OBJECTIVE

Preterm birth is a major cause of complications leading to death of children under 5 years old. Infections are important to be identified because antimicrobial treatment may prevent or delay progression to preterm delivery. This study determined if routine screening tests of infections are useful in the clinical management of preterm labor.

A cross-sectional (descriptive) study was done involving 417 pregnant patients who had preterm labor and was subsequently admitted from 2015 to 2019 at a tertiary hospital in the Philippines, using review of past medical records, inpatient charts, and admission charts.

Majority of the patients delivered at less than 34 weeks, most of the culture results turned out negative, and urine tests were more commonly employed as screening tests for preterm labor. The endocervical and rectovaginal swab studies had no significant growths. Asymptomatic bacteriuria was diagnosed in 1 out of 10 patients and they were subsequently started on antibiotic treatment. Majority of the patients who were given antibiotics delivered within 48 hours from admission. 

The routine use of cultures in the assessment of preterm labor is costly and is unlikely to be helpful in the clinical management of patients in preterm labor.

BACKGROUND

Maternal malnutrition is a major cause of low birth weight (LBW) newborn outcome especially among adolescent mothers. It is one of the key drivers of child stunting and initiates the vicious cycle of intergenerational malnutrition. The body mass index prior to pregnancy or at the initial trimester is currently being used to establish the desired weight gain throughout pregnancy. However, Filipino adolescents often delay their first antenatal visit at a later stage of pregnancy. Without a baseline weight, the establishment of appropriate weight gain and nutritional status is often challenging. Mid-upper arm circumference (MUAC) was proven to be a good proxy measure of acute malnutrition, however, there was no global consensus on what MUAC cut-off point to use to identify pregnant adolescents at risk for delivering LBW babies. Finding the optimal cut-off could facilitate early identification and intervention of pregnant adolescents who are nutritionally at risk and could eventually break the cycle of intergenerational malnutrition.

The study aims to determine the association of maternal MUAC and the birth weight outcomes among newborn deliveries of adolescents in a tertiary hospital for a period of six months and to identify the optimal maternal MUAC cut-off point that can be used to predict low birth weight outcome among newborn deliveries of adolescents in a tertiary hospital.

A cross-sectional study was conducted among adolescents ages 10 to 19 years who delivered babies in a tertiary hospital in the Philippines for a period of six months. Maternal MUAC and LBW outcome were documented, and their association was determined using a logistic regression analysis. To measure diagnostic accuracy, the sensitivity, specificity, and the area under the curve were taken for each MUAC point. A receiver operating characteristic (ROC) curve was used to aid the MUAC cut-off determination.

Out of 237 newborn deliveries, 35% were noted with low birth weight while 65% had normal birth weight. Most of the mothers were in their late adolescence at 78%. The crude association for the MUAC cut-offs ≤23.00 cm, ≤23.50 cm, and ≤24.00 cm and LBW showed a significant value of 2.19, 2.25, and 2.39 at 95% CI, respectively. However, it is only the cut-off ≤24.00 cm that showed significant results for adjusted association by the logistic regression analysis. The MUAC cut-off ≤24.00 cm also showed a better trade-off value between the sensitivity and specificity. Furthermore, the optimal maternal MUAC measurement that predicts LBW newborn outcome points to ≤24.00 cm cut-off based on the ROC curve.

This study shows that the maternal MUAC is predictive of LBW outcome among adolescent deliveries.A MUAC cut-off of ≤24.00 cm was superior to lower cut-offs studied. The pregnant adolescents might need a higher MUAC cut-off than adults to allow timely intervention and prevention of poor neonatal outcomes. By doing this simple screening test, suspected pregnant adolescents can be easily identified and referred for further confirmatory testing.

INTRODUCTION

Adolescent pregnancy is enduringly perceived as posing a considerable social threat in the Philippines. Recent data from the Commission on Population and Development shows that over 40,000 births annually are from adolescent mothers aged 10 to 14 years, with many of these early pregnancies potentially linked to rape, forced sex, and abuse. Most studies in the past focus on causes and prevention. Limited research explores the lived experiences of early adolescent mothers, especially in the context of unwanted pregnancies.

