Exposure of reproductive-aged pregnant and nonpregnant women to common environmental pollutants and endocrine-disrupting chemicals A cross-sectional survey at the University of the Philippines-Philippine General Hospital / Philippine Journal of Obstetrics and Gynecology

Context@#Exposure to environmental pollutants (EP) and Endocrine-disrupting chemicals (EDCs) is associated with several general negative health effects which compromise women's reproductive health, maternal, and neonatal outcomes. Unfortunately, many nonpregnant and pregnant women are unaware of their active exposure to these potentially slow-acting toxic substances, EPs, and EDCs. At any stage of life, and in the long-term minute exposures, there is no established safe level of exposure to these substances. Due to the potentially harmful effects on women in general, and to the pregnant and her unborn child in particular, it is important to establish the prevalence of their exposure. @*Aims@#The aim of this study was to determine the magnitude (prevalence) of exposure among nonpregnant and pregnant women aged 18–49 years to common EPs/EDCs such as bisphenol A, pesticides, phthalates, and perfluorinated compounds among others.@*Settings and Design @#This study was conducted at the Philippine General Hospital, University of the Philippines Manila.@*Subjects and Methods @#The study participants were nonpregnant and pregnant women, with low-risk singleton pregnancy, and had a prenatal checkup and eventual delivery at the Philippine General Hospital. After consent, women were asked to answer a survey focused on their sociodemographics and frequency of exposure to EP- and EDC-containing items.@*Satatistical Analysis Used@#Descriptive statistics were used to summarize the demographic and clinical characteristics of the patients. Null hypotheses were rejected at 0.05 α-level of significance. The computer software STATA 13.1 was used for data analysis.@*Results@#One hundred and fifty-nine survey responses by women were analyzed. Possible EDC-containing household items (carpets, linoleum, upholstered, and stain-resistant furniture) are more prevalent in the homes of pregnant women compared to nonpregnant women. Pregnant women are also exposed to wallpapers compared to nonpregnant individuals. Nonpregnant women were 1.5 times more exposed to lotions. Unexposure to hand sanitizers is 1.3 times higher among pregnant individuals.@*Conclusions@#There are differences in the prevalence of exposure to household EDC-containing items between pregnant and nonpregnant women, with pregnant women having a higher prevalence of exposure.

Perceptions on susceptibility to exposure to the COVID-19 virus: A qualitative study on pregnant and non-pregnant adult women, their partners, and healthcare workers in Metro Manila

Introduction@#The World Health Organization (WHO) reported that special populations are more susceptible to the COVID-19 virus. There is little information on whether COVID-19 affects women of reproductive age and their fertility, pregnancy status, and offspring give: We aimed to assess the knowledge, practices, and perceptions (KPP) on the risk and susceptibility to COVID-19 of women of reproductive age. @*Methods@#We conducted a qualitative exploratory descriptive study using the triangulation method. The study consisted of in-depth interviews (IDIs) with women of reproductive age and their spouses, focus group discussions (FGDs), and key informant interviews (KIIs) with health care professionals (HCP) in University of the Philippines-Philippine General Hospital. We assessed KPP using structured, open-ended interview guides. Interview responses were recorded and transcribed verbatim, and thematic analysis was performed using NVivo 12. @*Results@#Eighty participants, 20 women of reproductive age, 20 spouses, 20 non-pregnant women, and 20 HCPs in UP-PGH were included in the study. All participants were knowledgeable about COVID-19. Pregnant women would consult their physicians when they felt symptoms related to COVID-19. Spouses of pregnant women and non-pregnant women observed health measures to prevent the spread of the virus. Both pregnant and non-pregnant patients with COVID-19 felt shamed and stigmatized while the husbands worried that the exposure to the infection will pose a burden to their families. HCWs provided services through teleconsultation and found it challenging to refer patients to other facilities. @*Conclusion@#The study provided insights on KPP of women with reproductive-age to COVID-19 and views of HCWs in providing care to these patients during the pandemic. The effects of COVID-19 are still detrimental and highly evident from the micro to the macro level.

