Background: There has been a sustained increase in the rate of caesarean section in the last few years around the world. Data regarding the current caesarean rate and the trends of its indications in eastern Nepal have not been estimated earlier. Aim: To assess the rate of caesarean sections and the varying indications for caesarean section in a tertiary referral center in eastern Nepal. Methods: All hospital deliveries that took place in BPKIHS between January 2006 and December 2007 were recorded to assess the caesarean section rate and its indications. Results: A total of 5330 deliveries were conducted in 2006. Likewise the total number of deliveries conducted in 2007 was 6634. In 2006 caesarean sections were performed in 28.6% (1524) of all patients. The rate of caesarean sections in 2007 increased and was 33.7% (2239). The most common indication for caesarean section was meconiumstained liquor, which constituted 23.4% (883). The next frequent indication was previous caesarean section, which accounted for 17.2% (650), followed by breech presentation in 11.1% (417), fetal distress in 9.6% (364), non-progress of labor in 7.2% (270), cephalopelvic disproportion in 6.2% (234, and placenta previa in 4.4% (165). Conclusions: There is a increasing trend of performing cesarean section in the tertiary referral center in east era Nepal. The most common indication for cesarean section is meconium-stained liquor. Keywords: Caesarean section; caesarean delivery rates; Nepal DOI: http://dx.doi.org/10.3126/hren.v9i3.5587   HR 2011; 9(3): 179-183

Rheumatic mitral stenosis was the most frequent heart disease complicating pregnancy in a consecutive cohort from a teaching hospital in Nepal. Exercise intolerance, pulmonary hypertension and severe mitral stenosis were identified as predictors of maternal or fetal/perinatal mortality.

Background: Acute tonsillitis is the most common disease for the ENT surgeons.

Background: Postpartum hemorrhage is a common and occasionally life-threatening complication of labor. Cesarean section is associated with more blood loss in compared to vaginal delivery. Despite, there is a trend for increasing cesarean section rates in both developed and developing countries thereby increasing the risk of morbidity and mortality, especially among anemic women. The objective of this study was to evaluate the effect of preoperative administration of intravenous Tranexamic acid on blood loss during and after elective cesarean section.Methods: This was a prospective, randomized controlled study with 160 eligible pregnant women of 37 or more period of gestation. They were all planned for elective cesarean section and were randomized into two groups either to receive 10ml (1gm) of Tranexamic acid intravenously or 10ml of normal saline. Blood loss was measured during and for 24 hours after operation.Results: The mean estimated blood loss was significantly lower in women treated with Tranexamic acid compared with women in the placebo group (392.13 ml±10.06 vs 498.69 ml±15.87, respectively; p<0.001). The mean difference in pre-operative and post-operative hemoglobin levels was statistically significant in the Tranexamic acid group than in the control group (0.31±0.18 vs 0.79±0.23, respectively; p<0.001).Conclusions: Pre-operative use of Tranexamic acid is associated with reduced blood loss during and after elective cesarean section. In a developing country like ours where postpartum hemorrhage is a major threat to the life of the mothers, it seems to be a promising option.

Background: Packs are placed following nasal surgeries to arrest haemorrhage, to prevent septal haematoma and synechie formation. Despite Merocel, a tampon constructed from a foam polymer of hydroxylated polyvinyl acetate, which is less abrasive and hence associated with the less pain, we still use Neosporine Impregnated Ribbon Gauze (NIRG). Objective: To compare Merocel and the Neosporine Impregnated Ribbon gauze (NIRG) packs in regards to the post-operative pain levels caused by them and their ability to prevent haemorrhage, crusting and synechie. Methods: The nose was packed after surgery either with the Merocel pack or Neosporin Impregnated Ribbon Gauze (NIRG) according to the randomisation. The pain score was noted on the Visual analog score while packs were in situ and again immediately after the pack removal. The haemorrhage, crusting and synechie were noted if present. Results: Among 106 patients, 61 were male and 45 were female. In Merocel group there were 51 patients and in NIRG group 55. The mean pain score for merocel was 4.15 while in situ and 3.66 immediately after removal where as mean pain score for NIRG was 6 while in situ and 3.78 immediately after removals. Post-operative crusting and synechie were seen relatively more in NIRG pack group. Conclusion: Merocel is superior in terms of both patient comfort and pain. DOI: http://dx.doi.org/10.3126/hren.v10i1.6004 HREN 2012; 10(1): 30-34