Prelabour Rupture of Membranes among Pregnant Women Visiting a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Prelabour rupture of membranes is a common obstetrics problem associated with maternal and perinatal morbidity and mortality. The exact cause is not known although various factors are found to be related to this condition. Hence, the objective of this study was to find out the prevalence of prelabour rupture of membranes among pregnant women in a tertiary care centre. Methods: This was a descriptive cross-sectional study conducted from 1 November 2021 to 30 November 2022. Ethical approval was taken from the Institutional Review Committee (Reference number: 2078/79/49). A structured proforma was filled out after taking a detailed history from each pregnant woman. Convenience sampling method was used. Point estimate and 99% Confidence Interval were calculated. Results: Among 700 pregnant women, the prevalence of prelabour rupture of membranes was 56 (8%) (5.36-10.64, 99% Confidence Interval). Among them, 40 (71.43%) occurred in the term, while preterm (before 37 weeks) occurred in 16 (28.57%) of all pregnancies. Previous miscarriage occurred in 15 (26.78%) followed by gestational diabetes mellitus 8 (14.28%). Conclusions: The prevalence of prelabour rupture of membranes was found to be lower than other studies done in similar settings. Keywords: miscarriage; oligohydramnios; prevalence.

Contraception Use among Women Visiting Outpatient Department of Gynaecology in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Family planning services can bring a wide range of benefits to women, their families and society as a whole. Many women of reproductive age have little or incorrect information about family planning methods. Even when they know some methods of contraceptives, they don't know the availability or how to use them properly. The aim of this study is to find out the prevalence of contraception use among women visiting the outpatient department of gynaecology of a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among women visiting the gynaecological outpatient department from 10 April 2021 to 10 April 2022 after taking ethical approval from the Institutional review committee (Reference number: 2079/80-03). Women aged 18 to 49 years visiting during the study period were included and pregnant, postmenopausal and unmarried women were excluded from the study. Data was collected from one-to-one interviews. A convenience sampling method was used. Point estimate and 95% confidence interval were calculated. Results: Out of 208 patients, 146 (70.19%) (63.97-76.41, 95% Confidence Interval) women were currently using contraceptives. Short-acting reversible contraception was used by 97 (66.44%) and long-acting reversible contraception was used by 23 (15.75%). A total of 21 (14.38%) women used permanent sterilisation. The most commonly used contraceptive device was Depo Provera, 43 (29.45%) followed by condoms, 29 (19.86%). Conclusions: The prevalence of contraception use is lower than the other studies done in similar settings. Therefore, contraception promotion programs have to be encouraged to promote the efficient use of contraception. Keywords: contraception; family planning; prevalence; women.

Premenstrual Syndrome among Medical Students of a Medical College: A Descriptive Cross-sectional Study.

Introduction: Premenstrual syndrome is the premenstrual disorder with wide range of prevalence world-wide leading to higher rates of work absences, higher medical expenses, and lower health-related quality of life. The aim of this study was to find out the prevalence of premenstrual syndrome among medical students of a medical college. Methods: A descriptive cross sectional study was conducted in a medical college among medical students using self-reported questionnaires based on American College of Obstetricians and Gynaecologists criteria for premenstrual syndrome, and 12-Item Short Form Health Survey for quality of life, from 1 January 2022 to 31 March 2022 after obtaining ethical approval from the Institutional Review Committee (Reference number: 207807955). Convenience sampling was used among students who met the inclusion criteria. Point estimate and 95% Confidence Interval were calculated. Results: Among 113 patients, premenstrual syndrome according was seen in 83 (73.45%) (82.93-83.06, 95% Confidence Interval) out of which, 56 (67.46%) showed mild premenstrual syndrome, and 27 (32.53%) had moderate premenstrual syndrome. The most commonly reported affective symptoms of premenstrual syndrome was irritability 82 (98.79%), while the somatic symptoms was abdominal bloating 63 (75.90%). Conclusions: The prevalence of premenstrual syndrome among medical students was similar to in the other studies done in similar settings. Keywords: premenstrual syndrome; prevalence; quality of life.

Ascent rate and the Lake Louise scoring system: An analysis of one year of emergency ward entries for high-altitude sickness at the Mustang district hospital, Nepal.

