Sharing about Hypertension in Pregnancy
March 25, 2018
Normal people usually have normal blood pressure (BP). But, actually most people have hypertension nowadays. T_T However, pregnancy can also induce hypertension - due to hormones, the placenta (uri) and the struggle of pregnancy itself. Hypertension in pregnancy is not something to take for granted, in fact it is in the top 5 disorders in pregnancy that can harm mothers (lead to death).
For people who have family's background for hypertension, we need to be extra careful on our lifestyle and diet.
1. Hypertension - different terms in pregnancy.
There are quite a number terms and definitions I need to understand and remember in order to get the proper diagnosis and plans for specific patients.
Hypertension in general can reduce blood flow to many organs like:
I am still learning and observing this situation.
But, from my knowledge, once a pregnant woman is diagnosed with hypertension or have BP ≥ 140/90 in any check-ups in Klinik Kesihatan and written in their pink books, she need to get her BP measured every other day (EOD). This means, day 1 - day 3 - day 5 and continuously until her next check up or even until delivery of baby. Even after labor, her BP need to be monitored to make sure it is in a safe range.
Believe me, in unfortunate events, some patients can skip all these and go direct to seizure T_____T
Pregnant women who are / have:
These five alphabets are scary to me. It actually means - To Rule Out Impending Eclampsia
The havoc to manage a fitting pregnant woman is not a joke. At least few people need to take part in this especially to:
And if you are diagnosed with hypertension in pregnancy, please and please make sure you follow what your doctors have told you. If you need to take medications, please don't skip. If you need to get your BP measured every other day, please do so even though it can be a hassle.
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"Seizure in pregnancy is eclampsia until proven otherwise."
2. Why hypertension can be harmful in pregnancy?Well, hypertension is dangerous no matter someone is pregnant or not. In this post, I would love to share why and how hypertension in pregnancy is not an easy matter.
Hypertension in general can reduce blood flow to many organs like:
- brain (can lead to coma etc),
- heart (heart failure / attack etc),
- kidney (renal failure etc),
- eyes (blurring of vision etc),
- etc
So, can we imagine what can happen to the baby if the mother herself is not in good condition?
In O&G, mothers always come first to be rescued, only then the baby.
In O&G, mothers always come first to be rescued, only then the baby.
Effects - premature birth, stillbirth, complications to babies afterwards (learning disability, seizure etc)
3. How will be the routine for pregnant women with hypertension?
I am still learning and observing this situation.
But, from my knowledge, once a pregnant woman is diagnosed with hypertension or have BP ≥ 140/90 in any check-ups in Klinik Kesihatan and written in their pink books, she need to get her BP measured every other day (EOD). This means, day 1 - day 3 - day 5 and continuously until her next check up or even until delivery of baby. Even after labor, her BP need to be monitored to make sure it is in a safe range.
4. What are the signs & symptoms of impending eclampsia?Patients usually complain of headache, dizziness (rasa pinar-pinar), blurring of vision, epigastric pain (pedih ulu hati), nausea (mual), vomiting, edema (kaki bengkak). These are the things need to be watched out every time we meet patients with hypertension.
Believe me, in unfortunate events, some patients can skip all these and go direct to seizure T_____T
5. Who is at risk of pre-eclampsia / eclampsia?
Pregnant women who are / have:
- Previous history of pre-eclampsia
- Other diseases - kidney, diabetes etc
- Multiple pregnancy - twins / triplets etc
- Obesity
- Primigravida (first pregnancy)
- Family history of pre-eclampsia
6. How a hypertensive pregnant woman can be admitted to the hospital?As someone who have been clerking patients coming to EPAU (Early Pregnancy Assessment Unit) or in some place this unit is called PAC (Pregnancy Assessment Center), most pregnant women who came for high BP is diagnosed with 'TRO IE'.
These five alphabets are scary to me. It actually means - To Rule Out Impending Eclampsia
- They have high BP
- 80-90% of them have proteinuria (protein in urine).
- Some of them have signs and symptoms of Impending Eclampsia.
- Some even ended up with seizure.
- Most of them need to have induction of labor (IOL) / emergency C-sec (EMLSCS) as they can't exceed 38weeks! to deliver the baby - delivery is the best way to avoid the worst scenario.
