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

OBJECTIVES: To determine the clinicopathologic characteristics of patients with pre-operative diagnosis of endometrial polyp who underwent hysteroscopy in the Philippine General Hospital and to identify possible risk factors for pre-malignancy and malignancy among patients with pre-operative diagnosis of endometrial polyp.

STUDY DESIGN: Admission logbooks and surgico-pathologic census were analyzed to identify patients with a pre-operative diagnosis of endometrial polyp who underwent hysteroscopy from June 2009 to June 2014. Demographic, clinical and pathologic data were obtained and tabulated. Statistical analysis were performed to identify factors associated with pre-malignant and malignant lesion

RESULTS: A total of 180 patients were included in this study. Majority of the study population are below 50 years of age and are pre-menopausal. Eight cases were-malignant (n=2) and malignant (n=6). Diabetes mellitus, tamoxifen use and prolapsed endometrial polyps were the variables associated with pre-malignant and malignant lesions. Diabetes mellitus was the only strong predictor for malignancy (OR = 6.83).

CONCLUSION: Endometrial polyps are benign endometrial overgrowths common among premenopausal women. Known risk factors for malignancy in cases of endometrial polyps include age, menopausal status, abnormal uterine bleeding, hypertension, diabetes mellitus, obesity and large size of endometrial polp. In this study, only the presence of diabetes mellitus was interpreted as a significant predictor for either a pre-malignancy or malignancy.

OBJECTIVE: To review the POGS statistics on Maternal Mortality Rate and causes of direct and indirect maternal deaths from 2012 to 2014.
BASIC PROCEDURE: Data were retrieved friom the Integrated Statistical Information System, or ISIS, of POGS, and compliance in its use was assessed. Twenty four hospitals were chosen based on completeness of data and highest number of admissions.
RESULTS: Maternal Mortality Rate for the three-year period was 296 per 100,000 livebirths. The top causes of direct maternal deaths were hypertension, hemorrhage and infection. The top three causes of indirect maternal deaths were hypertension, hemorrhage and infection. The top three causes of indirect maternal deaths were cardiac, pulmonary and vascular.
CONCLUSION: Maternal Mortality Rate from 2012 to 2014 was reviewed. The low compliance submitting complete forms from POGS-accredited hospitals made the Committee on Nationwide Statistics strongly recommend an enhancement of the use of the electronic data-based system.

This is a case of a 22 year old nulligravid who presented with severe dysmenorrhea, and diagnosed with unicornuate uterus and an obstructed noncommunicating rudimentary horn, by pre-operative ultrasound. In this paper, the presentation, diagnosis and principles of surgical management of unicornuate uterus associated with a non-communicating rudimentary horn is presented. The embryological development of this anomaly and its association with renal agenesis are discussed.
Dysmenorrhea ; Uterus

