Awareness and perceptions of Filipino obstetrician-gynecologists on fertility preservation: a cross-sectional survey.

BACKGROUND: The demand for fertility preservation has increased substantially over the past decade as more women wish to delay childbearing and with improved survival outcomes of various medical conditions. This study evaluated the awareness and perceptions of Filipino obstetrician-gynecologists on fertility preservation. METHODS: A cross-sectional survey was conducted among diplomates and fellows of the Philippine Obstetrical and Gynecological Society from September to December 2021. A self-administered questionnaire with 24 items was distributed online. Univariate descriptive statistics were reported as means for continuous variables and frequencies with percentage for categorical variables. Differences in responses were tested using the chi-square test. RESULTS: A total of 215 respondents completed the survey. Majority of the respondents were female, general obstetrician-gynecologists practicing in the National Capital Region. There was an overall positive perception of fertility preservation, with 98.60% agreeing that discussions about childbearing intentions should be initiated. Most participants (98.60%) were aware of fertility preservation but had varying levels of awareness of the different techniques. Fifty-nine percent of the respondents were unaware of regulations on fertility preservation. Setting up dedicated centers for fertility preservation and offering it as a public service were viewed as necessary by the respondents. CONCLUSIONS: This study underscored the need to increase awareness of fertility preservation techniques among Filipino obstetrician-gynecologists. Meeting the need for comprehensive guidelines and centers is essential to promote fertility preservation in the country. Efficient referral systems and multidisciplinary approaches should be established for holistic care.

Antenatal care utilization during the COVID-19 pandemic: an online cross-sectional survey among Filipino women.

BACKGROUND: The COVID-19 pandemic resulted in unprecedented challenges to healthcare systems worldwide, including interruption of antenatal care services. The study aimed to determine the utilization of antenatal care services of Filipino women during the COVID-19 pandemic. METHODS: A cross-sectional study was conducted among postpartum women using an online self-administered survey in the Philippines from January 1 to March 31, 2022. The questionnaire used to assess health-seeking behavior was validated before the survey proper. Women aged 18 to 45 years who delivered in 2021 were recruited. The participants answered a structured questionnaire to assess their access, perceptions, and utilization of antenatal care. Utilization of antenatal care was evaluated using standard measures, including the timing of initiation of antenatal care, number of subsequent visits, and place of consults. The factors affecting the adequacy of antenatal care were determined for each variable through simple logistic regression. RESULTS: A total of 318 women were enrolled in the study. All the respondents agreed on the necessity of antenatal care. However, only 46.37% had six or more in-person antenatal visits, with the majority attended to by midwives at community health centers. Most respondents (71.38%) initiated antenatal care during the first trimester. Almost half reported deferrals of visits mainly due to lockdown restrictions, transportation problems, and financial issues. Positive predictors of adequate antenatal care were prior pregnancies (OR 1.80, 95% CI 1.11-9.20 for 2-3 prior pregnancies; OR 3.02, 95% CI 1.45-6.29 for 4 or more prior pregnancies), live births (OR 1.67, 95% CI 1.04-2.69 for 2-3 prior live births; OR 2.46, 95% CI 1.17-5.16 for 4 or more prior live births), having living children (OR 1.74, 95% CI 1.09-2.79), spousal support (OR 1.75, 95% CI 1.01-3.03 for married women; OR 1.89, 95% CI 1.09-3.28 for women with common-law partners), history of obstetric complications (OR 2.82, 95% CI 1.33-5.97), and use of private vehicles (OR 2.65, 95% CI 1.05-6.68). Negative predictors were employment (OR 0.37, 95% CI 0.22-0.63) and medical examination prior to pregnancy (OR 0.36, 95% CI 0.23-0.58). CONCLUSION: Despite an overall positive perception of the necessity of antenatal care, utilization has been inadequate in more than half of the respondents. Various individual, facility, and policy-level factors affected the utilization of services during the pandemic. There is a need to augment antenatal care services in the country by mitigating barriers to access. The public health response should strengthen collaborative efforts with primary-level healthcare to increase service provision, especially to more vulnerable populations.

Assessment of the knowledge, attitudes, and perceptions of Filipino obstetrics and gynecology residents on fertility preservation: A cross-sectional study.

Background: As primary reproductive healthcare providers, residents-in-training must be equipped with the knowledge of proven and available methods for fertility preservation. The study evaluated Filipino obstetrics and gynecology residents' current knowledge, attitudes, and perceptions about fertility preservation. Methods: A cross-sectional survey was conducted among obstetrics and gynecology residents in the Philippines. A 24-item questionnaire was distributed to the different accredited training institutions of the Philippine Obstetrical and Gynecological Society by electronic mail. Univariate descriptive statistics were reported as mean for continuous variables and frequency with percentage for categorical variables. The chi-square test was used to determine differences in responses. Results: A total of 143 respondents from different year levels of training were enrolled in the study. Most were female trainees (88.11%) from the National Capital Region (44.76%). Most respondents agreed that discussions about childbearing intentions (99.30%) and age-related fertility decline (98.60%) should be initiated during a patient's gynecological consult. Residents were most familiar with oocyte freezing (84.62%), fertility-sparing surgeries (83.22%), and the use of GnRH agonists (80.42%) as fertility preservation techniques. Despite being most familiar with oocyte freezing, the respondents have mainly referred patients for fertility-sparing surgeries (48.95%) and the use of GnRH agonists (48.25%). Conclusions: There was an overall reassuring perception and attitude of obstetrics and gynecology residents on fertility preservation. A standardized curriculum with teaching-learning activities on fertility preservation may be used to improve trainees' knowledge. There was a disparity in the knowledge and actual referral or utilization of the different methods, reflecting the inaccessibility of the procedures specific to their institutions. This highlights the need to improve accessibility and offer fertility preservation as a public health service.

