Wednesday, August 26, 2009

The Urine Test (尿液檢查)

Container for urine test

During every visit of your pregnancy follow up, urine test is routinely performed.

Why pregnant ladies need regular urine check-up?

There are two important things the doctor want to know from your urine test :

1) Whether any sugar in the urine

2) Whether any protein in the urine

Urine Dipstick test - fast result to detect urine sugar and protein

Is it normal to have sugar in the urine ?

Yes. We name this condition as glycosuria. This condition may present in a healthy pregnant lady and usually resolved by itself after the pregnancy.

However, persistent glycosuria may indicate underlying diabetes mellitus (糖尿) which requires further investigation.

What about protein ?

Protein should not present in the urine for a healthy pregnant lady. If protein is detected in the urine, most of the time it is due to bladder infection which requires antibiotic treatment.

Occasionally, the presence of protein in the urine may indicate underlying kidney problems and sign of high blood pressure in pregnancy.

If my urine repeatedly contain sugar, what should I do ?

A further blood test is necessary to exclude possibility of diabetes mellitus in pregnancy. It is important to diagnose diabetes mellitus early as it could cause adverse complications to your pregnancy.

In addition, the chance of bladder infection is higher if the urine contains high level of sugar.

Friday, August 21, 2009

H1N1 Update

The situation is worsening.......

The number of confirmed cases inceased significantly for the past 2 weeks.

Luckily, most of the patients only suffered from mild infection.


1) Wear a Face Mask when you come to hospital for your follow up.

2) Contact me if you have symptoms of infection.

3) Rapid test and the medicine to treat this disease is available in the hospital.

Rapid Test for Influenza A

Swab from the nose for the rapid test

Sunday, August 16, 2009

The Horoscope Baby (时晨八字)

Some of the parents are very concerned about the birthday of their babies.

Many superstitious parents prefer their babies to be born on the specific auspicious date according to the horoscope and the Chinese lunar calender (八字).

They believe that if the baby is born on the auspicious date, he/she will bring luck and money to the family.

On the other hand, if the date is not auspicious, the baby may cause disaster and even death threat to the family members.

As a gynaecologist, I had in many occasions been asked by my patients to deliver their baby on the specific date and time in order to fulfil the horoscope.

For examples:

1) Last year, a young mother requested me to deliver her baby on 8/8/2008 8:08am by caesarean section. The baby really brought luck to the mother because for the first time the mother was interviewed by The Star newspaper and appeared on the front page newspaper on the following day.
Unfortunately, the doctor in charged was not interviewed : )

Yes! I was holding the knife waiting for the time..........8.08am

2) A Chinese couple consulted a Fung Shui master who was in the opinion that their baby was best delivered by midnight 3 am.
Pity me.....I need to come to the hospital to deliver the baby at the middle of night.
The following day, I had to drink extra cup of coffee to stay awake......

3) One of my patients had her due date on the mid of the ghost month (七月十五) . The grandmother insisted that the baby must be born before the ghost month.
Finally, I had to deliver her one day before the ghost month.

4) A mother planned to have the same birthday with her baby because they could celebrate the birthday together.

As a doctor, it is very difficult to reject their wish to have a horoscope baby. In case the baby is born at the unauspicious time and coincidentally something really bad happen to the family members, the parents may blame the doctor for not following their advice.

However, from the medical point of view, the intention for the horoscope baby carries some medical risks to both the mother and the baby.

In order to fulfil the time and date, the mother needs to undergo induction of labour(吹生).
Medical induction is always associated with some risks to the patients.
The duration of the labour is longer in induction.
The possibility of caesarean is higher because sometimes the induction of labour could fail.
What do you think?
Will you choose the birthday for your baby? .........Leave a comment please!

Thursday, August 13, 2009

Reply to Hazelnut Latte

Hazelnut Latte said..

Dr Jason,
may i ask that if the person menses not accurate every months..then how she want to count the ovulation date.

i have try many ways -- taking clomid and use the ovulation paper test also can findout which date is my ovalution date.

Can you suggest to me that i need to do any further checking or not?



Hi ! Hazelnut,

It is not easy to estimate the date of ovulation for someone with irregular menses cycles.

The formula I mentioned in my blog on 10/7/2009 is only accurate for those with regular menses cycles.Anyway, you said that the urine test for ovulation was negative despite taking medicine clomid to induce ovulation.

