Introduction: As abortion is a safe service that authorized health care workers can provide, they must have adequate knowledge, attitude, and training to prevent complications and potential litigation. Methods: This study was a descriptive cross-sectional study conducted among 103 intern doctors of Lumbini Medical College, Nepal, after obtaining ethical approval. Only 91 interns responded to the survey online, which consisted of 32 item questionnaires regarding demographics, knowledge, and attitudes of interns regarding safe abortion services. Data were collected online from January to March 2026 and analyzed using PSPP 2.1.1. Results: The mean age of participants was 25.1 ± 1.3 years, of which 52 (57.1%) were female. All participants were unmarried, and 88(96.7%) were Hindu. The participants had good knowledge regarding abortion law, methods of safe abortion, and its complications. Only 38 (41.8%) had formal training, and 29 (31.9%) felt prepared; a significant gap was observed between knowledge and training. There was a positive attitude among interns regarding abortion; they were supportive of women's rights and its legalization. While acknowledging stigma and unsafe abortion as persistent public health issues, the majority were willing to offer services if given the necessary training. Conclusions: Supporting women’s autonomy, adequate knowledge and positive attitudes towards safe abortion services were observed among intern doctors. However, a huge gap existed between knowledge and training, which undermined the preparedness to provide safe and efficient service.

Introduction: Antenatal health-care given to pregnant women has great influence on the rates of perinatal morbidity and mortality. Amongst different causes of perinatal mortality, low birth weight is the single most significant factor. Therefore, routine histopathological examination of the placenta from all the low birth weight babies should be done to find out the likely cause. This study aimed to assess the pathological changes in placenta in association with low birth weight babies. Methods: A descriptive observational study was conducted from 1 April, 2022 to 31 March, 2023 in the Department of Obstetrics and Gynaecology and the Department of Pathology of Lumbini Medical College- Teaching Hospital after obtaining ethical clearance from the Institutional Review Committee (IRC-LMC-06/P-24) at Lumbini Medical College and Teaching hospital, Palpa, Nepal. A total of 83 placentas of low birth weight babies were included. The weight of the baby and placenta was taken within the first hour of birth. All the collected placentas with a portion of cord attached were sent to Department of Pathology for histopathological study and the reports were collected. All the quantitative data were expressed in frequencies and percentages. Results: The fetoplacental ratio was 5.99:1. The mean placental diameter was 14.73 centimetres while thickness was 2.95 centimetres. The umbilical cord was inserted centrally in 45, eccentric in 31, marginally in 6 cases and velamentous in 1 case. Microscopically, syncytial knot formation (75; 90.4%), perivillous fibrin deposition (49; 59%), hyalinisation (45; 54.2%), calcification (59; 71.1%), infarction (49; 59%) and hemorrhage (45; 54.2%) were found in placentas of low birth weight babies. Conclusions: Histological aberrations like presence of syncytial knots (90.4%), perivillous fibrin deposition (59%), hyalinisation (54.2%), calcification (71.1%), infarction (59%) and hemorrhage (54.2%) are observed in high rates in placentas of women with low birth weight babies.

Cases of mental illnesses and suicide attempts while pregnant are of grave concern because they negatively affect both the mother and her fetus. Here we report a case of an 18-year-old woman, who was found at 35 weeks into her pregnancy. She was unconscious when her sister-in-law rescued her. Upon arrival, she was agitated and had respiratory distress. She went into spontaneous labor the next day and delivered a premature infant who succumbed within 24 h. She had a history of mental illness in the past and previous suicide attempts. The reason for her suicide stemmed from conflicts within her family and disagreement with her husband. Various psychosocial elements play a role in suicide risk, such as young age, having a history of mental health issues, experiencing trauma facing domestic violence, and dealing with financial stress. This underlines the need for mental health screening in the course of antenatal visits for a complete risk assessment.

