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OBSTETRIC & GYNAECOLOGY DEPARTMENT

HEAD OF DEPARTMENT: DR.HARRIS NJOO SUHARJONO

INTRODUCTION

The Obstetric and Gynaecology department is one of the busiest clinical discipline in Sarawak General Hospital. It accounts for over 30% of all hospital admissions. It comprises of 5 main wards and the O&G outpatient clinic. The 5 wards are Labour Ward, Maternity 1, Maternity 2, Maternity 3 and Gynae Ward. The specialist outpatient clinic is located in the outpatient department complex.

The Labour Ward comprises of 15 ensuite delivery rooms which is equipped with the appropriate medical equipment and a centralized fetal and maternal monitoring system. The triage area located at the front of the Labour Ward function as the patient admission centre. There are 3 assessment bays equipped with CTG machine and an ultrasound room equipped with two portable ultrasound machines. The Labour Ward complex has one functional Maternity operating theatre which is currently operational from Monday to Friday from 8am till 9pm. Caesarean sections can also be performed in the main operating theatre complex.

The number of official inpatient beds in the other wards are, Gynae Ward with 28, Maternity 1 with 20 beds, Maternity 2 and Maternity 3 with 49 beds each respectively. The Early Pregnancy Assessment Unit (EPAU) and Obstetric Day Care Unit are located in Maternity 1 ward and it operates during office hours only.

DEPARTMENT OBJECTIVE

Menyediakan perkhidmatan rawatan, pemulihan dan pencegahan yang memuaskan kepada para pesakit yang dapat mengurangkan kesengsaraan mereka.

i. Memberi rawatan kejururawatan yang cekap dan bermutu tinggi kepada pesakit

melalui:

- memberi rawatan kepada pesakit dengan penuh timbang rasa, bersopan santun, berbudi bahasa dan menghormati kepercayaan agama dan latar belakang mereka.

- memberi rawatan individu melalui penilaian, perancangan perawatan dan menilaikan kemajuan mereka dari fizikal dan psikologi.

- memelihara dan menjamin pertalian yang baik dengan pesakit dan keluarga mereka.

- Memberi kerjasama serta membantu pegawai-pegawai perubatan dan pakar-pakar dalam perawatan pengubatan di dalam ruang lingkup tugas kejururawatan.

ii. Menentukan pentadbiran klinik-klinik pakar berjalan dengan berjalan dengan licin, cekap dan berkesan.

iii. Merancang dan memberi latihan yang mencukupi dan bermutu tinggi kepada kakitangan kejururawatan demi memenuhi keperluan-keperluan klinik pakar.

iv. Menyediakan pusat latihan untuk paramedik, pelajar perubatan, Pegawai Perubatan Siswazah, Pegawai Perubatan yang berminat dalam bidang perbidanan dan sakit puan.

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SERVICES PROVIDED

The department provides various O&G specialist services and this includes subspecialty services such as gynaeoncology, maternal fetal medicine, reproductive medicine and urogynaecology.

The specialized outpatient services being provided besides EPAU and Obstetric Day Care Unit include Outpatient Hysteroscopy, One Stop Colposcopy Clinic as well as a number of outpatient specialist clinics, such as the staff clinic, Infertility clinic, specialist antenatal clinic, combined antenatal clinic, antenatal diabetic clinic, gynaeoncology clinic, urogynaecology clinic, family planning clinic and the pre-pregnancy care clinic.

Other activities include organizing regular antenatal classes for expectant mothers and providing postnatal nursing for mothers staying in Anjung Kasih.

The department does extensive networking with other hospitals in the state and this include regular visiting schedules to Sibu, Sarikei, Bintulu and Miri for the gynae-oncologists, maternal fetal specialist and uro-gynaecologist. The Registrar in the department also provides weekly rotational cover in Sri Aman hospital to provide better obstetric and gynaecological services in a hospital which is located 3 hours away.

In 2017, the department has fully implemented the notification all deliveries through IKS (Informatik Kelahiran Sarawak). This notification is done online, and accessible by clinic staff to facilitate them in doing their postnatal nursing at both clinic and home. The keying in of delivery data in NOR (National Obstetrics Registry) is also being carried out.

STAFFING

To the date, the department has about 12 consultants/ specialists and about 35 medical officers. This include 2 reproductive medicine specialists, 2 gynae-oncologists, 1 maternal fetal specialist and 1 uro-gynaecologist.

The nursing staff are as follows;

Matron U42 - 1 (Woman & Child Directorate Matron)

Matron U36- 2

WARD NURSING SISTER

STAFF NURSE

JM PPK

Gynae Ward 2 30 12 6

Maternity 1 2 14 15 6

Maternity 2 2 21 23 6

Maternity 3 2 18 22 7

Labour Ward 3 48 30 7

WORKLOADS

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Labour room triage area function as a primary PAC (patient assessment centre) for obstetric cases. The distribution of the admission/ transfer in and out of patient shown in graph and summary of workload attached.

ACHIEVEMENTS:

Please refer to the attachment for achievement in :

A. Research and Publications

B. Summary of NIA/KPI 2017

DEPARTMENT ACTIVITIES

O & G organised numbers of courses and workshop with our main objective to maintain skill and also to update knowledge of staff. The participants not limited to O & G staff in SGH only but also all over Sarawak.

The courses and CME programs have attracted participants from all over Sarawak as well as from outside Sarawak.

Please refer to the attachment for the detail of courses and training

MOVING FORWARD – PLANS FOR 2018 ONWARDS

1. To publish the Labour Ward manual version 2018

2. To embark on clinical research and publications

3. To implement a competency based obstetric skill training log book for trainees with specific focus on managing shoulder dystocia, conducting vaginal breech deliveries and carrying out safe instrumental deliveries among others. This is part of our endeavour to improve quality care.

