BACKGROUND: Uterine arteriovenous malformation (AVM) is a web of arteries and veins lacking an intervening capillary network. Color flow Doppler is a popular method of diagnosis of uterine AVM. The definitive management is hysterectomy. However, for patients desirous of pregnancy, transarterial embolization is a safe and effective option. Although rare, uterine AVM can complicate pregnancy with torrential bleeding due to hormonal changes and significant remodeling of the myometrium.
CASE: We report a case of a term pregnancyin a 33 year old with a uterine AVM and a previous transarterial embolization procedure who developed a uterine AVM during multi-agent chemotherapy for gestational trophoblastic disease. She consulted for prenatal checkup. Due to the risk of massive bleeding during labor, she underwent elective cesarean section at term and delivered a baby with good outcome.
CONCLUSION: This case suggests that uterine AVM in pregnancy can be managed conservatively with serial ultrasound monitoring and close follow up.

Human ; Female ; Adult ; Pregnancy ; Myometrium ; Uterine Anomalies ; Uterus ; Urogenital Abnormalities ; Arteriovenous Malformations ; Gestational Trophoblastic Disease ; Hysterectomy ; Cesarean Section ; Arteries

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

Ovotesticular disorder of sex development (OT-DSD), previously known as true hermaphrodite, is a rare disorder of sexual differentiation in which the gonads of an individual are characterized by the presence of both mature ovarian and testicular tissues. The diagnosis has traditionally been applied only if an individual has 1) histologically verified ovarian follicles or proof of their prior existence (e.g. corpora albicantia) and 2) seminiferous tubules or spermatozoa. This paper introduces you to a 14 year-old, who presented with primary amenorrhea and enlarging abdominal mass, underwent exploratory laparotomy, salphingooophorectomy, histologically diagnosed as a possible case of a true hermaphrodite and chromosomally diagnosed as 45XO/46XY who developed endodermal sinus tumor, a germ cell tumor, considered highly malignant.

Human ; Female ; Adolescent ; Ovotesticular Disorders Of Sex Development ; Sex Differentiation ; Endodermal Sinus Tumor ; Amenorrhea ; Laparotomy ; Gonads ; Sexual Development ; Seminiferous Tubules ; Spermatozoa ; Ovarian Follicle

OBJECTIVE: To review the POGS statistics on Maternal Mortality Rate and causes of direct and indirect maternal deaths from 2012 to 2014.
BASIC PROCEDURE: Data were retrieved friom the Integrated Statistical Information System, or ISIS, of POGS, and compliance in its use was assessed. Twenty four hospitals were chosen based on completeness of data and highest number of admissions.
RESULTS: Maternal Mortality Rate for the three-year period was 296 per 100,000 livebirths. The top causes of direct maternal deaths were hypertension, hemorrhage and infection. The top three causes of indirect maternal deaths were hypertension, hemorrhage and infection. The top three causes of indirect maternal deaths were cardiac, pulmonary and vascular.
CONCLUSION: Maternal Mortality Rate from 2012 to 2014 was reviewed. The low compliance submitting complete forms from POGS-accredited hospitals made the Committee on Nationwide Statistics strongly recommend an enhancement of the use of the electronic data-based system.

Human ; Female ; Maternal Death ; Maternal Mortality ; Hemorrhage ; Hospitals ; Hypertension ; Heart

BACKGROUND: Bacterial vaginosis (BV) is the most prevalent cause of symptomatic vaginitis. In the Philippines, prevalence of BV is at 28.16%. The mainstay for the treatment of BV is Metronidazole. Although antibiotic therapy has been shown to eliminate BV associated organisms, there is extremely high recurrence rate.
OBJECTIVE: To compare the efficacy of metronidazole and metronidazole plus lactobacilli tablet in the treatment of bacterial vaginosis among non-pregnant patients seen at the outpatient department of a tertiary medical center.
METHODOLOGY: The population included non-pregnant women ages 15 t0 44 years old, with bacterial vaginosis diagnosed by Amsel's criteria and Nugent's scoring. The participants were randomly assigned to their treatment group, one is Metronidazole only and other received Metronidazole plus Lactobacillus tablet. All participants followed up on day 8,15,22 and 56 from initiation of treatment resolution or persistence of symptoms and collection of vaginal specimen for gram stain and inquire on adverse effects.
RESULTS: On day 8 treatment, there were significantly more participant in the metronidazole plus probiotic arm with an estimated lactobacilli count of more than 30/hpf as comapred to metronidazole alone. On day 15 post treatment, there was no statistically significant difference with the estimated Gardnerella vaginalis count, lactobacilli count, presence or absence of malodorous vaginal discharge between the metronidazole plus probiotic and the metronidazole alone arm. With metronidazole plus probiotic group, the proportion of women with less than 30 per hpf Gardnella vaginalis count and absent foul smelling vaginal discharge were accounted among 100% of the participants from day 8 to 56 post treatment. The early reduction in the causative agent and symptoms can be attributed to an increase in the estimated lactobacilli count sustained until 56 days post treatment metronidazole plus probiotic. However, from day 15 to 22 and 56 post- treatment, the proportion of participants who had a nugent's score of less than 4 were greater for both the metronidazole plus probiotic (100%) and metronidazole alone (95%) arm, when compared to day 8 post-treatment. This finding for the metronidazole plus probiotic group is due to sustained reduction in the Gardnella vaginalis count and increase in lactobacilli counts. Potentially , the metronidazole plus probiotic treatment was found to be more favorable in sustaining the normal flora and probiotic can be used as an adjunct may enhance the efficacy of metronidazole in the treatment of BV.
CONCLUSION: Metronidazole plus probiotic and metronidazole only treatment are comparable in treating bacterial vaginosis. In terms of restoring and maintaining the normal flora, metronidazole plus probiotic appears to be more significantly efficacious. Probiotic in the form of lactobacilli is a promising adjunct to enhance the efficacy of metronidazole in the treatment of bacterial vaginosis.

