Medicine
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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
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Item 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 practiceItem 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.