Browsing by Author "Dias, T."

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The Ability of ICU admission to detect maternal near misses as defined by the who near-miss criteria
(Sri Lanka College of Obstetricians & Gynaecologists, 2015) Bower, G.; Dias, T.; Shanmugaraja, V.; Lee, M.; Cooper, D.; Crofton, H.; Kumarasiri, S.; Padeniya, T.
OBJECTIVE: to assess the ability of intensive care unit (ICU) admission in pregnancy, or the postpartum period, to detect cases of obstetric near-miss. METHODS: All obstetric admissions to the ICU were included retrospectively and data collected as specified by 2011 World Health Organization (WHO) guidelines on evaluating obstetrics near-misses between 2010 and 2013 in a Sri Lankan Hospital. Proportion of ICU admissions which fulfilled the WHO criteria for Severe Acute Maternal Morbidity (SAMM), maternal mortality ratio (MMR), maternal near-miss mortality ratio (MNM: MM)), and maternal near-miss ratio (MNMR) were analysed. RESULTS: A total of 9,608 live births were reported. 118 ICU admissions and four maternal deaths were analysed. MMR was 42 per 100,000. MNMR was 9.7 per 1000, and MNM: MM was 23:1. From all ICU admissions 99 cases (79.8%) met additional WHO near-miss criteria and were classified as true SAMM. Pregnancy-induced hypertensive disorders accounted for majority of ICU admissions (37.7%). Out of eight published studies from our region none of them had a MNM: MM higher than ours. CONCLUSIONS: Obstetric near-misses may be over-diagnosed if ICU admission is considered an independent inclusion criterion for SAMM. Reporting the proportion of patients admitted to ICU which are true near-miss may illustrate differing admission thresholds for a given institution.
Accuracy of ultrasound estimated fetal weight formulae to predict actual birthweight after 34 weeks: prospective validation study
(Sri Lanka Medical Association, 2013) Kumarasiri, S.; Wanigasekara, R.; Wahalawatta, L.; Jayasinghe, L.; Padeniya, T.; Dias, T.
OBJECTIVES: Late onset fetal growth restriction is often missed and is responsible for most intrauterine deaths. Ultrasound fetal biometry is routinely used to calculate estimated fetal weight (EFW). The aim of this study was to determine the accuracy of established ultrasound EFW formulae to identify small and large for gestational age fetuses when used after 35 weeks gestation. METHODS: This was a prospective validation study done between January 2012 and July 2012 at General Hospital Ampara. An ultrasound examination was performed and fetal biometry was documented within one week before the delivery in well dated pregnancies. The mean of the differences between ultrasound EFW derived from 9 formulae and true birthweight and their standard error of mean (SE) were calculated for each formula. Systematic measurement error was assumed to exist if zero lay outside the mean difference ± 2SE. To show the EFW frequency distribution, z-scores were calculated as the number of standard deviations an observed EFW measurement deviated from the mean for gestation. RESULTS: A total of 393 pregnancies at gestational age between 35 and 41 weeks were recruited. Mean gestational age at the ultra sound scan was 39.36 weeks SD (1.05). All EFW formulae either under or over estimated the birthweight in singleton pregnancies. Almost all the formulae over estimated the fetal weight in low birthweight babies whilst underestimating the fetal weight in birthweight >3500g. Campbell formula remained the only EFW formula without systematic error when measuring babies between 2500g and 3500g. None of the EFW z-scores were normally distributed. CONCLUSIONS: This study found that all routinely used EFW formulae would either over or under estimate the fetal weight. Until an optimum EFW formula that suits the Sri Lankan population is determined, interpretation of ultrasound EFW should be done cautiously, especially in small for gestational age babies
Anaemia among females in child-bearing age: Relative contributions, effects and interactions of α- and β-thalassaemia.
(Public Library of Science, 2018) Mettananda, S.; Suranjan, M.; Fernando, R.; Dias, T.; Mettananda, C.; Rodrigo, R.; Perera, L.; Gibbons, R.; Premawardhena, A.; Higgs, D.
