This is a case report of M.C. a 32 year-old G3P2 (2001), who was admitted to the labor room of a tertiary government hospital for labor pains and watery vaginal discharge. The working impression at the time of admission was: Pregnancy uterine thirty-nine (39) weeks age of gestation by amenorrhea cephalic in labor, poor obstetric history for two full term deliveries with congenital anomaly. Patient is well with no medical co-morbidities. Her family and past medical histories were unremarkable. She previously delivered her two older children vaginally. Both of whom were later diagnosed with congenital adrenal hyperplasia (CAH) from newborn screening and manifestations of the external genitalia. Congenital adrenal hyperplasia can be identified as early as six weeks age of gestation by doing karyotyping following chorionic villus sampling or the less invasive fetal sex determination using the maternal plasma. The optimum time to conduct these tests is between six to eleven weeks age of gestation. At this juncture, embryogenesis of the external genitalia is completed. Unfortunately, the mother`s prenatal course began at seventeen weeks age of gestation thus a diagnosis of CAH for this pregnancy is inconclusive. After six hours of labor, she delivered to a live baby girl who on physical inspection of the genitalia appeared to be grossly normal at that time. She was directly roomed in. Newborn screening was done. With an unremarkable hospital stay, both mother and child were discharged. Follow-up at two weeks post patrum, the neonate presented with clitoromegaly and newborn screening came out positive for CAH.
Human ; Female ; Adult ; ADRENAL HYPERPLASIA, CONGENITAL ; HYPERANDROGENISM

OBJECTIVE: To determine the risk factors and the current actual incidence of surgical site infection (SSI) following a cesarean delivery in te Philippine General Hospital.

METHODS: In a case-control study, 729 patients admitted at PGH's post-partum clinic, emergency room and obstetrical wards, from November 2007- May 200, were interviewed using a data sheet from that included mother's age, gravidity and parity, body mass index, smoking history, steroid and illicit drug use, previous surgeries, co-morbidities and questions on personal hygiene, as part of the ongoing infection surveillance. Operation-related and obstetric-related variables were documented through review of medical records. Definitions of the Centers of Disease Control of surgical site infection were used.

RESULTS: Thirteen percent of patients developed SSI among 713 patients recruited in the study. Although univariate analysis of risk factors did not show statistically significant results, steroid use , smoking and illicit drug use, previous surgery, anemia prior to operation, longer duration of labor and rupture of membranes and longer duration of operation appear to predispose patients to surgical site infections after cesarean section. The incidence of SSI was significantly lower in patients with hypertensive complications.

Human ; Pregnancy ; Gravidity ; Parity ; Surgical Wound Infection ; Risk Factors ; Maternal Age ; Cesarean Section ; Obstetrics ; Smoking ; Street Drugs ; Anemia ; Hygiene

Objective. This study aims to determine time and motion in the operating room in emergent, urgent and scheduled cesarean section surgeries among pregnant COVID-19 patients. Methodology. A time and motion performance evaluation study was done by computing the following parameters: pre-induction time, pre-incision time, opening time, closing time, for both decision-to-delivery interval (DDI) and overall operative time. Results. During the study period, emergent DDI average was 2 hours and 38 minutes, emergent overall operative time was 1 hour and 31 minutes, urgent DDI average was 3 hours and 51 minutes, and urgent overall operative time of 1 hour and 57 minutes. However, in both urgent and emergent cases, the recommended DDI of 30 minutes, and the average duration of 44.3 minutes for CS were not feasible. Conclusion. The COVID-19 pandemic has negatively affected the provision of surgical obstetric care and OR utilization. Due to the new safety protocol for healthcare workers and patients, there was a significant delay in DDI and overall operative time. The causes were preparation, anesthesia factors or obstetrician factors. Identifying modifiable obstacles may improve the DDI, overall operative time, and the quality of maternal and child birth care during this pandemic.
Pregnancy ; Female ; Cesarean Section ; Time and Motion Studies ; COVID-19 ; Time Perception ; Motion

Background: When it comes to health, the most overlooked aspect of health in the Philippines is oral health. Numerous studies have reported the possible association of maternal periodontal diseases with preterm birth (PTB). However, their association remains controversial. To our knowledge, this is the first local study to describe the prevalence of periodontal disease in pregnant women and its association with PTB. Objective: This study aims to determine the association between PTB and maternal periodontal disease. Materials and Methods: PTB or cases (n = 28) included subjects who had spontaneous labor or rupture of membrane and delivered before 37 weeks of gestation. Full-term birth or controls were normal births at or after 37 weeks of gestation (n = 28). Sociodemographic and health-related characteristics were obtained through interviews and medical records. Full-mouth periodontal examination was performed on all mothers within 2 days of delivery. Three indices were utilized to assess periodontal diseases– oral hygiene index‐Simplified, Modified Gingival Index and Lindhe Classification of Tooth Mobility. The number of missing teeth and the presence of dental caries, pus, and calcular deposits were likewise noted. Results: RESULTS: Majority of the subjects had poor oral health care - 94.6% visit the dentist only as needed and 53.7% cannot recall their last dental consult. The multivariate logistic regression model, after controlling for other risk factors, demonstrated that gingivitis is a risk factor for PTB (P = 0.0057) with an odds ratio of 20.25. The presence of dental caries is another risk factor (P = 0232). Conclusion With the findings of gingivitis and the presence of dental caries having a significant association with PTB, we recommend a review of current antepartum practice guidelines to include preventive dental care as part of routine prenatal care.
Periodontal Diseases ; Pregnancy ; Premature Birth ; Risk Factors ; Oral health