Background: Induction is defined as artificial initiation of uterine contraction with the aim of achieving the normal vaginal delivery. It is most widely accepted obstetrical intervention worldwide. The most common indication for induction is post dated pregnancy. Objective: To assess the outcome of induction in both mother and baby. Methods: During our study period, 391 patients were selected for induction due to various indications. Most of them were induced with tablet Misoprostol and only those with higher degree of gravida were induced with Dinoprostone gel intracervically and maternal and fetal outcome was seen.Results: Out of 4020 patients, induction rate was 9.72%. Among them 98.2% were induced with Misoprostol. Most of the induced age group was in between 20-30 years of age with primigravida 62%. Among them 48.59% were in between 40-41 weeks of gestation with 93% of having poor bishops score. About 67.7% had normal vaginal delivery with 4.86%, assisted with instrumental delivery. Cesarean section was seen in 32.3% of patients. Most common indications for LSCS were for failed induction (44%). Regarding the fetal outcome 99.7% born alive, 97.92% went to mother side, 2.07% admitted and 0.51% expired. Beside this, 88.7% had birth weight between 2.5 to 3.5 kg and 87.4% had clear liquor and 99.22% had the good apgar score. Conclusion: Though the cesarean section rate is higher in this study in comparison of WHO references to be not more than 15% but still the induction is beneficial in high-risk pregnancy where continuing the pregnancy is more hazardous than to termination.

Introduction: Infertility is a global health issue and a socially destabilizing condition for couples with several stigmas including medical, social, psychological burdens and a marital disharmony. The aim was to study the incidence of infertility in couples attending outdoor of Nobel Medical College and to know the contributing factors among the infertile couples.Methods: A prospective cross-sectional study was carried out in the outpatient department of a teaching hospital July 2015-June 2016, where the incidence of infertility and the contributing factors for the same were evaluated.Results: The incidence of infertility in this study was 5.45% and it was dominated by secondary infertility. The most important cause was male factor in 37.39%. Majority of male factor abnormality was due to exposure to heat as these male work abroad in Arabian Countries.Conclusions: The study shows a dominance of secondary infertility and male factor being a major contributor. The most common semen abnormality was oligospermia. Keywords: infertility; incidence; oligospermia; semen. | PubMed

Introduction: The field of minimal invasive surgery has flowered explosively in the recent past. Modern endoscopy has changed the approach to diagnosis as well as the operative procedure. This study was done with the aim of sharing the experiences of gynecological laparoscopic procedures done at Nobel Medical College and Teaching Hospital, Nepal.   Methods: A descriptive study was done in the department of Obstetrics and Gynecology, Nobel Medical College from 1st April 2015 to 30th March 2016. All the patients undergoing laparoscopic procedures were analyzed for the indication, type of procedures and their complications.   Results: During the study period, 100 patients underwent laparoscopic procedures including 25 cases of diagnostic and 75 cases of therapeutic procedures. Fiftythree patients with an ovarian mass underwent laparoscopic cystectomy. Laparoscopic salpingectomy was done in 11 patients with ectopic pregnancy. Laparoscopy assisted vaginal hysterectomy (LAVH) was done in eight cases and laparoscopic sterilization in two cases. One patient underwent successful myomectomy. One patient undergoing laparoscopic cystectomy and one case of LAVH had conversion to laparotomy because of dense adhesion and vault bleeding respectively. No other major complication noted apart from port side bleeding, infection and vault hematoma.   Conclusion: Laparoscopy is a safe and feasible alternative to open gynecological surgeries though it has a longlearning curve and a lot of expertise is necessary.

Background TORCH is a group of organisms like Toxoplasma, Rubella, Cytomegalo virus and Herpes simplex virus. These groups of organisms causing infections in pregnant lady leads to various degree of adverse pregnancy outcomes in the form of spontaneous abortion, preterm delivery, intrauterine growth restriction, severe congenital defect with syndromic babies. So, to observe the relationship of TORCH infection in first trimester spontaneous miscarriage in our population and to treat them, this study was performed. Materials and MethodsA total of 103 patients with spontaneous abortion meeting inclusion criteria were taken in the study. TORCH profile was sent for those patients and observed the sero-prevalance for IgM and IgG. Thereafter organism was identified and the results were interpreted. Results Out of total 103 patients enrolled 58.25 % of patients were sero-positive for TORCH complex. IgM or IgG Sero-positive for Toxoplasma, Rubella, Cytomegalo virus and Herpes Simplex virus were 11.65% /17.47% ;7.76% / 43.68%; 19.41% / 41.74% and 31.06% / 54.36% respectively. ConclusionIn the present study on analyzing the association of TORCH antibodies in women with spontaneous abortion, infection with Herpes simplex virus was most commonly associated.

Background: Since the introduction of laparoscopic cholecystectomy in 1987 by Philips Mouret its popularity has increased tremendously and very rapidly because of its several advantages. But reports of randomized large control seriesare not yet available so we plan to report our experience of 5000 cases of single incision laparoscopic cholecystectomies and their anesthetic management. Objective: The purpose of this retrospective study was to evaluate the general anesthetic technique for laparoscopic cholecystectomy keeping in mind the pathophysiological effect of laparoscopy, head up position and pneumoperitoneum. Methods: A retrospective study of 5000 cases of symptomatic gall bladder disease that underwent laparoscopic cholecystectomy at Nobel Medical College Teaching Hospital, Nepal from Jan 2010-Dec 2015 was done. Detail pre-anesthetic check up, investigation, preparation and anesthetic techniques were carried out as per hospital protocol. Strict vigil was made to maintain the vital parameters within normal limit particularly ETCO2 below 35 mmHg. All efforts were made to keep ETCO2 below 35mHg. At the end of surgery residual neuromuscular blockade was reversed with neostigmine and glycopyrrolate, before they were transferred to PACU. Results: The mean age of the patients was 48 years with a male:female of 1:2.26. 28.64 % of patients belonged to ASA III. More than 95 % patients maintained SPO2 between 98-100% and 91% maintained their ETCO2 below or around 35 mmHg. Intra-operative surgical and anesthetic complications were controlled with proper therapies. There was no intra-operative death. Conclusion: Single incision laparoscopic Cholecystectomy (SILC) is a safe, cost effective ideal for day care surgery and general anesthesia with controlled mechanical ventilation with oxygen, air, fentanyl, isoflurane, midazolam and vecuronium/atracurium is good choice.