Objective: This study aimed to determine the maternal clinical factors associated with neonatal respiratory morbidity and other adverse neonatal outcomes in meconium-stained labor among term parturients. Methodology: A retrospective cohort study was done on admitted obstetric patients with term gestation and had meconium-stained labor. Maternal clinical factors such as age, parity, gestational age, manner of delivery, duration of labor, presence of term prelabor rupture of membranes (PROM), character of meconium-stained liquor (MSL), and presence of comorbidities were identified and analyzed to determine their association with neonatal respiratory morbidity and other adverse neonatal outcomes. Results: In this study, there were 986 cases identified to have meconium-stained labor, and 168 developed neonatal respiratory morbidity. As to primary outcome, maternal clinical factors, such as age >35 years, multiparity, age of gestation >41 weeks, prolonged labor, presence of PROM, significant MSL upon admission, presence of change from nonsignificant to significant MSL, presence of intrauterine growth restriction, and hypertension, were all shown to be statistically significant. Conclusion The presence of maternal clinical factors in meconium-stained labor was observed to be a risk factor in developing neonatal respiratory morbidity and other adverse neonatal outcomes. Hence, identification of maternal risk factors and early detection of meconium-stained amniotic fluid are vital in administering timely intervention to labor and delivery to reduce neonatal complications.
Infant, Newborn, Diseases

Background: This retrospective cohort study assessed the outcomes of combined surgeries for pelvic organ prolapse (POP) and stress urinary incontinence (SUI) in 31 patients with a follow-up of 7 years. Objectives: The study aimed to determine the success and recurrence rates of POP and SUI while comparing the outcomes, analyzing the predictors for recurrence, and reporting on complications. Materials and Methods: Demographic and clinical profiles were analyzed descriptively using frequency and percentages. Objective SUI cure rate was assessed via office cystometry with a cough stress test, while POP was evaluated using the POP-Q system. Subjective cure rates for both conditions were determined using a symptom severity checklist based on the King's Health Questionnaire. Chi-square tests assessed associations between objective outcome parameters and time elapsed since surgery, and other outcome predictors, with significance set at p < 0.05. Results: The results showed a high objective cure rate of 96% for SUI and subjective cure rates of 96% for both SUI and POP. Long-term symptoms included urine frequency and retention, while mesh erosion occurred in one patient. The objective cure rate for POP was 67.7%, with recurrence in the anterior compartment at the midterm and in various compartments at long term. Vault fixation suggests efficacy in reducing apical prolapse recurrence. The preoperative age was identified as a significant risk factor for POP recurrence. Conclusion This study supports the durability and efficacy of combined surgeries for SUI and POP, with high patient satisfaction.
Suburethral Slings

Background: With the advent of the COVID-19 pandemic, pregnant women may turn to online information searches regarding COVID-19 and COVID-19 vaccination. Objective: We aimed to determine global online interest in COVID-19 infection and COVID-19 vaccination in pregnancy. Materials and Methods: We utilized Google Trends data to determine the global search volume index (SVI) for the search terms “COVID-19 in pregnancy” and “COVID vaccine pregnancy” from January 1, 2020, to February 12, 2022, and ranked the top 15 search queries via their individual SVIs to assess the worldwide distribution of interest. Using Pearson correlation, we correlated several economic and pandemic-related country-specific data with the SVIs for the two search terms, while we utilized a one-way analysis of variance to country income groups with the SVIs using ANOVA. Significant correlations were denoted with P < 0.05. Results: SVI for “COVID-19” in pregnancy showed a minimal and nonsignificant downward trend in 2022. SVI for this search term was positively correlated with the SVI for “COVID vaccine pregnancy” (P < 0.05). On the other hand, SVI for “COVID vaccine in pregnancy” showed an exponential decline from November 2020 to 2022. SVI for this search term was also negatively correlated with deaths per 100,000 cases (P < 0.05). Although this was nonsignificant, high-income countries showed higher online interest with the two search terms than low- to low-middle-income countries. There were no significant correlations among specific economic and pandemic-related country-specific data and SVI for both search terms. Conclusion We observed a constant online interest in COVID-19 in pregnancy during the time period of the study, which may reflect the watchful engagement of people in the absence of face-to-face physician consultations. Peak online interest in COVID-19 vaccine in pregnancy declined steadily, which may reflect either vaccine hesitancy or an increase in public knowledge of COVID-19 vaccines. High-income countries have apparently higher online interest in COVID-19 vaccines, which may be due to access to early mass administration to the general public. These data can be used as a reference regarding future policy-making in the setting of potentially massive public health emergency in the future.
Infodemiology ; Pandemics

