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   Table of Contents - Current issue
Coverpage
January-February 2022
Volume 46 | Issue 1
Page Nos. 1-54

Online since Friday, April 15, 2022

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ORIGINAL ARTICLES  

Knowledge, attitude, and practices toward COVID-19 and infection prevention and control among tertiary level hospital labor and delivery room healthcare workers in time of pandemic: A cross-sectional survey p. 1
Joan M Flores, Maria Michelle G. Borbe
DOI:10.4103/pjog.pjog_4_22  
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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Acceptability of telemedicine among patients undergoing prenatal and postnatal care in the setting of the COVID-19 pandemic p. 12
Ivy E Quiñones, Virgilio M Novero Jr.
DOI:10.4103/pjog.pjog_5_22  
BACKGROUND: While COVID-19 spreads rapidly around the world, innovative means to provide continuing prenatal care are being developed to monitor maternal and fetal health while minimizing disease transmission. Telemedicine is one platform by which patients are provided the necessary prenatal and postpartum care safely as the pandemic rages. AIMS AND OBJECTIVES: To evaluate the acceptability of telemedicine in the delivery of prenatal and postnatal care in the setting of the COVID-19 pandemic. MATERIALS AND METHODS: A cross-sectional study was conducted in a tertiary hospital in Manila. A structured Likert scale-based survey consisting of a model measuring telemedicine perception was utilized. This was a predeveloped model by Lin in 2017.[1] Descriptive statistical analysis and Chi-square tests were done to evaluate the data. RESULTS: A total of 193 pregnant and postpartum patients participated in the study. Majority of the respondents were between 25 and 34 years old, living within Metro Manila, and normal obstetric patients who were previously seen at the outpatient department. Most of the participants considered telemedicine to be cost-effective, reliable, easy to use, and useful. CONCLUSION: We conclude that telemedicine is an acceptable means of providing prenatal and postnatal care among pregnant patients because it allowed the necessary interaction between patient and doctor and these “users” kept on using the system. There was no association between telemedicine perceptions and patient age, place of residence, type of patient encounter, disease, and treatment. In the setting of the COVID-19 pandemic, telemedicine is an acceptable means of providing prenatal and postnatal care regardless of patient characteristics.
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Comparison of maternal and neonatal outcomes between COVID-19 positive and negative parturients who delivered in a tertiary hospital: A retrospective cohort study p. 20
Stephanie M Lazo, Victoria N Sy-Fernando
DOI:10.4103/pjog.pjog_6_22  
INTRODUCTION: The coronavirus disease 2019 (COVID-19) is a respiratory disease caused by novel coronavirus named Severe Acute Respiratory Syndrome Coronavirus 2. Its growing number of cases with a very limited number of studies in the country is quite alarming, especially to the vulnerable populations, such as pregnant women. OBJECTIVE: To determine and compare the maternal and neonatal outcomes of COVID-19 positive versus negative parturient. MATERIALS AND METHODOLOGY: This is a retrospective cohort study of 131 parturient in a tertiary hospital. RESULTS: We analyzed a total of 131 patients, of whom 65 (49.6%) were COVID positive. At the time of testing, more than half were at their early term of pregnancy (64.89%) and at term (14.5%). Based on disease severity, 45 women (69.2%) exhibited mild disease, 39 were asymptomatic and 6 symptomatic, 19 (29.2%) moderate disease, and 1 (1.5%) severe disease. Among those symptomatic, the most common signs and symptoms were cough (33.85%), myalgia (10.77%), and a radiographic finding of localized or multilobar infiltrates (30.76%). Those who had laboratory examinations, the c-reactive protein (CRP) and D-dimer were found to be elevated. Based on maternal outcomes, there was a higher incidence of preterm birth (21.54%, P = 0.048) and longer length of hospital stay (P = 0.005) in the COVID-19-positive group. While the neonatal outcomes were similar in both groups, except for longer hospital stay, and delayed institution of breastfeeding among the COVID-19-positive group. CONCLUSION: In this study, there was no evidence that the presence of COVID-19 infection during pregnancy causes increased morbidity and mortality in mothers and their neonates. Close surveillance should be done on this population, especially if detected before term, as these patients are predisposed to having preterm labor. Further research is needed to understand the true extent of the risks to improve the management of these special population.
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SPECIAL ARTICLE Top

2020 POGS report on obstetrical and gynecological indicators of health care p. 29
Annette M Macayaon, Maria Antonia E. Habana, Helen R Amorin, Antoinette U Añonuevo, Jennifer C del Prado, Ina S Irabon, Angelito D L. Magno, Ma Luisa T. Mangubat
DOI:10.4103/pjog.pjog_10_22  
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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CASE REPORTS Top

A series of unfortunate events: Guillain-Barre syndrome on a COVID-positive pregnant patient p. 38
Ma Kristina Barbara O. Reyes, Encarnita D G. Nicolas
DOI:10.4103/pjog.pjog_7_22  
Pregnancy involves various changes to adapt and ensure the growth and development of the fetus. These changes explain why pregnant women are at high risk for certain diseases. Compared with the nonpregnant, their morbidity and mortality are increased. Severe acute respiratory syndrome coronavirus 2, the causative agent of coronavirus 2019 (COVID-19), has been associated with severe outcomes, especially in pregnant women with a propensity to attack the neural tissue and cause several neurologic manifestations and diseases like Guillain-Barre syndrome (GBS). This is a case report of a 22-year-old G2P0 (0010) who presented with upper respiratory tract infection symptoms and eventually develop an ascending symmetrical limb weakness. This paper aims to: (1) present a case of GBS on a COVID-19 confirmed pregnant woman, (2) discuss the association between GBS and COVID-19, and (3) discuss the intrapartum management in a pregnant woman presenting with GBS.
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A confirmed case of menstrual cup-associated toxic shock syndrome: A Philippine perspective p. 44
Andrea Francesca I. Santos, Merlind M Montinola-Morales
DOI:10.4103/pjog.pjog_8_22  
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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When the metastatic tumor presents as a primary tumor: Gastric signet-ring cell carcinoma presenting as advanced cervical cancer with ovarian metastasis p. 50
Marie Felle P. Flores, Angelito D L. Magno
DOI:10.4103/pjog.pjog_9_22  
Ovarian cancer is the second most common malignancy of the lower part of the female genital tract. Primary signet-ring cell carcinoma (SRCC) of the ovary is rare and is most commonly metastatic from a primary lesion. Discerning between primary and metastatic SRCC of the ovary or cervix may be difficult. SRCC of the cervix is also a rare type of cervical carcinoma, and just like in the ovary, it is usually metastatic from a primary gastric tumor. Presented here is a case of a 37-year-old nulligravid, who presented with an increase in abdominal girth with associated abdominal pain. The initial impression was ovarian new growth, probably malignant, and cervical mass, probably malignant. On laparotomy, intraoperative impression was cervical with ovarian malignant tumor, primary unknown versus double primary. Histopathology revealed metastatic adenocarcinoma, right ovary, cervical stroma, omentum, and umbilical mass with anterior abdominal mass. Peritoneal fluid was positive for malignant cells. Clinical correlation, further workup, and immunohistochemical stains for CK7, CK19, CK20, and CDX2 were recommended. All immunohistochemical results tested positive in tumor cells and were noted to be consistent with metastatic carcinoma of gastric versus pancreatic primary. Further workup was done, and the biopsy from the esophagogastroduodenoscopy revealed poorly differentiated adenocarcinoma with signet-ring features, antral mucosa.
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