Conference Papers
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This collection contains abstracts of conference papers, presented at local and international conferences by the staff of the Faculty of Medicine
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Item Post-placental and interval intrauterine contraceptive device (IUD) insertion: does timing matter?(Wiley-Blackwell, 2015) Dias, T.D.; Palihawadana, T.S.; Wijekoon, D.; Ganeshamoorthy, P.; Abeykoon, S.; Liyanage, G.; Padeniya, T.INTRODUCTION Unintended pregnancies in the first year after childbirth could be high as 10–44% and expose women to consequences of induced abortion, especially in countries where termination of pregnancy is illegal. Immediate postpartum contraception methods are beneficial for women who wish for early contraception and for women who have difficulty in returning for postpartum visits for contraception. Use of Copper containing intrauterine contraceptive device (IUD) immediately after delivery (post placental) has been described recently with varying success. The aim of this study was to compare the rate of spontaneous expulsion and intrauterine displacement between post placental IUD insertion and routine IUD insertion, 6 weeks after delivery. METHODS This was an interventional comparative study. Women who were willing to start on IUD as a contraceptive method after childbirth were recruited for the study. They were randomly allocated to either group before labour/ delivery and those in the group of post placental insertion had it inserted immediately following vaginal delivery and those allocated for interval group had insertion 6 weeks after delivery. Two ultrasound examinations were performed, just after the insertion and 6 weeks later in both groups. The distance from the IUD to the internal os was measured at each examination to evaluate the displacement. RESULTS The study included 30 subjects in the post placental group and 33 in interval insertion group. The postpartum insertion group and the interval insertion groups were comparable for age [mean (SD) 27.1 (5.42) versus 25.6 (4.34), P = 0.23] and BMI [mean (SD) 22.4 (7.28) versus 23.9 (5.76), P = 0.34]. As expected, the uterine length at insertion was higher among the post placental group [mean (SD) 144.1 mm (12.2) versus 66.8 (6.7), 95%CI 72.3 to 82.1] but similar in two groups at follow up [66.6 mm (15.1) versus 64.79 (6.64), 95%CI _4.01 to 7.47]. Spontaneous expulsion and displacement was not significantly different between the post placental and interval insertion groups [3/30 versus 2/33, OR 1.72; 95%CI 0.28 to 10.7]. In these two groups, there was no difference noted in the second ultrasound measurements from the IUD to the fundal wall [16.9 mm (3.99) versus 18.24 (4.36); 95%CI _3.45 to 0.77] or to the internal os [21.8 mm (15.7) versus 17.1 (6.03); 95%CI _1.12 to 10.6]. CONCLUSION This study demonstrates that insertion of an IUD immediately after delivery does not increase the risk of spontaneous expulsion or the risk of downward displacement. Therefore, such insertion can be recommended in clinical practiceItem Prevalence of menopausal symptoms and their impact on daily activities: A community based longitudinal study in Ragama, Sri Lanka(Sri Lanka College of Obstetricians & Gynaecologists, 2016) Heenatigala, C.S.N.; Gunathilaka, S.N.M.P.K.; Dias, T.D.; Palihawadana, T.S.; Motha, M.B.C.; de Silva, H.J.OBJECTIVES: To determine the prevalence and severity of menopausal symptoms among women. DESIGN,SETTING AND METHODS: A community-based cross sectional study was done in a study population of a larger ongoing longitudinal study named ‘Ragama Health Study’. Randomly selected 954 women from Ragama Medical Officer of Health (MOH) area were included. Data was collected using a self-administered questionnaire. Impact on daily activities by menopausal symptoms were scored using a scale from 1-10.RESULTS: Out of 954 women in the study, 814(85.3%) were postmenopausal. Age of the population distributed from 41-74 years with mean of 59.51 years. Mean age of onset of the menopausal symptoms was 52.16(SD=8.095) years. Among the symptoms inquired, the domain of sexual activity contained the most commonly experienced symptom, decreased libido, with a 65.4% (n=937) positive responses while 20.5% of women experienced vaginal dryness.. Mean score on impact on daily activities by this was 7.79(SD 2.36). Psychosocial symptoms of forgetfulness, bad temper, irritability and poor concentration was present in 60.5%, 33.8%, 25.4% and 24.8% of positive responses respectively. Mean scores on impact on daily activities by psychosocial symptoms lied within the range of 4.55-5.52. Presence of experiencing hot flushes and increased sweating were 24.8% and 22.1% with a mean score of effect on daily activities at 5.24 and 5.65, respectively. CONCLUSIONS The rate of menopausal symptoms among this perimenopausal age group was significant and the impact on daily activities in this population was comparable to the global contextItem A study on the rate of symptoms of pelvic floor dysfunction among healthy women in pre and post-menopausal age and its impact on their day-to-day life.