Clinical Services

Obstetrics & Gynaecology

Introduction

History

The Department of Obstetrics & Gynaecology, Queen Elizabeth Hospital, Hong Kong started its service since 1964. Today it has 126 beds (including first and second class beds) and over 250 dedicated staff. In May 2016, we had the honor of being designated as the first 'Baby Friendly Hospital' in Hong Kong.

Mission

• To improve women's health by providing compassionate high quality and personalized healthcare service through collaboration of professional staffs in our unit.
• To enhance life-long learning and continuous improvement for all health professionals in our unit through innovative training, accreditation and education.
• To support research in new advances in Obstetrics and Gynaecology.

Vision

We strive to provide the highest standards in obstetric, gynecologic, and reproductive health for women of all ages through excellence in clinical care, education, and medical research.

Scope of Services

• General Obstetric Service
• General Gynaecology Service
• Maternal & Fetal Medicine Service
• Gynae-Oncology Service
• Urogynaecology Service
• Reproduction Medicine Service
• Minimal Invasive Surgery Service
• Links of Scope Service

General Obstetric Service

Bearing in mind the target of being a client-friendly department, we have introduced the Husband Accompanying Labour program since 1994. This program encourages husbands to stay with their wives during delivery of their babies. The program was proven to be a great success.

Antenatal Education Program

To help couples have a smooth transition to parenthood, we have a series of comprehensive antenatal education program. The program is designed to meet the physical and emotional need of women and involves midwives, physiotherapists, social workers from voluntary agencies and aroma therapist.

Three categories of Antenatal Education Programs are planned to meet the needs of our clients:

1. Weekday evening & Saturday Antenatal Class – Series of 6 comprehensive talks booked on a first come first serve basis. (Free) <For details, please refer to below ( Link 1 )>
2. English Antenatal Class - for English speaking clients. (Please contact the midwives of our obstetric clinics) (Free)
3. There are also antenatal physiotherapy exercise classes organized by the Physiotherapy Department of QEH. You can enquire about the program with the obstetrician during the antenatal visit. (Chargeable)

Breastfeeding Promotion

We support successful breastfeeding in the following way:

1. Our staff is well trained to support breastfeeding.
2. In antenatal period, our midwives and nurses will provide comprehensive information and answer any question women may have on breastfeeding.
3. We will facilitate skin-to-skin contact of newborns soon after birth, we will be there to support and assist babies’ first breastfeeding.
4. Mothers will be shown how to hold their babies and breastfeed and express breastmilk correctly.
5. Mothers will be shown how to maintain lactation in case of temporary separation from their babies.
6. Most babies should be fed breastmilk exclusively in their first six months. If medical conditions require other food to be fed, our staff will explain the need and how to reduce the impact of supplementation.
7. Under normal circumstances, babies will stay with their mothers at all times. If babies have to be away temporarily for medical procedures, mothers are welcome to accompany them to minimize the separation as much as possible.
8. We encourage feeding whenever feeding responsively both to for hunger and comfort of the babies and mothers.
9. Teats, dummies and nipple shields are not recommended for breastfed babies.
10. Before leaving the hospital, we will provide a list of community resource and hotline services that support breastfeeding.

We have a Nurse Consultant (Breastfeeding) and her team in supporting mothers during their different stage of breastfeeding. We have a Hospital Authority accredited Midwife Clinic (Lactation) to provide breastfeeding counselling and treatment in lactation both for pregnant women and after delivery. There is a hotline 3506-6565 for breastfeeding enquiry.

Baby-Friendly Hospital

QEH is the first hospital in Hong Kong being designated as a “Baby-friendly Hospital” in May 2016 by the Baby-friendly Hospital Initiative Hong Kong Association (BFHIHKA) <For details, please refer to below ( Link 2 )> as supported by the United Nations Children’s Fund (“UNICEF”).

We firmly believe that breastfeeding offers enormous and irreplaceable health benefits to both mothers and children. The Hospital adopts the recommendations of the World Health Organization (“WHO”) and the UNICEF on promoting, protecting and supporting breastfeeding. This policy is based on the WHO’s “Ten Steps to Successful Breastfeeding” and “International Code of Marketing of Breast-milk Substitutes” with subsequent relevant WHO/World Health Assembly (“WHA”) resolutions. We actively initiate and implement mother and baby-friendly services for their well-beings. We will do our best to help parents make informed decisions on infant feeding and support their execution.

If mothers choose not to breastfeed we will discuss on their decision, and as an informed choice, they will be fully supported.

The Hospital Breastfeeding policy and QEH Baby-friendly Hospital movement <For details, please refer to below ( Link 3 )> information is available here.

