Papers by Prof. K Muhunthan
International Journal of Gynecology & Obstetrics
ObjectiveTo review available data on tranexamic acid (TXA) plasma concentration needed to inhibit... more ObjectiveTo review available data on tranexamic acid (TXA) plasma concentration needed to inhibit fibrinolysis and the time to achieve this concentration when giving TXA by different routes in humans. To identify ongoing trials assessing alternatives to intravenous TXA administration.MethodsWe updated two previous systematic reviews by searching MEDLINE, EMBASE, OviSP, and ISI Web of Science from database inception to July 2021. We also searched the WHO International Clinical Trials Registry Platform for ongoing trials to July 2021. Titles and abstracts were screened for relevant trials. Two reviewers independently reviewed and agreed the trials to be included.ResultsPlasma TXA concentrations over 10 mg/L provide near maximal inhibition of fibrinolysis, with concentrations over 5 mg/L providing partial inhibition. Oral TXA tablets take about 1 h to reach a plasma concentration of 5 mg/L in postpartum women. Studies in healthy volunteers and shocked trauma patients show that intramus...
Sri Lanka Journal of Obstetrics and Gynaecology
Intrauterine insemination is a simple, non-invasive and safe initial treatment option, especially... more Intrauterine insemination is a simple, non-invasive and safe initial treatment option, especially in low resource settings for selected group of patients before initiating assisted reproduction technology treatment. A wise selection of patients and timing are key to its success. Detailed assessment of the infertile couple, controlled ovarian stimulation with follicular development monitoring, appropriate processing the seminal fluid, trigger with hCG at a correct time, single IUI in strict aseptic condition followed by 10-15 minutes of immobilization are currently considered vital elements of Intrauterine insemination to improve its outcome. Intrauterine insemination can be considered as a bridge between basic and advanced fertility treatment for selected infertile couples especially in countries with limited resources for assisted reproductive technologies.
Jaffna Medical Journal
Mucoepidermoid carcinoma (MEC) is a locally invasive tumour of the salivary glands and accounts f... more Mucoepidermoid carcinoma (MEC) is a locally invasive tumour of the salivary glands and accounts for nearly one third of all malignancies of the major and minor salivary glands. It has a female preponderance and (3:2) common after the third decade of life. Here we report a case of a 32-year-old woman who had successful pregnancy outcome following treatment for extensive maxillary mucoepidermoid carcinoma with metastasis.
Sri Lanka Journal of Obstetrics and Gynaecology, 2021
The May-Hegglin Anomaly (MHA) is a rare autosomal dominant giant platelet disorder characterized ... more The May-Hegglin Anomaly (MHA) is a rare autosomal dominant giant platelet disorder characterized by abnormally large platelets with defective leucocytes and thrombocytopenia with varying degrees of bleeding manifestation. Here we report successful pregnancy outcome in a primigravida with MHA. (Preterm Pre-labour Rupture of Membranes) PPROM mother, with abnormalities of the extremities due to ABS is discussed.
Best Practice in Labour and Delivery
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2018
AFLP, though rare, is an obstetric emergency which carries a high incidence of maternal and perin... more AFLP, though rare, is an obstetric emergency which carries a high incidence of maternal and perinatal mortality, despite optimal care. We report a case of a 23-year-old primi mother, who presented to us with vague symptoms of feeling unwell and abdominal pain, was diagnosed with AFLP, and was managed accordingly with the highest level of care available but succumbed a few days into her illness though timely delivery was able to save the baby. By this case report we once again wish to emphasize the value of a timely diagnosis with a high level of clinical suspicion and supportive laboratory investigations including imaging; the need for early termination of pregnancy; and adequate supportive care as the key management options for AFLP. Further, we wish to explore the current treatment options available for AFLP and discuss a few novel therapeutic strategies such as plasma exchange in treating such cases and the pros and cons associated with these treatment modalities.
Obstetrics and Gynaecology Cases - Reviews, 2021
Cesarean scar pregnancy is a rare form of ectopic pregnancy where the conceptus is implanted at t... more Cesarean scar pregnancy is a rare form of ectopic pregnancy where the conceptus is implanted at the site of a previous cesarean section scar which pauses lifethreatening complications if not diagnosed and managed timely. Though numerous types of treatment approaches have been described there is no consensus on the optimal treatment modality which is a challenge to clinicians. Current treatment approaches are a combination of medical and surgical interventions with varying success rates and complications.
