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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty

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    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 practice
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    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.
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    Risk of stillbirth at term and optimum timing of delivery in uncomplicated south Asian singleton pregnancies
    (Sri Lanka Medical Association, 2014) Dias, T.; Kumarasiri, S.; Wanigasekara, R.; Cooper, D.; Batuwitage, C.; Jayasinghe, L.; Padeniya, T.
    OBJECTIVES: Aims of this study were to compare the perinatal mortality rate and the prospective risk of stillbirth for each given gestational age and to ascertain whether it is safe to continue the pregnancy beyond 40 weeks of gestational age and induce labour at 41 weeks in low risk singleton pregnancies. METHODS: This was a retrospective study. The perinatal mortality and prospective risk were calculated per 1000 total births and 1000 on going pregnancies respectively in well dated singleton pregnancies. 38+0 to 39+6 gestational age was taken as the reference. RESULTS: A total of 12,595 deliveries after 28 weeks of gestation were included. The risk of stillbirth at 38+0 to 39+6 weeks was 1.43 (95% CI, 0.9 to 2.4) per 1000 on going pregnancies. The perinatal mortality rate at 38+0 to 39+6 weeks was 2.9 (95% CI, 1.9 to 4.5) per 1000 total births. The perinatal mortality rate decreased throughout gestation and it was lowest at 40+0 - 41+6. In contrast, risk of stillbirth increased with advancing gestation and peaked at 40+0 - 41+6 (2.57, 95% CI, 1.4 to 4.7). However, risk of stillbirth at 40+0 - 41+6 was not statistically different from 38+0 to 39+6 (OR 1.79, 95% CI, 0.80 to 3.98). To prevent one stillbirth, 886 pregnancies should be induced at 38+0 to 39+6. CONCLUSIONS: Risk of stillbirth is more informative than perinatal mortality at term. Frequent antenatal fetal surveillance should be adopted towardsterm in order to identify high risk pregnancies. Elective delivery before 40 weeks in low risk pregnancies is not justified
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    Sri Lankan fetal birthweight charts:validation of global reference for fetal weight and birthweight percentiles
    (Sri Lanka Medical Association, 2013) Shanmugaraja, Y.; Kumarasiri, S. G.; Wahalawatte, S. L.; Wanigasekara, R. V.; Begam, P.; Jayasinghe, P. K.; Padeniya, T.; Dias, T.
    INTRODUCTION: Small for gestational age (SGA) is defined as birthweight below the tenth centile at a particular gestational week. Birthweight centiles for different populations are varied. Generic reference for fetal weight and birthweight that could be adapted to local populations was recently described. The purpose of this study was to validate the reference for birthweights adapted to the local population. METHODS: This was a prospective validation study done between January 2012 and July 2012 in well dated pregnancies at General Hospital, Ampara. Observed frequencies of birthweights of 5th, 10th, 50th, 90th and 95th percentiles for Hadlock formula, World Health Organization (WHO)global survey data for Sri Lanka and India were calculated. The expected frequencies for each birthweight centile of our study were compared with observed frequencies. RESULTS: A total of 411 patients were recruited and 207 delivered at 40 weeks (40+0-40+6). The mean birth-weight (SD) at 40 weeks of gestation was 3140g (432g). Hadlock formula and WHO reference data for India overestimate and underestimate most of the birthweights respectively. WHO generic reference adapted to Sri Lanka fitted well with our data. The mean birthweight of our population is similar, and the adapted reference range would identify most of the small fetuses correctly. It would also identify almost all the babies with weight above the 90th centile. CONCLUSIONS: The findings of the study show that the observed distribution of birthweight fitted well with the reference range derived from the WHO global reference range adapted to Sri Lankan population. WHO reference charts can be used effectively in Sri Lankan population
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