More travellers are making swift ascents to higher altitudes without sufficient acclimatization or pharmaceutical prophylaxis as road connectivity develops in the Himalayan region of Nepal. Our study connects ascent rate with prevalence and severity of acute mountain sickness (AMS) among patients admitted to the emergency ward of the Mustang district hospital in Nepal. A register-based, cross-sectional study was conducted between June 2018 and June 2019 to explore associations of Lake Louise scores with ascent profile, sociodemographic characteristics, and comorbidities using chi-square test, t-test, and Bayesian logistic regression. Of 105 patients, incidence of AMS was 74%, of which 61%, 36%, and 3% were mild, moderate, and severe cases, respectively. In the Bayesian-ordered logistic model of AMS severity, ascent rate (odds ratio 3.13) and smoking (odds ratio 0.16) were significant at a 99% credible interval. Based on the model-derived counterfactual, the risk of developing moderate or severe AMS for a middle-aged, non-smoking male traveling from Pokhara to Muktinath (2978m altitude gain) in a single day is twice that of making the ascent in three days. Ascent rate was strongly associated with the likelihood of developing severe AMS among travellers with AMS symptoms visiting Mustang Hospital's Emergency Ward.

Determinants of associated events following AZD1222 (Covishield) vaccination in a high-risk population in Nepal.

BACKGROUND: Vaccination is the most effective method to prevent the spread of infectious diseases and helps reduce mortality rate and economic costs associated with the pandemic. Despite these advantages, misinformation on vaccine safety and efficacy can lead to increased hesitation towards vaccination. This study reports the incidence of adverse events following Covishield vaccination, their associated factors, medication used for their management, and attitudes about vaccine safety. METHODS: A cross-sectional study was conducted from the sample of Covishield-vaccinated individuals from a secondary hospital, two primary health centres, and 36 health posts in eastern Nepal. Individuals (n = 602) were randomly sampled from a population (n = 1013) who had received the first dose of Covishield, namely frontline workers and other high-risk populations. The second-round follow-up had 516 participants. Association of incidence and severity of post-vaccination events with socio-demographic variables, comorbidity status, and medication use were estimated. RESULTS: Among the 79.9% of participants who reported adverse events after receiving the first dose, two-thirds of complaints were mild (67.4%, 95% CI 63.2-71.6) with the most common complaint being pain at the injection site (86.5%). Paracetamol or its combination with NSAIDs were used in the majority of cases (95.2%). After the second dose, only 31.2% (95% CI 27.2-35.2) reported adverse events, the overwhelming majority of which were mild (95.7%) and required a lower frequency of medication (7.5% vs. 26.0%). Adverse event following immunization were significantly associated with being 18-30 years old (χ2 = 16.9, df = 3, p < 0.001) and female gender (χ2 = 5.2, df = 1, p < 0.05). Prior to the first dose, 86.0% of participants (95% CI 83.3-88.8%) perceived the vaccine to be safe, and 96.0% recommended the vaccine post-vaccination, while 96.8% were interested in receiving the second dose. AEFI severity was negatively associated with vaccine recommendation to the peers (odds-ratio 0.062, p < 0.05) following the first dose, whereas, the optimistic pre-vaccination perception was associated with positive vaccine recommendation post-vaccination (odds-ratio 28.658, p < 0.01). CONCLUSIONS: Overall, vaccination-associated events were mild and majority were managed with paracetamol or its combination. Effective counselling about adverse events before vaccination should be prioritized to reduce hesitation and fear.

Thyroid Dysfunction in Patients with Abnormal Uterine Bleeding in a Tertiary Care Hospital: A Descriptive Cross-sectional Study.

INTRODUCTION: Abnormal uterine bleeding is a common gynecological presentation, accounting for at least 20% of all new outpatient visits. It has been recognized that thyroid dysfunction may have profound effects on the female reproductive system. Both hypothyroidism and hyperthyroidism are associated with a variety of changes, including delayed onset of puberty, anovulatory cycles, and abnormally high fetal wastage. Hence, this study was conducted to know the thyroid status of the patient with abnormal uterine bleeding. METHODS: A descriptive cross-sectional study was conducted in all the patients with abnormal uterine bleeding in a tertiary care hospital from 2 August 2019 to 2 February 2020. Ethical clearance was received from the institutional review committee of KIST Medical College. Convenient sampling was done. Data was collected using a questionnaire which includes patients profile, the pattern of abnormal uterine bleeding, and thyroid profile. Statistical analysis was done using Statistical Package for the Social Sciences version 23. RESULTS: Out of 79 patients, it was found that 67 (84.8%) were euthyroid, 11 (13.9%) were hypothyroid,and 1 (1.2%) was hyperthyroidism. The most common type of abnormal uterine bleeding wasmenorrhagia 34 (43%), followed by polymenorrhoea 23 (29%), oligomenorrhoea 13 (16.5%), menometrorrhagia 6 (7.6%), metrorrhagia 2 (2.5%), and hypomenorrhea 1 (1.3%). The maximum number of patients was between 20-25 years with the mean age of 31 years. Among hypothyroid, 7(8.8%) had subclinical hypothyroidism and 4 (5%) had frank hypothyroidism. CONCLUSIONS: Most females with abnormal uterine bleeding were euthyroid. Menorrhagia was the most common pattern of abnormal uterine bleeding.

