Sri Lanka Journal of Obstetrics and Gynaecology
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Open Access journal
ISSN (Print) 1391-7536 - ISSN (Online) 2279-1655
Published by Sri Lanka Journals Online [45 journals]
- A study on factors associated with clomifene resistance in infertile women
with WHO group II anovulation at a teaching hospital in Sri Lanka
Abstract: Background: Anovulation is a common cause of infertility and induction of ovulation with oral agents such as clomifene is the treatment of choice in women with normogonadotropic anovulation. While such treatment is able to achieve ovulation in many, some women fail to respond thus termed as having clomifene resistance. Knowledge on factors associated with such resistance would enable us to counsel patients more accurately and offer alternative treatment modalities without undue delays. This study was aimed at identifying factors associated with clomifene resistance among infertile women with WHO group II anovulation at a teaching hospital in Sri Lanka. Method: A case control study was done at the Infertility clinic of the North Colombo teaching hospital, Ragama conducted by the department of obstetrics & Gynaecology of the University of Kelaniya. Women with WHO group II anovulation (n=128) were included and underwent induction of ovulation with clomifene citrate starting at a dose of 50mg per day, increased up to 150mg till ovulation was achieved. Those who fail to respond to a maximum dose of 150mg were termed as clomifene resistant. The factors known to be associated with clomifene resistance were compared between the two groups who responded and those who failed to respond. The study was registered with the Sri Lankan clinical trial registry maintained by the Sri Lanka Medical association. The study was funded by the National Science foundation of Sri Lanka through a research grant (Grant No: RG/2007/HS/08) Results: Ovulation was achieved in 77.3% (n=99) of subjects and therefore the prevalence of clomifene resistance was 22.8% (n=29). Among those who responded, 41 did so at a dose of 50mg per day while 40% did with 100mg, thus over 80% achieving ovulation at a dose of 100mg per day or less. The factors associated with clomifene resistance in this population included infertility of more than three years (OR 2.06, 95%CI 1.51-9.14), presence of hirsutism (OR 2.76, 95%CI 1.18-6.46), a higher AFC (16 vs 13, p=0.04), PCOS (OR 2.99, 95%CI 1.06-8.41) and an LH:FSH ratio of > 1(OR3.11, 95%CI 1.33-7.24). Other factors that have been described to be associated with clomifene resistance such as advanced age, a BMI > 25, and a higher ovarian volume did not show any significant associations in this study. Discussion: This study was able to identify factors associated with clomifene resistance in a local population. Most factors identified included clinical and laboratory findings of PCOS thus highlighting the limitations in treatment success of clomifene among women with PCOS. This information may be used in clinical practice to counsel patients prior to treatment or to consider other alternative treatment options such as Letrozole or gonadotropins.
DOI : http://dx.doi.org/10.4038/sljog.v36i3.7715 Sri Lanka Journal of Obstetrics and Gynaecology 2014; 36: 71-73 Published on None
- Prenatal management of fetal supravevtricular tachycardia
Abstract: Introduction: Fetal cardiac arrhythmias are discovered in about 1% of fetuses and most of them are supraventricular tachycardia (SVT). Persistent tachycardia with a fetal heart rate (FHR) more than 220 bpm could lead into congestive cardiac failure and can manifests as non-immune fetal hydrops. With the rapid advancement in fetal echocardiographic skills, such arrhythmias can be diagnosed accurately during prenatal life by using M-mode echocardiogram and Doppler.Case 1: A 28 year old primigravida was referred from Jaffna due to fetal tachycardia and ascites detected at routine scan at 27 weeks. Detailed anomaly scan including cardiac evaluation was performed after admission to our unit and SVT with a heart rate of 278 bpm with hydrops fetalis found with no other gross anomalies. Mother was started on digoxin 0.25mg twice a day and changed in to sotalol 80mgtwice a day after 48 hours. Sotalol omitted and flicanide 100mg twice a day started after 4days. Because of persistently high FHR Cordocentesis done and 30μg of digoxin injected to umbilical vein and 4 days later amioderone 5mg injected. Subsequently FHR decreased to 137 bpm.Case 2: A 38 year old, mother of one was transferred from Badulla due to fetal tachycardia at 36 weeks. Scan at our unit revealed Ebstein anomaly of fetus lead to re-entral tachycardia. Atrial rate was 338 bpm and ventricular rate was 168 bpm. Baby delivered electively and admitted to SCBU.Discussion: Fetal SVTs may be associated with adverse perinatal outcome. Development of fetal hydrops is a poor prognostic factor and placental oedema reduces transfer of drugs to fetus. Early identification and intervention (before development of hydrops) will lead to better perinatal outcome.
