Malaysia Not Spared From H1N1

Malaysia National News Agency, BERNAMA
By Jumiati Rosly

KUALA LUMPUR, Dec 11 (Bernama) -- The influenza A (H1N1) pandemic caused panic worldwide this year, and Malaysia was no exception.

Setting the National Influenza Pandemic Preparation Plan in motion, the health ministry launched a big campaign to create public awareness of H1N1 and impart preventive measures to check its spread.

H1N1 was first detected in April in Mexico, forcing the government to shut down public buildings and public places.

The World Health Organisation (WHO) reported 622,482 positive cases of H1N1, with 7,826 deaths globally, until Nov 22.Malaysia recorded 77 H1N1-related deaths.

Prime Minister Datuk Seri Najib Tun Razak announced that the government would increase the anti-viral stock via a RM20 million allocation.To avoid panic, the health ministry plans to switch to seasonal influenza vaccines which contain H1N1 vaccine by February/March to protect against influenza-like diseases.

Malaysia has ordered 400,000 doses of H1N1 vaccines worth RM14 million, to be received in stages for high risk groups like pregnant women and 18-60 year-olds with chronic diseases, while 200,000 had been set aside for frontline medical staff.

More about H1N1 Vaccine: H1N1 Vaccine

Almost 50% of pregnancies in Malaysia MISCARRY!!

Wednesday December 2, 2009
Lifeparenting Headlines, The Star

OBSTETRICIAN and gynaecologist Datuk Dr Nor Ashikin Mokhtar of the Primanora Medical Centre says that about 50% of pregnancies miscarry.

According to her, sometimes women aren’t even aware that they have had a miscarriage and because the foetus is completely expelled from the body, there isn’t even a need to have a D&C (dilation and cutterage).

What is the cause of a miscarriage?

“Most of the time we do not know. You could divide it into foetal causes and maternal causes. When it comes to foetal causes, perhaps most of the time there is something abnormal about the pregnancy or the foetus itself. So that’s the reason why it’s not continuing as it should be.

“The maternal causes can be as simple as a chronic maternal illness – for example, if the mother is suffering from uncontrolled diabetes, hypertension or some auto immune disease. These are some of the underlying causes that affect the pregnancy. Or if the womb itself is abnormal, whether it’s the cavity of the uterus so it can’t implant adequately, or the uterus is normal but there is weakness in the neck of the womb.

“If that’s the case there would usually be a miscarriage after the first trimester. Sudden emotional trauma and stress have been associated with an increased risk of miscarriage.”

Get Tested

Wednesday September 30, 2009
LifeParenting Headlines, The Star

THERE are all sorts of tests that a woman should go for before and during pregnancy. Before getting pregnant, you should check for diabetes, thyroid problems and infections which you may not have had proper immunisation for, such as hepatitis, rubella and HIV. For hepatitis and rubella, it’s best to vaccinate before you get pregnant if you’ve not had your shots.

Obstetrician and gynaecologist Dr Gunasegaran PT Rajan say: “In the Malaysian context, before couples get pregnant, they should test for thalassaemia because it is more common here. The woman should go for the test to find out if she is a carrier. If her results are negative, then it doesn’t matter if her husband is a carrier or not. If she is positive, then the husband would also need to test if he is a carrier.”

Dr Guna says you don’t actually need to wait till you want to have children to test for thalassaemia. It is a test you can do at any age to find out if you are a carrier.

“If the husband and wife are carriers, then they need to be counselled of the risk that their baby will have thalassaemia. When they are both carriers, there is a 25% chance that the child will have thalassaemia major and a 75% chance that the child will be a carrier.”

During the pregnancy, a woman might have to undergo other diagnostic tests if the doctor thinks there are risks to her baby’s health.

Inherited disorder: Thalassemia

More about Thalassemia: Thalassemia

Cover Story: Water babies

18 Aug 2009, NST
By Suzanna Pillay

SHE may not be Malaysia’s first, but little Neena Ruth Mia Cheryan made history of her own earlier this year when she was born on June 14. She became the first baby to be delivered via water birth in Kuala Lumpur.

