Monday, February 28, 2011

Kehamilan molar/anggor

Kehamilan Anggur (Molar Pregnancy/Hydatidiform)


    









Wednesday, February 23, 2011

Kehamilan kembar


Kehamilan kembar.
Anak2 nabi Adam dan isterinya Hawa semua lahir kembar - satu lelaki dan satu lagi perempuan. Demi untuk membiakkan umat manusia, perkahwinan antara adik beradik dikalangan anak2 nabi Adam dibenarkan tetapi dilarang kahwin dengan teman kembarnya. 
Bilangan anak2 dan cucu2 serta cicit2 nabi Adam memang ramai . Mereka sangat subur kerana kahwin dalam umur muda, makan dari sumber2 makanan yang segar berkhasiat dab berzat iaitu hasil dari cucuk tanam sendiri. Stress mental dan emosi munkin sangat kecil atau pun tidak ujud sama sekali pada zaman tersebut. Mereka sangat subur dan amat mudah dapat anak2 kembar.
Dewasa ini kadar kelahiran kembar dalam lengkongan 1 dalam 80. Jika ada sejarah kembar peluang seseorang wanita hamil kembar lebih dari wanita biasa.
Pada keseleruhan risiko gugur bagi kehamilan kembar adalah lebih tinggi dari kandungan biasa. Dalam tiga bulan pertama kandungan jagaan lebih rapi diperlukan.




 Identical twin - atas
 Non identical twin - bawah


Identical twin - risiko pada kembar kedua, kekurangan bekalan oksijen dan makanan kerana terpaksa bersaing dapat bekalan dari satu uri.



Bolihkah kita rancang untuk hamil kembar? Biasanya ia berlaku secara kebetulan, dan meningkat peluang jika ada sejarah kembar dalam keluarga, bila makan pil subur , suntik hormon subur, buat bayi tabung uji IVF



http://pakbidan.blogspot.com/2011/01/punca-dan-mencegah-keguguran.html?m=0

Monday, February 21, 2011

Mencegah Premature Labour

Ini satu situasi yang bolih mengacam nyawa bayi ketika lahir kerana sistem pernafasan belum kuat lagi ia mudah diserang sesak nafas menyebabkan bekalan oksijen tidak mencukupi.










Premature labor means babies born before 37 weeks of pregnancy. Premature labor accounts for seven percent of total babies born in the UK. Though the risk for the mother is little, yet for the baby it is considerable.
Though premature labor can happen to any women, but it is quite risky for the young, single or smoking women and also those who are underweight.

Causes of Premature Labor

The causes of premature labor are not clear with 40 percent of cases. The main causes include:
Pre-eclampsia
Antenatal hemorrhage
Multiple pregnancies
Foetal abnormalities or death
Cervical incompetence
Illnesses like diabetes, high blood pressure or heart disease in the mother
Stress has shown to induce labor, especially when it is sudden or severe. Many vaginal infections like gonorrhoea, trichomonas, chlamydia, and group B streptococci are considered to be associated with premature labor.
Bacterial vaginosisin, in which the acidity of the vagina is changed, is also linked with premature labor. This could be possible due the reduction of the natural defenses of the body against infection.

Premature Labor Symptoms

Knowing premature labor is a challenging task. The only absolute sign of labor is the dilation of the cervix. But by this time it is not possible to stop the birth of the babay.
The challenge with premature labour is to spot it before it gets going. The only absolute proof of labour is dilation of the cervix, but by then it's too late to stop the baby being born.
Contractions of the uterus are not a sure sign of having a labor. There are cases of contractions from week 24 of the pregnancies, which are also known as Braxton Hicks or ‘practice’. Around two-third of labor cases will not deliver within 48 hours and one out of three of these women have full gestation periods.
If there is rupture of the woman’s membrane and there is loss of amniotic fluid, there is likelihood of labor as there are risks of infection. But sometimes urine is mistakenly taken for amniotic fluid and using special testing sticks give incorrect results.
The sure symptoms that show of an imminent premature birth include:
Four or more uterine contractions in one hour, before 37 weeks gestation.
Pain or rhythmic tightening in lower abdomen or back.
A watery discharge from the vagina, which may indicate premature rupture of the membranes surrounding the baby.
Menstrual cramps or abdominal pain.
Pressure in the pelvis or the sensation that the baby has "dropped".
Vaginal spotting or bleeding.

Treatment of Premature Labor

Screening of different infections mentioned above and treating them with antibiotics can reduce premature labor. The screening process must be done before the start of labor.
For stopping contractions there are drugs which can prevent in about quarter of the cases of premature labor. But these drugs hardly work for more than 48 hours. IF the membranes are ruptured, then these drugs carry some risk. These drugs are mainly used to delay delivery till the woman can go to a hospital.
During this time, there are treatments for making the baby arrive early, like drugs that help to mature the lungs. There treatments lessen the risk of complications, reducing to half the degree of respiratory distress syndrome.

Complications of Premature Labor

Babies born after 34 weeks have their systems completely matured and there is low risk of problems arising. The labor is continued in these cases. But if it is less than 28 weeks, then the babies have to be provided with neonatal intensive care unit in a hospital.
Nowadays, science has developed dramatically and babies born after 22 or 23 weeks can be survived by the doctors. There is the risk though of these babies for battling at the beginning of their life and there could be many long-term problems.
Babies who are born prematurely have the following kinds of problems:
Respiratory distress syndrome
Retinopathy of prematurity
Necritising enterocolitis
Low blood glucose
Hypothermia
Infection
Jaundice
Death

Prevention of Premature Labor

Though there is little one can do to stop premature labor, yet there are ways to reduce the risk. These include:
Stop smoking
Keep fit and healthy
Avoid excessive stress
Get vaginal infections or discharge treated
Symptoms like swollen ankles, blood loss or fluid loss should be reported

Sunday, February 13, 2011

Buasir ketika hamil





BUASIR WAKTU HAMIL


Waktu hamil buasir sering berlaku jika seibu sering mengalami sembelit. Ketika hamil perjalanan darah dari kaki menuju kearah jantung agak perlahan sedikit akibat tekanan olih rahim yang kian membesar keatas saluran darah. Akibatnya timbul urat2 vena dikaki - vericose vein. Kesan yang sama berlaku pada vena2 pada dubur menyebabkan timbulnya buasir (piles, hemorrhoids)

Kaedaan ini menjadi lebih teruk bila seibu mengalami sembelit. Makan banyak buah2 dan sayuran, cereal saperti corn flakes, bran, muesli dll. Minum fiber drink saperti fybogel dll. Makanan yang mengandungi banyak serabut/fiber adalah digalakkan.