INTRODUCTION: Anaemia in women during pregnancy and child bearing age is one of the most common global health problems. Reasons are numerous, but in many cases only minimal attempts are made to elucidate the underlying causes. In this study we aim to identify aetiology of anaemia in women of child bearing age and to determine the relative contributions, effects and interactions of α- and β-thalassaemia in a region of the world where thalassaemia is endemic. METHODS: A cross sectional study was conducted at the Colombo North Teaching Hospital of Sri Lanka. The patient database of deliveries between January 2015 and September 2016 at University Obstetrics Unit was screened to identify women with anaemia during pregnancy and 253 anaemic females were randomly re-called for the study. Data were collected using an interviewer-administered questionnaire and haematological investigations were done to identify aetiologies. RESULTS: Out of the 253 females who were anaemic during pregnancy and were re-called, 8 were excluded due to being currently pregnant. Of the remaining 245 females, 117(47.8%) remained anaemic and another 22(9.0%) had non-anaemic microcytosis. Of anaemic females, 28(24.8%) were iron deficient, 40(35.4%) had low-normal serum ferritin without fulfilling the criteria for iron deficiency,18(15.3%) had β-haemoglobinopathy trait and 20(17.0%) had α-thalassaemia trait. Of females who had non-anaemic microcytosis, 14(66.0%) had α-thalassaemia trait. In 4 females, both α- and β-thalassaemia trait coexist. These females had higher levels of haemoglobin (p = 0.06), MCV (p<0.05) and MCH (p<0.01) compared to individuals with only β-thalassaemia trait. A significantly higher proportion of premature births (p<0.01) and lower mean birth weights (p<0.05) were observed in patients with α-thalassaemia trait. CONCLUSIONS: Nearly one third of anaemic females in child bearing age had thalassaemia trait of which α-thalassemia contributes to a majority. Both α- and β-thalassaemia trait can co-exist and have ameliorating effects on red cell indices in heterozygous states. α-Thalassaemia trait was significantly associated with premature births and low birth weight. It is of paramount importance to investigate the causes of anaemia in women of child bearing age and during pregnancy in addition to providing universal iron supplementation.
Antenatal care:paradigm changes over the years
(Sri Lanka Medical Association, 2013) Goonewardene, M.; Dias, T.
This paper describes the antenatal care practices in Sri Lanka
The apt use of symphysio - fundal height chart during antenatal follow up: A multicenter audit
(Sri Lanka College of Obstetricians and Gynaecologists, 2014) Palihawadana, T.S.; Wasalthilaka, C.; Dias, T.
Assessing IADPSG criteria for gestational diabetes mellitus diagnosis in Sri Lankan pregnant women
(Sri Lanka College of Obstetricians & Gynaecologists, 2018) Dissanayake, D. M. T. C.; Dias, T.; Siraj, S. H. M.; Aris, I. M.; Li, L. J.; Tan, K. H.
INTRODUCTION AND OBJECTIVES: Gestational diabetes mellitus (GDM) is a condition of glucose intolerance first recognized during pregnancy. Currently, the guidelines for diagnosing GDM, as recommended by the International Association of Diabetes and Pregnancy Study Groups (IADPSG) and adopted by the World Health Organization (WHO) in 2013, include an elevation in either fasting ( 5.1 mmol/L), 1-hr (10.0 mmol/L) or 2-hour (8.5 mmol/L) venous plasma glucose level after a 75-gram glucose intake. IADPSG criteria is widely adopted in many countries. Clinicians have questioned the applicability of these diagnostic thresholds for different ethnicities. Therefore, we aimed to examine the prevalence of GDM diagnosed by three different guidelines and its association with offspring birthweight, in a hospital-based observational study among Sri Lankan pregnant women. METHODS: Medical records of 795 women with singleton pregnancy who attended two tertiary hospitals in Sri Lanka were utilized for the following information: age, height, weight and gestational age at the booking visit, 75g oral glucose tolerance test with fasting, 1- and 2-hour glucose readings after 20 weeks of gestation, and offspring birthweight. Body mass index was calculated at the booking visit. Following diagnostic thresholds were applied to define GDM: IADPSG criteria, Sri Lanka national guideline and WHO 1999. We calculated crude and age- and BMI-adjusted prevalence rates of GDM using STATA. Venn diagrams were used to represent the individual and overlapping diagnosis of GDM by each time point of glucose level. RESULTS: The crude, and age- and BMI adjusted GDM prevalence, were as follows: 31.2% and 31.2% for IADPSG criteria; 21.3% and 27.4% for Sri Lanka national guidelines; and 21.8% and 28.0% for WHO 1999. GDM diagnosed using the IADPSG criteria, or using Sri Lankan guidelines, had significant associations with birthweight in unadjusted models, yet the associations attenuated to non-significance after adjusting for age and BMI. It is notable that effect estimates for birthweight did not differ greatly among women diagnosed with GDM by IADPSG only and in those diagnosed with GDM by IADPSG and Sri Lankan guidelines. Linear regression of GDM diagnosed by WHO 1999 was not associated with birthweight in either unadjusted or adjusted models. CONCLUSIONS: The IADPSG criteria appeared to have a better diagnostic value, in terms of identifying cases of GDM and in predicting birthweight across all three guidelines. Our results suggest that adopting the IADPSG criteria for diagnosing GDM may be important in reducing hyperglycaemia-related outcomes in Sri Lankan women.
