Sunday, December 27, 2009

A tragedy !

工程師控訴私人醫院疏忽‧中秋節催生羊胎水入肺‧“害死我妻兒”

  • 陳通煌原本佈置給初生嬰兒的房間。(圖:光明日報)

1 of 2

(檳城‧大山腳)中秋節是人月兩團圓的好日子,37歲的陳通煌與太太興致勃勃的選擇這一天催生產子,要為一家人訂下一個最美麗的紀念日,可是他卻迎來了一生難忘的“妻兒倆皆失”悲劇。月圓那一天,他太太被推入產房後,就再也不起身了,連孩子也跟著走了。

擔任工程師的陳通煌因此痛訴,檳城一家私人醫院沒有提供周全的醫療服務,導致他的太太死在產房中,而初生嬰兒也因為曾缺氧心跳停止跳動,在出世2天後夭折。

37歲的陳通煌與任會計師的太太陳寶碹(34歲)在去年11月結婚後不久,太太便懷孕,兩人擇日在今年10月3日中秋節迎接首胎嬰兒出世,豈料產房內出現的狀況,讓他痛失兩名至親。

“院方較後對我說,我太太是死於羊胎水入肺,一種非常罕見的狀況。”

陳通煌今日(週二,12月22日)在章瑛國會議員安排的記者會上披露,太太的預產期是在今年9月28日,28日當天他們去了檳城一家私人醫院做檢查,醫生表明他的太太沒有自然生產的跡象,便替太太做了心電圖檢查,母子一切正常,還指太太可以擇日催生及詢問他們想在何時生子。

“當時,醫生並沒有說可以立即進行催生,我們便特地選在10月3日中秋節當天生產,因寓意人月兩團圓。”

測胎兒心跳不對勁

他指出,到了生產日當天下午4時,他陪太太到私人醫院後進行登記後,5時便回家收集生活用品。晚上10時,他帶著岳母和小姨子回到私人醫院,到達五樓病房時,被一名護士告知太太準備生產了。

他說,他們急忙趕到2樓的產房,但他是唯一一個獲得進入產房的家人,岳母及小姨子則在外守候。

“我看到產房裡只有一名護士在照顧我太太,我太太在床上痛苦掙扎,護士教我可通過換氣口罩(ventimask)提供氧氣給我太太,然後便留下我們獨自離開了。”

“護士並沒有在場鼓勵或是指導我的太太,反而是在忙著處理其他的工作,讓我大感無奈。我發現太太在咬自己的嘴唇至流血時,我立即詢問護士該如何預防,她的回答只是要我告訴太太不要咬她的嘴巴。”

陳通煌披露,2小時後即晚上10時30分,負責生產的Y醫生才抵達,對方馬上注意到檢測胎兒的心臟跳動有些不對勁,立即叫他到外守候。大約10至15分鐘,他看到醫生抱著他的新生寶寶沖到對面的房間,護士緊隨在後。

“他們在忙著看護我的新生嬰兒,我覺得幫不上忙,就去看太太,發現太太獨自一個人留在那邊。超過了10分鐘,我依然不見醫生回來,太太也已經汗流浹背了,在睜開眼睛看我一眼後,便閉上眼睛休息。”

忙顧嬰兒不理產婦

“不久後我聽到滴答滴答的聲音傳來,覺得好奇,便四處搜索,才驚覺太太的陰道出血了!我急忙跑到對面房去,請Y醫生替我太太做檢查,醫生回到產房後便開始為我太太善後,約10分鐘,醫生便叫我到外等候,她為太太進行縫合陰道。”

他披露,守候在外的時候,他還可以聽到太太與醫生在交談,突然,他聽到醫生大喊太太的名字,寶碹,寶碹!然後緊急燈就亮起了。

“當時我覺得非常的恐慌,完全不懂發生了甚麼事情,只見到來了一群人,推了各種不同的儀器,現場非常的混亂,還有一些人要填寫表格,但是卻也不懂該如何填寫,現場的狀況真的是很亂。”

“我和岳母及小姨子等了1個半小時後,醫生出來告訴我,我太太已經去世了。”這晴天霹靂的消息,猶如把他打入地獄。

護士沒發覺胎兒心跳異狀

陳通煌指出,孩子陳宗翔出世後,醫生透過檢測胎兒的心跳表發現孩子心跳出現困難,令他不滿的是守護在產房2個小時的護士竟然沒有發覺胎兒的心跳有狀況。

“醫生也無法解釋,胎兒的心跳為甚麼出現困難。在這個危機的狀況下,我的孩子竟然是由婦產科醫生搶救,竟不是兒科醫生,而且當時也沒有兒科醫生到場。”

陳通煌指出,孩子出生後立即被搶救,是由注射多劑量腎上素復蘇,20分鐘後醫生發現孩子的第一個心跳,半小時後,就把孩子送入新生兒重症監護病房。

“在10月3日,我的孩子依然沒有任何的自發呼吸,而有關醫生表示可能是寶寶心跳曾經停止20分鐘以上,而有可能導致腦損傷,而我也和醫生討論後,決定要進行大腦活動測試。”

“在10月4日進行的腦電圖,有駐院的神經科醫生主治,而他們並沒有記錄到我的孩子大腦有任何的活動,基於大腦活動的結果,X醫生問我是否要放棄孩子,我的向她表明,先處理太太的身後事,才做決定。”

“在10月5日的凌晨5時25分,我收到來自醫院的電話,孩子的心跳突然不均衡,要我馬上到醫院去,但在5時40分時,再次接到醫院的電話,孩子的心跳已經在凌晨5時40分時停止跳動了。”

“在凌晨6時30分時,我趕到醫院見孩子的最後一面,便和醫生做討論,在下午再回到醫院領回寶寶,然後準備太太的葬禮。”

