Validation of readings of locally made cardiotocogram (RxBox 2) model 2 compared with standard equipment / Philippine Journal of Obstetrics and Gynecology

Background@#The RxBox 2 Model 2 is a portable device developed by the National TeleHealth Center capable of measuring various physiologic signals including fetal heart beat and uterine contractions, making it able to act as a cardiotocogram. The first model of the RxBox 2 was used in an observational cross-sectional study and was noted to have a low accuracy compared with the standard cardiotocogram. An adjustment was made with the objective of improving the sensitivity and specificity. @*Objective@#The objective of this diagnostic cross-sectional study is to validate the RxBox 2 Model 2 by comparing its sensitivity and specificity with that of the standard cardiotocogram in detecting Category II traces. @*Results@#The results of this study exhibited an improvement in the sensitivity (77% versus 60%) and specificity (71% versus 61%). In terms of accuracy, there is no significant difference between the high risk and non-high risk groups. These contribute to the validity of RxBox 2 Model 2 as an acceptable screening tool. @*Recommendation@#Further studies may still be done to improve the correlation of each component of the trace to that of the standard cardiotocogram. Detailed analysis of the interpretations with corresponding interventions and perinatal outcomes may aid in validating the device.

The effectiveness of evening primrose oil gel capsule as a cervical ripening agent during labor induction as measured by bishop score on term singleton pregnant patients / Philippine Journal of Obstetrics and Gynecology

@#<p style="text-align: justify;"><strong>BACKGROUND</strong>: Pre-induction of labor cervical ripening increases success of labor induction when there is unfavorable cervix. Evening primrose oil soft gel capsule contains linoleic and gamma-linolenic acid, which are precursors of prostaglandins E1 andE2.<br /><strong>OBJECTIVE:</strong> To measure the effectiveness of evening primrose oil capsule as a cervical ripening agent by measuring the Bishop score before and 4 hours after intravaginal insertion of six capsules.<br />METHODS: A quasi-experimental cross-sectional study was conducted from the period of May to July 2016 involving labor induction patients with a Bishop score ?4, an intact amniotic sac and a Biophysical profile score of 10/10 or 8/8.<br /><strong>RESULTS:</strong> Thirteen patients had an average age of 27±6 years, and a mean age of gestation of 40±1 weeks. Seven patients (54%) were nulliparous, 2 (15%) were primiparous and 4 (31%) were multiparous. Seven patients (54%) had hypertension, 1 (8%) had diabetes mellitus, 5 (38%) had post-term pregnancies. A paired t-test was done to check for statistically significant changes in the Bishop score. Change in the Bishop score from baseline to 4 hours after insertion of evening primrose oil capsules was statistically significant (p=0.001). Eleven patients (85%) had improvement in the Bishop score after 4 hours, 4 (31%) of which had a clinically significant change in the Bishop score (?4). Specifically, there were statistically significant changes in the dilatation (p=0.027), effacement (p=0.006) and consistency (p=0.002). The mean birth weight of deliveries was 3192±351 grams. Nine patients (69%) underwent primary low segment cesarean section, six (46%) of which for nonreassuring fetal status, 2 (15%) for arrest in cervical dilatation, and 1 (8%) for intraamnionic infection. Four patients (31%) successfully delivered vaginally.<br /><strong>CONCLUSION:</strong> Results showed a positive effect on the Bishop score during cervical ripening although further studies are needed to establish direct correlation.</p>

Surveillance of the endometrium in women taking tamoxifen for breast carcinoma: A six month follow up report

Objective: To determine the role of transvaginal ultrasound, doppler velocimetry, saline infusion sonography and office hysteroscopy with endometrial biopsy and endocervical curettage in the detection of endometrial pathologies among breast cancer patients using Tamoxifen and subsequently recommend an acceptable cost effective protocol for the surveillance and follow up of these patients. Methodology: The study design is a descriptive type. Endometrial assessment was carried out using transvaginal ultrasound, doppler velocimetry, saline infusion sonography and office hysteroscopy with endometrial biopsy and endocervical curettage on initial consult. They were asked to follow up after 6 months during which time the same procedures will be repeated and performed. Results: Twenty one women were recruited to this study. The mean age of the subjects was 50.33 years. Of the 21 women in the study, 13 were postmenopausal and 8 were premenopausal. The mean age of menarche and menopause was 13.05 and 49.15 years, respectively. The body mass index was 23.92 (SD +/- 2.54). Other demographic characteristics were as follows; 19 percent had a history of oral contraceptive use, 35 percent were nulligravid, and 4.7 percent had a history of infertility x 9 years. The mean age when breast cancer was initially recognized was 47 years. Majority of patients (66.60 percent) had stage II disease. Seventy six percent was initially diagnosed by biopsy and the rest by fine needle aspiration cytology. All underwent modified radical mastectomy except for a 37 year old nulligravid who underwent quadrantectomy and axillary clearance. Eighteen (8-7.7 percent) of which showed ductal carcinoma on histopathologic examination. The mean duration of tamoxifen intake was 24 months. Women with breast cancer and taking Tamoxifen had a significant increase of vaginal bleeding on 6th month follow up. (P=0.00). On transvaginal ultrasound, a significant increase in the number of patients had thicker endometrium on 6th month follow up (P value 0.03). However, the role of Doppler and saline infusion sonography on the surveillance of the endometrium was not significant. Conclusion: A management scheme for the surveillance of the endometrium on breast cancer patients on Tamoxifen cannot be suggested at the moment and requires a long term follow up of these patients.

The carbon dioxide insufflation volume required to attain adequate pneumoperitoneum in gynecologic laparoscopy patients

Objectives: The objectives of this study were to determine the carbon dioxide insufflation volume needed to attain pneumoperitoneum in patients who underwent gynecologic laparoscopic surgery and to determine if body mass index (BMI) and parity affected the carbon dioxide insufflation volume. Methodology: The insufflation volume of carbon dioxide was noted after a present pressure of 16 mm Hg was attained in the carbon dioxide insufflator for patients who underwent laparoscopy. Patients were grouped according to BMI and parity. The mean, standard deviation and range was computed for the carbon dioxide insufflation volume. One-way analysis of variance was used to determine the significance of BMI and parity in relation to carbon dioxide insufflation volume. Results: The mean carbon dioxide insufflation volume needed to for pneumoperitoneum was 3.15 liters. When grouped according to BMI and parity, there were significant differences in carbon dioxide insufflation volume.