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Maternity 2. The Antenatal Ward.
Maternity 2 is a rather intimidating ward to work in as a house officer during the night shift. When all goes well, it will be a good night yet the next thing you know, a CTG (cardiotocograph) turns up suspicious or even worse a clear cut pathological CTG and you would have to refer the patient to any medical officers oncall and prep for emergency caesarean section.
On top of this, patients will be complaining of contraction pain here and there as well as the feeling of bearing down and you have to attend immediately to check the opening of the os. If they are 5cm or more, this warrants them to be sent to the labour ward. Besides that, there would be spontaneous rupture of membrane, SROM, to which you have to attend STAT as well and do a per speculum to assess if there is pooling of liquor as well as the presence of positive cough impulse.
As a house officer, we are required to work from 7pm till 9am the following day.
What do I do upon arrival?
I would usually arrive 10 to 30 minutes before the start of my shift and snap picture of the board of patients as they need to be updated in the “MO-HO” group every 7pm and 5am.
This is followed by receiving any handover from the morning team. In Maternity 2, the patients which are put on prostin, inserted foleys, acute bay patients and those whose names were sent for augmentation of labour will need to be reviewed during oncall rounds if they have yet to be called and still remain in the ward at that time.
Hence, there are days when the numbers of patients of such being handed over are less and then there are days when almost the whole ward needs to be reviewed.
Reviewing The Patients
Thus, I always begin with the acute bay patients first followed by the front and moving my way backwards for the foley / prostin / patients for augmentation.
On days when there are too many patients to be reviewed, I would usually only manage to complete about 70% before an issue creeps up or the oncall medical officer arrives and thus I would end up reviewing the patients together with the medical officer on call.
Acute Issues that I have faced so far?
One that I will never forget is the case of a cord prolapse.
It had to happen during the wee hours of 3am. A patient complained that their water broke and she was induced with foley’s catheter. Having just started my night shift in that ward, I do not know how I should go about, which is either to remove the foley’s first, then report to the medical officer or to report to the medical officer first then remove the foley’s. Being extremely blur, I asked the staff nurse to start the patient on CTG (cardiotocograph) monitoring and excused myself to the toilet.
While in the toilet, I received a call from the staff nurse asking me to check the CTG of that particular patient, explaining that there was a deceleration noted. Having looked through multiple CTGs, usually what is deemed a deceleration is usually not and not something to be worried about. Thus, I calmly told the nurse that I will attend to it soon, right after I am done.
Thus, I went and by that time, there had been multiple episodes of deceleration in just 10 minutes. The foetus was in a clear cut distress state. I proceeded to take picture of the CTG and ran downstairs to find any medical officer who could help me.
A particular medical officer spotted me and I showed her the picture. She calmly told me to go upstairs and that she would be up in a minute.
Upon her arrival, she removed the foley’s catheter followed by inserting her fingers to estimate the cervical opening. But upon inserting her fingers, she never pulled it out and asked me to call the registrar on call immediately. It was a case of cord prolapse. He came and everyone prepped the patient for emergency lower segment caesarean section, the case was posted and everything cooled down.
Next, a lady complained of contraction pain and when I checked the opening, it was fully dilated and the baby’s head was crowning, thus, the delivery was conducted bedside.
Other issues would be non-reassuring CTG or hypertensive crisis. Most of the time, it is contraction pain or spontaneous rupture of membrane (SROM) which essentially means “the water broke”.
What do I do after all these incidents?
Proceed with my coming morning bloods if any and send them followed by tracing any pending investigations.
Meanwhile, the morning team arrives around 5-6am and basically I would just wait to be “summoned” in the group by the morning team to complete certain simple tasks such as taking blood or helping to trace certain investigations, to post a case or to prep “Plan D”. “Plan D” are discharges which are prepped and awaiting the medical officer’s chop and signature.
Although, Maternity 2 can seem like a rather scary place to be in, it was less daunting and tiring for me than working in the labour ward. Perhaps it is due to the fact that we have extra autonomy on the patients’ management plan.
If it is your first time in the antenatal ward, fear not for it is the learning process. It is true that it can be somewhat scary but during the good days, it is extremely chill. Hence, all the very best, do have faith in yourself and always put your best foot forward!
Related Posts:
- The Types Of Wards In The O&G Department Of Sarawak General Hospital – Housemanship Diaries
- Being An O&G Operating Theatre House Officer – Housemanship Diaries
- The Labour Ward, O&G Department – Housemanship Diaries
- The Orthopaedics Posting – Housemanship Diaries
- My “Coming Morning” Priority – Housemanship Diaries
- 8 Best Advices I Will Remember For The Longest Time – The Orthopaedic Posting
- My Second Posting During Housemanship – Obstetrics & Gynaecology
- I Survived 26 Days Of Tagging In O&G – Housemanship Diaries
The Theoretical Doctor 