BACKGROUND: The IOTA Simple Rules provide a standardized ultrasound description in order to correctly classify ovarian tumors as benign or malignant even among non - expert readers. Its high accuracy rate was noted in foreign studies but was never validated in the local setting. The IOTA inconclusive tumors that were either assumed to be malignant or referred to experts in other studies were separately addressed in this research.

GENERAL OBJECTIVE: To determine the accuracy of the IOTA Simple Rules to predict malignant ovarian tumors

MATERIALS AND METHODS: Subjects: Patients with ovarian tumors admitted for surgery with complete ultrasound records done at Women's Health Unit and those with histopathologic report from the Department of Pathology. Setting: Department of Obstetrics and Gynecology in a tertiary hospital from August 2015 to February 2017. Design: Cross-sectional Diagnostic Accuracy Test. Data Collection: After obtaining approval from the IRB and Office of the Medical Director, the ovarian tumors were tallied and categorized according to their IOTA classification and final histopathologic diagnoses. The sensitivity, specificity, positive and negative predictive values, and accuracy were obtained using a 2x2 table. The biopsy reports of the inconclusive tumors were also reviewed and the sonographic characteristics of those which turned out to be malignant were noted.

RESULTS: A total of 110 adnexal masses were included, with the IOTA Simple Rules applicable in 84.55% of cases. It produced an accuracy rate of 100%. Among the 17 inconclusive tumors, two proved to be truly malignant with the presence of only one papillarity in a borderline tumor and the complex appearance of a germ cell tumor.

CONCLUSION: The IOTA Simple Rules is an accurate preoperative diagnostic tool in predicting ovarian malignancy. Two malignant tumors were classified as inconclusive and their sonographic characteristic of only one papillarity and the complex appearance of these tumors may warrant malignancy.

Human ; Female ; Gynecology ; Obstetrics ; Physician Executives ; Tertiary Care Centers ; Ethics Committees, Research ; Adnexal Diseases ; Ovarian Neoplasms ; Ultrasonography ; Sensitivity And Specificity ; Biopsy ; Neoplasms, Germ Cell And Embryonal

Primary cervical choriocarcinoma is extremely rare. Although rare, it is suggested that choriocarcinoma should be considered a possible cause of hemorrhage in a woman presenting with a cervical mass and a history of previous molar pregnancy. This is a case of a 50 year old woman with irregular vaginal bleeding for 3 weeks. A hemorrhagic cervical mass was detected by visual inspection. She underwent total abdominal hysterectomy and bilateral salpingooophorectomy and postoperative chemotherapy. Biopsy revealed cervical choriocarcinoma.

Human ; Female ; Middle Aged ; Choriocarcinoma ; Hydatidiform Mole ; Ovariectomy ; Hysterectomy ; Biopsy ; Uterine Hemorrhage

OBJECTIVES: The study aims to determine the degree of perineal trauma, postpartum perineal pain and fetal outcome in both groups using different maneuvers: "hands on" and "hands off" during the late second stage of labor among nulliparous women without episiotomy.
DESIGN: Prospective Randomized Research Study
SETTING: This study was conducted at the Labor / Delivery room complex from June 2012 to February 2013.
METHODS: In the second stage of labor, nulliparous women (120) giving birth were randomly allocated to "hands on"(the fetal head delivery was performed by using a towel-draped, gloved hand exerting forward pressure on the chin of the fetus through the perineum just in front of the coccyx) and "hands off" (the OB resident observed the parturient woman and did not touch perineum during the second stage of labor and the other hand exerts pressure superiorly against the occiput while the fetus was delivering) group. The two groups were compared as to their demographic characteristics, perineal trauma, postpartum pain and neonatal outcomes.
RESULTS: All women were nulliparous, term, without episiotomy and had similar demographic characteristics. Pain scores were collected in both groups after delivery. No significant difference in the postpartum pain scale values at 24 hours (p=0.134), 7 days (p=0.866), to 10 days (p=0.77) in both groups. Perineal trauma showed no significant association between laceration (p=0.212). Differences in APGAR Score as a measure of neonatal outcome was similar in both groups.
CONCLUSIONS: This study showed that perineal trauma, postpartum perineal pain and neonatal outcome between the "hands on" versus "hands off" have no significant difference. Therefore, it is not necessary to use "hands on" technique on all women in labor during the second stage of labor.

Human ; Female ; Adult ; Pregnancy ; Episiotomy ; Perineum ; Apgar Score ; Delivery Rooms ; Lacerations ; Coccyx ; Labor, Obstetric ; Delivery, Obstetric ; Term Birth ; Fetus ; Postpartum Period

Introduction: Postpartum depression (PPD) is a major health concern for child-bearing women and has its effects on her children. Advocacies for mental health have paved way for more awareness of conditions such as PPD. Currently, there is no particular screening protocol employed by attending physicians of these women. There is also a lack of data that determines the practices of obstetricians when dealing with patients with PPD or those at risk of developing it. Objective: This descriptive study evaluated the knowledge, attitudes, and practices of OB-GYN consultants and residents on the screening of PPD. Materials and Methods: A validated questionnaire was utilized with some modifications made to tailor fit the targeted population. All affiliated consultants and residents of the Philippine Obstetrical and Gynecological Society-accredited training hospitals in a Region VII were included while those retired were excluded. The Google Form link of the questionnaire was disseminated to the different institutions who gave approval to conduct the study. Anonymity and confidentiality of data acquired were maintained throughout the study. Results: A total of 110 responses were received. The key findings of the study showed that the respondents have above average knowledge on PPD including its risk factors, symptoms, complications, and treatments. They generally have positive beliefs toward their role in the screening and management of PPD. Moreover, majority of them have already tried screening for PPD although not routinely. Conclusion There is a significant relationship between the knowledge, attitude, and practices of the consultants and residents on the screening of PPD. Systems should be put in place to ensure effective treatment and follow-up of patients and thus impact good clinical outcomes.
Depression ; Postpartum Period ; Depression, Postpartum ; Mass Screening

Primary ovarian leiomyosarcoma (POLMS) is an exceedingly rare neoplasm accounting for only 0.1% of all ovarian malignancies and most commonly occurring in postmenopausal women. Prognosis is poor with only a 20% 5-year survival rate. Surgery remains to be its mainstay treatment. Discussed here is a 72-year-old nulligravid with hypogastric pain. Transrectal ultrasound showed a right ovarian new growth, probably malignant on International Ovarian Tumor Analysis (IOTA) simple rules, with a 79.2% risk of malignancy by IOTA ADNEX and an unremarkable uterus. Other workups were normal. She underwent primary cytoreductive surgery. Histopathologic diagnosis was ovarian leiomyosarcoma with positive immunohistochemical staining for desmin, S-100 protein, smooth muscle actin, and epithelial membrane antigen. She refused adjuvant chemotherapy postoperatively. The latest published literature on POLMS was also reviewed to develop the provisional criteria for its prompt diagnosis, thereby decreasing the heterogeneity of the diagnostic approach as well as supporting future researches on manifestations, clinical courses, and therapeutic plans.
Ovary ; Prognosis ; General Surgery