The goal of this study was to determine the ovarian reserve by sonographic measurement of ovarian volume and antral follicle count, then correlate with menstrual pattern in women belonging reproductive age. All patients were grouped accordingly into early, mid and late reproductive age group. Transvaginal or transrectal sonography was performed on the follicular phase of the menstrual cycle. Ovarian volumes and antral follicle counts of both ovaries were determined sonographically and recorded.

METHODS: A total of 160 subjects were included in the study. Infrequent; menstrual pattern were noted in half (50%) of the subjects. Irregular menstrual pattern were noted in more than half (55%) of the subjects. Almost 60% were noted to have shortened duration of menstrual pattern. There were 92 (57.5%) with light menstrual pattern.

RESULTS: Results showed ovarian volume and antral follicle count decreases with increasing age. Ovarian volume of subjects with infrequent menstrual pattern was significantly higher than those with frequent menstrual pattern but is significantly higher than those with normal menstrual pattern. Ovarian volume of subjects with irregular menstrual pattern were significantly higher than those with regular menstrual pattern. Antral follicle count of subjects with infrequent menstrual pattern was significantly higher than those with frequent menstrual pattern but is significantly higher than those with normal menstrual pattern. Antral follicle count of subjects with irregular menstrual pattern were significantly higher than those with regular menstrual pattern. Results showed that there was a significant difference both in the ovarian volume and antral follicle count according to age as well as frequency and regularity of menstrual pattern.

Human ; Female ; Adolescent ; Child ; Menstruation ; Menarche ; Ovary ; Ultrasonography ; diagnostic imaging

OBJECTIVES: The objective of this study was to determine the most accurate method to use for the diagnosis of membrane rupture as well as to compare the sensitivity, specificity, positive and negative predictive values of such different methods.

METHODOLOGY: This prospective, non-randomized, descriptive study included 100 subjects, 50 each for the control group or women with intact membranes documented by history and physical examination, and gold standard group or women with ruptured membranes documented by history and pooling of amniotic fluid on speculum examination. Endocervical samples for control group (no pooling) and vaginal/posterior fornix samples for gold standard group (with pooling of fluid) were obtained from each patient used to test for determination using Actim^TM PROM test kit, ferning test, and pH testing using litmus paper.

RESULT: Ferning's test, Litmus paper test and Actim^TM PROM test have sensitivity of 30%, 44% and 74%, respectively specificity of 100%, 96%, 96% and respectively; PPV of 100%, 91.7% and 94.9% respectively; and NPV of 58.8%, 63.2% and 78.7% respectively. Actim PROM test kit was noted to be superior in terms of accuracy, followed by Litmus paper test, and lastly, by Ferning test as shown by the Receiver Operating Characteristic curve.

CONCLUSIONS: Actim^TM PROM test was noted to have the highest accuracy, as evidenced by the result of ROC curve, with the highest probability of testing positive in patients with true rupture of membranes, and with the highest Kappa statistic value or lowest probability of having interobserver variability.

Human ; Female ; Adult ; Fetal Membranes, Premature Rupture-diagnosis ; Preterm Premature Rupture of the Membranes

BACKGROUND: Oxytocin is a drug widely used for induction of labor. Despite its widespread use, data on the benefit from continuous oxytocin infusion for labor induction beyond the onset of active phase of labor are scarce. To address this, a single-blind randomized clinical trial was done comparing the course and outcome of labor of patients given continuous oxytocin versus those whose oxytocin were discontinued during the active phase of labor.

METHOD: Term, singleton primigravid patients admitted in a tertiary hospital from January 1 to May 31, 2013 were included in the study. After careful assessment, 64 primigravids who fulfilled the inclusion criteria, (32 per group), were randomized to 2 groups, Group 1 (received continuous oxytocin infusion) and Group 2 oxytocin was discontinued during the active phase of labor). Analysis of data collected was done using SPSS software version 17, student T test, Chi square tests, z test of proportion were used.