Introduction: Cancer patients are more susceptible to coronavirus disease-19 (COVID-19) infection because they are immunosuppressed by their disease or therapy, most of them have coexisting medical conditions, and they frequently visit hospitals for treatment and surveillance. Objective: The objective of this study was to determine the prevalence of COVID-19 infection among gynecologic oncology patients receiving treatment in a COVID-19 referral hospital. Materials and Methods: A descriptive, cross-sectional study involving 47 gynecologic cancer patients receiving treatment from June 2020 to December 2020 was performed. All patients underwent SARS-CoV-2 reverse transcription-polymerase chain reaction (RT-PCR) swab test and symptom and exposure assessment before the start of cancer treatment. Patients with negative SARS-CoV-2 RT-PCR swab test results received their planned treatment, and a repeat swab test and triage assessment were done midtreatment and after treatment. Results: Five (10.6%) patients had positive baseline SARS-CoV-2 RT-PCR swab results, but all proceeded with treatment after negative results were obtained. Only 1 (2.13%) patient had a positive SARS-CoV-2 RT-PCR swab test result at midtreatment. All patients had no COVID-19-associated symptoms and none of them tested positive for COVID-19 infection posttreatment. Conclusion The prevalence of COVID-19 infection among gynecologic cancer patients receiving cancer treatment is 2.13%. All patients who had positive SARS-CoV-2 RT-PCR swab test results at baseline or midtreatment were able to continue and complete treatment. There were no severe clinical events or mortalities among those affected with COVID-19 infection.
COVID-19

Background: The majority of women described hysterosalpingography (HSG) as a painful procedure. There is little information on the features of HSG-associated pain and factors that predispose to increased pain experience. Objectives: This study investigated preprocedure psychological state and related demographic factors as predictors of pain perception in women undergoing HSG. Methods: The sample included 99 women selected through consecutive sampling at the Radiology Department, University of Benin Teaching Hospital, Benin City, Nigeria. The study utilized a cross-sectional survey design to collect data using Spielberger's State-Trait Anxiety Inventory, Zung Self-rating Depression Scale, and Visual Analog Scale for the perception of pain and state anxiety. Results: The women with lower state anxiety reported significantly lower pain perception (X̅ = 6.69) than the women with high anxiety (X̅ = 7.93). Trait anxiety, state anxiety, and depression jointly predicted pain perception among the women undergoing HSG, with R2 = 0.117, F (3,95) = 6.797; P < 0.001. They collectively accounted for about 17.7% variance in pain perception. Conclusion Patients being prepared for the HSG procedure can be educated on concerns related to anxiety and coping strategies and be provided with anxiolytics or other medication as clinically indicated.
Demography ; Pain Perception ; Women

Placental site trophoblastic tumor (PSTT) with uterine arteriovenous malformation (AVM) is a rare and potentially catastrophic occurrence. A high index of suspicion and immunohistochemistry secured the diagnosis. The use of appropriate imaging modalities led to the identification of the extent of the disease. Sequential planned management from neoadjuvant intensive chemotherapy, bilateral uterine artery embolization, and laparotomy, and coordinated among different medical disciplines resulted to a successful definitive treatment. Due to its relatively chemoresistant nature, hysterectomy is the mainstay of treatment. Adjuvant platinum-based intensive chemotherapy has been shown to improve overall survival in patients with metastatic disease and those with poor prognostic factors. This case of PSTT with a typical clinical profile was noteworthy due to the development of a significant AVM, a rare complication of PSTT. This case report included a review of treatment experiences as well as peculiarities that set PSTT apart from the more common gestational trophoblastic diseases.
Gestational Trophoblastic Disease ; Trophoblastic Tumor, Placental Site

A 49-year-old woman, Gravida 8 Para 8 (8007), came in due to vomiting and enlarging abdominal mass. Initial diagnosis was partial gut obstruction and acute kidney injury probably secondary to adenomyosis versus colonic pathology. Ultrasound showed adenomyosis but computed tomography scan showed a uterine mass with possible tumor rupture and mass effects. Emergency hysterectomy was done and showed an ill-defined endometrial mass with multiple areas of rupture. It was diagnosed with malignant but final histopathology revealed extensive adenomyosis with acute inflammation and necrosis with no malignancy identified. Unusual symptoms such as uterine rupture and mass effects can accompany adenomyosis, alongside typical signs like pain and bleeding. Ultrasound aided the diagnosis, although it missed uterine rupture, highlighting its limitations. Magnetic resonance imaging could have been useful. Ultimately, histopathology is the gold standard for diagnosing adenomyosis.
Adenomyosis ; Necrosis

INTRODUCTION

The conventional teaching of laparoscopic surgery in academic centers in the apprentice/mentor model is highly subjective. The Gynecological Endoscopic Surgical Education and Assessment is a well-structured education program proposed by the European Society for Gynaecological Endoscopy (ESGE). This program uses the Laparoscopic Skills Training and Testing (LASTT) kit, an objective, validated, and measurable test to evaluate an individual’s competence level in basic laparoscopic psychomotor skills. The LASTT kit may be used to assess the basic laparoscopic psychomotor skills of Filipino doctors, guide surgical training recruitment, and improve the local minimally invasive surgery curriculum.