Kalau berdarah atau luka sakit, beli ubat masuk dubur/suppository saperti anusol, proctosedyl, xyloproct dll. volteran supp. bolih mengurangkan sakit dan meredakan luka. Makan ubat daflon bolih bantu kecutkan buasir.


How are hemorrhoids treated?

At-home Treatments

Simple diet and lifestyle changes often reduce the swelling of hemorrhoids and relieve hemorrhoid symptoms. Eating a high-fiber diet can make stools softer and easier to pass, reducing the pressure on hemorrhoids caused by straining.
Fiber is a substance found in plants. The human body cannot digest fiber, but fiber helps improve digestion and prevent constipation. Good sources of dietary fiber are fruits, vegetables, and whole grains.
Doctors may also suggest taking a bulk stool softener or a fiber supplement such as psyllium (Metamucil) or methylcellulose (Citrucel).
Other changes that may help relieve hemorrhoid symptoms include
  • drinking six to eight 8-ounce glasses of water or other nonalcoholic fluids each day
  • sitting in a tub of warm water for 10 minutes several times a day
  • exercising to prevent constipation
  • not straining during bowel movements
Over-the-counter creams and suppositories ( anusol , proctosedyl, xyloproct , volteran supp,dll) may temporarily relieve the pain and itching of hemorrhoids. These treatments should only be used for a short time because long-term use can damage the skin.

Medical Treatment

If at-home treatments do not relieve symptoms, medical treatments may be needed. Outpatient treatments can be performed in a doctor’s office or a hospital. Outpatient treatments for internal hemorrhoids include the following:
  • Rubber band ligation. The doctor places a special rubber band around the base of the hemorrhoid. The band cuts off circulation, causing the hemorrhoid to shrink. This procedure should be performed only by a doctor.
  • Sclerotherapy. The doctor injects a chemical solution into the blood vessel to shrink the hemorrhoid.
  • Infrared coagulation. The doctor uses heat to shrink the hemorrhoid tissue.
Large external hemorrhoids or internal hemorrhoids that do not respond to other treatments can be surgically removed.
3Slavin JL. Position statement of the American Dietetic Association: health implications of dietary fiber. Journal of the American Dietetic Association. 2008;108(10):1716–1731.
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What foods have fiber?

Examples of foods that have fiber include
Breads, cereals, and beansFiber
1/2 cup of navy beans 9.5 grams
1/2 cup of kidney beans 8.2 grams
1/2 cup of black beans 7.5 grams
Drawing of a loaf of bread and a box of cereal.
Whole-grain cereal, cold
1/2 cup of All-Bran9.6 grams
3/4 cup of Total2.4 grams
3/4 cup of Post Bran Flakes5.3 grams
1 packet of whole-grain cereal, hot3.0 grams
(oatmeal, Wheatena)
1 whole-wheat English muffin4.4 grams
Drawing of an apple.
Fruits
1 medium apple, with skin3.3 grams
1 medium pear, with skin4.3 grams
1/2 cup of raspberries4.0 grams
1/2 cup of stewed prunes3.8 grams
Drawing of a 1/2 cup of peas.
Vegetables
1/2 cup of winter squash2.9 grams
1 medium sweet potato with skin4.8 grams
1/2 cup of green peas4.4 grams
1 medium potato with skin3.8 grams
1/2 cup of mixed vegetables4.0 grams
1 cup of cauliflower2.5 grams
1/2 cup of spinach3.5 grams
1/2 cup of turnip greens2.5 grams
Drawing of a baked potato.

Source: U.S. Department of Agriculture and U.S. Department of Health and Human Services, Dietary Guidelines for Americans, 2005.
[Top]

Points to Remember

  • Hemorrhoids are swollen and inflamed veins around the anus or in the lower rectum.
  • Hemorrhoids are not dangerous or life threatening, and symptoms usually go away within a few days.
  • A thorough evaluation and proper diagnosis by a doctor is important any time a person notices bleeding from the rectum or blood in the stool.
  • Simple diet and lifestyle changes often reduce the swelling of hemorrhoids and relieve hemorrhoid symptoms.
  • If at-home treatments do not relieve symptoms, medical treatments may be needed.

Saturday, February 12, 2011

Catatan suhu BBT


bbt 

Carta suhu BBT adalah satu kaedah mengesan penetasan telor / ovulation yang paling mudah, tepat dan murah harganya.
Perlu beli alat suhu yang khas , sering digelar ovulation / fertility thermometer yang bolih dibeli difarmasi dan ia disertai dengan kertas carta kosong yang perlu diisi mengikut sukatan suhu yang diukur pagi hari, sejurus sedar dari tidur dan belum melakukan apa2 aktiviti.