Obstetrics and Gynaecology Cases - Reviews, 2021
Invasive mole (IM) is one of the Gestational trophoblastic neoplasia lesions, characterized by lo... more Invasive mole (IM) is one of the Gestational trophoblastic neoplasia lesions, characterized by local invasion of trophoblastic with rare distal spread. It could follow any type of pregnancy and commonly arising from a complete hydatidiform mole (CHM). Pathogenesis of hydatidiform mole due to an underlying oocyte defect. Embryos are examined for triploidy to exclude dispermic fertilization in assisted reproduction technology (ART). Besides, several potential mechanisms and risk factors had been described to explain gestational trophoblastic neoplasia (GTN) following ART. However, ART will not eliminate the risk of development of Gestational trophoblastic disease after several precautions are taken to prevent an embryo with triploidy. This case describes a rare presentation of IM following term delivery after an ART that was successfully managed without distant spread.
Sri Lanka Journal of Obstetrics and Gynaecology, 2020
Objectives: To evaluate the clinicopathological features of adolescence diagnosed with polycystic... more Objectives: To evaluate the clinicopathological features of adolescence diagnosed with polycystic ovarian syndrome. Methods: This is a descriptive study conducted at the Gynecology Clinics of University Obstetric Unit, Teaching Hospital-Jaffna to evaluate the clinicopathological features of adolescence diagnosed with polycystic ovarian syndrome (PCOS) over a period of 3 years. A total of 56 adolescent girls were diagnosed with PCOS during this period with the currently accepted diagnostic criteria recommended by the Pediatric Endocrine Society and all of them were included in the study. Clinicopathological features at the time of diagnosis of PCOS obtained from medical records were analyzed and descriptive statistics were calculated. Discussion: Emphasizing the importance of early detection of PCOS in women especially during the adolescent periods, its diagnosis should be based on the presence of clinical and/or biochemical hyperandrogenism and irregular menses for at least 1 year as recommended. Our results suggest that the commonest feature of clinical hyperandrogenism being moderate hirsuitism (89.3%) and the commonest type of abnormal uterine bleeding being oligomenorrhea (54%). An obvious rising trend in the number of diagnosed patients with age was also observed. Though the prevalence anovulatory pattern of bleeding among adolescence diagnosed with PCOS consistent with larger studies in Caucasian population, commonest manifestation of clinical hyperandrogenism was moderate hirsutism which was significantly higher compared to other studies. This could be explained by its variation across ethnicities especially with a higher prevalence of hirsuitism among South Asian population. In the absence of any published data on clinicopathological features of adolescence diagnosed with PCOS in Sri Lanka, our series highlights its pattern at the time of diagnosis.
Jaffna Medical Journal, 2020
Risk estimation and prophylactic treatment of maternal morbidity and mortality due to thromboembo... more Risk estimation and prophylactic treatment of maternal morbidity and mortality due to thromboembolism through a standard formal VTE risk assessment tool with numerical scoring is more effective in clinical decision making and management than not using a scoring system. This study was designed to assess the risk factors and prospectively measure the uptake of pharmacological prophylaxis for postpartum VTE before and after introducing a standard risk assessment scoring tool. MethodsThe study was conducted in 200 postpartum women aged 18–39 without randomization. They were prospectively followed before and after introduction of a standard formal venous thromboembolism risk assessment tool with numerical scoring. Individual risk scoring and the uptake of pharmacological prophylaxis for venous thromboembolism were analysed descriptively. Data was collected from the postpartum mothers’ case notes in the postnatal ward without interfering the clinical practice of the ward. ResultsOf the 10...
Obstetrics & Gynecology, 2020
OBJECTIVE: To evaluate the pharmacokinetics of tranexamic acid after oral administration to postp... more OBJECTIVE: To evaluate the pharmacokinetics of tranexamic acid after oral administration to postpartum women. METHODS: We conducted a single-center pharmacokinetic study at Teaching Hospital—Jaffna, Sri Lanka, on 12 healthy postpartum women who delivered vaginally. After oral administration of 2 g of immediate-release tranexamic acid 1 hour after delivery, pharmacokinetic parameters were measured on plasma samples at 0, 0.5, 1, 1.5, 2, 2.5, 3, 3.5, 4, 5, 6, 8, 10, and 12 hours. Plasma tranexamic acid concentrations were determined by high-performance liquid chromatography. The outcome measures were maximum observed plasma concentration, time to maximum plasma concentration, time to reach effective plasma concentration, time period effective serum concentration lasted, area under the curve for drug concentration, and half-life of tranexamic acid. RESULTS: The mean maximum observed plasma concentration was 10.06 micrograms/mL (range 8.56–12.22 micrograms/mL). The mean time to maximum ...
