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Article ; Online: Integration of Physical and Mental Health

Shreyashi Aryal

Journal of Lumbini Medical College, Vol 6, Iss

A Reproductive Health Necessity

2019 Volume 2

Keywords	mental health ; reproductive health ; Medicine (General) ; R5-920
Language	English
Publishing date	2019-02-01T00:00:00Z
Publisher	Lumbini Medical College
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Adverse Pregnancy Outcomes in Overweight and Obese Pregnant Women in a Tertiary Care Center of Western Nepal

Deepak Shrestha / Kritina Singh / Shreyashi Aryal

Journal of Lumbini Medical College, Vol 9, Iss

A Prospective Cohort Study

2022 Volume 2

Abstract: 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, ... ...

Abstract	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.
Keywords	Body mass index ; Obesity ; Overweight ; Pregnancy outcomes ; Medicine (General) ; R5-920
Subject code	610
Language	English
Publishing date	2022-01-01T00:00:00Z
Publisher	Lumbini Medical College
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Abnormal Uterine Bleeding among Women Visiting Gynecology Out- patient Department of a Tertiary Care Hospital

Deepak Shrestha / Shreyashi Aryal / Archana Tiwari / Rupesh Sharma

Journal of Nepal Medical Association, Vol 60, Iss

A Descriptive Cross- sectional Study

2022 Volume 246

Abstract: 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 ... ...

Abstract	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.
Keywords	biopsy ; endometrial hyperplasia ; postmenopausal women ; uterine bleeding ; Medicine (General) ; R5-920
Subject code	610
Language	English
Publishing date	2022-02-01T00:00:00Z
Publisher	Nepal Medical Association
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Abnormal Uterine Bleeding among Women Visiting Gynecology Out- patient Department of a Tertiary Care Hospital

Deepak Shrestha / Shreyashi Aryal / Archana Tiwari / Rupesh Sharma

Journal of Nepal Medical Association, Vol 60, Iss

A Descriptive Cross- sectional Study

2022 Volume 246

Abstract	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.
Keywords	biopsy ; endometrial hyperplasia ; postmenopausal women ; uterine bleeding ; Medicine (General) ; R5-920
Subject code	610
Language	English
Publishing date	2022-02-01T00:00:00Z
Publisher	Nepal Medical Association
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Risk Factors and Perinatal Outcome of Meconium Stained Amniotic Fluid

Uma Chhetri / Shreyashi Aryal

Journal of Lumbini Medical College, Vol 8, Iss

2020 Volume 1

Abstract: Introduction: Meconium Stained Amniotic Fluid (MSAF) is a frequent finding during deliveries and is a cause for perinatal morbidity and mortality. Meconium Aspiration Syndrome (MAS) in neonates is an association in these deliveries with some infants ... ...

Abstract	Introduction: Meconium Stained Amniotic Fluid (MSAF) is a frequent finding during deliveries and is a cause for perinatal morbidity and mortality. Meconium Aspiration Syndrome (MAS) in neonates is an association in these deliveries with some infants requiring mechanical ventilation. This study was done with the aim of finding the risk factors for MSAF and its perinatal outcome. Methods: This was a hospital based, cross-sectional study. All the inborn babies delivered with MSAF were included in the study. Antenatal risk factors and perinatal outcomes like mode of delivery, Apgar score, NICU admission and neonatal morbidities mainly MAS were noted. Results: MSAF was seen in 202 (13.6%) neonates out of which 30 (15%)developed MAS. Antenatal risk factors were present in 97 (48%) cases. Mode of delivery was caesarean section in 78 (39%) and instrumental in 25 (13%) cases. Twenty three percent of the neonates required resuscitation at birth while 34% required respiratory support. Morbidities observed were meconium aspiration, pneumonia, septicaemia, perinatal asphyxia, shock, meconium gastritis and persistent pulmonary hypertension. Neonatal mortality amongst all neonates with meconium was 1.5%.Conclusion: Meconium stained amniotic fluid leading to aspiration is a significant cause of neonatal mortality and morbidity. Most of the risk factors for MAS are preventable.
Keywords	Amniotic fluid ; Meconium ; Meconium aspiration syndrome ; Medicine (General) ; R5-920
Subject code	610
Language	English
Publishing date	2020-07-01T00:00:00Z
Publisher	Lumbini Medical College
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: COVID-19 And Nepal

Samata Nepal / Shreyashi Aryal

Journal of Lumbini Medical College, Vol 8, Iss

A Gender Perspective

2020 Volume 1

Abstract: The ongoing Corona Virus Disease 19 (COVID-19) pandemic is in its height, the measures taken to control the spread of this pandemic is acute and harsh. With the increasing new cases every hour it has caused a panic among every individual. Economy of the ... ...

