Review Article
Pregnancy-associated breast cancer: Management of the mother, fetus and tumour
Breast cancer (BC) is the most common cancer affecting females worldwide, accounting for more than 50% of cancers in young females.1 It occurs in 1 in 3000–10,000 pregnancies, with reported incidence rising with delayed childbearing.2 The age standardised incidence rate in Singapore increased by 24.2% from 1993 to 2002.3...
Review Article
Premature ovarian insufficiency: When ovaries retire early
Illustration by LadyFingers Co.
Premature ovarian insufficiency (POI, also known as primary ovarian insufficiency) refers to loss of ovarian activity before the age of 40 years, leading to hypergonadotropic hypoestrogenism and 4 months or more of menstrual disturbance.1 In ovarian insufficiency, the ovarian dysfunction is not necessarily definitive, which is...
Commentary
Beyond BMI: The Janus-like effect of muscle versus fat on midlife women’s health
Janus—the Roman goddess of natural cycles, change and transitions—is an appropriate symbol for the life-changing shift from the reproductive period to the post-menopausal stage of life. Since the average age of menopause is 50 years,1 it is a universal life stage for long-living Singaporean women. The menopausal transition is...
Letter to the Editor
Infected ovarian endometrioma: Case series and management outcomes
Illustration by LadyFingers Co.
Dear Editor,
Infected endometrioma, which is the superimposed infection and abscess formation of ovarian endometrioma, is increasingly understood to be a distinct clinical entity from tubo-ovarian abscess (TOA). The pathophysiology of infected endometriosis has been postulated to be a result of endometriotic fluid acting as a culture...
Letter to the Editor
Group B Streptococcus screening with antenatal culture and intrapartum polymerase chain reaction: A prospective cohort study
Dear Editor,
Group B Streptococcus (GBS) is a common genital and gastrointestinal tract commensal in healthy women. Vertical transmission of GBS may cause neonatal early-onset GBS disease (EoGBS), and this is prevented by intrapartum antibiotic prophylaxis (IAP) GBS colonisation,1 coupled with long turnaround time of GBS culture, challenges the accuracy...
Review Article
Holistic preconception care: Providing real-time guidance via a mobile app to optimise maternal and child health
Global fertility rates have decreased by more than half since 1950, recorded at 2.3 births per woman in 2021.1 By 2056, this figure is projected to decline further to 2.09, which falls below the replacement fertility rate of 2.1 children per woman.1 In Singapore, the fertility rate has reached...
Review Article
Oocytes on ice: Exploring the advancements in elective egg freezing for women
Elective egg freezing (EEF), otherwise known as oocyte cryopreservation for age-related fertility loss, has become a viable option for single women to preserve their fertility.1 It is well known that female fertility decreases gradually, but significantly after the age of 32 and even more rapidly after age 37.2,3 As...
Editorial
Freezing hope: Balancing realism and optimism in elective egg freezing
The 2022 White Paper on Singapore Women’s Development, which aimed at a fair and inclusive society where both women and men can pursue their aspirations fully, announced the option for elective egg freezing (EEF) and that the age limit for EEF was planned to be set at 35 years....
Review Article
Polycystic ovary syndrome v.2023: Simplified diagnostic criteria for an East Asian phenotype
Polycystic ovary syndrome (PCOS) is a common endocrine condition affecting 6–19% of women of reproductive age, depending on the reference population and definition used.1,2 The incidence of PCOS is increasing and the syndrome can be considered the single most common endocrine abnormality among women of reproductive age.3 Although its...
Editorial
Enhancing the accuracy of polycystic ovary syndrome diagnosis
Polycystic ovary syndrome (PCOS) is the most common endocrine disorder, experienced by 1 in 10 women of childbearing age. Its aetiology is multifactorial and complex, and its clinical presentation is heterogeneous with menstrual irregularities, high levels of androgens and the presence of multiple follicles or cysts in the ovaries...
Letter to the Editor
A case series of higher-order multifetal pregnancies managed at a tertiary maternity unit
Dear Editor,
Delayed childbearing and increased use of assisted reproduction technology (ART) have resulted in a dramatic rise in the incidence of multifetal pregnancies. In 2022, the incidence of twin birth was 1 in 38.2 (932 live births) and triplet birth 1 in 1978 (18 live births) in Singapore.1 Preterm...
Editorial
Perinatal mental health in Singapore: Implementation opportunities and relevance of gender-carer roles in screening
In this issue of the Annals, the consensus statement on perinatal mental health by Chen et al. covers the handling of depression and anxiety symptoms in pregnancy, childbirth and the postnatal period.1 The guidelines were developed by a workgroup involving experts in perinatal mental health and obstetrics using a...