Abstract Background and Aims Despite the decriminalization of abortion in Nepal in 2002, unsafe abortion is still a significant contributor to maternal morbidity and mortality. Nepal has witnessed a significant drop in abortion‐related severe complications and maternal deaths owing to the legalization of abortion laws, lowered financial costs, and wider accessibility of safe abortion services (SAS). However, various factors such as sociocultural beliefs, financial constraints, geographical difficulties, and stigma act as barriers to the liberal accessibility of SAS. This review aimed to determine key barriers obstructing women's access to lawful, safe abortion care and identify facilitators that have improved access to and quality of abortion services. Methods A systematic search strategy utilizing the databases PubMed, CINAHL, Scopus, and Embase was used to include studies on the accessibility and safety of abortion services in Nepal. Data were extracted from included studies through close reading. Barriers and facilitators were then categorized into various themes and analyzed. Results Of 223 studies, 112 were duplicates, 73 did not meet the inclusion criteria, and 18 did not align with the research question; thus, 20 studies were included in the review. Various barriers to SAS in Nepal were categorized as economic, geographic, societal, legal/policy, socio‐cultural, health systems, and other factors. Facilitators improving access were categorized as economic/geographic/societal, legal/policy, socio‐cultural, and health systems factors. The patterns and trends of barriers and facilitators were analyzed, grouping them under legal/policy, socio‐cultural, geographic/accessibility, and health systems factors. Conclusion The review identifies financial constraints, unfavorable geography, lack of infrastructure, and social stigmatization as major barriers to SAS. Economics and geography, legalization, improved access, reduced cost and active involvement of auxiliary nurse‐midwives and community health volunteers are key facilitators.

Introduction: Cervical carcinoma is the third most common malignancy worldwide. The World Health Organization in 2014 reported the crude incidence rate of cervical cancer in Nepal as 24.2 per 100,000 women per year. This study was carried out with the aim of finding out the prevalence of cervical smear abnormality in pregnancy. Methods: An observational study was conducted in the department of Obstetrics and Gynecology of a tertiary center for a period of one year from May 2021 to April 2022. All pregnant women up to 28 weeks of gestation who had National Health Insurance coming for antenatal check-ups underwent PAP smear test. The cytological results were reported based on the Bethesda classification system 2001. Results: Of 200 pregnant women enrolled in the study, the Pap smear report revealed that 32% of the study subjects had inflammatory smear showing candidiasis and bacterial vaginosis with reactive inflammatory changes. However, 66.5% of the subjects showed negative for intraepithelial lesion or malignancy and only 0.5% of subjects had signs related to carcinoma cervix in which the subject had a low-grade squamous intraepithelial lesion. No satisfactory sample was reported in 1% of the subjects. Conclusion: Pap smear during pregnancy not only gives the opportunity to screen but also helps to create awareness.

Introduction: Hypothyroidism is a common endocrine problem in pregnant women with a reported prevalence of 1.5 to 4.4%. Both overt and subclinical hypothyroidism have adverse effects on perinatal outcome. Aim and Objective: To find the prevalence of hypothyroidism in pregnancy and its impact on perinatal outcome and neonatal hypothyroidism in a tertiary centre in western Nepal. Methods: This is a retrospective descriptive study conducted from April 2018 to April 2022 involving 75 hypothyroid pregnant women during their antenatal check-ups. It also included known cases of hypothyroidism. The hospital records of all the hypothyroid women who delivered in this centre were reviewed. The prevalence of subclinical and overt hypothyroidism were calculated. The relationship between the status of hypothyroidism and perinatal outcome in terms of mode of delivery, APGAR scores, birth weight and admission to neonatal intensive care unit were evaluated. Results: The prevalence of maternal hypothyroidism was 0.92% with subclinical hypothyroidism being 0.29% and overt hypothyroidism being 0.63%. The perinatal outcomes in terms of mode of delivery, APGAR scores, birth weight and admission to neonatal intensive care unit were not statistically significant between subclinical and overt hypothyroidism. Conclusion: The prevalence of maternal hypothyroidism, especially subclinical hypothyroidism was low. There were no significant adverse effects on perinatal outcome.

Introduction: Ovarian cancer is the fifth most common cancer in Nepalese females and the tenth overall, accounting for 5% of the total new cases of cancer in females in 2020. Ultrasonography (USG) remains the primary tool for the diagnosis and characterization of ovarian masses in which many grey-scale and Doppler characteristics are evaluated. Various scoring systems have been described incorporating different USG parameters to differentiate the benign and malignant nature of ovarian masses. Alcazar scoring system includes both grey-scale as well as Doppler characteristics of the ovarian masses and is one of the more widely used systems worldwide. Methods: This was an observational cross-sectional study based on 52 consecutive patients who were clinically suspected to have ovarian mass and referred for USG evaluation and who subsequently underwent surgery.Results:As confirmed by histopathology, 37 cases were benign and 15 were malignant masses. Alcazar system of scoring identified 34 out of 37 benign cases and 15 out of 15 malignant cases with sensitivity and specificity for diagnosing malignant cases of 83.3% and 91.1% respectively. Conclusion: Alcazar system of scoring is a highly effective tool to differentiate between benign and malignant ovarian masses and can be of great help in diagnosis, characterization and effective preoperative planning.

