INTRODUCTION

Adolescent pregnancy is enduringly perceived as posing a considerable social threat in the Philippines. Recent data from the Commission on Population and Development shows that over 40,000 births annually are from adolescent mothers aged 10 to 14 years, with many of these early pregnancies potentially linked to rape, forced sex, and abuse. Most studies in the past focus on causes and prevention. Limited research explores the lived experiences of early adolescent mothers, especially in the context of unwanted pregnancies.

This study was conducted to determine the lived experiences of unwanted pregnancy among early adolescents age 12 to 15 years old in Zamboanga City.

The study employed an Interpretative Phenomenological Study Design which involved understanding how the adolescents make sense of events, emotions, and interactions in their experiences. Ten (10) adolescent girls with experience of unwanted pregnancy were interviewed.

Analysis of transcripts generated three superordinate themes: (1) Living in the challenges of the present, (2) Facing the future with resilience, (3) Escaping the past. After identifying similarities across cases, two cross-case themes were generated: (1) Dysfunctional family background as a contributor to early pregnancy, and (2) The importance of relying on significant others for support.

The study revealed that unwanted pregnancies were influenced by dysfunctional family environments, socioeconomic challenges, and, in some cases, sexual exploitation. The participants faced emotional distress, financial instability, and social stigma, with support from family playing a critical role in the coping process. Despite the initial adversity, participants demonstrated resilience, finding ways to endure, adapt, and thrive.

BACKGROUND

Maternal malnutrition is a major cause of low birth weight (LBW) newborn outcome especially among adolescent mothers. It is one of the key drivers of child stunting and initiates the vicious cycle of intergenerational malnutrition. The body mass index prior to pregnancy or at the initial trimester is currently being used to establish the desired weight gain throughout pregnancy. However, Filipino adolescents often delay their first antenatal visit at a later stage of pregnancy. Without a baseline weight, the establishment of appropriate weight gain and nutritional status is often challenging. Mid-upper arm circumference (MUAC) was proven to be a good proxy measure of acute malnutrition, however, there was no global consensus on what MUAC cut-off point to use to identify pregnant adolescents at risk for delivering LBW babies. Finding the optimal cut-off could facilitate early identification and intervention of pregnant adolescents who are nutritionally at risk and could eventually break the cycle of intergenerational malnutrition.

The study aims to determine the association of maternal MUAC and the birth weight outcomes among newborn deliveries of adolescents in a tertiary hospital for a period of six months and to identify the optimal maternal MUAC cut-off point that can be used to predict low birth weight outcome among newborn deliveries of adolescents in a tertiary hospital.

A cross-sectional study was conducted among adolescents ages 10 to 19 years who delivered babies in a tertiary hospital in the Philippines for a period of six months. Maternal MUAC and LBW outcome were documented, and their association was determined using a logistic regression analysis. To measure diagnostic accuracy, the sensitivity, specificity, and the area under the curve were taken for each MUAC point. A receiver operating characteristic (ROC) curve was used to aid the MUAC cut-off determination.

Out of 237 newborn deliveries, 35% were noted with low birth weight while 65% had normal birth weight. Most of the mothers were in their late adolescence at 78%. The crude association for the MUAC cut-offs ≤23.00 cm, ≤23.50 cm, and ≤24.00 cm and LBW showed a significant value of 2.19, 2.25, and 2.39 at 95% CI, respectively. However, it is only the cut-off ≤24.00 cm that showed significant results for adjusted association by the logistic regression analysis. The MUAC cut-off ≤24.00 cm also showed a better trade-off value between the sensitivity and specificity. Furthermore, the optimal maternal MUAC measurement that predicts LBW newborn outcome points to ≤24.00 cm cut-off based on the ROC curve.

This study shows that the maternal MUAC is predictive of LBW outcome among adolescent deliveries.A MUAC cut-off of ≤24.00 cm was superior to lower cut-offs studied. The pregnant adolescents might need a higher MUAC cut-off than adults to allow timely intervention and prevention of poor neonatal outcomes. By doing this simple screening test, suspected pregnant adolescents can be easily identified and referred for further confirmatory testing.

