Turner syndrome is a congenital condition affecting 1 in every 2500 female live births. This condition is characterized by complete or partial loss of the X chromosome. They commonly present with normal female external and internal genitalia and may develop hypogonadism and streak ovaries later in life. We describe an unusual presentation of a case of Turner syndrome – a 31-year-old Filipino with male phenotype mosaic Turner syndrome, with 46,X,+mar[46]/45,X[4] chromosome, presenting with ambiguous genitalia and a pelvoabdominal mass. The patient underwent exploratory laparotomy, peritoneal fluid cytology, adhesiolysis, tumor debulking (gonadectomy) appendectomy, omentectomy, identification and inspection of bilateral ureters and bladder, gonioscopy and biopsy of the urogenital cavity (bladder vs. vagina). Histopathology revealed a mixed gonadal tumor, consisting of 70% yolk sac tumor, and 30% dysgerminoma. The patient eventually succumbed to postoperative complications. Postmortem fluorescence-in situ hybridization revealed a 46,X,+mar[46]/45,X,[4].ish der (Y) (DYZ3+), a marker of chromosome Y origin, consistent with a mosaic type Turner syndrome, associated with increased risk for gonadal malignancy.
Dysgerminoma ; mixed germ cell tumor ; mosaicism ; yolk sac tumor

A 16-year-old primigravida, at 33 weeks and 5 days age of gestation came in due to preterm labor. Sonographic examination revealed an incidental finding of a mass attached to the sacrococcygeal area. The mass has a cystic and solid component diagnosed as sacrococcygeal teratoma. Attached to the mass were two lower extremity structures identified as femurs with feet and was considered as an underdeveloped parasitic twin. A classical cesarean section was performed because of the advanced preterm labor, and a live female infant weighing 2500 g was delivered. The parasitic lower limbs, however, inadvertently detached during delivery. There was a high index of suspicion because of a larger fundic height of 37 cm compared to the age of gestation and the difficult palpation on Leopold's maneuver. Accuracy of ultrasound findings helped the obstetricians to a timely and prepared for delivery.
Teratoma ; Twins, Conjoined

OBJECTIVE: To determine the effect of Fetal Acoustic Stimulation Test on Non Stress Test Parameter

METHODS: A total of 650 subjects (power of 80%) were enrolled. Subjects were both high risk and non high risk pregnancies, at more than 36 weeks AOG with normal AFI. All subjects underwent non stress test followed by non stress test with acoustic stimulation test for minimum of 20-40 minutes. Once consent was obtained, a low frequency sound transducer (40 hertz) was applied on the maternal abdomen to provide acoustic stimulation. The data was gathered, analyzed and compared.

RESULTS: Acoustic Stimulation Test improved the results of NST by having reactive results, longer duration accelerations, improved variability from minimal to moderate variability, and increased number of fetal movement.

CONCLUSION: AST is not a standalone procedure but merely an adjunct to other antenatal tests for fetal surveillance such as BPS and Doppler.

Human ; Female ; Adult ; Young Adult ; Adolescent ; Acoustic Stimulation

Gestational diabetes mellitus (GDM) and pregnancy-induced hypertension (PIH) are common but their correlated is not well understood.
OBJECTIVE: Our objective was to determine the association of the occurrence of PIH among patients with GDM.
METHODS: This was retrospective study conducted among pregnant patients diagnosed with GDM. Chart review was done noting the occurrence of PIH, maternal characteristics including details on family history of diabetes and neonatal outcomes. Comparisons of the different variables under study were statistically analyzed.
RESULTS: A total of 93 patients of 6,248 deliveries were diagnosed with GDM (0.015%) in which 16 women also developed PIH (17.2%). There was no significant difference in the age, gravity, parity, age of gestation at diagnosis of GDM, and age of gestation on admission. There was a significant association between a patient's family history of hypertension with the occurrence of PIH among GDM cases (OR 3.89,95%CI 1.19-12.76, P=0.01). There was no significant difference in the manner of delivery (p=0.66), comparison of the APGAR scores, birthweight, and birthlength (p >0.05). However, there was a significantly greater proportion of small for gestational age (SGA) neonates among those with PIH and GDM (P=0.03). There was likewise a significantly longer NICU stay of neonates born of mothers with PIH and GDM (P=0.05).
CONCLUSION: The incidence of PIH among GDM patients is higher than the general population. Family history of hypertension predisposed a GDM patient to developed PIH. PIH in GDM predisposes to adverse neonatal outcomes.

