DEPARTMENT OF

OBSTETRICS & GYNAECOLOGY

CASE WRITE UP OBSTETRIC

YEAR 3/2020

GROUP 1 COHORT 5

LECTURER’S NAME : PROF DATO’ DR. MOHAMED ROUSE B. ABD MAJID

PREPARED BY : FARAH NUR AISYA BT FADZIL

MATRIC NUMBER : M183000334

DATE : 4th APRIL 2021

PATIENT’S IDENTIFICATION DATA

Name : Puan Rahimah Binti Rozali

Age : 40-year-old
Race : Malay
Gravidity :5
Parity :4
LMP : 19th May 2020
EDD : 26th February 2021
POG : 29 weeks 4 days

My patient is Puan Rahimah Binti Rozali, 40-year-old Malay lady, Gravida 5 Para 4 at 29
weeks 4 days period of amenorrhea (POA). Her last menstrual period (LMP) was on 19 th May
2020. She claimed that her menses was regular. Her estimated date of delivery (EDD) is on
26th February 2021. She was sure of date. Early urine pregnancy test (UPT) was done at 16
weeks POA and was found positive, while early scan dating was done at 16 weeks POA,
which corresponded to date.

HISTORY OF PRESENTING ILLNESS (HOPI)

Patient presented with a complaint of severe and persistent dizziness since one month ago.
The dizziness started suddenly when she was sweeping the floor at her house. She mentioned
that the dizziness was felt all over her head and it was spinning in nature with the pain score
of 6/10. The dizziness last for about 2 hours and will become worsen if she was standing. She
claimed that she will take a nap or ask her husband to massage her head in order to relieve the
dizziness. She denied taking any over the counter medication to alleviate the pain. However,
the dizziness will stop for a while after she took a nap but will come back later whenever she
tried to do some works. She said that in every three days, she will be experienced at least one
episode of dizziness. The dizziness disturbed her daily routine as she cannot get anything
done once the dizziness started. Hence, she claimed that over time, the frequency of the
dizziness was increasing to at least once every two days, and the intensity also increase with a
pain score of 8/10.

On further questioning, the dizziness was associated with a few episodes of projectile
vomiting. She said that she only vomit whenever the dizziness started. The content of the
vomitus was food that she just ate or sometimes it just unreproductive retraction. She denied
any treatment taken to relieve the symptoms.

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Apart from dizziness, she also feels fatigue but there was no fever. Patient also did not have
any blurring of visions or vertigo.

She also has no abdominal pain, no leaking liquor and fetal movements were good.

Otherwise, patient denied any per vaginal bleeding or vaginal discharge. There was no
episodes of diarrhoea or constipation. There were no dysuria, hesitancy, urgency, or polyuria.

Patient also denied any history of fall, trauma, or abdominal massage.

Upon clerking, her blood pressure value increased up to 149/80 mmHg. However, it resolved
to normal range two hours later after the patient was being warded.

ANTENATAL HISTORY (ANT)

This was a planned and wanted pregnancy.

Her first booking was at 16 weeks POA. She did not remember her booking blood pressure
but she was told as normotensive and her booking weight was 65 kg with a height of 155 cm
making her BMI was 27.1 kg/m2 which was overweight. On her booking urine test, urine
albumin and sugar were negative. Patient claimed that her VDRL and HIV screening was
non-reactive. On her booking blood test, her haemoglobin (Hb) count was 10 with a blood
group of B+.

Patient also could not recall the number of total antenatal follow-up, but she said that she
went for follow-ups at the clinic once every month. Throughout her follow-ups, she was told
that her blood pressure remained normotensive. Fundal heights were corresponded to date
and fetal movements were good. Her total weight gain was 9 kg.

Patient denied any excessive early pregnancy symptoms and her first quickening felt was on
12 weeks period of amenorrhea. She has taken her IM ATT at 28 weeks POA.

Serial Hb was done at O&G HSAH, with low range Hb level. However, she did not sure at
which POA they were done. Hb values were low, ranging from 9.7 – 9.9 g/dL. Her latest Hb
was 9.7 g/dL which was done in HSAH at 28 weeks POA.

She did not have any MGTT done due to her pre-existing diabetes mellitus type 2. Right now,
patient is on s/c Actrapid 14/10/10U, s/c Insulatard 16U ON & T. Metformin 1g BD for her
diabetes mellitus. She would monitor her blood sugar profile (BSP) once every 2 weeks.
Patient claimed that her blood sugar profile ranging from 5.7 - 7.7 mmol/L.

