Of ether, PPH, maternal mortality & gynae-land

Fascinating pictures from NY Times’ coverage on Tanzania and its high maternal mortality rate. Ether, if i’m not wrong, is a very old-fashioned way of anesthesia. 

One of my clinical tutors at the hospital i rotated for Obstetrics & Gynaecology is semi-retired now; he comes in weekly for an antenatal clinic and gives us weekly tutorials on mainly obstetrics. I can see that is his passion.  Often, he goes to sub-sahara Africa for medical missions. He liaises with the government officials and recently i heard him speak at one of the Friday morning CME meetings, where he talked about maternal mortality at Sudan. He reflected about his experiences and how the introduction of misoprostol easily dropped the rates of maternal mortality (hugely contributed by uncontrolled post-partum haemorrhage). According to UNICEF, in Sudan, there is  a maternal mortality ratio of 1,107 deaths per 100,000 live birth. In Australia, the rate is 8-10 per 100,000. What a stark contrast eh? Between 1991-96, 1 woman died in Australia of PPH. Most of the 1107 women who die per year in Sudan die of PPH. 

My 9-week Obstetrics & Gynaecology rotation ended today. I clearly remember attending one labour ward night shift (9pm to 7am). I was quite happy because one of the ladies consented to having me around, watching and learning. It was indeed a privilege to attend their birthing process. The lady was in stage 1 labour, so nothing much was happening. The midwife was checking some of the drugs and preparing them. She taught me as she did – syntocinon, ergometrine, misoprostol … we use this if there is PPH. sync is to help the uterine contract.. in the event of a PPH, we might use ergo, miso PR, etc. 

If only the women in Sudan had access to these drugs …

My time in O&G land was an eye-opening experience. I attended many theatre sessions; that was where i could do Vaginal Examinations under Anaesthesia! Women really didn’t care what happened when they’re knocked out. Most threw in that comment when i asked them as they waited in the pre-surgical area. It’s weird though, most had no palpable pathologies. I did feel a couple of retroverted uteruses though. No adnexal masses. I stopped doing them when i hit the minimum of 5. We have a logbook to sign off. One of which was to watch 1 hysteroscopy. I ended up watching like 3o or sth. I can almost do one if they asked me to. Just have to know how to fiddle and connect the hysteroscope and attach the Hartman’s bag. 

I loathed Obstetrics. That’s because as a student, you follow the midwife. No offense to midwives, but i don’t find their job very interesting. I admire their patience and preserverance in sticking around with a women for her labour. Gawd its long and boring. I would much rather be a resident, who usually only comes in a couple of times to pop their head in and check how the woman is progressing. And they come in for the final crowning bit. Push! Damnit woman push!*

* ok, not they don’t say that.

Gynaecology is so much more interesting. In fact i like it. I scrubbed in for 2 total abdominal hysterectomies, one for a uterine myosarcoma and another for a massive 10cm fibroid. 

Another cool pic i had from my iPhone was that of a dermoid cyst. Now to understand this, you have to know that dermoid cysts can have ectodermal derivatives in them – epithelial tissue, hair, skin, even teeth! Too bad this one had no teeth!

So anyway, that’s that. We also had a week where u follow a private consultant and experience the  life of a specialist. He practises mainly obstetrics. He tells me an average OBGYN does about 120 deliveries a year, he does about 3 times of that. A quick search of his name yielded recommendations on Bubhub, and other mummy forums. its nice that he can see sisters of sisters, friends of friends who all like him so much, and even a GP who refers her patients to him for specialist care! he provides her complimentary antenatal and obstetric care! he made me reconsider obstetrics, but warned me of potential lifestyle issues. and oh, the malpractice coverage is huge! but i think if i ever stepped down that path, i might focus more on gynaecology, particularly gynae surgery, e.g. oncology, or endometriosis interest, etc.

 

that’s O&G in a nutshell. my exams are next friday 12 june and the OSCEs are on 16 june!