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. 

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. 

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

5 Neurological Disorders in Pregnancy

We’re familiar with the threat of common diseases like gestational diabetes and pre-eclampsia in pregnancy. In addition to that, the nervous system can also be stricken with diseases that can turn into a health crisis in this delicate period of pregnancy and childbirth. These neurological disorders carry several symptoms that range from minor discomforts to medical emergencies. Therefore, being familiar with what these are will allow you to be more aware in identifying red flags. 

1. Pregnancy Headache

The surge of hormones and the increase in blood volume often result in frequent headaches in expectant moms. It’s a common discomfort during the first and third trimesters, which are usually challenging stages during pregnancy. 

Aggravating factors include: 

  • Stress
  • Lack of sleep
  • Nausea and vomiting
  • Dehydration
  • Sinus congestion or nasal stuffiness
  • Pregnancy-induced hypertension (PIH)
  • Low blood sugar levels
  • Poor nutrition

These trigger two of the most common types of headaches which are, tension headaches and migraines

Tension Headache

Due to the physical toll that pregnancy has on the body, tension headaches are likely to occur. This is why it’s also referred to as stress headaches

These are felt as mild to moderate pressing pain on both sides of the head, similar to having a tight band wrapped around it. This sensation is usually accompanied by a sore neck and shoulder. It resolves within a few minutes to a few hours, and in rare cases, it can last for several days. 

Migraine

Migraines, on the other hand, aren’t your typical headaches. It’s characterised by severe, throbbing pain that comes with neurological symptoms like blurred vision, numbness, flashes of light or tingling on the face, arms, or leg. 

Women with regular migraine headaches may notice that they experience fewer episodes during pregnancy. Some may encounter it for the first time after getting pregnant, while others experience the same frequency. However, some may notice it getting worse especially during the first trimester. 

These episodes should not be taken lightly because expectant women who suffer from migraines have a greater risk of hypertensive diseases associated with pregnancy. 

Tension-Headache-vs-Migraine

A person can experience both tension headache and migraine, and their symptoms may overlap. Therefore, pregnant women should be quick to have a doctor check unexplainable and persistent headaches. Even more so if this is accompanied by symptoms like sudden dramatic weight gain or puffiness in the face or hands. 

A person can experience both tension headache and migraine, and their symptoms may overlap. Therefore, pregnant women should be quick to have a doctor check unexplainable and persistent headaches. Click To Tweet

Tests and scans may be needed to determine the cause behind these headaches. Blood pressure levels will be checked routinely. The OB-GYN may also order blood tests, blood sugar tests, a vision test or a scan of the head and neck if serious. 

Ways to cope with pregnancy headaches

Besides medical interventions, there are non-pharmacologic measures to treat headaches during pregnancy. You may try any of the following:

  • Stay hydrated.
  • Eat well-balanced meals.
  • Relieve tension headaches by applying a cold compress or ice pack at the base of your neck. 
  • Maintain blood sugar levels by eating small, frequent meals. 
  • Rest in a dark room and practice deep breathing exercises.
  • Take a warm bath or shower.
  • Get a neck or shoulder massage.
  • Relax and get plenty of rest.
  • Practice good posture.
  • Put your feet in a tub of warm water.

Medical treatments for pregnancy headaches vary depending on the different factors that surround it. While we often reach for over-the-counter pain medications to counter any bouts of headache, in this case, a doctor’s advice is necessary to ensure that any measures taken don’t compromise a pregnancy or the health of the baby. Common painkillers found in pharmacies that fall under the NSAID group (including the patches) are contraindicated while some paracetamol (panadol) can be taken in safe doses.

2. Epilepsy

Epilepsy is a neurological disorder that involves recurrent seizures. In every 1000 pregnancies, between 2-5 infants are born to mothers who have it. However, most of these women remain free of seizures during pregnancy and even move on to have uncomplicated pregnancies and healthy babies. 

