Bring healthcare to thousands in rural Nepal

With the help of Chao Foundation and TFish Fund, Himalayan HealthCare (HHC) provided Rural Ultrasound Obstetrical Training (ROUSG) for women health providers especially midwives, who have received SBA certification. The three-week long training allows village midwives to use ultrasound technology which is newly introduced in rural Nepal as an important tool to help with pregnancies and deliveries on-site. This is a basic obstetrical training provided by experts in government designated city centers to help midwives use portable USG machines that are now available in each municipality through the government. Also, the goal of this course is to prepare competent rural nurses who can identify pregnancy related complications for timely referral to an appropriate health institution and save the lives of both mother and child.

Five rural municipalities requested HHC for the training and in turn HHC requested the Bagmati Province Health Training Center for the three-week long training for the 5 trainees from five rural municipalities.They were slotted in AMDA hospital, Damak, Jhapa and the training started on 30 May and ended on 20 June 2024.

Trainee details:

Trainees                            Rural Municipality                       Work Station

Reena G                             Kushe                                         Gharanga Health Post

Kamala K S                        Shivalaya                                    Jugathapahaur Health Post

Nirmala R                          Benighatrorang                           Mahadevsthan Health Post

Pratikshya S                      Siddhalake                                  Nalang Health Post

Muna T M                          Nilkantha Municipality               Jyamrung HP

The following is the curriculum of the basic rural obstetrical ultrasound training:

 Period of gestation: Identifying gestational period (1st, 2nd or 3rd trimester)

Ectopic pregnancy: How to identify ectopic pregnancy

Number of gestational Sac: Reading gestational sacs

Cardiac activity: Heartbeat positive or negative

Crown Rump Length: Measuring fetus from head to toe (maximal straight line of embryo)

Retained Product of Conception(RPOC): Finding missed abortion or blighted ovum, incomplete abortion/complete abortion

Fetus: Fetus condition live or dead

Location of Placenta: Placenta located either anterior or posterior

Hydatidiform (Molar Pregnancy): Finding if hydatidiform mole and when to refer and where to refer

Bi-Parietal Diameter: Measure outer table of the skull to inner table

Head Circumference: Measuring around the outer table of the skull

Abdomen: Measuring midpoint of the line between the riborcostal margin

Circumference and the iliac crest in the mid axillary line

Femur Length (fetal length calculation): Identifying fetal presentation either longitudinal liecephalic (LLCP) or breech (LLBP), non-longitudinal lie (NLL, transverse or oblique) and variable lie(VL),

Recording fetal heartbeat: Ultrasound measurements of biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC) and femur length (FL) are used to evaluate fetal growth and estimate fetal weight, fetus condition (living or dead), measurement of the cervical length (CL) (measuring the endo cervical canal from the internal cervical OS to the external cervical OS)

Retained product of conception: How to find out if miscarriage

Location of Placenta: Posterior or anterior

Polyhydramnios: Measurement of Amniotic fluid index

Oligohydramnios: Measurement of Amniotic fluid index if less than 7 to 8 cm

Placenta Previa: Condition that placenta is implanted at the bottom of the uterus,

covering the cervix

Abruptio Placenta: Placenta partly or completely separates from the inner wall of the

uterus before delivery.This can decrease or block the baby's supply of oxygen and nutrients and cause heavy bleeding in the mother

Fetus abnormalities: Identify fetal anomalies while scanning (Anencephaly/Cystic

Hygroma/Ventriculomegaly/Hydrocephalus