The 8th Singapore International Congress Of Obstetrics And Gynaecology

24 Aug 2011

By Dr Amy Khor
Venue: Raffles City Convention Centre

1. It gives me great pleasure to address you at the opening of the 8th Singapore International Congress of Obstetrics and Gynaecology.  I understand that the Congress is a 16-year old biennial event organised by the Obstetrical and Gynaecological Society of Singapore (OGSS) and is an important platform for local and international experts to share knowledge and exchange experiences.

Progress in Women’s and Children’s Health

2. The theme of this year’s Congress is Women’s Health in a Globalised World: Celebrating Differences, Embracing Diversity. I am glad to see the OGSS taking the initiative to discuss scientific issues pertinent to women’s health both in the local and international context.

3. Singapore has made great strides in the area of women’s health, having come a long way since the days of the first home-visiting service established specifically for mothers and children back in 1907. This home-visit service was eventually expanded to cover both rural and city areas and continued until 1960, resulting in the formation of the Maternal and Child Health Service (MCHS) in the Ministry of Health. The government’s commitment to protecting the health of our mothers and children has borne fruit - in 1957, the life expectancy at birth for women in Singapore was 63 years, in 2010 it was 84 years. This was ranked by the World Health Organisation (WHO) World Health Statistics 2011 report as being on par with Australia, Italy and Switzerland, and among the top 10 globally (joint 7 to 10th).  The World Health Statistics 2011 report also ranked Singapore’s adult mortality for women joint 3rd with Japan, behind only Italy and Cyprus.  We can also be proud of our low maternal mortality ratio, which is 8 per 100,000 live births and still-births.

4. Along with the improvement in women’s health is a corresponding improvement in children’s health. In 1931, our infant mortality rate was 191 per 1000 live births. Today,  we have one of the lowest infant mortality rates in the world, at 2 per 1000 live births. According to UNICEF data, almost 100% of our deliveries are carried out in the presence of a skilled attendant. These vast improvements in women’s and children’s health are a reflection of our progress as a nation, which is no surprise, but more importantly, our deliberate investment in a good healthcare system for our population.

Excellence in Clinical Services and Research

5. It is almost trite to say that a key part of what makes a healthcare system tick are its doctors and allied healthcare professionals. Here, as in many other fields, Singapore is greatly blessed with talent. The obstetricians and gynaecologists in our institutions lead in many areas of excellence. For example, in the area of gynaecology, the National University Hospital (NUH) and the Mount Elizabeth Medical Centre were amongst the first in Asia to go into robotic minimally invasive surgery (MIS).  KK Women’s and Children’s Hospital’s (KKWCH) Urogynaecology Centre was Asia’s first centre to perform the Tension-free Vaginal Tape obturator (TVT-O) procedure in 2004 for stress urinary incontinence, reducing recovery time and complications compared to standard surgery. In 2006, KK Hospital was the first in Southeast Asia to be accredited to treat uterine fibroids using non-invasive treatment guided by magnetic resonance imaging (MRI).

6. We have also achieved much in the area of fertility medicine. The first major achievement was in 1983, when the first in-vitro fertilization (IVF) baby in the whole of Asia was delivered in KK Hospital. In 1989, NUH followed that with the world’s first sub-zonal insemination (SUZI) micro-manipulation baby and again in 1997, the world’s first zona-free blastocyst transfer baby. In March this year, NUH opened the Centre for Reproductive Education and Specialist Training (CREST), the first training centre for fertility experts of its kind in the Asia Pacific region, to share Singapore’s knowledge on Assisted Reproductive Techniques with practioners from our region and beyond.

7. Our local research scientists have also made contributions to the field of reproductive medicine and stem cell research. Professor Ariff Bongso of NUS is one such example. In 1991, he developed the co-culture method, which enabled the growth of human embryos in a laboratory dish for up to 5 days to the blastocyst stage. This method was used widely by IVF programmes worldwide until recently. In 1992, Professor Bongso produced the world's first blastocyst transfer baby and increased pregnancy rates in childless couples significantly. In 1994, he became the first researcher in the world to derive embryonic stem cells from such 5-day-old human embryos. More recently in 2002, Professor Bongso achieved another breakthrough by being the first in the world to successfully derive and grow human embryonic stem cells completely on human feeders. This animal-free culture system avoids any risk of transmission of animal diseases to the human stem cells. I am proud to say that Professor Bongso’s achievements have made an impact on the lives of many childless couples worldwide.

8. We have also started centers of excellence in maternal-foetal medicine in our hospitals. The First Trimester Screen and Second Trimester Structural Anomaly Scans are now routinely offered to all pregnant women. The Singapore General Hospital also organises yearly courses for the management of high-risk pregnancies to keep our obstetricians abreast with the latest developments.

9. Aside from clinical research, I am glad to know that our doctors are fully engaged in the practice of evidence-based medicine. For example, our local obstetricians and gynaecologists have contributed to the Cochrane Review. The Cochrane Collaboration itself initially started in the area of obstetrics and the earliest Cochrane Reviews published pertained to care in pregnancy and childbirth and perinatal medicine. Examples of contributions from local authors include reviews on the use of oxytocin agonists for preventing postpartum haemorrhage, and use of tests to assess fetal wellbeing.

Evolving O & G healthcare landscape

10. A natural result of the advances in the practice of obstetrics and gynaecology is the development of subspecialty interests. Well-established subspecialty areas include gynaecology-oncology, maternal-fetal medicine, minimally invasive surgery and uro-gynaecology. Many obstetricians and gynaecologists now refer patients who might require a specific type of care to their relevant colleagues for further management. The demand for subspecialty care has also led to the establishment of subspecialty services in both the restructured and private sector hospitals.

11. However, increased subspecialisation has also given rise to dilemmas in current obstetric and gynaecological practice. As with other fields in medicine, increased interest in subspecialty areas may lead to fragmentation of care for our women. The patients may end up consulting multiple specialists for their problems, leading to lack of continuity of care and rising healthcare costs. We need to be wary of this phenomenon and work together to ensure that our specialists receive broad-based training and are able to manage the common obstetrical and gynaecological problems that our women may suffer from.

12.  Aside from ensuring that our doctors remain grounded and possess a broad-based set of skills, we also need to look at the way we practice medicine. Care of a patient is not merely the treatment of the acute medical condition but also includes management of related issues including their psychological and social needs. All of this cannot be done by the doctor alone. As doctors, you can help to lead our multi-disciplinary teams of allied healthcare professionals and nurses to better care for our patients holistically, in both the acute care sector and intermediate and long-term care sector.

13. The government will do our part to help clinicians provide patient-centric care. We are now preparing to roll out the National Electronic Health Records (NEHR), starting with our public sector hospitals.  When this happens, we can one big step closer to our vision of “One patient, one health record”. This will translate into a more holistic and consistent care for patients as doctors across the various sectors of care will eventually be able to access information on the same patient through just one record. An example would be a gynaecologist using the NEHR to monitor a patient’s cervical screening status, and to advise screening at an appropriate interval, and potentially minimizing morbidity and mortality resulting from undiagnosed cervical cancer.

Conclusion

14. It is my hope that our public and private doctors will continue to make strides in the field for the good of their patients, in clinical services and in research. I am honoured to have with us leaders at the cutting edge of obstetrics and gynaecology.  I am sure that the various symposia and plenary sessions scheduled can spur better obstetrical and gynaecological care to women locally, and across the world. I wish you a fruitful and successful congress.

15. Thank you.