CARING FOR WOMEN

EVERY STEP OF THEIR LIVES

CARING FOR WOMEN

EVERY STEP OF THEIR LIVES

CARING FOR WOMEN

EVERY STEP OF THEIR LIVES

CARING FOR WOMEN

EVERY STEP OF THEIR LIVES

CARING FOR WOMEN

EVERY STEP OF THEIR LIVES

CARING FOR WOMEN

EVERY STEP OF THEIR LIVES

WELCOME TO DR PAMELA TAN MEDICAL CLINIC

FEMALE OBSTETRICS AND GYNAECOLOGY SPECIALIST IN SINGAPORE

Obstetrics

View our list of obstetric services available during your pregnancy, birth and beyond. Find out more.

Gynaecology

Learn about our comprehensive gynecologic care including infertility, bleeding issues and abnormal pap smears, & more.

LIKE YOU, WE CARE

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.

Latest Blogs

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!

Menstrual-Cups

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

Other-option-for-sanitary-pad-tampons

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) or +65 6384 2759 (Sengkang).

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. 

Symptoms

  • 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.

Causes

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. 

Endnotes

1.  https://americanpregnancy.org/pregnancy-complications/molar-pregnancy/

2.  https://www.medicalnewstoday.com/articles/322634.php

3.  https://www.mayoclinic.org/diseases-conditions/molar-pregnancy/symptoms-causes/syc-20375175

4.  https://www.cancer.org/cancer/gestational-trophoblastic-disease/about/what-is-gtd.html

5.  https://obgyn.onlinelibrary.wiley.com/doi/pdf/10.1046/j.1471-0528.2003.01413.x


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.

HEPATITIS B

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

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 STREPTOCOCCUS (GBS, OR GROUP B STREP) 

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.

URINARY TRACT INFECTIONS

 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. 

SEXUALLY TRANSMITTED DISEASES

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.  

14 Methods of Contraception: Planning Against Unplanned Pregnancies

Having a child is a life changing decision. No woman would like to be a situation where she has an unplanned and unwanted pregnancy. Sadly, many women find themselves in this moral and ethical dilemma of being faced with the decision to keep or terminate an unplanned pregnancy. Contraceptive methods to avoid unplanned pregnancies are extremely important and should be discussed amongst couples who are not keen or ready to have a child. 

To practice safe and responsible sex, the different methods and efficacy of contraception will be outlined. 

Fertilization and Contraception 

For pregnancy to occur after sexual intercourse, the sperm must swim up the vagina through the cervical opening, upwards through the uterus and into one of the two fallopian tubes. If an egg, released during that month’s ovulation cycle, is in the tube a sperm has the chance of fertilizing it.

Contraceptives are designed to prevent this process, and they work in 4 basic ways: 

  • Block the sperm
  • Disable the sperm before it reaches the uterus 
  • Suppress ovulation
  • Prevent implantation

Blocking Sperm 

  • Condom

Disable Sperm

  • Spermicide

Suppress Ovulation

  • Injection
  • Implant 
  • Patch 
  • Pill 
  • Hormonal IUD

Prevent implantation

  • IUD

Emergency Contraception

Surgery

  • Tubal Ligation
  • Vasectomy
Effectiveness of Birth Control Methods

The vaginal ring and barrier methods for women eg cervical cap, female diaphragm and female condom are not available in Singapore.


Blocking the Sperm 

Also referred to as the Barrier Method, these types of contraception work by keeping a man’s sperm from reaching a woman’s egg. 

Barrier methods are not as effective at preventing pregnancy as other birth control methods, such as the birth control implant, injection, or intrauterine device (IUD). Out of 100 women per year, 18–28 women will become pregnant when using barrier methods. They work best when they are used correctly every time you have sex. Even one act of sex without using a barrier method can result in pregnancy. If your barrier method breaks or becomes dislodged during sex, or if you forget or are unable to use it, you may want to consider emergency contraception.

Condom

It is a thin sheath that acts as a physical barrier to prevent sperm from entering the uterus and reach the egg. Condoms come in two forms one for males and another designed for females. 

