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The prophylactic use of tranexamic acid for the reduction of blood loss after cesarean section and vaginal delivery in primiparas at a tertiary hospital in Manila: A single-blinded randomized controlled trial.

Aguedan Jo-an Marie G ; Martin Carolina Paula C

Philippine Journal of Obstetrics and Gynecology.2015;39(1):1-11.

OBJECTIVES: To determine whether Tranexamic Acid is effective in reducing postpartum blood loss in vaginal and cesarean deliveries and if intravenous Tranexamic Acid can be used as a prophylaxis to reduce blood loss for vaginal and cesarean deliveries in primiparas.
METHODS: This is a Single-Blinded Randomized Controlled Trial wherein two groups were assigned for the patients included, one for primiparas undergoing vaginal delivery and the other group for primiparas undergoing cesarean section. A dose of 2 grams of Tranexamic acid (given during the second stage of labor and over 30 minutes before abdominal delivery) were compared to primiparas to whom Tranexamic acid was not given. Blood loss was estimated from the main difference between the pre- and post-test hemoglobin and hematocrit obtained for each group and measured during two periods: first period was 30 minutes before
delivery and the second from the end of the delivery of the baby to 2 hours postpartum. The difference was then compared and was used in the computation of the statistics, where t-test on two independent samples was utilized.
RESULTS: One hundred twenty women were recruited to this study. The study was able to determine that those assigned to the Tranexamic acid or treatment group had significant reduction of postpartum blood loss as compared to the control group.
CONCLUSION: This study demonstrates that use of Tranexamic Acid prior to vaginal or abdominal delivery can reduce blood loss and maternal morbidity in women.

Human ; Female ; Adult ; Pregnancy ; Tranexamic Acid ; Hematocrit ; Postpartum Hemorrhage ; Delivery, Obstetric ; Labor, Obstetric ; Cesarean Section ; Postpartum Period ; Hemoglobins

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Intramyometrial oxytocin in preventing postpartum hemorrhage during cesarean delivery: A systematic review.

Guerra-Calilung Joanna Marie O ; Gonzaga Florante P

Philippine Journal of Obstetrics and Gynecology.2015;39(1):12-23.

Human ; Female ; Pregnancy ; Carboprost ; Uterine Inertia ; Postpartum Hemorrhage ; Oxytocin ; Maternal Mortality ; Cesarean Section ; Drug-related Side Effects And Adverse Reactions

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The efficacy of evening primrose oil as a cervical ripening agent for gynecologic procedures: A single-blinded, randomized controlled trial.

Verano Rusienne Mae A. ; Veloso-Borromeo Mary Girlie

Philippine Journal of Obstetrics and Gynecology.2015;39(1):25-28.

BACKGROUND: Evening Primrose Oil (EPO) is one of the most commonly prescribed cervical ripening agents. Cervical ripening is the softening, effacement, and dilation of the cervix that occur prior to active labor, and is an intervention that is used for certain indications, such as postdates pregnancy. There are gynecologic cases wherein the cervix is closed and dilatation has not occurred making the procedure difficult. In studies, EPO works by softening and ripening the cervix in the pregnant woman. More likely it has the same effects in a non-pregnant patient with regards to softening and dilating the cervix during gynecologic procedures.
METHODS: The study was conducted in a tertiary hospital. Patients scheduled for gynecologic procedures were randomly grouped under the control and study group. Both groups had an internal examination during admission. The study group, in addition, were given EPO 4 capsules intra-vaginally, 6 hours prior to the contemplated procedure. Cervical characteristics were assessed initially on admission and pre-proedure.
Consistency were assessed using the Consistency Index (CI) and graded as firm=1, medium=2 and soft=3. Dilatation were assessed using the Dilatation Index (DI) and graded as closed=1, admits tip =2 , >1cm= 3. Pre-procedure, cervical characteristics and the CDI of both groups were assessed. Hegars dilators were used to assess the degree of dilatation, noting the diameter of dilator that can be introduced freely, and to what diameter the cervix can be maximally dilated.
RESULTS: 80 patients were enrolled in the study; 39 patients were assigned in the control group and 38 patients were assigned in the study group (3 were excluded). In the study group, their DI improved by 36.2% (pre = 1.53+/-0.51 to post = 2.08+/-0.49) (p<0.001), CI increased by 115.9% (pre=1.16+/-0.37 to post = 2.50+/-0.65) (p<0.001), and their CDI changed by 70.6% (pre=2.68+/-0.74 to post = 4.58+/-0.95) (p<0.001). The changes of scores in all the cervical parameters in the study group were statistically significant.
CONCLUSION: EPO 4 capsules punctured and administered intra-vaginally 6 hours prior to contemplated gynecologic procedure can promote cervical ripening as exhibited by the improvement of the CDI from initial assessment to pre-procedure assessment.

