Browsing by Author "Rayamajhi, RT"
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Publication Baseline survey on functioning of abortion services in government approved CAC centres in three pilot districts of Nepal(Kathmandu University, 2009) Karki, C; Ojha, M; Rayamajhi, RTAbstract Background: Abortion has been legalized in Nepal since September 2002 and under this law, Comprehensive Abortion Care (CAC) service is being provided through listed service providers and listed health facilities from 2004. Nepal Government has prioritized the national safe abortion program and is working with many government and non government partners for providing this service. Till date medical abortion services are not made available at any of the health facility. Government is now preparing to introduce this service in six selected pilot districts. Objective: This survey was carried out to assess the functioning of existing abortion services in 12 Government approved CAC sites of three districts. Materials and methods: Direct observation of the functioning of these centers, assessment of physical facilities and service provider’s skill was done. At the same time service provider’s attitude and knowledge on CAC service and other abortion services were also assessed through semi structured interviews. Quality of record keeping and the feasibility of initiating the medical abortion service in these sites were also studied. Result: Number of listed centers in six pilot districts was twenty nine. Study districts have 16 listed centers. Visited sites were twelve; four managed by Government and eight by non government organizations. Thirty three thousand nine hundred and twenty women have availed this service so far: only 4.76% of them received service from Government facilities. Marie Stopes International (MSI) topped the list in providing service to the maximum number of clients (75.64%) and Family planning association of Nepal (FPAN) was the second. MSI centre was also first to initiate the service. Government facilities provide 24 hours service unlike private facilities which are open only up to 5.00 pm. Cost for the service varies from rupees 900/- to rupees 1365/- and is cheaper at Government facilities. Private sectors have separate setups and Government have allocated some space within their already existing infrastructure for CAC service. Private sectors were better in providing the information to public about the availability of service. There were total 20 trained service providers for first trimester abortion service. They are more at Government facilities. They seem to be positive to CAC service and had good knowledge and skill of service delivery. Complications were not recorded at most of the sites. Pain management and infection prevention practice needs improvement at the Government sites. All the sites had identified their referral sites and had one or the other arrangement for referral. Conclusion: CAC service has become accessible and affordable to Nepalese women even at peripheral level. CAC sites are functioning well. Initiation of medical abortion and second trimester abortion services at these sites are feasible and would expand the option and choices available. Key words: Comprehensive abortion care (CAC), medical abortion, unsafe abortion,Publication Indications for labour induction and predictors for failed induction at KMCTH(Kathmandu university, 2009) Rayamajhi, RT; Karki, C; Shrestha, N; Padhye, SMAbstract Objective: To study the incidence and indications for labour induction and study the predictors of failed induction. Materials and methods: A hospital based prospective study done over a 12 month period between 1st November 2007 to 30th October 2008. Selection criteria: Singleton pregnancies beyond 37 weeks with vertex presentation and unscarred uterus requiring induction of labour. Results: The incidence of labour induction was 19.7%. Operative delivery was 34.6% in the study group and 27.4% in those with spontaneous onset of labour. 74.07% of the induction group required operative delivery for failed induction and 25.03% for foetal distress. The predominant indication for induction was post term pregnancy (51.28%) followed by PROM (17.3%), isolated oligohydramnios (8.97%), hypertensive disorders of pregnancy (8.33%), maternal perception of decreased foetal movements (7.69%) and others. Failed induction was higher in nulliparas (41.2%) as compared to multiparas (23.7%). Failure rate was 53.8% when maternal age >30y and 28.2% in those <30y. Women with normal BMI had a failure rate of 25.6% compared to 36% for overweight and 44.4% for obese women. 24.1% had failed induction when Bishop score was >5 and 40.8% when Bishop score was <5. Between 38-41 weeks pregnancy failed induction occurred in 28-31% while it was higher at <38 weeks and >41 weeks pregnancy. The best outcome was seen when the birth weight was 2500-2900g (22.5% failures) while 72.7% had failed induction when the birth weight was >3500g. The duration of induction was >24 hours in 42.6% of women and 48.2% were in the latent phase of labour when taken for caesarean section. Conclusion: Despite the proven benefit of induction of labour in selected cases, one must keep in mind its impact on increasing the rates of operative delivery. Strategies for developing practice guidelines may help to prevent unwarranted case selection and help to reduce the current high operative delivery rates. Key words: caesarean section rate, failed induction, induction of labour.