Human ; Female ; Adult ; Pregnancy ; Diabetes, Gestational ; Gestational Age ; Parity ; Hypertension, Pregnancy-induced ; Intensive Care Units, Neonatal ; Birth Weight ; Parturition

OBJECTIVE: To determined the significant clinical variables associated with neonatal infection in prelabor rupture of the membranes at term.

METHODS: This was a retrospective cohort study of all patients with prelabor rupture of membranes at term. Inclusion criteria were as follows: singleton gestation, cephalic presentation, gestational age > 37 weeks, and rupture membranes. Clinical variables evaluated included the following: cervical dilatation on the admission, Bishop's score, amniotic fluid characteristics  during labor, use of oxytocin for induction/ augmentation of labor, electronic fetal monitoring during labor, total number of internal examinations (IE) done, time interval from PROM to delivery, time interval from active labor to delivery, and manner of delivery. Outcome measure was neonatal infection, both probable and definite neonatal infection.

RESULTS: The incidence of neonatal infection among 28 cases of term PROM in this study was 39%. Bishop's score, total number of internal examination done, time interval from PROM to delivery and time interval from active labor to delivery showed nearly statistically significant association with neonatal infection in the background that all cases underwent labor induction or augmentation and were given antibiotic prophylaxis. On multiple logistics regression analysis, only time interval from PROM to delivery showed statistically significant association with neonatal infection, OR 1.58, 95% CI 1.01-2.47.

CONCLUSION: When the clinical variables are analyzed all together, only the time interval from PROM to delivery showed statistically significant association with neonatal infection, suggesting that a time interval of >24 hours from PROM to delivery renders the neonates at about 1.58 times at increased risk of neonatal infection.

Human ; Infant (a Child Between 1 And 23 Months Of Age) ; Oxytocin ; Gestational Age ; Cardiotocography ; Incidence ; Labor Stage, First ; Amniotic Fluid ; Antibiotic Prophylaxis ; Labor, Induced ; Labor, Obstetric ; Delivery, Obstetric ; Parturition ; Outcome Assessment (health Care) ; Regression Analysis

OBJECTIVE: A randomized double blind controlled trial was undertaken to compare the efficacy of oral probiotics and oral metronidazole in the treatment of symptomatic bacterial vaginosis (BV) among non-pregnant women.

METHODS: A total of 66 patients were included in this investigative study. Thirty five patients were assigned to oral metronidazole (500mg twice a day for 7 days) and 31 patients to oral probiotics (1 capsule three times a day for 10 days). Symptoms of abnormal vaginal discharge, vaginal pruritis, vaginal burning sensation, and dyspareunia were recorded. Diagnosis of BV was based on Amsel's criteria: homogenous vaginal discharge; pH of vaginal fluid >4.5; positive whiff test; and presence of clue cells. Patients were seen 10 days from initiation of treatment. Review of symptoms and Amsel's criteria were re-evaluated including a Gram stain for Nugent's score.

RESULTS: There were significantly more patients still with symptoms of abnormal vaginal discharge and presence of homogenous vaginal discharge on examination in the oral probiotics group (77.8% vs 28.57%, P = 0.001, RR = 5.25). Based on the Nugent's score, there were significantly more patients evaluated with positive results for BV in the oral probiotics group (77.14% vs 33.33% , P = 0.001, RR = 7.4) after treatment. Giving oral probiotics shows a relative risk of 309%, a negative RRR and a negative ARR.

CONCLUSION: Based on resolution of symptoms and Amsel's criteria, oral metronidazole was superior to oral probiotics. Oral probiotics were not beneficial in eradicating the organisms causing BV. Oral probiotics should not be offered as treatment for bacterial vaginosis.