The havoc to manage a fitting pregnant woman is not a joke. At least few people need to take part in this especially to:
- Prepare Magnesium Sulphate bolus and infusion (to fight the seizure),
- To check all vital signs (BP. pulse rate, respiratory rate, temperature)
- To recheck Pre-Eclampsia profile (full blood count, liver function test, renal profile, urine full examination and microscopy examination, coagulation profile)
7. How to avoid these?Hmm.. first, let's pray hard to all pregnant women to have a smooth and uneventful pregnancy. Live a good and healthy lifestyle, control our diet, don't ever skip any antenatal check-ups.
And if you are diagnosed with hypertension in pregnancy, please and please make sure you follow what your doctors have told you. If you need to take medications, please don't skip. If you need to get your BP measured every other day, please do so even though it can be a hassle.
"Seizure in pregnancy is eclampsia until proven otherwise."
M, Perak, Malaysia
180323
Survived My First Oncall
March 24, 2018
While I am appreciating my offday today, I would love to prepare few scheduled posts for this favorite site of mine. Well, I guess most bloggers are their own blogs' die hard fans, right? I am not an exception :D
Off-tag last Sunday, in which I can join the normal schedule as other housemen. Normal schedule means I have different working hours each day, depends on how my schedule is prepared by the houseman-in-charge.
Different departments have different working hours, same goes to different hospitals as well. Everything depends on the need of that certain department in that certain hospital itself. As for me, it goes like this. Roughly 60-90hours per week.
- A - normal - 0700-1700 (10hours)
- B - stayback - 0700-2200 (15hours)
- C - oncall - 0700-1700 (10hours)
- D - postcall - 2200-1300 (15hours)
The ideal one is maybe? something like this:
- Monday - A
- Tuesday - B
- Wednesday - C
- Thursday - D
- Friday - OFF
- Saturday - A
- Sunday - B
Oncall will be followed by postcall. And it is NOT a must to have an off day after postcall. Depends. And we are allowed to have cuti rehat (CR) 8 days in 4 months. Seniors cakap kena pandai-pandai plan kalau nak holidays panjang. Usually, they will do like this "oncall - postcall - off - CR - CR - CR", so you can enjoy at least 4 days and a half to rest.
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| Mata memang nampak postcall... so cover sikit. |
How was my first oncall?
Alhamdulillah it was not that eventful, just I didn't managed to have much sleep due to my lack of experiences to do the tasks faster. The challenge for oncall is that, only one houseman need to be in charge of the ward for that night - from 10pm to 7am (until other housemen come to work the next morning).
There were few patients I need to review after Caesarean sections and for these patients, we need to review them at least:
- After they had been transferred out of the operating theaters to the post-natal wards,
- 6 hours after operation,
- Any active complaints like shortness of breath or as simple as cough. Noted that some patients may have underlying diseases especially hypertension (no matter pre-existing hypertension means before pregnancy, or pregnancy-induced hypertension) as these patients need to be watched out of impending eclampsia's signs and symptoms. We are scared if they get seizure / fitting episode!
Plus any other active complaints from another patients or any new cases in the ward.
No matter what complaints the patients have, we need to attend them stat.
STAT - short form for Latin word's statim which means immediately.
I plan to share few main topics in Obstetrics and Gynecology here in this blog, feel free to read. InsyAllah, I will try my best to explain based from what I've learned theoretically and real experiences I've encountered in the hospital. :)
Till next post.
M, Perak, Malaysia
180323
Wonderful March Giveaway by Raydah Alhabsyi
March 23, 2018
Because I have an off day now :D
Hey Ray, I am joining your giveaway!
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| Click the banner to join :) |
Life has been busy for me since I started working. Most of things are still bearable despite I am honestly still struggling to adapt. InsyAllah, it is going to be much better with time :)
Thanks Ray for these lovely words on your post. I found it beautiful for myself.
Why Wonderful March? It's simple, I am just hoping that this month of March will be a good month for me and all of us. I hope that things will get better for anyone who's having a hard time no matter where you are. Whenever you're having a really hard time or having problems of your own, remember that things happen for a reason and that there are more people out there who are less fortunate wishing they could be at your place. Be grateful and be thankful for what you have today. Try and help those who are around you, In shaa Allah, you'll feel a lot better. Take your time and say Alhamdulillah for the day you had today.
