Congenital malformations of the uterus are rare. Pregnancies in these uterine abnormalities are usually associated with poor reproductive outcomes such as recurrent pregnancy losses, preterm birth and intrauterine growth restriction. Presented here is the case of a 21-year old G2P1(1001), who was diagnosed intraoperatively with a septate bicornuate uterus during her second Cesarean delivery. She had to undergo abdominal delivery for both her pregnancies due to malpresentation, and delivered live healthy babies with no gross structural defects. Pathophysiology and classification of congenital uterine malformations are discussed in the case, as well as the diagnostics and management for such conditions.
Human ; Female ; Young Adult: 19-24 yrs old ; Bicornuate uterus ; Septate Uterus ; Uterine anomalies

Objectives: The objectives of this study were to present maternal and perinatal health indicators for the years 2019–2022. Methodology: This is a cross-sectional review that analyzed data on maternal and perinatal health indicators, generated from submissions of POGS-accredited hospitals (training and service) from January 2019 to December 2022. The data were compared to the national data obtained from official public documents published by the Philippine Statistics Authority in 2022 and 2023. Results: The number of member hospitals has steadily increased over the years, and compliance rates have been consistently over 85%. The total number of registered cases and live births declined in 2020 and 2021, but has increased to prepandemic levels in 2022. The primary cesarean section (CS) rates remained above 20%, with the highest rate noted in 2021 (25.5%). The top three-most common indications for primary CS were dysfunctional labor, fetal distress, and malpresentation. Stillbirth, perinatal, and maternal mortality rates showed an increase from 2019 to 2022, with peak rates registered for the year 2021. The top five causes of maternal death are: medical complications, hemorrhage, hypertension, infection, and others (unspecified). The case fatality rate among pregnant patients with confirmed COVID-19 infection was 1.18%. Conclusion From 2019 to 2021, there was a decline in the number of registered cases and live births, and an increase in the primary CS rates, maternal mortality ratio, perinatal death rates, and stillbirth rates. This may be explained by the prevailing social, health, and economic impact of the COVID-19 pandemic during these years.
Censuses ; COVID‑19

Unicornuate uterus with a rudimentary horn is a rare Müllerian anomaly, with an incidence of 0.06%. Due to this relative rarity, an accurate preoperative diagnosis of unicornuate uterus with rudimentary horn still remains to be a diagnostic challenge. Reported here is a case of a 27-year-old nulligravida who complained of severe debilitating dysmenorrhea 5 months prior to admission, necessitating frequent visits to the emergency department for administration of intravenous pain medications and antiemetics. She was misdiagnosed preoperatively with subserous leiomyoma, mainly based on clinical presentation, and findings on ultrasound and pelvic MRI. On exploratory laparotomy, a definitive diagnosis of unicornuate uterus with an enlarged rudimentary horn was established, and patient underwent resection of rudimentary horn, with enterolysis, due to dense adhesions in the left adnexa and cul de sac. We emphasize the need for early diagnosis and prompt management of cases like this to prevent complications, and optimize fertility and quality of life of affected patients.

Objective: To determine the prevalence of the causes of abnormal uterine bleeding based on the FIGO (PALM-COEIN) Classification, among patients admitted at a tertiary hospital in Las Pinas City Methods: A cross sectional (retrospective) study was done. Patients aged 15-50 years old who were admitted due to abnormal uterine bleeding from January 2017 to December 2019 were included. Patients with AUB due to pregnancy, vaginitis, bleeding before menarche, and bleeding after menopause were excluded from the study. Patient’s data as to age, obstetrical score, co-morbidity, bleeding patterns were tabulated. Results: A total of 455 subjects were included in the study. Results showed that the most common causes of abnormal uterine bleeding among admitted patients in Perpetual Help Medical Center Las Piñas from January 2017 – December 2019 were due to structural causes (91%). Most prevalent was bleeding due to polyps (50.5%), followed by adenomyosis (18.8%), leiomyoma (16.04%), and malignancy (6.2%). Prevalence of non-structural causes of bleeding was 0.4% for coagulopathy, 3.3% due to ovulatory dysfunction, 4.6% due to endometrial dysfunction, and 0.2% for AUB-N. Conclusion Based on this 3-year retrospective study, structural causes are the most common causes of AUB, comprising about 91% of all patients admitted for AUB. The most common structural causes are AUB-P (50.5%), followed by AUB-A, AUB-L and AUB-M. Prompt recognition of the causes of AUB is very important, to prevent complications such as severe anemia and shock. Proper treatment, be it surgical or medical, also depends on the exact cause of AUB.
Polyps ; Adenomyosis