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Her latest BSP readings was at 29 weeks POA which was on 3 rd December 2020 were
5.7/6.2/7.7/6.2/5.1/5.8 mmol/L. Her HbA1c level as of September 2020 was at 8.2%. She also
had non-proliferative diabetic retinopathy (NPDR) and went to check up at Ophthalmology
Clinic on 13th October 2020, which reveals that her right eyes have moderate NPDR, while
her left eyes have moderate to severe NPDR.

Other than that, patient also claimed that she had alpha-plus thalassemia and was diagnosed
in 2015. DNA analysis of her husband and children was taken, and the result was still
pending. Her serum ferritin as of November 2020 was 47.60.

Scans were done at KK Merbok with a total of 3 scans. However, she did not remember at
which POA the scan was done. Therefore, she was told normal that her fetal growth
correspond to date. Her latest scan was done at Klinik Pakar O&G HSAH at 29 weeks 4 days
POA. She was told normal, fetal heart seen, oblique lie, parameters correspond to date,
placenta was at upper segment, estimated fetal weight was ranging between 1.2 to 1.4 kg,
Amniotic fluid index (AFI) was 16 adequate.

There was no history of admission during this pregnancy.

PAST OBSTETRIC HISTORY (POH)

She delivered her first child in 2016 at full term via Spontaneous Vertex Delivery (SVD). Her
first child was a baby girl with a birthweight of 3.0 kg. Her second baby was delivered in
2009 at full term via SVD. It was a baby boy with a birthweight of 3.2 kg. Her third child
which was a baby girl was delivered at full term in 2013 via SVD with birthweight of 3.1 kg.
Her fourth child was delivered in 2017 at full term via SVD. It was a baby boy with a
birthweight of 3.4 kg.
All her babies do not have complications after delivery. Both baby and mother were well
after delivery. She breastfeeds all her babies for 2 years. All were planned and wanted
pregnancy. Patient denied any contraception taken after deliveries.

PAST GYNAE HISTORY

Patient attained her menarche at 11 years old, with menses 7 days normal flow with regular
28 days cycles, no menorrhagia, no dysmenorrhea, no post-coital bleeding, no intermenstrual
bleeding, and no sexually transmitted disease. Her last PAP smear done was in 2004 and was
told normal.

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Patient had no previous gynaecological problem and no gynaecological operation done
before.

PAST MEDICAL HISTORY

Patient has Type 2 Diabetes Mellitus since 2018 and under KK follow-up. Otherwise, she has
no heart disease, hypertension, or asthma.

Patient mentioned that since last year (2020), she had non-proliferative diabetic retinopathy
(NPDR). Other than that, she also claimed that she had alpha-plus thalassemia which was
diagnosed in 2015.

PAST SURGICAL HISTORY

Patient had no previous surgical problem and no previous surgical operation done before.

FAMILY HISTORY

Both of her parents are still alive. Her father is 68-year-old, and her mother is 62-year-old.
Both of her parents had diabetes mellitus and on KK follow-up. Otherwise, no hypertension,
no asthma, and no heart disease.
Patient is the first child from 4 siblings. All her siblings have no hypertension, diabetes
mellitus, asthma and heart disease.

DRUG / ALLERGY HISTORY

Patient denied taking any traditional drugs before.

Presently, patient is on s/c Actrapid 14/10/10U, s/c Insulatard 16U ON and T. Metformin 1g
BD for her diabetes mellitus. She also on T. Haematinic 1/1 od.
She has no history of allergy to drugs or seafood.

PERSONAL / SOCIAL HISTORY

Patient is married for 16 years. Patient is a rubber-tapper, and her husband is a factory
worker. Their total income is approximately RM 4500 monthly. Both of patient and her
husband’s education level is SPM. Both of patient and husband do not smoke, drink alcohol
or in case of drug abuse. She stays at Kampung Merbok, Kedah in a village wooden house,
with basic amenities, clean tap water supply, good electricity and using flushed toilet system.
The distance from her house to the nearest health clinic is 4 km. Both of patient and her

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husband wishes to have 5 children. She had good support from her parents and parents in law,
as well as her siblings, if needed, as they are staying nearby.

SYSTEMIC REVIEWS:

Respiratory System

Patient had no shortness of breath, no wheezing, and no early morning coughs.

Cardiovascular System

Patient had no palpitations, no orthopnea and no paroxysmal nocturnal dyspnea.

Musculo-Skeletal System

Patients had no bone pains, no joint pains, no back pains, and no muscle pains.

