Browsing by Author "Patabendige, M."

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Antimicrobials in Gynaecological practice
(Sri Lanka college of Obstetricians & Gynaecologists, 2017) Patabendige, M.; Herath, R.P.; Wijesooriya, W.R.P.L.I.
Surgical site infections are a common complication of Gynaecological surgeries. Up to 8-10% of Gynaecological patients undergoing an operative procedure will develop a surgical site infection. In surgeries with high rates of post-operative infection, antibiotic prophylaxis can play a major role in improving outcomes. In addition there are many indications where antimicrobial treatment is necessary in day-to-day Gynaecological practice. This review summarizes the available medical literature to assess the indications and appropriate antimicrobials for common circumstances in Gynaecological practice.
Blood flow changes in pelvic vessels associated with the application of an abdominal compression belt in healthy postpartum women
(Sri Lanka Medical Association, 2017) Dias, T.; Patabendige, M.; Herath, R.P.; Garvik, T.I.; Liland, F.; Arulkumaran, S.
INTRODUCTION: Postpartum haemorrhage (PPH) accounts for a high proportion of maternal mortality and morbidity throughout the world. A uterine compression belt which has been developed recently represents a very low tech, low cost solution in managing postpartum haemorrhage. OBJECTIVES :To evaluate the blood flow changes in pelvic vessels following application of the postpartum haemorrhage compression belt (Laerdal Global Health, Stavanger, Norway). METHODS: The sample included healthy postpartum women within 6 hours of vaginal delivery. The study was performed at Teaching Hospital, Ragama, Sri Lanka. PPH compression belt was applied on the lower abdomen in a supine position with a slight lateral tilt. Patient’s pulse, blood pressure and Doppler indices (RI, PI and PFV) of the uterine, internal iliac and femoral arteries were measured using transabdominal Doppler ultrasonography. Lower limb oxygen saturation was also measured. Measurements were obtained by connecting the subjects to a multimonitor throughout the study period of 20 minutes. Median RI, PI and PFV was calculated and comparisons were made between the baseline and after belt application at 10 and 20 minutes. RESULTS: A total of 20 healthy women were included and the mean time from delivery to study inclusion was 2.5 (range 0.5–5.0) hours. There were no adverse outcomes or altered vital signs noted among participants. Overall there were no significant changes in the internal iliac, uterine and femoral artery blood flow after application of the compression belt. CONCLUSIONS: There were no significant changes in the internal iliac, uterine and femoral artery blood flow after application of the compression belt. This preliminary study only shows that the application of the PPH compression belt has no apparent adverse changes in the iliac, uterine and femoral artery blood flow in postpartum mothers.
Childbirth Experience Questionnaire (CEQ) in the Sri Lankan setting: translation, cultural adaptation and validation into the Sinhala language
(BioMed Central, 2020) Patabendige, M.; Palihawadana, T.S.; Herath, R.P.; Wijesinghe, P.S.
OBJECTIVE: To adapt the CEQ into Sri Lankan Sinhala cultural context and to determine the psychometric properties of CEQ. This would yield an opportunity to evaluate childbirth experience among Lankan population. RESULTS: Out of 390, 226 (57.9%) postnatal mothers completed the CEQ after 1 month postpartum. Face validity and content validity were demonstrated with all participants stating that CEQ was easy to understand and complete. For reliability, internal consistency was acceptable for the overall score (0.85) and for all four domains in CEQ (0.65, 0.80, 0.70, 0.83 for "own capacity", "professional support", "perceived safety" and "participation", respectively). A weighted kappa of 0.61-0.80 for all 22 items in CEQ demonstrated a good test-retest reliability. This Sri Lankan version showed fit statistics in line with standard recommendations in exploratory factor analysis. Women with spontaneous onset of labour (except for "professional support" in women with spontaneous onset of labour) and women with a normal birth showed significantly higher CEQ scores. However, oxytocin augmentation could not yield a difference in CEQ scores. KEYWORDS: Birth satisfaction; Childbirth experience questionnaire; Low-resource settings.
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.
Fetal echocardiographic assessment: impact of gestational age and maternal obesity.
(Jaypee Brothers Medical Publishers, 2023) Patabendige, M.; Kodithuwakku, S.U.; Perera, M.N.I.; Dias, T.
