Prevalence of the different phenotypes of polycystic ovarian syndrome in adolescents and its association to metabolic and cardiovascular risk / Philippine Journal of Obstetrics and Gynecology

Background@#Polycystic ovarian syndrome (PCOS) is a prevalent heterogeneous disorder in females. Timely diagnosis and management are important, especially in adolescents; despite this, there is a paucity of data focusing on this group@*Objective@#The aim of this study was to determine the prevalence of the different phenotypes of PCOS in adolescents and identify their association with metabolic and cardiovascular risk@*Methodology@#All medical records of patients seen at the OPD of a tertiary institution from January 2015 to December 2019 that had a diagnosis of PCOS were reviewed. The data that were extracted included the patient’s age, blood pressure at the time of consult, weight, height, signs and symptoms (anovulation and hirsutism), and laboratory results (transvaginal ultrasound, 75 g oral glucose tolerance test [OGTT], and lipid profile). Purposive sampling was done for this study@*Results@#The prevalence of phenotypes A is 31.9%, B at 31.9%, C around 5.8%, and D at 49.6%, respectively. Those Phenotype D adolescents had significantly higher body mass index (BMI) (P = 0.021), while those having phenotype B had significantly higher total cholesterol levels (P = 0.038). No significant differences were noted in the blood pressure, 75 g OGTT, low‑density lipoprotein (LDL), very LDL, high‑density lipoprotein, and triglycerides among the different PCOS phenotypes@*Conclusion@#Adolescents with PCOS have an increased risk for metabolic and cardiovascular outcomes; however, there is no significant difference when compared across all phenotypes. It was among those having phenotype D that were found to have a BMI classified as overweight, and phenotype B have elevated total cholesterol levels

Comparison of the effect of miconazole and clotrimazole in the treatment of vulvovaginal candidiasis among women seen in a tertiary medical center from 2016 to 2020 / Philippine Journal of Obstetrics and Gynecology

Background@#Vulvovaginal Candidiasis (VVC) is one of the frequent infections of the female genital tract and is the second most common cause of vaginal infections after bacterial vaginosis. According to the Centers for Disease Control and Prevention, azoles are the first‑line treatment for VVC. Among the azoles available in the Philippines, only miconazole and clotrimazole are recommended for both pregnant and non‑pregnant women.@*Objective@#Compare the effect of miconazole versus clotrimazole in the treatment of vulvovaginal candidiasis among patients seen at the out‑patient department in a tertiary hospital@*Materials and Methods@#This involved review of the records of patients diagnosed with VVC in a tertiary medical center from 2016 to 2020. All records of women, pregnant and non‑pregnant, wherein single‑dose 1200 mg miconazole or 6‑day 100 mg clotrimazole given vaginally were included@*Results@#Eleven out of the 316 records (3.46%) remained symptomatic after treatment, about 18.1% (2/161) from those who used miconazole and 81.8% (9/155) from those treated with clotrimazole (p 0.027). In terms of failure rate, for miconazole it was 1.2% (2/161), whereas for clotrimazole it was 5.8% (9/155). None of the charts were found to have recorded adverse reaction to the given treatment@*Conclusion@#Single‑dose miconazole intravaginal regimen has a higher clinical cure rate than the 6‑day clotrimazole intravaginal treatment. Thereby, single‑dose intravaginal miconazole has the potential to improve patient compliance and treatment outcome at a lower cost

A comparison of the efficacy of single-dose Cefazolin versus single-dose Cefazolin plus 7-day Mupirocin ointment wound application in preventing surgical site infection among patients undergoing major Obstetric and Gynecologic procedures at a tertiary university hospital: A single-blinded, randomized controlled trial / Philippine Journal of Obstetrics and Gynecology

