Cesarean scar pregnancy is the rarest form of ectopic pregnancy. In the Philippines, little is known about its incidence and occurrence. However, increasing rates has been documented worldwide, closely related to the increasing cesarean section rates. This paper reports two cases of cesarean scar pregnancy who both presented with vaginal bleeding. The first case, a Gravida 6 Para 5 (5005), while the second case, a Gravida 3 Para 2 (2002). Both diagnosed early by ultrasonography but managed differently. The first case, managed by hysterectomy, while the second case, managed conservatively by laparoscopic excision of the cesarean scar pregnancy. This paper intends to raise awareness of the increasing incidence of cesarean scar pregnancy, its pathophysiology, different options in the diagnosis and management. Prevention is the key to decrease the incidence of cesarean scar pregnancy. To achieve this, reducing the cesarean section rate should be the primary goal.
Pregnancy, Ectopic ; Cesarean Section

BACKGROUND: The standard treatment for bacterial vaginosis is metronidazole. Side effects are not well tolerated by some patients and some develop resistance. Hence, the search for treatment with less side effects and less resistance.

OBJECTIVES: To determine the efficacy of vaginal dequalinium chloride compared to oral metronidazole in the treatment of bacterial vaginosis among non; pregnant women.

METHOD: Fourty non-pregnant women and non lactating women, 18-50 years old diagnosed with bacterial vaginosis by presence of vaginal discharge and malodor, Nugent's score of 4 and above, and clue cells seen in Gram stain, were randomly allocated to treatment groups. Group A received dequalinium chloride 10mg/vaginal tablet for 6 days at HS while Group B received metronidazole tablet, 500mg/tablet, 1 tablet per orem BID for 7 days. Microbiologic, clinical and complete cure rate as well as adverse effects of treatment were then assessed. Data entry and encoding was done using Epi info version 6. Analysis was done using stata version 9. Univariate analysis such as mean, median, mode and range were used to describe the characteristics of the subjects. Frequency distribution was used to describe the proportion of patients with microbiologic, clinical and complete cure. This was also used in describing proportion of the participants' acceptability in this study. Chi square was used for comparison of dequalinium chloride and metronidazole between treatment-arms.

RESULTS: Ninety five percent (19/20) of those in the dequalinium arm had gram-negative coccobacilli count of less than 10/hpf as compared to 80% (16/20) among those in the control (P < 0.30). Lactobacilli was only restored among 25% of those in the metronidazole and in 75% of the control group (P = 0.002). Reduced amount of discharge was observed in all paricipants in both groups. Malodor of the discharge disappeared in 95% (19/20) of the H₂O₂ and 85% (17/20) of the control group (P=0.30).

CONCLUSION: Dequalinium is comparable with the standard treatment. It is at par with the standard treatment in alleviating symptoms of bacterial vaginosis and reducing estimated coccobacilli. It is more effacious in restoring the normal flora.

Human ; Female ; Middle Aged ; Adult ; Young Adult ; Vaginosis, Bacterial ; Dequalinium ; Metronidazole ; bacteria ; Gardnerella vaginalis ; Mycoplasma hominis ; Fusobacterium

A 31 year old Filipino male diagnosed with obstructive azoospermia underwent TESE. Other current advanced sperm retrieval techniques include MESA, PESA and TESA confounded with female factors such as advanced maternal age and polycystic ovaries, IVF-ICSI eventually resulted to a successful pregnacy outcome. Several factors contributing to the success of IVF-ICSI eventually resulted to a successful pregnancy outcome. Several factors contributing to the success of IVF-ICSI in this case were also discussed. Although assisted reproductive technology is relatively new in our country, it proved to be promising in our local setting.
Human ; Female ; Adult ; REPRODUCTIVE TECHNIQUES, ASSISTED ; AZOOSPERMIA ; SPERM RETRIEVAL

OBJECTIVE: To determine the effectiveness of the addition of estrogen during clomifene induced ovulation cycles among infertile women in improving endometrial thickness, endometrial echogenicity and pregnancy rates.
DESIGN: Meta-analysis.
SETTING: University-based tertiary center.
MATERIALS AND METHODS: All clinical trials of estrogen in whatever form and route of administration with clomifene citrate compared with clomifene alone or plus placebo in the treatment of infertile women were identified thru electronic search through Medline Cochrane and HERDIN databases, reference hand searching of obtained journals and request for information from relevant organizations and then reviewed for methodological quality. Meta-analysis of weighted mean differences (WMD) for the endometrial thickness, uterine artery pulsatility index, number and size of dominant follicles as well as pooled odds ratios (OR) using Mantel-Haenszel Statistic for pregnancy were performed using Review Manager version 4.1.
RESULTS: Randomized controlled trials were included involving 354 women aged 21-37 years with unexplained/ anovulatory infertility. The pooled WMD for endometrial thickness was 1.71 mm (95% confidence interval (0.71, 2.69) in favor of clomifene plus estrogen. Subgroup analysis revealed that the endometrium was thicker if ethinylestradiol administered at a dose range of 0.02-0.05 mg was given on the 7th-10th say of the cycle for 5 days. Two studies reported pregnancy rates as outcomes showing an almost 2 times higher chance of pregnancy among those treated with clomifene plus estrogen. (OR=1.74; 95% CI 0.93, 3.27). There was a small but significantly higher value for WMD of 16 pg/ml for serum estradiol levels (95% CI 4.56, 27.8). No evidence of any effect on uterine artery pulsatility index, dominant follicle size nor number was seen.
CONCLUSION: Meta-analysis demonstrates that estrogen supplementation in clomifene citrate ovulation induction increases endometrial thickness and serum estradiol levels with a trend towards increased chances of pregnancy among infertile women.

Human ; Clomiphene ; Infertility, Female ; Pregnancy Rate ; Ethinyl Estradiol ; Estradiol ; Uterine Artery ; Ovulation Induction ; Estrogens ; Ovarian Follicle ; Endometrium ; Ovulation ; Citrates

A 31 year old Filipino male diagnosed with obstructive azoospermia underwent TESE. Other current advanced sperm retrieval techniques include MESA, PESA and TESA confounded with female factors such as advanced maternal age and polycystic ovaries, IVF-ICSI eventually resulted to a successful pregnacy outcome. Several factors contributing to the success of IVF-ICSI eventually resulted to a successful pregnancy outcome. Several factors contributing to the success of IVF-ICSI in this case were also discussed. Although assisted reproductive technology is relatively new in our country, it proved to be promising in our local setting.
Human ; Female ; Adult ; Reproductive Techniques, Assisted ; Azoospermia ; Sperm Retrieval

A 25 year old presented with primary amenorrhea. Work-ups revealed polycystic ovary syndrome as the cause. Discussed are the diagnostic algorithm, differentials, management and role of leptin for the amenorhea.
Human ; Female ; Adult ; POLYCYSTIC OVARY SYNDROME ; AMENORRHEA