==> It means you are not ovulating at all despite of the treatment.

Not all the women ovulate every menses cycle. About 10% to 20% of the women are not ovulating during their menses cycle.

This type of patients usually their period is irregular, they have problem to get pregnant and they gain weight easily.

To confirm that you are not ovulating, you can do a blood test at mid menses cycle to check the progestogen level.

This problem can be treated by increasing the clomid dosage to 150 mg.

If you still fail to ovulate despite of clomid, hormone injection is very effective to stimulate your ovary to ovulate.


Ovulation Urine Test

Saturday, August 8, 2009

Cervical Cancer Vaccine (子宫颈癌疫苗针)

What is Cervical cancer ?

Cancer of cervix is common among women in the age group between 35 to 55 years old.

70% of the victims of the cervix cancer are caused by HPV virus infection.

The diagram shows the progression and spread of cervix cancer

The gross appearance of cervix cancer

What is HPV virus ?

HPV virus is spread through sexual contact.
The chance of HPV infection is higher if you have many sexual partners.

There are many type of HPV virus, but only type 6, 11, 16 and 18 are associated with cervix cancer.

Type of HPV causing cervix cancer

Other than cervix cancer, what is the other disease caused by HPV infection?

HPV infection also can cause genital wart in the private part.

Multiple genital wart

How to prevent HPV infection?

There are many effective methods to prevent HPV infection:

1) Avoid multiple sex partners

2) Use condom as protection barrier.

3) HPV vaccine injection.

Gardasil HPV Vaccine

When should I receive my HPV vaccine ?

HPV vaccine ideally should be given before you are sexually active. Currently, HPV vaccine is recommeded for the girls between 9 to 26 years old.

If I’m already sexually active, is it too late for me to get vaccinated?

No, it's not.

If you're already sexually active, you may still benefit from HPV vaccine. That's because even if you have been exposed to HPV, it's unlikely that you have been exposed to all 4 types of the virus covered by the HPV vaccine.

What are the side effects of HPV vaccine?

HPV vaccine has been shown to be generally well tolerated and side effects of the injection are not commonly happened .

The most commonly reported side effects include:

1) Pain, swelling, itching, bruising, and redness at the injection site

2) Headache

3) Fever

4) Nausea

5) Dizziness

6) Vomiting

How many HPV vaccine injection I need to receive in order to obtain the protection?

You need to receive 3 doses over 6 months.

First dose: at a date you and your doctor choose.

Second dose: 2 months after the first dose.

Third dose: 6 months after the first dose.

Thursday, August 6, 2009

The Care of Newborn Umbilicus (婴儿肚脐治疗)

After the delivery of your baby, the umbilical cord will be cut and your baby will detach from you.

The baby umbilical stump will be clamped by a plastic clamp to prevent bleeding.

The umbilical cord plastic clamp

How long will my baby have an umbilical stump?

In about 10 to 14 days, the stump will dry up and drop off, leaving a small wound that may take a few days to heal.

Diagram A : Day 1 to Day 3

The umbilical stump is still thick and wet.

The colour is fresh white.

Diagram B: Day 4 to Day 7

The umbilical stump is dried and shrinking in size

The colour is dark chocholate.

Diagram C : Day 8 to Day 10

The umbilical stump is shrinking and slowly detached

The colour is black.

Diagram D : Day 10 to Day 14

The umbilical stump completely detached.

Small amout of blood stained is common.

Diagram E : Day 14 onward

A completely healed umbilicus.

Day 4 to Day 7

Day 8 to Day 10

How to take care of the stump?

1) Always keep the stump clean and dry.

2) Avoid applying any traditional oilment on the stump. The stump heals faster if left alone.

3) Rubbing the stump with alcohol only if the stump is dirty.

4) Avoid the pampers/ diaper from covering the stump to prevent urine staining on the stump.

5) Expose the stump to air to help dry out the base.

6) Change wet or soiled diapers quickly to prevent irritation.

7) Let the stump fall off on its own. Resist the temptation to pull off the stump yourself, even if it's hanging on by only a thread.

infected stump

Signs of umbilical stump infection

1) Appears red and swollen around the cord

2) Continues to bleed

3) Oozes yellowish pus

4) Produces a foul-smelling discharge

Reply to doreen

doreen said...

