Browsing by Author "Rawal, Suniti"
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Publication Cesarean Section or Instrumental Delivery: The Best Choice for Mode of Delivery during Second Stage of Labor(Institute of Medicine, 2020) Rawal, Suniti; Katuwal, Neeta; Shrestha, SajanaABSTRACT Introduction: Managing second stage of labour is very crucial. Emergency Cesarean Section (CS) or Instrumental Delivery (ID) is the only choices although complications might occur in both modes of deliveries. The rate of CS is at rise and the fear of failed ID followed by emergency CS with added complications makes the choice more difficult amongst the obstetricians. Methods: A retrospective study done to assess the maternal and fetal outcome in second stage of labour following ID and emergency CS from April 2018 to March 2019 among the pregnant women having completed 34 weeks of gestations and beyond. Results: Of 4761 deliveries, 2537 (53.2%) were vaginal and 2224 (46.7%) CS, and amongst all, 133 (2.7%) were second stage interventions. Out of 133, 78 had ID, 76 were successful and 2 failed. Fifty seven (2.6%) were second stage CS. Nulliparas (65.8%) needed more ID, teenage pregnancy (6.5%) (p=0.04) and heart disease (18.4%) (p=0.002) were high risk for ID. Complications were more in CS, uterine extensions, (29.8%) (p<0.001), urinary complications, (43.9%) (p<0.001) and blood loss (p<0.001). Neonatal admission too was higher in CS (n=29) and more so due to respiratory distress (16/29). Conclusion: Despite of few failed attempted ID, it still proved to be better choice for delivery during second stage, as both maternal and neonatal complications were higher following the second stage CS. Hence, the correct and timely decision for ID addressing the associated risk factors could lead to favorable outcome. Keywords: Cesarean Section, instrumental delivery, second stage of labourPublication COVID-19 among Pregnant Women Delivering in a Tertiary Care Center: A Descriptive Cross-sectional Study(Nepal Medical Association, 2022) Paudyal, Pooja; Katuwal, Neeta; Rawal, SunitiAbstract: Introduction: Coronavirus Disease 2019 pandemic is raging across the world and has affected pregnant women as well. There is limited information regarding COVID-19 in pregnant women. The study aimed to find the prevalence of COVID-19 among all pregnant women who delivered during the study period in a tertiary care center. Methods: This was a descriptive cross-sectional study conducted in a tertiary care center from 16th August to 15th November 2020 after obtaining ethical clearance from the Institutional Review Committee of a tertiary care center. All the women who delivered in the hospital during the study period were enrolled and they were subjected to COVID-19 Reverse Transcriptase Polymerase Chain Reaction test. A total of 667 samples were taken using convenience sampling technique. Data were analyzed using the Statistical Package for the Social Sciences version 24 software. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Among 667 pregnant women, the prevalence of COVID-19 was 47 (7.05%) (5.10-8.99 at 95% Confidence Interval). Though the majority of women were asymptomatic 40 (85.1%), 5 (10.64%) developed mild disease, 1 (2.12%) each had severe and critical COVID-19 pneumonia. Conclusions: The prevalence of COVID-19 among pregnant women delivering in our center is similar to other studies done in similar settings. In our study, we found that the majority of women had been asymptomatic and were diagnosed on routine testing. Hence, it is important to test all pregnant women before delivery for Coronavirus Disease 2019 irrespective of the presence or absence of symptoms.Publication Knowledge and Attitude about Labor Epidural Analgesia among Pregnant Women Attending Antenatal Clinic(Nepal Health Research Council, 2023) Parajuli, Bashu Dev; Koirala, Megha; Joshi, Pankaj; Katuwal, Neeta; Shrestha, Amit; Singh, Shreejana; Rawal, Suniti; Shrestha, AnilAbstract Background: Labour pain is one of the most painful experiences that a woman faces in her lifetime. There are various options for labour pain management. Epidural analgesia is the gold standard method for pain management during labour. In developing and under-developed countries there are many challenges to provide this service, a very important one being knowledge about epidural analgesia among the parturients and the physicians. Methods: A prospective cross-sectional study was carried out among 384 pregnant women attending Antenatal clinic of a tertiary level teaching hospital using pretested structured questionnaire prepared by a team of anaesthesiologists and obstetricians. Non-probability purposive sampling technique was used. The data was analysed by using SPSS version 20.0. Descriptive and inferential statistical methods were used for analysis. Results: Of the 384 pregnant women, only 29.4% had knowledge about some form of labour analgesia techniques and only 16% of the participants were aware of labour epidural analgesia. Also, only 6.2% were aware that epidural service is available at our hospital. Regarding acceptance, only 42.4% were willing to use epidural analgesia in their present pregnancy. Conclusions: The present study findings revealed that a significant number of participants had very limited knowledge about labour epidural analgesia and were also unaware of the availability of the service in our hospital. Educational programs need to be provided to all the pregnant women for enhancement of knowledge and awareness about epidural labour analgesia to increase its acceptability among them. Keywords: Acceptance; awareness; knowledge; labour analgesia.Publication Self-Assessment of Non-communicable Diseases related Competencies among Interns of a Medical Institute of Nepal(Institute of Medicine, 2022) Pradhan, Pranil MS; Adhikari, Bidur; Pant, Sagun B; Ranjit, Nirju; Rawal, Suniti; Basnet, SudhaABSTRACT Introduction: One of the essential strategies to tackle rising burden of non-communicable diseases (NCD) is development of competent local human resource. Assessing the level of competencies in pre-service curriculum is the first step towards building an NCD-ready health workforce. This study aimed to assess perception of competence in delivering World Health Organization Package of Essential Non-communicable diseases (WHO-PEN) interventions among interns of Maharajgunj Medical Campus of Institute of Medicine (IOM). Methods: A survey was conducted at Maharajgunj Medical Campus of Institute of Medicine among interns using online questionnaire. The questionnaire contained seven sections on different competencies to prevent and manage NCDs. Ethical approval was obtained from Institutional Review Committee of IOM. Descriptive analysis was done to identify the level of competencies. Statistical analysis was performed using Microsoft Excel and IBM SPSS version 20. Results: Majority of the interns expressed low to moderate confidence in managing patients with presenting complaints of major NCDs. Most interns could perform diagnostic procedures and screening related to NCDs and mental disorders under supervision only (56.9%-68.6%), and one third felt they were unable to perform spirometry and visual inspection of cervix with acetic acid. Most interns could provide counseling on major NCD risk factors, self-care and palliative care only under supervision. Majority could not identify key NCD service performance measures and their data sources. Conclusion: Skills of independently diagnosing and screening for NCDs, counselling on healthy lifestyle, alcohol and tobacco cessation and conduct motivational interviewing, self-care and palliative care were limited. Keywords: Competency based education, non-communicable disease, undergraduate medical education