We sat down with QUFW co-owner, Dr. Jackie Chua, to learn more about her unique contribution to obstetrics and gynaecology in Queensland, her passion for women’s health, the vision she has for QUFW, and more.
Dr. Jackie Chua is a RANZCOG-accredited sub-specialised Obstetrics and Gynaecology sonologist. She is currently the Head of Discipline in Obstetrics and Gynaecology for the Diploma of Diagnostic Ultrasound for the Australasian Society for Ultrasound in Medicine. She also represents Queensland on the COGU subcommittee at RANZCOG and the Australian Association for Obstetrical and Gynaecological Ultrasonologists committee. Dr. Chua has a special interest in fertility scanning and endometriosis assessment, and is the co-owner of QUFW.
Dr. Jackie Chua’s story is an inspiring blend of familial legacy, relentless self-education, and an unyielding advocacy for women’s health.
As we sit down to speak, it doesn’t take long for Dr. Chua to demonstrate why she has become an accomplished figure in Australia’s obstetrics and gynaecology space. Like many groundbreaking clinicians, her career ‘formula’ is unique. And it began with an origin story that started much earlier than her peers.
An early interest in obstetrics and gynaecology
Dr. Chua’s father, a medical school graduate from the University of Queensland, and her mother, a nurse from Toowoomba, instilled strong family values in their daughter from a young age. Moving from Australia to a small Canadian town when she was six months old, Dr. Chua was able to experience the colours of small-town medical life.
“When I was young, I would sit in the doctor’s waiting room waiting for my father, and I would sometimes hear ladies crying and screaming,” she recalls.
“But then every so often, I’d hear a baby.”
“And then, as I grew up, I thought, that’s very special.”
This backdrop of community care, and the vivid memories of experiencing the cries and joy of childbirth, sparked an interest in her future career.
However, despite these early influences, Dr. Chua’s path to medicine was not straightforward. After initially pursuing science in Canada, a family holiday back to Brisbane led to an impromptu, and successful, application to university.
Starting in pharmacy, she later transitioned into medicine and completed her medical training at the University of Queensland. An internship experience in an obstetrics and gynaecology (“O&G”) placement at the Mater hospital appealed to her.
“I liked obstetrics and gynaecology because it gave me a mix between medicine and surgery,” she explains.
“And I thought, well, that’s cool. You are able to use surgical skills and medical skills, rather than having to think you have to just do ‘medicine’ or you just have to do ‘surgery’.”
“And I felt that there must be somewhere I can actually actually help people, especially women, so that they understood their health better and weren’t scared by their bodies.”
“That’s why I wanted to do O&G when I graduated,” she explains.
“After doing my internship at the Mater, I decided to go and do my second year at Southampton General Hospital in the UK.”
Early career, inspiring role models
It was at this time in her career that Dr. Chua was influenced by two inspirational clinicians.
“At that time, one of the doctors I knew of was Dr. Aldo Vacca. He’s the gentleman who invented what’s called the Kiwi Cup, a vacuum suction cup for delivering babies.”
“He gave back to charity, went back to PNG and worked there every so often, and invented a vacuum extraction device that makes deliveries safer and better.”
“He unfortunately passed away quite a few years ago, but he was amazing,” Dr. Chua explains.
Dr. Chua also recalls her admiration for the late Professor Fung Yee Chan, a no-nonsense, fiercely intelligent female clinician who was the founder of, and a role model in, a department that was predominantly male at the time.
“She was no nonsense and she was smart. She was very dedicated. She was someone that you just sit and go, wow!”
“As a female doctor in a position of that type of departmental type of position, it was really cool because everyone at that time were actually all boys,” she explains.
When Dr. Chua returned to Australia, she embarked on a six-year O&G training program. Her decision to sub-specialise in ultrasound was sparked during her fifth year, after the program’s curriculum opened her eyes to the possibilities within the field.
When she completed her training, Dr. Chua found herself as the only COGU subspecialist in Queensland—a distinction she held for over a decade.
A graceful attitude towards patient care
Dr. Chua doesn’t rush appointments, despite the pressures of a busy clinic, and she is attentive to the underlying fears that might accompany a patient’s visit.
“I just stop and I listen,” she says.
“And I go back and say… look, I understand what you’re saying.”
“And please don’t feel like you can’t ask me a question. I will always listen.”
She explains her use of empathy as both a clinical tool and an instrument for putting her patients at ease.
“And I try to find out what it is that they’re scared of as well, which can be very relieving once they open and up and discuss it.”
