Browsing by Author "Kajendran, J."

Now showing 1 - 9 of 9

Audit on current practices of induction of labour at a tertiary care hospital
(Sri Lanka College of Obstetricians & Gynaecologists, 2016) Kajendran, J.; Jayawardena, G.R.M.U.G.P.; Gunarathna, S.M.S.G.; Herath, H.M.R.P.
OBJECTIVE: Induction of labour (IOL) is a common obstetric intervention done for several reasons. Most importantly, induction of labour has a large impact on the health of women and their babies and so needs to be clearly clinically justified. Yet it is also important to perform regular audit of this practice on account of ensuring risk-free medical practice. Thus, current practice of IOL was examined to assess the indications and outcomes of IOL. METHOD: This audit was carried out from January 2016 to April 2016 in obstetric professorial unit of Colombo north teaching hospital Ragama. Data on all women admitted for IOL was collected using data collection sheet. The processes of IOL were tested against the WHO clinical guideline. It was aimed to determine the IOL rate, reasons, and outcomes. RESULTS: Out of the1423 deliveries during those periods 377 were induced (26.49%). Mean maternal age was 28.08-years and mean gestation was 39-weeks. Number of successful induction was 286.The most common indications for IOL were: prolonged rupture of membranes (29.4%), prolonged pregnancy (20.7%) diabetes complicating pregnancy (12.2%), hypertensive disorders (9.8%), and small for gestational age (5.1%). Reason for IOL was not documented in 20% and rests of the IOL were due to social, IUD and other medical disorders. The most common indications at <37 weeks were prolonged rupture of membranes (52%) and small for gestational age (17%). Emergency caesarean section was 19.3% for lack of progress and fetal distress. Seventeen percentages of neonates were admitted for NICU and 96% had APGAR more than 7 at 7 minutes. CONCLUSION: Our unit IOL proportion is lower than national figure (35.5%).One fifth of the IOL indications were not documented and this highlights the deficiency in the documentation. Checklist for IOL has been decided in the unit meeting to enhance proper documentation.
Audit on current practices of induction of labour at a tertiary care hospital
(Sri Lanka College of Obstetricians & Gynaecologists, 2016) Kajendran, J.; Jayawardena, G.R.M.U.G.P.; Gunarathna, S.M.S.G.; Herath, H.M.R.P.
OBJECTIVE: Induction of labour (IOL) is a common obstetric intervention done for several reasons. Most importantly, induction of labour has a large impact on the health of women and their babies and so needs to be clearly clinically justified. Yet it is also important to perform regular audit of this practice on account of ensuring risk-free medical practice. Thus, current practice of IOL was examined to assess the indications and outcomes of IOL. METHOD: This audit was carried out from January 2016 to April 2016 in obstetric professorial unit of Colombo north teaching hospital Ragama. Data on all women admitted for IOL was collected using data collection sheet. The processes of IOL were tested against the WHO clinical guideline. It was aimed to determine the IOL rate, reasons, and outcomes. RESULTS: Out of the1423 deliveries during those periods 377 were induced (26.49%). Mean maternal age was 28.08-years and mean gestation was 39-weeks. Number of successful induction was 286.The most common indications for IOL were: prolonged rupture of membranes (29.4%), prolonged pregnancy (20.7%) diabetes complicating pregnancy (12.2%), hypertensive disorders (9.8%), and small for gestational age (5.1%). Reason for IOL was not documented in 20% and rests of the IOL were due to social, IUD and other medical disorders. The most common indications at <37 weeks were prolonged rupture of membranes (52%) and small for gestational age (17%). Emergency caesarean section was 19.3% for lack of progress and fetal distress. Seventeen percentages of neonates were admitted for NICU and 96% had APGAR more than 7 at 7 minutes. CONCLUSION: Our unit IOL proportion is lower than national figure (35.5%).One fifth of the IOL indications were not documented and this highlights the deficiency in the documentation. Checklist for IOL has been decided in the unit meeting to enhance proper documentation.
Case report: Giant adenomatoid tumour of uterus mimicking like large leiomyoma
(Sri Lanka College of Obstetricians & Gynaecologists, 2016) Kajendran, J.; Gunarathna, S.M.S.G.; Wijesinghe, P.S.; Hewavisenthi, S.J.