RESULTS: There was no statistically significant difference found between the two groups with regards to the outcome during the latent phase of labor as well as the second stage of labor. However, there was significant difference in the duration of the active phase of labor among patients from Group 1 (those given continuous oxytocin). In terms of mode of delivery, there was no statistically significant difference between 2 groups. Some of the patients from both groups eventually required abdominal delivery, this outcome was found to be not statistically significant. The neonatal outcome in terms of APGAR score, clearance given to be roomed-in immediately and the need for antibiotics were also found to be not statistically significant.

CONCLUSION: In this study, results show that discontinuing oxytocin during active phase of labor does not increase the abdominal delivery rate, affect labor and fetal outcomes.

Human ; Female ; Adult ; Young Adult ; Oxytocin-drug effects ; Pregnancy ; Labor Presentation

BACKGROUND: The standard treatment for bacterial vaginosis is metronidazole. Side effects are not well tolerated by some patients and some develop resistance. Hence, the search for treatment with less side effects and less resistance.

OBJECTIVES: To determine the efficacy of vaginal dequalinium chloride compared to oral metronidazole in the treatment of bacterial vaginosis among non; pregnant women.

METHOD: Fourty non-pregnant women and non lactating women, 18-50 years old diagnosed with bacterial vaginosis by presence of vaginal discharge and malodor, Nugent's score of 4 and above, and clue cells seen in Gram stain, were randomly allocated to treatment groups. Group A received dequalinium chloride 10mg/vaginal tablet for 6 days at HS while Group B received metronidazole tablet, 500mg/tablet, 1 tablet per orem BID for 7 days. Microbiologic, clinical and complete cure rate as well as adverse effects of treatment were then assessed. Data entry and encoding was done using Epi info version 6. Analysis was done using stata version 9. Univariate analysis such as mean, median, mode and range were used to describe the characteristics of the subjects. Frequency distribution was used to describe the proportion of patients with microbiologic, clinical and complete cure. This was also used in describing proportion of the participants' acceptability in this study. Chi square was used for comparison of dequalinium chloride and metronidazole between treatment-arms.

RESULTS: Ninety five percent (19/20) of those in the dequalinium arm had gram-negative coccobacilli count of less than 10/hpf as compared to 80% (16/20) among those in the control (P < 0.30). Lactobacilli was only restored among 25% of those in the metronidazole and in 75% of the control group (P = 0.002). Reduced amount of discharge was observed in all paricipants in both groups. Malodor of the discharge disappeared in 95% (19/20) of the H₂O₂ and 85% (17/20) of the control group (P=0.30).

CONCLUSION: Dequalinium is comparable with the standard treatment. It is at par with the standard treatment in alleviating symptoms of bacterial vaginosis and reducing estimated coccobacilli. It is more effacious in restoring the normal flora.

Human ; Female ; Middle Aged ; Adult ; Young Adult ; Vaginosis, Bacterial ; Dequalinium ; Metronidazole ; bacteria ; Gardnerella vaginalis ; Mycoplasma hominis ; Fusobacterium

Pregnancy in the rudimentary horn of a unicornuate uterus is a rare obstetric occurence. Rarer still is the continuation of such a pregnancy resulting in a term live birth with a healthy mother and child. Presented here is a case of a 28 year old primigravid who was referred at 40 weeks age of gestation and admitted for cesarean section for malpresentation. Intraoperatively, a transverse incision was done on the lower portion of the gravid rudimentary horn to deliver the baby followed thereafter by its removal by doing a hemi-hysterectomy. The patient gave birth to a healthy baby girl weighing 2100g with an APGAR score of 8-9 and a pediatric aging of 38 weeks. Discussed herein is the possible mechanism for fertilization in rudimentary horn pregnancies, its possible complications and its management.

Human ; Female ; Adult ; PREGNANCY ; Hysterectomy ;

BACKGROUND: Bacterial vaginosis is the most common vaginal infection among reproductive age women. It has been associated with preterm labor and emerged as a formidable disease entity associated with catastrophic sequelae especially in pregnant patients. Papanicolaou smear is the most successful screening test for cervical carcinoma in the history of medicine. Albeit being used by some clinicians as screening tool for bacterial vaginosis, it was not well established.

