Mature cystic teratoma in a five-year old female: Dilemmas in management

@#The patient is a five-year old female who complained of abdominal pain. A ping pong ball-sized mass on left lower quadrant of the abdomen was palpated six (6) months ago, which rapidly grew in size and caused abdominal pain. Physical examination showed a 10 cm x 10 cm firm, non-tender, smooth hypogastric mass with limited mobility. Primary impression was a mature cystic teratoma and a differential diagnosis of a malignant ovarian mass was considered because of the elevated tumor marker CA-125 and papillary excrescences on abdominal ultrasound. A multidisciplinary team composed of pediatric anesthesiologist, pediatric hematology-oncology expert, pediatric surgeon and the obstetrician gynecologist was formed to do thorough pre- and post-op planning. The patient underwent exploratory laparotomy, peritoneal fluid cytology, left oophorocystectomy, and frozen section under general anesthesia. Frozen section revealed teratoma with mature components in three sections. Final histopathologic result was mature cystic teratoma, 13.5 centimeters in greatest tumor dimension. She was discharged on the tenth hospital day. Dilemmas in management were discussed.

The role of GnRH agonists in the management of large myomas during a pandemic

@#<p style="text-align: justify;">This paper shall present a case of a 42-year-old nulligravid who complained of chronic pelvic pain, vaginal bleeding and palpable abdominal mass secondary to multiple large myomas. Due to the logistical and health restrictions in most hospitals during the peak of the COVID-19 pandemic, elective surgery was postponed and a temporizing medical management was instituted in the form of GnRH agonist, which afforded relief. This paper shall also discuss the mechanism of action of GnRH agonist, and its crucial role as an essential medical treatment option for patients with debilitating conditions such as myoma uteri.</p>

The association of neutrophil-lymphocyte ratio with medical treatment failure in patients with tubo-ovarian abscess

Background@#Pelvic inflammatory disease (PID) is an acute infection of the upper female genital tract, which may involve the uterus, fallopian tubes and ovaries. Tubo-ovarian abscess (TOA) is a complication of Pelvic Inflammatory Disease. Different methods are being utilized to predict the failure of medical management of TOA. Neutrophil-lymphocyte ratio (NLR) has been proposed as a significant marker for diagnosis in PID. @*Objective@#To compare NLR and sonographic TOA volume between patients who responded to medical management versus patients with failed medical management, and who eventually underwent surgery. @*Methods@#This is a cross-sectional study done by reviewing the hospital records of patients admitted for TOA in a tertiary hospital, from 2014 to 2018. Demographic details of the patients, computed NLR values and TOA volumes were gathered and analyzed.@*Results@#There was no statistical difference between the group who responded to treatment (medical group) versus the group of patients with failed medical management (surgical group) in terms of age, gravidity, parity and mean volume of the TOA. There was a statistically significant difference between the mean NLR of the two treatment groups. @*Conclusion@#Patients diagnosed with TOA, and with failed medical management have significantly higher levels of NLR compared with patients who responded to medical treatment. This positive association can be explored in future researches to validate NLR as a predictor of medical treatment failure for patients with TOA. NLR can also be potentially utilized as novel marker to indicate need for earlier surgical management to decrease the patient’s risk for sepsis.

Hormonal Contraceptives and Breastfeeding: A Review of Literature

@#<p>The use of hormonal contraceptives in a breastfeeding patient has been questioned by breastfeeding advocates. Their fear was that hormonal contraceptives will affect the milk production of the patient. This review of literature showed that progestins do not affect breastmilk supply whether it is the progestin only pill (POP), depot medroxyprogesterone acetate, levonorgestrel-containing intrauterine system (LNG-IUS) or the etonogestrel implant (ENG). The timing of administration of the progesterone derivative contraceptive method also does not affect milk production, whether immediately postpartum (within 48 hrs after delivery) or delayed (4 - 6 weeks postpartum). With this in mind, clinicians may safely advise these to breastfeeding patients to prevent unplanned pregnancies.</p>

