Browsing by Author "Wijesinghe, P.S."

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Acid aspiration Syndrome
(Sri Lanka College of Obstetricians and Gynaecologists, 2007) de Silva, B.A.; Herath, H.M.R.P.; Wijesinghe, P.S.
No Abstract Available
Adolescent sexual practices and contraceptive usage
(Faculty of Medicine, University of Kelaniya & Plan International, 2008) Herath, H.M.R.P.; Dissanayake, D.M.A.B.; Hilmi, M.A.M.; Pathmeswaran, A.; Wijesinghe, P.S.
INTRODUCTION: Adolescence is a critical period of development, as adoption of unhealthy risk behaviours such as unprotected sex, smoking and drug abuse, avoiding contraceptive methods will lead to long standing health and socioeconomic consequences. Therefore information is needed about the sexual practices and contraceptive usage of adolescents and young adults to develop interventions in the community. This study was undertaken to describe and compare the sexual practices, knowledge and usage of contraceptives by adolescents and young adults in selected urban and rural settings.METHOD: This cross sectional descriptive study was conducted among young adults aged less than 21 years at the time of interview in three settings in both rural and urban areas. The study subjects were students from universities, technical colleges and garment factory workers representing both rural and urban areas. The data was collected using a pretested self administered questionnaire during June 2007 to August 2007. Information collected included marital status, gender and the level of education, first sexual relationship (age, partner, contraception used), current contraceptive practices and knowledge about contraceptive methods. The data was analysed using SPSS 10.1 statistical package. Informed consent was obtained from all participants. RESULTS : There were a total of 1258 subjects who had returned the completed questionnaires. Out of them there were 290 garment factory employees, 480 technical college students, and 488 university students. The percentage of females was 58.9%. The mean ages of the males and the females of the total population were 20.75(50 1.13) years and 20.55(SD 1.63) and it was similar in the three settings. The level of education was highest among the undergraduates lowest among garment factory workers. Out of the population 303 (24.1%) were sexually active. It was significantly higher among males {33.5%0 than females (17.0%). Both among male and females this trend was significantly more common among garment factory workers. Sexual activity of the unmarried and the premarital sexual practices of married subjects are shown in the table. 6. 17% of females and 33.5% of males were sexually active before marriage. 90% male garment factory workers were sexually active. In contrast the proportion
Aetiology of infertility among females seeking treatment at a tertiary care hospital in Sri Lanka
(Sri Lanka Medical Association, 2012) Palihawadana, T.S.; Wijesinghe, P.S.; Seneviratne, H.R.
OBJECTIVES: Aim of this study was to describe the proportion of contributory factors of female infertility in a population that sought fertility treatment. Furthermore, the clinical findings and underlying pathologies associated with ovulatory dysfunction were also sought. METHODS: A cross-sectional study was carried out at the infertility clinic of the North Colombo Teaching Hospital. New clinic attendees were recruited and both partners had a detailed clinical interview. The women underwent a baseline pelvic ultrasound scan, assessment of ovulation and a hormone profile. Tests for tubal patency were carried out when clinically indicated. RESULTS: Ovulatory dysfunction was noted in 53% (n=218). Clinical and investigatory findings associated with ovulatory dysfunction included irregular menstrual cycles, acanthosis nigricans, hirsutism, polycystic ovary syndrome, a LH:FSH ratio of >1, and increased TSH or testosterone levels. Unilateral tubal occlusion was seen in 9.1 % (n=18) while it was bilateral in 1% (n=2). Abnormalities in sexual function were noted in 10.8% (n=56). CONCLUSIONS: Abnormalities in ovulation were common. Clinical findings that could be used to recognise women at risk of ovulatory dysfunction were identified. Abnormalities in sexual function, which are often overlooked in the clinical management of infertility, were seen in over 10% of patients. Tubal factor infertility is rare.
Aging population in Sri Lanka
(Sri Lanka College of Obstetricians and Gynaecologists, 2003) Wijesinghe, P.S.