產婦來不及見兒就走了

死者陳寶碹生前花費千多令吉,為新生兒購買玩具、嬰兒用品、衣服等,還細心佈置了一個房間給寶寶,希望孩子一出世後,可以在優質的環境中得到細心照顧。

陳寶碹也為新生兒的未來作好準備,除了計劃投保外,也為其購買信托基金,以提供更好教育給孩子。

死者母親方賽娥在受訪時說,她女兒很期待孩子的誕生,每天蒐找婦科資料,還購買書刊參閱,吃完飯後就坐在沙發上,一邊讀,一邊播放兒歌,以期讓胎內的寶寶吸取啟蒙知識。

“只可惜女兒來不及看孩子一眼就死去,我痛心難過,對院方的失責感到很氣憤。”

方賽娥說,女兒在家中排行最大,下有弟妹,是一個很顧家和孝順父母的孩子,她的生活也是全靠這位女兒。她稱,死者弟弟在吉隆坡讀書,妹妹剛在今年出嫁,死者與弟妹的感情很好,手足情深。

收拾寶寶房火化玩具

說到這裡,方賽娥聲音開始沙啞,眼眶含淚,她說,女兒曾計劃在生產後,帶她到中國和香港旅行。“我們還打算孫子出世後,由我看顧孩子,女兒擔心天氣熱,特在寶寶房間裝冷氣。”

如今,女兒和外孫都不幸去世,方賽娥與女婿每當走到寶寶的房間時,都會不禁流淚,所以幾天後,他們決定把嬰兒用品及睡床收拾起來,玩具則在火化時,一同燒了。

“院方應該給我們一個公平交代,不能讓我的女兒白白喪命啊。”

妻子賢淑能幹

死者的丈夫陳通煌說,妻子是一個賢妻良母,生前很喜歡小孩,兩人也沒有刻意要生男或生女,一切順其自然。

他稱,妻子是一名會計師,做任何事都很有規劃,所以他很放心把家內的事務,全交給妻子打理。

他指出,他和妻子是在去年11月23日結婚,妻子懷孕後很細心照顧自己,而且還買了很多書籍回來參考。

“我和妻子也曾到過私人醫院參加產後課程,當時她很興奮,不斷向醫生提問。”

他說,妻子生前很孝順父母,他們在峇眼達浪再也購買新屋後,便要求母親同住。

產婦羊水入肺
醫院否認疏忽

面對陳通煌的控訴,有關私人醫院鄭重否認人為疏忽的說法。此院負責人澄清,產婦陳寶(石宣)是死於羊水栓塞(Amniotic Fluid Embolism)症狀。

這名不願具名的醫院主管告訴《光明日報》記者,根據報告,女死者是因羊水入肺,死於羊水栓塞症。

“這是產婦分娩期間罕見的併發症(rare complication),並且是不可預測的情況。”

她指出,有關症狀的死亡率也相當高。

她還說,檳城醫院的法醫也已證實了死者的死因。

4點指醫院疏忽

陳通煌直斥私人醫院的疏忽,導致太太在產房中去世,而孩子在生產過程中曾一度沒了心跳,出世後,醫生立即搶救孩子,20分鐘後在發現孩子的第一個心跳,較後孩子被轉入加護病房。2天後,他卻收到院方的來電通知,孩子心跳不均衡,不幸夭折了。

他提出4點不滿,即當天主治護士沒有留意和照料到妻子和留意胎兒的心跳,相反是忙著其他的工作;其次是在醫生還未來到之前,護士沒有對妻子作出適當的指導,也沒有足夠的經驗處理緊急狀況;三院方把剛生產的太太獨子留在產房超過10分鐘,四在關鍵時刻,並沒有作出妥當的安排,也沒有安排兒科醫生在等待候命。

陳通煌不滿該家私人醫院對妻子的治療和所提供的服務,作為一個自稱是全球治療中心,該醫院的工作人員,設備及服務竟是如此令人失望。

羊胎水入肺乃罕見狀況

在處理太太和孩子的身後事後,他對於醫院提供的服務非常的不滿,也向大山腳國會議員章瑛投訴,並在章瑛的助理陪同下,到醫院瞭解導致太太的死因,而有關醫生給的答案是太太因為羊胎水進肺而死。

陳通煌也詢問過其他專業醫生,也都表示,一般上如果羊胎水入肺,產婦一定都會喪命。但會遇上如此的症狀都是生了4胎或5胎以上的產婦及高齡產婦,是非常罕見的狀況,在2萬個人裡面只有1個產婦會遇到這樣的狀況。

章瑛:醫療過程不能馬虎

大山腳國會議員章瑛表示,死者母親只有2個女兒,而且他們是來自單親家庭,現在女兒突如其來的離世,讓她傷心不已。無論是私人或政府醫院,都需要給予嚴肅的對待每個生產或是手術過程,不可以馬虎每個步驟。

她透露,醫院方面的人手也必須充足,而且必須具有專業的經驗去面對突發狀況,以減低產婦在生產時面對感染或是突發狀況。

她指出,根據世界衛生組織的統計表,在每個國家的10萬個產婦中,大馬就有41名在生產時去世、新加坡人15名、澳洲有6名、愛爾蘭有4名、泰國有44名、菲律賓有200人和印尼有230人。

“比起鄰近國家,大馬在生產中去世的比例也是蠻高的,如果要成為先進國家,大馬的醫療設備需要獲得提昇。”

章瑛呼吁婦女在懷孕期間,需要學習及增加本身懷孕的知識,而在發生突發時,才能冷靜的面對和作出決定,由於現今科技發達,要瞭解懷孕過程的知識非常容易,只需要上網查詢即可獲得許多資訊。

Wednesday, December 23, 2009

Merry Christmas and Happy New Year!


To all the readers,

Merry Christmas and Happy New Year.

May dreams come true in this coming new year!