Predictors of treatment failure of medical management among patients with pelvic inflammatory disease with tubo-ovarian abscess admitted in a tertiary hospital

@#OBJECTIVE: This study aimed to identify the predictors for treatment failure of medical management among admitted female patients diagnosed with pelvic inflammatory disease with tubo-ovarian abscess. METHODS: This was a retrospective nested case-control study, using chart review of all cases of pelvic inflammatory disease with tubo-ovarian abscess/complex (N = 49) admitted at the Department of Obstetrics and Gynecology, Philippine General Hospital from January 1, 2014 to December 31, 2018. RESULTS: Medical treatment failure was observed to be significantly higher (51.9%) among patients 40 years old and above as compared to patients less than 40 years old (13.6%). The risk of patients ≥40 years for failed management was 14x higher than those <40 years old (OR=14.00; 95% CI=1.06 to 185.5;p=0.04). The failed management group has significantly higher TOA size of 7.8 (7.8 ± 1.6) as compared to only 5.8 (5.8 ± 1.4) for medical treatment alone group. Correspondingly, those who failed have a significantly bigger volume of 120.4 ml (120.4 ± 84.5) as compared to only 55.2 ml (55.2 ± 40.6) for medical treatment alone group. Other predictive factors such as parity, admitting White blood cell count(WBC), C-Reactive Protein (CRP), and neutrophil-lymphocytic ratio(NLR) were all not significant. CONCLUSION: Tubo-ovarian abscess size of more than or equal to 7 cm, or a volume of more than or equal to 120 ml and advanced age of >40 were all predictive of failed response to medical treatment. Early recognition and intervention whether surgery or drainage may be beneficial to reduce morbidity and long-term sequelae of PID.

The association of chronic hepatitis B infectivity with fetomaternal outcome: A retrospective cohurt study in a tertiary hospital / Philippine Journal of Obstetrics and Gynecology

Background@#Hepatitis B infection on pregnancy has been linked to preterm labor, risk of prematurity, low birth weight, and the occurrence of gestational diabetes mellitus.@*Objective@#To determine the association between Chronic Hepatitis B infectivity and fetomaternal outcome such as preterm birth, low birth weight, gestational diabetes and preeclampsia among pregnant patients admitted in a Tertiary Hospital.@* Methodology@#A retrospective cohort study was done among pregnant women diagnosed with chronic hepatitis B infection admitted in a tertiary hospital from January 1, 2014 to December 31, 2018. The association of Hepatitis B infectivity and fetomaternal outcomes namely preterm birth, gestational diabetes, preeclampsia and low birth weight was determined.@*Results@#Chronic Hepatitis B infection had 1.43% prevalence among the study group. 149 patients were able to able to fulfill the inclusion criteria. Pregnant women with high infectivity Hepatitis B infection tend to be younger, have lower BMI, have lesser gravidity and parity than patients who are nonreactive to Hepatitis B e-antigen. AST and ALT were also higher among those with high infectivity Hepatitis B. However, there was no significant difference among the two groups in terms of elevated ALT. There was no significant association between Hepatitis B infectivity and fetomaternal outcomes such as preeclampsia, gestational diabetes mellitus, preterm birth and low birth weight. There is no increased risk for patients with high infectivity for preeclampsia, gestational diabetes mellitus, and low birth weight. There appears to be an excess risk in the likelihood of preterm birth/labor among those women who have a high infectivity Hepatitis B infection during pregnancy.@*Conclusion@#The prevalence of chronic hepatitis B infection among Filipino pregnant women admitted in a tertiary hospital was 1.43% from 2014 to 2018. There was no association between chronic hepatitis B infectivity and preeclampsia, Gestational diabetes mellitus. There seems to be an increased risk for HBeAg positive patients for preterm birth preterm labor, and occurrence of low birth weight, but was not statistically significant in the study population.