GENERAL OBJECTIVE

The study will describe the implementation of the LASTT kit in evaluating the psychomotor skills of Filipino physicians in training and assess the feasibility and user acceptance of the kit.

METHODOLOGY

A descriptive cross-sectional research design was used. A total of 34 trainees (19 medical interns and 15 surgical residents) were included. All trainees underwent the LASTT test to have the baseline data for comparison of each cohort. A posttest questionnaire for the feasibility and user acceptance of the kit was accomplished.

RESULTS

A majority of participants were right-handed, and female, with 0–30 laparoscopic assists. The mean age of surgical residents was higher than medical interns. Surgical residents showed a significantly shorter time to accomplish the exercises than medical interns. Finally, it showed that the kit was clear and understandable, easy to use, and represented a realistic model of the actual laparoscopic surgery.

CONCLUSIONS

The surgical residents were superior to medical interns in laparoscopic psychomotor skills, which supports that hands-on training and exposure to procedures improve skill proficiency. Furthermore, the LASTT kit was well accepted and would greatly aid in recruitment and skills training in the Philippines.

Human ; Laparoscopy

BACKGROUND

Hysteroscopic myomectomy is regarded as the gold standard in the management of intracavitary myomas. With its increased use, it is essential to explore its effectiveness for better therapeutic planning and patient selection.

OBJECTIVES

This study aimed to determine the effectiveness of hysteroscopic myomectomy performed in a tertiary hospital in the Philippines.

METHODS

A retrospective cross-sectional study of women who underwent hysteroscopic myomectomy in 5 years was performed.

RESULTS

A total of 167 women were included. Completeness of resection was achieved in 88.46% of the cases. In the final multivariate model, older age, pretreatment with gonadotropin-releasing hormone (GnRH) agonist, and lesser total fluid input were associated with increased odds of complete resection. Submucous myoma at least 3 cm in size had greater total fluid input, greater blood loss, the presence of complications, and a greater need for transfusion. Pretreatment with GnRH agonists had more International Federation of Gynecology and Obstetrics Grade 1 and 2 myoma, higher frequency of ≥3 myomas, lower frequency of complete resection, and increased operative time compared to those without pretreatment with GnRH agonists. Pretreatment with other hormonal therapy had a lesser need for transfusion compared to those without pretreatment with hormonal therapy.

CONCLUSIONS

Hysteroscopic myomectomy is a generally safe and effective procedure for the treatment of submucous myomas. The odds of complete resection are greater with older age and decreased with pretreatment with GnRH agonist and more distention fluid used. Larger submucous myoma was associated with greater total fluid input and blood loss, more complications, and greater need for transfusion. Pretreatment with GnRH agonist had no significant benefit and was associated with longer surgical time and lesser complete resection.

Human ; Female ; Fibroids ; Leiomyoma ; Hysteroscopy ; Myomectomy ; Uterine Myomectomy

BACKGROUND

Simulated video training has emerged as an effective method to enhance the surgical skills. However, in the local context, there is an absence of data contrasting the outcomes of unsupervised video training with the conventional supervised approach in surgical skill development.

OBJECTIVE

The objective of this study was to evaluate and contrast the performance score and total operating time between unsupervised video training simulations and supervised video training simulations, specifically in the domain of 30° hysteroscopic camera navigation.

MATERIALS AND METHODS

A single-blinded randomized controlled trial involved 24 obstetrics and gynecology residents in a tertiary government institution. Participants were randomized into Group A (unsupervised video training) and Group B (proctor-supervised simulation training). Utilizing a uterine model, both groups undertook nine designated tasks. The training process included a pretest simulation, 5 training repetitions, and a concluding posttest simulation. The principal investigator documented operating times and hand movements posteach session. Subsequently, a blinded Philippine Society for Gynecologic Endoscopy board-certified gynecologic endoscopist assessed these videos, using the Global Hysteroscopy Rating Scale for scoring.

RESULTS

The total operating time and performance score during posttest among Group A and Group B showed no significant difference (Group A 0.77 ± 0.19 min Group B 0.71 ± 0.15 min) (P = 0.377) (Group A 13.50 ± 1.73 Group B 13.83 ± 1.53) (P = 0.622) which suggest that participants performed comparably regardless of instructional method. On the Global Rating Scale (GRS) score, higher percentage of participants from Group B showed improved performance on respect for tissue, time and motion, and handling of hysteroscope as compared to Group A.

CONCLUSION

The video-based training simulation is effective as expert proctoring in hysteroscopic camera navigation. However, there was slightly greater improvement in the GRS scores in the proctor supervised group which suggest that feedback from proctors has a positive impact on the performance.

Human ; Hysteroscopy