Obstetrics & Gynecology

VISION

The Department of Obstetrics and Gynecology of Asian Hospital and Medical Center will be the premier center for Obstetric and Gynecologic care globally, providing compassionate, competent, comprehensive, advanced and quality evidence-based reproductive healthcare.

MISSION

We, the Department of Obstetrics and Gynecology of Asian Hospital and Medical Center, composed of a team of highly motivated health professionals, promote the health and safety of women and their families. 

We

• Provide the highest quality of primary and specialty women’s health care with utmost compassion and integrity.
• Adhere to evidence-based practice in a cost-effective manner.
• Maintain the highest ethical and moral standards in our practice.
• Contribute actively to the advancement of women’s healthcare by engaging in research, training and education.
• Strive to pursue excellence and maintain competence through further training and specialization in newer and more advanced technology and by actively recruiting and accepting highly trained staff members.

We

• Promote and maintain the highest standard of patient care through ongoing, objective and systematic monitoring, review and evaluation of the quality and appropriateness of the delivery of patient care.
• Foster an interactive, learning environment where mutual respect exists, ideas are shared, collaboration & creativity are encouraged, and individual professional growth & advancement are continually reinforced. 
• Empower our patients and their families in intelligent decision-making by educating them with the available options of management.
• Extend culturally sensitive health service to women and their families regardless of their beliefs, orientation and financial status.

CORE VALUES

• Compassion
• Leadership
• Integrity
• Excellence
• Nurturing
• Teamwork

The Department is further divided into 7 subspecialties:

1. Section of Maternal and Fetal Medicine

Maternal and Fetal Medicine is the subspecialty of Obstetrics and Gynecology that focuses on the specialized and advanced care of the high risk pregnant woman. It aims to provide the highest quality care for both normal and complicated pregnancy in a collaborative setting with our colleagues in other multiple disciplines including Pediatrics, Endocrinology, Cardiology, Surgery and Anesthesia, the main objective of which is to improve pregnancy outcome.

• Conditions evaluated and/or treated may include:
  • Maternal conditions or diseases, including:
    1. Preeclampsia and its complications, and other hypertensive disorders in pregnancy 
    2. Maternal metabolic diseases, including diabetes (both pregestational and gestational types) 
    3. Infectious diseases (to include parvovirus, toxoplasmosis, hepatitis, HIV, and AIDS) 
    4. Platelet alloimmunization  (e.g. Rh negative mother sensitized to an Rh positive fetus) 
    5. Maternal lupus (collagen vascular disorder) 
    6. Poor past obstetrical history (e.g. past preterm deliveries, preterm labor, cervical  incompetence, premature rupture of membranes, recurrent pregnancy loss)
    7. Thrombophilia in pregnancy, including antiphospholipid antibody syndrome
  • Multiple gestation (twins and higher order multiples) 
  • A known/suspected fetal anomaly 
  • Abnormal fetal growth
    • Macrosomia
    • Fetal growth restriction
  • Problems with amniotic (oligohydramnios, polyhydramnios)
• Prenatal genetic testing and consultation, advising patients on the use of the following tests:
  • First trimester screening  (serum maternal biochemical screen and ultrasound)
  • Second trimester screening (serum maternal biochemical screen and ultrasound)
  • The need for invasive fetal testing procedure/s or other in utero therapeutic techniques(i.e., blood sampling/transfusion, platelet infusion, fetal bladder stent placement, chorionic villus sampling (CVS) or amniocentesis for maternal age, chromosomal analysis or other factors, amnioreduction / amnioinfusion, EXIT procedure.
• Services provided by Maternal-Fetal Medicine include:  
  • First trimester risk assessment for Down Syndrome and other aneuploidies 
  • Congenital Anomaly Scan 
  • Genetic testing and counselling 
  • Antenatal fetal surveillance
    • Non stress test
    • Contraction stress test
    • Biometry ( fetal growth monitoring )
    • Biophysical Profile Scoring
    • Doppler velocimetry studies 
  • Amnioreduction/amnioinfusion
  • External cephalic version
  • Cervical cerclage

2. Section of Reproductive Endocrinology, Infertility, and Gynecologic Endoscopy

Section of Reproductive Endocrinology, Infertility and Gynecologic Endoscopy promotes the understanding of the basic and intricate physiology of the female reproductive system and provides advanced knowledge in the diagnosis and management of genetic,anatomic, hormonal and immunologic conditions affecting female development, menstrual physiology, fertility potential and pregnancy. This service provides counselling, appropriate diagnostics and specialized interventional procedures using minimally invasive surgery (hysteroscopy and laparoscopy)and techniques for assisted reproduction.Members of the section accept outpatient and inpatient referrals, providing co-management and continuity of care of referred patients.

