Browsing by Author "Dias, T.D."

Now showing 1 - 20 of 32

Anaemia among women of child-bearing age: Contributions of alpha and beta-thalassaemia
(Sri Lanka Medical Association, 2018) Mettananda, S.; Suranjan, P.D.M.; Fernando, V.R.; Dias, T.D.; Rodrigo, R.; Perera, L.; Mettananda, K.C.D.; Gibbons, R. J.; Premawardhena, A.; Higgs, D. R.
INTRODUCTION AND OBJECTIVES: Anaemia during pregnancy is attributed to iron deficiency and pregnant women prescribed iron supplements without investigating for a cause. However, aetiology can be diverse and iron efficiency may contribute only partly. We aimed to describe the aetiology of anaemia among women of child bearing age. METHODS: This descriptive study was conducted at Teaching Hospital, Ragama from June-December 2017. Patient database of deliveries between January 2015 and September 2016 at University Obstetrics Unit was screened (n=3636) to identify women with anaemia (haemoglobin
An Audit on Performance of Medical Students of the University of Kelaniya in Completing the Clinical Tasks during their Final
(Sri Lanka College of Obstetricians and Gynaecologists, 2014) Palihawadana, T.S.; Motha, M.B.C.; Dias, T.D.; Wijesinghe, P.S.
Breech at term: caesarean versus vaginal delivery
(Sri Lanka College of Obstetricians and Gynaecologists, 2005) Kumara, D.A.K.J.; Dias, T.D.; Perera, Y.A.G.
OBJECTIVE: In 3-4% of the pregnancies, the fetus will be in breech presentation at term. For most of these women the approach to delivery is controversial. The objective of the study was to compare the pregnancy outcomes of breech presentations at term delivered vaginally and by caesarean section METHODS: Hospital based cohort study. Study sample was all breech presentations at term with a singleton fetus delivering at Teaching Hospital, Galle during the specified period of study. Decision regarding the suitability for vaginal delivery was made by individual consultants of respective units as per unit protocols. Outcome measures were defined and data collected for each delivery on a printed data sheet. Results: The two study groups were comparable with regard to the basic characteristics and the presence of antenatal complications. There was no significant difference between the two study groups with regard to serious maternal morbidity (RR 1.08, 95% CI 0.75-1.56), neonatal mortality (RR 1.07, 95%CI 0.61- 1.90) or serious neonatal morbidity (RR 1.23,95% CI 0.76- 2.00) Discussion: In our study group there was no significant difference in maternal and neonatal outcomes between the vaginal delivery and the caesarean section.
A Case report of Meningioma with uncal herniation in pregnancy
(Sri Lanka College of Obstetricians & Gynaecologists, 2017) Suthakaran, V.; Perera, M.N.I.; Herath, H.M.R.P.; Dias, T.D.; Wijesinghe, P.S.
INTRODUCTION: The diagnosis and management of meningioma during pregnancy is a challenge, with growth and regression both reported. The occurrence of meningioma during pregnancy is rare, comparable with that in non-pregnant woman in the same age group. We report a case of meningioma with uncal herniation leading to maternal death during pregnancy. CASE: Thirty-year-old woman was referred to our unit on her 20th weeks of gestation for severe headache and vomiting. This is her third pregnancy with two living children, both delivered by caesarean section. She had early morning headache, lasting for 1 to 2 hours which resolved following vomiting from16th week of gestation. She did not have visual impairment, photophobia or focal neurological ymptoms. She was admitted to base hospital for increased frequency and severity of headache on her 18th week of gestation. Neurological examination was normal. Her blood pressure was normal throughout this pregnancy. She defaulted herneurology appointment. She was readmitted for same symptoms and transferred to our hospital. She complained severe headache, vomiting and blurred vision on day of admission followed by difficulty in breathing. Her SPO was 84 % on air and respiratory rate was 32/minutes. Ophthalmoscopy was normal. She was intubated for impending respiratory arrest and non-contrast CT was performed. CT showed Right sided sphenoidal wing tumour suggestive of a meningioma with midline shift and uncal herniation. She developed repeated episodes of a systole before transfer to neurosurgical unit and did not recover. Postmortem findings and histology confirmed the diagnosis of meningothelial type of meningioma. DISCUSSION: Intracranial tumours in pregnant woman are serious and life threatening conditions. The clinical presentation of intracranial mass mimics the symptoms of hyperemesis gravidarum, eclampsia and puerperal psychosis. MRI of the brain is the investigation of choice for prompt diagnosis of meningioma. Surgery is the key in the management of meningioma depend on the site of tumour. The general recommendation in pregnancy is for caesarean section as first surgery followed by neurosurgical interventions. Urgent neurosurgical linterventions are indicated for patients with malignant tumours, active hydrocephalus or benign tumours with impending herniation or progressive neurological deficits.
