Aims: This study was done to find out morbidity related with puerperal pyrexia/sepsis and its risk factors.Methods: This was retrospective study conducted from January 2011 to December 2012 at Department of Obstetrics and Gynaecology, Patan Hospital, Kathmandu, Nepal. All women who delivered in this hospital within 42 days of delivery with puerperal pyrexia/sepsis diagnosed on clinical examination and relevant investigations were included in the study. Women with malaria, typhoid fever and ??other fever were excluded. The data was recorded in predesigned proforma and analyzed.Results: During this period, there were 122 cases of puerperal pyrexia. Puerperal pyrexia accounted for 6.28% of 1945 admissions. Most of the women were aged between 20-29 years, primiparous and booked cases with absent membranes. The causes of puerperal pyrexia in our study were urinary tract infection (47.5%), wound infection (20.5%), endometritis (19.7%) retained product of conception (8.2%), pyoperitoneum (2.5%) and septicemia (1.6%). Conclusions:Puerperal pyrexia/sepsis is one of the causes of preventable maternal morbidity and mortality though in our study it was not proved to be very high in number. Optimal aseptic measures during labour can prevent most of the cases.

Introductions:Obstetricians have long debated the role of caesarean section as a potentially safer mode of delivery for the fetus with breech presentation. However, the experience of the health care provider remains a critical element in the decision to pursue a vaginal breech delivery, and it may still be a viable option. The aim of this study is to determine the incidence of breech delivery at Patan Hospital and compare maternal and neonatal outcomes subjected to either vaginal or caesarean section. Methods:This was a five-year retrospective study of breech deliveries covering the year 2010 to 2014. Patient's charts were retrieved from the medical record section and reviewed.Results: There were 896 breech deliveries out of a total 44,842 deliveries giving an incidence of 1.99%. One hundred thirteen (12.61%) of breech deliveries were through vaginal route while 431 (48.10%) and 352 (39.28%) were through emergency and elective caesarean sections respectively. There were 154 (17.18%) preterm breech deliveries including 27 (17.5%) preterm intrauterine death. Among term pregnancy, there were 3 neonatal deaths not associated with mode of delivery. None of the term infant had neurological morbidity comprising neonatal seizures, brachial plexus injury, chephalohematoma. Maternal blood loss was significantly higher in caesarean section group. Conclusions:In well-selected cases, the neonatal outcome following assisted vaginal breech delivery and caesarean section may not be different.

Introductions: Relaparotomy after caesarean section is rare and literature are scanty. The decision requires a good clinical judgment to save mother’s life. Our objective was to analyse the outcome of relaparotomy after caesarean section at Patan Hospital.Methods: This was a cross sectional study done at the department of obstetrics and gynaecology, Patan Hospital, Lalitpur, Nepal. Charts of the caesarean section from January 2010 to December 2014 were reviewed to analyze the cases of relaparotomy for incidence, indication, management and outcome. Descriptive analysis was done using SPSS.Results: During 5 years, there were 17,538 caesarean deliveries, 39.15% of total 44,788 deliveries. Relaparotomy was done in 15 cases, 0.085% of 17,538 caesarean. Mean age was 26.6±4.7 years, 14 (93.3%) were between 25-35 years, 12 (80%) were primigravida. Indications for relaparotomy were pyoperitoneum (40%), hemoperitoneum (33.3%) and rectus sheath hematoma (26.7%). Out of 15 relaparotomies, 14 were conservative surgery and one required hysterectomy. There was no maternal mortality.Conclusions: Relaparotomy rate in our study was eight in 10,000. Those requiring relaparotomy had fetal distress as indication for first caesarean.Journal of Patan Academy of Health Sciences. 28 2016 Dec;3(2):28-31

Aims: To study the effectiveness of uterovaginal packing in the management of primary postpartum hemorrhage (PPH).Methods: This is a retrospective study conducted in Patan hospital, Lalitpur from January 2009-2011. Patients included in the study were those with intractable hemorrhage not responding to oxytocics. Exclusion criteria included cases of PPH due to trauma. Packing was done using approximately six inches sterile gauze soaked with povidine iodine packed into the uterus from the uterine fundus up to the vaginal canal. The packing is removed after 48 hours of insertion or earlier in cases of failure to control hemorrhage.Results:  There were 46 cases of  uterovaginal packing for primary PPH. Uterine atony was the commonest cause of packing. Uterovaginal packing was successful in 39(84.7%) cases.Conclusion: Uterovaginal packing is safe, easy and quick procedure to manage primary PPH. It is beneficial in cases of PPH due to atony thereby conserve the uterus.

Introduction: Caesarian section rate was 47% at Patan Hospital in 2014 despite the recommendation of keeping it below 15%. This has become a public health problem and it is debated as human right violation of childbearing women. This study aims use robust time series model to forecast caesarian deliveries to keep track of it at the hospital. Method: Univariate time series models were used to forecast 3-year caesarean deliveries at Patan Hospital using 60-month (2010-2014) data. A robust time series model with low mean average percentage error from validation period and without autocorrelation problem was selected and used to forecast caesarean deliveries for 2015-2017 period.   Result: Winter’s additive model had lowest validation forecasting error and showed decreasing trend of caesarian deliveries but it showed autocorrelation. Quadratic regression gave similar result but is also autocorrelation problem. Artificial Neural Network – Multilayer Perceptron model gave close forecasts but autocorrelation was not assessed. Best Autoregressive Integrated Moving Average (ARIMA) model gave valid forecasts without autocorrelation problem. Conclusion: ARIMA (0,1,1),(0,0,0) model with one difference and one level of moving error correction gave valid forecasts for Patan Hospital. Advanced univariate and multivariate time series models with large samples can be used to get precise forecasts of caesarean deliveries in Nepal.