Thursday, June 27, 2013

external cephalic version


Tahukah anda "pusingan bayi dari songsang menjadi kepala dibawah”atau dikenali sebagai "external cephalic version" adalah procedure lama yang telah praktikkan oleh bidan kampunng zaman dulu?  Bezanya ianya bukan lagi dilakukan oleh mak bidan tetapi oleh doctor terlatih dibawah pengawasan ultrasound,CTG dan dewan pembedahan.

 ECV ini dilakukan pada usia kandungan 36 hingga 37 minggu kerana awal dari itu bayi akan pusing balik menjadi songsang dan kalau lewat pula, ia sukar dilakukan kerana air ketuban telah pun berkurangan.

Namun apa yang lebih  penting di sini adalah jika berlaku komplikasi semasa ECV yang memerlukan bayi dilahirkan secara caesarean!

Sebab itu ECV mesti dilakukan oleh yang telah terlatih,dihospital yang ada dewan bedah dan pemantauan bayi dengan CTG.

Peratus berjayanya external cephalic version ini mengubah bayi songsang  adalah 50% dan dengan ini ia mampu mengurangkan setengah dari risiko caesarean. Namun kira-kira 3 % akan pusing balik menjadi songsang. Anda juga perlu tahu bahawa tidak semua ibu yang mempunyai kandungan songsang boleh melakukan ECV.

Jadi mari kita BACA sedikit info tentang External Cephalic Version dari buku department O n G ;


Def: a procedure designed to substitute one pole of the fetus by the other. The idea is to make cephalic delivery which is safer for the mother and infant..
Time: best 34-36 weeks

Before 34 weeks: 1.spontaneous version may occur
                              2. Recurrence after correction
                              3. Precipitate premature delivery
                              4. After delivery, difficult technique due to
                                                a)decrease amount of amniotic fluid
                                                b)increase size of uterus
                                                c) uterus more irritable and sensitive 4 manipulation

Prognosis: succeeds in about 75% primigravidas and 95% of multiparas

Aims & Advantages : 1. Decrease of fetal mortality & morbidity
                                    2. Decrease of maternal morbidity
                                    3. Test for cephalopelvic disproportion
                                    4. Decrease of CS rate

1. Patient lies with moderate Trendlerberg's position ( tp dlm video atas x guna pun cara ni)
2. Bladder & rectum empty
3. Vulva uncovered to detect any vaginal bleeding

          one hand grasping the head and the others graps the breech

         1st step : displace the breech into one or other iliac fossa after listen to FHS
         2nd step: push head down towards the pelvis and breech upward towards fundus. this turn fetus                                  transverse lie.
         3rd step: head pushed over pelvic brim & breech pushed up towards fundus
         4rd step: push head down into brim as low as possible by grasp with 2 hand
         Finally   : press upon fundus so as to push whole fetal body as low down as possible.

Failure of external cephalic version:

1. Extension of legs (commonest cause) as leg act as splints. Failure occurs in 50% of cases of breech with extended legs.
2. Obesity
3. Rigid abdominal wall
4. Irritable Uterus
5.Uterine abnormalities as bicornuate
6.Deficient or excessive liquor
7.Short umbilicus cord
8.Oversized fetus

Complications of external version :

1.Partial separation of the placenta leading to accidental haemorrhage
2.Rupture of membranes and premature labor
3.Fetal shock
4.Cord presentation and prolapse or entanglement of the cord around the fetus
5.Fetal mortality rate is about 2%

Contraindications of external version:

1.Antepartum Haemorrhage
2.Hypertension ( the placenta is liable to separation)
3.Marked contracted pelvis (CS will be done)
4. Twins
5.Scars in the uterus
7.Elderly primigravida ( above 35 years)

Sudah faham tentang EVC? semoga penjelasan ini dapat membantu anda.
Bagaimana pula dengan IPV iaitu internal podalic version? Jom sama2 discuss dan research..

Thursday, June 13, 2013

oh my ear !


وَهُوَ الَّذِي أَنْشَأَ لَكُمُ السَّمْعَ وَالْأَبْصَارَ وَالْأَفْئِدَةَ ۚ قَلِيلًا مَاتَشْكُرُونَ

"And it is He who produced for you hearing and vision and hearts ; lttle are you grateful."

(surah al- Mu'minun, 23:78)

 وَاللَّهُ أَخْرَجَكُمْ مِنْ بُطُونِ أُمَّهَاتِكُمْ لَا تَعْلَمُونَ شَيْئًا وَجَعَلَ لَكُمُ السَّمْعَ وَالْأَبْصَارَ وَالْأَفْئِدَةَ ۙ لَعَلَّكُمْ تَشْكُرُونَ

" And Allah has extracted you from wombs of your mothers not knowing a thing, and He made for you hearing and vision and hearts [ i.e., intellect ] that perhaps you would be grateful."

( surah an- Nahl, 16:78)

Do you realize wherever the faculties of hearing, sight and understanding [ intellect] are mentioned in the Quran, the faculty of hearing is always listed first?

It is well known fact that human learning is largely dependent upon hearing more than anything else. A child born blind may be seriously handicapped but still can learns and understand things by using his ear. However, a child born deaf has a much harder time and difficulty in learning.The Quran thus emphasizes the importance of hearing over any other faculty.

It is interesting to note that the Quran always uses the singular form of the word hearing (as-sam'), while it uses the plural form for sight ( al- absar). Recent studies have shown that the visual center in the brain, known as the occipital lobe, is in duplicate, while the hearing center is single. SubhanaAllah!

Do you know that that in the fetus, ear are developed as early as the twenty second day of pregnancy and are fully functioning as early as the fourth month?

The fetus can hear the rumbling of his mother's stomach and the sound of her eating and drinking. And of course the fetus also can hear his mother's external environment!

This could also explain why Quran mentions the faculty of hearing before any other. According to the Prophet's teaching, the first thing a child should hear after birth is the adhan (azan), and it should be pronounced in his right ear.

SubhanaAllah, miracles mentioned proof Quran is revealed by Allah, the All-Knowing Creator.

still remember anatomy of ear? Lets revise together! ;)

 Mentaqarrub diri kepada Allah,profesional doktor dalam genggaman!