A case report of Meningioma with uncal herniation in pregnancy
(Sri Lanka College of Obstetricians & Gynaecologists, 2017) Suthakaran, V.; Perera, M.N.I.; Herath, H.M.R.P.; Dias, T.D.; Wijesinghe, P.S.
INTRODUCTION: The diagnosis and management of meningioma during pregnancy is a challenge, with growth and regression both reported. The occurrence of meningioma during pregnancy is rare, comparable with that in non-pregnant woman in the same age group. We report a case of meningioma with uncal herniation leading to maternal death during pregnancy. CASE: Thirty-year-old woman was referred to our unit on her 20th weeks of gestation for severe headache and vomiting. This is her third pregnancy with two living children, both delivered by caesarean section. She had early morning headache, lasting for 1 to 2 hours which resolved following vomiting from16th week of gestation. She did not have visual impairment, photophobia or focal neurological ymptoms. She was admitted to base hospital for increased frequency and severity of headache on her 18th week of gestation. Neurological examination was normal. Her blood pressure was normal throughout this pregnancy. She defaulted herneurology appointment. She was readmitted for same symptoms and transferred to our hospital. She complained severe headache, vomiting and blurred vision on day of admission followed by difficulty in breathing. Her SPO was 84 % on air and respiratory rate was 32/minutes. Ophthalmoscopy was normal. She was intubated for impending respiratory arrest and non-contrast CT was performed. CT showed Right sided sphenoidal wing tumour suggestive of a meningioma with midline shift and uncal herniation. She developed repeated episodes of a systole before transfer to neurosurgical unit and did not recover. Postmortem findings and histology confirmed the diagnosis of meningothelial type of meningioma. DISCUSSION: Intracranial tumours in pregnant woman are serious and life threatening conditions. The clinical presentation of intracranial mass mimics the symptoms of hyperemesis gravidarum, eclampsia and puerperal psychosis. MRI of the brain is the investigation of choice for prompt diagnosis of meningioma. Surgery is the key in the management of meningioma depend on the site of tumour. The general recommendation in pregnancy is for caesarean section as first surgery followed by neurosurgical interventions. Urgent neurosurgical linterventions are indicated for patients with malignant tumours, active hydrocephalus or benign tumours with impending herniation or progressive neurological deficits.
Clinical practice of vitamin D screening and supplementation in pregnancy in Asia-pacific countries: A cross-sectional study
(Elsevier, 2023) Lee, R.W.K.; Chng, A.L.B.; Tan, K.H.; Shub. A.; Tan, T.; Ling, L.S.; Kuma, K.; Siew, C.Y.; Ting, W.; Myint, S.S.; Judistiani, R.T.D.; Shah, M.; Madulid-Sison, L.; Andres-Palencia, B.; Pagilagan-Palma, E.; Banu, L.A.; Boriboonhirunsarn, D.; Dias, T.D.
