Philippine Journal of Obstetrics and Gynecology

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INTRODUCTION: Polycystic ovarian syndrome (PCOS) is a common endocrinopathy affecting women during reproductive age. Women affected by PCOS generally have a higher risk of developing Metabolic syndrome (MetS). MetS on each phenotype of PCOS reflects some phenotypes with worse metabolic profiles and a higher risk of developing long-term complications in women with PCOS. OBJECTIVE: To determine the association of MetS with different phenotypes of PCOS among Filipino women in a tertiary hospital. MATERIALS AND METHODOLOGY: This is a retrospective cohort study of 154 women in a tertiary hospital, both private and service divisions. RESULTS: A total of 154 patients with PCOS were analyzed in this study: 67 (43.51%) Phenotype A, 25 (16.23%) Phenotype B, 3 (1.95%) Phenotype C, and 59 (38.31%) phenotype D. The prevalence of MetS in PCOS was 69.48%, with no significant difference statistically between phenotypes. MetS was most prevalent in Phenotype A (74.63%) and least prevalent in phenotype D (62.71%). Among Filipino women with PCOS, Phenotype A had a 2.5 times increased risk of developing MetS compared to Phenotype D. CONCLUSION: Phenotype A is the most common phenotype and has the highest prevalence in developing metabolic changes. Increasing body mass index and age played significant roles in elevating the risk of developing MetS. Early detection of MetS in all phenotypes of PCOS can aid in preventing the development of long-term complications such as cardiovascular disease and diabetes mellitus type II.

BACKGROUND: When it comes to health, the most overlooked aspect of health in the Philippines is oral health. Numerous studies have reported the possible association of maternal periodontal diseases with preterm birth (PTB). However, their association remains controversial. To our knowledge, this is the first local study to describe the prevalence of periodontal disease in pregnant women and its association with PTB. OBJECTIVE: This study aims to determine the association between PTB and maternal periodontal disease. MATERIALS AND METHODS: PTB or cases (n = 28) included subjects who had spontaneous labor or rupture of membrane and delivered before 37 weeks of gestation. Full-term birth or controls were normal births at or after 37 weeks of gestation (n = 28). Sociodemographic and health-related characteristics were obtained through interviews and medical records. Full-mouth periodontal examination was performed on all mothers within 2 days of delivery. Three indices were utilized to assess periodontal diseases– oral hygiene index-Simplified, Modified Gingival Index and Lindhe Classification of Tooth Mobility. The number of missing teeth and the presence of dental caries, pus, and calcular deposits were likewise noted. RESULTS: Majority of the subjects had poor oral health care - 94.6% visit the dentist only as needed and 53.7% cannot recall their last dental consult. The multivariate logistic regression model, after controlling for other risk factors, demonstrated that gingivitis is a risk factor for PTB (P = 0.0057) with an odds ratio of 20.25. The presence of dental caries is another risk factor (P = 0232). CONCLUSION: With the findings of gingivitis and the presence of dental caries having a significant association with PTB, we recommend a review of current antepartum practice guidelines to include preventive dental care as part of routine prenatal care.

BACKGROUND: Pre-eclampsia is a multi-organ progressive disorder that is estimated to complicate 2 to 8% of pregnancies. Numerous studies on prophylactic aspirin intake among high-risk pregnant women has been established but studies involving low-risk primigravida women are limited. OBJECTIVES: To determine if prophylactic intake of aspirin will reduce the occurrence of pre-eclampsia among primigravida women with no identified comorbidities and to determine the incidence and association of identified secondary outcomes. METHODOLOGY: This retrospective cohort study was conducted from January 2018 to December 2020 in two (2) tertiary hospitals in the province of Cavite. Two hundred four (204) primigravida women with no identified co-morbidities and delivered to a singleton fetus, vaginally or operatively, were identified and included. In-patient and out-patient charts of primigravida women, with aspirin intake versus no aspirin intake, were reviewed. Primary outcome (pregnancy induced hypertension) and secondary outcomes (preterm delivery, small-for-gestational age infants, IUFD, HELLP syndrome and abruption placenta) were identified. RESULTS: The mean age of patients was 27.1 years and 25.9 years in the aspirin and non-aspirin group, respectively. In aspirin group, 4.9% of the patients developed pre-eclampsia versus 9.8% in non-aspirin group showing statistical significance. The effect of aspirin across other hypertensive disorders of pregnancy were noted to be the same. However, influence of aspirin with the average blood pressure on admission and secondary outcomes were not statistically significant. CONCLUSION: Prophylactic aspirin intake has a significant effect in preventing pre-eclampsia among non-high risk primigravida women but did not influence the average blood pressure on admission, development of preterm PIH, and development of the secondary outcomes.

