BACKGROUND: Clinical studies showed a correlation between postmenopausal women with large ovaries and endometrial cancer. Considering the different average ovarian volumes among various races, it is prudent to identify the most valid ovarian volume among symptomatic menopausal women in our population and classify their probability of having a benign or malignant endometrium.

OBJECTIVE: To determine the relation of ovarian volume measurements using a reference value generated by an ROC curve with endometrial tissue biopsy diagnosis of pre-malignant and malignant endometrium among Filipino postmenopausal women.

METHODOLOGY: Fifty menopausal women with vaginal bleeding were included in a six-year review from January 2008 to December 2013. All had transvaginal ultrasonography and underwent endometrial sampling. A receiver operating characteristic (ROC) curve was generated and the most valid ovarian volume was obtained. The ROC curve -- generated ovarian volume was used as the cut-off value and was correlated with histopathologic diagnoses.

RESULTS:  Among the fifty patients, 30 with benign endometrium had an ovarian volume of 3.51 ml. Among the 10 patients with malignant endometrium, 9 had an ovarian volume of > 3.51 ml, and one had an ovarian volume of < 3.51 ml. The sensitivity of predicting endometrial cancer using ovarian volume of > 3.51 ml as cut-off is 90% (95% Cl 55.46 % to 98.34%), while the specificity is 75% (95% Cl of 58.80% to 87.29%). Using the chi-square test, it showed a significant association between ovarian volume of > 3.51 ml and malignant endometrium (P=0.0001).

CONCLUSION: The ROC curve - generated cut-off value of > 3.51 ml for Filipino postmenopausal women may serve as a useful diagnostic tool for classifying patients with pre-malignant and malignant endometrial conditions.

Human ; Female ; Aged 80 and over ; Aged ; Middle Aged ; Postmenopause ; Endometrial Neoplasms ; ROC Curve

Human ; Female ; Adult ; Intracranial Arteriovenous Malformations ; Uterine Hemorrhage ; Pregnancy Tests ; Pregnancy ; Uterine Artery

Human ; Female ; Adult ; Intracranial Arteriovenous Malformations ; Uterine Hemorrhage ; Pregnancy Tests ; Pregnancy ; Uterine Artery

A 24 year-old patient, single, with cervical agenesis and imperforate hymen is presented. She underwent hymenectomy for hematosalpinx and right oophorectomy for endometriosis, before finally undergoing hysterectomy. Cervical agenesis is a rare anatomic developmental abnormality and proposed guidelines in managing similar conditions are reviewed in this report. The management of choice will defend on the condition of the patient and the availability of resources. The patient underwent multiple surgeries in the past. However, despite all efforts to address her medical condition, due to the complications, the small chance of getting pregnant, and the absence of an experienced surgeon capable of performing a reconstructive procedure, she was eventually convinced to undergo hysterectomy. With cervical agenesis, the patient is faced with psychological difficulties that should be addressed. One can only hope that the future will hold a more optimistic outlook for young girls with this rare congenital abnormality.
Human ; Female ; Young Adult ; ABNORMALITIES ; HEMATOMETRA ; HEMATOCOLPOS ; HYSTERECTOMY

Herlyn-Werner-Wunderlich Syndrome (HWWS) is a triad of uterus didelphys, unilateral obstructed hemivagina, and ipsilateral renal agenesis.
In the review of the locally published literature, there have been seven HWWS cases reported, none of whom were pregnant.
A 24-year-old was diagnosed with Herlyn-Werner-Wunderlich Syndrome during caesarean section of a term pregnancy, occupying the right hemiuterus with obstructed hemivagina. Ultrasound showed uterus didelphys with communicating endometrial cavities. MRI revealed uterus didelphys, two cervices and an obstructed right hemivagina. The patient refused excision of vaginal septum. Two years later, she delivered spontaneously to a live fetus, occupying the hemiuterus with the unobstructed hemivagina.
In pregnant women with HHWS, who did not undergo prior surgical intervention, the mode of delivery depends on the side of pregnancy. If it is located on the obstructed hemivagina, caesarean section is inevitable. If it is on the unobstructed side, there is hope for vaginal delivery.