Symptoms-of-Epilepsy

How pregnancy affects epilepsy

It’s difficult to predict how pregnancy affects epilepsy. However, some may experience frequent seizures while they’re pregnant. The reason for it is that the medications used to treat epilepsy may work differently during pregnancy, or it may not be absorbed well. It might be the case that expectant women are no longer taking it regularly or have stopped taking it entirely. Furthermore, the physical and emotional stress that comes with pregnancy are also considered as potent triggers. 

How epilepsy affects pregnancy

On the other hand, epilepsy poses certain risks to pregnancy. Besides general complications that come with the condition, the medications used to treat it can also have adverse effects on the mother, the unborn baby, and the pregnancy. 

Since women are at a more delicate state while pregnant, having a seizure disorder heightens the risk for injuries and complications. Maternal risks include trauma from falls, bumps, or accidentally biting the tongue. Meanwhile, the type of medications may have serious side effects to the baby, such as abnormalities to the heart, slightly smaller size, birth defects (e.g. cleft lip or cleft palate), or stillbirths. In addition, the risks to the pregnancy itself may result in the premature separation of the placenta from the uterus, premature labour, and miscarriages. 

So what can be done to ensure a safe pregnancy even in the presence of a seizure disorder? 

Pregnant women with epilepsy need close monitoring of the disease and fetal health, which means that there will be more frequent prenatal visits needed.  Click To Tweet

Pregnant women with epilepsy need close monitoring of the disease and fetal health, which means that there will be more frequent prenatal visits needed.  

Most women will be prescribed with anticonvulsant medications. Proper monitoring also follows to ensure that seizures are controlled and side effects are reduced. The goal of treatment is to use as few medications as possible at the lowest dose necessary to control these seizures

There is also a particular need to increase folic acid dosage in pregnant women with epilepsy. This prenatal vitamin is routinely prescribed to all pregnant women to reduce the risk of babies having defects to the spine, heart, and limbs. However, there is a need to prescribe a higher dose because epilepsy medications can interfere with folic acid absorption increasing the risk of the baby being born with spinal abnormalities. Conversely, special monitoring is needed to check if folic acid hasn’t lowered the blood levels of these seizure medications. Otherwise, it could increase the risk of seizures

While epilepsy medications come with risks, they should not be discontinued or changed without consulting a healthcare professional. Poorly controlled epilepsy may result in a very rare but serious complication called sudden unexplained death with epilepsy (SUDEP), which is highly likely to occur during the time of delivery and the postpartum period. 

Epilepsy-and-Pregnancy


3. Multiple Sclerosis

Multiple Sclerosis (MS) is an autoimmune disorder that affects the central nervous system, which is the brain and spinal cord. In this disabling disease, the body mistakenly attacks the myelin sheath, which is an outer coating that protects the nerve cells. When it gets damaged, the flow of information between your brain and the rest of the body gets disrupted. This leads to common neurological symptoms such as loss of coordination, muscle weakness, and trouble with sensation. 

Multiple sclerosis and pregnancy

Having MS doesn’t seem to affect getting pregnant, and neither does pregnancy speed up the course or worsen the effect of MS. In fact, the nine months of pregnancy are generally associated with fewer relapses, especially during the third trimester. Those with unrecognized MS prior to getting pregnant are more likely to start experiencing symptoms during pregnancy. However, within 3-6 months after delivery, the symptoms usually tend to flare up again. 

Challenges MS pose on pregnancy

Due to debilitating symptoms, it may be physically challenging for MS patients to carry a pregnancy. It increases the likelihood of injuries due to muscle weakness and coordination problems. Meanwhile, fatigue may also be felt more profoundly. 

With pelvic sensation compromised, a woman may not feel pain with contractions. While this may sound like a dream come true, the absence of any sensation can be hard for a woman to tell when labor starts and even its progression. Furthermore, delivery becomes difficult as the muscles and nerves needed for pushing are also affected. It is for this reason that these patients usually undergo a C-section, a vacuum delivery, or a forceps delivery

Currently, there is no available treatment for MS, but there are medications that can help control the symptoms. Since relapse is unlikely during pregnancy, there is usually no need for any medications. However, drug therapies may have to be resumed after pregnancy which means that breastfeeding may not be advised; but these can be arranged based on how the disease progresses. 

