A new Professorship named after Singapore’s “Father of O&G” has been conferred on Professor Tan Kok Hian, Head and Senior Consultant, Perinatal Audit and Epidemiology Unit, Department of Maternal Fetal Medicine, KK Women’s and Children’s Hospital (KKH). The Benjamin Henry Sheares Professorship in Obstetrics & Gynaecology will support medical research, education and advances in clinical care to prevent and manage complications in pregnancy so as to protect mothers and give their babies the best start in life.
How have maternal mortality rates in Singapore improved over the decades?
The number of women dying during pregnancy or childbirth has dropped significantly in Singapore over the past 80 years. Much of the improvement can be attributed to the pioneering work of Professor Benjamin Sheares when he headed the then Kandang Kerbau Hospital in the late 1940s and 1950s. These included developing a safer Caesarean section (C-section) technique and researching better ways to diagnose and manage pre-eclampsia, a severe form of high blood pressure that can be lethal to a mother and her unborn baby.
The advances driven by Prof Sheares helped to drastically reduce maternal deaths from 800 per 100,000 deliveries to below 50 per 100,000 deliveries within a short period of time, and put Singapore on the international map for Obstetrics & Gynaecology (O&G). Prof Sheares was also a strong believer in medical education. He taught a generation of O&G specialists who built on his legacy of safer care for mothers and babies.
What are some of the challenges in maternal health today?
Today the maternal mortality rate in Singapore is less than 10 per 100,000 deliveries, which is similar to the UK. However, we are now seeing different challenges that have a significant impact on the health of pregnant women and their newborns. Rising obesity levels and the growing number of mothers having children over the age of 35 increase the risk of pre-eclampsia and gestational diabetes mellitus (GDM), a form of diabetes that only occurs during pregnancy. With this Professorship, I intend to build on my previous research for these conditions so we can further improve healthcare for pregnant women and their newborns.
What prompted you to study pre-eclampsia initially?
When I was training to be a specialist in the late 1980s, I was on call when a pregnant patient who was near full term, suddenly developed severe pre-eclampsia. As we were preparing her for emergency C-section, she suddenly went blind because the back portion of her brain which is responsible for vision became bloated (edematous). After I completed the C-section, her vision returned but unfortunately, we were unable to save her baby.
I followed up with her over the years because of a chronic kidney problem she had developed from pre-eclampsia. Through my consultations with her, I learnt that she did not try to conceive again for fear of a similar experience. This affected me deeply. From this, I wanted to achieve two things to prevent such tragedy – 1) to better predict and detect severe pre-eclampsia and 2) to enhance our system to perform an emergency C-section as fast as possible, to save lives, in life threatening situation for the baby or mother.
What have you done to improve the speed of emergency C-sections?
Every minute counts in a ‘crash’ C-section for such dire emergency situations and can make the difference between life and death for a mother and/or her baby. The international norm for delivery of a baby from an emergency C-section is usually between 20 to 30 minutes. However, here at KKH, we have managed to cut the time taken to perform the procedure (from the time the decision is made to the time the baby is delivered) to under 15 minutes consistently, averaging 10 minutes.
Previously, when a life-threatening complication occurred during a delivery, the labour nurse would have to call the different departments to notify the different specialists, such as the obstetrician, neonatologist and anaesthetist. To address this problem, we came up with a well-designed Code Green system, which when activated, will effectively mobilise a team of ready staff including specialists, nurses and porters; and the patient, to the operating theatre in shortest possible time. The reduction in time taken to deliver the baby from a ‘crash’ C-section has dramatically improved a baby’s chance of survival.
We were recognised by the World Health Organization (WHO-UAE Health Foundation Prize 2009) for our labour ward’s best practices including our ability to carry out such speedy emergency C-sections when required. While we appreciate this recognition, the greatest satisfaction comes from seeing the difference it makes to patients’ lives. I remember a patient who had severe pre-eclampsia and abruption. This is a condition where the placenta separates away from the womb lining before the baby is born. In such situations the prognosis of the baby in general, is very poor, but because of the Code Green system which we had developed, both mother and baby survived and did well. This was deeply satisfying to us.
How will the Benjamin Henry Sheares Professorship in Obstetrics & Gynaecology enable you to further your research?
My research will focus on pre-eclampsia and GDM because both of these conditions not only cause considerable risks to pregnant women and their babies but also impact the intergenerational population health of our nation.
Pre-eclampsia affects about 5 in 100 pregnant women in Singapore, and in serious cases, can lead to severe problems. It can cause a fetus to have a slower growth rate or be delivered pre-term because of inadequate blood, oxygen or nutrients. It can also cause the placenta to prematurely separate from the uterus, which can cause heavy bleeding and can be life-threatening for both the mother and baby. Pregnant women with pre-eclampsia are also at a higher risk of type-2 diabetes and cardiovascular disease. We are developing the use of novel biomarkers for clinical care so that we can detect women who are at risk of developing pre-eclampsia and diagnose it as early as possible. Monitoring with these new biomarkers and prompt treatment in the early stages of the condition means that we can prevent serious complications in the mother and help her baby to develop and grow well in the womb.
GDM occurs in about one in four to five pregnancies in Singapore and can lead to both short-term and lifelong health problems for mother and baby. If the mother’s blood sugar levels are not properly managed, the baby can suffer from complications such as excessive birth weight and respiratory distress syndrome. I pioneered the introduction of routine GDM screening programme and adoption of the new screening criteria for GDM in Singapore. Currently, I am studying and developing better models of care for GDM care to reduce the risks of developing chronic diabetes from GDM and to improve the health of the next generation. From the research findings, I am leading the development and dissemination of national guidelines on GDM including lifestyle changes in exercise and nutrition for pregnant mothers.
What does being conferred this Professorship mean to you?
While working as the chief editor of a book on the history of O&G (The History of Obstetrics and Gynaecology in Singapore), I developed a deep appreciation for the many sterling efforts Prof Sheares made to improve and promote the care of mothers and children of Singapore. The book contained a 50-page edited write-up on him, and I was inspired by his research on pre-eclampsia and pioneering work on C-sections and gynaecology surgery. It is an honour to be conferred a Professorship named after the ‘Father of O&G’ in Singapore and to be able to build on his legacy of clinical research and education. Hopefully the continuation of his legacy can further inspire future generations of O&G doctors.
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