Human ; Education, Medical ; Education

Objectives: This study aimed to determine the clinical outcomes of ultra high-risk gestational trophoblastic neoplasia (GTN) patients managed with and without induction chemotherapy in the Division of Trophoblastic Diseases, Department of Obstetrics and Gynecology, Philippine General Hospital. Methods: Clinical and demographic data were collected retrospectively from ultra high-risk GTN patients admitted in the Division of Trophoblastic Diseases, Department of Obstetrics and Gynecology, Philippine General Hospital from January 2015 to December 2021. Rate of remission and early death of those who received induction chemotherapy were compared to those who did not. Results: A total of 21 patients with ultra high-risk GTN were included in the study, nine of whom underwent induction chemotherapy while 12 had no induction chemotherapy and was given the standard EMACO regimen. There was no significant difference in the rate of early death as well as the rate and time to achieve remission between those who received induction chemotherapy compared to those who were immediately started on EMACO. Conclusion A firm conclusion cannot be drawn from the results considering the small population included in the study. Further studies with larger sample size and prospective study design are recommended.
Induction Chemotherapy ; Gestational Trophoblastic Disease

Hydatidiform mole coexistent with a live fetus (CMCF) is a rare entity occurring in 1:20,000 to 1:100,000 pregnancies. Three mechanisms of this type are possible: (1) a singleton pregnancy consisting of partial mole with a triploid fetus, (2) a twin gestation consisting of an androgenic complete hydatidiform mole with a biparental diploid fetus, and (3) a twin gestation consisting of a biparental diploid fetus with a normal placenta and a partial hydatidiform mole (PHM) with a triploid fetus. The abnormal triploid fetus in a partial mole tends to die in the first trimester while the fetus coexisting with a complete or partial mole in the dizygotic twin pregnancy has a chance to survive. Early detection and diagnosis of a molar gestation with a viable fetus is needed to allow medical interventions, if available. Three cases of complete mole with a twin fetus (CMTF) that were diagnosed in the prenatal period by ultrasonography will be presented. This report will also discuss the indications for continuing the pregnancy, and review the literature on the recommended prenatal care, intrapartum management, and postpartum surveillance. This report aims to encourage others to document cases of CMTF in order to arrive at a consensus regarding its optimal management.
Hydatidiform Mole ; Pregnancy, Twin

Routine intimate hygiene care has a major contribution in maintaining overall urogenital and perineal health in women. However, Filipino women continue to experience a major surge in vulvar and vaginal symptoms across all age groups, in a context of major changes in lifestyles and risk factors impacting their genital health. Personal beliefs, preferences, apprehensions to discuss intimate topics with health care practitioners (HCPs), availability of cleansing products in the market, and their affordability prevent many women from discussing the role of intimate hygiene care with their HCPs. Communication difficulties and lack of robust evidence, supporting optimal hygiene recommendations are some of the challenges experienced by HCPs. Through this review, the authors discuss the following factors: (i) Differing physiological needs and pathological effects that result from changing dynamics of microflora in the vulvar, perineal, and vaginal region across all age groups of women, (ii) Importance of focusing on perianal and perineal hygiene, and bowel habits, to improve the quality of vulvar hygiene and genital health, (iii) Designing approaches for HCPs to maintain genital health in the light of intimate hygiene, (iv) Recommending improvements in HCP-patient communications to help HCPs dispel the misconceptions pertaining to intimate hygiene practices, and (v) Highlighting the antimicrobial efficacy of feminine hygiene cleansers that preserve the natural microbiome and help maintain the vaginal pH within the normal range. These strategies can fill the knowledge gaps among HCPs, women, and their caregivers’ perspectives and help achieve optimal intimate hygiene.

Adenomyoma is a benign gynecologic condition affecting women in their late reproductive years. Common clinical presentations include pain, particularly dyspareunia and dysmenorrhea, abnormal uterine bleeding, and infertility. Majority, however, may be asymptomatic. Various presentations of adenomyoma have been written in the literature, but exophytic subserosal growths have rarely been reported. More commonly, it involves the endometrium with invagination into the myometrium. We present a rare case of a primary subserosal pedunculated adenomyoma with no evidence of adenomyosis in a nulligravid premenopausal woman who underwent a uterine-sparing surgery and an extensive colonic resection with colostomy.

Precision medicine is a form of medicine that utilizes information about a person’s own genes to prevent, diagnose, or treat disease. In trophoblastic disease, precision medicine is important for accurate diagnosis, risk stratification, prognostication, and management. Immunohistochemistry, particularly p57kip2, has become an important ancillary procedure for the accurate identification of complete hydatidiform mole (HM). Molecular genotyping, on the other hand, is now considered the gold standard for the accurate classification of HM. Both tests are important for prognostication and the determination of the appropriate follow‑up plan. For gestational trophoblastic neoplasia, immunohistochemical markers can confirm the histologic diagnosis of its various types. Molecular genotyping differentiates gestational from nongestational tumors with overlapping histology and allows for precise identification of the index or causative pregnancy of a choriocarcinoma.
Gestational Trophoblastic Disease ; Hydatidiform Mole ; Precision Medicine