Endocrine System

Patient had no tremors, no heat or cold intolerance and no polydipsia / polyuria

SUMMARY

40-year-old Malay lady, gravida 5 para 4 currently at 29 weeks 4 days period of amenorrhea
come with a complaint of severe and persistent dizziness for one month ago. Currently, no
contractions felt, no leaking liquor and good fetal movement.

CLINICAL EXAMINATION

General Examination

Patient is comfortable, lying supine on bed, slight prop-up 30’ and supported with 1 pillow.
She is not in pain or in any respiratory distress.

Her blood pressure (BP) is 122/80 mmHg, PR is 86 bpm, regular rhythm, normal volume.
Patient is not dyspnoeic with RR of 18 breath per min. She is afebrile with temperature of
37’C. Patient is obese with weight of 69 kg.

There is branula attachment over dorsum of her right hand, attached to a Dextrose Saline drip
infusion.

There is no clubbing and no peripheral cyanosis. The capillary refill time is < 2 seconds.

She is not pale and no jaundice.

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Her hydration status is good. Her oral hygiene is good. There is no central cyanosis and no
dentures.

There is no goitre and her JVP is not raised.

There is no ankle edema bilateral.

Other Systems Examination:

Respiratory System

The air-entry are equal bilateral. Lungs are clear bilateral. There is no crepitations and no
rhonchi.

Cardiovascular System

1st and 2nd heart sound are heard and normal. There are no murmurs.

Central Nervous System Examination

Reflexes are not brisk.

Breast Examination

The breasts are symmetrical bilateral. The nipples are everted and not deviated. There is no
nipple discharge. No mass palpable bilaterally.

Specific System Examination:

Abdomen Examination

Inspection

The abdomen is distended with a gravid uterus, as evidence by linea nigra and striae
gravidarum. The abdomen moves symmetrical with respiration. The umbilicus is centrally
placed and flat. There are no dilated veins, no pulsatile mass and no fetal movement seen.
There is no surgical scar seen and cough impulse is negative.

Palpation

The abdomen is soft and non-tender. The uterus is soft and non-tender. No contractions felt.

The clinical fundal height is at 28 weeks, while symphisio-fundal height measuring 29 cm

which corresponds to dates. There is a singleton fetus, in oblique lie with cephalic

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presentation, the head is not engaged and 5/5 palpable. The fetal back is on the maternal
right. Liquor is clinically adequate. The estimated fetal weight is 1.2-1.4 kg.

Auscultation

The fetal heart sound was heard over the anterior shoulder of the fetus. The fetal heart rate is
145 bpm and regular.

Vaginal Examination

Cervix tubular

Os closed

Nor per-vaginal bleeding seen

Speculum Examination

Uterus 29 weeks size, ante-verted

Cervix tubular

Os closed

DIAGNOSIS

40-year-old, Gravida 5, Para 4 at 29 weeks 4 days POA

- Pre-eclampsia

- Type 2 Diabetes mellitus with non-proliferative diabetic retinopathy (NPDR)

- Alpha-plus thalassemia

- Multigravida

- Advanced age

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MANAGEMENT

Investigation

A) Blood
1. Full Blood Count (FBC)
Results Reference
Haemoglobin (Hb) 10.6 g/dl 12.0 - 15.0 g/dl
Total WBC 12 x 103 /uL 4.0 - 10.0 x 103/uL
Platelet count 250 x 103 /uL 150 - 410 x 103 /uL
Result: Haemoglobin count and total white blood cell are abnormal

2. BUSE
Results Reference
BU 3.4 mmol/L 2.78 – 8.07 mmol/L
Na+ 145 mmol/L 136 – 145 mmol/L
K+ 3.5 mmol/L 3.5 – 5.1 mmol/L
Result: Normal

3. Group Screen & Hold (GSH)

Description Result
Group A-B-O B
Rhesus Positive
Indirect Antiglobulin test Negative
Direct Antiglobulin test Not done

B) Urine
1. UFEME: To detect any asymptomatic UTI.
Result Unit Normal Range
Specific gravity 1.014 /uL 1.000-1.020
pH 7 /uL 5-7
Leukocytes 74 Leu/uL Negative
Nitrite Negative Negative
Protein + G/dL Negative
Glucose Normal Mg/dL Normal
Ketone Negative Negative
Urobilinogen Normal Normal
Bilirubin Negative Umol/ Negative
L
RBC 0.4 Mg/dL 0-1
Result: UTI positive

C) Others

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 1. HVS C+S
Result: No Group B Streptococcal

D) CTG: To assess fetal well-being.