Background: The POGS committee on nationwide statistics uses an electronic census platform called the POGS nationwide statistics system (PNSS) to collect the statistical data on obstetric and gynecologic health indicators. Objectives: The article aims to present 2020 data gathered and compare these with the 2019 census. Obstetrical and gynecological indicators of health care and preliminary data on COVID-19 cases are reported. Methodology: This cross-sectional study reports the data generated from the submissions of POGS-accredited hospitals from January to December 2020, through the PNSS. Results: The number of accredited hospitals that submitted their census with 100% compliance is 94%. There was a total of 329,972 number of cases reported, 92% were obstetric cases. Live birth rate was the highest in the National Capital Region at 33.5%, with the highest age-specific birth rate in the 25–29 age group. Most live births were term pregnancies. Adolescent birth rate was 6.45 per 1000 women. Cesarean section rate, stillbirth rate, neonatal mortality rate, and perinatal mortality rate were higher than 2019. The maternal mortality ratio was 121.6 per 100,000 live births. There were 2,858 cases of confirmed COVID-19 infection. There were 26,164 gynecologic admissions, with the most common diagnosis being abnormal uterine bleeding. The most common gynecologic procedures performed were hysterectomy, salpingo-oophorectomy, medical management, and blood transfusion. Majority of the deaths from gynecologic cases had gynecologic malignancies and among these, cervical cancer (19%) had the greatest number of deaths. Conclusion Obstetric and gynecologic admissions are lower compared to last year. A deterioration in obstetrical indications can be seen and explanations for this occurrence must be explored further. Preliminary data on COVID-19 cases was likewise presented. Timely and accurate statistics will help us define the areas we need to improve on, as well as the unmet needs of our patients.
Censuses

Precocious puberty is defined as appearance of secondary sexual characteristics that begins earlier than usual, and may be central or peripheral in origin. It is the physician’s duty to undertake a detailed investigation of the cause of the condition so as not to overlook a potentially correctable pathologic lesion, and prevent long-term somatic and psychosocial consequences in the child. This paper presents a case of 10 year old female with clinical signs and symptoms and laboratory results that point to a possible peripheral type of precocious puberty , and with a huge ovarian mass, which intraoperatively yielded inconclusive histopathologic findings due to massive necrosis. This paper aimed to discuss the possible etiologies for the development of precocious puberty in the index case, and the treatment options for both precocious puberty and ovarian new growth.
Familial Testotoxicosis ; Puberty, Precocious

Objective: The aim of the study was to determine the impact of the COVID – 19 pandemic on fertility centers in the Philippines as reflected in the change in caseload for the different types of fertility procedures and modifications in the physical set up of laboratories, staff and patient screening. Methods: A descriptive cross-sectional study using a questionnaire was administered to all Philippine Society for Reproductive Medicine (PSRM) accredited fertility centers on November 2020. The study underwent ethics and technical review approval. The medical director or manager of the centers was requested to answer the questionnaire. All data were collated, summarized and analyzed. Results: All seven PSRM accredited fertility centers participated in the study. There was an overall decrease in fertility procedures performed in all the centers with most of the centers reporting a less than 50% decrease in oocyte pick up, less than 75% decrease in frozen embryo transfer and around 50 – 75% decrease in intrauterine insemination cases. All fertility centers implemented social distancing, triaging of patients by symptoms, use of personal protective equipment for doctors and staff, placing alcohol dispensers at the reception area and limiting the number of people allowed inside the center. Clinical visits were now scheduled and revisions in informed consent were done. Conclusion The majority of local fertility centers experienced a significant decline in fertility procedures. Modifications to the conduct of their clinic for safety of their staff and patients were compliant with local and international guidelines.
COVID-19 ; Safety

Placenta accreta is one of the most feared complications among gravid women, as it is associated with massive and potentially life-threatening intrapartum and postpartum hemorrhage. Due to its natural history, placenta accreta is only naturally seen or expected as a cause of bleeding only among obstetric patients. This case report describes a rare manifestation of profuse abnormal uterine bleeding secondary to a placenta accreta in a non-gravid patient. The non-pregnant state was evidenced by the absence of history of amenorrhea and pregnancy signs and symptoms, a negative urine pregnancy test and normal serum bhcg results. A diagnosis of placenta accreta was mainly based on a post-hysterectomy histopathological examination. Theoretical explanations to explain this phenomenon is discussed in this case report.
Pregnancy ; Female ; Placenta Accreta ; Uterine Diseases ; Uterine Hemorrhage

Ulipristal acetate (UPA) is a selective progesterone receptor modulator (SPRM) indicated for the medical treatment of myoma. Several theoretical mechanisms help explain how it induces apoptosis and cystic degeneration of a submucous myoma, leading to its expulsion. This paper presents the case of a young nulligravid diagnosed with heavy menstrual bleeding secondary to submucous myoma, who was started on UPA treatment but with very poor compliance. Despite the very short and incomplete course of treatment, degenerative changes still took effect, which led to the expulsion or prolapse of the pedunculated submucous myoma.
ulipristal acetate ; Norpregnadienes ; Leiomyoma ; Apoptosis ; Uterus

The use of hormonal contraceptives in a breastfeeding patient has been questioned by breastfeeding advocates. Their fear was that hormonal contraceptives will affect the milk production of the patient. This review of literature showed that progestins do not affect breastmilk supply whether it is the progestin only pill (POP), depot medroxyprogesterone acetate, levonorgestrel-containing intrauterine system (LNG-IUS) or the etonogestrel implant (ENG). The timing of administration of the progesterone derivative contraceptive method also does not affect milk production, whether immediately postpartum (within 48 hrs after delivery) or delayed (4 - 6 weeks postpartum). With this in mind, clinicians may safely advise these to breastfeeding patients to prevent unplanned pregnancies.