No Abstract Available
Antibiotics supplemented culture media can eliminate non-specific bacteria from human semen during sperm preparation for intra uterine insemination
(Medknow Publications, 2014) Dissanayake, D.M.A.B.; Amaranath, K.A.; Perera, R.R.D.P.; Wijesinghe, P.S.
RATIONALE: Bacterial flora can be isolated from many semen samples of subfertile males. Bacteriospermia can compromise the outcome of intra uterine insemination (IUI) by contaminating thepost-processed sperm sample. OBJECTIVES: The objective of the present study is to determine the efficacy of penicillin and streptomycin in eliminating the bacteria from semen samples in the sperm processing procedure, and to assess the effects of antibiotics on sperm motility, survivability, and pregnancy rates.DESIGN AND SETTINGS: A prospectively controlled study was carried out using couples undergoing IUI with their informed consent. INTERVENTION: Sperm processing using the swim-up technique in penicillin and streptomycin supplemented culture medium. SUBJECTS AND METHODS: Couples were consecutively allocated in two groups for sperm processing (a) Group AB+ (antibiotics supplemented culture medium, n = 33) and (b) Group AB- (antibiotic free culture medium, n = 33). Semen culture was performed before and after sperm processing. Sperm motility was assessed immediately after processing and after 24 h of incubation.RESULTS: Bacterial isolates were found in 20 (60.6%) and 22 (66.1%) of samples before processing in Groups AB+ and AB- respectively. Addition of antibiotics resulted in completely eliminating non-specific bacteria from semen samples without affecting sperm motility. In vitro survival rate of sperm enhanced in AB+ group compared with AB- group (motile sperm after 24 h), 62.21% (standard deviation [SD]: 37.27) versus 41.36% (SD: 30.78), P = 0.012. Pregnancy rate, was comparable between two groups (9% in Group AB+ vs. 6% in Group AB-, P = 0.45). CONCLUSION: Penicillin streptomycin combination could completely eliminate non-specific bacteria from semen samples during sperm processing in this population. The types of antibiotics and dosage used did not seem to have any harmful effects on human sperm.
An assessment on foeto-maternal haemorrhage
(Sri Lanka Medical Association, 2018) Dilhani, M.N.; Wijesinghe, P.S.; Ranasinghe, H.R.P.; Williams, H.S.A.
INTRODUCTION AND OBJECTIVES: Foeto-maternal haemorrhage leading to maternal sensitization against foetal antigens occurs predominantly during delivery. This leads to rhesus haemolytic disease of the newborn and foetus in subsequent pregnancies. Accurate estimation of volume of such haemorrhage is important to provide the correct dose of anti-D for the prevention of haemolysis in subsequent pregnancies. Objective was to assess the volume and determinants offoeto-maternal haemorrhage at delivery. METHODS: A prospective descriptive study was conducted among 625 mothers admitted to the Professorial Obstetric unit for delivery from 2006 June. 2cc of Ethylene Diamine Tetra Acetic acid anticoagulated blood was taken within 2 hours of partus. Volume of foeto-maternal haemorrhage was assessed using the Keilhauer test.A minimum of 6000 adult red cells was counted to achieve a reasonable precision and to narrow 95% confidence limits to 95%. The volume of the haemorrhage was reported to the ward for necessary action An interviewer-administered questionnaire was filled at the time ofvenepuncture. RESULTS: Only 1.76% (n=l l ) mothers had more than 4ml hemorrhage (Range 6ml-52ml) to be qualified as a large bleeder, requiring additional doses ofanti-D. The toal number oflarge bleeders identified were too small to make inferences on determinants of large haemorrhages but still, some important observations were made: None of the mothers were multiparous but most were primi (n=6). All were single cephalic presentations (n=l l) delivered vaginally (n=9) or by a caesarean section (n=2). One had a placenta praevia, but none of the pregnancies were . complicated with antepartum or postpartum haemorrhage, polyhydramnios, manual removal of placenta or external cephalic versions or asssisted by instruments which are already known factors for such large bleeds. CONCLUSION: Clinically significant foeto-maternal haemorrhage requiring additional anti-D was <2% in our study population. Prospective epidemiological study including a larger study population will help to identify factors associated with increasing volume of foetal haemorrhage
An Atypical presentation of an ovarian lymphoma: a case report
(BioMed Central, 2018) Ekanayaka, C.D.; Punchihewa, R.; Wijesinghe, P.S.