Abstract	The ongoing Corona Virus Disease 19 (COVID-19) pandemic is in its height, the measures taken to control the spread of this pandemic is acute and harsh. With the increasing new cases every hour it has caused a panic among every individual. Economy of the countries are equally affected. However, the direct and indirect impact of this pandemic on gender related needs are least prioritized and discussed. Evidences so far reveal the mortality being proportionately higher in males.This fact may not remain the same in Nepalese context because women are more vulnerable in this low-income country where limited resources are allotted to women’s health. Majority of the workforce at frontline health care are women in the form of nurses, midwives and female community health volunteers (FCHV). Government of Nepal has decided to mobilize FCHVs for COVID-19 response in the community and these FCHVs who provide services at ground levels are at occupational risk of acquiring the infection.
Keywords	Covid-19 ; pandemic ; Nepal ; Gender inequality ; Medicine (General) ; R5-920
Subject code	360
Language	English
Publishing date	2020-05-01T00:00:00Z
Publisher	Lumbini Medical College
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: “Overcoming the Defect”

Shreyashi Aryal / Deepak Shrestha

Journal of Lumbini Medical College, Vol 8, Iss

A Perinatal Review of Congenital Anomalies in 6984 Consecutive Deliveries in a Tertiary Center in Western Nepal

2020 Volume 1

Abstract: Introduction: Neonatal congenital anomalies are the 17th cause of global disease burden and are a traumatizing experience to a mother. Congenital anomalies in low income countries are high. This study was done with the aim to find various antenatal risk ... ...

Abstract	Introduction: Neonatal congenital anomalies are the 17th cause of global disease burden and are a traumatizing experience to a mother. Congenital anomalies in low income countries are high. This study was done with the aim to find various antenatal risk factors and the delays in health seeking behaviors in cases of still births with birth defects. Methods: This is a retrospective study in which records of mothers and neonates born with congenital anomalies during the period of thirty months were reviewed and antenatal risk factors noted. In cases of stillborns with anomalies, the three delays leading to morbidities namely, delay in seeking care, reaching care and receiving care were also noted. Results: There were 65 congenital anomalies out of 6984 deliveries, with an incidence of 9.3 per 1000 births. Out of all anomalies, 43 were live and 22 were still births. Commonest anomaly amongst live births was of musculoskeletal system 11(25.5%) and amongst still births was of nervous system 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, delay in deciding to seek care was observed in most cases 14(63.6%). Conclusions: Birth defects are common in this part of the country. Factors like consanguinity and intake of folic acid are modifiable factors which can be useful in preventing congenital anomalies. Encouraging early antenatal visits will provide an opportunity for timely diagnosis and counseling and will help minimize traumatizing exprience to the family.
Keywords	birth defect ; folic acid ; risk factors ; still birth ; Medicine (General) ; R5-920
Subject code	610
Language	English
Publishing date	2020-06-01T00:00:00Z
Publisher	Lumbini Medical College
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Reproductive Health Issues and Use of Family Planning Methods among Married Adolescent Mothers

Samata Nepal / Shreyashi Aryal

Journal of Lumbini Medical College, Vol 8, Iss

2020 Volume 2

Abstract: Introduction: Adolescent pregnancy is a major public health concern in low- and middle-income countries. Nepal ranks among the twenty countries with the highest child marriage rates in the world. Adolescent mothers are at higher risk for poorer maternal ... ...