Sri Lanka Journal of Obstetrics and Gynaecology, 2018
To determine the effectiveness and safety of single doses antibiotic against conventional multipl... more To determine the effectiveness and safety of single doses antibiotic against conventional multiple doses regimen on clinically detectable maternal and neonatal infectious morbidity. Method This is a randomized, non-blind clinical trial on women undergoing caesarean section. By block random sampling, 369 women, who were enrolled in this study, 185 (50.1%) randomly received single dose of antibiotics and 184 (49.8%) received multiple postoperative doses of antibiotics. All potentially infected cases were excluded. These patients were followed up prospectively for infectious and neonatal complications till discharge and verbal enquiry or direct observation done during suture removal. The effectiveness was measured in terms of febrile morbidity, surgical site infection, endometritis, urinary tract infection, other infection along with duration of hospital stay. Chi-square analysis (Fisher's Exact
Jaffna Medical Journal, 2018
Polycystic ovary syndrome (PCOS) is a common condition that has a number of reproductive and gene... more Polycystic ovary syndrome (PCOS) is a common condition that has a number of reproductive and general health implications in adults. It is also currently considered the commonest endocrine condition to affect women with an estimated prevalence of 10–15%. Anyhow this prevalence rate depends on the population studied and the diagnostic criteria used.There is significant heterogeneity of presentation, such that signs and symptoms manifest across a spectrum and their severity may vary.PCOS appears to be underdiagnosed and, as a result, patients may not be managed appropriately. Management of PCOS may require the collaboration of a variety of healthcare professionals.
BMC medical ethics, Jan 15, 2018
The use of lengthy, detailed, and complex informed consent forms (ICFs) is of paramount concern i... more The use of lengthy, detailed, and complex informed consent forms (ICFs) is of paramount concern in biomedical research as it may not truly promote the rights and interests of research participants. The extent of information in ICFs has been the subject of debates for decades; however, no clear guidance is given. Thus, the objective of this study was to determine the perspectives of research participants about the type and extent of information they need when they are invited to participate in biomedical research. This multi-center, cross-sectional, descriptive survey was conducted at 54 study sites in seven Asia-Pacific countries. A modified Likert-scale questionnaire was used to determine the importance of each element in the ICF among research participants of a biomedical study, with an anchored rating scale from 1 (not important) to 5 (very important). Of the 2484 questionnaires distributed, 2113 (85.1%) were returned. The majority of respondents considered most elements required...
SAGE Open Medical Case Reports, 2017
Pregnancy creates significant alterations in energy metabolism which itself is a physiological ad... more Pregnancy creates significant alterations in energy metabolism which itself is a physiological adaptation to provide continuous flow of energy metabolites to the foetus. The state of insulin resistance created by hormonal changes in pregnancy enables free flow of glucose to the foetus and allows its absorption through facilitated diffusion. As glucose is preferentially available for the foetus, maternal fasting glucose level would be less than that of a non-pregnant state and in contrast plasma ketones and free fatty acids levels are elevated, resulting in a state of accelerated starvation. These metabolic alterations place a pregnant woman at a higher risk of developing euglycaemic ketoacidosis when allowed to fast for prolonged periods due to medical, surgical and psychological reasons. We report a rare case of euglycaemic ketoacidosis causing severe increased anion gap metabolic acidosis in a non-diabetic mother following surgery for appendicitis at a gestation of 27 weeks.
Handbook of CTG Interpretation
Principles of Critical Care in Obstetrics, 2016
Childbirth is a major life event for women and their families. However, in a small proportion, se... more Childbirth is a major life event for women and their families. However, in a small proportion, severe and sometimes life-threatening complications occur during pregnancy. Such critically ill women should receive the same standard of care for both their pregnancy-related and critical care needs, delivered by professionals with the same level of competences irrespective of whether these are provided in a maternity or general critical care setting [1].
Screening in Obstetrics & Gynecology: Management of Abnormality, 2015
Nepal Journal of Obstetrics and Gynaecology, 2014
DOI: http://dx.doi.org/10.3126/njog.v9i1.11177 NJOG 2014 Jan-Jun; 2(1):5-7
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Papers by Prof. K Muhunthan