Share Care System

Starting from October 1992, our department cooperates with the Department of Health to provide antenatal care to low risk pregnant ladies in the Maternal & Child Health Centres. Pregnant ladies who wish to have their deliveries in Queen Elizabeth Hospital must have the antenatal registration in the Outpatient Department of the Hospital in advance. Low risk mothers will be directed to regional Maternal Child Health Centres for subsequent antenatal visit till delivery. This program improves the quality of care and benefits our clients by saving them a lot of travelling time to the hospital.

Midwives Clinic

The Midwife Clinic has been set up since January 2000. The goal is to enhance continuity of care and to promote optimal health of the woman and her family during pregnancy and childbirth. In 2002, its function was further developed into continuous team midwifery model to look after clients throughout antepartum, intra-partum and postpartum periods with full support by the obstetricians. The Clinic is bounded to a low to moderate risk model of care. Specific guidelines and procedures have been established for practice. For any problems arises, the midwife will closely collaborate with obstetricians for consultation and referrals. The clinic also adopts the same clinical management protocols for pregnant women enrolled in the department.

Central Fetal Heart Monitoring System

Central monitoring of the fetal heart tracings for all clients in labour ward was introduced since 1994. The fetal heart patterns of all fetuses in labour can be observed with monitors located at the nursing station. Obstetrician can access the fetal heart tracings of labouring women via the web based surveillance system with the hospital. An alarm system will be activated when there is abnormal tracing. This facilitates early detection of babies at risk of developing intrapartum asphyxia.

Information Technology

Obstetric Clinical Information System (OBCIS) was used to capture in-patient obstetric clients’ clinical data since 1995. The system was developed by the IT Department of the Hospital Authority with inputs from clinicians and nursing staff. It facilitates record keeping, case note enquiry, report generation, auditing and decision making. The information is linked up with the Clinical Management System (CMS) in the hospital so that discharge diagnosis and procedure can be electronically transferred without writing a discharge summary.

The Antenatal Record System (ARS) was in place since 2013. The system captures obstetric out-patient clients’ information and has replaced the hard copy Obstetric Record. In 2017 the OBCIS and ARS would be integrated into a single system that capture data from obstetric patients’ booking to their postnatal checkup. There is also a plan to upload the data in the integrated system to the Electronic Patient Record (ePR) for sharing of information with other health care providers.

An Obstetric mobile apps is currently under development to provide information and educational materials to obstetric clients.

Counseling Service

We provide holistic care on the physical and psychological health of our clients. Started in 1996, we provide the systematic counseling service to our clients in liaison with multidiscipline. Our obstetricians and midwives are dedicated to provide psychological support to the mothers and families. Consultation to other specialists would be arrangement for individual needs.

General Gynaecology Service

Early Pregnancy Assessment Clinic

Pregnant ladies in their early pregnancy are prone to have complications like vaginal bleeding and abdominal pain. This can account up to 1% of cases in Accident and Emergency Department. These complications will generate a lot of anxiety for the client although most of them are minor and self-limiting. The majority of patients are stable and they want to seek opinion from Gynaecologist for fetal viability.

Early Pregnancy Assessment Clinic (EPAC) are set up to provide timely care to these pregnant ladies, yet not jeopardizing the quality of care. The opening hour of EPAC is 9:00-10:00am on every weekday except Public Holiday. It is run in the day Centre in Department of Obstetrics and Gynaecology (Ward B3). After consultation, around 80% of ladies can go home after clinic without hospitalization. A follow up appointment would be made for her if necessary, or she will be referred to antenatal clinic if fetal viability is confirmed.

Hormone Replacement Clinic

Hormone Replacement Clinic was in operation since May 1995. Women with natural or surgical menopause were assessed, managed and followed up in these clinics by dedicated doctors. Education, counselling and hormone-replacement therapy to menopausal ladies are offered in the clinic.

Day Surgery

The day surgery service within our department provide the platform for minor and intermediate procedures to be done in the day setting so patients get admitted in the morning, undergo the procedure and discharge home on the same day.

Under this setting, we perform procedures under general anaesthesia such as diagnostic hysteroscopy, dilatation and curettage, hysteroscopic polypectomies, endometrial ablations (radiofrequency bipolar endometrial ablation (NovaSure)). We also perform procedures under local anaethesia such as removal of benign vulva lesions or masses. Uncomplicated laparoscopic procedures such as laparoscopic sterilization, laparoscopic bilateral salpingoophrectomy and laparoscopic cystectomies are also performed at this setting.

Day surgical procedures are known to reduce hospital stay, operative complications and generally improve patient satisfactions which are all beneficial to the patients.

