VTE DVT

 Dr Shaiful Ehsan: http://medwebapp.com/nsbapp/vte/

Dr Shaiful Ehsan: The apps...for mobile...

 Dr Shaiful Ehsan: Message from Dr Jamilah (haemato) & Dr Carol (o&g)...
VTE in pregnancy is indeed common in Msia.....and among the 1st contributing factor for maternal death...

**world thrombosis week

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6. Venous thromboembolism
Venouse thromboembolism in pregnancy:
 - occur due to hypercoagulable state in pregnancy and venouse stasis due to compression of ivc by gravid uterus.
- can cause direct maternal death.
- can have DVT( unilateral pain in calf, redness and swelling ) and pulmonary embolism (mild dyspnea, inspiratory chest pain, tachycardic and milg pyrexia).
- treated with LMWH

7. Homans sign

A positive sign is present when there is pain in the calf on forceful and abrupt dorsiflexion of the patient's foot at the ankle while the knee is extended 👆🏻.


treatment dvt:
1) unfractionated heparin - initial treatment in non pregnant
2) warfarin - contraindicated in pregnant woman becoz can cross placenta nd cause fetal defect and intracerebral haemorrhage
3) LMWH(such as clexane)- for pregnant woman
4) graduated elastic compression stockings

Clinical fundal height

 Izzat Mubarak: Dr Shaiful, if my patient is 39 weeks POA. And clinical fundal height is 36 weeks (i am not sure if i have estimated it well). Is the clinical fundal height corresponding to the POA??

Or the clinical fundal height should be 38 weeks??

 Alif Hussaini: Baby dah descend

Alif Hussaini: Normal

Dr Shaiful Ehsan: Waalaikumsalam izzat....what is the patient gravida?
And how many head fifth palpable?

Izzat Mubarak: Gravida 4 para 2+1
3/5 palpable

 Dr Shaiful Ehsan: Dear izzat and others...
As a general rules....discrepancies of SFH from POA is as follows:
2nd trimester = can not be more than 2cm
3rd trimester can not be more than 3 weeks...

And you can see further about the head engagement....

Like in ur case, the head is not engaged yet but 3/5th palpable...which may lead to the loss of about 1cm on SFH....
So overall I can tell that ur patent SFH is following POA...tq

 Dr Shaiful Ehsan: Homework, primigravida engaged when?

Dr Shaiful Ehsan: Gravida 2 and above fetal head engaged when?

Mb Izzat Mubarak: Tq dr

Mogtt

Izzat Mubarak: Dr Shaiful why is ogtt repeated at 3rd trimester(late pregnancy) at 30 wks when at that time we already know that blood glucose will be high at that time?? Simply said it is non informative.

In the words of Dr Muna "it is a malpractice performing mogtt at 3rd trimester"

P/S: Im sorry that it is already resting time

Dr Shaiful Ehsan: Assalam izzat....
It is NOT A MALPRACTICE performing OGTT at 3rd trimester...

IT IS IN OUR GUIDELINE AND UNIVERSAL GUIDELINE....

I am not sure why she said like this...
But try to look at guidelines and facts rather than someone's opinion only....
If u really wanna follow someone's opinion....then u can quote those expert in O&G (preferably local o&g which PRACTICE clinical in Msia)...

I would like to quote Dr Rachel's O&G consultant HOSHAS....
"OGTT  can be repeat at any weeks if new indication arise....eg polyhydramnios, excessive wt gain & suspected big baby durinh scan & ect...)

If there is RIsk factors for GDM, need to be done early for the 1st time (preferably around 12 weeks) and repeat 2nd time at 28 - 30 weeks...

Bear in mind...that's already a 3rd trimester....

Nevertheless, we already understand that GDM is related with hormonal changes in pregnancy which is diabetogenic....
Normal pregnancy would be able to adapt to this changes without expressing hyperglycaemia in blood....
But those GDM mother, they unable to adapt and exhibit intolerance / GDM.....

 Izzat Mubarak: Wasalam...thank you dr shaiful.👍

Yupp the more weeks of pregnancy, the more diabetogenic hormone there is....
And once the risk factor and indicator is there.....They need to be detected....
What's the point of doing ogtt at the point of most would able to adapt....we definitely do not want to miss the critical point as well....
Tq



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Liza: Dr, for mogtt, if fbg 6.2 then 2hpp 6.2 as well, pts diagnosed as gdm or not ?

 Dr Shaiful Ehsan: Fasting more than 5.6....we need only one reading to be high...so it is GDM...

 Kalau mcm ni....most likely yg glucose water tu dia tak minum betul....sebab tu tak berapa naik....
Sorry pt memang mcm tu....sometimes...