This holistic approach to patient care—balancing technical expertise with compassionate communication—is undoubtedly one of the traits that have contributed to her career trajectory.
When probed for a feel-good patient story, Dr. Chua, with a chuckle, admits the challenge in articulating a single moment. To her, each patient is a chapter, and while she may be a crucial part of their healthcare journey, the collective gratitude expressed by those she helps stands out more than any one experience.
“Some patients stop and just say thank you. Thank you for explaining it well. I didn’t understand. Thank you for actually listening or taking the time and explaining it,” she says.
Helping women understand their bodies
One of Dr. Chua’s passions is helping women understand, and not fear, their bodies.
She does this by delivering definitive diagnoses as best she possibly can, particularly in complex conditions like endometriosis. She tries to offer patients not just medical insights but also validation and relief from the angst of the unknown.
“Some ladies feel frustrated when their pain goes undiagnosed.”
“In my work in gynaecology, I’m sometimes able to say to some ladies that, yes, there is something wrong with you, even if other avenues haven’t been able to visibly see anything,” she explains.
“It gives patients the realisation that their pain is real.”
She considers herself a link in the healthcare chain, aiding fertility specialists by advising on the viability of natural conception or the need for IVF, assisting gynaecologic oncologists by identifying potential cancers, and ensuring that fetal abnormalities are appropriately managed through collaborative care.
Dr. Chua is humble and reluctant to celebrate her career. Yet the significance of her role transcends the technicalities of her specialty.
The limitations of ultrasound
Dr. Chua is also eager to address a common misunderstanding of medical ultrasound technology: while ultrasound is adept at revealing structural aspects of the body, it cannot ascertain functionality.
This limitation is a frequent source of misunderstanding among patients who seek absolute reassurance about their health, or the health of their unborn child.
“Patients often come with the hope of hearing that everything is perfect,” she explains.
“They say, ‘all I want is a healthy baby,’ and naturally so.”
“But the reality of what ultrasound can deliver in terms of answers is sometimes at odds with these expectations.”
She confronts the difficult task of conveying that, while she can identify the presence of vital organs and limbs, the ultimate functioning of these structures remains beyond the scope of the scan. Her clinical process becomes a delicate combination of providing clear information and managing patient expectations.
Additionally, in the world of gynaecology, Dr. Chua faces similar challenges. Women suffering from years of pelvic pain may expect a definitive diagnosis through ultrasound, which is not always possible.
“Ultrasound, on its own, is not meant to definitively diagnose conditions like endometriosis,” she asserts.
The task then becomes one of education, helping patients to understand that while ultrasound is a powerful tool, it has its bounds.
On professional and clinical developments
In discussing how she keeps herself and her clinic at the cutting edge, Dr. Chua reveals a commitment to continuous learning, jokingly referring to ‘osmosis from her peers’ before delving into more substantial methods.
“That’s why I like to teach. I like to learn. I always say… I’m not done learning.”
“At least I’m done having exams. At least I think I am,” she chuckles.
“But I don’t think I know everything and I’m always happy to learn.”
Dr. Chua’s approach to medicine is dynamic; she sees every procedure as a collective effort, influenced by various practitioners, where learning and teaching are reciprocal processes.
She maintains an affiliation with the public hospital system, not solely for the sake of helping more people but also to teach and learn from others.
Looking towards the future, Dr. Chua hopes to continue enhancing the standards of ultrasound in women’s health by building on the clinic’s achievements and fostering an environment of continuous improvement.
The future of her practice
Dr. Chua is passionate about QUFW’s future, ensuring the clinic’s longevity by welcoming junior fellows without overwhelming them. She envisions a collaborative future, not just within her immediate team of sonographers but extending into the wider medical community, including GPs, to optimise care for women.
What sets QUFW apart, in Dr. Chua’s view, is her team’s approachability and willingness to engage in dialogue. She believes in maintaining open lines of communication, where questions are welcomed, and answers are given thoughtfully—a philosophy that may be understated but is deeply valued.
Dr. Chua jumps at the chance to describe her team as exceptionally skilled.
“They’re darn good at what they do and I feel like I’m the support act sometimes to them, but hopefully, I’m a good support act,” she says.
In ten years from now, Dr. Chua sees QUFW growing and evolving while retaining the core team that makes it exceptional. Her modesty is clear when discussing the clinic’s success, highlighting her preference for service over self-promotion.
When asked about the next decade, she says she hopes QUFW will be, “slightly bigger, slightly older, and still with the great team.”
“And just continuing to work hard.”
