Triaging patients with post-abortion complications: a prospective study in Nepal.

The first manual vacuum aspiration (MVA) services unit in Nepal was established in 1995 at the country's largest national maternity hospital in Kathmandu. This research sought to assess and evaluate the safety, acceptability, and effectiveness of MVA services. This prospective study was conducted during 12 months in 1998, and follow-up was made at six weeks. Two groups of patients were compared: 529 patients treated in the MVA unit and 236 patients who were clinically eligible for treatment in the MVA unit but were treated instead in the main operation theatre (OT) owing to the unavailability of services in the MVA unit during the hours of their admission. The two groups differed with respect to some of their background characteristics but were similar in their clinical characteristics. The MVA group received contraceptive counselling and services and had significantly shorter stays in hospital. However, the direct cost incurred by the patients, regardless of the type of facility they used, was about the same. Follow-up at six weeks revealed that the MVA patients had significantly fewer complaints and were generally more satisfied with the services they had received than their counterparts. Slightly more than half of the women in the MVA group were using contraception at the time of follow-up compared to no women in the OT group. It is concluded that the MVA unit provided safe, effective, and efficient services to about 50% of all the patients admitted to the hospital with post-abortion complications. An additional 25% of the post-abortion patients could be served if the unit were kept open 24 hours a day, saving resources and time for patients and hospital staff. As a parallel development, both MVA and main OT services would need to be more effectively integrated with outside antenatal and family-planning clinics to address the reproductive health needs of women, thereby reducing the number of patients requiring post-abortion care.

Voluntary surgical contraception: a study on level of satisfaction.

Voluntary surgical contraception (VSC) is said to be one of the most popular, safe, effective and long term methods of birth control not only in Nepal but also in the world One of the very frequently suspected complication or effect of voluntary sterilization (female) is "post tubal sterilization syndrome". The term post tubal sterilization syndrome has been used variously to include abnormal menstrual bleeding, dysmenorrahoea, premenstrual distress, hysterectomy and miscellaneous other conditions like need for recanalisation, feeling of regret and menopausal syndrome. Abnormal vaginal bleeding due to ovarian dysfunction has been a regular and common complaint of the female clients after their TS. This study was carried out in a clinic setting to find out the level of satisfaction among the cases of VS. Level of satisfaction was measured by whether the client regretted the procedure, whether their menstrual pattern was changed after the procedure, performed either by themselves or VSC by the husband and also by finding out how many of them needed hysterectomy and recanalisation procedure. Women who had undergone TS were taken as the cases (group A) and those women whose husband has VSC were taken as control group (group B). The result showed that there is almost no difference in the age group of both case and control at the time of their consultation. At the time of VS almost 60% (56.53%) of cases were <29 years of age and >70% (71.23%) of the women were <29 years of age when their husbands were vasectomised. 26.15% of the women in group A were in the age group of 30-40 whereas this age group comprised of only 15.38% in group B. Average age at menarche was 14 years and average age at marriage 17 years. The menstrual pattern was not found to have changed in both groups excepts for those who had organic condition. Hysterectomy had been performed in only 5 cases at the age of 30, 34, 40, 42 and 43 years in group-A and in two case in group-B. Indications of hysterectomy n these cases were (DUB) and fibroids. Two patients in group-A had to undergo recanalisation but the indication in both the cases were loss of previous children.