Sri Lanka Journal of Obstetrics and Gynaecology最新文献

{"title":"Management of epithelial ovarian cancers","authors":"B. Alagoda, H. Hapuachchige, R. Wijesinghe, Y. Wijeratne, Sri Lanka College of Obstetricians and Gynaecologists","doi":"10.4038/sljog.v43i3.8015","DOIUrl":"https://doi.org/10.4038/sljog.v43i3.8015","url":null,"abstract":"Ultimate goal of treating a cancer patient is to cure the disease where possible and to have control of primary disease and delay the recurrences in patients in whom complete cure is not possible. Patients beyond above levels should receive appropriate symptom relieving treatment. Pre-operative staging, individualized treatment planning and appropriate adjuvant treatment and risk based follow up are corner stones in managing these patients.","PeriodicalId":186118,"journal":{"name":"Sri Lanka Journal of Obstetrics and Gynaecology","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125259142","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":"Perimortem caesarean delivery","authors":"K. Kodithuwakku, S. Padumadasa","doi":"10.4038/SLJOG.V43I2.7973","DOIUrl":"https://doi.org/10.4038/SLJOG.V43I2.7973","url":null,"abstract":"A 29 year old primigravida presented at 39 weeks of gestation to the Accident and Emer gency (A&E) Department of North Colombo Teaching Hospital, Sri Lanka, with shortness of breath. She was a diagnosed patient with pre-eclampsia who had defaulted follow up since 31 weeks. On admission, she was found to have a blood pressure of 230/120 mmHg and diffuse fine crepitations over both lung fields. The working diagnosis was flash pulmonary oedema due to preeclampsia, and she was treated with oxygen via face mask, intravenous (IV) furosemide, IV labetalol and 2 g of IV magnesium sulphate.","PeriodicalId":186118,"journal":{"name":"Sri Lanka Journal of Obstetrics and Gynaecology","volume":"99 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123731914","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":"Outcome assessment of total abdominal hysterectomy vs ascending vaginal hysterectomy","authors":"S. Kumara, S. Hemapriya","doi":"10.4038/SLJOG.V43I2.7995","DOIUrl":"https://doi.org/10.4038/SLJOG.V43I2.7995","url":null,"abstract":"Introduction \u0000Hysterectomy is a reasonably safe, common and routine surgical procedure which rarely leads to perioperative death. Minor complications including postoperative infections, fever, wound hematomas or wound separation occur in approximately 25% of patients. \u0000 \u0000Objective \u0000A comparative assessment of the post-operative outcomes of Sri Lankan patients subjected to Total Abdominal Hysterectomy and Ascending Vaginal Hysterectomy for benign uterine diseases. \u0000Methods \u0000A randomized controlled trial was conducted on 60 patients who underwent hysterectomy from July 2013 to June 2014, in a tertiary care hospital. Women those who were waiting for hysterectomy for benign uterine diseases within age 35-55yrs were included for the study.30 patients were underwent abdominal hysterectomy and 30 patients were underwent vaginal hysterectomy. Five main variables were measured such as operative time in minutes, blood loss, post operative pain, pyrexia, hospital stay in days. Data entered and analyzed by SPSS 25.0. \u0000 \u0000Result \u0000Age of participants was between 37 years of age to 51 years of age. Mean age was 44.87 years among Vaginal Hysterectomy group (SD 3.4 years) and 44.71 among Abdominal Hysterectomy group (SD 3.756 years). \u0000The average time duration for two procedures (t=10.4: p<0.05), average post operative hospital stay(t-10.1 ; df-58 ; p<0.05), Onset of post operative pain (X2 - 31.0:df – 2:p<0.05) and average blood losses between two groups(t-14.97;df-58;p<.05) were significantly different. Onset of fever was not significantly different in two groups (X2-0.48:df-1:p=.731). \u0000 \u0000Conclusion \u0000When comparing abdominal hysterectomy and vaginal hysterectomy the time taken for abdominal hysterectomy and post operative stay at hospital following abdominal hysterectomy is higher than those of vaginal hysterectomy. Abdominal hysterectomy was associated with a significantly higher post operative pain. Onset of fever following surgery does not depend on the type of surgery.","PeriodicalId":186118,"journal":{"name":"Sri Lanka Journal of Obstetrics and Gynaecology","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123950211","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":"Effectiveness of intramyometrial oxytocin versus intravenous oxytocin bolus administration during elective caesarean section – a randomized control trial","authors":"A. Dissanayake, U. Samaratunge, I. Piyadigama, K. Gunawardena","doi":"10.4038/SLJOG.V43I2.7979","DOIUrl":"https://doi.org/10.4038/SLJOG.V43I2.7979","url":null,"abstract":"Introduction: Intravenous oxytocin (IVO) is recommended during elective caesarean section to prevent postpartum haemorrhage. However, compared to IVO intramyometrial oxytocin (IMO), may result in better contractility with minimal haemodynamic side effects. Limited number of studies are available on IMO use at elective Caesarean section (CS). Objective: To evaluate the effectiveness of prophylactic IMO against IVO, in term singleton mothers at elective CS. Methods: Sixty five term singleton mothers undergoing elective CS at the Teaching Hospital, Kandy from 1st February 2015 to April 2015 were randomized to IMO and IVO. Prior to umbilical cord clamping, either IMO 5 IU divided half to each cornu or routine IVO 5 IU was administered. Blood loss was assessed using gravimetric methods and allowable blood loss calculation. Surgeon assessed uterine tone at 2,5,10 and 15 minutes following injection and gave a score of 1 to 5. Hameodynamic parameters, side effects, haemoglobin and haematocrit were recorded. Results: Thirty three were in IMO group while 32 were in IVO group. There was no significant difference between IVO and IMO groups in relation to mean blood loss, (303.83, SD 103.77ml vs 267.65 SD 93.53 ml, p=0.43), uterine contractions at 2 and 5 minutes and side effects. Calculated allowable blood loss in IMO group was significantly less than IVO group (p=0.04) and contraction scores at 10 and 15minutes were significantly higher in IMO group. There was no difference in haemodynamic parameters in each group. Conclusion: IMO oxytocin was not more effective than IVO during elective CS.","PeriodicalId":186118,"journal":{"name":"Sri Lanka Journal of Obstetrics and Gynaecology","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124585941","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":"Prophylactic use of antibiotic for incomplete and missed miscarriage, prior to medical and surgical management: a randomized controlled trial","authors":"D. Prasanga, C. Rathnayaka, S. Gunathilaka, C. Kandauda, M. Jayawardana","doi":"10.4038/SLJOG.V43I2.8000","DOIUrl":"https://doi.org/10.4038/SLJOG.V43I2.8000","url":null,"abstract":"Introduction: Miscarriage is a common gynaecological problem in day to day practice. Post miscarriage care is a challenging area coming under reproductive health. Prevention of pelvic sepsis is a main component. Effective antibiotic prophylaxis at the time of treatment for incomplete and missed miscarriage may be the answer for it. But in current practice, there is conflicting evidence and no clear guidance for the necessity of antibiotic prophylaxis. Objective: To determine the effectiveness of prophylactic doxycycline use, prior to surgical and medical evacuation of incomplete and missed miscarriage, in view of reducing the post -procedure pelvic infections. Method: Three hundred and ninety four patients were randomized into two groups. One group (n=200) received 200mg doxycycline single dose and the other group (n=194) received placebo single dose, one hour prior to the medical and surgical management. Post procedure pelvic infection was assessed by five clinical parameters within three days and two weeks later. SPSS used for the data analysis. Result: There were no statistically significant differences in the age, parity, number of children and gestational age in between the doxycycline and placebo groups. Post intervention pelvic infection was diagnosed 4% in the doxycycline group and 6.18% in the placebo group within three days, which was not statistically significant (P=0.367). It was 4.5% and 8.7% for doxycycline and placebo treated groups respectively at two weeks. It was also not clinically significant (P=0.104). There was no statistically significant difference in the type of miscarriage or the type of interventions in between the two groups. Conclusion: The study revealed that single dose doxycycline prophylaxis prior to medical and surgical management of miscarriage was not able to achieve a statistically significant reduction in post intervention pelvic infection.","PeriodicalId":186118,"journal":{"name":"Sri Lanka Journal of Obstetrics and Gynaecology","volume":"56 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131029480","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":"Efficiency of administering low dose aspirin to prevent preeclampsia based on NICE guideline – a policy to practice gap in antenatal care in a rural Sri Lankan district","authors":"D. Kumara, D. Ayeshmantha, D. Karunarathne, L. Senarathna","doi":"10.4038/SLJOG.V43I2.8001","DOIUrl":"https://doi.org/10.4038/SLJOG.V43I2.8001","url":null,"abstract":"The NICE guideline on managing pregnancy induced hypertension recommends a low dose aspirin as prophylaxis for pre-eclampsia. Eligibility for aspirin is assessed using risk factor-based evaluation using major and moderate risk factors. Understanding prevalence