Sri Lanka Journal of Obstetrics and Gynaecology最新文献

{"title":"Usefulness of knowledge in anatomy of the internal iliac artery in its ligation during life-threatening pelvic haemorrhages","authors":"Sri Lanka, Vasitha Abeysuriya, H. Dodampahala, L. Chandrasena","doi":"10.4038/sljog.v45i2.8079","DOIUrl":"https://doi.org/10.4038/sljog.v45i2.8079","url":null,"abstract":"Introduction: Post-Partum haemorrhage is a significant cause of maternal mortality. Bilateral internal iliac artery ligation is a life-saving procedure to control massive obstetric and gynaecological haemorrhages. Bilateral internal iliac artery ligation results in toning down the pulsatility making the arterial flow a slow venous flow encouraging the clot formation of the damaged pelvic vessels. This study assesses the retroperitoneal anatomy and regional variations of the internal iliac artery.Methods: The study was based on examining 45 pelvic halves (23 right sides and 22 left sides), which were dissected during the gross anatomy laboratory at the faculty of medicine, Ragama, University of Kelaniya, from 2020 -2023. There were all adult pelvises. The internal iliac artery and its major branches were carefully dissected and examined. Adachi classification was used to classify the distribution pattern of the internal iliac artery. The study was done on the donated cadavers, and the nature of the study did not warrant any special ethical clearance. No conflict of interest.Results: No anatomical deviation has been noted with regard to the levels of division of aorta, common iliac artery, the division into internal and external iliac arteries and the division of anterior and posterior branches of the internal iliac artery from that of classical anatomical literature. It was also noted that there had been no significant deviation of anatomical relations with regard to the structures as described in the internal lilac artery in our study. In our study, Type Ia was found in 35/45 (78%) of the specimens, Type IIa in 3/45 (6%), Type III in 7 (16%), and no specimens were found with Type IV and. Type V.Conclusion: Our study showed no significant anomalies of the pelvic anatomical structural relations to the internal iliac artery. The type Ia branching pattern was found to be the commonest.","PeriodicalId":186118,"journal":{"name":"Sri Lanka Journal of Obstetrics and Gynaecology","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122368849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The risky journey! – Can we help more?","authors":"S. Warnasuriya","doi":"10.4038/sljog.v45i2.8102","DOIUrl":"https://doi.org/10.4038/sljog.v45i2.8102","url":null,"abstract":"No abstract available","PeriodicalId":186118,"journal":{"name":"Sri Lanka Journal of Obstetrics and Gynaecology","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121640025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incisional herniae following lower segment caesarean section: A 20-year chart review","authors":"Sri Lanka, Vasitha Abeysuriya, H. Dodampahala, L. Chandrasena","doi":"10.4038/sljog.v45i2.8078","DOIUrl":"https://doi.org/10.4038/sljog.v45i2.8078","url":null,"abstract":"Introduction: The rates of caesarean delivery is increasing worldwide as well as in Sri Lanka. Incisional hernia is a known complication of abdominal surgery. To our knowledge there has been no study to assess the incidence of incisional hernia following caesarean section in Sri Lanka. This study was to assess the incidence of incisional hernia requiring surgical repair after lower segment caesarean section (LSCS) in a cohort during a 20-year period.Methods: This was a chart review based on tertiary care private sector hospital in Sri Lanka. Hernia repairs performed during 2002 to 2022 were identified. The data was retrieved from computer based data base and previous bed head tickets. The main inclusion criterion was a caesarean delivery from the 01st of January 2002 to 31st of December 2022 in women with no history of previous abdominal surgery. The cohort was assessed from their first caesarean delivery until 20 years in the inclusion period for an event of hernia repair. The following exclusion criteria for the hernia repairs were used: Diastasis rectiwithout hernia, hernia not in the caesarean incision, and no hernia. The study was approved by the Research and Ethical Committee of Nawaloka Hospital Sri Lanka. The patient records and the data-set were anonymized before analysis. No conflict of interest.Results: There were 2675 records retrieved. The mean age of the patients was 28±7.5 years. There were 10/2675 (0.37%) patients were found to incisional herniae following LSCS. The majority (7/10) of patients with incisional hernia had lower midline incisions for their LSCS. The average time duration of the occurrence of incisional hernia following a single LSCS was 19.5±2.3 months and it was 14.3±1.6 and 12.3±1.5 months for following second and third LSCS respectively. Majority of the incisional herniae were done as routine cases. Following the incisional hernia repair one patient had a recurrence after year.Conclusion: The overall incidence of having an incisional hernia requiring repair of a caesarean delivery was 0.37%. Most herniae appeared within the first two years and associated with the lower midline incisions.","PeriodicalId":186118,"journal":{"name":"Sri Lanka Journal of Obstetrics and Gynaecology","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128429519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validation