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Journal Cover Sri Lanka Journal of Obstetrics and Gynaecology
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  This is an Open Access Journal Open Access journal
   ISSN (Print) 1391-7536 - ISSN (Online) 2279-1655
   Published by Sri Lanka Journals Online Homepage  [47 journals]
  • Fetal Growth Restriction (FGR) - Identification and Management

    • Abstract: No abstractSri Lanka Journal of Obstetrics and Gynaecology Vol.37(3) 2015: 27-30 Published on 2016-02-22 00:00:00
  • The Ability of ICU Admission to Detect Maternal Near Misses as Defined By
           The Who Near-Miss Criteria

    • Abstract: Objective: to assess the ability of intensive care unit (ICU) admission in pregnancy, or the postpartum period, to detect cases of obstetric near-miss.Methods: All obstetric admissions to the ICU were included retrospectively and data collected as specified by 2011 World Health Organization (WHO) guidelines on evaluating obstetrics near-misses between 2010 and 2013 in a Sri Lankan Hospital. Proportion of ICU admissions which fulfilled the WHO criteria for Severe Acute Maternal Morbidity (SAMM), maternal mortality ratio (MMR), maternal near-miss mortality ratio (MNM: MM)), and maternal near-miss ratio (MNMR) were analysed.Results: A total of 9,608 live births were reported. 118 ICU admissions and four maternal deaths were analysed. MMR was 42 per 100,000. MNMR was 9.7 per 1000, and MNM: MM was 23:1. From all ICU admissions 99 cases (79.8%) met additional WHO near-miss criteria and were classified as true SAMM. Pregnancy-induced hypertensive disorders accounted for majority of ICU admissions (37.7%). Out of eight published studies from our region none of them had a MNM: MM higher than ours.Conclusions: Obstetric near-misses may be over-diagnosed if ICU admission is considered an independent inclusion criterion for SAMM. Reporting the proportion of patients admitted to ICU which are true near-miss may illustrate differing admission thresholds for a given institution.Sri Lanka Journal of Obstetrics and Gynaecology Vol.37(3) 2015: 31-37 Published on 2016-02-22 00:00:00
  • Outcome of Non-Descent Vaginal Hysterectomy at a Single Centre in Sri
           Lanka: an Observational Study

    • Abstract: Introduction: Hysterectomy is the commonest major gynaecological surgery performed worldwide. Though many routes of hysterectomy are described, open abdominal approach remains the commonest route to date for indications other than genital prolapse. There is evidence of advantages of non-descent vaginal hysterectomy (NDVH) over abdominal hysterectomy in such indications. However, the acceptance rate for vaginal approach by the gynaecologists remains low. We describe the outcome data of a series of non-descent vaginal hysterectomies performed in a single centre in Sri Lanka.Objectives: To describe the post-operative outcome and complications of NDVH for benign indications of uteri less than 14 weeks size.Method: An observational study was undertaken at the ward 14 of The De Soysa Maternity Hospital, Colombo over a period of one year from May 2007 to April 2008 among women who underwent NDVH for benign conditions. Those with co-existing genital prolapse requiring surgical correction, uteri larger than 14 weeks, a history of previous abdominal surgery and medical co-morbidities were excluded from the study.Results: The study included 53 patients who underwent NDVH. The majority had a normal sized uterus 39 (73.6%). There was a statistically significant improvement in post-operative urinary index compared to pre-operative urinary index [Kruskal-Wallis test-6.155, degrees of freedom = 2, p < 0.05 (0.046)]. There was no difference in pre-operative and post-operative bowel function. The frequency of coitus and patient satisfaction appear to have improved post-surgery. Most patients [n=45 (85%)] had a faster than expected recovery. There were no visceral injuries and only one patient required blood transfusion following surgery. One patient developed a urinary tract infection. The mean post-operative hospital stay was 4.11 days (95% CI=3.48-4.74 days).Conclusions: The outcome and complication rates of non-descent vaginal hysterectomy this series were comparable with evidence from literature. Therefore, we conclude that NDVH is a feasible option for benign gynaecological conditions with a uterus less than 14 weeks in size in the current gynaecological practice of Sri Lanka.Sri Lanka Journal of Obstetrics and Gynaecology Vol.37(3) 2015: 42-46 Published on 2016-02-22 00:00:00
  • A Clinical Study of Maternal and Fetal Outcome in Abruptio Placenta -
           Couvelaire Uterus a Preventable Obstetric Catastrophe

