Browsing by Author "Abeykoon, S."

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Birthweight standards - Ability of birthweight percentiles in predicting abnormal fetal growth and outcome
(Sri Lanka College of Obstetricians and Gynaecologists, 2014) Dias, T.; Shanmugaraja, V.; Ganeshamoorthy, P.; Kumarasiri, S.; Abeykoon, S.; Padeniya, T.
Introduction: Birthweight references for different populations are varied and most of abnormal growth deviations of given populations could be detected by creating local birthweight charts. The aim of this study was to compare the accuracy of commonly used birthweight centile charts in birthweight percentiles in predicting abnormal growth trajectories. Methods: This was a retrospective analytical study conducted between April 2010 and October 2013. Patient data and mortality data were traced from respective units and cross checked with the hospital monthly perinatal statistics. Centile values of >90th (large for gestational age -LGA),10th - 90th (appropriate for gestational age -AGA) and <10th (small for gestational age - SGA) of previously validated Sri Lankan fetal/ birthweight charts were compared with birthweight charts adopted by child health development record (CHDR) and for commonly used Hadlock charts. Proportions of adverse outcomes (perinatal deaths and late neonatal deaths) among preterm (<37 weeks) and term deliveries were also compared for SGA, AGA and LGA in three different birthweight centile charts. Results: Among 12501 singleton births, preterm and term neonates were classified differently for SGA, AGA, and LGA by Sri Lankan, CHDR and Hadlock birthweight references. More than 20% of babies were SGA by CHDR charts. SGA derived from Sri Lankan charts have detected significantly higher proportion of adverse outcomes among preterm babies than Hadlock (OR 2.08 95% CI, 1.21 to 3.56) charts. Furthermore, there is a positive trend in detecting more adverse outcomes among SGA babies from Sri Lankan charts than CHRD and Hadlock charts at term (OR 1.44, 95% CI, 0.66 to 3.12 and OR 1.93, 95% CI, 0.98 to 3.82 respectively). Conclusions: The newly created Sri Lankan birthweight chart detects most true SGA infants. It also improves the classification of abnormalities in birthweight and predicts substantially higher adverse outcomes. These new reference charts are clinically effective and can be used in the Sri Lankan population. DOI: http://dx.doi.org/10.4038/sljog.v36i4.7729 Sri Lanka Journal of Obstetrics and Gynaecology Vol.36(4) 2014: 85-88 Keywords: Birth weight standards, Fetal growth abnormalities, Prediction, Adverse perinatal outcome, Patient care, Preventive medicine
Comparison of ultrasound fetal biometry of singleton fetuses with a reference chart in pregnant women with normal nutritional and health status
(Sri Lanka Medical Association, 2017) Dias, T.; Chandrasiri, D.; Abeykoon, S.; Gunawardena, C.; Pragasan, G.; Padeniya, T.; Pathmeswaran, A.
OBJETIVES: The aim of this study was to compare fetal biometry of singleton fetuses in pregnant women with normal nutritional and health status in the Ampara district, with a commonly used reference chart. METHODS: A cross sectional study was carried out in the Ampara District. Women with normal nutritional and health status and minimal environmental constraints on fetal growth (n=714) were enrolled during the first trimester and gestational age was confirmed by fetal crown-rump length measurement between 11 weeks + 0 days and 13 weeks + 6 days. For this study, each mother was considered only once for measurement of fetal biometry, at gestations between 11 and 41 weeks. Fetal bi-parietal diameter (BPD), head circumference (HC), abdominal circumference (AC) and femur length (FL) were measured using standard techniques, and separate regression models were fitted to estimate the means and standard deviations and derive gestation specific centiles for each parameter, assuming that the measurements have a normal distribution at each gestational age. The fetal biometry results obtained from the current study were compared with a commonly used reference chart. RESULTS: The fitted 10th, 50th and 90th centiles at 40 weeks of gestation were, 87.9 mm, 93.2 mm and 98.5 mm for BPD, 313.8 mm, 328.9 mm and 344.0 mm for HC; 298.2 mm, 322.5 mm and 346.9 mm for AC and 69.7 mm, 75.0 mm and 80.2 mm for FL. When compared with the reference chart, significant differences of fetal biometry were seen in the third trimester but not in the second trimester. CONCLUSIONS: Ultrasound fetal biometry of singleton fetuses in pregnant women with normal nutritional and health status in the Ampara District were significantly different in the third trimester, from a routinely used reference chart.
Development of size charts of symphysis pubis height measurement for Sri Lankan Population
(Wiley-Blackwell, 2015) Dias, T.; Pathmeswaran, A.; Abeykoon, S.; Gunawardena, C.; Pragasan, G.; Padeniya, T.
