Census / Reten Wad Gynaecology HRPZ II 23-29 of April 2017

1. CENSUS MAWAR
23rd–29th April 2017
DR. MUHAMMAD REDZWAN BIN ABDULLAH

2. Total Admissions
TOTAL CASES 37
READMISSION 10
NEW CASE 25
TRANSFER IN 2

3. LIST OF CASES
NO CASES TOTAL
1 INCOMPLETE MISCARRIAGE 5
2 SILENT MISCARRIAGE 1
3 ECTOPIC PREGNANCY 2
4 EARLY PREGNANCY 2
5 FAILED PREGNANCY 1
6 NAUSEA AND VOMITING IN PREGNANCY 4
7 PUEPERAL PYREXIA 1
8 SECONDARY PPH 1
9 ENDOMETRIOMA 1
10 ABNORMAL UTERINE BLEEDING FOR INVESTIGATIONS 1

4. LIST OF CASES
NO CASES TOTAL
11 ENDOCERVICAL POLYPOIDAL TUMOUR 1
12 OVARIAN CANCER 3
13 ENDOMETRIAL CANCER 1
14 LEOIOMYISARCOMA 1
15 POST SVD WITH SINUS TACHYCARDIA SECONDARY TO ANEMIA 1
16 OVARIAN CYST 3
17 ADENOMYOSIS 1
18 INCOMPLETE EVACUATION OF MOLAR PREGNANCY 1
19 POST-MENOPAUSAL BLEEDING 1
20 ENDOMETRITIS 1
21 PELVIC TUMOUR 1
22 POST SVD WITH GESTATIONAL HYPERTENSION 1

5. CASES NEW READMISSION REMARKS
INCOMPLETE MISCARRIAGE 5 0 ●3 cases POC removed perspeculum at Casualty.
complete miscarriage
●1 case from EPAS. P/w bleeding PV Post S/L
misoprostol 600mcg OD x 2/7. TAS ET 21mm. In
ward developed PV bleed. Repeat TAS ET 12mm.
→ Complete miscarriage
●1 case POC removed per speculum at ED. ET
15mm in ED. Repeat scan in ward ET 15.3mm. →
incomplete miscarriage, treat conservatively.
SILENT MISCARRIAGE 1 0 To repeat scan at EPAS clinic in 2/52

6. CASES NEW READMISSION REMARKS
ECTOPIC PREGNANCY 2 0 ●1 case done Emergency Laparoscopy with left
Salphyngectomy for ruptured left tubal
EBL 500cc.
●1 case done Emergency Laparotomy with Right
Salphyngectomy for leaking right tubal
EBL 300cc
EARLY PREGNANCY 2 0 ●1 case initially referred for PUL. M4 prediction
score suggest 94% probability of IU pregnancy.
Repeat TAS: IUGS seen
●1 case initially referred for PUL. Discharged with
diagnosis of early pregnancy*
FAILED PREGNANCY 0 1 *case Readmitted to trace 48Hr B-HCG. M4
prediction suggested failed pregnancy

7. CASES NEW READMISSION REMARKS
NAUSEA AND VOMITING IN
PREGNANCY
3 1 Readmission case: 3rd readmission.
32 Years old G3P1+1 at 12w6d POG. PUQE 12.
Urine ketone 4+. Previously given Prednisolone
and maxolon. Discharge well, weight gaining,
ketone nil. Discharged with T zofran 8mg TDS, T
valoxene 1 tab OD for 2/52 and T prednisolone.
PUEPERAL PYREXIA 1 0 Para 1, Day 4 post SVD with maternal pyrexia.
Initially admitted secondary to Endometritis, but
discharged with pyrexia secondary to bilateral
breast engorgement

8. CASES NEW RE-ADMISSION REMARKS
SECONDARY PPH 1 0 Para 2 Day 4 post SVD with secondary PPH
to Endometritis
ENDOMETRIOMA 0 1 24 y.o Single Nulliparous. p/w dysmenorrhea with PS
9/10. Known case of endometrioma. H/o Open
cystectomy and for endometrium cyst and
appendicectomy for acute appendicitis. In this
admission treated as recurrent endometrioma.
Discharged with tab Rigividone 1 tab OD 21 days for
3 cycles and C Celebrex 400mg PRN
ABNORMAL UTERINE
BLEEDING
1 0 26 y.o Single, Nulliparous. Admitted for symptomatic
anemia secondary to menorrhagia. Referred with Hb
4.9. transfused 2 pints PC in ward. Hb on discharge
8.6.
Discharged with: TCA Gynae 3/12, T provera 10mg
x 21 days, T. tranexemic acid 500mg TDS D1-D5 for 3
cycles, T. Iberet folic 500mg BD x 3/12

9. CASES NEW READMISSION REMARKS
ENDOCERVICAL
TUMOUR
0 1 Electively admitted for Polypectomy KIV TAH
OVARIAN CANCER 0 3 All cases readmitted for chemotherapy

10. CASES NEW READMISSION REMARKS
ENDOMETRIAL CANCER 0 1 For chemo
LEIOMYOSARCOMA 0 1 For chemo
POST SVD WITH SINUS
TACHYCARDIA
SECONDARY TO ANEMIA
1
(t/in
from
CRW)
0 18y.o Para 1, Referred case from Hosp Tumpat at
6Hr post SVD with Tachycardia TRO Pulmonary
Embolism. Bedside ECHO/TAS: Normal. Admitted
to CRW for observation. CTPA done: No evidence
of PE. Transfused 1 pint PC during admission. Hb
post tx: 9.5. Discharged well with T Iberet 500mg
BD x 1/12