Assessing the diagnostic performance of four ovarian malignancy prediction risk models in differentiating benign and malignant ovarian masses in a tertiary hospital / Philippine Journal of Obstetrics and Gynecology

Introduction@#Ovarian cancer is considered the most lethal gynecologic malignancy because it is difficult to diagnose in its early stages. Ovarian malignancy prediction models may be useful in discriminating between benign and malignant masses, allowing for accurate and timely referral as well as proper therapeutic care@*Objective@#To evaluate the diagnostic performance of the four ovarian prediction models: Risk of Malignancy Index‑4 (RMI‑4), Risk of Ovarian Malignancy Algorithm (ROMA), Copenhagen Index (CPH‑I), and International Ovarian Tumor Analysis (IOTA)‑Assessment of Different NEoplasias in the AdneXa (ADNEX) in identifying malignant and benign ovarian masses@*Materials and Methods@#This was a retrospective, cross‑sectional, analytical diagnostic study in a tertiary hospital between January 2017 and December 2020. Receiver operating characteristic (ROC) curves, area under the curves (AUCs), sensitivities, specificities, positive and negative predictive values, and positive and negative likelihood ratios were used to assess the diagnostic performance of the prediction models.@*Results@#We analyzed a total of 248 patients. One hundred and sixty‑one (65%) had benign tumors, 28 (11%) had borderline, and 59 (24%) had malignant tumors. The AUCs of all models were all above 90%, but when compared to the other models, CPH‑I had the best estimate. RMI‑4 had the highest sensitivity (98.3%) in diagnosing malignancy. For appropriately diagnosing benign disease, the IOTA‑ADNEX model exhibited the highest specificity (92.1%). Overall, RMI‑4 had the lowest diagnostic accuracy (74.6%), whereas IOTA‑ADNEX had the greatest (93.2%).@*Conclusion@#The four malignancy prediction models in this study were all useful tools in discriminating between benign and malignant ovarian tumors. IOTA‑ADNEX, CPH‑I, and ROMA all demonstrated overlapping diagnostic performances indicating that they are equal in that regard. In terms of sensitivity in predicting malignancy, RMI‑4 was the most sensitive. CPH‑I is the predictor with the best overall estimate. Lastly, IOTA‑ADNEX was the most specific, and displayed highest diagnostic accuracy among the four

The effect of a two-day training and refresher program on the basic emergency obstetric and newborn care knowledge and skills of health workers in Legazpi City, Albay

@#<p style="text-align: justify;"><strong>Objectives:</strong> The availability of emergency obstetric and newborn care (EmONC) services is one of the key strategies in improving maternal health and achieving Sustainable Development Goal 3. Health staff knowledge and competency on these interventions are crucial to ensure the effective handling and management of obstetric and newborn emergencies. Health workers, despite having undergone formal training, require regular refresher courses to keep up with new, evidence-based information on EmONC intervention; and to ensure compliance with national and local referral guidelines. A two-day workshop was implemented to assess the knowledge and skills of health workers in Legazpi, Albay, regarding obstetric emergency cases and referral guidelines.</p><p style="text-align: justify;"><strong>Methods:</strong> A pretest was conducted on the first day to assess the knowledge of the participants. A series of lectures were given before administering a posttest at the end of these lectures. An Objective Structured Clinical Examination (OSCE) was conducted on the second day, which aimed to assess the skills of the participants.</p><p style="text-align: justify;"><strong>Results:</strong> The pretest findings indicated that the participants are generally knowledgeable about areas such as handwashing and prenatal care. Results of the posttest show that participants had difficulty with the category of referrals. Moreover, comparing the pretest and posttest scores, there is strong evidence that there is a difference in the median values of the pretest scores as compared to the posttest scores. The results of the OSCE also indicate the need for further training on partograph use and adherence to an EINC protocol. More than half of the participants passed all five parts of the OSCE.</p><p style="text-align: justify;"><strong>Conclusion:</strong> The workshop contributed to an improvement in the knowledge of health care workers in obstetric emergency cases. Skills-wise, more frequent training may need to be conducted to improve other competencies such as partograph utilization and the practice of EINC interventions.</p><p style="text-align: justify;"><strong>Key Words:</strong> emergency obstetric care, training, skilled birth attendants, knowledge, skills</p>

Barriers to an Effective Maternal Health Service Delivery Network: A Qualitative Study among Health Providers in Legazpi City, Albay

