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Nausea & vomiting during pregnancy (NVP) (Morning Sickness in Pregnancy)

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This is common in the first three months of pregnancy and occurs in 50% to 80% of pregnant women. The symptoms often occur in the morning (from 6-9 am) but may occur at any time during the day. The impact and severity of the nausea and vomiting is different for each woman.

SIGNS AND SYMPTOMS

It ranges from mild to severe nausea with or without vomiting. This is usually during the first 12 to 14 weeks of pregnancy. It may continue longer, and for a few women, may last throughout pregnancy. By the end of the third month, most symptoms will resolve in the majority of women. The symptoms are more severe in those with multiple pregnancy or molar pregnancy.

CAUSES

The exact causes of nausea and vomiting during pregnancy are unknown. Nausea may result from rising levels of human chorionic gonadotrophin (pregnancy hormone) in the blood or other hormonal changes that take place to permit normal growth of the fetus.

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Progestogen-only Injectable (POI) Contraception

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Progestogen-only injectable contraception is a hormonal type of contraception that is given through an injection. It contains a synthetic form of the hormone progesterone, known as progestin or progestogen. They provide protection against pregnancy for up to 8 to 14 weeks.

Types

  • Medroxyprogesterone acetate (DMPA)
  • Norethisterone enanthate (NET-EN)

Mechanism of action

  • This hormone works primarily by suppressing ovulation (preventing the release of an egg from the ovaries).
  • It also thickens cervical mucus, making it more difficult for sperm to reach and fertilize an egg.
  • It can thin out the uterine lining, making it less suitable for the development of the fertilized egg.

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Progestogen only pill (POPs)

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This type of pill does not contain oestrogen and the dose of progestogen is significantly lower than in those used in combined oral contraceptive pills (COC). It is also called the “mini-pill” and is useful for women who do not want pills that contain oestrogen or in situations where the oestrogen is not suitable for medical reasons. They are a highly effective method of birth control when taken correctly.

Formulation – Available formulations are:

  • Norethisterone 350 ug (NET) – (Noriday)
  • Levonorgestrel (LNG) 30 μg
  • Desogestrel (DSG) 75 μg – (Cerazette)

Levonorgestrel (LNG) and norethisterone (NET) are grouped as “traditional’ POPs”

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Wisdom versus Intelligence

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Article contributed by Dr Ong Tien Kwan (Klinik Ong)

A wise action – whether through bodily action, verbal action or mental action – is an act that is beneficial to the doer, the recipient and the community. For example, an act of generosity is a wise action because it brings benefits to the doer, the recipient and the community. A wise person is one who acts wisely.

In contrast, a foolish action is one that is harmful to oneself, to others and to the community. For example, a raging (angry) action brings harm to oneself, to others and to the community. A fool is one who thinks that his or her foolish action is beneficial to himself or herself, when in fact, it is not. Often, this is because he or she is only able to see the short-term gain but unable to see the long-term loss.

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Admission for surgery – what to bring to the Hospital

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This article will help you to prepare the essential items that you need to bring to the hospital for your admission. The list here is just a suggestion or a guide only, and you may make your own adjustment, based on your own preference. Decide which items you will need for a comfortable stay and recovery. However, you should not over-pack so as to inconvenience everyone, including yourself during your admission or discharge. The items will also depend on the expected length of stay in the hospital.

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Bartholin glands disorders (Bartholin cyst / Bartholin abscess)

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The Bartholin gland is located on either side of the vaginal opening, on the inner aspect at about 5 and 7 o’clock position. The glands secrete a fluid (mucus) that keeps the vagina moist and helps lubricate the vaginal area during sexual activity. The gland is not visible or palpable unless it is swollen.

Common disorders of the Bartholin glands are:

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Healing a Broken Relationship

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Understanding a Relationship

Article contributed by Dr Ong Tien Kwan (Klinik Ong)

Before we talk about healing a relationship, it is important that we understand what a relationship is, or rather, what makes a good relationship.

  1. A relationship is a mutual responsibility. A relationship can only happen when there are at least 2 people involved in it. A relationship is like a clap. It can only occur when two hands clapped. One hand alone cannot produce the clap. Therefore, a relationship is a mutual responsibility.
  2. A relationship is a privilege. It is a privilege because one can always choose not to have a relationship. One always has this freedom of choice. A relationship is not one-sided, coerced, or compelled. One must be free to enter into or walk out of a relationship.
  3. A relationship must be mutually beneficial. We choose to have a relationship because we see its potential to enrich our lives, to make it better, and to flourish together. Therefore, both sides must benefit from it. Without these mutual benefits, the relationship will eventually fail.
  4. A relationship is a mirror. We like someone or fall in love with someone because that person mirrors something in us that we like, admire or want. At the same time, we must bear in mind that he or she will also mirror our fears, insecurities, weaknesses, and limitations. This is not necessarily a bad thing. In fact, this offers us ample opportunities to recognize, acknowledge and heal our own fears and limitations, that may otherwise go unnoticed, unacknowledged, and therefore unable to be healed. It is here that you can turn a crisis into an opportunity for growth. Use it well.
  5. In a relationship. honesty is the best policy. At any time, a relationship can go bad, go sour or become broken. This often happens because one or both in the relationship fails to or is unwilling to face his or her own inner fears, and therefore ends up unable to communicate truthfully or effectively with each other. In fact, the most common reaction is one that looks for someone to place the blame on. Most ego understand this but cannot seem to help itself. Unfortunately, this is not only unhelpful but often worsens an already bad situation. It is here that honesty is the best policy. For any relationship to flourish, truth must be the foundation of that relationship. Honesty is needed for truth to be upheld.

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Dysmenorrhea (period pain / menstrual cramps / menstrual pain)

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Dysmenorrhea refers to lower abdominal pain felt during menstruation. It is divided into two broad categories, which are primary and secondary dysmenorrhoea.

  1. Primary dysmenorrhea refers to the presence of pain during menses without any obvious gynaecological disease that could account for these symptoms. The pain is typically recurrent, crampy pain that starts just before or with the onset of menses and then gradually reduces over the next 24 to 72 hours. It is more often seen in adolescents and young females. Physical examination and an ultrasound scan of the pelvis is usually normal.
  2. Secondary dysmenorrhea refers to the pain before and/or during menstruation in females with a gynaecological disease that could explain the symptoms. These could be endometriosis, adenomyosis, or uterine fibroids. The cramping pain can be in the lower abdomen, lower back or radiates to the inner thighs. The pain may even persist after menstruation has stopped.

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