ABSTRACT
@#A fetal neck mass such as cystic hygroma imposes a challenge in the continuing prenatal care and birth strategy for a 26-year-old gravida 2 para 1 (1001) with a scarred uterus from previous low transverse cesarean section (CS). An intricate delivery for the fetus with a potential airway obstruction necessitates an ex utero intrapartum treatment (EXIT) delivery. The patient was initially scheduled to undergo the procedure at 38 weeks of gestation, but preterm labor ensued. Close antenatal monitoring was done which carried the pregnancy to term. The multidisciplinary approach and planning requires consensus among varied specialties as this maternal–fetal surgery differs immensely from a regular CS. This aims to document and discuss the preoperative, operative and postoperative management done for this patient. The EXIT procedure was performed at 38 weeks' age of gestation with good maternal outcomes. The fetus was delivered safely.
Subject(s)
Lymphangioma, CysticABSTRACT
Background@#Postpartum Depression (PPD) and psychosis (PPP) are diseases that have detrimental impact to the patient and their family. Prenatal and postpartum screening are important to decrease its morbidity, hence obstetricians and gynaecologists’ (OBGYN) role in the diagnosis is vital. However, studies showed that the screening rate of PPD and PPP are low, which may be caused by several barriers.@*Objective@#This study aims to describe the knowledge, attitude and practices of the OBGYN’s practicing in a local tertiary hospital using a survey created by Leddy et al. in 2011.@*Methodology@#This survey is a 5-section questionnaire that tackled the clinical practice, knowledge, beliefs and attitudes of the subjects. It was given to 160 consultants with a response rate of 40% (n=64) during the time period of May 17, 2018 to June 27, 2018.@*Results@#The results showed that most OBGYN do not routinely screen for PPD and PPP (54.69%), which is analogous to literature but contrary to the original study. Most OBGYN agree that all the specified barriers to screening were limiting, the most cited among of which were their limited knowledge in the diagnostic criteria (PPD: 79.69%, PPP: 79.56%) and treatment options (PPD: 76.56%; PPP: 78.13%) and their lack in training in postpartum mental illnesses (PPD: 78.13%; PPP: 84.38%). These barriers were paralleled by the low scores in the knowledge section, despite the higher accuracy in diagnosing patients in the clinical cases. However, there was a low frequency screening rate among OBGYN’s with recent and personal experience with the disease.@*Conclusion@#This gap in knowledge can be addressed by organizing events for continuing medical education, focusing on peripartum mental health illnesses, creating avenues for research to increase knowledge among residents-in-training and fellows of the local organizing body, and establishing clear guidelines to incorporate screening in local practice during prenatal and postpartum care.