Background@#Surgical site infection (SSI) is a common complication among all surgical cases. It is the most common nosocomial infection identified in the developing world with pooled incidence of 11.8 per 100 surgical procedures. In our institution, the SSI rate in major obstetric and gynecologic cases in years 2000–2013 is 12.68%. @*Objective@#To compare the efficacy of a single-dose cefazolin versus a single dose cefazolin plus 7-day mupirocin ointment wound application in preventing SSI among women undergoing major obstetric and gynecologic abdominal surgical procedures.@*Materials and Methods@#The study included are 164 female participants, aged 18–65 years old who underwent major obstetric and gynecologic surgical procedures. Participants were randomly assigned to Groups A and B, wherein all participants were given single dose of 2 g cefazolin, intravenous, 30 min before skin incision. For the participants in Group B, an additional 7-day application of mupirocin ointment on incisional wound during the postoperative period was given. Assessment for occurrence of SSI and healing time using a standardized collection tool and Southampton wound scoring system, respectively, was done on the 8th, 15th, and 30th postoperative days. @*Results@#The incidence of SSI is 2.45% (4 out of 164 participants). It was slightly higher in the Cefazolin only arm having three cases, while only one case in the Cefazolin plus mupirocin group. However, the difference of SSI occurrence between the two groups is not statistically significant. Wound healing time was also evaluated which was comparable between treatment groups.@*Conclusion@#Single dose Cefazolin plus 7-day once daily Mupirocin ointment application is comparable to single dose of cefazolin in preventing SSI in patients undergoing major low-risk obstetric and gynecologic surgeries. Therefore, the addition of mupirocin in uncomplicated major obstetric and gynecologic surgical cases is not cost-beneficial.

“Antipodal asymmetry” – The undiagnosed twin in the opposite uteri: A case report of dicavitary twin pregnancy in uterine didelphys / Philippine Journal of Obstetrics and Gynecology

@#Muüllerian duct anomalies (MDAs) are congenital defects arising from probable teratogenic assault at 6–22 weeks of gestation.Uterine didelphys arises from complete lack of fusion of Muüllerian ducts, resulting in two entirely separate hemiuteri, cervices and vaginas.The incidence of MDA is <5% and the frequency of uterine didelphys is 1 in 1000–30,000 women and twin pregnancy in uterus didelphys is only 1 in a million. This is a case of a gravida 1 para 0, with uterine didelphys and unilateral renal agenesis diagnosed of single live intrauterine pregnancy in the left half of uterine didelphys who had a spontaneous passage of meaty material from the right hemiuterus which were histopathologically consistent with degenerating products of conception, hence confirming a dicavitary twin pregnancy. Management should be wholistic encompassing preconception, prenatal, intrapartum, and postpartum period as any complications may arise at any point.

Comparison of the efficacy of iron amino acid chelate and ferrous sulfate in the treatment of iron deficiency anemia among pregnant women seen at the out-patient department of a tertiary medical center on 2016-2017 / Philippine Journal of Obstetrics and Gynecology

Background@#Anemia is a major global problem that affects women and prevalent during pregnancy. Effective management is needed to prevent adverse maternal and pregnancy outcomes. Ferrous iron salts are the preparation of choice and recommended for both prevention and treatment of iron deficiency anemia (IDA). However, most commonly available iron supplement are poorly absorbed, with gastrointestinal disturbances as side effect.@*Objective@#To compare the efficacy of iron amino acid chelate and ferrous sulfate in the treatment of IDA among pregnant women seen at the out-patient department of a tertiary medical center.@*Methodology@#This study is a single blind randomized clinical trial which included women 18 to 40 years old, with singleton pregnancies diagnosed with IDA without any co-existing fetal and maternal complications seen at the OutPatient Department. Forty eight eligible participants were randomized, with 24 women allocated on each treatment arm who took their assigned treatment twice a day for 90 days. Hemoglobin, hematocrit, MCHC, MCV, RDW & serum ferritin levels were taken at baseline and monitored on days 30, 60 and 90 from initiation of treatment. Mean blood parameters between two treatment arms were compared on days 30, 60 and 90 post-treatment as well as the mean difference of blood parameters on days post-treatment from the baseline using T-test. Chi-square was used to compare adverse effects between two treatment arms.@*Results@#No statistically significant differences in the mean blood parameters on days 30 and 60 of treatment between Iron amino acid chelate and Ferrous sulfate. It was only on day 90 from initiation of treatment when there were a significantly higher hematocrit and MCHC and lower RDW in Iron amino acid chelate compared to Ferrous sulfate group. All of the CBC parameters on days 30, 60, and 90 post-treatment when compared to baseline level were significantly increased for both treatment arms. However, day 90 level of serum ferritin in the Iron amino acid chelate group significantly increased unlike those in ferrous sulfate group.@*Conclusion@#Iron amino acid chelate is comparable to Ferrous sulfate in the treatment of IDA among pregnant women. Iron amino acid chelate was found to be superior to Ferrous sulfate in achieving optimum treatment response even at a lower dose with lesser adverse effects. Hence, better oral iron treatment tolerability, thereby, compliance to long-term therapy can be expected resulting to successful treatment outcome.

