I.M.

SECHENOV FIRST MOSCOW STATE MEDICAL UNIVERSITY

MEDICAL FACULTY
Division for Foreign Students with Instruction Conducted in
English
The Department of Public Health
And Medical Care Organization

COURSE TASK
Name : Colette Fong Jiin Yann
Group No : GROUP 86
Year : 4th Year
Group Instructor :
MOSCOW 2014

Thomson Medical Center Singapore

In 1979, Thomson Medical Centre, now known as Thomson Medical Pte. Ltd,
commenced operations, becoming a healthcare service provider known for our focus in
the areas of Obstetrics & Gynaecology and Paediatrics.

The birth of the flagship hospital, Thomson Medical Centre (TMC), centred on one mans
vision, renowned O&G specialist and Founder, Dr Cheng Wei Chens aim to make
delivery an enjoyable experience for women.

Carving out a unique identity of providing quality services with a personalized touch in a
friendly and cosy ambience, TMC has taken women on the amazing journey of
motherhood and embraced the birth of thousands of babies.

With an excellent pool of dedicated doctors and nurses, we have the expertise to care for
and support mothers through the joyous yet complex months of pregnancy and childbirth
and continue to encourage them by guiding them on how to care for their babies after
childbirth.

The organisation has grown tremendously in breadth and depth since then with new areas
of specialties and services; and has even extended its footprint into the region.
Throughout the years, Thomson Medical remains committed to developing lasting
partnerships with our patients and their families by delivering quality care and service
through our Thomson Touch.

Vision & Mission

Our Vision
To be a leading healthcare provider for women and children.
Our Mission
We celebrate life with our patients and their families by being an innovator of services that are unique,
relevant and integrated, and delivered through our Thomson Touch.
Our Brand Promise
Through our Thomson Touch, we aim to build long-term relationships. We believe in being life partners with
our patients and their families.
Our brand promise is to D.E.L.I.V.E.R

Delight
Empathise
Learn
Innovate
Value-add
Empower
Respect

Delighting by exceeding expectations

Caring with compassion
Learning and adopting best practices
Creating unique, relevant and integrated services
Providing outstanding services at affordable prices
Equipping customers with the knowledge to manage
their health effectively
Treating each customer with respect and dignity

Our Core Values

Our core values reflect what is truly important to us as an organisation.
I.C.A.R.E

Integrity
Commitment
Accountability
Respect
Empathy

We serve with the highest standards of ethical

conduct.
We are committed to contributing our best to
society and the organisation and achieving service
excellence.
We take ownership and responsibility for our
actions.
We treat our customers with respect and dignity.
We learn from those more knowledgeable than us.
We care for our patients, doctors, customers and
staff. Of paramount importance is their well-being
and we will always respond with compassion.

Gynecology is the management of hormonal disorders, treatment of infections and

training in surgery to correct or treat pelvic organ or urinary tract problem. Doctors will
offers preventive health care.

Ectopic pregnancy is in a leading position in the structure of morbidity of patients in this

organization.
Background information about this pathology:

In a normal pregnancy, your ovary releases an egg into your fallopian tube. If the egg
meets with a sperm, the fertilized egg moves into your uterus to attach to its lining and
continues to grow for the next 9 months.
But in up to 1 of every 50 pregnancies, the fertilized egg stays in your fallopian tube. In
that case, it's called an ectopic pregnancy or a tubal pregnancy. In rare cases, the fertilized
egg attaches to one of your ovaries, another organ in your abdomen, the cornua (or horn)
of the uterus or even the cervix. In any case, instead of celebrating your pregnancy, you
find your life is in danger. Ectopic pregnancies require emergency treatment.
Most often, ectopic pregnancy happens within the first few weeks of pregnancy. You
might not even know you're pregnant yet, so it can be a big shock. Doctors usually
discover it by the 8th week of pregnancy.
Ectopic pregnancies can be scary and sad. The baby probably can't survive -- though in
extremely rare cases he or she might. (This is not possible in a tubal pregnancy, cornual
or cervical ) So it's a loss that may take some time to get over. It may comfort you to
know that if you have an ectopic pregnancy, you'll likely be able to have a healthy
pregnancy in the future.

Symptoms of an Ectopic Pregnancy

Light vaginal bleeding

Nausea and vomiting with pain

Lower abdominal pain

Sharp abdominal cramps

Pain on one side of your body

Dizziness or weakness

Pain in your shoulder, neck, or rectum

If the fallopian tube ruptures, the pain and bleeding could be severe enough to cause
fainting.
If you are experiencing the symptoms listed above, contact your health care provider immediately
and go to the emergency room. Getting to the hospital quickly is important to reduce the risk of
hemorrhaging (severe bleeding) and to preserve your fertility.

Causes of an Ectopic Pregnancy

One cause of an ectopic pregnancy is a damaged fallopian tube that doesn't let a fertilized egg
into your uterus, so it implants in the fallopian tube or somewhere else.
You might not ever know what caused an ectopic pregnancy. But you are higher risk if you have:

Current use of an intrauterine device (IUD), a form of birth control.

History of pelvic inflammatory disease (PID)

Sexually-transmitted diseases such as chlamydia and gonorrhea

Congenital abnormality (problem present at birth) of the fallopian tube

History of pelvic surgery (because scarring may block the fertilized egg from leaving the
fallopian tube)

History of ectopic pregnancy

Unsuccessful tubal ligation (surgical sterilization) or tubal ligation reversal

Use of fertility drugs

Infertility treatments such as in vitro fertilization (IVF)

Diagnosing an Ectopic Pregnancy

Once you arrive at the hospital, a pregnancy test, a pelvic exam, and an ultrasound test may be
performed to view the uterus condition and fallopian tubes.
If an ectopic pregnancy has been confirmed, the health care provider will decide on the best
treatment based on your medical condition and your future plans for pregnancy.

