Impact of an informational flipchart on lifestyle advice for Nepali women with a pelvic organ prolapse: a randomized controlled trial.

INTRODUCTION AND HYPOTHESIS: Pelvic floor muscle training (PFMT) and lifestyle advice are effective at improving the symptoms and severity of pelvic organ prolapse (POP) in a range of populations; however, the impact of these interventions in Nepali women is unknown. We aimed to evaluate the impact of an informational flipchart on PFMT and lifestyle advice on the quality of life (QOL) for Nepali women with a POP. METHODS: This prospective randomized controlled trial recruited 140 women with a stage I-III POP from Kathmandu Valley. The intervention group were instructed on PFMT and lifestyle advice through an informational flipchart and the control group were provided usual care. The primary outcome measure was the Prolapse Quality of Life questionnaire (P-QOL) and was completed at baseline, 6 weeks, 12 weeks and 6 months. The secondary outcome measure was the Pelvic Organ Prolapse Quantification (POP-Q) system and Modified Oxford Scale (MOS) assessed by clinical examination at baseline and 6 months. Differences in mean P-QOL scores for each domain were evaluated using analysis of covariance. RESULTS: Compared with usual care, the women in the informational flipchart group experienced significant improvement in six of the nine P-QOL domains and for the prolapse, bladder and bowel symptoms. Only a small percentage (20%) of women were able to attend the 6-month clinical assessment so we were unable to assess the secondary outcomes. CONCLUSIONS: A one-time intervention of an informational flipchart on PFMT and lifestyle advice is effective at improving QOL and symptoms for Nepali women with a stage I-III POP.

Putting Patient Safety First for the Quality Care: An Essential Component at all Healthcare Settings.

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Fetomaternal Outcome in Antepartum Hemorrhage After 34 Weeks of Gestation.

BACKGROUND: Antepartum hemorrhage is defined as any bleeding from or into the genital tract during pregnancy, after the period of viability until delivery of the fetus. APH complicates 2-5% of pregnancies and is a primary cause of perinatal and maternal mortality globally. Aim of this study is to evaluate maternal and perinatal outcome in patients with APH at a tertiary care hospital. METHODS: The present study was a cross sectional study conducted in Obstetrics and Gynaecology department of Paropakar Maternity and Women's Hospital, during a period of 5 months from December 2022 to April 2023. 50 cases of APH were enrolled with gestational age ≥ 34 weeks of gestation. RESULTS: Incidence of APH after 34 weeks of gestation was 0.51%. The most common type of APH was abruption placenta (44%) followed by placenta previa (32%) and undetermined (24%). The age range of 26 to 30 years old accounted for the highest number of APH patients i.e., 21(42%). In placenta previa, 75% and in abruption placenta 63.64% were multigravida. APH was presented mostly between 37-40 weeks. Around 26% of the patients had anemia at the time of admission. Most common mode of delivery was cesarean section (82%). Most common maternal complications were PPH (40%), blood transfusion (28%), DIC (4%), cesarean hysterectomy (4%). Low birth weight and preterm were the most common causes of fetal complications. Maternal mortality was 2% and perinatal mortality was 18% overall. CONCLUSIONS: APH is primary cause of maternal and perinatal morbidity and mortality. In our study, an abruption placenta was the most frequent cause of APH. Cesarean section was the most commonly used mode of delivery. PPH with blood transfusion was the most prevalent maternal complication, while fetal complications included low birth weight and preterm..

Implementation of cervical cancer prevention and screening across five tertiary hospitals in Nepal and its policy implications: A mixed-methods study.

