Browsing by Author "Dias, T. D."

Now showing 1 - 3 of 3

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.
OBJECTIVE: To identify the ability of acquiring fetal cardiac images 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
Snake bite in pregnancy: A rare case report
(Sri Lanka College of Obstetricians & Gynaecologists, 2017) Perera, M. N. I.; Suthakaran, V.; Kajendran, J.; Dias, T. D.
INTRODUCTION: Snake bite in pregnancy appears to be uncommon. Only few cases have been reported in the literature. Venomous snake bite in a pregnant woman may lead to poor outcome for both mother and the fetus. Anti-venom causes anaphylactic reactions that may have adverse effects on the mother or fetus. CASE REPORT: A 31-year-old G2P1C1, at 11w 3d of gestation presented one hour following a snake bite on her right foot. On admission, she was conscious and oriented. She was complaining of abdominal pain. Her vital signs were stable. There was an induration and erythema with fang marks on the right foot. Systemic examination was normal. On abdominal examination, there was suprapubic tenderness. Patient was kept under close observation and was investigated with coagulation profile as well as whole blood clotting time (WBCT) test which was repeated six hourly. Ultrasound scan confirmed a viable intrauterine pregnancy. Her third WBCT was delayed with prolonged clotting profile. She was treated with polyvalent antivenomserum (AVS) and was given ICU care. Patient recovered completely. Though she was discharged after three days of hospitalization her pregnancy ended up with miscarriage one week later. DISCUSSION: Snake bite is not common in pregnancy. Studies from Africa, India and Sri Lanka revealed that pregnant women accounted for 0.4% to 1.8% of hospitalized snake bite victims. Snake bite carries significant fetal wastage (43%) and maternal mortality (10%). Snake venom is a complex mixture of enzymes which lead to tissue injury, systemic vascular damage, haemolysis, fibrinolysis and neuromuscular dysfunction culminating in either haematological symptoms or neurological manifestations.The common adverse obstetrical events occurring due to snakebite are miscarriage, IUD, and premature labour. Mechanisms which causes fetal death are; fetal anoxia associated with maternal shock after envenomation, abruptio placentae, premature uterine contractions initiated by venom, pyrexia and cytokines released after tissue damage, maternal haemorrhage leading to acute fetal anaemia, supine hypotension syndrome and anaphylaxis to AVS.Anti-venomserum can cause anaphylactic reactions which may have an adverse effect on the mother or fetus. Though the fetal death rates up to 55% to 85% has been reported in mothers given AVS, most authors have recommended anti-venom administration for snake bite during pregnancy. While the safety of anti-venom is unclear in pregnancy, the risks of withholding, likely outweigh the risks of administrating in needy patients.