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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 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 populationItem Accuracy of ultrasound estimated fetal weight formulae to predict actual birthweight after 34 weeks: prospective validation study(Sri Lanka Medical Association, 2013) Kumarasiri, S.; Wanigasekara, R.; Wahalawatta, L.; Jayasinghe, L.; Padeniya, T.; Dias, T.OBJECTIVES: Late onset fetal growth restriction is often missed and is responsible for most intrauterine deaths. Ultrasound fetal biometry is routinely used to calculate estimated fetal weight (EFW). The aim of this study was to determine the accuracy of established ultrasound EFW formulae to identify small and large for gestational age fetuses when used after 35 weeks gestation. METHODS: This was a prospective validation study done between January 2012 and July 2012 at General Hospital Ampara. An ultrasound examination was performed and fetal biometry was documented within one week before the delivery in well dated pregnancies. The mean of the differences between ultrasound EFW derived from 9 formulae and true birthweight and their standard error of mean (SE) were calculated for each formula. Systematic measurement error was assumed to exist if zero lay outside the mean difference ± 2SE. To show the EFW frequency distribution, z-scores were calculated as the number of standard deviations an observed EFW measurement deviated from the mean for gestation. RESULTS: A total of 393 pregnancies at gestational age between 35 and 41 weeks were recruited. Mean gestational age at the ultra sound scan was 39.36 weeks SD (1.05). All EFW formulae either under or over estimated the birthweight in singleton pregnancies. Almost all the formulae over estimated the fetal weight in low birthweight babies whilst underestimating the fetal weight in birthweight >3500g. Campbell formula remained the only EFW formula without systematic error when measuring babies between 2500g and 3500g. None of the EFW z-scores were normally distributed. CONCLUSIONS: This study found that all routinely used EFW formulae would either over or under estimate the fetal weight. Until an optimum EFW formula that suits the Sri Lankan population is determined, interpretation of ultrasound EFW should be done cautiously, especially in small for gestational age babiesItem Early pregnancy growth and pregnancy outcome in twin pregnancies(Sri Lanka Medical Association, 2010) Dias, T.; Bhide, A.; Thilaganathan, B.OBJECTIVES: The objective of this study was to determine the association of crown-rump length (CRL) discrepancy in monochorionic and dichorionic twins with subsequent pregnancy outcomes. METHOD: A retrospective analytical study was performed among 660 twin pregnancies over 12 years in one fetal medicine tertiary referral center in the United Kingdom. A literature search was performed to identify all reports in the English language literature in this topic between 1998 and 2009. RESULTS: Five hundred and six dichorionic and 154 monochorionic twin pregnancies were studied. Median percentage CRL discordance in monochorionic and dichorionic pregnancies was not different (3.9 +/- 8.34, range 0-59 and 3.2 +/- 5.65 range 0-37.5, respectively, p = 0.225). Single or double fetal loss was higher in monochorionic twins than the dichorionic twins. Loss rate was 17.53% (27) and 3.95% (20) respectively (p = < .0001). CRL disparity and birth weight discordancy showed statistically significant correlation (Spearman's rho, p = 0.040). Statistically significant correlation was seen between percentage CRL disparity and pregnancy loss rate (p = 0.008). However, the sensitivity of this CRL discrepancy to detect subsequent fetal loss or birth weight discordance is poor. INTERPRETATION: CRL discrepancy is independent of chorionicity in twins. CRL discrepancy is correlated to subsequent pregnancy loss and birth weight discordance, but the clinical utility of this observation is limited. The difference in twin CRL at 11-14 weeks is likely to represent physiological variation in a majority of cases.