The water birth method is where a mother is immersed in warm water (equivalent to normal body temperature of between 35°C and 37°C) for some part or the entire part of her labour and delivery.It is a simple birthing option for low-risk mothers with uncomplicated pregnancies.

Joanna, who is married to a Malaysian, is a member of the Gentle Birthing Group, a support group in Kuala Lumpur for natural and water birthing.She delivered her first child via water birth in the Netherlands. Neena is her third child. Her second child was delivered normally, as at that time water birth services were not offered in Malaysia.

Besides having mothers share their water birth experience, the forum, which was held at the hospital, also included talks by practitioners about the safety, benefits and risks of water birthing, and the current practices around the region.

Vanessa Beyer is a certified professional midwife and doula from the United States. Beyer, who welcomed her son via water birth earlier this year, spoke about the benefits to the mother."She will still feel contractions and pain but the process is bearable. The water birth experience is gentle and empowering for the mother.Where a pregnant mother finds it cumbersome to move about because of her size, she can move about easily into any position in water because of its buoyancy.”

Apart from greater comfort and mobility, another advantage about water births is that not only do they reduce the need for drugs and intervention, they also promote relaxation and give the mother more control.

The mother has her own private, protected space which encourages an easier birth and a gentler welcome for the baby. Other benefits are that a water birth speeds up labour, reduces high blood pressure caused by distress, perineal trauma and eliminates episiotomies.

PHKL consultant obstetrician and gynaecologist Dr Choong Kuo Hsiang who assisted Joanna with her water birth said most women who have had water births are likely to opt for the method of delivery again, if given the option.He has performed two successful water births at PHKL.

He said mothers are usually introduced into the birthing pool when their contractions are well established and they are in advanced labour. They are also free to move in and out of the pool, and if they are trying the process for the first time and are not comfortable with proceeding with a water birth after a few hours in the pool, they can opt for a normal delivery.

There are two aspects to water births, said Dr Choong. “Some mothers use it for relaxation or comfort until normal delivery, or they go the whole way and deliver in the water.” Although water births are safe, there is a very minimal percentage of risk which include possibilities of drowning, water inhalation, infection, cord avulsion and water embolism. Risks usually arise if the procedure is performed incorrectly or if the mother has some complications with the pregnancy. Therefore, water births are only suitable for mothers with healthy, normal, low risk pregnancies.

The procedure may not be an option:

● if the baby is in a breech position
● in the case of shoulder dystocia (when one shoulder is preventing the baby from birthing)
● the baby has an irregular heartbeat
● in cases of multiple births or IVF babies

Mothers who have undergone C-sections, have high blood pressure or other complications are also excluded. Water births are also not suitable for parents who wish to store cord blood stem cells as the practice is to cut the umbilical cord later to establish proper respiration in the baby first “and there may not be enough cord blood left”.

In the United Kingdom, The Royal College of Obstetricians and Gynaecologists endorses the use of water in labour provided that there are suitably trained attendants to assist the women who opt for water births. However, it noted, that there may be rare but significant risks for the baby to be born underwater and mothers who choose this option should be screened for any complications and informed of the risk. Water births are offered in 64 per cent of hospitals in the United Kingdom.

In Singapore, the National University Hospital welcomed its first water birth in April 2006.The American College of Obstetricians and Gynaecologists has not taken any official position on water births as it feels more research in the area is required.

Despite this, Dr Choong said that as of 2005, 300 hospitals in the US offer the option.Dr Narinder Singh Shadan, who performed the first water birth delivery in Malaysia on Feb 14 last year, said water birthing is not for everybody.

“It’s a choice some mothers’ make. There is a group who wish to do things the natural way. People who choose it are those who do not want intervention or medication.

“The water process relieves anxiety and pain during labour. Mothers who opt for it are usually prepared for the process, have read up on it and know the journey they will be embarking on.”

In Malaysia, the practice is for interested mothers-to-be to approach their gynaecologist to ask for water births. The doctors will assess whether the pregnancy is safe and if it is possible to go ahead with a water birth.

“Age is not a barrier in water delivery provided there is low risk to both mother and baby, and there are no complications up to the time of labour.”

