This is a case of a 22 year old nulligravid who presented with severe dysmenorrhea, and diagnosed with unicornuate uterus and an obstructed noncommunicating rudimentary horn, by pre-operative ultrasound. In this paper, the presentation, diagnosis and principles of surgical management of unicornuate uterus associated with a non-communicating rudimentary horn is presented. The embryological development of this anomaly and its association with renal agenesis are discussed.
Dysmenorrhea ; Uterus

Background: Proper assessment and efficient diagnosis of central nervous system anomalies is essential in antenatal surveillance of pregnant patients. These anomalies are usually associated with genetic syndromes or severe malformations requiring timely intervention and antenatal counseling of the expectant couple. Objective: The study aims to evaluate the agreement of cranial biometric measurements and to determine if there is a significant difference in the time needed to complete the evaluation using standard 2D and semi-automated 5D ultrasound. Methods: An analytical cross-sectional study was employed on 93 women who underwent pelvic ultrasound scans from August to October 2022 in a tertiary hospital. Basic biometric fetal central nervous system (CNS) measurements were acquired using 2D ultrasound followed by 5D CNS ultrasound. Bland-Altman plots were used to evaluate the agreement of the measurements obtained. The difference in the time to completion was determined using independent t-test. Results and Conclusions Our study found that 5D CNS ultrasound measurements showed 96.8% agreement with 2D ultrasound in 90 out of 93 fetuses. The 5D CNS ultrasound takes a shorter time of 90 seconds (s) to completion in comparison to 99 s using the 2D method (p=0.076). Upon stratification of the study population per trimester, in the second trimester, it took 76 s with 5D CNS vs 89 s with 2D, resulting to a statistically significant 13-second difference (p=0.044). In the third trimester, 5D CNS took 105 s vs 108 s with 2D (p=0.614). The time to completion of the scan using this technology is faster when used for second trimester pregnancies but could be affected by fetal-dependent and operator-dependent factors. Therefore, application of this new technology has the potential to improve workflow efficiency after the necessary training on 3D sonography and 5D CNS ultrasound software.
Artificial Intelligence

Background: To reduce maternal morbidity and mortality associated with hypertension, standards for maternal safety and efforts to implement a structured team approach have been undertaken. Following the formulation of a policy document, a maternal safety bundle was developed. The implementation of bundle components including eclampsia kits, clinical pathways, and educational module occurred in phases due to pandemic restrictions. An eclampsia kit and clinical pathways were implemented in 2020. An online lecture was launched in 2021 followed by in-person eclampsia simulation workshop beginning 2022. Objectives: This paper aims to report the early outcomes of a severe preeclampsia and eclampsia maternal safety bundle implementation in a private hospital between 2020 to 2023. Materials and Methods: Demographic information, posttest knowledge assessment and preand post- eclampsia workshop confidence scores were recorded. Structure, process, and outcome measures were determined. Descriptive statistics were used for participant demographics and score percentages. Paired t-Test with a significance level of P<0.05 was used to compare the pre- and post-simulation confidence scores. Summary data for outcome and process metrics were manually calculated. Summary categorical data was used for structure metrics. Results: Two hundred eighty-eight (288) participants completed the online didactic lecture. Average posttest knowledge assessment score was 88.1%, 88.88%, and 82.6% from 2020 to 2023. Ninety-nine participants completed the eclampsia simulation workshops. Mean post-simulation confidence scores were greater than mean pre-simulation confidence scores (42.3 vs. 39, p=0.0259 in 2022 and 41.975 vs 36.65, P=0.0035 in 2023). There is 100% compliance with timely management of severe hypertension and eclampsia prevention and a decreasing trend in hypertension related severe maternal morbidity rates. Conclusion A severe preeclampsia and eclampsia maternal safety bundle is a feasible quality improvement initiative that promotes peer learning, strengthens clinical competencies, and improves access to emergency resuscitation supplies. The results of this program evaluation may serve as a framework for implementing quality improvement initiatives on maternal safety.