Male Condom 

This type of condom is placed over an erect penis. Most of the ones you find in stores are made from latex rubber. These are the ones that are effective in preventing STIs. However, for men who are sensitive to latex, polyurethane (a type of plastic) condoms are also good alternatives.

Check out the proper way to use a male condom, here

Pros

  • Protects against STIs. 
  • Cost less than other birth control methods and easily accessible.
  • No hormonal effects on women. 

Cons

  • Reduced sensitivity during intercourse
  • Excessive friction during intercourse may cause the condom to break. 
  • Those with latex allergies may not be able to use regular condoms. Polyurethane condoms, or those made of lambskin, can be alternatives but these can be expensive.
  • It should not be used with oil-based lubricants such as lotions, baby oil, or petroleum jelly. This can cause the latex material to disintegrate and the condom to break during intercourse. 

Disable sperm 

Spermicide

It is a chemical that is introduced into the vagina to immobilize and destroy sperm. It can also be a barrier method because it prevents the sperm from entering the uterus. Today’s spermicides can be in the form of gels, foams, creams, suppositories, and films (thin sheets) that dissolves in the vagina. 

It can be used alone or with other barrier methods such as condoms, cervical cap, or diaphragm to improve its effectiveness. On its own, a spermicide should be inserted deep into the vagina, close to the cervix. Be sure to read the label to know how long before sexual contact should the product be inserted.

Spermicides are effective for only 1 hour after insertion. You need to reinsert a spermicide for each sexual contact. 

Pros:

  • It increases lubrication during sex. 
  • It doesn’t require a prescription and it can be bought in a lot of stores.
  • It is easy to use. 
  • No hormonal side effects. 
  • It doesn’t affect your milk supply if you are still breastfeeding. 

Cons:

  • It can cause vaginal and penile irritation.
  • It does not protect against certain STI’s and may even increase the risk of getting HIV from an infected partner. 
  • Frequent urinary tract infections

Suppress ovulation

Injection

A birth control injection is a shot of hormones that is administered either in the muscle or under the skin by your healthcare provider 3 monthly. It is a safe and convenient options that provides long-term protection. This injection may contain progestin alone, or a combination of progestin and estrogen. They are formulated to stop the body from releasing eggs and it also thickens the mucus of the cervix.

Pros:

  • Safe and convenient
  • It is discreet. You can get the shot at a doctor’s office which means you don’t have to deal with any evidence that you are using it.
  • It doesn’t get in the way of the sexual experience. 
  • It is temporary, so you can still have the chance to get pregnant once the effect wears off. 

Cons

  • You need to get the injection every 3 months.
  • For it to be effective, you need to get it on time.
  • You may experience side effects (e.g. headaches, weight gain, spotting between periods, or more bleeding days than usual)
  • It may take up to 10 months after stopping the shots for you to be able to get pregnant again.

Implant

A birth control implant is a flexible, plastic rod that is about the size of a matchstick. It is inserted under the skin of the upper arm to release the hormone progestin into the body to prevent you from getting pregnant. 

If you get the implant within the first 5 days of your period, you will be protected right away. If you get it any other time during your cycle, you may have to use other forms of contraception for the first week. After that, you can enjoy protection for up to 3 years. The effectiveness may be long-lasting, but it is also reversible.

Implants work in two ways: 
  • Stops ovulation. Without any eggs released from your ovaries, you can’t get pregnant.
  • Thickens cervical mucus. This creates an environment that will make it hard for the sperm to reach the egg. 

Pros:

  • You don’t have to do anything once it is in place. 
  • No one can tell that you are on birth control.
  • It can be inserted immediately after childbirth or while breastfeeding.
  • It does not interfere with sex. 
  • It reduces the pain during menstrual periods. 

Cons:

  • It does not protect against STDs 
  • It may cause unpredictable bleeding.
  • It may result in certain side effects (e.g. weight gain, acne, breast pain, or headaches)

Patch

It is a small, adhesive patch that is worn on the skin either of your belly, upper arm, back, or buttock. It works by releasing hormones (estrogen and progestin) into your body through your skin to prevent pregnancy. They prevent ovulation which means there is no egg for the sperm to fertilize. The patch can also thicken the mucus on the cervix making it hard for the sperm to swim. 