Human ; Female ; Adult ; Pregnancy ; Hereditary Renal Agenesis ; Uterine Anomalies ; Uterus ; Urogenital Abnormalities ; Ultrasonography ; Cesarean Section ; Magnetic Resonance Imaging ; Fetus

GENERAL OBJECTIVE: To determine endometrial cancer risk among patients with abnormal uterine bleeding based on the International Endometrial Tumor Analysis (IETA) features.
SPECIFIC OBJECTIVES: 1. To described the profile of patients with AUB suspected of having endometrial pathology; 2. To describe sonologic features of patients with AUB suspected of endometrial cancer using IETA features; and 3. To determine the association of a scoring system and endometrial cancer risk.
METHODS: We prospectively studied 542 participants who came in the CWCU of CSMC with a diagnosis of AUB from July 1, 2016 to December 31, 2016. We excluded patients with endometrial thickness of less than 4 mm on gray-scale sonography, those with technical difficulties in assessing the endometrium such as in cases of very large myomas, absence of histopathological diagnosis, and those whose sampling was done as an office procedure. A total of 98 participants were included, 89 (90.8%) had benign pathologies and 9 (9.2%) were malignant. Patient characteristics including, age, gravidity, BMI, medical history, and endometrial assessment using IETA were tabulated with each characteristic given a score of 0-3 depending on the degree of risk factor. Percentages, Pearson Chi-square Test with corresponding P-value and ROC curve analysis were performed.
RESULTS: The best predictors for endometrial cancer were age more than 50 years, nulligravid, BMI of more than 25, and presence of hypertension and diabetes mellitus. Sonographic features based on IETA showed an endometrial thickness of more than 20mm, irregular endometrial-myometrial junction, heterogenous endometrium, presence of multiple and large vessels on doppler analysis, contributed to endometrial cancer risk. These variables were used to create a scoring system with an area under the curve of 0.974 giving the best cut-off value of more than or equal to 9, with 100% sensitivity and 89% specificity.
CONCLUSION: Among patients with abnormal uterine bleeding and endometrial thickness of more than 4mm, we can predict the risk for endometrial cancer and aid the clinician in decision making on who may be managed conservatively or aggressively based on the value obtained from the scoring system. The study, however, needs to be validated prior to use in clinical practice.

Human ; Female ; Adult ; Gravidity ; Body Mass Index ; Endometrium ; Endometrial Neoplasms ; Myoma ; Uterine Neoplasms ; Uterine Hemorrhage ; Diabetes Mellitus ; Hypertension ; Decision Making

GENERAL OBJECTIVE: To determine endometrial cancer risk among patients with abnormal uterine bleeding based on the International Endometrial Tumor Analysis (IETA) features.
SPECIFIC OBJECTIVES: 1. To described the profile of patients with AUB suspected of having endometrial pathology; 2. To describe sonologic features of patients with AUB suspected of endometrial cancer using IETA features; and 3. To determine the association of a scoring system and endometrial cancer risk.
METHODS: We prospectively studied 542 participants who came in the CWCU of CSMC with a diagnosis of AUB from July 1, 2016 to December 31, 2016. We excluded patients with endometrial thickness of less than 4 mm on gray-scale sonography, those with technical difficulties in assessing the endometrium such as in cases of very large myomas, absence of histopathological diagnosis, and those whose sampling was done as an office procedure. A total of 98 participants were included, 89 (90.8%) had benign pathologies and 9 (9.2%) were malignant. Patient characteristics including, age, gravidity, BMI, medical history, and endometrial assessment using IETA were tabulated with each characteristic given a score of 0-3 depending on the degree of risk factor. Percentages, Pearson Chi-square Test with corresponding P-value and ROC curve analysis were performed.
RESULTS: The best predictors for endometrial cancer were age more than 50 years, nulligravid, BMI of more than 25, and presence of hypertension and diabetes mellitus. Sonographic features based on IETA showed an endometrial thickness of more than 20mm, irregular endometrial-myometrial junction, heterogenous endometrium, presence of multiple and large vessels on doppler analysis, contributed to endometrial cancer risk. These variables were used to create a scoring system with an area under the curve of 0.974 giving the best cut-off value of more than or equal to 9, with 100% sensitivity and 89% specificity.
CONCLUSION: Among patients with abnormal uterine bleeding and endometrial thickness of more than 4mm, we can predict the risk for endometrial cancer and aid the clinician in decision making on who may be managed conservatively or aggressively based on the value obtained from the scoring system. The study, however, needs to be validated prior to use in clinical practice.

