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.

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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.

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BACKGROUND: For the past decade, advanced maternal age (AMA) became more common in developed and developing countries due to the postponement of pregnancy because of career goals, widespread use of family planning, and advances in assisted reproductive techniques. This increase bears an impact on maternal and perinatal outcomes. The link between AMA and adverse maternal, perinatal, and neonatal outcome showed contradicting results. This study was conducted to investigate the association between AMA and adverse outcomes among nulliparous, Filipino with singleton pregnancies who gave birth in a private tertiary hospital. METHODOLOGY: Medical records of patients admitted for delivery between January 2015 and December 2019 were reviewed retrospectively. The control (20–34 years), AMA 35–39 years, very AMA 40–44 years, and extremely advanced maternal age (EAMA) 45 years and above groups included 206, 111, 18, and 2, respectively. RESULTS: Five-year total deliveries at a private tertiary hospital were 8495 with a prevalence of 38.9% (95% confidence interval CI: 33.6%–44.3%) for elderly Filipino primigravids. AMA is a risk factor for diabetes mellitus and small for gestational age newborn in all 3 advanced age groups. Pregnancy induced hypertension, having cesarean section, admission of newborn to neonatal intensive care unit, and administration of antibiotics were more common to AMA but same risk for EAMA. AMA predisposes to having oligohydramnios, placenta previa and preterm delivery but pregnancy at EAMA predisposes more complications in maternal and neonatal outcomes such as having polyhydramnios, abruptio placenta, postpartum hemorrhage, maternal and neonatal death, low Appearance Pulse Grimace Activity and Respiration score, and stillbirth. There is no noted association between AMA and large for gestational age newborn, having meconium staining and delivering by classical cesarean section. CONCLUSION: AMA in Filipino gravida patients is markedly linked with adverse obstetrical, perinatal, and neonatal outcomes. This study confirms the current trend among women over 45 years that leads to more significant obstetric complications and neonatal morbidities.

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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.

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Menstrual toxic shock syndrome (TSS) is a severe, fatal, superantigen toxin-mediated illness, which leads to multiorgan system failure early in its course. At the time of writing, there are no local data available on menstrual cup-associated TSS. Reported is a 30-year-old healthy Filipino, diagnosed as a case of menstrual cup-associated TSS. Diagnosis was confirmed by case definition criteria and supported by vaginal discharge culture of methicillin-resistant Staphylococcus aureus. The patient was treated empirically with antibiotics that led to successful treatment outcomes with no recurrence. At present, when women empowerment is of utmost importance, we support women's decisions pertaining to their health, including their choice of menstrual hygiene products. This case is reported to raise awareness, promote wellness and safety among menstrual cup users and to educate clinicians on the course and management of menstrual cup associated toxic shock syndrome to prevent its catastrophic sequelae.

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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: 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.

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INTRODUCTION: Physician burnout (BO) is an increasing global concern due to its rising prevalence and effect on patient care. OBJECTIVE: This study determined the prevalence of BO, compassion fatigue (CF), and compassion satisfaction (CS), among residents of obstetrics and gynecology in the Philippines, and identified the factors associated with these. METHODS: This was a cross-sectional study, which used stratified random sampling. The strata comprised public and private hospitals that were subdivided into Luzon, Visayas, Mindanao, and National Capital Region. From these, 33 training hospitals were randomly selected, which served as clusters wherein all resident physicians of obstetrics and gynecology were invited to answer either an online or printed version of the Professional Quality of Life Scale Version 5 questionnaire. RESULTS: Majority of the 311 participants included had average level of BO (n = 281, 90.4%), CF (n = 237, 76.2%), and CS (n = 213, 68.5%). CS was negatively correlated with burnout (r = −0.31, P < 0.001) and CF (r = −0.34, P < 0.001), whereas BO and CS were positively correlated (r = +0.48, P < 0.001). Type of institution, sleeping hours, and interrupted leaves were the common factors that yield significant differences in BO (P = 0.037, P < 0.001, and P < 0.001) and CF (P = 0.002, P = 0.043, and P = 0.005). Significant differences were observed in CS scores in terms of age (P = 0.016), marital status (P = 0.038), child dependents (P = 0.006), level of training (P = 0.005), and location and type of institution (P ≤ 0.001 and P = 0.003). CONCLUSION: There is a need to develop active awareness of BO and CF among resident physicians to effect interventions at the individual and institutional level.