Just want to ask is there any idea or method can get twins at once?
This is because nowaday too many ladies are married at high age.


There is no definate way to pregnant a twin!

Generally, the chance of having a twin is 1 in 80 pregnancies. It means only 1 lucky pregnant mother expecting twin pregnancy, out of 80 of them.

The chance of twin pregnancy is higher if any of your family members had it before, because of genetic inheritance.

Pregnancy by fertility treatment, for examples : test tube baby, fertility drug treatment carry higher chance of twin pregnancy.

Tuesday, August 4, 2009

Reply to yion

yion asked :

Is it possible that the cervix cannot open even it is overdue?


First of all, make sure your calculation of expected date of delivery is correct. Some of women may have irregular menses. As a result, the date of delivery is not accurate.

Generally, 30% of the pregnancies will go overdue. Usually, the doctor will allow you to overdue for 10 days if your baby condition is perfect. Hopefully, you will go into spontaneous labour during this period.

There are few reasons why the cervix can't open even it is overdue:

1) A thick cervix.
2) The baby head is high.
3) The baby maybe overweight, big baby.
4) The pelvic bone is small and narrow. As a result, the birth tunnel is small.
5) A cyst or fibroid which may obstruct the passage.

The doctor needs to assess the underlying reason. If he is sure that you fulfil the condition for normal delivery, then induction of labour is the option of choice.

If you fail to fulfil the condition for normal delivery, the doctor will advise you for Caesarean section.

Is Water Birth Safe ? (水中生产)

Water Birth is an alternative labour approach practised mainly by the midwifes in the Western countries.

By delivering your baby inside a bath tub filled with warm water, many midwifes believe it can achieve better result then conventional approach.
The wife of a local singer who had a successful Water Birth.

The advantages of Water Birth :

1) Reduce labour pain and labour stress. Warm water is a good hydrotherapy to reduce the stress of the mother. As a result, it can reduce the need for pain killers.

2) By floating in the water, the mother can change her position and posture easier during the labour process. The water can support her spine and reduce the back pain.

3) Warm water can make the muscle in the birth tunnel more relax. It will facilitate the opening of the labour door.

The disadvantages of Water Birth:

1) Currently, Water Birth is not endorsed by professional doctor association. More scientific study is needed to make sure this method is safe.

2) Water birth is only suitable for low risk pregnancy. Those mothers with high risk pregnancy are not encouraged to use this method. For example; high blood pressure in pregnancy, twin pregnancy.

3) The baby heart beat monitoring is more difficult in Water Birth as the machine to monitor the baby heart beat is not water resistant.

4) There is small risk of water inhalation into the baby lung if the baby is not removed from water immediately after the delivery.

5) It is more difficult to estimate the blood loss in the water.

6) If complications happen during the labour process, you need to abandon the plan of water Birth immediately.

Monday, August 3, 2009

H1N1 Update

As reported in the Star (3/8/2009)

MIRI: A 24-year-old native woman suffering from Influenza A(H1N1) died at 4am on Monday, a mere two weeks after giving birth to her first child at the intensive care unit of the Miri Hospital.

Her baby girl is safe, Sarawak Deputy Chief Tan Sri Dr George Chan Hong Nam said, adding that this was the state’s first reported death from the deadly flu.

The woman, from here, was warded on July 17 after she contracted the disease. At that time she was already in an advanced stage of pregnancy.

The hospital managed to help her deliver a baby girl a few days after she was warded. The baby has been handed over to her father, a labourer in his late 20s.

“This is the first death in Sarawak due to A(H1N1). We (the Sarawak government) have increased the alert level throughout the whole state now.

“Nobody can take this disease lightly anymore,” Dr Chan said.

The Miri Hospital tightened security and safety by several notches to prevent any spread of the disease.
Its director Dr Uma Devi had issued directives to staff not to allow little children to enter the wards if they are not there for any health-related purposes.

Visitors are not allowed to bring babies or little kids to the wards anymore. Old folk are also discouraged from entering unless they are there for health checks.

Smokers are also barred from coming near the wards.
Dr Uma said the tighter safety measures are needed as those who are weaker have immune systems that can be easily attacked by the H1N1 virus.

The Sarawak woman brings the total number of deaths in Malaysia to seven, the previous being an 11-year-old boy who died in Johor Baru on Sunday.