Medicine
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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
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Item Clinical practice of vitamin D screening and supplementation in pregnancy in Asia-pacific countries: A cross-sectional study(Elsevier, 2023) Lee, R.W.K.; Chng, A.L.B.; Tan, K.H.; Shub. A.; Tan, T.; Ling, L.S.; Kuma, K.; Siew, C.Y.; Ting, W.; Myint, S.S.; Judistiani, R.T.D.; Shah, M.; Madulid-Sison, L.; Andres-Palencia, B.; Pagilagan-Palma, E.; Banu, L.A.; Boriboonhirunsarn, D.; Dias, T.D.BACKGROUND: Vitamin D deficiency is common in pregnant women. There is scarce information in the Asia-Pacific region on the understanding of vitamin D screening and supplementation in pregnancy among health care professionals. METHODS: We performed a cross-sectional study among health care professionals who are part of the Integrated Platform for Research in Advancing Metabolic Health outcomes of Women and Children (IPRMAHO) international study group on their understanding and perception of Vitamin D screening and supplementation in pregnancy. The cross-sectional survey comprised 4 main sections: demographics, existing policies, nutrient supplementation in pregnancy and various practices on screening, treatment and perceptions, with a total of 22 questions. A total of 15 responses were obtained from attendees from distinct health facilities across eleven participating Asia-Pacific countries. RESULTS: Majority of the surveyed hospitals (11/15, 78.6 %) did not have a national policy or regional guideline regarding Vitamin D screening and supplementation in pregnancy. More than half of respondents were (9/14, 64.3 %) were unsure of the percentage of women seen with Vitamin D deficiencies each year and were unsure of Vitamin D dosage prescribed to pregnant women with (8/15, 53.3 %) or without (6/14, 42.9 %) Vitamin D deficiency. Vitamin D was rarely prescribed in pregnancy when compared to other nutrient supplements such as folic acid and iron. Majority of respondents (9/11, 72.7 %) indicated that their hospital did not screen for Vitamin D deficiencies in pregnancy, even amongst high risk pregnant women. Nevertheless, majority of respondents indicated a need (12/15, 80.0 %) for a guideline or consensus regarding Vitamin D screening and supplementation in pregnancy. CONCLUSION: While majority of the surveyed hospitals did not have a national policy or regional guideline regarding Vitamin D screening and supplementation in pregnancy, majority of respondents indicated a need for the policy or guideline. There were varying clinical knowledge gaps and different perceptions on Vitamin D screening and supplementation in pregnancy among healthcare professionals.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 Evaluation of cervical length by transabdominal and transvaginal scans during early pregnancy.(Sri Lanka college of Obstetricians & Gynaecologists, 2021) Ruwanpura, L.; Wickramasinghe, J.B.; Marasinghe, P.; Ratnayake, G.M.; Dias, T.D.; Silva, D.ABSTRACT: Objective To compare the measurements and the client-preferences of transabdominal scan (TAS) and transvaginal scan (TVS) in assessing cervical length. Method A validation study with a cross sectional component on patient-preferences was conducted among 568 pregnant women with a period-of-amenorrahea between 11+0 to 22+6 weeks. Pre- and post-void TAS and a post-void TVS measurements were taken. Receiver Operating Characteristics (ROC) curves were generated to assess the detection of short cervix using pre and post-void TAS at different lengths of the cervix. Results The mean (SD) age of the participants was 28.4(5.7) years with a mean gestation age of 14+1 weeks. The mean (SD) cervical lengths detected by the pre-void TAS, post-void TAS and TVS were 32.2 (5.8)mm, 28.9 (5.8) mm and 34.4 (5.3) mm respectively. Factors with significant association with a higher TVS cervical length were; increasing age (p<0.001), higher gravidity (p<0.001), higher parity (p<0.001) and higher number of vaginal deliveries (p<0.001). The TAS and TVS measurements significantly correlated with each other (p<0.001). Post-void TAS could not obtain measurement in 49.47% of attempts. The shortest cervical length can be detected by