OBJECTIVE: To determine the diagnostic accuracy of papanicolaou smear in making the diagnosis of bacterial vaginosis in pregnant patients with the vaginal gram stain used as diagnostic standard.

METHODOLOGY: A total of 321 pregnant patients who consulted for prenatal care at the outpatient department of obstetrics and gynecology of the tertiary training hospital between November 2013 to-June 2014 were included in the study. Each patient had gram-stained vaginal smear and standard pap smear done consecutively. The sensitivity, specificity, positive predictive value, negative predictive value and the likelihood ratios of pap smear were determined.

RESULTS: The sensitivity of pap smear in determining the presence of bacterial vaginosis is 70.5%, its specificity of 93.6%, positive predictive value of 80.5%, negative predictive value of 89.3%. Likelihood ratio of a positive result is 10.9 and 0.3 for a negative result with diagnostic accuracy of 87.23%.

CONCLUSION: These results support the reliability of the pap smear in the diagnosis of bacterial vaginosis in asymptomatic pregnant patients. Since pap smear and gram stain have close diagnostic accuracy, duplication of the test could reasonably be avoided in most patients.

Human ; Female ; Adult ; Young Adult ; Adolescent ; Postmenopause ; Ovary ; Neoplasms ; ROC Curve ; Endometrial Neoplasms

BACKGROUND: Clinical studies showed a correlation between postmenopausal women with large ovaries and endometrial cancer. Considering the different average ovarian volumes among various races, it is prudent to identify the most valid ovarian volume among symptomatic menopausal women in our population and classify their probability of having a benign or malignant endometrium.

OBJECTIVE: To determine the relation of ovarian volume measurements using a reference value generated by an ROC curve with endometrial tissue biopsy diagnosis of pre-malignant and malignant endometrium among Filipino postmenopausal women.

METHODOLOGY: Fifty menopausal women with vaginal bleeding were included in a six-year review from January 2008 to December 2013. All had transvaginal ultrasonography and underwent endometrial sampling. A receiver operating characteristic (ROC) curve was generated and the most valid ovarian volume was obtained. The ROC curve -- generated ovarian volume was used as the cut-off value and was correlated with histopathologic diagnoses.

RESULTS:  Among the fifty patients, 30 with benign endometrium had an ovarian volume of 3.51 ml. Among the 10 patients with malignant endometrium, 9 had an ovarian volume of > 3.51 ml, and one had an ovarian volume of < 3.51 ml. The sensitivity of predicting endometrial cancer using ovarian volume of > 3.51 ml as cut-off is 90% (95% Cl 55.46 % to 98.34%), while the specificity is 75% (95% Cl of 58.80% to 87.29%). Using the chi-square test, it showed a significant association between ovarian volume of > 3.51 ml and malignant endometrium (P=0.0001).

CONCLUSION: The ROC curve - generated cut-off value of > 3.51 ml for Filipino postmenopausal women may serve as a useful diagnostic tool for classifying patients with pre-malignant and malignant endometrial conditions.

Human ; Female ; Aged 80 and over ; Aged ; Middle Aged ; Postmenopause ; Endometrial Neoplasms ; ROC Curve

BACKGROUND: Clinical estimation of fetal weight is a basic skill an obstetrician should master. Although the use of ultrasound has gained much popularity in the recent decade, in low resource settings, most patients do not have the luxury to have an ultrasound done for their babies, more so a sonographic estimate. Four methods of clinical estimation - Dare's method, Johnson's formula, Modified Johnson's Formula and abdominal palpation were used in the study and compared with the actual weight of the baby.

OBJECTIVE: To come up with the best/most reliable clinical method to use in estimating fetal weight among women in the late third trimester of pregnancy.