of risk factors as per guideline and the level of adherence of clinicians to guideline are important in managing pre-eclampsia. This study aimed to assess the prevalence of major and moderate risk factors for pre-eclampsia in this population as per NICE guidelines and to understand the clinician's level of adherence to the guideline. A cross-sectional study was carried out in the professorial unit, Teaching Hospital, Anuradhapura, Sri Lanka using a structured data collection sheet to collect data from pregnant women admitted for delivery within a period of one month. Out of 420 pregnant women, 20 (4.5%) had major or moderate risk factors and eligible for aspirin prophylaxis as per NICE guideline. But only seven (35%) of them were identified based on the guideline and given aspirin during antenatal care. There were 11 (2.6%) women with major risk factors but only five were identified and from nine women with moderate risk factors, only two were identified as eligible. Comparatively, identifying eligibility based on major risk factors was higher than moderate risk factors. Although the prevalence of risk factors of preeclampsia is low, there is a gap between NICE guideline recommendations and the actual practice among clinicians in antenatal care from this rural district. Clinicians should be provided with updated information on NICE guideline to improve recognizing risk factors and prescribing aspirin.","PeriodicalId":186118,"journal":{"name":"Sri Lanka Journal of Obstetrics and Gynaecology","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115366012","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":"Impact of pelvic floor muscle training (PFMT) on quality of life among women suffering from stress urinary incontinence after first childbirth: a feasibility study","authors":"A. Jayawardane, M. Patabendige, W. J. G. S. N. T. Fernando, D. Jayasundara","doi":"10.4038/SLJOG.V43I2.7999","DOIUrl":"https://doi.org/10.4038/SLJOG.V43I2.7999","url":null,"abstract":"Objective: To determine the feasibility of performing a randomized controlled trial comparing Pelvic Floor Muscle Training (PFMT) and behavioral advice only for postpartum SUI. Results: A feasibility study was performed with 207 women in 7-16 weeks postpartum at community postpartum clinics. Women reporting SUI were randomized to an intervention group (n=15), which followed an organized PFMT programme for six weeks and a control group (n=14). Control group was advised on routine postnatal care with behavioral advice. Both groups were assessed for QoL using a validated incontinence-quality of life (I-QOL) questionnaire at recruitment and in six weeks. There were 14% (29/207) of women suffering from SUI amongst the study sample. Before intervention there was no difference between I-QOL score in both groups. There was significant improvement (p Conclusion: SUI is a common postpartum problem in this urban cohort of Lankan women. These women can be effectively treated improving their QOL with PFMT intervention.","PeriodicalId":186118,"journal":{"name":"Sri Lanka Journal of Obstetrics and Gynaecology","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128761715","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":"Pregnancy complicated with May-Hegglin anomaly","authors":"K. Guruparan, T. Sooriyakumar, K. Muhunthan","doi":"10.4038/SLJOG.V43I2.7988","DOIUrl":"https://doi.org/10.4038/SLJOG.V43I2.7988","url":null,"abstract":"The May-Hegglin Anomaly (MHA) is a rare autosomal dominant giant platelet disorder characterized by abnormally large platelets with defective leucocytes and thrombocytopenia with varying degrees of bleeding manifestation. Here we report successful pregnancy outcome in a primigravida with MHA. (Preterm Pre-labour Rupture of Membranes) PPROM mother, with abnormalities of the extremities due to ABS is discussed.","PeriodicalId":186118,"journal":{"name":"Sri Lanka Journal of Obstetrics and Gynaecology","volume":"52 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123134833","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":"Caesarean sections in the second stage of labour – a risk evaluation","authors":"S. Karunananda","doi":"10.4038/SLJOG.V43I2.7985","DOIUrl":"https://doi.org/10.4038/SLJOG.V43I2.7985","url":null,"abstract":"Objective: To retrospectively analyse the relative rate of complications of caesarean sections performed in the second stage, in comparison to those done in the first stage of labour, in singleton uncomplicated pregnancies. A secondary objective was to see whether a conscious attempt had been made for an instrumental delivery where it seemed feasible to avert a caesarean in the second stage of labour. Method: A retrospective cohort study of 2440 caesarean sections out of a total of 5349 procedures done in 2019 and 2020, at ward 10, at a shocking rate reaching 49% and 