BACKGROUND AND OBJECTIVE

Proper documentation of patient safety events is important to be able to provide changes that can prevent events from occurring again. The Philippine General Hospital launched an online platform for reporting patient safety events in 2017. This paper aimed to describe the patient safety events, initial response to the event, and preventive actions done in the institution.

This is a retrospective descriptive study of patient safety event records from August 2017 to April 2022. General data of the patients, details surrounding the events, response to the event, and preventive measures done after the event were documented. Descriptive analysis was performed.

There was a total of 625 events reported with 525 total unique reports. There was an increased rate of patient safety event reports from 2021 to 2022. The average rate was 23.8 and 25.7 reports per month, respectively. Most reports were for in-patient cases and were type 3 preventable adverse events. The general initial response of healthcare personnel to the adverse events is to provide the appropriate clinical care. Preventive measures include re-orientation and event specific actions.

Documentation is crucial for patient safety events to provide solutions and prevent reoccurrence of these events that can cause harm to patients.

BACKGROUND

Intraoperative transfusion for gynecologic surgery, when appropriately used, can improve patient outcomes. However, when utilized incorrectly, blood transfusion can worsen patient outcomes and increase patient cost. This study aimed to evaluate the blood transfusion practices of tertiary hospitals in the Philippines.

The study utilized a cross-sectional design wherein prospective data were gathered through multiple sources across seven tertiary-level hospitals. Women admitted to undergo gynecologic surgery were recruited based on a set of criteria. A chart review was conducted, and blood utilization indices were calculated. Outcomes were compared between public versus private facilities and transfused versus nontransfused patients.

Among 514 patients, 79.7% underwent cross-matching and 75.1% received transfusions. Adverse events were rare, with no transfusion-related deaths. The overall crossmatch-to-transfusion ratio (C/T ratio) was 2.8, exceeding the 2.5 optimal benchmark; all public hospitals recorded a C/T ratio >2.5, whereas private centers had more efficient usage. Six hospitals met acceptable benchmarks for transfusion probability and transfusion index. Open abdominal procedures, particularly hysterectomy, accounted for the most blood used. Transfused patients had longer operative times, greater blood loss, lower preoperative hemoglobin, and more frequently involved resident physicians in training. Public hospitals recorded higher cross-match and transfusion rates, greater resident physician participation, and broader use of general anesthesia.

Results of the study highlight the importance of monitoring blood transfusion parameters to optimize blood utilization. The observed differences between public and private institutions in the country highlight the urgent need for standardized and evidence-based practice to ensure efficient transfusion protocols nationwide.

Objectives: The objectives of this study were to present maternal and perinatal health indicators for the years 2019–2022. Methodology: This is a cross-sectional review that analyzed data on maternal and perinatal health indicators, generated from submissions of POGS-accredited hospitals (training and service) from January 2019 to December 2022. The data were compared to the national data obtained from official public documents published by the Philippine Statistics Authority in 2022 and 2023. Results: The number of member hospitals has steadily increased over the years, and compliance rates have been consistently over 85%. The total number of registered cases and live births declined in 2020 and 2021, but has increased to prepandemic levels in 2022. The primary cesarean section (CS) rates remained above 20%, with the highest rate noted in 2021 (25.5%). The top three-most common indications for primary CS were dysfunctional labor, fetal distress, and malpresentation. Stillbirth, perinatal, and maternal mortality rates showed an increase from 2019 to 2022, with peak rates registered for the year 2021. The top five causes of maternal death are: medical complications, hemorrhage, hypertension, infection, and others (unspecified). The case fatality rate among pregnant patients with confirmed COVID-19 infection was 1.18%. Conclusion From 2019 to 2021, there was a decline in the number of registered cases and live births, and an increase in the primary CS rates, maternal mortality ratio, perinatal death rates, and stillbirth rates. This may be explained by the prevailing social, health, and economic impact of the COVID-19 pandemic during these years.
Censuses ; COVID‑19

OBJECTIVE

This study aims to determine the prevalence of menopausal symptoms among Filipino perimenopausal women aged 43–48 years in a rural community setting.

