Obs and Gynae

On Wednesday, Ros and I reported to Chris de Wet clinic once more to witness more follow up appointments. I learned more about the CD4 count, which is the result of a blood test performed on HIV positive patients. The test measures the amount of t-cells that are present in the body and are able to fight off infection. A pregnant woman with a CD4 count less than 350 will be placed on ARV drugs for the duration of her pregnancy in order to protect the fetus from contracting HIV. However, she will be taken off the ARV's after the pregnancy because her CD4 count already indicates she has developed AIDS. The same applies if a woman's CD4 count is much much greater than 350 will not remain on the ARV's after pregnancy, since the patient still has enough t-cells to fight off infection. A pregnant woman with a CD4 count greater than 350 will be placed on ARV's during pregnancy and will remain on the drugs for the rest of her life.
I also learned the three ways to determine the week of gestation of the pregnancy. The most accurate method is the date of the last menstruation. Using this date the nurse or doctor will add 7 days and 9 months to give the EDD, or estimated date of delivery. The second most accurate method used is the sonogram. Lastly, if the mother cannot remember the date of her last menstruation and she is unable to receive a sonogram a SF measurement will be taken. SF or symphyseal fundal height measurement is taken by measuring from the top of the mother's uterus (by feeling her abdomen) to the top of the pubic symphysis. The measurement in centimeters is an estimate of the gestation of the pregnancy.
Thursday we reported to MUCPP, Manguang University Community Partnership Program. Several nursing students were also there for clinical rotations and their lecturer explained a full body examination of a pregnant woman at 40 weeks gestation.
Thursday night was the second on call night of the week. Ros, Nelson and I were assigned to Pelanomi hospital, which is a secondary care hospital in Bloem. Upon arrival there was a cesarean section being performed in the theater (surgical room). The mother had been placed under spinal anesthesia for the surgery, but began to doubt her decision to be awake during the birth. The anesthesiologist put the patient under general anesthesia and a healthy baby girl was delivered shortly after. A NVD or natural vaginal delivery, occurred shortly after 10pm. It was an unusually quick delivery and a healthy baby boy was born. Another cesarean section occurred immediately after the NVD. A spinal anesthetic was used and the mother was awake during the surgery. No complications occurred during the c/s. All three deliveries that were witnessed were by HIV positive mothers.
Pelanomi hospital was much warmer, and more up to date than National hospital (where we were on call Monday night). Pelanomi is a more specialized hospital since they are a secondary hospital and National is a primary.