Pregnancies can still be risky, despite great advancements in patient care. Dr Kanika Chaudhuri, a specialist in high-risk pregnancies, offers HiDoc Pulse a glimpse at how handholding patients through their maternity journey forms a crucial part of the process.
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Any number of things can go right — or wrong — when a woman is pregnant. It’s why Dr Kanika approaches the care of women in the high-risk pregnancy category with vigilance at her clinic, Astra Women’s Specialists Centre in Toa Payoh.
She handholds them, which is no mean feat, considering she sees up to 480 patients a month at her premises. They range between 20 to 38 years of age, and she helps each one through a spectrum of issues from the time they are trying to conceive, to when they deliver their babies. Dr Kanika handles four to five deliveries (of which one will likely be a high-risk pregnancy) in a month here, and engages not only with local patients but also those based overseas in countries such as India and China.
What this translates to is her barely taking time off work. “As an obstetrician, I can’t leave my station. I need to be on-call 24/7 and be accessible to my patients — be it through in-person visits or emails — as they depend on me, especially when it nears their due dates. I can maybe take a holiday of seven to ten days in a year.”
“Obstetricians have very difficult lives,” she quips.
Jokes aside, she is driven by one thing: “I firmly believe in patient-centric care.”
“Not only do I put my patients first, I also help them make informed decisions about their health and am present for them during their time of need. As a result, my patients feel comfortable in sharing their medical concerns and challenges with me.”
A close level of engagement is especially important during the first and third trimesters, she adds.
Initially, she sees her patients every two to three weeks to review crucial medical tests (such as prenatal testing) to ensure a smooth start to the birthing journey. When patients are 36 weeks into the pregnancy, she consults with them weekly to get them ready for the delivery.
Undetected complications may spell trouble for mother and child
Dr Kanika notes that pregnancies become high risk among women who have previously suffered multiple miscarriages — they face complications that jeopardise the health of both mother and child such as pre-eclampsia, a high blood pressure disorder that, in severe cases, could lead to stroke or severe bleeding from the placenta. Risks are also greater when those who are trying to conceive already have pre-existing medical conditions such as essential hypertension (high blood pressure) or diabetes, which is increasingly common.
As diabetes causes fetal abnormalities of the heart and spine, it needs to be controlled and managed properly. Some patients (usually 35 to 38 years of age) do not even know they have such pre-existing medical conditions as these are diagnosed only after they have consulted with Dr Kanika and undergone the tests she has ordered for them. Of that group, a small number of younger women are even pregnant by the time she has identified such high-risk pregnancy factors for them. Dr Kanika explains that usually, women discovered to have pre-existing medical conditions belong to a more advanced age group that, for example, would be more likely to see endocrinologists to manage their health.
Where needed, Dr Kanika ropes in an endocrinologist within her network to work in tandem with her to manage her patients’ diabetic conditions and ensure the wellbeing of mother and child. “Having run a high-risk pregnancy clinic in a government-owned hospital for three years, I have the training and experience to know when I need to manage complications by liaising with doctors from other specialities such as endocrinology, haematology and rheumatology.”
Robust engagement with healthcare providers serves patients well
With so much of the digital space being dedicated to health and medicine, people might be tempted to utilise such resources to self-medicate and self-diagnose. Dr Kanika strongly cautions against doing so: “Such resources should not be the first port of call as patient education is so important and should not be distorted by online misinformation.” As an example, a teenager who consulted with Dr Kanika feared that she had a vaginal prolapse after reading about it online, a condition which is highly unlikely and which proved not to be the case for her.
Dr Kanika advises her patients to seek the help of clinic staff instead when it is needed: “My nurses care just as much as I do for my patients. They play a vital role in alleviating patients’ fears and clarifying any questions or doubts they may have. We all want the same thing — for the patient to have a comfortable birth free of complications.”
What to do next should misfortune strike
For Dr Kanika, the worst-case scenario for both the patient and her is definitely a miscarriage. When that unfortunate event happens, she will advise her patients to undergo investigative tests (to be done right after the miscarriage and before the next attempt at conception) to see if it was an abnormality with the foetus or chromosomal problems stemming from either parent which caused the miscarriage.
Chromosome carrier testing for both parents would especially benefit patients who have suffered three or more miscarriages. While it is not possible to find out the exact reason in some cases, such tests can rule out major problems to facilitate the next attempt at conception. In one in every five cases, she also treats patients suffering from coagulation issues due to antiphospholipid syndrome by getting them started on blood thinners before they try to conceive again.
Telemedicine as an extension of the doctor’s duty of care
Dr Kanika takes pains to make herself accessible to her patients at all hours — be it through in-person visits or emails. Telemedicine, the use of telecommunication and information technology to provide clinical healthcare remotely, is a new and accessible channel which patients can use to virtually consult with Dr Kanika. “When there is an option to consult with me online, it relieves the stress they experience from not knowing just what that pain or bleeding episode means should they be unable to consult with me in-person for a multitude of reasons,” Dr Kanika explains. Virtual consultations would benefit these four categories of patients:
1. Patients who deliver their babies overseas.
60–80% of Dr Kanika’s patients go back to their home countries (such as The Philippines, India, China, and Malaysia) for delivery but they would still prefer to involve her in their delivery due to the trust they have placed in her.
2. Proxies for patients
Some patients would consult with Dr Kanika on behalf of their sister, sister-in-law or even their mother. As these proxies are more often than not based overseas, they would benefit from virtual consulting as there is no need to fly to Singapore to physically consult with her on behalf of the actual person needing the medical advice. Dr Kanika’s working hours would also be freed up to see patients who turn up for in-person consultations regarding their own personal health issues.
3. Women who are overseas for holiday/work trips and who experience complications
Through telemedicine, Dr Kanika can be accessible to her patients, even those who may be in an entirely different continent from her. Virtual consulting with Dr Kanika would enable her holidaying patients to have ease of mind that, no matter where they are, they can seek her help with their electronic device.
4. Patients who wish to consult after clinic operating hours
Patients suffering from pain or bleeding episodes after clinic operating hours would benefit from virtual consulting as Dr Kanika can then advise them through the HiDoc app on whether there’s a need to go to the hospital or if it can wait till the next day to see her in her clinic. This also saves patients a trip to the A&E department (which can incur significant costs).
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