Original Article
Fetal congenital heart diseases: Diagnosis by anatomical scans, echocardiography and genetic tests
Congenital heart diseases (CHDs) are the most common major congenital anomaly at up to 28%1 and are responsible for 5.7% of all infant mortality.2 While earlier studies in developed countries reported an overall CHD birth prevalence of 3.7–5.54 per 1000 live births,3,4 more recent studies report a global and...
Letter to the Editor
Systemic methotrexate in the management of ectopic pregnancy and pregnancy of unknown location
Dear Editor,
Ectopic pregnancy (EP) occurs in 2% of all spontaneous conceptions. It can be a life-threatening condition and is the most common cause of mortality during the first trimester of pregnancy, contributing to 7% of all pregnancy-related deaths.1,2 The risk factors for EP include tubal damage following surgery or...
Original Article
Clinical efficacy of primary human papillomavirus (HPV) screening with partial genotyping for HPV-16 and HPV-18 subtypes in women from 25 years old
The World Health Organization has launched a campaign to eliminate cervical cancer on the basis of effective vaccines against oncogenic human papillomavirus (HPV) subtypes, with mass screening and eradication of high-grade pre-malignant lesions, cervical intraepithelial neoplasia grade-2 (CIN2) and grade-3 (CIN3).1,2 HPV-based screening has been shown to be sensitive...
Original Article
Association between body mass index, body image and self-esteem with sexual function: A survey of young women in Singapore
Satisfaction with sexual activity is a good predictor of global life satisfaction.1 Problems with sexual function can lead to lower partner satisfaction and affect a woman’s mental and physical health.2 The prevalence of sexual dysfunction in premenopausal women globally was found to be 40.9% (95% confidence interval 37.1–44.7).3...
Letter to the Editor
Robotic surgery in morbidly obese women with endometrial cancer in Singapore
Dear Editor,
The standard of care for endometrial cancer is a total hysterectomy with bilateral salpingo-oophorectomy, and pelvic lymph node dissection (THBSO-PLND). Obesity is a known risk factor for endometrial cancer, and obese patients are challenging to operate on due to their anatomy and comorbidities. A recent database search showed...
Original Article
Factors associated with deep infiltrating endometriosis, adenomyosis and ovarian endometrioma
Endometriosis is a chronic inflammatory gynaecologic disease marked by the presence of endometrial-like tissue outside the uterus.1 Debilitating chronic pelvic pain, dysmenorrhoea, and subfertility in women of reproductive age are commonly associated with endometriosis. The disease is estimated to affect about 1 in every 10 women of reproductive age,...
Letter to the Editor
Case studies of fetal mosaicisms detected by non-invasive prenatal testing
Dear Editor,
The American College of Medical Genetics and Genomics recommended that all pregnant women be offered non-invasive prenatal testing (NIPT) regardless of the patient’s risk profile.1 With increasing NIPT uptake, encounters with genetic conditions other than the 3 common fetal trisomies are becoming prevalent. We report 2 cases of...
Letter to the Editor
Telepalliative care during the pandemic: Lessons for the future
Dear Editor,
Mok et al. gave hope for cautious optimism for the acceptance of telemedicine for palliative care—which will be referred to as “telepalliative care” in this article—during the COVID-19 pandemic.1 Properly organised, telepalliative care can save time, provide flexibility, improve access for patients2,3 and possibly reduce the need for...
Others
Laparoscopic Telesurgery Between the United States and Singapore
Telemedicine is the use of telecommunication technologies to provide medical information and healthcare services. Early applications include medical use of the telephone and facsimile.
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Others
The Combined Oral Contraceptive Pill in Women Over Age Forty
In the 1970s, several studies appeared to suggest that users of oral contraceptives (OCs) were at increased risk of cardiovascular events. More recently following newer studies on lower dose OCs and re-analysis of the old studies, it was concluded that the risk of cardiovascular accidents was attributable primarily to...
Others
Caesarean Scar Pregnancy: A Diagnosis to Consider Carefully in Patients with Risk Factors
A uterine scar pregnancy is a gestation separated from the endometrial cavity and completely surrounded by the myometrium and the fibrous tissue of the scar. The most probable mechanism through which this can occur is invasion of the myometrium through a microscopic tract. The tract is believed to develop...
Letter to the Editor
Telemedicine for palliative care: Current and future challenges
Dear Editor,
We read with interest the article published in the June 2021 issue of the Annals titled “Use of telemedicine in healthcare during COVID-19 in Pakistan: Lessons, legislation challenges and future perspective”.1 We would like to share our perspectives on using telemedicine to deliver palliative care during the COVID-19...
Review Article
Teleophthalmology and its evolving role in a COVID-19 pandemic: A scoping review
The World Health Organization declared coronavirus disease 2019 (COVID-19) a Public Health Emergency of International Concern on 30 January 2020. To control the outbreak, many countries have implemented nationwide lockdowns and social distancing measures, which have brought challenges to accessibility of healthcare services and continuation of long-term medical care,...