Category Archives: Obstetrics Gynecology

Finally…

Akhirnya medical report dari HUKM yang dah ‘berjamann’ ku submit pada tahun 2007 akhirnya sampai kelmarin. Medical report yang ku submit untuk claim insurance untuk keguguran ku pada bulan febuari tahun 2007, dimana pregnancy ku didiagnosed sebagai ‘molar pregnancy’ atau kehamilan anggur. Molar pregnancy boleh dibahagikan kepada dua kategori iaitu partial mole dan complete mole. Dalam kes ku, ku mendapat partial mole (nnti ku esplen pasal kehamilan molar ni dilain entri). Agaknya die terjumpa balik masa ku submit untuk medical report ku yang kedua utk claim insurance ku yang kedua plak, kali claim untukk sebab ku didiagnosed of having Cervical Intrephitelial Neoplasia atau cervical dysplasia yang memerlukan kan ku utk diminor operatekan bulan lepas dengan prosidur yang dikenali sbg LEEP atau cervical cautery. Wah, dah bertimpa2 claim ku pada MAA (kayo acik..keh keh)

My story of ‘LEEP’

Pada 16 Januari 2009, aku telah di ‘minor operate’ kan yang bertajuk LEEP (Loop -Electrosurgical Excision Procedure di HUKM. Apekemendenya tuh? Definisi-nya boleh la korang baca selepas ‘kemerapuan’ aku ni. Aku dikehendaki untuk diadmitkan selama 3 hari 2 malam (macam pernah ku dengar, salah satu dokumentari kat tv kot). Gara-gara aku yang telah didiagnosed for having Cervical Intraepithelial Neoplasia pada tahap ke-2 (CIN 2) atau dikenali juga sebagai Cervical Dysplasia. Apekemendenya tu lagi? Rajin2 la menyelak posting aku berkenaan CIN tu kek sobolah tu. Okeh, nak sambung ‘parang merapu kepunden parang skeper’ ni.

Seminggu sebelum keberangkatan ku ke ‘resort’ HUKM tu, aku dah siap-siap packing barang-barang yang perlu aku bawak. Lagilah disebabkan title aku sebagai ‘fully exclusively expressing mom’ (sendiri lantik) akan membanyakkan lagi barang-barang yang nak dibawa. Selepas settle menge-pack, jumlah beg yang akan ku bawa adalah 3 beg, satu beg baju, beg cooler (mana lah tahu takde fridge nak letak hasil tenusu ku tu), dan beg breastpump ku (skali tengok, mcm nak gi umrah pun ada, moga diperkenankanNya,Amin!)

15 januari, aku pun check-in kat wad Hukm ni, dengan segala bagai beg sampai tak cukup tangan. Agaknya, staf nurse2 kat situ mesti berkata2 dalam hati kecil mereka ..’ni nak tinggal sebulan ker ape’..(hish,menuduhya haku ni, tak baik punyaa!) Mana taknya, beg2 yang aku bawa ala2 nak gi bercuti. Nak aje aku label kan beg2 aku tu..’ni beg cooler & beg breastpump lah!!). Kalau boleh dengan aku2 skali nak pakai name tag ‘Saya ibu yang fully exclusively expressing’..err, faham kah mereka tu?

Sesampai je aku di wad, aku terus mem’buka kilang’(ni jolokan yang diberikan oleh patient sebelah katil ku setiap kali aku start mengepam). Aku pun memulakan sesi pengepaman aku dengan gaya santainya (membayangkan diriku berada ..’ditepi pantai yang indah, aku duduk seorang diri’..). Ada juga mata-mata yang cemburi melihat kegigihan ku mengepam dan menunjukkan muka betapa payahnya semata-mata nak memberi susu ibu, jika mereka berada di tempat ku (ye ker). Sepanjang satu hari aku mengepam dikatil ku tu, sebanyak 8 kali juga la aku berulang-alik (kadang2 belari-lari anak) ke pantry utk menyimpan hasil tenusuku. Sebelum aku menyimpannya ke fridge, awal2 staf nurse mengingatkan aku agar melabelkan cawan2 dadih ku itu, supaya tidak disalahsangka sebagai dadih ke ape (aku bawa bekas dadih tu sbb nak jimat space kat beg dari bawa botol). End of the day, aku berbangga (kembang hidung) bila hasil2 tenusu ku yang bercawan-cawan yang tersusun rapi dalam fridge tu dipuji oleh staf2 nurse tu, sebelum di collect oleh hubbyku yg datang pada waktu melawat.