Aims: To assess the knowledge of obstetrician and gynaecologists in Nepal about abortion legislation and to know their perception on its reform. Methods: A cross-sectional survey design was adopted. An online questionnaire was sent to all members of the Nepal Society of Obstetrician and Gynaecologists and response was collected. Profile of the respondents, their knowledge on the 2002 abortion legislation and their attitude on its reform were noted. Results: The response rate was 10.1%. There was a fair knowledge of previous abortion legislation amongst the 43 respondents. The mean score for the knowledge on previous abortion law and its reform was 3.85±0.35 and 3.0±1.14 respectively. Twenty-seven (62.8%) respondents felt the need for reform was necessary. In regards to the reform, 44.25% (19) stood for it and 46.5% (20) were against it. More (55%) obstetrician and gynaecologists practicing in the Bagmati province were against the reform. Conclusions: Obstetrician and gynaecologists practitioners in Nepal have a good knowledge of abortion legislation and are aware of its reform. The need for reform is also perceived well but there is a divided opinion amongst practitioners, with half of them positive about the reform and half standing against it.

Introduction: Abnormal uterine bleeding accounts for more than 70% of complaints in peri- and post-menopausal women. The main purpose of investigating them is to rule out premalignant and malignant endometrial lesions. This study aimed to find out the prevalence of abnormal uterine bleeding among out-patients visiting the gynecology department of a tertiary care hospital. Methods: This descriptive cross-sectional study was conducted in the Department of Obstetrics and Gynecology of a tertiary care center from August 1, 2020 to April 23, 2021. Ethical approval was obtained from the Institutional Review Committee of the same institution (IRC-LMC 07-C/020). A total of 2680 women visiting gynecology outpatient departments were included by convenience sampling technique. Women with abnormal uterine bleeding were evaluated by endometrial thickness measurement and endometrial biopsies. Statistical Package for the Social Sciences version 16 was used for data analysis. Point estimate at 95% Confidence Interval was calculated along with frequency, percentage, mean and standard deviation. Results: Among 2680 women visiting the gynecology outpatient department, the prevalence of abnormal uterine bleeding was 240 (8.9%) (7.82-9.98 at 95% Confidence Interval). The mean endometrial thickness was 10.15±6.63mm. Majority of patients 104 (43.3%) had endometrial thickness >10mm. Sixty-six (27.8%) patients had disordered proliferative endometrium while endometrial carcinoma was noted in three (1.2%) patients. Atrophic endometrium was observed in 17 (7.2%) and endometrial hyperplasia in nine (3.8%) patients. Conclusions: The prevalence of abnormal uterine bleeding was found to be higher in comparison to other studies. Disordered proliferative endometrium was the most common histopathological finding followed by secretory phase endometrium.

Introduction: The incidence of cervical cancer is very high in developing countries. The extensive use of cervical screening with PAP smear and colposcopy has considerably increased the detection of premalignant and malignant cervical lesions. Methods: This was a hospital-based study conducted over a period of three months. All the patients underwent gynecological examination, PAP smear and colposcopy. In case of abnormal findings in colposcopy or follow-up cytology, patients were advised for cervical biopsy. With reference to the histopathological reports, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of PAP smear and colposcopy were evaluated. Results: The most common cytological result was Negative for Intraepithelial Lesion or Malignancy (NILM, 60%) followed by Atypical Squamous Cells of Undetermined Significance (ASCUS, 10%), Atypical Squamous Cells- cannot exclude High grade lesion (ASC-H, 6%), Low grade Squamous Intraepithelial Lesion (LSIL,10%) and High grade Squamous Intraepithelial Lesion (HSIL, 11%). In colposcopy, 60% of the patients were normal and 40% showed atypical transition zone. Histo-pathological findings among 53 patients were NILM (13.2%), cervicitis (13.2%), Cervical Intraepithelial Neoplasia I (CIN I, 28.3%), CIN II and CIN III (39.6%) and invasive carcinoma (5.66%). The sensitivity, specificity, PPV and NPV of PAP smear were 63.6%, 66.6%, 33.3%, and 87.5% respectively. Similarly sensitivity, specificity, PPV, NPV of colposcopy for abnormal cervical lesions were 87.56%, 15.38%, 76.09% and 28.57% respectively. Conclusion: In the absence of HPV-DNA testing, the combined use of PAP smear and colposcopy to detect premalignant and malignant cervical lesions increases early detection and treatment.