One can always consult a doctor or OB for any concerns – whether if it’s about getting pregnant, any advise on pregnancy, or close monitoring. Just like other neurological disorders, the presence of MS will require more frequent prenatal visits. 

You can read about a Singaporean mum’s struggle with MS, here


4. Myasthenia Gravis

Myasthenia gravis (MG) is another autoimmune disorder that causes weakness to the skeletal muscles of the face and extremities. It worsens after periods of activity, and improves after periods of rest. It usually affects women who are in their 20s and 30s, or during the childbearing years. 

MG tends to worsen during the first trimester and postpartum period. One study showed that 30% of patients do not experience any change in their MG status, 29% reported improvement, and 41% showed worsening of their MG symptoms during pregnancy. However, the course of the disease varies and pregnant women face the risk of it getting worse, respiratory failure, adverse drug reactions, a myasthenic crisis, and even death. 

symptoms-of-Myasthenia-gravis

Labour and delivery for women with MG

Pregnancy does not appear to worsen the long-term effects of MG on women. Vaginal delivery is safe, and it should be encouraged. A c-section is carried out only when there is a need to because surgery is associated with worsening of MG, and it might even result in a myasthenic crisis. 

Since the uterine muscles are composed of smooth muscles, its ability to contract is not compromised with MG. Therefore, the first stage of labour is not affected. But as the woman progresses to the second stage of labour, she will need the striated muscles to work. This can be exhausting and it often requires the need for forceps or vacuum extraction.

Another complication of labour with a higher incidence in mothers with MG is premature rupture of membranes holding the amniotic fluid, although the reason for it is unclear. 

Effects of MG on the baby

Infants who are born to women with MG are thought to develop neonatal MG through the passage of MG antibodies between mother and fetus. The symptoms are usually mild to moderate, which is observed through poor sucking and muscle tone. Generally, this is temporary, and the baby’s symptoms disappear within two to three months after birth. 

Treatment of MG during pregnancy

Treatment must be individualised based on the severity of MG as well as the effectiveness of various treatment options and their possible harmful effects on pregnancy. Optimal management during this delicate period calls for a multidisciplinary team approach comprising an obstetrician, neonatologist/pediatrician, and neurologist. 

For those planning to get pregnant, but are also struggling with MG, doctors would often advise to delay pregnancy for at least 2 years following diagnosis. The severity of symptoms and risk of maternal death is highest within this period. Most myasthenic women can have an uneventful pregnancy with good outcome as long as there is careful planning and close monitoring.

5. Peripheral Neurological Disorder

The disorders mentioned above are issues that affect the central nervous system. But there are also conditions that target the nerves outside the brain and and spinal cord, and these are called peripheral neurologic disorders. 

There are over 100 types of these neuropathies, but the ones common to pregnancy are carpal tunnel syndrome and Bell’s palsy. These conditions are usually due to compression during pregnancy and childbirth. 

Carpal Tunnel Syndrome (CTS)

carpal-tunnel-syndrome-illustration
Carpal Tunnel Syndrome affects 4% of the general population, but it is more common during pregnancy where it is 31%-62% of pregnant women. Click To Tweet

Carpal Tunnel Syndrome affects 4% of the general population, but it is more common during pregnancy where it is 31%-62% of pregnant women. Experts could not pinpoint the root cause behind it, but they suspect that it could be hormone-related swelling. Increased fluid and relaxation of the ligaments puts pressure on the nerve on the wrist, called the median nerve, as it passes through the carpal tunnel in the wrist. 

symproms-of-Carpal-Tunnel-Syndrome

There are certain factors that increase a woman’s risk of developing CTS during pregnancy. Aggravating factors include obesity, gestational diabetes, pregnancy-related hypertension, and having previous pregnancies.

Read: Gestational Diabetes: Why It Is No Sweet Talk 

Most doctors recommend treating CTS conservatively during pregnancy because patients experience relief weeks or months after giving birth.