of RobsApp - Audit tool for Caesarean Section Trends","authors":"Chandana S. Jayasundara, Indu A. Jayawaradane, Dulani L. Samaranayake, Ananda Perera","doi":"10.4038/sljog.v45i2.8097","DOIUrl":"https://doi.org/10.4038/sljog.v45i2.8097","url":null,"abstract":"Robson classification is a globally recognised method in systematically classifying all pregnant women admitted for delivery. The World Health Organization (WHO) and the International Federation of Gynecology and Obstetrics (FIGO) recommend the Robson classification as a global standard for assessing, monitoring and comparing CS rates within and between heath care facilities, over time. Continuous audit of admission and delivery data is an essential component in service quality improvements including caesarean section rates. Previously we have reported data acquisition and quality as the main problems in carrying out a continuous audit in absence of a centralised electronic database. We developed and validated an app based on the hybrid JQuery Mobile (JQM) technology with an option for scalability to the regional and national level in the future for real time acquisition and analysis of admissions data in a maternity care setting using Robson classification.","PeriodicalId":186118,"journal":{"name":"Sri Lanka Journal of Obstetrics and Gynaecology","volume":"122 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133852983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hereditary leiomyomatosis and renal cell cancer syndrome","authors":"A. K. Prabodhana Ranaweera, D. Hettiarachchi, K. W. Gunawardena, M. D. S. Lokuhetty, V. H. W. Dissanayake","doi":"10.4038/sljog.v45i2.8070","DOIUrl":"https://doi.org/10.4038/sljog.v45i2.8070","url":null,"abstract":"Introduction: Hereditary leiomyomatosis and renal cell cancer syndrome (HLRCC) is a rare autosomal dominantly inherited cancer predisposing syndrome giving rise to cutaneous and uterine leiomyomatosis, leiomyosarcoma and renal cell cancer. Patients with this syndrome harbours germline pathogenic variants in the fumarate hydratase (FH) gene.Case presentation: A 28-year-old Sri Lankan female, a product of a consanguineous marriage with strong family history of young onset fibroids presented with progressive dysmenorrhea, menorrhagia and irregular menstrual cycles for 2 years duration. There was recent onset lower abdominal colicky pain lasting for 3-5 min occurring during the post coital and intermenstrual period over 2 months. Examination did not reveal abnormal skin lesions or abdominal masses.Ultrasound examination revealed enlarged uterus with 2 large fibroids in the posterior wall and fundus of the uterus. She underwent laparoscopic myomectomy without perioperative complications. Histology revealed a leiomyoma with morphological features supporting the variant “fumarate hydratase deficient leiomyoma”.Whole exome sequencing of the patient revealed her to be harbouring a pathogenic variant c.878T>G| p:Val293Gly in the FH gene for which she was heterozygous confirming that she had inherited the cancer predisposing syndrome of hereditary leiomyomatosis and renal cell cancer(HLRCC). Postoperatively her symptoms resolved, and she was able to sustain an uncomplicated pregnancy one year after. Currently she is closely followed up for future development of tumors including renal cell cancer bothclinically and via imaging.Conclusion: HLRCC is a rare autosomal dominantly inherited cancer syndrome predisposing to skin, uterine and renal tumors warranting surveillance at a younger age.","PeriodicalId":186118,"journal":{"name":"Sri Lanka Journal of Obstetrics and Gynaecology","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135047470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A clinical audit on uptake of delayed cord clamping at caesarean sections","authors":"M. Jayawardane, A. Rubasinghe, A. Fernando, D. Rathnapriya","doi":"10.4038/sljog.v45i1.8059","DOIUrl":"https://doi.org/10.4038/sljog.v45i1.8059","url":null,"abstract":"","PeriodicalId":186118,"journal":{"name":"Sri Lanka Journal of Obstetrics and Gynaecology","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129426720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of a case of large uterine leiomyoma with deep vein thrombosis","authors":"M. Sangeethaa, A. Abeysekara","doi":"10.4038/sljog.v45i1.8092","DOIUrl":"https://doi.org/10.4038/sljog.v45i1.8092","url":null,"abstract":"Deep venous thrombosis (DVT) is a potentially fatal condition. The association of this condition with uterine leiomyoma has rarely been reported in the medical literature. In this report we present a rare case of left lower limb DVT in a 30-year-old woman with a large fibroid. She is sub fertile for 8 years and had a history of heavy menstrual bleeding for 6 months. Examination revealed 20-week size abdominopelvic mass. She had developed left lower limb DVT, 3 months back and imaging investigation confirmed DVT in left femoral vein. She was on an oral anticoagulant. The patient was successfully managed with Inferior Vena Cava (IVC) filter insertion and abdominal myomectomy. Multidisciplinary involvement involving gynaecologist, haematologist, interventional radiologist and anaesthetist are crucial for successful outcome.","PeriodicalId":186118,"journal":{"name":"Sri Lanka Journal of Obstetrics and Gynaecology","volume":"133 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127319633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Research