INTRODUCTION: Adenomatoid tumours of uterus are rare benign neoplastic disorder of the female genital tract. Even though reported incidence is around 1-2% true incidence is probably more than that as they are not usually symptomatic. Most cases are under 3 cm in diameter, but giant variants up to 15 cm in diameter are also described. Here, we describe a case of giant adenomatoid tumor of the uterus that was managed surgically. CASE HISTORY: A 24-year-old nulliparous woman presented with abdominal distension, regurgitation and early satiety of five months duration. She did not have any menstrual disorders. Abdominal examination revealed a large pelvic tumour corresponding to 20 weeks gravid uterus. Ultrasonography revealed a large uterus with multiple fibroid. She underwent a laparotomy, a subserosal mass arising from the posterior uterine wall near the fundus and extending to the left uterine cornu was found. It was not a well-defined mass and consistency was firm in nature. Tumour was easily enucleated and sent for histology. Uterus was repaired into two layers. Post-operative recovery was uneventful. The histology report revealed as adenomatoid tumor of the uterus. DISCUSSION: Adenomatoid tumour arises from the germinal epithelium of abdomen and thorax. It is a variant of mesothelioma. They can be associated with fibroids and tend to mimic them clinically, making pre-operative diagnosis difficult. Macroscopically, most appear as nodular formations with ill- defined margins and can occur in ovary, mesentery, adrenal glands, and omentum. Rarely do they recur even after conservative surgery and so far no malignant transformation has been reported. Therefore, the recommended treatment is simple excision of the tumor, if possible.
Case report: Giantadenomatoidtumour of uterus mimicking like large leiomyoma
(Sri Lanka College of Obstetricians & Gynaecologists, 2016) Kajendran, J.; Gunarathna, S.M.S.G.; Wijesinghe, P.S.; Hewavisenthi, S.J.de.S.
INTRODUCTION: Adenomatoidtumours of uterus are rare benign neoplastic disorder of the female genital tract. Even though reported incidence is around 1-2% true incidence is probably more than that as they are not usually symptomatic. Most cases are under 3 cm in diameter, but giant variants up to 15 cm in diameter are also described. Here, we describe a case of giant adenomatoid tumor of the uterus that was managed surgically. CASE HISTORY: A 24-year-old nulliparous woman presented with abdominal distension, regurgitation and early satiety of five months duration. She did not have any menstrual disorders. Abdominal examination revealed a large pelvic tumourcorresponding to 20 weeks gravid uterus. Ultrasonography revealed a large uterus with multiple fibroid. She underwent a laparotomy,a subserosal mass arising from the posterior uterine wall near the fundus and extending to the left uterine cornuwas found. It was not a welldefined mass and consistency was firm in nature. Tumour was easily enucleated and sent for histology. Uterus was repaired into two layers.Post-operative recovery was uneventful.The histology report revealed as adenomatoid tumor of the uterus. DISCUSSION: Adenomatoidtumour arises from the germinal epithelium of abdomen and thorax. It is a variant of mesothelioma. They can beassociated with fibroids and tend to mimic them clinically, making pre-operative diagnosis difficult. Macroscopically, most appear as nodular formations with ill- defined margins and can occur in ovary, mesentery, adrenal glands, and omentum. Rarely do they recur even after conservative surgery and so far no malignant transformation has been reported. Therefore, the recommended treatment is simple excision of the tumor, if possible.
Case report: Giantadenomatoidtumour of uterus mimicking like large leiomyoma
(Sri Lanka College of Obstetricians & Gynaecologists, 2016) Kajendran, J.; Gunarathna, S.M.S.G.; Wijesinghe, P.S.; Hewavisenthi, S.J.