AIM: To identify the ability to acquire various fetal cardiac views using two-dimensional ultrasound at different gestational age and body mass index (BMI) categories. MATERIALS AND METHODS: We performed a prospective observational study among low-risk women with singleton pregnancies attending the University Obstetrics Unit, North Colombo Teaching Hospital, Ragama, Sri Lanka. The ability to obtain satisfactory views of the situs, four chambers, right and left outflow tracts, three vessels, aortic arch, ductal arch, and superior and inferior vena cava of fetal heart was studied. RESULTS: A total of 314 eligible pregnant women underwent fetal echocardiography and 288 had complete data. All eight cardiac views were obtained with 100% success at the gestational age of 18 – 21 + 6 weeks and days. All eight cardiac views were satisfactory in more than 97% at the gestational age of 22 – 25 + 6 weeks and days. Body mass index was not significantly associated with acquisition of cardiac views at all gestations (p = 0.62). All eight cardiac views were obtained with 50% success at 14 – 17 + 6 weeks and 5.4% success at 11 – 13 + 6 weeks and days. CONCLUSIONS: Acquisition of all fetal cardiac views was best at 18 – 21 + 6 weeks and days of gestation, but reasonably successful till 26 weeks. Acquisition was sub-optimal in first trimester, below 18 weeks and for some cardiac views after 26 weeks. BMI does not hamper the ability to obtain cardiac views during fetal echocardiography. CLINICAL SIGNIFICANCE: This could be used as a guide for the timing of echocardiography when a particular cardiac defect is suspected in the fetus, where specific cardiac view(s) are used to confirm the particular diagnosis as well as the most appropriate gestational age period.
Improvements of post caesarean section pain management following the introduction of a new pain management protocol
(Sri Lanka college of Obstetricians & Gynaecologists, 2017) Patabendige, M.; Herath, R.P.
OBJECTIVE :To evaluate improvements in post-caesarean section (CS) pain management in University Obstetrics Unit, Ragama, Sri Lanka following the introduction of a protocol for post-CS pain management. METHODS: A complete audit cycle was conducted in University Obstetrics Unit, Ragama, Sri Lanka. Initially a prospective audit was conducted among 126 consecutive CS during July and August, 2016. Basic demographic data and details regarding post-CS analgesia during the first 24 hours were collected. Re-auditing was done four months after the introduction of the protocol. In the re-auditing, 150 post-CS mother were conveniently selected over a period of three months and a coloured visual analogue scale (VAS) was used to assess the level of pain in the re-audit. RESULTS: There were no statistically significant difference between demographic details before and after the protocol. Before introduction of the protocol, use of diclofenac sodium rectal suppositories were the commonest analgesic type (42.9%) used. Only 6 (4.8%) out of 126 patients had properly documented pain management plan in the operative notes. None of the analgesics were prescribed for 6 (4.8%) patients. Out of total 126, only 6 (4.8%) subjects had a proper drug chart maintenance with regular analgesics. Forty two (33.3%) women were was not on any analgesics within the first 24 hours. After introduction of the protocol, regular analgesic dosing were given to 140 (93.3%) women with satisfactory drug chart maintenance in 140 (93.3%) cases. Out of 150, 140 (93.3%) patients received analgesia with at least a single method. Mean VAS score was 3.5 (SD 2.0) after first 24 hours. Diclofenac sodium suppository (86.7%) is the commenst first line medication. There was statistically significant difference (P < 0.05) in provision of pain relief after introduction of the protocol. CONCLUSION: There was a significant improvement in post-CS pain management after introduction of a new post-CS pain management protocol.
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.
Nonpuerperal uterine inversion: What the gynaecologists need to know?
(Hindawi Pub. Corp., 2020) Herath, R.P.; Patabendige, M.; Rashid, M.; Wijesinghe, P.S.
