Browsing by Author "Kumara, D.A.K.J."

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    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.
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    Time and the risk of ruptured tubal pregnancy
    (Sri Lanka College of Obstetricians and Gynaecologists, 2005) Dias, T.D.; Herath, H.M.R.P.; Perera, W.M.L.; Dharmarathne, S.D.; Kumara, D.A.K.J.; Amarasinghe, W.I.
    OBJECTIVES: Tubal pregnancy remains an important cause of maternal morbidity and mortality. "We sought to quantify the relationship between onset of symptoms, period of amenorrohoea, site of ectopic pregnancy and risk of tubal rupture. METHODS: A retrospective analysis of in-patient records (bed head tickets) of 83 mothers presented to the Gynaecology Department of the THP during 2003 and 2004 were carried out. The risk of tubal rupture with time and other related factors were assessed and analysed. RESULTS: Time between onset of symptoms and treatment varied from 7 hours to 1080 hours (45 days) with a mean 125 hours (5days). Overall 76% of women experienced tubal rupture (n=63). There was one death reported in 2004. The mean time between onset of symptoms and treatment in two groups (ruptured and not ruptured) varied 1 lOhrs to 173hrs and showed statistically significant difference in two groups (p = 0.017, 95% CI - -163.6 to 37.72). The study did not show statistically difference in mean period of amenorrhoea at presentation 44 and 45 days in two groups (p - 0.851 95% CI- -11.72 to-9.32). There was no statistically difference in mean age (29.8, 29.4 years) in two group (p- 0.793, 95%CI — -3.3 to -3.0).Our study did not observe statistically significant association between the site of tubal ectopic and the rupture (p=0.932) Discussion: Despite advances in the diagnosis and treatment of tubal pregnancy, rupture remains a significant problem. Our study confirmed that the time between onset of symptoms and treatment is an important risk factor for rupture. However, there is a wide range in the time between symptom onset and treatment, yet there .were women who experienced nearly one and half month of symptoms and did not go on to rupture. Therefore we recommend early confirmation of site of pregnancy with transvaginal ultra sound scan.