Consumer Feedback and Complaint Policy

 

Introduction

 

  • The Safety and Quality Governance Standard for consumer feedback and complaints management has been based on the NSQHS (National Safety and Quality Health Service Standards).

  • As supported through widespread use of the Australian Charter of Healthcare Rights, customer feedback and complaints assists in improving the quality of diagnostic imaging service provision.
     

Objectives 

  • To ensure St George Clinic for Women is committed to keeping the management of feedback and complaints consistent with the principals of open disclosure and fairness, accessibility, responsiveness, efficiency and integration.


    Policy

  • Complaints made by patients, referrers or relevant third parties about Dr Serag Youssif will at all times be considered serious.  Patient Feedback and Complaints Policy and forms will be on display in the practice and available to all patients.  Patient Feedback and Complaints Policy and forms are also available on www.drseragyoussif.com.au

  • All complaints made by patients, referrers or relevant third parties will be recorded in the Practice Complaints Register by either the Office Manager or delegate where relevant.

  • Patients, referrers or relevant third parties who wish to lodge a formal complaint regarding a provided service will be requested to submit the complaint to the practice principal in writing on St George Clinic for Women Patient Feedback and Complaints form. The practice principal is responsible for the investigation of the complaint.  The practice principal will notify the complainant (in writing) within <14> days of the outcomes and resolutions of the complaint. 

  • Verbal complaints by patients, referrers or relevant third parties will be responded to (where possible) immediately by the relevant staff member or practice principal.

  • Where patients, referrers or relevant third parties have provided their contact details on the Patient Feedback and Complaints form, St George Clinic for Women  will respond in writing to patient feedback within <14> days.

  • To achieve our objectives, we use two methods for receiving and recording feedback and complaints:

  • A Customer Feedback and Complaints Form, and

  • A Complaints Handling Register.

 Procedure

Complaints Procedure

  • If a complaint is received by the Practice, the complainant must be advised of this policy and procedure and expected resolution times. If the complaint is about a matter which can be resolved immediately without reference to others, then the Practice Principal will take the necessary action. Corrective action will take place within two days or as soon as possible. Staff members must ensure the complaint or feedback is recorded on the Customer Feedback and Complaints Form and included on the Complaints Handling Register.

  • Obtaining Feedback

St George Clinic for Women seeks client feedback by:

  • Encouraging patients and carers to complete feedback forms

  • Undertaking  periodic surveys

Feedback is periodically reviewed and assessed contributing to continuous improvement processes.

 Consumer Consent and Information Policy
 

Introduction

  • The Safety and Quality Governance Standard has been developed to ensure that diagnostic imaging procedure risks have been advised and consent obtained from the patient.

  • Only ultrasound examination are done at St George Clinic for Women and no imaging procedures are done at St George Clinic for Women

 
Objectives  

  • To ensure consumers are fully aware of the diagnostic imaging examinations that are available and what those examinations entail before a service is performed.

  • Only ultrasound examination are done at St George Clinic for Women and no imaging procedures are done at St George Clinic for Women

 
Policy

  • St George Clinic for Women ensures patient information has been obtained to determine any clinical risk and where relevant, patient consent is obtained prior to the procedure.

  •  Only ultrasound examinations are done at St George Clinic for Women and no image procedures are done at St George Clinic for Women.

  • No Medications are given for imaging procedures at St George Clinic for Women and there are no imaging procedures done at St George Clinic for Women.

 

  • St George Clinic for Women ensures comprehensive information on examinations performed is available to patients.  This information will be available in a variety of media forms, brochures, www.drseragyoussif.com.au and Patient Consent Forms.

  • Where patient preparation is required prior to a diagnostic imaging examination (e.g. full or empty bladder etc) St George Clinic for Women staff will be responsible for ensuring the patient is fully informed of the preparation requirements.

  • Not Applicable. Signed Patient Consent Forms are required by St George Clinic for Women for all diagnostic imaging examinations that are high risk/invasive to the patient or require injections and/or medication.

  • Not Applicable. St George Clinic for Women will deem which diagnostic imaging procedures require signed consent from the patient based on the risks associated with the procedure.