Thanks for this giveaway as well. All the best to myself and you, hehe.
M, Perak, Malaysia
180323
5 Days of Tagging
March 10, 2018
Well... I am still contemplating to share my housemanship life here. It can be misinterpreted and misunderstood, as people are reading from just one side of view. But, insyAllah I will try to reflect my days and improve every single thing that I can. Still trying to.
Let me share about how a doctor can become a practicing doctor.
A doctor is not yet a doctor in Malaysia, until s/he is certified by Malaysia Medical Council (MMC) with his/her registration number. How to be one? A graduate with a medical degree need to do housemanship as 'doktor pelatih' for 2 years with 6 departments. It means, s/he need to work for 4 months at least for 1 department before proceeding to the next one, only after s/he pass ALL requirements and assessments through out every departments.
So, how is my life right now?
5 days of tagging out of 2 weeks. Applied to all hospitals around Malaysia, tagging days start at 6-7am and end at 10pm plus. 15 hours of working every day for 6 days per week. If someone got lucky, the department will allow taggers to get an off day in a week Otherwise, some may require taggers to work every day for 2 weeks.
Depends.
So, I currently survived 5 days of tagging and have an off day today. Still thinking either to sleep or to go out or to do intense revisions. Deep down, I think I need to do all of them today. Haha.
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| Housemanship journey will not be like this straight path but things will work out, insyAllah :) |
What I have learned so far?
1. Doctors and responsibilities.
- Doctors are still students but not as a title of students. There are LOTS of thing to learn, adapt, manage every single day, while trying not to make the same mistakes twice.
- Doctors are responsible for the patients. We need to attend patients even with the slight symptom like headache due to stress as we are doctors and simple symptoms do not all the time mean nothing wrong is going on.
- Always seek help from seniors, superiors, hospital staffs every time we are not sure as we are dealing with people's life.
2. Masuk telinga kanan, keluar telinga kiri. Yang baik kita simpan dalam hati dan ingatan.
- Hospital environment is something new as a working place to me. Even though I managed to spend a month in hospital in Malaysia, the environment is totally different. Maybe because I were still a student back then and responsibilities of students and doctors are hugely different.
- Working is not all the time about happiness and calmness. We can get scolded for important stuffs we miss while clerking the patients. We can also get scolded for mistakes we made while trying to find out what are the things going on with the patients. And.... we can also get scolded for nothing.
3. Approach to patients.
- These are few things I can recall right now that I wish I will always try my best to do it:
- Always greet the patient with a smile and introducing myself, no matter how hard my day is.
- Always reconfirm the name of patients so that I do not attend the wrong patient with the wrong diagnosis and plan.
- Always be careful with needles and procedures to prevent harm to patients and even myself.
- Always double confirm with the patients about the symptoms they have as some will suddenly change their sickness when the superiors ask.
4. Advice to myself.
- Adapt faster and be familiarize with EVERY SINGLE SYMPTOMS WITH THEIR DIAGNOSIS AND PLANS.
- Write faster with readable handwriting.
- Take blood and insert branulas with more confidence. Always transfer the blood into the respective tubes and label them as soon as I took the blood.
- Be careful with names and R/N number of patients as patients may change their bed or I can't remember their faces.
- Smile, smile, smile.
- Be good to others no matter how bad they treat me.
- Think positive every time I got scolded - that scolds are for my own good and those are mistakes that I surely need to improve.
- Improve and don't keep harsh words I received in my heart. They surely have their bad days too.
- Admit the mistakes I made and always ask for help if I get lost somewhere.
- Always find time for prayers, meals and to contact my family.
All in all, tagging days are tiring but insyAllah these days are the one that will help me to be a better and a safe doctor to the community. InsyAllah, ameen ameen.
Doakan yang baik untuk saya ya.
I'll improve myself!
M, Perak, Malaysia
180310
Beginning of Housemanship - A New Life Phase
March 3, 2018
Post-PTM.
Post-orientation week.
2 days before tagging period for first posting.
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A place I found serenity. :D
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Orientation week was more towards patient safety or something with awareness course for junior HO (houseman) during working. Trust me when I said all medical health people really try hard to take care of our safety. The week ended with a test to see our understanding about it.