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BACKGROUND: Major changes in the practice of medicine have been adopted due to the COVID-19 pandemic and have not spared the practice of ultrasound among obstetrician–gynecologists, considered to have higher risk due to unique attributes of an ultrasound examination. OBJECTIVES: This study evaluated the awareness, attitudes, perceptions, and practices of the obstetric–gynecologic sonologists in the country during the pandemic, including the use of telesonography. METHODOLOGY: A descriptive, cross-sectional survey was conducted through a self-administered, structured questionnaire using an online survey software. RESULTS: There were 120 respondents with postresidency training in ultrasound (54.2%) or in maternal and fetal medicine (43.3%), practicing in different regions, and mostly with teaching affiliations (56.7%). Most are aware of the guidelines on the practice of ultrasound this pandemic and they perceived themselves to be especially vulnerable to the infection. They admitted having feelings of stress, sadness, and depression, and their concerns centered on being infected and potentially transmitting it to their family. These perceptions translated to specific practices that include use of level 3 personal protective equipment, patient screening, triaging, and use of physical barriers to minimize environmental and contamination. While most are consistent with guidelines, some practices are neither based on sound scientific evidence nor correctly adhered to, including noncompliance with appropriate ultrasound transducer cleaning and disinfection. Regarding telesonography, only half of the respondents had good knowledge, with most having informal sources of information on the technology. Although the respondents have a good attitude toward it, only a few (15.8%) admitted to using it, mainly to confer with an expert or colleague (38.3%), and for teaching purposes (11.7%). CONCLUSIONS: Obstetric–gynecologic sonologists in the Philippines are aware of the risks and have the same attitudes and perspective on COVID-19 infection as other health-care providers. Specific practices have been modified; however, the use of telesonography is not among the changes adopted.

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A 16-year-old primigravida, at 33 weeks and 5 days age of gestation came in due to preterm labor. Sonographic examination revealed an incidental finding of a mass attached to the sacrococcygeal area. The mass has a cystic and solid component diagnosed as sacrococcygeal teratoma. Attached to the mass were two lower extremity structures identified as femurs with feet and was considered as an underdeveloped parasitic twin. A classical cesarean section was performed because of the advanced preterm labor, and a live female infant weighing 2500 g was delivered. The parasitic lower limbs, however, inadvertently detached during delivery. There was a high index of suspicion because of a larger fundic height of 37 cm compared to the age of gestation and the difficult palpation on Leopold's maneuver. Accuracy of ultrasound findings helped the obstetricians to a timely and prepared for delivery.

