Background:Labor is a naturally occurring physiological process associated with uterine contractions, effacement, dilatation of cervix and descent of presenting part. Drotaverine hydrochloride is a non-anticholinergic isoquinoline derivative which acts by elevating intracellular cyclic Adenosine Mono Phosphate (cAMP) and cyclic Guanosine Mono Phosphate (cGMP) promoting smooth muscle relaxation. Materials And Method: This was a hospital based prospective study on effectiveness of Drotaverine Hydrochloride on enhancing dilatation of cervix and acceleration of active phase of labor. The sample size was 100. Fifty cases of women in active phase of labor received injection drotaverine hydrochloride 40 mg (group i) and fifty cases of women did not receive any drug (group ii) among those at term with singleton pregnancy and vertex presentation. Variables like maternal age, interval between administration of drug and delivery, mode of delivery, apgar score at 5 minutes, NCU (Neonatal Care Unit) admission and neonatal outcomes were recorded. Data analysis was done with the help of SPSS program. Results: The mean interval between drug adminstration to delivery in primipara and multipara in group i was 3.05 hours and 2.31 hours while in group ii was 4.5 hours and 3.75 hours respectively. The mean interval between drug adminstration and delivery was shorter in both groups of multipara. In group i, 96% had normal delivery and 4 % had vaccum delivery and in group ii 90% and 10% had normal delivery and vacuum delivery respectively. None of the participants had caeseraian section. There were no perinatal mortalities. Conclusion: The administration of drug Drotaverine Hydrochloride is effective in shortening duration of labor with favorable feto-maternal outcome.

Background: Caesarean section (CS) is one of the commonest obstetrics procedure to reduce the risks for mother and fetus when vaginal delivery is not anticipated. The objective of the study was to determine the rate and clinical indication of Caesarean section. Materials and Methods: This was a hospital based descriptive retrospective study done within a time frame of a year (from Shrawan 2075 BS to Ashad 2076 BS; 17 July 2018 to July 16 2019) in Matri Shishu Miteri Hospital, Pokhara, Nepal. The total number of deliveries, their modes of delivery, indication for the Cesarean section, age group, number of parity, period of gestation and type of Caesarean section either elective or emergency were descriptively analyzed. Results: A total of five hundred and eighty eight cases underwent delivery during the study period. Of them 128 (21.76%) cases were delivered by Caesarean section. Analysis revealed that the common age group for the CS patients was between 20-30 years (64.8%) of them 66 (51.6%) cases were primi gravida. Emergency Caesarean section was done for 75(58.6%) cases and elective Caesarean section for 53(41.4%) cases. The most common indication for Caesarean section was found to be previous caesarean section 21% (n=27), cephalopelvic disproportion (CPD) 18% (n=23), fetal distress 18% (n=23), failed induction 14.1% (n=18), breech presentation 10.2 %( n=13), non progress of labor (NPOL) 9.4 %( n=12) and oligohydramnios 7.8% (n=10). Conclusion: Our study revealed that the rate of Caesarean section is higher than that recommended by World Health Organization (WHO), which needed to be 10-15% of the total deliveries. The common indications for Caesarean sections were pervious Caesarean section, fetal distress, CPD, failed induction, breech presentation, non progress of labour (NPOL) and oligohydramnios among others.

Introduction: Fetal activity serves as an indirect measure of the fetus central nervous system integrity and function. Regular fetal movement can be regarded as an expression of fetal wellbeing. Maternal perception of decreased fetal movement is associated with poor feto-maternal outcome. This study is to find out feto-maternal outcome in cases of decreased fetal movement, done by assessing fetal heart rate (FHR) correlating with cardiotocography (CTG) and USG (ultrasonography) findings, Apgar score and meconium in amniotic fluid. Materials and method: This was a hospital based, prospective comparative study done in Patan Academy of Health Sciences, Lalitpur, Nepal. The sample size was 200; 100 cases of decreased fetal movement versus 100 cases of good fetal movement at same gestational age in weeks. Data processing was done in SPSS version 20.0 (SPSS, Chicago, IL, USA) and calculated by chisquare test. P value less than 0.05 was considered significant. Results: Significant difference was found in fetal kick chart counting. In the decreased fetal movement group, 16% had oligohydraminos, 3% had polyhydraminos and 5% had non reassuring CTG and 4% had abnormal heart rate detected clinically. There was statistically significant difference observed between the two groups in labor induction, cesarean section, meconium stain liquor, cord around the neck and different neonatal morbidities. Conclusion: Decreased fetal movement is associated with poor fetomaternal outcome. Improved vigilance, early identification, further evaluation with CTG, USG and proper management of these pregnancies have favourable pregnancy outcome.

Introduction: Hypertensive disorder in pregnancy (HDP) is one of the most common medical complications affecting approximately 5-10% of pregnancies. It remains a major cause of maternal/perinatal mortality and morbidity. Proteinuria is a sign of preeclampsia where there is >300 mg of protein in 24 hour urine collection. This usually correlates with 30mg/dl or 1+ reading in a random urine specimen. The main objective of this study is to find out whether urine dipstick correlates with 24 hour urine protein. Methodology: This is a hospital based comparative study, where proteinuria by dipstick method was compared with 24 hour urinary protein in 60 cases of pre eclampsia at Paropakar Maternity and Women’s Hospital, Thapathali, Kathmandu. Results: The dipstick method of detecting proteinuria significantly correlated with the total 24 hour urine protein excretion by Esbach Albuminometer. A dipstick factor of ≥300mg/24 hour indicates proteinuria with sensitivity of 97.5%, specificity of 65%, positive predictive value of 84.78% and negative predictive value of 92.85%. 3+ value in dipstick had high significance with 24 hour urine protein by Esbach’s Albuminometer (R=0.983 ). The cost of dipstick was Nepalies Rs (NPR) 14 in comparison to 24 hour dipstick which cost NPR 80.Time needed to get report was immediate in case of dipstick but takes 48-50 hour in case of 24 hour urine protein. Conclusion: Timely collection of six hourly urine for detection of proteinuria by dipstick is comparable to 24 hour urinary protein determination in laboratory by Esbach Albuminometer, which is more time consuming and expensive.

Background: The third stage of labor is that period from birth of the infant until the delivery of the placenta. Active management of the third stage of labor plays an important role in reducing maternal morbidity and mortality. Oxytocin is an effective drug in preventing postpartum hemorrhage (PPH) however; it requires a controlled environment and intramuscular administration. Misoprostol is an orally active uterotonic agent,stable at room temperature.The purpose of this study was to compare the efficacy of misoprostol with oxytocin in active management of third stage of labor. Materials and Methods: This was a hospital based study carried out in Paropakar Maternity and Women Hospital, Kathmandu, Nepal during six months period from February 2012 to July 2012. One hundred patients fulfilling inclusion criteria were recruited to receive either 10 unit of IM oxytocin or 600 mcg of oral misoprostol for the management of the third stage of labor. Results: The mean blood loss in misoprostol and oxytocin group was 209±76.7ml and 197±68.8 ml respectively with p value-0.41 which was insignificant. Similarly mean hemoglobin change was also not significant. The additional uterotonics needed in misoprostol was higher (9 cases) than that in oxytocin (5 cases) but it was also not significant. Shivering and fever were significantly high among misoprostol group than in oxytocin group. Conclusion: Efficacy of oxytocin and misoprostol is equal in active management of third stage of labor.