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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 An audit on perineal pain felt following childbirth: level of pain experienced and degree of analgesia used(Sri Lanka College of Obstetricians & Gynaecologists, 2016) Jayawardena, G.R.M.U.G.P.; Gunarathna, S.M.S.G.; Jogarasah, K.; Herath, R.BACKGROUND: Perineal pain is a common symptom following vaginal childbirth. Reducing of the degree of pain experienced has been shown to improve maternal wellbeing and normal functioning within the family. METHODS: We performed the audit in the professorial ward of the Colombo North Teaching Hospital. Participants perception of pain was assessed using a verbal numeric rating scale. RESULT: All participants had experienced some degree of perineal pain. However significantly reduced levels of pain were experienced in those who had received analgesia. CONCLUSION: Perineal pain is a common symptom among women following childbirth. However such pain can be significantly reduced with appropriate interventionsItem An audit on the completeness of partogramsin two obstetric units in two separate teaching hospitals in Sri Lanka(Sri Lanka College of Obstetricians & Gynaecologists, 2016) Liyanapatabandi, D.; Bhabu, B.; Krishoban, B.; Wenurajith, B. K.; Karunasinghe, J.; Jayasinghe, K. S.; Jayawardena, G.R.M.U.G.P.; Herath, R.; Gunarathna, S.M.S.G.INTRODUCTION: A systematic approach to labour is needed to make sure serious mistakes and variations are not made in management and cost effectiveness maintained. . We undertook an audit in two separate teaching hospital settings to assess thecompleteness of partogram maintenance in labour. METHODS: Retrospective analyses of partograms were done in non consecutive bed head tickets from January to April 2016. The research was conducted at Obstetric wards in the Colombo North Teaching Hospital and Colombo South Teaching Hospital. Annonymised data were entered into a database.RESULTS: A total of 72 and 81 bed head tickets were analysed in the two wards postnatal sections respectively. The completed partogram was available in 48 (66.7%) and 59 (72.8%) respectively with completeness of personal data as follows; name (100%, 97.5%), age (100%, 98.8%) parity (100%, 91.7%), bed head ticket (100%, 100%) and blood group (91.6%, 96.3%). Interpartum labour monitoring was documented as follows; fetal heart sounds (100%, 70.4%), contraction (37.5%, 43.2%), dilation (54.1%, 35.8%), alert and action lines (50%, 42%), descent (12.5%, 14.8%), liquor (50%, 66.7%), position (8.3%, 12.3%), caput (12.5%, 8.6%), and molding (8.3%, 4.9%). CONCLUSIONS: Both maternal and labour parameters show high levels of incompleteness which destroys the true use of a partogram which is early identification and prompt intervention in the instance of maternal or labour complications.Item Audit on current practices of induction of labour at a tertiary care hospital(Sri Lanka College of Obstetricians & Gynaecologists, 2016) Kajendran, J.; Jayawardena, G.R.M.U.G.P.; Gunarathna, S.M.S.G.; Herath, H.M.R.P.OBJECTIVE: Induction of labour (IOL) is a common obstetric intervention done for several reasons. Most importantly, induction of labour has a large impact on the health of women and their babies and so needs to be clearly clinically justified. Yet it is also important to perform regular audit of this practice on account of ensuring risk-free medical practice. Thus, current practice of IOL was examined to assess the indications and outcomes of IOL. METHOD: This audit was carried out from January 2016 to April 2016 in obstetric professorial unit of Colombo north teaching hospital Ragama. Data on all women admitted for IOL was collected using data collection sheet. The processes of IOL were tested against the WHO clinical guideline. It was aimed to determine the IOL rate, reasons, and outcomes. RESULTS: Out of the1423 deliveries during those periods 377 were induced (26.49%). Mean maternal age was 28.08-years and mean gestation was 39-weeks. Number of successful induction was 286.The most common indications for IOL were: prolonged rupture of membranes (29.4%), prolonged pregnancy (20.7%) diabetes complicating pregnancy (12.2%), hypertensive disorders (9.8%), and small for gestational age (5.1%). Reason for IOL was not documented in 