Conference Papers

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This collection contains abstracts of conference papers, presented at local and international conferences by the staff of the Faculty of Medicine

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Author: search.filters.author.Perera, W.M.L.

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    Trends in perinatal out come at teaching hospital peradeniya during the period of 1986-2004
    (Sri Lanka College of Obstetricians and Gynaecologists, 2005) Ganeshananthan, S.; Amarasinghe, W.I.; Perera, W.M.L.; PHerath, H.M.R.; Dias, T.D.
    INTRODUCTION: The obstetric care has tremendously improved over the past two decades worldwide, resulting in better maternal and perinatal outcome. To move forward we need to assess whether the standard of care provided at TH Peradeniya has also similarly advanced. Objectives: To analyze the trends in perinatal out come at TH Peradeniya and to refine the tertiary level obstetric care. METHOD: Retrospective descriptive study to analyze monthly perinatal statistics in the hospital during the period of 1" of January 1986 to 31" October 2004. RESULTS AND DISCUSSION: Crude perinatal mortality rate has shown a significant drop, reaching 22.9 per 1000 births in 2004, from 44.87 per 1000 births in!986.This is a reflection of improvement in obstetric and neonatal care. The gradual decline observed in admission to special care baby unit, from 179.9 per 1000 live births in 1986 to 144.2 per 1000 live births in 2004, reflects the improvement in intrapartum care. Intra uterine growth restriction was on the rise from 0.30 per 1000 live births in 1995 to 7.8 per 1000 live births in 2004 indicating, possibly more detection rate with application of advanced radiological technology. A decline found in neonatal septicaemia from 4.4 per 1000 live births in 1986 to 2.1 per 1000 live births in 2004 is because of effective implementation of infection control measures and judicious use of antibiotics. A significant drop noted in birth asphyxia, from 14.7 per 1000 live births in 1986 to 4.1 per 1000 live births in 2004, which can be due to improvement in intrapartum care and steady rise in caesarean section rate. A downward trends was observed in need for ventilatory support can be explained by the wide spread use of antenatal corticosteroids .It has dropped to 4.9 per 1000 live births in2004, from 5.2 per 1000 live births in 1986.Congenital abnormalities have declined from 12.8 per 1000 live births in 1986 to 7.7 per 1000 live births in 2004 possibly due to the pre-conceptual folic acid supplementation -But, the trend is on the rise from 3.1 per 1000 live births in2001 to 7.7 per 1000 live births in2004 indicating probable increase in the incidence. A decline observed in number of preterm deliveries from 49.5 per 1000 live births in!986 to 24-7 per 1000 live births in2004, could possibly due to improvement in facilities of fetal surveillance, which could have allowed obstetricians, to prolong the pregnancies until maturity. Alarmingly, meconium aspiration rate has risen from 7.7 per 1000 live births in!986 to 10.8 per 1000 live births in 2004.Currently an audit is underwayjo find out the possible causes. CONCLUSION: Most of the areas in perinatal outcome reflect improving trends. Increase in meconium aspiration rate needs urgent audit and remedial measures.
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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.