For it to be effective, a new patch must be worn every week for 3 weeks in a row. On the fourth week, no patch should be worn, and by this time you will have your menstrual period.

Pros:

  • It is simple to use. 
  • It can be highly effective with proper use. 
  • It doesn’t interrupt intercourse.
  • It may improve menstrual pain.
  • It can help improve acne

Cons:

  • It is not comfortable to use in the humid Singapore weather or in an active sporty person.
  • It does not protect against STIs.
  • You must follow a strict schedule in changing it every week for it to be effective. 
  • Some medications or supplements can make it less effective.
  • It may be less reliable on heavier women.

Pill

Oral contraceptive pills (OCPs) contain two hormones, estrogen and progestogen. These prevent ovulation, making fertilization and pregnancy impossible. Along with birth control patch and vaginal birth control ring, the birth control pill is one of the combined hormonal birth control methods. At present, there are three types of OCPs: the combined estrogen-progesterone, progesterone only, and the continuous or extended use pill.

A prescription from a GP or a gynaecologist is necessary to obtain birth control pills in Singapore. They will first assess your risk factors, medical history, and lifestyle needs. 

Type of Pills 
  • 21-day pills. One pill must be taken at the same time everyday for 21 days. You must wait 7 days before starting a new pack. You can expect your period during the 7-day period that you’re not taking the pill. Eg Yasmin, Meliane, Mercilon, Gynera.
  • 28-day pills. A pill is taken at the same time each day for 28 days. Some brands come with 21 or 24 pills that contain estrogen and progestin. The remaining pills may contain estrogen only, or dietary components minus the hormones. During the days that you are taking the hormone-free pills, you can expect your menstruation.
  • 90-day pills. You will take one pill during the same time each day for 84 days. The remaining pills may contain estrogen only or it may not have hormones. You will expect your period to happen during the last 7 days every 3 months. This type of pill is not available in Singapore. However, it’s possible to take the 21-day pill continuously for 84 days (4 boxes) before breaking for a period so it will be like a 90-day pill.

Pros:

  • Aside from preventing unplanned pregnancies, OCPs can also help regulate menstrual cycle, allay painful or heavy menses, control acne, and relieve premenstrual syndrome (PMS). 
  • Starting the pill on your first day of menses provides immediate protection. 
  • It is safe for breastfeeding mothers. 

Cons:

  • It must be taken daily, following a strict consumption schedule, making it unsuitable for women who are forgetful.
  • Like any drug, OCPs come with side effects like headaches, breast tenderness, nausea and breakthrough bleeding.
  • It has the tendency to interact with some medications (e.g. antibiotics, anti-epileptic drugs, and antiretrovirals)

Prevent Implantation

IUD (Intra Uterine Device)

Like the implant, this is considered as one of the long-acting reversible contraceptive method (LARC). It means that it can last for years and they can be removed should you change your mind in the future. They are the most cost effective over the long term, the most efficacious and have no issues with patient compliance unlike the contraceptive pills. During the first year of use, fewer than 1 in 100 women using an IUD or implant will get pregnant. Over time, LARC methods are 20 times more effective than birth control pills or the patch.

It is a small T-shaped device that is inserted and left inside the uterus to stop the sperm from fertilizing with an egg. It uses multiple approaches at the same time. Some IUDs contain synthetic hormones which suppress ovulation, thickens the mucus and thins the uterine lining making implantation difficult. Some contain copper which disables sperm while making it difficult for the embryo to implant in the uterus.

Types of IUDs:

Copper-releasing IUDs – It works immediately after insertion by releasing copper ions that are toxic to the sperm. It can stay in the uterus for up to 10 years. The 5 year copper IUD is available in Singapore and is one of the most popular types of contraceptive.

Progestin-releasing IUDs – It starts to work within 7 days after insertion. It releases progestin which is a hormone that prevents the ovaries from releasing an egg. It can stay in the uterus for up to 5 years. The Mirena ( https://www.mirena-us.com/ ) is available in Singapore and is particularly good for women with heavy or crampy periods.

