Browsing by Author "Ruwanpura, L."

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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 labour
Intra-uterine fetal blood transfusion
(Sri Lanka Medical Association, 2012) Dias, T.; Senanayake, H.; Ruwanpura, L.; Pathirana, P.; Dissanayake, P.
No aAbstract Available
Systematic introduction of obstetric ultrasound skills into practice
(Sri Lanka College of Obstetricians and Gynaecologists, 2011) Dias, T.; Ruwanpura, L.
OBJECTIVE: To identify the present skill level of obstetric ultrasound, to set quality standards and to make recommendations in terms of obstetrics ultrasound service improvement. METHODS: An audit was carried out in five provinces in Sri Lanka. At the beginning of the ultrasound workshops, attendees were requested to participate in this audit. Optimum ultrasound machine settings and biometry standards were defined at the beginning. Measures were taken to recruit a cross section of the obstetric service providers including postgraduate trainees and senior house officers (SHOO). They were asked to perform an ultrasound scan and obtain standard images. These images were assessed onsite and documented in structured data sheet. The level of competency was analyzed according to the pre-defined standards. A structured ultrasound training programs have been carried out to improve the existing knowledge and skills of the participants. In order to simulate their own scan environment and habits, participants were assessed without their knowledge in the second phase of this audit. RESULTS: Overall skills in controlling machine settings were very poor. Almost all the participants did not manage to set the machine competently. Postgraduates were slightly better in obtaining correct landmarks for fetal biometry. It is encouraging to note that most of the postgraduates were able to improve their machine setting skills in subsequent audit. First trimester crown-rump length is the least improved fetal biometry in second phase. CONCLUSION: At present background skills of obstetric ultrasound are substandard and it can be improved by dedicated training. Systematic introduction of obstetric ultrasound training in to post graduate training is necessary. This will produce a new generation of obstetricians competent in this field. All the newly appointed SHOO/MOO in obstetrics need to undergo mandatory training in obstetric ultrasound.