Introductions: Stillbirth (SB) is one of the most common adverse outcomes of pregnancy. The aim of this study was to determine the SB rate and to identify the likely causes contributing to SB. Methods: This cross-sectional study was conducted at Patan Hospital from 15th June 2014 to 14th June 2017 for all the cases of SBs, at or after 22 weeks, birth weight of 500 gm or more. The perinatal outcome, demographic profile, fetal characteristics, causes and contributing factors were analyzed. Results: There were 262 SB out of total 23069 deliveries, (11.24 per 1000) and 119 (46.12%) had antenatal check-up (ANC) at Patan Hospital. The 214 (82.95%) SB were among 20-34 years mothers, 133 (51.55%) being multigravida. Antepartum SB were 234 (89.31%), macerated 213 (81.30%), birth weight <1000gm 86 (32.82%) and male 156 (59.54%). The intrauterine growth restriction (IUGR) was present in 60 (22.90%), unexplained casue in 43 (16.41%), prematurity 28 (10.69%), congenital anomalies 26 (9.92%), pre-eclampsia 19 (7.25%), gestational diabetes, and abruptio placenta each 13 (4.96%). Delay in seeking care in 202 (78.30%) was a potential contributing factor. Conclusions: The SB was 11.24/1000 births. The causes in descending order were IUGR, unexplained, prematurity, congenital anomalies, pre-eclampsia, gestational diabetes and abruptio placenta. Delay in seeking care was found as a potential contributing factor.

Background The Mayer Rokitansky Küster Hauser (MRKH) syndrome is a rare congenital disorder characterized by the absence of uterus and vagina in a patient who is phenotypically a female, with 46 XX karyotypes. It affects 1 in 4000 to 5000 female new-borns. Pulmonary agenesis is a rare association in this MRKH syndrome. Females with MRKH face various mental health issues and psychological disturbances, including dissociative disorder which is a stress-related psychiatric disorder. Dissociative disorder in MRKH syndrome is under-recognized and under-treated. Case presentation A 23-year-old unmarried woman presented to the emergency forabnormal behaviour attack. Recurrent episodes of dissociative convulsions were present most of the time with MRKH syndrome as the pertinent stressor. Both antidepressants and psychotherapy helped to decrease the frequency of dissociative convulsions and come interms with the syndrome. Conclusion This case describes dissociative disorder as the presentation and comorbid condition of MRKH syndrome and the impact of MRKH syndrome on the patient. We attempt to explain the occurrence of dissociative disorder in MRKH syndrome and the results of under-recognition and under-treatment of the same. We aim to highlight the presence of commonly treatable conditions associated with a rare syndrome and its effect when untreated and unrecognized.

Introduction: Maternal age is an important determinant of pregnancy outcome. Women aged 35 years ormore at their first pregnancy are considered high risk as they are associated with increased adverse maternaland perinatal outcomes. Methods: A retrospective, comparative study was carried out over a period of two years in a tertiary center. Each elderly primigravida was matched with two primigravidwomen aged 20-34 years who delivered during the same period. Secondary data on obstetric outcomes (diabetes, oligohydramnios, polyhydramnios, hypothyroidism), postpartum complications (post-partum hemorrhage, postpartum eclampsia) and perinatal outcome (intra-uterine growth restriction, prematurity, congenital anomalies, and neonatal death)of 82 elderly primigravidae (study group) was compared to 164 younger primigravida (control group) delivered during the period of study. The Chi Square test and Fisher’s Exact test were used for statistical analysis and p value of <0.05 was taken as level of significance. Results: During the study period, there were 15,012 deliveries and 82 of these were elderly primigravidae giving an incidence of 0.55%. The mean age of the elderly primigravidae was 36.8±2.16 years. The study group had more antepartum complications with preterm labor, diabetes in pregnancy, hypertensive disorders in pregnancy, multiple pregnancy and polyhydramnios (p<0.05). Seventy-one elderly primigravidae were delivered by caesarean section, the commonest indication being maternal request. The study group had higher incidence of post-partum hemorrhage but no perinatal mortality of significant proportion. Conclusion: Maternal age at the first pregnancy influences pregnancy and neonatal outcomes. Hence, elderly primigravidae should be considered as high risk and followed up accordingly.

Introduction Maternal mortality reflects reproductive health status and availability of good health care facilities at different levels of the healthcare system at a given period, influenced by globally adopted safe motherhood policies. The leading causes of maternal death in Nepal mainly comprise of hemorrhage, eclampsia, abortion-related complications, gastroenteritis and anemia. Although a declining trend has been noted in Nepal it has yet to meet the target set by the Sustainable Development Goal (SDG) 3.1 of reducing the global MMR to less than 70 maternal deaths per 100,000 live births by 2030.  MethodsA cross-sectional study was conducted in the Department of Obstetrics and Gynaecology, Tribhuvan University Teaching Hospital (TUTH) from 1st Baisakh 2055- 30th Chaitra 2069 (15th April 1998- 14th April 2013). The study period of 15 years was divided into three parts, five years each: 2055-59 (14th April 1998-April 13th 2003) ; 2060-64 (14th April 2003- April 12th 2008) and 2065-69 (April 13th 2008 –April 12th 2013). MM was filled in Performa, discussed in morning conference and MM audit, computerized, analyzed, presented quarterly and yearly. Annual Maternal Mortality Ratio (MMR) expressed as MMR per 100,000 live births is calculated by dividing recorded (or estimated) maternal deaths by total recorded (or estimated) live births in the same period and multiplying by 100,000.  ResultsTotal MM/maternal mortality ratio (MMR) in the first, mid and last five years were 39 (270 %); 37 (212% ) and 37 (188%) respectively giving overall total MM/MMR 113 (223.5%) attributing to Direct: 55 ( 48.6%), Indirect: 44 (38.9%) and Non maternal deaths: 14 (12.3%). Predominating cause of MM in the first/mid/last five years were sepsis and infective hepatitis each (17.6%) and PPH (18.5 %). While SP/E were almost same over the years, in decreasing trend were hepatitis and puerperal sepsis but in rising trend was PPH and criminally induced abortion (10.6%). Thenumber of maternal death has not changed much, the median age in each five years is surprisingly similar, set at 25 years and the adolescents who died were not very different in every five years. It’s unfortunate that many primigravida died during this period which is a matter of concern.  ConclusionsMaternal mortality stresses the impact of timely health seeking behaviour and health providers making provision of prompt adequate services and referral to help so that all Nepalese mothers, especially the young and first-time pregnant thrive. Keywords: infective hepatitis, maternal mortality, maternal mortality ratio, PPH, sepsis.