What is Obstetrics?
Singapore obstetrics focuses on the well-being of a woman during pregnancy, labour and delivery, and postpartum. The health of the foetus is also monitored closely to ensure optimal development. Obstetrics also covers preconception services, which include evaluating a woman’s fertility and treating certain gynaecological conditions that may affect her chances of pregnancy.
On top of routine screenings as the pregnancy progresses, obstetricians in Singapore also manage any complications that may arise during pregnancy or childbirth, such as gestational diabetes, preterm labour, or preeclampsia. Obstetricians are also skilled in both natural birth techniques as well as Caesarean section to ensure the safety of both mother and baby. Overall, obstetricians play a crucial role in helping women have healthy pregnancies and safe deliveries.
We know from scientific studies that babies born at the extremes of birthweight either under 2.5kg or over 4.5kg are at an increased risk of developing chronic diseases later in life such as diabetes and heart disease. Studies have also found that food chemicals can act to switch certain genes on and off in the developing fetus during pregnancy through a process called ‘epigenetics’. A mother’s nutrition is therefore important even before she is pregnant as it can affect the development and subsequent health of her baby.
Being overweight or underweight can also affect fertility. Hence, optimizing ones’ health and observing a healthy diet and lifestyle should begin even before conception and pregnancy as it can affect a couple's chance of getting pregnant in the first place.
If you have plans to start trying to conceive, consider making an appointment with us for a Prepregnancy or Preconception health screen and consultation, where we can address your concerns, and discuss diet and lifestyle issues for a healthy pregnancy.
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What Does an Obstetrician Do?
An obstetrician in Singapore is a specialist doctor who helps with the safe and compassionate management of pregnancies and deliveries. Obstetric clinics should be well-equipped and licensed to ensure that services rendered are of high quality. It is recommended to visit an obstetrician if you are planning to conceive, as well as throughout the length of your pregnancy to ensure a safe and reassuring experience.
Pre-pregnancy Health Screen
Going for a pre-pregnancy health screening package is ideal to ensure that any health issues are addressed before pregnancy. This usually comprises a thorough examination and investigations.
We will then review the investigation results and provide the necessary advice with regard to fertility and pregnancy. For example, if a patient is found to lack immunity against rubella, vaccination is advisable as infection during pregnancy can cause congenital defects in the baby.
Pregnancy Screening
There is a small risk of fetal abnormality with every pregnancy. Unfortunately, this risk increases as the mother gets older. Prenatal screening is offered to all pregnant women to determine more accurately, the risk of having a baby with a chromosomal disorder such as Down’s Syndrome.
Screening tests for chromosomal disorders:
This test is also known as the OSCAR (One-Stop Clinic for Assessment of Risks of Fetal Anomalies). This includes a scan of the nuchal translucency or fluid-filled space behind the fetal neck. A nasal bone assessment is also usually done as babies with Down’s Syndrome may have an absence of the nasal bone. The scans may be combined with a blood test from the mother for hormone and biochemical markers for a more accurate risk assessment.
This involves a simple blood test from the mother which may be interpreted alone, or in combination with the first-trimester screening scan for a more accurate risk assessment.
This is a highly sensitive screening test for fetal genetic conditions including Trisomy 21, 13 and 18. It can detect these conditions with a sensitivity of 99%. It involves a simple blood test from the mother and detects the free fetal DNA present in the mother’s circulation, thereby assessing if there may be a genetic abnormality in the baby. The blood test can be drawn from the mother as early as 10 weeks of pregnancy and the results are available in 2 weeks.
Prenatal Screening
Chorionic Villus Sampling (CVS)
Amniocentesis
Diagnostic tests for fetal chromosomal disorders
Depending on the final risk assessment, the patient may be advised to undergo a diagnostic test such as chorionic villus sampling (CVS) or amniocentesis. The amniocentesis is normally carried out from 15 weeks of pregnancy. A needle is inserted into the amniotic cavity and amniotic fluid is sampled, allowing culture and assessment of fetal cells in the fluid. Fetal cells in the amniotic fluid can then be analysed. There is however a risk of miscarriage of around 0.5%.
The CVS can be carried out earlier - usually between 10-13 weeks of pregnancy. It involves sampling of the developing placenta and again the same type of analysis of fetal cells to detect chromosomal, genetically inherited and endocrine or metabolic conditions can be performed. There is a risk of miscarriage of 1-2%. While these diagnostic tests help to confirm if the baby truly carries a chromosomal disorder, these tests are invasive and carry a small risk of miscarriage. Hence, they are not offered as a routine.