INTRODUCTION: Nonpuerperal uterine inversion (NPUI) is a rare clinical problem with diagnostic and surgical challenges. The objective of our study was to review the literature on NPUI and describe causative pathologies, diagnosis, and different surgical options available for treatment. MATERIALS AND METHODS: A comprehensive literature review was carried out on MEDLINE and Google Scholar databases to look for NPUI using the term "non-puerperal uterine inversion," and further went through the cross-references of the published articles. Data are published case reports from 1911 to September 2018. Of the 153 published cases, 133 reports had adequate details of surgery for analysis. These reports were analyzed, concerning the clinical presentation, methods of diagnosis, and surgical treatment. RESULTS: Mean age of the women was 46.3 years (standard deviation: 18, N = 153). Leiomyoma remained the commonest (56.2%) aetiology. While malignancies contributed to 32.02% of cases, 9.2% were idiopathic. High degree of clinical suspicion and identification of unique features on ultrasonography and magnetic resonance imaging enable prompt diagnosis. In cases of uncertainty, laparoscopy or biopsy of the mass was used to confirm the diagnosis. Hysterectomy or repositioning and repair of the uterus are the only treatment options available. The surgical methods implemented were analyzed in three aspects: route of surgical access, method of repositioning, and final surgical procedure undertaken. The majority (48.8%) had only abdominal access, while 27.1% had both abdominal and vaginal access. Haultain procedure was the most useful procedure for reposition (18.0%) of the uterus. The majority (39.7%) required abdominal hysterectomy with or without debulking of the tumour abdominally, while 15.0% had uterine repair after repositioning. We reviewed the different surgical techniques and described and proposed a treatment algorithm. CONCLUSIONS: Fibroids were the commonest cause for NPUI. Malignancies accounted for one-third of cases. A combined abdominal and vaginal approach, followed by hysterectomy or repair after repositioning, seems to be better for nonmalignant cases.
Ultrasound parameters of pelvic organs and their age-related changes in a cohort of asymptomatic postmenopausal women: A community-based study.
(Sage Publishing, 2020) Dias, T.D.; Palihawadana, T.S.; Patabendige, M.; Motha, M.B.; de Silva, H.J.
No abstract available.
Use of antimicrobials in obstetric practice – A Narrative review
(Sri Lankan Society for Microbiology, 2020) Patabendige, M.; Herath, R.P.; Athulathmudali, S.R.; Wijesooriya, W.R.P.L.I.
ABSTRACT: Improvement of the outcome of infectious diseases by early and appropriate antimicrobial therapy is of paramount importance in any clinical discipline. Special considerations need to be given for the use of antimicrobial agents in obstetric practice, as it relates to the safety of both the mother and the fetus. However, their use and misuse are associated with significantly increasing antibiotic resistance. The objective of this review was to provide a useful overview for the practicing obstetrician, of current recommendations for the use of antibiotics in common situations related to pregnancy and the postpartum period. KEYWORDS: Antibiotic use, Obstetrics, Maternal health, Sepsis in pregnancy, Postpartum sepsis.
Validation of the international consultation on incontinence questionnaire-vaginal symptoms (ICIQ-VS) in two South- Asian languages
(Springer, 2017) Ekanayake, C.D.; Pathmeswaran, A.; Herath, R.P.; Perera, H.S.; Patabendige, M.; Wijesinghe, P.S.
INTRODUCTION: The multifaceted nature of pelvic floor disorders means that a systematic evaluation is required for optimal treatment outcome. It is also generally acknowledged that a valid tool is necessary to objectively assess symptoms reported by affected women. METHODS: The International Consultation on Incontinence Questionnaire-Vaginal Symptoms (ICIQ-VS) questionnaire was translated to Sinhala and Tamil and a validation study carried out among women attending gynecology clinics at North Colombo Teaching Hospital, Ragama, and the district general hospitals Mannar and Vavuniya. RESULTS: Content validity was assessed by the level of missing answers, which was < 4% and 2% for each item in Sinhala and Tamil, respectively. Construct validity was assessed by the ability of the questionnaire to differentiate between patients and controls. Both differentiated patients from controls on vaginal symptoms score (VSS) (p < 0.001), sexual symptoms score (SSS) (p < 0.01), and quality of life (QoL) (p < 0.001). There was a strong positive correlation between Pelvic Organ Prolapse Quantification (POP-Q) scores and VSS (Sinhala r s = 0.64, p < 0.001, Tamil r s = 0.65, p < 0.001), and QoL (Sinhala r s = 0.49, p < 0.001, Tamil r s = 0.60, p < 0.001). Internal consistency as assessed using Cronbach's coefficient alpha: 0.78 (0.76-0.78) and 0.83 (0.80-0.84) in Sinhala and Tamil, respectively. Test-retest reliability was assessed by weighted kappa scores (Sinhala 0.58-0.88 and Tamil 0.76-0.90). Both questionnaires were sensitive to change and showed that VSS and QoL improved following surgery (Wilcoxon matched-pairs signed-rank test p < 0.001). CONCLUSION: The validated Sinhala and Tamil translations of ICIQ-VS will be useful for assessing vaginal and sexual symptoms among women speaking Sinhala and Tamil.
