Philippine Obstetrical and Gynecological Society (Foundation), Inc.

(POGS)
2021 Annual Convention and 75th Diamond Anniversary Celebration
“#RISE Up to the New Normal: Relevant, Innovative, Sensitive, Engaging”

BOOK OF ABSTRACTS
2021

Subcommittee on Scientific Work Abstracts

Ana Victoria V. Dy Echo, MD, MHPEd

Editor-in-Chief and Subcommittee Chair

Kristine Therese R. Elises-Molon, MD

Co-editor

Maria Constancia Y. Wylengco, MD

Subcommittee Co-Chair

Members
Joanne Karen S. Aguinaldo, MD
Mikaela Erlinda M. Bucu, MD
Mary Judith Q. Clemente, MD
Ma. Febi B. De Ramos, MD
Sherri Ann L. Suplido, MD

Technical Secretary
Ms. Mary Rose P. Guinto
Philippine Obstetrical and Gynecological Society (Foundation), Inc. (POGS)
Board of Trustees 2021

Benjamin D. Cuenca, MD
President

Marlyn T. Dee, MD
Vice President

Leilani C. Coloma, MD
Secretary

Erwin R. De Mesa, MD
Treasurer

Ma. Socorro M. Solis, MD

Public Relations Officer

Board of Trustees
Rowena M. Auxillos, MD
Efren J. Domingo, MD
Pressie P. Eclarin, MD
Ma. Gay M. Gonzales, MD
Gil G. Gonzales, MD
Henrietta S. Lucasan, MD
Annette M. Macayaon, MD
Enrico Gil C. Oblepias, MD
Marjorie I. Santos, MD
Ronaldo Antonio R. Santos, MD
 Philippine Obstetrical and Gynecological Society (Foundation), Inc. (POGS)
2021 Annual Convention and 75th Diamond Anniversary Celebration
“#RISE Up to the New Normal: Relevant, Innovative, Sensitive, Engaging”

Organizing Committee 2021

Officers
POGS President and Honorary Chair Benjamin D. Cuenca, MD
POGS Vice President and Overall Chair Marlyn T. Dee, MD
POGS Board Secretary Leilani C. Coloma, MD
Convention Secretary Catherine Joie Carelle R. Ong, MD
POGS Treasurer Erwin E. De Mesa, MD
POGS Public Relations Officer Ma. Socorro M. Solis, MD

Committees
Scientific Program Angela S. Aguilar, MD
Ma. Cristina P. Crisologo, MD
Speaker’s Bureau Jocelyn Z. Mariano, MD
Katherine A. Dela Cruz, MD
E-Library Anne Catherine A. Castro, MD
Andrea S. Santiago, MD
Virtual Arrangements and Jennifer T. Go, MD
Technical Systems (VART) Marlene R. Javier, MD
Ways and Means Ditas Christina D. Decena, MD
Sybil Lizanne R. Bravo, MD
Exhibits Rosemarie P. Tiburcio, MD
Kristen C. Canlas, MD
Documentation Leslie R. Rigor, MD
Leedah L. Rañola-Nisperos, MD
Programs and Invitations Anne Marie C. Trinidad, MD
Maria Therese B. Mallen, MD
Souvenir Program Maria Lyn E. Sese, MD
Rosa P. Capinpin, MD
Scientific Work Abstracts Ana Victoria V. Dy Echo, MD
Maria Constancia Y. Wylengco, MD
Registration Emmanuel L. Dagala, MD
Maribel Emma C. Hidalgo, MD
Socials Jennifer A. Aranzamendez, MD
Marinella Agnes G. Abat, MD
Sports Antoinette U. Añonuevo, MD
Marinella Agnes G. Abat, MD
 Table of Contents

RESEARCH
R-1 A comparative study on the use of Friedman’s curve Lara Germaine Q. Torres-Gongora, MD
vs. Zhang partogram on maternal and neonatal Andrea Milagros L. Mapili, MD
outcomes in a tertiary hospital: A cross-sectional
study

R-2 A cross-sectional comparative study on the Bernadette Mayumi T. Mortel, MD

diagnostic accuracy of manual vacuum aspirator vs. Lilli May T. Cole, MD
endosampler among patients with abnormal uterine Debby P. Songco, MD
bleeding and postmenopausal bleeding in a tertiary Arnel C. Dy, MD
university hospital

R-3 Application of sono-elastography in differentiating Catherine M. Santos, MD

endometrial carcinoma from benign endometrial Nelinda Catherine P. Pangilinan, MD
lesions: A cross-sectional study Maria Christina C. Franada, MD

R-4 Assessment of functionality of selected BEmONC Margaret Rose C. Bocaya, MD

rural health units in Central Luzon Dolores A. Mercado, MD
Gene A. Nisperos, MD
Mary Christine R. Castro, MD
Maria Stephanie Fay S. Cagayan, MD, PhD

R-5 Association of total gestational weight gain and Francesca Debbie L. Liu, MD
maternal and perinatal outcomes among pregnant Maria Michelle G. Borbe, MD
patients using the Institute of Medicine 2009
gestational weight gain guidelines in a tertiary
hospital

R-6 Changes in obstetric practices in the first 3 months Kristine Mae A. de Guzman, MD
of the COVID-19 pandemic in a private tertiary Agnes L. Soriano-Estrella, MD, MHPEd
hospital: A descriptive cross-sectional study

R-7 Characteristics of COVID-19 positive pregnant Josephine Alexandra D. Lim, MD

patients admitted in a private tertiary hospital and Zarinah G. Gonzaga, MD
their maternal and neonatal outcomes Mariles R. Hernandez-Nazal, MD

R-8 Comparison of the effect of miconazole and Shiara Marriz T. Marquez, MD

clotrimazole in the treatment of vulvovaginal Lylah D. Reyes, MD
candidiasis among women seen at a tertiary medical
center from 2016 to 2020
RESEARCH
R-9 Comparison of maternal and neonatal outcomes Stephanie M. Lazo, MD
between COVID-19 positive and negative parturient Victoria N. Sy-Fernando, MD
who delivered in a tertiary hospital: A retrospective
cohort study

R-10 Effect of cytoreductive surgery and HIPEC on Romelyn April P. Imperio-Onglao, MD

epithelial ovarian, fallopian tube and peritoneal Jericho Thaddeus P. Luna, MD
cancer: An institutional review of outcomes and its
clinical implications

R-11 Effect of the COVID-19 pandemic on utilization of Maria Stephanie Fay S. Cagayan, MD, PhD
Luzon rural health units BEmONC facilities Mary Christine R. Castro, MD
Gene A. Nisperos, MD

R-12 Fears, perceptions and concerns on COVID-19 of Christine Mariz T. Ching, MD

term pregnant women in a tertiary hospital: A cross- Maria Michelle G. Borbe, MD
sectional study

R-13 Impact of adenomyosis on the patient’s quality of Joanne Y. Luy, MD

life in a tertiary hospital Marie Janice A. Boquiren, MD

R-14 Interpregnancy interval and associated maternal Frances Michelle B. Castillo, MD

and neonatal outcomes among multigravid Marbee Pherenice B. Torrizo, MD
singleton pregnant women delivered in a tertiary
hospital in Cebu-City: A retrospective cohort study
(2016-2020)

R-15 Intraoperative findings and neonatal outcomes in Christine Joy P. Embay, MD

emergency cesarean section for non-reassuring Lynette R. Lu-Lasala, MD
fetal heart rate pattern among low-risk term
pregnancies in a tertiary hospital in Davao City: A
retrospective study

R-16 Knowledge, attitude and practices of obstetrics and Kathleen R. Vista, MD

gynecology consultants and residents in Region 7 Pherdes E. Galbo, MD
towards teenage pregnancy

R-17 Local validation of the fullPIERS (preeclampsia Christine Noemi R. Etang, MD

integrated estimated risk score) model for the Christie Luz Rosal, MD
prediction of adverse maternal outcomes in women
with pre-eclampsia
RESEARCH
R-18 Octyl cyanoacrylate tissue adhesive vs. Aprille Lorraine M. Liao, MD
subcuticular suture for skin closure during cesarean Larisa Julia Diaz-Roa, MD
delivery at a tertiary hospital: A randomized
controlled trial

R-19 Patient and operative factors associated with Iza Roelle L. Maniego, MD
strategic or reactive conversion to laparotomy Prudence V. Aquino-Aquino, MD
during laparoscopy in pelvic endometriosis: A case- Maria Rica F. Arandia-Baltazar, MD
control study Zoraida R. Umipig-Guevara, MD

R-20 Pharmacologic treatment on chronic hypertension Edcyndi M. Tan, MD

in pregnancy based on ACOG vs. ACC/AHA Antoinette P. Mendoza, MD
guidelines

R-21 Prediction of postpartum depression based on Angelynn S. Sianghio, MD

perinatal risk factors among patients in a tertiary Elisa Patricia M. Cornelio, MD
hospital in the Philippines

R-22 Preterm birth research in Southeast Asia and its Koleen C. Pasamba, MD
association with socioeconomic determinants and Jean Anne B. Toral, MD, MSc
burden of disease: A bibliometric analysis

R-23 Prevalence of mismatch repair deficiency in Filipino Maria Patricia Angelica M. Tanchuling, MD
women with endometrial cancer and its correlation Michelle H. Diwa, MD
with clinicopathologic features, adjuvant treatment Karen Cybelle J. Sotalbo, MD
and outcomes Cecile C. Dungog, MD, PhD
Renee Vina G. Sicam, MD
Carolyn R. Zalameda-Castro, MD, MSc

R-24 Reproducibility study on the International Nina Rojana L. Yu, MD

Endometrial Tumor Analysis (IETA) terminology for Regina Rosario M. Panlilio, MD
the evaluation of sonographic endometrial vascular
parameters in women with abnormal uterine
bleeding

R-25 Sexual dysfunction among patients with Katrina Mae A. Natavio, MD

endometrial cancer at a tertiary training public Jimmy A. Billod, MD, MHCA
institution: A cross-sectional study

R-26 The difference in delivery outcomes of mothers with Venice M. Lawas, MD

gestational diabetes mellitus on metformin therapy Christie Luz Rosal, MD
vs. insulin therapy in a tertiary hospital: A
retrospective cross-sectional study
RESEARCH
R-27 The effectiveness of audiovisual distraction in Aileen F. Acuna, MD
reducing labor pain during the active stage: A Jaynet DC. Tan, MD
randomized controlled trial Yamami B. Chan, MD

R-28 The effectiveness of evening primrose oil capsule Anjelica Naguiat-Leynes, MD

vs. oxytocin pharmacologic approach in labor Jaynet DC. Tan, MD
augmentation: A randomized controlled trial Maria Myra G. Villaroman, MD

R-29 The prevalence of COVID-19 infection among Renee Riza C. Medalla, MD

gynecologic oncology patients receiving cancer Jericho Thaddeus P. Luna, MD
treatment in a COVID-19 referral hospital

R-30 The relationship of ultrasonographic modified Vanessa Marie T. Lim, MD

STEPW classification for submucous uterine Anna Liza C. Salita, MD
leiomyoma to hysteroscopic myomectomy outcome: Maria Ysidora Margarita Yap-Garcia, MD
A Philippine tertiary institutional experience Christine Joyce M. Omolida, MD

R-31 The utility of neutrophil-lymphocyte ratio in Lailanie Jane C. Santiago, MD

predicting medical failure in tubo-ovarian abscess Stella Marie L. Jose, MD, MHPEd

R-32 Total laparoscopic hysterectomy: Determining the Ana Katrina P. Estacio, MD

rate-limiting step by retrospective video evaluation Zoraida R. Umipig-Guevara, MD

R-33 Vaginal preparation before cesarean delivery Angelica Nicole N. Fernandez, MD

among pregnant women in a tertiary hospital: A Victoria N. Sy-Fernando, MD
randomized controlled trial Maria Michelle G. Borbe, MD

RCH
INTERESTING CASE
IC-1 A case of complex diagnosis and management of Ashley Ediamy D. Go, MD
obstetrically acquired hemophilia Maynila E. Domingo, MD

IC-2 A case of dysgerminoma associated with Swyer Janelyn I. Daguro-Cero, MD

syndrome in a 35-year old female Kara Angelica L. Valles, MD

IC-3 A case report: NonHodgkin’s lymphoma of the Nadia G. Agagon, MD

uterus Fritzie B. Tenorio, MD

IC-4 A case report on obstructed labor in a multigravida Kathlene Faye M. Llamera, MD

secondary to vesical calculus Kristina L. Dosdos, MD
INTERESTING CASE
IC-5 A confirmed case of menstrual cup associated with Andrea Francesca I. Santos, MD
toxic shock syndrome in a healthy Filipina: A Merlind M. Montinola-Morales, MD
Philippine perspective

IC-6 An undiagnosed live term extrauterine abdominal Nadzzida H. Maldisa, MD

pregnancy: A case report Fortunato B. Boto, Jr, MD
Marie Lovella S. Mangahas, MD
Roselle M. Martin, MD

IC-7 Atypical presentation of systemic lupus Marie-Lemyr N. Abelardo, MD

erythromatosus in a pregnant patient superimposed Ma. Athena P. Calmerin, MD
with COVID-19 infection Ma. Shierly D. Del Rosario, MD

IC-8 Avascular necrosis of the femoral head in a 22-year Hannah Shene M. Leong, MD
old with primary amenorrhea Concepcion D. Rayel, MD
Irene L. Uy, MD

IC-9 Broad ligament pregnancy: A diagnostic dilemma Christian Dave Docto, MD

Kristina L. Dosdos, MD

IC-10 Case of a 19-year-old with malignant spindle cell Leobert Julienne A. dela Peña, MD
neoplasm; pelvic monophasic synovial sarcoma Ronald Lanz R. Latap, MD
arising from the pelvic soft tissues and ligaments

IC-11 Cervicovaginal artery embolization: An Aiza Jane C. Damao, MD

interventional approach to control vaginal bleeding Lynette R. Lu-Lasala, MD
complication of gestational trophoblastic neoplasia

IC-12 Comparing the diagnostic and management Hannah Andrea A. Sombilla, MD

approach of two cases of Buschke-Lowenstein Ma. Evita D. Dela Cruz-Tabanda, MD
tumor Ma. Lorina Q. Esteban, MD
Mary Judith Q. Clemente, MD

IC-13 COVID-19 infection in pregnancy with human Marth Louie Z. Tarroza, MD

immunodeficiency virus: A case series Sybil Lizanne R. Bravo, MD, MSc

IC-14 Cytokine storm secondary to COVID-19 pneumonia Dominica Louise A. Sumera, MD

in a preterm pregnancy: A management and Zoraida R. Umipig-Guevara, MD
bioethical dilemma Jane Marie B. Samonte, MD
Joanna Pauline Chua-Ursua, MD

IC-15 Delayed diagnosis and management of late second Ana Patricia C. Vargas, RCh, MD, MBA
trimester intra-abdominal pregnancy Viktoria Ines P. Matibag, MD
Maria Anna Luisa F. Dalawangbayan, MD
INTERESTING CASE
IC-16 Detour: A case report on advanced abdominal Vivien Jovie A. Mercado, MD
pregnancy Jeejane A. Bonggao, MD

IC-17 Double trouble: A case of symptomatic olfactory Breann Katrina R. Chaplin, MD, MBA
nerve schwannoma diagnosed and managed in the Lyra Ruth C. Chua, MD
third trimester of pregnancy in a Philippine tertiary
hospital

IC-18 Early stage high grade endometrial stromal Renee Leen M. Laudato, MD
sarcoma of the cervix in the young: A case report Carolyn R. Zalameda-Castro, MD, MSc

IC-19 Fertility preservation of an exogenic-type of Rejo Mae B. Orola-Basilan, MD

cesarean scar pregnancy: A case report Jericho Thaddeus P. Luna, MD
Belen P. Rajagukguk, MD

IC-20 Giant immature teratoma in a 15-year old causing Alfonso Leandro del Rio Toreja, MD
anti-N-methyl-D-aspartate receptor encephalitis-like Angelito D.L. Magno, MD
and Guillain-Barre syndrome as paraneoplastic
manifestations: A case report

IC-21 Hematotrachelometra with acute salpingitis in a 46 Lara Sabine O. Villanueva, MD

XT disorder of sexual development: A case report Mona Ethellin M. Yiu-Senolos, MD

IC-22 Herlyn Werner Wunderlich syndrome with an Rochelle Mae M. Supan, RN, MD
incidental finding of unilateral adrenal gland Junette Grace A. Ko, MD
agenesis: A case report

IC-23 Isolated fallopian tube torsion in an early Princess Bianca DL. Palabrica, MD
adolescent: A case report Maria Therese B. Mallen, MD
Germaine Aldrene C. Tan, MD

IC-24 Management of aortic dissection Stanford type A, Sherlyn Marie O. Ingco, MD

De Bakey I in pregnancy: A rare case report Armie Angela C. Lara-Roy, MD, PTRP

IC-25 Metastatic gestational trophoblastic neoplasia in the Dhonna L. Cambronero, MD

absence of a primary uterine lesion: A case report Lynette R. Lu-Lasala, MD

IC-26 More than teen angst: A case of ovarian teratoma Ma. Rosila Flor DJ. Escudero, MD, MBA
presenting as anti-N-methyl-D-aspartate receptor Lyra Ruth C. Chua, MD
encephalitis

IC-27 Myasthenia gravis in pregnancy: A case report Regina Ann S. Santiano, MD

Kim Le D. Tan, MD
INTERESTING CASE
IC-28 Perianal endometriosis: A rare complication of Gerben F. Villanueva, MD
normal spontaneous delivery with episiotomy and Eileen Grace F. Tancinco, RPh, MD
repair Emille Teresa B. Apepe, MD

IC-29 Polypoid adenomyoma in a nulligravid teenager: A Elaiza Joyce M. San Pascual, MD

case report Janmarie F. Sandoval, MD

IC-30 Spontaneous hemoperitoneum in pregnancy: A life- Cristanne Deanne A. Santiago, MD

threatening emergency Jean Go-Du, MD

IC-31 Squamous cell carcinoma arising within a mature Inez Jade T. Quial-Riolo, MD
cystic teratoma of the ovary: A report of two cases Raymond S. Sulay, MD

IC-32 Struma ovarii associated with pseudo-Meigs’ Nicole Anna Marie H. Dionisio, MD
syndrome with concomitant abdominopelvic Elizabeth K. Jacinto, MD
tuberculosis masquerading as ovarian malignancy

IC-33 Successful management of acute fatty liver in Noel Isaiah G. Quinto, MD

pregnancy: A case report Nilo M. Alcoreza, MD

IC-34 The doublet protocol of etoposide-actinomycin in Kathryn M. Buque, MD

chemorefractory low risk gestational trophoblastic Sherry Joahne L. Cañete-Villariasa, RMT, MD
neoplasia: A case series

IC-35 The value of placental cannulation and dye injection Jessica G. De Dios, MD
in unraveling the mystery of a monochorionic twin Kathryn Kristy P. Bautista, MD
pregnancy with coexistent selective intrauterine
growth restriction and twin-to-twin transfusion
syndrome

IC-36 Trisomy 18 in utero: Detection, delivery and Mellen Joy H. Villanueva, MD

dilemmas Kathryn Kristy P. Bautista, MD

IC-37 Uterine carcinosarcoma in a young patient with Nicole S. Balagtas, MD

uterine inversion: A case report Raymond S. Sulay, MD

IC-38 Vaginal endometrioid adenocarcinoma arising from Roxanne Gillea G. Tan, MD

endometriosis after total abdominal hysterectomy Leo Francis N. Aquilizan, MD
and bilateral salpingo-oophorectomy

IC-39 When the metastatic tumor presents as a primary Ma. Rosila Flor DJ. Escudero, MD, MBA
tumor: Gastric signet ring cell carcinoma presenting Angelito D.L. Magno, MD
as advanced cervical cancer with ovarian
metastasis
R-1

A Comparative Study on the Use of Friedman’s Curve vs. Zhang

Partogram on Maternal and Neonatal Outcomes in a Tertiary Hospital:
A Cross-Sectional Study

Lara Germaine Q. Torres-Gongora, MD, Andrea Milagros L. Mapili, MD,

FPOGS
Baguio General Hospital and Medical Center

Introduction: Friedman’s curve is the gold standard for monitoring the progress of labor. Due to
the gradually increasing prevalence of cesarean delivery and changes in the characteristics of
parturients and labor management, Zhang labor curve progress was conducted to examine
whether the labor curves of parturients today follow the average labor curve constructed by
Friedman. The research aimed to explore whether the Zhang partogram can be used an
alternative tool for monitoring the progress of labor and as a basis for the definitions of
dysfunctional labor.
Objective: To compare the maternal outcome and neonatal outcome among parturients
managed according to Friedman’s curve vs Zhang partogram.
Methodology: This study utilized a cross-sectional design. A total of 179 patients of Baguio
General Hospital and Medical Center were enrolled in this study fulfilling the inclusion and
exclusion criteria. The patients were randomly assigned into either Group A (Friedman Group)
or Group B (Zhang group). Labor progress was plotted against the Friedman or the Zhang
partograph respectively. Chi-square was used to compare the maternal and neonatal outcomes
according to Friedman’s and Zhang partograph.
Results: Of the 179 patients, 89 were assigned in the Friedman group and 90 in the Zhang group.
The demographic data of patients in both groups were comparable. Utilization of the Friedman’s
curve as a basis for management of dysfunctional labor was associated with a higher incidence
of primary cesarean section (30 vs. 11, p=0.0006) and post-operative infection (11 vs. 2, p=0.008).
There was no difference in the incidence of hemorrhage (2 vs. 0, p=0.246) and atony (1 vs. 0,
p=0.497) in both groups. There was no significant difference in neonatal outcomes in both
groups.
Conclusion: The rate of primary cesarean section for dysfunctional labor was significantly higher
if labor progression was based on the Friedman’s curve as compared to the Zhang model without
any significant difference in the neonatal outcome.

