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.

Partial Gonadal Dysgenesis (PGD) is a rare disorder of sexual development defined by sexual ambiguity and the presence of mullerian structures due to variable degrees of testicular dysgenesis in individuals with a non-mosaic 46, XY karyotype. Due to incomplete gonadal development, the external phenotype would rely on the degree of testicular function. The dysgenetic gonads found in PGD have high risk for malignant transformation. Although ambiguous genitalia was noted upon birth, a case diagnosed in adulthood is presented. Discordance between sex of rearing and the psychosexuality of the patient prompted consult. On work up, 46, XY was noted on karyotyping but presence of a uterus was seen on ultrasound. Hormonal assay revealed elevated levels of FSH and LH, while testosterone levels were low and estradiol was high. Gonadoblastoma was noted on final histopathologic evaluation. This report shall tackle thorough preoperative evaluation, surgical and postoperative management of individuals with PGD.
Gonadal Dysgenesis ; Disorders of Sex Development ; Disorder of Sex Development, 46,XY

The true incidence and prevalence of congenital Mullerian duct anomalies are difficult to determine. Some patients may present as adolescents with apparent primary amenorrhea, cyclical abdominal pain and sexual difficulties. It is important to ascertain a correct diagnosis for timely and appropriate interventions necessary to prevent sequelae that often affect the future fertility of these patients. This is a case of a fifteen year old with severe cyclical pelvic pain and hematuria with amenorrhea. Work up included a transrectal ultrasound and a magnetic resonance imaging of the pelvis revealing presence of a uterine corpus and cervix but absence of uterine isthmus. A conservative surgical approach was planned. The patient underwent end-to-end anastomosis of the cervix and uterine corpus. At present, the patient is regularly menstruating with no pelvic pain.
Amenorrhea

Objectives: To estimate the prevalence and identify risk factors for non-alcoholic fatty liver disease (NAFLD) in women with polycystic ovary syndrome (PCOS).

Methods: This was a cross-sectional study on non-pregnant women newly diagnosed with PCOS based on the Rotterdam criteria. Clinical history, anthropometric measurements and modified Ferriman-Gallwey scores were obtained. Lipid profile, 75-grams oral glucose tolerance test and serum AST/ALT levels were determined. Liver ultrasound was used to diagnose NAFLD after excluding other causes of liver disease.

Results: Thirty-five women with PCOS (mean age: 25.74+5.23 years, mean body mass index: 25.81+4.96 kg/m2) were included; of which 48.57% (17/35) had NAFLD. Women with NAFLD had significantly higher BMI, waist circumference, mFG score, 2-hour blood glucose level and AST/ALT levels and had greater prevalence of overall obesity, central obesity and elevated aminotransferases. They also had greater prevalence of metabolic syndrome and had higher total cholesterol and lower HDL levels but the differences were not statistically significant. No difference in age was also found.

Conclusion: Non-alcoholic fatty liver disease is frequent in women with PCOS and is associated with overall obesity, central obesity, impaired glucose tolerance, hirsutism and elevated aminotransferases. Women with PCOS should be screened for NAFLD especially those with features of metabolic syndrome.

Congenital cervical dysgenesis is a rare mullerian anomaly occurring in 1 in 80,000 to 100,000 births and is thought to arise primarily from a defect in the elongation of the mullerian ducts. For decades, standard gynecologic practice for these patients has been the removal of the uterus to relieve the obstruction and conservative management is still a matter of debate. Presented here is a 17-year-old, nulligravid with congenital cervical dysgenesis who successfully underwent cervical canalization and cervico-vaginal anastomosis in a tertiary training institution. One month after surgery, the patient had normal menses and has been pain-free up to present. This paper concludes that a thorough investigation of patients with this anomaly is imperative and conservative management in carefully selected patients should be applied as first-line treatment option.

Vaginal agenesis is an uncommon congenital anomaly and such complex malformations are usually incorrectly identified. Deviations from the normal embryologic events in the reproductive system may result to malformations which may exhibit with the same clinical presentation. A complete history and physical examination coupled with appropriate imaging techniques are necessary to arrive at a correct diagnosis. Physicians must be aware of the differential diagnosis and management options available. A correct diagnosis must be made prior to any surgical intervention to prevent inappropriate surgeries with their anticipated complications. In cases with vaginal outlet obstruction, an accurate diagnosis with the adequate treatment reduces the need for re-operations and subsequent complications. Reported are three misdiagnosed cases of distal vaginal agenesis resulting to unwarranted surgical interventions.
Human ; Female ; Adolescent ; ABNORMALITIES ; VAGINA ; HEMATOCOLPOS ; HEMATOMETRA ; ROKITANSKY KUSTER HAUSER SYNDROME

Objective: The objective is to describe the clinical presentation and management of cervical agenesis. Study Design: This is a retrospective analysis of 5 patients with cervical agenesis managed in a university tertiary institution and a review of similar cases cited in literature. Results: There are only 119 cases of cervical agenesis described to date, with pelvic pain and primary amenorrhea as common presenting symptoms. Forty-nine percent presented with associated vaginal agenesis. Successful canalization was performed in 41-46 percent. Nine successful spontaneous pregnancies and by zygote intrafallopian transfer have been cited. Conclusions: Cervical agenesis is a rare condition. Concomitant vaginal agenesis occurs in nearly half of subjects. Results of successful conservative surgery are comparable between cervicovaginal agenesis and cervical agenesis but there are more morbidities and mortalities associated with the former. Hysterectomy is another option. Careful patient selection, psychological support and individualized treatment are key to proper management.
Human ; Female ; CRANE-HEISE SYNDROME ; ABNORMALITIES