Swyer syndrome is a type of gonadal dysgenesis wherein a 46,XY karyotype presents with a female phenotype. It is a rare cause of disorder in sexual development that occurs in 1:100,000 births. Local studies are currently limited to few case reports. Sex-determining region on the Y chromosome gene mutation is the root cause of nonfunctional gonads with no hormonal or reproductive potential. They are born with normal female external genitalia but not suspected until puberty when menses do not occur or if secondary sexual characteristics do not develop. This report presents the case of a 23-year-old phenotypically female presenting with primary amenorrhea and hypogastric discomfort. Ultrasound revealed an infantile cervix and uterus with streak left ovarian tissue and a cystic mass on the right pelvic area. Gonadotropin levels were elevated, and the karyotype showed a normal male 46,XY. Laparoscopic bilateral gonadectomy with salpingectomy was done, which revealed dysgerminoma on bilateral ovarian tissues. In conclusion, this report describes a rare case of Swyer syndrome associated with ovarian dysgerminoma. Accurate and prompt diagnosis, using a systematic approach in evaluating primary amenorrhea, is crucial in initiating treatment. Our goal is to ensure hormonal replacement, fertility preservation, psychosexual and emotional stress reduction, and overall patient survival.

A 51-year-old gravida 5 para 5 (5005) presented with an increasing abdominal girth and a palpable abdominal mass. She was initially diagnosed with ovarian new growth and underwent exploratory laparotomy. Intraoperatively, the uterus, Fallopian tubes, and ovaries were grossly normal and a large mass was seen attached to the cecum where the appendix should be referral to surgery service was done. Right hemicolectomy and ileostomy were performed. The histopathology report was "suggestive of a Müllerian adenosarcoma (MAS) involving the appendix and cecum." Microscopic examination showed evidence of endometriosis with no evidence of sarcomatous overgrowth, features that are favorable prognostic factors associated with higher disease-free survival. Postoperatively, the plan of management was hormonal therapy. Extragenital MAS is rare. This case is the fourth case to be reported in the literature to arise from the colon. Although there is still no standard of treatment, accurate diagnosis is imperative for appropriate management.

Primary ovarian leiomyosarcoma (POLMS) is an exceedingly rare neoplasm accounting for only 0.1% of all ovarian malignancies and most commonly occurring in postmenopausal women. Prognosis is poor with only a 20% 5-year survival rate. Surgery remains to be its mainstay treatment. Discussed here is a 72-year-old nulligravid with hypogastric pain. Transrectal ultrasound showed a right ovarian new growth, probably malignant on International Ovarian Tumor Analysis (IOTA) simple rules, with a 79.2% risk of malignancy by IOTA ADNEX and an unremarkable uterus. Other workups were normal. She underwent primary cytoreductive surgery. Histopathologic diagnosis was ovarian leiomyosarcoma with positive immunohistochemical staining for desmin, S-100 protein, smooth muscle actin, and epithelial membrane antigen. She refused adjuvant chemotherapy postoperatively. The latest published literature on POLMS was also reviewed to develop the provisional criteria for its prompt diagnosis, thereby decreasing the heterogeneity of the diagnostic approach as well as supporting future researches on manifestations, clinical courses, and therapeutic plans.

Online since 8^th July 2021