 

Only ultrasound examination and no Imaging procedures are done at St George Clinic for Women

 

 

 

Informed Consent for Ultrasound Examination 

 

  • Valid consent must be obtained before starting any ultrasound examination or procedure. Healthcare professionals who do not respect the right of a patient to determine what happens to their own body in this way may be liable to legal or disciplinary action.

  • The consent process is a continuum beginning with the referring health care professional who requests the ultrasound examination and ending with the practitioner who carries it out. It is the responsibility of the referring professional to provide sufficient information to the patient to enable the latter to consent to the ultrasound examination being requested. It is the responsibility of the practitioner to ensure that the patient understands the scope of the ultrasound examination prior to giving his or her consent.

  • Verbal consent must be obtained for all examinations.

  • Consent for those of an intimate or invasive nature should be recorded in the ultrasound report.

  • Written consent is occasionally required particularly vaginal ultrasound and is signed with consent to vaginal examination.

  • Literature which explains the scope of the examination clearly and accurately should be made available to patients prior to the ultrasound examination.

 Procedure

 

  • Information pamphlets are available for the full range of examinations performed at St George Clinic for Women.

  • No invasive Imaging procedures such as Amniocentesis, Chorion Villus Sampling, fetal reduction or sonohysterography Saline infusion are done at St George Clinic for Women.

  • St George Clinic for Women obtains all patient’s health status, relevant to the diagnostic imaging (ref. Patient Health Questionaire).

 Service Substitution Policy and Protocols

 

  • At St George Clinic for Women Only Obstetrics and Gynaecology Ultrasound are performed.  Abdominal or vaginal ultrasound is selected depending on clinical indication, patient history or preference. Often both examinations are required to improve or reach diagnosis.

  • At St George Clinic for Women only Ultrasound imaging is used.

  • Only substitutes diagnostic imaging procedures  abdominal or vaginal where:

 

  • Appropriate for the diagnosis of a patient’s medical condition;

  • Generally accepted on the basis of diagnostic medical opinion; and

  • Permitted by the Act and subordinate legislation for the payment of a Medicare benefit for that service. 

 

St George Clinic for Women

 

Consumer Information on Practice Services Policy

 Obstetric and Pelvic Ultrasound Information and Instructions

 

Appointment: Please telephone St George Clinic for Women to make an appointment. Arrive 5-10 minutes prior to your appointment time and bring your Medicare card and fee payment at time of visit. We accept Eftpos, credit cards or cash.

 

A full urinary bladder is necessary for women who have never been sexually active. A full urinary bladder is also necessary for women who choose to have abdominal but not vaginal scan. Start drinking 3 glasses of water starting 1-1 ½ hours prior to the appointment time.

 

Trans-Vaginal Ultrasound (TVS) provides high resolution or more detailed images of the pelvic organs and provides reproducible and reliable information. In most Gynaecological Ultrasounds and Early Obstetrics Ultrasounds TVS is performed as images provided by TVS are much clearer than that of abdominal ultrasound. Trans-Vaginal Scans are performed after a verbal consent. Some women choose not to have TVS and their wish is respected.  TVS is not offered and not performed on virgins.

 

TVS is painless, safe and does not harm the pregnancy. TVS is performed by introducing a plastic probe (transducer) into the vagina in a way similar to speculum as in a Pap smear. TVS could be performed during menstrual bleeding, irregular vaginal bleeding or with bleeding during pregnancy.

 

There is no facility for Video Taping but phone video recording and digital or thermal images are available.

 

Partners and support persons are welcome to attend (Covid19 regulations apply).

 

Parking is available on site at ground level at no charge.

 

 

Consumer and Stakeholder feedback and Complaints Policy

 

 

Introduction

 

  • The Safety and Quality Governance Standard for consumer feedback and complaints management has been based on the NSQHS (National Safety and Quality Health Service Standards). As supported through widespread use of the Australian Charter of Healthcare Rights, customer feedback and complaints assists in improving the quality of diagnostic imaging service provision.