Treatments that can safely be applied during pregnancy include the use of splints to keep the wrist in a neutral position. This also controls the motion to the wrist, like when one types on the keyboard. Proper rest, especially when the affected hand feels painful or fatigued. Elevating the wrists and applying a cold compress can help relieve the symptoms. On top of that, doctors may also prescribe physical therapy and pain relievers

breastfeeding-with-Carpal-Tunnel-Syndrome

Bell’s Palsy

Bells-palsy-image

Bell’s palsy is a temporary weakness of facial nerve. It can strike at any age and it occurs without warning. It’s more common during pregnancy, with most cases occurring during the third trimester and postpartum period. The symptoms are often confused with that of a stroke, which is why it must be evaluated immediately. 

Bell’s palsy is a temporary weakness of facial nerve. It can strike at any age and it occurs without warning. It’s more common during pregnancy, with most cases occurring during the third trimester and postpartum period. Click To Tweet
signs-and-symptoms-of-bells-palsy

There are several theories as to why pregnant women are more likely to experience Bell’s palsy than non-pregnant women. Below are the following reasons: 

  • Increased total body water which causes swelling and/or compression of the facial nerve
  • Increased blood clotting factors
  • Weakened immune system
  • Elevated levels of the female hormones, estrogen and progesterone

In general, those who experience Bell’s palsy will experience a full recovery within 6 months. Unfortunately for Bell’s palsy during pregnancy, the prognosis for complete recovery isn’t as great as the general population, 52% vs. 80%, respectively. It should be noted that the poorer outcomes reported are likely related to the past reluctance of physicians to prescribe steroids and antivirals in treatment. Today, management of Bell’s palsy in pregnancy should mirror that of nonpregnant individuals and include steroids combined with antivirals, with the exception of first trimester cases. Steroids help to reduce swelling and compression of the nerve and anti virals may aid in Bell’s palsy secondary to a viral infection. 

Neurologic disorders may come with symptoms that can make pregnancy more challenging, even to a point of being risky. However, it doesn’t mean that having these conditions can rob a woman of bearing a child.  With preparation, precaution, and close monitoring, it’s possible to have a safe pregnancy. 

Whether you are still planning for a baby or drafting your birth plan, it’s important that you have the right professional help to guide you along. In Singapore, Dr. Pamela Tan provides warm, caring, and personalised obstetric and gynaecological services for every woman’s unique concerns.  Make an appointment today!

What Can Pregnant Women Do Amidst the Looming Threat of COVID-19?

Facing a threat that is foreign to all of us can leave us paralysed with fear. Not fully knowing what we’re up against can breed panic, even more so in women who are about to bring a life into the world. But panic can only take us right into the trap of irrational decision-making, especially in a time where COVID-19’s prevalence has stricken us all. 

So, why not take what is already known and use that knowledge to ensure that you avoid this infection and have a healthy pregnancy. 

COVID-19: What we know so far

Coronavirus is an umbrella term that refers to a large family of viruses that can trigger illnesses that range from the common cold to severe diseases like the Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV)

The outbreak which started in December of 2019 was caused by a strain that hasn’t been identified in humans, hence the name 2019 novel coronavirus. In February 2020, the World Health Organization (WHO) officially named it SARS-CoV-2. This virus is the reason behind COVID-19 – the disease that is currently placing the world on hold as everyone is gripped with fear of an unseen enemy. 

Coronaviruses are transmitted between animals and humans. SARS-CoV was passed on from civet cats, while MERS-CoV was transmitted from dromedary camels. However, for COVID-19, the definite cause has yet to be identified.

For person to person transmission, COVID-19 virus can be transmitted through contact with certain bodily fluids, such as droplets in a cough. It can also be transmitted by touching something an infected person has touched or sneezed on, and then bringing your hand to your mouth, nose, or eyes.

What’s so sinister about this illness is that it can be spread even before it shows any symptoms. As one study revealed, the disease can have an average incubation period (the time elapsed between the exposure and when the first symptoms become evident) of 5 days. Seeing how community transmission is fast-moving and widespread, now making it a pandemic, pregnant women should engage in strong precautionary measures, especially in public places. 


Do pregnant women have a bigger risk of acquiring a COVID-19 infection? 

