While others were enjoying their long wesak weekend going camping and falling into the stream n wat not…there i was literally stuck in karawang with no friends except my trusty lenovo n mobile T waiting for the fateful 24 hour oncall day.
Alhamdulillah everything went smoothly…no unexpected seizure, apnea or death, but plenty of patients to learn from.
1. That bloody ShOW??
Simply speaking, the 3 major signs of labour is bloody show (blood + mucous), gush of amniotic fluid and frequent contractions.
Here comes a lady 9 months pregnant with chief complaint of profuse bleeding. Her vital signs were within normal limits (no signs of hemorrhagic shock). The 1st thing you would think about is antepartum bleeding (i.e. plasenta previa, solusio plasenta, uterine abruption). We didn’t do the vaginal touche fearing that if it was plasenta previa (low lying placenta), the bleeding would worsen.
Here comes dr doddy very early in the morning firing up his USG and discovered that the plasenta was infact in the fundus area (way up high!). He did inspeculum examination just to be sure…and he showed us the blood filled mucous …. that BLOODY SHOW!! haha
Rx/ Observe labour progression
This is not the 1st time i encountered the so called “antepartum bleeding”. The very 1st time, i consulted dr rhabby about it over the phone and without even looking at the patient is said “Itu mahhh…SHOW ..tenang aja!” (it’s just show…relax).
In the 5 years of med school i’ve always thought that bloody show would be dabs of blood, like your last days of menstrual period…in reality it might even be as ’gushing’ as the amniotic fluid. So if u ever encounter a term pregnancy with bleeding make sure to ask 1) is there mucous/lendir? 2) is this the very 1st time?…if the answer is yes to both then insyAllah it’s just SHOW. (plasenta previa usually bleeds earlier in pregnancy… around > 32 weeks).
2. A one year old molar??
Here’s another mind boggling tale for you. This girl (19 yo), married for one month came in with chief complaint of frequent, excessive, painfull mentrual period for almost over a year i.e. menometrorrhagia. (don’t ask me y she waited so long to come to the doctor)
Dr doddy did USG on her and discovered something that looked like “molar pregnancy”.
In molar pregnancy, beta HcG (the hormone pregnancy test pack detacts for) is veryy veryyy veryy high, due to hyperplasentosis. So clever enough we did a pregnancy test on her. Wo n behold..it was NEGATIVE..twice!
On vaginal touche…the uterus was like a 12-13 weeks gravid uterus, which is also another sign of molar pregnancy.
Let me sum up…
1. Menometrohagia for one year (before marriage)
2. VT: uterus 12-13 weeks
3. USG: suspect molar
4. Pregnancy test: negative
Any ideas??? I’m putting my money on endometriosis (based on the history). Will update on patient progress..n will read more on endometriosis. hehe
3. Missed Twin pregnancy
At 4 in the morning, this lady came refered by a midwife with High BD (160/100)…. ok, it’s not about pre-eclampsia this time! haha
I did her obstetrical exam n found out that her cervical dilatation with 8-9 cm…about an hour away from delivery. As i was trying to find the fetal heart rate via doppler i felt as though there was 2 hard long fetal parts on both sides of the uterus…thinking that the mother was having her contractions i dismissed reasoning and counted ONE fetal heart rate. Later, haris asked the mother weather she had done USG before…she said yes..and there was only ONE fetus found on USG.
One hour later she was fully dilated and ready to go. Here comes ONE baby girl….wait a minute….there’s another one!! breeched!! Thank god for the ever ready midwife, she delivered the breeched twin via Mauriceau–Smellie–Veit manoeuvre and BOTH babies finally managed to see each other face to face after many months being upside down. haha
Moral of the story is…never dismiss your instinct!!! even if there’s USG.
And oh yea….thank you to all the midwives in the world..even though some of u r very nasty people!!
