The Pro

First look at baby

Ultrasonography allows Dr Chow to show unborn babies moving in real-time scans, which makes parents exclaim in joy and amazement. Several patients changed their minds about abortion after seeing their babies.
Ultrasonography allows Dr Chow to show unborn babies moving in real-time scans, which makes parents exclaim in joy and amazement. Several patients changed their minds about abortion after seeing their babies.ST PHOTO: AZMI ATHNI

Obstetrician and gynaecologist Chow Kah Kiong tells Joan Chew how he takes pictures of unborn babies.

Q. I specialise in ultrasonography because...

A. This is a safe and non-invasive imaging system that can be used on pregnant patients, even in the very early weeks of their pregnancies.

It allows the unborn child to be seen clearly in real time and can be safely repeated in order for senior doctors to adequately teach their juniors without harming the patient.

Ultrasound imaging has time and again defied doctors' predictions that it has seen better days.

Since its discovery in the late 1950s in Scotland, every decade has seen new advances.

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These include real-time imaging, vaginal ultrasound, Doppler studies, colour mapping and three-dimensional scans - features which add clarity and precision to its use.

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  • DR CHOW KAH KIONG

    Age: 65

    Occupation: Specialist in obstetrics and gynaecology at the Raffles Women's Centre in Raffles Hospital

    When Dr Chow was a trainee specialist doctor at the department of obstetrics and gynaecology at Alexandra Hospital (AH) 38 years ago, he was in charge of taking 10 women to Kandang Kerbau Hospital (KKH) every Wednesday.

    All these women had to be taken to KKH for an ultrasound scan for conditions ranging from pregnancy complications to gynaecology tumours. In those days, AH did not have an ultrasound scanner, but KKH had one.

    Apart from the logistics of transporting the patients, Dr Chow had to watch patients undergo the scans and then relate the findings to the senior doctors back at AH.

    He recalled: "An ultrasound scan was so important and influential in the management of the patients' conditions that every gynaecologist in the hospital wanted his or her patients to get on that bus as soon as possible.

    "It was this early realisation of the wonders of this diagnostic tool in the 70s that got me deeply interested to devote my career to ultrasound in obstetrics and gynaecology."

    Dr Chow, who has 34 years of experience as a specialist doctor, is married to a housewife. They have two sons and two daughters.

Q. In obstetrics and gynaecology, ultrasound is used…

A. To diagnose early pregnancy and its complications, and to pick up any abnormalities in the foetus and monitor its growth.

The image of the unborn child also enhances the bond with the mother and the rest of the family.

For other women, ultrasound allows the female reproductive organs to be imaged, examined and studied with unparalleled accuracy.

It is also an excellent tool to guide certain procedures in clinics and operating rooms, such as artificial reproductive therapy and test-tube baby procedures.

Q. The womb is fascinating because...

A. Its unique location beneath the bladder allows it to be very clearly seen on ultrasound, which is best done through a liquid medium.

Similarly, the unborn baby in the womb is also surrounded by amniotic fluid, making the baby clearly seen.

The womb can also be scanned by ultrasound through the vagina. This is invaluable for small targets in the womb like an early pregnancy, a foreign body in the cavity of the womb and changes in the inner lining (endometrium) of the womb.

Q. If I were to give an analogy for what I do, I would be...

A. A drone operator who captures images.

The female reproductive organs are akin to a very complex, irregular and yet delicate tunnel in the mountains.

The ultrasonography machine is like my drone, which I control and use to investigate and document the status of the conditions within the corners of these irregular caves and tunnels, as well as structures found in these cavities.

Q. A typical day for me...

A. After the hospital rounds, I see patients in the clinic.

Some afternoons are reserved for surgery and elective deliveries. My workday would be punctuated by urgent births, which are often unpredictable.

I also assist in running clinics with the ob-gyn ultrasonogaphy unit of the Raffles Women's Centre, conduct lectures and attend academic meetings with colleagues on a monthly basis.

Q. One little-known fact about the amniotic fluid in a pregnant womb is...

A. Its amount and nature reflect the health of the baby and the placenta. It is like the mileage meter of a car, telling you how much it has been used.

If a pregnant woman's abdomen is much smaller than expected, that can be due to a small baby as well as a reduced amount of amniotic fluid.

In fact, when the doctor documents the amount of fluid, he can easily distinguish between a "genetically" small baby who has a normal amount of amniotic fluid from a poorly growing one with a reduced amount of this fluid.

The amount of amniotic fluid also helps to diagnose and monitor conditions like diabetes and hypertension in pregnancy, as well as pick up congenital abnormalities in the unborn baby's brain, spine and gastro-intestinal tract.

Q. Things that put a smile on my face are...

A. Hearing the "wows" and "wahs" and even screams of joy and amazement from patients and their spouses when they see their moving babies on scans.

I have seen several patients change their minds about undergoing abortion after seeing their unborn babies.

Q. It breaks my heart...

A. When a patient decides not to continue her pregnancy after I have scanned her.

When I went into private practice, a close colleague and I decided we were free to stop practising abortion altogether, and I have never looked back.

Q. I love patients who are...

A. Knowledgeable and yet trust and accept my judgment, especially in situations where there are uncertainties.

In my practice of ultrasonography, two areas give the most uncertainties in diagnosis - congenital defects of the heart and the irregular thickening of the endometrium in an elderly woman.

Some congenital heart defects can be surgically corrected after birth, but a minor variation, which may not be obvious at the time of the prenatal scan, may make this impossible.

The irregular thickening of the inner lining of an asymptomatic elderly woman may be ominous (pre-cancerous or even cancerous) or totally benign and need no treatment.

An invasive procedure is used to tell this difference, but may be an unnecessary risk for an elderly woman if it turns out to be benign.

Q. My best tip...

A. For women trying to conceive is not to rush to have the ultrasound scan done when you miss your period. Too early a scan, no matter how well it is done, often casts more doubts and uncertainties than accords reassurance.

The current urine pregnancy test is very sensitive and can detect a pregnancy just a few days after the missed menses.

On the other hand, the unborn baby and its heart activity are usually seen two weeks after the missed menses.

When the baby is not visualised on the scan, an ectopic pregnancy and early miscarriage cannot be ruled out.

Hence, if a woman is well and pregnant, she should wait for a full two weeks after the missed menses before having the scan.

A version of this article appeared in the print edition of The Straits Times on April 19, 2016, with the headline 'First look at baby'. Print Edition | Subscribe