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.

METHODS

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.

RESULTS

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.

CONCLUSION

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.

Human ; Female ; Blood Transfusion

Background: Uterine fibroids are the most common benign tumors in women. Management of symptomatic fibroids may ultimately require surgery and for those desirous of fertility, laparoscopically assisted myomectomy and the conventional laparoscopic procedure are conservative treatment options, with the former providing a less technically demanding approach. Objectives: This study aims to evaluate the clinical outcomes for laparoscopically assisted myomectomy (LAM) versus laparoscopic myomectomy (LM) done at a tertiary hospital. Methods: This is a retrospective chart review of 118 patients with symptomatic myomas who underwent LM (n=66) or LAM (n=52) at a tertiary hospital from January 2010 to December 2017. Results: There were significantly more fibroids removed in the LAM group compared to the LM group, but with no significant difference in the average diameter of fibroid removed. Complex plastic reconstruction with more than 2 layers of repair was done more often in the LAM group (p<0.001). The mean operative time was longer and more blood loss was incurred in the LM group, but this was not statistically significant. Almost 14% of patients in the LM group had blood transfusion compared to 4.1% in the LAM group (p=0.085). The rate of perioperative complications was similar for both groups. The length of hospital stay was shorter in the LM group, but was not statistically significant. A trend towards higher odds of pregnancy was seen in the LAM group. Majority of patients were delivered via cesarean section with no incidence of uterine rupture. The recurrence of fibroids was seen more in the LAM group (17.9% versus 13.7% for LM), however this was not statistically significant. Conclusions The surgical, reproductive, and long-term clinical outcomes for both LAM and LM are similar, thus, LAM provides a non-inferior minimally invasive approach and a conservative option for patients desirous of future fertility.
Uterine Myomectomy ; Laparoscopy

This commentary is focused primarily on the relationship between menopausal hormone therapy (MHT) and breast cancer risk, the primary adverse outcome measure of the Women’s Health Initiative (WHI) hormone trials. The WHI hormone trials are to date the largest randomized, placebo-controlled studies that evaluated the risks and benefits of hormone therapy in postmenopausal women. There are two arms: the estrogen-progestin (conjugated equine estrogen/medroxyprogesterone acetate) arm for women with intact uterus and the estrogen-alone (conjugated equine estrogen) arm for women who had a hysterectomy1. Both arms, planned to continue for 8.5 years, were stopped prematurely, the CEE/MPA arm after a mean of 5.2 years of follow-up and the CEE-alone arm after a mean of 7.2 years follow-up.
Female ; Estrogens, Conjugated (USP) ; Medroxyprogesterone Acetate

Mullerian duct anomalies (MDAs) are congenital defects of the female genital system that arise from abnormal embryological development of the Mullerian ducts. A didelphys uterus, also known as a "double uterus," is one of the least common amongst the MDAs. Reported here is a case of a 16 year old female with a uterus didelphys with the obstructed left hemiuteri adherent in the anterior abdominal wall, and an endometriotic cyst on the same side. She underwent hysteroscopy-guided vaginoscopy, laparoscopic left hemihysterectomy, left oophorocystectomy. Cases such as these require careful preoperative planning and diagnostic imaging for more accurate diagnosis and, hence, for the most appropriate surgical procedure to be carried out. 3D ultrasonography and Magnetic Resonance Imaging have been the most widely used imaging techniques. The goals of management are to relieve the symptoms of obstruction and to restore the normal anatomy as much as possible in order to provide the best chance for future fertility.
Uterine Didelphys

OBJECTIVE

To validate the EFI, a clinical tool that predicts the possibility of pregnancy in Filipino women with laparoscopically-diagnosed endometriosis-associated infertility.

DESIGN

Retrospective cohort

SETTING

St. Luke's Medical Center

PATIENTS

One hundred twenty-two infertile women with laparoscopically-diagnosed endometriosis.

METHODOLOGY

Subjects were scored using the Endometriosis Fertility Index (EFI). Pregnancy rates were determined separately. Discriminative capacity of the EFI was assessed by Receiver Operator Characteristic (ROC) analysis. Sensitivity, specificity, positive and negative predictive values of the test at different thresholds were determined. Correlation of EFI scores and pregnancy rates was determined by logistic regression analysis.

MAIN OUTCOME MEASURES

EFI scores, pregnancy rates, ROC curve, Area under the curve (AUC), sensitivity, specificity, positive and negative predictive values, Logistic fit of pregnancy VS. EFI scores.

RESULTS

Twenty-two pregnancies occurred during the 12-month period with 13 pregnancies occurring within the first six months. Over-all pregnancy rate was 18.3%. The ROC curve straddled the line and showed an AUC of 67%. The sensitivity and specificity of the EFI for each threshold showed increasing sensitivity with lower scores and higher specificity with higher scores. Positive predictive values (PPV) were low, but Negative predictive values (NPVs) were high. Logistic regression analysis showed a good correlation between EFI scores and pregnancy (P < 0.05).

