Awareness and practice of family planning methods in women attending gyne OPD at Nepal Medical College Teaching Hospital.

A cross sectional descriptive study of awareness and practice of family planning methods among 200 women of reproductive age attending gynecology out patient department (GOPD) of Nepal Medical College Teaching Hospital from 14th May 2008 to 14th July, 2008 was carried out. Most of the respondents (93.0%) were aware of at least one of family planning methods out often methods, but only 65.0% had ever used it and contraceptive prevalence rate was 33.5% which was slightly higher than the national data as 28.5%. The best known method of temporary contraception was depo provera (78.0%) followed by oral contraceptive pills (74.0%) and condom (71.0%) and least known methods were vaginal foam tablets/jelly (34.0%) and natural methods (16.0%). Among permanent family planning methods, awareness about female sterilization (81.0%) was more than male sterilization (77.0%) which was in accordance with studies done in other countries. Knowledge about emergency coritraception was quite low (12.0%) as it was newly introduced in the country. Regarding current use of contraception depo provera (11.0%) was the most widely used followed by oral contraceptive pills (4.5%) and condom (4.5%). 5.5% had undergone female sterilization while only 2.5% of male partner had sterilization Knowledge of non contraceptive benefits of family planning methods was claimed by only 35.0% of the respondents, 27.0% reported awareness that condoms protect from HIV/AIDS and sexually transmitted diseases (STD) while knowledge about various adverse effects was widespread (52.5%). The most common source of information on contraception was media (55.5%), both printed and electronic. This study also observed that with increase in level of education, awareness also increased. Although most of the women were aware about the methods, they were ignorant about the details like duration of protection, return of fertility on discontinuation and non contraceptive benefits. The most common reason for discontinuation of FP methods was stated as side effects. A wide knowledge practice gap was evident in this study, which was similar to the findings of studies done in other developing countries. Improved female education strategies and better access to services are needed to solve these problems. The use of communication media suitable for the audience and adequate message is important in conducting effective family planning awareness activities. Efforts should be made to educate the public about the safety and convenience of modern, long-term, reversible methods of contraception among both healthcare professionals and the public.

Study of low birth weight babies in Nepal Medical College.

This was a retrospective study conducted to study the newborns weigth less than 2500gm delivered in Nepal medical college in the year 2005 and 2006. The cases were studied to find out the incidence and relation of maternal age, parity, gestational age, sex, etiological factors, mode of deliveries with Low Birth Weight (LBW) babies. There were 172 patients with LBW babies out of 1517 patient. Including the 9 twin babies, there were total 181 babies with LBW. Thus the incidence of LBW babies was 11.9%.There were only 26 (15.0%) under 20 years of age. As for parity, 92 (53.0%) were primigravida and 80 (46.0%) were multigravida. There were 6 (3.5%) of the babies less than 28 weeks, 22 (13.0%) between 29 to 32 weeks, 61 (33.7%) between 33 to36 weeks, 78 (43.1%) between 37 to 40 weeks and 14 (7.7%) 41 weeks or above. The babies under 1000gm or 1000 gms were 7 (4.1%),1001-1500 gms were 15 (8.7%), 1501-2000 gms were 40 (23.0%) and 2001-2500 gins were 119 (69.2%). Male babies were 94 (52.0%) and female babies were 87 (48.0%). Caesarian section was 15.7% remaining babies were delivered vaginally. Among the risk factor for LBW babies, spontaeneous preterm labour were 61 (35.5%), intra-uterine growth restriction were 51 (29.0%), antepartum haemorrhage 10 (5.8%), twin 9 (5.2%), pregnancy induced hypertension 12 (7.0%), preterm premature rupture of labour 8 (4.7%), anomalies were 4 (2.3%) and urinary tract infection were 20 (11.6%). Other infection were Typhoid 4 (2.3%) and chest infection 2 (1.2%). Thus the incidence of LBW babies in our hospital is quite high in comparision to the Western world and primigravida has more chance of delivering LBW babies. Spontaeneous preterm labour and intra uterine growth restriction are major risk factor leading to LBW babies. Urinary tract infection also plays important role in spontaeneous preterm labour. So to reduce the prevalence of LBW babies, we should identify in early the high risk pregnancy, taking more care to primigravida, treating clinical and subclinical infection in time to prevent spontaeneous preterm labour, diagonosing and managing the intra uterine growth restricted babies in time.

Complications of home delivery: a retrospective analysis.

This study was conducted to analyze the cases who had attended Nepal Medical College Teaching Hospital (NMCTH) after home delivery in order to broadly review the complications. This is a retrospective descriptive study. The number of total deliveries during the study period of two years (April, 2002- April, 2004) was 1619, among which 88 (5.4%) were cases who attended after home delivery. Majority of women (35.2%) were primi, 57.9% belonged to 20-25 year age group, 17% were young primi, and 85.2% were full term deliveries whereas 9.1% were preterm. More than half of them (57.9%) had regular antenatal check up. Most of them came from within 1-2 km distance of NMCTH. 51.1% were brought only after 2 hrs of delivery. The most common reason for attending hospital was retained placenta (84.1%-74 cases) among whom 51 (68.9%) needed controlled cord traction, 8 cases (10.8%) needed manual removal, rest of the cases had placenta lying in the vagina. Fifteen (17%) cases had post partum hemorrhage, 9 cases (10.2%) were brought in a state of shock. 71.6% were anemic, 11 (12.5%) had Hb <7 gm%. Other complications included cervical, third degree perineal tear. Blood transfusion was needed in 19 (21.6%) cases. All cases improved with proper resuscitation, use of antibiotics and definitive management of complications. Most of them were discharged within 4 days of admission. Perinatal mortality rate was 65.9/1000 births. This study showed that home deliveries were associated with increased maternal morbidity especially the third stage complications. Studies done in developed countries have shown that home birth is safe for normal, low risk women, with adequate infrastructure and support i.e. given a well trained midwife and facilities to transfer to hospital if necessary. In our context, a community based obstetric service must be developed with emphasis on regular and quality antenatal care, health education to women and proper training of birth attendants.