(Sri Lanka College of Obstetricians & Gynaecologists, 2016) Pieris, K.V.M.; Prasanga, D.P.G.G.M.; Dias, T.D.; Palihawadana, T.S.; Motha, M. .C.; de Silva, H.J.OBJECTIVES: Aim of the study was to analyze the rate of symptoms of pelvic floor dysfunction, the presence of pelvic organ prolapse and to study how the symptoms affect the day to day life activities in a population of women living in the Ragama Medical Officer of Health (MOH) area.DESIGN, SETTING AND METHODS: A community-based cross sectional study was done in a study population of a larger ongoing longitudinal study named ‘Ragama Health Study’. Randomly selected 951 women from Ragama Medical Officer of Health (MOH) area were included. The symptoms of pelvic floor dysfunction were elicited using a self-administered questionnaire and a vaginal examination was performed to assess the presence and grade of pelvic organ prolapse. RESULTS: Among the 951 women 881(92.6%) did not have symptoms of pelvic floor dysfunction. Among the symptomatic women (n=70), urgency was the commonest symptom (26.8%) while 23.5% admitted urinary incontinence and 16.1% of women experienced fecal incontinence. Among the women with such symptoms of pelvic organ prolapse only 5.6% complained of these interfering with their sexual activities while 10.8% admitted them having an effect on their day-to-day activities. Pelvic organ prolapse was not elicited on clinical examination in 32.1% of symptomatic women while 60.7% had a prolapse up to the hymen and 7.2% had a prolapse beyond the level of hymen. CONCLUSIONS: Rate of symptoms of pelvic floor dysfunction was around 7.5% among this sample of women in peri and postmenopausal age. Urinary incontinence and fecal incontinence were the most frequent symptoms. Only a few symptomatic women considered this to have an effect on their sexual function (5%) and day-to-day activities (10%). More than two thirds of women with symptoms had genital prolapse with over 7% having a significant prolapse protruding beyond the hymen.Item Prevalence of menopausal symptoms and their impact on daily activities: A community based longitudinal study in Ragama, Sri Lanka(Sri Lanka College of Obstetricians & Gynaecologists, 2016) Heenatigala, C.S.N.; Gunathilaka, S.N.M.P.K.; Dias, T.D.; Palihawadana, T.S.; Motha, M.B.C.; de Silva, H.J.OBJECTIVE: To determine the prevalence and severity of menopausal symptoms among women. DESIGN, SETTING AND METHODS: A community-based cross sectional study was done in a study population of a larger ongoing longitudinal study named ‘Ragama Health Study’. Randomly selected 954 women from Ragama Medical Officer of Health (MOH) area were included. Data was collected using a self-administered questionnaire. Impact on daily activities by menopausal symptoms were scored using a scale from 1-10. RESULTS: Out of 954 women in the study, 814(85.3%) were postmenopausal. Age of the population distributed from 41-74 years with mean of 59.51 years. Mean age of onset of the menopausal symptoms was 52.16(SD=8.095) years. Among the symptoms inquired, the domain of sexual activity contained the most commonly experienced symptom, decreased libido, with a 65.4% (n=937) positive responses while 20.5% of women experienced vaginal dryness.. Mean score on impact on daily activities by this was 7.79(SD 2.36). Psychosocial symptoms of forgetfulness, bad temper, irritability and poor concentration was present in 60.5%, 33.8%, 25.4% and 24.8% of positive responses respectively. Mean scores on impact on daily activities by psychosocial symptoms lied within the range of 4.55-5.52. Presence of experiencing hot flushes and increased sweating were 24.8% and 22.1% with a mean score of effect on daily activities at 5.24 and 5.65, respectively. CONCLUSIONS: The rate of menopausal symptoms among this perimenopausal age group was significant and the impact on daily activities in this population was comparable to the global context.Item A study on the rate of symptoms of pelvic floor dysfunction among healthy women in pre and post-menopausal age and its impact on their day-to-day life.(Sri Lanka College of Obstetricians & Gynaecologists, 2016) Pieris, K.V.M.; Prasanga, D.P.G.G.M.; Dias, T.D.; Palihawadana, T.S.; Motha, M.B.C.; de Silva, H.J.OBJECTIVES: Aim of the study was to analyze the rate of symptoms of pelvic floor dysfunction, the presence of pelvic organ prolapse and to study how the symptoms affect the day to day life activities in a population of women living in the Ragama Medical Officer of Health (MOH) area. DESIGN, SETTING AND METHODS: A community-based cross sectional study was done in a study population of a larger ongoing longitudinal study named ‘Ragama Health Study’. Randomly selected 951 women from Ragama Medical Officer of Health (MOH) area were included. The symptoms of pelvic floor dysfunction were elicited using a self-administered questionnaire and a vaginal examination was performed to assess the presence and grade of pelvic organ prolapse. RESULTS: Among the 951 women 881(92.6%) did not have symptoms of pelvic floor dysfunction. Among the symptomatic women (n=70), urgency was the commonest symptom (26.8%) while 23.5% admitted urinary incontinence and 16.1% of women experienced fecal incontinence. Among the women with such symptoms of pelvic organ prolapse only 5.6% complained ofthese interfering with their sexual activities while 10.8% admitted them having