Pros:

  • It is convenient, since there is no need to do anything once it is in place. 
  • It does not interfere with sex. 
  • It is suitable for almost all women. Sometimes, slight preparation pre insertion is required for patients who have never delivered vaginally before and have a tight cervical opening.
  • Over time, hormonal IUDs can help decrease menstrual pain and heavy menstrual bleeding
  • The copper IUD can also be used as emergency contraception.
  • If removed, it does not affect your ability to conceive in the future. 

Cons

  • Hormonal IUDs may initially cause frequent spotting and heavier bleeding. 
  • Some women may experience side effects like nausea, breast tenderness, headaches, and mood changes.
  • It may slip out of place and would have to be removed. 
  • The IUD may come out of the uterus especially during heavy period days, resulting in unintended pregnancies. The risk is higher in teenagers, those with heavy menstrual bleeding, and in women who had it inserted immediately after childbirth. 
  • It doesn’t protect you against STDs.
  • In the unlikely event that a pregnancy occurs, it may be a tubal ( ectopic ) pregnancy.

Emergency Contraception

This is a form of contraception that is effective if it is administered within a specific period after unprotected sexual contact. It is also referred to as, “the morning after pill,” “the day after pill,” or “morning after contraception.” It can be used right away or up to 5 days after sex. 

Compared to the US where one can be purchased over the counter, emergency contraceptives need to be prescribed in Singapore. 

It is important to note that EC does not cause any abortion. An abortion ends an established pregnancy or harms a developing embryo. 

Instances When Emergency Contraception is Used:

  • If the condom broke or slipped off
  • If you have not used any birth control during sex
  • If you have used other contraception incorrectly
  • If a woman is made to have sex against her will

Two Main Types of Emergency Contraception: 

  1. Copper IUD. This is considered the most effective form of emergency contraception. It causes a chemical change in the sperm and egg before they meet, making fertilization impossible. 
  1. Emergency Contraception (EC) Pills
  • Ulipristal (ELLA)
  • Progestin-only pills eg postinor

Surgery

For those who prefer permanent methods of birth control, either the male or female partner can opt for sterilization. The procedure for women is called tubal ligation, while it is vasectomy for men.

Tubal Ligation 

According to data from the CDC, this method of contraception has surpassed OCPs as the most common form of female sterilization. Tubal ligation is a surgical procedure where the fallopian tubes are occluded to prevent pregnancy. 

Two methods of female sterilization include: 

  • Post-partum sterilization 

This form of female sterilization involves a small incision made in the abdomen under the umbilicus (minilaparotomy) right after a normal vaginal delivery or done together with a cesarean delivery. During this procedure, the fallopian tubes are clipped with metal inert clips to occlude the tubes. 

  • Interval ligation via laparoscopy

This procedure involves the use of a laparoscope inserted through an incision inside the belly button at a time not close to delivery. Using an instrument that is passed through key-hole incision in the belly, the fallopian tubes are closed off using metal clips. 

Vasectomy 

 This is a minor surgical procedure for the sterilization of the male partner. It prevents the sperm and egg from meeting by blocking the vas deferens, the tube that carries the sperm from the testicles to the penis. 

These procedures should only be considered if a couple are certain that they no longer want any more children. While there is no legal requirement for spouses to agree, it is important for partners to thoroughly discuss this matter before coming to a decision. It should be taken as a permanent form of contraception. 

There is a contraceptive method to suit different preferences. However, there are some that may not be available in Singapore. To know which among this would be a safe and suitable option for you, it is good to start with medical advice. Book a consultation with Dr. Pamela Tan today. 

What to Expect in a Cervical Cancer Screening In Singapore

Based on current estimates, there 429 women who are diagnosed with cervical cancer every year in Singapore and 70 die from it.  It’s alarming how a preventable disease remains to be among the top 10 cancers affecting women in the country today.

This makes screening an important topic for discussion because it draws the fine line from potentially fatal consequences and survival.

Cervical Cancer

Cervical cancer is a disease that stems from the cervix or the neck of the womb. The Human Papilloma Virus (HPV) has over 100 different strains and 15 of these are classified as highly likely to develop cancer. In most cases, cervical cancer is attributed to two types – HPV-16 and HPV-18 (high-risk HPV).