Choriocarcinoma is a malignant subtype of gestational trophoblastic disease that follows any type of pregnancy. It is characterized by rapid hematogenous spread to multiple organs, associated with high human chorionic gonadotropin levels with good response to chemotherapy. We present the case of a 31‑year‑old Filipina who initially presented with severe headaches and blurring of vision 3 years after an unremarkable term pregnancy. The transvaginal ultrasound was normal. After a series of diagnostic tests, the initial working impression was a primary brain tumor with metastases to the lungs, adrenal, kidney, and vulva. Emergency craniotomy was done due to deteriorating status secondary to an intracranial hemorrhage. The histopathology report showed choriocarcinoma. Chemotherapy using Etoposide‑Methotrexate‑Actinomycin D‑Cyclophosphamide‑Vincristine with high‑dose methotrexate and concomitant whole‑brain irradiation was then instituted with good response. This case highlights the importance of having a high index of suspicion for gestational trophoblastic neoplasia to prevent the performance of unnecessary procedures, leading to a delay in diagnosis and the institution of the appropriate treatment.
Gestational Trophoblastic Disease

Gestational trophoblastic neoplasia (GTN) with a concurrent cervical malignancy is very rare, making the case both a diagnostic dilemma and a therapeutic challenge. Currently, there has only been one reported case worldwide. We present a case of GTN Stage I:11 with non‑keratinizing squamous cell carcinoma of the cervix Stage II‑B. Initial treatment, in the form of chemotherapy, was directed toward the GTN, as this appeared to be the more aggressive disease. Surgery was not feasible during diagnosis due to the cervical carcinoma. However, the GTN proved resistant to chemotherapy due to the increasing beta human chorionic gonadotropin titers. An attempt to decrease the size of the cervix for surgery to be possible through chemoradiation was instituted, but due to complications and tumor progression to the lungs, she succumbed to the malignancy.
Uterine Cervical Neoplasms ; Gestational Trophoblastic Disease

Objective: To describe the experience of the Division of Trophoblastic Diseases of the Philippine General Hospital with the various third‑line chemotherapeutic regimens among high‑risk gestational trophoblastic neoplasia (GTN) patients who experienced resistance after receiving the etoposide, cisplatin–etoposide, methotrexate, actinomycin (EP‑EMA) regimen Materials and Methods: This was a 17‑year descriptive study that included all patients who used various salvage chemotherapy after resistance to EP‑EMA as treatment for metastatic, high‑risk GTN at the Philippine General Hospital from January 2002 to December 2018. The medical records of eligible patients were retrieved and assessed. All abstracted data were analyzed retrospectively. Descriptive statistics were used to compute for percentages for the various demographic characteristics of the sample population Results: From January 2002 to December 2018, a total of 291 patients with metastatic, high‑risk gestational GTN were treated at the Philippine General Hospital. Of these, only seven patients received various third‑line chemotherapy regimens after resistance to EP‑EMA. One patient was excluded due to incomplete data. Among the third‑line chemotherapeutic regimens used, 3 patients received paclitaxel/carboplatin, two of whom went into remission while one expired. One patient had vincristine, bleomycin, and cisplatin (VBP) with two adjunctive surgeries in the form of hysterectomy and thoracotomy. She also went into remission. Two patients received paclitaxel–cisplatin/paclitaxeletoposide (TP/TE) as third line of treatment. The first was shifted back to EP‑EMA and eventually developed chemoresistance to EP‑EMA and had multiple toxicities. After multidisciplinary conference with the patient and family, they decided to go home and refused further chemotherapy. The other patient had TP/TE followed by bleomycin–etoposide–cisplatin, with adjunctive hysterectomy. Despite multiple cycles of chemotherapy, the disease persisted. She was offered palliative care and the family decided to bring her home. Both patients eventually expired at home Conclusion No conclusion can be made about the most effective third line chemotherapy for resistant high‑risk GTN because of the limited cases included in this study. An individualized approach is still recommended. Physicians and centers for patients caring for such patients are encouraged to report their experience to improve the management of future patients
Gestational Trophoblastic Disease

Introduction: Physician burnout (BO) is an increasing global concern due to its rising prevalence and effect on patient care Objective: This study determined the prevalence of BO, compassion fatigue (CF), and compassion satisfaction (CS), among residents of obstetrics and gynecology in the Philippines, and identified the factors associated with these Methods: This was a cross‑sectional study, which used stratified random sampling. The strata comprised public and private hospitals that were subdivided into Luzon, Visayas, Mindanao, and National Capital Region. From these, 33 training hospitals were randomly selected, which served as clusters wherein all resident physicians of obstetrics and gynecology were invited to answer either an online or printed version of the Professional Quality of Life Scale Version 5 questionnaire Results: Majority of the 311 participants included had average level of BO (n = 281, 90.4%), CF (n = 237, 76.2%), and CS (n = 213, 68.5%). CS was negatively correlated with burnout (r = −0.31, P < 0.001) and CF (r = −0.34, P < 0.001), whereas BO and CS were positively correlated (r = +0.48, P < 0.001). Type of institution, sleeping hours, and interrupted leaves were the common factors that yield significant differences in BO (P = 0.037, P < 0.001, and P < 0.001) and CF (P = 0.002, P = 0.043, and P = 0.005). Significant differences were observed in CS scores in terms of age (P = 0.016), marital status (P = 0.038), child dependents (P = 0.006), level of training (P = 0.005), and location and type of institution (P ≤ 0.001 and P = 0.003). Conclusion There is a need to develop active awareness of BO and CF among resident physicians to effect interventions at the individual and institutional level.
Burnout, Psychological ; Compassion Fatigue