DOI : http://dx.doi.org/10.4038/sljog.v36i4.7734Sri Lanka Journal of Obstetrics and Gynaecology Vol.36(4) 2014: 102-103 Published on None
- Neurological disorders in pregnancy and puerperium
Abstract: Objectives: To study the clinical profile of the patients presenting with neurological disorders during pregnancy and puerperium. Methods: The study was carried out at Government General Hospital, Kakinada, Andhra Pradesh, India between June 2006 and May 2007. Patients in pregnancy, postabortal and postpartum period evaluated in Neurology out-patient and in-patient departments and referred to Neurology department, Government General Hospital, Kakinada during this time were included in this study.Results: A total of 55 patients presented during pregnancy and puerperium with neurological disorders. Age of the patients ranged from 17 to 31 years. The total number of deliveries in this hospital during this period was 9726. Out of 55 patients Epilepsy—27[49.09%], Eclampsia—11[20%], Cerebro vascular disorders—6[10.9%], Neuropathies —4[7.27%], Extrapyramidal disorders---2[3.64%], CNS infections—Tubercular meningitis –1[1.81%], Myelopathy—1[1.81%], Toxic/ metabolic encephalopathy—1[1.81%]. Conclusions: Epilepsy was the most common neurological condition followed by Eclampsia and Cerebrovascular diseases. Health education measures for prospective mothers regarding the appropriate, adequate and regular use of anti-epileptic drugs should be taken up. Diligent care is to be taken to watch for neurological deficit in cases of Pre-eclampsia/ Eclampsia to identify special investigation team—Obstetrician, Neurologist, Physicians and Neurologist. The treating team should have the complete knowledge of the effects of rare neurological disorders during pregnancy and puerperium.
DOI : http://dx.doi.org/10.4038/sljog.v36i3.7722 Sri Lanka Journal of Obstetrics and Gynaecology 2014; 36: 74-78 Published on None
- Mirror syndrome: a rare presentation with a trisomy 21 fetus
Abstract: No abstract available
DOI : http://dx.doi.org/10.4038/sljog.v36i3.7726Sri Lanka Journal of Obstetrics and Gynaecology 2014; 36: 83-84 Published on None
- An audit on performance of medical students of the University of Kelaniya
in completing the clinical tasks during their final year obstetrics &
gynaecology clinical attachment
Abstract: No abstract available
DOI : http://dx.doi.org/10.4038/sljog.v36i3.7724Sri Lanka Journal of Obstetrics and Gynaecology 2014; 36: 79-82 Published on None
- The burden of avoidable emergency gynaecological admissions; a service
Abstract: No abstract available.
