Kenapa la jonah sangat!!!

Salam alayk...

OK, it's time to update blog! Hehe. I was oncalled last night with Dr Mas Ayu (ayat mukaddimah wajib setiap kali pass over case. haha). I was (or should i say 'we were'?) so 'jonah' last night that we had 3 major cases to attend.

CASE 1:
35 years old Gravida 5 Para 4 at 32 weeks, came to Labour Room Hospital Kemaman at 7 pm with birth before arrival (BBA). Upon attending, we were told that it was a twin pregnancy and the first twin was already out from mother's vagina. However, noted that the mother was brought in unconcious, pulseless, with pupils fixed and dilated. Red alert was activated immediately and the mother was brought to resuscitation. Cardiopulmonary resuscitation (CPR) was initiated as cardiac monitoring showed pulseless electrical activity (PEA). Mother was successfully intubated by anaesthetist after 3rd trial. After repeated adrenaline administration and active resuscitation, she was finally reverted. 2nd twin was delivered by obstetrician by internal podalic version. Baby was resuscitated and intubated by paediatrician, and was sent to HSNZ for further ventilation in view of hypoxia and possible hypoxic ischaemic encephalopathy (HIE). The 1st twin was observed in SCN.

Further history form husband, patient had pregnancy induced hypertension (PIH) and was advised for admission in view of high blood pressure, but she refused admission at her own risk (AOR). She started to have contraction pain since 5 pm and the couple planned to go to a private hospital in Kuantan for delivery. However, upon passing Kijal (they were from Paka), the mother started to fitting and collapse. Currently mother was ventilated and sedated in High Dependency Ward (HDW) and was on inotrope. Risk of mortality and morbidity was explained to husband.

CASE 2:
24 years old Para 1, 13 hours post spontaneous vertex delivery (SVD), complained of dizziness and nearly syncope. Upon attending, patient looked mild pallor, sweating, mild tachypnoiec and hypotensive. She revealed having increased per vaginal bleeding since post delivery (estimated blood loss 700 ml). Uterine massage already done by staff nurse and bleeding stopped. 1 pint whole blood was transfused last night and patient currently stable.

CASE 3:
29 years old Para 4, Day 3 post SVD, had late onset PIH. Noted systolic blood pressure was high. Patient also complaint of dizziness, nausea and blurring of vision (sign of impending eclampsia). T. Labetolol was increased to 300mg TDS and T. Prazosin 1 mg BD was added on. Patient was transferred out to pre-eclampsia (PE) room and was started on IV MgSO4 bolus and infusion.

What a night~ Even though I was barely able to sleep, but the experience is priceless!

Maido ari, jaa~

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