Aims: To assess safety and feasibility of non-descent vaginal hysterectomy. Methods: A hospital based prospective study was conducted at the department of obstetrics and gynecology of Kathmandu Medical College Teaching Hospital from 1st January 2010 to 31st December 2011. All the patients undergoing non -descent vaginal hysterectomy for benign indication, without suspected adnexal pathology were included in the study. Vaginal hysterectomy was done in usual manner. In bigger size uterus morcellation techniques like bisection, debulking, myomectomy, slicing, or combination of these were used to remove the uterus. Data regarding age, parity, uterine size ,estimated blood loss, length of operation, complication and hospital stay were recorded. Results: A total of 50 cases were selected for non-descent vaginal hysterectomy. Among them 43 cases successfully underwent non-descent vaginal hysterectomy. Commonest age group was (41-45 years) i.e. 40%. All patients were parous. Uterus size was <10 weeks in 27 cases and >10 weeks in 23 cases. Commonest indication was leiomyoma of uterus (63%). Mean duration of surgery was two hours. Mean blood loss was 205.26ml. Reasons for failure to perform NDVH was difficulty in opening pouch of Douglas in three cases. In rest of four cases there was difficulty in reaching the myoma and transverse diameter was too large so as to prevent descent of the uterus. The most common complication was post –operative pain in 23% of cases. Febrile morbidity was present in 4.6% of cases. Blood transfusion was required in seven cases. Average duration of hospital stay was three days. Conclusions: Vaginal hysterectomy for benign gynecological causes other than prolapse is safe and feasible. For successful outcome size of uterus, size in all dimensions and location of fibroid should be taken into consideration.Today in the era of minimally invasive surgery, non descent vaginal hysterectomy needs to be considered and seems to be a safe option. DOI: http://www.dx.doi.org/10.3126/njog.v7i2.11134   Nepal Journal of Obstetrics and Gynaecology / Vol 7 / No. 2 / Issue 14 / July-Dec, 2012 / 14-16

Objective To assess the prevalence and biosocial and obstetric risk factors for antepartum and intrapartum stillbirths at a tertiary hospital in Kathmandu, Nepal. Study Design A prospective hospital based study during a one year period from 1st November 2007 to 30th October 2008. Results:18 stillbirths occurred out of the 790 deliveries that took place during the study period giving an overall stillbirth rate of 22.7 per 1000 births of which 22.2% occurred in the intrapartum period. The majority(89.9%) of patients were in the low risk age group, viz. 20-35 years. 62% were overweight, 16% obese and 22% had normal BMI. More than half (56%) were either illiterate or had only primary education and 33.3% were moderate smokers. 66.6% were nullipara and there were no grand multipara in the series. 72% had regular prenatal visits but only 33% presented with a history of loss of fetal movements. 50% delivered preterm and 22.2% were post-term while 66.6% had low birth weights. Hypertensive disorders of pregnancy and IUGR were the leading causes of stillbirths, others being prolonged PROM, cholestasis of pregnancy and congenital anomalies. 11.1% were unexplained and there was one case each of gestational diabetes, antepartum hemorrhage and vaginal breech delivery. Conclusion Avoidable intrapartum stillbirths continue to be quite high where timely and appropriate intrapartum intervention must be taken to prevent fetal loss. The identified antenatal risk factors should serve as potential targets for antenatal intervention and due importance of maternal fetal movement scoring must be stressed in the at risk patient.

A 32 year old, Para 2 with normal vaginal delivery presented with cyclical bleeding from a dark brown painful umbilical nodule for 6 months. The ultra sonogram showed a subcutaneous nodule at the umbilicus without any other abnormality. FNAC of the nodule diagnosed it as a case of umbilical endometriosis. A diagnostic laparosopy ruled out any associated pelvic endometriosis. Umbilectomy was done for the treatment of the condition.

Anthropogenic stressors, including restoration activities, can have ecosystem wide impacts, reflecting in various biotic components, particularly the basal levels in the trophic webs. Functional traits link taxonomic diversity to ecosystem function, thereby enabling a better ecological assessment of ecosystem health. We studied the effects of restoration activities on the community structure and functional diversity of freshwater cladoceran zooplankton in an urban water reservoir. Samples were taken in the early and late phases of the restoration work. Cladoceran species community and functional composition was significantly different between the two phases. There was a considerable reduction in taxonomic richness, functional richness and redundancy in the late phase. Taxonomic beta diversity between the two phases was explained more by nestedness. Habitat degradation due to haphazard restoration measures such as destruction of littoral zone and arbitrary desilting in addition to the dumping of untreated sewage could have contributed to the decrease in species and functional richness within the reservoir.