Patient experience and decisional satisfaction with the informed consent process for elective gynecologic surgeries: A cross-sectional study.

Background: The informed consent process is a vital component of daily medical practice. It involves providing patients with sufficient, accurate, and understandable information to decide on a contemplated therapy. The study aims to evaluate the patient experience and satisfaction with the preoperative informed consent process. Methods: A cross-sectional study was performed on adult women admitted for elective gynecologic surgery in a tertiary training hospital. Participants were recruited on their second postoperative day and were asked to answer a structured questionnaire assessing decisional satisfaction and experience with the informed consent process. Satisfaction was measured using a 6-item Satisfaction with Decision Scale. Knowledge of the surgery and experience with the informed consent were measured using an Informed Consent Questionnaire. Bivariate associations between highly satisfied and not highly satisfied groups were tested using Fisher exact test. Results: A total of 150 patients were enrolled in the study with a mean age of 44.5 years. The resident-in-charge provided the information and assisted in the documentation of the informed consent in 86.7% and 67.3% of patients, respectively. There was an overall high decisional satisfaction with a mean score of 27.4 and 52.7% of patients strongly agreeing to all statements of the Satisfaction with Decision Scale. The majority of the respondents were informed and acknowledged comprehension of the surgery including its risks, benefits, and alternative treatment options. Knowing the success rate and benefits of the procedure as well as being informed of the need for postoperative catheterization were significantly associated with high satisfaction. Conclusion: Knowledge and understanding of the key components of informed consent influence patient satisfaction. The current study highlights the high decisional satisfaction rates of patients who underwent elective gynecologic surgery. Strategies to further improve this patient-physician encounter include the establishment of standard policies on personnel involved, timing, and quality of information given to patients. Patient satisfaction should serve as an indicator of the quality of healthcare rendered and guide for continuous improvement of services.

Patient waiting time analysis for elective gynecologic surgeries in a tertiary training hospital in the Philippines: A retrospective cross-sectional study.

Objectives: This study aimed to determine the median waiting time and assess the factors affecting patient waiting time and scheduling for elective gynecologic surgery in a tertiary training hospital in the Philippines. Methods: A retrospective analysis of waiting times for elective gynecologic surgeries was performed. The different time intervals for each step of the process map were determined. Regression models were used to study the relationship between waiting time intervals and demographic data, consideration of malignancy, and surgeries performed. Results: The median waiting time from the date of the first consult to surgery was 154 days. Patients with consideration of malignancy and pelvic organ prolapse had significantly longer intervals from the Waitlist Clinic to actual surgery with regression coefficients of 6.76 and 17.53 days, respectively. Other intervals in the process map did not show significant differences. Conclusions: The median waiting time for elective gynecologic surgeries in a tertiary training institution in the Philippines was longer than global standards. A significant amount of time was spent waiting for diagnostic studies and referral to the Waitlist Clinic. The study recommends regulating and improving systems processes at the hospital and national levels to decrease patient waiting time. Surgical waitlists, referral systems, and benchmarks for safe waiting times should be established.

Myomatous erythrocytosis syndrome: A case series.

Uterine leiomyomas are tumor-associated causes of secondary erythrocytosis. Ectopic erythropoietin production by fibroid smooth muscles has been proposed and demonstrated in the literature. Here, we present three cases of large leiomyomas with an incidental finding of isolated erythrocytosis on preoperative workup. Two patients underwent total abdominal hysterectomy while one patient underwent a myomectomy. Both histologic examination confirming the diagnosis of leiomyoma and serial complete blood counts showing normalization of postoperative hemoglobin levels together with isolated erythrocytosis constitute the criteria to fulfill a diagnosis of myomatous erythrocytosis syndrome. All three criteria were observed in the three cases described. To date, fewer than 40 cases have been reported worldwide. These are the first reported cases of myomatous erythrocytosis syndrome in the Philippines.

Ovarian new growth creating a cutaneous fistula: A case report / Philippine Journal of Obstetrics and Gynecology

Ovarian new growths are among the most common tumors in women. Their presentation at time of diagnosis vary and are often incidental findings on ultrasound examination. Complications of ovarian masses include torsion, rupture, infection, hemorrhage, and malignant degeneration. These masses have also been known to create fistulous tracts to other organs of the body. Entero-adnexal communications have been reported in literature. However, fistula formation to the skin has not yet been reported. Here, we present an adult woman diagnosed to have ovarian new growth and a one-year history of serous discharge from a skin lesion. Imaging studies show a fistulous connection to the abdominopelvic mass. She underwent excision of the mass with fistulectomy. This is the first reported case of an ovarian new growth which created a cutaneous fistula.