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BACKGROUND: Anti-Mullerian hormone (AMH) levels have been used as an invaluable tool in reproductive medicine for over a decade, especially in predicting ovarian reserve and follicular response during in vitro fertilization (IVF) cycles. Age-specific reference values of AMH levels have been derived from mostly Western and few Asian population groups but none from the Philippines. In this study, we attempted to determine the first age-specific AMH reference values from infertile Filipino women to be able to provide local infertility centers a guide in treating Filipinos and those with similar racial and lifestyle characteristics. MATERIALS AND METHODS: This was a retrospective cross-sectional study that was conducted at the Center for Advanced Reproductive Medicine and Infertility at St. Luke's Medical Center Global City. Age, serum AMH levels, body mass index (BMI), and cause of infertility of Filipino women who underwent IVF from August 2015 to March 2020 were taken. AMH was assayed using the automated Access AMH Immunoassay (Beckman Coulter). RESULTS: A total of 1463 women who underwent IVF and with valid AMH results were initially found but only 1233 were included in the study. Mean age was 36.67 + 4.35 years and mean BMI was 24.43 + 4.14 kg/m². There was minimal effect of BMI on AMH levels and increasing age (R² = 0.0068), but there were significant differences of mean AMH levels among the general causes of infertility. The mean and median AMH values decreased with advancing age (R² = 0.1391) although the mean values were consistently higher than the median values. The mean level of the AMH was 2.32 ± 1.90 ng/mL with a 0.16 ng/ml (confidence interval: 0.14–0.19 ng/ml) level decrease per year of increase in age. By age category, the following were the derived AMH values (ng/ml) at the 25^th to 75^th percentiles: 25–29 = 1.52–4.92; 30–34 = 1.60–4.10; 35–39 = 0.95–3.13; 40–44 = 0.44–1.99; 45 = 0.47–1.08. The mean AMH in this study appears to be similar to several but lower than most other reported AMH nomograms from other population groups. CONCLUSION: The first age-specific AMH reference values for infertile Filipino women are presented and may serve as a useful diagnostic marker in local infertility centers, especially those treating Filipino patients or others with similar characteristics.

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Background: Preeclampsia (PE) has significant health and economic burden. Early screening for PE through first trimester screening (FTS) can direct decision-making on early initiation of aspirin (ASA) therapy, which has been known to reduce the incidence of PE. Objectives: The objective of the study is to evaluate the cost-effectiveness of FTS and early initiation of ASA for disease prevention. Methodology: A population of 1916 women who delivered in a private tertiary hospital from January 2019 to March 2020 was categorized based on the risk of developing PE, results of FTS, initiation of ASA therapy, development of PE, and mode of delivery. Descriptive statistics using counts and percentages were used to summarize the data. Association between ASA therapy and PE was assessed using the Chi-square test. Costs of screening, ASA therapy, inpatient management, and delivery were computed. Results and Conclusion: Results showed that PE was prevented in 71.4% of those high-risk patients who underwent FTS and started on ASA therapy. Total cost of urgent care of PE and delivery was P119,687.02 to P149,687.02 for early PE, and P103,587.02 to P133,587.02 for late PE. Prevention of early PE and late PE results in net cost savings of P69,694.02 and P53,594.02, respectively, with the investment of P9,993.00 on FTS and ASA therapy. Implementation of FTS and initiation ASA therapy is an effective and cost-saving approach that can prevent PE.

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INTRODUCTION: Postpartum depression (PPD) is a major health concern for child-bearing women and has its effects on her children. Advocacies for mental health have paved way for more awareness of conditions such as PPD. Currently, there is no particular screening protocol employed by attending physicians of these women. There is also a lack of data that determines the practices of obstetricians when dealing with patients with PPD or those at risk of developing it. OBJECTIVE: This descriptive study evaluated the knowledge, attitudes, and practices of OB-GYN consultants and residents on the screening of PPD. MATERIALS AND METHODS: A validated questionnaire was utilized with some modifications made to tailor fit the targeted population. All affiliated consultants and residents of the Philippine Obstetrical and Gynecological Society-accredited training hospitals in a Region VII were included while those retired were excluded. The Google Form link of the questionnaire was disseminated to the different institutions who gave approval to conduct the study. Anonymity and confidentiality of data acquired were maintained throughout the study. RESULTS: A total of 110 responses were received. The key findings of the study showed that the respondents have above average knowledge on PPD including its risk factors, symptoms, complications, and treatments. They generally have positive beliefs toward their role in the screening and management of PPD. Moreover, majority of them have already tried screening for PPD although not routinely. CONCLUSION: There is a significant relationship between the knowledge, attitude, and practices of the consultants and residents on the screening of PPD. Systems should be put in place to ensure effective treatment and follow-up of patients and thus impact good clinical outcomes.

