Tuesday, January 25, 2011

Ventouse delivery

When I told a friend of mine I'm currently in O&G posting, he was actually quite surprised... Guess what he said? "Hey! I taught u studying medicine? how come end up posted to Oil &Gas? LOL... bro!! O&G means obstetric and gynaecology! It's a medical specialties focus on female reproductive organs in their pregnant and non-pregnant state... definitely have nothing to do with oil nor gas!!

Well... O&G posting was pretty fun... Never been this excited to go for night duty before... although the long hours of waiting in the labour room is kinda tiring but when u get to see a delivery u know it's all worth it... Can't wait to go back for hospital posting... community medicine for O&G is BORING!! all u do is just clerk cases and help new mummy with their booking and follow up... If u are lucky u can play with some really cute babies and that's all...

Finally done with my presentation... The topic was quite nice actually... enjoy preparing the slides and reading about it... I don't know... This is my very first time I feel like sharing medicine information on my blog... Will be only focus on the main points and definitely dedicated for those that fall asleep in the class ya!! Please refer to standard textbook for details... (actually nothing much u can find on textbooks too... go read my slides lah!! I send to group email dy~)

Okay let's get it started. (will be in very layman explanation for the non-medical readers)

What's ventouse delivery?

It's a type of assisted instrumental delivery by using a vacuum extractor applied on the baby scalp (head) to pull the baby out from the mother's uterus in order to hasten the second stage of delivery ( a stage in which the baby is being delivered from the mother's womb)...

This is how the machine look like...

Why do we need to use it?

Simple... Just think of any situation that require the shortening of the period of time in second stage of delivery... Let it be prolonged labour ( 2 hours in primigravida - women that's pregnant for the very first time and 3 hours in multigravida - women that's pregnant for twice or more ), maternal condition such as diabetes, hypertension, fetal distress and fetal in occipitoposterior position (for this please remember to use the Bird's modification posterior cup!!)


The flexible silastic cup
Bird's modification posterior cup...
take note that the suction tube is connected to the periphery of the cup...

Is it applicable for all delivery?

Definitely NO! Please remember that it's ONLY for fetus presenting with vertex (baby's head come out first from the mother's womb) and NOT on pre-term babies (those that's less than 34 weeks in gestation)...

How it's done?

The steps are quite simple... Less experience is required compare to forceps delivery...

1. Preparation

Explain to patient the purpose and procedures of the use of vacuum extractor.. please remember that maternal contraction is required for the procedure to be done... ask her to tell you when she begin to contract and when it's end until the next contraction...

Place the mother in lithotomy position and catheterized the bladder (empty the urinary bladder)... Check if the vacuum pump and extractor is working and make sure no leaking in anywhere of the tube because specific pressure is required...

2. Application of vacuum cup

Insert the cup into the vagina and place it as near as possible to the posterior fontanelle over the mid sagittal line with the edge 3cm from the anterior fontanelle... This is to promote flexion of the head and lead the smallest diameter of fetal skull into the maternal passage....

The point where we apply the vacuum cup

3. Creating vacuum

Creating negative pressure by raising the vacuum pressure to 0.2kg/cm²... increase the pressure for 0.2kg/cm² in every minute until the pressure of 0.8kg/cm² is acquired... this is for the chignon formation in the fetal head... (note* this only applied for metal cup... not required in silastic cup due to it's flexibility and ability to grab on the fetal scalp without waiting for the chignon formation) However, the chances for detachment in silastic cup is higher compare to metal cup... BTW... remember to run your finger around the cup to make sure no maternal soft tissues (vagina or cervix) is included in the vacuum cup before applying the pressure...

4. Traction

Apply traction or pull only when the mother contract... Make sure the traction is perpendicular to the fetal head to reduce the chances of cup detachment and also to control the direction of the fetal passage from the mother's womb through the birth canal...

Finally the baby head should be out and the rest of the steps is similar to normal vaginal delivery... detach the cup slowly to prevent any risk of scalp damage... Remember to explain to the concern parents about the chignon at the baby head due to it's disfigurement but it will resolve spontaneously after a day or 2....

Chignon... Don't worry.. It will disappear in at most 2 days..

What's the rule for ventouse delivery?
  • The delivery should be completed in not more than 15 minutes.
  • The head should descent in each pull.
  • The cup should reapplied not more than twice.
  • If failure despite good traction, do not try using forceps as well!! prepare the patient for a Caesarean section.
Pros and Cons?

The advantages of ventouse delivery is episiotomy is usually not required and mother still play an active role in the process of delivery... Besides, damage to the fetal head is reduced compare to forceps due to the lower compression force and also reduce the possibility of maternal injury...

Disadvantages... practically nothing much... just remember that ventouse is only applicable for vertex presentation and not for after coming head of breech... maternal effort is required and more expensive compare to forceps...

