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.

Aims: To determine the prevalence of premenstrual syndrome and premenstrual dysphoric disorder and their association with psychiatric cases and dysmenorrhea in students of Lumbini Medical College, Palpa, Nepal.Methods: This is a cross-sectional study where self-report questionnaires based on American College of Obstetrics and Gynecology and Diagnostic and Statistical Manual of Mental Disorders-V criteria for PMS and PMDD and the General Health Questionnaire-12 for psychiatric caseness were filled by the students. The results were calculated using SPSS 16.0 as frequencies, mean, standard deviation and chi square with a p-value of < 0.05 as significant. Results: There were 382 participants out of which 113 (61.1%) medical and 126 (64%) nursing students met the ACOG criteria for PMS. PMDD was diagnosed in 78 (39.6%) nursing students and 72(38.9%) medical students. The most common somatic symptom was headache 256(77%) and behavioral symptom was irritability 310(81.2%). A significant relation (p value <0.05) was seen between psychiatric caseness, dysmenorrhoea and PMS/PMDD.Conclusion: PMS and PMDD are common in young medical and nursing students.  A significant relation was present between PMS and psychiatric caseness and dysmenorrhea therefore comprehensive efforts should be made by healthcare providers to screen and manage symptoms including dysmenorrhea efficiently, thereby improving daily functioning, academic performance and professional skills of the students.

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Introduction: When more than two fetuses simultaneously develop in the uterus, it is called higher order multiple pregnancy. The incidence of such pregnancies ranges from 0.01% to 0.07%.   Case report: We report a case of 26-year-old G2P1L0D2 with previous history of preterm vaginal twin delivery, diagnosed to have quadruplet pregnancy. She was admitted at 28 weeks of gestation for safe confinement. At 33 weeks of gestation, emergency cesarean section was conducted with outcome of two female and two male babies with quadriamniotic and quadrichorionic placenta, without any intra and post-operative complications.   Conclusion: A multidisciplinary approach with good neonatal care facilities is warranted for a better outcome in higher order multiple pregnancies.

Accusations of witchcraft and witch-hunting activities remain serious problems in Nepal, where many women are subjected to violence or torture following accusation and persecution. Many experience serious physical and mental injury, and some die. However, most of these incidents are not reported because women and their families fear reprisals. Poverty, systemic gender inequality and weak state laws provide a context in which this behaviour occurs. Allegations of witchcraft will, however, not be fully eradicated without improvements in education and legal safeguards.