Browsing by Author "Padumadasa, G.S."

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Audit on cardiotocographs
(Sri Lanka College of Obstetricians and Gynaecologists, 2005) Padumadasa, G.S.; Amarasena, J.M.T.; Ratnatilake, R.M.K.R.M.; Wijesinghe, P.S.
METHOD: One hundred cardiotocographs taken in women who presented between 01 April 2005 and 22 April 2005 were analyzed. In those who had more than'one cardiotocograph (CTG), the first one was analyzed. Documentation about name, B.H.T No., date and time of CTG, time of seeing the CTG, whether reactive or not, action taken, signature and designation were assessed. Ninety percent was considered the target. RESULTS: The mean age of the subjects was 27.2 years ( SD 3.1 ). The period of gestation ranged from 29 to 41 weeks with a median of 38.7 weeks. Fifty six subjects had only one CTG while 19 had two CTGs and 25 had three or more CTGs. There was a median delay of 1.3 hours ( range 0.1 to 6 hours) in taking the CTGs. Eighty seven CTGs had the name documented while only 66 had the B.H.T. No. documented. The date was documented in 95 CTGs, but the time was documented only in 76. Time of seeing the CTG was documented only in 72. Eighty one CTGs had documentation on whether it was reactive or not. However, only 11 gave any details on the action taken. The signature was found in 84 CTGs, but only 78 had the designation of the person documented. CONCLUSION: The results were discussed at an audit meeting. It was concluded that documentation on CTGs was poor. The importance of proper documentation on CTGs was stressed to the team members. A re-audit is planned in three months to assess any improvement.
Audit on management of past section
(Sri Lanka College of Obstetricians and Gynaecologists, 2005) Padumadasa, G.S.; Ratnatilake, R.M.K.R.M.; Amarasena, J.M.T.; Wijesinghe, P.S.
OBJECTIVE: To audit management of women with one past section. DESIGN AND SETTING: A retrospective audit at the University Obstetric Unit, North Colombo Teaching Hospital. Method: Twenty five records of women with one past section awaiting delivery, who presented between 01 April 2005 and 22 May 2005 were analyzed. "Whether the placental site was checked, estimated fetal weight assessed and pelvic assessment done was assessed. Ninety percent was considered the target, Results: The mean age of the women was 33.1 years (SD 2.6). The mean period of gestation was 37.6 weeks (SD 0.7) and the mean height of the women was 152.4cm (SD 2.7). In eight women a decision was taken to subj ect them to a trial of scar and in 11, it was decided to perform an elective caesarean section. Six women underwent emergency caesarean section on admission. The placental site was checked in 13 (52 %), estimated fetal weight assessed in 12 (48 %) and pelvic assessment done in four (16 %) women. Out of the eight women who were awaiting a trial of scar, seven (87 %) had the placental site checked and seven (87 %) had the estimated fetal weight assessed. However only four (50 %) had a pelvic assessment performed. CONCLUSION: The results were discussed at an audit meeting. It was concluded that assessment in women with one past section awaiting delivery was not adequate. The importance of proper assessment was stressed to the team members. A re-audit is planned in three months to assess any improvement.
Child sex abuse-a global problem
(Sri Lanka College of Obstetricians and Gynaecologists, 2008) Padumadasa, G.S.
There has been increased awareness globally of child sexual abuse and harassment. In Sri Lanka too, the National Child Protection Authority has probed many incidents of child'sexual abuse and highlighted them via the media, thereby increasing the public awareness. Although worldwide, girls have a higher prevalence of sexual abuse, according to studies in Sri Lanka, more boys are abused than girls. The incidence increases with age. Anumber of psychological and medical consequences have been described as associated with child sex abuse. Psychological disorders are reported as having an increased incidence in those who have been abused sexually and include depression, eating disorders, anxiety disorders, substance abuse, somatization, post traumatic stress disorder, dissociative disorders, psychosexual dysfunction in adulthood and a number of interpersonal problems including difficulties with issues of control of anger, shame, trust, dependency and vulnerability. Furthermore there are physical effects such as bruising, abrasions, lacerations and these children are more likely to be infected with sexually transmitted diseases. Majority of cases of child sexual abuse go unreported due to fear and shame. Most cases of child sex abuse occur within the privacy of the family and this adds to the difficulties of diagnosis and management.