How is BBT Taken and Charted?
BBT is body temperature taken in the morning before rising, moving about, or eating.  To be accurate, the temperatures must be taken at the same time every day upon waking, preferably after a good night’s sleep. BBTs are measured orally with a thermometer and recorded on a chart in graph form.  It is essential that the thermometer reads accurately to the 10th of a degree, so you may want to purchase a specific BBT thermometer.  Any discrepancies to your normal sleep cycle or wake time should be noted so your practitioner can account for inconsistent readings.
Several factors can influence and distort BBT, including:
  • Irregular sleep, disruptive sleep, or travel to different time zone
  • Alcohol or drug consumption including antipyretic and anti-inflammatory medications or sleeping aids.
If you work swing shifts for work or have sleep difficulties, BBT charting may not be the most reliable tool for you.


bbt2 

The Picture Perfect BBT
BBT chart fluctuations reflect changes in a woman’s body throughout the menstrual cycle.  During pre-ovulation (also known as the follicular phase) temperatures should remain fairly stable.  Typically, there is a dip in BBT when lutenizing hormone (LH) surges just before ovulation and a spike in temperature shortly after ovulation.  Luteal phase (post-ovulatory) temperatures should remain at least 0.4 degrees higher than follicular phase temperatures in order for implantation to be successful.
Keep in mind that most women’s BBT charts are not picture perfect, and conception can occur despite irregularities.  This tool should be used as information only, not a complete diagnosis.  If you tend to be more stressed out by “too much information,” BBT charting may cause more harm than good.  Talk to your practitioner to decide BBT charting is right for you.

Placenta previa - uri dipintu rahim















Bila uri terletak dipintu rahim , kelahiran normal tidak bolih berlaku dan jika diteruskan , ia bolih menyebabkan tumpah darah yang amat banyak dan akan mengancam nyawa kedua ibu dan bayi



Placenta previa

Pregnancy in which the placenta grows in the lowest part of the womb (uterus) and covers all or part of the opening to the cervix.
The placenta is the organ that nourishes the developing baby in the womb.

Causes, incidence, and risk factors

During pregnancy, the placenta moves as the uterus stretches and grows. In early pregnancy, a low-lying placenta is very common. But as the pregnancy progresses, the growing uterus should "pull" the placenta toward the top of the womb. By the third trimester, the placenta should be near the top of the uterus, leaving the opening of the cervix clear for the delivery.
Sometimes, though, the placenta remains in the lower portion of the uterus, partly or completely covering this opening. This is called a previa.
There are different forms of placenta previa:
  • Marginal: The placenta is against the cervix but does not cover the opening.
  • Partial: The placenta covers part of the cervical opening.
  • Complete: The placenta completely covers the cervical opening.
Placenta previa occurs in 1 out of 200 pregnancies. It is more common in women who have:
  • Abnormally developed uterus
  • Many previous pregnancies
  • Multiple pregnancy (twins, triplets, etc.)
  • Scarring of the uterine wall caused by previous pregnancies, cesareans, uterine surgery, or abortions
Women who smoke or have their children at an older age may also have an increased risk. Possible causes of placenta previa include:
  • Abnormal formation of the placenta
  • Abnormal uterus
  • Large placenta
  • Scarred lining of the uterus (endometrium)

Symptoms

The main symptom of placenta previa is sudden, painless vaginal bleeding that often occurs near the end of the second trimester or beginning of the third trimester. In some cases, there is severe bleeding, or hemorrhage. The bleeding may stop on its own but can start again days or weeks later.
There may be uterine cramping with the bleeding. Labor sometimes starts within several days after heavy vaginal bleeding. However, in some cases, bleeding may not occur until after labor starts.

Signs and tests

Your health care provider can diagnose placenta previa with an ultrasound exam. Most cases of placenta previa are identified by routine ultrasound during pregnancy.

Treatment

Treatment depends on various factors:
  • How much bleeding you had
  • Whether the baby is developed enough to survive outside the uterus
  • How much of the placenta is covering the cervix
  • The position of the baby
  • The number of previous births you have had
  • Whether you are in labor
Many times the placenta moves away from the cervical opening before delivery.
If the placenta is near the cervix or is covering a portion of it, you may need to reduce activities and stay on bed rest. Your doctor will order pelvic rest, which means no intercourse, no tampons, and no douching. Nothing should be placed in the vagina.
If there is bleeding, however, you will most likely be admitted to a hospital for careful monitoring.
If you have lost a lot of blood, blood transfusions may be given. You may receive medicines to prevent premature labor and help the pregnancy continue to at least 36 weeks. Beyond 36 weeks, delivery of the baby may be the best treatment.
If your blood type is Rh-negative, you will be given anti-D immunoglobulin injections.
Your health care providers will carefully weigh your risk of ongoing bleeding against the risk of an early delivery for your baby.
Women with placenta previa most likely need to deliver the baby by cesarean section. This helps prevent death to the mother and baby. An emergency c-section may be done if the placenta actually covers the cervix and the bleeding is heavy or very life threatening.

Expectations (prognosis)

Placenta previa is most often diagnosed before bleeding occurs. Careful monitoring of the mother and unborn baby can prevent many of the significant dangers.
The biggest risk is that severe bleeding will require your baby to be delivered early, before major organs, such as the lungs, have developed.
Most complications can be avoided by hospitalizing a mother who is having symptoms, and delivering by C-section.

Complications

Risks to the mother include:
  • Death
  • Major bleeding (hemorrhage)
  • Shock
There is also an increased risk for infection, blood clots, and necessary blood transfusions.
Prematurity (infant is less than 36 weeks gestation) causes most infant deaths in cases of placenta previa. The baby may lose blood if the placenta separates from the wall of the uterus during labor. The baby also can lose blood when the uterus is opened during a C-section delivery.

Calling your health care provider

Call your health care provider if you have bleeding from the vagina at any point in your pregnancy. Placenta previa can be dangerous to both you and your baby.

Prevention

This condition is not preventable.

Bayi lemas / fetal distress

Apakah makna bayi lemas atau fetal distress?

Bolih dikatakan punca yang sering kita dengar mengapa bayi dilahirkan secara bedah cesarean ialah ' fetal distress'. Malah ia juga jadi penyebab bagi doktor bidan lakukan kelahiran secara forceps atau vakum.

Situasi ini timbul sebab bekalan oksijen kepada bayi ketika labor/sakit bersalin berkurangan sehingga ia bolih mengancam nyawa bayi. Perlu dingat bayi mendapat bekalan oksijen dan pemakanan dari ibu melalui perantaraan uri dan tali pusat.

