It was indeed a long hiatus, being away from updating for the past 6 months. How time flies and we're already in the third quarter of 2014. I was in HUKM for a total of 2 months, plus another 3 months of maternity leave.
Aaron is Alvin's brother, and he's slightly more than 3 months old now. I personally prefer calling adik Ken-ken (it's part of his Chinese name) so that Alvin may learn to call his brother sooner because it's easier to say "ken-ken".
Introduction
My journey this time began almost the same way as previously - antenatal check-ups at Columbia Asia Cheras during my first trimester, KKIA in the second trimester, and subsequently went on to HUKM (to UKMSC first, later referred to the public wing). Don't know what suddenly drove me to HUKM this time instead returning to Hospital Ampang as initially planned, or to Hospital Serdang as it's the nearest to my home, but I just had a strange feeling that HUKM would be the right place.
Before it All Began.....
Prior to admission to HUKM, I had received 2 doses of IM Dexamethasone at 28 weeks. This was how I spent the 2nd day of Chinese New Year - a journey back-and-forth HUKM once in the morning and another at night. These steroid injections were given in view of the risk of a recurrent premature labour, to help speed up fetal lungs maturity.
Also, in view of the complaint of "heaviness" on my lower abdomen during my first pregnancy from the 25th week onwards, I also did TVS this time on top of the usual scans during my antenatal check-ups, to monitor my cervical length. That's because such "heaviness"sounds a lot like shortening of cervix, which in the past, I didn't realise was a red flag until a year later.
Source: NICHD
So, to all pregnant mothers, should you feel pelvic pressure / persistent heaviness on your lower abdomen when you're only in your second or early third trimester, please seek your doctor to check your cervical length because it's not normal to feel heavy so early. Cervical incompetence is very rare, but it happens and for unknown reasons, I just happen to be among the minority.
Treatment room of Ward 2B
The Arabin Pessary
My cervical length appeared normal until the 28th week. The first line of treatment offered to me was the Arabin pessary.
Source: www.dr-arabin.de
The Arabin is a "ring" that is made of silicon. It serves to prevent further shortening of the cervix. It's painless, non-invasive, and can be inserted within minutes.
That Fateful Night when History Almost Repeated Itself
I was still in the ward for observation a day after the Arabin was in.
On history almost repeating itself... It was all too familiar that I did not even panic, but instead I calmly finished my (super-plain) dinner before calling the nurse.
The meals served at HUKM are very plain... mostly boiled, and it's difficult to describe what the taste is like. I'm neither a fussy eater nor someone who likes to comment about food, but I have to say that the caterer who's awarded with the tender could have done better. This comes from my experience of eating the food provided for 2 months and I actually lost weight there although I was supposed to gain some.
Back to the threatened premature labour, I saw blood coming out the same way as previously, but didn't feel any pain. There was contraction, as shown by the CTG, but I did not feel anything. More dreadfully, the internal os was already 2 cm opened and the bag of membrane was visible.
The CTG... number in red is fetal heart rate while the one in green is contraction. At the time when this is captured, contraction was only very mild.
Although I looked calm and kept quiet, I was already into "Oh no, I've caused a blunder... another one into the NICU... I'm losing the battle despite being super careful."
That Saturday night itself, I had consumed don't-know-how-many nifedipine tablets - that oh-so-familiar pill! I had lost count. Note: Nifedipine is an antihypertensive drug, but is used off-label as tocolytic agent to stop uterine contraction.
Three Days in HDU
The O&G HDU of HUKM is located on the 1st floor. Just opposite the OT. It's blasting-cold, very quiet, and isolated.
I was on nifedipine for a total of 5 days - 3 days pre-cerclage and 2 days post-cerlage. BP and pulse rate were closely monitored (nifedipine may cause low BP for a non-hypertensive person). It's feels "rimas"i.e. highly-uncomfortable to be hooked on multiple wires. I believe such discomfort is not even a fraction of what my first-born Alvin felt in the NICU and I have to salute him for his strength even though he's only so small (1.16 kg).
As I was prohibited from standing up and walking (including no toilet visit), I was on CBD, which was highly uncomfortable each time I tossed myself. As for eating, I was only allowed to sit 45 degrees.
Buttons of "my bed"... just a finger away to adjust the bed position. Sometimes I 'curi-curi' reduced the slant of my bed in order to gain greater comfort, but at the expense of doing myself a disfavour actually.
Compression Stocking and blood clot
A person who's bed-bound is at higher risk for blood clot. As "simple" as it may sound, it's not something to be taken lightly.
Compression stocking, or TED stocking is available at the pharmacy of HUKM for RM80 per pair. It's cheaper in comparison to pharmacies outside. The stocking is long and very tight, serves to prevent blood clot in the legs.
The reason why a blood clot is dangerous is that the clot is capable of moving upwards. If it goes to the lungs, then it will cause pulmonary embolism. May be fatal if not careful. So,this is the reason why doctors always emphasised on wearing the stocking at all times during the bed-bound period.
The Cerclage Experience
That's right... 29 weeks.
A cerclage (pronounced as "ser-klaj") is usually done at around the 16th week. In simple words, it's placement of stitch onto the cervix to prevent preterm delivery.
Just like any other surgery, whether major or minor, it comes with some risks. The outcome is normally good when it's done early.
I was initially not feeling optimistic because my pregnancy was already at an advance stage. But for a while, I felt on top of the world when Prof Azurah told me I could go for cerclage.
D-Day
It was February 11, 2014. I was really hungry because I was required to fast. The sight and smell of yummy food from neighbouring cubicles were tempting yet irritating. Irritating because it challenged my patience even further.
This cup is great for drinking while lying down... provided at the HDU. In moments of hunger and thirst, I took a few sips of water when no one's looking. I am not as obedient as people think...
The Spinal Anaesthesia Experience
The cerclage was done under spinal anaesthesia (sitting down hugging a pillow, 3x injections on the back). I find spinal anaesthesia very "pleasant", my legs felt hot at first, followed by a loss of sensation within minutes. I felt extremely relaxed and sleepy. I didn't expect spinal anaes to make me as sleepy as this. There's no nauseousness, but my legs were full of hives post-op. The antihistamine Piriton had aggravated my sleepiness and I ended up sound asleep for 4 hours straight post-op. This is only spinal, if it's GA, I cannot imagine how long will the sleep last.
Back to cerclage, it was 2.30 pm by the time I was taken to be OT. Dr Suraya did mine. This is the first time I went for an op.
My comment about the procedure? It's painless during as well as post-op. I was relieved that it's finally done... Prof had initially set a "target" of 32 weeks for me, followed by 34 weeks (another round of IM Dexa b.d.), and finally 36 weeks (successful treatment, thanks to the great doctors and nurses at HUKM, yayyy!).
After cerclage, I spent a total of another 2 months in ward where I continued with bed rest in Trendelenburg position and weekly Proluton injections.
Coming up next... in Part 2, or Part 3:
1) Out of HDU and how I spent the remaining of my days in HUKM, meeting friends, living a life of Sleeping Beauty (what beauty is there in me?);
2) How I find it at HUKM. The people, the food, the environment, medical students, and other stuff;
3) The day of cerclage removal;
4) The arrival of Aaron;
5) What lies ahead should I become "p2 g3", which I pray hard that I will not need to go through.
6) Another few days in ward. I was very stressed at first, but later thought it's probably a blessing in disguise in some ways.
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