Analysis of the Perinatal Care System in a Remote and Mountainous District of Nepal.

INTRODUCTION: Despite significant improvements in recent years, maternal and neonatal health outcomes remain poor in many regions of the world. One such area is in the remote mountainous regions of Nepal. The purpose of this study is to describe the current antenatal care practices and delivery support in a mountainous district of Nepal. METHODS: This study took place in Solukhumbu District between December 2015 and February 2018. A household survey was created using evidence-based maternal and neonatal care indicators. Women who had delivered within the previous two years were surveyed regarding antenatal and delivery care they received. A standardized health facility survey was used to evaluate the operational status of health facilities. The study was approved by the Nepal Ministry of Health and the University of Utah IRB. RESULTS: A total of 487 households and 19 facilities were surveyed. 35.7% (174/487) of deliveries occurred in a health facility (hospital, primary health care center or birthing center). 35.2% (171/486) of deliveries were attended by a skilled birth attendant. 52.8% (47/89) of women who did not deliver in a facility noted that transportation issues and not having sufficient time to travel during labor prevented them from delivering in a facility. No health posts had staff trained in obstetric and neonatal emergencies. DISCUSSION: The majority of women in Solukhumbu District do not receive high quality antenatal and delivery care. An intervention that would make antenatal care and delivery support more accessible could improve maternal and infant outcomes in this district and other similar regions.

Spontaneous Heterotopic Pregnancy: A Case Report.

Spontaneous heterotopic pregnancy is a rare clinical condition which is a potentially dangerous condition where at least two pregnancies are present simultaneously at different implantation sites and only one is located in the intrauterine cavity. It is a life-threatening condition with an incidence estimated as 1 in 30,000 natural conceptions. Being rare it's challenging to diagnose such conditions due to complex clinical and laboratory findings. In view of the survival of maternal as well as intrauterine pregnancy, a high index of suspicion leading to timely diagnosis and appropriate intervention is needed. We are reporting a case of a 28-year-old female with heterotopic pregnancy at 8 weeks of gestation following natural conception diagnosed by ultrasound and managed successfully by laparoscopic salpingectomy. Intrauterine pregnancy was continued normally till term with no complications. Hence, with timely diagnosis and early intervention, maternal and fetal survival is possible. Keywords: case reports; ectopic pregnancy; laparoscopy; ultrasound.

A Study of Metabolic Parameters in Patients with Gout: A Single Center Study from Nepal.

BACKGROUND AND AIMS: To study the prevalence of deranged metabolic parameters in patients with gout. METHODS: This was a prospective, cross-sectional observational study conducted at a tertiary level rheumatology center in Nepal. Patients over 18 years and diagnosed as gout using the ACR/EULAR 2015 classification criteria were included in the study. Known cases of chronic kidney disease, liver disease and heart diseases were excluded. Baseline demographic data along with records of weight, waist circumference, lipid profile, glucose profile, blood pressure measurement, serum uric acid level and inflammatory markers were taken. Diagnosis of metabolic syndrome (MS) was made according to the National Cholesterol Education Program criteria. Approval was obtained from the ethical review board of the National Center for Rheumatic Diseases. RESULTS: A total of 523 patients with gout were enrolled in the study, out of which 97.0% were male. The mean age at diagnosis was 49.1±12.8 years. Most of the patients were overweight with a mean BMI of 27.0±3.6 kg/m2. About 8.1% had preexisting diabetes mellitus, 24.6% had hypertension, 5.1% had hypothyroidism and 45.1% had dyslipidemia. Patients fulfilling 2 out of 5 criteria of MS were 60.6% whereas 30.6% fulfilled 3 out of 5 criteria. CONCLUSION: Gout was commonly observed in middle-aged men. The prevalence of metabolic syndrome and its components was high in patients with gout. Management of gout should also include screening and management of the metabolic syndrome.