This study was conducted to determine the lived experiences of unwanted pregnancy among early adolescents age 12 to 15 years old in Zamboanga City.

The study employed an Interpretative Phenomenological Study Design which involved understanding how the adolescents make sense of events, emotions, and interactions in their experiences. Ten (10) adolescent girls with experience of unwanted pregnancy were interviewed.

Analysis of transcripts generated three superordinate themes: (1) Living in the challenges of the present, (2) Facing the future with resilience, (3) Escaping the past. After identifying similarities across cases, two cross-case themes were generated: (1) Dysfunctional family background as a contributor to early pregnancy, and (2) The importance of relying on significant others for support.

The study revealed that unwanted pregnancies were influenced by dysfunctional family environments, socioeconomic challenges, and, in some cases, sexual exploitation. The participants faced emotional distress, financial instability, and social stigma, with support from family playing a critical role in the coping process. Despite the initial adversity, participants demonstrated resilience, finding ways to endure, adapt, and thrive.

Pregnancy after undergoing major gastrointestinal surgeries like the Whipple’s procedure (pancreaticoduodenectomy) for pancreatic neoplasm is rare. This case report describes a 24-year-old woman who conceived and delivered a healthy baby after undergoing a Whipple’s procedure 5 months earlier for a pancreatic tumor. Her pregnancy was managed by a multidisciplinary team, and she delivered at 37 weeks of gestation through cesarean section without any complications. This case highlights the potential for successful pregnancy following a Whipple’s procedure, with proper counseling, coordinated care, and close monitoring during pregnancy.
Pancreatic Neoplasms ; Pancreaticoduodenectomy ; Pregnancy

INTRODUCTION

One significant challenge facing the Filipino youth today is adolescent pregnancy, as the nation having one of the highest rates of adolescent births rates in the ASEAN region. Various sociocultural, economic, and individual factors have been identified as contributing factors. However, the impact of family, including maternal intergenerational factors, has yet to be substantially explored. This study aimed to investigate the root cause of adolescent pregnancy in San Juan city through the identification and examination of common familial factors.

This was an unmatched case-control study with a 1:2 ratio using a non-probability sampling. It included two groups of adolescent females: pregnant/ever pregnant and non-pregnant) aged 13 to 19. A three-part modified questionnaire was used to collect the data and was administered through a faceto-face interview.

This study revealed that adolescent women in grandparent-headed families are 4.47 (CI: 1.33, 15.0) times more likely to be pregnant as adolescents compared to the reference group. Adolescents with low educational attainment among their fathers and mothers are 4.25 (CI: 1.80, 10.10) and 3.30 (CI: 1.58, 6.93) times more likely to get pregnant, respectively. Additionally, if a mother is unemployed, they were 1.89 (CI: 1.09, 3.30) times more likely to get pregnant, and if their mother passed away, they were 4.24 (CI: 1.03, 17.42) times more likely to experience pregnancy. Moreover, they are 7.69 (CI: 4.21, 14.02) and 9.07 (CI: 2.74, 30.03) times more likely to get pregnant if their mother and sister have a history of adolescent pregnancy. There was also a significant association found between severe family dysfunctionality (p=0.0430) and adolescent pregnancy. Cases were 8.33 times less likely to have a severely dysfunctional family than controls.

A statistically significant association was found between adolescent pregnancy and several familial factors, including exposure to a grandparent-headed family structure, low parental educational attainment, maternal unemployment, maternal death, and a family history of early pregnancy involving the mother or an older sister. While moderate family dysfunction was also associated, this relationship was not statistically significant.

