Speech by Dr Lam Pin Min, Minister of State for Health at the 13th Singapore ISUOG Course in conjunction with the Combined Scientific Meeting of College of O&G, 10 February 2017

Professor George Yeo, Chairman, Organising Committee of the 13^th Singapore International Society of Ultrasound in Obstetrics & Gynaecology (ISUOG) Course in conjunction with the Combined Scientific Meeting of College of O&G 

Professor Arijit Biswas, President, College of Obstetrics & Gynaecology, Singapore 

Professor Tan Lay Kok, President, Obstetrics & Gynaecology Society of Singapore 

Ladies and Gentlemen 

Good morning.

          It is my pleasure to join you all at the opening ceremony of the 13^th Singapore ISUOG Course, in conjunction with the combined Scientific Meeting of the College of O&G, Singapore and O&G Society of Singapore. I would like to extend a warm welcome to all our friends and colleagues from Singapore and overseas.

2        The Singapore ISUOG course serves as a model of ultrasound education for the obstetrics and gynaecology (O&G) residents in Singapore, delivering up to date education for O&G practitioners locally and in the region.

Optimising pregnancy outcomes and maximising Singapore’s population

3        Singapore is one of the safest places in the world to be a mother and to be born. We have one of the lowest neonatal and infant mortality rates in the world. In 2015, our maternal mortality rate (MMR) was 7 per 100,000 live and still births, and our infant mortality rate was 1.7 per 1,000 resident live births.

4        The O&G community plays a key role in helping to optimise pregnancy outcomes and, in turn, Singapore’s population. O&G professionals leverage advancements in obstetric care, as well as the appropriate use of technology, to help maximise Singapore’s population in the face of falling birth rates. However, declining fertility rate is a common challenge faced by many developed countries, including Singapore. One of the factors behind the declining fertility rate is that many couples are opting to have children later in life and thus having fewer children.

5        There are also couples who need help to conceive. Assisted Reproduction (AR) treatment in Singapore has been on the rise, with the number of patients on AR treatment cycles increasing from 4,450 in 2010 to more than 6,000 in 2014^[1]. Improved techniques in AR, such as In-Vitro Fertilisation (IVF) have changed the reproductive landscape, and helped couples conceive.  Refined procedures such as single embryo transfers, and advances in prenatal diagnosis and obstetric medicine have also reduced the complications and risks of AR treatments. Pre-implantation Genetic Diagnosis (PGD), a procedure used to identify the genetic abnormality in embryos created through IVF before the embryo is implanted, is currently available at the National University Hospital. Parents who are carriers of a known genetic abnormality may opt for a PGD test to avoid transferring affected embryos for implantation.

6        Besides PGD, MOH has approved the launch of a three-year pilot study on Pre-implantation Genetic Screening (PGS). PGS does not screen for genetic diseases by detecting genetic abnormality. Instead, PGS is designed to assess the number of chromosomes in each embryo, and then select embryos with the correct number of chromosomes for transfer. PGS will be offered as a pilot service in the first quarter of 2017 to eligible patients. MOH will monitor the pilot and review the clinical outcomes and clinical effectiveness of PGS in improving live birth rates in AR pregnancies.

7        In the last five years, molecular genetics have become an established standard practice. Non-invasive prenatal tests for aneuploidy can now be performed as early as 10 weeks into a patient’s pregnancy. With contemporary ultrasound practice, about 20 to 40 percent of structural abnormalities can be detected early in the first trimester where more efficient prenatal diagnostic strategies can be deployed to mitigate the disadvantages of older mothers. Advancements in ultrasound expertise have expanded the use of these scans to also screen for other pregnancy-related problems.

8        Good antenatal care is the key to ensure that babies are given the best possible start in life. The practice of obstetrics has evolved from focusing on the safe delivery for the mother and child, and the management of labour-related complications to more advanced medical care for both the mother and the foetus during the pregnancy itself, through the continuously advancing fields of foetal and maternal medicine. Various new technologies and treatment options are now available to improve the perinatal outcome for our new born babies.

New developments in prenatal testing

9        The field of O&G continues to innovate and improve its current processes and procedures. Non-invasive prenatal testing (NIPT) involves sending a blood sample taken from the mother to the laboratory for analysis to determine the risk of chromosomal abnormalities in the foetus. It is done after 10 weeks into the pregnancy, which is earlier than most prenatal screening or diagnostic tests. I am happy to share that as part of a pilot under MOH’s Health Service Development Programme (HSDP), a Non-Invasive Prenatal Testing (NIPT) laboratory will be sited in KKH in early 2017. Prior to the setting up of this lab, such tests were sent overseas for analysis. I understand that one of the sessions at this Congress will cover pretest counseling and clinical updates on NIPT.

10        With the ability for better prenatal and antenatal testing, there would also be a need for new technologies and treatment options to improve the perinatal outcome for our new born babies. The Fetal Therapy Symposium will provide the platform to update you with these prenatal therapeutic options.

O&G’s Role in Disease Prevention

11        Apart from antenatal care, the O&G specialist in Singapore also has an important role in disease prevention. In April 2016, Health Minister Mr Gan Kim Yong declared War on Diabetes. One aspect of diabetes unique to women is gestational diabetes mellitus (GDM). An estimated 20 percent of pregnant women will develop gestational diabetes mellitus (GDM) during their pregnancy. These women and their babies have a higher risk of complications during their pregnancy and will require closer care. Even after delivery, they will still be at a higher risk of developing type 2 diabetes. Hence it is important for pregnant women to maintain a healthy lifestyle and weight, eat healthily, and to exercise regularly. They should also be screened for gestational diabetes during pregnancy. Once diagnosed, it is essential to ensure they receive regular follow-up with their primary care physicians after delivery, as they are at higher risk of developing diabetes later in life.

12        O&G specialists have also played a key role in the prevention and management of cervical cancer. With higher uptake of Pap smear screening and better treatment, the mortality rate for cervical cancer in Singapore has steadily fallen from 6.5 in the late 1970s to 2.3 per 100,000 in 2014. These achievements are testament to our dedicated and well-trained professionals, sound policies and good medical facilities. New developments in HPV DNA screening and the availability of a vaccine for the prevention of cervical cancer have also contributed to the reduction in the number of women being diagnosed with cervical cancer.

Conclusion

13        I am pleased to note that in October 2018, Singapore will be hosting the 28^th ISUOG World Congress. To our friends from abroad, do take the time to enjoy the sights and good food of Singapore. I wish you a fruitful conference. 

Thank you.

^[1] There were 6,197 patients on AR treatment in 2014.