Still new. So much things to learn.
Had my first oncall last night.
Alhamdulliah not so jonah :p
Still able to sleep for a minute- two ha-ha.
3 weeks in OBGYN so far.
My first time conducting delivery of baby, I was scared to pull out the head. In the process of labour, after the baby had gone into the stage of crowning, baby will naturally rotate their head so that the occiput will be in line with the spine. Once the head already in position, we have to check for any cord round neck before pulling out the head, and then proceed with the delivery of anterior shoulder. To be honest, I still feel scared to pull out the head, afraid that I will break their neck. Because theyre so fragile. SO SOFT. The moment I saw the seniors did it, OKAY so the baby can just withstand the force ea? Wow. I did it softly haha macam mana kepala baby nak keluar?
Now, talking about delivery of the placenta.
The question is, what is the signs of placenta separation? 1. 2. 3. GO!
First you'll see gushing of blood, second, lengthening of the cord and the fundus will look globular and hard. Once all these 3 appears, you can now pull the placenta out BUT in a controlled manner we call it Control Cord Traction. One hand put at the fundus, while the other hand pulling the cord in a gentle manner side to side. This to prevent uterine inversion from happening. The first time I did it, I was being scolded by the seniors "Tarik kuat sikit dik" hahahaha I was really afraid the cord would snap! Adoi-lah. Maciam-maciam.
Vaginal examination.
The patient will ask you,
"Doktor jalan dah buka berapa cm? Lama lagi ke?"
The most important thing you need to differentiate between 3 cm and 4 cm. 3 cm still in latent phase of labour, can still admit patient to ward whereas 4 cm indicates its already active phase of labour, let's go to labour room! The baby's coming!
For my finger,
1 finger = 1 cm
2 finger = 2 cm
3 cm I still feel tight
4 cm ada lax sikit
Yang lain tu agak-agak je ha-ha
Os fully = 10 cm is when semua dah lax, dah tak rasa cervical lip, kena pusing-pusing jari rasa sekeliling os tu.
You know the first time I did VE I was confused between vagina and cervical os. Aiyoo. Vagina memanglah terbuka gitu, but cervical os you need to go deeper, and you'll feel another opening. Every woman's different. Some you just insert your finger je dah rasa (axial), some need to go deeper (posterior).
Perineal repair.
Still learning. The difficult part when there's too much tear. The moment akak nurse compliment me, "cantik dah ni dokter jahit" I feel proud kejap hahahahaha. Still need to improve a lot! Barang nak pakai lama kenalah jahit cantik-cantik.
Cases that Ive seen so far;
Most of the preggy ladies will come with,
Leaking liquor, contraction pain, and show. These are the signs of labour.
Hence, the common cases in clerking bay are: PROM - air ketuban pecah bila baby dah matang more than 37 weeks, PPROM- air ketuban pecah sebelum masanya which baby tak matang lagi <37 weeks, latent phase of labour, active phase of labour some datang dah os fully straight away we push to labour room, some tak sempat thus terberanak dekat clerking bay!, thereatened preterm labour, false labour, pre eclampsia, elective admission for induction of labour (IOL), postdate, hmm lagi apa ya? GDM kencing manis masa mengandung referred from KK for BSP optimization.
Have you noticed I mentioned labour so many times?
Latent Phase of Labour
Active Phase of Labour
Threatened Preterm Labour
False Labour
This brings to the favorite question from my superiors,
WHAT IS LABOUR?
When there is strong regular contraction, that leads to the descending of the presenting part, cervical dilatation and effacement and delivery of the baby and placenta.
From the definition itself, it explains all the 3 stages of labour.
These are the next favorite question after the definition of labour! Ha-ha.
- So latent phase of labour is when the lady at term gestation (37 weeks and above), come with contraction pain mostly irregular and +/- other labour symptoms eg leaking liquor/show and the os is still 3 cm and below.
- Active phase of labour, usually contraction dah regular, then os is 4 cm and above.
- Threatened Preterm Labour, when the mentioned things above occurs in a lady at gestation <37 weeks
- False labour is when the definition of labour is not fulfilled.
- When the patient come with leaking liquor, irregular contraction, os closed it's either PROM or PPROM depends on the gestational age.
Need to get the diagnosis right, different diagnosis, different management. In OBGYN the management is case to case basis, not solely from textbook. I have encounter some mother with premature gestation come with labour symptoms we didnt give IM dexa/tocolytic agent pun, we just allow the labour to progress. Tapi ni kes yang bukan severe prem lah of course, borderline prem dalam 34/35 weeks. So much things to learn and I guess I started to enjoy this posting.
Hopefully I will survive this posting.
Ameen ameen inshallah.
Okay,
Happy fasting for those fasting today
&
Happy Eidul-Adha people
:)
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