Although under five and infant mortality has been reducing in Nepal, neonatal mortality remains largely unchanged. Newborn care practices in the family and in the community acts as contributing factors which could be improved by adopting simple interventions at community level. The objective of the study was to identify newborn care practices (cord care, breastfeeding, and bathing) and factors affecting it. The study is crosssectional descriptive and analytical conducted at Bachauli and Khairahani VDCs of Chitwan district from July to December 2012. A total 181 Tharu mothers were interviewed using semi structured interview schedule. Data processing and analysis was done using SPSS. The study revealed that 99.4% newborns had cord care (cutting, tying and applying nothing or using antiseptic). All newborns were breastfed and given colostrums as first feed but initiation of breastfeeding within one hour of delivery was only 52.5 %. Ninety seven per cent were bathed after 24 hours of delivery. Mothers who knew about newborn care were more likely to practice cord care (OR=0.10, 95% CI=0.02-0.41) in comparison to mothers who do not know about it. Compared to mothers with secondary and primary education, mothers having higher education were breastfeeding within one hour of delivery (OR= 2.06, 95% CI=1.12-3.81). Delaying in bathing was more practiced in institutional deliveries compared to home deliveries (OR= 12.11, 95% CI=1.65-88.64). Overall newborn care practices were acceptable as per the findings of this study. Awareness programs regarding initiation of breastfeeding within one hour of delivery should be strengthening.

ObjectivesStillbirth is one of the vital indicators of quality care. This study aimed to determine maternal-fetal characteristics and causes of stillbirth in Nepal.DesignSecondary analysis of single-centred registry-based surveillance data.SettingThe study was conducted at the Department of Obstetrics and Gynecology, Chitwan Medical College Teaching Hospital, a tertiary care hospital located in Bharatpur, Nepal.ParticipantsAll deliveries of intrauterine fetal death, at or beyond 22 weeks’ period of gestation and/or birth weight of 500 g or more, conducted between 16 July 2017 and 15 July 2019 were included in the study.Main outcome measuresThe primary outcome measure of this study was stillbirth, and the secondary outcome measures were maternal and fetal characteristics and cause of stillbirth.ResultsOut of 5282 institutional deliveries conducted over 2 years, 79 (1.5%) were stillbirths, which gives the stillbirth rate of 15 per 1000 births. Of them, the majority (75; 94.9%) were vaginal delivery and only four (5.1%) were caesarean section (p<0.0001). The proportion of the macerated type of stillbirth was more than that of the fresh type (58.2% vs 41.8%; p=0.13). Only half of the mothers who experienced stillbirth had received antenatal care. While the cause of fetal death was unknown in one-third of cases (31.6%; 25/79), among likely causes, the most common was maternal hypertension (29.1%), followed by intrauterine infection (8.9%) and fetal malpresentation (7.6%). Four out of 79 stillbirths (5%) had a birth defect.ConclusionHigh rate of stillbirths in Nepal could be due to the lack of quality antenatal care. The country’s health systems should be strengthened so that pregnancy-related risks such as maternal hypertension and infections are identified early on. Upgrading mothers’ hygiene and health awareness is equally crucial in reducing fetal deaths in low-resource settings.

Molar pregnancy can occur outside the uterine cavity. Ectopic molar pregnancy although a rare entity does exist. The patient presents with features similar to ruptured or unruptured ectopic gestation. Management requires surgical removal of the conceptus and follow-up. Diagnosis with histopathological examination of the specimen is the gold standard. Here, we report an unusual case of 30 years female with a left tubal partial hydatidiform mole. The initial suspicion was made with preoperative raised serum beta Human Chorionic Gonadotropin levels and the diagnosis was confirmed with the histopathological examination of the specimen. The patient was followed up with serial weekly serum beta Human Chorionic Gonadotropin monitoring and remission was achieved. Therefore, sending samples for histopathological examination after surgical management of ectopic pregnancy is mandatory to detect molar ectopic pregnancy in order to make a proper follow-up and to prevent persistent gestational trophoblastic diseases.

Background: Operative vaginal delivery is safe and effctive when applied by well-trained personnel. However, it is an underutilized component of obstetric care. We aimed to estimate the frequency of operative vaginal delivery in a tertiary care center and evaluate the immediate maternal and fetal morbidities. Methods: This descriptive retrospective study was carried out in the Department of Obstetrics and Gynecology, Chitwan Medical College and Teaching Hospital. Medical records of all operative vaginal deliveries conducted from May 2019 to April 2020 were retrieved. Data regarding demography, delivery characteristics, maternal and fetal morbidity and mortality associated with operative vaginal deliveries were collected. Results: The frequency of operative vaginal delivery was found to be 2.3% among 3060 deliveries. It was more commonly used in nulliparous women (n = 54, 76.1%); the commonest age group being 20 to 35 years. The commonest indication was fetal distress (n = 32, 45.1%) followed by prolonged second stage of labor (n = 26, 36.6%). The associated maternal morbidities included postpartum hemorrhage (n = 12, 16.9%), need of blood transfusion (n = 9, 12.7%), fever (n = 6, 8.5%), cervical tear (n = 3, 4.2%) and third/fourth degree perineal tears (n = 3, 4.2%). One neonate had cephalhematoma and 14 neonates (19.7%) needed admission in neonatal intensive care unit. Conclusion: Operative vaginal delivery accounted for 2.3% of the total deliveries and was associated with a few maternal and fetal morbidities.