Apakah punca yang menyebabkan bekalan oksijen ini berkurangan atau terputus sama sekali? 
Sebenarnya gangguan bekalan oksijen bolih berlaku ketika hamil sebelum sakit bersalin/ labor berlaku. Sebab itu pemantauan pertumbuhan bayi dalam dua bulan terakhir kehamilan amat penting. Gejala pertumbuhan bayi menandakan gangguan pada fungsi uri yang berperanan sebagai pembekal makanan dan oksijen kepada bayi. Ia bolih dikesan dari beberapa petanda, turun atau tidak naik berat badan ibu, ukuran tinggi rahim pada perut ibu dan kekerapan gerakan bayi dalam perut ibu.
Lebih tepat lagi ,untuk mengukur gejala pertumbuhan bayi dan kecekapan fungsi uri ialah melakukan beberapa ukuran tubuh bayi dengan alat ultrsound scan. Diantara ukuran2 ialah, biparietal diameter kepala (BPD) , femur length (FL), abdominal circumference (AC) dan dari sini anggaran berat badan bayi bolih dibuat. Anggaran amaun air toban bolih juga dibuat dengan scanning. Dari angka2 tersebut , doktor bidan bolih membuat jangkaan samada bayi bolih lahir secara normal atau tidak. Jika berlaku gejala pertumbuhan bayi sebab fungsi uri terganggu (placental insufficiency) , bayi ini tidak tahan menempuhi sakit bersalin/ labor dan situasi bayi lemas/ fetal distress akan timbul. Lebih selamat lagi bayi ini dilahirkan secara bedah cesar sebelum labor.

Satu lagi faktor yang bolih meyebabkan gangguan bekalan oksijen kepada bayi ialah perdarahan ketika hamil yang mengakibatkan kerosakkan uri saperti yang berlaku pada accidental hemorrhage.

Toxemia iaitu satu rangkaian gejala terdiri dari tekanan darah tinggi, kencing mengandungi perotin dan bengkak kaki/ edema, juga bolih menyebabkan gangguan bekalan oksijen ekoran dari kerosakkan uri.

Lilitan tali pusat keliling lehir bayi khususnya jika terlilit banyak kali pusingan bolih menyebabkan bayi lemas waktu labor. Kadang kali lilitan ini dapat dikesan waktu ultrasound scanning. Tidak semua lilitan tali pusat menyebabkan bayi lemas. Saya banyak kali melahirkan bayi secara normal atau vakum dengan tali pusat terlilit tetapi tidak langsung ada kesan gangguan bekalan oksijen pada bayi.

Satu lagi kaedaan yang berpotensi menimbulkan situasi bayi lemas ialah rongga ponggong ibu sempit iaitu cephalo pelvic disproportion (CPD). Biasanya ukuran tinggi ibu rendah iaitu kurang dari lima kaki. Dalam situasi begini jika labor dibenarkan berterusan akhirnya bayi akan lemas.

Kadang2 bentuk rongga ponggong ibu tidak bulat tetapi lepir dan ini juga bolih timbulkan kaedaan bayi lemas.
Ada kala juga kepala bayi bila masuk kedalam rongga ponggong ketika labor dalam kaedaan sengit (asynclitism) dan ini menyebabkan labor berpanjangan dan akhirnya bayi lemas.

Ada kalanya berlaku pintu rahim tidak mahu buka ketika labor dan berterusan begitu walau pun telah lama sakit bersalin dan akhirnya bayi lemas. Kaedaan ini digelar cervical dystocia.

Sangat penting untuk memantau kemajuan labor : kekerapan dan kekuatan kuncupan rahim, kadar denyutan jantung bayi, dan pembukaan pintu rahim serta kedudukan kepala bayi didalam rongga ponggong. Hampir kesemua hospital bersalin mempunyai alat2 pemantau CTG untuk memudahkan doktor dan bidan mengesan bayi lemas / fetal distress. Kemudahan ini telah dapat mengurangkan kadar kematian dan kecacatan bayi.










Apakah tanda2 bayi lemas ketika sakit bersalin?

Tanda utama ialah kadar denyut jantung menurun ke 120 beat/min kebawah atau melebihi 180 bt/min atau FH tracing menunjukkan 'flat' tanpa turun naik, dan air toban berwarna hijau bercampur najis bayi. Lebih lagi lihat video ini.





What is Fetal Distress?

The theory of fetal distress is this:
  • Neurological damage occurs when the baby's brain is deprived of oxygen. Lack of oxygen to the brain can be recognized by patterns in the baby's heart rate.
  • When the baby's heart rate pattern demonstrates a lack of oxygen (fetal distress) it is necessary for the baby to be born immediately.
  • To recognize changes in oxygenation, the baby's heart rate will be monitored, probably with an electronic fetal monitor (EFM) during labor for indications of fetal distress.
Read more about fetal distress

Friday, February 11, 2011

Waktu pantang lepas bersalin








Ada kah patang larang yang diamalkan olih ibubapa dan nenek moyang kita membawa faedah atau lebih banyak mudharat?
PEKEJ SET LEPAS BERSALIN



Luka waktu bersalin


Second-degree vaginal tear


Second-degree vaginal tears involve vaginal tissue (vaginal mucosa) and the perineal muscles — the muscles between the vagina and anus that help support the uterus, bladder and rectum. Second-degree tears typically require stitches and heal within a few weeks.
To ease discomfort while you're recovering:
  • Sit on a hard surface or padded ring.
  • Squat — rather than sit — on the toilet. Pour warm water over your vulva as you're passing urine, and rinse yourself afterward. Press a clean pad firmly against the wound when you bear down for a bowel movement. Guna SITZ BATH
  • Cool the wound with an ice pack, or place a chilled witch hazel pad between a sanitary napkin and the wound. Guna FEMEPAD
  • Take pain relievers or stool softeners as recommended by your health care provider.


