Trend of utilization of Safe Motherhood Services in rural Nepal

Binod Dangal; Arun Upreti; Karuna Khati; Roshan Kumar Thapa; Ramesh Shrestha; Reena Lamichhane; Himshail Khadka; Shankar Prasad Kalaunee; Shyam Khadka

Binod Dangal Nyaya Health Nepal / Charikot Hospital
Arun Upreti Charikot Hospital
Karuna Khati Charikot Hospital, Dolakha, Nepal
Roshan Kumar Thapa Charikot Hospital, Dolakha, Nepal
Ramesh Shrestha Charikot Hospital, Dolakha, Nepal
Reena Lamichhane Charikot Hospital, Dolakha, Nepal
Himshail Khadka Charikot Hospital, Dolakha, Nepal
Shankar Prasad Kalaunee Nyaya Health Nepal
Shyam Khadka Bhimeshwor Municipality

Keywords: Caesarean Section, Electronic Health Record (EHR), Neonatal and Maternal Morbidity

Abstract

Introduction: The government of Nepal has implemented Safe Motherhood programs throughout the country to decrease the perinatal morbidity and mortality. Safe motherhood service includes normal vaginal delivery, Caesarian Section (CS) and perinatal management. CS rates are a major public concern. Currently 18.6% of all births occur by CS, ranging from 6 to 27.2% in different parts of the world.

Methods: Retrospectively collected data from Electronic Health Record (EHR) of deliveries from May 1,2016 to October 31,2020 were used. We have analyzed demographic profiles like age, geographical location. Similarly, gestational age, caste, gravida, parity, various indications of CS, maternal, fetal and neonatal outcomes were also recorded.

Results: A total of 4168 deliveries were conducted over four and half years with 3694 (88.6%) vaginal deliveries and 474 (11.4%) CS. There was constant maintenance of CS rate from 5-15% over four and half years, 11% in 2016 to 12% in 2019. Fetal distress was the commonest indication of overall CS followed by Non-progress of labor. The women from Bhimeshwor municipality were 156 (32.9%). The most CS was done in the age group of 20-24 years, which was 192 (40.5%). Neonatal Death was 3/1000 births. There was one maternal mortality due to PPH and late presenation.

Conclusion: Different from the other evidences, we found that our CS rate was within the limit of WHO’s recommendation for lower resource setting. Following strict guidelines and with dedicated care, it’s possible to maintain recommended CS rate with less neonatal and maternal morbidities even in lower resource setting where there are no NICU, ICU facilities and Electronic Fetal Monitoring (EFM).