Birth weight differences at term are explained by placental dysfunction, but not by maternal ethnicity
(John Wiley & Sons, 2018) Morales-Roselló, J.; Dias, T.; Khalil, A.; Fornes-Ferrer, V.; Ciammella, R.; Gimenez Roca, L.; Perales-Marín, A.; Thilaganathan, B.
OBJECTIVE: The main aim of this study was to investigate the influence of ethnicity, fetal gender and placental dysfunction on birth weight (BW) in term fetuses of South Asian and Caucasian origin. METHODS: This was a retrospective study of 627 term pregnancies assessed in two public tertiary hospitals in Spain and Sri Lanka. All fetuses underwent a scan and Doppler examination within two weeks of delivery. The influences of fetal gender, ethnicity, gestational age (GA) at delivery, cerebroplacental ratio (CPR), maternal age, height, weight and parity on BW were evaluated by multivariable regression analysis. RESULTS: Fetuses born in Sri Lanka were smaller than those born in Spain (mean BW= 3026g±449g versus 3295g±444g, p<0.001). Multivariable regression analysis demonstrated that GA at delivery, maternal weight, CPR, maternal height and fetal gender (estimates=0.168, p<0.001; 0.006, p<0.001; 0.092, p=0.003; 0.009, p=0.002; 0.081, p=0.01) were significantly associated with BW. Conversely, no significant association was noted with maternal ethnicity, age and parity (estimates= -0.010, p=0.831; 0.005, p=0.127; 0.035, p=0.086). The findings were unchanged when the analysis was repeated using IG21 EFW instead of BW centile (-0.175, p=0.170; 0.321, p<0.001). CONCLUSIONS: Fetal BW variation at term is less dependent on ethnic origin and better explained by placental dysfunction.
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
Blood flow changes in pelvic vessels associated with the application of an abdominal compression belt in healthy postpartum women
(Sri Lanka Medical Association, 2017) Dias, T.; Patabendige, M.; Herath, R.P.; Garvik, T.I.; Liland, F.; Arulkumaran, S.
INTRODUCTION: Postpartum haemorrhage (PPH) accounts for a high proportion of maternal mortality and morbidity throughout the world. A uterine compression belt which has been developed recently represents a very low tech, low cost solution in managing postpartum haemorrhage. OBJECTIVES :To evaluate the blood flow changes in pelvic vessels following application of the postpartum haemorrhage compression belt (Laerdal Global Health, Stavanger, Norway). METHODS: The sample included healthy postpartum women within 6 hours of vaginal delivery. The study was performed at Teaching Hospital, Ragama, Sri Lanka. PPH compression belt was applied on the lower abdomen in a supine position with a slight lateral tilt. Patient’s pulse, blood pressure and Doppler indices (RI, PI and PFV) of the uterine, internal iliac and femoral arteries were measured using transabdominal Doppler ultrasonography. Lower limb oxygen saturation was also measured. Measurements were obtained by connecting the subjects to a multimonitor throughout the study period of 20 minutes. Median RI, PI and PFV was calculated and comparisons were made between the baseline and after belt application at 10 and 20 minutes. RESULTS: A total of 20 healthy women were included and the mean time from delivery to study inclusion was 2.5 (range 0.5–5.0) hours. There were no adverse outcomes or altered vital signs noted among participants. Overall there were no significant changes in the internal iliac, uterine and femoral artery blood flow after application of the compression belt. CONCLUSIONS: There were no significant changes in the internal iliac, uterine and femoral artery blood flow after application of the compression belt. This preliminary study only shows that the application of the PPH compression belt has no apparent adverse changes in the iliac, uterine and femoral artery blood flow in postpartum mothers.