Pregnancy after undergoing major gastrointestinal surgeries like the Whipple’s procedure (pancreaticoduodenectomy) for pancreatic neoplasm is rare. This case report describes a 24-year-old woman who conceived and delivered a healthy baby after undergoing a Whipple’s procedure 5 months earlier for a pancreatic tumor. Her pregnancy was managed by a multidisciplinary team, and she delivered at 37 weeks of gestation through cesarean section without any complications. This case highlights the potential for successful pregnancy following a Whipple’s procedure, with proper counseling, coordinated care, and close monitoring during pregnancy.
Pancreatic Neoplasms ; Pancreaticoduodenectomy ; Pregnancy

INTRODUCTION

One significant challenge facing the Filipino youth today is adolescent pregnancy, as the nation having one of the highest rates of adolescent births rates in the ASEAN region. Various sociocultural, economic, and individual factors have been identified as contributing factors. However, the impact of family, including maternal intergenerational factors, has yet to be substantially explored. This study aimed to investigate the root cause of adolescent pregnancy in San Juan city through the identification and examination of common familial factors.

This was an unmatched case-control study with a 1:2 ratio using a non-probability sampling. It included two groups of adolescent females: pregnant/ever pregnant and non-pregnant) aged 13 to 19. A three-part modified questionnaire was used to collect the data and was administered through a faceto-face interview.

This study revealed that adolescent women in grandparent-headed families are 4.47 (CI: 1.33, 15.0) times more likely to be pregnant as adolescents compared to the reference group. Adolescents with low educational attainment among their fathers and mothers are 4.25 (CI: 1.80, 10.10) and 3.30 (CI: 1.58, 6.93) times more likely to get pregnant, respectively. Additionally, if a mother is unemployed, they were 1.89 (CI: 1.09, 3.30) times more likely to get pregnant, and if their mother passed away, they were 4.24 (CI: 1.03, 17.42) times more likely to experience pregnancy. Moreover, they are 7.69 (CI: 4.21, 14.02) and 9.07 (CI: 2.74, 30.03) times more likely to get pregnant if their mother and sister have a history of adolescent pregnancy. There was also a significant association found between severe family dysfunctionality (p=0.0430) and adolescent pregnancy. Cases were 8.33 times less likely to have a severely dysfunctional family than controls.

A statistically significant association was found between adolescent pregnancy and several familial factors, including exposure to a grandparent-headed family structure, low parental educational attainment, maternal unemployment, maternal death, and a family history of early pregnancy involving the mother or an older sister. While moderate family dysfunction was also associated, this relationship was not statistically significant.

Ewing’s sarcoma is a rare cancerous tumor of bone or soft tissue that usually occurs mostly in young adults. The diagnosis of Ewing’s sarcoma in pregnancy, most especially the subtype extraskeletal Ewing’s Sarcoma, is very rare with only few cases published in the literature worldwide. We present a case of a primigravida diagnosed with extraskeletal Ewing’s sarcoma at 6 weeks age of gestation. Currently, because of the rarity of this condition, there is lack of a universal consensus on the recommended therapeutic approach. A multidisciplinary management involving the generalist obstetrician, perinatologist, medical oncologist, and neonatologist was initiated at the outset to provide timely balance between optimal maternal treatment and fetal well-being. The maternal and fetal condition was stable all throughout the course of the chemotherapy using doxorubicin during pregnancy. Close interdisciplinary coordination regarding the treatment plans across these subspecialists resulted in a successful pregnancy outcome.

Miliary tuberculosis (TB) is a disseminated form of TB resulting from the lymphohematogenous spread of Mycobacterium tuberculosis (MTb). Since pregnancy-related TB lacks the typical respiratory symptoms, clinicians might overlook the condition, complicating early diagnosis and treatment. This is a case of a 39-year-old multigravida, who presented with vaginal bleeding in the second trimester. She was admitted for tocolysis and correction of severe anemia. On the 6th hospital day, there was a note of febrile episodes accompanied by productive cough. Chest X-ray revealed miliary spread, eventually detecting MTb on sputum GeneXpert. At 19-week age of gestation, she delivered to an abortus. Histopathology of the endometrial tissues revealed caseating granulomas, consistent with tuberculous etiology. The disease’s severity, stage of the pregnancy at the time of diagnosis, and the existence of extrapulmonary dissemination might influence the outcome of pregnancy.