Keywords: Dysfunctional labor, Friedman’s curve, Zhang partogram

R-2

A Cross-Sectional Comparative Study on the Diagnostic Accuracy of

Manual Vacuum Aspirator vs. Endosampler Among Patients with
Abnormal Uterine Bleeding and Postmenopausal Bleeding in a Tertiary
University Hospital

Bernadette Mayumi T. Mortel, MD, Lilli May T. Cole, MD, FPOGS, FPSGOP,
Debby P. Songco, MD, FPOGS, FPSRM, Arnel C. Dy, MD
University of the East – Ramon Magsaysay Memorial Medical Center, Inc.

Introduction: Abnormal uterine bleeding (AUB) and postmenopausal bleeding (PMB) are
healthcare burdens constituting majority of gynecologic consults. As these are primary
manifestations of benign and malignant endometrial lesions, evaluation through endometrial
sampling is crucial in early diagnosis and disease prevention. Hysteroscopy, the gold standard in
endometrial evaluation, is often unavailable in low-resource settings. Also, available outpatient
devices like the Pipelle, may yield insufficient samples affecting diagnostic accuracy. Improved
variations, like the endosampler, are reported to obtain more tissues. Additionally, the World
Health Organization (WHO) has recently recommended manual vacuum aspiration (MVA) as an
alternative sampler for its accuracy and cost-effectiveness.
Objective: This study aimed to compare MVA to endosampler in detecting endometrial
pathology among women with AUB or PMB, specifically comparing histopathologic diagnosis,
tissue yield, and pain scores.
Methodology: This cross-sectional diagnostic study was done at a tertiary university hospital
from August 2020 to January 2021. Thirty-one (31) women with AUB or PMB underwent
endometrial sampling using both endosampler and MVA. Participants were randomly divided
into two groups based on treatment sequence. Age, gravidity, and endometrial thickness were
recorded. Histopathologic diagnoses, weight of endometrial tissues, and pain scores by Visual
Analogue Pain Scale (VAPS) were evaluated.
Results: The MVA had high sensitivity and specificity in detecting premalignant and malignant
lesions, with a diagnostic accuracy of 96.7%. There was histopathologic concordance to
endosampler in all cases of hyperplasias and carcinomas. The MVA also detected the following
over endosampler: 1 hyperplasia without atypia, 1 atypical hyperplasia, 1 endometrial
carcinoma, 1 leiomyoma, and 1 proliferative endometrium. The MVA sampled significantly more
endometrial tissue than endosampler (2.1 g vs 1.5 g, p=0.008). The pain scores for both groups
had no significant difference.
Conclusion: The MVA is comparable to endosampler as an endometrial sampling alternative in
low-resource settings. It yields more endometrial tissues than the endosampler with no
significant difference in pain scores.

Keywords: abnormal uterine bleeding, manual vacuum aspirator, endosampler

R-3

Application of Sono-elastography in Differentiating Endometrial

Carcinoma from Benign Endometrial Lesions: A Cross-Sectional Study

Catherine M. Santos, MD, FPOGS, Nelinda Catherine P. Pangilinan, MD,

FPOGS, FPSUOG, Maria Cristina C. Franada, MD, FPOGS, FPSUOG
Rizal Medical Center

Introduction: The diagnostic approach for abnormal uterine bleeding to rule out endometrial
carcinoma is constantly evolving. Sono-elastography is a novel imaging technique that has been
shown to differentiate benign from malignant lesions in other organs but has limited studies in
the field of gynecology.
Objective: To evaluate the diagnostic value of sono-elastography in distinguishing endometrial
cancer from benign endometrial lesions.
Methodology: A cross-sectional study was conducted and included 31 subjects with abnormal
uterine bleeding who required endometrial sampling. Sono-elastography assessment was done
qualitatively and quantitatively using Tsukuba elasticity score and strain ratio, respectively.
Results were compared between those with endometrial cancer and those with benign
endometrial lesions (hyperplasia and polyp) using Kruskal-Wallis test and Mann-Whitney U test.
Diagnostic accuracies of Tsukuba elasticity score and strain ratio in differentiating endometrial
cancer from benign endometrial lesions were determined with cut-off values derived from ROC
analysis.
Results: Both the Tsukuba elasticity score and strain ratio values were significantly higher among
patients with endometrial cancer (n=15; mean age: 55.07 ± 8.53 years) compared to those with
benign endometrial lesions (n=16; mean age: 41.63 ± 8.02 years) (p<0.0001). A Tsukuba elasticity
score of ≥ 3 showed the highest diagnostic accuracy at 93.5% (95% CI 79.3%-98.2%), with
sensitivity of 86.7% (95% CI 62.1%-96.3%), specificity of 100% (95% CI 80.6%-100%), positive
predictive value (PPV) of 100% (95% CI 77.2%-100%), negative predictive value (NPV) of 88.9%
(95% CI 67.2%-96.9%), positive likelihood ratio (LR) of undefined indicating high value, and
negative LR of 0.10 (95% CI 0.05-0.40). A strain ratio value of ≥ 2 showed the highest diagnostic
accuracy at 93.5% (95% CI 79.3%-98.2%), with sensitivity of 93.3% (95% CI 70.2%-98.8%),
specificity of 93.8% (95% CI 71.7%-98.9%), PPV of 93.3% (95% CI 70.2%-98.8%), NPV of 93.8%
(95% CI 71.7%-98.9%), positive LR 14.9 (95% CI 2.1-107.1), and negative LR of 0.07 (95% CI 0.01-
0.51).
Conclusion: The results indicate that sono-elastography can distinguish endometrial cancer from
benign endometrial lesions. However, external validation on a larger scale of population should
be done.

Keywords: abnormal uterine bleeding, endometrial cancer, sono-elastography

R-4

Assessment of Functionality of Selected BEmONC Rural Health Units

in Central Luzon

Margaret Rose C. Bocaya, MD, Ma. Dolores A. Mercado, MD, FPOGS,

Gene A. Nisperos, MD, Mary Christine R. Castro, MD,
Maria Stephanie Fay S. Cagayan, MD, PhD, FPOGS, FPSSTD
Perinatal Association of the Philippines

Introduction: The readiness of primary birthing facilities to avert maternal and neonatal
mortalities arise from their capacity to perform signal functions for emergency obstetric and
newborn care.
Objective: This study assessed the functionality of basic emergency obstetric and newborn care
(BEmONC)-capable rural health units (RHUs) in Central Luzon in providing obstetric services from
December 2019 to November 2020. Barriers and facilitators to effectively deliver services were
determined.
Methodology: A mixed method approach was employed for this observational cross-sectional
study. Randomly selected RHUs in 4 representative provinces in Central Luzon known to have
low, medium, and high maternal mortality rates (MMRs) were visited. A scorecard summarizing
points given to infrastructure, personnel, ability to perform signal functions and provision of
maternal health services, all gathered electronically using the BEmONC Functionality Assessment
Toolkit, was used. Focus group discussion of 6 mothers and 15 healthcare personnel was done
virtually to determine their insights on the impact of BEmONC in their community.
Results: A total of 30 RHUs from Aurora, Zambales, Bulacan and Pampanga were visited. Based
on the scorecard, only 7 (23%) facilities were BEmONC-functional and 23 (77%) were not. The
number of facilities which were able to perform selected signal functions during the observation
period are the following: 12 (40%) for antibiotic administration, 9 (30%) for magnesium sulfate
administration, 13 (43.4%) for administration of uterotonics, 15 (50%) for use of partograph and
12 (40%) for performance of newborn resuscitation. Facilitators of facility functionality include
support from the local government units (LGU) and central offices, adequately trained personnel
and intact referral systems. Barriers identified included problems in infrastructure, lack of
medicines, fast turnover of trained personnel, and pandemic-related issues.
Conclusion: Public birthing facilities in selected provinces in Central Luzon are operational
because the physical infrastructure and services are present but fulfilling signal functions remains
limited. Capacity-building measures are needed to ensure effective delivery of services.

Keywords: BEmONC, maternal mortality, service delivery network

R-5

Association of Total Gestational Weight Gain and Maternal and

Perinatal Outcomes among Pregnant Patients Using The Institute of
Medicine 2009 Gestational Weight Gain Guidelines in a Tertiary
Hospital
Francesca Debbie L. Liu, MD, Maria Michelle G. Borbe, MD, FPOGS, FPSUOG
Chinese General Hospital and Medical Center

Introduction: Obesity carries a worldwide population epidemic rate that affects both genders
especially women, most significantly pregnant women, influencing one’s daily routine and
activities. The proposed guideline is by the Institute of Medicine (IOM) 2009 Gestational Weight
Gain (GWG), by measuring pre-pregnancy Body Mass Index (BMI) category and the World Health
Organization (WHO) BMI Classification for both International and Asian categories.1 This value
can be influenced by demographic status, medical conditions and maternal and fetal adverse
outcomes.
Objective: The study determined the association of total GWG and maternal and perinatal
outcomes based on the IOM 2009 guidelines among pregnant patients in a tertiary hospital.
Methodology: The prospective cohort study included 565 pregnant women from June 1, 2020
to April 30, 2021. BMI at initial prenatal visit < 14 weeks age of gestation (AOG) and upon
admission, birth weight, and co-morbidities were all assessed and recorded. Main outcome
measures were total GWG, perinatal outcomes (small for gestational age [SGA], large for
gestational age [LGA], intrauterine fetal demise [IUFD], admission to the neonatal intensive care
unit [NICU]) and maternal outcomes (gestational diabetes mellitus [GDM], gestational
hypertension, preeclampsia/eclampsia, preterm birth).
Results: The mean BMI was 23.6 kg/m2 and based on BMI classification, 8% were underweight,
while 28.1% and 9% were overweight and obese, respectively. Based on the recommendations
of total GWG on each BMI category, using chi square test, there was significant association of
having excess GWG and inadequate GWG against maternal and perinatal outcomes.
Conclusion: Women having excess or inadequate total GWG has effects on maternal and
perinatal outcomes. Furthermore, women that are classified as overweight and obese on 1st
trimester has higher risk of developing co-morbidities.

Keywords: pregnancy, gestational weight gain, overweight, obesity

R-6

Changes in Obstetric Practices in the First Three Months of the COVID-

19 Pandemic in a Private Tertiary Hospital: A Descriptive Cross-Sectional
Study
Kristine Mae A. de Guzman, MD, Agnes L. Soriano-Estrella, MD, MHPEd,
FPOGS, FPSSTD
St. Luke’s Medical Center – Global City

Introduction: With the increasing number of COVID positive cases still being reported in the
country, coupled with the possible vulnerability of pregnant patients to the disease, aggressive
measures must be taken by all institutions to ensure safety of the patients.
Objective: This study aimed to determine the clinical profile and pregnancy outcome of patients
who were admitted at a tertiary private hospital in Metro Manila from March 16, 2020 to June
15, 2020 in relation to the protocols that were implemented in response to COVID-19 Pandemic.
Methodology: The protocols and guidelines implemented by the Department of Obstetrics and
Gynecology of a private tertiary hospital in Metro Manila from March 16, 2020 to June 15, 2020
were retrieved. The case record of patients who were admitted and delivered during this period
were retrieved and reviewed for pertinent data, which were recorded in a patient data collection
form.
Results: During the 3-month study period, COVID positive pregnant patients were effectively
separated from COVID negative patients from admission to discharge based on a health
declaration form and universal RT-PCR testing. Discharge was facilitated after 12-48 hours for
uncomplicated deliveries and postpartum follow-up was done via telemedicine.
Conclusion: The separation of COVID positive from COVID negative patients based on symptoms
and RT-PCR results were effective in ensuring the safety of patients.

Keywords: COVID-19, obstetric protocol, pandemic, SARS-CoV-2, quarantine

R-7

Characteristics of COVID-19 Positive Pregnant Patients Admitted in a

Private Tertiary Hospital and Their Maternal and Neonatal Outcomes

Josephine Alexandra D. Lim, MD, Zarinah G. Gonzaga, MD, FPOGS, FPSMFM,

FPSUOG, Mariles R. Hernandez-Nazal, MD, FPOGS, FPIDSOG
The Medical City

Introduction: The SARS-CoV-2 pandemic has had profound effects globally. Previous
coronaviruses have shown increased maternal and perinatal morbidity and mortality,
theoretically secondary to the physiologic changes of pregnancy. As of August 2021, the
Philippines is the 23rd top country worldwide in terms of total cases, yet there remains to be a
sparse pool of information both internationally and locally.
Objective: This study aimed to present the prevalence, clinical characteristics, as well as the
neonatal, obstetric, and maternal outcomes of all pregnant women admitted in a private tertiary
hospital who had active or previous COVID-19 infection.
Methodology: Retrospective review of data using the hospital’s health information system was
utilized. Within the study period, all admitted obstetric patients who had at least one positive
result in an RT-PCR naso-oropharyngeal swab for SARS-CoV-2 were included and categorized into:
(1) symptomatic, (2) recovered, or (3) asymptomatic.
Results: A total of 48 patients were included, where prevalence of COVID-19 in pregnancy was
3.65%. Results showed that most patients were in the third trimester (mean age of gestation
35.26 + 6.39), and contrary to the non-pregnant population, majority (29, 60.41%) did not have
co-morbidities. Most remained asymptomatic (16, 33.33%) or had mild symptoms (9, 18.75%),
and underwent abdominal delivery (23, 47.91%) for obstetric indications. There was one
mortality, who had developed critical severity. COVID-19 status was not associated with adverse
obstetric outcomes in this study population, but had significant association with preterm birth
(p=0.019) and neonatal intensive care unit (NICU) admission (p<0.001).
Conclusion: Overall, most cases of COVID-19 in pregnancy were asymptomatic and had good
prognosis even with the adaptations a pregnant woman undergoes. In addition, neonatal
outcomes were generally good regardless of the association with preterm birth and NICU
admission. Lastly, there was no appreciated evidence for vertical transmission.

Keywords: COVID-19, pregnant patients, maternal and neonatal morbidity

R-8

Comparison of the Effect of Miconazole and Clotrimazole in the

Treatment of Vulvovaginal Candidiasis Among Women Seen at a
Tertiary Medical Center from 2016 to 2020
Shiara Marriz T. Marquez, MD, Lylah D. Reyes, MD, FPOGS
Far Eastern University – Nicanor Reyes Medical Foundation Medical Center

Introduction: 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 Center for Disease Control and Prevention (CDC), azoles are the first-line of
treatment for VVC. Among the azoles available in the Philippines, only miconazole and
clotrimazole are recommended for both pregnant and non-pregnant women.
Objective: The objective of this study is to compare the effect of miconazole vs. clotrimazole in
the treatment of VVC among patients seen at the outpatient department in a tertiary hospital.
Methodology: This study reviewed a total of 316 records of patients, regardless of pregnancy
status who were given either single dose 1200 mg miconazole or a 6-day 100 mg clotrimazole
vaginal suppository as treatment for VVC.
Results: Among women whose chart records were included, there were 161 (50.94%) who used
miconazole while 155 (49.05%) took clotrimazole. All 316 women included in the study presented
with signs and symptoms of VVC. The most common of which is curd-like vaginal discharge
(86.7%), followed by vulvar pruritus (80.7%), vulvar erythema (50.6%), and the least occurring is
dyspareunia (0.94%). When the signs and symptoms were individually compared between the
two treatment arms, no statistically significant differences were noted. Upon follow- up, 11 out
of 316 (3.46%) were still symptomatic which was noted in 2 (18.1%) from the miconazole group
while 9 (81.8%) from the clotrimazole group. The difference for these outcome between the
treatment groups is statistically significant. With regards to treatment failure rate, for
miconazole it is 1.2% (2/161) while for clotrimazole, it is 5.8% (9/155). None of the charts of these
women had recorded adverse reaction to the given treatment.
Conclusion: Single-dose miconazole regimen has a significantly higher clinical cure rate than the
6-day clotrimazole. It has the potential to improve patient compliance and improve treatment
outcome at a lower cost.

Keywords: vulvovaginal candidiasis, miconazole, clotrimazole, azole antifungals, vaginitis

R-9

Comparison of Maternal and Neonatal Outcomes Between COVID-19

Positive and Negative Parturient Who Delivered in a Tertiary Hospital: A
Retrospective Cohort Study
Stephanie M. Lazo, MD, Victoria N. Sy-Fernando, MD, FPOGS, FSGOP
Chinese General Hospital and Medical Center

Introduction: The Coronavirus disease 2019 (COVID-19) is a respiratory disease caused by novel
coronavirus named Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-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
vs. negative parturient.
Methodology: This is a retrospective cohort study of 131 parturient in a tertiary hospital.
Results: The study analyzed a total of 131 patients, of whom 65 (49.6%) were COVID-19 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 (69.2%) women 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 exams, the c-reactive protein and D-dimer were found to be elevated. Based
on maternal outcomes, there was 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. 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 prior to term, as these
patients are predisposed to having preterm labor. Further research is needed to understand the
true extent of the risks to improve management of these special population.

Keywords: COVID-19, novel coronavirus, pregnancy

R-10

Effect of Cytoreductive Surgery and HIPEC on Epithelial Ovarian,

Fallopian Tube and Peritoneal Cancer: An Institutional Review of
Outcomes and Its Clinical Implications

Romelyn April P. Imperio-Onglao, MD, Jericho Thaddeus P. Luna, MD,

FPOGS, FSGOP
University of the Philippines-Manila, Philippine General Hospital

Introduction: Ovarian, fallopian tube and peritoneal cancer patients with advanced stage at
diagnosis or recurrences spread to the peritoneal surface of the abdomen. Hyperthermic
intraperitoneal chemotherapy (HIPEC) can penetrate and eradicate tumors up to a diameter of
2.5 cm and microscopic disease from the peritoneal surface after cytoreductive surgery (CRS).
Objective: The study aimed to determine the efficacy and safety of CRS with HIPEC vs CRS alone
for patients with epithelial ovarian, fallopian tube and peritoneal cancer.
Methodology: This retrospective cohort study included 50 patients (20 patients who underwent
CRS with HIPEC, and 30 patients who underwent CRS alone). Records of these patients from 2014-
2020 were reviewed and tabulated.
Results: Recurrence rate between patients who underwent CRS with HIPEC and CRS alone was
not statistically significant (50% vs. 43%, p=0.774). Median time to recurrence was 10 and 9
months, respectively (p=0.636). One patient (5%) expired in the CRS with HIPEC group, and 4
patients (13%) expired in the CRS alone (p=0.636). More postoperative complications were noted
in the CRS with HIPEC group (9 vs. 3, p=0.007), but only 2 cases had grade 3 to 4 complications
(10%). CRS with HIPEC patients had longer operative time (360 vs. 240 minutes, p<0.001) and
post-operative hospital stay (8 vs. 6 days, p=0.026). There were no intra- or perioperative
mortalities in both groups.
Conclusion: CRS with HIPEC and CRS alone showed similar time to recurrence and recurrence
rate. CRS with HIPEC had low risk of grade 3-4 complications and may still be considered as a
treatment option for advanced and recurrent epithelial ovarian, fallopian tube and peritoneal
cancer.

Keywords: cytoreductive surgery, HIPEC, ovarian, fallopian tube and peritoneal cancer
R-11

Effect of the COVID-19 Pandemic on Utilization of Luzon Rural

Health Units BEmONC Facilities

Maria Stephanie Fay S. Cagayan, MD, PhD, FPOGS, FPSSTD, Mary Christine R.
Castro, MD, Gene A. Nisperos, MD
Perinatal Association of the Philippines

Introduction: The entire island of Luzon was placed under Enhanced Community Quarantine
(ECQ) last March 16, 2020, limiting population mobility and access to health facilities in eight
regions. Local government units offer Basic Emergency Obstetric Newborn (BEmONC) services,
including delivery of low-risk pregnancies in their rural health units (RHUs) or city health offices
(CHOs).
Objective: This study determined the effect of the COVID-19 pandemic and quarantine restriction
on the number of deliveries and utilization of RHU BEmONC facilities in Luzon.
Methodology: The number of total monthly deliveries of 245 randomly selected BEmONC-
provider RHUs in Luzon was collected from BEmONC registries covering the period December
2019 to November 2020. An interrupted time series analysis was conducted for aggregated data
per region and for the entire Luzon. Focus groups discussions among 102 healthcare providers
and 98 mothers were conducted to provide insights on the effect of the pandemic and the
quarantine on healthcare accessibility.
Results: There were significant increases in the number of monthly deliveries during the
quarantine in Regions 1, 3, 4A, and 5 due to fear of going to hospitals because of COVID-19.
However, Regions NCR, CAR, and MIMAROPA had a high proportion of non-functional BEmONC
RHUs due to COVID-19 and recent calamities, or because these RHUs were converted to COVID-
19 facilities and therefore could no longer offer BEmONC services. In Regions 1, 5, and
MIMAROPA, BEmONC RHUs had to provide other services, especially to non-COVID-19 patients,
as other facilities were converted to focus on COVID-19 patients. The effect of seasonality on
total deliveries was not determined.
Conclusion: During the pandemic, BEmONC RHUs catered to additional patients. Decreased
access to facilities for non-COVID-19 patients, as well as fear of contracting COVID-19 in hospitals
are intervening factors. Strengthening primary care services can be an integral part of the COVID-
19 pandemic response.