Outpatient Hysteroscopy

These are procedures within the uterine cavity aided by a camera looking directly into the uterus. Simple diagnostic hysteroscopy with the possibility of polyp removal and or endometrial sampling are done regularly in an outpatient setting. Procedures are done without anaesthesia to reduce risk for the patient and ensure patient can resume their daily life immediately without the need to stay in the hospital.

Information Technology

The Clinical Management System (CMS) is an integrated computer-based patient information system. It keeps track of the patients' location and movement as well as patients' diagnosis and procedures performed. It also caters for out-patient appointment booking and scheduling. Laboratory and radiology request, result enquiry and printing can be done easily. Patients' progress notes and plan of management can be entered for easy future reference. Scheduling of operations, preparation of operating lists and operation records can also be done in the system. Discharge summary, referral letter, sick leave certificate, drug prescription and consultation forms can be printed easily with the data stored in the system. It helps not only the clinical management of patients but also the collection of data and statistics for administrative purpose.

In the latest CMS version 3, In-patient Medication Order Entry (IPMOE) would also be available with the use of mobile devices.

Gynaecology was also the first specialty to offer out-patient new case booking through mobile apps.

Our department is one of the pioneering departments in paperless consultation since 2016. Gynaecology consultation summary would not be printed and kept in patient’s record after consultation. The move will not only be environmental- friendly but also relieve the problem of filing and storage of medical records.

Maternal & Fetal Medicine Service

The Maternal Fetal Medicine Team provides prenatal screening, diagnostic, therapeutic options and counselling services according to maternal and fetal conditions. The unit is accredited by the Hong Kong College of Obstetricians and Gynaecologists as the subspecialty training centre in Maternal Fetal Medicine. Our services include:

Prenatal Diagnosis and Counselling Services

Prenatal diagnosis and counselling is an integral part of our obstetric service. We offer prenatal counselling and diagnostic tests for pregnant women with positive Down syndrome screening, familial or hereditary problems. Various prenatal diagnostic procedures are performed, including chorionic villus sampling, amniocentesis and cordocentesis. Our team collaborates with the prenatal laboratories of two University hospitals and Government Clinical Genetic Service to provide comprehensive service in prenatal counselling and genetic testing. Joint counselling and assessment with specialists of multi-disciplinary teams is offered to expectant parents when a fetal anomaly or syndrome is diagnosed prenatally and formulate the care plan during the pregnancy and after delivery. We will offer planned delivery and fetal therapy as appropriate. Obstetricians and midwives of our team are dedicated to provide psychological support to these mothers and families from antenatal to postnatal periods.

Prenatal Screening

Down syndrome screening is offered and performed by qualified doctors and midwives to all eligible pregnant women.

First trimester combined Down syndrome screening is offered to pregnant women from 11 weeks to 13 weeks and 6 days of gestations.

Second trimester biochemical Down syndrome screening is offered to pregnant women from 16 weeks to 19 weeks and 6 days of gestations.

Fetal morphological assessment is performed by qualified doctors and midwives in the second trimester for low risk pregnancies to exclude major fetal anomalies.

Detailed Anomaly Scan

Detailed anomaly scan is provided to define various fetal anomalies. Fetal blood flow Doppler as well as colour Doppler studies can be performed whenever necessary. Apart from 2D ultrasonography, addition of 3D or 4D obstetric ultrasound examinations are used as appropriate to allow comprehensive assessment and accurate diagnosis of fetal structural anomalies to facilitate patient counselling on nature and severity of the problem.

Fetal assessment clinic

Fetal assessment clinic is set up in the Obstetric and Gynaecological Day Centre and dedicated for assessing fetal well-being of growth retarded fetuses and those high risk pregnancies with complicated medical problems or bad obstetric history. Fetuses requiring frequent monitoring are offered anomaly scans, fetal cardiotocography and fetal blood flow Doppler study whenever necessary.

Multiple Pregnancy Clinic

All multiple pregnancies are seen and managed in our one-stop specialized multiple pregnancy clinic. This clinic is run by the maternal and fetal medicine team composed of subspecialists and trained midwives to provide good quality patient-centered service including a comprehensive assessment according to a standard protocol, combination of ultrasound examination and antenatal visit, frequent monitoring of maternal and fetal well-beings, early detection of complications and management. Early dating, determination of chorionicity, Down syndrome screening, anomaly scans and growth scans are provided.

Fetal Therapy

In selected situations like fetal anaemia, pleural effusion, lower urinary tract obstruction, or polyhydramnios, offer fetal therapy such as in-utero transfusion, fetal chest or bladder aspiration or shunt, or amnioreduction.

