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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  [48 journals]
  • Central Serous Chorioretinopathy in pregnancy

    • Abstract: No Abstract available Published on 2016-06-14 00:00:00
  • Factors associated with compliance to a course of physical exercises for a
           selected group of primigravida mothers in Sri Lanka

    • Abstract: Introduction: The aim of this study was to assess factors associated with compliance to a course of exercises administered for a selected group of primigravida mothers in second trimester.Methods: This was a descriptive cross sectional and qualitative study performed at a Medical Officer of Health area in Kegalle district. Study population was a group of postnatal mothers who had taken part in the course of exercises from second trimester, for a period of 16 weeks. Sample size was 138 postnatal mothers. Study instruments were a self-administered questionnaire to obtain baseline data, psychological state and compliance to exercises, a diary and an interviewer administered questionnaire for views of husband and household members.Results: There were statistically significant associations between maternal age being less than or equal to 30 years and increase regularity of exercises (p<0.05), levels of education of husbands and the exercise regularity of pregnant mothers (p<0.05) and absence of physical symptoms and increase participation in regular exercises (p<0.05). There was no statistically significant association (p>0.05) between psychological distress status at six weeks postpartum and exercise regularity. There was a statistically significant association (p<0.05) between regularity of exercise and reduced presentation of depression at six weeks postpartum. Lethargy (41%), tiredness (20%), lack of time (16%), lack of privacy (13%) and absence of husband (11%) were reasons for not carrying out exercises regularly. Encouragement and motivation by family members (38%), husband (33%) and Public Health Midwife (27%) and feeling of good health after doing exercises (20%) were the main factors which helped a mother to carry out exercise regularly. Conclusions: Younger age, absence of physical symptoms and absence of depressive symptoms is significantly associated with regularity of exercises as opposed to irregularity Published on 2016-06-14 00:00:00
  • Hypertension in pregnancy

    • Abstract: No abstract available Published on 2016-06-14 00:00:00
  • Complications of blunt versus sharp expansion of the uterine incision in
           lower segment caesarean section. A randomized controlled trial

    • Abstract: Introduction: Caesarean section has now become the most frequently performed major surgical procedure in women in the field of Obstetrics and Gynaecology. There is however a wide variation in the surgical technique of caesarean section. Our objective was to compare incidence of complications associated with blunt versus sharp expansion of the uterine incision at the time of caesarean section.Methods: 274 women who underwent a lower segment caesarean section at North Colombo Teaching Hospital, Ragama was assigned randomly to have the expansion of the primary uterine incision either bluntly using the index fingers of both hands of the surgeon or sharply using a curved scissors. Rest of the surgery was performed alike in all participants.Results: The blunt expansion group (n=141) and the sharp expansion group (n=133) were similar with regard to age distribution, BMI, parity, history of previous LSCS and proportion of elective or emergency procedures and the cervical dilatation at the time of LSCS. The incidence of inadvertent extensions (42.1% vs 28.4%; p=0.02) and the mean time taken to repair the uterine incision (14.9min vs 13.7min; p=0.03) was significantly higher in the blunt expansion group compared to the sharp expansion group. The percentage drop in haematocrit more than 10% (30.8% vs 28.4%; p=0.48) and the drop in haemoglobin more than 2g/dl (22.6% vs 20.6%; p=0.47) was not significantly different in the blunt expansion group compared to the sharp expansion group. Incidence of inadvertent extensions was significantly different (38.5 vs 24.1; p=0.03) during elective LSCS but not during emergency LSCS (50% vs 44.8%; p=0.67) between the blunt expansion group and sharp expansion group. The incidence of inadvertent extensions was significantly higher (36.5% vs 24%; p=0.03) when the cervical dilatation was less than 4cm at the time of LSCS in the blunt expansion group compared to the sharp expansion group. Blunt expansion group required more blood pint transfusions when compared to the sharp expansion group (6 vs 2).Conclusion: The sharp expansion of the uterine incision at the time LSCS is associated with a lower risk of inadvertent extensions as well as extensions into broad ligament and uterine vessels compared to the blunt expansion method.The sharp expansion of the uterine incision is preferable to blunt expansion during LSCS and its advantage is more evident during elective LSCS than during emergency LSCS and when the cervical dilatation was less than 4cm at the time of LSCS. Published on 2016-06-14 00:00:00
  • Knowledge, attitudes and practices regarding antenatal exercises among
           pregnant mothers attending De Soyza Maternity Hospital Colombo

    • Abstract: Introduction: Antenatal exercises provide many health benefits not only to pregnant mothers but also to the fetuses. Adequate knowledge among pregnant mothers is vital to promote practicing of it. The aim of this study was to describe the knowledge, attitudes and practices regarding antenatal exercises and factors associated with them among pregnant women attending De Soyza Maternity Hospital (DMH) Colombo.Methods: A descriptive cross-sectional study was conducted among 110 pregnant mothers with a period of amenorrhoea of 20 weeks or more using an interviewer-administered questionnaire.Results: Knowledge regarding antenatal exercises was ‘poor’ among a majority (72.7%, n=80). Only 6.4% (n=7) and 5.5% (n=6) knew the importance of pelvic floor strengthening exercises and its technique, respectively. Most had somewhat favourable (49.1%, n=54) and favourable (35.5%, n=39) attitudes towards antenatal exercises while overall practices were ‘poor’ with a majority not exercising (86.4%, n=95). The sources of information were written media (49.1%, n =54) and electronic media (48.2%, n=53). Doing a job during pregnancy was significantly associated with possessing a ‘Good/Excellent’ level of knowledge (p=0.02) while living in a district other than Colombo was also associated significantly with a ‘Good/Excellent’ level of knowledge (p=0.039) and a ‘Good’ level of practice (p=0.042). Average family monthly income of > Rs. 25000 was associated with a level of ‘Favorable’ attitude (p=0.004).Conclusion: Knowledge and practices regarding antenatal exercises among pregnant women attending DMH were suboptimal while their attitudes were mostly favourable. Measures should be taken to improve knowledge and practices of antenatal exercises during pregnancy Published on 2016-06-14 00:00:00
  • 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
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