Hr Seneviratne

Tracking progress towards safe motherhood: meeting the benchmark yet missing the goal? An appeal for better use of health-system output indicators with evidence from Zambia and Sri Lanka

Objectives  Indicators of health‐system outputs, such as Emergency Obstetric Care (EmOC) density, have been proposed for monitoring progress towards reducing maternal mortality, but are currently underused. We seek to promote them by demonstrating their use at subnational level, evaluating whether they differentiate between a high‐maternal‐mortality country (Zambia) and a low‐maternal‐mortality country (Sri Lanka) and assessing whether benchmarks are set at the right level.

Safe motherhood in Sri Lanka: a 100-year march.

The present safe motherhood status in Sri Lanka has been achieved by a series of activities for health and social development during the past century. While ancient and traditional religious, as well as cultural concepts provided a sound foundation, it was the policies that focused on human development that resulted in reducing the maternal mortality rate to 2.4 per 10 000 live births, and the infant mortality rate to 16.5 per (1000) live births. Maternal and Child Health (MCH) services were initially closely linked to improvements in the healthcare infrastructure and social development, while family planning introduced in 1953 enhanced its progress further. With MCH integrated into reproductive health, the march towards a safer motherhood in Sri Lanka will require the implementation of new policies and strategies.

Candidate gene study of genetic thrombophilic polymorphisms in pre-eclampsia and recurrent pregnancy loss in Sinhalese women

Aim:  Genetic thrombophilias are known to contribute to adverse pregnancy outcomes. Studies in Western populations show that 5, 10‐methylenetetrahydrofolate reductase (MTHFR) 677C>T and Factor V (F5) 1691G>A (Leiden) polymorphisms are commonly associated with pre‐eclampsia and recurrent spontaneous pregnancy loss. The objective of this study was to investigate the association of MTHFR 677C>T (rs1801133); 1298A>C (rs1801131) and F5 1691G>A (rs6025); 4070A>G (rs1800595) polymorphisms with pre‐eclampsia and recurrent pregnancy loss among Sinhalese women in Sri Lanka.

The urine protein heat coagulation test—a useful screening test for proteinuria in pregnancy in developing countries: a method validation study

In many parts of the developing world, the urine protein heat coagulation test is routinely used to screen for proteinuria in pregnancy. The aim of this study was to determine whether ≥1+ on a standardised heat coagulation test reliably detects significant proteinuria and to compare it with the dipstick test for urinary protein. Heat coagulation test, dipstick test and 24‐hour urine protein excretion results of 102 women were compared. ≥1+ on heat coagulation test is as sensitive and specific as ≥2+ on the dipstick test in detecting proteinuria of ≥500 mg/day. The heat coagulation test, however, is less sensitive than ≥1+ on dipstick in detecting lesser degrees of proteinuria.

Modified anchored B-Lynch uterine compression suture for post partum bleeding with uterine atony

A prospective observational study was performed to evaluate the performance of a modified uterine compression suturing technique for the management of refractory post partum hemorrhage (PPH) at two leading tertiary referral centers in Colombo, Sri Lanka. An modified anchored B‐Lynch suture was done in 17 women with PPH due to uterine atony. In 13 of the women (76%), bleeding was arrested and the uterus conserved. Four women (24%) did not respond to the anchored compression sutures, necessitating emergency post partum hysterectomy. Mean age was 31.2 years. Nine of the women (53%) were primiparous and eight (47%) parous. Mean estimated blood loss was 1994 ml (range 1200–3300 ml). This newly modified anchor B‐Lynch compression suture appeared effective in controlling about 75% of PPH due to uterine atony, which allowed uterine conservation. This simple modification can provide a first line surgical step to control PPH.