60% (university, health ministry units) at the Teaching Hospital, Peradeniya. The instrumental delivery rate was a mere 1.63% in 2020. There were only 1220 caesareans performed in the second stage of labour. Hence, only a similar number (1220) of cases were selected from first stage procedures for the purpose of comparison of complications. Results: Requirement of blood transfusions; intraoperative or within 24 hours of delivery were 6 against 36 instances for first and second stage respectively. There were 16 recorded instances of extensions of angles or tears, and 3 cases of broad ligament haematomas in the second stage procedures. There was one instance of even a vaginal tear dislodging a jammed fetal head following failed forceps. Only 3 records of angle extensions were recorded when attempting to deliver high floating heads during the first stage. Uterine scar dehiscence was found in 36 instances in second stage procedures against 12 in the first but this was not a result of the procedure but the longer duration of labour in the former situation. There were two recorded instances of bladder injury in the first stage against 7 in the second. The mean duration of hospital stay was markedly different at 2.2 and 4.6 days. 6 against 17 patients ended in the high dependency unit or the ICU due to procedure-related complications. There were no mortalities. The mean operating times from the sample drawn from operating theatre records (300 of each stage) drawn was 28.6 min against 46.5 min. Failed forceps and ventouse were recorded in only 2 instances. Conclusions: Second stage caesareans seemed more technically difficult as judged by the longer time taken and were more likely to be complicated and result in a longer hospital stay and a higher risk of admission to Intensive care. We cannot conclude that they were any safer than AVD, as a comparison with complications of AVD were not audited in this study. Better training in instrumental delivery may improve an unacceptable situation where half the women (49%) had caesarean deliveries in 2019. Failed trial of instrumental delivery and any resultant injury should not result in automatic reprimand of the operator as this leads to performing caesareans as defensive medicine. Senior-most obstetricians on site must be called in for second stage caesareans with higher morbidity. This is more so when a trial of AVD has failed.","PeriodicalId":186118,"journal":{"name":"Sri Lanka Journal of Obstetrics and Gynaecology","volume":"383 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131192351","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":"Evaluation of cervical length by transabdominal and transvaginal scans during early pregnancy.","authors":"L. Ruwanpura, J. Wickramasinghe, P. Marasinghe, G. Ratnayake, T. Dias, D. Silva","doi":"10.4038/SLJOG.V43I2.7986","DOIUrl":"https://doi.org/10.4038/SLJOG.V43I2.7986","url":null,"abstract":"Objective \u0000To compare the measurements and the client-preferences of transabdominal scan (TAS) and transvaginal scan (TVS) in assessing cervical length. \u0000Method \u0000A validation study with a cross sectional component on patient-preferences was conducted among 568 pregnant women with a period-of-amenorrahea between 11+0 to 22+6 weeks. Pre- and post-void TAS and a post-void TVS measurements were taken. Receiver Operating Characteristics (ROC) curves were generated to assess the detection of short cervix using pre and post-void TAS at different lengths of the cervix. \u0000Results \u0000The mean (SD) age of the participants was 28.4(5.7) years with a mean gestation age of 14+1 weeks. The mean (SD) cervical lengths detected by the pre-void TAS, post-void TAS and TVS were 32.2 (5.8)mm, 28.9 (5.8) mm and 34.4 (5.3) mm respectively. Factors with significant association with a higher TVS cervical length were; increasing age (p<0.001), higher gravidity (p<0.001), higher parity (p<0.001) and higher number of vaginal deliveries (p<0.001). The TAS and TVS measurements significantly correlated with each other (p<0.001). \u0000Post-void TAS could not obtain measurement in 49.47% of attempts. The shortest cervical length can be detected by pre-void TAS was 26mm with an ideal cut-off of 33mm. For post-void TAS the shortest length was 28mm with an ideal cut-off of 28.16mm. Majority preferred TAS over TVS. \u0000Conclusion \u0000Pre-void TAS can predict a cervical length of 26mm or less with 87.5% sensitivity whereas the shortest length predicted by post-void is relatively longer. Nearly in half, a valid post-void TAS could not be recorded. Client preference was more favorable for TAS.","PeriodicalId":186118,"journal":{"name":"Sri Lanka Journal of Obstetrics and Gynaecology","volume":"58 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134043059","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}