Objectives  

 

  • To ensure St George Clinic for Women is committed to keeping the management of feedback and complaints consistent with the principals of open disclosure and fairness, accessibility, responsiveness, efficiency and integration.

 

Policy

 

  • Complaints made by patients, referrers or relevant third parties about St George Clinic for Women staff or practice principal will at all times be considered serious.  Patient Feedback and Complaints Policy and forms will be on display in the practice and available to all patients. 

  • Patient Feedback and Complaints Policy and forms are also available on www.drseragyoussif.com.au

  • All complaints made by patients, referrers or relevant third parties will be recorded in the Practice Complaints Register by either the Diagnostic Radiographer/Medical Imaging Technologist, Office Manager or delegate where relevant.

  • Patients, referrers or relevant third parties who wish to lodge a formal complaint regarding a staff member will be requested to submit the complaint to the practice principal in writing on St George Clinic for Women Patient Feedback and Complaints form. The practice principal is responsible for the investigation of the complaint.  The practice principal will notify the complainant (in writing) within 10 days of the outcomes and resolutions of the complaint.

  • Verbal complaints by patients, referrers or relevant third parties will be responded to (where possible) immediately by the practice principal.

  • Where patients, referrers or relevant third parties have provided their contact details on the Patient Feedback and Complaints form, St George Clinic for Women will respond in writing to patient feedback within 10 days.

  • To achieve our objectives, St George Clinic for Women use three methods for receiving and recording feedback and complaints:

 

  • A Customer Feedback and Complaints Form, and

  • A Complaints Handling Register.

  • Practice staff training in managing and responding to feedback and complaints

 

Procedure

 

  • Complaints Procedure

 

If a complaint is received by the Practice, the complainant must be advised of this policy and procedure and expected resolution times. If the complaint is about a matter which can be resolved immediately without reference to others, then the staff member is expected to take the necessary action. Staff members are to seek clarification from the Practice Principal or delegate where required.

 Corrective action will take place within two days or as soon as possible. Staff members must ensure the complaint or feedback is recorded on the Customer Feedback and Complaints Form and included on the Complaints Handling Register.

 

 

 

  • Obtaining Feedback

 

St George Clinic for Women seeks client feedback by:

  • Encouraging patients and carers to complete feedback forms

  • Undertaking  periodic surveys

  • Feedback is periodically reviewed and assessed contributing to continuous improvement processes.

     

     

 

Reference documents:

Department of Health  Practice Accreditation Standards 3rd edition: 1.1 &  4.3

Other: NSQHS (National Safety and Quality in Health Service Standards), Australian Charter of Healthcare Rights, Customer Feedback and Complaints Form, Complaints Handling Register.

 

St George Clinic for Women

 

 

 

Ultrasound information pamphlet

 

 

 

Ultrasound has been around for more than 60 years and studies have shown that it is a safe technique with no harmful side effects.

 

 

 

Ultrasound uses sound waves to produce images. The sound waves are transmitted into your body from a small handpiece that looks a bit like a microphone (called an Ultrasound Probe). Some of these waves are reflected and are processed by the ultrasound machine to form pictures. This is the same way the navy looks for submarines. These pictures are shown on a TV screen and recorded.

 

 

 

Depending on the type of examination you are having you may need some preparation.

 

 

 

For vaginal ultrasound you need to empty your bladder prior to test.

 

 

 

For abdominal ultrasound you would need a comfortably full bladder. For some scans you will be asked to change into a gown.

 

 

 

The examination will be performed by Dr Serag Youssif.

 

 

 

You will be shown into the ultrasound room and asked to either lie down on a couch or sit on a chair.

 

Abdominal ultrasound: A warmed jelly like substance is placed on your abdominal skin on to the area of interest. The sound waves don’t travel through air so this allows transmission of the sound waves into your body. The probe produces sound waves that will form the images. You will be completely unaware of these sound waves and there should be no discomfort during the examination apart from a little pressure.

 

 

 

 Vaginal ultrasound: The best technique for looking at the female pelvis is by performing an internal scan i.e vaginal scan. This procedure is only performed with your consent and where appropriate for the area your doctor is concerned about. Dr Serag Youssif  will explain in detail what is involved. Remember, you are under no obligation to have this done although the ovaries etc are seen well and clearer images are taken.

