2020 POGS report on obstetrical and gynecological indicators of health care / Philippine Journal of Obstetrics and Gynecology

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.

Fertility specialist practice in the Philippines during the COVID- 19 pandemic

@#<p style="text-align: justify;"><strong>Objective:</strong> To determine the changes in the clinical practice of infertility specialists in the Philippines, specifically, the proportion of specialists who stopped practice, length of break from clinics, the decrease in caseload, changes in consultation platform, screening frequency, number of clinicians that contracted COVI D 19 and safety protocols employed during the COVID - 19 pandemic.</p><p style="text-align: justify;"><strong>Methods:</strong> A cross-sectional study using an online questionnaire given to all members of the Philippine Society for Reproductive Medicine (PSRM) last November 2020. Participants were requested to answer the questionnaire through google spread sheet, with informed consent. All data were collated, summarized and reported in terms of frequencies, and measures of central tendency.</p><p style="text-align: justify;"><strong>Results:</strong> There were 110 active members of the PSRM who participated in the study. There was an overall decrease in the percentage of fertility consultations during the pandemic. There is also a substantial decrease in the caseload from different practices: 45.4% reported more than 50% decrease in !VF-related procedures, 54.5% noted more than 50% decrease in intrauterine insemination procedures, 52.8% reported more than 50% decrease in ovulation induction treatment, and 66.3% reported more than 50% decrease in endoscopic procedures. About 37% of the respondents deferred approximately 5-10 cases for fertility treatment, with 27.3% of the respondents reported deferring embryo transfer to less than 5 couples. More than half of the specialists (51.8%) stopped performing fertility procedures and 68.2% of the respondents completely stopped doing out patient consultations. However, some specialists resumed clinics by May 2020 (30.9%) and June 2020 (30.9%). Upon resumption of clinics, specialists used both face to face consultation and teleconsultation, with the largest proportion of respondents using both platforms. Safety measures employed during face-to-face consultations to prevent disease transmission included hand sanitizers in the clinics, restricted number of people in the waiting room and consultation room, use of personal protective equipment, symptom check prior to face to face consults, installation of air purifiers, and acrylic barriers, and use of health declaration forms. Majority of the specialists are aware of the international and local guidelines regarding infertility care during the pandemic (98.2%) and inform patients regarding the contents of the guidelines (90%).</p><p style="text-align: justify;"><strong>Conclusion:</strong> There is a significant decline in the consultations and fertility procedures during the pandemic. Specialists are well informed of the international and local guidelines regarding fertility care during the pandemic.</p>

Rational blood transfusion in elective gynecologic surgeries in a tertiary hospital in the Philippines / Philippine Journal of Obstetrics and Gynecology

Background@#Blood transfusion plays a vital role in modern health care; however, local studies on the utilization of blood products intra-operatively, especially in elective gynecologic surgeries, are lacking. @*Objective@#To determine the blood transfusion use during elective gynecologic surgical cases performed at a tertiary hospital in the Philippines. Methods: This retrospective descriptive study included data from patients admitted for elective gynecologic surgeries between January 2019 – December 2019. Pertinent data was gathered from the admission charts, preoperative laboratory results (hemoglobin levels, prothrombin time, partial thromboplastin time), blood bank records of deposited/donated blood and crossmatched units, anesthesia as well as intra-operative records, and medical charts. All abstracted variable were analyzed and transfusion indices were calculated. @*Results@#Majority of the patients who underwent elective surgeries were from the general gynecologic service (60.4%), with abdominal hysterectomies comprising majority of the transfused patients. The calculated crossmatched-to-transfused ratio (C/T ratio) for pRBCs, FFPs, and PCs are 5.1, 7.6, and 19.7; the transfusion indices are 0.57, 0.44, and 0.17, while transfusion probabilities are 28.1%, 10.4%, and 4.2%, respectively. We found a significant association between transfusion status and primary service (p = 0.01), previous pregnancy (p = 0.02), preoperative hemoglobin count (p < 0.01), preoperative hematocrit (p < 0.01), postoperative hemoglobin count (p < 0.01), postoperative hematocrit (p < 0.01), and intra-operative blood loss (p < 0.01).@*Conclusion@#There is consistent over-ordering of blood products. Primary gynecologic service, previous pregnancy, preoperative hemoglobin and hematocrit, as well as introperative blood loss are factors associated with transfusion status.

