H1N1 Update

As published in medical journal Lancet on 29/7/2009

1) Every 1 in 4 H1N1 infected pregnant mothers required hospital admission for serious complications.

2) Treatment should be started within 48 hours from the onset of symptoms of H1N1.

3) The medicine to treat H1N1, tamiflu is relatively safe for the pregnant mothers.


In conclusion, seek treatment early if you have the symptoms of H1N1 infection.

H1N1 infection in Pregnancy

I received many phone calls from my pregnant patients lately. They were very concerned about the H1N1 outbreak in Butterworth area, particularly after the closure of one of the Chinese Primary schools in Sungai Puyu and a Polytechnic in Permatang Pauh.



Their fear and worry are justifiable because pregnant ladies carry higher chance of H1N1 infection.



Why pregnant lady is prone for serious H1N1 infection ?


No one know the answer as the disease is still new. Maybe the immunological chances in pregnancy is the reason to explain it.




What is the effect of H1N1 infection to my baby ?


Again no one know the answer !! The doctors are still monitoring the situation.

However, there were 2 cases of H1N1 in pregnancy reported in Singapore. Both of them are doing fine at the moment.




What are the symptoms of H1N1?

Symptoms are like seasonal flu and include the following:

1) Fever

2) Cough

3) Sore throat

4) Body aches

5) Headaches

6) Chills and fatigue

7) Sometimes, diarrhea and vomiting




What can I do to protect myself, my baby and my family?

1) Cover your nose and mouth with a tissue when you cough or sneeze, or sneeze into your sleeve. Throw the tissue in the rubbish bin after you use it.

2) Wash your hands often with soap and warm water for 15 minutes, especially after you cough or sneeze.

3) Avoid touching your eyes, nose or mouth. Germs spread this way.

4) Try to avoid close contact with sick people.

5) If you are pregnant and you live or have close contact with someone who has H1N1 flu, talk to your doctor about medicines to prevent flu.

6) Avoid crowded places like shopping centre and public transport.


Finally, those who are still not pregnant, delay your pregnancy until the outbreak is over.

Umbilical Cord Wraps Around Baby's Neck (婴儿脐带总结颈部)

Inside the womb, the baby receives food and oxygen from the mother through the placenta and umbilical cord.

The length of umbilical cord measures approximately 60 cm.

Due to the baby body turning inside the womb, sometimes the cord could wrap around the baby's neck.

Diagram on the left : The umbilical cord in normal position.

Diagram on the right : The umbilical cord wrap the baby neck.

How to know my baby neck is wrapped by umbilical cord ?

2 types of ultrasound scan could identify this condition.

1) 3D/4D scan of the neck region.

This 3D picture clearly show the cord location around the neck.

2) Umbilical Colour Doppler scan:

Doppler scan is used to identify the blood vessels within the umbilical cord.

Is this condition serious and threaten the safety of my baby?

Luckily, this condition is not as serious as you think. Most of the time, the umbilical cord is loosely wrapped around the neck without causing any problem to your baby.

Can I choose normal delivery with the umbilical cord wrap around my baby neck?

Yes. You still can go for normal delivery.

During the labour process, the doctor will monitor the baby's heartbeat because sometimes the heart rate could slow down because of this condition.

Consequently, the chance of emergency caesarean section is higher.

Confinement Centre (坐月中心)

It is a new trend to stay in the confinement centre during your confinement period.
There are many confinement centres in Butterworth and Bukit Mertajam.
Some of the centres are operated by the experienced nurses and some of them are operated by traditional confinement ladies.

Despite of these confinement centre service, some of the new mothers still prefer to stay at home and employed a confinement lady to take care of them.

Today, I want to make some comparisons between confinement centre care and home care.


The advantages of Confinement Centre care :

1) More cost effective compared to home care. The confinement centre usually provide package of services which include food, lodging, herbal treatment, massage service and baby formula milk powder. The cost to employ a confinement lady to your house for 1 month is quite expensive nowadays.
2) Some of the confinement centres even equipped with medical facilities such as Infrared lamp, photo light for the jaundiced baby.


