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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Family planning among Medically ill people in a sri lankan setting: a descriptive study(Sri Lanka College of Obstetricians and Gynaecologists, 2007) Palihawadana, T.S.; Fernando, W.S.; Mallawaarachi, W.P.P.K.; Attanayake, A.M.J.H.; Motha, M.B.C.; Wijesinghe, P.S.INTRODUCTION: Sri Lanka has a high contraceptive prevalence with a low total fertility rate. In spite of this, unmet need of family planning among medically ill people is observed in day to day clinical practice. Medical illnesses complicating pregnancy are a major cause of maternal morbidity and mortality in Sri Lanka. This is thought to result from non usage as well as use of methods with low efficacy. We studied the contraceptive usage among people suffering from medical illnesses as a preliminary survey of a large scale study. METHOD: The study was carried out at the medical clinics of the Colombo North teaching hospital from March to July, 2007. Those who suffer from medical conditions that could complicate a pregnancy were interviewed to find out the family planning practices and identify the limiting factors for uptake of modern methods. Sixty seven sexually active subjects who are in their reproductive age group were interviewed for the research purpose. RESULTS: Study population comprised of 55% of Buddhists, 38% Catholics and 6% Islamics. Mostly encountered medical conditions were diabetes mellitus (n=18), hypertension (n=15), Valvular heart disease (n=10) and thyroid dysfunction (n=6). Seven subjects were planning for a pregnancy at the time of interview though none of them had been advised that it is safe to do so. Nearly 80% (n-53) of subjects admitted to practicing family planning. However, among them 71% (n=38) were using the traditional methods of family planning, where calendar method was the most commonly used (43.3%) followed by withdrawal (20.8%) and the cervical mucous (75%) methods. Norplant was the most commonly used modern method (13.2%) while other methods used included combined contraceptive pill (9.4%), intrauterine contraceptive device (3.8%) and DMPA (1.9%). None of the study subjects practiced male or female sterilisation. Of the total study population 35.8% (n=24) had received family planning advice from the family health midwife after diagnosis of their condition, while only 6% (n=4) had such advice at the medical clinic. CONCLUSIONS: Though family planning is practiced by a high proportion of medically ill people, only a minority use modern methods. High prevalence of traditional family planning usage make this group vulnerable to unintended pregnancies due to the low efficacy of the methods used by them. Family planning advice does not seem to adequately reach this more deserving population. Possible reasons for this could be either the reluctance of field health workers to dispense modern methods of family planning to these people or the deficiencies in the family planning program to reach such special groups, thus stressing the point that such services should be integrated at the level of the medical clinic.Item Dengue fever with bleeding manifestations in pregnancy: our experience(Sri Lanka College of Obstetricians and Gynaecologists, 2004) de Silva, B.A.; Palihawadana, T.S.; Fernando, W.S.; Wijesinghe, P.S.Dengue fever, a mosquito borne flavivirus infection is endemic in Sri Lanka. An increased number of cases are seen in the recent past. An increase in the number of patients with secondary infection who are prone to develop complications such as bleeding manifestations, are expected due to repeated outbreaks of the disease, We report four cases of serologically confirmed Dengue fever. Different management strategies were adopted in each patient according to the clinical circumstances. Three antenatal mothers presented in 33, 38 and 39 weeks of POA and bleeding manifestations were present in all three of them. One of them died of an intracerebral haemorrhage after Caesarean section to deliver a stillborn following intrauterine death. Post Partum Haemorrhage (PPH) was experienced in another mother following caesarean section. In one patient bleeding manifestation appeared 2 days following normal delivery. She was managed conservatively. Though the clinical presentations may be similar to that of non pregnant patients, there can be many pitfalls in diagnosis and management of dengue fever occurring in pregnancy. Two of the patients described above developed acute dengue viral hepatitis, which needs to be differentiated from HELLP syndrome and acute fatty liver of pregnancy. Serological tests have a special place in diagnosis than in the non pregnant patients. The classical criteria used to identify Dengue Haemorrhagic fever (DHF), such as an increased haemotocrit and postural hypotension were not present in these patients. In management, the administration of intravenous fluids needed to be more closely observed. They seemed to be more prone to develop bleeding manifestations than non pregnant patients and therefore platelet transfusions were required in early stages. Early interventions to deliver the baby, if the other circumstances permit, seem to offer a better outcome in patients presenting in the antenatal period.Item A study on the incidence and the outcome of teenage pregnancies and the associated socio-economic factors: an interim analysis(Faculty of Medicine, University of Kelaniya & Plan International, 2008) Palihawadana, T.S.; Motha, M.B.C.; Fernando, W.S.; Wijesinghe, P.S.INTRODUCTION: Teenage pregnancy is known to be associated with adverse pregnancy outcomes for both the mother and her offspring. Knowledge on the socio-economic conditions associated with teenage pregnancy and the short term and intermediate outcomes would provide information useful in prevention and management of teenage pregnancy. OBJECTIVE: To describe the prevalence of teenage pregnancy in a low risk population and two identified high risk populations and to identify the associated socio-economic characteristics as well as to assess the incidence of short term and intermediate adverse outcomes in the mother and the offspring. METHODS: The study will be conducted in three phase. The prevalence of teenage pregnancy and associated socio-economic factors would be assessed at three study settings of Ragama, Nuwara Eliya and Puttalam. Second phase would be at Ragama and the pregnancy outcome of the teenage mothers would be compared against a parity matched sample of controls while in phase three a community based follow up study would be done in teenage mothers who delivered at Ragama Hospital two years ago to assess the intermediate outcome of mothers and their offspring. Here we report the results of the Ragama component of Phase I and a part of the data accumulated for Phase II. RESULTS: Review of records of 5249 deliveries yielded a teenage pregnancy rate of 4.74% (n=249). Results pertaining to 25 subjects and 50 parity matched controls in phase I and 102 subjects with 179 controls are described here. The distribution according to religion and ethnicity was not different between the subjects and the controls. The occupations and marital status as well as alcohol consumption of fathers did not demonstrate a difference between the teenage mothers and the controls. Five percent of subjects were not married while all were married in the control group (p<0.05). There was a significant difference in the educational level between subjects and controls (p<0.001); education beyond Ordinary level was 14% in subjects as compared to 33% among