Dr Narinder said after handling his first successful water birth in Malaysia at Island Hospital there were plans for six more waterbirth deliveries. However, labour being a dynamic process, three had to opt for another method of delivery. So far there will be one water birth due at the end of this month.

Malaysia's first 'water baby'

Sat, Feb 16, 2008 NST, ANN
By Melissa Darlyne Chow

GEORGE TOWN, MALAYSIA: A 40-year-old secretary from here could not have asked for a better Valentine's Day gift.

Wang Chiew Kian (above, with husband) created history when she gave birth to a 3.64kg baby boy through the water-birth method.She is believed to be the first person in the country to have opted for the method.

Water-births, which are new in Malaysia, are already a norm in other developed countries.It is simply a normal birth carried out with the woman immersed in water.

Wang's baby, who was born at 5.20pm on Thursday at the Island Hospital, is her fourth child with husband Goh Beng Huat, 37, a subcontractor.She opted for the water-birth method after being told that it reduced the intensity of labour pains.

"When I had my first three children, I had a severe back pain which was unbearable."With the water-birth method, the pain only lasted a short while," Wang said.Goh was supportive of his wife's decision and recommends the method for other couples.

Island Hospital's consultant obstetrician and gynaecologist Dr Narinder Singh Shadan said they had to use a water tank as a birth pool as the hospital did not have the facilities for a water-birth delivery.

"The tank was filled with water up to Wang's abdominal area and we maintained a temperature of 37oC which is the body's normal temperature."

Dr Narinder said a woman's position in the tank varied according to the individual. In Wang's case, she was kneeling in the water with her arms on the rim of the pool. Her husband, who was also in the pool, supported her.

Dr Narinder said the waterbirth method required three things -- a couple who is motivated, family support and finding the right obstetrician to carry out the process.

"The water-birth method is good as the patient is not given medication, and there is no intervention.My job is to check the heartbeat and monitor the progress of the labour. Also I do not touch the patient at all unless necessary."This method reduces the intensity of pain, as the buoyancy of the water supports her weight and enables her to move freely."

"There is less trauma to the mother and baby, as the baby is born into an environment he is familiar with."

Degree & Training Requirement

REGISTRATION AS A SPECIALIST IN OBSTETRICS AND
GYNAECOLOGY, NATIONAL SPECIALIST REGISTER

I.

1. Application must be on the Application Form for registration as a specialist in Obstetrics and Gynaecology in the National Specialist Register of Malaysia.
2. Obstetrics and Gynaecology is listed as No. 6 of the list of Specialities
3. The list of recognised postgraduate qualifications recognised for registration are as listed below:

1. Master in Medicine Obstetrics and Gynaecology, University
   Kebangsaan


2. Master in Medicine Obstetrics and Gynaecology, University
   Malaya


3. Master in Medicine Obstetrics and Gynaecology, University
   Sains Malaysia


4. Membership Royal College of Obstetrics and Gynaecology
   London (MRCOG)

4. The applicant must be registered with the Malaysian Medical Council. Thus the applicant has a registrable basic medical degree

5.The applicant must have a minimum of 2 years practice after their postgraduate qualification
6. There are 3 groups of Obstetricians and Gynaecologists.

1. Obstetricians and Gynaecologists gazetted with the Ministry of Health Malaysia
   


2. Obstetricians and Gynaecologists working in various Universities:
   • Appointed by the University concerned as a specialist.
   • Possessing postgraduate qualification listed 3.1 to 3.4
   


3. Obstetricians and Gynaecologists in private practice having the above postgraduate qualification listed but not having been gazetted by KKM or any of the public universities.
   3.1 Those with less than 5 years of active practicing must submit :
   • Details of the postgraduate training received after obtaining Basic Medical Degree.
   • Previous/ current appointments.
   • Log Book of work experience.
   • Training, courses attended since postgraduate qualification.
   • Must have undergone a structured training programme with supervisor of 5 years working experience.
   

II.

Application for registration as a specialist in the NSR by applicants with post graduate degree not on the list of approved Obstetrics and Gynaecology post graduate qualifications.