INTRODUCTION Fetal growth restriction is responsible for majority of explained and unexplained intrauterine deaths. Screening and diagnosis of fetal growth restriction is one of the main objectives of the antenatal care. Symphysis pubis height measurement (SFH) is routinely measured to assess the fetal growth during antenatal period. Use of SFH charts made elsewhere may either under or overestimate the fetal size in our population. The aim of this study was to construct new size charts for SFH for Sri Lankan population. METHODS This was a prospective, cross-sectional study carried out at the District General Hospital Ampara. In order to increase generalisability 1220 women with normal nutritional and health status and minimal environmental constraints on fetal growth were enrolled during first trimester. Fetal crown–rump length measurement between 11+0 and 13+6 was considered for gestational age assessment in all patients. Each mother considered only once for measurement of SFH for the purpose of this study at gestations between 24 and 41 weeks. SFH was measured using non-elastic, blinded tape using standard technique. For SFH measurement separate regression model was fitted to estimate the mean and standard deviation at each gestational age. Centiles were derived from this mean and standard deviation, assuming that the measurements have a normal distribution at each gestational age. RESULTS A total of 387 mothers had their SFH measured directly. New charts were created for SFH. 10th, 50th and 90th centile values for SFH at 40 weeks are 34, 37 and 41 cm. CONCLUSIONS We have constructed new size chart for SFH. This chart can now be used to assess the fetal size of Sri Lankan population.
Fetal Doppler reference values in women with a normal body mass index
(Sri Lanka Medical Association, 2019) Dias, T.; Abeykoon, S.; Mendis, P.; Gunawardena, C.; Pragasan, G.; Padeniya, T.; Pathmeswaran, A.; Kumarasiri, S.
OBJECTIVES:To construct gestation specific reference limits for fetal umbilical (UA), middle cerebral artery (MCA) pulsatility indices (PI) and the cerebroplacental ratio (CPR) in singleton pregnancies with normal BMI between 16 and 40 weeks of gestation.METHODS:We ultrasonographically examined 596 fetuses from women with normal nutritional and health status and minimal environmental constraints on fetal growth. Each mother was considered only once for measurement of fetal Doppler indices, at gestations between 16 and 40 weeks in a prospective cross-sectional study. Gestational age was confirmed by fetal crown-rump length measurement between 11 and 14 weeks. Pulsatility indices of umbilical and middle cerebral arteries were measured by real time and Doppler ultrasonography. CPR ratio was calculated by dividing MCA PI by UA PI. The fetal Doppler measurements obtained from the current study were compared with commonly used reference charts. For each parameter separate polynomial regression models were fitted to estimate the gestation specific means and standard deviations, assuming that the measurements have a normal distribution at each gestational age.RESULTS:A significant difference of fetal Doppler indices was observed between our study and previously published reference charts for most gestational weeks. The fitted 10th, 50th and 90th centiles at 40 weeks of gestation were 0.65, 0.87 and 1.08 for UA PI; 0.93, 1.32 and 1.71 MCA PI; 1.02, 1.58 and 2.13 for CPR.CONCLUSIONS: These charts can be used for better defining the normal range of fetal arterial Doppler indices. This will be useful in the diagnosis and management of fetuses with abnormal fetal growth
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
Pregnancy outcome in extremes of reproductive age at a tertiary care hospital
(Sri Lanka College of Obstetricians and Gynaecologists, 2013) Dias, T.; Wijesinghe, E.; Abeykoon, S.; Ganeshamoorthy, P.; Kumarasiri, S.; Kodithuwakku, M.; Gunewardena, C.; Padeniya, T.
INTRODUCTION: Pregnancy outcomes in teenagers and in elderly are independently associated with adverse outcomes. The aim of this study was to find out pregnancy outcome at extremes of reproductive age. METHODS: This was a retrospective cohort study conducted between April 2010 and October 2013 at a tertiary care hospital. Individual pregnancy records, delivery suite register and neonatal care unit records were traced in order to gather information. Mortality data were traced from respective units and cross checked with hospital monthly perinatal statistics. Outcome data were compared between teenage pregnancies and pregnancies at normal age (20-34). Same comparison was done for mothers with advanced maternal age. RESULTS: A total of 12477 pregnancies were included (teenage-1009, normal-10192, advanced maternal age-1276). Intra-uterine death (IUD) rate and early neonatal death rates were not significantly higher among teenagers compared to age group 20-34 (OR 0.57, 95% CI 0.17 to 1.83 and OR 2.53, 95% CI 0.71 to 8.97 respectively). Preterm birth rate was significantly high among teenagers (OR 1.33, 95%, CI 1.12 to 1.56). In mothers with advanced age, early neonatal death rate and caesarean section rate were significantly higher than the age group of 20-34 (OR 3.33 95% CI 1.17 to 9.49 and OR 2.17 95% CI 1.92 to 2.44 respectively). In contrast, caesarean section rate was low in teens (OR 0.44 95% CI 0.36 to 0.52). Stillbirth and preterm birth rates were not significantly different (OR 1.36 95% CI 0.66 to 2.76 and OR 0.98 95% CI 0.83 to 1.15) in mothers with advanced maternal age. CONCLUSIONS: Risks of pregnancy complications are different from teens and in advanced maternal age. More studies are needed to establish the exact causes of these risks and evaluate management options in these women.