Fortunately, based on the evidence so far, pregnant women don’t appear to have a higher susceptibility to a COVID-19 infection compared to the general population. However, pregnancy in a minority of patients can affect how the immune system responds to severe viral infections. At the moment, there is no evidence that coronavirus causes a viral infection worse in pregnant women, but the amount of evidence available is still quite limited. Hence, to be cautious, pregnant women should be given special consideration especially those with coexistent medical illnesses which make them immunocompromised and vulnerable to infection. 

What are the symptoms?

In the beginning, the virus will create flu-like symptoms like cough, lethargy and fever. But as soon as the virus starts reproducing in your lung cells, it gradually destroys your lung tissue, affecting your ability to inhale oxygen. That is why one of the early symptoms is that people tend to experience shortness of breath which would render the need for hospital care.

In severe cases, the infection can cause pneumonia, severe acute respiratory syndrome, kidney failure and even death. This is commonly observed among those who are immunosuppressed or those with long-term conditions such as diabetes – which is also present in some pregnant women. Therefore, expectant moms who are also dealing with other health conditions should heighten their caution. 

Read: Gestational Diabetes Mellitus: Why It Is No Sweet Talk

What happens if a pregnant woman gets infected?

Comparisons have been drawn between COVID-19 and influenza. Both cause respiratory diseases that comprise a wide range of illnesses, from asymptomatic to severe, with rare cases resulting in death. The large majority of pregnant women with COVID will experience only mild or moderate flu-like symptoms. This is reinforced by the Chair of the Society of Infectious Diseases of China Medical Association who shared that in Shanghai, pregnant patients had mild disease and there were no severe cases requiring intubation. 

The large majority of pregnant women with COVID will experience only mild or moderate flu-like symptoms. Click To Tweet

While COVID-19 may initially appear like the seasonal flu, here are important comparisons that should be noted so that you get prompt medical treatment.

Runny nose/ cold is NOT typically a symptom of COVID-19. In addition to fever, dry cough, muscle aches, headaches and diarrhea, a significant number of COVID 19 patients report a loss of smell and/or taste as their symptom. 

Flu vs Covid

As this is a new virus, we are just starting to be familiar with its outcomes. Currently, there is no evidence to suggest that COVID-19 can result in adverse pregnancy outcomes, such as miscarriage. However, looking at cases of infections from other related coronaviruses (SARS-CoV and MERS-CoV), these diseases have resulted in miscarriages and stillbirths. 

A high-grade fever (more than 38 degrees celsius) during the first trimester of pregnancy is also a cause for concern among expectant women. It increases the risk of certain birth defects, such as neural tube defects affecting the brain and the spine, heart or facial abnormalities (e.g. cleft lip or cleft palate) in the fetus. 

In COVID-19, fever is among the triad of symptoms, along with cough and shortness of breath. So, whether it’s a serious strain of the coronavirus or the common flu, the same risk is present if we focus on the fact that if a pregnant woman’s temperature goes through the roof, it can lead to serious complications to the unborn baby. Conversely, up to this point, there is also no concrete information on the real effect of the virus on women in early pregnancy. 

Can infected pregnant women pass on the COVID-19 virus to her baby? 

Passing on a disease-causing agent, such as the COVID-19 virus, from a mother to her offspring while pregnant or during birth is called vertical transmission. Two cases of possible vertical transmission have been reported. In both cases, it remains unclear whether transmission was prior to or soon after birth. Another recent report from China of four women with coronavirus infection when they gave birth found no evidence of the infection in their newborn babies. After testing amniotic fluid, cord blood, and neonatal throat swab, there was no evidence of intrauterine fetal infection. Hence, it is also presumed that it’s unlikely for the COVID-19 virus to cause congenital issues affecting baby’s development. 

Expert opinion is that the baby is unlikely to be exposed to the virus during pregnancy.

Some babies born to women with symptoms of coronavirus in China have been born prematurely. It is unclear whether coronavirus caused early labour, or whether it was recommended that the baby was born early in order to preserve the mother’s health.