This is a cross-sectional study conducted in a rural community. A self-administered, validated Women’s Health Questionnaire, Filipino version, was given to 232 women aged 43–48 years. Data were analyzed using STATA 16.1/IC.

Nearly 32% of respondents reported a negative impact of symptoms on their quality of life (QOL). The highest was seen in the physical/somatic (PS) domain followed by the vasomotor/menstrual and emotional/anxiety domains. Overall, majority of the scores reflect a good QOL.

Filipino women in the rural community remain to have good QOL despite experiencing menopausal symptoms. A minority experience symptoms that negatively influence their QOL and most of these were in the physical/somatic domain. Education regarding awareness, treatment options, and expectations during perimenopause is important. Timely intervention can continue to improve the QOL of these women.

The incidence rate of Myasthenia Gravis coexisting with other autoimmune diseases is approximately 8.7 – 25%, but it is rarely associated with premature ovarian insufficiency (POI) with only less than 1% of women affected. This is a case of premature ovarian insufficiency in a 29 year old woman diagnosed with Myasthenia Gravis, who presented with lower extremity weakness and experienced two episodes of myasthenic crisis requiring thymectomy. Three years after, she noted oligomenorrhea that quickly progressed to amenorrhea. Extensive immunologic and genetic investigative studies showed no identifiable cause for the POI, except for its close temporal relationship with the occurrence of Myasthenia Gravis. The patient has been responsive to hormone replacement and immunomodulation therapy, and has not developed any further episodes of myasthenic crisis. A review of seven other reported cases describing a similar condition was also included in the discussion.
Myasthenia Gravis

Background: The prone position has been seen to benefit patients experiencing acute respiratory distress syndrome. However, performing this position in pregnant patients has been difficult and raises safety concerns. Objective: The current study aimed to test the use of a supportive pillow (Prone Pillow for Pregnant Patients or 4P) to address concerns regarding pregnant patients in prone position. Methods: The study prospectively evaluated the use of the prone pillow for patient comfort and usability among healthcare workers with qualitative and quantitative measures. Results: A total of three patients were recruited alongside 16 healthcare workers assisting pregnant patients to the prone position. Overall, awake pregnant patients found the pillow to be comfortable while healthcare workers perceived the pillow to be useful in improving quality of care among awake and intubated pregnant patients. Conclusion The 4P is a potentially useful and beneficial product in placing pregnant patients in the prone position during episodes of acute respiratory distress. However, due to the limited sample size, more clinical trials are needed to evaluate the impact of this innovation in improving patient and healthcare worker safety.
Covid-19

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.

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

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

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.

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.

Background: The POGS committee on nationwide statistics uses an electronic census platform called the POGS nationwide statistics system (PNSS) to collect the statistical data on obstetric and gynecologic health indicators. Objectives: The article aims to present 2020 data gathered and compare these with the 2019 census. Obstetrical and gynecological indicators of health care and preliminary data on COVID-19 cases are reported. Methodology: This cross-sectional study reports the data generated from the submissions of POGS-accredited hospitals from January to December 2020, through the PNSS. Results: The number of accredited hospitals that submitted their census with 100% compliance is 94%. There was a total of 329,972 number of cases reported, 92% were obstetric cases. Live birth rate was the highest in the National Capital Region at 33.5%, with the highest age-specific birth rate in the 25–29 age group. Most live births were term pregnancies. Adolescent birth rate was 6.45 per 1000 women. Cesarean section rate, stillbirth rate, neonatal mortality rate, and perinatal mortality rate were higher than 2019. The maternal mortality ratio was 121.6 per 100,000 live births. There were 2,858 cases of confirmed COVID-19 infection. There were 26,164 gynecologic admissions, with the most common diagnosis being abnormal uterine bleeding. The most common gynecologic procedures performed were hysterectomy, salpingo-oophorectomy, medical management, and blood transfusion. Majority of the deaths from gynecologic cases had gynecologic malignancies and among these, cervical cancer (19%) had the greatest number of deaths. Conclusion Obstetric and gynecologic admissions are lower compared to last year. A deterioration in obstetrical indications can be seen and explanations for this occurrence must be explored further. Preliminary data on COVID-19 cases was likewise presented. Timely and accurate statistics will help us define the areas we need to improve on, as well as the unmet needs of our patients.
Censuses

Objective: To determine the changes in the clinical practice of infertility specialists in the Philippines, specifically, the proportion of specialists who stopped practice, length of break from clinics, the decrease in caseload, changes in consultation platform, screening frequency, number of clinicians that contracted COVI D 19 and safety protocols employed during the COVID - 19 pandemic.