BACKGROUND: Ovarian lymphoma has a varied clinical presentation and rarely presents with heavy menstrual bleeding. It may occur de novo or secondary to systemic disease and macroscopically appear as solid ovarian tumors. CASE PRESENTATION: A 32-year-old Tamil woman presented with heavy menstrual bleeding of 4 months' duration. On examination she was anemic with no lymphadenopathy. A large immobile pelvic mass and three firm nodules were found involving her vaginal walls. Ultrasonography suggested a fibroid uterus with two large pedunculated fibroids. Following preoperative optimization an endometrial sampling and biopsy of the nodules were done. Subsequently, histology revealed proliferative phase endometrium. The vaginal nodules showed lymphoid tissue. She presented a week later with an undulating fever and features of acute abdomen with clinical evidence of ascites. During an emergency laparotomy two large solid ovarian masses, gross ascites, pelvic lymph nodes, para-aortic lymph nodes, mesenteric lymph nodes, omental deposits, and a 24-week-size uterus were found. Bilateral oophorectomy was done. Laboratory investigations revealed raised lactate dehydrogenase with normal serum β-human chorionic gonadotropin, alpha-fetoprotein, and cancer antigen-125 levels. Histology of ovarian specimens revealed a diffuse large B cell lymphoma. A bone marrow biopsy revealed more than 80% infiltration with lymphoid cells. Two weeks after the laparotomy a computed tomography of her chest, abdomen, and pelvis revealed a pelvic mass, gross ascites, omental deposits, hepatosplenomegaly, and enlarged lymph nodes above and below her diaphragm. Immunohistochemistry confirmed the diagnosis of B cell lymphoblastic lymphoma. She was classified as stage IV E non-Hodgkin's lymphoma on the Ann Arbor staging system. CONCLUSION: This is an atypical presentation of an ovarian lymphoma. The atypical presentations of ovarian lymphomas can lead to diagnostic dilemmas.
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.
An Audit on Performance of Medical Students of the University of Kelaniya in Completing the Clinical Tasks during their Final
(Sri Lanka College of Obstetricians and Gynaecologists, 2014) Palihawadana, T.S.; Motha, M.B.C.; Dias, T.D.; Wijesinghe, P.S.
Benign intracranial hypertension (BIH) in pregnancy
(Sri Lanka College of Obstetricians and Gynaecologists, 2010) Pathiraja, P.D.M.; Motha, M.B.C.; Wijesinghe, P.S.
INTRODUCTION: Benign intracranial hypertension (BIH) is a rare disorder of unknown aetiology that is most often seen in obese women of reproductive age. BIH is a syndrome of increased intracranial pressure without hydrocephalus or a mass lesion with elevated cerebrospinal fluid {CSF} pressure. Both pregnancy and exogenous estrogens are thought to promote BIH or worsen it. CASE REPORT 1: A 32-year old mother in her third pregnancy with two living children presented at 38 weeks of gestation. She was diagnosed to be having BIH after her second pregnancy. She had used oral contraceptive pills for five years. She was on Acetazolamide 0.5 mg twice a day. She delivered a 2960g baby by elective caesarean section under general anaesthesia. CASE REPORT 2: A 37-year old mother in her third pregnancy with two living children presented at 40 weeks of gestation. Her first two babies were delivered vaginally and thereafter she was on oral contraceptive pills for seven years. She was diagnosed to be having BIH for the last two years and was on lumboperitoneal shunt after laminectomy. She went into spontaneous labour and it was augment with oxytocin. The baby was delivered vaginally and the second stage of the labour was shortened by applying low cavity forceps. DISCUSSION: The method of treatment should aim to preserve vision and to improve symptoms. The medical therapy includes weight control, diuretics, steroids, analgesics and surgical methods were optic nerve sheath fenestration and lumboperitoneai shunt. Case reports indicate that pregnant women can go into normal vaginal delivery, and decisions regarding the mode of delivery and anesthesia should be based within a multidisciplinary approach. The use of outlet forceps has been suggested to prevent prolonged second-stage labour. Spinal anesthesia has been shown to be safe and effective in a patient without prior LP shunt. In pregnant women with a preexisting LP shunt, general anesthesia for cesarean section has been recommended due to potential damage to the shunt during spinal needle insertion.