Additionally, the virus was not detected in samples of breastmilk, which means that there is no advice against breastfeeding for infected moms. In the United Kingdom, the current guidance is that there is no need for patients to be separated from their newborns. However, it’s important that precautionary measures are applied while doing so. Moms who are carriers of the virus should wear a mask while feeding, wash her hands before and after it, and disinfect contaminated surfaces. But if she’s too ill, she can express her milk for the baby using the necessary precautions. In hospitals, proper isolation and strict protocol should help in making sure that the baby is protected from acquiring a COVID-19 infection. In China, babies were kept strictly away from their infected mothers for 14 days to reduce the chance of transmission. There have been reports of very early neonatal infections where babies were severely ill so it may well be prudent to isolate until we have more data.  

How can pregnant women protect themselves against a COVID-19 infection?

Since the COVID-19 virus can be transmitted by contact and droplets, public health measures were provided by the World Health Organization. These are applicable to all, and pregnant people can use it to protect themselves and prevent the spread of infection.

Protective measures against covid-19

What can I do about pre-natal check-ups? 

Part of the list of precautions that the government and healthcare workers have been constantly repeating to flatten the curve of community-acquired infection is to avoid crowded places and to practise social distancing. But what if you can’t avoid hospitals as COVID-19 spreads?

Pre-natal check-ups are vital in ensuring a safe and healthy pregnancy. There is a stronger need for visits to the doctor especially for those with delicate pregnancies, therefore these appointments can’t be postponed indefinitely. 

In Singapore, the pre-natal check-ups will continue as usual. However, if you exhibit any fever and flu symptoms, some hospitals will not allow entry. Instead, you will be advised to see your local general practitioner (GP) for medications, and your appointments will be deferred until you are well. 

Take note of the following reminders for this type of GP check-up:

  • You are advised to wear a mask.
  • You should maintain social distance. 
  • You will be assessed if you have high-risk factors of being positive for COVID-19. 
  • If you are considered low risk, you will be given medications for symptoms and told to isolate at home for five days but to return if worsening or persistent symptoms. It will be at the GP s discretion to determine if you warrant a referral to NCID for a swab test. 
  • In general, patients who have clinical pneumonia or prolonged flu symptoms or serving a stay-home notice from countries with heightened vigilance and any sort of acute respiratory symptoms are likely to be referred. 
  • If you are high risk, eg on home quarantine orders or have any contact with anyone who is positive for COVID-19, you should call for an ambulance to bring you to NCID directly if you have symptoms instead of going to a GP. 
  • Pregnant patients in NCID will be co-managed by KK Women’s and Children’s Hospital, if needed.

In cases of any pregnancy-related emergency or if you are in labour, co-existing with your symptoms, then you will be directed to the cordoned off triage area in your obstetric hospitals. Please telephone your specialist beforehand to highlight your situation so that preparations can be made prior to your arrival. If necessary, you will be admitted to a negative pressure labour wardroom for delivery. This is to protect you from coming into contact with other patients and reduce cross contamination room to room. 


What will delivery be like for a woman who is positive for COVID-19?

Under the circumstances, the mode of delivery will be discussed with the mother. Doctors will not outright advise a Caesarean section for suspected COVID-19 patients. However, if the mother’s respiratory condition demands urgent delivery, a C-section would be an appropriate course of action. In China, most patients underwent a Caesarean section for delivery but it is still unknown if vaginal delivery increases infection. There was a report following up 9 pregnant patients of which 2 underwent normal vaginal delivery. The three babies (including 1 set of twins) did well post delivery and tested negative for infection. 

Under the circumstances, the mode of delivery will be discussed with the mother. Doctors will not outright advise a Caesarean section for suspected COVID-19 patients. However, if the mother’s respiratory condition demands urgent… Click To Tweet

Epidural anaesthesia is advised for pain relief during labour instead of Entonox gas because the latter poses a higher risk of aerosolisation increasing the risk of spreading the virus. To this effect, spinal anaesthesia rather than general anaesthesia is advised during a Caesarean section also to curb any risk of spreading infection. 


Will the newborn be separated from an infected mother? 

Health authorities advise separate isolation of the infected mother and her newborn for 14 days. However, routine precautionary separation of mother and a healthy baby shouldn’t be taken lightly considering the potential detrimental effects on feeding and bonding.