The disadvantages of Confinement Centre care :

1) The quality of the service is depent on the operator.
2) The risk of infection to your baby is higher in the confinement centre compared with home care. In the confinement centre, many babies stay together within the same room. If one baby is sick, your baby maybe infected as well.
3) The chance of depression is higher. You feel sad because you stay away from your family for 1 month. You may have problem to adjust yourself to the new environment in the confinement centre.

Well, the choice is yours. From the medical point of view, my opinion is home care is still better than confinement centre care.

What is your opinion? Leave some comments please!

The Mystery of The Labour Door

The labour door is referred to the cervix.

The Cervix needs to go through 2 stages of changes during the labour:


Stage 1 : Effacement
=> The cervix slowly become thinner and shorter.


Stage 2: Dilatation
=> The cervix is gradually open in diameter.

Pictures below explain the changes of cervix during the labour process.

Picture A & B => The cervix is thick and long. Typically a beginning stage of labour.

Picture C => The cervix is effaced, become thinner and shorter.

Picture D => The cervix start to open after the effacement.

How the doctor measures the diameter of the labour door?


The doctor measures the diameter of the cervix by using the fingers to estimate the width of the cervical opening.



As a general reference,

=> if the diameter is about a slice of banana, then it is 3 cm

=> if the diameter is about a can of soft drink, then it is 7 cm

=> if the diameter is about a size of donut, then it is 10 cm.





The door needs to open to 10 cm before the baby can go through it.
Why the duration of labour is longer in the 1st pregnancy, compared with the 2nd pregnancy ?

As mentioned earlier, the cervix needs to go through 2 stages of changes before it is fully open.

For those expecting their 1st pregnancy, the cervix needs to EFFACE first, then only DILATE....

For those expecting their subsequent pregnancy, the cervix effaces and dilates at the same time.
For this reason, the second pregnancy is faster and easier then the 1st pregnancy.




How fast the labour door can open ?

For those expecting their 1st pregnancy, the door usually opens by 1 cm every hour.

For those expecting their subsequent pregnancy, the door usually opens by 2 cm every hour.




In what conditions the door refuse to open?

=> If the cervix is very thick and long, it will take a long time to open, compare with a thin and short cervix.

=> If the baby is over weight. A big baby is difficult to negotiate through the cervix.

=> If the contraction is weak and irregular.

=> If the pelvic bone is narrow and small.

=> A fibroid or cyst that located next to the cervix sometimes can prevent the cervix from dilating.

Care of Episiotomy Wound

What is Episiotomy?


It is a surgical incision at the vaginal outlet which is performed during a normal vaginal delivery.






What is the purposes of Episiotomy ?


1) To assist in the delivery of the baby's head by extending the diameter of outlet.


2) To prevent extensive perineum tear which may injure the anus.


3) To assist in instrumental delivery, such as Forceps and Vacuum delivery.

Is it necessary to perform Episiotomy to all the normal vaginal deliveries?

No. Episiotomy is not a compulsory procedure in normal vaginal delivery. In fact, some of the pregnant mothers refuse to give permission for the doctor to perform episiotomy.

The decision for episiotomy should be based on case to case basis.

For example,
1) First vaginal delivery usually needs episiotomy due to tight outlet.
2) If the doctor suspect the baby is big.
3) When instrumental delivery ( forceps or Vacuum ) is required.


How to take care of Episiotomy wound after the delivery?

The wound will be stitched immediately after the delivery. The healing process usually takes about 1 week.
Things you should do to assist the recovery:

1) Keep the surrounding area clean.

2) Don't rub the wound with tissue paper after passing motion. Use water to clean yourself after passing motion.

3) Some medication to reduce pain and swelling is helpful.

4) Infrared care is sometimes helpful to reduce the pain.

4) Sitz-bath to assist the healing process.

How to do Sitz Bath at home after discharged from hospital?

You need a toilet bowl to perform Sitz bath.

Use warm water, add in 2 to 3 spoons of salt.

Sit on the warm bowl with your buttock is fully soaked.

Duration of sitz bath is about 15 minutes.

Do it 2 to 3 times perday and everytime after you pass motion.

Reply to 夏娃

夏娃 said...