Ewing’s sarcoma is a rare cancerous tumor of bone or soft tissue that usually occurs mostly in young adults. The diagnosis of Ewing’s sarcoma in pregnancy, most especially the subtype extraskeletal Ewing’s Sarcoma, is very rare with only few cases published in the literature worldwide. We present a case of a primigravida diagnosed with extraskeletal Ewing’s sarcoma at 6 weeks age of gestation. Currently, because of the rarity of this condition, there is lack of a universal consensus on the recommended therapeutic approach. A multidisciplinary management involving the generalist obstetrician, perinatologist, medical oncologist, and neonatologist was initiated at the outset to provide timely balance between optimal maternal treatment and fetal well-being. The maternal and fetal condition was stable all throughout the course of the chemotherapy using doxorubicin during pregnancy. Close interdisciplinary coordination regarding the treatment plans across these subspecialists resulted in a successful pregnancy outcome.

Miliary tuberculosis (TB) is a disseminated form of TB resulting from the lymphohematogenous spread of Mycobacterium tuberculosis (MTb). Since pregnancy-related TB lacks the typical respiratory symptoms, clinicians might overlook the condition, complicating early diagnosis and treatment. This is a case of a 39-year-old multigravida, who presented with vaginal bleeding in the second trimester. She was admitted for tocolysis and correction of severe anemia. On the 6th hospital day, there was a note of febrile episodes accompanied by productive cough. Chest X-ray revealed miliary spread, eventually detecting MTb on sputum GeneXpert. At 19-week age of gestation, she delivered to an abortus. Histopathology of the endometrial tissues revealed caseating granulomas, consistent with tuberculous etiology. The disease’s severity, stage of the pregnancy at the time of diagnosis, and the existence of extrapulmonary dissemination might influence the outcome of pregnancy.

Lymphangioma is a rare developmental anomaly of the lymphatic system, commonly arising at birth, in infancy, or early childhood. Treatment is rarely curative. We report a case of macrocystic lymphangioma treated with sildenafil in a 16-year-old Filipino child diagnosed clinically, radiologically and histologically. The patient presented with grouped papulovesicles on the left lower extremity, associated with limb length discrepancy, unilateral leg pain and difficulty in ambulation. Given the recurrent course of this condition, even with surgical management, the use of a non-invasive approach such as sildenafil as a potential treatment option for lymphangioma is an important emerging area of study.

PURPOSE

To report the technical details and outcomes of a case of cervical cancer in pregnancy treated with reduced standard radiation volume via Intensity Modulated Radiation Therapy (IMRT).

A 33-year-old G4P3 (3003) was diagnosed with cervical squamous cell carcinoma at 17 weeks of gestation. She had a 5-year history of intermittent post-coital bleeding and an incidental finding of a cervical mass during prenatal ultrasound. Internal examination revealed a 6-cm mass with no extension to the upper vagina and pliable bilateral parametria, leading to a staging of IB3. A multidisciplinary meeting with a gynecologic oncologist, radiation oncologist, medical ethicist and the patient was held wherein different treatment options were discussed. She consented to definitive external beam radiation therapy (EBRT) with concurrent cisplatin and was administered during 19-25 weeks of gestation using IMRT. A prescribed dose of 45 Gy in 25 fractions was delivered to the entire cervix with a 1-cm geometric expansion covering the lower uterus, and upper vagina as well as the pelvic lymph nodes, followed by four fractions of brachytherapy.

The patient tolerated treatment with only grade 1 gastrointestinal and genitourinary adverse effects. After completion of concurrent chemoradiation, she underwent induction of labor and delivered a nonviable fetus. Three months post-treatment, MRI found no evidence of disease. At 15 months follow-up, she remains asymptomatic with no palpable disease.

This report demonstrates that treating only the involved uterus may be considered in cases wherein giving the full radiation dose to the whole uterus may lead to significant toxicities and eventual treatment interruption.

Cervical cancer during pregnancy poses a rare and complex clinical and ethical challenge, particularly in low- and middle-income countries such as the Philippines. The dual obligation to preserve maternal life while protecting fetal viability requires a nuanced balance between medical science, ethics, and cultural values.This commentary explores the ethical implications of treating cervical cancer in pregnancy using Intensity Modulated Radiation Therapy (IMRT) at reduced standard radiation volumes, highlighting how medical innovation intersects with the principles of biomedical ethics.