an effect on their day-to-day activities. Pelvic organ prolapse was not elicited on clinical examination in 32.1% of symptomatic women while 60.7% had a prolapse up to the hymen and 7.2% had a prolapse beyond the level of hymen. CONCLUSIONS: Rate of symptoms of pelvic floor dysfunction was around 7.5% among this sample of women in peri and postmenopausal age. Urinary incontinence and fecal incontinence were the most frequent symptoms. Only a few symptomatic women considered this to have an effect on their sexual function(5%) and day-to-day activities (10%). More than two thirds of women with symptoms had genital prolapse with over 7% having a significant prolapse protruding beyond the hymen.Item Semen ph in infertile males and its association with semen parameters(Sri Lanka College of Obstetricians and Gynaecologists, 2005) Dissanayake, D.M.A.B.; Palihawadana, T.S.; Amarasena, J.M.T.; Fernando, W.S.INTRODUCTION: Assessment of pH of the ejaculate is part of the basic seminal fluid analysis. The WHO defines the reference range for seminal fluid pH to be 7.2 or more. In practise we have observed that the pH is commonly in the alkaline range in patients with normal as well as abnormal seminal parameters. Furthermore, there are many others who question the reference range defined by the WHO, and claim it to be too low. Objective: To define the range of pH in seminal fluid in a infertile male population and to assess the association it shows to seminal fluid parameters. METHOD: Seminal fluid analysis including pH assessment was done on 168 males who sought infertility treatment at the university infertility clinic, at teaching hospital, Ragama. The pH was assessed within 30 minutes from collecting the sample using a pH meter. The seminal fluid analysis was done according to the WHO criteria. Log inversion of pH was done prior to calculation ofmeans. Results: The mean (±SD) pH of the sample population was 7.70 (±0.25) with a minimum of 6.78 and a maximum of 8.52. Only five patients (3%) had a pH less than 7.2. The distribution of the pH showed a 5" percentile value of 7.37 and a 95 'percentile of8.21.Thirty four percent (n=57) of subjects had a normal Seminal fluid analysis with regard to volume, concentration, motility and viability. Mean pH value showed a significant difference between the groups with a normal vs. abnormal volume of ejaculate, 7.75 vs. 7.59, P<0.05. Similar differences were not seen with any other semen parameter. Conclusion: The pH of ejaculate in this study sample is towards an alkaline range. Associations between semen pH and seminal parameters needs further study.Item Evaluation of reproductive hormone profile in relation to semen quality in male partners of subfertile couples(Sri Lanka Association for the Advancement of Science, 2007) Dissanayake, D.M.A.B.; Palihawadana, T.S.; Wijesinghe, P.S.; Ratnasooriya, W.D.; Wimalasena, S.The objective of the study was to assess the reproductive hormone profile of a Sri Lankan subfertile male population and to relate it to their semen parameters. Male partners of 152 subfertile couples who sought treatment at the subfertility unit of the department of Obstetrics and Gynaecology at the Faculty of Medicine, Ragama were included in the study. Serum samples were assayed for follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL), Estradiol (E2) and testosterone (T) levels, using electrochemiluminescence immunoassay (ECLIA). A semen sample was obtained from each participant on the same day. Seminal fluid analysis was done according to the WHO guidelines. The mean (SEM) of FSH, LH, PRL, E2 and T levels of the males were 5.35 (0.53) mIU/mL, 6.20 (0.33) mIU/mL, 17.53 (0.60) ng/mL, 30.48 (1.80) pg/mL and 523.80 (14.74) ng/dL and the prevalence of abnormalities of these hormones were 9.8% (n=15), 5.9% (n=9), 13.15% (n=20), 0.6% (n=1) and 2.6% (n=4) respectively. Of the study population 20.3% (n=31) men had either single or combination of hormone abnormalities. When the mean hormone levels of the men with normal semen parameters were compared with those of men with abnormal semen parameters, none showed a statistically significant difference; FSH - 4.18 (2. 78) Vs 4.58 (3.15), LH - 5.90 (2.78) Vs 5.70 (2.36), PRL - 28.63 (14.96) Vs 17.59 (7.63) and T -551.39ñ208.17 Vs 515.73 (158.25). Mean (SD), FSH and LH levels were significantly higher among azoospermic participants compared with normozoospermics; 19.69 (9.93) Vs 4.18 (2.78) for FSH, 12.82 (11.82) Vs 5.90 (2.78) for LH, p<0.01). Similarly FSH and LH levels were significantly higher in severe oligospermic participants compared with the normozoospermics; 7.58 (4.34) Vs 4.18 (2.78) for FSH, and 6.96 (2.65) Vs 5.90 (2.78) for LH, p<0.05). The serum FSH level showed an inverse correlation with sperm concentration (r= -0.203, p<0.05) and total sperm count (r= -0.206, p<0.05). In conclusion, an endocrinopathy was present in up to 20% of this population. Abnormalities in Gonadotrophin levels were related with azoospermia and severe oligozoospermia. Serum FSH showed a negative correlation with the sperm concentration and the total sperm count. Other hormones failed to show a significant relationship with the semen parameters in this population. Acknowledgement: National Science Foundation research grant No. RG/2004/M/14