In Nepal, cervical cancer is the most common cancer among women despite the existing policies. This study intends to assess the implementation of cervical cancer prevention and screening through service utilization by women, knowledge and attitude among health professionals, and the perceptions of stakeholders in Nepal. This mixed-methods study was conducted in 2022 across five tertiary hospitals in Kathmandu, Nepal. The quantitative study comprised the health professionals and women attending gynecology outpatient clinics from the selected hospitals. The qualitative study comprised stakeholders including service providers and experts on cervical cancer from selected hospitals, civil societies, and the Ministry of Health and Population. The utilization of screening through pap smear among 657 women across five hospitals was 22.2% and HPV vaccination was 1.5%. The utilization of cervical cancer screening was associated with older age [adjusted odds ratio (AOR) = 1.09, CI: 1.07, 8.19], married (AOR = 3.024, CI: 1.12, 8.19), higher education (AOR = 3.024, CI:1.12, 8.42), oral contraceptives use (AOR = 2.49, CI: 1.36, 4.39), and ever heard of cervical cancer screening (AOR = 13.28, CI: 6.85, 25.73). Among 254 health professionals, the knowledge score was positively associated with them ever having a training [Standardized Beta (ß) = 0.20, CI: 0.44, 2.43)] and having outreach activities in their hospital (ß = 0.19 CI: 0.89, 9.53) regarding cervical cancer screening. The female as compared to male health professionals (ß = 0.16, CI: 0.41, 8.16, P = 0.03) and having a cervical cancer screening guideline as compared to none (ß = 0.19 CI: 0.89, 9.53, P = 0.026) were more likely to have a better attitude for screening. The qualitative findings among 23 stakeholders reflected implementation challenges in policy, supply, service delivery, providers, and community. This study showed low utilization of prevention and services by women and implementation gaps on cervical cancer prevention and screening services across five tertiary hospitals in Kathmandu, Nepal. The findings could help designing more focused interventions.

Fetomaternal Outcome of Pregnant Women at Term Undergoing Cesarean Section.

BACKGROUND: Cesarean section is one of the most common procedures performed in obstetric practice today and is a lifesaving surgery for mother and fetus. Cesarean sections are classified traditionally, as elective cesarean section or emergency cesarean. The purpose of this study is to compare the maternal and neonatal outcomes in elective and emergency cesarean section so that measures can be taken to reduce maternal and neonatal morbidity and mortality. METHODS: A descriptive study including 400 pregnant women who underwent caesarean section were included in this study. Patients were subjected to elective or emergency cesarean section as per the indication and protocol of institute. were included in the study. RESULTS: During the study period there were total 1080 deliveries. The average age of the women was 29.21±4.07 years. Of the 400 cesarean section cases, only 2.8% had wound infection, 3.8% had fever, 4.8% urinary tract infection (UTI) whereas no women had observed with post-partum hemorrhages (PPH) and maternal death. Regarding fetal outcome, neonatal intensive care unit (NICU) admission was observed in 16%, birth asphyxia was 2.3% poor Apgar score 2.5% and neonatal death was not observed. Rate of fever, UTI, wound infection, need of resuscitation and poor Apgar score was significantly high in emergency section than elective caesarean section whereas NICU admission was not statistically significant. The most common indication of emergency cesarean section were fetal dress and for previous LSCS. CONCLUSIONS: Emergency cesarean was associated with increased maternal and perinatal complications than in elective cesarean section.

Ruptured Endometrioma with Hemoperitoneum Requiring Emergency Laparotomy: A Case Report.

Endometrioma is the localization of endometriosis in ovary which often develops as cyst. The condition can be complicated with infection, torsion and rupture leading to significant hemoperitoneum and ascites. We present here a 28-year female P2 L1 presented with the features of acute abdomen and severe anemia referred from other hospital where pain management was done. She had raised Ca-125 level, negative Urine Beta HCG and USG findings of left endometrioma with degenerating subserosal fibroid. The improvement of her general condition with analgesics was misleading however a static hematocrit level despite blood transfusion raised suspicion of ongoing pathology leading to blood loss and diagnostic paracentesis confirmed the hemoperitoneum while awaiting of CT report. She underwent Emergency Laparotomy which revealed hemoperitoneum of 2000ml and right ruptured ovarian endometrioma measuring and left ovarian cyst measuring 6x6 cm was noted. The postoperative period was uneventful. Keywords: Acute abdomen; case report; endometriosis; hemoperitoneum; ruptured endometrioma.

Vaginoplasty with Amnion Graft: Management of Mayer-Rokitansky-Kuster-Hauser Syndrome.

Mayer-Rokitansky-Kuster-Hauser syndrome also known as mullerian agenesis is a rare congenital condition in which there is absence of uterus along with upper vagina. Patient usually presents with primary amenorrhea with or without cyclical lower abdominal pain but have normal secondary sexual characters. Modified McIndoe Vaginoplasty with amnion graft is the commonest surgery performed worldwide. A 23 year old girl with normal secondary sexual characters presented with primary amenorrhea with cyclical lower abdominal pain; on examination blind vagina was present. Vaginoplasty with amnion graft was done and vaginal mould was placed. Vaginal dilatation with Hegar's dilator was done weekly until 6 weeks. She is under regular follow-up at present and advised for regular manual dilation at home. McIndoe Vaginoplasty with amnion graft is a simple yet rewarding procedure especially in low resource countries like ours, with good success rate and with minimal postoperative complications. Keywords: Amnion graft; Mayer-Rokitansky-Kuster-Hauser Syndrome; Modified McIndoe Vaginoplasty; Primary amenorrhea; Secondary sexual characters.

