Maternal Near Miss Analysis in Three Hospitals of Nepal: An Assessment Using Three Delays Model.

BACKGROUND: Maternal Near Miss cases have similarities with those dying from such complications and so present an important opportunity to improve practice. This study was conducted to assess the prevalence of Maternal Near Miss events and identify the delays experienced. METHODS: This was a facility-based cross-sectional study conducted in three tertiary referral hospitals from three provinces of Nepal. All the women surviving a near miss event during six months data collection period were included in the study. RESULTS: There were 67 near miss cases, 7 maternal deaths, and 9158 live births in the study hospitals during the data collection period. This resulted in Maternal Near Miss ratio of 7.31/1000 live births and facility-based Maternal Mortality Ratio of 76/100,000 live births. Severe obstetric haemorrhage (54%) was the most frequent clinical cause of near miss, followed by hypertensive disorders (43%). At least one type of delay was experienced by 85% women. First delay occurred in 63% (42 of 67) cases, second delay occurred in 52% (33 of 62) cases and third delay occurred in 55% (37 of 67) cases. CONCLUSIONS: This study found out that all three delays were common among women experiencing maternal near miss event. Raising awareness regarding dangers signs, improving referral system and strengthening ability of health workers can help in reducing these delays.

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.

Safe abortion services in Nepal: initial years of availability and utilization.

INTRODUCTION: Following the liberalization of the very strict Nepalese abortion law in 2002, the first services for safe induced abortion were introduced in 2004 at the nation's largest women's hospital. This paper examines the client profile, the context of demand for services, affordability and satisfaction with services. DATA AND METHODS: Data for the analysis came from a survey of women who presented themselves at the hospital for induced abortion services and subsequently received the services. RESULTS: Based on a survey of 672 clients, the median age was 26, and most women were married with an average of two living children. The majority reported being impregnated by the husband. Nearly three out of five gave their primary reason for termination as already having the number of children desired; another 42% cited finances. About two-thirds made the decision to abort jointly with the male partner. Most were satisfied with the services received and expenses incurred. About two-fifths reported having used a modern contraceptive method at the time the unwanted pregnancy occurred, while 22.6% reported practising either the safe-period or withdrawal methods. CONCLUSION: The clinic has provided affordable, quality abortion services to women in need. Findings also suggest that many areas need services strengthened, including the continued role of the family planning program in preventing unintended pregnancies.