• To provide for the understanding of the following clinical conditions and formulate a treatment plan cognizant of the differing needs at every age group:
  • Amenorrhea
  • Abnormal uterine bleeding 
  • Contraception
  • Infertility
  • Perimenopause and Menopause
• To offer appropriate counselling, diagnostics and interventional options for patients exhibiting subfertility and infertility; diagnostic and interventional options encompassing, but not limited to 
  • Hysterosalpingography
  • Diagnostic hysteroscopy and laparoscopy
  • Hysteroscopic resection of endometrial masses (i.e. polyps, submucous myomas, uterine septa), lysis of uterine adhesions
  • Operative laparoscopy
  • Pelvic reconstructive surgery for congenital mullerian abnormalities affecting fertility potential
  • F. Assisted reproductive counselling, treatment planning and techniques
• To utilize minimally invasive surgery in the diagnosis and management of:
  • Chronic pelvic pain
  • Abnormal uterine bleeding
  • Uterine, ovarian and adnexal masses
  • Ectopic pregnancy
  • Congenital mullerian anomalies

3. Section of Gynecologic Oncology

Section of Gynecologic Oncology provides for the comprehensive evaluation and management of a woman suspected of or diagnosed with a gynecologic malignancy. Maintaining the highest standards in screening, diagnosis, surgical and medical treatment planning, the service addresses the woman’s concerns regarding clinical course of the disease, appropriate  and alternative treatment (to include chemotherapy and  radiotherapy),and  quality of life with expertise and empathy.

The section offers the following services:

• For the doctors
  • Provide regular updates to the physicians  in Asian Hospital and nearby hospitals
  • Assist in difficult and complicated gynecologic and obstetric surgeries
• For the patient:
  • To evaluate and manage patients seen at the Gynecologic – Dysplasia unit which is situated near the Breast Center
  • To evaluate and treat patients referred to the Cervical   Dysplasia Unit/ Colposcopy which is situated at the Genesis Center
  • To perform radical surgeries in gynecologic cancer patients and complicated surgeries in benign gynecologic patients
  • To perform chemotherapy in  gynecologic cancer patients
  • To perform radiation therapy in gynecologic cancer patients
  • To provide family therapy for the members of the gynecologic cancer patient
  • To build the confidence and well-being of the gynecologic cancer patients
  • To support and educate the different cancer support groups
  • To educate the public in disseminating cancer awareness
• For the hospital:
  • To make Asian Hospital a home to the cancer patient by providing quality health care
  • To make Asian Hospital a center which is capable in treating and diagnosing pre-cancer  gynecologic lesions
  • To make Asain Hospital a center for treating cancer patients
  • To make Asian Hospital  a center  which educates patients, the non-medical personnel and the medical personnel regarding new trends in cancer

4. Section of Ultrasonography

Section of Ultrasonography provides reliable, high quality, and professional sonographic services to obstetric and gynecologic patients. Using state of the art sonographic machines, competent and compassionate sonologists perform antenatal fetal ultrasound examinations as well as sonographic imaging of the female reproductive anatomy in order to aid the clinician in the management of common obstetric and gynecologic conditions.

Members of the section perform the following at the Center for Women’s Health

• Transvaginal Scan (TVS)
• Transrectal Scan (TRS)
• Transabdominal / Pelvic Scan
• First Trimester Scan
• Fetal Biometry
• Biophysical Profile Score (BPS)
• Congenital Anomaly Scan (CAS) / Targeted Scan
• Maternal and Fetal Doppler Velocimetry
• Placental / Color Doppler
• Obstetric 3D / 4D Ultrasound
• Follicle Monitoring
• Saline Infusion Hysterogram (SISH) / Hysterosalpingsonogram (HSSG)
• Gynecologic Doppler Study / Color Flow Mapping
• Gynecologic 3D Ultrasound

Members of the section perform the following at the Genesis Center: 

• Transvaginal Ultrasound (TVS)
• Transrectal Ultrasound (TRS)
• Transabdominal / Pelvic Scan
• Fetal Biometry / Determination of fetal presentation / Placental localization
• Biophysical Profile Score (BPS)
• Maternal and Fetal Doppler Velocimetry
• Placental / Color Doppler
• Ultrasound-Guidance for Obstetric and Gynecologic Procedures

5. Section of Gynecologic Infectious Diseases

Section of Infectious Diseases upholds the commitment to offer women, both pregnant and non-pregnant, suspected of and diagnosed with infectious diseases the updated and evidence based  management. The head of the section is likewise a member of the Infection Prevention and Control Committee (IPCC).

