Placenta accreta is one of the most feared complications among gravid women, as it is associated with massive and potentially life-threatening intrapartum and postpartum hemorrhage. Due to its natural history, placenta accreta is only naturally seen or expected as a cause of bleeding only among obstetric patients. This case report describes a rare manifestation of profuse abnormal uterine bleeding secondary to a placenta accreta in a non-gravid patient. The non-pregnant state was evidenced by the absence of history of amenorrhea and pregnancy signs and symptoms, a negative urine pregnancy test and normal serum bhcg results. A diagnosis of placenta accreta was mainly based on a post-hysterectomy histopathological examination. Theoretical explanations to explain this phenomenon is discussed in this case report.
Pregnancy ; Female ; Placenta Accreta ; Uterine Diseases ; Uterine Hemorrhage

Ulipristal acetate (UPA) is a selective progesterone receptor modulator (SPRM) indicated for the medical treatment of myoma. Several theoretical mechanisms help explain how it induces apoptosis and cystic degeneration of a submucous myoma, leading to its expulsion. This paper presents the case of a young nulligravid diagnosed with heavy menstrual bleeding secondary to submucous myoma, who was started on UPA treatment but with very poor compliance. Despite the very short and incomplete course of treatment, degenerative changes still took effect, which led to the expulsion or prolapse of the pedunculated submucous myoma.
ulipristal acetate ; Norpregnadienes ; Leiomyoma ; Apoptosis ; Uterus

OBJECTIVE: This study aimed to identify the predictors for treatment failure of medical management among admitted female patients diagnosed with pelvic inflammatory disease with tubo-ovarian abscess. METHODS: This was a retrospective nested case-control study, using chart review of all cases of pelvic inflammatory disease with tubo-ovarian abscess/complex (N = 49) admitted at the Department of Obstetrics and Gynecology, Philippine General Hospital from January 1, 2014 to December 31, 2018. RESULTS: Medical treatment failure was observed to be significantly higher (51.9%) among patients 40 years old and above as compared to patients less than 40 years old (13.6%). The risk of patients ≥40 years for failed management was 14x higher than those <40 years old (OR=14.00; 95% CI=1.06 to 185.5;p=0.04). The failed management group has significantly higher TOA size of 7.8 (7.8 ± 1.6) as compared to only 5.8 (5.8 ± 1.4) for medical treatment alone group. Correspondingly, those who failed have a significantly bigger volume of 120.4 ml (120.4 ± 84.5) as compared to only 55.2 ml (55.2 ± 40.6) for medical treatment alone group. Other predictive factors such as parity, admitting White blood cell count(WBC), C-Reactive Protein (CRP), and neutrophil-lymphocytic ratio(NLR) were all not significant. CONCLUSION: Tubo-ovarian abscess size of more than or equal to 7 cm, or a volume of more than or equal to 120 ml and advanced age of >40 were all predictive of failed response to medical treatment. Early recognition and intervention whether surgery or drainage may be beneficial to reduce morbidity and long-term sequelae of PID.
C-Reactive Protein ; Pelvic Inflammatory Disease ; Abscess ; Neutrophils ; Oophoritis ; Salpingitis ; Abdominal Abscess ; Lymphocytes

Background: In the Philippines, the extent to which hormonal contraceptives (HC) are used for reasons other than birth control is unknown. This study aims to examine how Filipino women use HC for contraceptive and non-contraceptive indications. Methods: This is Project 1 of a descriptive cross-sectional study involving a hospital-based (Project 1) and community-based (Project 2) survey. The questionnaire is adapted from the Georgia Reproductive Health Survey (RHS) 2005 and The Fog Zone 2009 from Guttmacher Institute. A face-to-face questionnaire collected demographic information and issues related to knowledge, attitude and experience in HC use among 15-45-year old Filipino women (n=244) seen at the Gynecologic Outpatient Department of the Philippine General Hospital. Results: Filipino women showed positive attitudes towards efficacy and safety of HC, which positively correlated with patterns of use. Majority possessed little knowledge regarding OCPs (82%), injectables (56%), and IUDs (39%). The major reasons for HC use were contraception (46%) and menstrual regulation (26%). Pills (77%) were most commonly utilized. A doctor’s recommendation (67%) primarily influenced choice of HC. Four out of 10 reported some difficulty in HC use. Conclusion: Although with limited knowledge, Filipino women have positive attitude towards, and have utilized HC both for gynecologic and contraceptive purposes.
Contraceptive Agents ; Knowledge

To study the profile of menopausal women, particularly age, reproductive history body mass index, abdominal circumference, smoking history, duration of menopause in years, type and duration of use of hormone replacement therapy, calcium intake, frequency of exercise, history of fracture and their bone mineral density.
Human ; Female ; Aged 80 and over ; Aged ; Middle Aged ; Adult ; OSTEOPOROSIS ; WOMEN ; ;

