Wednesday, January 7, 2009

Labour room

Hmm..where do I begin

I'm officially posted to the Labour room right now.Its fun to learn manynew things.Its more exhilirating when you get to actually perform things that you only previously see in the texbooks.For instance, I did my first Vaginal Examination or affectionately known as 'VE' yesterday during on-call.It was aight I guess, though I was tired becoz it was midnight at that time.The pregnant lady is already on the Active phase of labor.The cervical os was opened at 5cm, occiput can be felt, station +1.Owh yeah, I also observed the amniotomy (artificial rupture of membrane) using the amniohook before that.
While in the labour room, there are basically 3 areas that needs to be covered - Patient Admission Counter(PAC), Labour suites and also the Maternal Operation Theatre.The idea is to see the whole process of managing the labour.Staff wise...O&G department is more inviting.The nurses,HOs and MOs are extremely nice.Be humble and always asked them questions if in doubt.You'll be amazed at the rate of knowledge that you are getting.They are also accommodative and obliging.They will encourage you to do this and that, even up to the level of conducting the delivery itself.As for now, I have not mustered all the courage yet to conduct a delivery.InshaAllah,one of these days.Do simpler stuff first such as Placenta cord traction, Episiotomy suturing, Partograms, Interpreting CTG, Inject IM syntocinon etc. muahaha...
I've already observed 7 deliveries so far.No complicated delivery except for one yesterday night when I was on-call.A baby was born flat ( ie- no crying, APGAR score was probably 5/10).We had to resuscitate the baby, alerting the Paediatrician at the same time.At the end of the day, we gave the baby Naloxone, an antidote to the opiod-analgesic which was given to the mother to relief the pain while in the labour.That drug must have significantly crossed into the fetal circulation from the maternal's circulation and eventually caused Opiod-induced respiratory depression.Seriously, baby tu nampak macam tengah high,mata terbukak mcm orang tengah berkhayal.Apparently, Serdang Hospital uses many expensive drugs which sometimes cannot be found even in private hospitals.Instead of using Pethidine, they use Nalbuphine( Nuban ).So who says HospitalKerajaan guna ubat murah?Try to say that in front of my face.

I went back to the hospital the next morning and arrived at 7.30am for Morning Pass-over.Its a ritual thing in this hospital to have a morning-passover.Not sure about other hospitals tho.This is when the MO oncall present the cases to the specialists and the head of department.He/she will make summaries regarding the number of deliveries,number of SVDs(spontaneous vaginaldeliveries),number of C section done and why it is done etc.A HO then must also present an obstetric related disease in front of the nurses,sisters, HOs,MOs and medical students.It's a good revision for me.

Note 1: I'll be having my O&G misposting exam tomorrow

Note 2: Kenapa orang tak berenti-renti beranak? Labour room tu sentiasa beroperasi 24 hours

Note3: Most big hospitals in Malaysia such as Hospital Serdang would have around 15-20 percent of Cesaerian deliveries each month.They will try to keep the precentage lower if possible.In a nutshell, never request for a Cesaerian to any obstetrician.They wont do unless indicated.

Note 4: Had two teachings today from Dr Zainurrashid and Dr Suhaimi.Dr Zain had twice conduct deliveries in a bathtub while he was in the UK last time at patients' request.Can u believe that?Evidence-based medicine shows that warm water is known to relieve the pain of labour.Unfortunetely we dont do that in Malaysia.I sure need to bring my swimming trunk next time if we do have that!


yellowrose said...

waa..cant wait to do my Obgyn posting nxt yr...!!yes water birth is so popular nowadays.the baby wont drown coz they still breathing thru the cord..most important ,the pushing phase is much less intense in the bout this somewhere on net..maybe kt msia xfamous lg..mak2 kat msia should try it.

chi am said...

mak aih.. pizza deliveries pon ak x sure mampu ke x.. inikan pulak delivery yg ini. heh!

congrats doc!

N a b i L said...

yellowrose: Surely there will b an increase risk of aspiration kalau bersalin kat bathtub.Hmm probably, Michael Phelps lahir kat dlm bath tub kut, thats why dia terer berenang.

Chi am: Bro, why did u stop blogging? Nk tau gak serba sedikit tentang kehidupan seorang engineer yang berjaya spt anda =)