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INTRODUCTION: There is insufficient local data on the maternal and fetal morbidity and mortality of cases seen initially at the primary health-care facility (PHCF) and subsequently referred to a tertiary hospital for acute management. This study aimed to determine the maternal and fetal outcomes of such patients using the World Health Organization maternal near miss, mortality, and neonatal mortality rates. MATERIALS AND METHODS: A cross-sectional study was done that involved obstetric patients beyond 20-week gestation and in the immediate postpartum who were initially managed at the PHCF then referred to a tertiary hospital for management. RESULTS: There were 485 deliveries (85.5%) with a primary cesarean section rate of 16.6%. One patient underwent exploratory laparotomy for uterine rupture with extraction of a stillborn baby and hysterectomy. Eighteen cases (3.2%) necessitated other forms of surgical interventions including hysterectomy (6), transverse compression suture (3) with bilateral uterine or hypogastric artery ligation, uterine repositioning (1), evacuation of vaginal hematoma (4), balloon pack insertion (2), postpartum curettage (1), and removal of retained suture needle (1). The maternal near-miss rate is 46.7/1000 live births (46.7%). There were three intensive care unit admissions and 5 cases required ventilatory support. The maternal mortality rate is 10.6 maternal deaths per 1000 live births (1.06%). Majority of the babies had good APGAR scores at birth. Twenty-two babies (4.5%) required intensive neonatal management. The neonatal mortality rate is 0.42% or 4.2/1000 live births. CONCLUSIONS: Almost 40% of referred cases were primigravidas and have preexisting medical problems that should not have been seen at the primary care level but directed to secondary or tertiary center at the outset. It cannot be understated that education of the populace, more training, and monitoring the performance of base health facility workers should be done to prevent maternal and fetal catastrophes.

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BACKGROUND: In our recent times, COVID-19 is an evolving, rapidly changing global health challenge affecting all sectors. Health-care workers (HCWs) are not only the first in defense against this highly contagious infectious disease but also are directly or indirectly affected by it, and the likelihood of acquiring this disease is higher among HCWs compared to the overall population. It is of utmost importance, therefore, that HCWs have adequate knowledge about all aspects of the disease from clinical manifestation, diagnosis, proposed treatment, and established prevention strategies. In this present study, we assessed the knowledge, attitudes, and practices (KAP) among HCWs toward the COVID-19 and infection prevention during the ongoing pandemic. METHODOLOGY: A KAP and infection prevention and control (IPC) questionnaire was adapted and was administered to the recruited labor and delivery room HCWs involved in the COVID-19 response at a tertiary-level hospital. Clinical characteristics, prevention, and management of COVID-19 consisted of the knowledge questionnaire. Knowledge questionnaire on IPC consisted of questions regarding nosocomial infections, hand hygiene, and universal precautions. Assessment on attitudes and practices toward COVID-19 included questions on behavior and change in practices made toward COVID-19 response while attitude and practice assessment on IPC included questions on guidelines, conducts, and trainings. Knowledge scores were considered and associated by demographic characteristics and their attitude and practices. RESULTS: The study included 114 HCWs with a median age of 30 years (range: 22–72), dominated by females, 85.09% versus 14.91%. The majority of the respondents attained doctorate (44.55%) and bachelor (43.56%) degrees. These HCWs mostly assume 8–16 h tour of duty (62.28%). The mean knowledge score of the HCWs on COVID-19 was 87.48 ± 14.17. The correct overall rate of the knowledge questionnaire was 80.7%. The mean attitude was 3.32 ± 0.55. More than half contemplated that the country is not on a good position to contain COVID-19 spread (54.39%) and only 38.60% are confident that they can manage patients with signs and symptoms of the disease when present to them. As for their current health practices, the past 14 days before the time of data gathering, 63.16% admitted that they have never gone to any crowded places. They always wore their masks when contact with patients (99.12%), refrained from doing handshakes (80.70%), cautiously washed their hands before and after handling patients (99.12%), and avoided patients with signs and symptoms suggestive of COVID-19 (82.46%). Overall, up to 97.4% of the participants had good practices. Based on the study findings, it was evident that HCWs are knowledgeable in IPC. The mean score for knowledge among nurses in IPC was 86.7. The mean scores for attitude and practices among nurses in IPC were 4.06 and 2.69, respectively. Therefore, nurses had positive attitudes and good practice toward IPC. CONCLUSION: Our findings suggest that labor and delivery room HCWs have adequate knowledge, and possess good preventive practice to contain the transmission of SARS-COV-2 during the amount of the COVID-19. They even have adequate knowledge and positive attitude and apply appropriate practice on IPC. However, their attitude was less optimistic toward COVID-19 even with better knowledge. Health education schemes geared toward improving COVID-19 knowledge are helpful for encouraging an optimistic attitudes and maintaining safe practices. Continued professional education is suggested among HCWs to enhance the knowledge of HCWs, hence averting negative attitudes and promoting positive preventive and therapeutic practices.

