A 40-year-old, gravida 3 para 2 (1-1-0-2), previous primary cesarean section for nonreassuring fetal status, presented at a tertiary hospital for confirmation of cesarean scar pregnancy (CSP). Transvaginal ultrasound confirmed a CSP at 8 2/7 weeks age of gestation with good embryonic cardiac activity, raising concern for early placenta accreta spectrum. A multidisciplinary team composed of an obstetrician, advanced pelvic surgeon, urologist, and anesthesiologist managed the patient. The patient underwent total abdominal hysterectomy with bilateral salpingectomy, as the patient has a completed family size. Before the procedure, she was given cefuroxime as prophylactic antibiotic. Intraoperatively, there were dense adhesions between the posterior bladder wall and the previous cesarean section scar. Inadvertent injury to the bladder wall was incurred during adhesiolysis. Cystorrhaphy was done by a urologist, while the rest of the surgery was unremarkable, with a 450 ml estimated blood loss. The postoperative course was unremarkable. Bladder rest was achieved by maintaining an indwelling Foley catheter, which remained in place upon discharge on postoperative day 3 and was continued for 7 days thereafter. At follow-up, a successful voiding trial was conducted, confirming the return of normal bladder function.

Human ; Female ; Adult: 25-44 Yrs Old ; Cesarean Section ; Salpingectomy ; Hysterectomy ; Fetal Distress ; Placenta Accreta ; Cefuroxime ; Catheters ; Cicatrix

Background: Early stage ovarian cancer may be managed with fertility-sparing surgery, to preserve the uterus and contralateral ovary, thus preserving future reproductive function. The aim of this study was to determine the reproductive outcome of early stage ovarian cancer managed conservatively by unilateral salpingooophorectomy, and to compare the survival and recurrence rate among those who had and did not have pregnancy after treatment. Methodology:: A retrospective cohort study was conducted on 34 patients with early stage ovarian cancer who underwent fertility-sparing surgery from January 2005 to December 2018. Fertility outcome following treatment was determined. Survival and recurrence rate was analyzed between those who had and did not have pregnancy after surgery. Results: A total of 34 out of 661 (5.14%) new cases of ovarian cancer who underwent fertility-sparing surgery were analyzed, with a mean age of 23.71 ± 5.57 years (range: 12-36 years old), with the most common complaints of increasing abdominal girth (11/34, 32.35%) or palpable abdominal mass (11/34, 32.35%). Successful pregnancy was seen in 9 cases (26.47%), with 2 of them currently pregnant. Overall recurrence and survival rates were 14.71% and 91.18%, respectively. There was no statistically significant difference in the survival rate (88.89% vs 92%, p-value 0.7778) and rate of recurrence (22.22% and 12%, p-value 0.4578) between those who got pregnant after fertility-sparing surgery for early stage ovarian cancer, FIGO Stage IA and IC, compared to those who did not get pregnant. Conclusions Fertility-sparing surgery can be effectively offered to young patients with early stage ovarian cancer, to preserve reproductive function, with 26.47% successful pregnancy rate. Pregnancy had no significant effect on recurrence and survival among FIGO stage IA and IC ovarian cancer who underwent fertility-sparing surgery by unilateral salpingooophorectomy.
Fertility ; Health Services ; Ovarian Neoplasms

Human ; Female ; Influenza, Human

OBJECTIVE: To determine and analyze the demographic data, clinical, presentation and course, as well as maternal and neotal outcome of pregnant Filipino patients with influenza-like illness (ILI) versus confirmed cases of Influenza AH1N1 during the 2009-2010 pandemic who presented at the Influenza-like-illness (ILI) Clinic at a tertiary hospital in the Philippines from May 2009 until February 2010.
DESIGN: Cohort study
SETTING: The Medical City
PATIENTS: Pregnant patients who presented with influenzalike illness (ILI) and were seen at the Influenza-like-illness (ILI) Clinic from May 2009 until February 2010.
METHODOLOGY: This is a cohort study that reviewed the charts of pregnant patients who presented with influenza-like illness, diagnosed as Case under Observation (CUO) at the Influenza-like Illness (ILI) Clinic at The Medical City, from May 2009 until February 2010. The pregnant patients were classified into two groups: those who tested positive and those who tested negative to the H1N1-rRT-PCR (realtime reverse transcriptase polymerase chain reaction) throat swab test. Demographic characteristics, course and management of illness as well as prenatal and peripartum course were compared between the two groups. Followup was also done by phone calls. Any history of preterm labor, hospital admissions, respiratory illness, and complications were gathered. Maternal and neonatal outcome were documented including mode of delivery, birthweight, maturity and any neonatal complications.
MAIN OUTCOME: Pregnant women presenting with influenzalike illness (ILI) and confirmed Influenza A H1N1 infection have a higher rate of hospital admission (59.1% and 61.5%) compared to non-pregnant women of reproductive age (19.1% and 29.4%) with similar conditions (P = 0.05). Pregnant women who presented with influenza-like illness and with a positive throat swab result were significantly younger than those with negative results, with a 2.25 times higher risk for pregnant women aged 30 years old to have a positive throat swab test result (RR - 2.25; 95% CI = 1.08-4.67; P = 0.005). Difficulty of breathing was significantly more common among those with negative throat swab test result (44.4%) (P = 0.02). Association between the types of specimen collected with throat swab test results among pregnant patients with ILI showed a significantly higher proportion of subjects to have a positive result with nasooropharyngeal samples (P = 0.03).
CONCLUSION: Pregnant women with influenza-like illness (ILI) and confirmed cases of Influenza A H1N1 have a higher rate of hospitalization compared to non-pregnant women of reproductive age with similar conditions. Pregnant women who presented with influenza-like illness and with a positive throat swab result were significantly younger than those with negative results. Difficulty of breathing was significantly more common among those with negative throat swab test result. A significantly higher proportion of subjects have a positive result with naso-oropharyngeal samples. The issue of protecting the Filipino pregnant women from this vaccine-preventable disease remains a challenge to every healthcare worker in this country.

Human ; Female ; Adult ; Influenza, Human ; Influenza A Virus, H1n1 Subtype ; Peripartum Period ; Pharynx ; Delivery, Obstetric ; Health Personnel ; Vaccines