Methods: A cross-sectional study using an online questionnaire given to all members of the Philippine Society for Reproductive Medicine (PSRM) last November 2020. Participants were requested to answer the questionnaire through google spread sheet, with informed consent. All data were collated, summarized and reported in terms of frequencies, and measures of central tendency.

Results: There were 110 active members of the PSRM who participated in the study. There was an overall decrease in the percentage of fertility consultations during the pandemic. There is also a substantial decrease in the caseload from different practices: 45.4% reported more than 50% decrease in !VF-related procedures, 54.5% noted more than 50% decrease in intrauterine insemination procedures, 52.8% reported more than 50% decrease in ovulation induction treatment, and 66.3% reported more than 50% decrease in endoscopic procedures. About 37% of the respondents deferred approximately 5-10 cases for fertility treatment, with 27.3% of the respondents reported deferring embryo transfer to less than 5 couples. More than half of the specialists (51.8%) stopped performing fertility procedures and 68.2% of the respondents completely stopped doing out patient consultations. However, some specialists resumed clinics by May 2020 (30.9%) and June 2020 (30.9%). Upon resumption of clinics, specialists used both face to face consultation and teleconsultation, with the largest proportion of respondents using both platforms. Safety measures employed during face-to-face consultations to prevent disease transmission included hand sanitizers in the clinics, restricted number of people in the waiting room and consultation room, use of personal protective equipment, symptom check prior to face to face consults, installation of air purifiers, and acrylic barriers, and use of health declaration forms. Majority of the specialists are aware of the international and local guidelines regarding infertility care during the pandemic (98.2%) and inform patients regarding the contents of the guidelines (90%).

Conclusion: There is a significant decline in the consultations and fertility procedures during the pandemic. Specialists are well informed of the international and local guidelines regarding fertility care during the pandemic.

Objective: This study aims to establish baseline information on the practice of minimally invasive gynecologic surgery (MIGS) among Filipino gynecologic endoscopists amid the COVID-19 pandemic. Materials and Methods: MATERIALS AND METHODS: An online survey was conducted among Fellows of the Philippine Society for Gynecologic Endoscopy (PSGE) practicing in private and government hospitals in the Philippines after informed consent. The survey had five subsections: (1) demographic data, (2) impact of COVID-19 pandemic on MIGS practice, (3) changes of practice during the COVID-19 pandemic, and (4) changes in the conduct of surgery and postoperative care. Results: A total of 119 out of 144 PSGE Fellows based in the Philippines participated in the survey, 83% were Fellows in both laparoscopy and hysteroscopy. The majority had more than 15 years of practice and were practicing in the National Capital Region. Surgeries were canceled initially but have since resumed. The majority were hysteroscopy cases, the most common being polypectomy. Majority of the respondents reduced their clinic hours and appointments. Most have used telemedicine for consultations. Use of face masks, face shields, and personal protective equipment (PPE) were the top precautions taken in the clinics. Screening and precautions per guidelines inside the operating room setting were observed. Modifications during surgery include the use of smoke evacuators, minimizing energy device use, and wearing enhanced PPE. Conclusion The volume of laparoscopy and hysteroscopy cases was greatly reduced during the pandemic. The pandemic has disrupted the practice of MIGS both in the outpatient clinics and the operating rooms. Most of the changes made are congruent to local and international automotive task force guidelines. Precautionary measures and screening procedures must remain in place to reduce the risk of severe acute respiratory syndrome coronavirus 2 transmission to patients and health-care workers.
COVID-19 ; Personal Protective Equipment ; Telemedicine