Objective To study the change in trend of antenatal mental health and associated factors among a cohort of pregnant women during the second wave of COVID-19 using Hospital Anxiety and Depression Scale (HADS). Previous study using the same scale, during the first wave reported a higher prevalence of anxiety and depression. Results A descriptive cross-sectional study was carried out at the two large maternity hospitals in Colombo, Sri Lanka: Castle Street Hospital for Women (CSHW) and De Soysa Hospital for Women (DSHW). Consecutively recruited 311 women were studied. Out of which, 272 (87.5%) were having uncomplicated pregnancies at the time of the survey and 106 (34.1%) were either anxious, depressed, or both. Prevalence of anxiety was 17.0% and depression 27.0%. Overall, continuing COVID-19 pandemic increased antenatal anxiety and depression. The trend was to aggravate depression more intensively compared to anxiety in this cohort of women studied. Special support is needed for pregnant mothers during infectious epidemics taking more attention to antenatal depression.

Introduction:Caesarean section has now become the most frequently performed major surgical procedure in women in the field of Obstetrics and Gynaecology. There is however a wide variation in the surgical technique of caesarean section. Our objective was to compare incidence of complications associated with blunt versus sharp expansion of the uterine incision at the time of caesarean section.Methods: 274 women who underwent a lower segment caesarean section at North Colombo Teaching Hospital, Ragama was assigned randomly to have the expansion of the primary uterine incision either bluntly using the index fingers of both hands of the surgeon or sharply using a curved scissors. Rest of the surgery was performed alike in all participants. Results:The blunt expansion group (n=141) and the sharp expansion group (n=133) were similar with regard to age distribution, BMI, parity, history of previous LSCS and proportion of elective or emergency procedures and the cervical dilatation at the time of LSCS. The incidence of inadvertent extensions (42.1% vs 28.4%; p=0.02) and the mean time taken to repair the uterine incision (14.9min vs 13.7min; p=0.03) was significantly higher in the blunt expansion group compared to the sharp expansion group. The percentage drop in haematocrit more than 10% (30.8% vs 28.4%; p=0.48) and the drop in haemoglobin more than 2g/dl (22.6% vs 20.6%; p=0.47) was not significantly different in the blunt expansion group compared to the sharp expansion group. Incidence of inadvertent extensions was significantly different (38.5 vs 24.1; p=0.03) during elective LSCS but not during emergency LSCS (50% vs 44.8%; p=0.67) between the blunt expansion group and sharp expansion group. The incidence of inadvertent extensions was significantly higher (36.5% vs 24%; p=0.03) when the cervical dilatation was less than 4cm at the time of LSCS in the blunt expansion group compared to the sharp expansion group. Blunt expansion group required more blood pint transfusions when compared to the sharp expansion group (6 vs 2). Conclusion:The sharp expansion of the uterine incision at the time LSCS is associated with a lower risk of inadvertent extensions as well as extensions into broad ligament and uterine vessels compared to the blunt expansion method.The sharp expansion of the uterine incision is preferable to blunt expansion during LSCS and its advantage is more evident during elective LSCS than during emergency LSCS and when the cervical dilatation was less than 4cm at the time of LSCS.

Methods-This randomized controlled non-blinded clinical trial conducted at a leading tertiary obstetric care unit in Colombo, Sri Lanka, compared the maternal acceptability and effectiveness of membrane sweep (MS) and cervical massage (CM) in ripening uterine cervix to avoid formal induction of labour. MS, CM and control (C) groups had 104, 106 and 102 women after randomization. Primiparous women underwent either MS or CM at 39th and 40th weeks while multiparous women underwent at 40th week of gestation only. All were followed up until 24 hours postpartum. 100, 102 and 101 women in MS, CM and C groups respectively were included in the analysis. Results- Overall, MS significantly improved Modified Bishop’s Score (MBS) to ≥7 compared to C (p=0.0310) but not compared to CM (p=0.2639). There was no significant improvement of MBS after CM compared to C (p=0.2795). Among primiparous (p=0.047) and multiparous (p=0.038) women separately, mean survival times without going into labour (MBS ≥7) were significantly shorter after MS compared to C but not compared to CM. Hospital stay for delivery was less overall after both MS (p=0.0015) and CM (p=0.0197). There were no significant differences between MS, CM and C groups with regards to synthetic oxytocin use, uterine hyperstimulation during labour, emergency cesarean section rate in labour, postpartum hemorrhage, maternal fever and APGAR score at 5 minutes. Maternal acceptability was assessed using a validated questionnaire consisting of 4 Likert scale items (S-CVI = 0.875; Cronbach’s Alfa = 0.876). Maternal acceptability score of CM was significantly higher than that of MS during overall analysis as well as during subgroup analysis according to parity (p=0.0011). Conclusions- MS is an effective adjunct to induction which ripens cervix, prevents formal induction of labour (NNT = 7), significantly reduces the duration of pregnancy and shortens hospital stay for delivery overall. Although CM is more acceptable than MS and shortened hospital stay for delivery overall, it is not an effective method to ripen the uterine cervix or to prevent formal induction labour regardless of parity. This trial was self-funded. Trial Registration No - SLCTR/2020/003, Universal Trial Number - U 1111-1244-8026.

Inferior epigastric vessels; laparoscopic vascular injuries; trans-illumination; internal inguinal ring Aim Avoidance of injury to the epigastric vessels is an important safety consideration in siting secondary ports at laparoscopy. We evaluated trans-illumination, direct visualization of vessels and using the internal inguinal ring, which has a constant relationship with the inferior epigastric vessels as an anatomical landmark to locate these vessels.

collection plays a crucial role. It is recommended to have continuous data collection, processing, and interpretation. However, this is difficult to implement at most institutions and therefore often neglected.