By SeeFoon Chan-Koppen
Most women worry when they are expecting, especially so if it is their first child.
According to Dr Chakr Sri Na Nagara, one of the more senior Gynaecologist and Obstetrician (and founder) of the KPJ Ipoh Specialist Hospital, there is no need for worrying if all the correct steps are taken by the soon-to-be mother as she puts herself in the hands of a qualified professional.
Dr Nagara is one of these professionals, having been trained in Singapore and the United Kingdom, receiving his MBBS (Singapore), FRCS (UK) and FRCOG (UK), and subsequently on returning to Malaysia, his FAMM (Malaysia). He remembered experiencing the use of one of the early clinical ultrasound machines when practising in the UK. Those ‘ancient’ machines weighed almost a ton and cost almost a million pounds.
Today these ultrasound machines have much more capability, are much smaller, costs a lot less and have become an important accoutrement in the Obstetricians’ bag of tools, monitoring the progress of the unborn from early pregnancy to full term.
Ensuring a Safe Pregnancy
Dr Nagara feels strongly that a woman should attend antenatal care checkups from early in pregnancy to assess the state of foetus and monitor its eventual progress and growth over the nine months. Early assessment could detect healthy pregnancy in its early stages, diagnose threatened, or even missed miscarriages; and ectopic pregnancies (i.e. pregnancies outside the womb which is dangerous and could be fatal if missed); multiple pregnancies, and other conditions that can occur in the early stages of pregnancy.
Early ultrasound measurements can give a higher value of the exact expected due date (but of course labour can occur earlier or later by a few days and be still normal).
Ultrasonic examinations of the pregnancy at 12 weeks and 20 weeks are important to screen for foetal abnormality.
Another screening test for foetal abnormality is the first trimester screening at around 10 to 12 weeks when the ultrasound measurements at the foetus is checked against biochemical markers in the mother’s blood. This gives around 80+% accuracy in the screening of Down’s Syndrome and Patau’s Syndrome.
For a 98 to 99% accuracy, maternal blood can now be examined at this stage of pregnancy for a more sophisticated testing – the NICC – Non-Invasive Chromosomal Check, testing an array of chromosomes of the embryo.
The gold standard test is the Amniocentesis which gives 100% accuracy but is INVASIVE, as the amniotic fluid of the pregnancy sac is sampled via a long needle introduced through the abdominal wall. This has a disadvantage of a 1% risk to harming the foetus and is carried out at about 16 weeks.
At 20 weeks, we often do a full detailed scan of the foetus to check on the anatomical structures from ‘head to foot’ to ascertain presence or otherwise of any organ abnormality.
Other conditions the Obstetrician look for are maternal abnormal conditions, such as anaemia, concurrent diseases such as diabetes, hypertension (which can arise during pregnancy, known as GDM (Gestational Diabetes) and PET, Pre-eclamptic Toxaemia). Vaginal infection must be detected and eradicated prior to delivery to prevent the baby from being infected during the process of labour.
Maternal diet is also important. In the context of the Malaysian pregnant patient, it is important to teach expectant mothers not only on healthy nutritious diet but also to warn them against taking TCM (traditional complementary medication) and herbs, as these have a potential of causing heavy bleeding during labour, and babies could also be exposed to a higher risk of jaundice especially if the above are consumed during the confinement period when the infant is being breastfed.
Childbirth & Labour Pain
Though childbirth is a natural process since Adam and Eve, it is nonetheless a painful event. Currently, it borders on being sadistic to allow a woman to go through the pain of labour without giving relief. There are several methods, some bordering on the esoteric, such as hypnosis and acupuncture, but the mainstay are 3 methods. One is ‘laughing gas’– which is inhaled. Used to lessen labour pains that are of short duration.
The second is the injection of opiate derivatives – which give fair pain relief but has the drawback of having a depressive effect on the newborn’s breathing if given too close to time of birth.
The third method, which gives full pain relief is the Epidural analgesia, where the analgesic drug is injected into the Epidural space of the spine. This is a safe method provided it is given by an experienced and qualified anaesthetist. It gives pain free labour, but has had bad press by the older generation who blame old age backache on Epidural analgesia- pure old wife’s tales, as old men also have backache but they never have epidural or labour!!!
So, don’t be worried about pregnancy and deliveries. Relax and leave the worries in the hands of your obstetrician.
Don’t worry, be happy and celebrate the safe arrival of an addition to the family.Dr Chakr Sri Na Nagara Klinik Nagara / Teoh / Adlan, Suite 1-05, KPJ Ipoh Specialist Hospital, 26 Jalan Raja DiHilir, 30350 Ipoh. Clinic hours: Monday to Friday 9am – 12.30pm, 2.30pm – 4.30pm; Saturday 9 am – 12.30pm Tel: 05-2418350, 2408777 EXT. 243