Third-degree vaginal tear


Third-degree vaginal tears involve the vaginal tissues, perineal muscles and the muscle that surrounds the anus (anal sphincter). These tears sometimes require surgical repair and may take six weeks to heal.
To ease discomfort while you're recovering:
  • Sit on a hard surface or padded ring. Guna SITZ BATH
  • Squat — rather than sit — on the toilet. Pour warm water over your vulva as you're passing urine, and rinse yourself afterward. Press a clean pad firmly against the wound when you bear down for a bowel movement.
  • Cool the wound with an ice pack, or place a chilled witch hazel pad between a sanitary napkin and the wound. Guna FEMEPAD
  • Take pain relievers or stool softeners as recommended by your health care provider.

Kecerdaan ketika bersalin kadangkali tidak bolih dielakkan khususnya jika kelahiran perlu pertolongan forceps atau vakum. jika bayi terlalu besar kedudukan kepala singit ( OP, asynclitism)
Untuk percepat sembuh luka faraj , sila gunakan set POST DELVERY HEALING SET




Perdarahan waktu bersalin



Perdarahan waktu bersalin mengancam nyawa ibu

Hemorrhage is not something that we want to think about when it comes to giving birth. In fact, 95% of births will not have a problem with hemorrhage. However it is important to know the risk factors for hemorrhage and discuss your personal risk factors with your doctor or midwife.
Postpartum hemorrhage is defined as a loss of blood in the postpartum period of more than 500 mL. The average, spontaneous vaginal birth will typically have a 500 mL blood loss. In cesarean births the average blood loss rises to 800-1000 mL. There is a greater risk of hemorrhage in the first 24 hours after the birth, called primary postpartum hemorrhage. A secondary hemorrhage occurs after the first 24 hours of birth.
There are certain risk factors that make a postpartum hemorrhage more likely to happen:

These risk factors can make it more likely but are not certain indicators of hemorrhage. Knowing that there are greater risks for some may make certain precautions more necessary than for low risk women. In the majority of cases the cause of hemorrhage is uterine atony, meaning that the uterus is not contracting enough to control the bleeding at the placental site. Other reasons for a hemorrhage would include retained placental fragments (possibly including a placenta accreta), trauma of some form, like a cervical laceration, uterine inversion or even uterine rupture, and clotting disorders.
If hemorrhage does occur there are several steps which can be taken to treat the bleeding, steps used depend on the reason for the bleeding:

  • Uterine massage
  • Have the mother in the trendelenberg position (Feet above heart)
  • Give oxygen
  • Ensure two large IV sites are available
  • Give Medications (Several types: Pitocin, methergine, hemabate)
  • Consider surgery including ligation of Uterine and Hypogastric arteries and/or hysterectomy (removal of the uterus)
Preventing Hemorrhage All women will receive care to help prevent hemorrhage after the birth of their baby. Immediately following the birth of the baby, signs of placental separation will be watched for to know when the placenta is ready to be delivered. A placenta that does not deliver spontaneously is a risk factor for postpartum hemorrhage.
Some hospitals and birth centers choose to give every woman a routine injection of pitocin to help prevent hemorrhage and to help ensure that the placenta comes quickly and easily. However, many choose a more natural route, which is to wait and see if there is a bleeding problem. Many also encourage the American Academy of Pediatrics recommendation of breastfeeding beginning as soon as possible after birth. This allows the mother to secrete her own oxytocin to help contract the uterus and expel the placenta.
Massaging the uterus is also done to help expel clots of blood. It is also used to check the tone of the uterus and ensure that it is clamping down to prevent excessive bleeding. Poor tone of the uterus at this point is what causes 70% of the cases of postpartum hemorrhage. This can be uncomfortable to painful. Be sure to utilize any and all relaxation and breathing techniques and not tense your abdominal muscles. If it is too painful, medications can also be used. This will be done with decreasing frequency after the birth, as your bleeding slows.
Ensuring your bladder is empty will also help you avoid hemorrhage. Simply emptying the bladder in any manner can do this. Women who have not used regional anesthesia can usually use the restroom themselves within the hour after birth. Those who had regional anesthesia can use the restroom or bedpan in varying time increments, but usually within an hour of the anesthesia wearing off, unless a cesarean was performed. Catheterization can also be of benefit here, including both the indwelling catheter (usually done for cesareans and those with major urethral trauma) or what is called an "in/out" or "straight cath" to drain the urine and allow the bladder to not impede the uterus.
Talking to your practitioner to see which after birth protocol he or she uses and what might be best for your situation can go a long way in helping you to understand your personal risk factors and prevention strategy for postpartum hemorrhage.

Cara mudah bersalin







Setengah wanita mudah melalui kelahiran tanpa kesakitan yang terok dan berpanjangan, manakala yang lain memang perlu merintangi cabaran kesakitan yang kuat dan berpanjangan. Bagaimana cara untuk atasi.
Alhamdulillah isteri saya mudah melahirkan 5 anak saya dan mengalami sakit bersalain selama satu jam sahaja.  Anak2 dan menantu perempuan pun mudah melahirkan anak , tapi sakit lebih lama lagi 4-6 jam. dan mereka tidak memerlukan apa2 ubat penawar sakit. Munkin faktor baka dan keturunan ada memainkan peranan.

n
Tip untuk mudahkan bersalin
Tanya emak kita atau saudara mara dan kawan yang pernah bersalin .
Ketenangan fikran dan kemantapan mental dan emosi sangat penting.
Kuatkan iman dan sentiasa bertawakkal kepada Allah SWT setelah kita berusaha.
Sokongan moral dan emosi dari suami dan ibu sangat penting.
Banyak baca quran dqn bibir sentiasa berzikir menyebut dan memuji Allah.
Bualan terakhir kandungan - buat exercise, jalan selam 30 minit lepas makan malam, sambil buat breathing exercise. Pelajari teknik breathing exercise. penting untuk tahan sakit dan meneran bila kepala bayi keluar.
Makan banyak buah2 dan sayur2, buah papaya, jambu, timbikai , apple, oren, nenas pun bolih.
Hubungan sex pun bolih diteruskan kerana ia membantu buka pintu rahim.
Air selusuh - dari bacaan quran, surah yaasin, ayat kursi dll
Air suam yang direndam 'akar fatimah' ini biasa dibeli diMekah atau Medinah, juga mula diminum dibulan terakhir.
Waspada produk2 yang dikatakan mudahkan bersalin, kerana mereka yang makan sering dilanda tumpah darah yang banyak ketika bersalin.
Penawar sakit bersalin
Alhamadulillah sebahagian besar dari wanita muslim daya ketahanan sakit adalah tinggi. Ini bermakna mereka kurang memerlukan bantuan ubat penawar sakit. Ini disebabkan mereka kuat iman dan banyak bertawakkal kepada AllahSWT. Bacaan 'suhanallah' memang ada kesan untuk mengurangkan sakit atau meringkan bebanan.. Baca fatiha, ayat kursi, 3 qul, berulang2 kali. atau baca mana2 surah alquran - surah mariam mithalnya. Terus menerus berzikir.
Amalkan doa2 ini



