After 2 weeks in karawang district hospital in obgyn department it’s safe to say that i have learned alot. Wish i was brave to learn more. I’m constantly in fear of what mistake i’ll make day by day n think that the consultant will start screaming “Lu begok!” (u’re stupid!) in my ear.
Everyone is subjected to mistake once in awhile right? but when u think about other ppl’s health n life at stake u can’t help but be afraid terrified of the mistake u will make…may make.
But anyways…the main objective of this entry today is to write down the cases i’ve encounted so that i won’t forget it.
1. Asherman Syndrome
It’s what happens when the uterus becomes scarred and stick together (intrauterine adhesion) post op. This lady came in with chief complain of amenorrhea (no menstrual bleeding), she previously had a large uterine myoma removed. The consultant (dr. Rhabby) did sound via her portio and felt that the sound could even past through the endocervix.
The result of this syndrome is the lady will become infertile. The consultant recommended a procedure to release the adhesion via stent. It uses a balloon catheter which is inflated intrauterine.
i suppose it can also be use for uterine tamponade for uterine bleeding. Cool huh?
2. Incomplete spontanous abortion
Ni semalam punye cite. This lady came with chief complain of vaginal bleeding. She’s 8 weeks pregnant and the consultant (dr.doddy) did USG and found that there was no longer any gestational sac but there where still some product of conception left in the uterine.
I did vaginal touche and found that the cervix was 2cm dilated n i felt the retained products intrauterine.
The doctor suggested curettage to be done the next day. And he also suggested the mother to take a Toxoplasmosis test…apparently it is one of the major causes of spontaneous abortion here.
3. Pre-eclampsia (AGAIN!)
Right now i’m following a patient with severe pre-eclampsia. She came in on the 16th of may with high BP (220/130). She was 21-22 weeks pregnant then. She was put on ceremax (nimodipine) for her high BP and placed under intensive care. Today her bp was 120/80..alhamdulillah. Sadly when we did USG on her baby…the baby was only 500kg (it’s supposed to be an average of 600-1000kg) by now. And since the only treatment of pre-eclampsia (in order to safe the mother’s life) is termination of pregnancy the dr (dr rhabby) decided to end the pregnancy…now it’s up to the patient. Hope to go see her again this saturday during oncall.
4. Molar pregnancy
“Hamil anggur” as it’s called here. Nothing sweet about it. A pregnant lady came in thinking that she’s pregnant and when we did USG on her there was no gestational sac only proliferating chorionic villi. She did go to a district clinic but the doctor there didn’t suggest curettage (to prevent molar from becoming cancerous is to do curettage)…wat a dumbass doctor!!
Post curettage the lady is not supposed the get pregnant in one year and is only allowed condom for contraceptives (no pills, no japs nodda).
What is curettage u ask? It’s a procedure to remove unwanted remnants (of conception or endometrium) from the uterus using a curette. It’s sometimes used for intentional abortion.
I did it once but nothing came out. I’m supposed to be more forceful…hehe
I’m supposed to be more forceful…hehe
How funny to cause Asherman’s syndrome. You must be a very compassionate doctor. Perhaps your wife or future wife will get it from a D&C and you won’t find it so funny then… hehe.
There are alternatives to D&Cs which you should know about as a doctor. Does your hospital not have a hysteroscopy to provide visual guidance during intrauterine surgery? Or perhaps you don’t have the necessary skills and training to perform hysteroscopy. Have you been taught how to use misoprostol for managing miscarriages?
By the way, the uterus does not become scared, it becomes scarred, and usually from a D&C.
Thank you for your comment.
1st of all, sorry for the spelling mistake.
2nd of all, please understand that i’m not an O&G specialist. I’m a clerkship student doing my rotation in O&G department.
3rd: The patient that came in with asherman’s syndrome, she underwent MULTIPLE myomectomy, so i would imagine that asherman’s syndrome is an inevitable complication no matter how competent the surgeon is…who ever he is.
4th: i don’t have a wife.
5th: D&C happens to be the hospital’s Standard operating procedure for incomplete abortion etc. Please understand that I’m working in a developing country where ppl r poor n usually don’t come back for follow ups. Giving simple uterotonic may lead to retained product of conception and thus infection one way or the other.
Again i apologize if the article is very vague that u prematurely judge me as an incompetent doctor.
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