ObjectivesThe Bhutanese Screening Programme recommends a Pap smear every 3 years for women aged 25–65 years, and coverage ranges from 20% to 60%, being especially challenging in rural settings. The ‘REACH-Bhutan’ study was conducted to assess the feasibility and outcomes of a novel approach to cervical cancer screening in rural Bhutan.DesignCross-sectional, population-based study of cervical cancer screening based on the careHPV test on self-collected samples.SettingWomen were recruited in rural primary healthcare centres, that is, Basic Health Units (BHU), across Bhutan.ParticipantsOverall, 3648 women aged 30–60 were invited from 15 BHUs differing in accessibility, size and ethnic composition of the population.InterventionsParticipants provided a self-collected cervicovaginal sample and were interviewed. Samples were tested using careHPV in Thimphu (the Bhutanese capital) referral laboratory.Main outcome measuresScreening participation by geographic area, centre, age and travelling time. Previous screening history and careHPV positivity by selected characteristics of the participants.ResultsIn April/May 2016, 2590 women (median age: 41) were enrolled. Study participation was 71% and significantly heterogeneous by BHU (range: 31%–96%). Participation decreased with increase in age (81% in women aged 30–39 years; 59% in ≥50 years) and travelling time (90% in women living <30 min from the BHU vs 62% among those >6 hours away). 50% of participants reported no previous screening, with the proportion of never-screened women varying significantly by BHU (range: 2%–72%). 265 women (10%; 95% CI 9% to 11%) were careHPV positive, with a significant variation by BHU (range: 5%–19%) and number of sexual partners (prevalence ratio for ≥3 vs 0–1, 1.55; 95% CI 1.05 to 2.27).ConclusionsCommunity-based cervical cancer screening by testing self-collected samples for human papillomavirus (HPV) can achieve high coverage in rural Bhutan. However, solutions to bring self-collection, HPV testing and precancer treatment closer to the remotest villages are needed.

Objective To investigate the factors associated with cesarean section (CS) in Bhutan. Methods This was a cross‐sectional study, using the retrospective data from the birth registers maintained in comprehensive emergency obstetric care centers for the year 2018. The data were entered in excel 2013 and analyzed using STATA 13. Multiple logistic regression was used to understand the factors associated with CS in Bhutan. Results The rate of CS in Bhutan was 18.7%. The indications for CS were previous CS, fetal distress, prolonged labor, and failed induction. The factors associated with CS were maternal age over 25 years, male child, women with smaller number of living children, multiple pregnancy, and gestation over 40 weeks. In addition, mothers delivering in Samtse Hospital and Central Regional Referral Hospital had higher odds of CS. Conclusion In Bhutan, CS was commonly performed for mothers with previous CS, fetal distress, and prolonged labor. Increasing maternal age, multiple pregnancy, and postdated pregnancy and those with one child, or none, were more likely to undergo CS. To reduce the CS rate, Bhutan should focus on decreasing the primary CS rate as well as preventing over‐diagnosis of prolonged labor by focusing on the partograph.

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Background Colposcopy is a tool for triaging screen positive women regardless of method used for cervical cancer screening. The objective of this study was to evaluate the diagnostic performance of colposcopy in the diagnosis of histologic cervical intraepithelial neoplasia 2+ (CIN 2+) at Jigme Dorji Wangchuck National Referral Hospital (JDWNRH), Thimphu, Bhutan. Methods This cross-sectional study was conducted from March 2021 to August 2021 among 299 women who availed colposcopy services at the colposcopy clinic of JDWNRH, Bhutan. Women included in this study were either screen positive (Pap smear) or were suspected to have invasive cancer; they underwent colposcopy and a cervical biopsy irrespective of colposcopy impression. This histopathologic assessment was considered as the gold standard test for the diagnosis of cervical intraepithelial neoplasia (CIN) or invasive cancer. Results The mean age of the study participants was 43 years (ranges, 25–76 years). The sensitivity, specificity and accuracy of senior colposcopists to diagnose histologic CIN 2+ were 80.0% (95% CI 59.30, 93.17), 71.07% (95% CI 62.13, 78.95), and 72.60% (95% CI 64.61, 79.65), and for junior colposcopists were 59.46% (95% CI 42.10, 75.25), 76.72% (95% CI 67.97, 84.04), and 72.55% (95% CI 64.76, 79.45) respectively. The overall sensitivity, specificity, and accuracy of colposcopy to diagnose histologic CIN 2+ were 66.67% (95% CI 53.66, 78.05), 73.73% (95% CI 67.63, 79.23), and 72.24% (95% CI 66.79, 77.24) respectively. Conclusions In this study, the senior and junior colposcopists had a comparable colposcopic accuracy to diagnose histologic CIN 2+, whereas senior had a higher sensitivity but a lower specificity than junior colposcopists.

Uterus didelphys is a rare uterine anomaly. It is associated with fetal breech presentation, preterm delivery, and cesarean section. Longitudinal vaginal septum may be associated with uterus didelphys, which may cause dyspareunia and labor obstruction. We report a case of 28-year-old woman whose uterus didelphys and longitudinal vaginal septum were diagnosed during third cesarean section. This case report highlights the importance of routine examination of adnexal structures during cesarean section, so that any unsuspected pathologies in the uterus, tubes, and ovaries are diagnosed.

Instrumental vaginal delivery (IVD) is a core signal function in emergency obstetric and neonatal care. The revival of declining trend in IVDs worldwide against an alarming rise in cesarean section must be viewed in a holistic manner. Every country must devise its own evidence-yet context-based strategies to revive the dying art of this lifesaving obstetric procedure.

Fetal growth restriction associated with continued maternal sirolimus therapy in pregnancy has not been reported. We hereby present a case of maternal sirolimus therapy resulting in fetal growth restriction and propose a multi-hit model. This hypothetic model is based on inhibition of mTOR signaling pathway and epigenetic modulation. This case report adds to the paucity of literature on continued monotherapeutic maternal sirolimus in pregnancy and its adverse fetal effects.

Bats are ecologically crucial as they are good pollinators and pest controllers, but are less known in Bhutan.  We investigated bat diversity and richness in broadleaved forests of southwestern Bhutan.  Fieldwork was carried out from July 2016 to April 2017 using mist nets and hoop nets.  The main objective of the study was to document bat diversity and species richness. We captured 157 bats of 10 species belonging to four families. Two species (Myotis siligorensis Horsfield, 1855 and Rhinolophus affinis Horsfield, 1823) accounted for almost 52% of the total captures.  Species richness of bats differed depending upon habitat types. Myotis siligorensis was captured more often from broadleaved forests whereas Rhinolophus macrotis Blyth, 1844 and Rhinolophus affinis were common around human settlements. The present study contributed three new records for Bhutan which increased the bat diversity from 65 to 68 species. We conclude that the southwestern region, especially Chukha District, could be one of the bat diversity hotspots in Bhutan.