Preterm birth accounts to 35 % of deaths in a year. Twin gestation, around 7.2 per 1000 births in the Philippines, is a known risk factor that increases likelihood of preterm birth compared to singletons. Most studies that addresses preterm births are focused on singleton pregnancies. There have been no established recommendations to control preterm labor in twin pregnancies. Pessary insertion is among these recommendations. There are no reported cases of pessary insertion to control preterm birth among twins in the Philippines. This study presents a case of twin gestation in preterm labor and no functional cervix on transvaginal ultrasound. Hodge pessary was inserted at 28 weeks age of gestation. She delivered at 36 weeks to live baby girls, both 2,200 grams and were directly roomed-in. Further studies are recommended to establish stronger evidence supporting pessary use in multiple gestation to improve outcome of neonates.
Pessaries ; Premature Birth ; Obstetric Labor, Premature ; Pregnancy, Twin

Background: Transvaginal ultrasound prior to IUD insertion may be helpful in appropriate patient selection and optimal patient conditions in preventing IUD malpositions and complications. Objective: To describe the sonographic features of correctly positioned and malpositioned intrauterine device (IUD) in women and correlate with associated symptoms and concurrent cervical, uterine and ovarian pathology Methodology: This is a 5-year retrospective cross-sectional study. Patients in a tertiary hospital with sonographically detected correctly positioned and malpositioned IUDs were selected from the Obstetrics and Gynecology Ultrasound Database from January 1, 2014 to December 31, 2018. The patient’s name and case number were used to review the patient’s charts for the demographic profile and other necessary data. Intrauterine device sonographic features were recorded, correlated clinically and analyzed statistically. Results: Three hundred two patients were eligible for the study with ages between 41 to 50 years old and with an average of 1 to 3 pregnancies and livebirths. Almost half of the women with malpositioned IUDs complained of missing IUD string. Sonographically, the IUD appeared echogenic with more than half demonstrating a linear echogenic stripe. The most common type of malpositioned IUD was partial or fully embedding the myometrium (45.2 %), followed by those located in the cervix or in the lower uterine segment (35.7%), partially expelled with IUD segment extending through the external cervical os (11.9%), and fragmented (4.7%). The least common malpositioning was malrotation of the IUD (2.3%). There were significantly more women with cervical disease among those who had correctly placed IUDs. Thirteen women were pregnant, 9 of whom had intrauterine pregnancies. 3 had ectopic pregnancies and 1 had an abortion. Eight of the 9 intrauterine pregnancies had malpositioned IUD and only 1 had correctly positioned IUD which was statistically significant. Conclusion Women with IUD who became pregnant and with missing IUD strings are important predictors to re-assess IUD placement. Uterine pathologies such as myomas and adenomyomas do not affect placement of intrauterine devices. IUDs remain in place in the presence of cervical diseases such as cervical malignancies.
Ultrasonography ; intrauterine devices ;

Background: The International Endometrial Tumor Analysis (IETA) group developed a catalog of standardized terms to describe findings that may be associated with uterine pathology. However, there is a lack of reliability studies for these descriptors in the literature. Objective: The objective of this study was to estimate interobserver and intraobserver reliability with regard to the IETA group descriptors for endometrial vascular characteristics in women with abnormal uterine bleeding. Materials and Methods: Five nonexpert and five expert raters assessed stored still images of transvaginal ultrasound examinations obtained from 68 women with abnormal uterine bleeding and endometrial thickening. Endometrial vascularity was evaluated using the IETA group descriptors for color flow and vascular pattern. Interobserver agreement was estimated by comparing the assessments of the nonexpert and expert raters. Intraobserver agreement was estimated by repeating the raters’ assessment after 4 weeks. Interrater agreement to the subjective assessment of an expert investigator was also computed. Results and Conclusion The reproducibility of assigning IETA color score is good regardless of the degree of expertise of the rater, although the experts displayed better interobserver reliability (κ = 0.74 vs. 0.57) and intraobserver reliability (κ = 0.84 vs. 0.63). However, the reproducibility of describing IETA vascular patterns is significantly worse for both expert and nonexpert raters in both interobserver reliability (experts κ = 0.49 vs. 0.34) and intraobserver reliability (experts κ = 0.65 vs. 0.42). Both expert and nonexpert raters exhibited acceptable agreement with the reference standard, with experts performing better for both color score (κ = 0.79 vs. 0.70) and vascular pattern (κ = 0.63 vs. 0.44).
Endometrium