The HEALTH : May 2019 | Page 21

MAy, 2019 | The Health junior o&g 360 O&G services for our young ones Given the problems our younger female individuals might face, there is definitely a need for an obstetrics and gynaecology services catering to them specifically 21 research projects, published in peer-reviewed journals, conducted public forums and given lectures at schools, workshops, national and international congresses. Two national workshops in PAG have been done; in 2007 and 2013. Tha PAG unit in HCTM UKMMC manages over 300 cases per year on average. Referrals are mainly from paediatric and gynaecology departments from all over Malaysia, even from Sabah and Sarawak. New outpatient cases have increased from 43 cases in 2012 to 64 cases in 2016. This unit provides mainly gynaecological services to young women aged between newborn up to 21 years old. However, due to delayed diagnoses of Differences of Development Disorders (DSD), older women are also managed by this unit, up to 45 years of age. Common problems tackled by PAG The most common presenting complaints of the cases referred are menstrual-related problems such as abnor- mal uterine bleeding, both primary and secondary amenorrhea, and dysmenorrhea. In terms of diagnosis, common ones include DSD, Mullarian abnormalities, vulvovaginitis, labial adhesions, sexual abuse cases, and menstrual disorders and puberty delay (due to various causes such as primary ovarian insufficiency, chronic illness, delayed development and polycystic ovarian syndrome). Surgeries performed by this unit include examina- tion under anaesthesia, laparoscopic procedures such as gonadectomy, ovarian cystectomy and detorsion, IUCD insertion for menstrual suppression, vaginal septotomy and utero-vaginal anastomoses in cases of obstructive Mullerian anomalies. Wide collaboration The unit collaborates with many other disciplines such as paediatric surgeons, paediatric and adult endocri- nologists, psychiatrists, psychologists, radiologists, geneticists and the SCAN team. The PAG team have formed a multidisciplinary com- mittee managing DSD patients with gender issues and have been invited to give expert opinions to various government agencies on female adolescent issues. Liaisons with patients support groups like the MRKH Malaysia group have also been formed. Rising number of clinics offering PAG the younger female demographics as well. There are two newly established PAG clinics in Malaysia. Dr Nik Rafiza Afendi, a lecturer from Universiti Sains Malaysia (USM) Kelantan, started serving young female patients in her clinic at Hospital USM, Kubang Kerian in 2015. Dr Lavitha Sivapatham, an O&G specialist from the Ministry of Health started the PAG clinic in Hospital Ampang in 2017. She works closely with the National Haemotology Team in Hospital Ampang in managing young girls with bleeding disorders. The PAG unit The need is present The Paediatric and Adolescent Gynaecology (PAG) Unit was first established in April 2008 by the Department of Obstetrics and Gynaecology at Hospital Canselor Tuanku Muhriz UKM Medical Centre, (HCTM UKMMC) Cheras, Kuala Lumpur. The unit was started by both Prof Nur Azurah Abdul Ghani and Assoc Prof Dr Ani Amelia Dato Zainuddin. PAG is an emerging subspecialty in O&G. In Asia, there are established PAG clinics / units in Singapore, the Philippines, and Hong Kong. There is definitely a need for PAG services in Malaysia. It is hoped that many more O&G specialists would train in this subspecialty and serve various parts of Malaysia to enable easier access to our young patients and their families. It is hoped that this subspecialty will receive due recognition as an O&G subspecialty on its own in Malaysia and have the full support of the Ministry of Health in Malaysia. Associate Prof Dr. Ani Amelia Dato’ Zainuddin is a Consultant Obstetrician & Gynaecologist in UKM Medical Center, subspecializing in Paediatric & Ado- lescent Gynaecology (PAG). She is the Head of the PAG Unit in UKMMC, the first PAG Unit established in Malaysia in 2008. — The Health Gynaecology and obstetrics services for young and adolescent females proved to be more effective as its own separate unit rather than bundled up together with O&G for adults. By Assoc Prof Dr Ani Amelia Dato Zainuddin O bstetrics and gynaecology is a specilisation that encompasses the two subspecialties of obstetrics (pregnancy, childbirth, and the postpartum period) and gynaecology (covering the health of the female reproductive system). Even though the need for an individual to deal with this particular healthcare specilisation might come later in life, there is a growing need to have them catering to Trained pros The unit has trained many O&G Masters degree stu- dents and O&G specialists interested in PAG and in reproductive medicine. The unit has conducted several