Outcome of maternal and neonatal effects of forceps and vacuum assisted deliveries
(Sri Lanka College of Obstetricians and Gynaecologists, 2010) Pathiraja, P.D.I.W.; Padumadasa, G.S.; Gayani, G.G.A.
INTRODUCTION: Forceps and vacuum are instruments designed to aid in the delivery of the fetus by applying traction on fetal head. The use of vacuum extraction in relation to forceps has increased in other countries. The aim of this study was to compare the risk of maternal and neonatal adverse outcomes between forceps and vacuum assisted deliveries. METHOD AND MATERIALS: This was a descriptive study of 70 singleton operative vaginal deliveries at the University Obstetric Unit, Colombo North Teaching Hospital from 1 st of January 201 0 to 7th of June 201 0. Maternal outcome, such as perineal tears and presence of lacerations, were studied. Neonatal outcome was evaluated with Apgar scores, admissions to neonatal intensive care unit, cephalhaematomas, bruising and instrument marks. RESULTS: Among 70 operative vaginal deliveries, 56 were forceps (80%), 14 were vacuum deliveries (20%). The mean age was 30. 5 years (range 23 -36). Forty two women out of seventy were primigravidae. The mean birth weight of babies delivered by forceps was 321 6g (range 2450 - 4200g) and by vacuum was 3260g (range 2280 - 3680g). There were five instances where vacuum was followed by forceps deliveries. The indications for instrumental deliveries were prolonged second stage 47 (68%), maternal exhaustion 8 (12%), valvular heart disease 6 (8%) and medical problems 9 (10%). Forceps were used more often than vacuum for prolonged second stage of labour (38 Vs 9). There were a higher rate of maternal third- and fourth-degree perineal (12 Vs 4) and vaginal lacerations (28 Vs 7) with the use of forceps. There were no perinatal deaths in either group. There were eight (5.6%) admissions to special care baby unit and receipt of assisted ventilation. More instrument marks and bruising (11 Vs 0) were also found in the neonates delivered by forceps, whereas there was a greater incidence of cephalhematomas (8 Vs 1) in the neonates delivered with vacuum.
A Review of post-operative morbidity following laparoscopic assisted vaginal hysterectomy compared to conventional types of hysterectomy
(Sri Lanka College of Obstetricians and Gynaecologists, 2002) Weerasekera, D.; Padumadasa, G.S.
OBJECTIVE: To analyse the indications, morbidity and duration of hospital stay for laparoscopic assisted vaginal hysterectomy in comparison to other types of hysterectomy. DESIGN: A prospective cohort study. PATIENTS: All women undergoing hysterectomy dur¬ing the period of October 2000 to April 2002 at the University Obstetrics and Gynaecology Unit, Colombo-South Teaching Hospital. INTERVENTIONS: A patient questionnaire completed prior to surgery, on discharge from the hospital, and two weeks after surgery. Data extracted from patient's hospital case notes. MAIN OUTCOME MEASURES: Indications, operative complications, postoperative morbidity and length of hospital stay for different types of hysterectomy. RESULTS: 270 women underwent hysterectomy during this period, out of which 60% were total abdominal hysterectomies, 19.6% were vaginal hysterectomy and repairs, and 17% were laparoscopic assisted vaginal hysterectomies. Common indications for hysterectomy were fibroids (39.6%), uterine prolapse (19.6%) and severe dysfunctional uterine bleeding (11.5%). Mean postoperative hospital stay was 2 days for laparoscopic hysterectomy, 4 for vaginal hysterectomy and repair, and 5 for total abdominal hysterectomy. CONCLUSIONS: Laparoscopic assisted vaginal hysterectomy appears to be a better alternative to conventional hysterectomy with regard to post-operative morbidity and hospital stay in selected patients.
A Trial of expectant management in incomplete miscarriage
(Sri Lanka Medical Association, 2011) Wijesinghe, P.S.; Padumadasa, G.S.; Palihawadana, T.S.; Marleen, F.S.