Introduction: Maternal obesity is an established risk factor for various adverse pregnancy outcomes. Increased chances of labour induction, prolonged labour, instrumental and cesarean deliveries, medical disorders of pregnancy, post partum haemorrhage, preterm deliveries, macrosomia, low Apgar score etc. are well recognised risks of maternal obesity. This study aimed to evaluate these maternal and fetal outcomes in relation to the body mass index (BMI) of parturients. Methods: A prospective cohort study involving 115 overweight and obese women was conducted. Various maternal and fetal outcomes were studied and compared with those of 115 postpartum women with normal BMI. Statistical analysis was done using student's t-test and Chi square test. Binomial logistic regression analysis was carried out to examine the magnitude and significance of the independent effect of BMI. Results: The three groups were comparable in terms of maternal age and gestational age at delivery. The total blood loss was significantly higher in the obese group as compared to the normal BMI (p=0.001) or overweight groups (p=0.005). Vaginal delivery was 69% less common in obese group in comparison to normal BMI group. The prevalence of meconium stained liquor, labour induction, preterm labour, and admission to neonatal intensive care unit were not significantly different across the three groups. Conclusion: This study highlighted the increased risk of total blood loss and birth weight >3500 grams with increasing BMI of pregnant women. A multicentric prospective study with larger sample size would shed further light on the strength of association between maternal BMI and various outcomes.

Hair tourniquet syndrome is the strangulation of body appendages by a thread of hair. If neglected, it results in lymphatic obliteration, venous congestion, and arterial obstruction. A 25 years lady with a history of insect bite presented with intense itching and painful swelling in the left labia minora for three days. She had tied the swollen part with a bunch of hair strands leading to painful swelling. Local inspection revealed a 2x2 cm swelling in the left labia minora. The tourniquet effect was released by cutting the hair. Hair tourniquet syndrome involving female genitalia requires immediate recognition and treatment. Keywords: Hair tourniquet syndrome; hair-thread tourniquet syndrome; labia minora.

BACKGROUND:Patient satisfaction is an individual's positive evaluation of a distinct dimension of health care. This study aimed to assess client satisfaction with maternity care in a tertiary hospital in the western region of Nepal.METHODS:This cross-sectional study was conducted among 405 delivered women. A structured questionnaire of 21 items was used as a tool during exit interviews at their discharge. Each item was assessed on 5 points Likert scale. Student's t-test and one-way ANOVA tests were applied to analyse parametric data. Binary logistic regression analysis was applied to identify the association of predictors with the satisfaction level. Strength of association was interpreted using odds ratio and 95% confidence interval.RESULTS:The mean waiting time was 16.94 +5.57 minutes. Education level of the clients was statistically significant with the mean satisfaction score (p<0.001). Women with unwanted pregnancies were more satisfied than those with wanted pregnancies (p<0.001). Lower complete satisfaction rates were observed for pain control (6.4%), information at discharge (14.6%) and the degree of privacy in the ward (13.6%). Mothers who underwent instrumental delivery were less satisfied with health worker's attitudes than those having vaginal deliveries (odds ratio 0.20, 95% confidence interval:0.05-0.84). Those having uncomplicated deliveries were 3.5 times more likely to be satisfied (odds ratio 3.50, 95% confidence interval: 1.1-11.5) with health workers communication. Mothers with waiting time less than 15 minutes were more satisfied.CONCLUSIONS:Lower educational level, unwanted pregnancy and shorter waiting time were associated with higher maternal satisfaction.

Although cases of sexual offenses are not uncommon in children, they present to the Emergency Department seeking treatment for a medical cause. Sometimes the history of abuse is missed by the treating clinicians who are only focused upon the presenting complaint and not upon the underlying cause. Furthermore, the lack of reporting of sexual abuse in medical literatures makes them a rarity in the Nepalese scenario. We present an uncommon case of a child where the perpetrator who tried to silence her during the sexual intercourse made a futile attempt to kill her cutting her throat with a sickle.

Safe Motherhood Program (SMP) has been one of the successful ongoing maternal health programs in Nepal. It is the major reason for Nepal being able to reduce its Maternal Mortality Ratio (MMR) significantly falling from 539 to 281 deaths per 100000 live births over the decades. SMP has nine components out of which three components mainly deal with pregnancy and puerperium; birth preparedness plan, rural ultrasound program and the “Aama and New born Program”. The latter one is one of the key components of SMP which includes incentives, free delivery services and free sick newborn care. Financial incentives are provided for transport and completion of four antenatal visits, and for health care workers attending deliveries. However, with the corona virus disease (COVID-19) pandemic, this program might not be enough to ascertain a safe motherhood for Nepalese women. This program aims to reduce the three delays leading to maternal morbidity and mortality namely, delay in reaching care, seeking care and receiving care. But with a nationwide lockdown, the chances of these delays have increased even more.

