Monday, August 30, 2010

Mode of delivery

Another case that we discussed was....
wic actually presented by junior...
gud try, please read wut prof had taught us & keep it up =)

39 yo malay lady G7P4+2 @ 30weeks POG

the issue that's been highlight here was her obstetric history
patient came to plan for her mode of delivery
So this history must be taken in detail

1st pregnancy:
term, 2.9kg, girl, LSCS, late onset PIH

Prof ask, why do u think she undergo LSCS???
her baby weight is 2.9kg, cudnt be IUGR
answer: she was dx PIH at 38weeks, her BP was very high but no proteinuria, no IE symptoms
Her baby was actually breech, so Emergency LSCS was done
if delay, she might go into labour

2nd pregnancy:
She was dx to have ectopic pregnancy & terminated at ?? weeks of pregnancy
(i cudnt remember the weeks)

prof: what is the operation done on her???
further asking the patient, she actually had ruptured ectopic pregnancy
laparotomy salphingectomy of right side was done

3rd pregnancy:
term, SVD, macerated stillbirth

prof: what happened to the baby??
she had chicken pox at that time
upon antenatal check up, her baby was already died few hours
the next day, she went to hospital for IOL
prostin was inserted
the baby had all 4limbs (cukup sifat)
there is desquamation of the skin of whole body
doctor said the baby died due to the infection,
damaged the brain
no syndromic facies noted

4th pregnancy:
missed carriage, ERPOC done

5th pregnancy:
term, weight saya xingt, girl, LSCS due to patient had severe pain & request for ceaser??

prof:did doctor do ceaser upon patient request??
answer: No

prof:then, why dis patient had LSCS??
answer: patient had contraction pain
at that time, she was in APOL - 4cm
but after 5hours, she still 4cm
she was augmented
afterwards, patient had severe pain
what do u think she had??
probably hyperstimulation patient might go into uterine rupture
so LSCS was done to this patient

6th pregnancy:
38weeks, weight xingt juga, girl, LSCS because she had 2 previous scar

prof: in our practice. in what week we do elective LSCS??
we answer 38weeks, but prof macam xagree.huhu
sape bole tlg???37 kah??hermmmm

No complication of surgery
-no abdominal pain, constipation - adhesion
-placenta previa/accreta
- wound dehiscence
- xingat dah..huhu

dont forget anaest cx-
difficult intubation (1 of her LSCS was under GA, other 2 under spinal)
failed to locate site for under spinal insertion wic later converted to GA
difficult ventilation eventho success for intubation

prof: So this patient already had 3 previous scar. Why does she allowed to pregnant again??
answer: all her 3 living children were girls. The doctor gave her chance to get a boy in her next pregnancy.
(prof did asked wether did the doctor taught her how she cud get a boy??patient said yes. hermm macam menarik je untuk tahu..hehe )

prof: what is her mode of delivery for her current pregnancy??
answer: LSCS with BTL

1 comment:

  1. Cik Yana. Tadi saya bertugas kat post natal clinic. Seperti biasa, doctor lagi ramai dari patient (patient tend to tak datang PNC maklumlas, dah selamat bersalin) so di waktu lapang saya belek-belek buku orang LPPKN (yang datang untuk counsel pt pasal family planning). Ada sebut pasal cara untuk dapat anak lelaki/perempuan. Saya pernah tau dulu. Something to do with whether sperm is in first or ovum. Kalau sperm in dulu, pastu ovum mostly dapat lelaki. Camtu la. Kat sini usually ELLSCS done at 38 weeks, macam pt saya masa antenatal clinic pagi tadi 2 prev scar so planned for ELLSCS+BTL at 38 wks. Kalau pt goes into labour first, for EMLSCS. Oh, and oh yes, doctors won't do LSCS upon pt's request. Lain lah kalau kat private. Census LSCS setiap bulan mesti ada indication for LSCS, paling kurang pun "1 prev scar not keen for VBAC" atau "suspected big baby".