COVID-19: ramifications in surgical practice

Nepal lies between two large countries (India and China) who have reported high incidence of COVID-19.  It is only logical that we prepare the best with the limited medical facilities that we have. There are numerous challenges that impact the surgical department and the hospital administration in general. New guidelines are being formulated and updated frequently. The challenge to provide sufficient personal protective equipment, limited finances and need to train staffs are pertinent challenges. A change in the method of treatment and execution has exerted pressure on the surgeons with a need to keep abreast of new developments.  We describe the numerous impacts of the COVID-19 on surgical practice, the impact on surgeons, patients, surgical residents and even the hospitals which have led to all “new normal” in surgery. Keyword: COVID-19, coronavirus, surgery, impacts on surger

Swyer syndrome: A rare case

Abstract not available Bangabandhu Sheikh Mujib Medical University Journal 2023;16(2): 128-13

Caesarean Section for Non-medical Reasons: A Rising Public Health Issue

Background: Caesarean section (CS) is a life-saving surgical intervention for childbirth. Emphasis is given to perform CS only for valid medical reasons. However, performing CS on non-medical indications is increasing worldwide. The scoping review aims to explore the non-medical reasons for performing CS. Methods: Articles on CS for non-medical reasons were searched using several electronic databases: PubMed, MEDLINE, CINAHL and open access journal databases such as Nepal journals on-line (NepJOL) and Bangladesh journals on-line (BanglaJOL). Additional articles were searched from the reference list of the selected articles and organizational websites. Eligible full-text articles were appraised, and relevant data extracted. Narrative synthesis of extracted data was performed using a content analysis. Results: Maternal request is the most common non-medical indication of performing CS. The main reason of women’s preference for a CS is to avoid labour pain followed by certainty/convenience, avoid damage pelvic floor and vaginal trauma, and safer for baby. Similarly, the main reason for requesting a CS is fear of labour pain followed by fear of childbirth, safer mode of birth for both mother and baby and maintaining pelvic floor integrity. The main reasons of willingness to perform CS by obstetrician were fear of litigation, financial incentives and convenience. The ethical aspect of non-medically indicated CS remains complex. Conclusions: Performing CS without medical indications is a rising public health issue which has created medical, financial and ethical dilemmas in obstetrics care. The reasons for maternal request for a CS should be explored well. Obstetric care must include education of pregnant women on mode of childbirth including indications, risks and benefits of CS during antenatal visits

Opportunities, challenges and systems requirements for developing post-abortion family planning services: Perceptions of service stakeholders in China

Post-abortion family planning (PAFP) has been proposed as a key strategy to decrease unintended pregnancy and repeat induced abortions. However, the accessibility and quality of PAFP services remain a challenge in many countries including China where more than 10 million unintended pregnancies occur each year. Most of these unwanted pregnancies end in repeated induced abortions. This paper aims to explore service providers’ perceptions of the current situation regarding family planning and abortion service needs, provision, utilization, and the feasibility and acceptability of high quality PAFP in the future. Qualitative methods, including in-depth interviews and focus group discussions, were used with family planning policy makers, health managers, and service providers. Three provinces—Zhejiang, Hubei and Yunnan—were purposively selected, representing high, medium and relatively undeveloped areas of China. A total of fifty-three in-depth interviews and ten focus-group discussions were conducted and analysed thematically. Increased numbers of abortions among young, unmarried women were perceived as a major reason for high numbers of abortions. Participants attributed this to increasing socio-cultural acceptability of premarital sex, and simultaneously, lack of understanding or awareness of contraception among young people. The majority of service stakeholders acknowledged that free family planning services were neither targeted at, nor accessible to unmarried people. The extent of PAFP provision is variable and limited. However, service providers expressed willingness and enthusiasm towards providing PAFP services in the future. Three main considerations were expressed regarding the feasibility of developing and implementing PAFP services: policy support, human resources, and financial resources. The study indicated that key service stakeholders show demand for and perceive considerable opportunities to develop PAFP in China. However, changes are needed to enable the systematic development of high quality PAFP, including actively targeting young and unmarried people in service provision, obtaining policy support and increasing the investment of human and financial resources