    • Abstract: Introduction : Hemorrhage is the single most important cause of maternal death worldwide. Obstetrical hemorrhage accounts for almost half of all postpartum deaths in developing countries. Among them Abruptio placenta occurs in around 1% of all pregnancies. Aim of this study was to determine the maternal and fetal outcome in pregnancy complicated by abruption placenta in relation to the risk factors.Methods: This was a retrospective study conducted in the Department of Obstetrics and Gynecology, Mamata medical college, khammam from January 2010 to December 2014 for a period of five years. All pregnant women who were diagnosed with abruptio placenta after 28 weeks of gestation were included in the study. Patients were identified from the admission and labour room registers.Results: Total number of deliveries during the study period were 4000. Patients identified with abruptio placenta were 100, giving a frequency of 2.5%. Majority women were multigravidae and 56% of all the between 26-30 years of age. The mean gestational age at diagnosis was 34 ± 4.21 weeks. Vaginal bleeding was the most common clinical finding seen in 80% of the women, followed by blood stained amniotic fluid in 16% suggesting concealed abruption placenta. Fetal heart sounds were absent on admission in 65% of the women. Most common cause of abruption 44% was either patients with past history of pre – eclampsia or PIH in the present pregnancy. 9 patients with couvelaire uterus were identified and treated effectively. Among them, two patients died due to postpartum hemorrhage. Parity and gestational age were found to be significant risk factors for abruptio placentae.Conclusion: Abruptio placenta was associated with poor maternal and fetal outcomes. Early diagnosis and significant treatment of pre eclampsia during the antenatal period would prevent abruption and related complications.Sri Lanka Journal of Obstetrics and Gynaecology Vol.37(3) 2015: 38-41 Published on 2016-02-22 15:04:06
  • Teenage Pregnancies: Obstetric Outcomes and their Socio Economic
           Determinants a Descriptive Study at Teaching Hospital Kandy

    • Abstract: Introduction: Teenage pregnancies account for approximately 6.1% of total pregnancies in Sri Lanka. The objectives of the study were to assess obstetric and psychological outcomes and socioeconomic determinants of teenage pregnancy.Method: A cross-sectional descriptive study carried out on 182 pregnant teenagers for a period of seven months. The validated translation of the Edinburgh Postnatal Depression Scale (EPDS), questions on socioeconomic status and obstetric outcomes were recorded.Results: Teenage pregnancy rates for Singhalese, Tamil and Muslim were 87.4%, 8.2% and 4.4% respectively. The social support was adequate as 177(97%) were living with partners or parents. Unwanted pregnancies accounted for 13(7.1%) of teenage pregnancies at term. Outcomes were; birth weight 2.69 kg (2.57-2.81kg), pre-term labour 17(9.7%), hypertensive disorders 20(11.1%) and perinatal depression 30(16.5%). 75(42.9%) of pregnant teenagers were separated from one or both parents for more than six months in their childhood. There were no pregnant teenagers from upper social class, while 69(46.6%) were from middle and 79(53.4%) were from lower social class. Disruption to family structure and parental educational level of primary school less had 2.32 times and 2.78 times higher risk of perinatal depression in pregnant teenagers respectively.Conclusion: Teenage pregnancies in Sri Lanka are unique compared to other countries as they did not appear to be related to ethnicity and had good social support. Disruption to family structure and socioeconomic background of the parents were risk factors for adolescent pregnancy. Although the majority were wanted pregnancies there was a significant amount of unwanted pregnancies at term.Sri Lanka Journal of Obstetrics and Gynaecology Vol.37(3) 2015: 47-53 Published on 2016-02-22 00:00:00
  • Assessment of Tumour Vascularity by Transvaginal Colour Doppler
           Ultrasound: a Novel Prognostic Factor of Cancer Cervix

