Patients with Gestational Trophoblastic Neoplasia commonly experience bleeding from metastatic sites in the vulvovaginal area. Digital pressure and early institution of chemotherapy usually achieve control of the hemorrhage, but massive hemorrhage ensues in some cases. This paper documents the case of a 48 year-old Gravida8 Para7 (7017) who previously underwent total hysterectomy for endometrial mass. On histopathologic examination, it was diagnosed as Choriocarcinoma. Patient was then advised multiagent chemotherapy indicated for high-risk metastatic gestational trophoblastic neoplasia. Chemotherapy was discontinued due to intermittent, profuse, vaginal bleeding that rendered the patient anemic, a contraindication to starting another cycle of chemotherapy. Despite direct pressure on the vulvar mass, the bleeding became intractable, rendering the patient hypotensive and hooked on ionotropes for hemodynamic stability. The only option remaining for the patient was emergency embolization.

This paper documents the first embolization to be done in the Philippines for labial metastasis from gestational trophoblastic neoplasia.

Human ; Female ; Middle Aged ; Pregnancy ; Gestational Trophoblastic Disease ; Choriocarcinoma ; Uterine Hemorrhage ; Hysterectomy ; Hemodynamics

Background: Multiple gestations, including twin gestations are commonly associated with adverse maternal, perinatal and neonatal outcomes compared with singleton pregnancies. Its incidence has shown a significant increase over the last decades. A retrospective cohort study was made at the Department of Obstetrics and Gynecology by review of medical records of twin pregnancies and their neonates. Objective: The purpose of this study is to describe and compare the outcomes of twin gestation against singleton pregnancies, in terms of the following: the presentation of the twin gestation, chorionicity, the mode and timing of delivery and fetomaternal complications. This study aimed to determine whether an association exists between the twin gestation and adverse perinatal outcomes. Methodology: The study included singletons and twin gestations admitted at a tertiary government hospital admitting section within a ten-year period, 2006-2015. Confirmation of diagnosis of multiple pregnancies was obtained by ultrasound. This retrospective cohort study conducted at a tertiary government hospital included 228 singletons and 110 twin gestations in a ten-year period. Results: Results showed women with twin pregnancies had a higher incidence of preterm labor and delivery. Compared to singleton pregnancies, complications of prematurity are not uncommon in twin gestations. This should encourage prenatal and antenatal care in women who have twin gestations. Conclusion The incidence of preterm labor and delivery for twin gestation, relative to singletons, was high in the study. Twin gestations are 3-4 times more likely to present with preterm labor relative to singletons.
Morbidity

Objectives. This study aims to determine perceptions of physicians in our institution on the role of telemedicine in cancer care during the COVID-19 pandemic and to assess its perceived benefits and barriers. Methods. This is a cross-sectional study of physicians involved in cancer care in a tertiary referral hospital in the Philippines. We administered a 21-item online survey questionnaire between August to October 2020. Results. We received and analyzed 84 physician responses. Ninety-six percent of physicians currently use telemedicine, an increase from 59% pre-pandemic. Eighty-nine percent use telemedicine for follow-up virtual consults, while 75% use telemedicine for case discussions in multidisciplinary meetings. The mean number of monthly patient consults conducted through telemedicine increased to 29.5 (SD: 24.8) from a pre-pandemic mean of 7.7 (SD: 18.7). Eighty-four percent of respondents perceived its main benefit as an infection control measure. The other perceived benefits of telemedicine include convenience (78%), accessibility to cancer care (72%), cost-effectiveness (68%), and time efficiency (44%). A quarter of the respondents believed that telemedicine has the potential to improve cancer outcomes. Ninety-two percent of the respondents expressed that they will use telemedicine occasionally in their practice. Conclusion. Telemedicine was perceived by Filipino physicians in a tertiary hospital as an acceptable solution for the provision of cancer care during and after the COVID-19 pandemic. Tele-oncology should be further investigated to maximize patient and physician satisfaction and improve cancer outcomes. Data from this study can be used to improve oncology practice and service delivery to suitable patients during and after the COVID-19 pandemic.
COVID-19 ; Telemedicine ; Medical Oncology ; Pandemics ; Neoplasms