Aim: To determine the demographic characters of patients of eclampsia and the effectiveness of Magnesium Sulphate in terms of maternal and perinatal outcome. Methods: A prospective study of the eclamptic patients was conducted from 18 th Aug -17 th Oct 2006 (1 Bhadra 2063 to 30 Ashwin 2063) attending the Obstetric Department of Janakpur Zonal Hospital (JZH). Results: Of the 50 eclamptic women [antepartum 80%, intrapartum 6 % and postpartum 14%] with overall improvement in 92% although 2 cases had to be referred to center with ICU facility and 2 cases died. The demographic characteristics were young primiparous population of low socioeconomic condtion. Caesarean was done for 48 %. Pretermaurity was seen in 50% and 76% were live birth. Conclusions: Nepal has a high maternal mortality rate and eclampsia is a big contributing factor, which could be reduced by using magnesium sulphate widely in all parts of Nepal taking, ours as one of the peripheral hospital as an example.

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We hereby report a case of retained second twin presenting with vertex which was delivered vaginally after 27hours from the first birth, without any complication in 25 years old G 2 P 1 L 1 A0 detailing that such obstetric events can be smoothly handled.

Introduction: Missed abortion is a nonviable intrauterine pregnancy in the presence of a closed cervix and little or no abdominal cramping. WHO recommends Misoprostol as a safe drug in the medical management of missed abortion. This study was conducted to study the efficacy of sublingual versus vaginal misoprostol in the medical management of missed abortion. Methods: A hospital based prospective study was carried out among 212 women with confirmed missed abortion who received 800 μg misoprostol either sublingually or vaginally for the medical management. All women were admitted to hospital for 2 days for observation. If the pregnancy was not completely evacuated in 2 days following misoprostol administration, manual vacuum aspiration or dilatation and curettage was performed for completion. Efficacy was defined as the percentage of women discharged without the need for manual vacuum aspiration or dilatation and curettage. Results: The efficacy of 800 μg misoprostol was high and statistically significant in the sublingual group. Success rate was 80.19% with sublingual route whereas it was only 59.43% with vaginal route (p-value = 0.001).Incidence of complications and side effects like bleeding, abdominal pain, diarrhea and fever was significantly higher in sublingual group. Conclusions: In the medical management of missed abortion sublingual misoprostol achieved a higher rate of complete abortion in comparison to the vaginal route. However, sublingual route showed more adverse effects.

Abnormal placental vascular anastomoses in monochorionic twins can give rise to a rare congenital anomaly known as Acardiac twin. With the advancement of antenatal care and ultrasonography many such cases are diagnosed early. However, in underdeveloped country like Nepal where early antenatal care coverage rate is low such cases may be diagnosed late. I report one such case of Acardiac acepahalus twin diagnosed during delivery.