METHODOLOGY: The study used a prospective study design. All women beyond 34 weeks age of gestation admitted at the OB admitting section and ward were included. A total of 370 parturients were included. Senior residents on duty at the OB admitting section were asked to record their examination after the patient had given her consent. Those admitted at the wards were examined by the resident in charge and principal investigator after the patient consented to the study. The actual birthweight was used as the gold standard value. Paired Sample T-test was used to determine whether the estimates are comparable to the actual birthweight. Each formulae for estimating fetal weight were compared to the actual birthweight. Percentage error of each was computed and compared using the Wilcoxon Test and absolute percentage error were compared using T-test. One-way ANOVA test was used to determine inter-observer difference.

RESULTS: The palpation method had the lowest mean absolute error, followed by Dare's Method. The Modified Johnson's Formula had the highest mean absolute error. Similarly, the palpation method had the highest number of estimates with difference less than 100 grams from the actual value. This is consistent with the absolute percent error which showed that the palpation method has most estimates (73.2%) having less than 5% error, followed by Dare's Method (49.5%), and Johnson's (38.6%). The Modified Johnson's Formula had the least number of estimates at less than 5%, at 10.8%. At 34 - 37 weeks age of gestation, the palpation method had the lowest mean percentage error (0.41±5.18) followed by Modified Johnson's formula (1.40±15.54). The Johnson's Formula yielded the highest percentage error at 13.29±18.56. At 37 weeks age of gestation and above, the Dare's Method had the lowest mean percentage error (0.91±8.51), followed by the Johnson's Formula (-1.14±9.62), then Palpation Method (-1.59±6.16).

CONCLUSION: Based on the data garnered, the clinician's estimate using the palpation method is by far the most accurate in any age of gestation, followed by Johnson's Method, with the Modified Johnson's Method with the least accurate estimate. At 34-37 weeks age of gestation, the palpation method had the closest estimate. At 37 weeks age of gestation and above, the Dare's Method is more superior.

Human ; Female ; Adult ; Milk ; Fetal Weight

Pregnancy with placental mesenchymal dysplasia (PMD), with concomitant cytomegalovirus (CMV) infection, and with coexistent normal viable fetus is very rare. An 18 year old, Gravida 2 Para 0 (0-0-1-0), was referred to our institution at 24 weeks age of gestation, with impression of molar pregnancy with a live twin fetus. Subsequent ultrasound revealed placentomegaly with placental features similar to hydatidiform mole. Her pregnancy was complicated with intrauterine growth restriction (IUGR) and oligohydramnios. TORCH panel at 25 weeks age of gestation revealed positive for CMV IgG. She had normal serum ?-HCG, with elevated maternal serum alpha feto protein (msAFP). A caesarean section was done at 37 weeks age of gestation for placenta previa marginalis in haemorrhage. She delivered a live baby girl, APGAR score of 9,9, maturity testing of 37 weeks, small for gestational age. The baby was also positive for CMV IgG. Gross examination of the placenta revealed tortuous vessels and multiple cystic spaces. Histopatho-logically, there were hydropic stem villi with no trophoblastic proliferation. Immunohistochemically, placental mesenchymal dysplasia was confirmed.

Human ; Female ; Adolescent ; Cytomegalovirus

Hemophilia is a relatively rare bleeding disorder. It is an X-linked hereditary bleeding disorder caused by a deficient or defective coagulation factor VIII (Hemophilia A) or factor IX (Hemophilia B). Hemophilia A is more common than Hemophilia B. The X-linked inheritance pattern results in men expressing the disease and women typically being carriers. Under rare circumstances a woman can also show a bleeding phenotype.

A 13 year-old female presented with profuse vaginal bleeding. She had history of several hospital admissions because of bleeding manifestations like hematuria and epistaxis. Based on the pedigree analysis and results of factor IX assay tests she was diagnosed to have Hemophilia B of moderate severity. She was given hormonal and non-hormonal treatments as well as blood transfusions which stop the bleeding and corrected the anemia. A multidisciplinary approach of management involving the gynecologist, hematologist and a geneticist will be beneficial to the patient.

The inheritance, clinical manifestations, diagnosis and treatment of Hemophilia B in a female adolescent are discussed

Human ; Female ; Adolescent ; Hemophilia B ; X Chromosome Inactivation ; Uterine Hemorrhage