 2011 to 12th April 2012). Results: Among 156 infertile women enrolled and analyzed in the present study, thyroid disorder was found in 12 women giving the prevalence of thyroid disorder in infertile women as 7.7%. Hypothyroidism was more common comprising 6.4% of all infertile women, out of which subclinical hypothyroidism was 3.8% and clinical hypothyroidism was 2.6%. Hyperthyroidism was seen in 1.3% of all infertile women of which subclinical hyperthyroidism was 0.64% and clinical hyperthyroidism was 0.64%. Prevalence of thyroid disorder in primary infertility was 9.8% and in secondary infertility it was 3.7%. Among the 12 infertile women with thyroid disorder, four infertile women (33%) conceived. Three cases of hypothyroidism conceived after treatment and one case of subclinical hyperthyroidism conceived without any treatment. Conclusions: This study shows that thyroid dysfunction shows a significant role in infertility. Proper management of the thyroid dysfunction can result regain of fertility. Therefore, routine screening is required to all cases of infertility for possible thyroid disorders.

Aims: This study was done to analyze the cases of obstetric hysterectomy and maternal complications and survival after that. Methods: A retrospective study was carried out from the review of records   of the near miss, maternal mortality, cesarean audit and operation theater record of the Department of Obstetrics and Gynaecology, Tribhuvan University Teaching Hospital (TUTH), Kathmandu from 2057-2071 BS. Results: Fourteen maternal survival resulted following total of 19 obstetric hysterectomy, subtotal hysterectomy being the procedure of choice in 11 cases, emergency peripartum hysterectomy (EPH) being performed in abundance (18/19) in comparison to an elective peripartum hysterectomy, which was undertaken in a single case of placenta percreta, and inclusive of latter were four cases of morbid placental adhesion, a placenta increta and two placenta accreta. Eight out of 19 cases had vaginal delivery and rest had cesarean section. Among seven cases of cesarean hysterectomy 3 were done for placenta previa with accreta one case each done for abruptio placentae  and placenta accreta and two cases were done for extra placental causes. Among four cases of emergency peripartum hysterectomy (EPH), which were relaparotomy followed by hysterectomy, three cases were done for complication of cesarean section and one done for uterine atonicity. Four cases of spontaneous vaginal deliveries needed peripartum hysterectomy two of them were complicated by morbid placental adhesion placenta increta (1), placental percreta (1), two cases were vaginal birth after cesarean (VBAC). Seven cases of uterine rupture had undergone peripartum hysterectomy.   Conclusions: Obstetric hysterectomy is a lifesaving surgical procedure for maternal survival whenever necessary and mandates a quick decision making process, however in consideration of younger age and low parity or nulliparity, the best obstetric governance and services must foresee not to let mothers meet such situation necessitating organ removal and to enjoy potential reproductive life cycle.DOI: http://dx.doi.org/10.3126/njog.v9i2.11759