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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  [49 journals]
  • Antenatal cough-induced rib fractures: an uncommon cause of upper
           abdominal pain

    • Abstract: Rib fractures secondary to cough are an uncommon cause of thoracic or abdominal pain in pregnancy. There is little in the literature describing this accidental phenomenon during pregnancy and why fractures occur so easily. In most cases, they are diagnosed fortuitously during the course of investigation for other more common causes of acute chest and upper abdominal pain. We report the case of a 38 year old, G11P5 who was 35 weeks pregnant, admitted with sudden onset right upper quadrant and right sided chest pain post coughing. This pain was caused by a 10th right rib fracture which was managed conservatively with analgesia. Despite numerous reviews, the fracture was not diagnosed. The patient also suffered a rib fracture on the contralateral side in a previous pregnancy. Published on 2017-06-30 00:00:00
  • Safety and Success of immediate post-placental intrauterine device
           insertion at the time of Cesarean Section

    • Abstract: Background: Evidence is building up in favour of insertion of an intrauterine device (IUD) in the immediate postpartum period i.e.: post-placental IUD (PPIUD) insertion with regard to its safety and effectiveness as a method of contraception. PPIUD insertion at the time of Cesarean section (CS) is also a safe and acceptable method. However there is not much research evidence to encourage service providers to adopt this practice. We carried out this study to determine safety and success rates of immediate post caesarean IUD insertion. Materials And Methods: A cross sectional study was conducted on women who underwent PPIUD insertion following childbirth at the Teaching Hospital, Kandy from January 2013 to March 2013. Data were collected by an intervieweradministered questionnaire at postnatal wards as an exit interview. Repeat interviews were carried out at 6 weeks and 6 months since the date of PPIUD insertion. All women were assessed clinically and ultrasonically. Patient perceived morbidities following insertion of PPIUD and expulsion rates were assessed as outcome measures. Result: At the end of 3 months, 121 mothers had undergone PPIUD following CS and 362 following vaginal Delivery (VD). Eight women (6.7%) complained of abdominal pain following PPIUD insertion in the CS group while the same for the VD group was 3(0.8%). Abnormal vaginal bleeding was the second commonest complaint with 5(6%) and 8(2.2%) in CS group and VD group respectively. At the end of the observational period of 6 months, Six (5%) IUDs had been expelled in the CS group, where one (4.5%) was in elective CS and five (5.5%) were in emergency CS. This difference was not significant (p=0.5). The expulsion rate in women in VD group was found to be 17.7% (16), which was significantly higher than the same reported from the CS group (p<0.001). Conclusions: Post caesarean IUD insertion appears to be a safe and effective option at this short term analysis. This could be an effective method of family planning for women wishing for long acting reversible contraception. Considering the poor compliance to other family planning methods and the rate of CS at hospitals, application of this intervention seems feasible. Further studies need to be carried out to evaluate the outcomes at long term. Published on 2017-06-30 00:00:00
  • Classification of perinatal deaths according to ICD-PM: an audit on
           perinatal post-mortems in a tertiary care centre in Sri Lanka

    • Abstract: Introduction: Ending preventable perinatal deaths have become a priority in global public health agenda, highlighting the importance of collecting quality data related to perinatal mortality. Pathological post-mortems and placental examination play a vital role in identifying the cause of death. The objective of this analysis was to classify causes of death according to a uniform classification system, enabling comparison of data in different settings. Congenital malformations were further categorized according to the involved organ system. Method: This is a retrospective analysis of post-mortems of stillbirths (including the placentas) and neonatal deaths already reported at the Department of Pathology, University of Colombo from 2009-2015. Autopsy and placental examination were performed according to standard protocols. The cause of death was classified according to ICD-PM. Results: The study included 291 post-mortems; 198 stillbirths, 7 intra-partum deaths and 86 neonatal deaths. Ante-partum hypoxia was the commonest cause of death in stillbirths (83/198=41.9%), while, congenital malformations was the commonest in intra-partum (5/7=71.4%) and neonatal deaths (38/86=44.2%). Low birth weight and prematurity is the second most common cause in neonatal deaths (24/86=27.9%). Malformations were commonly present in cardiovascular system (stillbirths: 22/47=47%, intra-partum and neonatal deaths: 31/62=50%) followed by respiratory system (stillbirths: 14/47=30%, intra-partum and neonatal deaths: 20/62=32%). Conclusion: Ante-partum hypoxia, congenital malformations and low birth weight and prematurity are the leading causes of death in stillbirths and neonates however, quality data of a prospective study, analyzing maternal and feto/infant pathology together, is required to improve the validity of the results. Published on 2017-06-30 00:00:00
  • Improvements of post caesarean section pain management following the
           introduction of a new pain management protocol

    • Abstract: Objective To evaluate improvements in post-caesarean section (CS) pain management in University Obstetrics Unit, Ragama, Sri Lanka following the introduction of a protocol for post-CS pain management. Methods A complete audit cycle was conducted in University Obstetrics Unit, Ragama, Sri Lanka. Initially a prospective audit was conducted among 126 consecutive CS during July and August, 2016. Basic demographic data and details regarding post-CS analgesia during the first 24 hours were collected. Re-auditing was done four months after the introduction of the protocol. In the re-auditing, 150 post-CS mother were conveniently selected over a period of three months and a coloured visual analogue scale (VAS) was used to assess the level of pain in the re-audit.Results There were no statistically significant difference between demographic details before and after the protocol. Before introduction of the protocol, use of diclofenac sodium rectal suppositories were the commonest analgesic type (42.9%) used. Only 6 (4.8%) out of 126 patients had properly documented pain management plan in the operative notes. None of the analgesics were prescribed for 6 (4.8%) patients. Out of total 126, only 6 (4.8%) subjects had a proper drug chart maintenance with regular analgesics. Forty two (33.3%) women were was not on any analgesics within the first 24 hours. After introduction of the protocol, regular analgesic dosing were given to 140 (93.3%) women with satisfactory drug chart maintenance in 140 (93.3%) cases. Out of 150, 140 (93.3%) patients received analgesia with at least a single method. Mean VAS score was 3.5 (SD 2.0) after first 24 hours. Diclofenac sodium suppository (86.7%) is the commenst first line medication. There was statistically significant difference (P < 0.05) in provision of pain relief after introduction of the protocol.Conclusion There was a significant improvement in post-CS pain management after introduction of a new post-CS pain management protocol. Published on 2017-06-30 00:00:00
  • The agreement between hematological indices obtained from two laboratories