Human ; Female ; Pregnancy ; Cervical Ripening ; Cervix Uteri ; Efamol ; Dilatation ; Capsules ; Gamma-linolenic Acid ; Linoleic Acids ; Plant Oils ; Administration, Intravaginal

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A retrospective analysis on treatment and survival outcome of locally advanced cervical cancer with or without brachytherapy: A single institution study

Joan Kristel B. Abrenica ; Genalin F. Amparo

Philippine Journal of Obstetrics and Gynecology.2020;44(6):1-11.

Background: Concurrent chemoradiotherapy composed of pelvic external beam radiotherapy (PEBRT) with weekly chemotherapy plus intracavitary brachytherapy (ICBT) remains to be the treatment of choice for locally advanced cervical cancer (LACC). However, some patients are not suitable to have ICBT right after pelvic radiation. Locally, active chemotherapy is being given to these patients until they can undergo the procedure. Objective: The aim of the study was to determine the impact of ICBT in the treatment and survival outcomes of cervical cancer and to compare it with active chemotherapy. Methodology: This was a retrospective study of patients with LACC treated with or without brachytherapy in a single institution from January 2002 to December 2017. Results: The 5-year over-all survival (OS) and 5-year recurrence free survival (RFS) of patients with ICBT were both significantly improved compared to those without ICBT (p=0.001 and p=0.038), respectively. Factors that were significantly correlated with adequate response for brachytherapy were non-squamous cell histology (OR 0.65, CI 0.46- 092, p=0.016), initial tumor size of > 5cm (OR 0.41, CI 0.26-0.65, p=0.001), > 50% decrease in the original tumor size at the middle part of PEBRT (OR 1.83, CI 1.2-2.8, p=0.005), > 3 cycles of chemotherapy as radiosensitizers (OR 2.66, CI 1.79- 3.9, p=0.001), > 45 days duration of PEBRT (OR 0.63, CI 0.41-0.97, p=0.04) and > 2 episodes of anemia during PEBRT (OR 0.67, CI 0.52-0.85, p=0.001). Conclusion Brachytherapy offers significant improvement on tumor control and over-all survival for patients with LACC. Active chemotherapy may offer some benefit in terms of delaying tumor recurrence or progression. However, this did not translate to survival impact if the patient was not able to have brachytherapy at all.
brachytherapy ;

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Early experience of gynecologic robotic surgery in a tertiary government hospital

Efren J. Domingo ; Patrick Jose D. Padilla

Philippine Journal of Obstetrics and Gynecology.2020;44(6):12-16.

Background: Robotic surgery is a form of minimally invasive surgery wherein the surgeon controls the camera and instruments in a console, remote from the operating room table. Currently, the system in place is the da Vinci Surgical System which was approved by the United States Food and Drug Administration in 2000 for laparoscopic surgery. Since its approval in 2005 for Gynecologic procedures, the da Vinci Surgical System has been used for hysterectomies, lymph node dissections, sacrocolpopexies, myomectomies, and cerclage. Objective: This paper presents the initial seven cases of benign gynecologic diseases operated on utilizing the da Vinci Surgical System in our institution – six hysterectomies and one myomectomy. Methodology: Seven gynecologic surgeries that utilized the da Vinci Surgical System in 2019 until the first quarter of the year 2020 were done. Medical records of the seven patients were reviewed. Results: The average docking time was 38 minutes (range: 25 – 65 minutes) and the average console time was 227 minutes (range: 175 – 345 minutes). The average blood loss was 576 cc (range: 80 – 1200 cc). No cases converted to an abdominal laparotomy and no morbidities were reported. While two cases underwent blood transfusion intraoperatively, all cases were stable post-operatively and were for discharge after two days. On follow-up, all patients were stable with an unremarkable clinical course. Conclusion Our initial experience demonstrates that robotic surgery appears as a viable alternative to traditional approaches. As more cases are to be done in the future, fine-tuning of the logistical set-up and surgical skills are expected, as well as venturing into other gynecologic diseases such as malignancies. Further research must be conducted on various aspects of robotic surgery, such as but not limited to outcome comparison with traditional and other laparoscopic approaches, long term outcomes, patient safety, and patient experience and preference, among others.
Female ; Gynecologic Surgical Procedures

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A five-year review of the clinicopathologic profile of patients with hydatidiform mole at the Philippine General Hospital

Sherry Joahne L. Cañ ; ete - Villariasa ; Agnes L. Soriano-Estrella

Philippine Journal of Obstetrics and Gynecology.2020;44(6):17-22.

