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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Emergency obstetric hysterectomy(Taylor and Francis Group, 2021) Padumadasa, S.; Wijesinghe, P.No abstract availableItem Uterine devascularization(Taylor and Francis Group, 2021) Padumadasa, S.; Wijesinghe, P.No abstract availableItem Umbilical cord prolapse(Taylor and Francis Group, 2021) Padumadasa, S.; Wijesinghe, P.No abstract availableItem Induction of labor in women over 35 years: How does it affect the outcome?(Sri Lanka College of Obstetricians & Gynaecologists, 2016) Tiran, D.; Janitha, G.; Chaya, H.; Padumadasa, S.; Wijesinghe, P.OBJECTIVE: Compare fetal and labor outcomes following induction of labor in singleton pregnant women over 35 years (>35) with women between 20 to 30 years (20-30) METHOD: This was a retrospective study carried out at North Colombo Teaching Hospital using North Colombo Obstetric Database (NORCOD) between March 2014 and May 2016. Two hundred and ninety six singleton pregnancies that underwent induction of labor were included. Women had been categorized into two groups based on their age. They were 20-30 years (2030) and above 35 years (>35). Two groups were matched against their booking visit body mass index. Labor and fetal outcomes of each group were assessed. RESULT: Lower segment Caesarean section (LSCS) rates observed in 20-30 and >35 groups were 16.2% (N=24) and 17.6% (N=26) respectively (P>0.05). Newborns of induced pregnancies of 20-30 mothers had an APGAR <7 at 5min in 1.4% (N=2) and 2.7% (N=4) babies of women >35 had an APGAR <7 at 5 min (P>0.05). Induced pregnancies of 20-30 mothers reported 16.2% (N=24) NICU admissions and >35 years group had 20.3% (N=30) NICU admissions (P>0.05). CONCLUSION: There is no significant difference between the two groups in terms of LSCS rates, low 5 min APGAR and NICU admissions.Item Term versus preterm induction of labor: Does it change the outcome?(Sri Lanka College of Obstetricians & Gynaecologists, 2016) Dias, T.; Gunasena, J.; Herath, R.; Pieris, V.; Wijesinghe, P.ABSTRACT: Induction of labour is important to timely deliver the fetus and minimize adverse perinatal outcomes to both the mother and the neonate. Therefore, comparison of the outcomes following induction of labour at term and preterm is invaluable to assess its benefits and detriments. OBJECTIVE: Compare fetal and labour outcomes following induction of preterm and term singleton pregnancies. METHOD:This was a retrospective studycarried out at North Colombo Teaching Hospital using North Colombo Obstetric Database (NORCOD) between March 2014 and May 2016. Six hundred and one singleton pregnancies that underwent induction of labour were included. Timing of induction of labor was categorized intopreterm labor induction (<38 weeks) and term labour induction (38-42 weeks). Vaginal delivery rate and neonatal outcomes were compared.RESULTS: Out of 601 cases 18.5% (N=111) were induced preterm and 81.5% (N=490) were induced at term. Vaginal delivery rates between the two groups were 71.2% (N=79) and 78.6% (N=385) (P>0.05). Preterm induced deliveries had an APGAR <7 at 5 minutes in 3 babies (2.7%) and six term babies(1.2%) had an APGAR <7 at 5 minutes (P>0.05). Preterm induced pregnancies reported 28.8% (N=32) NICU admissions and term induced pregnancies had 14.9% (N=73) NICU admissions (P<0.05). CONCLUSION: There’s no significant difference in LSCS rates and low 5 min APGAR among two groups. However preterm induction significantly increases NICU admission of the newborn, which is expected due to the complications associated with prematurity of the newborn.Item Challenges of costing a surgical procedure in a lower-middle-income country(Springer-Verlag, 2019) Ekanayake, C.; Pathmeswaran, A.; Kularatna, S.; Herath, R.; Wijesinghe, P.BACKGROUND: It is vital to enquire into cost of health care to ensure that maximum value for money is obtained with available resources; however, there is a dearth of information on cost of health care in lower-middle-income countries (LMICs). Our aim was to develop a reproducible costing method for three routes of hysterectomy in benign uterine conditions: total abdominal (TAH), non-descent vaginal (NDVH) and total laparoscopic hysterectomy (TLH). METHODS: A societal perspective with a micro-costing approach was applied to find out direct and indirect costs. A total of 147 patients were recruited from a district general hospital (Mannar) and a tertiary care hospital (Ragama). Costs incurred from preoperative period to convalescence included direct costs of labour, equipment, investigations, medications and utilities, and indirect costs of out-of-pocket expenses, productivity losses, carer costs and travelling. Time-driven