INTRODUCTION: Adenomatoidtumours of uterus are rare benign neoplastic disorder of the female genital tract. Even though reported incidence is around 1-2% true incidence is probably more than that as they are not usually symptomatic. Most cases are under 3 cm in diameter, but giant variants up to 15 cm in diameter are also described. Here, we describe a case of giant adenomatoid tumor of the uterus that was managed surgically. CASE HISTORY: A 24-year-old nulliparous woman presented with abdominal distension, regurgitation and early satiety of five months duration. She did not have any menstrual disorders. Abdominal examination revealed a large pelvic tumourcorresponding to 20 weeks gravid uterus. Ultrasonography revealed a large uterus with multiple fibroid. She underwent a laparotomy,a subserosal mass arising from the posterior uterine wall near the fundus and extending to the left uterine cornuwas found. It was not a welldefined mass and consistency was firm in nature. Tumour was easily enucleated and sent for histology. Uterus was repaired into two layers.Post-operative recovery was uneventful.The histology report revealed as adenomatoid tumor of the uterus. DISCUSSION: Adenomatoidtumour arises from the germinal epithelium of abdomen and thorax. It is a variant of mesothelioma. They can beassociated with fibroids and tend to mimic them clinically, making pre-operative diagnosis difficult. Macroscopically, most appear as nodular formations with ill- defined margins and can occur in ovary, mesentery, adrenal glands, and omentum. Rarely do they recur even after conservative surgery and so far no malignant transformation has been reported. Therefore, the recommended treatment is simple excision of the tumor, if possible
Jk3 antibodies complicated with severe fetal anaemia requiring intrauterine transfusion: a case report
(Blackwell Scientific Publications,, 2019) Dias, T.; Patabendige, M.; Kajendran, J.; Kularathna, M.
Neglected symptoms of heart failure presented as peripartum cardiomyopathy: a case of maternal near-miss
(Sri Lanka College of Obstetricians & Gynaecologists, 2016) Patabendige, M.; Perera, M. N. I.; Suthakaran, V.; Kajendran, J.; Padumadasa, S. P.
INTRODUCTION: Peripartum cardiomyopathy (PPCM) is a rare obstetric emergency affecting women in late pregnancy or up to five months of postpartum period. It occurs in the absence of an identifiable cause or recognizable heart disease prior to the last month of pregnancy. The aetiology of PPCM is unknown. It has potentially devastating effects on mother and fetus if not treated early. The signs, symptoms and treatment of PPCM are similar to that of heart failure. Early diagnosis and proper management is the corner stone for better outcome of these patients. CASE REPORT: A 41 year old woman in her fourth pregnancy with two vaginal deliveries followed by a first trimester miscarriage presented with cough and exertional dyspnoea for two weeks duration at 31 weeks of gestation. History also revealed features of orthopnoea and paroxysmal nocturnal dyspnea. Her pregnancy was uncomplicated up to this. On admission, she was dyspnoec with clinical signs of acute heart failure and pulmonary oedema and blood pressure of 170/122 mmHg. Arterial blood gas showed metabolic acidosis and 64% of oxygen saturation. She was transferred to ICUand intubated with continuous positive airway pressure followed by synchronized intermittent mechanical ventilation and multi-disciplinary care. Echocardiography revealed dilated cardiomyopathy with ejection fraction of 20% and improved only upto 35%-40%favouring diagnosis of PPCM over pre-eclampsia. With initial resuscitation, intravenous antibiotics and heart failure therapy hercondition improved. Ultrasonography revealed an intrauterine death.Since she was receiving ICU care with sepsis and also cesarean section does not confer any benefit over vaginal delivery, induction was done with prostaglandin E2followed by misoprostol. She was discharged with a plan of sterilization.DISCUSSION: Third trimester is the most vulnerable period for most of the maternal and foetal lethal events. Proper education regrinding earlier medical advice for uncommon symptoms in late pregnancy may help to reduce the occurrence of these maternal near-misses. Although PPCM has a higher chance of mortality, rational and evidenced-based management can save these mothers. Since it carries a higher risk of recurrence in subsequent pregnancies, sterilization is required.
Neglected symptoms of heart failure presented as peripartum cardiomyopathy: a case of maternal near-miss
(Sri Lanka College of Obstetricians & Gynaecologists, 2016) Patabendige, M.; Perera, M.N.I.; Suthakaran, V.; Kajendran, J.; Padumadasa, S.P.