Validation of the Sinhala translation of the International Consultation on Incontinence modular Questionnaire on Vaginal Symptoms (ICIQ-VS)
(Sri Lanka College of Obstetricians & Gynaecologists, 2016) Ekanayake, C.D.; Patabendige, M.; Wijesinghe, P.S.; Pathmeswaran, A.; Herath, R.P.; Weerasinghe, N.
OBJECTIVE: To translate and validate the International Consultation on Incontinence Modular Questionnaire on vaginal symptoms (ICIQ VS) from English to Sinhala. METHOD: ICIQ-VS questionnaire was translated to Sinhala and a validation study was carried out among women attending the gynaecology clinic at North Colombo teaching hospital, Ragama. RESULTS: Basic demographic characteristics of women with prolapse (n=64) versus women without prolapse (n=135) were as follows; Age 55.8 (SD 13.1) years, median parity 2.5 (IQ1- IQ3=2-4), BMI 23.8 kg/m2 (SD 3.2) versus age 42.6 (SD 13.1), median parity 2 (IQ1-IQ3=1-3), BMI 23.2 kg/m2 (SD 2.9) respectively. Content validity was assessed by the level of missing data which was less than 1% for each item. Internal consistency was assessed using Cronbach’s coefficient alpha scores which ranged from 0.75 to 0.78. Test–retest reliability as assessed by kappa values ranged from 0.54 to 0.80, except for item, ‘vagina too tight’ which demonstrated moderate reliability (kappa 0.41). Construct validity was assessed by the ability of the questionnaire to differentiate between patients and controls. The questionnaire differentiated between patients and controls on vaginal symptoms score (VSS) (p<0.001), sexual symptoms score (SSS) (p<0.05) and quality of life (p<0.001). There was a positive correlation between pelvic organ prolapse quantiﬁcation system (POP-Q) scores and VSS (rs= 0.61, p<0.001), SSS (rs = 0.22, p<0.01) and quality of life (rs = 0.52, p<0.001). CONCLUSION: The preliminary results for ICI Q VS (Sinhala) validation are satisfactory and once completed it will be invaluable to objectively assess vaginal and sexual symptoms in Sinhala speaking population in Sri Lanka.
Validation of the Sinhala translation of the International Consultation on Incontinence modular Questionnaire on Vaginal Symptoms (ICIQ-VS)
(Sri Lanka College of Obstetricians & Gynaecologists, 2016) Ekanayake, C.D.; Patabendige, M.; Wijesinghe, P.S.; Pathmeswaran, A.; Herath, R.P.; Weerasinghe, N.
OBJECTIVE: To translate and validate the International Consultation on Incontinence Modular Questionnaire on vaginal symptoms (ICIQ VS) from English to Sinhala.METHODS: ICIQ-VS questionnaire was translated to Sinhala and a validation study was carried out among women attending the gynaecology clinic at North Colombo teaching hospital, Ragama. RESULTS: Basic demographic characteristics of women with prolapse (n=64) versus women without prolapse (n=135) were as follows; Age 55.8 (SD 13.1) years, median parity 2.5 (IQ1IQ3=2-4), BMI 23.8 kg/m2 (SD 3.2) versus age 42.6 (SD 13.1), median parity 2 (IQ1-IQ3=1-3), BMI 23.2 kg/m2 (SD 2.9) respectively. Content validity was assessed by the level of missing data which was less than 1% for each item. Internal consistency was assessed using Cronbach’s coefficient alpha scores which ranged from 0.75 to 0.78. Test–retest reliability as assessed by kappa values ranged from 0.54 to 0.80, except for item, ‘vagina too tight’ which demonstrated moderate reliability (kappa 0.41). Construct validity was assessed by the ability of the questionnaire to differentiate between patients and controls. The questionnaire differentiated between patients and controls on vaginal symptoms score (VSS) (p<0.001), sexual symptoms score (SSS) (p<0.05) and quality of life (p<0.001). There was a positive correlation between pelvic organ prolapse quantification system (POP-Q) scores and VSS (rs= 0.61, p<0.001), SSS (rs = 0.22, p<0.01) and quality of life (rs = 0.52, p<0.001). CONCLUSIONS: The preliminary results for ICIQ VS (Sinhala) validation are satisfactory and once completed it will be invaluable to objectively assess vaginal and sexual symptoms in Sinhala speaking population in Sri Lanka