20% and rests of the IOL were due to social, IUD and other medical disorders. The most common indications at <37 weeks were prolonged rupture of membranes (52%) and small for gestational age (17%). Emergency caesarean section was 19.3% for lack of progress and fetal distress. Seventeen percentages of neonates were admitted for NICU and 96% had APGAR more than 7 at 7 minutes. CONCLUSION: Our unit IOL proportion is lower than national figure (35.5%).One fifth of the IOL indications were not documented and this highlights the deficiency in the documentation. Checklist for IOL has been decided in the unit meeting to enhance proper documentation.Item Case report: Giantadenomatoidtumour of uterus mimicking like large leiomyoma(Sri Lanka College of Obstetricians & Gynaecologists, 2016) Kajendran, J.; Gunarathna, S.M.S.G.; Wijesinghe, P.S.; Hewavisenthi, S.J.INTRODUCTION: Adenomatoidtumours of uterus are rare benign neoplastic disorder of the female genital tract. Even though reported incidence is around 1-2% true incidence is probably more than that as they are not usually symptomatic. Most cases are under 3 cm in diameter, but giant variants up to 15 cm in diameter are also described. Here, we describe a case of giant adenomatoid tumor of the uterus that was managed surgically. CASE HISTORY: A 24-year-old nulliparous woman presented with abdominal distension, regurgitation and early satiety of five months duration. She did not have any menstrual disorders. Abdominal examination revealed a large pelvic tumourcorresponding to 20 weeks gravid uterus. Ultrasonography revealed a large uterus with multiple fibroid. She underwent a laparotomy,a subserosal mass arising from the posterior uterine wall near the fundus and extending to the left uterine cornuwas found. It was not a welldefined mass and consistency was firm in nature. Tumour was easily enucleated and sent for histology. Uterus was repaired into two layers.Post-operative recovery was uneventful.The histology report revealed as adenomatoid tumor of the uterus. DISCUSSION: Adenomatoidtumour arises from the germinal epithelium of abdomen and thorax. It is a variant of mesothelioma. They can beassociated with fibroids and tend to mimic them clinically, making pre-operative diagnosis difficult. Macroscopically, most appear as nodular formations with ill- defined margins and can occur in ovary, mesentery, adrenal glands, and omentum. Rarely do they recur even after conservative surgery and so far no malignant transformation has been reported. Therefore, the recommended treatment is simple excision of the tumor, if possibleItem Case report: Giant adenomatoid tumour of uterus mimicking like large leiomyoma(Sri Lanka College of Obstetricians & Gynaecologists, 2016) Kajendran, J.; Gunarathna, S.M.S.G.; Wijesinghe, P.S.; Hewavisenthi, S.J.INTRODUCTION: Adenomatoid tumours of uterus are rare benign neoplastic disorder of the female genital tract. Even though reported incidence is around 1-2% true incidence is probably more than that as they are not usually symptomatic. Most cases are under 3 cm in diameter, but giant variants up to 15 cm in diameter are also described. Here, we describe a case of giant adenomatoid tumor of the uterus that was managed surgically. CASE HISTORY: A 24-year-old nulliparous woman presented with abdominal distension, regurgitation and early satiety of five months duration. She did not have any menstrual disorders. Abdominal examination revealed a large pelvic tumour corresponding to 20 weeks gravid uterus. Ultrasonography revealed a large uterus with multiple fibroid. She underwent a laparotomy, a subserosal mass arising from the posterior uterine wall near the fundus and extending to the left uterine cornu was found. It was not a well-defined mass and consistency was firm in nature. Tumour was easily enucleated and sent for histology. Uterus was repaired into two layers. Post-operative recovery was uneventful. The histology report revealed as adenomatoid tumor of the uterus. DISCUSSION: Adenomatoid tumour arises from the germinal epithelium of abdomen and thorax. It is a variant of mesothelioma. They can be associated with fibroids and tend to mimic them clinically, making pre-operative diagnosis difficult. Macroscopically, most appear as nodular formations with ill- defined margins and can