SummaryMeasuring maternal mortality ratios is fraught with problems and underestimates. Therefore process indicators have been proposed for monitoring the availability and use of obstetrics services. We report the results of process indicators for measuring the availability, use and quality of obstetric care in five districts in Nepal between 1997 and 1998. The number of comprehensive essential obstetric care (EOC) facilities was adequate for four of the five districts, but none had a minimum acceptable level of basic EOC facilities as set by UNICEF et al. The proportion of expected births in hospital was 21.5% in Rupandehi and Ͻ 5% in Baglung, Kailali, Okhaldunga and Surkhet. The minimum acceptable level is 15%. The 'met need' for obstetric care which pertains to the proportion of all women with direct obstetric complications that are treated in hospital was 14.9% in Rupandehi and Ͻ 5% in the other four districts, against the required minimum of 15%. The caesarean section rate calculated of all expected births in the population varied between 0.2% and 1.4%. The case fatality rate was 4.0% in Rupandehi Zonal Hospital. Analysis of these indicators clearly identified tremendous underuse of maternity services which has stimulated national policy discussions in Nepal with ensuing safe motherhood interventions and monitoring strategies.keywords process indicators, met obstetric need, Nepal, maternal mortality, maternal morbidity correspondence Dr Barbara E. Kwast,

Aim: To compare oxytocin used via intraumbilical or intramuscular route in the active management of third stage of labour with respect to duration and amount of bleeding. Methods: Prospective comparative study conducted in Maternity Hospital, Thapathali, Kathmandu for three months 29th April - July 28th 2004 (061/1/16 to 061/4/12 BS ). After immediate umbilical cord clamping following vaginal delivery, 120 women were divided into 2 groups administering 10 units of oxytocin; in Group I: which was diluted mixing with 10 ml of normal saline before it was infused intraumbilical and Group II: injected intramuscularly. Results: There was no difference in the duration of third stage of labour (3.6 vs. 3.7min) between the two groups. There was significant blood loss in the intraumblical group as compared to intramuscular group (242ml vs.168ml, p. 0.004). The need for additional oxytocic to control the uterine bleeding was more in intraumbilical group as compared to intramuscular group (28.3% vs 6.7%, p 0.005). There was more postpartum haemorrhage (PPH) in intraumbilical group (8.3% vs 3.3%, p 0.439). The injection delivery interval was significantly longer in the intraumbilical group as compared to intramuscular group (46.9 vs. 30.7 sec). Conclusion: Intraumbilical oxytocin is technically more difficult to administer without having any added benefit either in decreasing the duration of third stage of labour or reducing the blood loss. Key words: Intraumbilical oxytocin, intramuscular oxytocin, third stage of labour. doi:10.3126/njog.v2i1.1469 N. J. Obstet. Gynaecol Vol. 2, No. 1, p. 13 - 16 May -June 2007

Aim: To find out the relationship between utero-vaginal prolapse (UVP) and first vaginal birth at younger age <22 years and to identify single most frequently occurred risk factor in study group. Method: A hospital based descriptive comparative study was carried out in 200 women of age 40- 60 years in two hospitals. One hundred women with UVP were enrolled as case (Group I) and 100 women with similar parity and age group but admitted for other reasons than prolapse were enrolled as comparative group (Group II). Relationship was observed between two groups in their age at first vaginal birth, duration of labour, family history, smoking habit, menopause and BMI. Results: Cases of UVP occurred in younger <22 years at first vaginal birth than comparable group (OR 3.41, 95% CI 1.74-6.72, P = 0.00009). The mean of duration of labour pain was 30.85±26 vs 18.87±21.3 (P=0.006) hours in Group I and Group II respectively. There was increased risk of UVP in women who had family history (OR 2.35; 95% CI 1.16-4.78, P= 0.01). Conclusion: Single most frequently identified risk factor was young age <22 years at first vaginal birth. DOI: http://dx.doi.org/10.3126/njog.v3i2.10832 Nepal Journal of Obstetrics and Gynaecology Vol.3(2) 2008; 48-50

Introduction: This is a retrospective study done in cervical and endometrial biopsy specimens received in the pathology department of Shree Birendra Hospital over a period of one year from 14th April, 2011 to 13th April, 2012. The aims of this study were to analyze the histological findings of cervical and endometrial biopsies and to identify activities needed to critically evaluate these specimens. Methods: The histopathological diagnoses of 104 cervical and 84 endometrial biopsy specimens reported by the pathologists were retrieved. The diagnoses were categorized and correlated with age in order to work out a strategy for better patient management. Results: The majority of 104 cervical biopsies (76.0%) comprised of neoplastic lesions and 83.5% of them were low-grade squamous intraepithelial lesions. Among the nonneoplastic lesions, cervical polyps and cervicitis were in the ratio of 3:2. Of the 84 endometrial biopsies analyzed, proliferative endometrium comprised the majority (61.9%) with disordered proliferative being the most common pattern. Detailed information about the patients was minimal including the absence of age in 8.0% of cases. More than 80% of both cervical and endometrial biopsies were performed in the age group 30-59 years of age. Conclusions: Neoplastic lesions comprised the majority of the cervical biopsies while all the endometrial biopsies were nonneoplastic. Important clinical information like age of the patient has to be mentioned in the biopsy request form for useful clinical correlation of histological findings.  Medical Journal of Shree Birendra Hospital; January-June 2013/vol.12/Issue1/23-28DOI: http://dx.doi.org/10.3126/mjsbh.v12i1.9088

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