Warm Season Greeting,

Dr Jason Ong

Reply To Alyce

Anonymous said...

Dear Dr Jason,

I delivered my baby March this year via natural with forceps. My baby weighted 3.7kg at birth.


Until now my Episiotomy wound/scar is still pain every time I move my legs apart or squat down. FYI, my doc tried twice before managed to delivered my baby with forceps. I remember the 1st attempt, I was pulled down the bed. Could this be the reason my wound still hurts or this is normal?

I always wanted to know what is the standard/maximum diameter of the baby that can successfully pass through the birth canal? My baby head circumference was 34cm at birth.

Thank you and have a nice day!


Cheers,
Alyce




Forceps delivery



.........................................................................................



Hi, Alyce,

Sorry for my late reply due to tight schedule.

Let me summarise your problems:

1) Unpleasant birth experience caused by forceps delivery.

2) Persistent episiotomy scar pain despite more than 6 months after delivery


Forceps delivery is more traumatic due to extensive injury to your birth tunnel. Sometimes, the episiotomy wound is extended to become longer in forceps delivery due to the extensive tear in the skin and muscle. Therefore, the duration of recovery is longer than expected in the extended episiotomy wound.

However, your childbirth is more then 6 months now. I expect your episiotomy wound is completely recovered by now.

There are few possibilities to explain the persistent pain:

1) Extensive scarring in the stitching site and caused the vaginal tunnel to be narrowed and distorted. In this situation, you may have pain as well during sexual intercourse with your husbnd.

2) Injury to the symphysis pubic joint due to the size of your baby (3.7kg) and forceps delivery.

Symphysis pubis is a joint between 2 pelvic bones

3) The pain maybe psychologically related to the unpleasant forceps delivery. The unpleasant birth experience left a bad memory to you and you relate your bad experience to the pain in your private part.

To determine the cause of pain, you need to visit the gynae doctor again for detailed examination.


In my own practice, I usually encourage my patient to go for Caesarean delivery if the predicted birth weight is more than 4.0kg.


If the predicted birth weight is between 3.5kg to 4.0kg, I will NOT perform forceps / vacuum delivery if the labour is prolonged. Usually I will proceed to emergency Caesarean delivery to prevent complication.

Wednesday, December 16, 2009

Reply to Anonymous



Anonymous said:

Hello Dr Jason,

Good day to you!
I have one question need your help.

Attach picture is the pregnancy test result that i have done this morning. There are 2 lines, but the 2nd line is not as darker as the first line.

Attach below is the info about my period cycle which my last period is 17 Nov and today is 30th day after the last period. Would like to get your advise when is the suitable time for me to confirm the pregnancy with doctor? Thanks a lot!

period 2009


Dateduration
June6-Jun-09
July3-Jul-0927
July29-Jul-0926
August25-Aug-0927
September22-Sep-0928
October19-okt-0927
November17-Nov29




....................................................................................
Hi! Anonymous,

Based on your period duration of 27 days cycle on average, currently your period is delayed by 2 days.
The Urine Pregnancy test you showed it to me is weakly positive, it means you are in the early stage of pregnancy.
You need to consult your doctor 1 week later to confirm the pregnancy.
The best time to visit your doctor is after one week missed period because the scan machine can't detect the pregnancy if it is too early.
Make sure you keep a full bladder and don't pass urine before the scan for better picture quality.


Anyway, congratulation for being a new mother.

Regards,

Dr Jason.

Monday, December 14, 2009

Breastfeeding Positions - 喂母乳方式


There are 3 common breastfeeding positions that you can learn to breastfeed your precious newborn:

1) Cradle Hold

2) Side-Lying Hold

3) Football Hold



Cradle Hold



It is the the most common breastfeeding position.

This position works well:
1) If you are learning to breastfeed
2) If you have a small baby

Description of cradle hold position:


You need to sit upright and make sure you have back support. Raise your baby to the breast level. Use pillows or a chair with arm rests to support your shoulder.
Keep your knees level with your hips. Put a stool or pillow under your feet if necessary.
Cradle your baby. Make sure your baby’s back and bottom are well supported.
Also, make sure your baby’s ears, shoulders and hips are in line.



Side-Lying Hold


This is a good hold for breastfeeding in bed. It is also helpful if you are recovering from a Caesarean birth.

This position works well:

1) If you find it too painful to sit upright
2) If you have a caesarean delivery
3) If you want to rest and breastfeed at the same time.

Description of side-lying hold:

Stretch out on your side with your baby tummy to tummy with you. Use pillows to support your head, neck and back.
Support your baby’s head, neck and back with your hand.
To switch to the other breast, gather your baby close to your chest, then rolling onto your other side to feed from the other breast.


Football Hold



This is a good hold if you are recovering from a Caesarean birth. It is also helpful for mothers of twin babies.

This position works well:
1) If your baby is small
2) If your nipples are flat or inverted.
3) If you have a caesarean delivery


Description of football hold:

Place a pillow at your side. Lay the baby on the pillow.
Place the back of the baby’s head in the palm of your hand.
Your forearm should support your baby’s shoulders and spine.
Tuck your baby’s legs between your arm and body, as you are clutching a football.

Thursday, December 10, 2009

Antenatal Class Announcement!

An antenatal class will be organised by Dumex Malaysia in Sunway Carnival Convention Hall, Seberang Jaya in Jan 2010, before Chinese new year.

I will be the invited speaker of the event.

See all of you there!


Wednesday, December 2, 2009

Nuchal Thickness (頸皮測量)



What is nuchal skin thickness?

Nuchal skin is referred to the skin located at the back of the neck.
It is important to measure the nuchal skin thickness at the early stage of pregnancy because a thickened nuchal skin is associated with many diseases.


Down Syndrome baby with thickened skin fold at the neck

What are the diseases associated with thickened nuchal skin?