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OBJECTIVE: This study aimed to determine if the beta-human chorionic gonadotropin (hCG) levels during the first 5 weeks after a molar evacuation predict progression to gestational trophoblastic neoplasia (GTN). MATERIALS AND METHODS: This was a retrospective cohort study of complete mole cases managed at a Philippine tertiary hospital from January 2009 to December 2018. Extracted data were analyzed using applicable statistical tools. The level of significance was set at a P < 0.05 using two-tailed comparisons. RESULTS: One hundred and fifty-five complete patient records were available for review. Disease progression in 15.48% of cases while regression in 84.52% were noted. Uterine size was larger in those who eventually had postmolar GTN (t: −3.12, df: 32.64, P: 0.01). Analysis of the receiver operating characteristic curve showed that optimum cut-off levels for predicting GTN at 1, 3, and 5 weeks after evacuation were 4,152 mIU/ml (sensitivity: 50%, specificity: 94.7%, area under the curve [AUC]: 0.75), 804 mIU/ml (sensitivity: 62.5, specificity: 96.9%, AUC: 0.94), and 541 mIU/ml (70.8%, specificity: 97.7%, AUC: 0.96), respectively. CONCLUSION: The level of hCG within the first 5 weeks after molar pregnancy evacuation is predictive of progression to GTN.

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BACKGROUND: The COVID-19 pandemic has brought about mental anguish to the general population. This pandemic has changed the way we deliver healthcare. The enhanced community quarantine measures have caused the institution to close the outpatient department, leading to apprehensions among patients. Shifting to telemedicine to reach out to the patients as an alternative to face-to-face prenatal services is the current practice. OBJECTIVES: This study was conducted to assess the level of depression, anxiety, and stress in pregnant women enrolled under obstetric (OB) service who now have no access to regular antenatal services, as well as to determine the acceptance of telemedicine as a satisfactory alternative to regular prenatal visits. MATERIALS AND METHODS: This is a descriptive study among patients currently enrolled under OB service in a tertiary hospital in Cebu City and Mandaue City. Respondents have been provided the social media page and given prenatal checks by phone calls from the OB resident doctors since March 2020. A data collection form was filled up online consisting of three parts: (1) the mother's sociodemographic and obstetrical information, (2) a validated tool, the depression, anxiety, and stress-21 scale to assess depression, anxiety, and stress, and (3) query on whether telemedicine has helped alleviate depression, anxiety, and stress. RESULTS: Among the 196 patients surveyed, 21.94% were found to be moderately to severely depressed, 35.2% were moderately to severely anxious, and 8.61% were moderately to severely stressed. About 96.43% of the patients felt that telemedicine alleviated depression, anxiety, and stress during this crucial time. CONCLUSION: The level of depression, anxiety, and stress among the patients was generally normal or low. However, 21.93%, 35.2%, and 8.61% were found to be moderately to severely depressed, anxious, and stressed, respectively. Telemedicine was found to be a satisfactory alternative to regular prenatal visits. Respondents accepted telemedicine for the following reasons: unwilling to go to the hospital for fear of contracting the virus, fear of certain lockdown measures such as no available public transportation and no crossing of borders were allowed.

