Introduction: Nepal Society of Obstetricians and Gynecologists jointly with the Nepalese governmentand with the support from the International Federation of Obstetrics and Gynecology hasimplemented an initiative to institutionalize postpartum family planning services in selected majorreferral facilities of Nepal to address the gap of low uptake of postpartum family planning in Nepal.The aim of the study is to find the prevalence of the service coverage of postpartum contraception inthe selected facilities. Methods: A descriptive cross-sectional study was conducted in seven major referral facilities acrossNepal. Data were collected from the hospital records of all women who delivered in these facilitiesbetween October 2018 and March 2019. Ethical approval for this study was obtained from NepalHealth Research Council. Data analysis was done with SPSS version 23. Results: Among the 29,072 deliveries from all the facilities, postpartum family planning counselingcoverage was 27,301 (93.9%). The prevalence of uptake of Postpartum Intrauterine Device is 1581(5.4%) and female sterilization is 1830 (6.3%). In total 11387 mothers (52.2%) had the intention tochoose a postpartum family planning method. However, 36% of mothers neither used nor had theintention to choose a postpartum family planning method. Conclusions: The coverage of Postpartum Intrauterine Device counseling service coverage in Nepal ishigher in 2018 as compared to 2016-2017 and in other countries implementing Postpartum IntrauterineDevice initiatives. However, the prevalence of service coverage of immediate Postpartum FamilyPlanning methods, mainly Postpartum Intrauterine Device in 2018 is lower in Nepal as compared to2016-2017, and other countries implementing Postpartum Intrauterine Device initiative. More effortsare needed to encourage mothers delivering in the facilities to use the postpartum family planningmethod.

Introduction: Passage of meconium in utero is a dangerous sign for fetal outcome which influence the decision to deliver as well as the mode of delivery. Methods: This descriptive case control study was carried out in the department of Obstetrics and Gynaecology, Koshi Zonal Hospital from March 2006 to July 2006. A total of 50 women with meconium stained amniotic fluid( MSAF) were studied to identify maternal and fetal outcome and was compared with women with clear amniotic fluid. Results: Normal delivery was significantly higher (58%) in clear liquor group as compared to MSAF group (22%). Cesarean section was more common in MSAF group (66%) where as it was (38%) in the clear liquor group (p=0.005). Low Apgar scores of < 5 at one minute was seen in 48% of MSAF and 6% of clear liquor born babies (p<0.2). But at 5 minutes low Apgar score persisted in same 48% of MSAF babies whereas it was seen in 12% of clear liquor group (p<0.000). Among the babies born with MSAF 34% were referred to higher center compared to 6% in clear liquor babies (p=0.000). Four babies with thick MSAF and one baby with clear liquor had neonatal death (p=0.005). Conclusion: Mode of delivery and fetal outcome were adversely affected by the presence of thick meconium stained liquor as compared to clear liquor. Additional monitoring facilities e.g. cardiotocography (CTG) if available would reduce fetal distress and allow timely intervention in such cases.

Introduction: Eclampsia is an acute and life-threatening complication of pregnancy associated with elevated maternal and fetal morbidity and mortality. This study was done with the aim to evaluate the maternal and fetal outcome in eclampsia patients and to observe various factors affecting its occurrence and outcome. Methods: A retrospective cross-sectional hospital based study carried out in Nepalgunj Medical College, Nepalgunj from January 2015 to December 2016. Details and data obtained from maternity register were analysed. All patients with eclampsia were included and fetomaternal outcomes measured in terms of complications. Simple descriptive statistical method was applied for analysis. Result: Out of 6056 pregnant women, 46 had eclampsia with the incidence of 7.59 per 1000 deliveries. 58.7% of study population belonged to age group of 21-30 years followed by 36.96% from age less than 20 years. 78.26% cases were unbooked. 73.91% eclamptic patients were primi gravida and 60.87% had gestational age less than 37 weeks. Half of pregnancies with eclampsia underwent ceasarian for delivery and 30.44% required ICU care. One third women developed eclampsia related complications and 2(4.35%) died. Common complications were atonic postpartum heamorrhage (15.21%), psychosis (8.71%) acute renal failure (4.35%). 60.86% newborn were preterm and 56.52% were low birth weight. In 50% newborn, Apgar score at 5 minutes was less than 7. Fetal death was 10.85%. Conclusion: Eclampsia continues to be one of the prime etiological factors for maternal and fetal morbidity and mortality. Therefore early recognition and proper management are vital to tackle this challenge.

Introduction: Caesarean Section (CS) rates are a major public health concern and cause worldwide debates according to latest data from 150 countries. Currently 18.6% of all births occur by CS, ranging from 6 to 27.2% in the least and most developed regions. This study was done to find out incidence and outcome of CS and geographical variation of women coming for the service in this Zonal Hospital. Methods: A retrospective review of case files of 771 women who had CS from 16th April 2017 to15th April 2018 were analyzed for demographic profile like age, parity, geographical location. Similarly, gestational age, various indications of CS, incidence, parity, maternal and fetal outcome and duration of hospital stay were recorded. Results: Out of 5083 deliveries, 771 (15.17%) had CS. Most of the CS was done for Cephalopevic disproportion (CPD) which was 175 (22.70%) and previous CS, 140 (18.15%). Majority of CS which was 328 (42.54%), in age group 20-24 years. In relation to parity nulliparous were 463 (60.05%). Maternal morbidity was 31 (4.02%) and maternal mortality was one after CS. Apgar score of the baby between 0-3 was 3.24%. Three babies were expired within 24 hours due to severe birth asphyxia. The patients from Banke district were 408 (52.92%). Conclusion: Study showed CS rate, 15.7% which is in upper limit of WHO recommendation and 60.50% were nulliparous had CS and most common indication of CS was CPD and fetal distress. There was no CTG used in routine practice.

Aims: To evaluate pre-cancer lesion and presence of risk factors by visual inspection with acetic acid.Methods: A retrospective study was done to evaluate VIA positive women by demographic and reproductive history and presence of risk factors from the period 16th March, 2016 to 15th March, 2017.Results: A total of 605 women were included and counseled for screening mean age of patient in year's was 39.46±9.4 years and VIA positive rate was 4.63% (28/605).Conclusions: Cervical pre-cancer and cervical cancers were detected by VIA testing.