Human ; Female ; Adult ; Gravidity ; Body Mass Index ; Endometrium ; Endometrial Neoplasms ; Myoma ; Uterine Neoplasms ; Uterine Hemorrhage ; Diabetes Mellitus ; Hypertension ; Decision Making

OBJECTIVE: This is a prospective case control study which aimed to determine the correlation of ovarian volume measurements with endometrial tissue diagnosis such as benign, premalignant and malignant conditions in women with postmenopausal bleeding.

METHODS: Thirty four postmenopausal women with bleeding underwent transvaginal ultrasound for ovarian volume measurements prior to dilatation and curettage. The presence of benign (Group I), premalignant and malignant endometrial. conditions (Group II) were correlated with ovarian volume.

RESULTS: Mean endometrial stripe thickness for group I (N= 19; 1.16ml+/- SD 0.88ml) was not significantly different from group II (N = 15; 1.58ml +/- SD 0.53ml). Mean ovarian volume among patients with premalignant and malignant histology (5.70ml +/- SD 1.91ml) was significantly higher than those with benign histology (2.04ml +/- SD?1.10ml) (P = 0.023). Linear regression analysis showed an association between ovarian volume and premalignant and malignant endometrial conditions (P=0.000). Using the mean ovarian volume cut-off of 5.8ml for postmenopausal women with bleeding, the sensitivity, specificity, positive predictive value and negative predictive value for premalignant and malignant endometrial conditions were 100%, 67.87%,40% and 100%,respectively.

CONCLUSION: Large ovaries among postmenopausal women may represent a marker of risk for endometrial cancer and may be used as an adjunct to endometrial thickness in ruling endometrial malignancy.

Human ; Female ; Aged ; Middle Aged ; Adult ; Postmenopause ; Ovary ; Dilatation And Curettage ; Uterine Hemorrhage ; Endometrial Neoplasms ; Uterine Diseases

Fetal Pleural Effusion is a rare case whose management is still a matter of debate. Its course may spontaneously resolve or lead to pulmonary hypoplasia and result in death in utero or poor neonatal outcome. This paper is a report of 2 cases and their course, from prenatal diagnosis of Pleural Effusion to delivery. This report includes sonographic scans, description of the laboratory work – up and other imaging tests that were done. The 1st case report was successfully managed with Thoraco-amniotic shunting, while the 2nd case was seen late and had an adverse neonatal outcome. This case report was done to increase awareness among obstetricians and sonologists in offering counsel to patients and their families, especially in our low resource set-up, where in in utero interventions are not available.
Humans ; Pregnancy ; Obstetricians ; Pleural Effusion

BACKGROUND AND OBJECTIVES

This study aims to determine the prevalence of depression and anxiety among Obstetrics and Gynecology residents-in-training during the COVID-19 pandemic.

METHODOLOGY

A cross-sectional study was conducted among Obstetrics and Gynecology residents from December 2020 to January 2021. Participants answered a 37-question survey consisting of sociodemographic and occupational data, as well as the Patient Health Questionnaire-9 (PHQ-9) and General Anxiety Disorder – 7 (GAD-7). The prevalence of the symptoms of depression and anxiety were computed.

RESULTS

A total of 120 (52.6%) residents, 62 from private hospitals and 58 from government hospitals completed the online survey. The overall prevalence of depression among Obstetrics and Gynecology residents was 42.5%, while the overall prevalence of anxiety was 31.7%. Three residents who had suicidal ideations were advised to seek counsel from a mental health professional.

CONCLUSION

The symptoms of depression and anxiety are common among OBGYN residents in selected tertiary hospitals in the National Capital Region during the COVID-19 pandemic. Quarterly surveys should be carried out for the trainees to increase awareness of depression and anxiety.

Human ; Anxiety ; Covid-19 ; Pandemics ; Depression