Estrogen replacement therapy (ERT) is known to significantly decrease menopausal health risks, thus, a survey of 200 women attending a tertiary hospital was conducted. Assess their attitudes toward menopause and ERT to determine factors that might increase its use revealed that women taking their ERT were more likely to know that decreased estrogen hormone causes osteoporosis. All groups however believed that natural approaches to menopause are more preferable and ERT should be reserved for women with distressing symptoms. The study suggests that a systematic educational approach could increase awareness and use of ERT especially if the recommended therapy will not cause vaginal bleeding and will cost minimally.
Human ; MENOPAUSE ; ESTROGEN REPLACEMENT THERAPY

A case of successful twin pregnancy following severe ovarian hyperstimulation syndrome (OHSS) is reported. Ignorance of this complication of ovulation induction may result to serious morbidities, and even mortality. With awareness of this condition, preventive measures can be instituted. Similarly, early recognition and prompt treatment may result to a reduction in the rate of its progression to a severe, potentially fatal stage. Consequently, a favorable outcome may be achieved.
Human ; Female ; Adult ; OVARIAN HYPERSTIMULATION SYNDROME ; PREGNANCY, MULTIPLE

Objective: To determine which of the following factors at initial surgery-such as diameter of largest endometriotic cyst, number of cysts, diseases severity, type of surgery (laparoscopy versus laparotomy), or postoperative medical therapy-best correlated with the time of recurrence of ovarian endometrioma. Design: A retrospective descriptive study was performed on 25 patients who underwent initial surgical excision of endometriotic cyst and had cyst recurrence demonstrated either on ultrasound or repeat surgery. The clinical presentation of cyst recurrence was described. The operative findings of the first and second surgeries were compared. Factors which may affect the time of cyst recurrence were evaluated. Results: Cyst recurrence was demonstrated by ultrasound in 24 (96 percent) cases; repeat surgery for recurrence was done in only 10 (40 percent) cases. The different factors in the initial surgery: type of operation, size, number, and laterality of the endometriotic cyst, disease severity, adhesions and postoperative medical therapy, did not influence the time of recurrence of ovarian endometrioma. Disease severity was a significant factor on repeat surgery. Conclusion: The different factors aforementioned, which were present in the first surgery, did not influence the time of recurrence of ovarian endometrioma.
Human ; Female ; Adult ; ENDOMETRIOSIS ; RECURRENCE

Objectives: To compare the effects of clomiphene citrate with conjugated equine estrogen (early or beginning day 2 of menses vs. late or beginning day 7 of menses) and clomiphene citrate alone on endometrial thickness and pattern (i.e. trilaminar or non-trilaminar) among patients for induction of ovulation. Study Design: Prospective, randomized Setting: tertiary care hospital Inclusion criteria: Women aged 25-40 years old with infertility of at least 2 years duration who are candidates for ovulation induction. Exclusion criteria: Women on hormonal treatment 1 month prior to ovulation, with ovarian cysts, mullerian abnormalities, myomas or uterine cavity abnormalities. Results: Fifty-four women were included in the study with mean age 31.093 years +/- 4.655 (range 21 to 40 years), duration of infertility 4.954 +/- 3.228 (range 2 to 20 years), and day of the cycle when dominant follicle was noted was 11.907 +/- 1.751 (range of 8 to 16 days). Mean endometrial thickness was 0.960 cm in group I, 1.053 cm in group II and 0.850 cm in group III with a p value of 0.040625. There was significant improvement in thickness from baseline with a p value of 0.015166. There was no significant effect on endometrial pattern (p value = 0.236146). Conclusion: The addition of conjugated equine estrogens in ovulation induction with clomiphene citrate improves endometrial thickness.
Human ; Female ; Adult ; ESTROGENS, CONJUGATED (USP) ; CLOMIPHENE ; ENDOMETRIUM

Objective: To detail the experience and evaluate the effectiveness of hysteroscopy in the Philippine General Hospital. Setting: Tertiary care center Study population: All available records of patients admitted for hysteroscopy from July 1996 to December 2000. Results: There were 240 records available for review with a mean patient age of 39.4 +/- 14.2 years (range 15-75). There was an increasing number of hysteroscopy cases, especially operative cases performed through the years. Bleeding was the most common complaint. Indications for hysteroscopy were: endometrial mass (49 percent), abnormal uterine bleeding (16 percent), infertility (10 percent), and thickened endometrium (7 percent). There were 6 cases of lost IUD. A total of 58.7 percent intracavitary abnormalities were noted during hysteroscopy and were observed in the following subgroups: 65.7 percent in those with premenopausal bleeding, 46.7 percent in those with postmenopausal bleeding, 28.9 percent in infertility, and 74.5 percent with the diagnosis of an intracavitary mass. Conclusion: A summary of hysteroscopy cases done at a tertiary care center in the Philippines was presented. This review demonstrates the utility of hysteroscopy in the diagnosis of intracavitary abnormalities and in the removal of IUDs.
HYSTEROSCOPY ; UTERINE HEMORRHAGE ; MENORRHAGIA