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   Table of Contents - Current issue
Coverpage
May-June 2022
Volume 46 | Issue 3
Page Nos. 97-145

Online since Tuesday, August 23, 2022

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ORIGINAL ARTICLES  

Prevalence of vulvar intraepithelial neoplasia: Experience in a tertiary Government Hospital p. 97
Mikaela Erlinda M. Bucu, Efren J Domingo
DOI:10.4103/pjog.pjog_22_22  
Vulvar intraepithelial neoplasia (VIN) is a precancerous lesion involving the squamous epithelium of the vulva. This retrospective descriptive study aims to determine the prevalence of VIN in a tertiary government hospital in a developing country. Medical records of outpatient consultations with the diagnosis of VIN from January 2000 to June 2012 were reviewed. The prevalence of VIN was 1.6/100,000 women over the 12 years. The diagnosis was based on biopsy results of an incidental finding of vulvar lesions on physical examination. The profile of a patient with VIN was a woman aged 40 years old and above, married, multigravid, nonsmoker, high school graduate, and unemployed. Vulvar lesions noted were multiple hyperpigmented papules located at the posterior labia majora. VIN was associated with abnormal colposcopy findings, and 40% were associated with concomitant cervical disease. Treatment was wide local excision. Prompt diagnosis and appropriate treatment of VIN aim to prevent its progression to vulvar carcinoma. Although vulvar carcinoma is a rare condition, there has been a notable rise in prevalence in recent years. Hence, gynecologists should be vigilant and have a high index of suspicion to detect the disease early in its course.
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Timing of urinary catheter removal after radical hysterectomy for cancer of the cervix and uterus: A single-institution observational study p. 103
Jimmy A Billod
DOI:10.4103/pjog.pjog_23_22  
BACKGROUND AND OBJECTIVE: Radical hysterectomy remains to be the first surgery for early-stage cervical and selected stage 2 endometrial carcinoma. Functional disorders of the lower urinary tract are the foremost common complications following radical surgery necessitating catheterization. This study was undertaken to determine the number of postoperative days (POD) of the removal of urinary catheters after hysterectomy and assess the practicability of earlier removal of the catheter without compromising the bladder function. METHODOLOGY: A descriptive observational study of patients who underwent Type 2 or 3 hysterectomy for cervical or endometrial carcinoma. Clinical, intraoperative, and anesthesia records and results of the histopathologic reports of every patient were reviewed. Demographic, clinical, and histopathologic data needed during this review were recorded. Descriptive statistics were used. RESULTS: Between January 2016 and December 2019, a complete 45 patients underwent radical hysterectomy (43 patients for cervical cancer and a pair for endometrial carcinoma), with a median age of 50 years. The mean operative time is 2.5 h and also the average blood loss is 500 ml. The mean size of the cervical tumor was 2.2 cm, the mean length of the vagina was 2.5 cm, and the mean lateral width of parametria was 3.6 cm. Catheters were removed between the 3rd and 20th (mean = 6 days) POD. All patients had adequate spontaneous void within 6 h after removal. Five patients had their catheters removed beyond 7 days, 3 patients between POD 8 and POD 14, and 2 patients between days POD 15 and POD 20. All patients were able to return to bladder function within 3 weeks of catheterization. CONCLUSION: The outcome showed that earlier removal of catheter seems to be a practical and safe option compared to long-term catheterization for patients who underwent radical hysterectomy without causing morbidities.
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Comparison of the effect of miconazole and clotrimazole in the treatment of vulvovaginal candidiasis among women seen in a tertiary medical center from 2016 to 2020 p. 109
Shiara Marriz T. Marquez, Lylah D Reyes
DOI:10.4103/pjog.pjog_24_22  
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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Profile of women admitted with a history of induced abortion at a tertiary government hospital from 2013 to 2017 p. 118
Genevieve A Vista, Helen V Madamba
DOI:10.4103/pjog.pjog_25_22  
INTRODUCTION: Unsafe abortion is one of the major medical and public health problems in developing countries. However, there is a lack of up-to-date and reliable information on induced abortion distribution and its determinant factors in the country. OBJECTIVES: This study determined the sociodemographic and clinical profile of women admitted for abortion at a tertiary government hospital in Cebu city from 2013-2017. METHODS: This study reviewed the charts in medical records of women diagnosed with abortion admitted at a government tertiary hospital from January 2013 to December 2017 with key words “abortion” in the final diagnosis. RESULTS: The results of this study showed that 86% of patients who had induced abortion discharged improved from this institution, 2 patients died due to medical complications and 12% were discharged against medical advice. Majority of abortions were within early ages of gestation. Primigravidas and primiparas had the highest incidence of induced abortion 20.44% and 27.73%respectively. Of the treatments employed, the major method of abortion employed was mechanical. Majority of induced abortions did not develop septic complications. CONCLUSION: The trend in admission of induced abortions from 2013 to 2017 showed a downward trend. This decrease in incidence may be attributed to improved access to family planning methods since the Reproductive Health Law was implemented in 2014 and the introduction of the Maternal Perinatal Statistics quarterly conferences headed by Department of Health (DOH) Region 7 and the different DOH-retained hospitals as well as BEMONC/SEMONC facilities in Cebu Province. 17. These statistical events focuses the spotlight on the importance of health education and further improvement in the provision of health care in the local setting. Moreover, further improvement in post abortive care and adequate coverage should be provided to patients with abortion to reduce the incidence of complications and potential mortality.
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CASE REPORTS Top