Background: To address the need to improve the collation of vital statistical data from POGS-accredited institutions, the POGS Committee on Nationwide Statistics developed a new electronic census platform (now called the POGS Nationwide Statistics System or PNSS), that replaced the Integrated Statistical Information System (ISIS) which was started in 2008. Objectives: The aims of this paper are the following: (1) to present initial data gathered through the PNSS and compare it to the Department of Health (DOH) census; (2) to discuss obstetrical and gynecological indicators of healthcare and (3) to assess the limitations of the PNSS and recommend improvements. Methodology: This is a cross-sectional study that shall report obstetrical and gynecologic data generated from submissions of POGS-accredited hospitals from January to December 2019, through the PNSS. Charts and tables illustrating frequencies of the different health indices are presented. Health indices include crude livebirth rate, age-specific birth rate, adolescent birth rate, cesarean section rate, stillbirth rate, neonatal mortality rate, perinatal mortality rate, maternal mortality ratio, frequency of gynecologic admissions and procedures, and death secondary to gynecologic diseases. Results: The number of accredited hospitals that submitted their census with 100% compliance was 135, thus 91.8% of accredited hospitals had full compliance. A total of 365,947 cases were reported, 89% (326,026) of cases were obstetric cases and the remaining 11% (39,921) were gynecologic cases. For obstetrical health indicators: the livebirth rate is highest in the NCR 36%, with the highest age-specific birth rates in the 20-29 age groups; adolescent birth rate is 7.3%, overall CS rate is 32.8%, stillbirth rate is 14.3 per 1000 neonates, neonatal mortality rate is 3.65 per 1000 livebirths, perinatal mortality rate is 18.35 per 1000 total births and maternal mortality ratio is 81.72 per 100,000 livebirths. The most frequent indications for gynecologic admissions are leiomyoma uteri, Abnormal Uterine Bleeding-Polyp (AUB-P) and Abnormal Uterine Bleeding-Myoma (AUB-M), while endometrial biopsy/diagnostic curettage is the most frequent gynecologic procedure performed; There were 150 deaths (0.38%) reported among gynecologic cases and majority (96%) had gynecologic malignancies, with ovarian cancer being the highest (41%). Conclusion Nationwide statistics serve as strong evidence on which policies are created. It provides vital information that serves as a basis for decision-making, planning and implementation of health programs and basic services and can also be used for monitoring and evaluation. It is recommended that preparations be undertaken for an improved 2021 version with enhancing the mechanism of encoding and transmitting data, improving data quality and developing more health indicators. Regular coordination with the accredited hospitals is encouraged for a more accurate data outcome and compliance performance. Collaboration in identifying areas for research should be fostered.

Intrauterine device is a popular means of reversible birth control in the world. In the Philippines, Copper T intrauterine device (IUD) supplies may come from private sources but the bulk has been from the public sector. The public sector gets IUD for free and inserts them at virtually no cost. Although the IUD has been known for decades, there is still low utilization despite its effectiveness and safety. It is worthwhile to determine the dynamics of IUD use. This study reviewed the use of IUD among women consulting the Family Planning Unit of a tertiary university hospital. It is necessary to evaluate the clients’ needs both by improving the accessibility and quality of services and intensifying information dissemination on available family planning services. This is especially true for those who already want to limit their children but do not want to undergo a permanent method.
Intrauterine Devices ; Contraception

Introduction: The COVID 19 infection has greatly affected health care delivery in the Philippines. However, the concerns of healthcare workers have yet to be explored Objective: This study determined the logistical concerns of the residents and fellows of an academic government hospital that serves as a COVID‑19 referral center in the Philippines Methods: This is a cross‑sectional, online survey administered to the trainees of the Department of Obstetrics and Gynecology Results: Eighty‑seven participants were included in the study. Mean age was 30.7 ±3.7. Most were single, female and resident doctors. Eighty‑one percent agreed there was easy access to food and water during duty and that the food and water provided by the hospital were adequate. Fiftyfour percent agreed that they feel safe going to and from the hospital.  However, fifty‑five percent  disagreed to feeling safe from COVID‑19 within the hospital. A high majority of the participants agreed that they have access to personal protective equipment but  only fifty‑eight percent  agreed that the supply was adequate. The top 5 logistical concerns identified were: (1) safety and security, (2) food, (3) supply of personal protective equipment, (4) water, and (5) transportation Conclusion Although provisions on basic needs and protective equipment were adequate, trainees still felt unsafe from COVID‑19 within the hospital. Both the government and hospital administrators must continue to work together to improve strategies to address concerns of frontliners

