Monday, January 12, 2009

Tumpah Darah

10 AM, Dewan Bersalin hospital

One of my patient had a condition called Post partum hemorrhage.Orang Melayu kita panggil 'tumpah darah'.Puan S had a prolonged stage 2 labour, around 45 minutes.Peneranan( is there such word?) tu tak brape mantap dan efektif.Ramai la yang masuk ke dalam labour suite pastu beri sokongan.Macam nk pecah je bilik bersalin tu agaknye.I was beside her, encouraging here to do this and that.Nasib baik baby tu tak lemas.CTG reading was reactive.I was surprised.

Later, I delivered the placenta by using the Continuous Cord Traction technique.Placenta delivery pun agak lambat.Agak-agaknye around 10 ke 15 minit.Slalunye 5 minit je placenta a.k.a uri tu dah keluar.Then she started to feel thirsty.Then she complained that she wants to faint and that her vision was blurry.Ahhh sudah, patient nak masuk hypovolaemic shock.Apa lagi terkejut la kami semua kat situ.BP was taken and the reading was 55/28 mmHg.Bayangkan diastole hanya '28' je.We run a lot of IV fluid both crystalloids and colloids(plasma expander) like mad - Hartman's solution, Voluven, Normal saline you name it.Specialists Dr S was alerted and she came running and panting.

This patient had what we called Primary Post Partum Haemorrhage( meaning excessive bleeding within 24 hours post delivery).The commonest cause is either retained placenta in the uterus or vaginal wall tear.Its unlikely to be from retained placenta.I've checked the placenta thoroughly- cotyledons are complete, 2 membranes, 1 vein and 2 arteries.Impossible.MO check.Check punye check, laa rupe rupe nye ade left lateral vaginal wall tear.Tear dia sangat halus dan susah untuk dijumpai.We sutured the the tear and the bleeding stops.Fuh, akhirnya stop gak pendarahan tu.Estimated blood loss for the whole labour is around 1 litre to 1.5 litres.Tuan-tuan dan puan-puan sekalian, darahtu banyakye.Jangan dibuat main-main

Oh by the way I had the chance to do episiotomy surturing just now.Seriously, the feeling of menjahit tu sangat best.Rasenye aku memang la berbakat nk jadi Surgeon <----- Habisla, puji diri sendiri tak bertempat.Oh well, takde org lain nk puji aku, so aku puji la diri sendiri hahaha...

Oh the best part was when Puan S said to me:

'Akak nak amanahkan adik Nabil utk mengazankan anak akak tadi yer"

OK.The keyword here is 'amanah'.Its such a big word for me and it was such an honour to do that.Bile fikirkan balik, kesian akak tu sakit sakit labour camtu tapi suami masih dalam perjalanan ke hospital from Perak.So bakal-bakal suami disana, jgn lupa temankan isteri anda yang nak beranak.In evidence based medicine, companionship during labour has been proven to lessen patient's pain during labour.

K chow cincau.Nak pegi On-call malam ni!

Sambung cerita...

Juz got back from the hospital.Fuh, penat.Rasa nk hilang je suara memberi sokongan kpd ibu-ibu/bakal-bakal ibu ni.Anyway, I went straightaway to the obstetric ward juz now once arrived in the hospital, dengan harapan nk jumpe Puan S tadi.Cari punye cari tak jumpe.Rupe-rupenye dia still labour room for close monitoring.Blood transfusion is being done in order to bring up her haemoglobin level.Dapat la berborak dgn dia dan ahli keluarga dia.Gembira teramat dia tu.Asik la cakap tenkiu sebab azankan anak dia.Part paling best bile dia cakap dia nak namakan anak dia Fakhrul Nabil.Read, N.A.B.I.L. Hehe...I feel honoured.

Note1: Nasib baik la aku bukan perempuan.Kesian gile tengok patient tadi.Memang betul betul in pain.

Note 2 : Ada midposting exam tadi.Ditunda ke hari Isnin.Ok la kut soalan dia.Yang tak boleh blah bile Prof kate ," Saya akan ambik markah midposting exam ni untuk dikira masa final posting mark ni nanti hanya bile lebih dari 50% daripada kamu semua fail'. One word that can describe that 'K.E.J.A.M'

Note 3: Baru tengok episode 1 cerita 'Code Blue', Japanese medical series.Terasa cerita tu tersangatla over.BUt at least ada substance.Tak mcm Ampang Medikal.

8 comments:

Sarah Mohd Shukor said...

Wah Nabil. Best betul yang kali ni! I never done any episiotomy suturing yet. Nak cuba jugak! Bestnya belajar kat Malaysia. U did a good decision back then. If I were u, I would have done the same. Uwaaaa.

crack creaker@shamsul said...

hey dude!! sebab itu la orang kata syurga kita dibawah kaki ibu.. tu memang benar dan sahih.. tengok la betapa peritnya dia nak lahirkan ank..dah la 9 bulan gendong kehulu kehilir.. than azab giler nak lahirkan anak..lebih2 lagi anak pertama..wanita adalah insan yang cukup istimewa di bumi ini..aku selute dia orang..

roi said...

waa nabil
anda seperti sangat enjoy posting ni,sungguh banyak entry pasal posting ni eh~

Wahidah said...

ah buat episiotomy eik...good job...nak jd surgeon mmg kena pandai bab2 suturing ni..:)

N a b i L said...

Sarah - Tak lama lagi KS kena buat semua benda benda tu.dont worry hehe

Shamsul - Ha'a la bro.kite kena respek kaum wanita ni, especially mak kite.

Roi- Agak la roi.definitely better than Paeds!

Wahidah - Yes, a famous surgeon in the making!

alia said...

might as well consider uterine atony since u mentioned she had prolonged 2nd and 3rd stage of labour which could have exhaust the uterus.. and then there's the tear to aggravate her condition..

obstetrics is indeed interesting isn't it?:)

N a b i L said...

Alia- yup, dat is true

nOnnie_sayang said...

salam Nabil. Very nice entry. S'gai seorang ibu kepada 4 anak, akak boleh bayangkan macamana situasi di LR and OT macam entries Nabil sbb 2-2 situasi akak dah pernah alami dan ada mcm2 komplikasi pernah akak alami. heheh.. nak cerita kat sini tak best lah kan sbb blog awak. anyway, menjadi seorang ibu bukan semudah yang disangka. cam tu juga nak jadi doktor kan? semoga terus berjaya. insya Allah, ada kelapangan akak akan ceritakan kes akak pada Nabil, mungkin boleh jadikan rujukan satu hari nanti..