Paratubal mass carcinosarcoma: A case report of a rare malignancy in a rare location p. 126
Irish Kate A. Albon, Jimmy A Billod
DOI:10.4103/pjog.pjog_26_22  
Carcinosarcoma, formerly known as malignant mixed Mullerian tumors (MMMTs) are highly aggressive tumors that include both malignant epithelial and mesenchymal or stromal elements. The most common site of carcinosarcomas in a female reproductive organ is the endometrium with an incidence of 2/100,000 females, whereas carcinosarcomas arising from the paratubal mass are extremely rare malignancies accounting for fewer than 0.1% of MMMTs. Carcinosarcomas of the Fallopian tube usually occur in the fifth to sixth decades in postmenopausal women with the most common presenting symptom of abdominal pain, followed by vaginal bleeding and abdominal distention. There have been limited published cases worldwide, that is, it has been a thing of interest to be analyzed in today's era. A rare case of paratubal carcinosarcoma is highlighted in this paper as it discourses its clinicopathological characteristics and assesses the prognostic factors associated with treatment outcome and survival.
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Primary vaginal gestational trophoblastic neoplasia treated with uterine angiographic embolization and chemotherapy p. 131
Maria Concepcion D Cenizal-Santos, Angelica Anne A. Chua, Leon Francis N. Aquilizan
DOI:10.4103/pjog.pjog_27_22  
Gestational trophoblastic neoplasia (GTN) in itself is an uncommon condition, much so is a primary extrauterine GTN. The incidence of GTN in the Philippines is at 22.4/40,000 pregnancies. However, no report has been made for primary extrauterine GTN. Only two cases of primary vaginal choriocarcinoma are reported in the literature. This is a case of a 26-year-old gravida 1 para 0 (0010) who came in for profuse vaginal bleeding. Serum beta-human chorionic gonadotropin (β-hCG) was elevated and ultrasound showed a hypervascular vaginal mass and an empty uterus. A primary vaginal GTN was considered, and the patient was treated with etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine (EMACO) regimen. During the course of chemotherapy, there was a note of profuse vaginal bleeding, which was controlled by angiographic uterine artery embolization. A normal β-hCG level was achieved after six cycles of EMACO. The patient was able to have three successful pregnancy outcomes thereafter. Primary vaginal GTN is a rare condition that requires a high index of suspicion. In a nulliparous patient complicated with profuse vaginal bleeding, angiographic embolization is an effective fertility-sparing procedure that can manage the said complication.
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A successful spontaneous pregnancy after surgery and chemotherapy in a patient with recurrent dysgerminoma: A case report p. 136
Amor Mae M. Pasigon, Jimmy A Billod
DOI:10.4103/pjog.pjog_28_22  
Dysgerminoma comprises 3%–5% among ovarian malignancies, mostly seen in adolescent and early adult women. The recurrence rate is approximately 10%–20%, occurring within 2 years of diagnosis, and has been reported that more than 75% occur in the 1st year. A 19-year-old nulligravid initially presented with severe abdominal pain, who underwent emergency exploratory laparotomy and left salpingo-oophorectomy, whose histopathologic result revealed dysgerminoma, Stage IC2. Recurrence of dysgerminoma was noted on the contralateral ovary 10 months after for which she had undergone another surgery for wedge resection of the right ovarian mass and complete surgical staging. She received adjuvant chemotherapy without complications. Despite two consecutive surgeries and chemotherapy, she had conceived naturally and her pregnancy was carried to term with no complications and delivered to a live baby girl by normal spontaneous delivery. This case is a proof of how fertility-sparing surgeries and chemotherapy in dysgerminoma can successfully preserve reproductive functions for future conceptions.
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CASE SERIES Top

A case series on the use of pessaries for shortened cervix p. 141
Jean Aileen M Elauria-Manalastas, Almira J Amin-Ong, Lisa T Prodigalidad-Jabson
DOI:10.4103/pjog.pjog_29_22  
A cervical length <25 mm is correlated with an increased risk of preterm delivery. Pessaries have been used in patients with a short cervix to prevent preterm birth. Compared to cerclage, it is seen as a novel approach, which is more affordable, less invasive, and can be inserted at a later gestational age. We present our experience on the use of pessaries for shortened cervix. In this case series, we inserted a pessary in pregnant patients from 10 to 30 weeks of age of gestation (mean 23 weeks) with cervical length of 0.9 cm to 2.1 cm. We were able to prolong the pregnancy in 5 of the 7 cases with a mean interval to delivery of 14 weeks. One proposed mechanism of a pessary for shortened cervix is that it directs the inclination of the cervix posteriorly, which allows majority of the weight of the pregnancy to lie on the anterior segment of the uterus instead of on the internal cervical os. Based on the cases presented, we have proposed some guidelines in offering a pessary for patients with a shortened cervix: (1) recommend a pessary in patients with a cervical length <25 mm or a diagnosis of cervical insufficiency; (2) exclude infection or active labor; and (3) remove the pessary if there is rupture of membranes, significant vaginal bleeding, or persistent uterine contractions.
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