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Written by Administrator   
Wednesday, 23 November 2005

OBSTETRICS

  

ANTENATAL CARE

We will spend much time during our Antenatal visit with the couple. This is a great time get any queries answered, and to discuss the Labour Plan and to address any concerns with regard to the day of Labour. Finally, assistance can be extended during the Postnatal period to include Cellulite Reduction & Hepatitis or HPV vaccination.

 


PRENATAL

All parents want to have a healthy baby. With proper counselling we could assist the couple in selecting Prenatal tests that will help them to allay the fear of having an unhealthy newborn. Prenatal Tests include the use of ultrasound,   blood hormonal assay and an invasive Amniocentesis test to achieve this aim.

 

1 Foetal Viability Scan - Carried out between 6 to 10 weeks, the foetal viability scan is a useful test for patients who have had previous miscarriages or who are experiencing pain or bleeding. It is possible to confirm the presence and number of live foetuses  using the trans-vaginal or abdominal scan

 

2 Dating Scan - This scan aims to take measurements which accurately predict the due date of the baby. This can be done from 8 to 20 weeks, but dating is more accurate when the scan is done before 14 weeks.

 

3 Nuchal Translucency & Maternal Blood Test - Done from 12-14 weeks to screen for Down’s syndrome.

 

4 Foetal Anomaly Screening Scan - To examine the foetal anatomy and assess normal growth, and check the placental position and cervical status. This scan is carried out between 20 to 24 weeks.

 

5 Growth/Foetal Well-Being Assessment Scan - This scan, which is done from 24 to 41 weeks, aims to assess the baby's growth and evaluate the placental location, amniotic fluid volume as well as foetal movement

 

GYNAECOLOGY

 

FIBROID

 

1. Non-cancerous tumour in the muscle of the womb (uterus).

 

2. 25%of women of child bearing age may have fibroid.

 

3. Female hormone Estrogen, stimulates growth of fibroids

 

4. Infertility Problem 

 

5. Discovered during routine check up with no complaint.

 

6. Increase in menstrual flow

 

7. Pressure symptoms on bladder or bowel, leading to retention of urine & painful bowel action.

 

8. Low backache or Lower Abdominal Pain

  

Conservative Management

  

1. Observation, a large percentage fall into this group.

2. Symptomatic treatment.

3. Hormonal therapy e.g. Progesterone, Danazol or GnRH agonist.

4. Non-Surgery Management:  With Therapeutic Ultrasound & Uterine Artery Embolisation. 

 

 

SURGERY Management:

 


A) Myomectomy Removal of fibroid.

Myomectomy can be done by Conventional Open Surgery, Laparoscope (Keyhole Surgery), or Trans-vaginal Hysteroscopy Surgery.

 

     
 

   

 
 

Left: Operation done from Vaginal route to remove Fibroid with no Scar.

 

 

 

 

B) Hysterectomy (removal of the womb)

 

Route - Vaginal
             Abdominal
             Laparoscopic (MIS) eg
.LAVH
            

 

Myomectomy is the choice surgery if the patient is young, has not completed her family and where the patient desires to retain her uterus.

 

 

 

Hysterectomy is normally requested by patients who have completed their family, large & multiple fibroid or with gynaecological problem (cervical dysplasia CINlll)

 

 

OVARIAN CYST

  

Ovarian Cyst occurs in your body silently. Thus, it is good to have routine Gynaecological Ultrasound Screening.

 

1.  No symptoms especially if cysts are small

 

2.  Swelling of the abdomen

 

3.  Lower abdominal pain, when cysts rupture or get twisted

 

4.  Pressure on bladder - urinary symptoms, Pressure on rectum - urge to open bowel or constipation

 

 

 

Ovarian cysts are fluid filled tumours that arise from one or both ovaries. Can be classified under four categories:

 


1. Functional Cyst
-   Follicular cyst, Corpus luteum cyst

 

Normally disappears after 1-2 months, and does not require surgery

 

 

 

2. Endometriosis Cyst (Chocolate cysts)
Menstrual lining and menstrual blood embedded in the ovary and enlarges in size. Associated with Infertility, Lower Abdominal or Menstrual Pain
.
 

 

   

 
 

Left: Keyhole operation done for Endometriosis Cyst for an Infertility Patient who then had a successful pregnancy three months after surgery.

 

 

 

 

 

3. Benign Ovarian Cysts (non-cancerous)
    Serous Cyst, Mucinous Cyst or Dermoid Cyst.
 
   

 

 

   

 
 

Left: Keyhole Operation done to remove Dermoid Cyst from a 13 year old girl

 

 

 

 

 

 

 

4. Ovarian Cancer

 
 Less than 5% of all ovarian cysts

OPERATION depends on:

 


Severity of complaints
Size of cysts
Complexity of cysts on ultrasound study
Suspicion of cancer

 

 

 

Type Of Surgery:
 

 

1.  Ovarian Cystectomy
removal of cyst and conserving the ovary for hormonal function especially for young women.

 

2.  Oophorectomy
removal of whole ovary

 

3.  Total Hysterectomy & Bilateral Oophorectomy 
removal of both ovaries and the uterus

  

Mode of Operation:

 

Laporotomy – Open Method

Laparoscopy or "keyhole" surgery (Minimal Invasive Surgery MIS)

 

Advantages of Laparoscopy (MIS) 

 

1. Small scars - less painful, cosmetic effect.

 

2. Able to eat & go home on day of surgery.

 

3. Return to work earlier.

 

 

Urinary Incontinence

 

Many people, especially older ladies, suffer from the silent leakage of urine not knowing that this condition can be treated & eventually cured.

 

We will spend time with such patients and assist them in achieving a cure.

  

Available Services include Diagnosis and Treatment of:

 

1) stress incontinence

 

2) urge incontinence

 

3) overflow incontinence

 

4) true incontinence

 

5) functional incontinence

 

  

COLPOSCOPY

 

We will perform a Colposcopy on suspicious cervix and on abnormal Pap smear. This direct visualization of the cervix will enable us to perform a direct punch, so as to obtain a histological diagnosis. Colposcopy is a safe and painless procedure. Colposcopic Leep Cone Biopsy can be performed as a day clinic surgery in our clinic with use of your Medisave.

 

    

Left: Colposcopic Photo before surgery. Right: Photo showed a smooth healed cervix after day surgery. Patient has recovery from CIN 1 & Vaginal Discharge.
 
Last Updated ( Wednesday, 02 November 2011 )

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