Timing of singleton births by onset of labour and mode of birth in NHS maternity units in England, 2005-2014: A study of linked birth registration, birth notification, and hospital episode data

BACKGROUND: Maternity care has to be available 24 hours a day, seven days a week. It is known that obstetric intervention can influence the time of birth, but no previous analysis at a national level in England has yet investigated in detail the ways in which the day and time of birth varies by onset of labour and mode of giving birth. METHOD: We linked data from birth registration, birth notification, and Maternity Hospital Episode Statistics and analysed 5,093,615 singleton births in NHS maternity units in England from 2005 to 2014. We used descriptive statistics and negative binomial regression models with harmonic terms to establish how patterns of timing of birth vary by onset of labour, mode of giving birth and gestational age. RESULTS: The timing of birth by time of day and day of the week varies considerably by onset of labour and mode of birth. Spontaneous births after spontaneous onset are more likely to occur between midnight and 6am than at other times of day, and are also slightly more likely on weekdays than at weekends and on public holidays. Elective caesarean births are concentrated onto weekday mornings. Births after induced labours are more likely to occur at hours around midnight on Tuesdays to Saturdays and on days before a public holiday period, than on Sundays, Mondays and during or just after a public holiday. CONCLUSION: The timing of births varies by onset of labour and mode of birth and these patterns have implications for midwifery and medical staffing. Further research is needed to understand the processes behind these findings

Maternal death review and outcomes : an assessment in Lagos State, Nigeria

Strong political will by hospital management and supervising government agencies are a prerequisite for effectively addressing the human and infrastructural deficits that predispose to maternal mortality in Lagos State. Failure to address the patients and facility-related causes of maternal mortality could account for the persistently high maternal mortality ratio (MMR) in the hospitals. Interventions aimed at redressing all causes identified in the reviews will likely reduce MMRs. The study investigates results of Maternal and Perinatal Death Surveillance and Response (MPDSR) conducted in three referral hospitals in Lagos State, Nigeria over a two-year period and reports outcomes and lessons learned

A study of reproductive morbidity of women in the Eastern Terai Region of Nepal

Aim: This study aims to fill the gap of information of reproductive health (RH) of women living in rural eastern Terai by providing baseline data on reproductive morbidity (RM) leading to pelvic organ prolapse (POP), reproductive tract infections (RTIs), menstrual problems and subfertility. Methods: This is a descriptive analysis of women who attended mobile RH camps in eastern Terai of Nepal organized at different villages falling in three districts namely Rautahat, Mahottari and Saptari during December 2005 and 2006. The diagnoses were made mostly on clinical evaluation and treatment provided. The leading reproductive morbidity of POP was dealt in detail and surgeries were performed in the district headquarters. The data were recorded and analysed manually. Analysis was done by standard statistical methods and a two tailed P value less than 0.05 was considered to indicate a significant difference. Results esults: Total number of women treated in the camps was 7750. Majority of the women in this study were found to be suffering from STI (30.1%), followed by POP (20.1%), menstrual disorders (16.7%) and subfertility (9.3%). Among POP patients majority received ring pessary insertion (43.8%) followed by counseling plus pelvic floor exercise (32.9%) and surgical correction (23.3%). Third-degree POP (38.6%) was commonest among all POP cases. Majority (60%) developed POP after first and second child birth. Conclusion: The major reproductive morbidity in this study was STI, POP (most of the women having thirddegree uterovaginal prolapse), menstrual disorders and sub-fertility. Surgical treatment at the camps could only be provided to small number, suggesting expansion of health services in rural Nepal by reproductive health barriers like poverty, education. Key ey words: menstrual disorders, pelvic organ prolapse, reproductive morbidity, reproductive tract infections, sub-fertility