Pregnancy Scanning and Pregnancy Care Singapore
At around 6 weeks of pregnancy, an early dating ultrasound scan will help confirm the location and gestational age of the embryo and check whether it is a single or twin pregnancy.
At around 20 weeks of pregnancy, a fetal anomaly scan is usually performed to assess the baby’s growth, anatomy, placental position and cervical status. This scan can usually detect up to 90% of the major abnormalities.
From 24 weeks of pregnancy, patients are usually seen on a monthly basis up to 32 weeks, fortnightly up to 36 weeks, and finally weekly until delivery. Pregnancy growth scans are usually performed after 24 weeks of pregnancy to ensure that your baby is growing well. They also evaluate the placental location and amniotic fluid volume. The use of colour Doppler ultrasound helps to assess the blood flow in the umbilical cord and other blood vessels in the baby. The results from such scans can help determine if the blood is circulating properly and if the baby is under stress.
A 3D scan provides a life-like image of your baby while a 4D scan is a real-time moving image of the baby. These scans may take around 30 minutes or longer depending on your baby’s position and movement. They may help to provide reassurance that the baby is growing well, but are not meant to replace the screening scans which are advised in the second trimester.
This is a recording of the fetal heart rate. It is performed to determine the baby’s well-being. It also helps to assess for the presence of uterine contractions.
Delivery and Postnatal Care
The 3 modes of delivery are normal vaginal delivery, assisted or instrumental delivery, and Caesarean. Most women are encouraged to try for a normal vaginal delivery. Occasionally, some require help with forceps or a vacuum cup. Others may require a Caesarean section.
Each mode of delivery has its benefits and risks. Every woman is unique with different pain thresholds and perceptions of how their delivery should be conducted. Do share with us your birth plan so that we can work with you towards the safe delivery of your child.
Following delivery, we are strong advocates of breastfeeding and will be happy to provide advice and support in this area.
FAQs on Obstetrics
Ensure that the obstetrician you choose is accredited, experienced, accepts the insurance you have, is located at a hospital that is convenient for you, and is someone that you feel comfortable and assured with.
Schedule an appointment with an obstetrician as soon as you find out you are pregnant, as antenatal care is vital for keeping you and your baby healthy. The earlier, the better, especially when it comes to managing potential complications.
In a healthy pregnancy, most women tend to have around 8 to 10 visits. In a high-risk pregnancy, however, the frequency of obstetrician visits will generally be higher.
A high-risk pregnancy is one that poses increased health risks for the pregnant woman, the foetus, or both. These include pregnancies with maternal health conditions, multiple pregnancies (e.g. twins), pregnancy complications, age-related risks and previous pregnancy complications. Extra medical care will usually be required to ensure the safety of both mother and baby.
If your morning sickness is minor, your obstetrician may suggest lifestyle changes such as getting sufficient rest, avoiding foods and smells that trigger your nausea, and consuming small, frequent meals. However, if your nausea is serious, you may be prescribed pregnancy-safe anti-sickness medications, or further interventions depending on how you respond to the treatment.
Common pregnancy complications include:
- High Blood Pressure: Narrowed arteries can reduce blood flow to the placenta, potentially slowing foetal growth and increasing risks for preterm labour and pre-eclampsia.
- Gestational Diabetes: This occurs when the body doesn’t produce or use insulin properly during pregnancy, leading to high blood sugar.
- Infections: Certain infections, including STIs, can affect both the mother and baby. Early testing and treatment can reduce risks like miscarriage and preterm labour.
- Preeclampsia: A serious condition marked by high blood pressure and organ damage; it can lead to preterm birth.
- Preterm Labor: Labour before 37 weeks increases health risks for the baby due to possible incomplete organ development.
- Pregnancy Loss: Pregnancy loss, encompassing miscarriage and stillbirth, refers to the loss of a foetus due to natural causes before or after 20 weeks of gestation, respectively.
Gynaecology Services We Provide
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3 Mount Elizabeth, #15-16,Mount Elizabeth Medical Centre, Singapore 228510
Tel: (65) 6235 5066Fax: (65) 6235 6455 Answering Service: (65) 6535 8833Email: info@healthfertility.com.sg
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