Human ; Female ; Adult ; Adolescent ; Gardnerella Vaginalis ; Vaginosis, Bacterial ; Metronidazole ; Lactobacillus ; Gardnerella ; Probiotics ; Vaginal Discharge ; Gentian Violet ; Phenazines ; Tablets ; Anti-bacterial Agents

INTRODUCTION: Serial beta human chorionic gonadotropin (?hCG) monitoring after molar evacuation is advised for early detection of persistent trophoblastic disease. The aim of this study was to determine the percentage of patients who developed post-molar gestational trophoblastic neoplasia during a 6-month follow up period after normalization of ?hCG surveillance for patients who underwent treatment for molar pregnancy.
METHODS: Data was analyzed from the Section of Trophoblastic Diseases at the Philippine General Hospital- Department of Obstetrics and Gynecology to estimate the incidence of persistent trophoblastic disease among 258 women with molar pregnancy form 2000-2011.
RESULTS: Among the 258 registered hydatidiform mole patients, 205 patients (79.5%) attained normal ?hCG titers titer levels after evacuation of molar products. There was no occurrence of postmolar gestational trophoblastic neoplasia among patients who achieved normalization of ?hCG titers after treatment. ?hCG levels did not attain normalization following evacuation in 53 patients (20.5%). Out of the 53 patients, 50 patients (94.3%) were detected to have gestational trophoblastic neoplasia within the first six months post-treatment. Only 3 patients (5.7%) were determined to have disease progression after six months during the one-year follow-up period.
CONCLUSION: The follow-up period after a molar pregnancy may be reduced for patients whose serum ?hCG levels spontaneously decline to normal levels after evacuation. The results of this study showed that the median time to obtain normal ?hCG levels is 88 days for those who received chemoprophylaxis and 85 days for those with lower initial ?hCG values (less than 100,000 mlU/ml).

Human ; Female ; Aged ; Middle Aged ; Adult ; Gynecology ; Obstetrics ; Gestational Trophoblastic Disease ; Hydatidiform Mole ; Chorionic Gonadotropin ; Disease Progression ; Chemoprevention ; Molar

OBJECTIVE: The study aims to correlate the histopathologic characteristics of patients diagnosed with complete hydatidiform moles with the risk of developing postmolar gestational trophoblastic neoplasia.
METHODOLOGY: A retrospective review of 71 histopathologically-confirmed cases of complete hydatidiform moles was made. Group 1 consisted of 65 patients who achieved normal titers and remained to have normal ?-hCG titers after at least 1 year of follow up. Group 2 included 6 patients who developed postmolar gestational trophoblastic neoplasia. Histopathologic slide review was done to assess the following: trophoblastic proliferation, nuclear atypia, hemorrhage, necrosis along with measurement of the shortest diameter of the largesthydropic villus. The association of the histopathologic features and the development of postmolar gestational trophoblastic neoplasia was done using chi square. Analysis of the association of histopathologic features included in the study predictive of the development of postmolar gestational trophoblastic neoplasia was done.
RESULTS: Analysis of several histopathologic parameters which may precisely identify which patients with complete hydatidiform moles were more likely to develop postmolar gestational trophoblastic neoplasia failed to produce statistically significant results. However, among all the features studied, the presence of extensive necrosis favored the occurrence of postmolar sequela.
CONCLUSION: Trophoblastic proliferation, nuclear atypia, hemorrhage and villus size of complete hydatidiform moles do not predict progression to postmolar disease. In spite of this, all patients with complete hydatidiform moles should be considered for prophylactic chemotherapy  should be monitored closely.

