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   Table of Contents - Current issue
January-February 2023
Volume 47 | Issue 1
Page Nos. 1-41

Online since Tuesday, May 30, 2023

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The obstetrician-gynecologist as a researcher with integrity p. 1
Efren J Domingo, Jose Mario C. Espino
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Exposure of reproductive-aged pregnant and nonpregnant women to common environmental pollutants and endocrine-disrupting chemicals: A cross-sectional survey at the University of the Philippines-Philippine General Hospital p. 3
Erlidia F Llamas-Clark, Francisco M Heralde III, Maria Stephanie Fay S. Cagayan, Maria Esterlita V. Uy, John Robert Medina, Paulyn Jean R. Ubial
CONTEXT: Exposure to environmental pollutants (EP) and Endocrine-disrupting chemicals (EDCs) is associated with several general negative health effects which compromise women's reproductive health, maternal, and neonatal outcomes. Unfortunately, many nonpregnant and pregnant women are unaware of their active exposure to these potentially slow-acting toxic substances, EPs, and EDCs. At any stage of life, and in the long-term minute exposures, there is no established safe level of exposure to these substances. Due to the potentially harmful effects on women in general, and to the pregnant and her unborn child in particular, it is important to establish the prevalence of their exposure. AIMS: The aim of this study was to determine the magnitude (prevalence) of exposure among nonpregnant and pregnant women aged 18–49 years to common EPs/EDCs such as bisphenol A, pesticides, phthalates, and perfluorinated compounds among others. SETTINGS AND DESIGN: This study was conducted at the Philippine General Hospital, University of the Philippines Manila. SUBJECTS AND METHODS: The study participants were nonpregnant and pregnant women, with low-risk singleton pregnancy, and had a prenatal checkup and eventual delivery at the Philippine General Hospital. After consent, women were asked to answer a survey focused on their sociodemographics and frequency of exposure to EP- and EDC-containing items. STATISTICAL ANALYSIS USED: Descriptive statistics were used to summarize the demographic and clinical characteristics of the patients. Null hypotheses were rejected at 0.05 α-level of significance. The computer software STATA 13.1 was used for data analysis. RESULTS: One hundred and fifty-nine survey responses by women were analyzed. Possible EDC-containing household items (carpets, linoleum, upholstered, and stain-resistant furniture) are more prevalent in the homes of pregnant women compared to nonpregnant women. Pregnant women are also exposed to wallpapers compared to nonpregnant individuals. Nonpregnant women were 1.5 times more exposed to lotions. Unexposure to hand sanitizers is 1.3 times higher among pregnant individuals. CONCLUSIONS: There are differences in the prevalence of exposure to household EDC-containing items between pregnant and nonpregnant women, with pregnant women having a higher prevalence of exposure.
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Prevalence of premalignant cervical lesions among women in community-based screening program using visual inspection with acetic acid in Metro Manila p. 11
Genalin Fabul Amparo, Carolyn Reyes Zalameda-Castro, Michelle S Diwa-Hernandez
BACKGROUND: Cervical cancer remains a health-care burden in our country. Majority of women afflicted with this cancer are diagnosed in advanced stage. Several groups like the Philippine Society for Cervical Pathology and Colposcopy (PSCPC) have put forth efforts to decrease and eventually eliminate cervical cancer through improvement in level of awareness on the disease and community-based cervical cancer screening programs using visual inspection using acetic acid (VIA). Data on the prevalence of premalignant lesions using this screening method are limited in our country. Thus, the initiative of the society (PSCPC) to embark on this study. OBJECTIVE: The objective of this study was to determine the prevalence of premalignant cervical lesions among women screened in community-based screening program using VIA in Metro Manila. METHODOLOGY: A retrospective cross-sectional study with collection of data from medical records of cervical screening programs done by the PSCPC from March 2017 to December 2019 was done. VIA was done for screening. All VIA-positive women underwent colposcopy and those with abnormal findings had colposcopically guided cervical punch biopsy. RESULTS: A total of 1072 women were screened with a positivity rate of 14.6%. One hundred and fifty-six women were VIA positive and 79 of these women underwent colposcopically guided biopsy. Premalignant cervical lesions were seen in 21 women. The prevalence rate of premalignant cervical lesions in VIA-positive women was 13.5%. The prevalence of premalignant cervical lesions among all women screened was 2%. Risk factors associated with premalignant lesions were early coitarche and smoking. CONCLUSION: The prevalence of premalignant cervical lesions among women who underwent community-based cervical cancer screening using VIA is lower compared to other studies at 2%.