 

 

 

 

 

 

 

The sterilised probe which is also covered by a protective sheath is inserted into the vagina prior to the examination and manipulated very gently to show the anatomy in the pelvis.

 

 

 

The sound waves don’t travel through air so the gel allows transmission of the sound waves into your body. The probe produces sound waves that will form the images. You will be completely unaware of these sound waves and there should be no discomfort during the examination apart from a little pressure.

 

 

 

You may be asked to hold your breath ‐ this is very important because when you breathe the organs go up and down in the tummy. When you hold your breath the organs stay still allowing a better view of them.

 

Updated 17.2.2021

 

Results

 

 

Your scan will be read to you and and reported by Dr Serag Youssif. The report will then be sent to the person who referred you.  Digital images can be obtained.

 

 

 

 

 

 

 

Updated 20.02.2021

 

 

Consumer Feedback and Complaint Policy

 

 

Introduction

 

 

  • The Safety and Quality Governance Standard for consumer feedback and complaints management has been based on the NSQHS (National Safety and Quality Health Service Standards).

  • As supported through widespread use of the Australian Charter of Healthcare Rights, customer feedback and complaints assists in improving the quality of diagnostic imaging service provision.

 

Objectives 

 

  • To ensure St George Clinic for Women is committed to keeping the management of feedback and complaints consistent with the principals of open disclosure and fairness, accessibility, responsiveness, efficiency and integration.


    Policy

 

  • Complaints made by patients, referrers or relevant third parties about Dr Serag Youssif will at all times be considered serious.  Patient Feedback and Complaints Policy and forms will be on display in the practice and available to all patients.  Patient Feedback and Complaints Policy and forms are also available on www.drseragyoussif.com.au

 

  • All complaints made by patients, referrers or relevant third parties will be recorded in the Practice Complaints Register by either the Office Manager or delegate where relevant.

 

  • Patients, referrers or relevant third parties who wish to lodge a formal complaint regarding a provided service will be requested to submit the complaint to the practice principal in writing on St George Clinic for Women Patient Feedback and Complaints form. The practice principal is responsible for the investigation of the complaint.  The practice principal will notify the complainant (in writing) within <14> days of the outcomes and resolutions of the complaint.

 

  • Verbal complaints by patients, referrers or relevant third parties will be responded to (where possible) immediately by the relevant staff member or practice principal.

 

  • Where patients, referrers or relevant third parties have provided their contact details on the Patient Feedback and Complaints form, St George Clinic for Women  will respond in writing to patient feedback within <14> days.

 

  • To achieve our objectives, we use two methods for receiving and recording feedback and complaints:

 

  • A Customer Feedback and Complaints Form, and

 

  • A Complaints Handling Register.

 

 

 

 

 

Procedure

 

Complaints Procedure

 

  • If a complaint is received by the Practice, the complainant must be advised of this policy and procedure and expected resolution times. If the complaint is about a matter which can be resolved immediately without reference to others, then the Practice Principal will take the necessary action. Corrective action will take place within two days or as soon as possible. Staff members must ensure the complaint or feedback is recorded on the Customer Feedback and Complaints Form and included on the Complaints Handling Register.

 

  • Obtaining Feedback

 

St George Clinic for Women seeks client feedback by:

 

  • Encouraging patients and carers to complete feedback forms

 

  • Undertaking  periodic surveys

 

Feedback is periodically reviewed and assessed contributing to continuous improvement processes.

 

 

 

Consumer Consent and Information Policy

 

Introduction

 

  • The Safety and Quality Governance Standard has been developed to ensure that diagnostic imaging procedure risks have been advised and consent obtained from the patient.

  • Only ultrasound examination are done at St George Clinic for Women and no imaging procedures are done at St George Clinic for Women

 


Objectives  

 

  • To ensure consumers are fully aware of the diagnostic imaging examinations that are available and what those examinations entail before a service is performed.