Most women infected with HPV do not develop cervical cancer since 90% of infections resolve on their own within 2 years. Those with persistent infection are the ones who have a higher risk of developing cervical cell abnormalities and eventually cancer. Even if a woman is infected with HPV within a few years after she first had sex, the incidence of cervical cancer peaks at around 45 years of age. This means that the progression from persistent infection and invasive cervical cancer peaks well into your 40s.

However, what’s so sneaky about it is that if the problem persists, there are no red flags on any abnormal changes. It is only when the problem has advanced that it starts to show symptoms.

Read: What You are Missing Out On When You Skip Regular Visits to Your Female Gynaecologist

Symptoms

Precancerous cellular changes and early cancers of the cervix are very discreet. These changes occur years before cancer develops, giving you a good window of opportunity for screening and early detection.

As the disease advances, it usually comes with the following symptoms:

  • Pelvic pain that is unrelated to your menstrual cycle
  • Heavy or unusual discharges that may be thick or watery with a foul odor.
  • Abnormal bleeding:
  • Between the regular menstrual period
  • After sexual intercourse
  • Pelvic exam
  • After douching
  • After menopause
  • Pain during urination
  • Pain during intercourse
  • Increased urinary frequency

These symptoms may also be related to other health problems aside from cervical cancer. Nevertheless, it is important that you seek medical advice if anything is out of the ordinary.

Cervical Screening

Pap Smears

Short for Papanicolaou Test, Pap-smears help detect cervical cancer in its early stages. Doing so makes it easier to be treated with surgery, chemotherapy, or radiotherapy. This gives you a stronger chance at survival.

How it is done:

During the procedure, you lie on your back with your knees up and bent while your feet are placed on stirrups. The doctor will then insert a small metal or plastic instrument called a speculum. This is used to open the vagina to properly visualise its walls as well as that of the cervix. This may be slightly uncomfortable, but it is tolerable.

Using a small cervical brush or broom, the doctor obtains a sample of the cervical cells.  A pap test should not be painful. So, if you feel any pain during the procedure, inform your doctor.

The samples are then sent to the lab and examined for abnormalities. An abnormal result doesn’t always mean that you have cervical cancer. This means that there is something that requires further evaluation by the doctor. A colposcopy may be done, which is an examination that uses a microscope to confirm if it is indeed cervical cancer.

While a Pap Smear test is a reliable tool for screening, it is not 100% accurate. It detects only about 55-65% of the time when there is an abnormality. This means that if there are 100 women who had cervical cell abnormalities, a Pap test will currently detect 55-65 and miss out on 35-45.

Cost of Pap Smear in Singapore

If you are not aware of this yet, you can get a Pap smear done free through the Singapore Cancer Society. Alternatively, you can also get it at an affordable cost because of the program rolled out by the Health Promotion Board. You can get it for $5 if you are a Singapore citizen (check your eligibility, here) and  $12.25 for Permanent Residents.

If you are a CHAS (Community Health Assist) card holder, your Pap test will have a subsidized rate of $2. However, this is only applicable to participating clinics and healthcare centres.

HPV Testing

Since a Pap Smear is subject to false negative and interpretation errors, HPV testing is regarded as a more accurate screening tool. However, it will not tell you whether you have cancer, rather it will detect the presence of HPV and what strain is in your system.

Having the knowledge of what type of HPV you are infected with allows you and your doctor to better decide on the next steps in your health care. If a woman’s HPV test is negative, it means that high-risk HPV types were not detected, she has a low risk of developing cervical cancer. A negative result will also mean that you don’t have to return for 5 years. If you tested positive, you will have to go back to your doctor every 6 months for monitoring.

How it is done:

The process is similar to a Pap Smear where a speculum is inserted into the vagina so the doctor can collect samples of your cervical cells. Sometimes, an HPV test is done at the same time as a pap test so that the doctor can obtain 2 samples for both.

A Help for Helpers

The country has widened its scope in a strong effort to help more women prevent or overcome this disease by making cervical cancer screenings free for foreign domestic helpers. It aims to lower the incidence of cervical cancer to these population of women who may not have access to it.

