Objectives The World Health Organization (WHO) recommends induction of labour (IOL) for low risk pregnancy from 41+0 gestational weeks (GW). Nevertheless, in Sri Lanka IOL at 40 GW is common practice. This study aimed to compare maternal/newborn outcomes after IOL versus spontaneous onset of labour (SOL) at 40 GW (IOL40) and 41 GW (IOL41). Design Observational study. Setting De Soysa Teaching Hospital for Women, Colombo, the largest maternity hospital in Sri Lanka. Population Low risk pregnancies at 40 or 41 GW. Methods Data from a routine prospective individual patient database were analysed. IOL and SOL groups were compared using logistic regression. Main Outcome Measures Births with one or more negative maternal/newborn outcome/s; maternal/newborn complications; caesarean section (CS); operative vaginal delivery. Results Of 13670 deliveries, 2359 (17.4%) were singleton and low risk at 40 or 41 GW. Of these, 456 (19.3%) women underwent IOL40, 318 (13.5%) IOL41, and 1585 (67.2%) SOL. Both IOL40 and IOL41 were associated with an increased risk of any maternal/newborn negative outcomes (OR=2.21, 95%CI=1.75-2.77, p<0.001 and OR=1.91, 95%CI=1.47-2.48, p<0.001 respectively), maternal complications (OR=2.18, 95%CI=1.71-2.77, p<0.001 and OR=2.34, 95%CI=1.78-3.07, p<0.001 respectively) and CS (OR=2.75, 95%CI=2.07-3.65, p<0.001 and OR=3.01, 95%CI=2.21-4.12, p<0.001 respectively). Results did not change in secondary and sensitivity analyses. Conclusions Both IOL groups were associated with higher risk of negative outcomes compared to SOL. These findings, though potentially explained by selection bias, local IOL protocols and CS practices, are valuable for the Sri Lankan context, particularly given contradictory findings from other settings.

Objective: The aim of this study was to investigate the utility of a single value non fasting glucose tolerance test as described by the Diabetes in Pregnancy Study Group of India (DIPSI) in detecting GDM Design: A Prospective Descriptive Cross Sectional study Setting: A Tertiary care maternity hospital in Sri Lanka. Sample: A sample of 165 pregnant women between 24-28 weeks of gestation was recruited Method: All women had the DIPSI and standard OGTT tests performed within a one week and results compared using standard non parametric tests. Main outcome measures:DIPSI and IADPSG criteria were compared using sensitivity, specificity and area under the ROC curve. Results: According to the IADPSG criteria 20% (33/165) had GDM, compared to 22.4% (37/165) detected by DIPSI. Sensitivity of DIPSI criteria was 64% while specificity was 88%. The area under receiver operator curve was 0.8. The mean satisfaction for DIPSI was of 8.9 ± 0.4, compared to 4.7 ± 1.3 for OGTT (p<0.001). Analysis of false positives showed that it was mainly due to elevated fasting values in the IADPSG criteria. Conclusion: Although DIPSI has a low sensitivity compared to the IADPSG criteria, area under the ROC curve is 0.80 indicating its utility for diagnosing GDM. It has additional advantages of allowing a diagnosis of GDM in a single visit and high acceptability among women. Funding: This study was self-funded Key words : Gestational Diabetes Mellitus, Diabetes in Pregnancy Study Group India, Oral Glucose Tolerence Test