Birth simulation on model

Jahit pintu rahim cegah gugur


Setengah wanita megalami keguguran berulang kali , yang sering berlaku sekitar 4-6 bulan kandungan. Punca berlaku demikian ialah pintu rahim longgar - cervical incompetence. Pintu rahim perlu dijahit sekitar 3 bulan hamil - kaedah ini digelar Shirodkar suture atau cervical cerclage




Cervical incompetence is basically a cervix that is too weak to stay closed during a pregnancy. Therefore resulting in a premature birth and possibly the loss of the baby, because of the shortened gestational length. It is believed that cervical incompetence is the cause of 20 - 25 % of all second trimester losses. This incompetence generally shows up in the early part of the second trimester, but possibly as late as the early third trimester.
It is generally categorized as premature opening of the cervix without labor or contractions. Diagnosis can be made either manually or with ultrasonography. The use of ultrasonography has been very helpful with the diagnosis, and is made when the cervical os (opening) is greater than 2.5 cm, or the length has shortened to less than 20 mm. Sometimes funneling is also seen, this is where the internal portion of the cervix, internal os (portion of the cervix closer to the baby) has begun to efface. The external os will be unaffected if diagnosed in time. Factors that increase the likelihood of suffering from an incompetent cervix are:

  • DES exposure
  • Cervical Trauma
  • Hormonal influences
  • Congenitally short cervix
  • Forced D & C
  • Uterine anomalies
If you are diagnosed after a second trimester loss or prior to pregnancy it is suspected that you will have problems with the strength of your cervix, a cerclage (stitching the cervix closed) can be performed prophylactically at approximately 14-16 weeks. It is said that the earlier you have the cerclage performed the more likely the pregnancy is to continue.



Diabetes ketika hamil


Setengah wanita mengidap diabetes waktu hamil sahaja, mereka ada potensi dapat gestational diabetes kerana, sejarah keluarga atau keturunan yang ada diabetes, obesity/kegemokkan and pengidap PCOS.

Gestational diabetes

Glucose intolerance during pregnancy
Gestational diabetes is high blood sugar (diabetes) that starts or is first diagnosed during pregnancy.

Causes, incidence, and risk factors

Pregnancy hormones can block insulin from doing its job. When this happens, glucose levels may increase in a pregnant woman's blood.
You are at greater risk for gestational diabetes if you:
  • Are older than 25 when you are pregnant
  • Have a family history of diabetes
  • Gave birth to a baby that weighed more than 9 pounds or had a birth defect
  • Have sugar (glucose) in your urine when you see your doctor for a regular prenatal visit
  • Have too much amniotic fluid
  • Have had an unexplained miscarriage or stillbirth
  • Were overweight before your pregnancy

Symptoms

Usually there are no symptoms, or the symptoms are mild and not life threatening to the pregnant woman. Often, the blood sugar (glucose) level returns to normal after delivery.
Symptoms may include:

Signs and tests

Gestational diabetes usually starts halfway through the pregnancy. All pregnant women should receive an oral glucose tolerance test between the 24th and 28th week of pregnancy to screen for the condition. Women who have risk factors for gestational diabetes may have this test earlier in the pregnancy.
Once you are diagnosed with gestational diabetes, you can see how well you are doing by testing your glucose level at home. The most common way involves pricking your finger and putting a drop of your blood on a machine that will give you a glucose reading.

Treatment

The goals of treatment are to keep blood sugar (glucose) levels within normal limits during the pregnancy, and to make sure that the growing baby is healthy.
WATCHING YOUR BABY
Your health care provider should closely check both you and your baby throughout the pregnancy. Fetal monitoring to check the size and health of the fetus often includes ultrasound and nonstress tests.
  • A nonstress test is a very simple, painless test for you and your baby. A machine that hears and displays your baby's heartbeat (electronic fetal monitor) is placed on your abdomen. When the baby moves, the baby's heart rate normally increases 15 - 20 beats above its regular rate.
  • Your health care provider can compare the pattern of your baby's heartbeat to movements and find out whether the baby is doing well. The health care provider will look for increases in the baby's normal heart rate occurring within a certain period of time.
DIET AND EXERCISE
The best way to improve your diet is by eating a variety of healthy foods. You should learn how to read food labels, and check them when making food decisions. Talk to your doctor or dietitian if you are a vegetarian or on some other special diet.
In general, your diet should be moderate in fat and protein and provide controlled levels of carbohydrates through foods that include fruits, vegetables, and complex carbohydrates (such as bread, cereal, pasta, and rice). You will also be asked to cut back on foods that contain a lot of sugar, such as soft drinks, fruit juices, and pastries.
You will be asked to eat three small- to moderate-sized meals and one or more snacks each day. Do not skip meals and snacks. Keep the amount and types of food (carbohydrates, fats, and proteins) the same from day to day.
  • Your doctor or nurse will prescribe a daily prenatal vitamin. They may suggest that you take extra iron or calcium. Talk to your doctor or nurse if you're a vegetarian or are on some other special diet.
  • Remember that "eating for two" does not mean you need to eat twice as many calories. You usually need just 300 extra calories a day (such as a glass of milk, a banana, and 10 crackers).
For details on what you should eat, see: Diabetes diet - gestational
If managing your diet does not control blood sugar (glucose) levels, you may be prescribed diabetes medicine by mouth or insulin therapy. You will need to monitor your blood sugar (glucose) levels during treatment.
Most women who develop gestational diabetes will not need diabetes medicines or insulin, but some will.