With the limited evidence, UK doctors advise that women and healthy infants, not otherwise requiring neonatal care, are kept together in the immediate postpartum period. A risk-benefit discussion between neonatologists and families is recommended to individualise care in babies that may be more susceptible. However, it is also emphasised that this guidance may change as the COVID-19 pandemic is rapidly evolving. 

For the baby’s well-being and because of other reports of infection during the early neonatal period, Dr Pamela Tan prefers isolating the mother and newborn as a needed interim consideration to prevent transmission. The American CDC (Centers for Disease Control and Prevention) also suggests the same measure. 

Is there a drug treatment or a vaccine for COVID-19?

At present, there is no direct treatment or a drug that can destroy the COVID-19 virus. What can be done to relieve symptoms is to apply supportive care. For example, if a person can’t breathe, they are given oxygen therapy, or if they cannot drink or eat, intravenous fluid replacements are introduced.

Possible vaccines and specific drug treatments are still under investigation. In some countries, drug trials are already underway, and just like the flu vaccine, let’s hope that these treatments would be safe for pregnant women too. A study from Wuhan reported that 7 pregnant patients with COVID 19 pneumonia were treated with oxygen therapy and antiviral therapy in isolation. The outcomes for both mother and neonate were good for the 7 patients. More trials are needed to prove the effectiveness of the drugs and effects on the fetus. 

At a time where the disease is at its infancy but potently affecting many around the world, pregnant women should aim to keep themselves in harm’s way as much as possible.

While little is known yet about COVID-19 and how it affects pregnant women, Dr Pamela Tan would be happy to assist you with your concerns. You may check out our official FACEBOOK PAGE for recent updates on this topic, or you may give us a call at +65 6254 2878 (Thomson). 

Major Thyroid Disorders During Pregnancy

Your Thyroid Gland at a Glance

The thyroid gland is a butterfly-shaped organ located in the base of the neck. It’s about 2 inches long and it is wrapped around your windpipe (trachea). It’s part of the endocrine system, and it plays a vital role in the growth, development, and metabolism of the human body. 

Thyroid Anatomy - Dr Pamela Tan

The thyroid makes and stores hormones (T3 and T4) that are essential to how every cell in the body functions. Among many other things, these hormones help regulate body processes such as your heart rate, blood pressure, body temperature, metabolism and even fertility. 

Thyroid Function in Pregnancy

Thyroid hormone is important during pregnancy for normal fetal development. During the first 10-12 weeks, your baby completely relies on you for thyroid hormones for brain development. This explains why your thyroid hormone requirements increase during pregnancy. 


By the end of the first trimester, your baby can already produce thyroid hormones on its own. However, it will continue to depend on you to get adequate iodine intake to make thyroid hormones. 


To avoid pregnancy issues related to thyroid hormone levels, striking a balance is vital. Studies show that deficiencies can result in several complications and even irreversible damage. Meanwhile, overproduction isn’t any better since it also poses health risks for both mother and child. 

Thyroid Disorders in Pregnancy

Thyroid disorders are relatively common, but many are unaware that they have it. 

Besides being a pre-existing disease, thyroid problems can also develop during and after pregnancy. It can even alter thyroid function in women who have no abnormalities, to begin with. Pregnancy-related hormones may cause your thyroid levels to rise making it challenging to diagnose thyroid diseases during pregnancy. This is why it’s important to get thyroid hormone levels screened before planning for pregnancy or soon after you discover that you’re pregnant. 


Moreover, women can still develop thyroid problems up to a year after giving birth. This is why post-partum doctor visits will help keep everything in check. 


Here’s a closer look at two major thyroid issues during pregnancy. 

Hypothyroidism

Symptoms of Hypothyroidism - Dr Pamela Tan

Hypothyroidism is a condition where the thyroid gland is unable to make enough thyroid hormones to keep the body running normally. It can stem from several causes, the most common of which is the initial presence of an autoimmune disorder called Hashimoto’s thyroiditis. It can also occur in women with inadequate treatment for hypthyroidism, or in hyperthyroid women who got over-treated with anti-thyroid medications. 