Prevalence of Cesarean Section and Its Indications in A Tertiary Care Hospital.

INTRODUCTION: Cesarean section is a surgical procedure performed to deliver fetus through abdominal route. Increasing rate of cesarean section worldwide is an alarming concern for public health and obstetricians due to increase in financial burden and risk to health of the mother in comparison to vaginal delivery. The aim of the study was to find the prevalence of cesarean section and its most common indication in a tertiary care hospital. METHODS: This descriptive cross-sectional study was done in a tertiary care hospital, from July 2016 to June 2018 after taking ethical clearance from institutional review board registration number 38970/062/063. Convenience sampling was done. Data was collected and entry was done in microsoft excel, point estimate at 95% CI was calculated along with frequency and proportion for binary data. RESULTS: Out of total deliveries conducted, 862 (36.8%) were CS deliveries, 1477 (63.1%) were vaginal deliveries, and 12 (0.51%) were instrumental deliveries. Prevalence of CS is 862 (36.8%) at 95% CI (34.82%-38.78%). Mean age±S.D of delivering mother was found to be 26.1±0.25 years. Primi cesarean section was more than repeat cesarean section. Most common indication of cesarean section was fetal distress 243 (28%) followed by previous cesarean section 165 (18%), non-progress of labour 106 (12%), oligohydramnios 59 (7%), malpresentation 59 (7%), cephalo pelvic disorders 52 (6.5%), and hypertensive disorder in pregnancy 33 (4%). CONCLUSIONS: Prevalence of cesarean section in a tertiary care hospital is high compared to WHO data. The most common indication of cesarean section are fetal distress and previous cesarean section.

Prevalence of Perinatal Deaths in a Tertiary Care Hospital of Nepal.

INTRODUCTION: Perinatal mortality indicates quality of maternal and neonatal care and is high in Nepal. This study was conducted to find out the prevalence of perinatal deaths in a tertiary care center. METHODS: This descriptive cross-sectional study was conducted from July 2017 to June 2018 at KIST Medical College and Teaching Hospital. Details of each perinatal death were filled in predesigned proforma from hospital in-patient records within 24 hours of perinatal death. The total of 1088 cases were selected for the study and convenience sampling was done. Statistical analysis was done with Statistical Package for Social Sciences version 17.0. RESULTS: Prevalence of perinatal death is 16 (1.46%) out of 1095 births. In the same way, perinatal mortality rate, stillbirth rate and early neonatal mortality rate were calculated and found to be 14.61 per 1000 births, 8.21 per 1000 births and 6.44 per 1000 live births respectively. Preterm neonates constituted of 71.4% of early neonatal deaths. CONCLUSIONS: Perinatal mortality rate was 50% lower than that of national survey, however comparable with study at another tertiary care center at Kathmandu. Stillbirth and prematurity contributed significantly to perinatal mortality. Provision of good antenatal surveillance, identification of high risk pregnancies and good neonatal care to preterm neonates would be required to reduce perinatal mortality.

Newborn Care Practices at Home among Mothers of Neonates Admitted with Sepsis.

BACKGROUND: Child rearing practices and family environment determine the health of newborn. Harmful newborn care practices are the risk factors for late onset neonatal sepsis. The objective was to identify newborn practices related to breast feeding, cord care, hygiene of newborn and thermal care practice at home of admitted neonates with diagnosis Late Onset Neonatal Sepsis in pediatric unit of B.P. Koirala Institute of Health Sciences tertiary center in eastern Nepal. METHODS: Descriptive cross sectional study was carried out from December 2014 to January 2015 using consecutive sampling. Semi structured, pretested questionnaire was used to interview 40 mothers. Data were analyzed using SPSS 20, descriptive and inferential statistics were used. RESULTS: Initiation of breastfeeding within one hour of delivery was practiced by only 40% of mother. Among neonates, 65% were given colostrum, 25% were given pre lacteal feed, and 45% were given formula milk and animal milk. Mustard oil was used to care umbilical cord by 72.5 %. Hand washing was practiced by 62.5 % before touching the baby. Application of kajal (52.5%) in eyes and use of mustard oil (95%) for massaging newborn was common. For thermal care, burning charcoal (75%) was mostly used. The study revealed association between newborn care and mother education, per capita income of family and family type (p =0.012, p= 0.012, p=0.039) respectively. CONCLUSIONS: Majority of practices in breast feeding and thermal care were good however in cord care and newborn hygiene practices was poor which stresses the need for the promotion of health education program to mothers by health care facilities.