Expectations (prognosis)

Most women with gestational diabetes are able to control their blood sugar and avoid harm to themselves or their baby.
Pregnant women with gestational diabetes tend to have larger babies at birth. This can increase the chance of problems at the time of delivery, including:
  • Birth injury (trauma) because of the baby's large size
  • Delivery by c-section
Your baby is more likely to have periods of low blood sugar (hypoglycemia) during the first few days of life.
Mothers with gestational diabetes have an increased risk for high blood pressure during pregnancy.
There is a slightly increased risk of the baby dying when the mother has untreated gestational diabetes. Controlling blood sugar levels reduces this risk.
High blood sugar (glucose) levels often go back to normal after delivery. However, women with gestational diabetes should be watched closely after giving birth and at regular doctor's appointments to screen for signs of diabetes. Many women with gestational diabetes develop diabetes within 5 - 10 years after delivery. The risk may be increased in obese women.

Complications

  • Delivery-related complications due to the infant's large size
  • Development of diabetes later in life
  • Increased risk of newborn death and stillbirth
  • Low blood sugar (glucose) or illness in the newborn

Calling your health care provider

Call your health care provider if you are pregnant and you have symptoms of diabetes.

Prevention

Beginning prenatal care early and having regular prenatal visits helps improve your health and the health of your baby. Knowing the risk factors for gestational diabetes and having prenatal screening at 24 - 28 weeks into the pregnancy will help detect gestational diabetes early.
If you are overweight, decreasing your body mass index (BMI) to a normal range before you get pregnant will decrease your risk of developing gestational diabetes.
References

Toxemia kehamilan


Preclamptic toxemia atau PET adalah satu situasi ketika hamil dimana tekanan darah naik tinggi, kencing mengandungi albumin, dan kaki bengkak/edema


Bahaya darah tinggi dan keracunan kehamilan

Masalah darah tinggi dan keracunan kehamilan (pre-eclampsia) biasa berlaku mulai kehamilan tujuh bulan.Kadang-kala kita tidak menjangka siapa yang akan terkena penyakit ini, tetapi bagi mereka yang hamil pertama kalinya, ataupun mereka yang terlalu gemuk dan mengidap penyakit kencing manis, ataupun memang pernah mengidap penyakit darah-tinggi dan buah pinggang adalah di antara mereka yang terdedah kepada masalah ini.
 
Pemeriksaan 'antenatal' setiap bulan, selepas tujuh bulan dua minggu sekali dan bulan terakhir seminggu sekali,adalah sangat penting untuk mengesan keadaan penyakit darah tinggi dan keracunan (toxemia) kehamilan.Setiap kali ibu hamil datang ke klinik di antara pemeriksaan yang dilakukan ke atasnya ialah mengukur tekanan darah, mengukur timbang beratnya dan juga memeriksa air kencingnya untuk gula dan albumin.
Ini sangat penting untuk tujuan mengesan penyakit keracunan (toxemia) kehamilan yang biasanya ditandakan dengan bengkak kaki, timbang berat yang naik secara mendadak, sembab muka dan apabila diukur tekanan darah didapati terlalu tinggi iaitu melebihi 140/90 mm Hg dan air kencingnya mengandungi albumin.

Apakah risiko kepada ibu?

Toxemia kehamilan boleh mengancam nyawa ibu jika ia tidak terkawal khususnya apabila tekanan darahnya meningkat mungkin melebihi 180/110 mm Hg dan apabila air kencing ibu tersebut mengandungi banyak albumin iaitu mungkin + + + + . Ibu juga merasa pening, mungkin gelap mata dan hampir pitam dan rasa kesakitan pada bahagian ulu hati.Jika keadaan begini berlaku kadang-kala ibu boleh terkena serangan sawan (eclampsia).
 
Sawan ini sangat merbahaya pada ibu kerana ini menandakan pendarahan mungkin telah berlaku dalam otak ibu (cerebral haemorrhage), atau bekalandarah kepada otak telah terganggu akibat daripada kuncupan saluran darah tersebut dan biasanya otak telah dipenuhi dengan cecair (cerebral adema).Risiko kematian ibu adalah sangat tinggi dalam keadaan begini khususnya mereka yang telah tidak sedarkan diri (coma).
Dalam keadaan begini doktor perlu melakukan pembedahan caesarean untuk mengeluarkan bayi tanpa mengira umur atau akibat kepada bayi tersebut sama ada boleh hidup atau tidak demi untuk menyelamatkan nyawa ibu.Apabila bayi dan uri telah dikeluarkan melalui pembedahan, biasanya penyakit ini akan reda dengan cepatnya dan hanya inilah yang boleh menyelamatkan nyawa ibu setelah diserang dengan sawan tersebut.

Dalam kes yang kurang teruk doktor boleh mengawal penyakit toxemia ini dengan memasukkan ibu tersebut ke hospital untuk berehat sambil mengawal tekanan darahnya, air kencingnya dan pertumbuhan bayi melalui ujian-ujian klinikal , ukuran timbang berat dan juga ujian ultrasound yang dilakukan berulangkali untuk mengetahui samaada pertumbuhan bayi masih berlaku atau tidak.
Jika tidak ada pertumbuhan bayi dan bayi mungkin terancam nyawanya, dan dijangka bayi boleh hidup apabila dilahirkan, maka langkah yang sewajar ialah untuk melakukan pembedahan cesarean untuk menyelamatkan bayi.
Jika keadaan darah tinggi dan toxemia ini sangat sederhana dan tidak ada tanda-tanda ia mengancam ibu dan bayi, setakat berehat dan diberi rawatan dengan ubat untuk mengurangkan tekanan darah, kawalan pemakanan untuk mengurangkan karbohidrat, minyak dan garam dalam makanan.

