Pelvic hemorrhage is a major cause of maternal morbidity and mortality in developing countries. A sound clinical judgment, adequate assessment, and preparation of the patient are the best preoperative means to avoid its occurrence. Bilateral internal iliac artery ligation is a life-saving procedure to control massive obstetric and gynecological hemorrhage when other measures fail. This procedure significantly reduces the pulse pressure and rate of blood flow abolishing the‘triphammer effect’ of arterial pulsation and subsequently resulting in sluggish blood flow allowing effective thrombosis within the small bleeding vessels. This has helped to save many lives and uteruses for more than a century. No tissue necrosis occurs due to ample collateral circulation in the pelvis from the major pelvic anastomoses. An increased understanding of retroperitoneal anatomy and regional variations of the internal iliac artery is needed to reduce the risk of intraoperative andpostoperative complications.

The aim of the study was to assess the use of contraceptive methods among women seeking safe abortion services in a family planning center, Kathmandu. Methods: It was a descriptive cross sectional study undertaken among 119 women seeking safe abortion services from August 18 to September 2018 at Marie Stopes Center, Gongabu, Kathmandu. Non-probability purposive sampling technique was adopted and data were collected through face to face interview. The collected data was analyzed by SPSS version 16 using descriptive statistics and inferential statistics. Results: Among a total of 119 respondents enrolled in the study, a total of 90 (75.64%) women used post abortion contraceptive methods. Among them, nearly half (44; 48.9%) had used oral contraceptive pills and least users were IUCD (19; 14.4%). More than half (67; 56.3%) had terminated the current pregnancy due to the reason of completed family. Almost three-fifth of them (50; 57.47%) had history of discontinuation of family planning methods in the past due to side effects. Similarly, almost three-fifth (68; 57.1%) had preferred medical abortion for termination of the current pregnancy. There was statistically significant association between post abortion contraceptive use with educational level (p=0.01), parity (p=0.000), contraceptive use in past (p=0.012), plan of future pregnancy (p=0.001), and family planning discussion with husband/partner (p=0.000). Conclusion: There is an increasing trend in the use of some forms of post-abortion contraceptive measures in Nepal from 56.0% in 2014 to 75.64% in 2018 after surgical or medical abortion. Among the post-abortion contraceptive non-users, more than half denied use of post-abortion contraceptives due to fear of side effects. Hence, raising the knowledge, attitude, practice and social awareness of post-abortion contraceptive use among women of reproductive age groups would certainly reduce undue fear of the use of post-abortion contraceptive use, its side effects and also help to raise the acceptance and compliance of its use.

Introduction: Small-for-gestational-age (SGA) is defined by a birth weight below the 10th percentile for mean weight corrected for gestational age. It is associated with adverse health events throughout life, including substantial perinatal morbidity and mortality rates. Objectives: The aims of the study was to estimate the prevalence of the SGA newborns, attributable factors for SGA and perinatal outcomes of SGA. Methodology: A hospital based prospective cohort study was conducted among pregnant women after 28 weeks' gestational age in the Department of Obstetrics and Gynaecology, BPKIHS, Dharan from October, 2016 to June, 2017.A total of 150 study population was sampled using purposive sampling technique whose symphysio-fundal height lags the gestational age by four cms. The association for risk factors between the various socio-demographic parameters and SGA was analysed using chi-square test for categorical data and t-Test for continuous data with p value<0.05 considered as significant. The mothers and babies were followed up till discharge from the hospital for outcomes. Result: There was a total of 140 SGA with 10 appropriate for gestational age (AGA) fetuses among 6,500 hospital deliveries above 28 weeks' gestation, hence the prevalence was 2.15%. The risk factors for very small for gestational age were history of birth of SGA fetus (OR, 1.25; 95% CI, 1.15-1.35); history of recurrent pregnancy loss (OR, 1.25; 95% CI, 1.15-1.35); personal history of substances abuse in the index pregnancy (OR, 1.68; 95% CI, 1.47-1.92); adverse obstetrics or medical events in the index pregnancy (OR, 2.21; 95% CI, 1.10-4.45); high blood pressure at admission (OR, 1.58; 95% CI, 1.96- 2.59) and significant urinary proteinuria (OR, 2.26; 95% CI, 1.00-5.09).SGA newborns correlated with increased risk of operative delivery and adverse perinatal outcomes, including oligohydramnios, low Apgar scores, resuscitation at birth, admission to the neonatal intensive care unit or nursery, metabolic complications and fetal death. Conclusions: SGA have distinct modifiable risk factors and mortality patterns suggesting potential implications for public health and urgent need to intervene with effective interventions.

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Introduction: Birth defect refers to any abnormality of physical structure or form or function of prenatal origin, whether genetic or not, which is present at birth. Congenital birth defect is one of the causes of perinatal morbidity and mortality especially in developed countries. Studies of congenital birth defects are useful to establish baseline data, document changes over time and identify clues to etiology. This study was aimed to determine the overall prevalence of newborns with congenital birth defects, outcomes of those babies at birth, modes of delivery as well as various organ systems involved. Methods: It is a short term observational study conducted in the Department of Obstetrics and Gynaecology, B.P. Koirala Institute of Health Sciences, Dharan from July, 2016 to December, 2016 after ethical approval. All the intramural deliveries after 22 weeks of gestation in six months were looked for gross congenital birth defects soon after birth through meticulous examination. Antenatal sonographic documentation of fetal anomalies was noted and correlated after birth. The birth defects were categorized according to the ICD10 th Revision of birth defects. Results: During the study duration, there was a total of 6,496 births out of which 26 babies had birth defects. All the babies were delivered to mothers of age less than 35 years with no history of parental consanguinity. 11 (42.3%) babies were born to mothers with no folic acid supplementation and three (11.5%) babies had ambiguous sex. Most of them (22; 84.6%) were alive at birth and majority of them born vaginally (19; 73.0%) and had normal birth weight (18; 69.2%). Majority of them had defects detected incidentally after delivery (19; 73.0%) and were non-lethal. The most common birth defect was related to central nervous system (12; 46.15%). Conclusions: In this study, the prevalence of congenital birth defects was 0.4%. Majority of the birth defects (73.0%) were detected after delivery. Most of the babies with defects (84.6%) were alive at birth and non-lethal. The most common birth defects were related to central nervous system (46.15%). Hence, preconceptional counselling and folic acid supplementation are recommended for prevention, termination for lethal defects and surgical repairs of non-lethal defects for viable newborns after delivery.