BACKGROUND: Vitamin D deficiency is common in pregnant women. There is scarce information in the Asia-Pacific region on the understanding of vitamin D screening and supplementation in pregnancy among health care professionals. METHODS: We performed a cross-sectional study among health care professionals who are part of the Integrated Platform for Research in Advancing Metabolic Health outcomes of Women and Children (IPRMAHO) international study group on their understanding and perception of Vitamin D screening and supplementation in pregnancy. The cross-sectional survey comprised 4 main sections: demographics, existing policies, nutrient supplementation in pregnancy and various practices on screening, treatment and perceptions, with a total of 22 questions. A total of 15 responses were obtained from attendees from distinct health facilities across eleven participating Asia-Pacific countries. RESULTS: Majority of the surveyed hospitals (11/15, 78.6 %) did not have a national policy or regional guideline regarding Vitamin D screening and supplementation in pregnancy. More than half of respondents were (9/14, 64.3 %) were unsure of the percentage of women seen with Vitamin D deficiencies each year and were unsure of Vitamin D dosage prescribed to pregnant women with (8/15, 53.3 %) or without (6/14, 42.9 %) Vitamin D deficiency. Vitamin D was rarely prescribed in pregnancy when compared to other nutrient supplements such as folic acid and iron. Majority of respondents (9/11, 72.7 %) indicated that their hospital did not screen for Vitamin D deficiencies in pregnancy, even amongst high risk pregnant women. Nevertheless, majority of respondents indicated a need (12/15, 80.0 %) for a guideline or consensus regarding Vitamin D screening and supplementation in pregnancy. CONCLUSION: While majority of the surveyed hospitals did not have a national policy or regional guideline regarding Vitamin D screening and supplementation in pregnancy, majority of respondents indicated a need for the policy or guideline. There were varying clinical knowledge gaps and different perceptions on Vitamin D screening and supplementation in pregnancy among healthcare professionals.
Diabetes mellitus in pregnancy
(Sri Lanka College of Obstetricians and Gynaecologists, 2015) Motha, M.B.C.; Dias, T.D.
Do teenager prefer contraception or termination?
(Sri Lanka College of Obstetricians and Gynaecologists, 2007) Herath, H.M.R.P.; Dias, T.D.; Amarasinghe, W.L.
INTRODUCTION: Teenage pregnancy is universal in all known societies past and present. One in four girls in the world becomes a mother before the age of 19 years. In Sri Lanka, 22.2% of maternal deaths due to illegal abortions were in this age group during 1996. Lack of knowledge regarding contraceptive methods is thought to be the main reason for not practicing proper contraception. On the other hand information about domestic violence in families with teenage mother is scares. OBJECTIVES: To describe the use of contraception, attempted pregnancy terminations and violence against women during the pregnancy among teenage mothers delivered at Teaching Hospital Peradeniya. METHOD: A prospective descriptive study was done on teenage mothers who delivered at teaching hospital Peradeniya from 1st of April 2005 to 31st of March, 2006, using interviewer administered questionnaire. RESULTS: There were 190 teenage mothers delivered during the study period. Data was collected from 186 of them. Among these teenage mothers Only 3(1.6%) has studied above GCE ordinary level. Only 28% ofwomen of the group have used any form of contraception, and of which 64% has used barrier methods of contraception. 80 (43%) of teenage mothers had thought of future contraception before they were discharged from the hospital. Termination of the pregnancy has been attempted by 9.1% of the study population. Of those who had'attempted termination 82.4% had not used any form of contraception. Male partners have assaulted 16.1% of teenage mothers during the pregnancy. CONCLUSION: The teenage pregnant mothers have poor educational background. The contraceptive use in the population was very low leading to unnecessary pregnancies and termination of pregnancies. Domestic violence in this population is fairly common.
Evaluation of cervical length by transabdominal and transvaginal scans during early pregnancy.
(Sri Lanka college of Obstetricians & Gynaecologists, 2021) Ruwanpura, L.; Wickramasinghe, J.B.; Marasinghe, P.; Ratnayake, G.M.; Dias, T.D.; Silva, D.