Keywords: COVID-19, BEmONC services, primary care

R-12

Fears, Perceptions and Concerns on COVID-19 of Term Pregnant

Women in a Tertiary Hospital: A Cross- Sectional Study

Christine Mariz T. Ching, MD, Maria Michelle G. Borbe, MD, FPOGS, FPSUOG
Chinese General Hospital and Medical Center

Introduction: The emergence of COVID-19 pandemic has left the vulnerable members of the
society at risk, most especially the pregnant women. This event has caused anxieties on their
pregnancy journey. Their main concerns are the effects and transmissibility of the infection to
them and to their unborn child. COVID-19 significantly affects their mental health status.
Objective: The study determined the fears, perceptions and common concerns of pregnant
women during COVID-19 in a tertiary hospital in Manila.
Methodology: This is a prospective, cross-sectional study that used a pretested and validated
questionnaire, which directly asked the fears, perceptions and common concerns on COVID-19
among pregnant women. The survey proper was conducted among 313 singleton, term pregnant
women, aged 18 years old and above.
Results: The analysis included 313 respondents with a mean (±SD) age of 31 ± 6 years. The three
most common fears relayed by the pregnant women were: (1) losing their babies if they get
COVID-19 (67.41%), (2) dying if they get the infection (58.79%), and (3) getting a positive test
result for COVID-19 (54.95%). Most of these patients (99.04%) were aware of the changes on
their prenatal consultation and health care services. Majority of the participants (53.35%) raised
their concerns on the in-utero transmission of the virus, swabbing of their baby if ever they are
positive (44.41%) and nosocomial COVID infection on their newborn from the hospital personnel
(42.81%).
Conclusion: Fear is a common emotion among pregnant women. With the emergence of COVID-
19 pandemic, it exacerbated their fears and raised concerns on the harmful effects that it may
bring on their well-being and on their unborn child. This pandemic had caused a significant
impact on their mental health.

Keywords: COVID-19 pandemic, mental Health, pregnancy

R-13

Impact of Adenomyosis on the Patient’s Quality of Life in a Tertiary

Hospital

Joanne Y. Luy, MD, Marie Janice A. Boquiren, MD, FPOGS, FPSRM, FPSGE
Southern Philippines Medical Center

Introduction: Adenomyosis is a condition affecting the uterus, characterized by endometrial

invasion of the uterine myometrium. It is a benign pathology with often severe symptoms that
causes a significantly negative impact on the quality of life (QOL) of women in the reproductive
age.
Objective: To determine the QOL of patients with adenomyosis in a tertiary hospital in Davao
City
Methodology: A cross-sectional research design was employed and included 56 women with
sonographic evidence of adenomyosis. The patients’ demographic, clinical profiles, and QOL
were determined using the Endometriosis Impact Questionnaire (EIQ), a 63-item, self-
administered questionnaire.
Results: The respondents were about 41.85 (±7.53) years old and 87.5% (n=49) were parous. The
mean age of diagnosis was 39.89 (± 7.49) years old, with mean age of onset of symptoms at 37.58
(± 8.92) years old. Only 1 respondent (1.79%) reported problems with fertility and majority had
diffuse (94.64%, n=53), rather than focal type of (5.36%, n=3) adenomyosis. Heavy menstrual
bleeding was the most common symptom at 76.79% (n=43) followed by period pain at 60.71%
(n=34). Most respondents (69.64%, n=39) never visited the emergency room for consultation and
the remaining 30.36% (n=17) visited only once or twice in the past. Hormonal medications
(71.43%, n=40) and painkillers (69.64%, n=39) were the most commonly used treatment
methods. Among all 56 respondents, it was noted that adenomyosis had a low impact in the QOL
with an EIQ score of 23. Then again, the impact of adenomyosis became notably more
pronounced for every time frame in all dimensions.
Conclusion: The negative impact of adenomyosis on women’s quality of life caused by bleeding
and cyclic pain requires a long-term holistic management. What was previously only a
histopathologic diagnosis found incidentally in post-hysterectomy specimens has now become a
clinically significant condition, presenting with potentially debilitating symptoms.

Keywords: abnormal uterine bleeding, adenomyosis, quality of life

R-14

Interpregnancy Interval and Associated Maternal and Neonatal

Outcomes Among Multigravid Singleton Pregnant Women Delivered in
a Tertiary Hospital in Cebu City: A Retrospective Cohort Study (2016-
2020)

Frances Michelle B. Castillo, MD, Marbee Pherenice B. Torrizo, MD, FPOGS

Chong Hua Hospital - Cebu

Introduction: Interpregnancy interval (IPI) is the period between termination of one pregnancy
and conception of a subsequent one. IPI allows assessment of future pregnancy complications.
Objective: To determine the association of the different IPI on maternal and neonatal outcomes
in multigravid singleton pregnancies.
Methodology: This was a retrospective cohort study, which included multigravid patients with 2
consecutive singleton pregnancies within January 2016 to December 2020, with the first live birth
delivered via normal spontaneous delivery. A comprehensive chart review was utilized. The
population was divided into short IPI (< 24 months), optimal IPI (24-59 months), long IPI (> 60
months). Maternal outcomes measured included incidence of gestational diabetes mellitus,
hypertension, anemia, placental abnormalities and mode of delivery. Fetal outcomes measured
included Apgar score, Ballard score, birthweight, incidence of congenital anomalies and need for
neonatal intensive care unit (NICU) admission. Demographic data, and maternal and neonatal
outcomes were then compared with the different IPI categories.
Results: From the 289 samples collected, 60 had short, 162 with optimal and 67 had long IPI. IPI
was associated with age (p=0.000) and history of contraception (p=0.008). There was no
significant association with the different IPI categories, and maternal and neonatal outcomes.
Conclusion: There was no significant association between IPI, and maternal and neonatal
outcomes among multigravid singleton pregnant women with two consecutive pregnancies.

Keywords: interpregnancy interval, maternal and neonatal outcomes

R-15

Intraoperative Findings and Neonatal Outcomes in Emergency Cesarean

Section for Non-reassuring Fetal Heart Rate Pattern Among Low-Risk
Term Pregnancies in a Tertiary Hospital in Davao City: A Retrospective
Study

Christine Joy P. Embay, MD, Lynnette R. Lu-Lasala, MD, FPOGS, FPSSTD

Southern Philippines Medical Center

Introduction: A non-reassuring fetal heart rate pattern is the leading indication for primary
cesarean section. Most cases are associated with hypertension and pre-labor rupture of
membranes. However, low-risk patients without co-morbidities or identified risk factors come in
third.
Objective: This study aimed to determine the clinical profiles, intraoperative findings and
neonatal outcomes of low-risk patients with term pregnancies who underwent emergency
cesarean section for non-reassuring fetal heart rate pattern in a tertiary hospital in Davao City.
Methodology: A retrospective cross-sectional research was used involving 160 patient records
of low-risk patients who underwent emergency cesarean section for non-reassuring fetal heart
rate patterns.
Results: Majority of patients were 20 – 34 years old (123, 77%), single (112, 70%), primigravid
(99, 62%), college undergraduates (48, 30%), with 5 prenatal check-ups (111, 69%) at health care
centers (96, 61%). A few had vices: smoking (5, 3%), alcohol abuse (5, 3%) and illicit drugs (2, 1%).
Most patients were admitted at 39 - 40 6/7 weeks (96, 60%) in latent phase of labor (82, 51%),
with absent or reduced variability and recurrent variable decelerations (93, 58%), absent nuchal
cord (116, 73%), moderate amount of amniotic fluid (82, 52%) and meconium staining (96, 60%).
There were no cases of congenital anomaly and uterine rupture but with 1 placental abruption.
Most had Apgar scores of 6 or more at the 1st (153, 96%) and 5th minute (158, 99%) of life, Ballard
scores of 37-41 weeks (158, 99%) and birthweights appropriate for gestational age (150, 94%).
All were livebirth deliveries with no neonatal complications.
Conclusion: Livebirth babies with good Apgar scores may be attributed to majority of term and
appropriate for gestational age and/or early intervention by cesarean section. Electronic fetal
monitoring is beneficial in improving fetal outcome but close monitoring and judicious
interpretation are warranted to curb rising cesarean section rates.

Keywords: low-risk pregnancy, emergency cesarean section, non-reassuring fetal heart rate
pattern, intraoperative findings, neonatal outcomes
R-16

Knowledge, Attitude and Practices of Obstetrics and Gynecology

Consultants and Residents in Region 7 Towards Teenage Pregnancy

Kathleen R. Vista, MD, Pherdes E. Galbo, MD, FPOGS, FPSGOP

Cebu Velez General Hospital

Introduction: Teenage pregnancy is currently a significant issue globally. In the Philippines, about
10.7% of births were from those aged 15 to 19 years old.
Objective: This study determined the socio-demographic profile and the level of knowledge,
attitude, and practices of obstetrics and gynecology (OB-GYN) consultants and residents and their
correlation.
Methodology: This descriptive cross-sectional research was conducted using total enumeration.
Data was collected via a modified self-administered online questionnaire by Mustafa & Mirkhan
in 2020 to OB-GYN consultants and residents of Region 7. Data were analyzed using descriptive
statistics, chi square test, and Pearson rho correlation tests.
Results: A total of 99 respondents were included in the study, with 60 consultants and 39
residents. Majority of the respondents (70, 70.71%) have a high level of knowledge towards
teenage pregnancy while almost 30% (n=29) have average or low level of knowledge. More than
half of the respondents (51, 51.52%) have a favorable attitude towards teenage pregnancy while
the rest were neutral about it. Common practices of the respondents include discussing antenatal
results to the pregnant mother, involving the adolescent to prenatal care, and advising about
risk-taking behaviors. However, referring pregnant adolescents to pediatrician and screening for
postpartum depression are uncommon. Knowledge levels of the participants were strongly
correlated with their attitudes (0.44, p=0.00) and practices (0.29, p=0.003). There was no
statistical difference between the attitude of the consultants and residents (p<0.05). However,
the highest frequency of practice was from the general OB-GYN followed by subspecialists then
the residents (p<0.05).
Conclusion: There is adequate knowledge on teenage pregnancy among OB-GYN consultants and
residents in the Central Visayas but interventions geared towards improvement of knowledge
may translate to positive attitudes and better practices. Moreover, the practice of postpartum
depression screening among pregnant teens is highlighted.

Keywords: teenage pregnancy, prenatal care, postpartum depression

R-17

Local Validation of the fullPIERS (Preeclampsia Integrated Estimated

Risk Score) Model for the Prediction of Adverse Maternal Outcomes in
Women with Pre-eclampsia

Christine Noemi R. Etang, MD, Christie Luz Rosal, MD, FPOGS

Perpetual Succour Hospital Cebu

Introduction: Pre-eclampsia is best described as a pregnancy-specific syndrome that can affect

virtually every organ system. Careful decision-making should be done as to the management of
these patients since wrong decisions can lead to worse adverse outcome to the patient.
Therefore, the need for a validated model to predict adverse maternal outcomes is evident. This
model, if accepted for utilization in our setting can be of great help in proper management of
patients. This will serve as a guide to the course of management and for timely referral in
institutions not capable of taking care of these patients.
Objective: To validate if the fullPIERS model can be helpful in predicting the risk of developing
complications of pre-eclampsia within 48 hours after being admitted.
Methodology: This is a prospective cohort study involving 50 women diagnosed with pre-
eclampsia. The study used determining factors (age of gestation, symptoms of dyspnea,
creatinine and SGPT levels, platelet count, oxygen saturation level) to calculate the score in the
fullPIERS tool and scores were assessed if it can predict adverse maternal outcomes of pre-
eclampsia within 48 hours of admission. This was tested on pregnant women admitted due to
pre-eclampsia, superimposed pre-eclampsia or those who developed pre-eclampsia during
admission. Sensitivity and specificity were calculated.
Results: Seven out of 50 patients developed severe outcomes and 43 did not. In the study, most
of these women (90%) scored in the range of 0-10 with 4% of which had adverse outcomes and
86% did not have. A marginal proportion of patients (10%) had scores greater than 30 having all
of which, developed adverse maternal outcomes. A p-value <0.001 was recorded which depicts
that the scores and outcomes were significantly associated. The study plotted the sensitivity and
specificity of the fullPIERS scores to detect the presence of adverse outcomes. The overall
accuracy was 92.4% which is considered an outstanding diagnostic ability. The variables
predictive of adverse maternal outcome are oxygen saturation and creatinine levels. A cut-off
score of ≥ 30% is predictive of adverse maternal outcome.
Conclusion: The fullPIERS risk assessment tool can be used to predict adverse maternal outcomes
brought by pre-eclampsia.

Keywords: fullPIERS model, pre-eclampsia

R-18

Octyl Cyanoacrylate Tissue Adhesive vs. Subcuticular Suture for Skin

Closure During Cesarean Delivery at a Tertiary Hospital: A
Randomized Controlled Trial
Aprille Lorraine M. Liao, MD, Larisa Julia Diaz-Roa, MD, FPOGS
Cebu Doctors’ University Hospital

Introduction: Closure of wounds to attain an aesthetically pleasing scar has always been
a challenge. There is a continuous search for the optimal way to close surgical wounds.
Objective: To compare octyl cyanoacrylate tissue adhesive and sutures in skin closure of
cesarean section
Methodology: This prospective randomized controlled study was conducted at a tertiary
hospital. Patients were randomized to application of octyl cyanoacrylate tissue adhesive
vs. subcuticular skin closure. Scars were evaluated 6-8 weeks postoperatively using the
Patient and Observer Scar Assessment Scale (POSAS). Skin closure time, wound
complications and provider satisfaction were also compared.
Results: Seventy-nine (79) patients were included in the study, 40 of which were in the
suture arm and 39 in the tissue adhesive arm. Demographic characteristics were similar
in both groups. No significant difference was detected between the suture and tissue
adhesive scores using the POSAS 6-8 weeks after cesarean delivery, at p=0.60 for patients
and p=0.43 for observer. Tissue adhesive recorded significantly faster skin closure time,
but the obstetricians involved in the study were more satisfied with using suture for skin
closure. No significant differences in wound disruption rates were observed in both
groups (p=0.45). Age significantly affected patient’s perception for scar cosmesis. Body
mass index (BMI) was incrementally associated with wound disruption.
Conclusion: Tissue adhesive and subcuticular suture for skin closure had similar cosmetic
appearance. Both methods are safe and can be used interchangeably.

Keywords: cesarean section, subcuticular skin closure, octyl cyanoacrylate tissue

adhesive
R-19

Patient and Operative Factors Associated with Strategic or Reactive

Conversion to Laparotomy During Laparoscopy in Pelvic
Endometriosis: A Case-Control Study
Iza Roelle L. Maniego, MD, FPOGS, Prudence V. Aquino-Aquino, MD, FPOGS,
FPSGE, Maria Rica F. Arandia-Baltazar, MD, FPOGS, FPSGE, Zoraida R. Umipig-
Guevara, MD, FPOGS, FPSGE
Quirino Memorial Medical Center

Introduction: Conversion laparoscopy is the intraoperative switch from a laparoscopic to an open

abdominal approach. Strategic conversion is a standard laparotomy that is made after
laparoscopic assessment of the feasibility of completing the procedure laparoscopically and
because of anticipated operative difficulty or logistic considerations. Reactive conversion is the
need for a laparotomy because of a complication. Common reasons for strategic conversions are
enlarged immobile uterus, visibility and/or mobility problems, severe adhesions and unexpected
additional disease than expected. Uncontrollable bleeding is the primary adverse event leading
to a reactive conversion.
Objectives: To determine the factors associated with strategic or reactive conversion from
laparoscopy to laparotomy among patients with pelvic endometriosis.
Methodology: This is a retrospective case-control study among 59 patients with diagnosis of
pelvic endometriosis who underwent laparoscopy between June 2017 to June 2021. Chart
review done. Odds ratios and 95% confidence intervals from Firth logistic regression were
computed to determine the association between patient factors and conversion. STATA 15.0
used for data analysis.
Results: Among the 59 patients who underwent laparoscopy for pelvic endometriosis, 10
(16.49%) had conversion laparoscopy, 9 were strategic conversions and 1 was a reactive
conversion. Anticipatory referrals were made for 8 patients, 6 were converted and 2 were not
converted (p<0.001). Nasogastric tube (NGT) decompression for gastrointestinal distention was
performed in all 10 of the converted group and in 12 (24.49%) of the 49 non-converted group
(p<0.001). Reactive conversion was done in 1 patient with intractable bleeding that was
controlled by ligating both internal iliac arteries on laparotomy. When grouped according to
conversion, a significantly higher amount of estimated blood loss in the converted group than in
the non-converted group (950 ml vs. 200 ml, p<0.001) was observed.
Conclusion: The factors associated with conversion laparoscopy among patients with pelvic
endometriosis are expected operative difficulties requiring anticipatory referrals, gastrointestinal
distention requiring NGT decompression and blood loss.

Keywords: laparoscopy, conversion, endometriosis

R-20

Pharmacologic Treatment on Chronic Hypertension in Pregnancy

Based on ACOG vs. ACC/AHA Guidelines

Edcyndi M. Tan, MD, Ma. Antoinette P. Mendoza, MD, FPOGS, FPSUOG, FPSMFM
Cebu Doctors’ University Hospital

Introduction: Hypertension is a common medical problem during pregnancy. The American

College of Cardiology (ACC) and American Heart Association (AHA) changed the criteria for
diagnosing hypertension in adults, which is not consistent with the definition of hypertension by
the American College of Obstetrics and Gynecology (ACOG). The ACC-AHA recommendation
suggest that antihypertensive drug should be given in patients with at least stage 1 hypertension
with risk factors. However, the uncertainty of this recommendation as applied to obstetric care
should be investigated.
Objective: To compare the incidence of adverse maternal and fetal outcomes between the
chronically hypertensive pregnant women who are medically treated using ACC-AHA and ACOG
guidelines.
Methodology: A prospective cohort study was conducted among 69 subjects diagnosed with
chronic hypertension. Patients with elevated blood pressure were assigned to ACOG group and
ACC-AHA group treatment guidelines. The primary outcomes were the maternal and fetal
outcomes such as preeclampsia, eclampsia, abruptio placenta, diabetes mellitus, intrauterine
growth restriction (IUGR) and preterm birth. Secondary outcome determined the presence of
risk factors such as older age, parity, obesity and family history of hypertension.
Results: The two groups did not differ significantly in terms of age (p=0.406), body mass index
(BMI) (p=0.440), parity (p=0.135) and family history of hypertension (p=0.745). In terms of blood
pressure upon admission, the p-values were greater than the significance level which did not
differ significantly. The overall adverse maternal (p=0.162) and fetal (p=0.532) outcomes showed
no statistically significant difference.
Conclusion: The ACOG and AHA recommendations did not differ significantly in the incidences of
adverse maternal and fetal outcomes. As a result, ACOG continues to be the best practice
guideline in offering a rational approach to chronic hypertension in pregnancy.

Keywords: hypertension, pregnancy, methyldopa, aspirin

R-21

Prediction of Postpartum Depression Based on Perinatal Risk Factors

Among Patients in a Tertiary Hospital in the Philippines

Angelynn S. Sianghio, MD, Elisa Patricia M. Cornelio, MD, FPOGS, FPSUOG,

FPSMFM
San Juan De Dios Educational Foundation Inc. (Hospital)

Introduction: Nowadays, expectant mothers deal with evolving practices, societal expectations,
woes of childcare, and postpartum changes. This could lead to postpartum depression (PPD)
which has been characterized and identified in different countries, however, pre-identification
remains a dilemma. Education, marital violence, and genetic disposition are a few identified
factors.
Objective: The study aimed to predict the occurrence of PPD among patients of a tertiary hospital
in Pasay City from September 2019 to September 2020, using a validated and translated perinatal
risk factors questionnaire and Edinburgh Postnatal Depression Scale (EPDS).
Methodology: This is a cross-sectional prospective study with a minimum sample size of 231
subjects. Primiparous and multiparous subjects delivered by vaginal or cesarean section with live
offspring. Informed consent, instigation of perinatal risk factor questionnaire prenatally and the
EPDS 7 days after delivery were done.
Results: A total of 235 subjects were included in the study. The subjects had a median age of 30
years, majority were single (122, 51.91%), attended college (206, 87.66%) and were employed
(191, 81.28%). Pregnancies were mostly planned (181, 77.02%) and wanted (109, 84.26%);
majority were primigravid (159, 67.66%), primiparous (185, 78.72%), and delivered vaginally
(147, 62.55%). Ten (4.3%) were preterm neonates, and 131 (56%) were males. Prevalence of PPD
was 2.13%. On univariate analysis, high school education, unemployment, unplanned and
unwanted pregnancies were associated with greater odds of PPD among women.
Conclusion: The perinatal risk factor questionnaire correlated with EPDS scores is an effective
instrument to identify who may eventually develop PPD when included during prenatal check-
ups. The researchers believe that the low prevalence among the participants may be due to the
strong family cohesiveness of the Filipinos. Hence, patients identified at risk would be better
monitored and counselled closely after delivery.

Keywords: postpartum depression, Edinburgh Postnatal Depression Scale

R-21

Preterm Birth Research in Southeast Asia and Its Association with

Socioeconomic Determinants and Burden of Disease: A Bibliometric
Analysis

Koleen C. Pasamba, MD, Jean Anne B. Toral, MD, MSc, FPOGS, FSGOP
University of the Philippines-Manila, Philippine General Hospital

Introduction: Preterm birth – delivery at less than 37 weeks age of gestation – is one of the
leading causes of neonatal morbidity and mortality in the world. Research and development has
a crucial role in decreasing the rate of preterm birth through discovering means to prevent and
manage the condition.
Objective: The aim of this study was to assess research productivity on preterm birth in
Southeast Asian (SEA) countries and its correlation with socioeconomic characteristics and
burden of disease.
Methodology: A systematic review of preterm birth publications by SEA authors indexed in
Scopus, PubMed, ClinicalTrials.gov and Cochrane was done. Research productivity was assessed
by determining total publications, total citations and total PlumX metrics indices of each SEA
country. The correlation of bibliometric indices, namely Scopus citations, and PlumX metrics
indices (citations, usage, captures, mentions, and social media), with socioeconomic status and
burden of preterm birth in SEA countries were analyzed by computing for the correlation
coefficient (r) and p-value at an alpha of 0.05.
Results: Thailand had the highest number of publications and the highest count across all
bibliometric indices among all countries in SEA. The percent gross domestic product (GDP) per
capita allotted for research and development had direct correlation with publications and
captures while crude birth rates had indirect correlation with publications, citations, and
captures. Neonatal mortality had indirect correlation with publications and captures.
Conclusion: Support for research and development is essential to increase research productivity
in SEA, which in turn may help in finding solutions to decrease the rate of preterm birth in the
region. Further studies are recommended to quantify effect of research productivity on the
decrease of preterm birth rates.