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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 8^th, 15^th, and 30^th 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.

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BACKGROUND/INTRODUCTION: As the world face health-system shocks from COVID-19, Obstetrician-Gynecologists become perplexed by the uncertainties these bring to the vulnerable pregnant and gynecologic population. The country's capacity for diagnosis via RTPCR consists of only a tiny proportion of the population. With the intent of coming up with a less expensive fast point of care test kits, antibody-based lateral flow assays were developed. AIMS AND OBJECTIVES: Determine the diagnostic accuracy of a lateral flow immunoassay for the detection IgM/IgG antibodies to SARS-CoV2 using RT-PCR as gold standard among symptomatic and asymptomatic high risk OBGYN population. MATERIALS AND METHODS: This is a multicenter cross-sectional prospective study performed on 147 asymptomatic and symptomatic high risk OBGYN patients who underwent both RTPCR and RAT. Test results were entered using a two by two table to compute for the sensitivity (Sn), specificity (Sp), positive and negative predictive value (PPV/NPV), likelihood ratios (LR) comparing RT-PCR with IgM/IgG using Medcalc statistical software. RESULTS: The RAT for IgG/IgM was not found to be sensitive in both groups. It was able to identify only one of the five patients who had COVID-19 based on RT-PCR. Moreover, the (PPV) was found to be only 20% since only one patient tested positive in the RAT for IgM/IgG that was also positive in the RT-PCR. The (LR+ and LR-) for the symptomatic group was close to 1 implying a slightly higher probability of a true positive compared to that of a false positive test and a negative test result given the absence of the disease respectively. (Sp) and (NPV) of the RAT for IgM/IgG is high for both groups. This means that RAT for IgM/IgG does well in identifying patients who truly do not have COVID-19. CONCLUSION: With a very low sensitivity of 5% in this study, RAT for COVID-19 cannot be used for screening purposes.

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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.

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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. Fifty-four 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.

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Placenta accreta syndrome (PAS) is rare in first-trimester abortions with an unscarred uterus. It is this rarity that makes diagnosis and management difficult and challenging. This is a case report of a multigravid with an early incomplete abortion complicated by PAS (placenta increta) manifesting as an ill-defined hypervascular uterine cavity mass on transvaginal ultrasound, with decreasing trends of serum beta-human chorionic gonadotropin. PAS was successfully diagnosed preoperatively, and an uneventful hysterectomy was performed. A curettage that could potentially lead to catastrophic hemorrhage was prevented. This case highlights the diagnostic dilemma in early trimester PAS, the importance of early accurate diagnosis, and a good correlation with ancillary diagnostics to provide prompt and appropriate management.

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A fetal neck mass such as cystic hygroma imposes a challenge in the continuing prenatal care and birth strategy for a 26-year-old gravida 2 para 1 (1001) with a scarred uterus from previous low transverse cesarean section (CS). An intricate delivery for the fetus with a potential airway obstruction necessitates an ex utero intrapartum treatment (EXIT) delivery. The patient was initially scheduled to undergo the procedure at 38 weeks of gestation, but preterm labor ensued. Close antenatal monitoring was done which carried the pregnancy to term. The multidisciplinary approach and planning requires consensus among varied specialties as this maternal–fetal surgery differs immensely from a regular CS. This aims to document and discuss the preoperative, operative and postoperative management done for this patient. The EXIT procedure was performed at 38 weeks' age of gestation with good maternal outcomes. The fetus was delivered safely.