A doting family figure
Dr. Chua finds solace in family life, allowing the comforts of home to provide rejuvenation. She emphasises the importance of leaving work at the door–a strategy to preserve her own well-being amidst the demands of her career.
“I do try to leave it at the doorstep and, if occasionally it does come home with me, that’s fine,” she says.
In a final reflection on her career, Dr. Chua considers the possibility of maintaining her surgical skills but ultimately expresses contentment with her chosen path, affirming that specialising has allowed her to excel in her field.
If she could offer her younger self a piece of advice, it would simply be, “you’ll get there,” a nod to the patience and perseverance that have been hallmarks of her journey in medicine.
As the interview concludes, Dr. Chua’s gentle, confident, yet humble nature is evident. Her pioneering spirit, commitment to her work, and the care of her patients and team speaks louder than any self-praise.
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March 2024
Content Disclaimer
The information provided on this website is for educational and informational purposes only. It is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment and before undertaking a new healthcare regimen.
The content on this website is not intended to be a comprehensive source of information on any particular topic and should not be relied upon as such. The authors and publishers of this website are not liable for any damages or injury resulting from the use or misuse of the information provided on this website.
Placenta accreta spectrum is a potentially life-threatening obstetric condition where the placenta grows too deeply into the wall of the uterus. This abnormality may prevent the placenta from detaching after childbirth, causing significant maternal bleeding and other complications for both the mother and her baby.
Placenta accreta was traditionally classified into different types based on the severity and depth of placental invasion (accreta, increta and percreta). Often, however, the only way to determine this is after delivery. As a result, all disorders of abnormal placentation are now referred to collectively as placenta accreta spectrum (or PAS)
PAS is often diagnosed during pregnancy through ultrasound, although it may sometimes only be detected during delivery. It requires advanced diagnosis and careful management by a multidisciplinary medical team.
‘Placenta accreta spectrum disorder’ (PAS) is a pregnancy-related condition where the placental villi abnormally invade the myometrium during the first trimester of pregnancy.
Normally, the placenta separates from the wall of the uterus after childbirth. However, in cases of PAS, this detachment does not occur as it should.
Animated portrayal of placenta accreta spectrum (PAS) – John Hopkins Medicine
A study covering Australia and Aotearoa New Zealand found that the occurrence of PAS is around 44.2 in every 100,000 women (or 1 in 2000) who are giving birth, although there are some risk factors which make PAS much more likely in some patients.
What are the different types of PAS?
PAS is classified into three types based on the depth of placental invasion into the wall of the uterus. This differentiation can only definitively be made after delivery, on histopathological assessment.
Placenta accreta: This is the most common. In placenta accreta, the placenta attaches itself deeply into the uterine wall but does not penetrate the muscle of the uterus. This can lead to difficulties in placental detachment during childbirth.
Placenta increta: In this form, the condition is more severe. The placenta invades into the muscles of the uterus, embedding itself more deeply than in placenta accreta. This increases the risk of severe bleeding during delivery and can pose more significant health risks.
Placenta percreta: This is the most severe form of the condition. In placenta percreta, the placenta penetrates through the entire uterine wall and can attach to other organs, like the bladder or intestines. This type poses the highest risk of severe complications, including severe bleeding, and may require extensive surgical intervention, and earlier delivery.
The severity and extent of PAS significantly impacts the approach to delivery and the type of medical intervention required. Early and accurate diagnosis is essential for managing these risks and planning a safe delivery strategy.
PAS is typically diagnosed through a combination of imaging tests and clinical assessment. The most common diagnostic methods include:
Ultrasound: Ultrasound is the first line imaging modality for diagnosing PAS. A detailed ultrasound can show abnormal placental attachment and blood flow. Doppler ultrasound, which visualises blood flow, can be particularly useful in identifying unusual blood vessels that may suggest the presence of PAS.
Magnetic Resonance Imaging (MRI): If ultrasound results are inconclusive or if a more detailed view is needed, an MRI can be used. MRI has similar sensitivity in detection of PAS as ultrasound, but can be useful when ultrasound is limited (e.g. in higher BMI, or when the placenta is posterior) .
Clinical History and Risk Factor Assessment: A thorough assessment of the patient’s medical history, including previous caesarean sections, uterine surgeries, and other risk factors, is important. This information (also known as the pre-test probability, or likelihood), combined with imaging results, helps in making a diagnosis.
Early diagnosis is crucial for planning appropriate medical care to manage the condition and reduce the risk of complications during delivery. Women with known risk factors for PAS are typically monitored more closely with these diagnostic tools, and an accurate antenatal diagnosis of PAS impacts delivery planning.
