Class with Dr A

Just finish class with Dr A just now... had discussed about 2 cases. (I wrote it here because I forgot to bring my notebook during class, so I think why not share it here..haha)

First Case

25 yo Malay lady G2P1@37 weeks POA came for ELLSCS with conjoint twin. diagnosed at 21 weeks POA

Complications of twin pregnancy?

In general, all possible obstetrics complications!! So early detection of twin is needed to prepare the mother & family...(so friends try to practice scan before becoming MO ok)

Why do we need to take BP every time we clerk patient? (which most of us don't)

Because we afraid of hypertension in pregnancy more specifically pre-eclampsia & eclampsia

Why?

Because it's one of the common cause of maternal and perinatal death... then he started to take about a patient who had twin pregnancy with rapidly progressed pre-eclampsia before. Both twins died in utero while mother succumbed after 1 month staying in ICU

Second Case

18 yo unmarried G1P0@33 weeks POA came with fainting episode that associated with symptoms of anemia. She unable to tolerate oral hematinics lead to poor compliant.

Management of anemia in pregnancy other than typical oral hematinics?

Oral Obimine, IM interferon, IV Venofer (like coke) etc...transfusion is the last resort

Why do we treat anemia in pregnancy aggressively?

Because patient can develop pph, thus lead to maternal death

How to reduce bleeding during labour?

Optimise the hemoglobin level (at least 10 g/dL)

Avoid prolong labour since It could lead to pph secondary to uterine atony. (augmentation of labour if poor contraction)

Active management of 3rd stage where most common time to develop pph (syntocinon injection, control cord traction)

If patient had pph/risks to develop pph, infused 40 unit pitocin after removal of placenta

Complication of teenage pregnancy?

cephalopelvic disproportion due to undeveloped pelvis

Legal issue regarding baby from unmarried mother?

Currently, baby had to be given name with bin/binti of his/her mother...Kesian budak tu bukan dia yang salah tapi mak ayah dia. Seumur hidup la malu anak luar nikah tu dapat pada dia & semua orang tahu. Dulu bin/binti Abdullah..orang tau juga, tapi kurang la sikit stigma tu.

(personally I think this is not a good management of issue by Government)

well that are some of the things that we discussed...enjoy study ok!