- Singapore, Australia, New Zealand, Hong Kong, Canada.

1. Must have Basic Medical Degree qualification registrable with the Malaysian Medical Council.
2. Must submit the list / details of training with supervisors of 5 years working experience.
3. Details of the structured training programme, and in active clinical practice for at least 5 years.

4. Log book of work experience since postgraduate qualification.
5. Training courses attended since postgraduate qualification
6. Previous / current appointments.
7. Must submit the names of at least two referees who can submit reports on the applicant’s clinical skills, practice and competence.
8. Registration with NSR is for a duration of 5 years and renewable on a 5 yearly basis.
9. Must have take part in Continuous Professional Development (CPD) programmes.
10. Approval by the Specialist Subcommittee Obstetrics and Gynaecology of NSR will be on a case to case basis based on the circumstances of each case.
11. Registration with NSR is for 5 years period and renewable every 5 years based on assessment by scoring system for CPD.

III

Application for Registration with Unrecognised Postgraduate Qualifications

1. Must posses a recognised basic Medical Degree qualification that is registrable with the Malaysian Medical Council.
2. Must submit details of structured training programmes attended under the supervision of specialist of 5 years working experience.
3. Must submit list of workshops, courses and short training programmes attended during training.
4. List all procedures trained and certified by the relevant consultants.
5. Must have taken part in Continuous Professional Development (CPD) programme.
6. Must submit list of past and current appointments.
7. Must submit the names of at least two referees who can submit reports on the applicant’s clinical skills, practice and competence.
8. Must have been in active clinical practice for at least 5 years post specialist qualification.
9. Need to work under supervision in Malaysia for up to 6 months in an accredited training centres such as KKM, UKM, UM and USM. At the end of this supervised training, evidence of certification of competence should be submitted.
10. The approval by the Specialist Subcommittee Obstetrics and Gynaecology of NSR will be on a case to case basis based on individual circumstances.
11. The Specialty Subcommittee Obstetrics and Gynaecology of NSR shall call the applicant for an interview, if required.
12. Registration with NSR is for 5 years period and renewable every 5 years based on assessment by the scoring system for CPD

IV

Non Malaysians with Unrecognised Postgraduate Qualification.

The criteria listed under III No. 1 to 12 shall be applicable. The applicants from overseas must also submit their letter of offer from the Malaysian employer when applying to be registered in the NSR.

Training Structured Programme for the Master In Medicine Obstetrics and Gynaecology
1. Master Medicine Obstetrics and Gynaecology UKM
2. Master Medicine Obstetrics and Gynaecology UM
3. Master Medicine Obstetrics and Gynaecology USM

1.1. Master in O&G – Selection/Training the Conjoint Board UM/UKM/USM
a) The Masters in O&G Specialist Training programme is currently run by the conjoint Board of University of Malaya, Universiti Kebangsaan Malaysia and Universiti Sains Malaysia with the Ministry of Health.
b) The President of College of O&G – AMM is a member of the Conjoint of UM, UKM and USM.
c) The doctors need at least 2 years of compulsory training as housemen and Medical Officers prior to entry into programme. A recommendation has been made to shorten the 3 year requirement to 2 years.
d) The selection of candidates into Masters in O&G programme is by application and interview of the candidate by the respective Universities. Recently efforts have been made to standardise the admission criteria. A suggestion has been made to have an open system and by examination.
e) The candidate selected is posted to one of the accredited Hospitals,under the Ministry of Health or the University They undergo a period of orientation prior to their clinical postings. The masters programme has the following requirements.

1st year - Part 1 Examination
2nd year - Case write up
3rd year - Study and thesis write ups
4th year - Rotation to various subspecialities 3 month rotation

f) On passing the final Master Examination, the doctor is conferred the master O&G Degree by the respective University.
g) The Masters O&G doctors are required to do minimum of 6 months pre-gazettment posting.
h) At the end of 6 months, an evaluation is made by the Head of Department of O&G and if the report is satisfactory, the masters O&G doctor is gazetted as a specialist by the Ministry of Health or the University

TRAINING STRUCTURED SUBSPECIALTIES PROGRAMME IN O&G

The subspecialist training in O&G is currently conducted by the Ministry of Health through the JKPPOG (Jawatankuasa Pengurusan dan Perkembangan O&G).