A comparison between ultrasonically assessed cervical volumes with modified bishop score to predict the favourability of the uterine cervix prior to induction of labour
(Sri Lanka College of Obstetricians & Gynaecologists, 2018) Athulathmudali, S.R.; de Silva, P.H.P.; Dias, T.; Palihawadana, T.; Chandrasinghe, S.K.; Solangaarachchi, D I.K .
INTRODUCTION AND OBJECTIVES: Induction of labour (IOL) is one of the most frequently performed obstetric interventions. In current obstetric practice approximately 15-20% of women undergo induction of labour. Sri Lanka has the highest prevalence of IOL in the region (35%) according to WHO. Conventionally Bishop score system have been used to assess pre induction cervical favourability for vaginal delivery. Several recent studies have proposed that transvaginal sonographic assessment of cervical length is more sensitive in prediction of obstetric outcome in induction of labour. The purpose of this study was to comparatively assess the predictive value of ultrasonically assessed cervical volume, in compared to Modified Bishop’s score, prior to IOL. The primary objectives of the study were To compare the cervical volume with Modified Bishop Score for assessing the favorability of cervix prior to induction of labour. To evaluate the women’s perception on degree of discomfort caused by a transvaginal ultrasound scan at term. METHODS: Study was carried out as a cross sectional study. Pre induction digital cervical assessment and transvaginal two dimensional sonographic cervical volume assessment was done in 120 consecutive women admitted for IOL at term, by two different clinicians who were unaware of each other's findings. IOL was done according to a standard protocol, uniformly in all women. All the obstetric outcomes including induction delivery interval were documented.RESULTS: Out of 125 study participants 83(66.4%) were nulliparous and 42 (33.6%) were multiparous. The mean gestational age at induction of labour was 40 weeks. Vaginal delivery succeeded in 97 (77.6%) women and 28 (22.4%) of women needed caesarean section. In vaginal delivery group, in 65 (52%) women, delivery occurred within first twenty-four hours of primary modality of induction. In 56% of nulliparous women vaginal delivery occurred in first 24 hours compared to 85% of multiparous women. The median induction to delivery interval in multiparous women was 9 hours and in nulliparous women it is 19 hours. Induction success and likelihood of vaginal delivery within first 24 hours, increased with Bishop Score and decreased with cervical volume in a linear correlation. There was a significant association between induction to delivery interval (IDI) with the Bishop score and the cervical volume. Out of 125 study participants, 110 (88%) experienced minimal or no pain during procedure. 15 (12%) experienced moderate discomfort and no study participant report severe pain or discomfort.CONCLUSIONS: Transvaginal cervical volume assessment is comparable to Modified Bishop’s core, in predicting the likelihood of vaginal delivery within 24 h following IOL. It doesn’t cause significant discomfort to the pregnant women, when performed at term.
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.
Controversies in management of multiple pregnancy
(Sri Lanka College of Obstetricians and Gynaecologists, 2013) Dias, T.
This article focuses mainly on controversies in screening and prevention of preterm labour (PTL), fetal growth restriction (FGR) and preeclampsia in multiple pregnancy
Cord entanglement and perinatal outcome in monoamniotic twin pregnancies
(Wiley, 2010) Dias, T.; Mahsud-Dornan, S.; Bhide, A.; Papageorghiou, A. T.; Thilaganathan, B.