Background: The clinical presentation of patients with hydatidiform mole have changed in recent years due to earlier diagnosis as a result of widespread use of ultrasonography and availability of assays for human chorionic gonadotrophin. Objective: To determine the clinicopathologic profile of patients diagnosed with hydatidiform mole at the Philippine General Hospital from January 2013 to August 2018. Methods: This retrospective cross-sectional study included all patients with histologically confirmed diagnosis of hydatidiform mole managed at the Philippine General Hospital from January 2013 to August 2018. Medical records of patients were retrieved. All abstracted variables were analyzed retrospectively. The level of significance for all sets of analysis was set at p-value < 0.05 using two-tailed comparisons. Results: From January 2013 to August 2018, a total of 435 patients diagnosed with hydatidiform mole were managed at the Philippine General Hospital with a prevalence rate of 15.7/1,000 pregnancies. Diagnosis was made in the first trimester in 52% of patients. A quarter of the patients had pre-evacuation B-hCG levels of more than 1 million mIU/mL. Vaginal bleeding was the most frequent presenting symptom but only 59% of the patients had anemia requiring blood transfusion. Majority (90.57%) had a histopathologic diagnosis of complete hydatidiform mole. Conclusion The prevalence and clinicopathologic profile of patients with hydatidiform mole in the Philippine General Hospital have remained largely unchanged.
hydatidiform mole ; Pregnancy ; Female ; gestational trophoblastic diseases

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Papillary squamous carcinoma of the cervix with metachronous clear cell renal cell carcinoma

Renee Riza C. Medalla ; Jericho Thaddeus P. Luna

Philippine Journal of Obstetrics and Gynecology.2020;44(6):23-27.

Multiple primary tumors can be classified as synchronous or metachronous. Cases have been reported, with a prevalence, in gynecologic malignancies, of 1.9 to 4.3%, and commonly occurring in endometrial and ovarian malignancies. Renal tumors coexisting with primary cervical cancer are mostly metastatic tumors, and at present, no case of cervical carcinoma metachronous with renal cell carcinoma has been reported on literature. This is a case of Papillary Squamous Cell Carcinoma of the cervix who developed a metachronous Clear Cell Renal Cell Carcinoma. Several months after the diagnosis of cervical cancer, she presented with an abdominal mass and signs of uremia secondary to obstructive uropathy. She underwent radical nephrectomy with contralateral percutaneous nephrostomy. Definitive plan for the cervical mass is concurrent chemotherapy and radiation, depending on the improvement in renal function. Currently, there are no clearly established guidelines in managing metachronous cervical and renal masses, and this presents a unique opportunity to document this case, and study its implications on management and prognosis.
Neoplasms, Multiple Primary ;

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Squamous cell carcinoma of the cervix with cranial metastasis: A case report

Maria Patricia Angelica M. Tanchuling ; Jean Anne B. Toral

Philippine Journal of Obstetrics and Gynecology.2020;44(6):28-31.

Squamous cell carcinoma is the most common female genital tract malignancy that typically spreads to the pelvic organs first by direct extension, and less commonly to distant sites through lymphangitic and hematogeneous spread. We report on a 47-year-old woman diagnosed with squamous cell carcinoma who underwent concurrent chemoradiation, presenting with a fronto-parietal scalp mass which on histopathologic examination also shows squamous cell carcinoma, likely metastatic.
Uterine Cervical Neoplasms ; skull ; scalp

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Recurrent Paget’s disease of the vulva in a split-thickness graft

Romelyn April P. Imperio-Onglao ; Jericho Thaddeus P. Luna

Philippine Journal of Obstetrics and Gynecology.2020;44(6):32-40.