4. To implement and focus on some aspects of mother friendly care

5. To maintain and improve training of MRCOG candidates as well as subspecialty trainees to continue to produce specialists

6. To prepare for administrative, personnel and clinical impact of the eventual opening of the Petrajaya hospital in 2018/20

PREPARED BY : NS SHELA ANAK JUMOI ( LABOUR WARD )

CHECKED AND EDITED BY : DR HARRIS N SUHARJONO

( HEAD OF DEPARTMENT, O&G DEPARTMENT, SGH)

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ATTACHMENTS

DEPARTMENTAL WORKLOAD AND GRAPH

Activity Total

1 Admission 14553

2 Discharges 14500

3 Deliveries 12052

4 Total LSCS 3001

Elective 841

Emergency 2160

5 Total Patient at EPAU/Daycare 8903

6 Total Workload at EPAU/Daycare 32715

7 Admission to Gynae Ward 3110

8 Total Discharges from Gynae 3094

9 Major operation in Gynae Ward 674

10 Minor operation in Gynae Ward 810

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RESEARCH AND PUBLICATION

NO TITLE & AUTHORS INDEXED JOURNAL

1 Edrus ED, Jerip A, Kipli M, Chai MC, Suharjono HN. Pregnancy and dumping syndrome post-bariatric surgery: A case report

Med J Malaysia 2017 April; 75(5): 259-63

2 Voon HY, Amin R, Kok JL, Tan KS. Call for caution: Neonatal portal vein thrombosis following embolization of chorioangioma.

Fetal Diagn Ther. 2017 Aug; doi: 10.1159/000479105

3 Voon HY, Shafie AA, Bujang MA, Suharjono HN. Cost effectiveness analysis of carbetocin during cesarean section in a high volume maternity unit.

J Obstet Gynaecol Res. 2017 Oct 13. doi:10.1111/jog.13486

4 Voon HY, Leong MS, Li CW, Suharjono HN. Corticosteroid-induced leukocytosis in pregnancy: A prospective observational study.

Med J Malaysia 2017 Oct; 75(5): 259-63

5 Tan LN, Mariappa G, Voon HY, Suharjono HN. Septic miscarriage with toxic shock syndrome and disseminated intravascular coagulation (DIC):The role of surgery, recombinant activated factor VII and intravenous immunoglobulin (IVIG).

Med J Malaysia 2017 Dec; 72(6):380-1

6 Soe Lwin, Nina Lau Lee Jing, Haris Suharjono, Mardiana bt Kipli, Tin Moe Nwe, Myat San Yi, Lucas Luk Tien Wee. Caecal Perforation from Primary Intestinal Tuberculosis in Pregnancy.

Case Reports in Gastrointestinal Medicine 2017. doi:10.1155/2017/2173724

NO TITLE POSTERS

7 Voon HY, Chai MC, Hii LY, Amin R, Suharjono H. Acceptability of low molecular weight heparin thromboprophylaxis amongst Muslim mothers in Sarawak.

25th Congress of the Obstetrical & Gynaecological Society of Malaysia. July 2017

8 Tan YL, Ng JJ, Voon HY. Toxic Epidermal Necrolysis in the First Trimester of Pregnancy.

25th Congress of the Obstetrical & Gynaecological Society of Malaysia. July 2017

9 Chua WC, Edrus ED, Luk LTW, Amin R, Suharjono HN. A case report:

25th Congress of the Obstetrical & Gynaecological

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Methemoglobinemia in pregnancy. Society of Malaysia. July 2017

10 Chua WC, Edrus ED, Demong RH, Sim WW, Suharjono HN. Gestational choriocarcinoma with pulmonary and choroidal metastasis: Is it still an enigma?

25th Congress of the Obstetrical & Gynaecological Society of Malaysia. July 2017

Summary of NIA/KPI/QA 2017

Indicators Standard Achievement

Percentage of patients with eclampsia administered Magnesium Sulphate ( MgS04)

100% 100%

Percentage of massive PPHincidences in cases delivered in the hospital

≤ 1% 0.64%

Quality Care ( Rate based process indicator) ≥ 80% 100

Percentage of cases with EES administration for PPROM cases

> 95% 100

Percentage of unrecognised ureteric injury intraoperatively during Benign gynaecological surgery

<1.5%

0%

Percentage of patients diagnosed antenatally with morbidity adherent placenta have their caeserean section performed or supervised by consultant/specialist

≥ 90%

100%

Rate of obstetric trauma following vaginal delivery without instrument in corresponding year

N/A 0.28%

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COURSES AND TRAINING

Courses/workshop No of courses/ workshop organised

Total participants

SALSO- Sarawak Life Support in Obstetric

7 series of SALSO, including 3 at Hosp Bintulu, Sarikei and Lundu

320

Basic Suturing Workshop 3 92

O & G Updates 1 170

O & G FamilyMedicines Update

1 94

Family Planning Courses 1 150

Cervical Cancer Awareness 1 122

Perineal Trauma Workshop 1 73

Basic Ultrasound 1 100

Gynae Masterclass 1 70

SAMs ( Sarawak MRCOG Survival Course)

2 70

Back to Basic Infertility 1 100

Laparoscopic Course 1 100

Fetal Endocardiography 1 25

The department also has other scheduled program such as;

1. HO teaching session every Thursday

2. Departmental CME/Audit every Friday at 11 am

3. 2 Hours Suturing Practice every 2 weekly (10 house officers per session)

In 2017, a total of 5 obstetric drills were conducted; 4 for shoulder dystocia and 1 for massive PPH, involving both doctors and nursing staff.

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