Keywords: bibliometric analysis, preterm birth, prematurity, gross domestic product

R-23

Prevalence of Mismatch Repair Deficiency in Filipino Women with

Endometrial Cancer and Its Correlation with Clinicopathologic
Features, Adjuvant Treatment and Outcomes

Maria Patricia Angelica M. Tanchuling, MD, DPOGS, Michelle H. Diwa, MD,

DPSP, Karen Cybelle J. Sotalbo, MD, DPSP, Cecile C. Dungog, MD, PhD,
Renee Vina G. Sicam, MD, FPOGS, FSGOP, FPSGE, Carolyn R. Zalameda-Castro,
MD, MSc, FPOGS, FSGOP
University of the Philippines-Manila, Philippine General Hospital

Introduction: Recent advances in the understanding of endometrial cancer have shown that
behavior and prognosis correlate more with molecular profile than histopathologic morphology.
Objective: This study aimed to determine if immunohistochemistry stains for mismatch repair
(MMR) genes are associated with disease outcomes.
Methodology: This is a cross-sectional study using chart reviews conducted among endometrial
cancer patients who underwent surgery as primary treatment (2015-2019).
Immunohistochemistry staining with MMR antibodies – MLH1, MSH2, MSH6 and PMS2 – was
done on formalin-fixed paraffin-embedded tissue blocks to determine MMR status.
Results: A total of 243 patients were included; 230 samples were analyzed for MMR stains.
Demographic data, histology, stage, tumor grade, adjuvant treatment and outcomes did not
correlate with MMR status. There was lymphovascular space invasion in 48% of patients,
irrespective of MMR status. The prevalence of MMR deficiency is 37.39% (95%CI 31.35-43.86).
The odds ratio of disease recurrence or progression among MMRd patients is 1.04 (95% CI 0.49-
2.19).
Conclusion: MMR status did not correlate with clinical profile or surgico-pathologic outcomes.
Although this study was underpowered to determine association between MMR status and risk
of progression owing to the number of patients lost to follow-up, this is the first study to attempt
MMR testing among endometrial cancer patients in the Philippines.

Keywords: endometrial cancer, immunohistochemistry, MMR status

R-24

Reproducibility Study on the International Endometrial Tumor Analysis

(IETA) Terminology for the Evaluation of Sonographic Endometrial
Vascular Parameters in Women with Abnormal Uterine Bleeding

Nina Rojana L. Yu, MD, Regina Rosario M. Panlilio, MD, FPOGS, FPSUOG
University of the Philippines-Manila, Philippine General Hospital

Introduction: In 2008, the International Endometrial Tumor Analysis (IETA) group released a
consensus statement to standardize the sonographic descriptors for key uterine cavity and
endometrial features. While this may minimize the observer subjectivity inherent in sonography,
there are no local studies analyzing its reproducibility.
Objective: To determine reproducibility by estimating interobserver and intraobserver reliability
in describing the vascular characteristics of the endometrium of women with abnormal uterine
bleeding (AUB) using the IETA group terminology.
Methodology: This is a prospective cross-sectional study. Five (5) non-expert (fellows-in-training)
and 5 expert (consultants) raters assessed stored still images of the endometrium obtained from
68 women with AUB and endometrial thickening. Color flow and vascular pattern were evaluated
using the IETA group descriptors. Interobserver agreement was estimated by comparing the
assessments of the non-expert and expert raters, while intraobserver agreement was computed
following repeat assessment after 4 weeks. Interrater agreement of both groups to the reference
assessment was also determined.
Results: Compared to the non-expert raters, the expert raters displayed better interobserver
reliability (κ = 0.74 vs. 0.57) and intraobserver reliability (κ = 0.84 vs. 0.64) in assigning the color
score using IETA’s four-point scoring system. However, both expert and non-expert raters
exhibited markedly worse interobserver reliability (κ = 0.49 vs. 0.34) and intraobserver reliability
(κ = 0.84 vs. 0.63) in assigning the vascular pattern according to IETA’s seven categories. All raters
exhibited moderate to good agreement with the reference assessment for both color score and
vascular pattern.
Conclusion: The reproducibility of assigning color score is good regardless of the degree of
expertise of the rater. However, the reproducibility of describing vascular patterns is significantly
worse for all raters. Both non-expert and expert raters exhibited acceptable agreement with the
reference standard. Expert raters have consistently demonstrated better reliability in their
assessment compared to the non-expert raters.

Keywords: Doppler ultrasound, IETA, abnormal uterine bleeding, endometrial pathology

R-25

Sexual Dysfunction Among Patients with Endometrial Cancer at a

Tertiary Training Public Institution: A Cross-Sectional Study
Katrina Mae A. Natavio, MD, Jimmy A. Billod, MD, MHCA, FPOGS, FSGOP
Baguio General Hospital and Medical Center

Introduction: Studies on sexual dysfunctions among gynecologic cancer after treatment are
sparse in the Philippines and data on sexual dysfunction vary greatly within the gynecologic
oncology literature. As the numbers of female cancer survivors continue to grow, there is a
growing need to bridge the gap between the high rate of women's cancer-related sexual
dysfunction and the lack of attention and intervention available to the majority of survivors who
suffer from sexual problems.
OBJECTIVE: To determine the presence of sexual dysfunction among endometrial cancer patients
managed in the institution.
METHODOLOGY: This is 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 (desire, arousal, lubrication, orgasm, satisfaction and pain). Descriptive
statistics such as frequency and percentages were used in determining the prevalence of sexual
dysfunction 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, 53 patients participated in this study. Among
them, 41 (77.36%) have sexual dysfunction. Majority of the respondents either reached up to
high school level (12, 22.6%) or are college graduates (12, 22.6%). Most of them are also self-
employed (21, 51.22%). Twenty-three (56.10%) have children (1-3). 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. Hence, proper screening, diagnosis and counselling should be done
to all patients upon diagnosis to promote better quality of life.

Keywords: endometrial cancer, female sexual function index Filipino version, sexual dysfunction,
quality of life
R-26

The Difference in Delivery Outcomes of Mothers with Gestational

Diabetes Mellitus on Metformin Therapy vs. Insulin Therapy in a
Tertiary Hospital: A Retrospective Cross-Sectional Study

Venice M. Lawas, MD, Christie Luz Rosal, MD, FPOGS

Perpetual Succour Hospital

Introduction: Gestational diabetes mellitus (GDM) is associated with grave feto-maternal

complications. Although the prevalence varies widely, the proportion of pregnancies complicated
by GDM are more common among Asian women. GDM is diagnosed between 24-28 weeks of
gestation using the 75g oral glucose tolerance test (OGTT) as recommended. Management is
aimed at optimizing glycemic levels and subcutaneous insulin is considered the standard of
treatment. Metformin as an oral hypoglycemic was recently endorsed as an alternative to insulin
for pregnant women and studies showed comparable outcomes and glycemic control.
Objective: To determine the difference in delivery outcomes of mothers with GDM on
metformin therapy vs. insulin therapy in a tertiary hospital.
Methodology: A retrospective cross-sectional study was conducted on patients with GDM on
metformin vs. insulin therapy who delivered term singleton pregnancies and enrolled at the
Maternity Service Program in Perpetual Succour Hospital from January 1, 2017 to May 31, 2020.
Maternal profile was determined in terms of parity, age of gestation and mode of delivery, as
well as neonatal outcomes in terms of Apgar score, Ballard score, birthweight and size for
gestational age. Z-test was used for continuous variables and two-tailed test to determine
significance of null hypothesis.
Results: Among 76 patients with GDM, 19 of them were on insulin and 57 were on metformin.
Most of the mothers on insulin and metformin delivered spontaneously (57.89% and 63.16%
respectively, p=0.68), with neonates having good Apgar scores and a mean Ballard score of 39
weeks on both. Although the neonates of mothers on metformin had a greater average
birthweight as compared to those on insulin, the difference was also not statistically significant
(3,095.77 g vs. 2,895.59 g, p=0.15).
Conclusion: There is no difference in maternal outcomes between patients with GDM on
metformin as compared to those on insulin. Thus, metformin may be used as a safe alternative
to insulin in the management of GDM.

Keywords: gestational diabetes mellitus, metformin, insulin, maternal and neonatal outcomes
R-27

The Effectiveness of Audiovisual Distraction in Reducing Labor Pain

During the Active Stage: A Randomized Controlled Trial

Aileen F. Acuna, MD, Jaynet DC. Tan, MD, FPOGS, FSGOP,

Yamami B. Chan, MD, FPOGS, FPSUOG
Tarlac Provincial Hospital

Introduction: Cultural and societal expectation on women to accept labor pain and the
physician's focus on vaginal birth progress over pain management translate the idea of pain
management as highly desired by women.
Objective: The study determined the effectiveness of audio and visual distraction methods in
reducing labor pain during the active stage.
Methodology: The randomized controlled trial (RCT) conducted in a government hospital in
Tarlac from the period of June to September 2020 involved the 275 laboring mothers who were
randomized into control (n=91), experimental group 1 (n=98) and experimental group 2 (n=86).
Baseline and post-intervention pain ratings were obtained in the 3 groups using Visual Analogue
Scale (VAS). Dependent t test (before and after pain rating) and one way ANOVA (comparison of
3 groups) were utilized.
Results: The subjects had a mean age of 22.82 years old (SD ±3.72), age of gestation of 38.55
weeks (SD ±1.69), and an initial cervical dilatation of 5.19 cm (SD ±0.54) without any significant
difference according to age (p=0.175), age of gestation (p=0.431), cervical dilatation (p=0.442)
and baseline pain rating (p=0.058) between the 3 groups. There was a statistically significant
increase in pain rating in all 3 groups. Pain rating was statistically significantly higher in the control
group (9.63) when compared to audio (8.45, p=0.000) and visual (8.51, p=0.000). The depiction
of labor curve reveals increasing pain experience with or without non-pharmacologic
intervention. As stress response is the opposite of relaxation, the findings revealed that pain
distraction methods can reduce tension and fear during childbirth.
Conclusion: Access to all available pain relief methods by the mother is critical to effective
management. It highlights these methods, while economical and non-invasive, can be of clinical
application with the goal of promoting positive maternal outcomes respective to manageable
labor pain.

Keywords: audiovisual distraction, labor pain

R-28

The Effectiveness of Evening Primrose Oil Capsule vs. Oxytocin

Pharmacologic Approach in Labor Augmentation: A Randomized
Controlled Trial

Anjelica Naguiat-Leynes, MD, Jaynet DC. Tan, MD, FPOGS, FSGOP,

Maria Myra G. Villaroman, MD, FPOGS
Tarlac Provincial Hospital

Introduction: The natural form to labor augmentation emanates from the idea concerning the
effect of prostaglandins in evening primrose oil (EPO) that is documented in anecdotal evidence.
Faced with limited evidence largely caused by smaller clinical studies to support its therapeutic
effect, the study materialized to determine its effectiveness on the length of labor.
Objective: The study aimed at determining the effectiveness of intravaginally applied EPO
compared to the commonly used pharmacologic approach using oxytocin on term primigravid
patients undergoing labor augmentation.
Methods: This randomized controlled trial involved 80 mothers (40 control, 40 experimental) in
a government hospital in Tarlac City, Tarlac based on eligibility characteristics (primigravida, term
pregnancy, at least 18-years-old, cephalic fetal presentation, intact amniotic membranes, with
regular prenatal check- up). The control group received the standard oxytocin while the
experimental group had the intravaginal EPO capsules.
Results: The 80 mothers were 21.65 years-old (SD ±4.661) at 39.14 weeks age of gestation (SD
±0.522) with baseline Bishop’s score of 7.04 points (SD ±1.804). Bishop’s scores statistically and
significantly increased with the use of either oxytocin (p=0.000) or EPO (p=0.000). The use of
oxytocin resulted in shorter length of labor (3.37 hours, p=0.000) and higher follow-up Bishop
scores (8.58 points, p=0.001) compared to the EPO capsules (4.55 hours; 7.73 points). EPO’s
effect on Bishop’s scores and labor duration is based on the premise that a cervix that is prepared
for labor augmentation favors progress of vaginal delivery.
Conclusion: The oxytocin treatment for labor augmentation asserts the needed inquiry for EPO
to influence labor length as the former has been proven to have shorter labor duration than the
latter. Worthy of clinical application, the use of EPO still at large, requires conduction of large-
scale research to further strengthen the validity of findings to labor augmentation.

Keywords: evening primrose, oxytocin, labor augmentation

R-29

The Prevalence of COVID-19 Infection Among Gynecologic Oncology

Patients Receiving Cancer Treatment in a COVID-19 Referral Hospital

Renee Riza C. Medalla, MD, Jericho Thaddeus P. Luna, MD, FPOGS, FSGOP
University of the Philippines-Manila, Philippine General Hospital

Introduction: Cancer patients are more susceptible to coronavirus disease-19 (COVID-19)

infection because they are immunosuppressed by their disease or therapy, most of them have
co-existing medical conditions, and they frequently visit hospitals for treatment and surveillance.
Objective: To determine the prevalence of COVID-19 infection among gynecologic oncology
patients receiving treatment in a COVID-19 referral hospital.
Methodology: A descriptive, cross-sectional study involving 47 gynecologic cancer patients
receiving treatment from June to December 2020 was performed. All patients underwent SARS-
CoV-2 RT-PCR swab test and symptom and exposure assessment prior to start of cancer
treatment. Patients with negative SARS-CoV-2 RT-PCR swab test results received their planned
treatment, and a repeat swab test and triage assessment were done mid-treatment and after
treatment.
Results: The average age of the patients was 47.6 + 12 years and majority (27, 57.4%) were
classified as obese. Eleven (23.4%) patients were either previous or current smokers, and in
addition to cancer, 24 (51.0%) patients had at least one or more co-existing morbidities, with
hypertension (18, 38.3%) being the most common. Patients received an average of 6 cycles of
chemotherapy and 30 patients received pelvic or para-aortic external beam radiation, and/or
brachytherapy. Eighteen (38.30%) patients had treatment-related complications. Five (10.6%)
patients had positive baseline SARS-CoV-2 RT-PCR swab result, but all proceeded with treatment
after negative results were obtained. Only 1 (2.13%) patient had a positive SARS-CoV-2 RT-PCR
swab test result at mid-treatment. All patients had no COVID-19-associated symptoms and none
of them tested positive for COVID-19 infection post-treatment.
Conclusion: The prevalence of COVID-19 infection among gynecologic cancer patients receiving
cancer treatment is 2.13%. All patients who had positive SARS-CoV-2 RT-PCR swab test results at
baseline or mid-treatment were able to continue and complete treatment. There were no severe
clinical events or mortalities among those affected with COVID-19 infection.

Keywords: COVID-19, gynecologic cancer, cancer treatment

R-30

The Relationship of Ultrasonographic Modified STEPW Classification

for Submucous Uterine Leiomyoma to Hysteroscopic Myomectomy
Outcome: A Philippine Tertiary Institutional Experience

Vanessa Marie T. Lim, MD, FPOGS, Anna Liza C. Salita, MD, FPOGS, FPSUOG,
Ma. Isidora Margarita Yap-Garcia, MD, FPOGS, FPSRM, Christine Joyce M.
Omolida, MD, FPOGS
St. Luke’s Medical Center – Quezon City

Introduction: Submucous leiomyomas lead to significant uterine bleeding which necessitates

surgical resection. The STEPW classification includes five components: size, topography, extent
of base, penetration, and involvement of lateral wall allowing a better prediction for degree of
hysteroscopic myomectomy difficulty. With technological advancements, STEPW classification
can be done without diagnostic hysteroscopy through transvaginal ultrasound
sonohysterography and 3D scanning. Accurate pre-operative evaluation aid in decision-making
whether hysteroscopic myomectomy is indicated, and prognosticating complete resection.
Objective: To determine the relationship between ultrasonographic modified STEPW
Classification to hysteroscopic myomectomy outcome
Methodology: This was a retrospective cohort study from January 2016 to January 2020.
Component description of the modified STEPW Score was taken intraoperatively from operative
technique and corresponding transvaginal ultrasound. Intraoperative and post-operative status
were determined by chart review. A retrospective approach was undertaken due to the
pandemic; the component of the lateral wall was excluded as it was not possible to deduce from
all of the ultrasonographic files of the patients.
Results: One hundred eight patients were included in the study. Modified STEPW scores more
than 4 (Group II and III) were statistically associated (p <0.05) with longer duration of surgery,
higher fluid deficits, more blood loss, and surgical complications. Length of hospital stay was not
associated with any of the independent variables. There was an almost perfect agreement at
97.9%, Cohen’s kappa of 0.82, between the ultrasonographically derived classification and
intraoperative classification. Ultrasonographic-derived modified STEPW classification had a
sensitivity of 88.7%, specificity of 54.6%, PPV of 94.5%, NPV of 35.3%, positive likelihood ratio of
2, negative likelihood ratio of 0.2, diagnostic accuracy of 85.2%, and diagnostic odds of 9.4.
Conclusion: STEPW classification through ultrasound is a cost-effective pre-operative assessment
tool prior to operative hysteroscopy for submucous uterine leiomyoma. However, a prospective
multicenter study highlighting the actual scoring of ultrasonographic STEPW classification for
submucous myoma is still needed.

Keywords: submucous leiomyoma, STEPW classification, ultrasound

R-31

The Utility of Neutrophil-Lymphocyte Ratio in Predicting Medical

Failure in Tubo-ovarian Abscess

Lailanie Jane C. Santiago, MD, Stella Marie L. Jose, MD, MHPEd, FPOGS,
FPIDSOG
University of the Philippines-Manila, Philippine General Hospital

Introduction: Tubo-ovarian abscess (TOA) is common among reproductive-age women but may
also affect the menopausal women. According to Munro, et. al., the prevalence of TOA in pelvic
inflammatory disease (PID) cases is approximately 2.3%. Neutrophil-lymphocyte ratio (NLR) has
been proposed as a significant marker for diagnosis in TOA.
Objective: To determine the level of NLR in predicting medical failure in TOA in a tertiary hospital
in the Philippines.
Methodology: This is a retrospective cross-sectional study, which was done through a chart
review of all cases seen at the obstetric emergency room of a tertiary hospital in the Philippines
from 2014 to 2018. The sample size is 82 participants. Lesions were determined with cut-off
values derived from receiver operating characteristic (ROC) analysis.
Results: Out of the 4,828 gynecologic admissions in the institution, 82 (1.7%) patients were
diagnosed to have TOA. From 2014 to 2018, 82 patients were admitted in a tertiary hospital due
to TOA. A total of 45 (54.9%) patients were managed medically and 37 (45.1%) patients were
managed surgically. The mean age of patients with TOA who underwent medical management
was 30, while for those who had surgical management was 35.65. The transvaginal ultrasound
measurement (mass volume) of the TOA was 141.9 ml for those who underwent medical
intervention and 351.9 ml for those who had surgical management. The NLR mean value was of
5.6 for those who underwent medical management and 13.4 for those who had surgical
management. There was no statistical difference between the medical group and surgical group
in terms of age, gravidity, parity and volume of the TOA. There was a statistical significant
difference between the medical treatment group and the surgical treatment group in terms of
NLR ratio (p=0.037).
Conclusion: This study suggests that NLR can be a simple tool to use to predict the probability of
needing surgical management among patients with TOA.

Keywords: tubo-ovarian abscess, pelvic inflammatory disease, neutrophil-lymphocyte ratio,

transvaginal ultrasound
R-32

Total Laparoscopic Hysterectomy: Determining the Rate-Limiting Step

by Retrospective Video Evaluation

Ana Katrina P. Estacio, MD, FPOGS, Zoraida R. Umipig-Guevara, MD, FPOGS,

FPSGE
East Avenue Medical Center

Introduction: Total laparoscopic hysterectomy (TLH) has been increasingly recommended as the
surgical method for removing the uterus for benign gynecological diseases. Minimally invasive
surgery, with the development of new techniques and instruments, results to faster recovery.
However, its practice in the country has been limited even among gynecologic endoscopists
because of the reported prolonged operating time.
Objective: To determine the rate-limiting steps that prolong operating time in TLH performed by
the most senior fellows-in-training.
Methodology: This is a retrospective, cross-sectional study, using videos and clinical records of
32 patients who satisfied the inclusion criteria between January 2018 and December 2020. TLH
technique used was the 10 steps validated by the European Society for Gynecologic Endoscopy.
Results: The mean total surgical time, total blood loss and uterine size were 226.34 minutes, 150
ml and 7.76 x 7.05 x 4.11 cm, respectively. The longest surgical time of all the steps were observed
in step 6 (colpotomy; 16.02 + 8.02 minutes) and step 8 (vault closure; 24.77 + 11.07 minutes).
There was significant correlation between total amount of blood loss and duration of step 6
(p=<0.001), as well as with step 8 (p=0.010). There was also significant correlation between
uterine size and duration of step 6 (p=0.026), and presence of adhesions and duration of step 6
(p=0.009).
Conclusion: The 2 rate-limiting steps determined to prolong operating time in TLH performed by
the most senior fellows-in-training were colpotomy and vault closure.