pre-void TAS was 26mm with an ideal cut-off of 33mm. For post-void TAS the shortest length was 28mm with an ideal cut-off of 28.16mm. Majority preferred TAS over TVS. Conclusion Pre-void TAS can predict a cervical length of 26mm or less with 87.5% sensitivity whereas the shortest length predicted by post-void is relatively longer. Nearly in half, a valid post-void TAS could not be recorded. Client preference was more favorable for TAS. KEYWORDS: Ultrasound, Cervical length, Screening, Preterm labourItem 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.Item A multicentre study on pattern of fetal anomalies detected in Sri Lanka(Sri Lanka College of Obstetricians & Gynaecologists, 2017) Padeniya, A.G.P. M.; Dias, T.D.; Ediriweera, D.S.; Mendis, B.M.I.U.OBJECTIVE: Prenatal diagnosis is a rapidly evolving specialty in modern medicine. The mid-trimester scan has been an important practice in safe antenatal care which predicts birth defects of the developing fetus. This scan performed during 18-23 weeks of pregnancy detects both internal and external abnormalities of the fetus. The objective of this study was to present the pattern of fetal anomalies detected in Sri Lankan pregnant women who were referred for the anomaly scan.METHODS: A multi centre retrospective study was carried out in all the fetal medicine referral centers conducted in the Island including Colombo, Ragama, Galle and Kurunegala between July 2013 and March 2017. Patient information and the ultrasound scan findings were obtained from the purpose built database maintained by the authors. RESULTS: A total of 7370 referrals were reviewed and 6704 singleton pregnancies were selected. The mean maternal age and the mean gestational age at which the anomaly scan was performed were 31 years (SD=4.9) and 23 weeks (SD= 4.5) respectively. Congenital Heart Disease (CHD) was the commonest abnormality detected in the study group 149 (2.2%). Thirty-one (0.5%) fetuses had Atrioventricular Septal Defect which predicts Down syndrome at the mid-trimester scan. Majority (8.3%) of the CHD were referred from the Uva province. Of the 7370 referrals 63 (0.9%) and 27 (0.4%) had Neural Tube Defects (NTDs) and cleft lip/palate respectively. Highest percentage (4.4%) of NTDs were referred from the North Central province and cleft lip/palate referrals were commonest in Sabaragamuwa (0.9%) province. Abdominal wall defects and cystic renal disease were detected in 33 (0.5%) and 38 (0.6%) fetuses correspondingly. Referrals received from the Uva (1.9%) province reached the highest number of abdominal wall defects and cystic renal disease referrals were peaked in the Uva (7.4%) province. Forty-eight (0.7%) referrals had Congenital Talipes Equino Varus deformity and highest number of referrals was from the Eastern (2.4%) province. CONCLUSION: Referrals received from the Uva province had highest number of fetal anomalies (20%) either as a major or minor birth defect. Of the total referrals congenital heart defect was the commonest congenital abnormality detected in the study group.Item 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.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.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 Anaemia among women of child-bearing age: Contributions of alpha and beta-thalassaemia(Sri Lanka Medical Association, 2018) Mettananda, S.; Suranjan, P.D.M.; Fernando, V.R.; Dias, T.D.; Rodrigo, R.; Perera, L.; Mettananda, K.C.D.; Gibbons, R. J.; Premawardhena, A.; Higgs, D. R.INTRODUCTION AND OBJECTIVES: Anaemia during pregnancy is attributed to iron deficiency and pregnant women prescribed iron supplements without investigating for a cause. However, aetiology can be diverse and iron efficiency may contribute only partly. We aimed to describe the aetiology of anaemia among women of child bearing age. METHODS: This descriptive study was conducted at Teaching Hospital, Ragama from June-December 2017. Patient database of deliveries between January 2015 and September 2016 at University Obstetrics Unit was screened (n=3636) to identify women with anaemia (haemoglobinItem Nutcracker syndrome in pregnancy: a worrying presentation of a benign condition(Sri Lanka Medical Association, 2017) Motha, M.B.; Palihawadana, T.S.; Dias, T.D.; Wijesinghe, P.S.