  • Only ultrasound examination are done at St George Clinic for Women and no imaging procedures are done at St George Clinic for Women

 


Policy

 

  • St George Clinic for Women ensures patient information has been obtained to determine any clinical risk and where relevant, patient consent is obtained prior to the procedure.

  •  Only ultrasound examinations are done at St George Clinic for Women and no image procedures are done at St George Clinic for Women.

  • No Medications are given for imaging procedures at St George Clinic for Women and there are no imaging procedures done at St George Clinic for Women.

 

  • St George Clinic for Women ensures comprehensive information on examinations performed is available to patients.  This information will be available in a variety of media forms, brochures, www.drseragyoussif.com.au and Patient Consent Forms.

  • Where patient preparation is required prior to a diagnostic imaging examination (e.g. full or empty bladder etc) St George Clinic for Women staff will be responsible for ensuring the patient is fully informed of the preparation requirements.

  • Not Applicable. Signed Patient Consent Forms are required by St George Clinic for Women for all diagnostic imaging examinations that are high risk/invasive to the patient or require injections and/or medication.

  • Not Applicable. St George Clinic for Women will deem which diagnostic imaging procedures require signed consent from the patient based on the risks associated with the procedure.

 

Only ultrasound examination and no Imaging procedures are done at St George Clinic for Women

 

 

 

 

 

 

 

 

Informed Consent for Ultrasound Examination

 

 

 

  • Valid consent must be obtained before starting any ultrasound examination or procedure. Healthcare professionals who do not respect the right of a patient to determine what happens to their own body in this way may be liable to legal or disciplinary action.

  • The consent process is a continuum beginning with the referring health care professional who requests the ultrasound examination and ending with the practitioner who carries it out. It is the responsibility of the referring professional to provide sufficient information to the patient to enable the latter to consent to the ultrasound examination being requested. It is the responsibility of the practitioner to ensure that the patient understands the scope of the ultrasound examination prior to giving his or her consent.

  • Verbal consent must be obtained for all examinations.

  • Consent for those of an intimate or invasive nature should be recorded in the ultrasound report.

  • Written consent is occasionally required particularly vaginal ultrasound and is signed with consent to vaginal examination.

  • Literature which explains the scope of the examination clearly and accurately should be made available to patients prior to the ultrasound examination.

 

 

 

Procedure

 

  • Information pamphlets are available for the full range of examinations performed at St George Clinic for Women.

  • No invasive Imaging procedures such as Amniocentesis, Chorion Villus Sampling, fetal reduction or sonohysterography Saline infusion are done at St George Clinic for Women.

  • St George Clinic for Women obtains all patient’s health status, relevant to the diagnostic imaging (ref. Patient Health Questionaire).

 

 

 

Service Substitution Policy and Protocols

 

  • At St George Clinic for Women Only Obstetrics and Gynaecology Ultrasound are performed.  Abdominal or vaginal ultrasound is selected depending on clinical indication, patient history or preference. Often both examinations are required to improve or reach diagnosis.

  • At St George Clinic for Women only Ultrasound imaging is used.

  • Only substitutes diagnostic imaging procedures  abdominal or vaginal where:

 

  • Appropriate for the diagnosis of a patient’s medical condition;

 

  • Generally accepted on the basis of diagnostic medical opinion; and

 

  • Permitted by the Act and subordinate legislation for the payment of a Medicare benefit for that service.

 

 

 

St George Clinic for Women

 

Consumer Information on Practice Services Policy

 

 

 

Obstetric and Pelvic Ultrasound Information and Instructions

 

Appointment: Please telephone St George Clinic for Women to make an appointment. Arrive 5-10 minutes prior to your appointment time and bring your Medicare card and fee payment at time of visit. We accept Eftpos, credit cards or cash.

 

A full urinary bladder is necessary for women who have never been sexually active. A full urinary bladder is also necessary for women who choose to have abdominal but not vaginal scan. Start drinking 3 glasses of water starting 1-1 ½ hours prior to the appointment time.