on reasons for not accepting postpartum family planning in first 48 hours, in a tertiary care hospital","authors":"A. Atapattu, P. Senthilnathan","doi":"10.4038/sljog.v45i1.8080","DOIUrl":"https://doi.org/10.4038/sljog.v45i1.8080","url":null,"abstract":"","PeriodicalId":186118,"journal":{"name":"Sri Lanka Journal of Obstetrics and Gynaecology","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126790595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The usefulness of flexible sigmoidoscopy in bleeding per rectum during pregnancy: an observational study","authors":"V. Abeysuriya, S. Dodampahala, L. Chandrasena","doi":"10.4038/sljog.v45i1.8068","DOIUrl":"https://doi.org/10.4038/sljog.v45i1.8068","url":null,"abstract":"Introdction: Bleeding per rectum is not an infrequent complaint during pregnancy, which may require endoscopic evaluation and treatment. Flexible sigmoidoscopy is a relatively simple, quick procedure. The current study was aimed to assess the usefulness of flexible sigmoidoscopy in bleeding per rectum during pregnancy from a single tertiary care centre. Methods: A single centre retrospective study was carried out. Randomly selected 1000 medical records of the pregnant mothers who were referred as out patients and hospitalized from 2012 to 2022 were retrieved. All patients had the passage of fresh blood as their chief complaint. All of them had not undergone any prior diagnostic workup for their presentation. All had undergone flexible sigmoidoscopies and patients with significant additional bowel symptoms underwent colonoscopy following sigmoidoscopy. Endoscopic findings were recorded in a computer based database. Ethical approval was obtained from the Ethical Review Committee of Nawaloka Hospitals of Sri Lanka. No conflict of interest. Results: A total of 48 pregnant women had undergone lower GI endoscopies. The mean age of the patients was 25.3 ± 6.5 years. Twenty-four patients (50%) were primigravida. Majority was in the second trimester of pregnancy 89.5% (43/48). The mean (±SD) gestational age at the time of procedure was 18(±2) weeks. All had undergone sigmoidoscopy, and an additional colonoscopy were done in 2 patients. Bleeding per rectum was the main indication. All flexible sigmoidoscopies were done without sedation. Wiliest, the colonoscopies were performed under conscious sedation. Majority of the pregnant mothers found to have haemorrhoids followed by anal fissures (46/48; 95.8%). Ulcerative colitis and a sigmoidal cancer were found in two patients (4.2%). None had an immediate post procedure-related complication. Conclusion: Flexible sigmoidoscopy is useful and safe to be performed in pregnancy with clinically significant bleeding per rectum. It has a good diagnostic yield. Further prospective multicentre research studies are strongly recommended.","PeriodicalId":186118,"journal":{"name":"Sri Lanka Journal of Obstetrics and Gynaecology","volume":"101 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116353608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Asymptomatic bacteriuria in pregnancy","authors":"R. Sivalingarajah, B. Balasingham, J. C. Camilas","doi":"10.4038/sljog.v45i1.8091","DOIUrl":"https://doi.org/10.4038/sljog.v45i1.8091","url":null,"abstract":"Background: The risk of urinary tract infection is higher in pregnancy. Due to lack of symptoms in asymptomatic bacteriuria, patients seldom seek any treatment. If left untreated, it may lead to complications like acute pyelonephritis, preterm labor, low birth weight etc. Adequate and early treatment reduces the incidence of these complications. Aim and Objectives: The objectives of this study were to determine the prevalence of Asymptomatic Bacteriuria (ASB) among pregnant women, evaluate the accuracy of rapid tests in assessing ASB in pregnancy, to know the common causative organisms and their sensitivity pattern and to correlate the demographic data. Material and Methods: One thousand four hundred and ten pregnant women were included in the study. Midstream urine specimen was subjected to semi quantitative culture method and also for urine analysis by microscopy and reagent strip method. Results: Of the 1410 pregnant women, 117(8.3%) had ASB. Sensitivity, specificity, positive and negative predictive value of reagent strip test was good enough when both leukocyte esterase and nitrate test results together or separately were considered positive. E. coli was the commonest organism 65.8 % followed by Klebsiella species 30.7%. Amongst the E. coli, sensitivity to nitrofurantoin, ceftazidime/clavulanic acid and imipenem was found to be 94.1%, 88.2%, and 88.2% respectively. Conclusion: Due to lack of symptoms and harmful consequences in pregnancy, ASB needs special considerations. All the pregnant females should be screened for ASB during pregnancy to prevent maternal and perinatal morbidity. Rapid strip test could be used as an OPD diagnostic test to screen ASB among pregnant women and reserve urine culture for those who turnout positive in screening tests. Wide variation in antibiotic sensitivity pattern of the bacteria causing ASB emphasizes the need of antimicrobial susceptibility testing rather than empirical treatment which is a common practice.","PeriodicalId":186118,"journal":{"name":"Sri Lanka Journal of Obstetrics and Gynaecology","volume":"67 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129902376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}