Browsing by Author "Motha, M.B.C."

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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.
A Clinical guide for dengue detection, appropriate timing of investigations and hospital admissions
(Sri Lanka Medical Association, 2005) Premaratna, R.; Pathmeswaran, A.; Amarasekera, N.D.D.M.; Motha, M.B.C.; Perera, K.V.H.H.K.; de Silva, H.J.
Abstract Available.
A Clinical guide for early detection of dengue fever and timing of investigations to detect patients likely to develop complications
(Oxford University Press, 2009) Premaratna, R.; Pathmeswaran, A.; Amarasekera, N.D.D.M.; Motha, M.B.C.; Perera, K.V.H.K.K.; de Silva, H.J.
We aimed to identify clinical features that would be useful for case detection and the appropriate timing of investigations and hospital admissions in patients with short-duration fever, suspected to be dengue fever (DF). Of 928 adult patients with short-duration fever admitted to Colombo North Teaching Hospital, Sri Lanka during February-June 2004, one in four were randomly selected for assessment of the severity of six clinical features: headache, body aches, vomiting, retro-orbital pain, generalised weakness (scale 0-9) and skin erythema (grade 1-5). There were 148 DF patients (95 males, mean age+/-SD: 28+/-12 years) and 54 non-DF patients as controls (44 males, mean age+/-SD: 25+/-11 years). All symptoms assessed (cut-off >or=5) and skin erythema (>or=grade 2) had a good positive predictive value for DF. However, erythema had the best negative predictive value, helping to differentiate DF from other short-duration fevers. More than 95% of patients with dengue had a platelet count above 50000/microl until the third day of illness. The platelet counts were significantly reduced when erythema, fever, vomiting and generalised weakness were persistent. In conclusion, erythema elicited by hand impression may help in the prediction of DF, and follow-up blood counts are indicated when symptoms persist.
Diabetes mellitus in pregnancy
(Sri Lanka College of Obstetricians and Gynaecologists, 2015) Motha, M.B.C.; Dias, T.D.
Family planning among Medically ill people in a sri lankan setting: a descriptive study
(Sri Lanka College of Obstetricians and Gynaecologists, 2007) Palihawadana, T.S.; Fernando, W.S.; Mallawaarachi, W.P.P.K.; Attanayake, A.M.J.H.; Motha, M.B.C.; Wijesinghe, P.S.
INTRODUCTION: Sri Lanka has a high contraceptive prevalence with a low total fertility rate. In spite of this, unmet need of family planning among medically ill people is observed in day to day clinical practice. Medical illnesses complicating pregnancy are a major cause of maternal morbidity and mortality in Sri Lanka. This is thought to result from non usage as well as use of methods with low efficacy. We studied the contraceptive usage among people suffering from medical illnesses as a preliminary survey of a large scale study. METHOD: The study was carried out at the medical clinics of the Colombo North teaching hospital from March to July, 2007. Those who suffer from medical conditions that could complicate a pregnancy were interviewed to find out the family planning practices and identify the limiting factors for uptake of modern methods. Sixty seven sexually active subjects who are in their reproductive age group were interviewed for the research purpose. RESULTS: Study population comprised of 55% of Buddhists, 38% Catholics and 6% Islamics. Mostly encountered medical conditions were diabetes mellitus (n=18), hypertension (n=15), Valvular heart disease (n=10) and thyroid dysfunction (n=6). Seven subjects were planning for a pregnancy at the time of interview though none of them had been advised that it is safe to do so. Nearly 80% (n-53) of subjects admitted to practicing family planning. However, among them 71% (n=38) were using the traditional methods of family planning, where calendar method was the most commonly used (43.3%) followed by withdrawal (20.8%) and the cervical mucous (75%) methods. Norplant was the most commonly used modern method (13.2%) while other methods used included combined contraceptive pill (9.4%), intrauterine contraceptive device (3.8%) and DMPA (1.9%). None of the study subjects practiced male or female sterilisation. Of the total study population 35.8% (n=24) had received family planning advice from the family health midwife after diagnosis of their condition, while only 6% (n=4) had such advice at the medical clinic. CONCLUSIONS: Though family planning is practiced by a high proportion of medically ill people, only a minority use modern methods. High prevalence of traditional family planning usage make this group vulnerable to unintended pregnancies due to the low efficacy of the methods used by them. Family planning advice does not seem to adequately reach this more deserving population. Possible reasons for this could be either the reluctance of field health workers to dispense modern methods of family planning to these people or the deficiencies in the family planning program to reach such special groups, thus stressing the point that such services should be integrated at the level of the medical clinic.
Hypertension in pregnancy
(Sri Lanka college of Obstetricians & Gynaecologists, 2015) Motha, M.B.C.; Jayasundara, C.