activity-based costing was used for labour, and top-down micro-costing was used for utilities. RESULTS: The total cost [(interquartile range), number] of TAH was USD 339 [(308-397), n = 24] versus USD 338 [(312-422), n = 25], NDVH was USD 315 [(316-541), n = 23] versus USD 357 [(282-739), n = 26] and TLH was USD 393 [(338-446), n = 24] versus USD 429 [(390-504), n = 25] at Mannar and Ragama, respectively. The direct cost of TAH, NDVH and TLH was similar between the two centres, whilst indirect cost was related to the setting rather than the route of hysterectomy. CONCLUSIONS: The costing method used in this study overcomes logistical difficulties in a LMIC and can serve as a guide for clinicians and policy makers in similar settings.Item Induction of labor in women over 35 years: How does it affect the outcome?(Sri Lanka College of Obstetricians & Gynaecologists, 2016) Dias, T.D.; Janitha, G.; Chaya, H.; Padumadasa, S.; Wijesinghe, P.OBJECTIVE: Compare fetal and labor outcomes following induction of labor in singleton pregnant women over 35 years (>35) with women between 20 to 30 years (20-30) METHOD: This was a retrospective study carried out at North Colombo Teaching Hospital using North Colombo Obstetric Database (NORCOD) between March 2014 and May 2016. Two hundred and ninety six singleton pregnancies that underwent induction of labor were included. Women had been categorized into two groups based on their age. They were 20-30 years (20- 30) and above 35 years (>35). Two groups were matched against their booking visit body mass index. Labor and fetal outcomes of each group were assessed. RESULTS: Lower segment Caesarean section (LSCS) rates observed in 20-30 and >35 groups were 16.2% (N=24) and 17.6% (N=26) respectively (P>0.05). Newborns of induced pregnancies of 20-30 mothers had an APGAR <7 at 5min in 1.4% (N=2) and 2.7% (N=4) babies of women >35 had an APGAR <7 at 5 min (P>0.05). Induced pregnancies of 20-30 mothers reported 16.2% (N=24) NICU admissions and >35 years group had 20.3% (N=30) NICU admissions (P>0.05). CONCLUSION: There is no significant difference between the two groups in terms of LSCS rates, low 5 min APGAR and NICU admissions.Item Term versus preterm induction of labor: Does it change the outcome?(Sri Lanka College of Obstetricians & Gynaecologists, 2016) Dias, T.; Gunasena, J.; Pieris, V.; Herath, R.; Wijesinghe, P.ABSTRACT: Induction of labour is important to timely deliver the fetus and minimize adverse perinatal outcomes to both the mother and the neonate. Therefore, comparison of the outcomes following induction of labour at term and preterm is invaluable to assess its benefits and detriments. OBJECTIVE: Compare fetal and labour outcomes following induction of preterm and term singleton pregnancies. METHOD: This was a retrospective studycarried out at North Colombo Teaching Hospital using North Colombo Obstetric Database (NORCOD) between March 2014 and May 2016. Six hundred and one singleton pregnancies that underwent induction of labour were included. Timing of induction of labor was categorized intopreterm labor induction (<38 weeks) and term labour induction (38-42 weeks). Vaginal delivery rate and neonatal outcomes were compared. RESULTS: Out of 601 cases 18.5% (N=111) were induced preterm and 81.5% (N=490) were induced at term. Vaginal delivery rates between the two groups were 71.2% (N=79) and 78.6% (N=385) (P>0.05). Preterm induced deliveries had an APGAR <7 at 5 minutes in 3 babies (2.7%) and six term babies(1.2%) had an APGAR <7 at 5 minutes (P>0.05). Preterm induced pregnancies reported 28.8% (N=32) NICU admissions and term induced pregnancies had 14.9% (N=73) NICU admissions (P<0.05). CONCLUSION: There’s no significant difference in LSCS rates and low 5 min APGAR among two groups. However preterm induction significantly increases NICU admission of the newborn, which is expected due to the complications associated with prematurity of the newborn.Item A Fatal case of dissecting aortic root aneurysm due to undiagnosed Marfan syndrome in the puerperium(Sri Lanka College of Obstetricians and Gynaecologists, 2012) Nishad, A.A.N.; Herath, R.; Silva, G.R.C.; Mohamed, R.; Wijesinghe, P.; Padumadasa, S.; Premawardhena, A.; Premaratna, R.Aortic dissection in pregnancy is a lethal cardiovascular complication in women with Marfan syndrome. The course of the treatment would be decided upon by the size of aortic root dilation. We report a case where the unawareness of the diagnosis of Marfan syndrome antenatally led to disastrous post partum consequences even after an uneventful childbirth.Item Leiomyomatosis peritonealis disseminata presenting as an acute abdomen(Sri Lanka Medical Association, 1997) Wijesinghe, P.No abstract available