11. CASES NEW READMISSION REMARKS
OVARIAN CYST 3 0 ●Initially admitted to surgical ward 28 for acute
appendicitis. Upon reassessment from surgical team
mass per abdomen. p/w on and off abdominal pain, PS
upto 9/10 ot Casualty. Done Exploratory Laparotomy
Right Ovarian Cystectomy. Final diagnosis: Right twisted
ovarian dermoid cyst. For WI today.
●26 years old Para 2. Referred for Twisted ovarian cyst.
Upon further review and scan in ward mass just below
liver 13 x 4cm:Most likely gall bladder. Refer and T/o to
surgical ward, treated as Biliary colic, Ddx Pancreatitis.
●36 years old, Para 2. TAS done Rt multiloculated ovarian
cyst 3.7x5.5cm cystic, no solid component. Lt ovarian
measuring 4.5x5.4cm,mixed solid and cystic. Unlikely
twisted. Treated conservatively. Discharged well and
comfortable. TCA Gynae x 4/12

12. CASES NEW READMISSION REMARKS
ADENOMYOSIS 1 0 Para 0+1. k/c/o Adenomyosis since 2006.
admitted for TAH KIV BSO today.
INCOMPLETE EVACUATION
OF MOLAR PREGNANCY
1 0 30 years old, G3P2. h/o 2 previous scars.
to HSNZ for Molar Pregnancy. Day 12 post
and Evacuation at HSNZ, discharged with TCA
HSNZ. However presented to us with nausea and
vomiting with persistent PV spotting. Post suction
HCG at HSNZ: 112,897U. Repeated HCG Day 10 at
HRPZII: pending. Repeat TAS: Cystic like lesions,
with honeycomb appearance. Treated as Molar
pregnancy with incomplete evacuation.

13. CASES NEW READMISSION REMARKS
ENDOMETRITIS 1 1
POST-MENOPAUSAL
BLEEDING
0 1 73y.o Para 2. Admitted for hysteroscopy +
Diagnostic Dilatation and Curretage under LA.
Findings: VV and cervix atrophy. Very minimal
endometrial tissue currete from endometrium.
Discharge with TCA 6/52 to review HPE.

14. CASES NEW READMISSION REMARKS
PELVIC TUMOUR 0 1 69y.o Para 3, Electively admitted for TAHBSO on
tuesday.
GESTATIONAL
HYPERTENSION
1 0 24 y.o Para 2. Day 5 post SVD with Skin Nick
complicated with primary PPH secondary to
Uterine Atony. Antenatally: Severe PE, completed
MgSO4. Discharge well without medications.
Admitted for gestational hypertension. Urine Alb
nil. Dishcarged with t labetolol 100mg TDS, and T
iberet folic 500mg BD, and daily BP monitoring
1/52.

15. CASES No
Elective 7
Emergency 6

16. ELECTIVE CASES
TOTAL CASES: 7
NO OPERATION POST-OP DIAGNOSIS
1 Halimah Binti Said TAH for Para 4 with Multiple Uterine
Fibroid
2 Halimah Binti Harun Laparoscopic + Salphyngoopherectomy
KIV Open for Dermoid Cyst
3 Rosliza Mustapha Secondary Suturing for Day 21 post
EMLSCS with Infected Hematoma
4 Roshidah binti Ab Salam Suction and Evacuation for Molar
Pregnancy

17. ELECTIVE CASES
TOTAL CASES: 2
NO OPERATION POST-OP DIAGNOSIS
5 Hamidah Abu Bakar TAH + Omentectomy for Advanced
Ovarian Ca.
6 Azizah Binti Ahmad TAH + Omentectomy + PLND for Ovarian
Tumour with Ascites
7 Rahmah binti Ibrahim Hysteroscopy and Diagnostic Dilatation
and Curretage for Post Menopausal
Bleeding

18. EMERGENCY CASES
TOTAL CASES: 5
NO OPERATION POST-OP DIAGNOSIS INTRA-OP FINDINGS
1 EMERGENCY LAPAROSCOPY + LEFT
SALPHYNGECTOMY
LEFT RUPTURED TUBAL PREGNANCY
2 EMERGENCY LAPAROTOMY + RIGHT
SALPHYNGECTOMY
RIGHT LEAKING TUBAL PREGNANCY POOLING OF BLOOD 250CC + CLOT 50CC
INTRAPERITONEUM. UTERUS SIZE 8 WEEKS.
RIGHT LEAKING TUBAL PREGNANCY 4 X 2 X 2
CM. LATERAL THIRD RIGHT TUBE.
3 EMERGENCY LAPAROTOMY + RIGHT
CYSTECTOMY
RIGHT OVARIAN DERMOID CYST TWISTED RIGHT DERMOID CYST 10X10CM.
TWISTED X3. RUPTURED DURING
MANIPULATION: STRAW COLOURED FLUID,
SEBUM AND HAIR. MINIMAL SPILLAGE
4 WOUND DEBRIDEMENT + CHEMOPORT
RESUTURING
INFECTED NECROTIC CHEMOPORT
SITE
NECROTIC TISSUE
5 EMERGENCY LAPAROTOMY WITH
SPLENECTOMY
PREOP DIAGNOSIS:
RETROPLACENTAL BLEEDING TRO
SPLENIC INJURY
POSTOP DIAGNOSIS: SPLENIC
INJURY TRO CAUSES
*Initially referred for retroplacental bleeding
with IUD. Referred surgical on table for splenic
injury.

19. THANK
YOU
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