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 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.
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
Challenges of costing a surgical procedure: a case study on hysterectomy
(Sri Lanka College of Obstetricians & Gynaecologists, 2018) Ranasinghe, S.W.; Liyanage, L.; Peiris, R.; Bandaranayake, H.; Ekanayake, C.D.; Pathmeswaran, A.; Kularatna, S.; Wijesinghe, P.S.
INTRODUCTION: It is vital to enquire in to cost of healthcare to ensure that maximum value for money is obtained with available resources. However, there is a dearth of information on cost of healthcare in lower-middle income countries. Our aim was to study the costs for three routes of hysterectomy in benign uterine conditions; total abdominal (TAH), non-descent vaginal (NDVH) and total laparoscopic hysterectomy (TLH). METHOD: A societal perspective with a micro-costing approach was applied to find out direct and indirect costs. Patients were recruited from a district general hospital (Mannar) and an urban tertiary care hospital (Ragama). The total cost incurred during pre-operative, operative, post-operative periods and convalescence included direct costs of labour, equipment, investigations, medications and utilities. Indirect costs included of out-of-pocket expenses, productivity losses, carer costs and travelling. Time-driven activity-based costing was used for labour costs and top down micro-costing was used for utilities. RESULTS: The median direct cost [(interquartile range), number] of TAH was Rs. 43054 [(41604 - 46243), n=24] versus Rs. 39430 [(37690 - 43054), n=25] (Mann-Whitney U test, p<0.01), NDVH was Rs. 40590 [(36965 - 44793), n=23] versus Rs.40155 [(36676 - 43779), n=26] (Mann-Whitney U test, p=0.984) and TLH was Rs. 47258 [(44359 - 51897), n=24] versus Rs. 53056 [(48128 - 55811), n=25] (Mann-Whitney U test, p=0.16) at Mannar and Ragama respectively. The median indirect cost (interquartile range) of TAH was Rs. 4204 (2174 12757) versus Rs. 9857 (5219 - 17251) (Mann-Whitney U test, p<0.05), NDVH was Rs.4349 (2174 - 8263) versus Rs. 10872 (5943 - 34646) (Mann-Whitney U test, p<0.01) and TLH was Rs. 6668 (2754 - 12902) versus Rs. 7538 (4929 - 21454) (MannWhitney U test, p=0.28) at Mannar and Ragama respectively. Sensitivity analysis using the best case scenario and a minimum wage of Rs. 1500 per day till time to recovery for TAH, NDVH and TLH showed a total cost of Rs. 87557, 78715 and 79150 respectively. CONCLUSION: Time-driven activity-based costing for labour and top down micro-costing of utilities helped to overcome logistical difficulties. Indirect costs at Ragama were significantly more than that at Mannar. Sensitivity analysis adjusted for the best case scenario and minimum wage suggested that NDVH and TLH may in fact be cheaper than TAH. The costing method used in this study is a simple and reproducible way of calculating costs of a surgical procedure which will serve as a guide for clinicians and policy makers in similar settings.
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.