Keywords: laparoscopic hysterectomy, colpotomy, vault closure

R-33

Vaginal Preparation Before Cesarean Delivery Among Pregnant

Women in a Tertiary Hospital: A Randomized Controlled Trial

Angela Nicole N. Fernandez, MD, Victoria N. Sy-Fernando, MD, FPOGS, FSGOP,

Maria Michelle G. Borbe, MD, FPOGS, FPSUOG
Chinese General Hospital and Medical Center

Introduction: Cesarean delivery, one of the most common procedures done in the field of
Obstetrics and Gynecology, is the most important risk factor for postpartum infection. Common
postpartum complications associated with cesarean deliveries are endometritis (6-27%), clinically
significant fever (5-24%), and wound infection (2-9%).
Objective: To determine the effects of vaginal preparation before cesarean operation on
postoperative factors and morbidities and to compare the maternal outcomes of patients who
underwent vaginal preparation prior to cesarean section vs. those who had no vaginal
preparation.
Methodology: The study was a prospective randomized controlled trial in which 172 subjects
were randomized to receive vaginal preparation with povidone-iodine solution immediately prior
to cesarean delivery (intervention group) and to no vaginal preparation (control group). The
primary outcome measures were the rate of postpartum endometritis, postoperative fever,
postoperative pain, wound infection, and hematologic factors on postoperative day 1.
Results: The incidence of endometritis was 2.3% in both groups. Febrile morbidity occurred in 4
(4.65%) of the intervention group and 8 (9.30%) of the control group (p=0.231). Wound infection
affected 1.2% of the intervention group and 4.7% of the control group. The incidence of wound
infection was decreased by 8% among patients who were in labor and were given vaginal
preparation (RD -0.08, 95% CI -0.16 to -0.005, p=0.041). There was insufficient evidence to
demonstrate a difference between the 2 groups in terms of endometritis, febrile morbidity and
wound infection in those not in labor.
Conclusion: Vaginal cleansing with povidone-iodine solution immediately prior to cesarean
section may reduce the risk of wound infection after delivery in patients who are in labor. There
was no significant benefit of povidone-iodine vaginal preparation in the risk of postoperative
endometritis, febrile morbidity and postoperative blood loss.

Keywords: cesarean section, povidone-iodine solution, vaginal preparation

IC-1

A Case of Complex Diagnosis and Management of Obstetrically

Acquired Hemophilia

Ashley Ediamy D. Go, MD, Maynila E. Domingo, MD, FPOGS, FPSMFM, FPSUOG
Medical Center Manila

Introduction: Obstetrically acquired hemophilia is a rare autoimmune entity which is estimated

to affect approximately 0.2-1 individuals per 1,000,000 per year in the general population. It is a
life-threatening condition. Diagnosis alone can be a complex and challenging task, as affected
individuals may go undiagnosed or misdiagnosed.
Course of the Patient: This is a case of a 28-year old, G3P2 (1102) who had a history of
postpartum hemorrhage on her first pregnancy, and had pre-eclampsia, intraperitoneal
hemorrhage, and exploratory laparotomy with evacuation of hemoperitoneum on her second
pregnancy, which were all consistent with the clinical characteristics of a blood dyscrasia. In the
present pregnancy, hemostatic tests indicated a prolonged activated partial thromboplastin time
(aPTT) and decreased factor specific assay VIII. Further work up demonstrated a positive for
mutation on Southeast Asian (SEA) double gene deletion consistent with alpha thalassemia trait.
The patient was closely monitored prenatally and maintained on immunosuppressive treatment
with oral prednisone. The patient then underwent a repeat cesarean section at 38 weeks age of
gestation (AOG).
Discussion: This clinical case report aims to emphasize that diagnosis of exclusion for blood
dyscrasia by early detection, along with proper management and preparedness, is essential to
save both maternal and fetal lives.

Keywords: blood dyscrasia, acquired hemophilia, thalassemia, hemorrhage

IC-2

A Case of Dysgerminoma Associated with Swyer Syndrome in a 35-

Year-Old Female

Janelyn I. Daguro-Cero, MD, Kara Angelique L. Valles, MD

Governor Celestino Gallares Memorial Hospital, Tagbilaran City, Bohol

Introduction: Swyer syndrome, a pure gonadal dysgenesis, presents as a phenotypical female

with a 46 XY karyotype, and a hypoplastic or rudimentary uterus. Gonadal streak replaces the
ovaries, thus there is absence of normal ovarian function. These gonads, however, have
increased risk for malignant potential such as dysgerminomas.
Course of the Patient: This is a case of 35-year-old nulligravid who came in for change in sensorium,
generalized weakness and abdominal pain. The patient has a history of primary amenorrhea and
an enlarging abdominal mass. Physical examination showed breasts in Tanner stage I and vulva
in Tanner stage II. Abdominal examination showed a well-circumscribed, solid, movable, tender,
pelvo-abdominal mass at the level of the umbilicus. This correlated with an imaging showing a
non-benign left ovarian mass measuring 17 x 6 x 19 cm with absent uterus. CA-125 and B-hCG
were elevated at 80 U/mL and 184.4 mIU/mL, respectively and lactate dehydrogenase at 640 u/L.
Chromosomal analysis revealed 46 XY male karyotype. Medical complications lead to patient’s
demise. Autopsy done showed gross findings of symmetrical, undeveloped breasts with
hypopigmented areola, labial pubic hairs, blind pouch vagina and hypoplastic cervix. Abdominal
mass was attached by a fibrous tissue on the left inguinal area (17 x 10 x 5 cm) with absence of
visible female reproductive organs. Microscopic evaluation of the mass showed dysgerminoma,
rudimentary uterus and residual fallopian tube.
Discussion: Swyer Syndrome is thought to result from a mutation in the SRY gene or in other
genes with testis-determining effects. In gonadal dysgenesis, ovaries are replaced by gonadal
streak with failure to produce necessary hormones to initiate puberty and secondary
characteristics. These gonads are high risk for developing gonadal tumors such as
gonadoblastomas and dysgerminomas; thus, gonadectomy should be performed. If prompt
hormonal and surgical management are provided, prognosis is good as these are highly sensitive
to chemotherapy.

Keywords: Swyer Syndrome, gonadal dysgenesis, dysgerminoma, primary amenorrhea

IC-3

A Case Report: Non-Hodgkin’s Lymphoma of the Uterus

Nadia G. Agagon, MD, Fritzie B. Tenorio, MD, FPOGS

Batangas Medical Center

Introduction: Non-Hodgkin’s Lymphoma (NHL) can originate from sites other than the lymph
node, with the uterus being a rare site of involvement. It is difficult to distinguish from primary
neoplasms of the uterus; thus, diagnosis can be delayed leading to poor prognosis. Treatment
poses another difficulty because of the absence of standard treatment. Individualization of
treatment is recommended.
Course of the Patient: This is a case of a 17-year-old nulligravid admitted because of vaginal
bleeding and difficulty in urination. She had a 5-month history of intermittent, profuse vaginal
bleeding. On examination, there was a 10 x 10 cm firm, irregular, friable mass protruding out of
the cervical os and extending to the lower third of the vagina. Biopsy revealed malignant round
cell neoplasm, considering poorly differentiated carcinoma, High-grade Sarcoma, Lymphoma.
Immunohistochemistry favored High-Grade Lymphoma. She had episodes of seizure,
electroencephalogram (EEG) was normal and cranial computed tomography (CT) scan showed
brain metastasis. She underwent 2 cycles of chemotherapy with Methotrexate,
Cyclophosphamide, Vincristine. She expired due to acute respiratory and renal failure,
obstructive uropathy secondary to Non-Hodgkin’s Lymphoma of the uterus with central nervous
system metastasis.
Discussion: NHL is the most common type of lymphoma, with 1/3 affecting the extranodal
regions. Involvement of the female genital tract is rare, seen in approximately 2%. The incidence
of NHL of the uterine corpus ranges from 0.54 to 0.64%. Clinical presentations are abnormal
uterine bleeding, abdominal pain, pelvic pain associated with palpable mass and urinary
symptoms. Biopsy is the most common and most useful method for its diagnosis.
Immunohistochemistry studies are important to determine the type and subtype of lymphoma.
There is no evidence-based recommendation and no formal protocol for the management of
uterine lymphoma due to inadequate number of cases. The treatment of patients needs to be
individualized with surgery, chemotherapy, irradiation, or a combination of these. However, the
prognosis usually remains poor with five-year survival reported by recent study on lymphoma.

Keywords: Non-Hodgkin’s lymphoma, uterus

IC-4

A Case Report on Obstructed Labor in a Multigravid Secondary to

Vesical Calculus

Kathleen Faye M. Llamera, MD, Kristina L. Dosdos, MD, FPOGS, FPSMFM

Vicente Sotto Memorial Medical Center

Introduction: Obstructed labor is a well-known clinical entity. A vesical calculus causing

obstructed labor is extremely rare. Very few cases of it causing labor obstruction have been
reported in literature till date. Presence of vesical calculus can cause complications in 1 out of
200 pregnant women. This case provided an insight about vesical calculus in pregnancy. It helped
us become aware on the causes of vesical calculus, how it affected pregnancy, its diagnosis and
management.
Course of the Patient: This is a case of a 29-year-old G4P3 (3003) diagnosed with pregnancy
uterine 37 weeks and 4 days age of gestation who underwent primary low segment transverse
cesarean section for arrest in cervical dilatation secondary to tumor previa. A smooth, round,
solid, movable mass approximately 8 x 8 cm was palpated on the anterior vaginal wall. She was
referred to Urosurgery intraoperatively and a 10 x 8 cm cystolithiasis was noted. Cystolithotomy
with suprapubic tube insertion was done. Stone composition was made of calcium oxalate
stones. The patient was discharged improved 5 days after the surgery.
Discussion: Vesical calculus in pregnancy is very rare. Rarer still is vesical calculus complicating
pregnancy. Stones appear to be more common in multiparous women, with 80-90% stones
occurring in the 2nd and 3rd trimester. An early diagnosis of a large vesical calculus in pregnancy
and its appropriate management can help avoid serious complications.

Keywords: vesical calculus, obstructed labor, tumor previa

IC-5

A Confirmed Case of Menstrual Cup Associated with Toxic Shock

Syndrome in a Healthy Filipina: A Philippine Perspective
Andrea Francesca I. Santos, MD, Merlind M. Montinola-Morales, MD, FPOGS,
FSGOP
Medical Center Manila

Introduction: Menstrual cup-associated toxic shock syndrome is a severe, fatal, super antigen
toxin-mediated illness which leads to multiple organ-system failure early in its course. Pathology
of the disease is centered on the TSS 1 toxin produced by Staphylococcus aureus accumulated in
the menstrual blood within the cup. To the best of our knowledge, at present time there are only
3 international journals under the specialty of Internal Medicine who have published case reports
of menstrual cup-associated toxic shock syndrome. In the local setting, there is rare, if not limited,
knowledge in terms of incidence, morbidity and mortality rates of this disease and our index
patient may be the first Philippine reported case.
Course of the Patient: Reported is a 30-year-old healthy Filipina, a known menstrual cup user
for 6 years, who reported prolonged use of menstrual cup of more than 12 hours on day 3 of
menses. Her diagnosis was confirmed by the Case Definition Criteria set by the Center for Disease
Control (CDC) 2011, where she fulfilled 5 of the clinical criteria: fever, rash, desquamation and
hypotension, with the presence of multisystem involvement – vomiting, myalgia, vaginal and
oropharyngeal hyperemia. This was further supported by the heavy growth of methicillin-
resistant Staphylococcus aureus in her vaginal discharge culture. She was treated empirically
with antibiotics that lead to successful treatment outcomes with no recurrence.
Discussion: At this day and age, we give women freedom to choose what is right and appropriate
for them, including choice of menstrual hygiene products. It is a personal decision often
influenced by cultural acceptability, user preferences and affordable options. This paper is
written to promote knowledge, advocate wellness and most of all to educate clinicians to have
high index of suspicion on this disease and eventually prevent its catastrophic sequalae.

Keywords: toxic shock syndrome, menstrual cup, methicillin resistant, TSS1 toxin Staphylococcus
aureus
IC-6

An Undiagnosed Live Term Extrauterine Abdominal Pregnancy: A

Case Report

Nadzzida H. Maldisa, MD, Fortunato P. Boto, Jr., MD, FPOGS,

Maria Lovella S. Mangahas, MD, FPOGS, Roselle M. Martin MD, FPOGS
Dr. Jose N. Rodriguez Memorial Hospital and Sanitarium

Introduction: Abdominal pregnancy is a rare form of ectopic pregnancy that accounts for 1-1.4%
of all pregnancies. It refers to a pregnancy that has implanted in the peritoneal cavity, external
to the uterine cavity and fallopian tubes. Most are terminated early due to poor fetal prognosis
or high likelihood of maternal hemorrhage. It poses a great risk to both maternal and fetal
survival and has high chances of morbidity or mortality. Those that reach advanced gestation and
even term with viable fetal outcome are indeed more special and unique. Misdiagnosis is
common because symptoms are usually non-specific.
Course of the Patient: This is a term abdominal pregnancy in a 40-year-old G5P4 (4004) who
underwent emergency cesarean section for a preoperative diagnosis of placenta previa and
malpresentation. She had poor prenatal check-ups and her two ultrasound scans revealed
intrauterine pregnancy. Intraoperatively, a live, abdominal pregnancy was diagnosed, with good
fetal outcome. The placenta was noted to be markedly adherent to the posterior wall of the
uterus invading up to the myometrial tissue, the right fallopian tube and right ovary inferiorly
and the intestinal serosa superiorly, hence, total abdominal hysterectomy with right salpingo-
oophorectomy was also done. The rest of the hospital days were uneventful. She was then
discharged on the 6th hospital day with no other complications.
Discussion: The goal of management for this case was to deliver the baby safely with careful
assessment of the placenta as not to induce hemorrhage and prevent life-threatening condition
which may cause maternal morbidity or mortality.

Keywords: live term, abdominal pregnancy

IC-7

Atypical Presentation of Systemic Lupus Erythematosus in a Pregnant

Patient Superimposed with COVID-19 Infection

Marie-Lemyr N. Abelardo, MD, Ma. Athena P. Calmerin, MD, FPOGS,

Ma. Shierly D. Del Rosario, MD, FPSMFM, FPSUOG
Victor R. Potenciano Medical Center

Introduction: Co-existence of systemic lupus erythematosus (SLE) and COVID-19 has paved way
to a constellation of articles aiming to find clues on potential peculiarities of COVID-19
epidemiology and course among those with SLE. This co-existence is rare but more so if
associated with pregnancy that can lead to significant mortality and morbidity to both mother
and baby. Appropriate management presents major dilemma and requires multidisciplinary
approach.
Course of the Patient: A 37-year-old G4P2 (2012), 23 weeks age of gestation, with no co-
morbidities, and with 2 unremarkable previous pregnancies, presented with unstable vital signs,
generalized pallor, pale conjunctiva, oral ulcers, crackles on auscultations, tea-colored urine and
anasarca. Work-up revealed severe anemia, elevated BUN, creatinine and urine
protein:creatinine ratio, hematuria with cast, positive Coomb’s test, bilateral pneumonia on
chest x-ray, low albumin and abnormal 2D-echo findings. She was eventually diagnosed with SLE
based on lupus titer. COVID-19 RT-PCR turned out to be positive. She underwent dialysis, blood
transfusions and medical management; however, due to multiple complications, the patient
expired.
Discussion: Lupus nephritis and pulmonary manifestations of SLE in pregnancy can increase the
maternal and fetal morbidity and mortality. Although successful pregnancy outcomes are
possible for SLE patients, miscarriages, preterm deliveries, and intrauterine fetal demise remain
a concern, requiring close monitoring and intensive multi-specialty team approach. This case
highlights a difficult clinical scenario having a possible flare-up of lupus pneumonitis during the
COVID-19 outbreak. Presenting symptoms between these two diseases comprise significant
overlap including pulmonary manifestations. This caused difficulty in early diagnosis and
management. Likewise, because of the risk and low chances of survival of the fetus due to
extreme prematurity, the decision was to delay the delivery until viability. All pregnancies with
SLE should be planned during periods of disease quiescence prior to conception. Hence, active
SLE at the time of conception is a strong predictor of adverse maternal and obstetrical outcomes.

Keywords: systemic lupus erythematosus, lupus pneumonitis, pregnancy, SARS-COV-2

IC-8

Avascular Necrosis of the Femoral Head in a 22-Year Old with Primary

Amenorrhea

Hannah Shene M. Leong, MD, Concepcion D. Rayel, MD, FPOGS, FSGOP,

Irene L. Uy, MD, FPOGS
Davao Doctors Hospital

Introduction: Avascular necrosis is a serious complication of slipped capital femoral epiphysis

(SCFE). SCFE in adults is an uncommon condition associated with panhypopituitarism,
hypothyroidism, hypogonadism and hypoestrogenism. Panhypopituitarism is a well-recognized
and rare complication of bacterial meningitis and only a few cases have been reported in
literature. This case report highlights the importance of a multidisciplinary approach in the
management of panhypopituitarism resulting in hypoestrogenism, primary amenorrhea and
avascular necrosis of the bone.
Course of the Patient: A 22-year-old G0 presented with avascular necrosis of the femoral head
and primary amenorrhea. Physical examination revealed a patient with tall stature, eunuchoid
body habitus, cubitus valgus, Tanner stage 1 breast and pubic hair development. Transrectal
ultrasound revealed an infantile uterus and a right streak gonad. Cytogenetic study revealed a 46
XX karyotype. Endocrinologic investigation showed multiple hormone level deficiencies
manifesting as hypothyroidism, hypocortisolism, growth hormone deficiency and
hypogonadotropic hypogonadism. The absence of congenital aberrations and a history of
childhood meningitis provided the etiology of pituitary dysfunction. The patient is currently on
her 10th month of hormone therapy (HT) showing marked improvement. Pelvic x-ray showed
resolution of the avascular necrosis and restoration of osseous structures. Transrectal
sonography showed increase in the size of the uterus and ovaries with presence of immature
follicles. The patient currently shows gradual development of secondary sex characteristics. HT
is continuously given to achieve goals of correcting the endocrine deficiencies. Continuous
monitoring of the breast and uterus is also being undertaken while on treatment.
Discussion: Hypogonadism due to hypopituitarism resulting to amenorrhea and avascular
necrosis of the bone is a rare occurrence and only one case was reported in a case series of SCFE
from 1963-2013 by Song et al. last 2014. HT in female adolescents and young adults with estrogen
deficiency is necessary and is best continued until the age of menopause in the absence of
contraindications.

Keywords: avascular necrosis, primary amenorrhea, hypogonadism, hypopituitarism, meningitis

IC-9

Broad Ligament Pregnancy: A Diagnostic Dilemma

Christian Dave Docto, MD, Kristina L. Dosdos, MD, FPOGS, FPSMFM

Vicente Sotto Memorial Medical Center

Introduction: One of the rare types of ectopic pregnancy leading to maternal and neonatal
morbidity and mortality is broad ligament pregnancy. In literature, its incidence is reported as 1
in 613 ectopic pregnancies and 1 in 183,900 pregnancies. In our institution, there are no other
cases of broad ligament pregnancy in the last 5 years. Beyond its rarity, broad ligament
pregnancies poses a diagnostic challenge, as it is elusive on imaging and it masks behind the
manifestations of the more common types of ectopic pregnancies.
Course of the Patient: This is a case of a 32-year-old multigravid who was 16 5/7 weeks gestation
and who presented to the emergency room with severe abdominal pain, hypotension,
tachycardia and tachypnea. She underwent emergency exploratory laparotomy for a suspected
ruptured ectopic pregnancy and intraoperatively, a large complex mass with a 3-cm point of
rupture was seen adherent to the left ovary, thus a left salpingo-oophorectomy was done for a
suspected ovarian pregnancy. Postoperatively, the patient had several episodes of seizure
activity and eventually expired secondary to complications of the intractable hypovolemic shock.
Histopathology later confirmed the diagnosis of broad ligament pregnancy.
Discussion: The clinical manifestations of broad ligament pregnancy are similar to other ectopic
pregnancies, with minimal or no signs and symptoms in early gestation to massive intra-
abdominal bleeding and shock as the pregnancy progresses and ruptures. Such was the case of
this patient who was early in her second trimester. Broad ligament pregnancies are commonly
misdiagnosed as tubal pregnancies on routine ultrasound, and correct diagnosis is usually made
intraoperatively through the location of the pregnancy within its anatomical borders; lateral to
the uterus, medial to the pelvic side walls, superior to the pelvic floor, and inferior to the fallopian
tube. Mainstay treatment is surgical intervention, as with this patient who came in with signs of
shock.