COVID-19 is an infectious disease caused by the severe acute respiratory syndrome coronavirus 2. Although not well established, COVID-19 infection carries a great effect on pregnant patients with increased severity compared to the nonpregnant population. Cytokine storm is a severe immune reaction and is one of the pathogeneses of COVID-19 infection. Studies have shown the benefit of hemoperfusion in managing cytokine storm, but the use in the pregnant population remains limited. We report the case of a 41-year-old pregnant woman at 25 weeks and 5 days age of gestation infected with COVID-19 presenting with difficulty of breathing and desaturation and then underwent hemoperfusion which improved her clinical condition.

Objectives: Acute Kidney Injury (AKI) during pregnancy is a complication that poses a serious risk of life for the mother and the fetus. In most cases, the treatment considered in the first instance is pregnancy interruption with subsequent conventional treatment of AKI. The aim of this review is to describe the risks and benefits of using renal replacement therapy [peritoneal dialysis (PD) and hemodialysis (HD)] in pregnant patients with AKI. Methods: A systematic review of pregnant women with AKI/CKD on RRT (pointing out the results of maternal and neonatal morbidity and mortality) in the last three decades was done between January and March 2021 using the databases Pubmed, LILACS, Cochrane, Tripdatabase, AJKD, and Elsevier. Articles in Spanish, English, and French languages were included. A summary of cases of pregnant women on RRT with women and fetus survival percentages was shown in a table. Results: Making a summary of all the included patients, it resulted in 1673 women, 1208 in HD and 170 in PD with 15 maternal deaths and survival percentages for the fetus of 74% in HD and 40% in PD. Conclusion The RRT in pregnant women with AKI/CKD offers a high survival rate for the women and fetus.
Hemodialysis ; Renal Dialysis ; Peritoneal Dialysis ; Pregnancy ; Renal Replacement Therapy

This is a case of a 35-year-old Gravida 5 Para 5 (5005) who underwent curettage for retained placental fragments after delivering her fifth child. Within 16-month postpartum, the patient had nonspecific occasional abdominal pain and oligomenorrhea. Imaging studies revealed a uterine defect with a bowel segment passing through. A referral to a tertiary-level hospital was made. Hysteroscopy was attempted; however, an obliterated cervical canal was encountered. Laparoscopy revealed a 10 cm ileal segment completely herniating into a 2.5 cm uterine defect at the posterior uterine wall. Laparoscopic enterolysis followed by hysterectomy, extracorporeal resection, and anastomosis of the involved ileal segment was performed. This is an uncommon case of an iatrogenic uterine perforation following curettage after a term pregnancy. Its unique clinical presentation and intraoperative findings resulted in an equally unique array of surgical approach.

The case report discusses a rare occurrence of tubal pregnancy in a patient with uterine didelphys, managed using combined hysteroscopy and laparoscopy. A 29-year-old Gravida 2 Para 0 (0010) with a right tubal ectopic pregnancy alongside incidental uterine didelphys detected via physical examination and three-dimensional transvaginal ultrasound. The patient underwent a combined diagnostic and operative laparoscopy, where a right salpingectomy was performed using a harmonic scalpel. Diagnostic laparoscopy showed two uterine horns with each attached fallopian tube and ovary with an interostial length of 4 cm. Diagnostic hysteroscopy confirmed the presence of two separate uterine cavities and cervices without communication. The procedure demonstrated that the technique for laparoscopic salpingectomy in cases of uterine didelphys parallels that for a normal uterus. The use of combined hysteroscopy and laparoscopy proved effective in evaluating both the external uterine structure and internal cavity, facilitating accurate diagnosis and treatment of Müllerian anomalies with ectopic pregnancy.