ABSTRACT: Objective To compare the measurements and the client-preferences of transabdominal scan (TAS) and transvaginal scan (TVS) in assessing cervical length. Method A validation study with a cross sectional component on patient-preferences was conducted among 568 pregnant women with a period-of-amenorrahea between 11+0 to 22+6 weeks. Pre- and post-void TAS and a post-void TVS measurements were taken. Receiver Operating Characteristics (ROC) curves were generated to assess the detection of short cervix using pre and post-void TAS at different lengths of the cervix. Results The mean (SD) age of the participants was 28.4(5.7) years with a mean gestation age of 14+1 weeks. The mean (SD) cervical lengths detected by the pre-void TAS, post-void TAS and TVS were 32.2 (5.8)mm, 28.9 (5.8) mm and 34.4 (5.3) mm respectively. Factors with significant association with a higher TVS cervical length were; increasing age (p<0.001), higher gravidity (p<0.001), higher parity (p<0.001) and higher number of vaginal deliveries (p<0.001). The TAS and TVS measurements significantly correlated with each other (p<0.001). Post-void TAS could not obtain measurement in 49.47% of attempts. The shortest cervical length can be detected by pre-void TAS was 26mm with an ideal cut-off of 33mm. For post-void TAS the shortest length was 28mm with an ideal cut-off of 28.16mm. Majority preferred TAS over TVS. Conclusion Pre-void TAS can predict a cervical length of 26mm or less with 87.5% sensitivity whereas the shortest length predicted by post-void is relatively longer. Nearly in half, a valid post-void TAS could not be recorded. Client preference was more favorable for TAS. KEYWORDS: Ultrasound, Cervical length, Screening, Preterm labour
Evaluation of the proportion of Genetic Disorders detected at prenatal testing in a Tertiary fetal medicine referral centre
(Sri Lanka College of Obstetricians & Gynaecologists, 2017) Padeniya, A.G.P.M.; Dias, T.D.; Punchihewa, C.
OBJECTIVE: Prenatal suspicion of fetal chromosomal aneuploidies is the most common indication for invasive prenatal testing. Amniocentesis followed by genetic testing for chromosomal aneuploidies is the diagnostic technique for prenatal detection of chromosomal disorders. Prenatal detection of these disorders would enable timely medical or surgical treatment of a condition before or after birth. It further “prepare” the family psychologically, socially, financially, andmedically of a baby with a health problem or disability or for the likelihood of a still birth. The objective of this study was to evaluate the proportion of genetic disorders detected at prenatal testing procedures at a Tertiary Fetal Medicine referral centre. METHODS: A retrospective study was carried out from 2016 October to 2017 April in all invasive procedures done in the Fetal Medicine Unit, Ninewells Care Mother & Baby hospital, Colombo, Sri Lanka. Prenatal samples were analyzed by Fluorescent in situ hybridization for the common chromosomal aneuploidies including chromosome number 13, 18, 21, X andY and by karyotype. Patient information and details of invasive procedures were obtained from the Fetal Medicine Unit database. RESULTS: A total of 57 prenatal examinations was performe during the study period of which 55 were amniocentesis and 02 were cordocentesis procedures. The mean maternal age at which the procedure was performed was 33 years(SD=6.3). The commonest indication for the prenatal testing was increased nuchal translucency (NT) thickness (27) detected at the NT scan. The other common indications for prenatal detection were atrioventricular septal defect (5), omphalocoele (4), nonimmunehydrops (3) and Diaphragmatic hernia (2) detected at the second trimester scan. There were 3 who had elevated double test and1 with increased Non Invasive Prenatal test result which directed them for prenatal testing. Chromosomal abnormalities were detected in 13 fetuses of which majority were Trisomy 18 (5). Trisomy 21 and Trisomy 13 syndromes were detected in 4 and 3 fetuses respectively. Of the 27 fetuses who had elevated NT thickness, 4 fetuses were Trisomy 21. Fetuses who had structural abnormalities 4 had Trisomy 18 syndrome. There was one which had Trisomy 21 mosaic syndrome and one with Turner mosaic syndrome. CONCLUSION: Testing for diseases or conditions in a fetus/embryo by an invasive method before it is born would enable the doctors to improve the outcome of the developing fetus/embryo hence prepare the family for an anticipated problem.