In our day to day obstetric practice, we face a number of concerns raised by the pregnant women regarding their health. Some of the frequently asked queries include: if they would develop health problems like high blood pressure and/or diabetes; if they would have a normal delivery or would require an intervention in the form of cesarean section or instrumentation, if they would have the birth experience as they envision and if the stress is harmful during the ongoing pregnancy. Every pregnant woman strives her best to give birth to a healthy child. As every pregnancy is a period of uncertainties and risks, pregnant women are anxious about their well-being and that of their baby. The list of concerns is endless with the addition of corona virus disease (COVID-19). If we look back into the past, viral infections such as influenza, H1N1, and Severe Acute Respiratory Syndrome (SARS) caused immense maternal and fetal complications during pregnancy. Due to compromised, pregnant women are more vulnerable to being infected. SARS-CoV-2 is a new strain of corona virus that is similar to Middle East Respiratory Syndrome corona virus (MERS-CoV) and Severe Acute Respiratory Syndrome coronavirus (SARS-CoV). These viruses spread primarily by coughing and sneezing or direct contact. Most patients infected with any one of these three strains of corona virus may remain asymptomatic or may develop relatively mild symptoms such as fever, cough and fatigue. However, some may develop severe forms of the disease leading to pneumonia and respiratory failure; requiring oxygen or other respiratory support. Pregnant women infected with MERS-CoV or SARS-CoV were at high risk of developing severe pneumonia; heart failure and other complications which could be life-threatening leading to death in many cases.

In Nepal, after the first case was diagnosed with Corona Virus Disease -19 (COVID -19) in a 32-year-old returnee from Wuhan, China on 13 January 2020, it took more than four months to reach a figure of 500 infected cases. Seventy of them have already recovered and returned home. However, the curve has been taking a steeper slope after the first 50 cases were documented. With the first mortality from COVID-19 confirmed on 16thMay, 2020, the fact that this pandemic is tightening its grip in the country is more evident now. And witheach passing day, more cases are being diagnosed. In such a situation, strategies of screening the infected/suspects are of paramount importance and those already in place should be strengthened. On March 19, the Nepal Medical Council asked all hospitals, both private and public, with over 100 beds to operate a separate fever clinics and postpone elective surgeries to conserve resources for an outbreak. Such fever clinicsaim at separating and filtering out the suspected/ diagnosed COVID-19 patients. Arguably started firstin Kathmandu Medical College, fever clinics now have been established and run in almost every largehealth care centers. United Nations International Children’s Emergency Fund (UNICEF) has been pivotal in supporting some of these centers. Rising up to the task, Lumbini Medical College and Teaching Hospital started its fever clinic from 22 March 2020 in a separate makeshift place which later moved to a more organized structure. The fever clinic is set up in a separate area in order to keep off suspected patients from the main hospital.

Introduction: Neonatal congenital anomalies are the 17th leading cause of global disease burden. Congenital anomalies in low-income countries are high due to prevalence of nutritional deficiencies, intrauterine infections, teratogenic exposure and unsupervised self medication. This study aimed to find various antenatal risk factors for birth defects and the delays in health seeking behaviors in cases of still births with birth defects. Methods: In this retrospective study the records of mothers and neonates born with congenital anomalies during the period of 30 months were reviewed. Consanguinity, intrauterine infections, presence of anemia, and history of drug intake were noted. In cases of stillborns with anomalies, mode of delivery, labor complications and the three delays leading to morbidities were also noted. Results: There were 65 congenital anomalies during the study period with an incidence of 9.3 per 1000 births. Out of them, 43 were live births and 22 were still births. The commonest anomaly amongst live births was of musculoskeletal system (n=11, 25.5%) and amongst still births was of nervous system (n=10, 45.4%). Consanguineous marriage was present in 30 (46.1%) parents and folic acid was taken by only 26(40%) of the mothers. In cases of still births with anomalies, most deliveries were vaginal (97%) without any maternal complications. Among the three delays, delay in deciding to seek care was observed in most cases (n=14, 63.6%).Conclusion: Factors like consanguinity and intake of folic acid are modifiable factors useful in preventing congenital anomalies. Encouraging early antenatal visits might help in early detection of anomalies.