Improved quality of life after surgery for pelvic organ prolapse in Nepalese women.

BACKGROUND: Pelvic organ prolapse (POP) is a common gynecological condition that can affect quality of life (QOL) in women. In Nepal, the prevalence of POP is high, but many affected women are still deprived of treatment. Vaginal hysterectomy with pelvic floor repair is one of the common treatment options for advanced POP. However, QOL outcomes after surgery have not been reported in low-income countries. Thus, we aimed to examine changes in QOL among Nepalese women with POP after such surgery. METHODS: This longitudinal study was conducted in the selected central and peripheral hospitals in Nepal where vaginal hysterectomy was being performed free of cost for POP. A baseline study first measured the QOL domains (physical, psychological, social relationships and environment) among 252 women with advanced POP. Follow-up data was then collected at six weeks and three months after surgery. Among the 177 women that were available at six weeks post-surgery, 166 participated in the follow-up study at three months post-surgery. To evaluate QOL at baseline, 142 women with no history of POP were included as a comparison group. RESULTS: The mean scores across QOL domains improved from baseline to 3 months after surgery. The baseline score for the physical domain increased from 11.2 to 12.8 at six weeks and 13.5 at three months post-surgery (p < 0.001); the psychological domain score increased from 11.6 to 13.1 at six weeks and 13.8 at three months post-surgery (p < 0.001); the social relationships domain score increased from 13.6 to 14.4 at six weeks and 15.0 at three months post-surgery (p < 0.001); and the environmental domain score increased from 12.9 to 13.9 at six weeks and 14.0 at three months post-surgery (p < 0.001). CONCLUSION: QOL progressively improved among women undergoing surgery for POP. Such surgical services need to be scaled up for treatment of advanced POP in low-income countries.

Clinical Profile of Patients of Pelvic Organ Prolapse and Its Associated Factors.

BACKGROUND: Prolapse is among the most common indication for gynaecological surgery. It is difficult to estimate prevalence of pelvic organ prolapse even in developed countries due to lack of epidemiological studies. This study was done to find the prevalence, risk factors and common presenting complaints of women with pelvic organ prolapse. METHODS: Women with pelvic organ prolapse visiting Paropakar Maternity and Women's Hospital during 4 months duration in 2021 were approached and after obtaining an informed consent, all the patient information on various risk factors and clinical profile(age,parity,body mass index,smoking etc.) for pelvic organ prolpase were collected in a pre-developed proforma. Pelvic Organ Prolapse was classified by Pelvic Organ Prolapse Quantification system. Data analysis was done using statistical package for the social sciences-25. Ethical approval was taken from Institutional Review Committee- National Academy of Medical Sciences. RESULTS: Out of 58 cases enrolled in the study, prevalence of pelvic organ prolapse was found to be 1.28%. Women belonging to age group ≥ 49 years was 91.4%. Bulge symptom was the most common presenting complain among the women, 98.3%. 50% of women (n=29) were grand multipara. 53.4% (n=31) of women had delivered their first baby before 20 years of age. Multiparity,vaginal birth and menopausal age were the common risk factors. CONCLUSIONS: Menopausal age, multi-parity, vaginal births, age at first vaginal delivery of less than 20 years were significant risk factors for development of prolapse. Bulge symptom was the most common presenting complaint. However,Smoking habit, overweight were not related to pelvic organ prolapse.

Correlation of Endometrial Thicknessby Transvaginal Sonography with Histopathological Examination in Abnormal Uterine Bleeding in Perimenopausal Age Group.