Keywords: broad ligament pregnancy

IC-10

Case of a 19-year-old with Malignant Spindle Cell Neoplasm; Pelvic

Monophasic Synovial Sarcoma Arising from the Pelvic Soft Tissues and
Ligaments

Leobert Julienne A. dela Peña, MD, Ronald Lanz R. Latap, MD, FPOGS, FSGOP
West Visayas State University Medical Center

Introduction: Synovial sarcoma, also called malignant synovioma, can arise from different types
of soft tissues such as muscles and ligaments in the arms, legs, foot, near the joints and rarely in
the abdomen. It is further classified into biphasic, monophasic or poorly differentiated.
Course of the Patient: This is a case of a 19-year-old nulligravid presenting with hypogastric pain
and right lower quadrant mass. Computed tomography (CT) scan revealed complex ill-defined
mass with blood clots and moderate ascites. Baseline tumor markers were within normal. She
underwent exploratory laparotomy, peritoneal fluid cytology, right salpingo-oophorectomy with
tumor debulking with findings of a pelvic mass attached to the right ovary, fallopian tube,
posterior broad ligament and uterus. Histopathologic result revealed malignant spindle cell
neoplasm. Immunohistochemical studies showed positive CD 99, TLE 1, Bcl-2, S100 and Desmin
confirming monophasic synovial sarcoma. Following the American Joint Committee on Cancer
(AJCC) staging system, the final stage of the patient was 1A (T1 N0, M0, GX) and was for adjuvant
Ifosfamide-based chemotherapy.
Discussion: Synovial sarcoma is a rare type of soft tissue neoplasm that affects adolescents and
young adults aged 15-40 years old. It originates from primitive or uncommitted mesenchymal
cells that eventually differentiate to resemble synovial cells. It is caused by unique chromosomal
translocations of t(X;18) (p11.2;q11.2) found in more than 90% of cases resulting in formation
two fusion genes: SYT-SSX1 or SYT-SSX2. Magnetic resonance imaging (MRI) is the modality of
choice. Immunohistochemistry has been proven to be pivotal in its diagnosis mainly of the
monophasic variant, primarily demonstrating positive TLE1, CD99, Bcl-2, S-100 and Desmin while
negative for CD34. Adequacy of initial surgery is an important prognostic factor, with a 5-year
survival rate of 76% following a complete cytoreductive surgery. Adjuvant chemotherapy with
Ifosfamide with or without Doxorubicin may be given but there are no specific guidelines because
of its rarity. The knowledge of its occurrence in unusual locations is necessary to avoid its
misdiagnosis which may lead to delay in treatment and tumor metastasis leading to poorer
prognosis.

Keywords: sarcoma, monophasic synovial sarcoma, malignant synovioma

IC-11

Cervicovaginal Artery Embolization: An Interventional Approach to

Control Vaginal Bleeding Complication of Gestational Trophoblastic
Neoplasia

Aiza Jane C. Damao, MD, Lynette R. Lu-Lasala, MD, FPOGS, FPSSTD

Southern Philippines Medical Center

Introduction: Gestational trophoblastic neoplasia (GTN) is the collective term for invasive mole,
choriocarcinoma, placental site trophoblastic tumor (PSTT), and epithelioid stromal tumor (EST).
Chemotherapy remains to be the cornerstone of management. However, adjuvant treatment
may include surgery, radiation and vaginal artery embolization.
Course of the Patient: This is a case of a 32-year-old G2P1 (1011), who was managed as GTN
III:14 and underwent total abdominal hysterectomy (TAH). She developed vesico-uterine fistula
and was advised for computed tomography (CT) scan with intravenous pyelogram (IVP);
however, the patient was lost to follow-up. Two days prior to admission, the patient had vaginal
bleeding soaking 3 diapers per day, which prompted consultation and subsequent admission. A
multidisciplinary approach with gynecology trophoblastic section, urology and interventional
radiology department was done. The plans were to control the bleeding, work up the vesico-
uterine fistula, and give salvage chemotherapy. She underwent pelvic angiogram then
cervicovaginal artery embolization which significantly controlled the bleeding. She received 2
regimens of salvage chemotherapy with etoposide and cisplatin with etoposide, methotrexate
and dactinomycin (EP-EMA) for 5 cycles followed by carboplatin-paclitaxel for 3 cycles. With still
persistent high levels of ß subunit of human chorionic gonadotropin (ß-hCG), the patient decided
to discontinue treatment and opted for terminal discharge.
Discussion: Choriocarcinoma is a rapidly growing tumor which invades both myometrium and
blood vessels to create hemorrhage and necrosis. The bleeding can be caused by malignant
tumor extension, infection, surgery and pelvic radiation due to changes in pelvic vascular
anatomy. The angiographic approach to control the bleeding is minimally invasive and safe.
Arterial embolization is 69-100% effective and the bleeding is controlled up to 95.7% in 24 hours.
The procedure decreases the need for blood transfusion and the incidence of new bleeding
episodes as well as improves the general condition of the patient.

Keywords: cervicovaginal artery embolization, gestational trophoblastic disease, vaginal

metastasis
IC-12

Comparing the Diagnostic and Management Approach of Two Cases of

Buschke-Lowenstein Tumor

Hannah Andrea A. Sombilla, MD, Ma. Evita D. Dela Cruz-Tabanda, MD,

Ma. Lorina Q. Esteban, MD, FPOGS, FPIDSOG, Mary Judith Q. Clemente, MD,
FPOGS, FPIDSOG
University of the Philippines-Manila, Philippine General Hospital

Introduction: Buschke-Lowenstein tumor (BLT) is a rare anogenital disease with undetermined

clinical course wherein some remain benign while some undergo malignant transformation.
Absence of definitive treatment protocols result to diagnosis and management dilemma.
Course of the Patients: Presented are two cases of BLT with differing presentations and risk
factors. Case 1 is a 54-year-old multigravida, a newly diagnosed case of pulmonary tuberculosis
with a ten-year history of gradually enlarging condyloma acuminata. Multiple biopsies revealed
progressive results, from initially benign to malignant transformation. She was for
chemoradiation followed by skinning vulvectomy with skin grafting; however, she succumbed
prior to treatment initiation. Case 2 is a 20-year-old immunocompromised host with 2-month
history of progressively enlarging vulvar warts obliterating the urethral orifice, vaginal introitus
and anus. Multimodal therapy in the form of electrocauterization and topical medications like
Imiquimod and Trichloroacetic Acid (TCA) were done. No tumor recurrence was noted within 20
months posttreatment.
Discussion: BLT is a slow-growing tumor infecting 0.1% of the general population. Immunologic
state of the host dictates its growth and development wherein rapid size increase were recorded
in immunocompromised hosts. In persons with Human Immunodeficiency Virus, Human
Papillomavirus (HPV) infections can still occur even with low viral load and high CD4 count. Early
detection and treatment could prevent malignant transformation. Management should be
individualized considering the patient’s age, sexual preservation and nature of lesion. Treatment
plan must be mutually agreed upon by the physician and patient. It includes a combination of
medical and surgical interventions aimed to obtain tumor-free margins. Due to its high
recurrence rate, serial post treatment surveillance is a must. Periodic clinical assessment is
advised to evaluate the need for treatment plan revision and early detection and treatment of
tumor recurrence.

Keywords: Buschke-Lowenstein tumor, giant condyloma acuminata

IC-13

COVID-19 Infection in Pregnancy with Human Immunodeficiency

Virus: A Case Series

Marth Louie Z. Tarroza, MD, DPOGS, Sybil Lizanne R. Bravo, MD, MSc, FPOGS,
FPIDSOG
University of the Philippines-Manila, Philippine General Hospital

Introduction: The effect of COVID-19 on patients with human immunodeficiency virus (HIV) has not been
well-studied extensively. This case series presents symptoms, clinical course, and outcome in this special
population. Knowing the effects of COVID-19 disease in this vulnerable population can help us obtain good
clinical outcomes and prevent possible maternal morbidity and mortality.
Course of the Patients: First case is a 27-year-old G4P2 (2012), 38 4/7 weeks age of gestation (AOG), HIV-
positive, COVID-19 asymptomatic, who came in due to labor pains and underwent low segment cesarean
section (LSCS) with bilateral tubal ligation (BTL). She has been a known HIV patient since December 2018
and has been on anti-retroviral therapy (ART) since January 2019. She tested positive for COVID-19 RT-
PCR prior to admission. Second case is a 28-year-old G2P1 (1001), 37 weeks AOG, with 1 previous cesarean
section, HIV-positive, COVID-19 asymptomatic, who underwent repeat LSCS. She has been a known case
of HIV since 2019 and is on ART. She also tested positive for COVID-19 RT-PCR prior to admission. Third
case is a 22-year-old G3P2 (1102), 37 1/7 weeks AOG by ultrasound, with 1 previous cesarean section (CS),
HIV-positive, to consider COVID-19 recovered, who came in due to watery vaginal discharge and
underwent repeat low segment CS. She has been a known case of HIV since 2019 and is on ART. She had
cough, colds and ageusia at 26 weeks AOG but no SARS COV-2 RT-PCR swab was done. Home quarantine
was completed for 14 days. Her COVID-19 RT-PCR on admission was negative, but her COVID-19 total
antibody assay was reactive. Last case is a 22-year-old G2P1 (1001), 37 5/7 weeks AOG, with 1 previous
CS, HIV-positive, COVID-19 asymptomatic, who came in due to labor pains and underwent repeat LSCS.
She has been a known case of HIV since 2018 and was initially on ART, which she took only for 3 months.
She was lost to follow up until 1 month prior to admission. She was referred back to an HIV Hub for
reinstitution of ART. She also tested positive for COVID-19 RT-PCR prior to admission. All of their CD4
count levels were within acceptable levels (316-950 cells/uL) and majority of them were virally
suppressed. All of them had good clinical outcomes.
Discussion: Contradicting theories were observed in studies on COVID-19 and persons living with HIV
(PLWH). Some suggested that HIV infection can increase the risk of having a poorer course of COVID-19
because of the abnormal immune response but some, due to the mild immunosuppression and the
possible protection from ART, believed that HIV patients may show a milder COVID-19 disease
presentation. Based on the clinical course of the 4 cases, which was also supported by several studies, it
showed that the clinical presentation, levels of inflammatory markers and course of COVID-19 disease
were similar for the general population and in PLWH. Current evidence also showed that the risk of disease
severity is dependent on the chronic medical conditions commonly present in PLWH like cardiovascular
diseases, chronic lung disease and diabetes mellitus. The index cases can somehow possibly benefit from
the lymphopenia caused by HIV infection and immunomodulatory effects of Tenofovir, but these
assumptions need to be supported by more research and more randomized clinical trials.

Keywords: COVID-19 infection, HIV, pregnancy

IC-14

Cytokine Storm Secondary to COVID-19 Pneumonia in a Preterm

Pregnancy: A Management and Bioethical Dilemma

Dominica Louise A. Sumera, MD, Zoraida R. Umipig-Guevara, MD, FPOGS,

FPSGE, Jane Marie B. Samonte, MD, FPOGS, Joanna Pauline Chua-Ursua, MD,
FPOGS, PSMFM, FPSUOG
De Los Santos Medical Center

Introduction: Cytokine storm is a complication of severe coronavirus disease-19 (COVID-19)

infection marked with aggressive inflammatory response with the release of a large amount of
pro-inflammatory cytokines which causes influx of various immune cells from the circulation
thereby causing lung injury, multi-organ failure and unfavorable prognosis. A normal pregnancy
by itself is a pro-inflammatory condition with elevated cytokines, interleukin 6 and tumor
necrosis factor !. For this reason, a pregnant woman is vulnerable to COVID-19 infection and is
considered to belong to a high risk population.
Course of the Patient: A 27-year-old primigravida at 26 weeks’ age of gestation presented with
difficulty of breathing, nonproductive cough and generalized body malaise. COVID-19 infection
was confirmed by a positive Reverse Transcription Polymerase Chain Reaction (RT-PCR). She was
diagnosed to have severe COVID-19 pneumonia with progressive oxygen desaturation requiring
intubation and intensive care unit (ICU) admission. Cytokine storm was diagnosed as evidenced
by the elevated interleukin 6 and C-reactive protein. The management and bioethical dilemma
involved the use of investigational therapeutic interventions to manage the cytokine storm and
prolong pregnancy or to terminate the pregnancy hoping that it might improve the deteriorating
condition of the patient. The decision to prolong the pregnancy and administer investigational
interventions with unknown effects to the fetus, namely, Remdesivir, Tocilizumab,
Dexamethasone and hemoperfusion to manage the cytokine storm was made by the family after
the management plans were presented by the multidisciplinary team of infectious disease,
cardiology, pulmonology and perinatology specialists. On the 11th hospital day, after 5 days of
intubation, the patient improved and was discharged on her 28th week age of gestation.
Discussion: The successful outcome of this case further underscores the importance of teamwork
and family involvement to attain a decision regarding administration of investigational treatment
in a timely manner. The outcome would not have been successful had the family refused the
management presented to them.

Keywords: COVID-19, Hemoperfusion, Remdesivir, Tocilizumab

IC-15

Delayed Diagnosis and Management of Late Second Trimester Intra-

abdominal Pregnancy

Ana Patricia C. Vargas, RCh, MD, MBA, Viktoria Ines P. Matibag, MD,
Maria Anna Luisa F. Dalawangbayan, MD, FPOGS, FPSUOG
University of the Philippines-Manila, Philippine General Hospital

Introduction: Abdominal pregnancies, defined as implantation in the peritoneal cavity exclusive

of ovarian, tubal, or intraligamentary implantation, are rare, constituting only 1.37% of ectopic
pregnancies. Due to the conceptus’ proximity to other abdominopelvic organs, diagnosis and
management may be challenging.
Course of the Patient: This is a case of a 48-year-old G5P3 (3022) who consulted for an ultrasound
finding of an abdominal pregnancy. Repeat transvaginal and transabdominal ultrasound done on
admission confirmed abdominal pregnancy. Plain abdominal computed tomography (CT) scan
and CT angiogram with aortogram showed a contracted extrauterine fetus at the right upper
quadrant with blood supply from the right ovarian, right L5, and left uterine arteries, which were
embolized preoperatively to decrease the risk of massive and fatal hemorrhage. The patient then
underwent exploratory laparotomy, adhesiolysis, enterolysis, evacuation of fetal parts, total
abdominal hysterectomy with bilateral salpingectomy, colporrhaphy, and Jackson-Pratt drain
insertion. Intraoperatively, there was a right pelvic mass measuring 10.0 x 10.0 cm with fetal
bones embedded in necrotic tissue. No placenta was identified. A 1-cm uterine rupture was seen
at the right posterofundal area. The patient tolerated the procedure and was discharged well.
Discussion: Abdominal pregnancies occur either due to the primary implantation at the
peritoneal cavity or secondary to expulsion of the conceptus into the abdomen via tubal or
uterine rupture. More complications arise as the gestation is prolonged, thus, it is important to
establish the diagnosis as early as possible. Ultrasound may not be enough to confirm the site of
gestation, thus, CT scan and MRI may be used to ascertain the site of gestation and to determine
the involvement of other organs and vessels. The gold standard for management is surgical
management. This may be supplemented with preoperative and postoperative arterial
embolization to prevent excessive hemorrhage, especially in cases wherein the placenta is
adherent to vascular structures.

Keywords: abdominal pregnancy, arterial embolization, fetal death in utero, lithopedion

IC-16

Detour: A Case Report on Advanced Abdominal Pregnancy

Vivien Jovih A. Mercado, MD, Jeejane A. Bonggao, MD, FPOGS, FPSSTD

Bicol Medical Center, Naga City

Introduction: Abdominal pregnancy is a rare type of ectopic pregnancy with incidence of 1 out
of 10,000 pregnancies. This type generally does not reach term due to high incidence of morbidity
and congenital anomalies. Maternal hemorrhage due to placental detachment is a common
cause of mortality, hence, leaving it in-situ is considered a safer option. This case highlights the
importance of anticipation and preparedness to different scenarios that may arise
intraoperatively. To the best of our knowledge, this is the first case of advanced abdominal
pregnancy reported with successful delivery of a term baby with complete placental extraction.
Course of the Patient: This is a case of a 29-year-old G2P2 (1001), on her 38th week of gestation,
who consulted due to generalized abdominal pain. Ultrasound findings revealed an empty uterus
with a live term fetus occupying the abdominal cavity. Magnetic resonance imaging (MRI)
described the placenta’s possible attachment to the abdominal aorta. A multidisciplinary
subspecialty team carried out the preoperative preparations. Patient underwent exploratory
laparotomy, fetal extraction to a live baby with no gross anomalies. Placenta was not
manipulated. However, spontaneous detachment was noted after cord clamping which resulted
to bleeding. Placental extraction was carried out successfully with activation of massive blood
transfusion protocol. The post-operative course was uneventful both for the mother and the
baby.
Discussion: Abdominal pregnancy is a rare form of ectopic pregnancy where implantation takes
place in the peritoneal cavity. Its management lies not solely in the delivery of a live baby but
more importantly in the approach on placental management since hemorrhage is the common
cause of maternal mortality. The multidisciplinary team approach and adequate preoperative
preparation in the index case had a great positive impact on the intraoperative call to do placental
extraction which fortunately, was carried out successfully. The management of abdominal
pregnancy is, therefore, individualized.

Keywords: abdominal pregnancy, maternal hemorrhage

IC-17

Double Trouble: A Case of Symptomatic Olfactory Nerve Schwannoma

Diagnosed and Managed in the Third Trimester of Pregnancy in a
Philippine Tertiary Hospital
Breann Katrina R. Chaplin, MD, MBA, Lyra Ruth C. Chua, MD, FPOGS, FPSUOG,
FPSRM
The Medical City

Introduction: The diagnosis of a brain tumor is a life-changing and stressful event. This is
heightened if the patient is an expectant mother. Intracranial neoplasms typically present with
nonspecific symptoms of cerebral dysfunction, those of which are easily confounded in
pregnancy since several conditions that mimic an increased intracranial pressure may be
attributed to normal physiological changes.
Course of the Patient: This is a case of a 34-year-old G2P1 (1001), with a history of recurrent
bitemporal headaches, nausea and vomiting, and an isolated episode of loss of consciousness.
At 35 4/7 weeks age of gestation (AOG), the patient was eventually diagnosed with an intracranial
neoplasm, accompanied by extensive perilesional edema and leftward subfalcine herniation, via
magnetic resonance imaging (MRI). An elective cesarean section followed by right frontal
craniotomy and excision of tumor was done at 37 weeks age of gestation. Post-operative course
was unremarkable. Surgical histopathology revealed an olfactory nerve schwannoma.
Discussion: Schwannomas of the anterior cranial fossa are extremely rare. Fewer than 70 cases
of olfactory nerve schwannoma have been reported worldwide since 2018. The expected
hypervolemic state of normal pregnancy by intravascular volume expansion and water retention
can potentially exacerbate an already increased intracranial pressure. Uncontrolled cerebral
edema secondary to a brain tumor may precipitate such changes, with danger of acute herniation
syndromes that can cause permanent neurological dysfunction and potentially fatal herniation.
Moreover, subfalcine herniation, as in the patient’s case, poses a risk of cingulate gyrus
herniation leading to compression of the distal anterior cerebral arteries, and can result in
ischemia or infarction. This case report highlights the challenges faced by obstetricians and
neurosurgeons towards balancing maternal and fetal welfare in terms of detection, diagnosis,
medical management, timing and method of delivery, and surgical intervention, when presented
with a symptomatic intracranial neoplasm in pregnancy.

Keywords: schwannoma, brain tumor, pregnancy

IC-18

Early Stage High-Grade Endometrial Stromal Sarcoma of the Cervix in

the Young: A Case Report

Renee Leen M. Laudato, MD, Carolyn R. Zalameda-Castro, MD, MSc, FPOGS,

FPSGOP
University of the Philippines-Manila, Philippine General Hospital

Introduction: Endometrial stromal sarcomas (ESS) arising from the cervix is uncommon. The
occurrence of a high-grade malignancy in a very young premenopausal patient poses the
dilemma on optimal surgical approach and multimodality adjuvant treatment in the absence of
clear management guidelines.
Course of the Patient: C.P., a 17-year-old nulligravid, consulted for heavy vaginal bleeding. She
underwent vaginoscopy revealing a mass occupying the vaginal canal. On internal examination,
the cervical mass was occupying the vaginal canal with no forniceal involvement. Biopsy and
immunohistochemistry studies of the mass were performed with findings suggestive of low-
grade stromal sarcoma. The patient underwent extrafascial hysterectomy with bilateral salpingo-
oophorectomy (EHBSO) with lymphadenectomy. The anterior lip of the cervix was converted to
a 10 x 6.0 x 5.0 cm friable, necrotic mass. The posterior lip of the cervix, uterus, bilateral adnexa
and the rest of the abdominal organs were grossly normal. The histopathologic diagnosis was
high-grade ESS confined to the uterine cervix, positive for lymphovascular space invasion. The
patient received 4 cycles of systemic chemotherapy with Ifosfamide-Doxorubicin to be followed
by vaginal brachytherapy. Medroxyprogesterone acetate was started.
Discussion: Extrauterine ESS is rare and its natural history, prognostic factors, and optimal
treatment is limited due to its rarity. Complete surgery for ESS is total hysterectomy with bilateral
salpingo-oophorectomy (THBSO) in stage I patients and removal of enlarged lymph nodes and
debulking of extrauterine disease is done in stages II-IV. Most recommendations for adjuvant
treatment with chemotherapy, radiotherapy, and hormonal therapy have been based on
extrapolation from treatment used for similar stage uterine ESS. Prognosis depends on the stage
of tumor, grade, surgical margins, age, optimal surgery, number of mitoses, and vascular and
lymphatic invasion. Genetic testing may also play a role in the prediction of prognosis.