Result: Reactive CTG

E) Trans-abdominal ultrasound scan: To assess the fetal presentation, fetal

parameters, estimated fetal weight, placental location and amniotic fluid index.
Result:
- Singleton, cephalic presentation, fetal heart present
- Parameters correspond to 28 - 32 weeks
- Placenta at upper segment
- AFI: 19
- Estimated fetal weight: 1.35 kg

IMMEDIATE AND SUBSEQUENT MANAGEMENT

Treatment:

1. Admit to obstetric ward from PAC

2. Put on temperature / BP / pulse rate chart / ECG / CTG
3. To inform if any contraction or abnormal ECG / CTG
4. Trace investigation result

PROGRESS IN WARD

− Blood pressure in ward ranging from 100-130/60-74 mmHg

− Patient was referred to medical team for giddiness for investigation. Upon review, serum
magnesium level derangement was noted, hence was corrected with IV MgSO4 on 9 th
December 2020, with the level of 0.62  0.58  0.57  0.74.
− ECG was reviewed, showing sinus rhythm, and no ischaemic changes.

Plan by medical team:

1. If serum Mg > 0.7, patient will be allowed to be discharged

2. If serum Mg < 0.7, patient will be given 1 ampoule MgSO4 over 30 minutes and
repeat serum Mg level after correction was done.

Besides, patient was also reviewed by Ophthalmology team for eye assessment in view of
giddiness.

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Ophthalmology impression: Right eye moderate NPDR, left eye moderate to severe NPDR.

Plan by ophthalmology team:

1. Continue previous eye appointment on 1st February 2020.

2. Advised for strict DM control.
3. RA at private optometrist

Upon discharge, patient has good fetal movement, no sign and symptoms of labour, no more
giddiness, ambulating in ward on her own.

Case was initially planned to be reviewed by ENT team prior discharge, but after
consultation, patient will be seen as outpatient on 20th December 2020.

Plan by ENT:

1. TCA outpatient 20th December 2020

2. Discharge with T. Stemetil 5 mg 1 / 1 TDS

*Injected S / C actrapid and insulatard, no episode of hypoglycaemia

*CTG prior discharge: Reactive. Baseline fetal heart rate was 130 - 140 bpm

Upon discharge day 3 post-admission, patient had no more giddiness, no contraction, no

leaking liquor, good fetal movement and patient generally well, allowing for discharge.

CTG prior discharge: reactive

Patient was discharge well with:

1. For delivery at 38 weeks (GDM on insulin)

2. To decide mode of delivery at 36 weeks (GDM on insulin)
3. Biweekly blood pressure monitoring
4. Continue previous eye appointment on 1st February 2021.
5. Advised for strict DM control.
6. RA at private clinic
7. Medications:
− T. Hematinics 1/1 od x 1/52
− S/C Actrapid 14/10/10U x 2/522
− S/C Insulatard 16U ON x 2/52
− T. Metformin 1g 1/1 BD x 1/52

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 − T. Zincofer 200 mg 1/1 BD x 1//52
− T. Stemetil 5 mg 1 / 1 TDS x 5/7
Advise admit if abdominal pain, leaking liquor, reduced fetal movements.
TCA x 1/52 ANC for review

DISCUSSION

Hypertensive disorders of pregnancy which classified into chronic hypertension, gestational

hypertension, and preeclampsia are uniquely challenging as the pathology and its therapeutic
management simultaneously affect mother and fetus, sometimes putting their well-being at
odds with each other. Preeclampsia, in particular, is one of the most feared complications of
pregnancy. Often presenting as new-onset hypertension and proteinuria during the third
trimester, preeclampsia can progress rapidly to serious complications, including death of both
mother and fetus.

Preeclampsia is defined as the presence of a systolic blood pressure (SBP) greater than or
equal to 140 mm Hg or a diastolic blood pressure (DBP) greater than or equal to 90 mm Hg,
on two occasions at least 4 hours apart in a previously normotensive patient. In addition to
the increases in blood pressure, other criteria required to diagnose preeclampsia include
proteinuria of greater than or equal to 0.3 grams in a 24-hour urine specimen, a
protein/creatinine ratio of 0.3 or higher, or a urine dipstick protein of 1+ is required to
diagnose preeclampsia.

Risk factors for preeclampsia include nulliparity, advanced maternal age, family history, pre-
existing chronic renal disease or chronic hypertension, Diabetes mellitus, multiple gestation,
smoking and obesity.