Treating an Ectopic Pregnancy

If the doctor suspects that the fallopian tube has ruptured, emergency surgery is necessary to
stop the bleeding. In some cases, the fallopian tube and ovary may be damaged and will have to
be removed.

If the fallopian tube has not ruptured and the pregnancy has not progressed very far, laparoscopic
surgery may be all that is needed to remove the embryo and repair the damage. A laparoscope is
a thin, flexible instrument inserted through small incisions in the abdomen. During this surgery, a
tiny incision is made in the fallopian tube and the embryo is removed, preserving the fallopian
tubes integrity.

In some cases, medication may be used to stop the growth of pregnancy tissue. This treatment
option may be appropriate if the tube is not ruptured and the pregnancy has not progressed very
far.
After medical treatment for an ectopic pregnancy, you will usually have to have additional blood
tests to make sure that the entire tubal pregnancy was removed. The blood tests detect the hCG
level, the hormone that is produced during pregnancy.
Getting Pregnant After an Ectopic Pregnancy
Most women who have an ectopic pregnancy have normal pregnancies and births in the future,
even if a fallopian tube was removed. As long as you have one normally working fallopian tube,
you can get pregnant. If the ectopic pregnancy was caused by a treatable illness, such as a
sexually transmitted disease, getting treated for it can improve your chances of a successful
pregnancy. The infection is not what caused the ectopic it is the scarring that occurs due to the
infection. Treatment of the infection does not get rid of the damage already done.
Talk with your doctor about how long to wait after an ectopic pregnancy before trying to conceive
again. Some doctors suggest waiting 3 to 6 months.
After an ectopic pregnancy, take the time you need to heal your body and mind. Above all, don't
blame yourself. Counseling or pregnancy loss support groups can help you and your partner
cope. Ask your doctor about groups near you.

Social significant of ectopic pregnancy

Ectopic pregnancy cases are relatively uncommon in primary care. Although it comprises
only 2% of all pregnancies,2 the incidence has been on the rise.2,3 It is associated with
high mortality if diagnosis and management is delayed. Early intervention carries
significantly better prognosis.4 Even surgery can be avoided if management starts before
tubal rupture and cardiovascular compromise.1 Hence, it cannot be over emphasised that
early diagnosis is of paramount importance.
As illustrated in this case, diagnosis can be easily missed in absence of classical
symptoms of ectopic pregnancy compounded by incomplete patient assessment. The

presentations of ectopic pregnancy vary from subtle abdominal pain to profound

cardiovascular compromise. Common clinical presentations are as illustrated in Table1.
Approximately 43-55% of ectopic pregnancies do not present with the classical triad of
lower abdominal pain, period of amenorrhea and vaginal bleeding.3,5 Early symptoms
such as abdominal pain although the commonest, is not specific to ectopic pregancy6.
About 9-30% of women may not have abdominal pain at presentation.2,8 Differential
diagnoses for abdominal pain in a young lady includes appendicitis, miscarriages, pelvic
inflammatory disease and ovarian torsion.5 Absence of a period of amenorrhoea in
ectopic pregnancy is rather common and occurs in about 25% of cases.4,9 A detailed
menstrual history is important and any sudden change of menstrual pattern should alert
the physician to think of the possibility of tubal ectopic pregnancy even in the absence of
a clear period of amenorrhoea in women in the reproductive age group.

Table 1: Common clinical presentations of ectopic pregnancy

Signs and symptoms

Number (%)

Abdominal pain

90-97

Abdominal tenderness

87-91

Nausea or vomiting

80

Vaginal bleeding

79-83

Amenorrhea

75

Dizziness

55-60

Adnexal tenderness

54-57

Shoulder or neck or pleuritic pain

50

Cardiovascular compromise

50

Economic damaged cause by ectopic pregnancy in Singapore

The total cost of ectopic pregnancy in 1990 was estimated to be nearly $1.1 billion.
Direct costs of hospitalization and other medical treatment contributed 77% of the total

costs, with average hospital costs estimated to be $6079, hospitalization-related physician

fees $3254, and average outpatient costs $149, for a total direct cost-per-case of $9482.
Of the total indirect costs ($250.5 million), 67% was attributed to the value of lost wages
and the remainder to the lost value of household management. Public payment sources
covered the largest portion of ectopic pregnancy-related direct costs among women aged
19 and younger (35%), but private insurance covered the largest portion among women
aged 20-29 (32%) and women aged 30 and older (43%). In general, the proportion of
payments made by private insurance has decreased, while the proportion of payments
made by public pay sources and health maintenance organizations and preferred provider
organizations has increased.
Therefore in conclusion ectopic pregnancy results in a substantial economic burden, with
an increasing share of direct costs being borne by public pay sources. Appropriate use of
cost-effective management approaches can reduce costs, while preventive measures that
decrease the risk of ectopic pregnancy can both save resources and, more important,
spare human suffering.

Prevention measures taken by Thomson Medical Center Singapore

Primary measure : Giving talks to educate about the danger of ectopic pregnancy and
causes of it.
Secondary measures: Not encouraging patients to take birth control or using IVF . Giving
proper check up during pregnancy.
Tertiary measures : Giving proper health care for patients with ectopic pregnancy before
and after surgery.

SWOT-analysis of the medical organization

Strength
Access to capital
Marketing
IT investment

Weakness
Land-locked
Dont control patients

Opportunities
ACOs
Political influence
Mobile healthcare

Threats
Reimbursement
Physician shortage