Safe Journey

As the Chinese New Year is coming, many of you will take the opportunity to visit your long distant relatives.

Long distant travel for the pregnant mothers is safe, but special precautions should be taken to avoid unneccessary problems to your pregnancy, especially to those who plan to travel by air flight.

Before you start your journey, make sure you take the important safety precautions as listed below:

1) Inform your obstetrician of your plans.

Because the most common pregnancy-related emergencies happen in the first and third trimesters, the second trimester is generally considered the safest time to travel.

2) Reconsider traveling if there are complications.

If you've experienced second- or third-trimester vaginal bleeding, have gone into premature labor in the past, high blood pressure during pregnancy and twin pregnancy, the doctor may recommend you to stay at home.

3) Air travel is safe for most women up to 34 weeks of pregnancy, provided there are no complications.

Some airlines will only permit women to fly with a fitness certificate from the doctor after 28 weeks (7 months) of pregnancy.

4) Avoid long distant flight to avoid prolonged exposure to X ray in high attitude. Any air travel more than 8 hours is not encouraged.

5) Before traveling, locate the hospital nearest to your destination. Be prepared for an emergency by packing your medications and a copy of your medical records.

6) Avoid swimming in the ocean. Ocean swimming can increase the risk of vaginal or womb infections, which could lead to preterm delivery.

7) Drink plenty of water when traveling or flying. Dehydration can cause the uterus to contract. If in a foreign country, stick to mineral water. This includes staying away from ice cubes, too.

8) Take anti-vomiting pills if needed for travel sickness. Anti-dizziness medications can be taken safely during pregnancy.

9) Move about and walking around while traveling.

To reduce the risk of water retention in your legs and feet, get up and walk around the cabin once every hour. Support stockings can also help. Wear flat, comfortable shoes.

10) Fasten your seat belt. Don't forget to buckle up, with your seat belt below your belly.

Wish all of you have a safe and memorable journey.

Happy Chinese New Year.

Happy Chinese New Year !

To all the readers, Happy Chinese New Year and Gong Xi Fa Cai !

Malaysia Vaccination Programme

Hi Dr. Jason,

I just come across your blog which i find very informative.
I've just delivered a baby boy last month. I'd like to seek for your advice regarding the injections like Pneumococcal, Rotavirus & Influenza, do you think it's a must to get these vaccines? As I know the first two ( Pneumococcal & Rotavirus ) are more common and Pneumococcal is not cheap/dose.

Another question is how come the dose given might different from Dr. to Dr.? For instance, Pneumococcal some only need 2 doses, some even 4 doses and period of time given also different. Can I have your explanation on these?

Any more extra informations you would wanna share? Thanks in advance!

Waiting for your reply. Have a nice day!

From : Yvonne

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Hi! YvonneL,

Attached below the tables of the standard Malaysia Vaccination programme:

Malaysia - Mandatory
Age	Vaccine	Immunisation Against
Birth	BCG Hep B	Bacille Calmette-Guérin vaccine Hepatitis B vaccine
2 months	Hep B DTP / Hib / Polio	Hepatitis B vaccine Diphtheria and tetanus toxoid, pertussis vaccine Haemophilus influenzae vaccine Oral Polio vaccine
3 months	Hep B DTP / Hib / Polio	Hepatitis B vaccine Diphtheria and tetanus toxoid, pertussis vaccine Haemophilus influenzae vaccine Oral Polio vaccine
5 months	Hep B DTP / Hib / Polio	Hepatitis B vaccine Diphtheria and tetanus toxoid, pertussis vaccine Haemophilus influenzae vaccine Oral Polio vaccine
1 year	MMR	Measles, Mumps and Rubella vaccine
18 months	DTP / Hib / Polio	Diphtheria and tetanus toxoid, pertussis vaccine Haemophilus influenzae vaccine Oral Polio vaccine

Malaysia - Recommended
Age	Immunisation Against
2 months	Rotavirus Pneumococcal C
3 months	Rotavirus Pneumococcal C
5 months	Pneumococcal C
6 months	Influenza (annually)
1 year	Chicken Pox Pneumococcal C
2 years	Pneumococcal P Hepatitis A
2.5 years	Hepatitis A

It is compulsory for the baby to undergo mandatory vaccination as stated in the table 1.

The pneumococcal and rotavirus are categorised in the table 2 as the optional and recommended vaccination.

Both pneumococcal and rotavirus are not available in the government health clinic.

The parents need to obtain the injection in the private clinic with the cost range from RM 220- RM 250 per injection for pneumococcal and RM 150 per injection for Rotavirus.

Pneumococcal is associated with lung infection, ear infection and brain infection of the newborn.