Fetal cardiac ultrasonography: An optimum gestational age of assessment
(Sri Lanka College of Obstetricians & Gynaecologists, 2017) Perera, M.N.I.; Kulasinghe, I.R.M.M.; Dias, T.D.
OBJECTIVES: To identify the ability of acquiring fetal cardiacimages at different gestational age windows using ultrasound scan. DESIGN, SETTING AND METHOD: This was a prospective descriptive study using ultrasound machine “Alpinion EC-15 V4.0” and “Toshiba Aplio 300”. Fetal cardiac views at gestational age from 11 to 30 weeks were obtained by an expert in obstetric fetal echo. Low risk women with singleton pregnancy were recruited. The sample was stratified into 5 gestational age windows between 11 and 28 weeks. Ability to view four chambers, right and left out flow tracts, three vessels, aortic arch, ductal arch and superior and inferior vena cavae at each gestational window was assessed. RESULTS: A total of 313 pregnant women were analyzed. All seven fetal cardiac images were obtained at the gestational age of 18 weeks to 25+6. There was a sub-optimal acquisition of the three vessels and SVC/IVC (96.3%) at 26-30 weeks. Six out of seven cardiac images were possible in more than 80% of cases from 14 to 17+6 weeks. At the gestational age between 11 weeks to 13+6, the ability to view four chambers was 92.98% and the ability to view the rest of the images was as follows: right out flow tract – 38.6%, left outflow tract – 42.11%, three vessels - 38.6%, aortic arch- 36.84%, ductal arch- 35.09%, superior and inferior vena cavae-5.26%. CONCLUSION: Ability of acquiring fetal cardiac views was best at 18 to 25+6. Cardiac image acquisition is sub optimum in early gestations and beyond 26 weeks.
Induction of labor in women over 35 years: How does it affect the outcome?
(Sri Lanka College of Obstetricians & Gynaecologists, 2016) Dias, T.D.; Janitha, G.; Chaya, H.; Padumadasa, S.; Wijesinghe, P.
OBJECTIVE: Compare fetal and labor outcomes following induction of labor in singleton pregnant women over 35 years (>35) with women between 20 to 30 years (20-30) METHOD: This was a retrospective study carried out at North Colombo Teaching Hospital using North Colombo Obstetric Database (NORCOD) between March 2014 and May 2016. Two hundred and ninety six singleton pregnancies that underwent induction of labor were included. Women had been categorized into two groups based on their age. They were 20-30 years (20- 30) and above 35 years (>35). Two groups were matched against their booking visit body mass index. Labor and fetal outcomes of each group were assessed. RESULTS: Lower segment Caesarean section (LSCS) rates observed in 20-30 and >35 groups were 16.2% (N=24) and 17.6% (N=26) respectively (P>0.05). Newborns of induced pregnancies of 20-30 mothers had an APGAR <7 at 5min in 1.4% (N=2) and 2.7% (N=4) babies of women >35 had an APGAR <7 at 5 min (P>0.05). Induced pregnancies of 20-30 mothers reported 16.2% (N=24) NICU admissions and >35 years group had 20.3% (N=30) NICU admissions (P>0.05). CONCLUSION: There is no significant difference between the two groups in terms of LSCS rates, low 5 min APGAR and NICU admissions.
Invasive prenatal testing at a Tertiary Fetal Medicine referral center in Sri Lanka: A service evaluation audit
(Sri Lanka College of Obstetricians and Gynaecologists, 2015) Padeniya, A.G.P.M.; Dias, T.D.
Metabolic syndrome and risk of endometrial carcinoma among asymptomatic, post-menopausal, urban Sri Lankan females: a community cohort follow-up study
(Sri Lanka Medical Association, 2017) Dias, T.D.; Niriella, M.A.; de Silva, S.T.; Ediriweera, D.; Motha, C.; Palihawadana, T.; de Silva, H.J.