Keywords: endometrial stromal sarcoma, cervix

IC-19

Fertility Preservation of an Exogenic-Type of Cesarean Scar Pregnancy:

A Case Report

Rejo Mae B. Orola-Basilan, MD, Jericho Thaddeus P. Luna, MD, FPOGS,

FSGOP, Belen P. Rajagukguk, MD, FPOGS
Adventist Medical Center Manila

Introduction: Cesarean scar pregnancy is a rare form of ectopic pregnancy. The incidence
approximates 1 in 2000 normal pregnancies and has increased with the cesarean delivery rate.
Transvaginal ultrasound has major role in establishing the diagnosis.
Course of the Patient: This was a case of an asymptomatic patient with a cesarean scar pregnancy.
Serial transvaginal sonology was done starting at 6 weeks age of gestation (age of gestation). The
last ultrasound result was at 9 weeks AOG with the following sonologic description: The
gestational sac was located at the lower anterior isthmic portion, the chorionic implantation
extended to the whole thickness of the isthmic wall on the left just above the internal os. The
urinary bladder was intact. Abundant color flow was noted surrounding the implantation of the
early placenta. No myometrium was seen between the sac and bladder. Sonologic diagnosis was
exogenic-type of cesarean scar pregnancy and possible placenta accreta. Quantitative β subunit
of human chorionic gonadotrophin (β-hCG) revealed >10,000 mIU/mL. She was managed
surgically with an open laparotomy with excision of cesarean scar pregnancy, curettage of the
remaining products of conception and repair of the scar. The left uterine artery was also ligated
due to profuse bleeding during uterine repair. The surgery was successful and post-operative
course was unremarkable.
Discussion: In the management of an asymptomatic, exogenic-type of cesarean scar pregnancy,
timely diagnosis and prompt treatment are essential to avoid life-threatening complications such
as hemorrhage and uterine rupture. Transvaginal ultrasound with Doppler is the gold standard
for the diagnosisbut magnetic resonance imaging (MRI) may be used if transvaginal ultrasound
result was equivocal. There is no established management for cesarean scar pregnancy.
Treatment should be tailored according to gestational age, β-hCG levels, type of cesarean scar,
experience and availability of facilities. With early diagnosis and treatment, fertility preservation
may be achieved.

Keywords: cesarean scar pregnancy, excision of cesarean scar pregnancy

IC-20

Giant Immature Teratoma in a 15-Year Old Causing Anti-N-Methyl-D-

Aspartate Receptor Encephalitis-like and Guillain-Barré Syndrome as
Paraneoplastic Manifestations: A Case Report
Alfonso Leandro del Rio Toreja, MD, Angelito D.L. Magno, MD, FPOGS, FSGOP
De La Salle University Medical Center

Introduction: Germ cell tumor is the most prevalent ovarian tumor in young women between 10
to 30 years of age. However, immature teratomas account for only 20% of the malignant ovarian
tumors found in adolescent age group. More uncommon is the occurrence of immature teratoma
causing Anti-N-methyl-D- aspartate (Anti-NMDA) receptor encephalitis-like and Guillain-Barré
Syndrome (GBS).
Course of the Patient: This is a case of 15-year-old nulligravid, who initially presented sudden
behavioral change and symmetrical weakness of both lower and upper extremities with
concomitant seizure episodes and with palpable lower abdominal mass. The patient was
diagnosed to have GBS and treated with intravenous immunoglobulin causing resolution of
neurologic symptoms months after. During the management of GBS, the patient noted increasing
abdominal girth. Tumor markers showed elevated AFP, CA 125 and LDH. Imaging study revealed
a predominantly solid ovarian mass, hence, malignancy was considered. Once the medical
condition stabilized, the patient underwent fertility sparing surgery with final histopathologic
result of immature teratoma.
Discussion: Paraneoplastic syndrome is a rare neurological disorder caused by abnormal immune
system reaction that develops from the remote effects of tumor cells. The ovarian teratoma has
neural tissue which acts as antigenic material. The newly formed onco-neural antibodies circulate
in the serum or CSF where it is then able to bind to the NMDA receptor that is primarily expressed
in the hippocampus and forebrain neurons. Anti-NMDAR encephalitis is an autoimmune disorder
with a typical sequential presentation: acute onset of prodromal symptoms, followed by a
psychiatric manifestation, then decreased level of consciousness and seizures, and lastly,
autonomic disability. GBS was considered due to the classic progressive ascending motor
weakness and eventual areflexia. This is due to the immune reactions directed against epitopes
in Schwann cells which can cause the acute demyelinating form of GBS. However, screening for
well-characterized paraneoplastic antibodies against intracellular antigens must be done to
further support the diagnosis.

Keywords: encephalitis, Guillain-Barré syndrome, ovarian teratoma, paraneoplastic syndrome

IC-21

Hematotrachelometra with Acute Salpingitis in a 46 XY Disorder of

Sexual Development: A Case Report

Lara Sabine O. Villanueva, MD, Mona Ethellin M. Yiu-Senolos, MD, FPOGS,

FPSRM
Cebu Velez General Hospital

Introduction: 46,XY disorders of sexual development (DSD) is characterized by atypical external

genitalia due to incomplete masculinization with or without the presence of mullerian structures.
This paper discusses a rare case of 46,XY partial gonadal dysgenesis (PGD) presenting as acute
abdomen and hematotrachelocolpometra. Management in the setting of limited finances and
diagnostics will be discussed.
Course of the Patient: A 23-year-old male presented with abdominal pain and history of recurrent
urinary tract infection. Exploratory laparotomy and biopsy of right adnexal mass with purulent
discharge showed salpingitis. Hence, referral to a tertiary center was made. Examination revealed
hypospadias, left scrotal sac with testis but empty right scrotum. A patient-centered
multidisciplinary team composed of a gynecologic oncologist, reproductive endocrinologist,
urologist, and psychiatrist managed the patient. Preoperative work-up showed pelvic masses: 2
tubulocystic masses – 7.7 x 5.0 x 9.0 cm with incomplete septations and medium low-level echo
fluid posterior and more to the left of the urinary bladder, and 6.7 x 2.6 x 3.0 cm superior and
more to the right of the previous mass. Plain computed tomography (CT) scan showed a 9.5 x 5.2
x 6.6 cm thick-walled multilocular cystic mass posterior to the urinary bladder. The impression
was tubo-ovarian abscess vs. complicated seminal vesicle or prostatic cyst. Elevated follicle
stimulating hormone (FSH) with normal estradiol and testosterone indicated testicular
dysfunction, while elevated CA-125 supported infection or malignancy. Surgery and
histopathology confirmed a uterus with proliferative phase endometrium causing
hematotrachelometra and salpingitis. Karyotype was 46,XY. Mild depression postoperatively was
addressed through psychiatric counseling. Gender orientation remained male, congruent with his
external genitalia.
Discussion: Alteration in gonadal development genetic pathway leads to 46,XY PGD. This was
suspected upon diagnosis of salpingitis. Majority of 46,XY DSDs have structural anomalies of the
urinary system and present gonadal tissue, both were absent in this case. Malignancy is 16-30%
in PGD with increased risk in nonscrotal gonad. Absence of gonad portends low malignancy risk,
yearly contralateral scrotal ultrasound and hormone evaluation was advised. The complexity of
the case and emergent need for surgery, required psychosocial support. Semen analysis was
deferred. Long-term multidisciplinary team approach towards preserving reproductive function
and quality of life is key to management of patients with 46,XY DSD.

Keywords: disorders of sexual development, 46,XY partial gonadal dysgenesis,

hematotrachelometra, salpingitis
IC-22

Herlyn Werner Wunderlich Syndrome with an Incidental Finding of

Unilateral Adrenal Gland Agenesis: A Case Report

Rochelle Mae M. Supan, RN, MD, Junette Grace A. Ko, MD, FPOGS, FPSGE
Davao Regional Medical Center

Introduction: Herlyn Werner Wunderlich Syndrome (HWWS) is a rare form of mullerian duct
anomaly characterized by a combination of uterine didelphys, obstructed hemivagina, and
ipsilateral renal agenesis. Internationally, its incidence is 0.1-3.8% and among the reported cases,
none presented with a concomitant adrenal gland agenesis. This is the first case report of a
diagnosed HWWS with a concomitant unilateral adrenal gland agenesis.
Course of the Patient: This is a case of a 10-year-old Filipino who presented with severe cyclic
abdominal pain. Magnetic resonance imaging (MRI) results showed two separate uteri and
cervices, obstructed left hemivagina, and absent left kidney and adrenal gland. This patient has
no symptoms of adrenal insufficiency, and serum cortisol and adrenocorticotropic hormone
(ACTH) levels were within normal limits. She underwent vaginoscopy and resection of the
longitudinal vaginal septum. Postoperatively, the regular menstrual cycle continued and was no
longer associated with dysmenorrhea. Follow-up after six months revealed no recurrence of
hematocolpos on 3D transrectal sonography.
Discussion: A high index of suspicion is the key to diagnose Herlyn Werner Wunderlich syndrome,
especially in patients who present with cyclic pelvic pain during puberty and those who have
findings of renal anomaly. The preferred surgical approach for these patients is resection of the
vaginal septum since the main reason for the symptoms is the physical obstruction of the
menstrual flow. This procedure is associated with a successful future reproductive performance,
if timely done. The incidental finding of concomitant unilateral adrenal gland agenesis, which in
itself is also a rare occurrence, in a diagnosed HWWS brings the possibility that other abnormality
or defects may be associated with this syndrome and not just what is presently known. The
congenital anomaly involving the reproductive organ poses a challenge in the patient’s capacity
to bring about a successful pregnancy. Adding to that is the possibility of developing adrenal
insufficiency during stressful situations or during pregnancy.

Keywords: Herlyn-Werner-Wunderlich syndrome, OHVIRA, unilateral adrenal agenesis

IC-23

Isolated Fallopian Tube Torsion in an Early Adolescent: A Case Report

Princess Bianca DL. Palabrica, MD, Maria Therese B. Mallen, MD, FPOGS,
FIFEPAG, Germaine Aldrene C. Tan, MD
University of Santo Tomas Hospital

Introduction: Isolated fallopian tube torsion is an infrequent but significant gynecological cause
of pelvic pain in female patients, with literature approximating its overall incidence as 1 in 1.5
million women, and incidence of which in pediatric and adolescents is difficult to determine.
Locally, there has never been a published paper regarding the condition in young adolescents,
emphasizing its rarity.
Course of the Patient: A 12-year-old female presented with right lower quadrant (RLQ) pain. She
was initially treated for urinary tract infection and a whole abdominal ultrasound done prior to
referral to the institution showed a cystic structure in the mid-pelvic region and an inflamed
appendix. The abdomen was soft with direct and rebound tenderness at the RLQ and hypogastric
area. On rectal examination, pelvic organs could not be fully evaluated due to voluntary guarding.
Abdominal CT scan revealed a 10.0 x 8.4 x 7.4 cm thick-walled cystic pelvic mass, probably
ovarian, and a normal appendix measuring 0.6 cm. Assessment was adnexal pathology, probably
ovarian. Pelvic laparotomy was performed and upon exploration, there was a hemorrhagic
pelvoabdominal mass which measured 13.0 x 11.0 x 8.0 cm, found to be a cystically enlarged
right fallopian tube, twisted once on its vascular pedicle. Upon untwisting, the fimbriated end
was noted to be necrotic. The left tube, left ovary and the uterus looked normal. Right
salpingectomy was performed.
Discussion: The entity is difficult to recognize pre-operatively because of its vague clinical
presentation. Abdominal tenderness may present with or without peritoneal signs. There may be
adnexal tenderness, but a mass is not always palpable. There is no specific laboratory finding and
radiologic diagnosis is also limited. Isolated tubal torsion should be considered in cases of acute
lower abdominal pain since awareness and early detection of the condition, especially in children
and adolescents, allows early surgical intervention that may prevent removal of the tubes and
render preservation of fertility.

Keywords: isolated tubal torsion, fallopian tube, adolescent

IC-24

Management of Aortic Dissection Stanford Type A, De Bakey I in

Pregnancy: A Rare Case Report

Sherlyn Marie O. Ingco, MD, Armi Angela C. Lara-Roy, MD, PTRP, FPOGS,
FPSMFM
Southern Philippines Medical Center

Introduction: Aortic dissection (AoD) is an extremely rare condition during pregnancy. Because
of the heightened risk for significant morbidity and high rates of mortality for the mother and the
fetus, it remains an important cause for concern during pregnancy.
Course of the Patient: This is a case of a 36-year-old G2P1 (1001), 32 weeks pregnant who
presented with back pain and exertional dyspnea was initially managed as COVID-19 suspect with
bibasal pneumonia. Work-up revealed that the patient was negative for COVID-19 and antibiotic
coverage didn’t provide relief hence 2D echo was done revealing aortic dissection Stanford type
A, De Bakey I, confirmed by computed tomography (CT) angiogram. The patient was managed
medically while waiting for the surgical plan; however, her labor progressed. She underwent
primary cesarean section with bilateral tubal ligation under continuous epidural blockade. She
was discharged with heart failure medications while waiting for her surgery which is the Modified
Bentall’s procedure.
Discussion: AoD is a serious and life-threatening condition in which the inner layer of the aorta
develops a tear creating a false channel. Diagnosis is done by imaging with CT angiography. AoD
in pregnancy is a rare condition commonly diagnosed during the third trimester and early
postpartum period. Pregnancy alone is considered an independent major risk factor. AoD may
be labelled as type A (ascending aorta involved) or type B (ascending aorta not involved) based
on the Stanford classification and type I (involves ascending and descending aorta), type II
(involves ascending aorta only), or type III (involves descending aorta only, commencing after the
origin of the left subclavian artery) based on the DeBakey classification. Type A (DeBakey I & II)
carry a high mortality rate if left untreated hence, surgical intervention is warranted. For our case,
she is to undergo Modified Bentall procedure at a later schedule.

Keywords: aortic dissection, Stanford classification, DeBakey classification

IC-25

Metastatic Gestational Trophoblastic Neoplasia in the Absence of a

Primary Uterine Lesion: A Case Report

Dhonna L. Cambronero, MD, Lynette R. Lu-Lasala, MD, FPOGS, FPSSTD

Southern Philippines Medical Center

Introduction: Gestational trophoblastic neoplasia (GTN) is the malignant end of the gestational
trophoblastic spectrum which arises from abnormal proliferation of placental trophoblasts.
These tumors arise from any form of pregnancy and are characterized clinically by their
aggressive invasion into the endometrium and myometrium and propensity to widely
metastasize. Common clinical presentation is vaginal bleeding related to the invasive tumor
eroding the uterine vessels and uterine enlargement. It is relatively uncommon for GTN to
present with symptoms related to metastasis without a primary uterine lesion.
Course of the Patient: A 25-year-old G2P1 (1011), presented with a 2-month history of dyspnea
and easy fatigability. She was initially managed as a case of pulmonary mass, malignant vs.
metastatic, rule out pulmonary tuberculosis. Further evaluation revealed an intermittent vaginal
bleeding and a positive pregnancy test result. Her obstetric history was significant for one term
delivery and one spontaneous abortion. Quantitative serum β subunit of human chorionic
gonadotrophin (β-hCG) was elevated at 258,400 mIU/ml. Transvaginal ultrasound scan revealed
normal-sized uterus with thin endometrium and normal Doppler studies. No uterine or adnexal
mass was noted. Based on the clinical history of spontaneous abortion in the past, intermittent
vaginal bleeding, and symptoms of exertional dyspnea and easy fatigability, associated with
elevated serum β-hCG levels and metastatic lesions, a clinical diagnosis of GTN IV:17 was
established.
Discussion: This highlights a rare clinical presentation of GTN as the patient mainly presented
with symptoms related to a metastatic disease to multiple organs with minimal gynecologic
symptoms and no primary uterine lesion. This also demonstrates how the medical team was able
to think outside the box and work collaboratively to correctly diagnose the case as well as to
properly manage the patient.

Keywords: gestational trophoblastic neoplasia, lung metastasis, absent uterine lesion

IC-26

More Than Teen Angst: A Case of Ovarian Teratoma Presenting as

Anti-N-Methyl-D-Aspartate Receptor Encephalitis

Ma. Rosila Flor DJ. Escudero, MD, MBA, Lyra Ruth C. Chua, MD, FPOGS,
FPSUOG, FPSRM
The Medical City

Introduction: Ovarian teratoma is usually diagnosed as an incidental finding of an adnexal mass

or abdominal pain. However, there have been reports of teratomas associated with sudden-
onset neuropsychiatric symptoms. The link behind the peculiar symptomatology was discovered
when anti-N-methyl-D-aspartate receptor (NMDAR) antibodies were found in the patients’
cerebrospinal fluid (CSF), and the disease is then called anti-NMDAR encephalitis. Currently,
treatment is focused on immunotherapy and surgery, with favorable prognosis, as long as
predictors of good outcome such as early intervention and absence of intensive care unit (ICU)
admission are present.
Course of the Patient: A 17-year-old nulligravid presented with labile mood, insomnia and hyper-
productive speech for two days, which progressed to seizures. CSF was positive for anti-NMDAR
antibodies. Despite immunotherapy and seizure prophylaxis, she had status epilepticus and
decrease in sensorium. She was placed on ventilatory support and was admitted in the ICU. On
the 44th hospital day, an ovarian teratoma was seen on abdominal computed tomography (CT)
scan. She underwent right salpingo-oophorectomy, which revealed an immature teratoma. Post-
operatively, there was no significant improvement on her mental status. She was then
discharged, maintained on mechanical ventilation.
Discussion: Anti-NMDAR encephalitis with a concurrent teratoma should be suspected in young
females presenting with sudden-onset neuropsychiatric symptoms in order to provide the timely
intervention necessary for a good prognosis.

Keywords: ovarian teratoma, anti-N-methyl-D-aspartate receptor encephalitis, immunotherapy

IC-27

Myasthenia Gravis in Pregnancy: A Case Report

Regine Ann S. Santiano, MD, Kim Le D. Tan, MD, FPOGS
University of Santo Tomas Hospital

Introduction: Myasthenia gravis in pregnancy is a rare condition, with variable course,

unpredictable remissions and exacerbations. There are only a few published articles on its course
and management, especially when dealing with an impending or ongoing myasthenic crisis, and
most are limited to case reports.
Course of the Patient: Presented is an 18-year-old primigravid with myasthenia gravis, confirmed
positive with acetylcholine receptor antibody, initially presented with ptosis of the left eyelid,
dysphagia, weakness of both lower extremities and uncontrolled drooling, and maintained on
Pyridostigmine, Prednisone and Azathioprine. During her pregnancy, she had episodes of
dyspnea, accompanied by progressive weakness of lower extremities, which persisted in her third
trimester, hence an assessment of an impending crisis. With multi-disciplinary team approach,
securing the airway by general endotracheal anesthesia and subsequent delivery via cesarean
section was the best option. With delayed extubation, she delivered to a live, moderately
preterm baby girl, with an Apgar score of 6, 7. At birth, the baby was assessed with transient
neonatal myasthenia gravis prompting intubation. Twenty-four hours post-intubation, due to
episodes of desaturation and decreased breath sounds, a repeat chest radiograph was done
which showed pneumothorax. Needle aspiration was done, followed by chest tube insertion,
with slight expansion of the left lung. Twenty-four hours post-operatively, extubation was well-
tolerated by the mother. However, on the third post-operative day, she was noted to be dyspneic
and gasping. Two doses of Pyridostigmine were given, however, her condition still progressed to
respiratory depression, which prompted re-intubation. Ideally, IVIg should have been given,
Pyridostigmine and Azathioprine were continued. A week postpartum with no recurrence of
respiratory distress, extubation was done. Both mother and baby were subsequently discharged
improved.
Discussion: Myasthenia gravis can be challenging in pregnancy. Management is highly
individualized and clinical decision making involves multidisciplinary team approach made up of
the obstetrician, neurologist, pediatrician and anesthesiologist with family consultation involving
the patient and her family.

Keywords: myasthenia gravis, pregnancy, acetylcholine receptor antibody

IC-28

Perianal Endometriosis: A Rare Complication of Normal Spontaneous

Delivery with Episiotomy and Repair

Gerben F. Villanueva, MD, Eileen Grace F. Tancinco, RPh, MD, FPOGS,

Emille Teresa B. Apepe, MD, FPOGS, FPSRM
Quirino Memorial Medical Center

Introduction: Endometriosis is a benign gynecologic disorder presenting as progressive and

aggressive disease wherein endometrial glands/stroma is found in aberrant locations, influenced
by estrogen. It is known as a disease of great individual variability and of contrasting
pathophysiologic processes. When presenting in areas other than the pelvic region, it can cause
confusion. It may mimic other conditions such as carcinomas with its characteristics of being
locally infiltrative, invasive and widely disseminating. Presented is a rare case of perianal
endometriosis which manifested as painful perianal mass 13 years after a normal spontaneous
delivery with 4th degree episiotomy and repair.
Course of the Patient: This is a case of a 47-year-old G2P2 (2002) with a 7-year history of
progressive cyclic painful mass at the 7 o’ clock aspect of the perianal canal on dorsal lithotomy
position. Her first child was born via normal spontaneous delivery with 4th degree episiotomy and
repair. She was admitted by the Surgery service and the impression was anal malignancy. She
was referred to the obstetrics and gynecology service with an impression of perianal scar
endometriosis. The patient underwent wide excision of the 2 x 2 cm mass, which on cut section
contained chocolate-like fluid.
Discussion: Episiotomy scar endometriosis is very rare. The patient satisfied the typical
characteristics of perianal scar endometriosis: (1) past perineal tear/episiotomy during vaginal
delivery, (2) a tender nodule/mass in the perineal lesion, and (3) progressive/cyclic perineal pain.
Current literature suggests surgical approach with wide excision of the mass including 1 cm of
surrounding healthy tissue. The recurrence rate is at 3.33%, especially if the anal sphincter is
involved. Hormonal therapies should always be considered in order to conservatively manage
episiotomy scar endometriosis. This can improve surgical outcomes, lessen complication risks,
and a better quality of life for our patient.