OBJECTIVES: To assess the prevalence of cord entanglement and perinatal outcome in a large series of monoamniotic twin pregnancies and to review the recent literature on similar published large series. METHODS: Prospective observational study of all prenatally detected cases of monoamniotic twin pregnancies during an 8-year period in a tertiary fetal medicine unit. A Medline database review for publications since 2000 containing five or more cases of monoamniotic pregnancies that showed data on cord entanglement and perinatal outcome was also undertaken. RESULTS: A total of 32 monoamniotic pregnancies were diagnosed during the study period, including three conjoined twins, seven pregnancies with twin reversed arterial perfusion (TRAP) syndrome, three surgical pregnancy interruptions for discordant fetal abnormality and one miscarriage before 16 weeks' gestation. The remaining 18 monoamniotic pregnancies were included in the study analysis. All monoamniotic pregnancies were complicated with antenatal cord entanglement diagnosed by B-mode and color Doppler ultrasound. There were 34 live births and a double intrauterine death diagnosed at 19 + 2 weeks' gestation. There were two late neonatal deaths, one from congenital complete heart block and the other after surgery for transposition of the great arteries. The overall perinatal loss rate was 11.1% after 16 weeks and 5.9% after 20 weeks' gestation. The cumulative rates of cord entanglement and perinatal mortality in the reviewed literature were 74% and 21%, respectively. CONCLUSIONS: Umbilical cord entanglement is present in all monoamniotic twins when it is systematically evaluated by ultrasound and color Doppler. Perinatal mortality in monoamniotic twins is mainly a consequence of conjoined twins, TRAP, discordant anomaly and spontaneous miscarriage before 20 weeks' gestation. Expectantly managed monoamniotic twins after 20 weeks have a very good prognosis despite the finding of cord entanglement. The practice of elective very preterm delivery or other interventions to prevent cord accidents in monoamniotic twins should be re-evaluated.
Crown-rump length discordance and adverse perinatal outcome in twins: analysis of the Southwest Thames Obstetric Research Collaborative (STORK) multiple pregnancy cohort.
(Wiley, 2013) Dias, T.; Thilaganathan, B.
OBJECTIVE: Evidence for the role of first-trimester ultrasound in predicting outcome in twin pregnancies is conflicting. The aim of this study was to determine the association between crown-rump length (CRL) discordance and adverse perinatal outcome in twin pregnancies. METHODS: This was a retrospective study of all twin pregnancies of known chorionicity from a large regional cohort over a 10-year period. Terminations of pregnancy, cases with fetal or chromosomal abnormalities and monoamniotic pregnancies were excluded. Receiver-operating characteristics (ROC) curve and logistic regression analyses were performed to evaluate the association between CRL discordance and stillbirth, neonatal mortality, intrauterine growth restriction, preterm birth (PTB) at < 34 weeks' gestation and birth weight (BW) and ultrasound estimated fetal weight (EFW) discordance of ≥ 25%. RESULTS: A total of 2155 twin pregnancies were analyzed, of which 420 were monochorionic (MC) and 1735 dichorionic (DC). There were 42 fetal losses before 24 weeks' gestation and 23 perinatal deaths. CRL discordance was poorly predictive for fetal loss at < 24 weeks (area under the ROC curve (AUC), 0.54 (95% CI, 0.46-0.62)), perinatal loss (AUC, 0.52 (95% CI, 0.41-0.64)), BW discordance (AUC, 0.61 (95% CI, 0.56-0.65)), BW < 5(th) centile (AUC, 0.56 (95% CI, 0.53-0.59)), EFW discordance (AUC, 0.55 (95% CI, 0.51-0.60)) and PTB at < 34 weeks (AUC, 0.50 (95% CI, 0.47-0.54)). Overall mortality was significantly higher in MC (5.0%) than in DC (2.6%) twins (P = 0.016). Logistic regression analysis demonstrated that chorionicity (odds ratio 2.09 (95% CI, 1.06-4.10); P = 0.033) independently contributed to determining mortality, while CRL discordance (P = 0.201) did not. Adjusting for chorionicity did not improve the detection of adverse outcomes using CRL discordance. CONCLUSION: In the absence of aneuploidy or structural fetal abnormality, CRL discordance is of poor predictive value for adverse perinatal outcome in both MC and DC twin pregnancies. CRL discordance should not be used routinely to identify twin pregnancies at high risk of adverse perinatal outcome. Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd.
Determinants of timely pregnancy dating scan in a Sri Lankan antenatal clinic setup
(Sri Lanka College of Obstetricians and Gynaecologists, 2015) Dias, T.; Fernando, A.; Kumarasiri, S.; Padeniya, T.