 

Trans-Vaginal Ultrasound (TVS) provides high resolution or more detailed images of the pelvic organs and provides reproducible and reliable information. In most Gynaecological Ultrasounds and Early Obstetrics Ultrasounds TVS is performed as images provided by TVS are much clearer than that of abdominal ultrasound. Trans-Vaginal Scans are performed after a verbal consent. Some women choose not to have TVS and their wish is respected.  TVS is not offered and not performed on virgins.

 

TVS is painless, safe and does not harm the pregnancy. TVS is performed by introducing a plastic probe (transducer) into the vagina in a way similar to speculum as in a Pap smear. TVS could be performed during menstrual bleeding, irregular vaginal bleeding or with bleeding during pregnancy.

 

There is no facility for Video Taping but phone video recording and digital or thermal images are available.

 

Partners and support persons are welcome to attend (Covid19 regulations apply).

 

Parking is available on site at ground level at no charge.

 

 

 

Consumer and Stakeholder feedback and Complaints Policy

 

Introduction

 

  • The Safety and Quality Governance Standard for consumer feedback and complaints management has been based on the NSQHS (National Safety and Quality Health Service Standards). As supported through widespread use of the Australian Charter of Healthcare Rights, customer feedback and complaints assists in improving the quality of diagnostic imaging service provision.

 

Objectives  

 

  • To ensure St George Clinic for Women is committed to keeping the management of feedback and complaints consistent with the principals of open disclosure and fairness, accessibility, responsiveness, efficiency and integration.

 

Policy

 

  • Complaints made by patients, referrers or relevant third parties about St George Clinic for Women staff or practice principal will at all times be considered serious.  Patient Feedback and Complaints Policy and forms will be on display in the practice and available to all patients. 

  • Patient Feedback and Complaints Policy and forms are also available on www.drseragyoussif.com.au

  • All complaints made by patients, referrers or relevant third parties will be recorded in the Practice Complaints Register by either the Diagnostic Radiographer/Medical Imaging Technologist, Office Manager or delegate where relevant.

  • Patients, referrers or relevant third parties who wish to lodge a formal complaint regarding a staff member will be requested to submit the complaint to the practice principal in writing on St George Clinic for Women Patient Feedback and Complaints form. The practice principal is responsible for the investigation of the complaint.  The practice principal will notify the complainant (in writing) within 10 days of the outcomes and resolutions of the complaint.

  • Verbal complaints by patients, referrers or relevant third parties will be responded to (where possible) immediately by the practice principal.

  • Where patients, referrers or relevant third parties have provided their contact details on the Patient Feedback and Complaints form, St George Clinic for Women will respond in writing to patient feedback within 10 days.

  • To achieve our objectives, St George Clinic for Women use three methods for receiving and recording feedback and complaints:

 

  • A Customer Feedback and Complaints Form, and

  • A Complaints Handling Register.

  • Practice staff training in managing and responding to feedback and complaints

 

Procedure

 

  • Complaints Procedure

 

If a complaint is received by the Practice, the complainant must be advised of this policy and procedure and expected resolution times. If the complaint is about a matter which can be resolved immediately without reference to others, then the staff member is expected to take the necessary action. Staff members are to seek clarification from the Practice Principal or delegate where required.

 

 

 

Corrective action will take place within two days or as soon as possible. Staff members must ensure the complaint or feedback is recorded on the Customer Feedback and Complaints Form and included on the Complaints Handling Register.

 

 

 

  • Obtaining Feedback

 

St George Clinic for Women seeks client feedback by:

 

  • Encouraging patients and carers to complete feedback forms

  • Undertaking  periodic surveys

  • Feedback is periodically reviewed and assessed contributing to continuous improvement processes.

     

     

 

Reference documents:

Department of Health  Practice Accreditation Standards 3rd edition: 1.1 &  4.3

Other: NSQHS (National Safety and Quality in Health Service Standards), Australian Charter of Healthcare Rights, Customer Feedback and Complaints Form, Complaints Handling Register.

 

 

 

 

 

 

 

Updated 20.02.2021

 

The pipelle endometrial biopsy (EB) is accurate, safe, economical and acceptable to patients, clinicians and pathologists. Transvaginal sonography can reduce the number of EBs needed, and when both techniques are used together the sensitivity and specificity in the diagnosis of endometrial adenocarcinoma reach 100%.  