Iron deficiency anaemia in pregnancy: diagnosis, prevention and treatment
(Sri Lanka College of Obstetricians and Gynaecologists, 2014) Palihawadana, T.S.; Goonewardene, I.M.R.; Motha, M.B.C.; Williams, H.S.A.
Liver dysfunction in pregnancy
(Sri Lanka College of Obstetricians and Gynaecologists, 2005) de Silva, H.J.; Motha, M.B.C.; Wijesinghe, P.S.
No Abstract Available
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 context
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.
Recurrent pregnancy loss and thrombophilia.
(Sri Lanka Medical Association, 2014) Motha, M.B.C.; Palihawadana, T.S.; Perry, D.J.
No Abstract available
Seizure patterns, preconception care and pregnancy outcomes in women with epilepsy in a tertiary care hospital
(Journal of the Ceylon College of Physicians, 2020) Motha, M.B.C.; Palihawadana, T.S.; Jayasinghe, C.; Ranawaka, U.K.
INTRODUCTION AND OBJECTIVES: Data on epilepsy in pregnancy is limited from South Asia and other resource-limited countries. We sought to describe seizure patterns, preconception care and pregnancy outcomes in women with epilepsy attending a Sri Lankan tertiary care hospital. METHOD: All pregnant women with epilepsy admitted to University Obstetrics Unit, Colombo North Teaching Hospital during the period January 2017 February 2020 were recruited. Data were collected by a single physician using an interviewer-administered questionnaire. RESULTS: Out of 9520 pregnant women screened, 63 had a history of epilepsy (prevalence 6.6/1000); 46% generalized epilepsy, 22.2% focal epilepsy. Of 38 women on antiepileptics at conception, only 44.7% were given folic acid 5 mg preconceptionally. 42.9% were seizure free over preceding 2 years. Majority (55%) had a seizure during current pregnancy (average number of seizures per patient: 1s1 trimester 1.85, 2nd trimester 2.2, 3rd trimester 2.95, postpartum 2.5). 18.4% of seizure events were attributed to sleep deprivation, and 2.7% to unsatisfactory drug compliance. 81.6% were on monotherapy at conception and 18.4% were on two antiepileptic. 22.2% had a hypertensive disorder of pregnancy and 9.5% spontaneous premature delivery. 33.3% underwent caesarian delivery. 1.58% each had a stillbirth and neonatal death. Low birth weight was seen in 42.9%. Major congenital malformations were found in 11.1% of newborns. CONCLUSIONS: Pre-conceptional folic acid coverage was poor. Seizures occurred in more than half of the women and were more common in third trimester and postpartum. Rates of hypertensive disorders, caesarean deliveries, low birth weight and congenital malformations were high.
A study on the incidence and the outcome of teenage pregnancies and the associated socio-economic factors: an interim analysis
(Faculty of Medicine, University of Kelaniya & Plan International, 2008) Palihawadana, T.S.; Motha, M.B.C.; Fernando, W.S.; Wijesinghe, P.S.
INTRODUCTION: Teenage pregnancy is known to be associated with adverse pregnancy outcomes for both the mother and her offspring. Knowledge on the socio-economic conditions associated with teenage pregnancy and the short term and intermediate outcomes would provide information useful in prevention and management of teenage pregnancy. OBJECTIVE: To describe the prevalence of teenage pregnancy in a low risk population and two identified high risk populations and to identify the associated socio-economic characteristics as well as to assess the incidence of short term and intermediate adverse outcomes in the mother and the offspring. METHODS: The study will be conducted in three phase. The prevalence of teenage pregnancy and associated socio-economic factors would be assessed at three study settings of Ragama, Nuwara Eliya and Puttalam. Second phase would be at Ragama and the pregnancy outcome of the teenage mothers would be compared against a parity matched sample of controls while in phase three a community based follow up study would be done in teenage mothers who delivered at Ragama Hospital two years ago to assess the intermediate outcome of mothers and their offspring. Here we report the results of the Ragama component of Phase I and a part of the data accumulated for Phase II. RESULTS: Review of records of 5249 deliveries yielded a teenage pregnancy rate of 4.74% (n=249). Results pertaining to 25 subjects and 50 parity matched controls in phase I and 102 subjects with 179 controls are described here. The distribution according to religion and ethnicity was not different between the subjects and the controls. The occupations and marital status as well as alcohol consumption of fathers did not demonstrate a difference between the teenage mothers and the controls. Five percent of subjects were not married while all were married in the control group (p<0.05). There was a significant difference in the educational level between subjects and controls (p<0.001); education beyond Ordinary level was 14% in subjects as compared to 33% among
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.
Systemic lupus erythematosus and pregnancy--a challenge to the clinician
(Sri Lanka Medical Association, 2009) Motha, M.B.C.; Wijesinghe, P.S.
No Abstract Available
Thyroid dysfunction in pregnancy
(Sri Lanka College of Obstetricians and Gynaecologists, 2015) Motha, M.B.C.; Palihawadana, T.S.; Dias, T.D.