Having an underactive thyroid means crucial body processes slow down. Mild hypothyroidism may show no symptoms and even if there was, it may be attributed to pregnancy. However, in severe cases, complications are more likely to occur. Maternally, it can increase the risk of miscarriage, pre-eclampsia, congestive heart failure, placental abnormalities, and postpartum bleeding. If left untreated or if poorly managed, these complications can be life-threatening to you and your baby.


Inadvertently, hypothyroidism can also impair a baby’s brain development. Babies who are born with hypothyroiditis will suffer from cognitive, neurological, and developmental abnormalities. They are also likely to be born prematurely with low birth weight. 


Planning ahead and discussing thyroid status with your primary care physician and OB helps prevent complications, especially among high-risk women. This involves proper screening tests, optimised treatment prior to becoming pregnant, and close monitoring throughout your pregnancy. For hypothyroidism, the goal is to provide adequate thyroid hormone replacement.

New mothers must ensure that they get follow-up medical attention even after delivery because thyroid conditions don’t usually resolve by itself. Some may even develop postpartum thyroiditis, which is the occurrence of a thyroid problem in the first year after pregnancy. Hence, therapy may have to be continued as necessary. 

Hyperthyroidism

Symptoms of Hyperthyroidism - Dr Pamela Tan

Normally, pregnancy hormones can cause the thyroid gland to slightly enlarge during pregnancy. However, in hyperthyroidism, there is an excess production of thyroid hormones which results in a goiter. This complication in pregnancy is often linked to an autoimmune disorder called Grave’s disease


This condition mostly affects young to middle-aged women in their child-bearing years, and it also tends to run in families. It may first appear during pregnancy or it may already be a pre-existing condition. Nevertheless, Grave’s disease poses a risk for both mother and baby if left unmanaged. 


Pregnant women with uncontrolled hyperthyroidism may experience a dangerous rise in blood pressure called pre-eclampsia. They are also at risk for miscarriages, pre-term delivery, and congestive heart failure. For some women, they may experience a sudden worsening of symptoms which is a medical emergency referred to as a thyroid storm


Furthermore, hyperthyroidism also carries a high risk for the baby with complications such as  intrauterine growth retardation, birth defects, and increased incidence of stillbirths. 


For the proper treatment of hyperthyroidism, your doctor will first review your symptoms and do appropriate screening tests to measure thyroid hormone levels. This condition entails frequent monitoring throughout your pregnancy. Medications will also be prescribed to control thyroid hormone production. Radioactive iodine is also a common treatment for hyperthyroidism, but it is not advised in pregnant and breastfeeding women. In some cases, surgery is needed to remove part of your thyroid, especially if there is an overactive nodule. 


Diagnosing the Problem

Since the symptoms of thyroid problems are closely similar to that of pregnancy, a correct diagnosis can be easily missed. 


The challenge with pinpointing thyroid problems in pregnancy is distinguishing the symptoms of the disease from that which are typical in pregnancy. Depending on the severity of the condition, a correct diagnosis can be easily missed. So, if you notice that something doesn’t feel right, alert your doctor as soon as possible. 


Diagnosis can be made through blood tests and imaging tests. Your blood can be extracted to tst for TSH (Thyroid Stimulating Hormone), T3, and T4 levels. Checking for thyroid antibodies may also be done to check for any autoimmune disorders – a condition where your immune system attacks the thyroid gland by mistake. 


Imaging tests may also be done to arrive at a diagnosis. An ultrasound of the thyroid is used to detect the presence of nodules, it is also a necessary tool for disease management. A thyroid scan and uptake can also be done to check the size, shape and position of the thyroid. However, this is advised against pregnant and breastfeeding women because it uses radioactive materials. If there is a lump or nodule found during these diagnostic tests, a needle aspiration biopsy will be done where a small sample of that growth is removed to check if it is cancerous or not.

Women with thyroid problems can increase their chances of a healthy pregnancy if they get early prenatal care and closely work with healthcare providers in disease management.  Get in touch with Dr. Pamela Tan today for a thorough evaluation and customised medical advice.