 

 

 

Hysteroscopy and dilatation and curettage are indicated in the minority of patients under the age of 40 years.


 

 

 


S N YoussifD L McMillan


Department of Obstetrics and Gynaecology, Whipps Cross Hospital, London.


British journal of hospital medicine 1995 Sep 6-19


Citation


S N Youssif, D L McMillan. Outpatient endometrial biopsy: the pipelle. British journal of hospital medicine. 1995 Sep 6-19;54(5):198-201


 


 

 

Symptoms and Signs of Pre-Eclampsia

Women diagnosed with preeclampsia often do not feel sick. Preeclampsia is a serious condition of pregnancy, and can be particularly dangerous because many of the signs are silent while some symptoms resemble “normal” effects of pregnancy on your body and women may be surprised or become frustrated when they are admitted to the hospital or prescribed bed rest since they still feel well.

Prenatal care is essential. Tests taken at these visits including weight, blood pressure, urine are important to screen for preeclampsia.

A good prenatal diet full of vitamins, antioxidants, minerals and the basic food groups is important; cutting back on processed foods, refined sugars, and stopping caffeine, alcohol and any medication not prescribed by a physician is essential. It is also advisable to speak with your obstetrician before taking any supplement, herbal or otherwise.


High blood pressure is an important sign of preeclampsia. The disease is sometimes referred to as a silent killer because most people can’t “feel” their blood pressure going up.


High blood pressure (Hypertension)

High blood pressure is defined as blood pressure of 140/90 or greater as measured on two separate occasions within six hours. A rise in the diastolic (lower number) of 15 degrees or more, or a rise in the systolic (upper number) of 30 degrees or more is cause for concern.
 
It is good to know your blood pressure prior to pregnancy. If you have had preeclampsia in a previous pregnancy you should have a full screening to rule out any underlying disease or problems, such as chronic hypertension, autoimmune disorders, thrombophilias, renal disease, etc.

The single large risk factor for getting preeclampsia is a history of having had it before.

If you are inactive or have a higher-than-average body mass index (BMI), make sure to exercise moderately and get yourself in the best shape you can. Women with a BMI of 30 or higher are at an increased risk of preeclampsia and should make efforts to reduce this risk by following the advice of their doctor.

If you are diagnosed with preeclampsia, I recommend bed rest, and in late pregnancy, lying on your left side. The thinking is that lying flat on your back might cause the pregnant uterus (and the weight of the baby) to restrict the vein that supplies the heart.


Swelling (Edema)


A certain amount of swelling during pregnancy is normal. Edema is the accumulation of excess fluid. It is particularly concerning when it accumulates in the face (eyes) or hands. It is normal to have trouble wearing rings throughout pregnancy.

If you feel your face is getting excessively puffy or the swelling in your limbs becomes severe, notify your obstetrician. You may notice pitting edema (when you press your thumb into your skin, an indentation remains for a few seconds) or discoloration of your legs.


Put your feet up every day but avoid sitting for extended periods.



Protein in your urine (Proteinuria)

Proteinuria is the result of proteins, normally confined to the blood, spilling into your urine because the small blood vessels in the kidneys become damaged. A simple urine test at each prenatal check-up can screen for proteinuria.

If the strip shows a reading of 1+ or greater, it may signify the onset of preeclampsia, even if your blood pressure is less than 140/90.

You may have to do a 24-hour urine collection for a formal lab assessment. Please follow the directions and make every effort to be accurate.


Sudden Weight Gain

A gain of more than I Kilogram in a week or 3 Kiliograms in a month could be cause for concern.

Eat a healthy, balanced diet. Eat fresh raw fruit and vegetables. Take your prenatal vitamin and folic acid supplement. Be sure to drink plenty of water and get regular moderate exercise. Do not attempt to disguise any weight gain by skipping breakfast, using diet pills or fasting.

Do not diet or try to lose weight. Avoid excessive salt. Avoid alcohol, caffeine, smoking and recreational drugs. Consult with your Obstetrician regarding non-prescription drugs and any herbal medications you might take. 

