Hemantha Senanayake

Microbiome of the placenta in pre-eclampsia supports the role of bacteria in the multifactorial cause of pre-eclampsia

This study was aimed at detecting, identifying, quantifying and comparing the bacteria present in the placental tissues of women with pre‐eclampsia with that of normotensive pregnant women.

Cadmium a metalloestrogen: are we convinced?

Metalloestrogens are inorganic metal ions that bind to and activate oestrogen receptors. They are implicated in the aetiology of oestrogen‐dependent diseases such as cancers of the breast and endometrium as well as endometriosis. Cadmium is one of the most studied metalloestrogens. In this review, scientific evidence for the oestrogenic effects of cadmium is critically evaluated to determine if there is sufficient evidence to support cadmium as an aetiological factor of oestrogen‐dependent disease in humans. Results of the review indicated that, although the in vitro and in vivo evidence of the oestrogenic properties of cadmium was persuasive, evidence from population‐based human studies remains conflicting. Considerable knowledge gaps exist on the potential oestrogenic effect of cadmium in humans. Research that focuses on bridging these knowledge gaps would be useful in preventing and managing oestrogen‐dependent disease in humans. Copyright

Achieving Millennium Development Goals 4 and 5 in Sri Lanka

Please cite this paper as: Senanayake H, Goonewardene M, Ranatunga A, Hattotuwa R, Amarasekera S, Amarasinghe I. Achieving Millennium Development Goals 4 and 5 in Sri Lanka. BJOG 2011;118 (Suppl. 2):78–87.

Elective cesarean section without urethral catheterization

Aim: To determine the feasibility and safety of carrying out elective lower‐segment cesarean section without urethral catheterization.

Implementation of the WHO safe childbirth checklist program at a tertiary care setting in Sri Lanka: a developing country experience.

BackgroundTo study institutionalization of the World Health Organization’s Safe Childbirth Checklist (SCC) in a tertiary care center in Sri Lanka.MethodA hospital-based, prospective observational study was conducted in the De Soysa Hospital for Women, Colombo, Sri Lanka. Healthcare workers were educated regarding the SCC, which was to be used for each woman admitted to the labor room during the study period. A qualitatively pretested, self-administered questionnaire was given to all nursing and midwifery staff to assess knowledge and attitudes towards the checklist. Each item of the SCC was reviewed for adherence.ResultsA total of 824 births in which the checklist used were studied. There were a total of births 1800 during the period, giving an adoption rate of 45.8%. Out of the 170 health workers in the hospital (nurses, midwives and nurse midwives) 98 answered the questionnaire (response rate = 57.6%). The average number of childbirth practices checked in the checklist was 21 out of 29 (95% CI 20.2, 21.3). Educating the mother to seek help during labor, after delivery and after discharge from hospital, seeking an assistant during labor, early breast-feeding, maternal HIV infection and discussing contraceptive options were checked least often. The mean level of knowledge on the checklist among health workers was 60.1% (95% CI 57.2, 63.1). Attitudes for acceptance of using the checklist were satisfactory. Average adherence to checklist practices was 71.3%. Sixty eight (69.4%) agreed that the Checklist stimulates inter-personal communication and teamwork. Increased workload, poor enthusiasm of health workers towards new additions to their routine schedule and level of user-friendliness of Checklist were limitations to its greater use.ConclusionsAmongst users, the attitude towards the checklist was satisfactory. Adoption rate amongst all workers was 45.8% and knowledge regarding the checklist was 60.1%. These two factors are probably linked. Therefore prior to introducing it to a facility awareness about the value and correct use of the SCC needs to be increased, while giving attention to satisfactory staffing levels.

History, pelvic examination findings and mobility of ovaries as a sonographic marker to detect pelvic adhesions with fixed ovaries

To compare the performance of history and examination findings combined with transvaginal ultrasound (TVS) ‘soft marker’ evaluation of ovarian mobility for the prediction of fixed ovaries secondary to endometriosis at laparoscopy.

Simple educational intervention will improve the efficacy of routine antenatal iron supplementation

Aim:  Sri Lanka has a policy of free provision of iron supplements to pregnant women. However, iron deficiency anemia remains common in pregnancy.

Elevated levels of whole blood nickel in a group of Sri Lankan women with endometriosis: a case control study

BackgroundEndometriosis is characterized by the persistence of endometrial tissue in ectopic sites outside the uterine cavity. Presence of nickel, cadmium and lead in ectopic endometrial tissue has been reported previously. While any association between blood levels of nickel and endometriosis is yet to be described in literature, conflicting reports are available with regards to cadmium and lead levels in blood and urine.FindingsIn fifty patients with endometriosis and fifty age-matched controls confirmed by laparoscopy or laparotomy, whole blood samples were collected and digested using supra pure 65% HNO3. Whole blood levels of nickel and lead were measured using Total Reflection X-ray Fluorescence (TXRF) while cadmium levels were evaluated using graphite furnace atomic absorption spectroscopy (GFASS). Women with endometriosis had significantly higher (P=0.016) geometric mean (95% CI) whole blood nickel levels [2.6(1.9-3.3) μg/L] as compared to women without endometriosis [0.8 (0.7-0.9) μg/L]. Whole blood levels of cadmium and lead were similar between the two groups.ConclusionsAlthough women with endometriosis in this study population had higher levels of nickel in whole blood compared to controls, whether nickel could be considered as an aetiological factor in endometriosis remains inconclusive in view of the smaller sample that was evaluated.

Comparison of transabdominal versus transvaginal ultrasound to measure thickness of the lower uterine segment at term

To compare the accuracy of transvaginal (TVS) versus transabdominal (TAS) ultrasound to assess the thickness of the lower uterine segment (LUS).

Mid-trimester fracture of femur in a normal fetus

We report a case of an intrauterine fracture of the femur detected at routine mid‐trimester sonography in an otherwise normal fetus. There was no associated maternal trauma. At birth, callus formation was palpable and confirmed by radiography. Absence of further fractures despite normal childhood activity and other features precluded a diagnosis of skeletal dysplasia. Although such an event is extremely rare, the possibility of an intrauterine origin should be considered in the differential diagnosis of battered baby syndrome presenting with a single fracture.