INTRODUCTION Incomplete miscarriage is often treated with surgical evacuation in Sri Lanka. Expectant management, which is an alternative treatment, was assessed for efficacy and safety in a local setting. METHODS Randomised clinical trial of two treatment groups of expectant and surgical management with 71 and 69 participants, respectively, was done at the University Gynaecology Unit of the Colombo North Teaching Hospital, Ragama, from December 2007 to July 2009. Women with incomplete miscarriage at a period of amenorrhoea of <14 weeks and retained products of conception of <50mm were included. Expectant management involved in-ward treatment till resolution of heavy bleeding and pain and follow up for two weeks. In surgical treatment, evacuation was undertaken and the patient sent home from hospital after bleeding settled with follow up. The maximum anteroposterior diameter of the endometrial cavity was measured with transvaginal ultrasonography and a diameter <15mm was considered as complete miscarriage. RESULTS Expectant management had a treatment success of 90.1% at one week and 94.4% at two weeks. For surgical treatment this was 95.7%. Infection was noted in one subject from the surgical group and none in the expectant group. Fall in the haemoglobin concentration in the two groups was clinically not significant. The expectantly managed group had a shorter hospital stay than the surgically managed group (1.58 vs 2.57 days, p=0.008). CONCLUSIONS Expectant management is an effective and safe alternative to surgical evacuation in management of incomplete miscarriage in the local setting. It relieves the burden on the healthcare provider by shortening the hospital stay and avoiding the need for evacuation of retained products of conception under anaesthesia.
An Unusual case of polycystic ovary syndrome
(Sri Lanka College of Obstetricians and Gynaecologists, 2005) Padumadasa, G.S.; Wijesinghe, P.S.; Hewavisenthi, S.J.de S.
A 19 year old girl with primary smenorrhoea presented with lower abdominal pain, deepening of voice, hirsutism and hyperpigmentation of skin for five years. She had undergone left sided oophorectomy and wedge biopsy of the right sided ovary five years back and histology had revealed multiple ovarian cysts of follicular origin. On examination she was found to have a normal body habitus, temporal recession of hairline, hirsutism and clitoromegaly. Breasts were of Tanner stage 4-An ultrasound scan of abdomen revealed a right adnexal cyst of approximately 7x7 cm size. Serum testoeterone was mildly elevated. Serum dehydroepiandrosterone sulphate and 17 hydroxy progesterone levels were normal. A laparotomy carried out on 10 May 2005 revealed a right ovarian cyst of 7x7 cm. Cut surface of the cyst showed a large unilocular cyst and peripherally displaced multiple cysts of 0.5x0.5 cm size in thinned out stroma. Right sided oophorectomy was performed. Histology revealed multiple follicular cysts which was suggestive of polycystic ovaries. One month after surgery there is already an improvement in the pigmentation of skin and hirsutism. She was started on oral contraceptive pills. She is awaiting results of androstenedione, follicle stimulating hormone, luteinizing hormone and karyotype. This is a rare presentation of polycystic ovary syndrome.
Xanthogranulomatous salpingitis and oophoritis associated with endometriosis and uterine leiomyoma presenting as intestinal obstruction
(Informa Healthcare, 2012) Abeysundara, P.K.; Padumadasa, G.S.; Tissera, W.G.; Wijesinghe, P.S.
Xanthogranulomatous inflammation is a rare form of chronic granulomatous inflammation. Bacterial infections, immunosuppression, chronic inflammatory conditions, luminal obstruction, endometriosis, leiomyoma, abnormal lipid metabolism, ineffective antibiotic therapy, ineffective clearance of bacteria by phagocytes and chronic irritation of the urachal remnant have been implicated in the pathogenesis. There are very few reported cases of xanthogranulomatous salpingitis and oophoritis. We present such a case in a 34-year-old female, with primary subfertility for eight years, endometriosis, uterine leiomyoma, type II diabetes mellitus and a history of surgery for endometriosis and fibroids and surgical wound infection, who presented with symptoms of intestinal obstruction. The patient underwent emergency laparotomy followed by total abdominal hysterectomy and bilateral salpingo-oophorectomy. Histology revealed xanthogranulomatous salpingitis and oophoritis. Chronic inflammation due to inadequate treatment of bacterial infection, coupled with pelvic endometriosis and uterine leiomyoma may have led to xanthogranulomatous salpingitis and oophoritis.