Objectives: To identify clinical, sonographic and hysteroscopic characteristics associated with malignant endometrial lesions. Methods: This is a retrospective descriptive study that included all menopausal women presenting with vaginal bleeding in a tertiary care hospital from January 2007 to June 2010. Clinical, sonographic and hysteroscopic findings were evaluated as predictor variables for development of endometrial adenocarcinoma. Results: Thirteen out of the 215 patients had endometrioid adenocarcinoma, in women presenting with postmenopausal bleeding, with a prevalence rate of 6%. A trend towards harm is seen among the following factors: age of > 60 years (OR 1.19; 95% CI, 0.29-4.46), menarche < 12 years (OR 1.07; 95% CI, 0.22-4.66), endometrial stripe >/- 10mm (OR 2.02; 95% CI, 0.58-7.09), lesion of diameter < 1cm (OR 1.57; 95% CI, 0.45-5.74), presence of cystic space (OR 4.28; 95% CI, 1.00-17.36), and soft consistency (OR 1.94; 95% CI, 0.47-9.21). Conclusion: Increasing age, early onset of menarche, endometrial thickness of >/- 10mm, hysteroscopic characteristics (lesion diameter of less than 1 em, presence of cystic space and soft consistency) increases the probability of carcinoma.
Human ; Female ; Aged ; Middle Aged ; ENDOMETRIAL NEOPLASMS ; HYSTEROSCOPY ; MENORRHAGIA ; UTERINE HEMORRHAGE

OBJECTIVE: To determine the effect of Fetal Acoustic Stimulation Test on Non Stress Test Parameter

METHODS: A total of 650 subjects (power of 80%) were enrolled. Subjects were both high risk and non high risk pregnancies, at more than 36 weeks AOG with normal AFI. All subjects underwent non stress test followed by non stress test with acoustic stimulation test for minimum of 20-40 minutes. Once consent was obtained, a low frequency sound transducer (40 hertz) was applied on the maternal abdomen to provide acoustic stimulation. The data was gathered, analyzed and compared.

RESULTS: Acoustic Stimulation Test improved the results of NST by having reactive results, longer duration accelerations, improved variability from minimal to moderate variability, and increased number of fetal movement.

CONCLUSION: AST is not a standalone procedure but merely an adjunct to other antenatal tests for fetal surveillance such as BPS and Doppler.

Human ; Female ; Adult ; Young Adult ; Adolescent ; Acoustic Stimulation

A total of 365 women were included in this retrospective study that aimed to correlate the transvaginal ultrasound endometrial thickness and histopathology report of the fractional dilatation and curettage among those presenting with perimenopausal bleeding. The incidence of perimenopasual bleeding was 6.32%. Most were in the 46- 50 years age range and were within gravida 1 to 3 presenting with menometrorrhagia. Transvaginal endometrial thickness was mostly within 0.5cm to 1.50cm. Most common endometrial pathology were endometrial polyp, disordered endometrium and simple hyperplasia without atypia. The incidence of adenocarcinoma was 0.8%. There was no significant correlation between age, gravity and parity and the endometrial thickness as measured on transvaginal ultrasound. There was a significant difference in mean endometrial thickness when comparing patients presenting with vaginal spotting and menorrhagia, vaginal spotting and menometrorrhagia and metrorrhagia and menometrorrhagia. There was a statistically significant difference between the endometrial thickness of those with normal histopathology report, meaning endometrium with no pathology and appropriate with menstrual cycle and those with pathologic findings. Using a cut-off of greater than or equal to 1cm for endometrial thickness showed an OR of 3.57, 95%CI 1.24-10.53 for significant pathologic finding on histopathology report with 69.5% sensitivity, 61.1% specificity, 97.2% positive predictive value and a 9.4% negative predictive value.

Human ; Middle Aged ; Adult ; Metrorrhagia ; Menorrhagia ; Parity ; Hyperplasia ; Perimenopause ; Dilatation And Curettage ; Endometrium ; Menstrual Cycle ; Hemorrhage ; Polyps ; Adenocarcinoma

A case of Idiopathic Thrombocytopenic Purpura (ITP) in pregnancy managed by multidisciplinary team approach is discussed. A case of 35-year old patient with ecchymoses and easy bruisability at four months age of gestation is presented. Diagnostics revealed prolonged bleeding time with peripheral blood smear and bone marrow aspirate biopsy consistent with ITP. Pertinent findings and evidence on management strategies on ITP in pregnancy were discussed and a consensus was arrived at. The patient was maintained on oral steroids, underwent fetal being surveillance and platelet count monitoring. Patient unremarkably delivered vaginally to a term livebirth who eventually developed neonatal thrombocytopenia. The neonate was treated with steroids and likewise discharged improved.

PURPURA, THROMBOCYTOPENIC, IDIOPATHIC

A 16-year-old primigravida, at 33 weeks and 5 days age of gestation came in due to preterm labor. Sonographic examination revealed an incidental finding of a mass attached to the sacrococcygeal area. The mass has a cystic and solid component diagnosed as sacrococcygeal teratoma. Attached to the mass were two lower extremity structures identified as femurs with feet and was considered as an underdeveloped parasitic twin. A classical cesarean section was performed because of the advanced preterm labor, and a live female infant weighing 2500 g was delivered. The parasitic lower limbs, however, inadvertently detached during delivery. There was a high index of suspicion because of a larger fundic height of 37 cm compared to the age of gestation and the difficult palpation on Leopold's maneuver. Accuracy of ultrasound findings helped the obstetricians to a timely and prepared for delivery.
Teratoma ; Twins, Conjoined

Turner syndrome is a congenital condition affecting 1 in every 2500 female live births. This condition is characterized by complete or partial loss of the X chromosome. They commonly present with normal female external and internal genitalia and may develop hypogonadism and streak ovaries later in life. We describe an unusual presentation of a case of Turner syndrome – a 31-year-old Filipino with male phenotype mosaic Turner syndrome, with 46,X,+mar[46]/45,X[4] chromosome, presenting with ambiguous genitalia and a pelvoabdominal mass. The patient underwent exploratory laparotomy, peritoneal fluid cytology, adhesiolysis, tumor debulking (gonadectomy) appendectomy, omentectomy, identification and inspection of bilateral ureters and bladder, gonioscopy and biopsy of the urogenital cavity (bladder vs. vagina). Histopathology revealed a mixed gonadal tumor, consisting of 70% yolk sac tumor, and 30% dysgerminoma. The patient eventually succumbed to postoperative complications. Postmortem fluorescence-in situ hybridization revealed a 46,X,+mar[46]/45,X,[4].ish der (Y) (DYZ3+), a marker of chromosome Y origin, consistent with a mosaic type Turner syndrome, associated with increased risk for gonadal malignancy.
Dysgerminoma ; mixed germ cell tumor ; mosaicism ; yolk sac tumor