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Association of Vitamin D supplementation in pre-eclampsia: Systematic review and meta-analysis p. 17
Felise Tiffany Suyo Ong, Floriza Crisostomo Salvador, Dirdrah Aina Crisostomo Salvador
INTRODUCTION: In the Philippines, hypertensive diseases of pregnancy belong in the top three causes of maternal mortality and complicate up to 10% of pregnancy worldwide. In relation with this, proper interventions must be given during the prenatal check-up to prevent occurrence that may cause feto-maternal mortality and morbidity. During prenatal check-up, pregnant women are given vitamin and mineral supplementations. Vitamin D has an association of having a risk for preeclampsia. Receptors of Vitamin D and 1-a hydroxylase are both expressed in the decidua and trophoblast cells. The active form of Vitamin D affects the transcription and function of genes associated with angiogenesis, invasion of the placenta, and normal implantation. The mechanisms mentioned are all involved in the pathophysiology of preeclampsia. OBJECTIVES: The primary outcome of this study is to determine the association of Vitamin D supplementation in preeclampsia. Specifically, this study aims to compare the following secondary outcomes: Maternal outcomes (complication of gestational diabetes mellitus and underwent cesarean delivery) and fetal outcomes (preterm delivery and birth weight). METHODOLOGY: Meta-analysis and systematic review of eight randomized controlled trials. RESULTS: Vitamin D reduced the risk of preeclampsia (risk ratio [RR] 0.45, 95% confidence interval [CI] 0.30–0.69; P = 0.0002). No significant difference on risk of gestational diabetes mellitus (RR 0.84, 95% CI 0.48–1.48) and risk of preterm delivery (RR 0.71, 95% CI 0.49–1.03). Results showed that newborns of mothers who had no Vitamin D supplementation had a higher birthweight (P = 0.010). No significant difference on cesarean section rate (RR 1.12, 95% CI 0.87–1.45). CONCLUSION: Evidence suggests that Vitamin D supplementation can reduce the risk of preeclampsia. This study encourages obstetricians in our country to add Vitamin D supplementation as prenatal medication to prevent preeclampsia, thereby reducing maternal morbidity and mortality.
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Risperidone as a galactogogue of choice in peripartum: A concise review p. 27
Saheed Olanrewaju Raji, Sunday Onyemaechi Oriji, Adam Ahmad
Human lactation is a dynamic physiological process that produces a complex biological fluid that provides nutritive and nonnutritive factors for an optimal child growth and well-being. Several factors play a formidable role in maternal breast milk production with respect to quality, and quantity, which will adequately sustain the child for at least the first 6 months after delivery. Evidence has shown majority of new mothers who wished to immediately commence exclusive breastfeeding after birth as recommended by the WHO, are unable to initiate lactation immediately. In view of this lactation insufficiency, health-care personnel have not only been campaigning on appropriate breastfeeding education but also offer early lactation support such as encouraging liberal fluid intake, dietary modifications, and in a worst-case scenario, administering agents/drugs such as galactogogue. Orthodox galactogogues in current use are either hormonal or antipsychotics; most of them have relative efficacy and safety limitations. Risperidone is an atypical antipsychotic which has been used for decades with established safety in lactating mothers and the highest propensity to induce galactorrhea as a secondary effect when compared to other antipsychotics that are currently being used as galactogogues. We call the attention of the medical community in conducting further researches on its possible adoption as a galactogogue, using this review as an insight.
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An approach to the management and care of an individual with 46, XX ovotesticular disorder of sexual differentiation p. 30
Maria Angela B de Castro-Abesamis, Mikaela Erlinda G Martinez-Bucu
Ovotesticular disorder of sexual differentiation (OT-DSD) is a rare condition defined by the presence of both testicular and ovarian elements in the same individual. Definitive diagnosis is made based on histological assessment of the gonad/s confirming both ovarian and testicular components. In this paper, we describe how a diagnosis of 46XX, OT-DSD was made in a 20-year-old individual with enlarged breasts and ambiguous genitalia. The initial impression was congenital adrenal hyperplasia (CAH) based on 46, XX karyotype and absence of testes on physical examination and imaging. However, biochemical tests were inconsistent with CAH, hence a more probable diagnosis of 46, XX OT-DSD was considered. The patient suffered from gender dysphoria and after extensive counseling, he decided to undergo gender-affirming surgery: laparoscopic excision of the left gonad, subtotal hysterectomy, bilateral mastectomy, and a masculinizing genitoplasty. Histopathology of the left gonad revealed an ovotestes which confirmed the diagnosis of 46, XX OT-DSD.
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Double the trouble: A case report on uterine didelphys with unilateral cervical atresia p. 37
Cristyne G Loquero, Mona Ethellin L Yiu-Senolos
Genetic errors and teratogenic events during embryonic development can lead to congenital abnormalities of the female reproductive tract. Many patients are asymptomatic, while some have major abnormalities that can cause severe impairment of menstrual and reproductive functions. This case report focuses on Müllerian anomaly Class III, uterine didelphys, along with obstructed hemivagina and ipsilateral renal agenesis (the Herlyn–Werner–Wunderlich syndrome [HWWs]). The patient presented with cyclic pelvic pain due to the hematometra and hematocolpos. She initially underwent resection of the vaginal septum but had a recurrence of obstructive symptoms more than a year after vaginal surgery was performed. This prompted further evaluation with magnetic resonance imaging revealing cystic dilatation of the right uterine horn and a hypoplastic right vagina appearing to end blindly. The patient subsequently underwent hemihysterectomy. The right hemiuterus was noted to have a depression on its thickened inferior aspect, but no cervix was identified. This case is a variant of the classic HWWS, as there was cervical atresia on the right uterine corpus. A thorough preoperative evaluation and accurate intraoperative assessment of patients with Müllerian anomalies can decrease misdiagnoses, guide appropriate intervention, and decrease the risk of future reproductive complications.
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