Assessment of the knowledge, attitude and practice of pregnant women towards hepatitis B infection seen at a tertiary hospital in the Philippines / Philippine Journal of Obstetrics and Gynecology

Background@#Multiple studies have described the insufficiency in knowledge, attitude and practices of the general population and of healthcare workers towards HBV infection across different countries.@*Objective@#This study aims to assess the knowledge level and correlate it with the attitude and practices of pregnant women towards Hepatitis B infection.@*Methodology@#This is a descriptive study on pregnant women consulting for their first antenatal visit in the outpatient department of a tertiary hospital. A structured self-administered questionnaire, adapted from a study by Han et al, was reviewed and modified by infectious disease experts, and then validated prior to use. 164 pregnant patients, aged 18-45 years old, were recruited. Logistic regression analysis was used to correlate attitude and practice to knowledge scores.@*Results@#Most participants (48.78%) belonged to the 18-25 year old age group. Only 7.32% of the participants answered all knowledge questions correctly while 39.02% answered at least 2/3 of the questions correctly. Knowledge scores were not associated with patient demographic information but were correlated with their attitude and practices towards Hepatitis B infection.@*Conclusion@#A lack of knowledge regarding Hepatitis B infection exists among pregnant patients. Government and private institutions must invest time and effort to bridge this knowledge gap. Health promotion should be directed towards the pregnant population since vertical transmission remains to be the most common route of transmission in our country.

Fertility-sparing surgery for a prepubertal female with malignant ovarian germ cell tumor

@#<p style="text-align: justify;">Malignant ovarian germ cell tumors are rare ovarian malignancies accounting for 3 to 5% of all ovarian malignancies. They are mostly seen in adolescents and young women and are usually unilateral making fertility preservation imperative. Raised alpha-feto protein level is the hallmark of this tumor. Presented is a case of a premenarcheal 13 year old female diagnosed with yolk sac tumor and who underwent fertility-sparing surgery and adjuvant platinum-based chemotherapy post-operatively, with good outcome. In young patients, conservative surgery with adjuvant chemotherapy has made the preservation of fertility possible, even in patients with advanced disease. The increase in cure rates has shifted the focus of recent studies to the long term menstrual, reproductive, and gynecologic outcomes in these patients. </p>

Determination of the microbiologic flora on the inclusion site among obstetric patients who underwent surgical skin preparation with either 10% povidone iodine or 4% chlorhexidine antiseptic solution prior to cesarean section in a tertiary hospital / Philippine Journal of Obstetrics and Gynecology

Objectives@#To determine the microbiologic flora after surgical skin preparation of the incision site using either chlorhexidine or povidone iodine antiseptic solution prior to cesarean section among obstetric patients.@*Materials and Methods@#This is a cross-sectional study of ninety-two (92) obstetric patients who were admitted for cesarean section. They underwent fishbowl lottery, wherein participants drew from a bag of folded stubs written chlorhexidine or povidone iodine, to determine their distribution to either group. Forty six (46) participants were distributed in each group. Skin cultures were obtained by the researchers from the incision site after surgical skin preparation using chlorhexidine or povidone iodine. @*Results@#Total of 92 participants enrolled in this study, 46 participants in chlorhexidine group and another 46 participants in povidone iodine group. There was no statistically significant difference between the 2 groups in terms of clinicodemographic characteristics. Out of the 92 participants, only one participant, under the povidone iodine group, showed a growth of 100,000 colony-forming units of Enterobacter cloacae and has no statistical significance in the growth of microbiologic flora after effective surgical skin preparation with either chlorhexidine or povidone iodine.@*Conclusions@#This study showed that chlorhexidine and povidone iodine are both effective in eliminating microbiologic flora after surgical skin preparation prior to cesarean section. Povidone iodine is still a sound choice of antiseptic especially in low resource setting. Due to the descriptive nature of this paper, only assumptions that chlorhexidine and povidone iodine are comparable antiseptic solutions can be deduced from this study.