Cesarean scar pregnancy: “A rarity no more?” A report of 2 cases / Philippine Journal of Obstetrics and Gynecology

@#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.

High grade Ovarian Serous Carcinoma associated with Chronic Schistosomiasis / Philippine Journal of Obstetrics and Gynecology

@#Schistosomiasis has been established as a causative factor in urinary bladder, liver, colorectal and cervical cancer. However, its role in ovarian malignancy has not been described. With the premise that long-standing inflammation secondary to chronic infection predisposes to cancer by promoting an environment that cultivates genomic lesions and tumor initiation, we are left with an open question: Does chronic infection with schistosomiasis also predispose to ovarian cancer? In this paper, we presented a case of a 54-year-old diagnosed with high grade serous carcinoma of the ovary and fallopian tube with a history of chronic infection with Schistosomiasis. In this case, the infection caused neoplastic lesions in the right fallopian tube with subsequent seeding of malignant cells to the right ovary, indirectly causing the high grade serous ovarian carcinoma of the patient.

Pseudomyxoma peritonei: Revisited / Philippine Journal of Obstetrics and Gynecology

@#Bleeding after menopause raises suspicion of malignancy; more

Comparison of the efficacy of metronidazole and metronidazole plus probiotics capsule in the treatment of bacterial vaginosis among non-pregnant patients seen at the outpatient department of a tertiary hospital: A single blind randomized controlled trial / Philippine Journal of Obstetrics and Gynecology

BACKGROUND: Bacterial vaginosis (BV) is the most prevalent cause of symptomatic vaginitis. In the Philippines, prevalence of BV is at 28.16%. The mainstay for the treatment of BV is Metronidazole. Although antibiotic therapy has been shown to eliminate BV associated organisms, there is extremely high recurrence rate.OBJECTIVE: To compare the efficacy of metronidazole and metronidazole plus lactobacilli tablet in the treatment of bacterial vaginosis among non-pregnant patients seen at the outpatient department of a tertiary medical center.METHODOLOGY: The population included non-pregnant women ages 15 t0 44 years old, with bacterial vaginosis diagnosed by Amsel's criteria and Nugent's scoring. The participants were randomly assigned to their treatment group, one is Metronidazole only and other received Metronidazole plus Lactobacillus tablet. All participants followed up on day 8,15,22 and 56 from initiation of treatment resolution or persistence of symptoms and collection of vaginal specimen for gram stain and inquire on adverse effects.RESULTS: On day 8 treatment, there were significantly more participant in the metronidazole plus probiotic arm with an estimated lactobacilli count of more than 30/hpf as comapred to metronidazole alone. On day 15 post treatment, there was no statistically significant difference with the estimated Gardnerella vaginalis count, lactobacilli count, presence or absence of malodorous vaginal discharge between the metronidazole plus probiotic and the metronidazole alone arm. With metronidazole plus probiotic group, the proportion of women with less than 30 per hpf Gardnella vaginalis count and absent foul smelling vaginal discharge were accounted among 100% of the participants from day 8 to 56 post treatment. The early reduction in the causative agent and symptoms can be attributed to an increase in the estimated lactobacilli count sustained until 56 days post treatment metronidazole plus probiotic. However, from day 15 to 22 and 56 post- treatment, the proportion of participants who had a nugent's score of less than 4 were greater for both the metronidazole plus probiotic (100%) and metronidazole alone (95%) arm, when compared to day 8 post-treatment. This finding for the metronidazole plus probiotic group is due to sustained reduction in the Gardnella vaginalis count and increase in lactobacilli counts. Potentially , the metronidazole plus probiotic treatment was found to be more favorable in sustaining the normal flora and probiotic can be used as an adjunct may enhance the efficacy of metronidazole in the treatment of BV.CONCLUSION: Metronidazole plus probiotic and metronidazole only treatment are comparable in treating bacterial vaginosis. In terms of restoring and maintaining the normal flora, metronidazole plus probiotic appears to be more significantly efficacious. Probiotic in the form of lactobacilli is a promising adjunct to enhance the efficacy of metronidazole in the treatment of bacterial vaginosis.