Cervical Screening Guidelines in Singapore

Who are advised to undergo screening?

  • All women who have ever had sexual intercourse are advised to have their first pap smear test from the age of 25.
  • Women who have never had sexual intercourse don’t have to undergo screening, but if they exhibit any symptoms, they should consult a doctor.

Frequency of Screening

According to the National Cervical Cancer Screening Programme, the frequency is as follows:

  • Age 25-29 years – Pap smear must be taken once every 3 years
  • Age 30-69 years – HPV test alone every 5 years for a negative HPV test. The reason for not testing girls younger than 30 is because almost a quarter will be HPV positive at that age and most will clear up within a year. It will not help doctors in triaging who is at a higher risk.

Under a non-national screening programme the options for those 30 years of age and above the following applies:

  • Pap Smear alone every 3 years
  • HPV test alone every 5 years
  • Co-testing with Pap smear and HPV test every 5 years

Discharge from Screening

Cervical cancer screening is not indefinite. If a woman has committed to regular screenings, she can already stop doing so at age 69 if she has:

  • 3 consecutive negative pap smear tests
  • Or 2 consecutive negative HPV tests in the last 10 years, with most recent test occurring within the last 5 years
  • Or 2 consecutive negative Co-tests (pap smear + HPV testing) in the last 10 years, with the most recent test occurring within the last 5 years.

Routine screening will continue for at least 20 years in women with a history of CIN2, CIN3 or AIS. It will still apply even if it extends beyond 69 years of age. You may visit our clinic for a thorough discussion on this.

Primary Prevention

Since HPV infection is necessary for the development of cervical cancer, it is only logical to give yourself a blanket of protection through vaccinations. Screening is only secondary prevention, but an HPV vaccination is considered the primary line of defense. Therefore, it is only right to add it into the discussion because screening and vaccinations go hand in hand so you can safeguard better.

An HPV vaccine not only protects you from cervical cancer, it also prevents other cancers like anal, vulva and mouth cancer. It can even protect you from genital and anal warts.

Who Gets the Shot?

Girls and even boys can get HPV vaccinations. Under the National Childhood Immunisation Schedule, the government encourages girls aged 9-26 to get vaccinated. In April 2019, all 13-year-old girls in Singapore (citizen and PR) can get the HPV vaccine for free. This is an opt-in scheme, which means that parents must give their consent.

The reason why this vaccine is encouraged to be given at a young age is because it serves as a preventive measure and not a treatment. It is advised that you get vaccinated before you become sexually active. When administered too late, it may not be effective in giving you protection. If you are above 26 and haven’t gotten the HPV vaccine yet, you may discuss this with your doctor to see if you are a suitable candidate.

Boys must also get into the movement because men can also catch and spread HPV. It can also cause cancers of the throat, genitals or anus in men. Unfortunately, there are no national healthcare programmes that will subsidise HPV vaccines for boys.

There are 3 types of HPV vaccines that are approved for use in Singapore at present and these are:

  • Gardasil 4 (4-valent vaccine) – protects against HPV-6, 11, 16 and 18; for boys and girls aged 9-26 years of age
  • Gardasil 9 (9-valent vaccine) – protects against HPV-6, 11, 16, 18, 31, 33, 45, 52, and 58; for boys and girls aged 9-26 of age
  • Cervarix  – protects against HPV-16 and 18; licensed only for girls 9-25 years of age

Vaccination Schedule and Recommendations

Gardasil

  • 3-dose schedule: 0,2 and 6 months for individuals 9-26 years of age.
  • 2-dose schedule: 0 and 6 months for individuals 9-13 years of age.

Cervarix:

  • 3-dose schedule: 0,1 and 6 months in females 9-25 years of age.
  • 2-dose schedule: 0 and 6 months in females 9-14 years of age.

Source: sccps.org

The protection you need against cervical cancer is already available today. You only need to make the first step; even the government is making efforts to help. Don’t allow yourself to be part of the statistic, seek the protection you need today.
If you have more questions, do give us a call so we can schedule your appointment. Let’s get into an in-depth discussion on this matter.