Keesokan harinya,16 januari, pukul 10.30 pagi, aku telah di ‘holla’ (panggilah) oleh nurse untuk bersiap-siap ke medan OT. Dari pukul 10.30pagi, selesai pukul 1 tengahari, tapi aku tengah mamai-mamai akibat dari ubat bius tu, so sambung tido sampai kol 3 petang baru sedar. Sedar2 baju pond ah basah. Aisey, banyak dah sesi pengepaman aku terlepas ni. Sebelum aku bergerak2 khas ke OT, aku ade memyampaikan hasrat murni ku pada Dr yang bertugas agar aku boleh discharge pada petang tu jugak. Dan Dr. mengiyakan sahaja hasrat ku itu, jika kondisi aku mengizinkan. Alih-alih, sampai kepetang, Dr tu pun tak nampak batang hidung!. Terpaksalah aku bermalam lagi. Sementara tu aku telah menambah kenalan geng-geng ibu yang baru pas bersalin disekitar kawasan katil aku tu. Sempat lah aku me-war2kan kempen penyusuan ibu dan memotivasi kan mereka dan keluarga mereka!.

Pada sesiapa yang nak tahu macam mana prosidur LEEP itu dilakukan, rajin2lah baca artikel yang aku copy dari http://womenshealth.about.com ni. Bak kata pepatah ‘tak baca maka tak tahu!’. Renungkanlah.

LEEP Procedure – What is LEEP? – Loop Electrosurgical Excision Procedure

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By Tracee Cornforth, About.com

Updated: October 14, 2008

About.com Health’s Disease and Condition content is reviewed by the Medical Review Board

If your doctor has told you that you need to have a LEEP procedure, it’s because your annual Pap smear indicated the presence of abnormal cervical cells, or cervical dysplasia. While the loop electrosurgical excision procedure, or LEEP procedure, may make you wonder if your doctor wants you to jump. The LEEP procedure has nothing to do with jumping. The LEEP procedure is one of several procedures your doctor has available to help diagnose and treat abnormal cervical cells. Other procedures your doctor may want you to have either before or during the LEEP procedure include, a colposcopy and / or a cone biopsy.

LEEP uses a thin wire loop electrode which is attached to an electrosurgical generator. The generator transmits a painless electrical current that quickly cuts away the affected cervical tissue in the immediate area of the loop wire. This causes the abnormal cells to rapidly heat and burst, and separates the tissue as the loop wire moves through the cervix.

This technique allows your physician to send the excised tissue to the lab for further evaluation which insures that the lesion was completely removed, as well as allowing for a more accurate assessment of the abnormal area.

You may want to ask your doctor if it’s OK to take an over-the-counter pain reliever such as ibuprofen before your procedure to help minimize any pain. Never take any drug before any medical procedure without explicitly asking your doctor about it. Always follow your doctors instructions for preparation for the LEEP.

What happens during the LEEP procedure?

The LEEP procedure takes about 20-30 minutes and is usually performed in your physician’s office. In some ways it may seem much like a normal pelvic exam because you will lie on the exam table with your feet in the stirrups. A colposcope will be used to guide your doctor to the abnormal area. Unlike a normal colposcopy, a tube will be attached to the speculum to remove the small amount of smoke caused by the procedure.

An electrosurgical dispersive pad will be placed on your thigh. The pad is a gel-covered adhesive electrode which provides a safe return path for the electrosurgical current. A single-use, disposable loop electrode will be attached to the generator hand piece by your physician. Your cervix will be prepared with acetic acid and iodine solutions that enable your physician to more easily see the extent of the abnormal area. Next a local anesthetic will be injected into the cervix; the electroloop will be generated and the wire loop will pass through the surface of your cervix.

After the lesion is removed your physician will use a ball electrode to stop any bleeding that occurs; he may also use a topical solution to prevent further bleeding. You can leave your physician’s office soon after the procedure.

Are there any complications associated with the LEEP?

Complications are usually mild but can include:

  • mild pain or discomfort
  • bleeding

You should call your physician if you experience bleeding that is heavier than a normal period, or if pain is severe. Other symptoms that should be reported to your physician include any heavy vaginal discharge or strong vaginal odor.

After the LEEP you should not:

  • Have sexual intercourse for as long as recommended by your physician
  • Lift heavy objects
  • Use tampons
  • Douche
  • Take tub baths–take showers only to prevent infection

It’s important for you to remember that having cervical dysplasia does not mean that you have cervical cancer. However, treatment of the abnormal area is imperative to prevent abnormal cervical cells from developing into cervical cancer

After the LEEP procedure, make sure to follow your doctor’s instructions precisely. Your doctor will tell you when to return for follow up Pap smears, and / or colposcopies. Keeping these follow up appointments is necessary to verify that all of the abnormal cervical tissues have been removed, as well as to make sure that if abnormal cervical cells redevelop they are caught early and treated appropriately.

Source: http://womenshealth.about.com/cs/surgery/a/leepprocedure.htm

Cervical Intraepithelial Neoplasia (CIN)

I’ve been diagnosed of having Cervical Intraepithelial Neoplasia (CIN) or Cervical dysplasia. I was lucky to discover this at early stages. Because CIN can be further associated to Cervical cancer at later stages. It started when i went to Klinik to check my episiotomy (whereby i had to undergone 2nd time stitch coz the granulation tissue has grow outside at the opening of episiotomy), ni case ganas sgt during my confinement, asyik berjalan je. Mane taknya, Azri was admitted to Paed NICU, Hospital Kajang for three days when his 5 days old sebab jaundice. So, at the klinik, i opted to do pap smear skali, kebetulan aku ternampak package ‘Pap Smear & Ultrasound Pelvic for RM50 only.Before this, aku dah pernah buat Pap smear test dekat hospital serdang, end of 2006 dulu and the result was normal.

