The surrounding compound
A bit of here and there along the way
The second trimester had just begun and a few things had so-called "progressed" recently.
As contemplated, the plan itself is isn't complicated, but sometimes, involves a small degree of red tape.
PPUKM, or formerly called HUKM, is the nearest hospital with the necessary facilities and expertise from where I live when it comes to cases of high risk pregnancies, which include cervical insufficiency.
Obtaining a referral to the O&G clinic of PPUKM is straightforward, likewise obtaining an appointment. However, when it comes to decision on further management, it depends on how soon the case gets elevated to a specialist. For instance:
Flow of event
I have taken action very early this time. At 5 weeks when things were still highly uncertain, I made an appointment with one of the Profs at UKMSC, whom I've met during my stay at Ward 2B in 2014. The waiting list is long, so the fastest appointment I could get is when I'm already 14 weeks. There's been some changes in the list of doctors, e.g. Prof Jamil whom I used to see during Aaron’s time had retired while Dr Suraya who did my emergency cerclage back in 2014 is currently practising elsewhere.
At the same time, immediately upon confirmation that the baby is inside the uterus at 7 weeks, I went to my nearest ob-gyn Dr. Norshida for referral to the O&G clinic at PPUKM - public wing. It was done, and I was given an appointment within a reasonable period. Let's keep both options on and see which one works.
My first antenatal visit at the O&G clinic PPUKM was given on 26/4, which was close to 12 weeks. Routine tests such as BP and weight measurements, urine test for protein and glucose, and USG were done. There was a 15-minutes session on breastfeeding by student-nurses that day. Apart from HVS taken that day, but contrary to my expectation that some sort of decision may be available regarding what's next, I was told to return in 2 weeks' time for cervical TVS.
2 weeks later, I had my first check-up with Prof Azurah at UKMSC - the private wing as per my appointment. Prof Azurah immediately remembered me when I told her about my previously dislodged Arabin, because apparently, at PPUKM, among the many success stories, I'm the tiny minority with an opposite outcome.
Prof Azurah expressed her surprise that I was not referred to her while at the public wing for check-up on 26/4. Had my routine check-up, with an additional scan to measure the cervical length, which thank God was still within normal parameter for 14 weeks.
Arabin insertion at PPUKM: My history and now
Prof Azurah suggested that I should go for the Arabin pessary early this time, but I will have to be referred to the public ward. Arabin and I, at first I felt great suspense, in view of how it failed in just 24 hours back in 2014, resulting in an emergency cerclage and prolonged bed rest in the ward until delivery!
(Note: The Arabin pessary is a device used for those with incompetent cervix for the prevention of preterm delivery - an alternative to cervical cerclage. At PPUKM, depending on the case, it's the first in line treatment for cervical competence. In Malaysia, the use of the Arabin is limited, mainly available at teaching hospitals)
I was asked to be admitted to the good old Ward 2B on Monday (today) for Arabin insertion by Dr. Rahana was Prof Azurah will be out of town the following week for examination.
Day 1 and precious Monday
Other than the familiarity which is the only comforting factor, it's pretty devastating to be informed in the late afternoon that the Arabin insertion will only be done on the next day.
The present scene
The reality: A mixed bag of good and bad
Other than praying that this time will be better than previously, trying to avoid as many physical activity as possible, and to stick to whatever diet or medication I'm supposed to take, there's nothing else that I can do to make sure that I deliver full-term for another time - for one last time.
Ahh..... many things are running across me right now. I had an instinct that I should try for one last child for only one obvious reason, and I finally did. But when I think again, I wonder why am I putting myself through so many challenges once more - have I forgotten about how the 2014 long medical leave crept into my work that I felt really blur when I finally returned to work?
Where I wish I am right now, besides home
The waiting time, the risk of yet another prolonged leave for bed rest if the Arabin fails once more, the risk of premature delivery is everything else fails, and the emotional toll for all these mess............. Although people always tell that beneath all the hard work and pain, you'll finally see the blessing, keeping motivated isn't as easy as how I wish it is.
Three years down the line: Ward 2B of PPUKM in 2017
On a more positive side, it's pleasant to note that Ward 2B is still generally comfortable, and the 2 meals that I've had so far were better than back in 2014. It's a different caterer now, the utensils used are different and feels more at home this time, the chicken rendang served during lunch was tastier compared to previously although the menu looked the same.
A layout that suddenly reminds me of Hospital Ampang when Alvin's still very tiny
Tea at 3 pm
Conclusion
The ward is quiet today, and I hope it will remain throughout my stay. I don't know whether the Arabin will work or not this time, I don't know when, where and how will Baby No. 3 come out, and right now, I am most concerned if I can safely carry the baby at least until early term. How I wish I can be like those who are able to continue going to work even in the third trimester so that conscience remains intact. Regardless of the outcome of this time, this shall be my last pregnancy, because this is my maximum threshold, after various rocky paths.