Well... I guess that's some basic info on ventouse delivery... The video below will actually summarize and u how it's done... enjoy!! *note... not for those weak heart... =)

PS: thanks to Dr Hla Min for sending me the video early midnight... what a dedicated teacher we have!!



Saturday, January 22, 2011

random weekend...

woke up at 6am... went to the bathroom and wondering why my alarm is not working... suddenly i realize it's Friday!! (at Terengganu weekend is on Friday and Saturday) damn.. busy days really make me lost track of time... went back to the bed after a morning pee and switch on the unconscious mode again for 6 hours!! feels great to have ample sleep... another record is set!! wake up at 12.30pm!!

Chinese new year is around the corner and i notice my room is full of dust and webs... spend almost half a day just to give a good clean-up... the most exciting part while cleaning is to suck those little spiders into the vacuum cleaner... hahaha... they have no place to run...

Don't feel like studying for the day and I practically have nothing better to do... suddenly remember my dear cousin been bugging me for sands from KT for almost 7 months... dunno why she want the sand for but at least i found myself something fun to do... jog to the nearest beach and get her some sand...

If I'm not mistaken the beach is named Pantai Chendering and was about 15 minutes jogging distance away from my house... usually some of the Malay youngsters or the Mat REMPITs will either shout or honk at us if they happen to see us (non-Malay) walking around alone or in a small group... but today is totally different... pass by a few groups of youngster while jogging to the beach and what surprise me is that when we have eye contact we actually smile and greet each other... the moment is just amazing... totally a true Malaysian spirit... Love the Country, Hate the Politics...

Spend some very own moment at the beach... Just simply stare at the sea and think of nothing... Perfect way to calm my mind... The beach is beautiful after the cessation of monsoon season... no more rain, muddy colour sea, strong wind and huge waves... the only problem is the area is full of used bottles and plastic bags... some people just don't know how to deal with rubbish even when there's bins provided... "Take nothing but pictures, leave nothing but footprints"... opps I curi-curi take away a bottle of sand!! It was a fun evening.. hope to do it again someday...

My favourite picture!

wonderful weather for kites

little boy swimming naked!!

broken shells...

a view of Pulau Kapas from the beach...

sunset!! it's time to go home for the homemade steamboat... thanks to ah bi!!

a view of the river from the bridge...

Medan ikan bakar!! they say the fried sotong is nice... haven't try it before...
it's on my next to do list...

Wednesday, January 12, 2011

Done with Internal Med!!

Hoorrraaayyy! days of totally no games and entertainment is FINALLY over!! internal med EOP exam is definitely a challenging one... at least harder than surgery...

acute coronary syndrome in diabetic patient present ONLY with lethargy and vomiting for 2 times (after meal summore) as long case and pleural effusion in TB patient as short case... moderate performance I guess... too bad he din't give me the AEBA and mitral regurgitation case... that will be way easier... anyway what's done is done... most important of all is to enjoy the moment!!~

First thing I did after EOP exam is Counter Strike session with 3 of my housemates... (the game is subconsciously installed in my com and I subconsciously played it... LOL) This is the very first time I actually play CS... soo gan jiong!! being blur and get killed most of the time without knowing where the shooter are... quite fun lah... Beware of ji yin! he has an eagle eye! always 1 shot KO me... hahaha...

Took quite a number of old games and yes.. "angry bird" from ah bi! spend almost 4 hours playing infront of the com... so long never been this crazy ady! it's like there's no mock exam next week... anyway since no marks is counted for it I guess cincai study abit abit can dy lah... hehehe...

Can't wait for O&G posting... can't wait to see delivery... can't wait for my very 1st delivery... and most important of all... Can't wait for CNY holiday!! back to games again~ (mummy! if u wan to blame... blame my house mates ya! 是他们带坏我的! hehehe... XD

Tuesday, January 4, 2011

Beijing~

When people say they are going to visit China 10 to 20 years back I'm sure most of them will be advised to bring along an umbrella!! Why? There's no door in the toilet and u will need something to cover yourself!! But things had changed... Now even their toilet are way cleaner and high tech than you can get in Malaysia (okay lah if u exclude those rural area... not every places in China are well developed)...

beautiful sunrise while we 1st arrived at Beijing~

No doubt Shanghai and Beijing are currently one of the few leading city in the World... Unfortunately no matter how well your country can develop it's hard for you to change the character and habit of the people... Until now you will still able to see most of the people spitting around like nobody business... digging their nose as though others are blind... people arguing or fighting on the street... bugging you to buy their merchandise and worst of all... doing big business in the toilet without closing the door even when there's a DOOR!! Ok lah... to be fair.. MOST of the incident mentioned above I only manage to see it once during the trip... so China is still a nice place to visit... (If u are lucky.. u get to see people defecating... LIVE!!) hahaha... how cool is that man!!