I'm a 26 yr old 18weeks pregie with 20 years asthma record. Average asthma attack was 1-2 a year until my recent pregnancy caused twice emergency nabuliser due to accute attack. Under the control of ventolin inhaler and having problem of morning sickness till today,gastric,tonsilitis,sinusitis,unstoped nose bleed yet cauterization not helping,low hb 10.4 on iron supplement. Soft tissue of my last back joint is out of alignment due to car accident 3 years ago. Can I take epidural? Need your advise on whether can I undergone natural birth as my asthma wasn't so under control recently.





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It is very unfortunate to know that your pregnancy is complicated by multiple underlying medical conditions.



To make the thing worse, most of the problems you listed will get worse as your pregnancy progresses. They will get better only after the delivery.



Let us write down the list of medical problems you have:



1) Childhood asthma which was worsening during your pregnancy.

2) Recurrent sinusitis, tonsilitis and rhinitis.

3) Gastritis

4) Prolonged morning sickness till 18 weeks pregnancy

5) ? spine injury due to car accident

6) Low hemoglobin ( anaemia )

7) Mental stress due to uncertainty in your chance of normal delivery.



Airway allergy:



The first and second problems are related to airway allergy. You are born with strong genetic history of allergy. I believe some of your family members have the similar problem as it is an inheritance problem.



Your asthma was worsening recently because during the pregnancy period, some of the products from your baby may circulate in your blood stream. FYI, 50% of your baby genetic products are contributed by your husband. Your body unable to accept the presence of your husband genetic products in your body and hence resulting in allergic reaction in the airway.



To make thing worse, your baby is growing in size daily. Your tummy will keep on increasing in size and compressing the lung function. A mild asthma attack after 7 months can become a serious problem due to lung compression by the baby.



If ventolin inhalation is not helpful, you can start steroid inhalation to control the attack. Generally, steroid inhalation in pregnancy is safe.



Since there is a chance that your baby may inherit the allergy problem from you, I strongly encourage you to give breast feeding for your baby. Breast milk reduces the allergic rection to your baby compared with cow milk. Alternatively, choose a hypoallergic milk formulation.



You still can go for normal delivery. The doctor can offer you some prevention measures before you enter the labour room, such as ventolin nebuliser and high flow oxygen. Caesarean section that requires general anaesthesia sometimes can cause severe asthmatic attack due to the anaesthetic gas. Therefore, Caesarean section is NOT SAFER than normal delivery in this situation.



Prolonged Morning Sickness.



Morning sickness usually will not last longer than 16 weeks ( 4 months). It is unfortunate your problem drag on for so long.

Maybe you need to check your thyroid function to exclude hyperthyroid.

Your gastritis maybe related to prolonged morning sickness due to frequent empty stomach.

Try small but frequent meals. Avoid oily diet and foods that leave behind a strong smell in your mouth.



Spine Injury



It is important to know the level of the injury. If you have fully recovered from the injury, to give epidural is not a problem. Epidural is NOT ASSOCIATED with back pain, although general public always think so......


Otherwise, you can consider other options of pain relieve during the labour, such as Entonox, Pethidine injection and breathing exercise.




Low Hemoglobin



Your hemoglobin level of 10.4 g% is not too bad. It is just borderline. Normally we accept more than 11g% as normal.

However, during pregnancy because of water retention, the blood can be diluted due to increased in water component.

As far as the level is more than 10 g%, it is considerd acceptable.

Since you are only 18 weeks pregnant, you still have plenty of time to increase the Hb level. You can take more protein diet and iron supplement.



If you are very keen for normal delivery and you fulfil the conditions for normal delivery, why not.....go ahead and try it....


Cheer!

Reply To Lychee

Hai Dr Jason,

My question is:

1)my age is 25 years old and in family no one is down syndrome children, so is it i still need check the doen syndrome for my baby? I have go to Blood test lab for asking, but the doctor say i no need do it because i'm still young. This make me confuse. your answer we are apreciated

Thanks

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Hi! Lychee

Thank for your question.

Since you are still young, only 25 years old and there is no family history of Down Syndrome, the chance of giving birth to a Down Syndrome baby is low.

Medical research showed that at your age the chance of giving birth to a Down Syndrome stands at 1 in 1000.It means every 1000 women pregnant at your age, only one will give birth to Down baby, compared with the risk of a 35 years old woman who stands at the chance of 1 in 350.


