BackgroundUnderlying adenomyosis is often the cause of treatment failure for patients undergoing medical therapy for abnormal uterine bleeding and or chronic pelvic pain. Given the limitation of ultrasonography in diagnosing adenomyosis and MRI being unaffordable to most of the patients belonging to developing countries like us, it often remains undiagnosed before a hysterectomy. ObjectiveTo find out the clinical profile associated with adenomyosis and to determine the prevalence of adenomyosis in hysterectomy specimens; frequency distribution, as well as to correlate clinical examination with histopathological examination. MethodsA total of 60 women who had undergone hysterectomy with histopathologically proven adenomyosis between April 2009 and March 2010 were included . Data were collected on indication for the intervention, age, symptoms, clinical findings, hemoglobin, menopausal status, gross and histopathological findings. ResultsA total of 256 women were scheduled for hysterectomy. Adenomyosis was diagnosed in 60 of 256 cases (23.4%). Menorrhagia (91.2%), dysmenorrhoea (84.2%), lower abdominal pain (84.2%) beginning later in reproductive life (mean age-45yrs) is the classic presentation. Adenomyosis was present in 10 of 61 patients (16.3%) with fibroids; 27 of 60 (45%) with abnormal uterine bleeding; 11 of 55 (20%) with prolapse; four of 35 (11.4%) with ovarian mass; five of 25 (20%) with chronic pelvic pain; three of four (75%) with endometriosis. ConclusionWomen undergoing hysterectomy with diagnosis of adenomyosis have a distinct symptomatology. The choice of therapy in adenomyosis is hysterectomy for those women who have completed family and had failed medical therapy .

ObjectivesStillbirth is one of the vital indicators of quality care. This study aimed to determine maternal-fetal characteristics and causes of stillbirth in Nepal.DesignSecondary analysis of single-centred registry-based surveillance data.SettingThe study was conducted at the Department of Obstetrics and Gynecology, Chitwan Medical College Teaching Hospital, a tertiary care hospital located in Bharatpur, Nepal.ParticipantsAll deliveries of intrauterine fetal death, at or beyond 22 weeks’ period of gestation and/or birth weight of 500 g or more, conducted between 16 July 2017 and 15 July 2019 were included in the study.Main outcome measuresThe primary outcome measure of this study was stillbirth, and the secondary outcome measures were maternal and fetal characteristics and cause of stillbirth.ResultsOut of 5282 institutional deliveries conducted over 2 years, 79 (1.5%) were stillbirths, which gives the stillbirth rate of 15 per 1000 births. Of them, the majority (75; 94.9%) were vaginal delivery and only four (5.1%) were caesarean section (p<0.0001). The proportion of the macerated type of stillbirth was more than that of the fresh type (58.2% vs 41.8%; p=0.13). Only half of the mothers who experienced stillbirth had received antenatal care. While the cause of fetal death was unknown in one-third of cases (31.6%; 25/79), among likely causes, the most common was maternal hypertension (29.1%), followed by intrauterine infection (8.9%) and fetal malpresentation (7.6%). Four out of 79 stillbirths (5%) had a birth defect.ConclusionHigh rate of stillbirths in Nepal could be due to the lack of quality antenatal care. The country’s health systems should be strengthened so that pregnancy-related risks such as maternal hypertension and infections are identified early on. Upgrading mothers’ hygiene and health awareness is equally crucial in reducing fetal deaths in low-resource settings.

Aim: To find out the relationship between utero-vaginal prolapse (UVP) and first vaginal birth at younger age <22 years and to identify single most frequently occurred risk factor in study group. Method: A hospital based descriptive comparative study was carried out in 200 women of age 40- 60 years in two hospitals. One hundred women with UVP were enrolled as case (Group I) and 100 women with similar parity and age group but admitted for other reasons than prolapse were enrolled as comparative group (Group II). Relationship was observed between two groups in their age at first vaginal birth, duration of labour, family history, smoking habit, menopause and BMI. Results: Cases of UVP occurred in younger <22 years at first vaginal birth than comparable group (OR 3.41, 95% CI 1.74-6.72, P = 0.00009). The mean of duration of labour pain was 30.85±26 vs 18.87±21.3 (P=0.006) hours in Group I and Group II respectively. There was increased risk of UVP in women who had family history (OR 2.35; 95% CI 1.16-4.78, P= 0.01). Conclusion: Single most frequently identified risk factor was young age <22 years at first vaginal birth. DOI: http://dx.doi.org/10.3126/njog.v3i2.10832 Nepal Journal of Obstetrics and Gynaecology Vol.3(2) 2008; 48-50

Background: Hysterosalpingography (HSG) is an integral part of the Conventional clinical evaluation of infertile women. Now a day, Sonohysterography is a modern technique widely used in the clinical evaluation. The objective of this study was to identify pelvic pathology; compare the effect and findings of tubal patency test between Sonohysterosalpingography and single film HSG radiograph.Methods: This is a prospective evaluation of infertile women who attended the infertility unit of the gynecology department from 2017 March to 2018 October. Women 220 clients were subjected to clinical including SHSG evaluation followed by a single film HSG radiograph on the single sitting. The Chi-square test, multinomial logistic regression analysis was done using IBM SPSS statistics version 20.Results: Women had bilateral tubal patency 181(82.2%) in SHSG and conformed the same number later by HSG. SHSG showed bilateral tubal occlusion in 33 (15%) whereas HSG conformed only in 22(10%) and block was seen in 18(8.18%) only by HSG. The pathological findings were polycystic ovaries in 33 (15%), Fibroid uterus 11 (5%), ovarian cysts 5(2%), endometrial polyps in 2 cases, endometriotic cyst with hydrosalpinx 8(4%). Procedural side effects were no pain in 69(31.1%), mild pain 125(56.3%), Moderate pain 21(9.5%), vasovagal symptoms 7(3.1%). Conclusions:The outcome of the Sonohysterosalpingraphy (SHSG) test for tubal patency is significantly synergized by concurrent HSG in the same sitting. The combined test is best indicated if SHSG alone is not able to demonstrate the sign of tubal patency.

Background: Emergency Peripartum Hysterectomy (EPH) is an important lifesaving surgical procedure considered in cases of severe hemorrhage unresponsive to medical and conservative management. The objective is to review incidence, identification, intervention and impact of emergency peripartum hysterectomy. Methods: The retrospective, cross-sectional study designed was to used. EPH data were collected from January 2014 to December 2018.Descriptive statistics was used to analyzed data and presented in tables and charts. Results: Incidence of Emergency Peripartum Hysterectomies was 2.3% out of 252(2.6%) cases of obstetrical emergencies and 0.06% that is 1 in 1600 deliveries. Most common indications for EPH were uterine rupture (33.3%); placenta accreta (33.3%) followed by retained placenta (16.6%) and endometritis with pyometritis (16.6%). Estimated blood loss 1916 ml., timeliness from delivery to hysterectomy was 140 minutes; most common post-operative complication was surgical site infection (33.3%) and length of hospital stay 11.7 days. Maternal morbidity rate was 33.3%. There was no maternal mortality recorded. Conclusions: The timely intervention improves the outcome in Peripar­tum Hysterectomy, which is frequently associated with abnormal placen­tation as a consequence of increasing caesarean deliveries rate.