Browsing by Author "Gunasekera, P.C."

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Altered pelvic floor physiology in uterovaginal prolapse: evidence for a pan-pelvic floor disorder
(1998) Deen, K.I.; Gunasekera, P.C.
Better reproductive health: a strategy for poverty reduction
(Sri Lanka College of Obstetricians and Gynaecologists, 2003) Gunasekera, P.C.; Wijesinghe, P.S.
The Caesarean section rate is rising
(Sri Lanka Medical Association, 2001) Gunasekera, P.C.; Wijesinghe, P.S.; Goonewardene, I.M.R.
No Abstract Available.
A Clinical and cost evaluation between outpatient endometrial biopsy and dilatation and curettage
(Sri Lanka College of Obstetricians and Gynaecologists, 1997) Gunasekera, P.C.; Wijesinghe, P.S.; Saparamadu, P.A.M.
Objective To evaluate the clinical and financial benefits of endometrial aspiration biopsy using a new aspiration device (Probet) over conventional dilatation and curettage. Design Comparison of histology and adequacy of samples obtained by endometrial aspiration and formal curettage. The histopathologist was blinded with regard to the biopsy method. Setting The gynaecology outpatient department of a teaching hospital. Patients 52 consecutive women requiring dilatation and curettage (D and C). Interventions Endometrial aspiration was performed in the out patient department and conventional D and C performed within 3 days. Main outcome measures Degree of discomfort to patients during endometrial aspiration was assessed by a visual analogue scale. Histological adequacy of the endometrial samples obtained was determined. The histological diagnosis of samples obtained by the two methods was passed. Cost of the two methods was determined. Results Eight patients experienced moderate to severe discomfort during endometrial aspiration. These were done for investigation of subfertility (2) and postmenopausal bleeding (6). Scanty or no endometrial aspirate was obtained in 9 women, 6 of whom had postmenopausal bleeding. No curettings were obtained in 5 of the women with postmenopausal bleeding. Active bleeding was present at the time of the procedure in 5 patients which was reported as blood clot and menstrual endometrium. In only 2 of the paired endometrial samples did the histological diagnosis differ from the specimen obtained by endometrial aspiration. Histological concordance was noted in 30 pairs. Conclusions Outpatient endometrial biopsy is acceptable to the majority of patients. Nulliparous and postmenopausal woman feel discomfort. Endometrial biopsy in the presence of active bleeding is of little value. There is good histological concordance between samples from endometrial aspiration is as ten times cheaper than conventional curettage
Closure of the peritoneum during vaginal hysterectomy and repair (VH & R)
(Sri Lanka Medical Association, 1998) Wijesinghe, P.S.; Gunasekera, P.C.
INTRODUCTION : Standard VH & R involves closure of the peritoneum with a purse string suture. Potential benefits are prevention of Fallopian tube prolapse, prolapse of intestines, vault prolapse and recurrence of the cntcrocoele. However, damage to the ureters, blood vessels and intestines is possible with this method. OBJECTIVES : To assess the usefulness of a technique which does not involve closure of the peritoneum with a purse string suture. DESIGN :Case control study. Setting : The Professorial Gynaecology Unit of the North Colombo General Hospital, Ragama. MAIN OUTCOME MEASURES :Post operative febrile morbidity, vault haematoma and abscess formation, and prolapse of viscera. Follow up for recurrence of components of prolapse. RESULTS : Over a period of 15 months from June 1995, 115 women awaiting VH & R were randomly allocated to two groups viz. A and B. conventional VH & R was carried out in group A. In group B the peritoneum was not closed separately but the pedicles except the vascular one were tied together in the midline. In spite of prophylactic antibiotics 3 out of 56 in group A and 4 out of 59 in group B developed post operative fever which lasted more than 48 hours. The incidence of postoperative haematoma and abscess formation was not different between the two groups and there were no cases of fallopian tube prolapse or intestinal prolapse. Apart from two cases each of recurrent cystocoele in the two groups, there were no other relevant morbidity during the follow up of upto two years. CONCLUSION : In this series closure of the peritoneum during VH & R with a purse string suture does not appear to be of any extra benefit. This step can be safely omitted during this procedure without adding to morbidity.
Comparison of maternal anthropometry and a single symphysis fundal height measurement as a screening test for low birth weight babies
(Sri Lanka College of Obstetricians and Gynaecologists, 1997) Gunasekera, P.C.; Wijesinghe, P.S.; Pathmeswaran, A.