1) Down Syndrome (唐氏症)
2) Turner' Syndrome (特納綜合徵)
3) Edward's disease (愛德華綜合徵)
4) Congenital heart defects (心臟問題)
5) Cystic Hydroma (囊性水瘤)



Diagram on the left: A normal nuchal skin measurement
Diagram on the right: A swollen nuchal skin with abnormal thickness



When the measurement of nuchal skin thickness should be done?

The measurement of nuchal skin thickness should be done between 11 to 14 weeks by using high defination ultrasound scan machine.
A measurement more than 2.5mm is considered abnormal.


A routine nuchal measurement and nasal bone at 12 weeks to exclude Down Syndrome baby


If my baby's nuchal measurement is more than 2.5mm, what should I do?

A detailed scan should be done to look for any other organs abnormality.

Sometimes, you are advised by the doctors to undergo amniocentesis to check the baby's DNA.


Friday, November 27, 2009

Reply to Sean Coles

Dear Dr,

my wife and I lost our daughter this week at 40 weeks. My wife had at least five ultrasound scans due to her age 40 years . We were informed that everthing was fine with the baby and it was developing as normal. Her last scan was at 37-38 weeks and again nothing was mentioned of conern. She visited the midwife on Tuesday 20th October, when she was informed that everything was alright. This appointment involved a blood pressure and urine test as well as the midwife listing to the baby's heart. My wife questioned the midwife about the heart beat not being very loud, but was assurred that it was ok. The midwife referred my wife to the hospital for a carbohydrate blood test the following day. We received the result as being normal on Thursday 22 October. On Sunday morning at 8.30 am my wife noticed a small jelly like discharge. We rushed to the hospital where the doctor conducted a scan and heartbeat monitor. Sadly no heartbeat could be detected a second doctor conducted a scan but this confirmed the same.Obviously devistated my wife then had to endure a 48 hour natural birth, knowing what the outcome would be. When the baby was finally delivered, it was found to have the umbilical cord wrapped around the neck tightly, no less than 4 times. There was obvious sore markes and damaged sknin on the baby's neck, presumably where the cord had been. Please can you help. Should the hospital have noticed this during the numerous scans that had taken place during my wife's pregnacy, or as one of the doctors told me , it would not have been possible to detect this.

The baby was difficult to birth as it's neck was pulled back
We have decided to have an autopsy and our daughter has been sent to a hospital in London. Her body is due to return this week.

Thank you for your time .

Regards


---------------------------------------------------------------------------------------------

Hi, Mr Sean Coles,

It is very regrettable for this terrible incidence happened to your family. You have my full sympathy. I hope your family could gain the strength and determination to overcome it.

Cord-round-neck is a common incidence to happen during antepartum period. However, this condition rarely lead to fetal in-utero demise. It is because the cord entanglement to the neck is usually very loose and rarely resulting in neck strangulation.

It is important to perform an autopsy to investigate for the cause of death before we can make any conclusion that the demise is related to the cord round neck.
The autopsy should include:
1) Fetal chromosomal constitute to exclude chromosomal abnormality.
2) Fetal blood for bacterial culture to look for possibility of in-utero fetal infection
3) Internal organs examination for any internal organ malformation
4) Placenta for any infarction/ infection/ blood clots.


After exclude all the possibilities above, then only we could possible link the death to the cord round neck.

Unfortunately, the clinical management guideline is not available in the Royal College of Obstetricians and Gynaecologists (RCOG) of London. Most of the doctors will consider cord round neck as a benign condition as far as the fetal heartbeat and the fetal growth rate are not compromised.
This condition could be detected by using umbilical Doppler scan to locate the position of the umbilical cord.
In my own practice in Malaysia, I usually perform cord round neck screening at 36 weeks of pregnancy.

If the cord tightly entangles the neck, I may advise the patient for early delivery.

i hope my opinion is useful for your reference.

Warm regards.

Dr. Jason Ong.

Tuesday, November 24, 2009

Epidural Pain Relief (硬膜外麻醉)



What is epidural anesthesia?

Epidural anesthesia is an effective pain relief approach to control labour pain during normal delivery.
Epidural blocks the nerve impulses from the lower spinal segments resulting in decreased sensation in the lower half of the body.
If it is given correctly, epidural could reduce the labour pain up to 90% to 100%.




Area of numb after the epidural


How is an epidural given?

A doctor who specializes in anesthesia will administer your epidural.
You will be asked to arch your back and remain still while lying on your left side or sitting up. This position is vital for preventing problems and increasing the epidural effectiveness.

After the cleaning process with antiseptic, a needle will be inserted into the area that surrounds the spinal cord in the lower back. A plastic small tube is inserted through the needle into the epidural space. The needle is carefully removed leaving the plastic tube in place so medication can be given through periodic injections or by continuous infusion.
The plastic tube will be taped to your back to prevent it from slipping out.



A needle is used to guide the plastic tube into epidural space


Needle is removed and the plastic tube will remain in the epidural space for medication infusion



The plastic tube is plastered to the skin until the labour process is completed.


What are the benefits of epidural anesthesia?

1) Effective in labour pain control

2) Allows you to rest if your labor is prolonged

3) Relieving the discomfort of childbirth can help some woman have a more positive birth experience

4) Most of the time an epidural will allow you to remain alert and be an active participant in your birth

5) If you deliver by cesarean, an epidural anesthesia will allow you to stay awake and also provide effective pain relief during recovery.
.
What are the Disadvantages of epidural anesthesia?

1) Epidurals may cause your blood pressure to suddenly drop. As a result, you may feel dizzy and vomit.