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OBJECTIVE: Studies on Sexual dysfunctions among gynecologic cancer after treatment are sparse in the Philippines and data on sexual dysfunction varies greatly within the gynecologic oncology literature. This study aims to determine the sexual dysfunction among patients with endometrial cancer managed at a tertiary training public institution. METHOD: This research was a cross-sectional study, which utilized a self-administered, validated Filipino version of the Female Sexual Function Index (FSFI) questionnaire in assessing the different domains such as desire, arousal, lubrication, orgasm, satisfaction and pain. Descriptive statistics such as frequency and percentages were used in determining the prevalence of sexual dysfunction in patients with endometrial carcinoma while Kruskal Wallis test and Spearman Rank Correlations were used to determine the association of sexual dysfunction with age, body mass index (BMI), duration and stage of endometrial cancer, presence of comorbidities and mode of treatment. RESULTS: Between May 2020 and January 2021, there were 53 women who participated in this study. Forty-one (77.36%) have sexual dysfunction. Majority of the respondents either reached up to high school level (22.6%) or are college graduates (22.6%). Most of them are also self-employed (58.1%). Fifty eight percent have only 1–3 child/children. Analysis showed no significant correlation of presence of sexual dysfunction to stage of cancer, BMI, presence of comorbidities, period of diagnosis and type of treatment received by the patients. CONCLUSION: The study showed that there was high prevalence of sexual dysfunction among endometrial cancer patients in this study institution. Furthermore, presence of sexual dysfunction is irregardless of BMI, presence of comorbidities, stage of diagnosis, length of diagnosis and type of treatment. Hence, proper screening, diagnosis and counselling should be done to all patients upon diagnosis to promote better quality of life.

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Intestinal obstruction secondary to sigmoid colon volvulus in pregnancy is a rare but serious complication of pregnancy with significant maternal and fetal mortality. We report the first case in this institution of volvulus of the sigmoid colon in a pregnant patient on her 30^th week age of gestation that was successfully managed conservatively with flexible colonoscopic decompression and detorsion. The presenting signs and symptoms seen in this patient are the same as with a nonpregnant patient and are often nonspecific. Hence, a high level of suspicion is essential for early diagnosis. Fetal and maternal mortality rates are higher during pregnancy if the diagnosis is delayed.

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BACKGROUND: Gestational trophoblastic neoplasia (GTN) is a tumor known to be sensitive to chemotherapy. However, a subset of patients still develop resistance to the primary intensive chemotherapy. OBJECTIVE: This study aimed to determine the risk factors for multidrug resistance among high-risk metastatic GTN patients at University of the Philippines–Philippine General Hospital from January 2014 to December 2018. MATERIALS AND METHODS: A case–control study involving 111 high-risk metastatic GTN patients who underwent primary intensive chemotherapy Etoposide Methotrexate Actinomycin Cyclophosphamide Oncovin (EMACO) was done at the Philippine General Hospital from January 2014 to December 2018. The medical records of eligible patients were retrieved and reviewed. A comparison of the profile between patients who achieved remission (controls) and those who exhibited chemoresistance (cases) to the EMACO regimen was done. Stepwise logistic regression analysis and Cox's proportional hazards regression were used to determine the significant risk factors that could predict EMACO chemoresistance among these high-risk patients. RESULTS: The cases and controls were comparable in terms of their clinicodemographic profiles. Adjusting for confounders, multivariate analysis showed that the number of metastasis, FIGO stage, and World Health Organization (WHO) prognostic scores were all predictors of survival. Using the fitted logistic regression model, the accuracy of predicted death and survival was 85.16%. CONCLUSION: The pretreatment serum beta-human chorionic gonadotropin level, number of metastasis, tumor size, FIGO stage, and WHO prognostic score were significant predictors of treatment failure. A higher number of metastatic lesions, stage, and WHO prognostic scores indicated poor survival.

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