Besides, in complicated multiple pregnancies like twin-twin transfusion syndrome, selective fetal abnormalities or growth restriction, offer fetoscopic laser photocoagulation, bipolar cord coagulation or selective reduction where appropriate.

High Risk Pregnancy Clinic

Specialized doctors are designated to look after pregnancies at risk of medical or fetal complications in the out-patient clinic. Close collaboration with other specialties to ensure high standard of care.

Gestational Diabetes Mellitus Clinic

Patient who are having established diabetes or gestational diabetes will have follow up in our gestational diabetes mellitus clinic. Their condition and glucose control are monitored by a group of obstetricians, midwives and dietitians. Referral to physician will also be made if necessary.

Gynae-Oncology Service

Introduction

The Gynaecological Oncology Division provides specialized care in the management of various gynaecological cancers. We are a tertiary referral centre and accept referrals from private gynaecologists, general out-patient clinics, private general practitioners, Department of Health (including Maternal and Child Health Centers), Well Women Clinics, Family Planning Association clinics and other specialties of the Hospital Authority (HA) hospitals, including gynaecologists from other HA Hospitals.

Women with pre-malignant or malignant conditions will be assessed and managed by our team members led by Gynae-Oncology subspecialist. We provide various out-patient clinics as well as in-patient services to our patients. Through multidisciplinary approach, we are able to provide management tailored to individual patients.

Oncology Case Manager

In order to improve patient care and to facilitate multidisciplinary treatment, a nurse led Cancer Case Manager Program was introduced in late 2012 and a case manager will be assigned to selected Gynaecological cancer patients.

Out-patient services include:

Colposcopic Service

• Colposcopy Clinic
  We provide diagnostic and therapeutic procedures (such as LEEP or cryotherapy) to patients with disorders of the lower genital tract
• Cervical Intraepithelial Neoplasia Clinic
  For aftercare of patients with pre-malignant conditions of the lower genital tract who need specialist care. For the low risk patients, shared care with the MCHC and FPA is available

Regular Clinical Meetings include:

• Colposcopy Rounds
• Cytology Histology and Colposcopy Review Meetings (with Pathologists)
• Clinical Pathological Conference

Oncology Service

• Oncology Clinic
  For assessment or follow-up management of patients with gynaecological malignancies
• Combined Oncology Assessment Clinic
  In this clinic, patients are assessed by gynae-oncologists, clinical oncologists and radiologists.
  A well-structured plan of management involving all specialists can be provided to the patients.
• Oncology Assessment Clinic
  For assessment of patients with suspected or newly diagnosed gynecological cancers.

In-patient services include:

• Designated in-patient beds

Gyaecological Surgery

• Open surgery
• Endoscopic surgery
• Robotic assisted surgery for suitable gynecological cancer patients

Clinical Oncology Referral

Patients requiring chemotherapy or radiation therapy will be managed by the Department of Clinical Oncology of our Hospital.

Urogynaecology Service

Introduction

Urogynaecology service has been started since 1991 as a tertiary referral centre which offers in- patient & out- patient service to female with pelvic organ dysfunction such as pelvic organ prolapse, urinary incontinence or bowel incontinence.

The team has been led by Urogynaecology subspecialists to provide a comprehensive & integrated care for therapeutic & prophylactic measures.

Urodynamic Study

It enables a detailed evaluation for patients with urinary incontinence & lower urinary tract symptoms (LUTS). Assessment tools include uroflometry, pressure-flow study, video-cystourethogram (VCU).

Other investigations such as cystoscopy, trans-perineal ultrasound of the pelvic floor, endoanal ultrasound and anal anal manometry are also available for the comprehensive investigation of the pelvic floor dysfunction.

Surgery for pelvic organ prolapse & Urodynamic stress incontinence

We aim to provide minimally invasive surgery to achieve ultimate satisfaction for our patients. For Urodynamic stress incontinence, Tension- free vaginal tape (TVT) has been used as a first-line treatment.