So, if you guys want to know, patient safety can be defined as absence of preventable harm to a patient during process of health care (WHO). Understandable, right?
A lot of topics were covered in this course - from the right way to prescribe medications (ubat-ubat kita dapat tu), the right way to have safe surgery, the right way to prevent antimicrobial resistance (this is a big issue in the health world today), the right way for safe blood transfusion (one of the most IMPORTANT things to take note as the mistakes here can lead to death) etc.
Actually, I think any kind of mistakes can harm the patients.
But, doctors are human beings as well. Humans can never run away from making mistakes. But still, the main point here, have we done the best to prevent the mistakes from happening?
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| Teluk Batik |
Alhamdulillah, still surviving. :)
Next week will be the beginning of real battle :)
May Allah ease, may Allah help.
And welcome to another phase of life, Nina :)
New responsibilities.
New knowledge and skills.
New environment.
New friends and colleagues.
New room.
New neighborhood.
It will be challenging. Ultimate one.
But... keep holding on and keep your faith, Nina.
InsyAllah you will get through it.
Don't keep emotions to yourselves. Let it go, let it out.
Learn fast, every single moment.
Respect others.
Respect others.
Offer yourself.
Help yourself. Help people.
Praise and compliment yourself, praise others.
Eat well.
Pray consistently.
Never lose hope.
Remember all beautiful people and memories.
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| Watching sunset on my 3rd day of orientation week. |
It is going to be hard but it is not impossible.
You can do it, Nina!
Fightingggg!
p/s - O&G for 4 months, bismillahirrahmanirrahim.
Fightingggg!
p/s - O&G for 4 months, bismillahirrahmanirrahim.
SS, Perak, Malaysia
180318
A Life Lesson I Learned From Black Knight (Korean Drama)
February 13, 2018
This drama was still ongoing at the time I started writing this. But it is over now, with a sad ending. Ops, spoiler alert!
To those who have no ideas about this drama, let me share a bit of its synopsis. The full title is Black Knight: The Man Who Guards Me. I don't remember if the story started with life in Joseon years or current one. But it is about tangled relationships between few people - consist of long lost childhood plus long term grudges and curse. A very interesting drama as it has different timelines that are hundreds of years apart.
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| credit - Pinterest |
Soo Ho, is a successful businessman who has lost his parents. He has arguable childhood when his father died in a fire and he was 'taken care' by Hae Ra's father. Soo Ho then left Korea to live abroad while Hae Ra lives a miserable life since her parents died. On a stressful day, Hae Ra dreams of a coat her parents ordered when she was a child and had not pick it up. Only then, Hae Ra meets Sharon / Seo Rin.
So what are actually relationships between all of these 3 people?
Who is holding grudges against who?
Watch it yourself. Hahaha. Tak larat nak taip panjang-panjang.
But if you can't tolerate sad ending, don't do it. To be honest, I would prefer another style of sad ending T_T
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| A thing that keep me watching... is the views of Slovenia. |
I am sure there are lot of other life lessons we can learn from the drama. But this is the main point I realised throughout the story.
There is a character named Park Chulmin. He is actually a father of Haera's friend, Gon. In this drama, if you watch it, Chulmin's greediness started when he fell in love with Cheo Seorin, a lady who has lived for 250 years and she always mentioned to Chulmin to be rich in any means. He is doing everything he can to raise his wealth even by threatening people.
I once watched a video about things that can threaten our iiman. When the presenter asked the audience about what are those dangerous things to our iiman, many people will answer majority stuffs that are certainly haram, prohibited or forbidden in Islam like drinking alcohol, adultery, murder etc.
There is a hadith about the greatest threat (At-Tirmidhi).
Narrated K’ab bin Malik: Allah’s Messenger said, “Two hungry wolves sent in the midst of a flock of sheep are not more destructive to them than a man’s greed for wealth and fame is to his religion.” (At-Tirmidhi)
Greed for wealth and fame.
Wealth is important though, even some of Prophet's companions were wealthy and they used their wealth for Islam.
But the greed beyond what is needed and involve unnecessary values are not good. Greedy people can do many things to get what they want - no matter how illegal they are.
T_T
This can be reflected to our life.
Bribe is almost everywhere, in almost every organisation.
May Allah guide us away from this.
SS, Perak, Malaysia
180213
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