INTRODUCTION & OBJECTIVES: Metabolic syndrome (MetS) has been recognized as a risk factor for malignancies. The aim of this study was to evaluate the association of MetS and risk of endometrial carcinoma (EC), by measuring endometrial thickness (ET). METHODS: The Ragama Health Study (RHS) recruited 35-64-year-old females from the Ragama MOH area by age-stratified random sampling in 2007 and re-evaluated them in 2014, using a structured interview, anthropometric measurements and biochemical tests. Liver ultrasound to detect fatty liver was performed in 2007. Pelvic ultrasound to detect ET was performed in 2014 among consenting participants. MetS was diagnosed on established International Diabetes Federation (IDF 2012) criteria. Increased ET was defined as >5mm. Simple logistic regression was used to screen variables and multiple logistic regression was used to obtain adjusted effects of risk factors for increased ET. RESULTS: Of the original female cohort, 813/1636 (49.7%) attended follow-up; ET was measured in 567 (69.7%). Median (IQR) age of females was 61 (56-66) years. 323 fulfilled criteria for MetS (prevalence 57.1%) in 2007. 57 (10.1%) had increased ET in 2014. Increasing plasma triglycerides [OR=1.004 per mg/dl, 95% CI 1.001-1.007, p<0.05] and being hypertensive [OR=2.16, 95% CI 1.11–4.08, p<0.05] were associated with increased ET, while advancing age [OR=0.93 per year, 95% CI 0.89–0.98, p<0.01] and being diabetic [OR= 0.34, 95% CI 0.10–0.89, p<0.05] were protective. CONCLUSION: Hypertension and increased plasma triglyceride levels, in the pre-menopausal period, were risk factors for future asymptomatic increased ET.
Mirror syndrome: a rare presentation with a trisomy 21 fetus
(Sri Lanka College of Obstetricians and Gynaecologists, 2014) Prasanga, D.P.G.G.M.; Dias, T.D.; Palihawadana, T.S.; Gunathilaka, S.N.M.P.K.; Herath, H.M.R.P.; Wasalathilaka, C.D.
A multicentre study on pattern of fetal anomalies detected in Sri Lanka
(Sri Lanka College of Obstetricians & Gynaecologists, 2017) Padeniya, A.G.P.M.; Dias, T.D.; Ediriweera, D.S.; Mendis, B.M.I.U.
OBJECTIVE: Prenatal diagnosis is a rapidly evolving specialty in modern medicine. The mid-trimester scan has been an important practice in safe antenatal care which predicts birth defects of the developing fetus. This scan performed during 18-23 weeks of pregnancy detects both internal and external abnormalities of the fetus. The objective of this study was to present the pattern of fetal anomalies detected in Sri Lankan pregnant women who were referred for the anomaly scan. METHOD: A multi centre retrospective study was carried out in all the fetal medicine referral centers conducted in the Island including Colombo, Ragama, Galle and Kurunegala between July 2013 and March 2017. Patient information and the ultrasound scan findings were obtained from the purpose built database maintained by the authors. RESULTS: A total of 7370 referrals were reviewed and 6704 singleton pregnancies were selected. The mean maternal age and the mean gestational age at which the anomaly scan was performed were 31 years (SD=4.9) and 23 weeks (SD= 4.5) respectively. Congenital Heart Disease (CHD) was the commonest abnormality detected in the study group 149 (2.2%). Thirty-one (0.5%) fetuses had Atrioventricular Septal Defect which predicts Down syndrome at the mid-trimester scan. Majority (8.3%) of the CHD were referred from the Uva province. Of the 7370 referrals 63 (0.9%) and 27 (0.4%) had Neural Tube Defects (NTDs) and cleft lip/palate respectively. Highest percentage (4.4%) of NTDs were referred from the North Central province and cleft lip/palate referrals were commonest in Sabaragamuwa (0.9%) province. Abdominal wall defects and cystic renal disease were detected in 33 (0.5%) and 38 (0.6%) fetuses correspondingly. Referrals received from the Uva (1.9%) province reached the highest number of abdominal wall defects and cystic renal disease referrals were peaked in the Uva (7.4%) province. Forty-eight (0.7%) referrals had Congenital Talipes Equino Varus deformity and highest number of referrals was from the Eastern (2.4%) province. CONCLUSION: Referrals received from the Uva province had highest number of fetal anomalies (20%) either as a major or minor birth defect. Of the total referrals congenital heart defect was the commonest congenital abnormality detected in the study group.
