Common Obstetric Conditions in Sri Lanka - hmislk/hmis GitHub Wiki

Common Obstetric Conditions in Sri Lanka

Obstetrics deals with pregnancy, childbirth, and the postpartum period. Sri Lanka has a strong maternal health system with nearly universal antenatal care (99%) and facility-based deliveries (99.5%), but certain conditions remain prevalent based on recent studies and national guidelines. Here's a list of the most common obstetric issues your wife might encounter as a Medical Officer in Admissions, drawn from population-based surveys and clinical data. I've focused on morbidities rather than rare fatal cases, as these are more likely in day-to-day practice.

  1. Anaemia in Pregnancy: This is one of the most widespread issues, affecting about 37.9% of pregnant women. It's primarily due to iron deficiency, often exacerbated by intestinal parasites, poor nutrition, or malaria in endemic areas. Routine screening occurs at the first antenatal visit and around 28 weeks, with management involving iron-folic acid supplements from 12 weeks gestation through six months postpartum. Complications include low birth weight, preterm delivery, and increased risk of postpartum haemorrhage (PPH).

  2. Gestational Diabetes Mellitus (GDM) or Hyperglycaemia in Pregnancy: Prevalence is around 14.9-17.9%. Screening involves blood sugar tests at the first visit and around 28 weeks. It increases risks like macrosomia (large babies, 4.5% in affected cases), preterm birth, and neonatal complications such as respiratory distress (6%) or jaundice (5.5%). Management follows national guidelines with diet, monitoring, and insulin if needed.

  3. Gestational Hypertension or Hypertensive Disorders of Pregnancy (including Preeclampsia/Eclampsia): Affects 11.1-13.6% of pregnancies. Blood pressure and urine protein checks happen at every antenatal visit. High-risk cases (e.g., with proteinuria or severe symptoms like epigastric pain) are referred to obstetricians. It contributes to about 24% of maternal deaths in some settings and raises risks of placental abruption, fetal growth restriction, and perinatal mortality.

  4. Obesity in Pregnancy: Seen in 18.1% of pregnant women, often linked to non-communicable diseases (NCDs). It heightens odds of GDM, hypertension, preterm birth (OR=2.3), and neonatal issues like sepsis (OR=2.5) or hypoglycaemia (OR=3.5). Counselling on weight management is key during antenatal care.

  5. Miscarriages or Pregnancy Terminations (including Stillbirths): Overall rate is 16.14%, with higher odds in older women (>35 years), those with obesity, or prior history. Causes include chromosomal issues, diabetes, or hypertension. Early antenatal care helps identify risks.

  6. Heart Disease Complicating Pregnancy: Accounts for 17.3% of maternal deaths, with rheumatic heart disease being prominent (21.1%). Screening via clinical assessment occurs each trimester. Multidisciplinary management is required, and it affects about 1-4% of pregnancies globally but is notable in Sri Lanka due to underlying cardiac conditions.

  7. Postpartum Haemorrhage (PPH): Occurs in 3-4% of deliveries, causing 25% of maternal deaths worldwide (similar in Sri Lanka). Primary cause is uterine atony (90%). Active third-stage management (oxytocin, cord traction) prevents over 50% of cases.

Other notable issues include sexually transmitted infections (STIs) like syphilis or HIV (screened antenatally), malaria in endemic areas, and obstructed labour (1-20% incidence, leading to fistulae). Antenatal risk factors overall affect 52% of pregnancies, including advanced maternal age or teenage pregnancy.

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