Practice of minimally invasive gynecologic surgery in the Philippines during the COVID-19 Pandemic / Philippine Journal of Obstetrics and Gynecology

Objective@#This study aims to establish baseline information on the practice of minimally invasive gynecologic surgery (MIGS) among Filipino gynecologic endoscopists amid the COVID-19 pandemic. @*Materials and Methods@#MATERIALS AND METHODS: An online survey was conducted among Fellows of the Philippine Society for Gynecologic Endoscopy (PSGE) practicing in private and government hospitals in the Philippines after informed consent. The survey had five subsections: (1) demographic data, (2) impact of COVID-19 pandemic on MIGS practice, (3) changes of practice during the COVID-19 pandemic, and (4) changes in the conduct of surgery and postoperative care. @*Results@#A total of 119 out of 144 PSGE Fellows based in the Philippines participated in the survey, 83% were Fellows in both laparoscopy and hysteroscopy. The majority had more than 15 years of practice and were practicing in the National Capital Region. Surgeries were canceled initially but have since resumed. The majority were hysteroscopy cases, the most common being polypectomy. Majority of the respondents reduced their clinic hours and appointments. Most have used telemedicine for consultations. Use of face masks, face shields, and personal protective equipment (PPE) were the top precautions taken in the clinics. Screening and precautions per guidelines inside the operating room setting were observed. Modifications during surgery include the use of smoke evacuators, minimizing energy device use, and wearing enhanced PPE.@*Conclusion@#The volume of laparoscopy and hysteroscopy cases was greatly reduced during the pandemic. The pandemic has disrupted the practice of MIGS both in the outpatient clinics and the operating rooms. Most of the changes made are congruent to local and international automotive task force guidelines. Precautionary measures and screening procedures must remain in place to reduce the risk of severe acute respiratory syndrome coronavirus 2 transmission to patients and health-care workers.

Logistical concerns faced by frontliners in obstetrics and gynecology during the COVID-19 pandemic in a COVID-19 referral hospital in the Philippines / Philippine Journal of Obstetrics and Gynecology

Introduction@#The COVID 19 infection has greatly affected health care delivery in the Philippines. However, the concerns of healthcare workers have yet to be explored@*Objective@#This study determined the logistical concerns of the residents and fellows of an academic government hospital that serves as a COVID‑19 referral center in the Philippines@*Methods@#This is a cross‑sectional, online survey administered to the trainees of the Department of Obstetrics and Gynecology@*Results@#Eighty‑seven participants were included in the study. Mean age was 30.7 ±3.7. Most were single, female and resident doctors. Eighty‑one percent agreed there was easy access to food and water during duty and that the food and water provided by the hospital were adequate. Fiftyfour percent agreed that they feel safe going to and from the hospital.  However, fifty‑five percent  disagreed to feeling safe from COVID‑19 within the hospital. A high majority of the participants agreed that they have access to personal protective equipment but  only fifty‑eight percent  agreed that the supply was adequate. The top 5 logistical concerns identified were: (1) safety and security, (2) food, (3) supply of personal protective equipment, (4) water, and (5) transportation@*Conclusion@#Although provisions on basic needs and protective equipment were adequate, trainees still felt unsafe from COVID‑19 within the hospital. Both the government and hospital administrators must continue to work together to improve strategies to address concerns of frontliners

The impact of the COVID-19 pandemic on fertility centers in the Philippines

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.

POGS 2019 report on obstetrical and gynecological indicators of healthcare / Philippine Journal of Obstetrics and Gynecology

Background@#To address the need to improve the collation of vital statistical data from POGS-accredited institutions, the POGS Committee on Nationwide Statistics developed a new electronic census platform (now called the POGS Nationwide Statistics System or PNSS), that replaced the Integrated Statistical Information System (ISIS) which was started in 2008.@*Objectives@#The aims of this paper are the following: (1) to present initial data gathered through the PNSS and compare it to the Department of Health (DOH) census; (2) to discuss obstetrical and gynecological indicators of healthcare and (3) to assess the limitations of the PNSS and recommend improvements.@*Methodology@#This is a cross-sectional study that shall report obstetrical and gynecologic data generated from submissions of POGS-accredited hospitals from January to December 2019, through the PNSS. Charts and tables illustrating frequencies of the different health indices are presented. Health indices include crude livebirth rate, age-specific birth rate, adolescent birth rate, cesarean section rate, stillbirth rate, neonatal mortality rate, perinatal mortality rate, maternal mortality ratio, frequency of gynecologic admissions and procedures, and death secondary to gynecologic diseases. @*Results@#The number of accredited hospitals that submitted their census with 100% compliance was 135, thus 91.8% of accredited hospitals had full compliance. A total of 365,947 cases were reported, 89% (326,026) of cases were obstetric cases and the remaining 11% (39,921) were gynecologic cases. For obstetrical health indicators: the livebirth rate is highest in the NCR 36%, with the highest age-specific birth rates in the 20-29 age groups; adolescent birth rate is 7.3%, overall CS rate is 32.8%, stillbirth rate is 14.3 per 1000 neonates, neonatal mortality rate is 3.65 per 1000 livebirths, perinatal mortality rate is 18.35 per 1000 total births and maternal mortality ratio is 81.72 per 100,000 livebirths. The most frequent indications for gynecologic admissions are leiomyoma uteri, Abnormal Uterine Bleeding-Polyp (AUB-P) and Abnormal Uterine Bleeding-Myoma (AUB-M), while endometrial biopsy/diagnostic curettage is the most frequent gynecologic procedure performed; There were 150 deaths (0.38%) reported among gynecologic cases and majority (96%) had gynecologic malignancies, with ovarian cancer being the highest (41%).@*Conclusion@#Nationwide statistics serve as strong evidence on which policies are created. It provides vital information that serves as a basis for decision-making, planning and implementation of health programs and basic services and can also be used for monitoring and evaluation. It is recommended that preparations be undertaken for an improved 2021 version with enhancing the mechanism of encoding and transmitting data, improving data quality and developing more health indicators. Regular coordination with the accredited hospitals is encouraged for a more accurate data outcome and compliance performance. Collaboration in identifying areas for research should be fostered.

