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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Management of anaemia in pregnancy: experience from a Sri Lankan tertiary hospital unit(Wiley-Blackwell, 2015) Palihawadana, T.; Dias, T.; Motha, C.; Thulya, S.D.; Herath, R.; Wijesinghe, P.S.INTRODUCTION: Higher rates of pregnancy complications have been reported among anaemic pregnant women. Universal iron supplementation during pregnancy is recommended in countries where iron deficiency anaemia (IDA) prevalence rates are high. Sri Lanka also carries out a policy of such supplementation. The effectiveness of such programmes in different settings is variable. A retrospective analysis of the effectiveness of our current policy on prevention and treatment of anaemia was done for programme evaluation. METHODS: The North Colombo Obstetric Database (NORCOD) was used retrospectively to analyse the data between March and August 2014, at the university obstetric unit of the North Colombo Teaching Hospital, Sri Lanka. All singleton pregnancies without medical comorbidities were included in the analysis. Those who did not have haemoglobin (Hb) recording in the first trimester or in the third trimester were excluded at the data cleaning stage. An Hb level of <11 g/dL and a level of <10.5 g/dL were considered as anaemia in first and third trimesters respectively. The prevalence of anaemia at booking, and the Hb status in the third trimester were assessed. RESULTS: A total of 1340 singleton pregnancies were included in the analysis and 74 were excluded from the analysis due to incomplete data. 28.9% (n = 366) were found to be anaemic at booking while 63.9% (n = 809) were with a normal Hb and 7.1% (n = 91) were with an Hb of >13 g/dL. In the third trimester the prevalence of anaemia was 11.5% (n = 146) while 64.7% (n = 820) were with normal Hb and 23.6% (n = 300) were with an Hb of >13 g/dL. Among the anaemic women at booking, 22% (n = 81) persisted to be anaemic in the third trimester while 65% (n = 238) became normal and 12.8% (n = 47) developed a higher Hb level. Among those with a high Hb at booking only 1% became anaemic by third trimester while 40.6% persisted to have a high Hb level. CONCLUSION The prevalence of anaemia in this population was of moderate severity (>20% but <40%) as defined by the WHO. Major shortcoming in our practice is that we were unable to successfully treat nearly quarter of women who present with anaemia at booking, thus highlighting sub-optimal treatment. Furthermore, a policy of universal supplementation seems to over treat women with a high Hb at booking. Therefore, a more individualised supplementation and treatment policy should be encouraged in routine clinical practice.Item 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.