After Pap, aku kena tunggu result dari lab for three days. On third day, Dr Aziani call and wanted to see me. Aku dah budget, ni mesti ada yang tak best ni. Masa jumpa Dr.Aziani, she explained how to read a pap smear report. Basically macam ni (from my understandinglah), dalam pap smear report ni ada 4 category which class 1,2,3 & 4. If class 1 & 2, basically the result is okay, just repeat pap smear untuk next2 year. But if class 3&4, result shows that there was an abnormalities in Pap smear test. In this class, Dr. advise to do a copolcospic biopsy dekat hospital. In my case, i was in class 4!.So Dr. Aziani tulis referal letter to do the biopsy and again aku pilih HUKM jugak sebab dah banyak history aku kat situ.

On 17 December 2008, aku buat colposcopic biopsy tu, caranya lebih kurang mcm ni lah, dia masukkan wayar mcm camera tu untuk tengok tisu2 kat pangkal rahim tu,so kita pun bleh tengok skali kat skrin tv tu. Then die spray liquid yg macam cuka (kita akan rasa pedih la time tu) dekat cervix area tu, klu permukaan/tisu2 kat cervix tu turns into white, meaning that memang ada unhealthy tisu kat situ. And dr. need to remove those infected area by doing a minor surgery called LEEP (Loop Electrosurgical Excision Procedure),ni haku explain di lain tajuk. Masa buat biopsy tu, dr ambik sket tisu/daging di permukaan cervix tu untuk dihantar ke lab. After 2 weeks, the result shows that aku CIN II . Sebab Cervival Intraepithelial neoplasia ni ada 3 categories; CIN I, II, III. Kat bawah ni aku excerpt artike dari ‘MedlinePlus Medical encyclopedia’ pasal Cervical Dyslplasia.

Cervical dysplasia

Cervical intraepithelial neoplasia (CIN); Precancerous changes of the cervix

Definition Return to top

Cervical dysplasia is the abnormal growth of cells on the surface of the cervix. Although this is not cancer, this is considered a precancerous condition.

Cervical dysplasia is grouped into three categories:

  • CIN I — mild dysplasia (a few cells are abnormal)
  • CIN II — moderate to marked dysplasia
  • CIN III — severe dysplasia to carcinoma-in-situ (precancerous cells only in the top layer of the cervix)

Causes Return to top

Most cases of cervical dysplasia occur in women aged 25 to 35.

The cause is unknown. However, the following may increase your risk:

  • Multiple sexual partners
  • Becoming sexually active before age 18
  • Giving birth before age 16
  • If your mother took a drug called diethylstilbestrol (DES) during pregnancy
  • Sexually transmitted infections, especially HIV or HPV (genital warts)

Symptoms Return to top

There are usually no symptoms.

Exams and Tests Return to top

A pelvic examination is usually normal.

A Pap smear shows abnormal cells. A colposcopy-directed biopsy is done to confirm the condition and determine its severity.

Other tests may be done to find out if the abnormal cells have spread outside the cervix:

Treatment Return to top

Treatment depends on the degree of dysplasia. Mild dysplasia may go away on its own . You may only need careful observation by your doctor with repeat Pap smears every 3 to 6 months.

Treatment for moderate to severe dysplasia or dysplasia that does not go away may include:

Women with dysplasia need consistent follow-up, usually every 3 to 6 months or as recommended by their provider.

Outlook (Prognosis) Return to top

Early diagnosis and prompt treatment cures nearly all cases of cervical dysplasia.

Without treatment, 30-50% of cases of severe cervical dysplasia may lead to invasive cancer. The risk of cancer is lower for mild dysplasia.

Possible Complications Return to top

The condition may return.

When to Contact a Medical Professional Return to top

Call for an appointment with your health care provider if you are a woman who is sexually active or aged 20 or older and you have never had a pelvic examination and Pap smear.

See: Physical exam frequency

Prevention Return to top

To reduce the chance of developing cervical dysplasia:

  • Wait until you are 18 or older before becoming sexually active
  • Practice monogamy and use condoms during intercourse

References Return to top

Noller KL. Intraepithelial Neoplasia of the Lower Genital Tract (Cervix, Vulva) : Etiology, Screening, Diagnostic Techniques, Management. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2007: chap. 28.

Wright TC Jr, Cox JT, Massad LS, Twiggs LB, Wilkinson EJ; ASCCP-Sponsored Consensus Conference. 2001 Consensus Guidelines for the management of women with cervical cytological abnormalities. JAMA. 2002 Apr 24;287(16):2120-9. Review.

Hoffman MS, Martino MA. 2001 consensus guidelines for the management of women with cervical intraepithelial neoplasia. Am J Obstet Gynecol. 2004 Sep;191(3):1049

Update Date: 5/26/2008

(Source :http://www.nlm.nih.gov/medlineplus/ency/article/001491.htm)