NJOG 2011 Nov-Dec; 6 (2): 37-43 Aims: To identify the determinants of antenatal care (ANC) attendance and its impact on maternal / perinatal outcome.Methods: Prospective descriptive study of women delivered at Nepal Medical College Teaching Hospital (NMCTH), a 700 bedded tertiary care hospital situated at periphery of Kathmandu.Results: Among 322 women delivered during period of four months, majority (87%) reported of attending more than 4 antenatal visits, only 21 (6.5%) women had not attended ANC. The most preferred place of ANC was hospital (71.6%). Women with secondary education and above, business/service holders, 20-29 years age group, primigravida and Brahmin likely to attend. Financial problem (52.4%) followed by ignorance (28.6%) were the most commonly stated reasons for not attending ANC. Women attending attending more than 4 antenatal visits have more chance of full immunization with tetanus toxoid and iron supplementation. Most of the women started attending ANC from their second trimester (75.8%), women who had attended ANC, because of the fact that all elective cesarean section were planned in these women only. Also, all inductions of labor (9.3%) were performed among them. Maternal complications like anemia and pregnancy induced hypertension occurred more commonly in women without ANC. The proportion of low birth weight and preterm babies was higher in women with inadequate or no ANC. Special care baby unit (SCBU) admission was also higher among them due to various reasons like neonatal sepsis, birth asphyxia, jaundice etc. While there were no neonatal deaths during the study period, 3 still births have occurred. Perinatal mortality rate was similar in no ANC and inadequate ANC groups; it was 16 times higher than that in the group with more than 4 visits. Maternal and perinatal outcomes were found to be better in women who attended regular ANC. Conclusions:trimester is low. The quality of antenatal care needs to be strengthened. The health system needs to ensure the availability of ANC in primary care level and to establish mobile clinics for those living far from the health facilities.

Introduction: Menopause is an unavoidable and sometimes problematic condition in which women may suffer from a number of health problems. Knowledge of the major symptoms associated with menopause helps reduce the burden and stress associated with the condition. In this context, a study was conducted to establish baseline data regarding menopausal health problems among Nepalese women. Methods: A descriptive cross-sectional study was conducted among 2000 women aged over 40 years to identify their knowledge, attitude and practice related to menopausal health problems. Data was collected by interviewing the women and doing physical examination. Analysis was done using descriptive statistics and SPSS software was used for data analysis. Results: A cohort of 2073 women (ages 40-60 years) participated in the research, among them 2000 yielded complete response. The study revealed that 820 (41%) women had reached menopause. The average age of menopause was 48.7 years. Majority of the women 1183 (59.2%) in the study did not know about menopausal health problems. Abnormal bleeding 353 (17.65%), sweating 315 (15.75%), hot flushes 299 (14.95%), joint/muscle pain 285 (14.25%) were the most common menopausal symptoms known by the women. Joint pain 736 (36.8%), hot flushes 584 (29.2%), irregular bleeding 582 (29.1%) were the most common experienced symptoms of menopause and only 586 (29.3%) consulted the health workers to alleviate menopausal symptoms. Moreover, most of the women 926 (46.3%) accepted menopause as a part of life. Conclusions: The research has tried to establish the baseline of menopausal health problems in the Nepalese women. The average age of menopause was 48.7 years. Majority did not know about menopausal health problems. Further researches with nationally representative sample are recommended to further explore the menopausal health problems of Nepalese women.Keywords: health problems; menopause; Nepal; women.

Self-administration of mifepristone outside the clinic should be offered to all women as part of routine medical abortion services in Nepal. Clinical trials.gov: NCT00994734.

Introduction: Abnormal uterine bleeding is a common gynecological presentation, accounting forat least 20% of all new outpatient visits. It has been recognized that thyroid dysfunction may haveprofound effects on the female reproductive system. Both hypothyroidism and hyperthyroidism areassociated with a variety of changes, including delayed onset of puberty, anovulatory cycles, andabnormally high fetal wastage. Hence, this study was conducted to know the thyroid status of thepatient with abnormal uterine bleeding. Methods: A descriptive cross-sectional study was conducted in all the patients with abnormaluterine bleeding in a tertiary care hospital from 2 August 2019 to 2 February 2020. Ethical clearancewas received from the institutional review committee of KIST Medical College. Convenient samplingwas done. Data was collected using a questionnaire which includes patients profile, the pattern ofabnormal uterine bleeding, and thyroid profile. Statistical analysis was done using Statistical Packagefor 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 maximumnumber 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 themost common pattern of abnormal uterine bleeding.

Aim: To study the effect of various determinants of home delivery in Nepal.Methods: Prospective descriptive study among women who after being delivered at home were admitted inNepal Medical College Teaching Hospital (NMCTH), a tertiary care hospital situated at suburban area ofKathmanduResults: Of 114 women, majority were between the ages of 20-24 yrs. Most of the women were multipara(64%). Majority had no formal education accounting for 68.4 %. Lasheta (Lama, Sherpa , Tamang) was themost common ethnic group. Most (30.1%) of their spouses also were illiterate or had only primary leveleducation. Majority of the husbands of the respondents were laborers (63.2%). Regarding attendance ofantenatal care (ANC); at least 84 (73.7%) women had attended ANC once and half of the women hadattended 4 more visits. Home delivery was planned by 67 (58.8%) women; whereas only 47 (41.2%) hadchosen hospital delivery and delivered at home due to various reasons. Financial problem was the mostcommon reason followed by ignorance and transportation problem. Among all the women, only 5.3% wereattended to by a professionally trained provider (doctor, nurse, and midwife). A disturbingly high proportionof women (87.6%) were attended by an untrained family member, friend or neighbor, and 7% of womendelivered completely unattended. Women were brought to the hospital by family member 59.6% other thanhusband and 8.8% were accompanied by neighbors/friends. Most of these women were brought with retainedplacenta, primary post partum hemorrhage.Conclusion: In this study area, usage of the antenatal care was high, but the opportunity to deliver athospital was not fully utilized. This study has highlighted some of the factors affecting the choice of place ofdelivery among mothers in a semi urban settlement in Nepal namely mothers educational level, husband'seducation and occupation, financial constraints, lack of transportation and ignorance. Majority of thedeliveries took place at home and unsupervised by a skilled attendant thus aggravating the risk of the highperinatal and maternal morbidities and mortalities in the study area.Key words: Home delivery; determinants; antenatal care; delivery attendanceDOI: 10.3126/njog.v4i1.3329Nepal Journal of Obstetrics and Gynaecology June-July 2009; 4(1): 30-37