However, lychee, 1 in 1000 is not equal to zero!


Nowadays all the patients have very high expectation on their children. Every mother hopes to deliver a perfectly normal baby.

Furthermore, blood test and ultrasound scan to screen for Down Syndrome are easily done without any risk to the mothers.


In UK and US, blood test and ultrasound screening are offered to all pregnant mothers regardless their age.


We must think of the consequences of giving birth to the Down Syndrome baby, in term of emotional and financial burden to your family.

Your Suggestion, Please!

I have a lot of topics in my mind which
i want to share with you.

But I am not sure which one you are interested in......

Please leave a comment and suggestion on the topic you want me to blog about.

Thank you.

How To Calculate For Ovulation

It is an interesting question asked by Cherrie.

Every woman ovulates at different time because the duration of the menses cycles were different. Some of them have 28 days cycle and some of the women may have 32 days cycle.

Regardless the cycle length, every woman ovulates 14 days before their next menses.

Example 1

Miss X has a regular menses every 30 days. So, Miss X ovulates at Day 16 of her period. Yes, simple mathematic, 30 minus 14.

Example 2

Miss Y has a regular menses every 35 days. So, Miss Y ovulates at Day 21 of her period.

For your information, first day of your menses is considered Day 1 of your cycle.


Other than calculation method, other methods you can depend on are:

1) Measuring your body temperature. Your early morning temperature may go up to 37.3 to 37.5 degree celsius during the day of ovulation.

2) Monitoring the symptoms of ovulation. Some of the women may complain of mood swing, breast pain, bloated stomach, stomach pain.

3) Urine test for ovulation

How to Calculate Expected Date of Delivery?

It is a simple mathematic. Yes, very simple.

The basic rule is to add 7 days and 9 months to your first day of last period.


Example 1 :

First day of your last period : 8/3/2009

Calculation : 8 (+7) / 3 + (9) / 2009

Expected Date of delivery : 15/12/2009


Example 2:

First day of your last period : 20/11/2009

Calculation : 20 (+7) / 11 (+9) / 2009

Expected Date of delivery : 27/ 8/2010


*This calculation formula is based on the menses cycle length of 28 days.

My Baby is kicking me!

Feeling the baby's movement within the womb is a wonderful experience for most of the pregnant mothers.

It is one of the ways your baby communicates with you. This precious experience slowly develops a special bonding between both of you.

For the mothers who are expecting their first pregnancy, they usually feel the baby movement after 20 weeks of pregnancy ( 5th month ).

For those expecting their second pregnancy onwards, they could feel the movement earlier after 16 weeks of pregnancy ( 4th month).

Why it is important to count my baby movement ?

By counting the number of movement, we can monitor the condition of the baby inside the womb.

The doctor only assess your baby's condition during the consultation, During the normal days, the monitoring is depent on you.

When should I start counting?

You should start counting after 7 months of pregnancy.

There are 2 methods you can use:

1) Counting the number of movement from 9am till 7pm. Within this 10 hours, the baby should have more than 10 kicks.

2) Counting the number of movement from 7pm till 10pm. This method is useful for the working mothers who are busy during the office hours. Within these period, your baby should make more than 5 kicks.

What should I do if my baby has less movement?

Don't be panic!

You need to take your meal as soon as possible, then observe the movement again.

A lot of time, your baby will start kicking again after your meal because of increased blood sugar.
If your baby movement is still reduced after the meals, consult your doctor as soon as possible.

Why my baby is so naughty during the night time? He likes to kick me during the night time. As a result, I can't sleep properly throughout the night.

It is normal to feel more movement during the night time because you pay more attention to your baby when you are relaxing.

It is also because of the sleeping pattern of the baby. Usually, the baby's sleeping time is shorter during night time.

Why after 9 months of pregnancy, my baby doesn't like to kick me anymore?

As your baby is growing bigger and bigger, the empty space within the womb is decreasing. The baby is cramped inside a small space and limit its movement.

Boy or Girl ?

Can we choose the sex for our baby?

No. The nature will select the sex for us.

Although the modern medical advance allows sex selection in the 'test-tube' baby, it involves a high cost of treatment and it is not 100% success.