BACKGROUND: Transvaginal sonography and endometrial biopsy are the two diagnostic tests, most frequently used to investigate the cause of abnormal uterine bleeding.The aim of this study is to correlate the findings between transvaginal sonography and histopathology for diagnostic evaluation in perimenopausal women with abnormal uterine bleeding. METHODS: A descriptive observational study was carried out at Paropakar Maternity and Women's Hospital, Thapathali, Kathmandu, Nepal during the period of one year (1st January 2019 to 30th December 2019) in 70perimenopausal women with abnormal uterine bleeding. Transvaginal sonography wasdone and endometrial thickness was noted. Endometrial biopsy was done under intravenous anaesthesia. Histopathological reports reviewed and analysis done. RESULTS: The most common age group of women presenting with abnormal uterine bleeding was 40 to 43 years(42.9%) and the commonest clinical feature was menorrhagia (50%) followed by menometrorrhagia (27.1%). The transvaginal sonography showed that majority of women had endometrial thickness of 10-12mm(35.7%) followed by 7-9mm(27.1%). Proliferative endometrium (37.1%) was most common histopathologicalfinding followed by secretory endometrium (30%). 10 cases of proliferative endometrium was seen at ET 7-9mm and 1 case of endometrial carcinoma was seen at ET 13-15 mm with P-value <0.13. CONCLUSIONS: Transvaginal sonography and histopathological examination are the standard diagnostic procedures for the assessment of abnormal uterine bleeding and for early detection of precancerous lesion like endometrial hyperplasiaand endometrial cancer.

Non Stress Test as a Predictor of Maternal and Fetal Outcome in Patients Presenting with Reduced Fetal Movement at Term.

BACKGROUND: Establishing the predictive utility of Non stress test could be helpful to improve perinatal outcome especially in countries like Nepal, with heavy workload and limited resources. The aim of the study was to assess association between Non stress test abnormalities and fetal outcome in terms of Apgar score and newborn intensive care unit admission rate for patient with decreased fetal movement. METHODS: The study included total 54 women with decreased fetal movement at term without any pregnancy complication not in labor admitted to paropakar maternity and women's hospital, Thapathali, Kathmandu from June 2020 to December 2020. Non stress test was done for 20 to 40 minutes and the readings were categorized in to three groups. The results were compared to see the relationship between normal, suspicious and abnormal Non stress test result in terms of mode of delivery, Apgar score, neonatal resuscitation and need for neonatal intensive care unit newborn intensive care unit admission. RESULTS: Total 54 cases remained under inclusion criteria were included in this study. Mode of delivery on the basis of Non stress test result shows that 31.48% with abnormal Non stress test had a Lower segment Caesarian section, 1.8% had instrumental vaginal delivery and 14.8% had spontaneous vaginal delivery. While in reassuring Non stress test group 20.4% had spontaneous vaginal, 0% had Lower segment Caesarian section and 1.85% had instrumental vaginal delivery. There is statistically significant relationship between Non stress test result and Apgar score. In reactive Non stress test result only5.4% required neonatal resuscitation. However, in persistently non-reassuring or abnormal Non stress test result, 62.1% require neonatal resuscitation. Similarly, in reactive Non stress test result none of the neonate required newborn intensive care unit admission. However, in persistently non-reassuring or abnormal Non stress test result 46.1% neonates require newborn intensive care unit admission. There were 9 neonatal mortalities from abnormal Non stress test result. CONCLUSIONS: We concluded that the Non stress test is a good predictor of maternal and fetal outcome detecting fetal hypoxia already present or likely to develop in patient presenting with reduced fetal movement in term pregnancies without complication.

Minimum Service Standard: A Hospital Strengthening Program that Facilitates Hospitals' Attainment of Quality-of-Care Standards.

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Clinical Outcome of Non-descent Vaginal Hysterectomy Versus Abdominal Hysterectomy.

BACKGROUND: Hysterectomy is one of the most common operations performed by the gynecologists second to caesarean section. Hysterectomies are done vaginally, laparoscopically or abdominally. This study has been conducted to compare the complications of abdominal hysterectomy with non-descent vaginal hysterectomy with an aim to establish a safer, superior and lesser complication for the patients. METHODS: This is a cross sectional study conducted at Kathmandu Model Hospital over the period of one year among 70 women. Women according to inclusion criteria were randomly allocated into two groups; 35 women in group 1 underwent non-descent vaginal hysterectomy and 35 in group 2 underwent total abdominal hysterectomy. Demographic data, intraoperative blood loss, intraoperative complications, operation time, postoperative complications, pain, and hospital stay was recorded and analyzed using statistical tool..  Results: The average age of the women was 45.77±6.33 years. Median blood loss (p=0.033) and hospital stay (p=0.005) was significantly low in group 1 as compare to group 2. Mean pain score at discharge (p=0.0005) and follow-up (p=0.0005) was also significantly less in group 1 as compared to group 2. Overall rate of complication was rare and not statistically significant between groups (p=0.643). Rate of wound infection was 5.7% that was observed in group 2, Vault infection 5.7% in group 1, UTI in 2 cases (5.7%) and paralytic ileus was found in 1 case in group 2. CONCLUSIONS: Non-descent vaginal hysterectomy is safe, effective and feasible procedure compared with abdominal hysterectomy. Less complications, faster operating time and easy recovery post operatively makes this a patient friendly mode of hysterectomy.

