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