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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Recurrent vaginal vault dehiscence and evisceration following total laparoscopic hysterectomy, successfully repaired with polypropylene mesh and sacrocolpopexy(Oxford University Press, 2022) Rathigashini, R.; Wanniarachchi, W.A.D.P.; de Silva, A.; Herath, R.P.Recurrent vault dehiscence is a rare and potentially serious complication following hysterectomy. We report a rare case of recurrent vault dehiscence and evisceration following a total laparoscopic hysterectomy (TLH) which was successfully repaired with polypropylene mesh and sacro-colpopexy. A 47-year-old multiparous woman underwent TLH for adenomyosis. During the surgery, vaginal wall was incised with monopolar diathermy and sutured with synthetic absorbable barbed suture in a single layer. She presented 12 weeks later with vault dehiscence and evisceration of omentum. Laparoscopically, eviscerated omental part was removed and the vaginal cuff was repaired vaginally with absorbable synthetic suture. She came with a recurrence in 3 months with vault dehiscence and a vault prolapse without any evisceration. She underwent laparoscopic mesh repair of the vault combined with laparoscopic Sacro-colpopexy with complete recovery. Incidence of vault dehiscence is found to be higher in TLH than abdominal or vaginal hysterectomy. Treatment options for recurrent vault dehiscence involve strengthening the vault with tissues, or with a prosthesis.Item 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.Item 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.Item Hyperglycaemia in pregnancy and anthropometric parameters in the offspring at 10 Years: A community-based retrospective cohort study in Sri Lanka(Hindawi Publishing Corporation., 2020) Herath, H.P.; Herath, R.P.; Wickremasinghe, R.BACKGROUND: Studies of developmental origins of health and disease have highlighted the possible role of intrauterine hyperglycaemia, increasing the future risk of obesity, diabetes, and cardiovascular diseases in the offspring. There is limited evidence from South Asian populations for risk estimates for childhood obesity that are attributable to maternal diabetes in utero. OBJECTIVE: The aim of this study was to determine the association between hyperglycaemia in pregnancy (HIP) and anthropometric parameters in the offspring at 10-11 years of age. METHODS: A community-based retrospective cohort study was conducted in Colombo district, Sri Lanka. In the first stage, children born in 2005 were identified, and the availability of antenatal records was assessed. In the second stage, the exposure status of participants was ascertained based on antenatal records and predefined criteria. In the third stage, height, weight, waist circumference, and triceps skinfold thickness (TSFT) of eligible participants were measured to ascertain the outcome status. Background characteristics were collected by interviewing mothers. A 24-hour dietary recall and a 3-day diet diary were recorded. RESULTS: 159 children of mothers with HIP (exposed) and 253 children of mothers with no HIP (nonexposed) participated. Mean ages (SD) of exposed and unexposed groups were 10.9 (0.3) and 10.8 (0.3) years, respectively. The median BMI (17.6 vs 16.1, p < 0.001), waist circumference (63 cm vs 59.3 cm, p < 0.001), and triceps skinfold thickness (13.7 mm vs 11.2 mm, p < 0.001) were significantly higher in the exposed group. Offspring of women with HIP were more likely to be overweight (aOR = 2.6, 95% CI 1.4-4.9) and have abdominal obesity (aOR = 2.7, 95% CI 1.1-6.5) and high TSFT (aOR = 2.2, 95% CI 1.06-4.7) at 10-11 years than children who were not exposed after adjusting for maternal BMI, maternal age at delivery, and birth order. CONCLUSIONS: Intrauterine exposure to HIP is a significant determinant of overweight, high TSFT, and abdominal obesity in the offspring.Item 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.Item 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.Item Non-alcoholic fatty liver disease and pregnancy complications among Sri Lankan women: A cross sectional analytical study.(Public Library of Science, 2019) Herath, R.P.; Siriwardana, S.R.; Ekanayake, C.D.; Abeysekara, V.; Kodithuwakku, S.U.A.; Herath, H.P.BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is the commonest cause of liver disease worldwide and is the hepatic manifestation of metabolic syndrome. Effects of NAFLD on pregnancy is still unclear with few studies showing an association to gestational diabetes and pre-eclampsia. We aimed to describe the association between the NAFLD and pregnancy complications. This is the first study, to our knowledge, in a South Asian population. METHOD: A cross sectional analytical study was done in Teaching Hospital, Ragama, Sri Lanka. Women carrying a singleton pregnancy, admitted for delivery were assessed for NAFLD with liver ultrasound scan. Data were extracted from interviewer administered questionnaire and antenatal and inpatient records. Pregnancy complications and labour outcomes were compared between the women with NAFLD and women without NAFLD (non-NAFLD). RESULTS: Out of the 573 women who participated, 18.2% (n = 104) were found to have NAFLD. Out of them, 58 (55.8%), 32(30.8%), and 14(13.5%) had fatty liver grade 1,2 and 3 respectively. Women with NAFLD were 2 times more likely to develop gestational hypertension and pre-eclampsia compared to the women in the non-NAFLD group, after adjusting for BMI, age and Hyperglycaemia in pregnancy [Adjusted OR 2.09, (95% CI 1.07-4.10)]. There was no association between the grade of steatosis and a composite outcome of gestational hypertension and pre-eclampsia, within the NAFLD group. Composite outcome of gestational diabetes mellitus and diabetes in pregnancy diagnosed during pregnancy was a significant complication in the NAFLD group compared to non-NAFLD group in the bivariate analysis (27.2% vs 17.7%; p<0.05), but the significance disappeared after adjusting for confounders. The current study did not demonstrate a significant association between NAFLD with preterm labour, caesarean section rate, low birth weight, and Apgar score of the baby. CONCLUSION: Women with NAFLD had a 2-fold higher risk of developing gestational hypertension and pre-eclampsia during pregnancy compared to women without NAFLD, after controlling for other confounding variables.Item A Case of labial adhesions following primary genital herpes infection(Kandy Society of Medicine, 2018) Casather, D.M.; Herath, R.P.; Ranathunga, R.D.J.; Pannala, W.S.Labial adhesions are usually associated with hypo-oestrogenism, but it is also a rare complication of genital herpes infection. We present a case report of a 23-year-old woman presenting with primary genital herpes infection, progressing to labial adhesions.Item 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.Item 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.