Objectives@#To A functioning referral system is critical to the maternal health program, especially in the management of obstetric emergencies. This study explored supply-side barriers affecting the effective implementation of the said service delivery network (SDN) in Legazpi, Albay in the Bicol Region of the Philippines. @*Methods@#Face-to-face in-depth interviews using semi-structured questionnaires were performed with health care providers involved in the SDN in Albay. Extensive note taking was done by the primary investigator while participants were observed during performance of duties from June - November 2018. Interviews were audio-recorded, transcribed, translated into English, and analyzed thematically along with the observation notes using NVivo. A deductive-dominant approach was utilized for the data content analysis.@*Results@#Referral system barriers identified were cross-cutting across the different components of the health system such as governance, human health resource, service delivery and information systems. The barriers were further classified into individual, organizational and external-related factors in relation to the SDN. Examples of barriers included lack of knowledge of protocols and guidelines, lack of coordination between facilities, poor data management, inadequate capacity building opportunities, and constantly changing political landscape and policies.@*Conclusions@#The study is the first to explore barriers to effective service delivery network in maternal health in the country. Findings from the study provide significant insight to areas of improvement in the SDN that must be addressed to strengthen local health systems, especially with the country’s movement towards Universal Health Care where local health systems play a key role.

Analysis of trends in maternal mortalities in Bicol region using national health surveys and maternal death reviews / Philippine Journal of Obstetrics and Gynecology

Background@#Since 1976, Bicol Region had higher maternal mortality ratio (MMR) than the Philippine average and became the fourth region with the highest MMR in 2012. Looking at trends of maternal health outcomes and determining risk factors among mothers who died may guide interventions to reduce MMR.@*Objectives@#To determine the changes in maternal mortality ratio (MMR) in the Bicol region from 2004 to 2017 and determine the sociodemographic profile of pregnant women who died from 2015 to 2018. @*Materials and Methods@#A records review of Bicol?s Regional Field Health Services Information System from 2004 to 2017 and maternal death review reports from 2015 to 2018 was done. Changes in MMR was determined using Poisson regression. The sociodemographic characteristics and causes of maternal deaths were analyzed using frequencies and proportion. @*Results@#From 2004 to 2017, MMR of 100.9 remained higher than the regional target of 31.6. Significant reductions in MMR were achieved in 2007 to 2008 and in 2011 to 2012 wherein MMR ranged between 75.3 to 89.3. However, by the end of 2012, maternal deaths again increased which reached 122.5 in 2017. From the maternal death reviews, it was observed that 29.5% of maternal deaths were aged 35 years and above and 7.5% were less than 20 years old. Mothers who had more than five pregnancies were 30.1% of total deaths. In terms of place of death, 15.7% died at home or in-transit to referral facilities. Hemorrhage or hypertension-related causes were the leading reasons for maternal deaths. @*Conclusion@#Significant reduction in MMR was not sustained after 2012 and higher deaths were reported in the succeeding years. Maternal deaths can be further reduced by using a systems approach, by promoting family planning, and by strengthening service delivery networks to effectively manage hemorrhage and hypertension-related emergencies.

Effect of second-hand cigarette smoke exposure on neonatal birth weight and prematurity among pregnant patients in secondary hospitals in Manila: A prospective cohort study / Philippine Journal of Obstetrics and Gynecology

Background@#Smoking is a known risk factor for many maternal and perinatal morbidities. Regrettably, as many as 69.8% of mothers, though not active smokers themselves, are exposed to second-hand cigarette smoke (SHS). No level of SHS exposure is safe. Due to the potential harmful effects to the mother and her unborn child, it is important to establish the effect of SHS exposure on neonatal outcome among our pregnant patients. @*Objective@#To determining the effect of second hand cigarette smoke exposure on neonatal outcomes. @*Methods@#Participants are patients with low risk singleton pregnancies who were going for prenatal check up and eventually delivered in secondary hospitals in Manila. Descriptive statistics was used to summarize the demographic and clinical characteristics of the patients. Null hypotheses were rejected at 0.05 ?-level of significance. The computer software STATA 13.1 was used for data analysis. @*Results@#The husband was the most identified source of second-hand smoke. Maternal weight was also higher among the exposed group. The most significant effect of SHS exposure among newborns was a 103 grams difference in mean birth weight. There was no difference in pediatric aging, birth length, and anthropometric measurements. @*Conclusion@#The prevalence of smoking in Philippines remains high at 23.8% among adult population, majority being male adults. Exposure to second-hand smoke during pregnancy was noted to be as high as 69.8%. The most common source of second-hand smoke is the husband, and thus, he should be one of the targets of preventive strategies in second-hand smoke exposure.