A multicentre study on pattern of fetal anomalies detected in Sri Lanka
(Sri Lanka College of Obstetricians & Gynaecologists, 2017) Padeniya, A.G.P. M.; Dias, T.D.; Ediriweera, D.S.; Mendis, B.M.I.U.
OBJECTIVE: Prenatal diagnosis is a rapidly evolving specialty in modern medicine. The mid-trimester scan has been an important practice in safe antenatal care which predicts birth defects of the developing fetus. This scan performed during 18-23 weeks of pregnancy detects both internal and external abnormalities of the fetus. The objective of this study was to present the pattern of fetal anomalies detected in Sri Lankan pregnant women who were referred for the anomaly scan.METHODS: A multi centre retrospective study was carried out in all the fetal medicine referral centers conducted in the Island including Colombo, Ragama, Galle and Kurunegala between July 2013 and March 2017. Patient information and the ultrasound scan findings were obtained from the purpose built database maintained by the authors. RESULTS: A total of 7370 referrals were reviewed and 6704 singleton pregnancies were selected. The mean maternal age and the mean gestational age at which the anomaly scan was performed were 31 years (SD=4.9) and 23 weeks (SD= 4.5) respectively. Congenital Heart Disease (CHD) was the commonest abnormality detected in the study group 149 (2.2%). Thirty-one (0.5%) fetuses had Atrioventricular Septal Defect which predicts Down syndrome at the mid-trimester scan. Majority (8.3%) of the CHD were referred from the Uva province. Of the 7370 referrals 63 (0.9%) and 27 (0.4%) had Neural Tube Defects (NTDs) and cleft lip/palate respectively. Highest percentage (4.4%) of NTDs were referred from the North Central province and cleft lip/palate referrals were commonest in Sabaragamuwa (0.9%) province. Abdominal wall defects and cystic renal disease were detected in 33 (0.5%) and 38 (0.6%) fetuses correspondingly. Referrals received from the Uva (1.9%) province reached the highest number of abdominal wall defects and cystic renal disease referrals were peaked in the Uva (7.4%) province. Forty-eight (0.7%) referrals had Congenital Talipes Equino Varus deformity and highest number of referrals was from the Eastern (2.4%) province. CONCLUSION: Referrals received from the Uva province had highest number of fetal anomalies (20%) either as a major or minor birth defect. Of the total referrals congenital heart defect was the commonest congenital abnormality detected in the study group.
Nutcracker syndrome in pregnancy: a worrying presentation of a benign condition
(Sri Lanka Medical Association, 2017) Motha, M.B.; Palihawadana, T.S.; Dias, T.D.; Wijesinghe, P.S.
Post-placental and interval intrauterine contraceptive device (IUD) insertion: does timing matter?
(Wiley-Blackwell, 2015) Dias, T.D.; Palihawadana, T.S.; Wijekoon, D.; Ganeshamoorthy, P.; Abeykoon, S.; Liyanage, G.; Padeniya, T.
