Found out today that all magazines and toys have been removed from waiting rooms for clinics at Ryehill health centre on Perth Road. Mother attending the clinic says its a nightmare bringing two kids along because there's nothing for them to do. Managed to ask the midwife at the clinic (Linda) lots of antenatal health questions and she was really helpful. Performed several abdominal palpations and got to play with the hand held Doppler.

Read the following article about H1N1 virus today on the BMJ website:

'Two swine flu call centres in England will close on Sunday with the loss of 1200 jobs reports The Guardian. Demand for Tamiflu has plummeted: it peaked on 27 July with nearly 39,000 authorisations for the use of Tamiflu while on 16 August there were only 3396. According to the HPA there were only 11,000 new cases of swine flu last week and the GP consultation rates have dropped from a peak of 35 consultations per 100,000 of the population to under 5 (similar to the rate in January this year for seasonal flu). 59 people in the UK are reported to have died from the virus so far.

Time for a break?

With everything seemingly back to normal it’s tempting to forget all about swine flu. But we shouldn’t get too comfortable, as the RCGP mentioned in its weekly flu update: this quiet time should be used to prepare for the next wave of flu. But what more can be done? We’ve already had a dress rehearsal this summer and clinicians’ knowledge, skills and organisation regarding swine flu are now fine-tuned. Perhaps the best thing people can do is take a hard earned break to recharge the batteries for the winter ahead."

Wonder whether it will be a problem when the winter comes around and what I'll be able to do to help treat patients with flu like symptoms in hospital.

Came across a patient today with Ehlers-Danlos syndrome at the high risk antenatal clinic, Ninewells Hospital. Its an autosomally dominant inherited disorder caused by a defect in collagen synthesis and comes on 4 major clinical sub-types - type I to IV. This patient had Type III, also known as 'Hypermobility EDS'. It affects between 1 in 10,000 and 1 in 15,000 people. A serious complication of type 4 EHD is coarctation of the aorta and this patient did have a positive family history of coarctation of the aorta. It was recommended that due to this risk in the patient, the second stage of labour should be as short as possible to minimise risk.

Discussing with the doctor afterwards I learnt that the most important thing about aortic dissection in labour is recognising it by picking up key clinical signs such as marked hypotension, severe chest pain and shock. This severe complication had caused a fatality on the ward in the past year.

On a slightly lighter note, at the pathology MDT meeting the medical stereotypes were out in force, consultant gynaecologist 'surgeons are pretty thick anyway' and my favourite from the pathologist when discussing the patient's tumour 'we could just dissect it on autopsy'. Seriously?

Symptoms of early pregnancy include: nausea, vomiting, dry skin, weight gain, mood changes, chest pain, constipation, heartburn, pelvic pressure / joint pain, carpal tunnel syndrome, vaginal discharge and fatigue. Many of these symptoms disappear after approximately 16 weeks gestation although there's no 'magic cut-off'. Meanwhile UTIs are very common in pregnancy and must be treated as they may cause pre-term labour.

I cannot make up my mind on where I stand regarding the release of Abdelbaset Ali al-Megrahi on compassionate grounds. Ethically if the man was soon to die from terminal cancer, I would support his release to be with his family. However, he is guilty of a crime for which he was given a life-sentence and I can understand why many people are particularly upset by his release. I don't know what's true about the economic discussions taking place between Scotland and Libya and the rumours that his release were part of a trade deal although I sincerely hope they are not true. If they do turn out to be true, it would pose serious questions about the members of the Scottish parliament who warranted his release.

From now on I will take something to do in clinics between patients not turning up, tutors being absent, patients not wanting students present etc instead of wasting hours like this afternoon!

Clinical features:

Hydatidiform Mole: vaginal bleeding, large for dates uterus, passage of vesicles, hyperemesis, early onset pre-eclampsia and hyperthyroidism.

Ruptured Ectopic Pregnancy: Shock, peritonism, haemorrhage, cervical excitation, uterus small for dates.

Tubal Miscarriage: Abdominal pain / peritonism, PV bleeding, uterus small for dates, cervix closed, shoulder pain.

Exciting times, delivered my first baby last night on the labour ward at about 3AM on Sunday morning! After a normal labour (patient brought to labour ward 2 weeks post-dates) para 1 + 0 woman I was able to assist in the delivery of the baby and the placenta with two midwives present in the room. The midwives are all fantastic, all of them have been really welcoming over the past week which has really helped. There was some post-partum haemorrhage, probably caused by trauma to the vagina during the delivery. Blood pressure and haemoglobin levels were closely monitored and the patient made a full recovery. Carried out checks on the placenta for completeness, presence of both the amnion and chorion, and also presence of three blood vessels in the umbilicus. Also was present in theatre earlier in the evening for to witness a forceps delivery.

Been very busy on the labour ward this week, an interesting case from last night:
28 y.o. para 0 + 0 woman presentation breech, admitted to the labour ward from DMU for emergency caesarian section, fetal presentation was confirmed by ultrasound scan. On delivery the baby was seen immediately by the on-call paediatrician with some concerns over baby's breathing. Grunting sounds were heard, heart rate greater than 100. Discussed with the on-call consultant the importance of using accuracy when describing fetal position, lie, and presentation. Learnt that whilst it is possible to have a SVD with a breech fetus, recent evidence has shown that caesarian section has a higher chance of positive outcome.