Placenta praevia completely covering the internal cervical os with placenta accreta
What risk factors may contribute to PAS?
There is some thought that PAS may be a later gestation manifestation of caesarean-scar pregnancy, or a pregnancy which implants within the prior caesarean scar. Rather than being an abnormality innate to the placenta itself, the abnormal invasion and development of the placenta may relate to the location in which it implanted, and the nature of the scar tissue.
PAS is known to be associated with several risk factors, each contributing to the increased likelihood of its occurrence:
Previous Caesarean Delivery: A history of caesarean delivery is a major risk factor for PAS. With each subsequent caesarean, the risk of PAS increases. This is because the surgical scar in the uterus can be a site where the placenta abnormally adheres in future pregnancies.
Low-Lying Placenta or Placenta Previa: When the placenta is positioned low in the uterus or covers the cervix (placenta previa), the risk of PAS is higher. This abnormal positioning can lead to a deeper implantation of the placenta into the uterine wall. However, placenta accreta spectrum is still relatively rare in placenta praevia, unless a patient has also had prior caeasarean sections.
Advanced Maternal Age: Women who are older, typically over the age of 35, have a higher risk of developing PAS.
Multiparity: Having multiple pregnancies increases the risk of PAS.
Previous Uterine Surgery Including Myomectomy, D&C, Cornual Resection, or Endometritis: Any previous uterine surgery, such as the removal of fibroids (myomectomy), dilation and curettage (D&C), cornual resection, or a history of endometritis (inflammation of the uterine lining), can leave scars or changes in the uterus. These alterations can create areas where the placenta can attach too deeply, increasing the risk of PAS.
Transvaginal ultrasound image demonstrating placenta praevia with suggestion of placenta increta. Bladder wall appears intact.
What are the symptoms of PAS?
PAS often does not present with multiple distinct symptoms, especially early in pregnancy, which is why it is frequently diagnosed through routine imaging in at-risk patients. However, there are a few signs and symptoms that may suggest the presence of PAS, particularly as a pregnancy progresses:
Vaginal Bleeding: This is the most common symptom and usually occurs in the second or third trimester of pregnancy. The bleeding can range from light to heavy.
Fetal malpresentation: The baby may persistently remain in a non-cephalic (breech or transverse) position because the abnormally implanted placenta (when covering the cervix) prevents the baby descending in the pelvis.
It’s important to note that many women with PAS do not experience any noticeable symptoms, and the condition is often detected during routine prenatal imaging in women who have risk factors for the condition.
What are the risks associated with PAS?
PAS carries several significant risks and potential complications, mainly due to the abnormal attachment of the placenta to the uterine wall. These risks can impact both the mother and the baby:
Severe Maternal Haemorrhage: This is the most significant risk. The deep attachment of the placenta can lead to severe bleeding during attempts to remove the placenta after childbirth. This can result in a life-threatening situation requiring immediate medical intervention.
Need for Hysterectomy: Most commonly, a hysterectomy (surgical removal of the uterus) is necessary following delivery, as the placenta will not detach from the uterine wall.
Preterm Birth: PAS can increase the risk of preterm labour and delivery, which carries risks for the baby, including respiratory distress syndrome, developmental delays, and other prematurity-related complications. This can be either iatrogenic (planned preterm birth to reduce potential complications), or spontaneous, in which case delivery may be indicated in the scenario of a large bleed.
Blood Transfusions and Surgery: Due to the risk of severe bleeding, blood transfusions and multiple surgical interventions may be required.
Damage to Other Organs: In severe cases, particularly in placenta percreta, the placenta can invade other organs like the bladder or intestines, leading to additional complications and the need for more complex surgery.
Mental Health Impact: The diagnosis and management of PAS, including the potential loss of fertility and the stress of a high-risk pregnancy, can have significant emotional and psychological impacts.
For the baby, the risks are mainly associated with premature birth and the potential complications that can arise from being born early. There is also a risk of fetal growth restriction associated with placenta accreta spectrum, and this is why serial ultrasound is recommended to monitor fetal growth.
Transvaginal ultrasound image demonstrating colour flow in placenta accreta.
How is PAS treated?
The treatment of PAS primarily focuses on managing the risks during childbirth and addressing potential complications, especially severe bleeding. The treatment plan depends on the severity of the condition, the health of the mother and baby, and the stage of pregnancy.