Background: Early accurate estimation of gestational age is the most important intervention in pregnancy. Ultrasound between 11 and 13 weeks is most reliable in dating. There is no uniform policy in timing of dating scan in Sri Lanka. Objective: Aim of this study was to find out factors that determine the timely dating scan before 14 weeks in a district general hospital in Sri Lanka. Methods: This was a prospective observational study carried out at District General Hospital in Sri Lanka. A detail history was taken in order to ascertain age, parity, menstrual history, time taken to reach the hospital, distance to the hospital, level of education and gestation at the first booking visit with public health midwife (PMH). We offered dating scans for every pregnant mother before 14 weeks. Logistic regression analyses were performed to evaluate the association of socio-demographic factors and receiving timely dating scan before 14 Weeks. Results:A total 199 women were included for the analysis with a mean age of 26.98 years (SD 5.58). A 190 out of total recruitments (95.5%) were booked with PHM before 14 weeks. A total of 171 (86%) pregnant women received their first scan before 14 weeks. Logistic regression analysis demonstrated that only booking before 14 weeks with PMH (Odds ratio 12.272 (95% CI, 4.563-33.000) p<0.000) contributed significantly to receive dating scan before 14 weeks, while maternal age, parity, time taken to reach the hospital, distance to the hospital and mother’s level of education did not. Conclusion: Our study showed it is entirely possible to offer dating scan before 14 weeks even in a peripheral District General Hospital. Moreover, we demonstrated that none other than booking before 14 weeks was determined the dating scan prior to 14 weeks.
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.
Diabetes mellitus in pregnancy – a Sri Lankan experience
(Wiley-Blackwell, 2015) Dias, T.; Palihawadana, T.; Motha, C.; Thulya, S.D.
INTRODUCTION Diabetes mellitus in pregnancy carries high perinatal morbidity/mortality and maternal morbidity. Only a proportion of women would have pre-existing diabetes mellitus with the majority developing gestational diabetes (GDM). The burden of diabetes in pregnancy is expected to increase in Sri Lanka as obesity is high among pregnant population. Aims of this study were to look at the prevalence, risk factors and complications of diabetes in pregnancy. METHODS The North Colombo Obstetric database (NORCOD), which records pregnancy data of all women delivering at the university obstetric unit of the North Colombo Teaching hospital, Ragama, Sri Lanka, was used for retrospectively analysis. 1830 deliveries between March and August 2014 were included. Those with incomplete data were excluded. Details regard to prevalence, associated risk factors and complications were identified. RESULTS: Diabetes mellitus complicated 130 (7.1%) pregnancies. This consisted of 26 with pre-existing disease and 104 with GDM. A positive family history in first degree relative (OR 7.87, 95% CI 5.08–12.1), and a BMI of >23 kg/m2 (OR 2.68 95% CI 1.75–4.11) were associated with development of GDM. The mean (SD) age was significantly higher among women who developed GDM compared to those did not (32.1 (4.76) versus 28.7 years (4.7), P = 0.03 respectively). The mean (SD) postprandial blood sugar (PPBS) estimate done in the first half of the pregnancy was significantly higher among women who developed GDM later in pregnancy compared to those who did not (120 (39.2) versus 95 mg/dL (14.6), P < 0.0001 respectively). Hypertensive disorders of pregnancy was significantly associated with diabetes in pregnancy (OR 2.39 95% CI 1.49–3.83) and a birthweight of >3 kg at term (OR 1.63 95% CI 1.11–2.40). CONCLUSION: Diabetes mellitus complicates a significant number of pregnancies. Pre-existing diabetes constitutes one fifth of thesepregnancies, highlighting the importance of provision of preconception care to women contemplating pregnancy. A positive family history increases the risk of GDM by nearly 8 fold. Abnormal PPBS results in early part of pregnancy, in women who later develop GDM suggest the presence of abnormal glucose homeostasis in this group even at early stages of pregnancy. This has the potential for developing in to a test of early detection of GDM in pregnancy.
Does antenatal ultrasound labeling predict birth order in twin pregnancies?
