Ampara Hospital leads the way in birthweight research
Studies of immense importance for newborns have come forth from the Ampara District General Hospital which has gained prominence for the work being done there over the years. Dealing with foetal birth weights and whether the references used worldwide are relevant for Sri Lanka, it was a team from the hospital’s Obstetrics Unit that decided to take up the matter.
Dr. Tiran Dias
When a foetus (the baby while in the womb) is small for his/her gestational age, the risk of pregnancy complications mainly perinatal death and handicap increases, explains Consultant Obstetrician and Gynaecologist, Dr. Tiran Dias, attached to the Ampara Hospital. He was part of the team which carried out the two studies, ‘Sri Lankan fetal/birthweight charts: Validation of global reference for fetal weight and birthweight percentiles’ and ‘Accuracy of ultrasound estimated fetal weight formulae to predict actual birthweight after 34 weeks: Prospective validation study’ which were published in the Ceylon Medical Journal, the one and only index journal in Sri Lanka, in its issues of June and September 2013. The team’s findings have also been commended by their peers due to their impact on the mothers and babies of Sri Lanka.
The research team included Dr. V. Shanmugaraja, Dr. S.G. Kumarasiri, Dr. S.L. Wahalawatte, Dr. R.V. Wanigasekara, Dr. P. Begam, Dr. P.K.C.L. Jayasinghe and Dr. T. Padeniya. Pointing out that ‘small for gestational age’ (SGA) is defined as birthweight or foetal weight below the 10th percentile at a particular gestational week, Dr. Dias says that there is no uniformity in this definition as the 5th or 3rd percentiles are also used sometimes to assess the severity of SGA.
With the birthweight of a baby often being influenced by maternal ethnicity, body-mass index, parity and some undetermined causes, he says that accurate determination of foetal/birthweight percentiles for a given gestation is important. Underscoring the fact that this would reduce the complications of a misdiagnosed SGA foetus, Dr. Dias is quick to point out that it would also help doctors to make early decisions with regard to delivery and prevent unnecessary interventions as well as save resources.
This is why between January and July 2012, the team studied 411 expectant mothers of whom 207 mothers delivered their babies at 40 weeks.
In their first study, the team found that the mean birthweight at 40 weeks of gestation in Sri Lankan babies was 3,140g. However, both the commonly used Hadlock birthweight charts and Indian birthweight charts, either overestimate or underestimate SGA babies. The saving grace, however, was that the “WHO generic reference adapted to Sri Lanka fitted well with Sri Lanka”, he says.
In the second study, the team scanned all mothers between 11 and 14 weeks of pregnancy to determine the accurate due date. Within a week before delivery, the team also measured the foetal head circumference, bi-paretal diameter, circumference of the tummy and length of the femur to calculate the foetal weight. Thereafter, they compared the findings with the actual weight measured at birth.
An interesting finding of this study was that none of the commonly used foetal weight calculating formulae (presently there is no Sri Lankan formula) gives the precise foetal weight of Sri Lankan babies. “Our study is a clear indication that we should not go by western figures or even those used in other parts of the world as our babies’ birth-weights differ from those,” says Dr. Dias, adding that as calculations worked out from scans may also not be accurate, we need to find our own formula.
This is why the team from Ampara is now in the process of creating a Sri Lankan formula.
Therefore, the findings of both studies at the Ampara Hospital are truly groundbreaking.