Rotavirus infection is associated with severe infant diarrhoea and vomitting.

The number of injection of pneumococcal is depent on how soon the baby starts its injection.

If the baby starts its injection from 2 months, he/she will require 4 injections. If the injection is started after 1 year old, he/she will only need 2 injections.

However, the earlier you start the pneumococcal injection, the earlier baby will receive the protection from the pneumococcal infection.

Dr Jason

Chinese Translation :

BCG –肺痨

Hepatitis B - B型肝炎

DTP -白喉 / 破伤风 /百日咳

HiB -脑膜炎

Polio - 脊髓灰质炎

MMR -麻疹 / 风疹 / 咀嚼

Pneumococcal - 肺炎

Rotavirus -轮状病毒

Cleft Lip and Cleft Palate (兔唇/兔颚)

It is the expectation of every pregnant mother to deliver a healthy and perfectly normal baby.

Unfortunately in real life, sometimes the baby is born with some degree of handicaps, such as cleft lip and cleft palate.

Cleft Lip (兔唇)

Cleft Palate (兔颚)

What is cleft Lip and cleft palate?

Cleft lip and palate is a inborn defect affecting 1 in 700 newborns.

It is caused by a split or separation in the structure of the lip or the roof of the mouth.
During early pregnancy, separate areas of the face develop and then join together. When some parts fail to come together, a cleft is formed.
Cleft lip and palate can happen together or separately.

How does it happen?

In Malaysia, it is estimated that one out of 700 babies is born with a cleft lip or palate.
The causes of cleft lip and/or palate are not understood very well.

Sometimes clefts run in families and sometimes a baby is born with a cleft without anyone else in the family having one.

One study has shown that mothers who smoke 20 or more cigarettes a day during pregnancy are more than twice as likely to have babies born with a cleft lip and/or palate than non-smokers.

The same study found that babies were eight times as likely to have a cleft lip and/or palate if they were genetically predisposed and if their mother smoked during her pregnancy.

How to detect cleft lip and cleft palate before delivery ?

A detailed ultrasound scan at 5 months of pregnancy is important to detect this defect.
4D ultrasound scan provides extra accuracy to pick up this inborn defect.
If the baby has cleft lip and cleft palate, a detailed scan to look for other associated abnormality is necessary because occasionally the baby may have more than one inborn defect.

4D Scan Image of Cleft Lip

What should I do if my baby has cleft lip and cleft palate?

It is not easy for the parents to accept the fact and it is also very difficult for the doctor to break the news to them if the baby is diagnosed to have this defect.
The parents usually need a lot of emotional support to face the reality.
Once the diagnosis of cleft lip/palate is confirmed after the delivery, the parents need to learn a proper feeding method to prevent milk aspiration. The baby needs a special feeding teak to prevent leaking of milk to the nose.
Cleft lip can be surgically repaired after the baby is 3 months old and the cleft palate is usually repaired after the baby is one year old.
With the modern plastic surgery techniques, the repairs can be done nicely without leaving obvious surgical scar.

Plastic surgery repair of cleft lip

H1N1 Vaccine ( H1N1 疫苗)

Anonymous said:

Hi Dr Jason

On Saturday when I went to see you for my regular prenatal check-up, I have forgotten to ask you regarding the H1N1 vaccinations which will be made available soon by the Government clinics to all high risk groups, including pregnant wormen. The question is, is it safe to take up the vaccinations and are there any side effects to the fetus if taken. I am now at my 24 week of pregnancy.

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Hi, Annonymous,

The outbreak of H1N1 infection is generally under controlled in the Northern Malaysia. For the past 3 months, there was no new case reported in my hospital.

H1N1 vaccine is relative safe in pregnancy as the vaccine is derived from genetic recombinant material, rather than from the material of the killed virus. Therefore, H1N1 vaccination during pregnancy is acceptable practice.

Unfortunately, the vaccine is still unavailable in Bagan Specialist and most of the private hospitals because the supply is limited.

Generally, H1N1 infection will only produce mild flu for majority of the infected pregnant mothers. Most of the H1N1 infections are self limiting without causing serious complication.

I had 2 patients who were infected during pregnancy period. Both of them had delivered their babies without any handicap or complication.

Despite claiming that this vaccine is safe during pregnancy, special precaution should be taken since this vaccine is still new in the market. There is no medical study to prove its long term safety.

As far as your job doesn't require you to travel, H1N1 vaccination during pregnancy is NOT compulsory.

