Salam, tumpang lalu...
Mintak izin, nak serabutkan blog dengan sharing of experience skit...
15y/o G2P0+1 at 37 weeks + 3 days (based on LMP)
After general examination, proceed with abdomen.
But in ascertaining the fetus presentation, I was biased since her calculated POA is 37 weeks plus, and since she is a pseudoprimid, the baby’s head usually at this point is already engaged. BUT, the pelvis felt empty, no head pun kat bawah, seriously. So I thought it was breech since the presenting part was quite broad, I rechecked the fundal grip, and balloted the ‘head’ at the left hypochondriac area. Breech kah? Tiba-tiba ‘head’ meluncur laju bergerak menuju ke epigastrium pulak– ish, unstable lie nih.
Bila present, baru perasan… “I forgot to do the clinical fundal height”
Dr: That’s the 1st thing you should do. So show me how you check.
Clinical fundal height is 34 weeks
Dr: I scanned her, she is actually 33 weeks. So she is FALSELY admitted for abnormal lie, thinking that she is already approaching term when she is actually just 33 weeks – kes wrong date la ni, patutla baby masih pusing2 (Her LMP is unreliable since she just had a miscarriage less than 3 months before current conception)
Bila Dr check, baby is cephalic. Head is still very high up and not engaged. (alahai… salah lagi…)
So I expected Prof to ask about causes of unstable or abnormal lie. But instead, she asked…
Dr: So, tell me the issues regarding teenage pregnancy.
Maka, terdiamlah daku sejenak. Mata bertentang mata. Senyap seketika.
Alamak, soalan apa ni, ish, kenapa tak tanya unstable lie… nak jawab apa ni…
Me: Erm… In teenage pregnancy, she is at risk of developing PIH or eclampsia, and also preterm labour… Because this is her 1st (viable) pregnancy, there is always a risk of CPD and obstructed labour, especially since she herself has not completed growing…
Dr: Hah? She’s tall enough! Don’t you think?
Me: Hm, but girls can grow (in height) up to 18 years old, she is only 15 and still growing. (Dah mula merapu, sebab tak expect langsung soalan ni…)
Dr: What else?
Me: I would also like to address certain social issues, since she is still young, she must be educated regarding the care of her coming baby. She also needs to be counselled on good spacing (contraception)…
Dr: Farhanah, you need to improve on your technique of answering. Always divide into antenatal, intrapartum and post-partum risks, and divide into maternal and fetal. Sekarang ni you jawab merapu… terabur…..
Harap ambil pengajaran. Jangan ulangi kesilapan di atas. Dan pengajaran juga, kalau tak buat, cakap je tak buat…
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All the best everyone, may Allah ease all of us.... Ameen...
Biostatistics Workshop using R #1/2021
3 years ago
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