Introduction: Globally, there is a dramatic rise in cesarean section rate which has increased the maternal morbidity and adverse effects in a subsequent pregnancy. Robson’s classification will aid in the optimization of the cesarean section use, assessment of the strategies aimed to decrease the cesarean section rate and thus improve the clinical practices and quality of care in various health care facilities. The main aim of this study is to find out the prevalence of caesarean section for Robson’s group 2 among total caesarean sections done in a tertiary care hospital. Methods: A descriptive cross-sectional study was carried out at a tertiary care centre in Nepal from August 2020 to January 2021. Ethical approval was taken from the institutional review committee (reference number: 1607202003) and data were entered using Robson’s criteria. The convenient sampling technique was used. Data was analyzed using Microsoft Excel. Point estimate at 95% Confidence Interval was calculated along with frequency and percentage for binary data. Results: According to Robson’s group 10 classification, among 380 caesarean sections, 110 (28.94%) (24.38-33.50 at 95% Confidence Interval) cases were in Robson’s group number 2. Conclusions: This study showed that the prevalence of caesarean section which lies in Robson’s group 2 in our study is higher than the standard of World Health Organization. It showed that Robson’s group 2 was one of the significant contributors to the greater caesarean section rate. Improved case selection, standardization, and protocol for induction of labour as well as regular audit could also reduce caesarean section rates.

Introduction: Menopause is the permanent cessation of menstruation for more than a year resulting from the loss of follicular activity of the ovaries. It is manifested by vasomotor, psychological, and urogenital symptoms which can be assessed by an internationally accepted scale known as Menopause Rating Scale. This study was conducted to find out the issues of perimenopausal women and proceed for management and proper counseling. Methods: A descriptive cross-sectional study was conducted among women visiting the gynecological outpatient department of a tertiary care hospital from June 2017 to May 2018 using the Menopause Rating Scale. Ethical approval was taken from the Institutional Review Committee (reference number: 20122016). Convenient sampling was done. Statistical Package for the Social Sciences version 20.0 was used for data analysis. Point estimate at 90% confidence interval was calculated along with frequency and proportion for binary data. Results: Out of 189 perimenopausal women interviewed, the mean age of menopause was found to be 50.2±2.1 years. The most common gynecological symptoms among the study population was abnormal uterine bleeding 66 (34.9%) followed by abnormal vaginal discharge 50 (26.5%). Among symptoms in Menopause Rating Scale, the depressive mood was found in 99 (52.4%) cases followed by joint and muscular discomfort 88 (46.6%) and bladder problems in 87 (46%). None of the women had a score on the Menopause Rating Scale more than 16 and did not require management for their problem. Conclusions: Most of the women didn't know menopausal symptoms. However, none required intervention from gynecologists for their problems reflecting better quality of life.

Introduction: The full term human placenta is a flattened discoidal mass with an approximately circular or oval outline. However, variations can be present in the morphology in the form of bidiscoidal shape, lobed, diffused, fenestrated or circumvallate. The objective of the study was to find out the prevalence of morphological variations in placentas among deliveries in the Department of Obstetrics and Gynaecology in a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among total in the Department of Obstetrics and Gynaecology in a tertiary care centre after receiving ethical approval from the Institutional Review Committee (Reference number: 2308202105). The study was conducted between September 2021 to November 2021 and the shape of the placenta was observed and the variations present were noted. Point estimate and 95% Confidence Interval were calculated. Results: Out of 105 placentas observed, morphological variations were seen in two (1.91%) (0-4.53, 95% Confidence Interval). One (50%) was observed to be placenta succenturiata and one (50%) was triangular in shape. Conclusions: The prevalence of morphological variations in placentas was found to be higher than the studies done in similar settings.

Aims:This study was done to know the pattern of obstetric emergencies and its influence on maternal and fetal outcome.Methods: A descriptive study was carried out in the department of obstetrics and gynecology at Kathmandu Medical College Teaching Hospital from 1st June 2013 to 31 st May 2014. Cases were categorized as early pregnancy emergencies (ruptured ectopic pregnancy, complications of abortion), ante-partum emergencies and intra-partum emergencies (antepartum haemorrhage, preeclampsia, eclampsia, preterm prelabor rupture of membranes, rupture uterus), post-partum emergencies (postpartum haemorrhage, retained placenta, placenta accreta, uterine inversion), puerperal emergencies (postpartum sepsis), fetal emergencies (cord prolapse, shoulder dystocia). Outcome noted were type of emergency, obstetric intervention done, maternal and perinatal morbidity and mortality.Results: A total of 80 (4.45%) obstetric emergencies occurred among 1796 deliveries .The most common obstetric emergencies were obstetric hemorrhage (62.5%), severe preeclampsia (23.5%) and preterm prelabor rupture of membranes (10%). The obstetric interventions done were cesarean section (43.75%), exploratory laparotomy (33.75%) and blood transfusion (40%). Obstetric emergencies were responsible for 66.6% of total maternal death and 24.56% of total perinatal death. Conclusions:In spite of best efforts, some obstetric emergencies do occur. Obstetric hemorrhage and severe preeclampsia are the frequent obstetric emergencies. Cesarean section, exploratory laparotomy and blood transfusion were the commonly performed interventions. A better outcome can be achieved by national policy of promoting utilization of antenatal care, institutional deliveries, skilled birth attendance at delivery, liberal blood transfusion and regular training of doctors and nurses.

Background: Glycosylated haemoglobin (HbA1c) level during early pregnancy has been proposed as a predictor of gestational diabetes mellitus (GDM). Objectives: To determine the mean value of first trimester’s glycosylated haemoglobin (HbA1c) in gestational diabetes mellitus cases. Methods: An analytical cross-sectional study was conducted among GDM cases at the Obstetrics and Gynaecology Department of Kathmandu Medical College after ethical clearance. Purposive sampling was done to enrol 102 cases that presented over a period of August 2020 to January 2021. First trimester HbA1c levels were recorded. The HbA1c values were grouped into two taking 5.7% as a cut-off which is an established threshold for prediabetes in a normal population. Results: The mean age of participants was 28.74 ± 4.1 years and mean body mass index was 29.13 ± 2.73 kg/m2. Mean value of HbA1c was 5.52 ± 0.44%. Mean value of fasting blood glucose and postprandial glucose after oral glucose tolerance test (OGTT) was 102.25 ± 7.36 mg/dl and 167.55 ± 10.91 mg/dl respectively. Out of total participants, only 40 (39.21%) had HbA1c value more than 5.7% while 62 (60.78%) had HbA1c value less than 5.7%. There was weak positive correlation between HbA1c and Fasting Blood Glucose (Pearson’s correlation coefficient r = 0.13). Similarly, correlation between HbA1c and blood sugar after OGTT (r = 0.17) was also insignificant. Conclusion: This study concluded that the HbA1c value of first trimester is not very different than normal population. Hence, diabetic range of HbA1c value in first trimester is useful in diagnosing overt diabetes.