The following information is only for general reference and is not scientifically proven.

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Man’s sperm consists of X & Y spermatozoa, X spermatozoa decides the female whereas Y is the male.

Referring to these physiological properties of the spermatozoa, gynaecologists set up the theory of ‘Choice of A Girl or Boy’.

1st Factor : Food

If you want a baby girl:
Husband must eat more alkaline food, wife eats more acidic food.
If you want a baby boy:
Husband eats more acidic food, wife eats more alkaline food.
Alkaline food : vegetables, fruits, white egg, milk, algae, etc
Acidic food : meat, seafood, etc.

2nd Factor : Timing of Sexual intercourse

If you want a baby girl:
Frequent sexual intercourse just before ovulation
If you want a baby boy:
Frequent sexual intercouse on ovulation and just after the ovulation

3rd Factor : Penetration ( How to do it )

If you want a baby girl:
Husband to avoid deep penetration in the female vagina during sexual intercourse
If you want a baby boy:
Deep penetration by the husband is suggested
Reasoning:
Characteristics of X & Y spermatozoa:
X : Marathon runner with good stamina
Y : Sprinter but poor stamina
With deep penetration, the chances of Y to reach destination will be higher.

Down Syndrome (唐氏综合征)

It is everybody wish to give birth to a healthy and normal baby.

Unfortunately in real life thing may not happen according to our plan.

Some of the newborns might have congenital abnormality, such as Down Syndrome.


What is Down Syndrome?

It is a genetic problem caused by an extra chromosome-21.


What type of problems related to Down Syndrome?

1) Learning difficulty due to mental retardation
2) Inborn error in the formation of heart ( hole in heart)
3) Childhood leukemia
4) Poor social interaction and upbringing
5) Premature dementia


Am I at risk to deliver the Down Syndrome baby?

1) Age of pregnancy more than 35 years old generally increases the risk.
2) Any family member who had delivered a Down syndrome baby before.


Can I make sure my baby is not a Down Syndrome baby before the delivery?

Yes. The advance of medicine makes it possible for the doctor to diagnose this syndrome before the delivery.

Screening for Down Syndrome is commonly done nowadays.

Firsrt trimester blood test and ultrasound scan of at 12 weeks offer 90% of accuracy in detecting Down Syndrome.

Second trimester blood test at 16 weeks offers 70% to 80% of accuracy.


If my screening blood test was abnormal, what should I do?

If the screening blood test is abnormal, it means your chance of delivering a Down Syndrome baby is increased.
If you want to confirm it, you need to do amniocentesis.


What is amniocentesis?

By using ultrasound scan as the guide, the doctor will insert a needle into the worm to aspirate the amniotic fluid.

The amniotic fluid will be sent for chromosomal study.

Ultrasound Scan – Is it Safe and Useful?

Safety of Ultrasound


This technology has been using for the past 50 years in the field of obstetrics.

Ultrasound exposure during pregnancy is safe as there was no major adverse effect to the baby.



A 3 months old baby



Type of Ultrasound Scan Used in Pregnancy

1. 
   Routine 2D scan is good enough to monitor your baby growth and detect any congenital abnormality.
   
2. 
   3D/4D scan will show your baby physical appearance including the face. 3D/4D is superior in detecting cleft lip, club foot and cord round neck.
   
3. 
   Doppler scan is useful to monitor the baby wellbeing and healthiness.
   

The advantages of Ultrasound scan

• 
  Confirm the pregnancy during early stage of pregnancy.


• 
  Confirm the date of delivery.


• 
  Confirm the location of the pregnancy inside the womb.


• 
  Detect any gynaecological problem during pregnancy ( eg: cyst and fibroid)


• 
  Detect the number of baby in the worm. Some of the lucky mothers may have twin pregnancy.


• 
  Detect any congenital abnormality of the baby ( eg: Heart defect, Cleft lip )


• 
  Monitor your baby growth inside the womb.


• 
  Locate the placenta and the baby position.


• 
  Monitor the wellbeing of your baby after 9th month of pregnancy.

Twin Pregnancy




Thickened Nuchal. Risk of Down Syndrome is increased.

3D image of a 7 months baby

Cleft Lip