2) You may experience a severe headache caused by leakage of spinal fluid. Luckily, it is not a common problem to happen (less than 1%)

3) You may experience the following side effects: shivering, ringing of the ears, backache, soreness where the needle is inserted, nausea, or difficulty urinating

4) You may find that your epidural makes pushing more difficult when the baby is about to deliver. As a result, sometimes forceps or vacuum extraction may become necessary

5) For a few hours after birth the lower half of your body may feel numb which will require you to walk with assistance




Possibility of Vacuum / forceps delivery is increased with epidural.

Friday, November 13, 2009

The Overweight Baby

A baby is considered overweight if the birth weight after 9th months of pregnancy is more than 4.0kg.

About 5 to 10 percent of babies are overweight by term.




What are the common reasons for the baby to be overweight?

The birth weight of the baby is genetically determined. If both parents are big size, most probably the baby is big size as well.

The mother who has delivered a big baby before has higher tendency to pregnant another big baby.

Other reasons that may cause the baby to be overweight:

1) The mother has diabetes mellitus during pregnancy
2) The mother has excessive weight gain during pregnancy
3) Pregnancy is overdue.
4) A baby boy is generally bigger than a baby girl.





What are the problems associated with the overweight baby?

For those mothers who keen to try normal delivery, the labour process maybe more complicated and prolonged.
It may lead to slow dilatation of the cervix, excessive perineal tear, excessive bleeding after the delivery and the chance for emergency caesarean delivery is higher.
Sometimes, the baby’s shoulder maybe impacted behind the pelvic bone. As a result, the baby shoulder was stuck and unable to deliver normally. Excessive use of force to dislodge the baby shoulder will lead to fracture collarbone and sometimes even the nerve injury.



The baby's left shoulder is stuck behind the pelvic bone


Excessive use of force to deliver the shoulder may lead to baby's bone fracture and nerve injury.



Left hand is paralysed due to birth injury.

How to prevent my baby from overweight?

You need to avoid excessive weight gain during pregnancy.
The doctor will monitor your urine and blood to make sure that you are not diabetic.
Ultrasound scan is useful to estimate the baby’s weight and detect early sign of big baby.
Sometimes, you are advised by the doctor to undergo caesarean delivery to prevent the complication of normal delivery if the baby is suspected to be overweight.

Tuesday, November 10, 2009

A Preventable Tragedy!


I believe many of you have read about the tragic news above. A woman who just delivered a baby committed suicide because of depression due to the baby in-born problem.
Post partum depression (產後抑鬱症)is a common problem during confinement period. It is estimated 25% of women suffer from depression during the confinement period.

Among the reasons that cause depression during confinement period:

1) Unexpected result from the pregnancy. All of the pregnant women expect to deliver a healthy and beautiful baby.
Unfortunately, sometimes baby is born with some degree of in-born defects, for example, hole in the heart, cleft lip.

2)Bad experience from the labour process. The duration of labour maybe too long and they suffer from long duration of labour pain.

3) Poor husband/family support. The women from a broken family have a higher chance of developing post partum depression.

4) Lack of sleep during confinement and uncomfortable living environment, especially if the newborn is frequently crying for milk.

5) The women with depressed personality and mental illness before the pregnancy have higher chance to face with this problem. A cheerful and open minded personality has less chance of developing this problem.

What are the symptoms of post partum depression?

The symptoms usually appear after 1 week of delivery. The woman who suffer from this problem usually feels hopeless, sleepless, moody and sometimes crying for no reason. Her appetite for food is poor.
Sometimes, in the severe cases, the patients may have the intention to commit suicide.

What should I do to prevent post partum depression?

1) You need to work closely with your doctor. Find a doctor who you can trust and comfortable with. The doctor concerned will take care of you throughout the pregnancy period.

2) Your husband must understand this situation and provide you with the support to assist you to go through this difficult period.

3) If possible, spend your confinement period at home to stay close to your family members. Generally, those stay in confinement home are more common to suffer from this problem.

4) You need to have at least 8 hours of quality sleep during confinement period. The duty to take care of your baby should pass to a confinement lady.

5) Drink plenty of water.

6) You can pursuit your hobby during confinement. If you like reading, surfing internet, watching TV or chit-chatting, just do it.

7) See your doctor early if you have symptoms of depression. Some medications may help to prevent the problem from worsening.

Friday, November 6, 2009

Reply To Anonymous

Hello Dr Jason.

I am thalassemia carrier. I just went to see my doc and my doc now wants to check my husband's full blood count. However my husband works in Shanghai and won't be back until mid Dec. Is it ok to wait till then? I am 4 1/2 months pregnant.

Thanks.

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Hi, Anonymous,

Your problem needs urgent action!!

Since you have already known that you are a Thalassemia carrier(地中海貧血), your husband should be checked for his status before the pregnancy. That is the reason the doctors usually encourage the couples to perform pre-marital medical checkup to identify this problem early.

Currently you are 18 weeks into your pregnancy. You can't wait until mid of December because at that time you are 22 weeks already. It is too late to do anything if your husband is a carrier as well.

Since Full blood count is a simple and widely available test, I advise your husband to do the test in Shanghai now and fax the result to your doctor as soon as possible.

If your husband is a carier as well, 25% of the chance that your baby will develop severe Thalassemia Major. This type of disease requires life-long blood transfusion and it will bring severe emotional distress to your family.

With the modern medical service, the doctor can diagnose your baby whether have Thalassemia before the delivery and this should be done before 22 weeks. Amniocentesis (羊膜穿刺术) is a procedure to obtain small amount of amniotic fluid (羊水) to check for the Thalassemia gene.


Amniocentesis


If your husband is not a carrier, your baby is safe.If your husbnd is a carrier, you need to undergo amniocentesis to determine your baby status.


Anyway, I wish you luck in your subsequent follow up with your doctor.

Wednesday, November 4, 2009

Sleepless Night…..(失眠)


Good quality of sleep is important for the pregnant mother to achieve emotional wellbeing and normal baby development.
Every pregnant mothers should have at least 8 hours of sleep everyday.
Unfortunately, nearly 30% to 40% of the pregnant ladies unable to sleep well, particularly toward later stage of pregnancy.