CONCLUSION

The individual scores correlate well with the chances of pregnancy and the negative predictive value of the test is high. This index is a newly validated, simple clinical tool that can predict pregnancy in infertile women with endometriosis. The discrimination Gapability of the EFI needs further analysis.

Human ; Female ; Endometriosis ; ; Infertility ; ; Laparoscopy ; ; Pregnancy Rate ; ; Pregnancy ; ; Women ; ; Philippines

To compare the accuracy of transvaginal ultrasound, hysterosalpingography and hysteroscopy in the detection of intrauterine lesions that may be associated with infertility, the medical records of 452 women who each underwent all three procedures from January 2007 to July 2010 were reviewed. Hysteroscopy appears to have the highest sensitivity for the diagnosis of endometrial polyp, submucous myomas and endometrial hyperplasia. On the other hand, hysterosalpingography has the highest specificity for the diagnosis of endometrial polyp, submucous myomas, endometrial hyperplasia, and intrauterine septa. Combination of procedures improved diagnostic accuracy in terms of specificity.
Human ; Female ; Middle Aged ; Adult ; ULTRASONOGRAPHY ; HYSTEROSALPINGOGRAPHY ; HYSTEROSCOPY

This is the case of a 26 year-old nulligravida with Polycystic Ovary Syndrome who developed severe Ovarian Hyperstimulation Syndrome (OHSS) during ovulation induction for Intrauterine Insemination (IUI). Three problems were encountered during treatment. The first was whether to convert a planned ovulation induction and IUI, that resulted in multiple follicular development, to an in vitro Fertilization - Intracytoplasmic Sperm Injection cycle. The second problem was determining what strategies are relevant in preventing OHSS in a woman at high risk for developing severe hyperstimulation. The third problem was why, when and how to employ abdominal paracentesis in the management of severe OHSS. Though the patient's course was turbulent, management was successful. She is now awaiting embryo transfer and, ultimately, motherhood.
Human ; Female ; Adult ; OVARIAN HYPERSTIMULATION SYNDROME ; POLYCYSTIC OVARY SYNDROME

The diagnosis of the Herlyn-Werner-Wunderlich syndrome is frequently misleading, not only to underreporting of cases, but, more seriously, to suboptimal treatment that can be detrimental to the reproductive potential of the affected woman. The case of a 14-year old girl with the HWW syndrome is presented. Although the diagnosis was suggested by imaging modalities such as ultrasound and magnetic resonance imaging, the use of endoscopic procedures such as laparoscopy and hysteroscopy, provided additional vital information that allowed an accurate assessment of her condition and a definitive, minimally-invasive management that was protective of her reproductive function.
Human ; Female ; Adolescent ; MULLERIAN DUCTS ; HEREDITARY RENAL AGENESIS

Intrauterine insemination (IUI) together with controlled ovarian hyperstimulation (COH) has been increasingly used for the treatment of variety of subfertile indications, both male and female or even combined. The overall success rate of IUI ranges from 4% to 66%. The wide variance of success of the procedure is likely to be influenced by a number of factors. The pregnancy rate in the local setting has never been determined. This cross-sectional study reviewed all available clinical records of patients undergoing fertility work-up who had sperm processing in a hospital-based andrology unit and who underwent intrauterine insemination in either the hospital-based facility or a private clinic from January to December, 2004. Objective: It aimed to determine the pregnancy rate following IUI and assess the intrinsic and extrinsic variables affecting its success and describe the IUI's pregnancy outcome. The intrinsic factors include patient's age (male and female), number of subfertility years, previous reproductive history specifically involving the different factors (male, cervical, uterine, ovarian, tubal, peritoneal). Extrinsic factors include treatment effect and timing of IUI (medicine administered, monitoring of number and size of follicles, endometrial thickness, total motile count inseminated, number of inseminations) and preference for facility (hospital-based clinic or private clinics). Results: For the period of one year, there were a total of 1051 cycles of IUI, 305 in the hospital-based facility and 746 in private clinics. Due to limitation of accessible data, only 424 cycles were studied. However, out of the 424 cycles data retrieved, only 365 showed IUI outcomes. The overall pregnancy rate following IUI was 2.47%. In this study, it seems that only the wives' age (younger) and years of subfertility (2.9 years), were found to be associated with pregnancy rates. The median female age was 35.4 years (range 23.4-48.2), and median male age was 36.5 years (range: 25.0 - 54.4) with a median duration of subfertility of 6.0 years (range: 0.3 -18.0). Conclusion: There is no sufficient evidence to conclude that the other factors studied under treatment, different parameters and topography are associated with rates of pregnancy following IUI.

Human ; Male ; Female ; Adult ; Reproductive History ; Spouses ; Infertility ; Uterus ; Fallopian Tubes ; Insemination ; Fertility ; Spermatozoa