Browsing by Author "Perera, M.N.I."

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A Case report of Meningioma with uncal herniation in pregnancy
(Sri Lanka College of Obstetricians & Gynaecologists, 2017) Suthakaran, V.; Perera, M.N.I.; Herath, H.M.R.P.; Dias, T.D.; Wijesinghe, P.S.
INTRODUCTION: The diagnosis and management of meningioma during pregnancy is a challenge, with growth and regression both reported. The occurrence of meningioma during pregnancy is rare, comparable with that in non-pregnant woman in the same age group. We report a case of meningioma with uncal herniation leading to maternal death during pregnancy. CASE: Thirty-year-old woman was referred to our unit on her 20th weeks of gestation for severe headache and vomiting. This is her third pregnancy with two living children, both delivered by caesarean section. She had early morning headache, lasting for 1 to 2 hours which resolved following vomiting from16th week of gestation. She did not have visual impairment, photophobia or focal neurological ymptoms. She was admitted to base hospital for increased frequency and severity of headache on her 18th week of gestation. Neurological examination was normal. Her blood pressure was normal throughout this pregnancy. She defaulted herneurology appointment. She was readmitted for same symptoms and transferred to our hospital. She complained severe headache, vomiting and blurred vision on day of admission followed by difficulty in breathing. Her SPO was 84 % on air and respiratory rate was 32/minutes. Ophthalmoscopy was normal. She was intubated for impending respiratory arrest and non-contrast CT was performed. CT showed Right sided sphenoidal wing tumour suggestive of a meningioma with midline shift and uncal herniation. She developed repeated episodes of a systole before transfer to neurosurgical unit and did not recover. Postmortem findings and histology confirmed the diagnosis of meningothelial type of meningioma. DISCUSSION: Intracranial tumours in pregnant woman are serious and life threatening conditions. The clinical presentation of intracranial mass mimics the symptoms of hyperemesis gravidarum, eclampsia and puerperal psychosis. MRI of the brain is the investigation of choice for prompt diagnosis of meningioma. Surgery is the key in the management of meningioma depend on the site of tumour. The general recommendation in pregnancy is for caesarean section as first surgery followed by neurosurgical interventions. Urgent neurosurgical linterventions are indicated for patients with malignant tumours, active hydrocephalus or benign tumours with impending herniation or progressive neurological deficits.
A case report of Meningioma with uncal herniation in pregnancy
(Sri Lanka College of Obstetricians & Gynaecologists, 2017) Suthakaran, V.; Perera, M.N.I.; Herath, H.M.R.P.; Dias, T.D.; Wijesinghe, P.S.
INTRODUCTION: The diagnosis and management of meningioma during pregnancy is a challenge, with growth and regression both reported. The occurrence of meningioma during pregnancy is rare, comparable with that in non-pregnant woman in the same age group. We report a case of meningioma with uncal herniation leading to maternal death during pregnancy. CASE: Thirty-year-old woman was referred to our unit on her 20th weeks of gestation for severe headache and vomiting. This is her third pregnancy with two living children, both delivered by caesarean section. She had early morning headache, lasting for 1 to 2 hours which resolved following vomiting from16th week of gestation. She did not have visual impairment, photophobia or focal neurological ymptoms. She was admitted to base hospital for increased frequency and severity of headache on her 18th week of gestation. Neurological examination was normal. Her blood pressure was normal throughout this pregnancy. She defaulted herneurology appointment. She was readmitted for same symptoms and transferred to our hospital. She complained severe headache, vomiting and blurred vision on day of admission followed by difficulty in breathing. Her SPO was 84 % on air and respiratory rate was 32/minutes. Ophthalmoscopy was normal. She was intubated for impending respiratory arrest and non-contrast CT was performed. CT showed Right sided sphenoidal wing tumour suggestive of a meningioma with midline shift and uncal herniation. She developed repeated episodes of a systole before transfer to neurosurgical unit and did not recover. Postmortem findings and histology confirmed the diagnosis of meningothelial type of meningioma. DISCUSSION: Intracranial tumours in pregnant woman are serious and life threatening conditions. The clinical presentation of intracranial mass mimics the symptoms of hyperemesis gravidarum, eclampsia and puerperal psychosis. MRI of the brain is the investigation of choice for prompt diagnosis of meningioma. Surgery is the key in the management of meningioma depend on the site of tumour. The general recommendation in pregnancy is for caesarean section as first surgery followed by neurosurgical interventions. Urgent neurosurgical linterventions are indicated for patients with malignant tumours, active hydrocephalus or benign tumours with impending herniation or progressive neurological deficits.
Fetal cardiac ultrasonography: An optimum gestational age of assessment
(Sri Lanka College of Obstetricians & Gynaecologists, 2017) Perera, M.N.I.; Kulasinghe, I.R.M.M.; Dias, T.D.
OBJECTIVES: To identify the ability of acquiring fetal cardiacimages at different gestational age windows using ultrasound scan. DESIGN, SETTING AND METHOD: This was a prospective descriptive study using ultrasound machine “Alpinion EC-15 V4.0” and “Toshiba Aplio 300”. Fetal cardiac views at gestational age from 11 to 30 weeks were obtained by an expert in obstetric fetal echo. Low risk women with singleton pregnancy were recruited. The sample was stratified into 5 gestational age windows between 11 and 28 weeks. Ability to view four chambers, right and left out flow tracts, three vessels, aortic arch, ductal arch and superior and inferior vena cavae at each gestational window was assessed. RESULTS: A total of 313 pregnant women were analyzed. All seven fetal cardiac images were obtained at the gestational age of 18 weeks to 25+6. There was a sub-optimal acquisition of the three vessels and SVC/IVC (96.3%) at 26-30 weeks. Six out of seven cardiac images were possible in more than 80% of cases from 14 to 17+6 weeks. At the gestational age between 11 weeks to 13+6, the ability to view four chambers was 92.98% and the ability to view the rest of the images was as follows: right out flow tract – 38.6%, left outflow tract – 42.11%, three vessels - 38.6%, aortic arch- 36.84%, ductal arch- 35.09%, superior and inferior vena cavae-5.26%. CONCLUSION: Ability of acquiring fetal cardiac views was best at 18 to 25+6. Cardiac image acquisition is sub optimum in early gestations and beyond 26 weeks.
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.
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.