Rehat adalah sangat penting untuk mengawal penyakit darah tinggi ini.Biasanya jika keadaan ini boleh dikawal dan pertumbuhan dan nyawa bayi tidak terancam, maka kelahiran secara normal boleh dilakukan dengan memaksa sakit bersalin (induced labour)pada umur kehamilan antara 37 hingga 38 minggu.Kelahirantidak boleh lambatkan kerana uri boleh rosak dan dengan itu bekalan oxygen dan makanan pada bayi boleh terjejas menyebabkan kematian bayi dalam rahim.

Apakah punca sebenar bagi toxemia dan darah tinggi?

Punca yang sebenar tidak diketahui, tetapi mungkin dalam darah pesakit yang mengidap toxemia ini terdapat banyak jenis racun yang boleh menyebabkan darah tinggi dan merosakkan organ-organ badan khususnya otak dan hati.

Racun-racun ini adalah dikeluarkan oleh uri (placenta).Mengapa uri mengeluarkan racun, tidaklah diketahui dan mengapa sesetengah wanita keluarkan racun ini dan yang lainnya tidak, ini pun tidak diketahui.Mungkin ia merupakan satu reaksi untuk menolak uri tersebut.
Uri dibentuk sebahagiannya daripada baka suami, tubuh isteri cuba menolaknya dan dengan ini timbullah reaksi dengan mengeluarkan racun.Bagaimana ia berlaku tidaklah diketahui.Biasanya selepas kelahiran bayi dan uri telah sempurna dikeluarkan, keracunan akan lesap dan tekanan darah turun ke tahap normal dengan cepat. Perkara-perkara yang boleh mengelakkan kejadian ini ialah dengan amalan makanan yang seimbang, memakan vitamin Folik Asid yang terus-menerus antara 5mghingga 10 mg setiap hari dari awal kandungan hingga akhir.

Mengawal berat badan supaya ia tidak melebihi had biasa,berat badan sepatutnya tidak boleh melebihi 15 kilo bagi keseluruhan kehamilan.Bagi panduan para ibu yang hamil, lima bulan pertama berat badan patut meningkat satu kilo sebulan dan empat bulan terakhir dua kilo sebulan menjadikan jumlahnya lebih kurang 13 kilo di akhir kehamilan.

Kerehatan dan ketenangan juga memainkan peranan penting untuk mengelakkan masalah darah tinggi dan keracunan.Bagi mereka yang tenangrohnya serta kuat iman mungkin kurang tededah kepada ancaman toxemia, sebab itu saya sentiasa menasihati ibu-ibu yang hamil untuk membaca Al Quran dari awal kehamilan dan tidak melupakan segala suruhan Allah seperti solat, berpuasa dan sering melakukan amalan zikir, bertasbih, bertasmid dan lain lain untuk mengingati Allah.Memang amalan amalan ini boleh mengurangkan ketegangan fisikal dan mental .



Signs and Symptoms of PET:
  • Mild PET: In mild cases of PET, blood pressure is persistently at and above 140/90 mmHg but below 160/110 mmHg. There may be edema and/or proteinuria.
  • Severe PET: In severe cases of PET, blood pressure lies at /above 160/110mmHg. There may be edema all over the body including the face. Grade III Proteinuria is almost always present. The patient may complain of other grave symptoms like headache, giddiness, pain in the upper part of the abdomen (epigastric pain), vomiting, various eye symptoms, and sometimes decrease in the volume of urine (oliguria).
  • All types of PET: In both mild and severe cases, the patient is usually carrying her first pregnancy and is more than 20 weeks pregnant, usually more than 28 weeks.
  • Excessive Weight Gain: There may be abnormal weight gain. Pressure Symptoms: Pressure symptoms like breathlessness and palpitation can occur due to the excessive weight gain.
Tests in PET
  • Blood : Haemoglobin level and serum Uric Acid levels.
  • Urine : The total quantity of urine; presence of protein in the urine.
  • Eyes : The fundus of the eye has to be checked for any changes caused by hypertension.
Complications of PET:
  • Eclampsia: The most important complication is eclampsia which is PET complicated with convulsions or fits. Cerebral hypoxia (lack of oxygen in the brain) and cerebral edema due to high blood pressure are the main causes.
  • Placental Abruption: Placental Abruption i.e. bleeding into the base of the placenta leading to fetal death is another important complication.
  • Chronic Hypertension: Some patients may develop chronic hypertension after delivery.

Management / Treatment of Pre-eclamptic Toxaemia (PET)
Mild PET :
  • Bed rest: Bed rest should be taken for at least 8 hours at night and 2 hours during the day. She should also lie down in bed on her left side during the other hours as much as possible. Rest causes decrease in hypertension, decrease in oedema, increases the placental blood flow.
  • Diet and Salt Restriction: Pregnancy Diet should be nutritious with adequate fluid intake. Salt is restricted to 5 mg per day instead of 10 mg per day as advised in normal pregnancy.
  • Medicines: Anti-hypertensive and sedative drugs are prescribed.
  • Regular monitoring: Regular monitoring of blood pressure, fluid intake and output chart; urine for protein; weight increase; check up of eyes; blood tests.
  • Regular fetal monitoring The rate and rhythm of the fetal heart sound and number of fetal movements per day is monitored.
  • Delivery of the baby: Pregnancy is terminated at 37 weeks after checking for fetal maturity by USG. If cervix is soft and inducible, then labor is induced. If fetus is deemed to be at risk and cervix firmly closed , elective caesarian section should be done.
Severe PET :
  • Total Bed rest: The patient is advised total bed rest, rising from bed only to go to the bathroom. Sometimes in very severe cases, she may even have to use the bed pan.
  • Immediate hospital admission: She is admitted in the hospital immediately as soon as she is diagnosed as a a severe case of pre-eclamptic toxaemia. This ensures constant monitoring of the vital parameters.
  • Medicines: Drugs to control convulsions, hypertension and maintain urine output are prescribed.