INTRODUCTION Unintended pregnancies in the first year after childbirth could be high as 10–44% and expose women to consequences of induced abortion, especially in countries where termination of pregnancy is illegal. Immediate postpartum contraception methods are beneficial for women who wish for early contraception and for women who have difficulty in returning for postpartum visits for contraception. Use of Copper containing intrauterine contraceptive device (IUD) immediately after delivery (post placental) has been described recently with varying success. The aim of this study was to compare the rate of spontaneous expulsion and intrauterine displacement between post placental IUD insertion and routine IUD insertion, 6 weeks after delivery. METHODS This was an interventional comparative study. Women who were willing to start on IUD as a contraceptive method after childbirth were recruited for the study. They were randomly allocated to either group before labour/ delivery and those in the group of post placental insertion had it inserted immediately following vaginal delivery and those allocated for interval group had insertion 6 weeks after delivery. Two ultrasound examinations were performed, just after the insertion and 6 weeks later in both groups. The distance from the IUD to the internal os was measured at each examination to evaluate the displacement. RESULTS The study included 30 subjects in the post placental group and 33 in interval insertion group. The postpartum insertion group and the interval insertion groups were comparable for age [mean (SD) 27.1 (5.42) versus 25.6 (4.34), P = 0.23] and BMI [mean (SD) 22.4 (7.28) versus 23.9 (5.76), P = 0.34]. As expected, the uterine length at insertion was higher among the post placental group [mean (SD) 144.1 mm (12.2) versus 66.8 (6.7), 95%CI 72.3 to 82.1] but similar in two groups at follow up [66.6 mm (15.1) versus 64.79 (6.64), 95%CI _4.01 to 7.47]. Spontaneous expulsion and displacement was not significantly different between the post placental and interval insertion groups [3/30 versus 2/33, OR 1.72; 95%CI 0.28 to 10.7]. In these two groups, there was no difference noted in the second ultrasound measurements from the IUD to the fundal wall [16.9 mm (3.99) versus 18.24 (4.36); 95%CI _3.45 to 0.77] or to the internal os [21.8 mm (15.7) versus 17.1 (6.03); 95%CI _1.12 to 10.6]. CONCLUSION This study demonstrates that insertion of an IUD immediately after delivery does not increase the risk of spontaneous expulsion or the risk of downward displacement. Therefore, such insertion can be recommended in clinical practice
Precision of predicting expected date of delivery by ultrasound scan in comparison to last menstrual period
(Sri Lanka College of Obstetricians & Gynaecologists, 2014) Wasalathilaka, C.; Kumari, S.D.T.L.; Palihawadana, T.S.; Herath, H.M.R.P.; Padumadasa, S.; Pathmeswaran, A.; Dias, T.D.
INTRODUCTION: Estimation of the expected date of delivery (EDD)is important in management of pregnancy, as many clinical decisions would rely on the estimated gestation of the fetus. In routine clinical practice, this is done by either adding the duration of a pregnancy to the last menstrual period (LMP) or by assessment of fetal biometry by an early pregnancy ultrasound scan (USS). The accuracy of these methods can be assessed either by correlating the dates with people with a know date of conception, such as following IVF, or by study of the correlation with the date of delivery in a cohort of women who goes in to spontaneous labour. In this study we have assessed the accuracy of the two methods by the latter approach. The aim of this study was to assess the agreement of EDD calculated by LMP or USS, to the date of delivery in spontaneous labour. METHODS: This was a retrospective cohort study. 675 patients who had a spontaneous onset of labour were included in the analysis. USS fetal crown rump length was considered for gestational age assessment between 8 and 14 weeks and fetal head circumference considered thereafter. Their agreement of the date of delivery with the estimated expected date of delivery by LMP or USS was assessed. RESULTS: Spontaneous delivery was seen with 6 days of the USS EDD and 7 days of the LMP EDD in 50% of women and within 11days of USS EDD and 15days of LMP EDD among 75% of women. A delivery within 14 date of the EDD was observed in 93.7% when USS EDD was considered and it was only in 86.2% with the LMP EDD (OR 2.40, 95%CI 1.64-3.52). CONCLUSION: This study demonstrate that the USS EDD is more in agreement with the date of spontaneous delivery than the EDD estimated from LMP. This highlights the importance of dating USS in all pregnancies which would be helpful in management of pregnancy in late stages.