For pelvic organ prolapse, surgical treatment modalities are as follows

1. Vaginal Hysterectomy and Pelvic Floor Repair
2. Pelvic Floor Repair
3. Vaginal Mesh Repair
4. Sacrospinous Fixation
5. Open Sacrocolpopexy or Laparoscopy Sacrocolpopexy
6. Manchester’s Operation
7. Colpoclesis

Continence nurse‘s service

Conservative management in form of pelvic floor exercise, vaginal ring pessary, bladder training, biofeedback etc. is provided. Pre-operative counselling for clients who will undergo continence or pelvic organ prolapse surgeries and initial post-operative follow-up are conducted by specialized nurses. Other services include:

1. Teaching of pelvic floor exercise to strengthen pelvic floor muscle to decrease urinary incontinence
2. Teaching of bladder training to decrease frequency of urine & reduce urge incontinence
3. Teaching of clean intermittent self-catheterization for clients with voiding difficulty
4. Insertion of vaginal ring pessary for clients with pelvic organ prolapse
5. Teaching of biofeedback for clients with bowel incontinence

Reproduction Medicine Service

“Assisted Reproductive Unit” was licensed for Artificial Insemination by Husband under “Human Reproductive Technology Ordinance “since November 2008. We provide wide range of investigation and treatment for subfertile couples up to Artificial Insemination by Husband.

When you attend our Reproductive Medicine Clinic, doctors will perform different tests for you and your husband to identify the cause of infertility and treat accordingly. The success rate of treatment decreases with advancing age. We provide services for subfertile couples in outpatient basis. Under our treatment, around 15% of women successfully get pregnant.

There is no “Test Tube Baby” service in our hospital. If you want to have “Test Tube Baby” service directly, please take the referral letter to Kwong Wah Hospital, Queen Mary Hospital, Prince of Wales Hospital or private hospitals.

Assisted reporductive treatment would usually require a long period of time and may cause stress and psychological burden, which may further worsen the problem of infertility and decrease effectiveness of treatment.

There is evidence that psychological factors play an important role in infertility treatment. Couples with relaxed mood may get pregnant more easily.

Minimal Invasive Surgery Service

Introduction

Our gynaecological endoscopic surgery (GES) service was established since May 1994. The service we provide mainly include laparoscopic and hysteroscopic procedures. We aim to provide an alternative to open surgery, which is safer, less invasive, less discomfort and improve general the cosmetic appearance after surgery. This service also provides faster post-operative recovery, quicker return to work and social life and reduces hospital stay which is all beneficial to our patients. Our department also aims to thrive continuously by adapting newer surgical techniques established worldwide to ensure faster and safer procedure for our patients.

Over 250 cases of endoscopic surgeries are being performed in our department each year. A wide range of laparoscopic and hysteroscopic procedures are performed in our department and these are all performed by experienced gynaecological endoscopists accredited by the Hong Kong College of Obstetricians and Gynaecology.

Laparoscopy

These key-hole procedures involve surgery inside the abdominal cavity using minimal incisions on the abdomen. Our laparoscopic procedures range from those major laparoscopic operations such as total laparoscopic hysterectomies, laparoscopic myomectomies, and laparoscopic ovarian cystectomies to those less invasive such as laparoscopic sterilisations.

Hysteroscopy

These are procedures within the uterine cavity aided by a camera looking directly into the uterus. Simple diagnostic hysteroscopy, dilatation and curettage are done regularly while more advanced hysteroscopic surgery such as hysteroscopic resection of submucosal fibroid and hysteroscopic endometrial ablations are also performed. New surgical techniques such as the intrauterine morecellation of fibroid technique and radiofrequency bipolar endometrial ablation (NovaSure) have been incorporated into our service to promote faster and safer operations.

Links of Scope Service

Link 1: Antenatal Class : http://www3.ha.org.hk/qeh/antenatal_class_booking/default.asp

Link 2: BFHIHKA : http://www.babyfriendly.org.hk/en

Link 3: QEH Baby-friendly Hospital movement : http://www3.ha.org.hk/qeh/breastfeeding/main.html

Services Hours

Antenatal ward, Labour Ward and Postnatal Ward is providing 24 hours service to clients

Obstetric Clinic	Monday to Friday : 9am - 1pm; 2pm - 5pm Saturday : 9am - 1pm
Day Ward	Monday to Friday : 9am - 5pm Saturday : 9am - 1pm

Contact Us

Location	Telephone
Gynaecological wards	A2 (Tel: 3506-5011) C2 (Tel: 3506-6339)
Obstetric wards	C2 (Tel: 3506-6339) G2 (Tel: 3506-6321) E2 (Tel: 3506-6318)
Labour wards	B4 (Tel: 3506-6201)
Private ward (1st & 2nd class)	A11 (Tel: 3506-6343)
Day Care Centre	B3 (Tel: 3506-6341)
Operating Theatre	D2 (Tel: 3506-7622)
Secretary	Rm 14, H10 (Tel: 3506-6049)
Gynaecology & Obstetrics Clinic	4/F, Ambulatory Care Centre (Tel: 3506-6227)
L Block Gynae. & Obs. Clinic	1/F, L Block (Tel: 3506-6128)