Browsing by Author "Wijesundere, A."

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Descriptive study of maternal deaths in castle street hospital for women; a changing trend
(Sri Lanka College of Obstetricians and Gynaecologists, 2005) Herath, H.M.R.P.; Ellepola, R.K.; Gajanayake, R.S.P.; Wijesundere, A.
INTRODUCTION: Deaths from pregnancy complications remain an important public health problem. With the development of the health care system in Sri Lanka maternal mortality rate has come down significantly. Castle Street Hospital for Women is one of the leading tertiary centers with ICU facilities providing maternal health care in Sri Lanka. We have analyzed the maternal deaths occurred during the period of 1st of January 1998 to 31" of December 2004. Objectives: To describe socio-demographic characteristics, causes of maternal deaths, and the contributory factors associated with these deaths. Method: Retrospective study of maternal deaths during the period of 1"' January 1997 to 31" of December 2004 using patients case notes, ICU notes and autopsy findings when available. Results: There were 111,617 deliveries and 73 maternal deaths at CSHW during the period giving crude MMR of 65.per 100,000 births. Sixty six of these deaths were analyzed. Most of the deaths were in the age range of 25 to 29 years. Primipara accounted 33.3% of deaths and second pregnancies accounted for another 33.3% of deaths. Out of these deaths 55.1% had received shared care while 10.6% had never received any antenatal care. PIH was the commonest (18%) risk factor identified during the antenatal period while in 50% of cases there were no risk factors identified. PIH and its complications accounted for 28.8% of deaths while post partum hemorrhage (16.7%) and medical disorder (16.7%) were also important causes of maternal deaths. Out of the PIH related deaths 78.9% were among transferred patients. Hepato-reanl failure accounted for 36.8% of PIH related deaths. Most of deaths have occurred between the 2"d and 42" days of delivery. ICU care was to 83% of patients before death. In 85% of cases autopsy reports were not available. CONCLUSIONS: PIH and its complications is the most important cause of maternal mortality at CSHW. It is the commonest risk factor identified during antenatal period. PPH and medical disorders also remain important causes. ICU facilities were available for most of the patients.
Dietaryadviceongdmmothers-an audit
(Sri Lanka College of Obstetricians and Gynaecologists, 2006) Jayasundar, C.; Ellepola, U.K.; Herath, H.M.R.P.; Perera, A.; Wijesundere, A.
BACKGROUND: Gestational Diabetes Mellitus (GDM) is considered a global problem and in Sri Lanka. It is emerging as a common complication in pregnancy. Hence, an audit was undertaken to evaluate dietary advice given to GDM mothers as it is the primary modality of treatment. OBJECTIVE: To ascertain the standard of dietary advice given to GDM mothers attending a tertiary care ,. ater.STUDY TYPE: Retrospective study. STUDY SETTING: Tertiary care center. STUDY SAMPLE: 49 consecutive GDM mothers, who was diagnosed in the ANC and ward. METHOD: Study was carried out from 1st of June to 1st of August 2006. A questionnaire was developed to evaluate the standard of the dietary advice in accordance with the unit policy. RESULTS: Out of the population 39% were in the age group of 21-30 and 61% in the 31-40 age category. Out of the total sample 96% of mothers received advice on a diabetic diet but out of which, only 4% had been supplemented with written format. The SHO, registrar, and senior registrar contributed dietary advice to 37% of the mothers while nursing officers have advised to 22%. The intern medical officers have advised 19% of mothers, while public health rnidwives, MOH have accounted for advising 15% and 5% respectively. The dietician advised only 2% of the mothers. Out of the mothers who were interviewed following the dietary advice, 69% understood the advice satisfactorily. Furthermore 24% stated that they understood the advice partially and 7 % reported poor understanding. In addition 16% of the mothers had requested repeated dietary advice. Finally, 56% reported satisfaction with the overall dietary management of the above medical complication. CONCLUSIONS AND RECOMMENDATIONS: The dietary advice given in our study population is unsatisfactory, considering the fact that the diet control is the primary modality of treatment in GDM. We recommend that advising on diet is a joint responsibility of medical officers, nursing officers, midwives and dieticians. Such advice should be solid and tailored to follow the Sri Lankan dietary habits and expectations. In addition the explanations should be done in a simple manner with use of a dietary advice leaflet according to a common protocol and each hospital should have a specialized supplemented with written format. The SHO, registrar, and senior registrar contributed dietary advice to 37% of the mothers while nursing officers have advised to 22%. The intern medical officers have advised 19% of mothers, while public health rnidwives, MOH have accounted for advising 15% and 5% respectively. The dietician advised only 2% of the mothers. Out of the mothers who were interviewed following the dietary advice, 69% understood the advice satisfactorily. Furthermore 24% stated that they understood the advice partially and 7 % reported poor understanding. In addition 16% of the mothers had requested repeated dietary advice. Finally, 56% reported satisfaction with the overall dietary management of the above medical complication. CONCLUSIONS AND RECOMMENDATIONS: The dietary advice given in our study population is unsatisfactory, considering the fact that the diet control is the primary modality of treatment in GDM. We recommend that advising on diet is a joint responsibility of medical officers, nursing officers, midwives and dieticians. Such advice should be solid and tailored to follow the Sri Lankan dietary habits and expectations. In addition the explanations should be done in a simple manner with use of a dietary advice leaflet according to a common protocol and each hospital should have a specialized dietician.