Common treatment strategies include:
Planned Caesarean Hysterectomy: Women with PAS will be recommended to deliver by planned caesarean section. This is often planned around 34-36 weeks of gestation, to minimise the risk of spontaneous labour, which could lead to uncontrollable bleeding. In most cases, with the exception of small focal placenta accreta spectrum, a hysterectomy (removal of the uterus) is planned as a part of the same operation and performed immediately after the delivery of the baby. This is often necessary to control bleeding and can be a life-saving measure.
Blood Transfusions: Due to the high risk of severe bleeding, arrangements for blood transfusions are usually made in advance of the delivery.
Medication Management: Medications may be used to control bleeding, manage pain, and prevent infection during and after the delivery.
Follow-up Care: Postpartum care is crucial, especially if a hysterectomy is performed. Monitoring for complications like infection, bleeding, or psychological impact is important.
Each case of PAS is unique, and the treatment plan is tailored to the individual’s specific situation. Early diagnosis and careful planning are key to the successful management of PAS.
Will I need a Caesarean section if I have PAS?
If you have PAS, a caesarean section will be recommended for delivery. This is because the abnormal attachment of the placenta to the uterine wall in PAS makes it impossible for the placenta to separate naturally and safely during vaginal delivery. Attempting a vaginal birth in such cases could lead to severe, life-threatening bleeding.
In many cases a hysterectomy (surgical removal of the uterus) will be planned immediately after the delivery of the baby during the same surgical procedure. This is done to control bleeding and is often a necessary step in managing the condition.
It’s important to discuss your specific case with your healthcare provider, who can advise on the best approach for delivery based on the extent of the PAS and your overall health. They will also consider other factors, such as whether the PAS is considered likely to be focal (a small area which may be able to be resected) or more diffuse.
Can PAS be prevented?
Preventing PAS can be challenging because the exact cause of the condition is not entirely understood. However, there are certain measures and considerations that can help reduce the risk:
Limiting Caesarean Deliveries: Since a major risk factor for PAS is previous caesarean deliveries (Caesarean sections), limiting the number of Caesarean sections when medically possible can reduce the risk.
Careful Management of Uterine Surgeries: Procedures that involve the uterus, such as myomectomy (removal of uterine fibroids), can increase the risk of PAS in future pregnancies. This is more the case when fibroidectomy is cavity breaching.
Early Prenatal Care: Early and regular prenatal care is important, especially for women with risk factors for PAS. Early detection of potential issues allows for better planning and management.
Family Planning and Birth Spacing: Thoughtful family planning and spacing between pregnancies can help minimise the cumulative risk associated with multiple pregnancies and Caesarean sections.
Can I still have a vaginal birth with PAS?
Most cases of placenta accreta spectrum also occur in the setting of a low lying or praevia placenta, which will often prevent descent of the baby into the birth canal to allow a vaginal delivery.
Additionally, when the placenta is abnormally adherent, even if the baby can be delivered vaginally, the PAS will prevent placental separation warranting operative management following delivery to manage bleeding and retained placenta.
The information provided on this website is for educational and informational purposes only. It is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your obstetric doctor or other qualified provider with any questions you may have regarding a medical condition or treatment and before undertaking a new healthcare regimen.
The content on this website is not intended to be a comprehensive source of information on any particular topic and should not be relied upon as such. The authors and publishers of this website are not liable for any damages or injury resulting from the use or misuse of the information provided on this website.
The festive season is here! Here are our opening dates over the Christmas and New Year period, at all four of our practice locations.
Brisbane
Open Wednesday 27th, Thursday 28th and Friday 29th (normal business hours). Closed Christmas Day and Boxing Day. No Saturday clinic on the 23rd December at Spring Hill.
Southport
Open Wednesday 27th, Thursday 28th and Friday 29th (normal business hours). Closed Christmas Day and Boxing Day.
Tugun
Open Thursday 28th and Friday 29th (normal business hours). Closed Christmas Day, Boxing Day and Wednesday 27th Dec.
Ipswich
Closed – Last day is Friday 22nd December (normal business hours). Will reopen on Tuesday 2nd January.
We wish you all the very best during this time, as we reflect on 2023 and welcome in 2024.
At QUFW, we use a convenient smartphone app called Tricefy to share some select images, videos and report from your ultrasound scan with you.
Here is a short video to show you how to view and download images of your little one, as well as how to download your ultrasound report with Tricefy after it is completed by our doctor.
It was at this time in her career that Dr. Chua was influenced by two inspirational clinicians.
Dr. Chua is passionate about QUFW’s future, ensuring the clinic’s longevity by welcoming junior fellows without overwhelming them. She envisions a collaborative future, not just within her immediate team of sonographers but extending into the wider medical community, including GPs, to optimise care for women.