    • Abstract: Background :Transvaginal Color Doppler Ultrasound is proposed as a novel prognostic tool in women with cervical cancer. We evaluated the assessment of tumour vascularity as a prognostic factor and its correlation with other well-known prognostic factors such as tumour size, parametrial invasion and lymph node status determined by MRI.Method : Transvaginal Colour Doppler Ultrasound (TVCDUS) was used to assess vascularity of tumour among 56 patients with histologically proven cervical carcinoma. A visual analyzing system of 1 to 5 was used to grade vascularity. Correlation between the visual grading of vascularity and size of lesion, lymphadenopathy and stromal invasion were studied.Result: All patients who had a tumour volume of >0.1cm3 had abundant vascularisation (a vascularity of 4 or more on visual grading). Thirteen out of 15 patients who had lymphadenopathy had a visual grading of vascularity of 4 or more. Out of 45 patients who showed parametrial invasion 20 had a visual grading of vascularity of>=4.Conclusion : The vascularity of tumour as assessed by TVCDUS correlated very well with well established prognostic factors of cancer cervix such as lymphadenopathy, parametrial invasion and size of tumour mass lesion. Transvaginal Colour Doppler ultrasound is a useful non-invasive method to assess tumour vascularity, which has some value in predicting prognosis..Sri Lanka Journal of Obstetrics and Gynaecology Vol.37(1) 2015: 6-9 Published on 2015-11-06 00:00:00
  • Non-Invasive Prenatal Testing (NIPT) for Low-Risk Women

    • Abstract: No abstract available Sri Lanka Journal of Obstetrics and Gynaecology Vol.37(1) 2015: 13-15 Published on 2015-11-06 00:00:00
  • Xanthogranulomatous inflammation in female pelvis: a diagnostic and
           therapeutic challenge

    • Abstract: Xanthogranulomatous inflammation is an unusual form of chronic inflammation that can present clinically with destructive or obstructive symptoms. It may also mimic malignancy at times. It is a rare entity as far as female genital tract is concerned. Histologically well characterized by a massive infiltration of the tissues by lipid-laden histiocytes, it usually poses diagnostic and therapeutic challenges for the clinician. We present here two interesting cases of the same, encountered by us.Case 1: A 42-year-old lady with history of intra-uterine device (IUD) in situ for 8 years presented with a picture of acute on chronic pelvic inflammatory disease (PID). She was started on inpatient CDC regimen of PID. Despite this her symptoms persisted and based on high index of suspicion she was started empirically on anti-tubercular treatment (ATT). Three months later she presented again with similar complaints. Laparotomy picture was typical of abdominal tuberculosis and thus multiple biopsies were obtained. Histo-pathological report showed xanthogranulomatous inflammation. As there is no specific treatment for this condition, patient was continued with ATT. On three, six and twelve months follow up patient had been asymptomatic.Case 2: A 48 year old lady with history of vaginal hysterectomy 6 months ago presented with right sided hydro-uretero nephrosis. CT scan showed this was because of external compression caused by an adnexal mass measuring 5.8×3.9 cms. She underwent laparotomy with right oophorectomy. Right distal ureter was fibrotic so was excised and Boari flap was done. Histopathological diagnosis rendered was Xanthogranulomatous inflammation with abscess formation and chronic ureteritis with fibrosis.Xanthogranulomatous inflammation of the genital tract is enigmatic disorder of unknown etiology. Gynecologist should be aware of this entity whenever the clinical presentation is atypical and not fitting into a diagnosis, or when the patient is not responding to conventional treatment of PID. Early diagnosis and management is very important as it can cause tissue destruction or may lead to obstructive disasters. Sri Lanka Journal of Obstetrics and Gynaecology Vol.37(1) 2015: 18-20  Published on 2015-11-06 00:00:00
  • Invasive prenatal testing at a Tertiary Fetal Medicine referral center in
           Sri Lanka: A service evaluation audit

    • Abstract: No abstract available Sri Lanka Journal of Obstetrics and Gynaecology Vol.37(1) 2015: 10-12 Published on 2015-11-06 00:00:00
  • Choriocarcinoma of the ovary: a case report

    • Abstract: Ovarian choriocarcinoma whether gestational or non-gestational, is an extremely rare malignant germ cell tumour. We report a young patient with an ovarian choriocarcinoma who was successfully treated with fertility sparing conservative surgery and adjuvant chemotherapy. Sri Lanka Journal ofObstetrics and Gynaecology Vol.37(1) 2015: 16-17 Published on 2015-11-06 00:00:00
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