Tony Tan Women and Fetal Clinic

30/03/2026

Spoke on 2 topics before the Obstetrical and Gynaecological Society of Singapore Annual General Meeting:

1. The use of continuous glucose monitor (CGM) in obstetric practice - can use in gestational diabetes mellitus to reduce rates of large for gestational age fetus whilst being careful to avoid overzealous control which may result in small for gestational age fetus. Best to combine the use of CGM with close ultrasound surveillance of the fetal growth for optimal control and growth. Need to set appropriate glucose targets that are individualized.

2. Real World Evidence of maternal RSV vaccination - effective in reducing risk of severe RSV infection to the infant < 3-6 months without any increase in risk of preterm birth.

27/03/2026

Being sedentary, when the cervix is short, increases the risk of preterm birth < 34 weeks.

"This prospective study used objective data collection of activity through an accelerometer in patients who are at risk for preterm birth. There was no association between latency to delivery and activity level in patients at risk for preterm birth with a short cervix. This study does not support the use of activity restriction in patients with an increased risk of preterm birth."

Read the full study for FREE at: https://journals.lww.com/greenjournal/fulltext/2026/04000/activity_restriction_in_pregnancy_and_the_risk_of.2.aspx

Listen to the Green Room podcast at: https://journals.lww.com/greenjournal/pages/podcastepisodes.aspx?podcastid=9

27/03/2026

We are attending a 3-day conference on Menopause. We learnt many things:

1. There are many menopausal symptoms that can be effectively treated with hormone replacement therapy.

2. There are different preparations available for hormone replacement therapy - some do not increase the risk of venous thromboembolism and breast cancer.

3. Increasingly, more and more patients are asking to be on hormone replacement therapy for symptoms like hot flushes, prevention of osteoporosis, for sexual dysfunction, and for healthy longevity.

4. The FDA US black box warning on the risks of hormone replacement therapy has been removed in Feb 2026 as the risks stated in the black box warning are now thought to be over-exaggerated.

Soon, at least in Singapore, there will be more menopausal women than pregnant women. All gynaecologists will have to be more well versed with managing perimenopausal and menopausal women.

27/03/2026

Another study to show that doing 2 scans routinely at 28-32 weeks and 35-37 weeks (compared to doing 1 scan at 28-32 weeks only) in low risk pregnancies is better at detecting small for gestational age fetus and reducing admissions to ICU for the newborn baby.

That shouldn’t surprise any of us. This is now one of increasing number of studies showing this.

We do this routinely as T3a (28-32 weeks) and T3b (35-37 weeks).

https://www.facebook.com/share/1LStS8GyLf/?mibextid=wwXIfr

Single versus longitudinal scans in the third trimester: a multicenter randomized clinical trial on screening for late-onset intrauterine fetal growth restriction (The RCT on Evaluation of LAte Iugr Screening study) https://ow.ly/C15l50Yz32q

26/03/2026

Induction of labour (compared to waiting longer either for labour to start spontaneously or eventually requiring an induction of labour later on) in pregnancies where the fetal abdominal circumference or estimated fetal weight is > 90th centile at 38+0 to 38+4 weeks reduces the risk of Caesarean section, and probably the risk of shoulder dystocia as well.

https://www.facebook.com/share/p/1HMmhtakPq/?mibextid=wwXIfr

🚨 Hot off the press from AJOG MFM! 🚨

Can early induction make a difference for pregnancies with suspected large-for-gestational-age (LGA) or macrosomic babies? This new meta-analysis of 5 RCTs (n=4,083) says YES!

✨ Key findings:
• Inducing labor at 38 weeks cut cesarean deliveries by 13%
• Fewer cases of macrosomia (≥4000g and ≥4500g)
• Promising trends: less shoulder dystocia and fewer neonatal fractures
• No rise in major maternal or neonatal complications

🔑 Bottom line: Induction between 38⁰/₇ and 38⁴/₇ weeks is a safe, effective option for LGA pregnancies—about 25 inductions needed to prevent 1 cesarean delivery.

Dive into the full study here: https://ow.ly/T6Uz50YyRjl

21/03/2026

Live ultrasound demonstration at the course.

21/03/2026

Gave 4 lectures in Phnom Penh on:
1. First Trimester Scan - Not just NT only
2. Second Trimester Scan - transvaginal cervical length should be done routinely
3. Third Trimester Scan - diagnosing and managing fetal growth restriction
4. Twin pregnancies - why we need to know the chorionicity.

The participants asked very good questions.

19/03/2026

When the risk of pre-eclampsia at first trimester scan is >= 1:100, aspirin 150 mg every night is given till 36 weeks. When the initial risk is >= 1:20, it is rare to have to deliver such patients at < 35 weeks. When the initial risk is 1:21-1:100, almost all babies will deliver after 37 weeks.

So aspirin works to reduce risk of pre-eclampsia requiring delivery at < 37 weeks.

The effect of aspirin on the risk of preeclampsia based on the Fetal Medicine Foundation first-trimester risk https://ow.ly/H9u650Yw6ze

18/03/2026

We played badminton today. There were more rallies when we played badminton than when we played pickle ball.

17/03/2026

Mothers should keep themselves mentally well. Fathers also have a role in keeping mothers mentally well. This is associated with better cognitive abilities in pre-schoolers as such mothers tend to set boundaries appropriately and communicate better.

16/03/2026

Pregnant women with Hepatitis B infection should have the viral load measured. Antiviral medications during pregnancy can reduce the viral load and reduce the rate of transmission to the baby.

Access our latest patient education fact sheet on Hepatitis B and Pregnancy. Hepatitis B is a serious liver infection caused by the hepatitis B virus (HBV). While there is no cure, treatment can help manage the infection and reduce the risk of long-term health problems. A safe and effective vaccine is also available to protect against hepatitis B infection.

Access this resource and help your patients stay informed: https://www.highriskpregnancyinfo.org/hbv

14/03/2026

Useful chart to decide on timing of delivery of early onset fetal growth restriction based on Doppler findings.

The risk of fetal death is low when there is no persistent reversed end diastolic flow in the umbilical artery or absent/reversed “a” wave in the ductus venosus.

Umbilical Artery Doppler Deterioration, Time to Delivery, and Risk of Fetal Death in Early-Onset Severe Fetal Growth Restriction Progressing to Absent or Reversed End-Diastolic Flow https://ow.ly/e3lh50YtYAT