Obstetrics

Pregnancy is a wonderful journey to motherhood. During the antenatal period, the nine months before delivery, regular antenatal check-ups will predict, prevent and detect maternal and fetal complications during pregnancy. This is necessary because 15% of pregnancies will have significant complications where treatments and interventions will be needed.

The symptoms of pregnancy include:

1. Missed period

2. Breast tenderness

3. Nausea sensation and vomiting

4. Increase frequency of urinating

5. Backache and rib pain

6. Heartburn

7. ​Fatigue

Normally, the first antenatal visit will be carried out between five to 12 weeks of your missed period. The first visit is important to:

1. Confirm pregnancy (not all missed period is due to pregnancy)

2. Determine if pregnancy is still ongoing

3. Determine gestational age and estimated date of delivery (EDD)

4. Identify early pregnancy problems such as threatened miscarriage, ectopic pregnancy (embryo implants and grows outside the womb), and molar pregnancy (abnormal fertilization of an egg by sperm)

At subsequent visits, the following examinations will be performed:

1. Maternal weight gain; mother-to-be will gain an average of 0.5kg weekly between 15 to 38 weeks of pregnancy, and an average total weight gain 12kg for the whole pregnancy.

2. Blood pressure; to detect gestational hypertension.

3. Detect oedema (swelling caused by the body’s tissue fluid); it is normally found at the ankle. If excessive, this may indicate other medical problems such as hypertension or renal disease. Elevate the legs on a pillow at night will improve the condition.

4. Urine test; to detect glucose and protein levels in the urine. The presence of elevated levels may indicate gestational diabetes or pre-eclampsia (pregnancy-induced high blood pressure) respectively.

5. Ultrasound scan; to monitor fetal growth and can detect 80% of fetal structural defects. A detailed scan should be done between 18-20 weeks of pregnancy.

6. Blood test; done at 18 weeks of pregnancy, checking on:

   1. Blood group and Rhesus factor

   2. Hepatitis B antigen and antibody; to detect hepatitis B carrier status

   3. Human Immunity Virus (HIV) antibody; to detect HIV carrier

   4. VDRL; to detect syphilis

7. Haemoglobin; to detect anaemia and thalassemia minor

8. Amniocentesis; recommended for mothers older than 35 years of age or those who had previous children with Down Syndrome or abnormality. This is done at 16 of pregnancy and can detect Down, Patau and Edward Syndrome.

Older mother (those over 35 years of age) will have more frequent check-up with our obstetricians because they carry a higher risk of:

1. Fetal chromosomal disorder

2. Gestational hypertension

3. Gestational diabetes

4. Bleeding

5. Intrauterine growth restriction (IUGR) – baby is smaller than normal during pregnancy.

Whenever you have the signs of labour, you should go to the maternity unit where you have planned to give birth. The signs of labour include: labour pain, show (release of the blood-stained mucus plug which seals the opening of the cervix), and leaking liquor (bursting of the water bag).

After you are admitted, our health care team will do the following for you:

1. Cardiotocography (CTG); to monitor fetal heartbeat

2. Enema; to clear your bowel1Vaginal examination; to monitor dilation of your cervix

3. Setup intravenous drip (IV drip); a plastic tube is inserted into your vein. This is for drug administration during emergency.

There are three stages of delivery process:

1. First stage:
   The cervix dilates slowly with each contraction until it is 10 cm which will allow the baby to pass through it. The contractions are initially weak and 10 minutes apart, and later they get stronger and more frequent. At the end of first stage, the contractions are two to three minutes apart and last for about 40 seconds. The first stage will take an average of eight hours.
2. Second stage:
   This stage starts when the cervix is fully dilated and ends when the baby is delivered. With a fully dilated cervix, the baby moved down the birth canal until the head appears at the vaginal opening. After the head and shoulders are born, the rest of the baby will slide out easily. This stage takes about 30 minutes. Normally episiotomy (a cut on the lower half of vagina) is done to prevent perineal tear.
3. Third stage:

   After the baby is born, the uterus resumes contractions and the placenta is expelled. This stage will last for 20 minutes.

   There are five types of delivery. The option will depend on the maternal and fetal conditions.

   1. Spontaneous vaginal delivery (SVD):
      The baby is delivered through the vagina. The baby is delivered ‘head first’ and the obstetrician guide the rest of the baby through lower half of the vagina.
   2. Breech delivery:
      The baby is delivered buttock first.
   3. Forceps delivery:
      This is done when the baby is in distress or mother has poor effort. The forceps is applied to the fetal head and traction applied to hasten the delivery.
   4. Vacuum delivery:
      This is done when the baby is in distress or mother has poor effort. A vacuum cup is applied to the fetal head and traction applied to hasten the delivery.
   5. Lower segment caesarean section (LSCS):
      This is done when the baby is in distress or mother has poor effort, placenta praevia, cephalopelvic disproportion (baby is too big to fit through mother’s pelvis), abnormal fetal position such as breech presentation (bottom first) and transverse presentation (sideway).

The vigorous process of delivery and hormonal changing during pregnancy will make you feel tired, down and emotional after delivery. This is especially so after three to five days after birth. It is important to follow through postnatal cares to ensure smooth recover from the pregnancy and childbirth.

1. Maintain healthy diet; to gain enough energy and nutrients

2. Drink plenty of water; especially for breastfeeding mothers

3. Obtain adequate rest; sleep eight hours everyday.

4. Do exercise; this will relax and help your body to recover. It will help you to keep fit as well as giving you a feeling of wellness. You should check with your healthcare team before start exercising. If you have a caesarean section, you are advised to defer exercise for 2 weeks after delivery.

If you still feel depressed and unwell, it is important to talk to your healthcare team.