Human ; Female ; Vaginosis, Bacterial ; Metronidazole ; Dyspareunia ; Probiotics ; Risk ; Gram's Stain ; Gentian Violet ; Phenazines ; Vaginal Discharge ; Pruritus ; Sensation

OBJECTIVE: A randomized double blind placebo controlled trial was undertaken to compare the effect of topical Mupirocin ointment and Aloe vera with Vitamin E cream versus a placebo on post surgical wound healing.
METHODS: A total of 101 patients with primary elective vertical infraumbilical incision were enrolled in the investigative study. Mupirocin ointment was used in 34 patients, Aloe vera with vitamin E cream in 33 patients and placebo in 34 patients. First application was immediately post operation prior to occlusive dressing followed by application on the third day post operation. The assigned topical agent was used for daily wound care. Would healing was assessed on the third postoperative day, first, second and third week post surgery. Wound infection, contact allergic dermatitis and would healing characteristics specially redness, edema, presence of wound discharge and wound dehiscence were evaluated.
RESULTS: There were no recorded cases of wound infection and allergic contact dermatitis among the patients enrolled in the different study groups at any time during the post surgery evaluation. Comparing the occurrence of the different wound healing characteristics, there were no significant differences during the first post operative day up to first to third week post operation evaluations.
CONCLUSION: Topical application of these agents before occlusive dressing immediately post operation and its use in daily wound care up to three weeks post operation did not show significant benefit for the patient.

Human ; Occlusive Dressings ; Aloe ; Mupirocin ; Surgical Wound ; Vitamin E ; Wound Healing ; Ointments ; Wound Infection ; Dermatitis, Atopic ; Dermatitis, Allergic Contact ; Edema

OBJECTIVE: To determine the relation of ovarian volume measured by transvaginal ultrasound and perimenopausal transition to menopause.
METHODOLOGY: This was a retrospective cohort review of all transvaginal ultrasound measurements of ovarian volume among reproductive-aged non-pregnant women. Details on their age and menstrual cycle were obtained and menstrual pattern categorized as regular, irregular, less than 1 year of menopause or menopause.
RESULTS: A total of 301 patients were included with a mean age of 45.1 ± 8.84 years. There was a significant decrease in mean volume of either ovary as age of the patient advanced. The ovarian volume dropped significantly between the age category of 30s and 50s (P
Human ; Ovary ; Menstrual Cycle ; Menstruation ; Menopause ; Reproduction

Objectives: To identify clinical, sonographic and hysteroscopic characteristics associated with malignant endometrial lesions. Methods: This is a retrospective descriptive study that included all menopausal women presenting with vaginal bleeding in a tertiary care hospital from January 2007 to June 2010. Clinical, sonographic and hysteroscopic findings were evaluated as predictor variables for development of endometrial adenocarcinoma. Results: Thirteen out of the 215 patients had endometrioid adenocarcinoma, in women presenting with postmenopausal bleeding, with a prevalence rate of 6%. A trend towards harm is seen among the following factors: age of > 60 years (OR 1.19; 95% CI, 0.29-4.46), menarche < 12 years (OR 1.07; 95% CI, 0.22-4.66), endometrial stripe >/- 10mm (OR 2.02; 95% CI, 0.58-7.09), lesion of diameter < 1cm (OR 1.57; 95% CI, 0.45-5.74), presence of cystic space (OR 4.28; 95% CI, 1.00-17.36), and soft consistency (OR 1.94; 95% CI, 0.47-9.21). Conclusion: Increasing age, early onset of menarche, endometrial thickness of >/- 10mm, hysteroscopic characteristics (lesion diameter of less than 1 em, presence of cystic space and soft consistency) increases the probability of carcinoma.
Human ; Female ; Aged ; Middle Aged ; ENDOMETRIAL NEOPLASMS ; HYSTEROSCOPY ; MENORRHAGIA ; UTERINE HEMORRHAGE

A case of Idiopathic Thrombocytopenic Purpura (ITP) in pregnancy managed by multidisciplinary team approach is discussed. A case of 35-year old patient with ecchymoses and easy bruisability at four months age of gestation is presented. Diagnostics revealed prolonged bleeding time with peripheral blood smear and bone marrow aspirate biopsy consistent with ITP. Pertinent findings and evidence on management strategies on ITP in pregnancy were discussed and a consensus was arrived at. The patient was maintained on oral steroids, underwent fetal being surveillance and platelet count monitoring. Patient unremarkably delivered vaginally to a term livebirth who eventually developed neonatal thrombocytopenia. The neonate was treated with steroids and likewise discharged improved.

PURPURA, THROMBOCYTOPENIC, IDIOPATHIC