Because the clinical manifestations of preeclampsia can be heterogeneous, diagnosing

preeclampsia may not be straightforward. Preeclampsia without severe features may be
asymptomatic. Many cases are detected through routine prenatal screening.

Patients with preeclampsia with severe features display end-organ effects and may complain
of headache, visual disturbances, oedema, epigastric or right upper quadrant abdominal pain,
nausea and vomiting.

Current management of preeclampsia includes preconception counselling, perinatal BP

control and monitoring, prenatal aspirin therapy in high-risk women, betamethasone for
patients <34 weeks, parenteral magnesium sulfate, and careful follow-up of postpartum BPs.

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Timely delivery of the fetus and placenta remains the only definitive treatment. Even among
patients who did not show antenatal signs of preeclampsia, surveillance continues postpartum
because of the rising incidence of postpartum preeclampsia. Preeclampsia without severe
features can be managed expectantly with twice-weekly maternal and fetal monitoring until
37 weeks in the absence of labour, rupture of membranes, vaginal bleeding, or abnormal
antepartum testing.

REFERENCES

1. Obstetric by Ten Teachers, 20th Edition

2. https://emedicine.medscape.com/article/1476919-overview#a1

DISCHARGE SUMMARY

40-year-old, gravida 5 para 4 at 29 weeks 4 days period of amenorrhea with diagnosis of:
1. Pre-eclampsia
2. Type 2 Diabetes mellitus with non-proliferative diabetic retinopathy (NPDR)
3. Alpha-plus thalassemia

DOA: 11/12/2020
DOD: 14/12/2020
Duration of stays: 4 days
Rahimah Binti Rozali, 40Y
G5P4 at 29w4d
LMP: 19/05/2020
EDD: 26/02/2021
BG: B positive
HIV / VDRL: NR
Hb: 9.7 g/dL

ANC:

1) Singleton fetus, in oblique lie with cephalic presentation

Presented with severe and persistent dizziness since one month ago
Associated with a few episodes of projectile vomiting
No leaking liquor

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 No show
Good fetal movement

VE
VVNAD
Os close
Cx tubular

Urine dipstick: nil

RTK: negative
___________________________________________________________________________
Progress in ward:
- Blood pressure in ward ranging from 100-130/60-74 mmHg.
- Patient was referred to medical team for giddiness for investigation. Upon review, serum
magnesium level derangement was noted, hence was corrected with IV MgSO4 on 9th
December 2020, with the level of 0.62  0.58  0.57  0.74.
- ECG was reviewed, showing sinus rhythm, and no ischaemic changes.

FULL BLOOD COUNT (FBC)

Haemoglobin (Hb): 10.6 g/dl
Total WBC: 12 x 103 /uL

UFEME
- Leukocyte: 74
- Protein: Trace

Upon discharge, patient had no more giddiness, no contraction, no leaking liquor, good fetal
movement and patient generally well, allowing for discharge.
CTG prior discharge: reactive

Impression:

1) Preeclampsia
2) Type 2 diabetes mellitus
3) Right eye moderate NPDR, left eye moderate to severe NPDR.

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4) Alpha-plus thalassemia

REFERRAL LETTER

To:
Medical officer in charge,
O&G Specialist Clinic,
Hospital Sultan Abdul Halim Mu’adzam Shah,
Sungai Petani, Kedah.

Dear Dr,
Thank you for seeing this patient.
Diagnosis: 40-year-old, gravida 5 para 4 at 29 weeks 4 days period of amenorrhea with

1. Preeclampsia
2. Type 2 diabetes mellitus
3. Right eye moderate NPDR, left eye moderate to severe NPDR.
4. Alpha-plus thalassemia

Presented with a complaint of severe and persistent dizziness since one month ago. The
dizziness was increasing in frequency and intensity until she came to hospital on 11/12/20.
the dizziness was associated with a few episodes of projectile vomiting.

Otherwise, she had no abdominal pain, no leaking liquor and fetal movements were good.

As she was in the ward, her blood pressure in ward ranging from 100-130/60-74 mmHg.
Patient was referred to medical team for giddiness for investigation. Upon review, serum
magnesium level derangement was noted, hence was corrected with IV MgSO4 on 9th
December 2020, with the level of 0.62  0.58  0.57  0.74. ECG was reviewed, showing
sinus rhythm, and no ischaemic changes.

