Pregnancy and Ramadhan Fasting.

Fasting during the month of Ramadan is a religious obligation for healthy adult Muslims. Pregnant and lactating mothers are exempt from fasting but they do fast during the month of Ramadan. Numerous metabolic, endocrinal changes and adaptations occur in pregnancy. The long hours of abstinence of food and liquids during pregnancy may affect the intrauterine environment. There are reports of undesirable and harmful effects of fasting on the mother and the foetus, whereas others do not report any such significant adverse effects. The conflicting reports confuse the pregnant mothers and the caring practitioners. The object of this article is to critically analyse the outcome of pregnancy due to Ramadan fasting and whether the Ramadan fasting adversely affect the mother and her foetus.

Prescribing Hormonal Contraception.

Millions of women are in the reproductive age group. Their age vary from 15 to 50 years. They differ in life style, culture and body mass index. They may have morbidities like high blood pressure, liver disease and other co-morbidities. They are prone to venous thrombosis, malignancies of the breast and endometrium. Therefore the prescription of contraception should be on individual basis. Over the past 40 years there had been many improvements in the contraceptive methods. The 50 microgram ethinyl oestradiol of the combined pill was reduced drastically. Many rods of the norplant had become a tiny single rod implanon. The inert Lippi’s loop has transformed into Levonorgestrel-releasing intra uterine system (LNG-IUS). When there are varieties of contraceptive methods available, it is obvious that no method is perfect and full proof to prevent conception. It is important for the caring practitioner to select the most appropriate method to suit each individual client.

Alternatives to Hormone Replacement Therapy in Postmenopausal Women.

Substantial number of postmenopausal women suffers in silence. They experience vasomotor symptoms, sleep disturbances, atrophic changes in the genital and urinary systems and lack of sexual desire. The fear, side effects and contra indications of oestrogen discourage hormone replacement therapy. Life style modification with change in dietary habit, regular exercise, cessation of alcohol and smoking can help them immensely. Tibolone, Selective oestrogen receptor modulators (SERMs), Antidepressants like Venlafaxine, th Alpha 2 agonists like clonidine, carbapentine and various supplements are frequently prescribed. Available alternatives and their merits are discussed.

An Appraisal of Screening Methods for Gestational Diabetes Mellitus.

The importance of screening and diagnosis of gestational diabetes mellitus (GDM) is universally accepted but there is controversy and uncertainty about the most suitable method of screening among various populations. The majority of the patients are asymptomatic. After nearly 60 years of research the screening and diagnosis of GDM, universal screening evades uniform acceptance and remains debatable. Multiple studies, numerous global consensus conferences and several multicenter trials had not identified the unique procedure. Surprisingly still there is uncertainty regarding the most effective method of screening among various populations. The prevalence of GDM varies from less than 1% to more than 10% It is increasing due to dietary habits, overweight, maternal age, ethnicity, family history and past history .Prevalence vary due to the use of a wide range of definitions and diagnostic test criteria, as well as variations across regions and ethnic groups. The merits of available screening methods such as urine testing for glycosuria, 50g glucose challenge test (GCT), random blood sugar testing, fasting blood glucose (FBS) , estimation of glycosylated haemoglobin , fructosamine ,75g oral Glucose Tolerance Test (75g OGTT) and two step approach (Combination of methods) are analysed. In countries where funds are limited, certainly the selective screening is cost effective compared to whole population screening. After many decades of research, only up-to-date considerations are Random blood glucose, O’Sullivan, 75g and Complete OGTT.

The Role of Family Health Workers in Providing Family Health Services in Sri Lanka.

Aims: The maternal mortality rate and Infant mortality rate are relatively low compared to neighbor countries. Child birth in hospitals, skilled care during pregnancy delivery and postpartum period, absolutely free health care facilities, freely available contraceptive services and high female literacy rate are the major contributory factors in improving the maternal health in Sri Lanka. Family Health Workers (FHW) working in the hospitals and field play an important role in providing health care services. This study is to evaluate the role of FHW in providing family health care services in Sri Lanka Study Design: This is the retrospective study of the reports from 1935 to 2012 of Ministry of Health, Family Health Bureau, Health Education Bureau, Department of census and statistics, and central bank of Sri Lanka were reviewed. The mothers admitted for confinement were interviewed about the services rendered by the FHW by the staff of the maternity unit. Results: In a survey in the year 2007, about 93% of the FHW were resident in their stations round the clock. 95% of the pregnant mothers were seen more than 5 times during pregnancy by FHW. 98% of the delivered were at the hospitals and attended by the skilled healthcare personnel including FHW. 78% of the delivered mothers were seen by the FHW within 10 days of delivery. The maternal mortality ratio in Sri Lanka declined from 265 per 10,000 deliveries in 1935 to 1 per 10,000 about 65 years later. Conclusion: Family health workers are the cornerstone of health care delivery system especially in the remote and rural areas of Sri Lanka. They are involved in the care during pregnancy, delivery and postpartum period and their work is supervised and collaborated with the adjacent hospitals. Studies had shown that they contributed substantially to improve the health care in Sri Lanka.