I urge caution trying diets, particularly those that encourage large amounts of protein. As women with underlying kidney disease; excessive protein can be unsafe.

Similarly, while some women might benefit from low-dose aspirin, studies show that it has been linked with increased placental abruption and miscarriage and so should not be taken routinely by pregnant women.


Headaches

Persistent dull, throbbing headaches, often described as migraine . If you have tried taking over-the-counter medication without relief, or if the headache is very painful or you have light sensitivity, call your Obstetrician immediately.

Is significant if the onset is sudden and in the second or third trimesters. You should have your blood pressure checked and your urine tested for proteinuria



Changes in Vision

Sensations of flashing lights, temporary loss of vision, light sensitivity, auras and blurry vision or spots may occur if you are developing preeclampsia. They may be indicative of irritation of the central nervous system or cerebral edema (swelling of the brain). It is very important that you consult with your obstetrician immediately and if not available contact the hospital where you are booked. These symptoms are very serious and should not be left unattended, even until the next morning.


Abdominal (stomach area) and/or Shoulder Pain

Is usually under the right-side ribs. It can be confused with heartburn, gallbladder problems, flu, indigestion or pain from the baby kicking. Shoulder pain is often called referral pain because it radiates from the liver under the right ribs. Lower back pain is different from muscle strain common to pregnancy. It is usually more acute and specific. All may be a sign of HELLP Syndrome or a related problem in the liver such as bleeding under liver capsule. Shoulder pain can feel like someone is deeply pinching you along the bra strap, or it can be painful to lie on your right side.

This pain is serious; call your obstetrician immediately.



Lower back pain

Lower back pain is a very common in pregnancy. Sometimes it may indicate a problem with the liver, especially if it accompanies other symptoms or preeclampsia. you should call your health care provider immediately.


Hyperreflexia

Hyperreflexia is when your reflexes are so strong that when your knee is tapped by a rubber “hammer,” your leg bounces back hard. Hyperreflexia is generally caused by an overreaction of the involuntary nervous system to stimulation. Deep tendon reflexes are increased in many women prior to seizures, but seizures can also occur without hyperreflexia.

This sign is generally measured by your obstetrician.  Like headache and visual changes, hyperreflexia may indicate changes in your nervous system.

If you are under treatment with magnesium sulfate to prevent seizures, your obstetrician may also test your reflexes to monitor for the need to start, adjust or stop the magnesium treatment. An overdose of magnesium sulfate may suppress or excessively slow your reflexes.



Shortness of breath, anxiety

Shortness of breath, a racing pulse, mental confusion, a heightened sense of anxiety, and a sense of impending doom can be symptoms of preeclampsia. If these symptoms are new to you, they could indicate an elevated blood pressure, or more rarely, fluid collecting in your lungs (pulmonary edema).

Contact your obtetrician immediately if these symptoms are new. If you've experienced these conditions before pregnancy, be sure to mention them to your care provider during your next visit so they can be monitoried throughout your pregnancy.
 
 
Please call or make an appointment to discuss anything unusual. The worst outcomes of preeclampsia can be avoided by early recognition.

 

Anal Sphincetr Damage and Foecal Incontinence

Diagnosis
·Physical exam
·Visual inspection of anus.
·A probe may be used to examine this area for nerve damage.
·Normally touching anus causes anal sphincter to contract and the anus to pucker.

Surgery
Foecal incontinence may require surgery to correct
·Rectal prolapse or
·Sphincter damage caused by childbirth. Sphincteroplasty. This procedure repairs a damaged or weakened anal sphincter that occurred during childbirth. The injured area of muscle and edges are freed from the surrounding tissue. The muscle edges are stitched back together in an overlapping fashion, strengthening the muscle and tightening the sphincter.

The Blue part is the internal anal sphincter. The red is the  Pudendal nerve S 2.3.4. The yellow is the external anal sphincter deep, superficial and subcutaneous parts.

Anal sphincters and nerve supply
Drawing by Dr Serag Youssif

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Dr Serag Youssif Official Website