The O&G specialist have to do a minimum period of 2 years of general Obstetrics and Gynaecology after passing the Masters in O&G, to gain experience in the field prior to be eligible for subspecialty training.

Four areas of subspecialisation has been identified in O&G :-
1. Maternal Fetal Medicine
2. Reproductive Medicine
3. Uro Gynaecology
4. Gynae Oncology

Each of the subspecialty training programme have their own curriculum, log book and structured training schedule. Candidates apply for subspecialty training through prescribed forms to the Ministry of Health. These applications are then submitted by the Ministry of Health to the respective Subspecialty Training Committees, which interviews the candidates and if suitable, he or she will be provided with the training schedule.

• 1st year training -Recognized centres in Ministry of Health or University
• 2nd year training -Recognized overseas centres or locally
• 3rd year training -The candidates will be posted to hospital to practice under indirect supervision.

During these periods of training the candidates need to keep log books and need a 6 monthly supervisors report.

After completion of 3 years of training, the candidates submits to the subspecialty training committee, his or her assessment reports, log book, research papers and other relevant documents. He/She is called for an interview by the subspecialty training committee which reviews all his/her training reports and issues a letter of satisfactory completion of training.

Since May 2006 an Exit Board had been created to review and evaluate the subcommittee’s report and issue a certificate of completion of training to the candidates. All these documents are then submitted to the Ministry of Health for gazettement of the candidates as a subspecialist.

Currently the subspecialty training in the Ministry of Health is conducted by the Jawatankuasa Pengurusan dan Perkembangan O&G (JKPPOG). The Head of the Ministry of Health O&G Services heads the JKPPOG committee and its members are all the state heads of O&G and other senior O&G specialists in the Ministry of Health. The JKPPOG committee appoints the head of the Subspecialty Training Committees and he in turn appoints the members of his subspecialty training committee.

Presently the following are the Head of the Subcommittee :-
1. Maternal Fetal Medicine - Dr. Ravichandran
2. Reproductive Medicine - Dr. Mukudan Krishnan
3. Uro Gynaecology - Dr. Wan Abu Bakar
4. Gynae Oncology - Dato’ Dr. Ghazali Ismail

Maternal Fetal Medicine
1. Dr. Ravichandran - Ministry of Health
2. Prof. Dr. Jamiyah Hassan - University of Malaya
3. Prof. Dr. Muhammad Abdul Jamil Mohd Yassin - Universiti Kebangsaan M’sia
4. Dr. Japaraj Robert Peter - Ministry of Health
5. Dato’ Dr. Alex Mathews - Academy of Medicine

Reproductive Medicine
1. Dr. Mukudan Krishnan - Ministry of Health
2. Dr. Hj. Mohamad Forouk Abdullah - Ministry of Health
3. Prof. Dr. Zainul Rashid Mohd Rashid - Universiti Kebangsaan M’sia
4. Dr. S.P Rachagan - Subang Medical Centre, KL
5. Dato’ Dr. Johan Thambu Malek - Academy of Medicine

Urogynaecology
1. Dr. Wan Abu Bakar - Ministry of Health
2. Dr. Soon Ruey - Ministry of Health
3. A.Prof. Dr. Seri Suniza Sufian - University Kebangsaan M’sia
4. Dr. Aruku Naidu - Ministry of Health
5. Dato’ Dr. N. Sivalingam - Academy of Medicine

Gynae Oncology
1. Dato’ Dr. Ghazali Ismail - Ministry of Health
2. Dr. S. Vijaendreh - Ministry of Health
3. Dr. Rushdan Md. Noor - Ministry of Health
4. Prof. Dr. Siti Zawiah Omar - University of Malaya
5. Assoc. Prof.(Clinical) Dr. Ahmad Zailani Hatta - University Kebangsaan M’sia
B.Mohd Dali
6. Assoc. Prof Dr. Nik Md. Zaki - University Science Malaysia
7. Dato’ Dr. N. Sivamohan - Academy of Medicine
8. Datuk Dr. Abdul Aziz Yahya - Gleneagles Intan Hospital

Nature of Work

Inpatient Consults –maternal fetal medicine specialist is available seven days a for consultation and evaluation of any patient designated by their generalist obstetrician as having a complicated or high-risk pregnancy.