Repeat Cesarean Section among Pregnant Women in a Tertiary Center of Nepal: A Descriptive Cross-sectional Study.

INTRODUCTION: Cesarean Section is the most common obstetrics surgery done for both maternal and fetal indications. There is a rising trend of cesarean section rates which is associated with increased maternal morbidities. This study aims to find out the prevalence of repeat Cesarean Section among women with previous cesarean sections done in a tertiary centre. METHODS: This was a descriptive cross-sectional study conducted in a tertiary care hospital of Nepal from August 2020 to January 2021. Pregnant women with previous Cesarean Section status without other pelvic surgery and medical comorbidities were included and data were collected regarding intraoperative findings. Ethical approval was taken from the Institutional Review Committee (Reference Number: 14). A convenience sampling technique was used. Data were analysed using Statistical Package for the Social Sciences version 22. Point estimate at 95% Confidence Interval was calculated, with frequency and percentage. RESULTS: Out of 1315 patients undergoing Cesarean Section, the prevalence of Repeat Cesarean Section was found to be 184 (13.99%) (12.11-15.86 at 95% Confidence Interval). CONCLUSIONS: The prevalence of Repeat Cesarean Cection from our study was similar to other studies done in similar settings. Repeat Cesarean Cection confers peri-operative morbidities which adversely affect postoperative recovery. Repeat Cesarean Cection continues to contribute to morbidity over subsequent pregnancies and serious maternal morbidity.

Vesico-Vaginal Fistula in Females in 2010-2020: a Systemic Review and Meta-analysis.

INTRODUCTION: In the Western world today, urogenital fistula, including vesicovaginal fistula (VVF), is rare. However, while it remains significant in developing parts of the world due to prolonged and obstructed labor, in this study, we systematically reviewed the existing literature, discussing VVF occurrence, its etiology, and outcomes. MATERIAL AND METHODS: We used electronic databases to search relevant articles from 2010-2020. The screening was performed with the help of Covidence. Relevant data from included studies were extracted in excel sheets, and final analysis was done using CMA-3 using proportion with 95% confidence interval (CI). RESULTS: Fifteen studies reported the VVF among the fistula series. The pooled result showed 76.57% cases of VVF (CI, 65.42-84.96), out of which 27.54% were trigonal, 55.70% supra-trigonal, and the rest with a varied description like circumferential, juxta-cervical, juxta-urethral. Obstetric etiology was commonly reported with 19.29% (CI, 13.26-27.21) with cesarean section and 31.14% (CI, 18.23-47.86) with obstructed labor. Hysterectomy was the commonly reported etiology among gynecological etiology (46.52%, CI; 36.17-57.19). Among different surgical treatments employed for fistula closure, 49.50% were by abdominal approach (CI, 37.23-61.82), and 42.31% by vaginal approach (CI, 31.82-53.54). Successful closure of fistula was reported in 87.09% of the surgeries (CI, 84.39-89.38). CONCLUSION: The vesicovaginal fistula is the most common type of genitourinary fistula. Major causes of fistula are gynecological surgery, obstructed labor, and cesarean section. The vaginal approach and abdominal are common modalities of repair of fistula with favorable outcomes in the majority of the patients.

Prevalence and Contributing Factors of Gender-based Violence in SAARC Territories from 2010 to 2020: A Systematic Review and Meta-analysis.