occur in ovary, mesentery, adrenal glands, and omentum. Rarely do they recur even after conservative surgery and so far no malignant transformation has been reported. Therefore, the recommended treatment is simple excision of the tumor, if possible.Item Audit on current practices of induction of labour at a tertiary care hospital(Sri Lanka College of Obstetricians & Gynaecologists, 2016) Kajendran, J.; Jayawardena, G.R.M.U.G.P.; Gunarathna, S.M.S.G.; Herath, H.M.R.P.OBJECTIVE: Induction of labour (IOL) is a common obstetric intervention done for several reasons. Most importantly, induction of labour has a large impact on the health of women and their babies and so needs to be clearly clinically justified. Yet it is also important to perform regular audit of this practice on account of ensuring risk-free medical practice. Thus, current practice of IOL was examined to assess the indications and outcomes of IOL. METHOD: This audit was carried out from January 2016 to April 2016 in obstetric professorial unit of Colombo north teaching hospital Ragama. Data on all women admitted for IOL was collected using data collection sheet. The processes of IOL were tested against the WHO clinical guideline. It was aimed to determine the IOL rate, reasons, and outcomes. RESULTS: Out of the1423 deliveries during those periods 377 were induced (26.49%). Mean maternal age was 28.08-years and mean gestation was 39-weeks. Number of successful induction was 286.The most common indications for IOL were: prolonged rupture of membranes (29.4%), prolonged pregnancy (20.7%) diabetes complicating pregnancy (12.2%), hypertensive disorders (9.8%), and small for gestational age (5.1%). Reason for IOL was not documented in 20% and rests of the IOL were due to social, IUD and other medical disorders. The most common indications at <37 weeks were prolonged rupture of membranes (52%) and small for gestational age (17%). Emergency caesarean section was 19.3% for lack of progress and fetal distress. Seventeen percentages of neonates were admitted for NICU and 96% had APGAR more than 7 at 7 minutes. CONCLUSION: Our unit IOL proportion is lower than national figure (35.5%).One fifth of the IOL indications were not documented and this highlights the deficiency in the documentation. Checklist for IOL has been decided in the unit meeting to enhance proper documentation.Item Case report: Giantadenomatoidtumour of uterus mimicking like large leiomyoma(Sri Lanka College of Obstetricians & Gynaecologists, 2016) Kajendran, J.; Gunarathna, S.M.S.G.; Wijesinghe, P.S.; Hewavisenthi, S.J.de.S.INTRODUCTION: Adenomatoidtumours of uterus are rare benign neoplastic disorder of the female genital tract. Even though reported incidence is around 1-2% true incidence is probably more than that as they are not usually symptomatic. Most cases are under 3 cm in diameter, but giant variants up to 15 cm in diameter are also described. Here, we describe a case of giant adenomatoid tumor of the uterus that was managed surgically. CASE HISTORY: A 24-year-old nulliparous woman presented with abdominal distension, regurgitation and early satiety of five months duration. She did not have any menstrual disorders. Abdominal examination revealed a large pelvic tumourcorresponding to 20 weeks gravid uterus. Ultrasonography revealed a large uterus with multiple fibroid. She underwent a laparotomy,a subserosal mass arising from the posterior uterine wall near the fundus and extending to the left uterine cornuwas found. It was not a welldefined mass and consistency was firm in nature. Tumour was easily enucleated and sent for histology. Uterus was repaired into two layers.Post-operative recovery was uneventful.The histology report revealed as adenomatoid tumor of the uterus. DISCUSSION: Adenomatoidtumour arises from the germinal epithelium of abdomen and thorax. It is a variant of mesothelioma. They can beassociated with fibroids and tend to mimic them clinically, making pre-operative diagnosis difficult. Macroscopically, most appear as nodular formations with ill- defined margins and can occur in ovary, mesentery, adrenal glands, and omentum. Rarely do they recur even after conservative surgery and so far no malignant transformation has been reported. Therefore, the recommended treatment is simple excision of the tumor, if possible.