Maternal-Fetal Medicine specialists available on-call at all times – The complex needs of our high-risk patient population is highly dynamic and requires ongoing evaluation and intervention. maternal-fetal medicine specialists are in house daily, and available either by phone or on-call as needed 24 hours a day.

Scope of Practise

The MFM specialist provides medical care for a broad range of problems encountered in pregnancy, such as twins, triplets, or more; diabetes; premature labor; and other special conditions occurring in pregnancy, including previous adverse outcomes.

• Consultations for patients with high-risk pregnancy issues prior to and during pregnancy


• Comprehensive care throughout pregnancy and delivery


• Education for medical students, residents, and fellows regarding normal and complicated pregnancies


• Clinical and basic scientific research, including randomized clinical trials and outcomes research, to benefit women and their newborns


• Leadership positions in national organizations and committees regarding research, education, and obstetric care policy

Development

Maternal-Fetal Medicine was first recognized as a subspecialty of obstetrics and gynecology in 1974, but the scientific advances leading to the emergence of this new medical field were made in the 1950s and 60s. The advent of medical ultrasound gave obstetricians a window through which to observe the behavior and development of the fetus. Amniocentesis, coupled with cytogenetics and later, molecular biology, made possible the diagnosis of many fetal conditions, even early in pregnancy. Fetal monitoring allowed evaluation for fetal well-being in late pregnancy and during labor, allowing physicians to intervene on behalf of the fetus. Techniques for safely entering the uterus with needles and various instruments allowed other forms of diagnosis and, in some instances, treatment of the fetus.

By the early 1970s there was no denying that the fetus had become a patient in his or her own right. At the same time it was becoming increasingly clear that the appropriate management of many maternal medical and surgical conditions could improve the health of the fetus. All of these advances led to a growing group of obstetrician/gynecologists who were limiting their work to the needs of mothers and fetuses in complicated pregnancies. In 1974 certification in the subspecialty of Maternal-Fetal Medicine was granted by the American Board of Obstetrics and Gynecology.

Definition

Obstetrics and gynecology (often abbreviated to OB/GYN, OBG, O&G or Obs & Gynae) are the two surgical specialties dealing with the female reproductive organs, and as such are often combined to form a single medical specialty and postgraduate training program. This combined training prepares the practicing OB/GYN to be adept at the surgical management of the entire scope of clinical pathology involving female reproductive organs, and to provide care for both pregnant and non-pregnant patients.

A Maternal Fetal Medicine (MFM) specialist is an obstetrician/gynecologist who deals with high-risk pregnancies or special problem pregnancies. MFM specialists have completed additional formal training and have advanced knowledge of the medical, genetic, surgical, and obstetrical complications that can occur during pregnancy.

Thus, a MFM specialist has obtained certification in Obstetrics/Gynecology and Maternal Fetal Medicine.

Introduction To Maternal Fetal Medicine

Maternal-Fetal Medicine (MFM) is a subspecialty of Obstetrics and Gynecology dealing with all matters that can affect the health of a mother or fetus from before conception to the postpartum period.MFM involves the prevention, diagnosis and treatment of those conditions responsible for morbidity and mortality of the mother, fetus and early newborn.

The rapidly expanding body of knowledge regarding maternal health and disease, the continuing introduction of new technologic methods for maternal and fetal assessment and increasing societal demands and expectations for mother and child, continue to modify the nature of obstetrical care. A direct result of these evolving processes is a need for specialists in maternal-fetal medicine with educational and research interests, administrative ability and special training in the identification and management of high risk obstetrical problems.

Specialists in maternal-fetal medicine are viewed primarily as consultants to the practising obstetrician and other health care providers. For the most part they will limit their practice to referred high risk obstetrical patients in a tertiary health care institution and function as regional consultants in matters of organization, standards and education in the broad field of maternal-fetal medicine.