The head of the section represents the department in the IPCC monthly meetings as well as functions dictated by the IPCC head. The head also approves and promotes appropriate antibiotic use by the members of the department.

Members of the section:

• Establish and implement policies and procedures related to control of infections within the Department of Obstetrics and Gynecology.
• Establish and implement the surveillance system for evaluating and reporting infections  like surgical site infections (SSI) in patients of the department.
• Safeguards and promotes rational antibiotic use in AHMC.
• Provides the department with pertinent information, counsel and advise in relation to infection control.
• Conduct regular educational venues for hospital personnel with regard to infection control policies and other special issues.
• Answer referrals for infections in pregnant patients and for gynecological infections, its diagnosis and management.

6. Section of Trophoblastic Diseases

Section of Trophoblastic Diseases answers the need for specialized comprehensive care of women diagnosed with benign and malignant trophoblastic diseases. Management is  based on diagnostics and proper staging and risk scoring. The primary mode of treatment is chemotherapy and adjuvant modalities, which includes surgery and radiotherapy.

Trophoblastic Disease consultants:

• Answer referrals to administer Methotrexate Chemoprophylaxis after evacuation of molar pregnancies.  The patient is also counselled regarding follow-up after evacuation and chemoprophylaxis.
• Attend to patients with Postmolar Trophoblastic Neoplasia (increasing or plateauing levels of hCG and/or persistent bleeding after molar evacuation).
• Manage patients diagnosed to have Gestational Trophoblastic Neoplasia, properly staged and scored according to the FIGO 2000 Staging and WHO Prognostic Scoring System.  Treatment will entail administration of chemotherapy and adjuvant surgery if needed.
• May also assist attending obstetricians who are considering medical management of ectopic pregnancy using Methotrexate.

7. Section of Urogynecology & Pelvic Reconstructive Surgery

Urogynecology concerns problems of the female genital and lower urinary tracts, which, being in close proximity and having common embryologic origin, often have co-existent disorders. The subspecialty mainly concerns lower urinary and lower intestinal tract disorders associated with obstetric and/or gynecologic conditions.  This field deals with women with pelvic floor disorders such as pelvic organ prolapse, fecal incontinence, and bladder control problems, specifically urinary incontinence. They are, at present, aspects of women’s health that are frequently neglected or ignored. 

• The subspecialty of Urogynecology and Pelvic Reconstruction deals with disorders that include, but are not limited to, the following: 
  • Disorders of the pelvic floor (e.g. pelvic organ prolapse, post-hysterectomy vault prolapse, uterovaginal prolapse)
  • Dysfunctions of the urinary tract (e.g. urinary incontinence, voiding difficulties, bladder neuropathy)
  • Urinary tract disorders associated with gynaecologic conditions (e.g. benign and malignant diseases)
  • Benign urinary tract neoplasms (e.g. urethral diverticulum, urethral polyp, urethral caruncle)
  • Iatrogenic injury to the genitourinary tract (e.g. urogenital fistula, bladder injury)
  • Recurrent urinary tract infection
  • Functional disturbances of the lower bowel (e.g. fecal and flatal incontinence, disorders of motility)
  • Obstetric perineal tears, anal sphincter disruption, rectovaginal fistulae, and rectal prolapse
  • Congenital anomalies of the mullerian system (e.g. vaginal agenesis)
• The Section of Urogynecology aims to provide comprehensive evaluation and management of various pelvic floor disorders including urodynamic evaluation.
• The members of the section provide urogynecologic evaluation to any patient seen or referred by other attending physicians. Evaluation may include any of the following:
  • Pad test
  • Bladder diary
  • Swab/dye test
  • Bladder scan
  • Simple office cystometry
  • Uroflowmetry
  • Multi-channel cystometrogram (with or without EMG)
  • Pelvic organ prolapse grading system (POP-Q Scoring System)
  • Pelvic floor muscle testing (Oxford Grading Scale)
  • Endoscopic techniques: cystourethroscopy including biopsy
• The members of the section offer medical, non-medical/behavioural, and surgical therapeutic options to women with various forms of pelvic floor dysfunction. We also manage and/or co-manage patients with postoperative or postpartum voiding dysfunction.
• Patients for prolapse surgery with co-existing urinary incontinence may be co-managed by the members of the section together with their primary attending physician.
• Patients with obstetric/gynecologic conditions in whom bladder involvement is suspected may be co-managed by the members of the section together with their primary attending physician (e.g. placenta percreta, bladder adhesiolysis, etc).