Among the reasons that cause you to be sleepless:

1) Constant baby’s movement during night time. The baby usually starts its gymnastic lesson during night time : )
2) Heavy compression from the womb to the back muscle.
3) Frequent urination. Most of you need to wake up 3 to 4 times every night to pass urine.
4) Leg cramping which is commnoly occurred during half way of sleep.



Tips to achieve good quality of sleep:

1) Make sure you are really tired and sleepy before going to bed.

2) Avoid from taking supper and drinking too much of water before sleep.

3) Avoid from taking excessive coffee and tea during day time. You are advised to drink not more than one cup of coffee/tea perday.

4) Avoid engaging in any excessive physical exercise before sleep.

5) Learn some relaxation techniques to induce sleep, such as muscle relaxation and breathing exercise.

6) Establish a regular and routine sleeping time. Try to regulate your sleep / wake schedule by going to bed and getting up at the same time every day.

7) Use your bed only for sleep. If you're in the habit of paying bills or watching TV in bed, stop. Reserve your bed for enjoyable activities, like sleep, sex, and maybe a little light reading.

8) Always sleep on your left side to avoid back muscle compression by the womb.



Always turn to the left side to avoid back muscle compression


9) If you still could not sleep…..get out from bed and leave the bedroom. You can watch TV or listen to music first before you try again.

10) Taking a nap in the afternoon is helpful to regain alertness if you are sleepless the night before.

Sunday, October 25, 2009

Reply To Anonymous

Hi Dr
I'm breastfeeding my 3.5mo bb and just had a sebaceous cyst removed today. I was presribed Unasyn 375mg antibiotics and for painkiller Biogesic 500mg. I don't know what's the name of the anaesthetic and antibiotic that was administered on me for the surgery.
The surgeon sd the medicines are suitable for pregnant women. But I worry it may not be so for babies.
A wk b4 the surgery I was prescribed by a GP Klasid and Papase to treat the supposed infection of the cyst. I was assured this was safe for the bb. But my bb reacted badly to it. (this prompted me to seek specialist treatment instead)
I've been pumping and disposing of my milk for the whole of today & the next 3 days. I feel so sad doing that bec I'm not the type who have lots of milk.
I wish to get your opinion if the prescription is really ok for bb.

--------------------------------------------------------------------------

Hi! Anonymous,

Welcome to this blog. Your questions will make this blog more interactive and informative.

Let me summarise your problems:
1) Infected Sebaceous cyst which was recently surgically removed.
2) Currently on antibiotic Unasyn and painkiller Biogesic.
3) Breastfeeding to your beloved newborn while on treatment of antibiotic.
4) Low breast milk production.

Generally, antibiotics are safe for the breastfeeding mothers as the concentration of antibiotic that present in the breast milk is very low.

Furthermore, the doctor only prescribed low dose of Unasyn 375mg. The usual dosage of Unasyn is 625mg. With this low dose of Unasyn, the amount of medicine to go to breast milk is extremely low.

Biogesic is a painkiller. As far as you are comfortable and pain free after the surgery, you can avoid from taking this medicine. My suggestion is you need to complete your antibiotic treatment and stop the painkiller as far as you are pain free.

Before taking the antibiotic, you should breastfeed your baby and fully extract the breast milk by using the breast pump. Once the antibiotic is taken, you should abstinent from breast feeding for 4 to 6 hours to avoid any side effect to your baby. After 4 to 6 hours, usually the effect of the antibiotic is over and you can safely breastfeed your baby again. This is the precaution step you can take to avoid the harmful side effect of antibiotic to your baby.

Regarding the low breast milk production problem, you should drink more water and consume more fish protein to stimulate the breastmilk production. You should breastfeed your baby every 3 to 4 hours to enhance the production, avoid from wearing tight bra which may reduce the production due to pressure effect. Hormone injection (Oxytocin injection) sometimes is helpful to increase the milk production.

Thursday, October 22, 2009

The Underweight Baby


A baby is considered underweight if the birth weight after 9th months of pregnancy is less than 2.5kg

What are the common reasons for the baby to be underweight?

The birth weight of the baby is genetically determined. If both parents are small size, most of the time the baby is small as well.

Sometimes, the baby is small because the growth potential is affected.

Among the factors that can influence the growth potential of the baby:

1) Mother’s living lifestyle is under constant stress
2) Lack of nutrition and vitamin
3) Pregnancy less than 1 year after the last childbirth
4) Placenta is not functioning normally to supply food to the baby.
5) Baby may has underlying congenital diseases, such as heart diseases
6) Baby acquires infection inside the womb.





What are the problems associated with low birth weight?

Sometimes, the underweight baby may pass motion inside the womb and requires emergency caesarean.
A low birth weight baby has a higher chance of jaundice (黃疸) in the first few days of life.
They are also prone to infection due to weak immune protection.
Some of the low birth weight baby may have learning disability and behavioural problem in the future.





A jaundiced baby under photo light treatment



What should I do to make sure my baby is growing normally inside my womb?

First of all, you need to modify your lifestyle during pregnancy period.
You are not advised to smoke, consume alcohol , take excessive coffee and tea.
You need to have 8 hours of sleep everyday.
During every visit to see your doctor, the doctor will monitor the growth of the baby by using scan to estimate the baby weight.
Sometimes, Colour Doppler Scan is done to assess the function of placenta and the blood flow in the umbilical cord.


Colour Doppler Scan



Wednesday, October 14, 2009

Baby Weight


There are still many questions asked by the readers about the baby weight according to the month of pregnancy.
Today I will repost my earlier article in this blog.