Abstract	Introduction: Adolescent pregnancy is a major public health concern in low- and middle-income countries. Nepal ranks among the twenty countries with the highest child marriage rates in the world. Adolescent mothers are at higher risk for poorer maternal and neonatal outcomes. This study intended to find the reproductive health issues and use of family planning methods among married adolescent mothers at a tertiary care center in a western part of Nepal. Methods: This was a cross-sectional study conducted among adolescent mothers who attended the family planning counseling session at Community Medicine Out-patient Department at a tertiary care center. Pre-tested semi-structured questionnaire was used for data collection and variables were entered in SPSSTM version 16. Descriptive statistics were presented in terms of mean and percentage. Results: Among 235 adolescent mothers, the mean age of adolescent mothers was 18.02 years (SD = 1.13). Almost 93.2% had not used any kind of contraceptive methods previously. Limited knowledge, uncomfortable talking about contraception and spousal denial were common reasons for not using contraception. Obstetric related complications were observed in 13.6% and one in ten neonates required neonatal intensive care unit admission during the study period. After the counseling session, six out of ten expressed current choice of long-acting reversible contraceptives method in which Jadelle implant was preferred. Conclusion: Our study among the adolescent mothers showed that use of family planning methods before pregnancy had been very low. Policies need to focus on meeting the unmet need for family planning among married adolescent girls.
Keywords	Adolescent mothers ; Family planning methods ; Reproductive health ; Medicine (General) ; R5-920
Subject code	360
Language	English
Publishing date	2020-12-01T00:00:00Z
Publisher	Lumbini Medical College
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Motherhood in Nepal during COVID-19 Pandemic

Dr Shreyashi Aryal / Deepak Shrestha

Journal of Lumbini Medical College, Vol 8, Iss

Are We Heading from Safe to Unsafe?

2020 Volume 1

Abstract: 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 ... ...

Abstract	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.
Keywords	COVID-19 ; Motherhood ; Nepal ; Safe ; Medicine (General) ; R5-920
Language	English
Publishing date	2020-05-01T00:00:00Z
Publisher	Lumbini Medical College
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Safe abortion services during the COVID -19 pandemic

Shreyashi Aryal / Samata Nepal / Sagun Ballav Pant

F1000Research, Vol

a cross-sectional study from a tertiary center in Nepal [version 1; peer review: 2 approved]

2021 Volume 10

Abstract: Background: Abortion is an essential service, the need for which has increased during the coronavirus disease 2019 (COVID-19) pandemic. Because of the lockdowns at several periods, these services were hampered. This study analyzed the pattern of Safe ... ...

Abstract	Background: Abortion is an essential service, the need for which has increased during the coronavirus disease 2019 (COVID-19) pandemic. Because of the lockdowns at several periods, these services were hampered. This study analyzed the pattern of Safe Abortion Services (SAS) at a tertiary healthcare center during the first six months of the COVID-19 pandemic in Nepal. Methods: This is a cross-sectional analytical study. We compared the pattern of safe abortion services between the first three months of the pandemic when a lockdown was implemented and the second three months when the lockdown was eased. Demographic and obstetric profile of women, their abortion choices, method of termination, difficulty in accessibility, and level of psychological distress were studied. Results: A total of 52 women were provided SAS during the study period. The number of women coming for SAS during lockdown was 47.1% less than that after easing of the lockdown. During the lockdown, women came at a later period of gestation with a mean of 9.5 weeks compared to 7.5 weeks in the later three months. Because of fear of COVID-19, 19.2% (n=10) women opted for termination of pregnancy. Increased need of contraception was felt but 40% (n=12) had problems of accessibility. More women had probable serious mental illness during the lockdown period (p=0.008). Conclusion: Lockdown during the pandemic decreased the number of women coming for SAS due to barriers in accessibility. Contraceptive needs are also increased but access is difficult. The need for safe abortion services and contraception has increased during the pandemic but the lockdown caused inaccessibility. Psychological distress is prevalent, and fear of COVID-19 has become a common reason for termination of pregnancy. This pandemic can be taken as an opportunity to provide and improve contraception and abortion accessibility, and quality with integration of mental health support.
Keywords	Medicine ; R ; Science ; Q
Subject code	360
Language	English
Publishing date	2021-02-01T00:00:00Z
Publisher	F1000 Research Ltd
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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