Browsing by Author "Amarasekara, A.M.A.K.G."

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    Conservative management of Placenta Percreta: Three cases and a review of the literature regarding conservative management of Placenta Accreta Spectrum (PAS) Disorders.
    (Hindawi Pub. Corp., 2020) Patabendige, M.; Sanjeewa, J.M.P.; Amarasekara, A.M.A.K.G.; Herath, R.P.
    BACKGROUND: The incidence of placenta accreta spectrum (PAS) disorders has risen over the last decades, and there has been a gradual shift towards expectant management. Conservative management of PAS is known to reduce major obstetric haemorrhage and salvage hysterectomy. There is a lack of consensus on the follow-up of patients undergoing conservative approaches. Here, we describe the follow-up of three patients with placenta percreta who were conservatively managed and review the literature for the conservative management of PAS. Case Presentation. We have successfully managed three cases of placenta percreta expectantly using combined methods involving symphysial-fundal height, serum beta-HCG, and ultrasonographic volume of placental mass.CONCLUSIONS: Use of a combined approach with symphysial-fundal height, serum beta-HCG, and ultrasonographic volume of placental mass with colour Doppler may guide the surveillance of these conservatively managed cases. However, at least one magnetic resonance imaging three months postoperatively may predict a further risk of delayed haemorrhage.
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    Cut-off Scores for International Consultation on Incontinence Modular Questionnaire on Vaginal Symptoms (ICIQ-VS) in Sinhala and Tamil
    (Sri Lanka College of Obstetricians & Gynaecologists, 2017) Amarasekara, A.M.A.K.G.; Ekanayake, C.D.; Pathmeswaran, A.; Wijesinghe, P.S.; Liyanage, L.L.C.; Kulasinghe, I.R.M.M.; Perera, H.S.S.
    INTRODUCTION: It is clinically beneficial to have cut-off scores for screening questionnaires, above which a patient can be referred for further evaluation at a specialist center especially in developing countries. OBJECTIVE: To calculate cut off scores for ICIQ-VS-Sinhala and ICIQ-VS- Tamil questionnaires. METHODS: The ICIQ-VS- Sinhala and ICIQ-VS-Tamil was administered to women attending the gynaecology clinics at North Colombo teaching hospital, Ragama, District General hospitals, Mannar and Vavuniya. The vaginal symptoms score (VSS), sexual symptoms score (SSS) and the quality of life score (QoL) were analysed against the clinician’s diagnosis of significant prolapse using receiver operating characteristic curves (ROC). Results: The AUC (area under curve) for ROC curves of VSS, SSS and QoL for ICIQ-VS-Sinhala were 0.89 (p<0.001), 0.64 (p<0.02) and 0.75 (p<0.001) respectively. The AUC for ROC curves VSS, SSS and QoL of ICIQ-VS-Tamil were 0.88 (p<0.001), 0.70 (p<0.02) and 0.82 (p<0.001) respectively. The optimal MCIDs for ICIQ-VS-Sinhala were VSS ≥≥ 8 (sensitivity 88.1%, specificity 73.9%), SSS ≥ 1 (sensitivity 59%, specificity 65%), QoL ≥ 3 (sensitivity 77.8%, specificity 60.4%) while for ICIQ-VS-Tamil VSS ≥ 9 (sensitivity 87.1%, specificity 80.9%), SSS ≥ 1 (sensitivity 76.5%, specificity 61.1%) and QoL ≥3 (sensitivity 77.8%, specificity 79.8%). CONCLUSION: Both questionnaires yielded promising cut off scores for VSS, SSS and QoL. Cut-off scores of VSS ≥9, SSS ≥1 and QoL≥3 for ICIQ-VS-Tamil and VSS ≥8, SSS ≥1 and QoL ≥3 for ICIQ-VS-Sinhala can be used as a guide for specialist referral when using ICIQ-VS to screen for pelvic floor dysfunction in Sri Lanka.
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    Cut-off scores for international consultation on incontinence modular questionnaire on vaginal symptoms (ICIQ-VS) in sinhala and tamil
    (Sri Lanka College of Obstetricians & Gynaecologists, 2017) Amarasekara, A.M.A.K.G.; Ekanayake, C.D.; Pathmeswaran, A.; Wijesinghe, P.S.; Liyanage, L.L.C.; Kulasinghe, I.R.M.M.; Perera, H.S.S.
    INTRODUCTION: It is clinically beneficial to have cut-off scores for screening questionnaires, above which a patient can be referred for further evaluation at a specialist center especially in developing countries. Objective: To calculate cut off scores for ICIQ-VS-Sinhala and ICIQ-VS- Tamil questionnaires. METHODs: The ICIQ-VS- Sinhala and ICIQ-VS-Tamil was administered to women attending the gynaecology clinics at North Colombo teaching hospital, Ragama, District General hospitals, Mannar and Vavuniya. The vaginal symptoms score (VSS), sexual symptoms score (SSS) and the quality of life score (QoL) were analysed against the clinician’s diagnosis of significant prolapse using receiver operating characteristic curves (ROC). RESULTS: The AUC (area under curve) for ROC curves of VSS, SSS and QoL for ICIQ-VS-Sinhala were 0.89 (p<0.001), 0.64 (p<0.02) and 0.75 (p<0.001) respectively. The AUC for ROC curves VSS, SSS and QoL of ICIQ-VS-Tamil were 0.88 (p<0.001), 0.70 (p<0.02) and 0.82 (p<0.001) respectively. The optimal MCIDs for ICIQ-VS-Sinhala were VSS ≥≥ 8 (sensitivity 88.1%, specificity 73.9%), SSS ≥ 1 (sensitivity 59%, specificity 65%), QoL ≥ 3 (sensitivity 77.8%, specificity 60.4%) while for ICIQ-VS-Tamil VSS ≥ 9 (sensitivity 87.1%, specificity 80.9%), SSS ≥ 1 (sensitivity 76.5%, specificity 61.1%) and QoL ≥3 (sensitivity 77.8%, specificity 79.8%). CONCLUSION: Both questionnaires yielded promising cut off scores for VSS, SSS and QoL. Cut-off scores of VSS ≥9, SSS ≥1 and QoL≥3 for ICIQ-VS-Tamil and VSS ≥8, SSS ≥1 and QoL ≥3 for ICIQ-VS-Sinhala can be used as a guide for specialist referral when using ICIQ-VS to screen for pelvic floor dysfunction in Sri Lanka.