Extramammary Paget’s disease (EMPD) of the vulva is a rare vulvar neoplasm but commonly arises during the postmenopausal period. Intraepithelial Paget’s disease may persist for prolonged periods without demonstrating invasion but with high rates of recurrence. Appearance of Paget’s disease in a split-thickness skin graft, is associated with an occurrence outside the grafted area. It demonstrates retrodissemination as the pathologic process hypothesized in the spread of the disease within the skin via lymphatics and vessels creating tissue bridges between sites of involvement. We present a case of an 81-year-old female, the patient came in for complaints of vulvar pruritus beginning at the left inguinal area three years prior to her diagnosis. She consulted with a dermatologist and was initially treated with steroids and emollients. Persistence of symptoms and enlargement of the lesion prompted a vulvar punch biopsy which showed Paget’s disease and referral to the Gynecologic Oncology service. Wide local excision with split-thickness skin grafting was performed. However, one year after her surgery, patient noted vulvar pain and palpable vulvar lesions. Biopsy was done which showed Extramammary Paget’s Disease recurrence. Patient underwent repeat wide local excision with frozen section, and split-thickness skin grafting. With the aid of frozen section, the intraepithelial involvement was noted to spread beyond the grossly apparent lesion. After 6 months post re-excision, patient noted vulvar pruritus and palpable vulvar lesions. Biopsy was done which showed Extramammary Paget’s Disease recurrence. Due to the proximity of the lesion to the sphincter and need for a colostomy, the patient did not consent for re-excision. Imiquimod 5% was chosen as the mode of treatment. The challenges of interventions are to remove or treat disease that may not be visible, without overtreatment and to minimize morbidity from radical surgery. Surgery remains the primary management for EMPD of the vulva. Imiquimod 5% can be used in recurrences. Despite the advances in the knowledge and management of vulvar Paget’s disease the high rate of recurrent disease remains a challenge for optimal management and would require frequent and long-term follow-up.
Paget Disease, Extramammary ; Female ; vulvar neoplasms ;

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POGS 2019 report on obstetrical and gynecological indicators of healthcare

Annette M. Macayaon ; Maria Antonia E. Habana ; Helen R. Amorin

Philippine Journal of Obstetrics and Gynecology.2020;44(6):41-48.

Background: To address the need to improve the collation of vital statistical data from POGS-accredited institutions, the POGS Committee on Nationwide Statistics developed a new electronic census platform (now called the POGS Nationwide Statistics System or PNSS), that replaced the Integrated Statistical Information System (ISIS) which was started in 2008. Objectives: The aims of this paper are the following: (1) to present initial data gathered through the PNSS and compare it to the Department of Health (DOH) census; (2) to discuss obstetrical and gynecological indicators of healthcare and (3) to assess the limitations of the PNSS and recommend improvements. Methodology: This is a cross-sectional study that shall report obstetrical and gynecologic data generated from submissions of POGS-accredited hospitals from January to December 2019, through the PNSS. Charts and tables illustrating frequencies of the different health indices are presented. Health indices include crude livebirth rate, age-specific birth rate, adolescent birth rate, cesarean section rate, stillbirth rate, neonatal mortality rate, perinatal mortality rate, maternal mortality ratio, frequency of gynecologic admissions and procedures, and death secondary to gynecologic diseases. Results: The number of accredited hospitals that submitted their census with 100% compliance was 135, thus 91.8% of accredited hospitals had full compliance. A total of 365,947 cases were reported, 89% (326,026) of cases were obstetric cases and the remaining 11% (39,921) were gynecologic cases. For obstetrical health indicators: the livebirth rate is highest in the NCR 36%, with the highest age-specific birth rates in the 20-29 age groups; adolescent birth rate is 7.3%, overall CS rate is 32.8%, stillbirth rate is 14.3 per 1000 neonates, neonatal mortality rate is 3.65 per 1000 livebirths, perinatal mortality rate is 18.35 per 1000 total births and maternal mortality ratio is 81.72 per 100,000 livebirths. The most frequent indications for gynecologic admissions are leiomyoma uteri, Abnormal Uterine Bleeding-Polyp (AUB-P) and Abnormal Uterine Bleeding-Myoma (AUB-M), while endometrial biopsy/diagnostic curettage is the most frequent gynecologic procedure performed; There were 150 deaths (0.38%) reported among gynecologic cases and majority (96%) had gynecologic malignancies, with ovarian cancer being the highest (41%). Conclusion Nationwide statistics serve as strong evidence on which policies are created. It provides vital information that serves as a basis for decision-making, planning and implementation of health programs and basic services and can also be used for monitoring and evaluation. It is recommended that preparations be undertaken for an improved 2021 version with enhancing the mechanism of encoding and transmitting data, improving data quality and developing more health indicators. Regular coordination with the accredited hospitals is encouraged for a more accurate data outcome and compliance performance. Collaboration in identifying areas for research should be fostered.

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