BACKGROUND: Gender-based violence is a key global concern due to the high prevalence and increased socio-economic burden for survivors. However, estimation of the prevalence of gender-based violence is difficult due to differences in study design and underreporting of abuse, especially in developing nations. Therefore, we conducted this study to estimate the prevalence of Gender-based violence among women living in the SAARC region. METHODS: The review protocol was registered in PROSPERO (CRD42020219577). Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed throughout the review. A thorough database search was conducted to identify studies done in the SAARC region. Title and abstract screening were done in Covidence, followed by a full-text review. Data were extracted and pooled for analysis using the inclusion and exclusion criteria. Subgroup analysis was done where possible. RESULTS: A total of 76 studies were included in the systematic review and metaanalysis. The community prevalence of domestic violence (DV) was 43.8% (95% CI, 35.1% - 52.9%), GBV prevalence was 34.9% (95% CI, 30.2% - 39.9%) and IPV prevalence was 39.8% (95% CI, 30.7% - 49.6%). GBV prevalence was highest in illiterate women [54.2% (95% CI, 46.8% - 61.5%)] and lowest among women with higher than secondary level education [23.1% (95% CI, 16.2% - 32.0%)]. The prevalence of GBV among women in pregnancy or postpartum period was 32.3% (95% CI, 25.1% - 40.4%, I2: 98.64), while among female sexual workers, the prevalence of Gender-based violence was 42.1% (95% CI, 28.1% - 57.5%, I2: 99.25). CONCLUSIONS: There is a high prevalence of Gender-based violence in the SAARC region. Higher socioeconomic status and educational status are protective factors for Gender-based violence. However, more studies using validated tools are needed to understand the true extent of the problem.

Essentials of Health Care Management: Challenges and Way Forward.

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An Overview and Changing Scenario of Post-graduate Medical Education in Nepal: What Is the Way Forward?

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Profile of Ectopic Pregnancy Cases in a Tertiary Hospital.

BACKGROUND: An ectopic or extra uterine pregnancy is one in which the blastocyst implants anywhere other than the endometrial lining of the uterine cavity. The objective of the study was to find incidence, risk factors, clinical presentation and mode of management of ectopic pregnancy. METHODS: Observational study was conducted at Paropakar Maternity and Women's Hospital, Thapathali, Kathmandu. All the relevant data were recorded in performa. The collected data were entered in MS Excel and exported into SPSS 26 version for statistical analysis. RESULTS: About one third of the patients 10 (33.3%) was of 25-29 age group.The most common risk factor was pelvic infection in 23 (76.6%) cases, abortion in 11 (36.7%), and abdominal surgery in 8 (26.7%) of cases. The of classic triad of amenorrhea (100%), pain abdomen (99.7%) and per vaginal bleeding (66.7%). Ruptured ectopic seen in 26 (86.7%) cases, unruptured status in 1 (3.3%) case, tubal abortion in 1(3.3%) case and organized ectopic in 2(6.7%) cases. The most common site was found to be ampulla in 23 (76.7%) cases, fmbria 3(10%) cases, corneal in 3(10%) cases and ithmus in 1 (3.3%) case. All the cases managed surgically, of them unilateral salphingectomy, unilateral salphingo-opherectomy and wedge resection for corneal pregnancy were done in 25(83.3%), 2(6.7%) and 3(10%) cases respectively. CONCLUSIONS: Ectopic pregnancy mostly present as ruptured form in young females in our context. Pelvic infection is the commonest risk factor with ampulla being the commonest site. All cases required surgical intervention in form of unilateral salphingo-opherectomy and wedge resection.

Fetal Outcome in Cesarean Versus Normal Deliveries in Pregnancy with Meconium-stained Liquor: A Cross-sectional Study.

BACKGROUND: Intrauterine meconium passage in near term or term fetuses has been associated with feto-maternal stress factors and/or infection and is contributing to the increased rate of cesarean section. This study aimed to evaluate effect of mode of delivery on fetal outcome in pregnancy with meconium-stained liquor. METHODS: A cross sectional study was done in 2019 at a tertiary care center. Data was collected from women in labor, in whom meconium was seen after rupture of membrane. Out of these, 115 cases, who underwent cesarean delivery for meconium-stained liquor were enrolled in one group; while in another group 115 cases who delivered vaginally were enrolled and the fetal outcome was compared in between these two groups. RESULTS: Out of 230 cases, most participants were from 21 to 25 years age group. Most of patients were primigravida accounting for 63%, and with mean gestational age of 39.4 weeks. Low Apgar score at one and 5 minutes, percentage of respiratory distress, perinatal asphyxia, need of bag and mask ventilation as mode of resuscitation were associated more with vaginal deliveries. Incidence of Neonatal Intensive Care Unit admission, meconium aspiration syndrome, and neonatal death were seen more in vaginal delivery in comparison to cesarean delivery. CONCLUSIONS: There was no much difference in Apgar score at 5 minutes in either mode of delivery. Incidence of respiratory distress, perinatal asphyxia, Neonatal Intensive Care Unit admission, meconium aspiration syndrome and neonatal death were higher in vaginal delivery. Fetal morbidity and mortality were seen more in moderate to thick meconium-stained liquor.