Recurrent Endometriosis: Contemporary Challenges

@#<p>Background: The recurrence of endometriosis after fertility sparing surgery poses a challenge to clinicians. Presently, no treatment option is curative and available medication only changes the hormonal milieu to suppress or delay disease recurrence.<br />Objective: The aim of this review was to present current literature on recurrent endometriosis including dilemmas in definition, risk factors for recurrence and medical options for the prevention of recurrent endometriosis after surgery.<br />Methods: A review of literature was done using PubMed, EMBASE and HERDIN, with the following keywords: endometriosis, endometrioma, endometriosis-associated pelvic pain, recurrence of endometriosis. The authors identified reviews, trials and guidelines. The population was limited to reproductive-aged women suspected of having endometriosis.<br />Results and Discussion: The recurrence rate of endometriosis after conservative surgery ranges from 7.1-56%. The incidence varies according to the criteria used to define recurrence: relapse of pain, physical examination findings, presence of endometrioma on imaging studies, increase in serum CA-125, and intraoperative findings during repeat surgery. The risk factors for disease recurrence include: young age, high body mass index, large endometriomas at diagnosis, severe pre-operative pain, intraoperative findings of extensive adhesions, and positive surgical margins. The identification of patients at high risk for recurrence will enable clinicians to give appropriate post-surgical therapy to prevent recurrence. The choice of pharmacologic agent after conservative surgery includes: combined hormonal contraceptive pills, progestogens, and GnRH agonist. Although no major difference was seen in the effect of available drugs used to relieve endometriosis- associated pain and prevent disease recurrence, differences exist in safety, tolerability and costs.<br />Conclusion: There is an urgent need to standardize the definition of recurrent endometriosis. Patients should be counselled on the need for long term medical management to delay disease recurrence. A step-wise approach and algorithm in the medical management for the prevention of endometriosis recurrence are proposed.</p>

Patterns of intrauterine device use among family planning acceptors seen in the outpatient Department of a Tertiary Hospital

@#Intrauterine device is a popular means of reversible birth control in the world. In the Philippines, Copper T intrauterine device (IUD) supplies may come from private sources but the bulk has been from the public sector. The public sector gets IUD for free and inserts them at virtually no cost. Although the IUD has been known for decades, there is still low utilization despite its effectiveness and safety. It is worthwhile to determine the dynamics of IUD use. This study reviewed the use of IUD among women consulting the Family Planning Unit of a tertiary university hospital. It is necessary to evaluate the clients’ needs both by improving the accessibility and quality of services and intensifying information dissemination on available family planning services. This is especially true for those who already want to limit their children but do not want to undergo a permanent method.

A study on the factors affecting the use of the POGS-Nationwide Statistics System (PNSS) among Philippine Obstetrical and Gynecological Society (POGS)-accredited institutions in 2016 / Philippine Journal of Obstetrics and Gynecology

Objective@#To evaluate the factors affecting the use of the POGS PNSS across institutions. @*Basic Procedure@#A cross-sectional study was done by the POGS Committee on Nationwide Statistics from November 2017 to April 2018. Eight representative institutions were chosen from POGS accredited institutions for service and training from the NCR, Luzon, Visayas, and Mindanao, based on the classifications of I. Complete Data, II. Incomplete Data, III. Wrong Format, and IV. No Data. Hospitals with the most number of admissions under each category were chosen. Interviews with chairpersons of the departments, Focus Group Discussions (FGD) with the OB-GYN residents, and actual direct observations of how data were encoded in the PNSS were done.@*Results@#All the chairpersons and Ob-Gyn residents of the selected institutions were aware of the importance of the PNSS especially in generating vital nationwide statistics like Maternal Mortality and Morbidity Rates. They had several pertinent suggestions on how improvement of the PNSS, like harmonization of classification of diseases with PHIC and ICD codes, and to include other co-morbidities in the system.@*Conclusion@#The factors affecting the use of POGS-PNSS in 2016 include: good attitude and compliance among POGSaccredited institutions, but there is a need to address multiple diagnosis including medical co-morbidities. Final diagnosis also needs to be PHIC-compliant, and there is a need to address the Data Privacy Act with the use of eMR (electronic medical records).