A study of three candidate genes for pre‐eclampsia in a Sinhalese population from Sri Lanka

Aim:  The aim of these investigations was to study three candidate genes for pre‐eclampsia – epidermal growth factor (EGF), transforming growth factor alpha, and angiotensinogen – in pregnant Sinhalese women from Sri Lanka, the first such study undertaken in this ethnic group. Reproducibility of results of genetic association studies of candidate genes for pre‐eclampsia has not been consistent across populations. One of the factors that may contribute to such inconsistencies is genetic stratification due to population admixture. We therefore compared the allele frequencies of these candidate genes in healthy Sri Lankan subjects from three ethnic groups – Sinhalese, Sri Lankan Tamils and Moors – and in white Western Europeans.

Comparison of transabdominal versus transvaginal ultrasound to measure thickness of the lower uterine segment at term

To compare the accuracy of transvaginal (TVS) versus transabdominal (TAS) ultrasound to assess the thickness of the lower uterine segment (LUS).

Feeling the Blues of Infertility in a South Asian Context: Psychological Well-Being and Associated Factors Among Sri Lankan Women with Primary Infertility

Primary infertility may have a considerable impact on the psychological well-being of women. In the present study, the authors investigated the psychological well-being and its correlates among Sri Lankan women with primary infertility. A total of 177 women with primary infertility were compared with 177 fertile women matched for age and duration of marriage to identify differences in the psychological well-being between the two groups. They were recruited from a prevalence survey conducted in the district of Colombo, Sri Lanka from August 2005 to February 2006. The General Health Questionnaire-30 (GHQ-30) and Mental Health sub-components of the Short Form-36 (SF-36) were used to measure psychological well-being. In addition, infertile women with and without psychological distress were compared to identify the social, marital, treatment, and demographic factors independently associated with psychological distress. A significantly higher proportion of women with primary infertility (66.1%; 95% CI 58.6–73.0%) had psychological distress as compared to fertile women (18.6 %; 95% CI 13.2–25.2%; P < 0.001). After adjustment for confounding factors, infertile women who were psychologically distressed were significantly less educated (OR = 55.3; 95% CI 15.2–201.0), had poor marital communication (OR = 3.5; 95% CI 1.3–9.8), had a higher priority for having children (OR = 4.2; 95% CI 1.3–13.8), and had been previously (OR = 39.1; 95% CI 8.3–185.4) or currently (OR = 11.0; 95% CI 3.0–40.6) investigated/treated for infertility when compared with infertile women without distress. Women with primary infertility reported more distress as compared to fertile women. Psychological distress among infertile women was associated with poorer education, being previously/currently investigated/treated, placing higher importance on having children, and having poor marital communication. The need for psychological intervention targeting infertile women in clinics and community settings is highlighted.

Serum insulin patterns and the relationship between insulin sensitivity and glycaemic profile in women with polycystic ovary syndrome

Objective  To evaluate serum insulin levels and insulin sensitivity in women with polycystic ovary syndrome (PCOS) in relation to their glycaemic status.

Aetiology of infertility among females seeking treatment at a tertiary care hospital in Sri Lanka.

OBJECTIVES Aim of this study was to describe the proportion of contributory factors of female infertility in a population that sought fertility treatment. Furthermore, the clinical findings and underlying pathologies associated with ovulatory dysfunction were also sought. METHODS A cross-sectional study was carried out at the infertility clinic of the North Colombo Teaching Hospital. New clinic attendees were recruited and both partners had a detailed clinical interview. The women underwent a baseline pelvic ultrasound scan, assessment of ovulation and a hormone profile. Tests for tubal patency were carried out when clinically indicated. RESULTS Ovulatory dysfunction was noted in 53% (n=218). Clinical and investigatory findings associated with ovulatory dysfunction included irregular menstrual cycles, acanthosis nigricans, hirsutism, polycystic ovary syndrome, a LH:FSH ratio of >1, and increased TSH or testosterone levels. Unilateral tubal occlusion was seen in 9.1 % (n=18) while it was bilateral in 1% (n=2). Abnormalities in sexual function were noted in 10.8% (n=56). CONCLUSIONS Abnormalities in ovulation were common. Clinical findings that could be used to recognise women at risk of ovulatory dysfunction were identified. Abnormalities in sexual function, which are often overlooked in the clinical management of infertility, were seen in over 10% of patients. Tubal factor infertility is rare.