Objective To compare a single pre-delivery symphysis fundal height (SFH) measurement and maternal anthropometric measurements as screening methods for low birth weight (LBW). Material and methods SFH, weight, height and mid. upper arm circumference (MUAC) were measured in 525 consecutive pregnant women carrying singleton pregnancies admitted for delivery. Birthweight was recorded. Results 46 percent of the observed variation in birthweight of babies from singleton pregnancies is explained by the SFH. The predelivery height, weight, body mass index (BMl) and MUAC had less influence on birthweight. A SFH measurement of 34 cm or less detected 75 of 93 LBW babies. The sensitivity and specificity were 80.6 percent and 74.8 percent respectively. The negative predictive value at SFH of 34 cm or less was 94.7 percent. Conclusion A single pre-delivery SFH is a better screening test for LBW than pre-delivery maternal height, weight, BMI or MUAC and 95 percent of mothers with a SFH measurement of more than 34 cm delivered a baby weighing more than 2500g.
Early pregnancy loss:are we doing enough?
(Sri Lanka College of Obstetricians and Gynaecologists, 2001) Wijesinghe, P.S.; Gunasekera, P.C.; Goonewardene, I.M.R.
No abstract available
Emergency Obstetric care: the key to further reducing maternal mortality in Sri Lanka
(World Health Organization Regional Office for South-East Asia, 2002) Gunasekera, P.C.; Wijesinghe, P.S.
This paper, in the South East Asia Regional Health Forum, discusses ways of reducing maternal mortality in Sri Lanka. Whilst the maternal mortality rate in Sri Lanka compares favourably with that of other countries in the region, much more can be done to bring down this rate further. The paper recommends that emphasis should be directed towards providing emergency obstetric care where all basic facilities for childbirth, including instrumental deliveries are provided. In addition, comprehensive emergency obstetric care must be made available in selected centres where mothers needing Caesarean section and blood transfusion are cared for. The paper concludes that the majority of maternal deaths occur due to delays in providing emergency obstetric care. This area has to be add-ressed urgently in order to maintain and improve the rate of reduction of maternal deaths. The political will to make drastic changes is a prerequisite if maternal deaths are to be reduced significantly. The authors argue that preventing maternal death and disability is not only a health issue – it is also a moral issue underpinned by the guiding principles of human rights, social responsibility, participation, and equity [adapted from author].
Female victims of sexual assault
(Sri Lanka Medical Association, 1997) Gunasekera, P.C.; Wijesinghe, P.S.
Drawbacks in this area are highlighted: admission may be hours or years after the offence, dearth of Forensic experts, lack of proper analysis of specimens, competence required of the clinicians to fulfil medical as well as legal responsibilities, lack of psychiatric assistance. (letter to editor)
Maternal Health in Sri Lanka
(Lancet Publishing Group, 1996) Gunasekera, P.C.; Wijesinghe, P.S.
Comment on: Lancet. 1995 Oct 21; 346(8982):1046. No Abstract Available
New contraceptive options
(Sri Lanka College of Obstetricians and Gynaecologists, 2004) Gunasekera, P.C.; Wijesinghe, P.S.
No Abstract Available
Obstetrics and Gynaecology in the developing world
(Blackwell Scientific Publications, 1996) Gunasekera, P.C.; Wijesinghe, P.S.
No abstract available Comment on: Br J Obstet Gynaecol. 1996 Jun;103(6):491-3.,
Reducing abortions is a public health issue
(Sri Lanka Medical Association, 2001) Gunasekera, P.C.; Wijesinghe, P.S.
No Abstract Available, Comment in: Jayasuriya, L.(Ceylon Med J. 2001; 46(4):163); Gunasekera, P.C.(Ceylon Med J. 2002; 47(2):74).
Rubella immunisation and pregnancy
(Sri Lanka Medical Association, 1997) Gunasekera, P.C.; Wijesinghe, P.S.; Gunasekera, D.P.
No Abstract Available
Screening for cervical cancer
(The Kandy Society of Medicine, 1995) Gunasekera, P.C.
No Abstract Available
Spontaneous hepatic rupture in pregnancy
(Sri Lanka Medical Association, 1998) Wijesinghe, P.S.; Gunasekera, P.C.; Sirisena, J.
Spontaneous hepatic rupture in pregnancy is rare and associated with significant maternal morbidity and mortality. It has been reported in association with severe pregnancy-induced hypertension and HELP (haemolysis elevated liver enzymes low platelets) syndrome. New imaging techniques enable early diagnosis, and in those with subcapsular haematomas, conservative management. Surgical intervention is necessary in capsular rupture with haemodynamic instability. We here report three fatal cases and discuss the diagnosis and management
Time we increased folic acid consumption in Sri Lanka
(Sri Lanka Medical Association, 1997) Gunasekera, P.C.; Chandrasena, L.G.; Gunasekera, D.P.; Sirisena, J.
No Abstract Available