Human ; Gestational Trophoblastic Disease ; Hydatidiform Mole ; Trophoblasts ; Risk

Ovarian new growths are among the most common tumors in women. Their presentation at time of diagnosis vary and are often incidental findings on ultrasound examination. Complications of ovarian masses include torsion, rupture, infection, hemorrhage, and malignant degeneration. These masses have also been known to create fistulous tracts to other organs of the body. Entero-adnexal communications have been reported in literature. However, fistula formation to the skin has not yet been reported. Here, we present an adult woman diagnosed to have ovarian new growth and a one-year history of serous discharge from a skin lesion. Imaging studies show a fistulous connection to the abdominopelvic mass. She underwent excision of the mass with fistulectomy. This is the first reported case of an ovarian new growth which created a cutaneous fistula.

Human ; Female ; Adult ; Cutaneous Fistula ; Incidental Findings ; Skin ; Skin Diseases ; Ultrasonography ; Neoplasms

OBJECTIVES: To identify the clinical factors associated with intrauterine insemination (IUI) success among Filipino couples and incorporate the significant clinical factors in a formula for a prognostic scoring index for the success of IUI.

METHODS: This is a review of cases who consulted for infertility and underwent IUI at a tertiary hospital between January 2007 and December 2014. The variables considered for analysis were female age, duration of infertility, etiology of infertility, method of sperm processing, number of preovulatory follicles, total motile insemination count (TMSC), and sperm motility. The outcome measure was determined either by a positive urine or serum beta HCG or a gestational sac on transvaginal ultrasound. Results from the logistic regression analysis were used to develop prognostic scoring index for IUI success. Computed scores were plotted in a Receiver Operating Characteristic Curve and cut off values were determined.

RESULTS: The overall pregnancy rate in this study was 10.7%. Duration of infertility (OR 10.33, 95% CI 3.488-30.602) and sperm motility (OR 5.30, 95% CI 1.830-15.331) showed the strongest significant association with the occurrence of pregnancy. Odds of pregnancy after IUI are likewise increased in female age of < 32.5 years (OR 2.52, 95% CI 1.704-3.734), swim-up method (OR 2.17, 95% CI 1.383-3.415) and TMSC of ?19.5 million (OR 1.78, 95% CI 1.076-2.954). The odds of successful pregnancy among patients whose duration of infertility is ? 2.5 years and who have a sperm motility count of ? 67.5 are more than thrice (OR 3.13, 95% CI 0.095-0.990), compared to those with duration of infertility of > 2.5 years. The formulated prognostic scoring index for IUI success was 18.6, with specificity of 91.1%, sensitivity of 39.4%.

CONCLUSION: Duration of infertility, female age, sperm motility, TMSC and sperm processing method significantly affect the success of IUI success among Filipino couples studied. Using the formula derived, with a sensitivity of 91% and a sensitivity of 39, couples with a score of ?18.6 are more likely to get pregnant 4 times more than those with a score of less than 18.6.

Human ; Female ; Adult ; Pregnancy ; Sperm Motility ; Pregnancy Rate ; Gestational Sac ; Prognosis ; Infertility, Female ; Spermatozoa ; Fertilization In Vitro ; Insemination

BACKGROUND: Episiotomy is a surgical incision of the perineum performed to widen the vaginal opening to facilitate the delivery of an infant. Bleeding is its common complication. A certain technique must be followed so as not to incur either dyspareunia, dehiscence or infection. Hence the application of policresulen solution during repair may minimize bleeding and facilitate better wound healing.

OBJECTIVE: To compare the operative and post-operative outcome between episiorraphy with and without application of policresulen solution during repair among puerperal patients admitted in a tertiary hospital.

METHODOLOGY: One hundred participants were randomized to two treatment groups. Those assigned to treatment A (n=50) underwent episiorrhaphy with policresulen solution application while those in treatment B (n=50) served as the control group. The main outcome measures were estimated blood loss, operative time and duration of wound healing.

RESULTS: There was a significantly shorter mean operative time with the participants in the Policresulen group (20.92 ± 0.90 minutes) as compared to the Control group (53.8 ± 1.79 minutes) with a P-value of < 0.001. Estimated mean blood loss was significantly lesser in the Policresulen group (195.2 ± 5.69 ml) than in the Control group (373.8 ± 16.14 ml) having a P-value of < 0.001. The duration of wound healing was also shorter among those in the Policresulen group (1.42 ± 0.09 weeks) than those in the Control group (2.14 ± 0.17 weeks), with a P-value of 0.003. A significantly greater proportion of participants had shorter operative time, lesser blood loss and shorter duration of wound healing in the policresulen group. (p-value < 0.005)

CONCLUSION: Policresulen solution application has a good hemostatic effect on the episiotomy wound hence shortened the operative time. It also has a good wound healing effect reflected by a shortened duration of wound healing of the episiotomy wound.

Human ; Female ; Adult ; Episiotomy ; Perineum ; Dyspareunia ; Surgical Wound ; Bleeding Time ; Blood Loss, Surgical ; Outcome Assessment (health Care)