(Wiley, 2013) D'Antonio, F.; Dias, T.; Thilaganathan, B.; Southwest Thames Obstetric Research Collaborative (STORK)
OBJECTIVE: It is often assumed by obstetricians, neonatologists and parents that the prenatal nomenclature used to identify twins on ultrasound is consistent with twin labeling after their birth. The aim of this study was to use a large regional database of twin ultrasound scans to validate the effectiveness of a scan before delivery in predicting twin birth-order. METHODS: A large regional database of twin ultrasound scans with data from nine hospitals over a 10-year period was used to identify all ultrasound examinations carried out just before birth. The discordance in twin order between the last scan and birth was evaluated by observing discrepancies in fetal sex and weight. RESULTS: In total, 2103 twin pregnancies with ultrasound estimated fetal weights (EFWs) and birth weights were assessed. Of these, fetal sex was recorded in 149 different-sex pregnancies. Discrepancy between antenatal labeling and the anticipated birth order was noted in 37.6% (56/149) of cases when judged by sex discordance and in 36% (757/2103) of cases when judged by weight discordance. Multiple logistic regression analyses demonstrated that weight discordance, but not chorionicity, scan-to-delivery interval, gestation at scan or gestation at delivery, significantly influenced the change in birth order (P < 0.001). CONCLUSION: Antenatal ultrasound labeling does not predict twin birth-order in a significant proportion of twin deliveries. This finding should be borne in mind not only by parents, but also by physicians when delivering twins discordant for anomalies that are not evident on external examination
Does emigration by itself improve birth weight? Study in European newborns of Indo-Pakistan origin
(Elsevier Ltd, 2023) Morales-Roselló, J.; Buongiorno, S.; Loscalzo, G.; Scarinci, E.; Dias, T.; Rosati, P.; Lanzone, A.; Marín, A.P.
OBJECTIVE: Our aim was to evaluate the effect of emigration on fetal birth weight (BW) in a group of pregnant women coming from the Indian subcontinent. METHODS: This was a retrospective study in a mixed population of pregnant women from the Indian subcontinent that either moved to Europe or stayed in their original countries. The influence of emigration along with several pregnancy characteristics: GA at delivery, fetal gender, maternal age, height, weight, body mass index (BMI) and parity on BW was evaluated by means of multivariable linear regression analysis. RESULTS: According to European standards, babies born to Indo-Pakistan emigrants and babies born to women staying in the Indian subcontinent were similarly small (BW centile 30± 29 and 30.1 ± 28, p<0.68). Multivariable regression demonstrated that emigration by itself did not exert a direct influence on BW (p = 0.27), being BMI and gestational age at delivery the true determinants of BW (p<0.0001). Conclusions: Maternal BMI is the most relevant parameter affecting fetal growth regardless of the place of residence. © 2023
Early fetal loss in monochorionic and dichorionic twin pregnancies: analysis of the Southwest Thames Obstetric Research Collaborative (STORK) multiple pregnancy cohort
(Wiley, 2013) D'Antonio, F.; Khalil, A.; Dias, T.; Thilaganathan, B.; Southwest Thames Obstetric Research Collaborative (STORK)
OBJECTIVES: Monochorionic (MC) twins are at increased risk of early fetal loss secondary to vascular complications such as twin-twin transfusion syndrome (TTTS). This study compared the early perinatal loss rates between MC and dichorionic (DC) twins in an era of invasive treatment for TTTS. METHODS: This was a retrospective study of all twin pregnancies of known chorionicity from a large regional cohort of nine hospitals over a 10-year period. Ultrasound data were matched to hospital delivery records and to a mandatory national register of pregnancy losses. Prospective risk of pregnancy loss from 14 to 24 weeks' gestation was calculated and the survival trend of MC and DC twins was analyzed using Kaplan-Meier survival analysis. RESULTS: The analysis included 3117 twin pregnancies (605 MC and 2512 DC). The total risk of early pregnancy loss (miscarriage and neonatal death) before 24 weeks was significantly higher in MC twins (60.3 per 1000 fetuses) than in DC twins (6.6 per 1000 fetuses), with a relative risk of 9.18 (95% CI, 6.0-13.9). Survival analysis showed a significant difference in overall and early mortality between MC and DC twins (log-rank test, P < 0.0001), while no difference was noted after 24 weeks' gestation (log-rank test, P = 0.08). CONCLUSIONS: Early pregnancy loss is significantly more common in MC than in DC twins, but no difference in the prospective risk of mortality between MC and DC twins is evident after 24 weeks' gestation. The observed early mortality rate has almost halved in comparison with previous studies in the published literature. Early detection and prompt treatment of complications in MC twins are likely to have contributed to this improvement in outcome. Copyright © 2012 ISUOG. Published by John Wiley & Sons Ltd.