Neelam Pradhan

Effects of abortion legalization in Nepal, 2001-2010.

Background Abortion was legalized in Nepal in 2002, following advocacy efforts highlighting high maternal mortality from unsafe abortion. We sought to assess whether legalization led to reductions in the most serious maternal health consequences of unsafe abortion. Methods We conducted retrospective medical chart review of all gynecological cases presenting at four large public referral hospitals in Nepal. For the years 2001–2010, all cases of spontaneous and induced abortion complications were identified, abstracted, and coded to classify cases of serious infection, injury, and systemic complications. We used segmented Poisson and ordinary logistic regression to test for trend and risks of serious complications for three time periods: before implementation (2001–2003), early implementation (2004–2006), and later implementation (2007–2010). Results 23,493 cases of abortion complications were identified. A significant downward trend in the proportion of serious infection, injury, and systemic complications was observed for the later implementation period, along with a decline in the risk of serious complications (OR 0.7, 95% CI 0.64, 0.85). Reductions in sepsis occurred sooner, during early implementation (OR 0.6, 95% CI 0.47, 0.75). Conclusion Over the study period, health care use and the population of reproductive aged women increased. Total fertility also declined by nearly half, despite relatively low contraceptive prevalence. Greater numbers of women likely obtained abortions and sought hospital care for complications following legalization, yet we observed a significant decline in the rate of serious abortion morbidity. The liberalization of abortion policy in Nepal has benefited women’s health, and likely contributes to falling maternal mortality in the country. The steepest decline was observed after expansion of the safe abortion program to include midlevel providers, second trimester training, and medication abortion, highlighting the importance of concerted efforts to improve access. Other countries contemplating changes to abortion policy can draw on the evidence and implementation strategies observed in Nepal.

Influence of family members on utilization of maternal health care services among teen and adult pregnant women in Kathmandu, Nepal: a cross sectional study

BackgroundIn some developing countries a woman’s decision to utilize maternal health care services is not made by the woman herself but by other family members. The perception of family members regarding who is the most influential person for making the decision to utilize these services is inconclusive. Hence, this study aimed to determine the perceived influential person on utilization of antenatal care (ANC) and delivery care services among teen, young adult and adult pregnant women from the perspective of the woman themselves, their husband and their mother-in-law, identify the factors associated with the woman being the most influential person, and assess the level of agreement between the woman’s and her husband’s response to the woman being the most influential person.MethodsA cross-sectional study was conducted at Paropakar Maternity and Women’s Hospital and Tribhuvan University Teaching Hospital. Purposive sampling technique was used to select 315 women of which 105 were from each age group and their accompanied husbands (n = 315) and mothers-in-law (n = 315). The proportion of perceived influential person and mean priority score of the perceived influence with its 95% confidence interval was calculated. The factors associated with the woman perceived as the most influential person were analyzed by multivariate logistic regression model. The agreement was analyzed using kappa statistic.ResultsAmong teens and young adults and their husband and mother-in-law, the woman’s husband was perceived as the most influential person. Among adults, the most influential person for ANC was the woman herself but for delivery care was the woman’s husband. A woman of adult age, having a non-indigenous ethnicity or who was not referred was more likely to perceive herself as the most influential person in the decision to utilize delivery care. A fair to poor level of agreement was found on the perception of the most influential person for ANC and delivery care utilization.ConclusionsBoth women and their husbands influenced the decision to utilize ANC and delivery care but husbands were more influential, especially in teens and young adults. Thus, husband’s involvement is crucial as a strategy to improve maternal health care utilization in Nepal.

Maternal mortality over the last decade: A changing pattern of death due to alarming rise in hepatitis in the latter five‐year period

Aims:  To study the causes of maternal mortality in two consecutive five year periods over a decade (1997–2001/2002–2006) in a university hospital.

Effect of education and pill count on hemoglobin status during prenatal care in Nepalese women: a randomized controlled trial.

Aim:  To determine the effect of an education program and/or pill count on the change in hemoglobin levels and the prevalence of anemia in pregnant women.

Mifepristone plus vaginal misoprostol vs vaginal misoprostol alone for medical abortion in gestation 63 days or less in Nepalese women: A quasi-randomized controlled trial

Aim:  To compare the efficacy of mifepristone and vaginal misoprostol with misoprostol alone for pregnancy termination up to 63 days.

Change in willingness to pay for normal delivery and caesarean section during pregnancy and after delivery in Kathmandu.

Objectives  To determine the change in willingness to pay (WTP) measured at pregnancy and at postpartum before and after knowing hospital costs among women who gave birth by normal delivery (NL) and caesarean section (CS) and to identify factors affecting the change in WTP.

PLACENTA PREVIA ACCRETA

Placenta accreta is defined as any placental implantation in which the placenta is abnormally and firmly adherent to the underlying uterine wall in part or in total. The probable cause is defective decidual formation as shown by its occurence in area where the endometrium is deficient or damaged. The commonest condition associated with it are placenta previa and previous caesarean section. A case of placenta previa accreta is described herewith in a 2nd gravida who eventually needed emergency caesarean hysterectomy (total) due to profuse bleeding.

UTERINE PERFORATION AS A SEQUEL TO REPEATED CURETTAGE FOR MOLAR

An 18 year old girl was subjected to emergency hysterectomy and unilateral salpingooophorectomy for uterine perforation because of repeated dilatation and curettage for persisting vaginal bleeding following molar evacuation. As significant proportion of molar do progress into Gestational trophoblastic Neoplasia which in this case was choriocarcinoma; directs our attention to the fact that proper follow up of post molar cases using at least urinary beta HCG and instituting chemotherapy whenever necessary should be advocated in order to avoid such a drastic management. CASE REPORT Journal of Nepal Medical Association, 2002:41:401-403