    • Abstract: Introduction: Agreement between hematological indices obtained by different laboratories has been shown to be unsatisfactory in the past. Objectives: To evaluate the agreement between the hemoglobin concentrations (Hb) and between the hematocrits obtained from two laboratories. Method: Consecutive pregnant women (n = 350), with gestations between 12 to 20 weeks, presenting to the Academic Obstetric Unit at the Teaching Hospital Mahamodera Galle (THMG), from 10 November 2014 to 13 January 2015 had their Hb and hematocrit measured by flow-cytometry and hydro-dynamic focusing methods at the Durdan’s Hospital Laboratory, Galle (DHLG) and the colorimetric method at the laboratory of the THMG (THMGL). The agreement between the Hb values and between the hematocrit values obtained from the two laboratories were assessed by comparison of means, Pearson’s correlation, and the calculation of the limits of agreement and the clinical limits of indifference. Results: No significant differences were seen between the mean Hb values and between the mean hematocrit values obtained from the two laboratories. Strong, positive correlations were seen between the Hb values as well as between the hematocrit values obtained from the two laboratories (r =0.86, p < 001 and r =0.83, p < 001 respectively). The limits of agreement and the clinical limits of indifference between the Hb as well as between the hematocrit values obtained from the two laboratories were satisfactory, but individual differences of > 10% were seen in 6.6% of results Conclusion: Although there was good agreement between the Hb values as well as between the hematocrit values obtained from the two laboratories, individual differences of > 10% were seen in 6.6% of cases. Published on 2017-06-30 00:00:00
  • Acceptability of Endometrial Polyp Resection under Local Anaesthesia

    • Abstract: Introduction: New evidence is emerging to suggest that outpatient endometrial polyp removal under hysteroscopic guidance by morcellation with local anaesthesia is non-inferior to in patient polypectomy under general anaesthesia. However, evidence on its acceptability warrants further evaluation. Objective: To assess the patient’s acceptability of endometrial polyp resection under local anesthesia in an outpatient setting. Methodology : A prospective cohort study was carried out for three months on all patients who underwent this procedure under local anaesthesia in a secondary care unit in the United Kingdom. Intra-operative and post-operative acceptability was assessed by a standard questionnaire filled immediately after the procedure and before discharge on the first post-operative day. Results : Fifty patients underwent this procedure. The mean age was 56.48(range36-83). Complete resection of the polyps was achieved in 94% of the patients, while 6% had partial resection without total failure. Average, intra operative, immediate post operative and day 1 post operative pain scores were 2.38, 1.44 and 1.38 respectively and were in the mild category of the Discrete Quantitative Pain Verbal Rating Scale. Seventy eight percent of the patients were totally satisfied with the procedure while 14% and 8% were generally and fairly satisfied. None expressed that the procedure was unacceptable. Ninety four percent opted to recommend the procedure to a friend while 96% of patients expressed their willingness to undergo the procedure under local anesthesia, if they were to have another resection of the polyp. Conclusion: Outpatient hysteroscopic polyp resection by morcellation under local anesthesia is well tolerated and accepted by patients in an outpatient setting. Published on 2017-04-19 00:00:00
  • Presidential address – 2017

    • Abstract: No abstract available Published on 2017-04-19 00:00:00
  • Perinatal asphyxia and hypoxic ischemic encephalopathy – the current

    • Abstract: No abstract available Published on 2017-04-19 00:00:00
  • Cervical cytology screening: knowledge attitudes and behaviour of public
           health midwives in an urban district in Sri Lanka

    • Abstract: Objective: To assess the knowledge, attitudes and behaviour of PHMM on cervical cytology screening.Method: It is a descriptive cross-sectional study. PHMM attached to the MOH division in Galle district were interviewed using a self-administered questionnaire on knowledge on cervical carcinoma screening their attitudes and screening behaviour.Results: Out of a total of 314 PHMM attached to MOH division in Galle only 274 participated in the study. 90% had an above average knowledge on cervical cytology screening and 94% identified cervical cytology as a screening method for cervical carcinoma. Awareness on Human Papilloma Virus (HPV) and DNA testing was low (26%). Correct identification of the target group, recommended interval of screening and benefits of screening by the PHMM were 90%, 98% and 83% respectively, and 94% had a favourable attitude on their role and capacity in cervical cytology screening. PHMM who are over 35-year age group 36 % had not undergone cervical cytology screening. There was a significant increase of overall knowledge with higher levels of educational (r2= 0.025, p=0.004).Conclusion: A vast majority of the PHMM had an above average overall knowledge and positive attitude towards cervical cytology screening and identified it as a screening method. Their awareness regarding HPV DNA as a screening tool for cervical carcinoma was not satisfactory. More than one third of PHMM had not undergone cervical cytology screening themselves. Published on 2017-04-19 00:00:00
  • A rare case of heterophagus twin presented as a footling breech

    • Abstract: No abstract available Published on 2017-04-19 00:00:00
School of Mathematical and Computer Sciences
Heriot-Watt University
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