Background: The recurrence of endometriosis after fertility sparing surgery poses a challenge to clinicians. Presently, no treatment option is curative and available medication only changes the hormonal milieu to suppress or delay disease recurrence.
Objective: The aim of this review was to present current literature on recurrent endometriosis including dilemmas in definition, risk factors for recurrence and medical options for the prevention of recurrent endometriosis after surgery.
Methods: A review of literature was done using PubMed, EMBASE and HERDIN, with the following keywords: endometriosis, endometrioma, endometriosis-associated pelvic pain, recurrence of endometriosis. The authors identified reviews, trials and guidelines. The population was limited to reproductive-aged women suspected of having endometriosis.
Results and Discussion: The recurrence rate of endometriosis after conservative surgery ranges from 7.1-56%. The incidence varies according to the criteria used to define recurrence: relapse of pain, physical examination findings, presence of endometrioma on imaging studies, increase in serum CA-125, and intraoperative findings during repeat surgery. The risk factors for disease recurrence include: young age, high body mass index, large endometriomas at diagnosis, severe pre-operative pain, intraoperative findings of extensive adhesions, and positive surgical margins. The identification of patients at high risk for recurrence will enable clinicians to give appropriate post-surgical therapy to prevent recurrence. The choice of pharmacologic agent after conservative surgery includes: combined hormonal contraceptive pills, progestogens, and GnRH agonist. Although no major difference was seen in the effect of available drugs used to relieve endometriosis- associated pain and prevent disease recurrence, differences exist in safety, tolerability and costs.
Conclusion: There is an urgent need to standardize the definition of recurrent endometriosis. Patients should be counselled on the need for long term medical management to delay disease recurrence. A step-wise approach and algorithm in the medical management for the prevention of endometriosis recurrence are proposed.

Background: Blood transfusion plays a vital role in modern health care; however, local studies on the utilization of blood products intra-operatively, especially in elective gynecologic surgeries, are lacking. Objective: To determine the blood transfusion use during elective gynecologic surgical cases performed at a tertiary hospital in the Philippines. Methods: This retrospective descriptive study included data from patients admitted for elective gynecologic surgeries between January 2019 – December 2019. Pertinent data was gathered from the admission charts, preoperative laboratory results (hemoglobin levels, prothrombin time, partial thromboplastin time), blood bank records of deposited/donated blood and crossmatched units, anesthesia as well as intra-operative records, and medical charts. All abstracted variable were analyzed and transfusion indices were calculated. Results: Majority of the patients who underwent elective surgeries were from the general gynecologic service (60.4%), with abdominal hysterectomies comprising majority of the transfused patients. The calculated crossmatched-to-transfused ratio (C/T ratio) for pRBCs, FFPs, and PCs are 5.1, 7.6, and 19.7; the transfusion indices are 0.57, 0.44, and 0.17, while transfusion probabilities are 28.1%, 10.4%, and 4.2%, respectively. We found a significant association between transfusion status and primary service (p = 0.01), previous pregnancy (p = 0.02), preoperative hemoglobin count (p < 0.01), preoperative hematocrit (p < 0.01), postoperative hemoglobin count (p < 0.01), postoperative hematocrit (p < 0.01), and intra-operative blood loss (p < 0.01). Conclusion There is consistent over-ordering of blood products. Primary gynecologic service, previous pregnancy, preoperative hemoglobin and hematocrit, as well as introperative blood loss are factors associated with transfusion status.
Blood Transfusion ; Blood

The incidence rate of Myasthenia Gravis coexisting with other autoimmune diseases is approximately 8.7 – 25%, but it is rarely associated with premature ovarian insufficiency (POI) with only less than 1% of women affected. This is a case of premature ovarian insufficiency in a 29 year old woman diagnosed with Myasthenia Gravis, who presented with lower extremity weakness and experienced two episodes of myasthenic crisis requiring thymectomy. Three years after, she noted oligomenorrhea that quickly progressed to amenorrhea. Extensive immunologic and genetic investigative studies showed no identifiable cause for the POI, except for its close temporal relationship with the occurrence of Myasthenia Gravis. The patient has been responsive to hormone replacement and immunomodulation therapy, and has not developed any further episodes of myasthenic crisis. A review of seven other reported cases describing a similar condition was also included in the discussion.
Myasthenia Gravis