Besides... most of the time it's hard to get a view of clear blue sky during the day... the air pollution is so severe until u can have 2 black dry nasal mucus produced at the end of the day!! seriously I mean BLACK!! hahaha... I guess until now I just keep talking bad about China huh... Better I write something good about the place...

air pollution!! lucky still can see the blue sky... are these nuclear power plant?

Okay... I was told that if you were ever gonna visit Beijing... There's 4 important things that you have to do... take a picture in front of Tian An Men square, watch Chinese Kung Fu, climb the Great Wall of China and most important of all... eat Beijing Roast Duck... there's a saying in Mandarin... “天安门前拍张照,中国功夫过几招” , “不登长城非好汉,不吃烤鸭真遗憾”... well... after I climb the Great Wall of China this sentence is better “登上长城就流汗,冷风吹来打冷颤” hahaha...

a ninja posing in front of Tian An Men

Acrobatic show.. I guess this can consider as Chinese KungFu huh...

登了长城,做了好汉

Beijing roast duck!! nyum nyum~

It's always fun to look at the design of buildings and skyscrapers... at Beijing, a place with the combination of both historical and modern architecture impressed me very much... really an eye-opening vacation... especially the Great Wall of China and the Hanging Monastery...
a view of the Forbidden City from 景山公园
(the place where last emperor of ming dynasty committed suicide)

weird animal statues found in the Forbidden city...

wax statue of the last emperor of Ming dynasty(崇祯皇帝)
committing suicide after Beijing was fallen to 闯王李自成...

Temple of Heaven (天坛公园)
a place where emperor of Ming and Qing dynasty pray to the God of Heaven...

3 of us make it to the top of 万里长城居庸关...
it is very cold up there with the strong wind...

sunset at 5pm when we are on our way to Da Tong from Beijing...

The hanging monastery with a ninja posing there (our Malaysia guide)...
50 meters above the ground with the history of more than a thousand years...
Impressive!!

a view from the Hanging temple...

Yungang Grottoes (云冈石窟) Guess what's inside?

statue of Buddha!! created during northern Wei dynasty when Buddhism is their state religion..

There's a total of 252 grottoes with more than 51,000 Buddha statues...

The largest sitting Buddha statue at Yungang Grottoes...

7 stars hotel build for Olympic Game... resemble the shape of a Dragon...

Bird nest stadium...
all the missing iron bar of our longkang finally end up here.. hahaha..

sitting inside the stadium!! alone... LOL

on of my favourite... CCTV building...

Silk street... a place where u can get very very cheap imitation stuff like shirts, bags and shoes... very fun place to go if u like to buy cheap stuff and negotiate for very low price..

HINT* when they offer you a price.. divide it with 4...
that's the price of the goods worth..
if possible, lower it summore with the walking away technique...
U will not believe how low they can end up offering you...

Food is also a very important part when one visit another place or country... Of course it must not be any preserved fruits... the only kind of food I will never try (dunno why I just don't like it)... anyway... Beijing has been the capital of the country for quite a few dynasty and off course directly influence their local delicacy (since they had been conquered and ruled by different ethnic and tribe before at this place)... Here u can get almost any type of delicacy you want from all around China... Yunnan, Shi Chuan, Mongolia and off course the Man Han (满汉)feast! manage to try some such as 大同刀削面,北京饺子宴,北京烤鸭,四川菜 and many more which I couldn't remember now... hahaha...

had our lunch at one of these Mongolia yurt...

tried Goat milk for the very first time... erm.. taste normal only lah...
still prefer cow's...

Mongolia roast lamb!! taste damn nice with the chili sauce...

Buffet dinner at Qing Hua Chi restaurant... eat eat eat...

Beijing dumplings with 10 different flavour...
to be honest.. 5 of them taste the same for me... no different one la... LOL

someone licking 冰糖葫芦 in the hotel room... =.=

Do not to forget to try out their very own instant noodle “康师傅快熟面”... tried once at China and taste real good compare to other instant noodle... big bowl and damn cheap... aww I miss it so much especially now... *stomach is craving for food*

such a big bowl with only 3RMB!! (around RM1.50)

Finally.. must not forget to introduce our local tour leader Mr Jack, China tour guide 小李 and sexy Pandas!!

Jack!!
curi-curi take one of the flag at The Great Wall just to pose...

小李...
her brain is full with the history and every single detail of the place we visited...
I doubt if I can still remember half of the things she said...

Before i introduce Mr and Ms Panda... have a look at their poo!! look like durian right?

some characteristic of Panda...

Finally... Panda!!

Hey!! i want to eat too!!

Well.. I guess that's about it... summarized most of the important part of the trip... It's time to prepare for exam!!

someone took our picture!!
it's fun to see airplanes take off at such a close view...

Flying back with China airline.. Boeing 757...

just randomly feel like sharing a cold joke....

为什么只有北京,南京和东京而没有西京呢?
因为给唐三藏取走了!(西经)冷~~