DOI : http://dx.doi.org/10.4038/sljog.v36i4.7731 Sri Lanka Journal of Obstetrics and Gynaecology Vol.36(4) 2014: 93-95 Published on None
- Correlation between Anti-Mullerian Hormone Levels and Antral Follicle
Numbers in Polycystic Ovary Syndrome
Abstract: Introduction: Polycystic Ovary Syndrome (PCOS) is characterized by clinical and biochemical hyperandrogenism, polycystic ovarian morphology, altered gonadotropin secretion, insulin resistance and /or hyperinsulinemia associated with obesity.Objective: The objective of this study was to compare the correlations between levels of FSH, LH, estradiol, Anti-Mullerian Hormone (AMH), and antralfollicle numbers in women with polycystic ovary syndrome.Methods: PCOS was diagnosed when at least two out of the three parameters were present, according to the Rotterdam criteria. Patients were grouped according to the presence of oligomenorrhea and amenorrhea. Levels of AMH, FSH, LH and Estradiol were determined and a transvaginal ultrasound was performed to determine ovarian volume and the number of antral follicles.Results: Pearson’s correlation revealed a significant correlation (0.283, p =0.01) between AMH and antralfollicle number. It was appetent that the higher the number of antral follicles the concentrations of AMH is also higher. A linear correlation showed that the AMH concentration and the number of antral follicles correlated positively (r =0.303, p =0.002). While the levels of FSH correlated negatively with the number of antral follicles(r = -0.182, p = 0.05).The ovarian volume also correlated positively with the number of follicles (r =0.708, p = 0.000).Conclusions: A significant correlation of AMH with the number of antral follicles was revealed.
DOI : http://dx.doi.org/10.4038/sljog.v36i4.7730Sri Lanka Journal of Obstetrics and Gynaecology Vol.36(4) 2014: 89-92 Published on None
- Birthweight standards - Ability of birthweight percentiles in predicting
abnormal fetal growth and outcome
Abstract: Introduction: Birthweight references for different populations are varied and most of abnormal growth deviations of given populations could be detected by creating local birthweight charts. The aim of this study was to compare the accuracy of commonly used birthweight centile charts in birthweight percentiles in predicting abnormal growth trajectories.Methods: This was a retrospective analytical study conducted between April 2010 and October 2013. Patient data and mortality data were traced from respective units and cross checked with the hospital monthly perinatal statistics. Centile values of >90th (large for gestational age -LGA),10th - 90th (appropriate for gestational age -AGA) and <10th (small for gestational age - SGA) of previously validated Sri Lankan fetal/ birthweight charts were compared with birthweight charts adopted by child health development record (CHDR) and for commonly used Hadlock charts. Proportions of adverse outcomes (perinatal deaths and late neonatal deaths) among preterm (<37 weeks) and term deliveries were also compared for SGA, AGA and LGA in three different birthweight centile charts.Results: Among 12501 singleton births, preterm and term neonates were classified differently for SGA, AGA, and LGA by Sri Lankan, CHDR and Hadlock birthweight references. More than 20% of babies were SGA by CHDR charts. SGA derived from Sri Lankan charts have detected significantly higher proportion of adverse outcomes among preterm babies than Hadlock (OR 2.08 95% CI, 1.21 to 3.56) charts. Furthermore, there is a positive trend in detecting more adverse outcomes among SGA babies from Sri Lankan charts than CHRD and Hadlock charts at term (OR 1.44, 95% CI, 0.66 to 3.12 and OR 1.93, 95% CI, 0.98 to 3.82 respectively).Conclusions: The newly created Sri Lankan birthweight chart detects most true SGA infants. It also improves the classification of abnormalities in birthweight and predicts substantially higher adverse outcomes. These new reference charts are clinically effective and can be used in the Sri Lankan population.
DOI : http://dx.doi.org/10.4038/sljog.v36i4.7729Sri Lanka Journal of Obstetrics and Gynaecology Vol.36(4) 2014: 85-88 Published on None
- The apt use of symphysio – fundal height chart during antenatal
follow up: A multicenter audit
Abstract: No abstract available.
DOI : http://dx.doi.org/10.4038/sljog.v36i4.7732 Sri Lanka Journal of Obstetrics and Gynaecology Vol.36(4) 2014: 96-98 Published on None
- Laparoscopic management of Dermoid Cyst with Elevated Carbohydrate antigen
DOI : http://dx.doi.org/10.4038/sljog.v36i4.7733Sri Lanka Journal of Obstetrics and Gynaecology Vol.36(4) 2014: 99-101 Published on None