The estimated weight of the baby according to the month of pregnancy:

16 weeks ( 4th month)
Average Weight : 140g
Normal range : 80g to 200g

20 weeks ( 5th month )
Average weight : 310g
Normal Range : 230g to 460g

24 weeks ( 6th month)
Average weight : 560g
Normal Range : 445g to 970g

28 weeks ( 7th month )
Average weight : 1140g
Normal range : 800g to 1540g

32 weeks (8th month)
Average weight : 1750g
Normal range : 1300g to 2200g

36 weeks (9th month)
Average weight : 2240g
Normal range : 1880g to 3100g

40 weeks (10th month)
Average weight : 2900g
Normal range : 2300g to 3500g


Friday, October 9, 2009

Reply To Anonymous


Anonymous said:
Hi Dr Jason, I am 3 1/2 months pregnant now with my first child. I had a miscarriage beginning of the year. Is it ok for me to go for massage? Must it be those pre natal massages only? Can I go for thai massage but only on shoulder area as I feel my neck and shoulders are very tense. I read that aromatherapy oil shouldnt be used. Is it true?
---------------------------------------------------------------------------------

Hi! Anonymous,

Congratulation for your new pregnancy. Apparently your pregnancy is more than 3 months now. The chance of miscarriage after 3 months is very low. I believe this pregnancy is going to be fine and hopefully you will deliver a healthy and chabby baby.

Massage in pregnancy is safe as far as your tummy is not involved. General massage or even Thai Style massage not involving your tummy is acceptable. Shoulder ,neck and back massage is safe.

Don’t worry, if you really keen to relax the muscle by using the massage method, you can do so.

There is no medical evidence to prove that aromatherapy oil is harmful to your baby.

But if you want to be extra careful, you can choose powder massage.

Monday, October 5, 2009

Tubal Ligation (絕育手術)


Tubal ligation is a permanent birth control procedure commonly known as "having your tubes tied."
The procedure prevents pregnancy by preventing transport of the egg to the uterus and by blocking the passage of sperm up the fallopian tube to the egg.

How to perform this surgery?

There are 2 methods to perform this surgery:

1) Immediately after the childbirth. A incision is made below the umbilicus (臍).
Both fallopian tubes ( 輸卵管) are identified and ligated by using a string.



Fallopian tubes (輸卵管) are ligated and disconnected.


2) Keyhole surgery by using a laparoscope ( 腹腔鏡) equipped with a camera. Both fallopian tubes are clipped by staples.



Fallopian tubes are clamped by Staples

Who should do it?

a)Women who have completed their family and do not have any intention for further pregnancy.

b)Women with underlying medical illness that make them not suitable to pregnant.

How effective is Tubal ligation to prevent pregnancy ?

The failure rate of tubal ligation is 1 in 200. It means every 200 women who had tubal ligation, 1 of them may still get pregnant eventually.

What is the side effect of tubal ligation?

This surgery is a common operation and can be done safely by the doctor. Long term side effect is not commonly happen.
There is no medical evidence to associate tubal ligation with menses disturbance, sexual dysfunction and hormonal imbalance.


Thursday, October 1, 2009

Antenatal Exercise (孕妇运动)





Exercise is important during pregnancy to promote physical and emotional wellbeing.
Regular exercise will improve blood circulation through the placenta and promote growth of the baby.
However, the pregnant ladies need to follow the safety guidelines to avoid unneccessary physical injury related to exercise.


Guidelines to ensure safety and well-being during pregnancy with your exercise program


Things To Do's



1) If you have been following a regular exercises program before your pregnancy, maintain that program to some degree throughout your pregnancy.

2) Exercises does not increase your risk for miscarriage

3) If you are a beginner, you should start very slowly and be careful not to over exert yourself.

4) Listen to your body signal for the level of exercises performed - the competitive element must be avoided.

5) Regular exercises sessions - at least 3 times per week - are safer than intermittent bursts of activity

6) Careful 'warm - up' should precede vigorous exercises which must be followed by -cooling-down' or gradual decline in activity.


7) Drink plenty of water and take frequent break.


8) Eat healthy diet that includes plenty of fruits, vegetables and complex carbohydrates.




Things To Avoid


1) Avoid jerky, bouncing, ballistic movement and activities.

2) Never exercises to the point of exhaustion or breathlessness. This is a sign of your body and your baby cannot get the oxygen supply needed.

3) Avoid exercise in extremely hot weather. Mother heart rate should not exceed 140 beats per minute and vigorous exercises should not be longer than 15 minutes.

4) Avoid rocky terrain or unstable ground when running or cycling.

5) Avoid contact sport (hockey, netball, volleyball).

6) Avoid lifting weights above your head and using weights that strain the lower back muscles.

7) Do not over bend any joints.

8) Stop exercises immediately if you experiences symptoms such as: chest pain, vaginal bleeding or uterine contraction, or if your membrane rupture, blurred vision, dizziness, fainting, irregular heart beats, increase swelling in your hand, feet and ankles, and Sudden change in body temperature.

9) During second and third trimesters, avoid exercises that involve lying flat on your back as this decreases blood flow to your womb.

Thursday, September 24, 2009

Weight Gain (懷孕體重增加)



Overweight during pregnancy is a common problem.

Modern mothers are very critical about their body weight during the pregnancy period because they want to maintain slimmed body after delivery.

In order to avoid unneccessary overweight problem, it is important to control your body weight during the pregnancy and confinement period.







What is the normal weight gain during pregnancy?

The normal range of weight gain during pregnancy is between 10 to 15 kg.
Averagely, you should gain around 12.5 kg in weight.
It means your weight gain is about 1 kg every month.



I am already overweight before pregnancy. How much weight should I gain during pregnancy?


If your BMI (body mass index) is more than 24 before the pregnancy, your ideal weight gain during pregnancy is 10 kg.



I am underweight before pregnancy. How much weight should I gain during pregnancy?