Sexual violence against women: a challenge
(Sri Lanka Medical Association, 2014) Dias, T.; Kociejowski, A.; Rathnayake, S.; Kumarasiri, S.; Abeykoon, S.; Padeniya, T.
Symphysis-pubis fundal height charts to assess fetal size in women with a normal body mass index
(Sri Lanka Medical Association, 2016) Dias, T.; Abeykoon, S.; Kumarasiri, S.; Gunawardena, C.; Pragasan, G.; Padeniya, T.; Pathmeswaran, A.
OBJECTIVES: To construct symphysis-pubis fundal height (SFH) charts to estimate fetal size in pregnant women with a normal body mass index (BMI) and to describe the variation of SFH measurements according to BMI. METHODS: cross sectional study was carried out at Ampara and Gampaha Districts in Sri Lanka. Women with normal nutritional and health status, normal BMI and minimal environmental constraints on fetal growth, with ultra sound confirmation of dates by fetal crown-rump length measurements between 11 weeks and 13 weeks + six days,had their SFH measured, using non-elastic tape and standard techniques, between 24 and 41 weeks gestation. Only one measurement of SFH was obtained from each pregnant woman. Linear and polynomial regression models were fitted separately to the means and standard deviations (SD) as functions of gestational age to identify the model with the best fit. Centiles were derived from the mean and SD at each gestational age. RESULTS: Pregnant women from the districts of Ampara (n=387) and Gampaha (n=200) were recruited. Other than a difference of -1.5 cm (95% CI -2.27 to -0.23) at 38 weeks of gestation, there were no significant differences between the SFH measurements obtained from women with normal BMI in Ampara and Gampaha Districts. Using the SFH measurements from the Ampara sample, charts were created for 10th, 50th and 90th centile values of SFH. At 40 weeks of gestation these were 34 cm, 37 cm and 41 cm respectively. At 40 weeks gestation, the variation in SFH measurements between BMI sub groups within the normal range was approximately 1.4 cm to 1.6 cm. CONCLUSIONS: These SFH charts could be used to estimate fetal size in pregnant women with normal BMI.
Use of ultrasound in predicting the success of intrauterine contraceptive device (Copper T) insertion immediately after delivery
(John Wiley and Sons, 2015) Dias, T.; Abeykoon, S.; Kumarasiri, S.; Gunawardena, C.; Padeniya, T.; D'Antonio, F.
OBJECTIVES: To assess by ultrasound examination the success of insertion of an intrauterine contraceptive device (IUD) immediately after delivery and to determine the optimal distance between the lower end of the IUD and the internal os in predicting successful retention of an IUD. METHODS: This was a prospective study carried out between December 2012 and April 2013. Two ultrasound examinations, transabdominal and transvaginal, were performed prior to hospital discharge following delivery and again at 6 weeks following delivery in women who received a postpartum IUD. Distance from the internal os to the lower end of the IUD was measured at each examination and compared in unsuccessful and successful cases of postvaginal delivery (PVD) and post-Cesarean section (PCS) IUD insertion. Logistic regression and receiver-operating characteristics (ROC) curve analysis were used to determine the difference in success between the two modes of delivery and to determine the optimal cut-off of the internal os-to-IUD distance for successful retention, respectively. RESULTS: Ninety-one women were included in the study, comprising 60 PVD and 31 PCS IUD insertions. Thirteen PVD (22.4%) and eight PCS (25.8%) IUDs were either expelled spontaneously or removed at the 6-week scan because of improper placement. Mean distance from the internal os to the lower end of the IUD on ultrasound examination immediately after insertion was significantly greater in successful cases than in those in which IUDs were subsequently expelled/displaced (mean difference after PVD insertion, 20.1 mm (P = 0.006); mean difference after PCS insertion, 10.3 mm (P = 0.05)). Logistic regression analysis demonstrated that mode of delivery was not independently associated with successful retention of the IUD (P = 0.72; OR, 0.831 (95% CI, 0.301-2.189)). The distance from the lower end of the IUD to the internal os measured at ultrasound examination prior to hospital discharge provided reasonable predictive accuracy for determining retention of the IUD, with an area under the ROC curve of 0.74 (95% CI, 0.60-0.88) and an optimal cut-off of ≥ 30 mm (sensitivity, 64.71% (95% CI, 52.17-75.92%) and specificity, 80.95% (95% CI, 58.09-94.55%)). CONCLUSIONS: IUD insertion immediately postpartum is feasible but carries a substantial risk of unsuccessful IUD retention. Ultrasound examination after insertion of an IUD could be considered for predicting the success of IUD retention. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd.