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Dr Pamela Tan is an obstetrics and gynaecology specialist practising at Thomson Medical Center in Singapore. Prior to leaving for private practice, Dr Tan was a female Consultant in the Department of Obstetrics and Gynecology, KK Women’s & Children’s Hospital.

She obtained her undergraduate medical degree at the National University of Singapore and her post-graduate MRCOG in London at the Royal College of O&G. She is a specialist accredited with the Specialist Accreditation Board (Ministry of Health) and is a Fellow of the Academy of Medicine, Singapore (FAMS). She is an accredited member of the Society for Colposcopy and Cervical Pathology of Singapore (SCCPS) with a subspecialty interest in colposcopy (for pre-cancer of the cervix and vagina) and vulval disease.

In further pursuing this interest, she was a fellow for pre-invasive disease at the colposcopy and vulval unit at the Whittington Hospital in the United Kingdom. She is a visiting consultant at KK Hospital for colposcopy and is still involved in research on computer imaging analytics for screening cervical cancer in low resource settings in a joint collaboration with the National University of Singapore.

While in the United Kingdom, she was also a fellow at the Assisted Conception Unit in Guys Hospital to learn the latest in reproductive techniques and approaches to infertility. She is accredited to perform advanced Level 3 minimally invasive keyhole surgery such as laparoscopic hysterectomy, myomectomy and cystectomy (womb, fibroids and cysts removal).

Her philosophy to doctoring is one that is focused on building relationships with her patients. She strives to deliver patient care that is warm, caring, professional and well advised. She is a believer of pro natural birthing and providing an optimal birthing experience as desired by her patients.

Dr Pamela Tan is an obstetrics and gynaecology specialist practising at Thomson Medical Center in Singapore. Prior to leaving for private practice, Dr Tan was a female Consultant in the Department of Obstetrics and Gynecology, KK Women’s & Children’s Hospital.

She obtained her undergraduate medical degree at the National University of Singapore and her post-graduate MRCOG in London at the Royal College of O&G. She is a specialist accredited with the Specialist Accreditation Board (Ministry of Health) and is a Fellow of the Academy of Medicine, Singapore (FAMS). She is an accredited member of the Society for Colposcopy and Cervical Pathology of Singapore (SCCPS) with a subspecialty interest in colposcopy (for pre-cancer of the cervix and vagina) and vulval disease.

In further pursuing this interest, she was a fellow for pre-invasive disease at the colposcopy and vulval unit at the Whittington Hospital in the United Kingdom. She is a visiting consultant at KK Hospital for colposcopy and is still involved in research on computer imaging analytics for screening cervical cancer in low resource settings in a joint collaboration with the National University of Singapore.

While in the United Kingdom, she was also a fellow at the Assisted Conception Unit in Guys Hospital to learn the latest in reproductive techniques and approaches to infertility. She is accredited to perform advanced Level 3 minimally invasive keyhole surgery such as laparoscopic hysterectomy, myomectomy and cystectomy (womb, fibroids and cysts removal).

Her philosophy to doctoring is one that is focused on building relationships with her patients. She strives to deliver patient care that is warm, caring, professional and well advised. She is a believer of pro natural birthing and providing an optimal birthing experience as desired by her patients.

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Pregnancy and Cardiac Disorders

Pregnancy is a time when you focus on a heart-healthy lifestyle. The changes your body goes through for the next nine months will stress your heart and circulatory system. In fact, cardiac disease is the most common cause of mortality in pregnancy. However, a woman’s body is designed to withstand this surge of cardiac load, and it’s still possible for women with heart conditions to have a successful delivery and healthy babies with proper care. 

Concerns about cardiac health highlight the importance of being aware of the risks and how to prevent complications. 

Your Heart During Pregnancy

Pregnancy increases your blood volume by a whopping 50 percent as your body accommodates your growing baby. These changes put extra stress on a woman’s body with profound effects on your cardiovascular system. With increased cardiac output, your heart rate at rest also increases by up to 30-50 percent.  

Labor and delivery also add to your heart’s workload. The demand for your heart increases during contractions and as labor advances. Furthermore, bearing down during delivery can cause a sudden change in blood flow and pressure, and it will take a few weeks before your heart reverts back to its pre-pregnancy state. Blood loss during delivery can also place an intolerable strain on an abnormal heart. 

Pregnancy increases your blood volume by a whopping 50 percent as your body adjusts to support your growing baby.

Pregnant women with congenital heart disease (CHD) have a higher risk of developing complications during pregnancy and delivery, especially if they have other pre-existent diseases. Depending on the type and severity of the disease, some of these heart conditions may pose life-threatening risks to the mother or the baby. Therefore, some women are required to undergo major treatments before they conceive, or they are advised to avoid pregnancy if they’re dealing with a rare congenital condition. 

Preparing Your Heart for Motherhood

Women of reproductive age with congenital or acquired heart disease must have access to specialised multidisciplinary preconception counselling to empower them to make choices about pregnancy. 

If you’re among those who are at risk, it’s important that you consult your OB and cardiologist before trying to conceive. The management of high-risk pregnancies and deliveries are done on an individual basis.  It is aimed to optimise your condition during pregnancy, monitor for deterioration, and minimise any additional load on your cardiovascular system during delivery and the postpartum period. 

You will undergo a pre-pregnancy evaluation which involves a risk assessment for you and your baby. Your doctor will also review the management of your heart condition and consider the necessary changes before you conceive and to accommodate your future pregnancy. For instance, certain cardiac medications are not advised for pregnant women, but due to circumstances, your doctor might adjust the dosage or prescribe a substitute. 

If you were born with a cardiac abnormality and have undergone an operation to correct it, it doesn’t mean that you are off the hook. Surgery may leave some scarring to your heart which makes you more prone to infections and an irregular heartbeat.

If you were born with a cardiac abnormality and has undergone an operation to correct it, it doesn’t mean that you are off the hook.

To ensure you and your baby’s safety, you will have multidisciplinary care where you can expect frequent prenatal visits.  This involves:

  • Close monitoring of your weight, cholesterol, blood sugar and blood pressure
  • Measurement of body mass index in early pregnancy
  • Diet management
  • Development of a treatment plan that could run along the spectrum of usual labor and delivery procedures, even up to the postpartum period
  • Blood tests
  • Urine tests
  • Medications
  • Echocardiogram
  • Electrocardiogram

A Mom’s Healthy Heart Means Healthier Children

A woman’s cardiovascular health during pregnancy also affects the baby’s environment in the womb. Maternal heart disease may deprive the baby of optimum oxygen levels and nutrients as the heart is unable to pump blood efficiently. This can slow down fetal growth rates, and it is also associated with preterm delivery and low birth weight

Adopting heart-healthy habits and precautions while pregnant sets your baby’s heart health on the right foot. Researchers found that a heart-healthy lifestyle has a strong link to a child’s cardiovascular health in the long term.

Labour and Delivery

A discussion on labour and delivery in consideration of your heart condition is also necessary especially if you’re making a birth plan.

You need to give birth in a hospital with the appropriate facilities for monitoring. It is still best to wait for spontaneous labour, unless the baby has to be delivered early to avert maternal or fetal compromise.

Women with congenital heart disease won’t be automatically offered a caesarean section. However, it may be recommended so you can have pain-free labour. This will entail the use of an epidural to mitigate large fluctuations in your heart rate and blood pressure associated with the pain brought by uterine contractions. Your doctor may also use vacuum and forceps to assist you in delivery and avoid excessive straining to push the baby out. 

Take This to Heart, Mommy

Heart conditions and diseases may lead to a high-risk pregnancy, but adequate preparation on your end coupled with the right medical management are vital steps towards a positive outcome. The decisions you make now regarding your heart health and pregnancy can have effects on you and your baby later in life.

As you plan to grow your family, start your preparations with professional help. In Singapore, you can approach Dr. Pamela Tan for caring and individualised management. 

Obstetric Cholestasis (What’s the Itch All About?)

If there is any milestone in a woman’s life that brings a string of changes, it is pregnancy.  However, the entire experience is not all rosy for women. Morning sickness, bloating, and weight gain are just some of the side effects that open your eyes to the unglamorous side of pregnancy. However, aside from the usual complaints, conditions like Intrahepatic Cholestasis of Pregnancy is one that must be taken seriously. Besides the disruptive itch, it also poses serious risks, so read more to protect you and your baby. 

What is Intrahepatic Cholestasis of Pregnancy (ICP)?

Intrahepatic cholestasis of pregnancy, which is also known as Obstetric Cholestasis, is a liver condition where the normal flow of bile slows down or is blocked. Instead of leaving the liver, it builds up in the organ resulting in bile salts leaking into the bloodstream and causing severe itching.

…bile salts leaking into the bloodstream…cause severe itching

For expectant moms, severe itching unaccompanied by spots or rashes is the main red flag.  You can either experience the itch localized to your palms and the soles of your feet, while others get generalized body itching. Itching usually worsens at night where it can impair your sleeping pattern.

Other less common signs and symptoms of obstetric cholestasis include:

  • Yellowing of the skin and the whites of the eyes (jaundice)
  • Nausea
  • Dark urine
  • Light-colored stool
  • Fatigue
  • Pain in the upper right side of your belly
  • Decreased appetite

The symptoms may appear earlier for some women, and worsen during the third trimester or as your due date approaches. The reason is that pregnancy hormones are at their peak during this stage.

What causes cholestasis of pregnancy?

This condition is thought to be caused by a combination of hormonal, genetic, and environmental influences.

Bile produced by the liver is supposedly stored in the gallbladder. However, additional estrogen hormones during pregnancy can change the way these two organs function. Hormonal changes slow down the normal flow of bile, which triggers a cascade of events that lead to itching.

Evidence shows that this condition tends to run in families. It is also common in certain ethnic groups in the South Asian, South American, Nordic, and Scandinavian regions. It can also be expected to reappear during subsequent pregnancies, with a 45-90% recurrence rate.

How is intrahepatic cholestasis of pregnancy diagnosed?

An accurate diagnosis relies on a high index of suspicion supported by abnormal liver function tests and raised bile acid levels. The doctor makes this conclusion after organic causes of liver disease has been ruled out.

Other lab tests include prothrombin time to check how well your blood clots. An ultrasound exam may even be done to assess the tubes that carry bile (bile ducts) for liver abnormalities and gallstones.

Is intrahepatic cholestasis of pregnancy dangerous?

Obstetric cholestasis runs a serious risk of complications to your developing baby. These include:

  • Preterm birth/Stillbirth. An early delivery improves a baby’s chance to thrive when they are exposed to the risks associated with intrahepatic cholestasis while in the womb.
  • Fetal distress. This results when your developing baby is not thriving well.
  • Meconium in the amniotic fluid. While in the womb, your baby’s gut normally collects a sticky, green substance in their intestines called meconium which may be expelled into the amniotic fluid if a mother develops cholestasis.
  • Respiratory problems. Meconium in the amniotic fluid can potentially be aspirated by the baby which can cause respiratory problems in a newborn or stillbirth. Steroids may be given at 34 weeks to help the baby’s lungs mature, especially with preterm births.

On the maternal end, obstetric cholestasis reduces your ability to absorb fat-soluble vitamins (A, D, and K). This effect puts you at risk for vitamin K deficiency, which can result in postpartum hemorrhage. It explains why you need to have your clotting time checked so that you get proper treatment before giving birth. Otherwise, you’ll run the risk of excessive bleeding during delivery.

What extra care do I need if diagnosed with ICP?

After a diagnosis, you’ll be advised to have additional antenatal checks. This will include liver function tests which is done as often as once or twice a week until you deliver. Additionally, your baby will also be closely monitored. This involves fetal heart monitoring and ultrasound scans to measure growth and the fluid around your baby.

While these efforts may not guarantee the prevention of stillbirth, they can still help you and your doctor be on top of your baby’s well-being inside the belly.

Does cholestasis go away after pregnancy?

You may continue to itch for some time after delivery, especially in prolonged cases, or if you have several pregnancies over a short period of time. It is fortunate that this condition typically goes away after your baby is born.

…this condition typically goes away after your baby is born.

How is intrahepatic cholestasis of pregnancy treated?

The goal of treatment is to relieve itching and prevent complications. Aside from the seemingly unbearable itching, it is the fear of not knowing how the condition is affecting your baby that increases your anxiety. To ensure your baby’s safety, treatment may include:

  • Home remedies. Cold or ice baths slows down blood circulation, which can help relieve itching, and wearing loose-fitting cotton garments help minimise it.
  • Skin creams and ointments. These products help relieve the itching temporarily and are considered safe interventions for pregnant women.
  • Proper assessment. Your doctor will carefully examine your skin to check if the itch is related to other skin conditions. 
  • Fetal monitoring. Management may vary with each OB, but it may often include recommendations increased antenatal monitoring for women with ICP. This will include fetal heart monitoring and contraction recordings.
  • Medicine. Drug treatment may include corticosteroids and ursodeoxycholic acid (drug that can decrease the concentration of bile acids). Antihistamines will be given but not so much for the itch, but only to help you sleep. While histamines cause the common itch, ICP is directly or indirectly caused by bile salts in your bloodstream.
  • Early delivery. The benefits of delivering the baby at 37-38 weeks outweigh the risks associated with early delivery. This is a necessary step to protect the baby from the complications attached to cholestasis.

What follow-up should I have during the postpartum period?

It is advised that you get a follow-up appointment with your doctor 6-8 weeks after giving birth. This visit is necessary to assess your symptoms and liver function thoroughly. Persistent symptoms and abnormal liver function test results suggest a different problem which calls for a referral to a specialist. It is generally not advisable to be on the oral contraceptive pill after such a condition.

This may not be a common condition, but it’s essential that you are aware of how obstetric cholestasis poses a real threat to your baby. Having this knowledge will help you adopt proper health-seeking behaviors if ever you experience this condition.

Therefore, if you are experiencing a rashless itch or other unusual symptoms, bring your concerns to a certified obstetrician. In Singapore, you can schedule your appointment with Dr. Pamela Tan.

Preeclampsia: The Hidden Dangers of Pregnancy

Hypertension can complicate a pregnancy. Preeclampsia and other hypertensive disorders of pregnancy can have serious effects to you and your baby, made worse by delayed diagnosis or management. By making yourself aware of the signs and symptoms, just might spell the difference between life and death.

What is preeclampsia?

Understanding preeclampsia can save you and your baby from potential medical emergencies during pregnancy and childbirth. This highlights the importance of understanding this condition because even though it is serious, it is manageable especially with early diagnosis and prompt treatment.

Originally known as “toxaemia,” preeclampsia is a complication that occurs during pregnancy or rarely after the baby is born.  While the cause remains unknown, it is associated with problems in the placenta, which is the temporary organ that serves as a lifeline between your own blood supply and that of your baby’s. 

Pregnancy Disorders

In preeclampsia, changes in blood vessels deprive the placenta of proper blood supply resulting in harmful effects to you and your baby. The first identifying factor is the time in which it occurs – that is during the second half of pregnancy, or anytime after the 20th week. On rare occasions, it can also happen earlier, during labour, or six weeks postpartum.

Preeclampsia is diagnosed by persistent high blood pressure with increased amounts of protein in the urine. It must not be confused with elevated blood pressure occurring after the 20th week unaccompanied by any traces of protein in the urine, which is gestational hypertension. 

Swelling that is localised to the face and hands is also a classic sign of preeclampsia. This significant increase in body fluids also explains the sudden weight gain. This may be accompanied by mild symptoms, or fall seriously ill with problems extending to the lungs, liver, brain, and even your blood clotting system. 

What puts me at risk of developing preeclampsia?

Preeclampsia can strike at any pregnancy, however there are also predisposing factors. Your risk of developing preeclampsia increases if:

  • This is your first pregnancy.
  • You are aged 40 and above
  • You have an existing high blood pressure (140/90 mm/Hg and above)
  • You are carrying more than one baby
  • You have a history of obesity or a Body Mass Index (BMI) of 35 or more
  • You have certain medical conditions such as diabetes, thrombophilia, lupus, or migraine
  • You have developed preeclampsia in a previous pregnancy
  • You have chronic hypertension and kidney disease
  • It has been a decade or more since your last baby
  • If you have any close relatives who have had preeclampsia
  • You have had an in vitro fertilization

If you fall under any of these criteria, seek medical help to ensure that you get a thorough assessment and close monitoring. 

What are the complications associated with preeclampsia? 

If left untreated preeclampsia can develop into a full-blown eclampsia, where high blood pressure results in seizures. It also involves loss of consciousness and agitation.

Your health can be further compromised when eclampsia results in HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count). This is characterised by damaged red blood cells, impaired clotting, and internal bleeding of the liver resulting in chest or abdominal pain. This is a medical emergency that can have lifelong effects or fatal consequences. 

Aside from maternal risks, preeclampsia also has profound effects on your little one. The lack of oxygen and nutrients caused by poor placental circulation can impair your baby’s growth. It can also result in preterm birth which can cause serious complications (e.g. congestive heart failure, high blood pressure, diabetes) later in life that would require ongoing medical care. Babies who are born early may sometimes fail to thrive especially with immature systems.

What signs and symptoms should I look out for?

Learning to recognise the warning signs of preeclampsia is critical to you and your baby’s safety. Remember that you will be your own first responder to any unusualities. Along with elevated blood pressure, important symptoms that may suggest preeclampsia include:

  • Headaches, similar to migraine, that don’t go away and is sometimes accompanied by nausea and vomiting.
  • Shortness of breath
  • Severe pain just below the ribs, on your right side. 
  • Confusion
  • Heightened state of anxiety
  • Visual disturbances (e.g. oversensitivity to light, blurred vision, seeing flashing spots or auras)
  • Severe swelling on the hands
  • Sudden weight gain

Since you know your body, the key here is to trust your instincts if you notice anything that is off. While these symptoms are not always serious, it is important that you immediately seek medical attention once you experience them. 

How is preeclampsia diagnosed?

With this risk present in each expectant mom, a routine screening will be done which includes blood pressure monitoring and urine protein tests. Along with thorough assessment, the doctor will determine if what you have is mild or severe preeclampsia from which they will base their management on. 

How is preeclampsia managed?

Mild preeclampsia can be managed in a hospital or an outpatient basis. This means you can stay at home while your doctor or midwife closely monitors your condition. By yourself, you can do a daily kick count to keep track of your baby’s movements alongside blood pressure monitoring. 

Report your observations during your antenatal doctor visits which is done once or twice weekly. At 37 weeks, you may be recommended to deliver your baby, but if test results continually stay in the red, you may be advised to have the baby earlier.

Preeclampsia with severe features require hospital admission. It is often recommended that you have your baby at 34 weeks once your condition has stabilised. But, if you are less than 34 weeks pregnant and under stable conditions, you may be advised to wait to deliver your baby. Medications will also be given to control your blood pressure and a seizure precaution. Magnesium sulfate will be given intravenously to prevent eclampsia. Corticosteroids will also be administered to help the baby’s lungs mature.

Preeclampsia Management

How is postpartum preeclampsia managed?

Preeclampsia eventually goes away after the delivery of the placenta. This may take hours or up to six months after giving birth. However, in some cases, this condition makes its entrance for the first time up to 4 weeks after birth.  

Blood pressure monitoring must be continued soon after birth because there are cases where a woman’s condition could deteriorate after delivery. This necessitates a longer hospital stay until it is established that your blood pressure has stabilised for 24-48 hours. Medications to control blood pressure and prevent seizures may be given as well. 

Most women with preeclampsia are able to deliver healthy babies and fully recover, while others proceed to experience life-threatening complications. Since the condition has a tendency to escalate quickly, it’s important for pregnant women to be proactive in observing symptoms and in monitoring their blood pressure at home. 
With this knowledge, we hope that expectant moms or those planning to have a baby, seek medical guidance as soon as possible. Preeclampsia is manageable when caught early, so, get your blood pressure levels closely monitored. Talk to your OB-GYN now, or book an appointment with Dr. Pamela Tan today.

Beyond Sanitary Pads and Tampons, What Are My Other Options?

Have you resigned to the fact that stained panties and soaked tampons are part of your reality until menopause makes its entrance? What if I tell you that there are other options that just might save you from these messy situations? Read on to know more!

Menstrual Cups

If this is your first time to hear about menstrual cups, you might think that these are new-age inventions. But did you know that it was first introduced way back in the 1930’s? Initially, it didn’t get a warm reception for religious and cultural reasons, but as we’ve seen today, its 80-year trajectory panned out differently. 

Today, menstrual cups are making the rounds with more women swearing by it as an alternative to their usual menstrual support. If you haven’t tried it yet, here’s what you need to know. 

Menstruation in a cup?

Menstrual cups are bell-shaped devices made from flexible material (silicone, latex or rubber) to be used inside the vagina to collect menstrual blood. It can be left in place for 4-12 hours before it is emptied, rinsed, and re-inserted. You’ve read that right; menstrual cups are reusable!


You can use a cup all throughout your period, but you must empty and clean it more often on heavy flow days to avoid leakage. This sounds familiar, right? But, compared to sanitary pads and tampons, which absorbs the blood, menstrual cups are set in place to collect it. The way it works may seem foreign to most women in Singapore, but those who have tried it vouch for its reliability. 

However, some would say that there is a learning curve to using the cup. Not all women are comfortable during the first few tries of inserting it. But once you get the right size and fit, it can give you the comfort and confidence to move even on your red days. One study even concluded that a menstrual cup is a satisfactory alternative to tampons. 

But, are menstrual cups safe?

The fact that cups are left inside the vagina for several hours raises concerns. Fortunately, with proper use and care, menstrual cups are safe to use. A 2017 study done on Kenyan schoolgirls indicated that there is no evidence that menstrual cups are hazardous.

However, menstrual cups are not advised for women who have an intrauterine device (IUD). The movement caused by the placement and removal of the cup may dislodge it. While there are studies which found no evidence of this risk, it is still important to discuss this with your OB-GYN so you can be properly advised. 

Getting by with a little help?

More women today embraced the use of menstrual cups, with some even praising it for changing their lives. While it’s true that it can do the job, we’ve discussed that it’s not a perfect option. This is reflected in the contradicting feedback surrounding this device. 

Some complain that, just like pads, it also has a chance for leakage probably due to an improper fit, particularly among those with a tilted cervix, or heavy flow. For days like these, sanitary pads may be needed for additional support.

But, did you know that women today are lucky that even concerns over having clean panties during these “leaky” situations are also covered? Enter Period Panties – probably what one would call a menstrual sidekick that prevents heavy flow from victimizing your favorite underwear!

Period Panties


Besides the promise of clean panties throughout your period with their layers of protection, period panties have the capacity to replace tampons, liners, and cups. It’s just like your usual underwear except that it can protect you from light, medium, to heavy flow – sometimes even absorbing up to 2 tampon’s worth of fluid. 

These panties are designed with moisture-wicking, breathable cotton that draws wetness and dries fast. This means that you don’t get the discomfort you often feel with soaked pads. On top of that, they are also leak-resistant, so you brush off any worries over accidental stains. This should give you the license to wear white pants even in the middle of your period! 

Furthermore, these period panties also come with odor-controlling technology that neutralizes smell, giving you 24-hour freshness. 

For pragmatic women, period panties can be a budget-friendly addition to your feminine hygiene repertoire because these are washable, reusable, and easy to maintain (just remember to skip the bleach and fabric softener). Having to wash these panties is a preferable downgrade than sacrificing your sheets, towels, and other items of clothing like bloody casualties of war every time your period floats by. 

Finally, put a period to embarrassing stains!

Let’s face it ladies, we are familiar with the struggle of pads slipping out of place, winged ones bunching up to the side, tampons filling up too fast, or your menstrual cup leaking over. Period panties gives you peace of mind because they are leak-proof to protect you from menstrual flows of different intensities.

As they become increasingly popular in Asia, women are now offered more options as different brands put their own spin on them. Some even went as far as creating a compartment where you can place a warm compress to help relieve period pains! Some also dial up the aesthetics so that these special garments still look chic and fashionable. 

Why you might want to make that switch

Menstrual cups and period panties for menstrual management became popular subjects of discussion today because it fits well into our social awareness narrative. With the clamor for environmental consciousness, many are now seeking sustainable solutions. 

Your feminine needs don’t have to harm the environment.  

As reusable forms of menstrual support, menstrual cups and period panties allow you to minimise the waste you contribute to landfills every year, compared to using tampons or sanitary pads. These are also cost efficient because some of these cups can be safely used for years before replacements are needed. This means that you also save yourself from your monthly trips to the pharmacy.

So, would you like to make that switch today? For any concerns, always talk to your doctor first for proper medical advice.  

Get down and dirty with some real talk to understand how you can maintain feminine hygiene and ensure safety with these options. For your questions, talk to Dr. Pamela Tan today at +65 6254 2878 (Thomson).

The Empty Belly: Truth Behind Molar Pregnancies

Pregnancy is a time of great joy for an expectant mother, but it can also be a time of great anxiety. The two often go hand in hand, especially for a first time mum. 

If this is you, one way to allay your worries is to see your OB GYN regularly, preferably before you even try to conceive. Your doctor will map out your prenatal care plan, and monitor your health and the pregnancy as it develops. This is crucial because every stage of gestation carries its own risks to the mum and her baby. Some are preventable and treatable, while others have no known causes and  are beyond anyone’s control. One such example is a molar pregnancy.

Molar Pregnancy

To the pregnant women reading this, let us begin by saying that molar pregnancies are relatively rare. It happens in 1 out of every 1,000 pregnancies.1 Statistically speaking, an overwhelming majority of pregnancies are uncomplicated and result in healthy births.2 

So what is a molar pregnancy? A molar pregnancy, also referred to as hydatidiform mole, occurs as early as fertilisation. A defect in the trophoblasts or the cells that are supposed to develop into the placenta, causes it to develop into an abnormal mass or a tumor instead. These masses or tumors appear as water-filled sacs in grape-like clusters.3 

A molar pregnancy falls under a group of conditions called Gestational Trophoblastic Disease or GTD. Aside from molar pregnancies, GTD covers other diseases that involve rare tumors that form inside a woman’s uterus from the cells that would have otherwise developed into the placenta.4   

There are two types of molar pregnancies: complete and partial.

Complete Molar Pregnancy

A molar pregnancy is considered complete when no foetal tissue develops in the womb. This happens when the sperm ends up fertilising an empty egg. Therefore, only molar tissues develop. This is the more common type.

Partial Molar Pregnancy

In a partial molar pregnancy, an incomplete embryo and placenta may develop along with the molar tissues. This happens when a normal egg is fertilised by two (instead of the usual one) sperm, resulting in a non-viable embryo. Partial molar pregnancy is even rarer than complete molar pregnancy. 


  • Dark brown to bright red spotting or bleeding
  • Severe nausea and vomiting
  • Early preeclampsia
  • Pelvic pressure or pain
  • Rapid uterine growth
  • Vaginal passage of grape-like cysts

Most of these symptoms are not exclusive to molar pregnancy. In fact, they are quite similar to normal pregnancy symptoms or they can be symptoms of something else entirely. If you’re experiencing any of these symptoms, see an OB GYN for an accurate diagnosis.


Molar pregnancies are caused by the abnormal fertilisation of the egg resulting in an abnormal fetus. Instead of fetal tissue, the placental tissue forms a mass in the uterus instead.

This phenomenon can be narrowed down to chromosomal (genetic material) imbalance in the pregnancy. This happens when an egg, which doesn’t contain genetic information, fertilise with a sperm, or when a normal egg is fertilised by two sperm.

Read also : Gestational Diabetes Mellitus: Why It is No Sweet Talk

Detection and Diagnosis

Most molar pregnancies are discovered only when a miscarriage occurs, but it can also be detected through a transvaginal ultrasound as early as eight to nine weeks of pregnancy.

A complete molar pregnancy may reveal:

  • The absence of an embryo
  • The absence of amniotic fluid
  • Thick molar tissues in the uterus

A partial molar pregnancy may reveal:

  • A growth-restricted embryo
  • Low amniotic fluid
  • Thick molar tissues in the uterus

Risk Factors

Although it is generally rare, certain factors increase the likelihood of developing a molar pregnancy. The women who are more at risk are typically:

  • Over 35 years old or under 20 years old
  • With a history of previous molar pregnancy
  • With a history of miscarriage
  • Of Asian ethnicity
    • Women from Southeast Asia and Korea have a slightly increased risk for a molar pregnancy. There have been some dietary theories proposed about why this may be the case.5

Treatment, Management, and Prevention

The typical treatment for molar pregnancies begin with removing the non-viable embryo and placenta from the uterus through vacuum suction (evacuation of uterus) procedure. The molar tissue will then be examined to confirm the molar pregnancy diagnosis. 

After an evacuation, for the next six months to a year, her hCG levels will be regularly checked through blood tests. Human Chorionic Gonadotropin or hCG is a hormone produced during pregnancy. If the hGC levels remain high after the evacuation procedure, it could mean than some molar tissue remains or has grown back in the uterus. 

This is the reason why women who go through molar pregnancy are advised to wait until after a year before trying to conceive again. It’s impossible to tell if the increased hCG levels in the blood is a result of a new pregnancy or because of the presence of molar tissue.

If molar tissue remains and continues to grow in the uterus after it has been surgically removed, it has developed into gestational trophoblastic neoplasia, a rare form of cancer. The risk of this developing is 15% in a complete mole and 0.5% in a partial mole. The doctor may recommend additional treatment, such as chemotherapy or medication. In very rare cases, this could progress to choriocarcinoma, a form of cancer that can spread to the other parts of the body. 

Whether you’re pregnant or not, planning to get pregnant or considering contraceptives, see your Gynaecologist regularly to properly monitor your reproductive health. Book a consultation with Dr. Pamela Tan today. 







5 Common Maternal Infections During Pregnancy

Infections are quite common. At best, they are unpleasant and at worst, life-threatening. But an infection is never more worrying than when pregnant. Contracting an infection while pregnant can have a wide range of effects on both mother and baby. This is why during an expecting mother’s first prenatal visit, her OB-GYN will order screening tests and a complete blood workup. This is done to determine the mother’s baseline health status and to screen her for both the presence of infectious diseases and immunity against certain infections. 

The World Health Organization tags infections among the leading causes of maternal death. Infections also increase the risk of stillbirth and certain birth injuries. A thorough prenatal care plan is necessary to prevent and diagnose infections, as well as to treat and mitigate their harmful effects on both the mother and her developing baby.

The Zika virus disease is one example of a maternal infection that results in birth defects like severe microcephaly, a condition wherein the baby’s brain was unable to fully and properly develop in utero. The disease rose to worldwide prominence in early 2015 because of the  Zika Virus epidemic in South America. But despite the media mileage, Zika is relatively rare compared to other maternal infections. Unless the mother has been to a known area with risk of Zika and is at a high-risk for exposure to the virus and exhibiting viral illness like symptoms (eg fever, rash, joint pains, muscle aches), her OB-GYN will unlikely order a test for it. 

There are other far more prevalent and more likely infectious diseases that a pregnant woman will be routinely screened for. Below, we will outline the five common maternal infections that will be tested for at the beginning and as needed throughout the pregnancy.


There are five major types of Hepatitis viruses all targeting the liver. A simple blood test should show whether a person is infected by, immune to, or susceptible to the virus. 

The standard screening for pregnant women prioritizes Hepatitis B Virus (HBV) because this type of hepatitis is most prevalent in the population and occasionally transmitted from mother to baby during childbirth. Some patients who have an acute infection never fully get rid of the virus and become chronic carriers. There is a staggering 90% chance that mothers will pass on the virus to their babies during an acute infection in pregnancy and about 10-20% chance that chronic Hep B carrier mothers may pass the virus to their child. Nevertheless, there are no restrictions on vaginal birth for pregnant women positive for HBV. 

The virus is also transmitted through direct contact with infected bodily fluids. Interestingly enough, an HBV positive mother can safely breastfeed her baby as long as the baby has been immunized. There is no evidence that the virus can be transmitted via breast milk. 

HBV vaccine is safe, effective, and easily accessible. The World Health Organization recommends that all babies be immunized within 48 hours of birth and babies of Hep B carriers additionally be given protective immunoglobulin antibodies. This reduces the chances of perinatal transmission of the virus if the mother is HBV positive, as well as all other modes of transmission. Pregnant women who have partners or family members who are hepatitis B carriers and have been shown to lack the protective antibodies on blood testing are at risk of Hepatitis B infection and should be vaccinated in pregnancy.


Rubella or German Measles is a viral infection that is accompanied by a low-grade fever and rashes. But for pregnant women who contract this otherwise mild infection, it can take on a devastating form as Congenital Rubella Syndrome in her developing baby. 

The first trimester of pregnancy is the most dangerous time to contract the virus. It puts the pregnant woman at risk for miscarriage or a stillbirth. If the baby survives, there is a likelihood that he will be born with multiple severe birth defects such as deafness, blindress, intellectual impairment, and heart defects. 

As part of the routine preconception tests, the mother’s blood will be screened for rubella immunity, which she could have gotten from a prior rubella infection or from a routine childhood MMR (Measles, Mumps, and Rubella) vaccination. The MMR vaccine cannot be given to pregnant women so it is advised for women to get tested for rubella immunity before trying to get pregnant. She should wait at least one month after the MMR vaccine before trying to get pregnant as it is a live vaccine. 


Group B Strep is an extremely common bacteria found in the rectum or vagina of two out of five people. This bacteria rarely causes any complications, except for the immunocompromised and those who might have trouble fighting off infections, i.e., the elderly and newborn babies. 

The best time to test pregnant women for Group B Strep is around 35 to 37 weeks of gestation. A positive result for the bacteria carries a slight increase of risk of uterine and bladder infections. There is only a slim chance (1-2%) that the mother will pass on the bacteria to her baby during birth. It the baby does get infected, it can lead to, worst case, pneumonia, sepsis, and meningitis. Group B Strep positive mothers will need to be put on intravenous antibiotics during labour to prevent transmission.


 Although it’s most common in the urethra, urinary tract infections cover a lot of ground. It can refer to an infection anywhere from the kidneys to the bladder. Pregnant women are more prone to this infection because of all the drastic changes happening near that area of her body. Recurrent UTI is normal while pregnant and poses very little risk to the developing baby, if looked after.

Usually, UTIs can be treated with a round of antibiotics that should not harm the baby. But if it progresses, and left untreated, it could lead to a kidney infection, which in turn, could lead to preterm labor or low birth weight in babies. 


All sexually transmitted diseases will pose a risk for a woman, whether she is pregnant or not. Some OB-GYN will order routine STD screening during the first prenatal visit or order tests based on risk factors. If the pregnant woman does present with obvious symptoms like bumps, ulcers or abnormal discharge, it’s better to get tested. Some sexually transmitted infections are asymptomatic but no less harmful for the mother and baby. 

Infections like Syphilis can be transmitted to the baby and can be fatal in some cases or cause congenital syphilis and fetal abnormalities. With treatment and medication, the risk of transmission of HIV in HIV positive mothers to the infant is very low. Chlamydia and Gonorrhea can increase the risk for miscarriage and cause newborn eye infections during a vaginal delivery. Herpes is generally harmless to the baby in utero, but is transmittable during delivery and medications to suppress a reactivation can be given from 36 weeks to prevent a relapse during delivery.

Are you an expectant mother? The best time to see your OB-GYN and to get checked out is not when you suspect you might be pregnant, but as soon as you decide you want to have a baby. The more prepared you are, the more favorable the outcome will be for you and your baby-to-be.