If your BMI is less than 20 before the pregnancy, your ideal weight gain during pregnancy is 15 kg.

Why the doctor take 12.5kg as normal weight gain?

Generally, the baby birth weight is around 3kg. The total weight of the placenta(胎盤)and the water bag (羊水)is about 2.5 kg. After the delivery, 5.5kg will be immediately disappeared.
The remaining 7 kg is the weight of the fat deposited in the breast, buttock and water retention in the limbs. It takes 2 weeks for the water retention to resolve.

I am overweight during the pregnancy period, What should I do?

Of course you can’t attend a slimming programme during the pregnancy : )
You should control your weight through the food intake.
You should reduce the carbohydrate foods which supply calories to your body ( rice, white bread, noodle, sugar, meehoon).
During pregnancy period, your physical activity is limited. Therefore, you don’t need to consume too much of carbohydrate. Excess calories intake will be converted into fat in your body.
You should emphasize on high protein food, vegetables and fruits which supply vitamin and nutrition for the baby.

Tuesday, September 15, 2009

Reply to Claire

Claire said:

Dr. I have been breast feeding my child for one year so now planning to stop it, and what is the formula that is more recommended and better.

I listen from some body that the Soy based milk is the better choice 2nd from breast milk is it true?

----------------------------------------------------------------------

Hi! Claire,

First of all, congratulation for successfully breastfed your beloved baby for 1 year. It is not easy to breastfeed your baby for 1 year, particularly for a working mother. Your sacrifice and determination is admired by me!

Since your baby is already 1 year old, I believe his/her is already started on weaning diet. You need to provide a balanced and nutritious food in his weaning diet, eg: meat, fish, carrot, porridge, cereals and fruit juice.

Formula milk at this stage is not too important as the baby can source his vitamin from the weaning diet. Formula milk is just a supplement to his weaning diet, and not the other way round. The priority of his vitamin intake should come from the weaning food. I hope you understand my point here.

Soy based milk is not superior than the formula cow milk. In fact, the formula cow milk contains more protein ingredient than the soy milk. Protein is important at this stage to promote growth and development for your baby.

But if your baby has cow milk allergy, then soy milk is better than formula cow milk.

Cheers and Happy Motherhood.



Monday, September 14, 2009

Reply To Jess


Jess said :



dear Doctor,
I have a strong positive line of my urine test but no sac being found from the ultrasound scanning this morning.Would it be too early to detect the sac.My last menses is on 25/07/09 and provided that i have an irregular menses cycle for where it can be delayed about two weeks times. so it's hard for me to tell exactly when is my last ovulation date.


----------------------------------------------------------------



Hi! Jess,


We are dealing with a few possibilities here:

1) Based on your Last Menses Date of 25/7/2009, currently you are pregnant at 7 weeks gestation. The pregnancy sac should be seen by ultrasound at this stage of pregnancy.However, due to your irregular menses cycle, your pregnancy may be delayed due to delay in ovulation.It means you may be pregnant at the very beginning stage. The pregnancy sac is difficult to detect by ultrasound if it is less than 6 weeks.



2) You may have a failed pregnancy where the sac fails to develop. As a result, it was not seen by the scan. Miscarriage is a common problem during early stage of pregnancy. 10% to 20% of the women actually suffer from miscarriage during early stage of pregnancy.



3) If the sac is not located inside the uterus, then it may be located at the outside the uterus. We call this condition ectopic pregnancy.



Pregnancy sac in Fallopian tube




So.. Jess, how to know you belong to which possibility ?

1) In a normal pregnancy, the symptoms of pregnancy will appear by now. Among the symptoms of pregnancy are vomiting, dizziness, breast pain and lost of appetize.If your pregnancy is a failed pregnancy, this symptoms will not appear.



2) If this pregnancy is an ectopic pregnancy, usually you will suffer from abdominal pain and bleeding from vagina.


What should you do now ?


Well, you have a few options in this situation:

1) Wait for 1 week and repeat the scan after 1 week. If your pregnancy is healthy and located inside the uterus, you should able to see it after 1 week.

2) If your are very worried and you want to know the answer now, the doctor can perform a vaginal scan which produce a clearer image. In vaginal scan, the sac can be seen as early as 5 weeks pregnancy.




3) Blood test to measure the pregnancy hormone level (beta HCG). This test is useful to early diagnose ectopic pregnancy.



Anyway, I wish you best luck in your subsequent follow up with your doctor.



Cheers!

Wednesday, September 9, 2009

Preparation for Breastfeeding (餵母乳計劃)



Breast milk is always better than formula milk to provide best nutrition to your baby.
Nowadays, breastfeeding is a popular option among the new mothers because they realise that breast milk is the best food for their newborn babies.
In order to succeed in breast feeding, you need to prepare yourself before the delivery.


The things you need to do before the delivery:

1) Maintain nutritious diet for yourself.

You need to take high calcium food such as milk, yogurt, cheese and meat.
During breastfeeding, your body need to supply enough calcium in the breast milk.
Protein from fish and seafood products is also very important to supply omega oil (DHA) in the breast milk.
Remember to drink plenty of water during breastfeeding.



2) Avoid taking unneccessary medicine and alcohol during breastfeeding.



3) Check your breasts before the delivery.

Some women may have an inverted nipples(乳頭凹進). They need an artificial nipples(人造乳頭) to help them in breast feeding.



The artificial nipple for breastfeeding




4) Breast Massage
Breast massage should be done 1 month before the delivery to help milk production and nipples distension.

The direction of breast massage. Do it 15 min everyday.



Things you need to buy before delivery.

1) A breast supporting bra to support the heavy and engorged breast.

Remember, always buy a bigger size bra as the breast is usually enlarged during breastfeeding.


2) Nipple pad to prevent leaking of breast milk.

Nipple pads


3) Breast pump maybe helpful to reduce breast engorgement.

Breast pump