Besides, patient was also reviewed by Ophthalmology team for eye assessment in view of
giddiness. Ophthalmology impression was right eye moderate NPDR, left eye moderate to
severe NPDR.

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Case was initially planned to be reviewed by ENT team prior discharge, but after
consultation, patient will be seen as outpatient on 20th December 2020.

Patient was discharge well with no more giddiness, no contraction, no leaking liquor, good
fetal movement and patient generally well, allowing for discharge.

Patient request to have her follow up at your hospital, as it is nearer to her home.

I would like to refer this patient to you for her further follow up and treatment, and your hand
care.

Thank you.

farah

Medical Officer HSAH

14 December 2020

PRESCRIPTION SLIP

Name : Rahimah Binti Rozali

RN : SP00733826

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 Diagnosis : 40-year-old, gravida 5 para 4 at 29 weeks 4 days period of amenorrhea
with:
1. Pre-eclampsia
2. Type 2 Diabetes mellitus with non-proliferative diabetic retinopathy
(NPDR)
3. Alpha-plus thalassemia
Treatment 1. T. Hematinics 1/1 od x 1/52
2. S/C Actrapid 14/10/10U x 2/522
3. S/C Insulatard 16U ON x 2/52
4. T. Metformin 1g 1/1 BD x 1/52
5. T. Zincofer 200 mg 1/1 BD x 1/52
6. T. Stemetil 5 mg 1 / 1 TDS x 5/7
farah
Medical officer HSAH
13 December 2020

PROFESSIONALISM

Professionalism is a core quality to be developed and understood as part of becoming a

doctor. It brings together many aspects of how a medical student learns about and contributes
to the care of patients.

a. Professional judgement: As a medical student, I must behave professionally by

being responsible, open-minded, honest, and always learn from mistake, so that I can
make an improvement on myself.

b. Communication issues: During history taking, I need to use Layman’s term instead
of medical terms as the patient might not be able to understand the questions that was
being asked and they might give out the wrong answer.

c. Spiritual issues: I must take care of the patient modesty and privacy when
performing physical examination as most of my patients are Muslim.

d. Ethical issues: As a medical student, I must ask for patient’s permission before
continuing to ask her questions. After obtaining all the information, it is crucial to
protects patient confidentiality.

CRITICAL APPRAISAL

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Preeclampsia is a disorder of widespread vascular endothelial malfunction and vasospasm
that occurs after 20 weeks' gestation and can present as late as 4-6 weeks post-partum. It is
clinically defined by hypertension with presence of proteinuria.

Preeclampsia is defined as the presence of a systolic blood pressure (SBP) greater than or
equal to 140 mm Hg or a diastolic blood pressure (DBP) greater than or equal to 90 mm Hg,
on two occasions at least 4 hours apart in a previously normotensive patient. In addition to
the increases in blood pressure, other criteria required to diagnose preeclampsia include
proteinuria of greater than or equal to 0.3 grams in a 24-hour urine specimen, a
protein/creatinine ratio of 0.3 or higher, or a urine dipstick protein of 1+ is required to
diagnose preeclampsia.

Preeclampsia is a serious health problem for pregnant women around the world. It affects 2 to
8 percent of pregnancies worldwide (2 to 8 in 100). In the United States, it’s the cause of 15
percent (about 3 in 20) of premature births. Premature birth is birth that happens too early,
before 37 weeks of pregnancy.

Most women with preeclampsia have healthy babies. But if it’s not treated, it can cause
severe health problems to the mother and also the baby.

REFLECTION AND LONG-LIFE LEARNING

Obstetrics and Gynaecology posting is the second posting for me in third year of medical
school. Approaching pregnant mother and woman with gynaecological problem was slightly
different. Physical examination and history taking were also different. There were some
elements that was not included in other department. For example, gynaecological and
obstetric history needed us to be more details compared to other posting. It was necessary to
know patient’s last menstrual period and expected date of delivery in order to know period of
gestation. If patient could not remember it, there was formula on how to calculate the
estimated date of delivery. I found it is very useful for future reference when I was working
in the hospital later. History taking was not as easy as I expected. It was very important to
know whether patient has underlying diseases like hypertension, diabetes mellitus, heart
disease and asthma in order to manage patient properly because there are precautions that
need to be taken if the patients have any underlying medical or surgical problems.

During physical examination, when examining the abdomen, I have some difficulties to
identify fetal head, fetal back and where to listen for the fetal heart. At the end of this posting,

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I hope that I could do abdomen examination properly and picked up several signs such as
multiple fetus, polyhydramnios and oligohydramnios.

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