S'pore doc on the immune system's role in helping a woman give birth

SINGAPORE - Dr Sheila Vasoo, 43, wanted to be a doctor so she could interact with patients and help them regain their health.

She opted for the speciality of rheumatology because many patients have disorders of the immune system, which can affect any organ in the body and show itself in subtle ways, such as joint pain, or in dramatic and devastating forms, such as organ failure.

The consultant physician and rheumatologist at The Choolani Clinic at Mount Elizabeth Novena Hospital said: "This challenges me to think broadly and deeply, and keeps me on my toes."

Her interest in reproductive immunology - the role of the immune system in promoting a healthy pregnancy - was ignited during a six-month training stint at St Thomas' Hospital in London.

There, the joy of couples with their newborns after enduring years of multiple miscarriages left an indelible impression on her.

When she returned to Singapore in 2005, she wanted to reach out to women who had recurrent miscarriages.

Research has shown that the problem affects only 3 per cent of couples who are trying to conceive, but she calls this "far too significant in terms of its psychological and emotional impact".

In 2009, she set up the pregnancy loss clinic at the National University Hospital (NUH) with Associate Professor Mahesh Choolani, a senior consultant at NUH's obstetrics and gynaecology department.

She joined Prof Choolani's private practice last November, but still returns to the NUH as a visiting consultant.

She is married to a 48-year-old emergency-medicine specialist. They have three sons aged eight, 13 and 14.

Dr Vasoo spoke at the free Pregnancy, Birth & Beyond forum at Mount Elizabeth Novena Hospital on Sunday from 2pm to 5pm.

I have an interest in reproductive immunology because...

This emerging field of medicine, first established 50 years ago, focuses on the immune system and the miracle of pregnancy.

Medical science has discovered that numerous changes occur in a mother's immune and blood systems to enable her to accept a foetus that has only half of her genetic make-up. A breakdown of these changes can lead to miscarriage.

The immune system is fascinating because...

It is so complex that it keeps me, as a doctor, humble.

The divine ability of the immune system to keep everything in check in our bodies, enabling us to fight off infections and foreign or cancerous cells, is astounding.

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

A detective. I try to leave no stone unturned as every clue counts.

I have learnt that it is so important to listen carefully to my patients.

Following a thorough review of their medical histories, tests are conducted in order to devise a management plan for the next pregnancy. Some of these tests include chromosome, genetics, hormonal and immune tests to find potentially treatable causes for recurrent miscarriages.

A typical day for me would...

Start at around 6am with a good cup of coffee and prayers. Then I'm off to the clinics or wards.

I also make time regularly for research meetings, to teach junior doctors at the National University Hospital (NUH) and discuss complex cases with my colleagues.

My workday usually ends around 6pm unless I have to attend to patients. I enjoy long after-dinner walks with my family, movie nights and discovering new food haunts.

Our family also sets aside time to travel - our last trip was to Sri Lanka last December.

I have come across all types of cases...

With a wide range of rheumatic diseases - from the benign, such as rheumatism, osteoarthritis, gout and osteoporosis, to more complex and serious conditions, such as rheumatoid arthritis and lupus.

My practice is unique as I also care for patients with recurrent miscarriages. This may be due to a condition known as "sticky blood" syndrome.

In a pregnant woman with "sticky blood", blood clots could clog up blood vessels running through the placenta and cut off blood flow to the baby.

I remember treating a woman in her 20s at the NUH who had "sticky blood". While most women can be treated with blood-thinning medication, that alone did not help her keep three pregnancies.

She had such resistant "sticky blood" that we had to put her on another therapy to block her antibodies so as to allow the blood-thinning medication to work.

With that, she finally carried her fourth baby to term.

I love patients who are...

Willing to understand their illness, thereby overcoming their fears and participating in their treatments with me.

Some patients with arthritis cannot accept that it is a chronic condition and that they have to be on lifelong medication, so they seek alternative therapies instead.

Patients who get my goat are...

Those who expect miracles or instant cures for their conditions. Unfortunately, there is none.

One little known fact about the role of the immune system in reproduction is...

There is a selective suppression of the immune system in the womb so that the foetus does not get rejected and yet the mother is able to robustly fight off infections during pregnancy.

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

Couples holding their newborns for the first time and patients getting back to life as it was before the onset of rheumatic disease.

It breaks my heart when...

A pregnancy ends in a miscarriage, more so if there are recurrent losses.

I would not trade places for the world because...

It is such a privilege to be a part of the lives of my patients.

My best tip...

Couples with recurrent miscarriages should know that they do not need to suffer alone.

With appropriate care and therapy, there is a good chance that their next pregnancy will succeed.

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