INTRODUCTION: Peripartum cardiomyopathy (PPCM) is a rare obstetric emergency affecting women in late pregnancy or up to five months of postpartum period. It occurs in the absence of an identifiable cause or recognizable heart disease prior to the last month of pregnancy. The aetiology of PPCM is unknown. It has potentially devastating effects on mother and fetus if not treated early. The signs, symptoms and treatment of PPCM are similar to that of heart failure. Early diagnosis and proper management is the corner stone for better outcome of these patients. CASE REPORT: A 41 year old woman in her fourth pregnancy with two vaginal deliveries followed by a first trimester miscarriage presented with cough and exertional dyspnoea for two weeks duration at 31 weeks of gestation. History also revealed features of orthopnoea and paroxysmal nocturnal dyspnea. Her pregnancy was uncomplicated up to this. On admission, she was dyspnoec with clinical signs of acute heart failure and pulmonary oedema and blood pressure of 170/122 mmHg. Arterial blood gas showed metabolic acidosis and 64% of oxygen saturation. She was transferred to ICUand intubated with continuous positive airway pressure followed by synchronized intermittent mechanical ventilation and multi-disciplinary care. Echocardiography revealed dilated cardiomyopathy with ejection fraction of 20% and improved only upto 35%-40%favouring diagnosis of PPCM over pre-eclampsia. With initial resuscitation, intravenous antibiotics and heart failure therapy hercondition improved. Ultrasonography revealed an intrauterine death.Since she was receiving ICU care with sepsis and also cesarean section does not confer any benefit over vaginal delivery, induction was done with prostaglandin E2followed by misoprostol. She was discharged with a plan of sterilization. DISCUSSION: Third trimester is the most vulnerable period for most of the maternal and foetal lethal events. Proper education regrinding earlier medical advice for uncommon symptoms in late pregnancy may help to reduce the occurrence of these maternal near-misses. Although PPCM has a higher chance of mortality, rational and evidenced-based management can save these mothers. Since it carries a higher risk of recurrence in subsequent pregnancies, sterilization is required.
Snake bite in pregnancy: A rare case report
(Sri Lanka College of Obstetricians & Gynaecologists, 2017) Perera, M. N. I.; Suthakaran, V.; Kajendran, J.; Dias, T. D.
INTRODUCTION: Snake bite in pregnancy appears to be uncommon. Only few cases have been reported in the literature. Venomous snake bite in a pregnant woman may lead to poor outcome for both mother and the fetus. Anti-venom causes anaphylactic reactions that may have adverse effects on the mother or fetus. CASE REPORT: A 31-year-old G2P1C1, at 11w 3d of gestation presented one hour following a snake bite on her right foot. On admission, she was conscious and oriented. She was complaining of abdominal pain. Her vital signs were stable. There was an induration and erythema with fang marks on the right foot. Systemic examination was normal. On abdominal examination, there was suprapubic tenderness. Patient was kept under close observation and was investigated with coagulation profile as well as whole blood clotting time (WBCT) test which was repeated six hourly. Ultrasound scan confirmed a viable intrauterine pregnancy. Her third WBCT was delayed with prolonged clotting profile. She was treated with polyvalent antivenomserum (AVS) and was given ICU care. Patient recovered completely. Though she was discharged after three days of hospitalization her pregnancy ended up with miscarriage one week later. DISCUSSION: Snake bite is not common in pregnancy. Studies from Africa, India and Sri Lanka revealed that pregnant women accounted for 0.4% to 1.8% of hospitalized snake bite victims. Snake bite carries significant fetal wastage (43%) and maternal mortality (10%). Snake venom is a complex mixture of enzymes which lead to tissue injury, systemic vascular damage, haemolysis, fibrinolysis and neuromuscular dysfunction culminating in either haematological symptoms or neurological manifestations.The common adverse obstetrical events occurring due to snakebite are miscarriage, IUD, and premature labour. Mechanisms which causes fetal death are; fetal anoxia associated with maternal shock after envenomation, abruptio placentae, premature uterine contractions initiated by venom, pyrexia and cytokines released after tissue damage, maternal haemorrhage leading to acute fetal anaemia, supine hypotension syndrome and anaphylaxis to AVS.Anti-venomserum can cause anaphylactic reactions which may have an adverse effect on the mother or fetus. Though the fetal death rates up to 55% to 85% has been reported in mothers given AVS, most authors have recommended anti-venom administration for snake bite during pregnancy. While the safety of anti-venom is unclear in pregnancy, the risks of withholding, likely outweigh the risks of administrating in needy patients.