Dr Lee Say Fatt

Caesarean Section

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WHAT IS IT?
Delivery of a baby through an incision in the mother’s lower abdominal and uterine walls and is performed when a vaginal delivery is not possible or is unsafe. This procedure is also called a C-section or Lower Segment Caesarean Section (LSCS).

 

 

 

REASONS FOR PROCEDURE

Danger to the mother or baby from one or more of many causes, including:

  • Baby’s head too large to pass through the birth canal.
  • Baby in the wrong orientation – head up (breech) or transverse.
  • Failure of cervix to dilate (failed induction of labour).
  • Abnormal placenta location obstructing the birth canal (placenta praevia).
  • Failure of normal labour progress.
  • Situation where urgent delivery is indicated such as fetal distress or severe illness in the mother (such as severe hypertension or sudden fits).
  • Infection such as HIV or acute herpes genitalis infection in the mother.

Special situations: pregnancy resulting from assisted reproductive technology (ART), maternal request

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Post-Natal Care – what to expect

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Most women stay in the hospital for 24 to 48 hours after giving birth (or 3 to 4 nights after a caesarean section). This will depend on the condition of the mother and baby.
The physical changes that occur with pregnancy usually resolve by the end of 6 weeks, although some may resolve much earlier than this. It is important to know all these changes, as it will help you cope better and lessen your worries. Emotional sup¬port and much needed help from your spouse and family members is equally important to assist you in facing these changes and coping with the arrival of a new member into the family. You will also get lots of advice from friends and relatives who visit you – some may be conflicting and may be harmful. There are many ways of doing things with no particular hard and fast rules on what is best for you. It is best to avoid traditional or Chinese herbs during this period. In the end, it is all boils down to common sense and you have to decide what is best for you and your baby. Do some reading and ask your doctor or midwife about your recovery during the postnatal period

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Ectopic pregnancy

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Ectopic pregnancy is one that develops outside the uterus. The egg (oocyte) and the sperm meet in the fallopian tube and fertilization occurs. The embryo is supposed to move back to the uterine cavity for implantation. However, in ectopic pregnancy this does not occur, and the embryo gets implanted elsewhere. The most common location is in one of the narrow tubes that connect each ovary to the uterus (fallopian tube). As the fertilized egg enlarges, the fallopian tube stretches and ruptures, causing life-threatening internal bleeding. Other locations include the ovary, cervix, space beside the uterus (broad ligament space) or in the abdominal cavity. About 1 in 100 pregnancies is an ectopic.

CAUSES AND RISK FACTORS

The occurrence of ectopic pregnancy is usually associated with an abnormal function of the fallopian tubes. Hence, tubal pregnancy is the most common type. Hormonal imbalances or abnormal development of the fertilized egg might also play a role. Certain condition may predispose to a higher chance of ectopic pregnancy such as:

  • Previous abdominal or pelvic infection
  • Pelvic inflammatory disease (PID), involving the fallopian tubes
  • Pregnancy after tubal ligation
  • Assisted reproduction techniques such as in vitro fertilization.
  • Adhesions (bands of scar tissue) from previous pelvic surgery.
  • Previous tubal pregnancy.
  • History of endometritis (infection of the inner uterine lining)
  • Malformed (abnormal) uterus or fallopian tubes
  • Pregnant with an intrauterine device (IUD) in place (failure of IUD)

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Fibroids removal (Myomectomy)

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A myomectomy is the removal of fibroids (leiomyomas, myomas) from the uterus. Patients can have a single or numerous fibroids. Myomectomy treatment for fibroids preserves the uterus. It is most often recommended to women who desire future pregnancy or wishes to retain her uterus. A patient undergoing the myomectomy procedure should be informed regarding the risk of hysterectomy. This may be necessary if excessive bleeding occurs, or if it is not possible to reconstruct the uterus because of the many defects left by the removal of multiple small fibroids or a single large fibroid.

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Uterine Fibroids

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It is an abnormal growth of cells in the muscle layer (myometrium) of the uterus. Uterine fibroids are common and usually benign (not cancerous). Fibroids range in size from very tiny to the size of an orange or larger.

INCIDENCE

Uterine fibroids are the most common pelvic growth in women. The actual incidence among all women is unknown but generally cited as 20 to 25 % in the general population and is highest between age 35 to 45 years old.

TYPES (based on location in the uterus)

 

  • Subserous which appear on the outside of the uterus.
  • Intramural, which is confined to the wall of the uterus.
  • Submucous which appears inside the uterus.
  • Pedunculated fibroids, which are attached to the uterine wall by stalks.
  • Broad ligament type which grows to the side of the uterus
  • Cervical type, which is rare.

 

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Adenomyosis

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Definition

Adenomyosis is a benign uterine disease in which endometrial tissues (glands and stroma) are found within the myometrium (wall of the uterus). It has been described as endometriosis interna. In a normal menstrual cycle, the endometrial tissue will grow, becomes thicken, and then shed, resulting in the expected cyclical or monthly menstrual bleeding. If this happens in the uterine wall (myometrium), the resulting bleeding in the wall will cause pain and in the long term, the uterine wall will progressive thicken, thus produces a diffusely enlarged uterus.

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Emergency Contraception

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New Strait Times online recently reported that  Malaysia is expected to have a baby boom in January next year, thanks to the Movement Control Order (MCO). The newspaper quoted the National Population and Family Development Board (LPPKN) Health Unit head Dr Hamizah Mohd Hassan who said that the MCO could influx the country’s birth rate by early next year as the majority of married couples have to stay at home.

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COVID-19 and Pregnancy

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We are now faced with an unprecedented pandemic due to the coronavirus. The COVID-19 is a new strain that has not been previously identified in humans. Those infected may take up to 14 days to develop symptoms. The main mode of transmission is mainly through respiratory droplets and close contacts. It may be possible that a person can get COVID-19 by touching a surface or object that has the virus on it and then touching their own mouth, nose, or possibly their eyes, but this is not thought to be the main way the virus spreads. Routes of transmissions such as fecal-oral, in-utero from mother to baby and others are not confirmed yet. Some infected persons may be asymptomatic and they potentially can pass along the infection to others. However, this is less common. For more information about coronavirus, click here and here

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