Dr Jason

声称服私人医院药物后下体流血 胎死腹中产妇讨公道

（槟城13日讯）一名高龄产妇声称，她因为腹泻及呕吐前往一家私人医院检查及留医，医生在她出院时开出药物给她，在二度服用之后，感身体不适，下体流血，婴儿胎死腹中。她欲向院方索取医药报告，以了解事情真相及讨回公道。

吴海宝：医生劝动手术

该名高龄产妇吴海宝（40岁）说，当时，身怀5个月半身孕的她在去年12月27日因为腹痛而前往槟城医院检查，医生告知胎位已经往下移，因此劝说她动手术生产。

她说，她在28日又前往一家私人医院检查，而医生却告知没有上述情况。直至今年1月1日，她因为不断腹泻和呕吐，于是再前往该家私人医院检查，医生表示食物中毒，并留医检查。

“我在4号出院时，医生给我两种药物，其中一种是抗生素，另一种是抗高血压药物，由于抗生素药物之前我没有服食过，因为我是高龄产妇所以感到担心，因此，我在隔一天再返回医院询问，但护士说医生开的药物是可以服食的。”

她阐述，她在6号早上服食有关药物时还没有出现问题，直到晚饭后服药，准备上床休息时，下体突然流血，于是赶紧联络这家私人医院。

逾1小时救伤车仍没抵达

她声称，其丈夫不断联络该家医院的救伤车，但等了超过一个小时，救伤车依然还没有抵达，在紧急的情况下，其丈夫惟有赶紧联络槟城医院，之后，便被告知婴儿已经胎死腹中。同时，医生也告知若再延迟，恐怕连孕妇的性命也不保。

李清辉：索医药报告被拒

其丈夫李清辉（46岁）说，他在孩子不保之后，直往该家私人医院理论追究，而当局表示给他们两个星期的时间调查，因此他相信有意拖延和让他们忘记事发细节，所以便向光大区州议员黄伟益求助。他也说，当他向该家医院索取妻子的医药报告时，却被告知由于其医药费尚未还清，因此,不能拿医药报告。他怀疑是因为药物所引起而产生的副作用才导致上述情况发生。

他说，其太太每个月都会前往中路医疗所检查，并且没有面对高血压的问题，因此，对于院方为何要让其太太服食抗高血压的药物感到不解。

黄伟益：要求院方解释

光大区州议员黄伟益指出，他联络该家私人医院的首席执行员告知有关事件时，对方完全不知情，并表示会向有关医生了解情况。

他说，当询及是否没有缴清医药费就不能拿医药报告一事时，对方表示，院方并没有规定未缴清医药费就不可拿医药报告这一回事。同时，他们也将安排于周五下午会面。

对于吴海宝所面对的事情，他将会向院方了解并要求院方作出解释。

他说，如果发现医院或医生有疏忽之处，他将协助他们寻求法律援助，并采取法律行动，不过，一切要先等医药报告，包括把药物送往检验、是否是因为药物所引起以及病人的身体状况等相关因素，以做进一步确定。

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

It is very unfortunate for this disaster to happen. My sincere condolence to this lady.

However, I suspect the cause of death of her baby might not related to the antibiotics.

The symptoms described are more consistent with placenta abruption, a serious medical emergency that usually happen to the pregnant lady who has high blood pressure during pregnancy.

Placenta abruption is due to sudden placenta bleeding inside the womb, causing the blood clots formation behind the placenta bed.

Diagram on the Left : Normal placenta.

Diagram on the Right : A bleeding placenta with blood clots behind the placenta bed.

This condition usually happens among the pregnant ladies who have high blood pressure during pregnancy and insufficient vitamin B and folic acid.

This condition is serious and maybe life threatening to the baby.

So far there is no association between antibiotics usage and placenta abruption.

Boom in C-section births

HANOI - NEARLY half of all births in China are delivered by cesarean section, the world's highest rate, according to a survey by the World Health Organisation - a shift toward modernisation that isn't necessarily a good thing.

The boom in unnecessary surgeries is jeopardising women's health, the UN health agency warned in the report published online on Tuesday in the medical journal The Lancet.

Unnecessary C-sections are costlier than natural births and raise the risk of complications for the mother, said the report surveying nine Asian nations. It noted C-sections have reached 'epidemic proportions' in many countries worldwide.

The most dramatic findings were in China, where 46 per cent of births reviewed were C-sections - a quarter of them not medically necessary, the report said.

The WHO, which reviewed nearly 110,000 births across Asia in 2007-2008, found 27 per cent were done under the knife. That mirrors similar results reported by WHO in 2005 from Latin America, where 35 per cent of pregnant women surveyed were delivering by C-section.

In the US, where C-sections are at an all-time high of 31 per cent, the surgery is often performed on older expectant mothers, during multiple births or simply because patients request it or doctors fear malpractice lawsuits. A government panel warned against elective C-sections in 2006.