Keywords: perianal endometriosis, episiotomy scar, iatrogenic, hormone therapy

IC-29

Polypoid Adenomyoma in a Nulligravid Teenager: A Case Report

Elaiza Joyce M. San Pascual, MD, Janmarie F. Sandoval, MD, FPOGS

Batangas Medical Center

Introduction: Polypoid adenomyoma is a rare benign endometrial tumor among teenagers. The
management of polypoid adenomyoma in a teenage patient is a great challenge to gynecologists
which include combination of medical and surgical techniques to assure safety and success in
order to preserve reproductive functions.
Course of the Patient: This is a case of an 18-year-old nulligravid who came in with a chief
complaint of a bulging introital mass. Since menarche, she had irregular cycles occurring every
1-3 months, moderately to heavy menstrual bleeding using 2 baby diapers lasting 1-2 weeks. Five
days prior to admission, she noticed a sudden presence of a fleshy mass about 4 cm in diameter,
described as non-tender, protruding from her vagina. Four days prior to admission, the mass
which measured 7 x 9 cm and which was associated with foul smelling vaginal discharge, minimal
bleeding, hypogastric pain and lower back pain, prolapsed out of her vagina. Biopsy was done,
and histopathology showed adenomyoma. GnRH agonist was administered, and after a month,
the mass was noted to have decreased in size, fallen off and was no longer visible in the introitus.
Saline infusion sonohysterography (SIS) and hysteroscopic resection were done with
intraoperative findings of an attachment of the pedicle on the posterior fundal area with diffused
thickening endometrial lining. Histopathology showed pedicle of adenomyoma consistent with
endometrial polyp. Months after the procedure, the patient reported to have regular monthly
menstrual cycle with no other symptoms.
Discussion: Polypoid adenomyoma is a rare benign endometrial tumor of mixed epithelial and
mesenchymal origin. It may mimic several disease conditions on imaging and clinical
presentation and may be quite confusing hence several possible differential diagnosis were
considered for this case including prolapsed submucous myoma, non-puerperal uterine inversion
and gestational trophoblastic tumors. This case report shows the rarity of polypoid adenomyoma
in a young nulligravid. The clinical presentation varies among age groups, hence, management is
always individualized. A step-by-step process, from obtaining complete history, physical
examination, imaging and diagnostic procedures, aids in choosing the appropriate medical and
surgical management.

Keywords: polypoid adenomyoma, GnRH agonist, teenager

IC-30

Spontaneous Hemoperitoneum in Pregnancy: A Life-Threatening

Emergency

Cristanne Deanne A. Santiago, MD, Jean Go-Du, MD, FPOGS

St. Luke’s Medical Center – Quezon City

Introduction: Spontaneous hemoperitoneum in pregnancy (SHiP) is an unknown and

unrecognized condition wherein significant bleeding occurs in the abdominal cavity without any
apparent cause. Although there appears to be an association with pelvic endometriosis in many
reported cases, the exact cause of the bleeding remains elusive. Since SHiP may jeopardize the
mother and fetus's life, it is important to be aware of the possibility of this diagnosis in a pregnant
with acute abdomen. To this end, we present the case of a woman with unique features of SHiP.
This is the first one reported in our institution.
Course of the Patient: A 34-year-old normotensive, nondiabetic G1P1 (1001) was rushed to the
hospital on the 6th day after a normal vaginal delivery of a normal term baby. She had a history
of primary infertility and underwent a successful in-vitro fertilization and embryo transfer. She
had sudden-onset severe colicky abdominal pain. On admission, she was pale and tachycardic.
Emergency laparotomy was performed. Active bleeding was identified and controlled by suture
ligation and a hemostatic barrier. The immediate post-operative period was uneventful. On the
10th post-operative day, the patient re-experienced severe and worsening epigastric pains. A
second laparotomy disclosed hemoperitoneum and significant varicosities were noted. An
actively bleeding vessel was seen on the left pelvic sidewall. The previously ligated ruptured
uterine varicosity was intact. A subtotal hysterectomy was performed. Multiple blood
transfusions were required during the intraoperative and immediate post-operative periods. The
pathologist opined that the histopathology of decidual tissues from the left pelvic sidewall were
probably endometriosis.
Discussion: This case has two features that make it unique among the cases reported. First is
that the ShiP occurred during the postpartum period. The second feature is that the patient did
not have just one, but two separate episodes of massive spontaneous hemoperitoneum; the
second occurring ten days after the first. Recurrent SHiP is rarely reported. It is still not possible
to determine which patients are at risk for developing this condition, but a high index of suspicion
may be provided to pregnant women with history of IVF and endometriosis.

Keywords: spontaneous hemoperitoneum, pregnancy

IC-31

Squamous Cell Carcinoma Arising Within a Mature Cystic Teratoma of

the Ovary: A Report of Two Cases

Inez Jade T. Quial-Roilo, MD, Raymond S. Sulay, MD, FPOGS, FSGOP

Perpetual Succour Hospital, Cebu City

Introduction: Mature cystic teratoma of the ovary, or dermoid cyst, is the most common type of
ovarian teratoma and the most common type of ovarian germ cell neoplasm. However, its
malignant transformation is an uncommon complication and occurs only in approximately 2% of
cases. In the Philippines, there has been only two reported cases of this tumor.
Course of the Patients: Presented are two cases: the first case is in a 31-year-old G2P2 (1102)
who presented with right lower quadrant abdominal pain and the second case in a 41-year-old
G2P2 (2002) who also presented with right lower quadrant pain but with an associated mass on
palpation. The first case underwent exploratory laparotomy, right salpingo-oophorectomy with
frozen section, which revealed a squamous cell carcinoma arising from a cystic teratomatous
germ cell tumor, and subsequent left oophorocystectomy, peritoneal fluid cytology, and
omentectomy. The final stage was IA. However, 2 months later, the patient had tumor recurrence
and underwent total abdominal hysterectomy, left salpingo-oophorectomy, en bloc resection
and anastomosis of ileum and sigmoid with partial cystectomy. The second case underwent total
abdominal hysterectomy, bilateral salpingo-oophorectomy, peritoneal fluid cytology and cell
block, bilateral lymph node dissection and total omentectomy. The final stage was stage IIIC. Both
had final histopathology of squamous cell carcinoma arising in a mature cystic teratoma. Both
women were advised chemotherapy but only case 1 was able to comply. Unfortunately, both
died within a year.
Discussion: Malignant transformations arising from a cystic teratoma are exceedingly rare with
no guidelines on management. The two cases presented were both women in their reproductive
age with no significant risk factors for ovarian neoplasm. Squamous cell carcinoma arising in a
mature cystic teratoma is an aggressive type of carcinoma. Despite diagnosing as early as stage
I, a tumor recurrence may occur within a short interval of time. Although generally with a poor
prognosis, early detection is very important for better outcome. Surgery should be individualized,
depending on the stage and desire to preserve fertility. A close follow-up should be done
especially if a fertility-sparing procedure was done.

Keywords: squamous cell carcinoma, mature cystic teratoma, malignant transformation

IC-32

Struma Ovarii Associated Pseudo-Meigs’ Syndrome With Concomitant

Abdominopelvic Tuberculosis Masquerading as Ovarian Malignancy
Nicole Anna Marie H. Dionisio, MD, Elizabeth K. Jacinto, MD, FPOGS, FPSSTD
University of the Philippines-Manila, Philippine General Hospital

Introduction: Pseudo-Meigs’ Syndrome (PMS) is a rare disease characterized by the triad of (1)
an ovarian neoplasm, other than a fibroma or thecoma, (2) ascites, and (3) pleural effusion.
Tumors such as struma ovarii, mucinous and serous cystadenomas, and germ cell tumors have
been linked with the condition. Struma ovarii, known as ovarian goiter, is a specialized mature
teratoma derived from germ cell layers wherein thyroid tissue (>50%) has predominantly
overgrown other elements. Due to its clinical features combined with the elevation of serum
cancer antigen 125 (CA- 125) levels, it is often mistaken and treated as a malignant ovarian tumor.
Despite its presentation, this entity has an excellent prognosis when surgical excision of the
tumor is performed.
Course of the Patient: Presented is an unusual case of a 41-year-old G10P10 (10-0-0-9) who was
diagnosed as a case of struma ovarii associated with pseudo-Meigs’ syndrome, a concomitant
abdominopelvic tuberculosis and a fourth degree pelvic organ prolapse. Initial consideration of
a malignant tumor was based on the history, physical examination and imaging findings. With
the peritoneal fluid cytology finding of the presence of acid-fast bacilli, Anti-Koch’s regimen was
initiated for 1 month before performing the definitive surgical procedure of exploratory
laparotomy, total hysterectomy with bilateral salpingo-oophorectomy with staging procedure,
appendectomy, Halban culdoplasty, uterosacral fixation under continuous lumbar epidural
anesthesia. The post-operative course was uneventful. Six months of anti-Koch’s regimen was
completed with resolution of the ascites and pleural effusion.
Discussion: Increasing awareness in the occurrence of benign complex pelvic masses which
mimic malignant conditions is essential in arriving at a correct diagnosis. Thus, considering
pseudo-Meigs’ syndrome, doing confirmatory laboratory tests and imaging procedures, and an
intraoperative frozen section, could aid in accurately diagnosing and planning the surgical
management appropriate for the patient.

Keywords: pseudo-Meigs’ Syndrome, struma ovarii, abdominopelvic Koch’s

IC-33

Successful Management of Acute Fatty Liver in Pregnancy: A Case

Report

Noel Isaiah G. Quinto, MD, Nilo M. Alcoreza, MD, FPOGS, FPSUOG

Batangas Medical Center

Introduction: Acute fatty liver of pregnancy (AFLP) is a unique liver disease in pregnancy that
warrants early detection and critical care management as it confers significant morbidity and
mortality in both mother and fetus. Prognosis depends on the severity, temporal development,
management, and complications arising from the disease. Management should be individualized
as to system affectation as there is currently no definitive treatment for this disease.
Course of the Patient: This is a case of a 33-year-old G5P5 (1405) admitted postpartum for loss
of consciousness. The patient was assessed to be drowsy, hypotensive, tachycardic, pale,
jaundiced and with epigastric tenderness. AFLP was highly considered. Laboratory results showed
severe anemia, leukocytosis, deranged bleeding parameters and elevated liver enzymes, serum
creatinine and bilirubin. The management required a multidisciplinary approach with careful
considerations regarding hemodialysis, blood transfusion, bleeding, multi-organ damage and
liver transplantation. The major issues that were encountered were the fulminant liver damage
and the persistently elevated serum creatinine. Daily hemodialysis was done to the patient and
with significant improvement observed.
Discussion: Pathogenesis of AFLP involves several inciting events with fatty acid oxidation and
deposition of harmful metabolites at its core. Treatment for AFLP is primarily directed at the
management of complications. This supports the notion that the accumulation of toxic long-chain
3-hydroxyl fatty acids (LCHA) metabolites in the maternal circulation may be the cause of liver
failure and associated sequelae; thus, removal of these metabolites brought significant
improvement. Despite the successful management of this case, there is still a paramount need
for a treatment protocol that will address the complex and severe presentation of this condition,
such as the need and timing for hemodialysis, appropriate blood transfusion vs. the severe
coagulopathy, and indication of liver transplantation for AFLP.

Keywords: acute fatty liver of pregnancy, fatty acid activation, liver transplantation
IC-34

The Doublet Protocol of Etoposide–Actinomycin in Chemorefractory

Low Risk Gestational Trophoblastic Neoplasia: A Case Series

Kathryn M. Buque, MD, Sherry Joahne L. Cañete-Villariasa, RMT, MD, FPOGS,

FPSSTD
Vicente Sotto Memorial Medical Center

Introduction: Gestational trophoblastic neoplasia (GTN) are uncommon malignant tumors that
mostly follow a molar pregnancy but can develop after any gestation. They are immensely
chemosensitive with excellent prognosis despite widespread metastases. Primary chemotherapy
with Methotrexate or Actinomycin is recommended for nonmetastatic and low-risk metastatic
disease. Chemoresistance or chemotoxicities may occur with either drug hence requiring a
subsequent treatment protocol. Etoposide-Actinomycin (EA) is an efficacious and well-tolerated
salvage therapy but there is paucity of data regarding its treatment experience.
Course of the Patients: This case series chronicles three patients diagnosed with low-risk
postmolar GTN. Case 1 is 23 years old, G2P1(1011), asymptomatic but with rising ß subunit of
human chorionic gonadotrophin (ß -hCG) titers while on outpatient monitoring. Case 2 is 18 years
old, G1P0 (0010) who consulted for hematuria; while Case 3 is 25 years old, G2P1(1011) who
consulted months after evacuation with her biopsy result but both did not comply with ß-hCG
surveillance. All three had unsuccessful primary and secondary chemotherapy, and were
switched to EA after considering the following attributes: ß-hCG < 60,000 mIU/mL at the time of
primary or secondary chemotherapy failure, minimal tumor burden, and no evidence of
metastases in other sites. Cases 1 and 2 achieved remission with the EA protocol with only mild
chemotoxicities. Both remain in remission and are doing regular ß-hCG surveillance at present.
Case 3 became chemorefractory to EA and had to be shifted to the fourth line regimen of
Etoposide, Actinomycin, Methotrexate, Cyclophosphamide, and Vincristine (EMACO). Then she
was lost to follow-up because of the COVID-19 pandemic, eventually had tumor progression and
succumbed.
Discussion: Resistance to the primary chemotherapy occurs in nearly 30-40% of low-risk
patients, but >90% will be cured by the use of sequential single-agent chemotherapy. In about
10% of cases, multi-agent chemotherapy with or without surgery to achieve remission will be
ultimately needed. EA is a reasonable second-line or third-line salvage regimen for selected
nonmetastatic and low-risk metastatic patients because it is simple, effective, safe, and
affordable.

Keywords: etoposide, actinomycin, gestational trophoblastic neoplasia, salvage regimen

IC-35

The Value of Placental Cannulation and Dye Injection in Unraveling

the Mystery of a Monochorionic Twin Pregnancy with Coexistent
Selective Intrauterine Growth Restriction and Twin-to-twin Transfusion
Syndrome

Jessica G. De Dios, MD, Kathryn Kristy P. Bautista, MD, FPOGS, FPSMFM,

FPSUOG
Dr. Pablo O. Torre Memorial Hospital

Introduction: Selective intrauterine growth restriction (IUGR) and twin-to-twin transfusion

syndrome (TTTS) are conditions unique to monochorionic twin diamniotic (MCDA) pregnancies
which are both associated with substantial perinatal risk. The presence of both clinical entities
in the same twin pregnancy is a diagnostic challenge, and management is even more complex
since the effects of placental insufficiency in the growth-restricted twin is compounded by inter-
twin blood transfer through placental anastomoses.
Course of the Patient: A 27-year-old multigravid started prenatal care at 11 weeks age of
gestation (AOG). At 28 weeks, ultrasound revealed 13% growth discordancy, with Twin A being
appropriate for gestational age (AGA), and twin B being small for gestational age (SGA). Doppler
velocimetry showed diastolic flow in the umbilical artery, indicative of selective IUGR Type I. At
30 weeks AOG, ultrasound revealed polyhydramnios (13.9 cm) for Twin A, and oligohydramnios
(1.9 cm) for Twin B, indicative of TTTS. Umbilical artery of Twin B showed reversed end-diastolic
flow. There was a 32% growth discordance, with an AGA Twin A and an SGA Twin B. Admission
was done for fetal surveillance and administration of magnesium sulfate and dexamethasone.
After 1 week, the amniotic fluid index and doppler waveforms deteriorated, with note of reversed
a-wave in the ductus venosus. Twin B showed fetal bradycardia, thus, patient was delivered via
cesarean section to two preterm male neonates with unremarkable postnatal course. Placental
study showed unequal placental share and velamentous cord insertion for Twin B. Dye
cannulation and injection revealed presence of several arteriovenous anastomoses with a large
arterio-arterial anastomosis.
Discussion: We believe that it is the large arterio-arterial anastomosis that allowed for
compensatory flow, thus protecting the twins from rapid progression of fluid and Doppler
abnormalities. This case shows the value of Doppler velocimetry in diagnosis, monitoring and
management, while placental cannulation and dye injection gives information on the
pathophysiology of the unique complications of MCDA pregnancies.

Keywords: monochorionic diamniotic pregnancy, selective IUGR, twin-to-twin transfusion syndrome,

placental cannulation, Doppler velocimetry
IC-36

Trisomy 18 in Utero: Detection, Delivery and Dilemmas

Mellen Joy H. Villanueva, MD, Kathryn Kristy P. Bautista, MD, FPOGS, FPSMFM,
FPSUOG
Dr. Pablo O. Torre Memorial Hospital

Introduction: Pregnancies complicated with chromosomal abnormalities are bounded by ethical

dilemmas. The complexity and severity of clinical presentations at birth and high neonatal
mortality make the perinatal and neonatal management particularly challenging and
controversial. This case report stresses the importance of antenatal diagnosis and the need for
adequate counseling at all stages, beginning with the suspicion of the disorder, continuing until
the diagnosis is validated, and thereafter.
Course of the Patient: This is a case of a 34-year-old multigravida who developed polyhydramnios
at 27 4/7 weeks’ gestation. Subsequent congenital anomaly scan revealed a fetus with
esophageal atresia and other congenital anomalies coexisting with fetal growth restriction, with
sonologic findings suspicious of Trisomy 18. A multidisciplinary family counselling was done with
emphasis on prognostication and issues regarding delivery and newborn care. At 34 4/7 weeks’
gestation, the patient had preterm labor and cardiotocography revealed a pathologic tracing
indicating possible fetal asphyxia. She delivered via cesarean section to a live female neonate, 33
weeks by Ballard Score, diagnosed by a pediatric geneticist as Edwards syndrome. An upper
gastrointestinal series revealed esophageal atresia type C. Surgical correction was proposed,
however the parents signed a Do Not Resuscitate form. The baby expired on the 25th day of life.
Discussion: In the holistic management of patients carrying a fetus with Trisomy 18, the
multidisciplinary team should counsel patients compassionately with all possible interventions in
meeting goals of care. This should begin from the time the presence of a congenital anomaly is
detected, and should ideally involve a team of perinatologist, neonatologist, pediatric surgeon,
geneticist, and bioethicist. As a result, the parents may have more choices than what was
traditionally offered in the past. The prenatal, antepartum and postpartum counselling should
be given in an approach driven by the best interpretation of prognosis, viability, and ethical
considerations.

Keywords: Trisomy 18, congenital anomaly, counseling, ethics

IC-37

Uterine Carcinosarcoma in a Young Patient with Uterine Inversion: A

Case Report

Nicole S. Balagtas, MD, Raymond S. Sulay, MD, FPOGS, FSGOP

Perpetual Succour Hospital, Cebu City

Introduction: Uterine carcinosarcoma is a very aggressive and poor histologic type of cancer
comprising less than 5% of uterine malignancies. It primarily affects postmenopausal females.
However, the lowest age of presentation at 15-17 years old has also been reported. The overall
outcome remains poorly understood. A comprehensive surgical staging procedure is
recommended.
Course of the Patient: This is a case of a 15-year-old nulligravid with menarche at 13 years. Five
months prior to presentation, the patient experienced prolonged heavy menses and a rapidly
growing vaginal mass. Transrectal ultrasound was suggestive of cervical pathology. Biopsy
showed embryonal rhabdomyosarcoma. Surgery was advised but the patient did not comply. In
the interim, the onset of dizziness and severe hypogastric pain prompted admission. On
examination, the patient was pale, hypotensive, tachycardic and tachypneic. Internal
examination showed a 20-cm prolapsing necrotic introital mass, solid and multilobular with
hemorrhagic areas. The patient underwent total abdominal hysterectomy with bilateral
salpingectomy. The prolapsed mass and uterus were transected vaginally, leaving behind the
barely identifiable cervix and fallopian tubes. The remainder of the specimen was removed
intraabdominally. Final histopathology showed uterine carcinosarcoma, stage IB.
Postoperatively, the patient had an unremarkable course, and subsequently underwent adjuvant
chemotherapy, with no recurrence noted for one year.
Discussion: Due to the rarity of the case, there is no standard management. No uniformly
defined staging criteria exist, and the International Federation of Obstetrics and Gynecology
(FIGO) recommend that staging be equivalent to endometrial cancer. An important clinical aspect
to note is the patient’s age, which is atypical for the disease. Age is an independent prognostic
factor, and older age is associated with poor prognosis.

Keywords: prolapsing vagina mass, uterine carcinosarcoma, young

IC-38

Vaginal Endometrioid Adenocarcinoma Arising from Endometriosis

After Total Abdominal Hysterectomy and Bilateral Salpingo-
oophorectomy

Roxanne Gillea G. Tan, MD, Leo Francis N. Aquilizan, MD, FPOGS, FSGOP
St. Luke’s Medical Center, Quezon City

Introduction: Primary carcinoma of the vagina is rare and accounts for 1% of gynecologic
malignancies. Adenocarcinoma is the second most common primary cancer in the vagina.
Although less common than squamous cell carcinoma, it represents 15% of all primary vaginal
malignancies. The most common manifestation of this malignancy is vaginal bleeding. Specific
criteria in establishing endometriosis-related malignancy as presented by Sampson include the
presence of benign endometrial and malignant tissue at the same site, the presence of
endometrial stroma surrounding glands, and the exclusion of metastasis from another primary
site.
Course of the Patient: This is a case of a 63-year-old G1P1 (1001), who presented with
postmenopausal bleeding. She had a history of total abdominal hysterectomy and bilateral
salpingo-oophorectomy for endometriosis 20 years ago. A 3-cm vaginal mass was appreciated on
internal examination. Vaginal stump biopsy and immunohistochemical stains revealed vaginal
endometrioid adenocarcinoma. Positron emission topography (PET) scan showed no metastasis;
hence, surgical intervention was advised. The patient underwent peritoneal fluid sampling,
excision of vaginal mass, vaginectomy, bilateral lymph node dissection, omentectomy under
combined regional – general anesthesia where in histopathology revealed vaginal endometrioid
adenocarcinoma, grade III.
Discussion: Primary endometrioid adenocarcinoma of the vagina is the second most common
subtype of vaginal adenocarcinoma and accounts to 8-10% of cases. In majority of cases, it is
seen in association with endometriosis, which is a finding that helps in the exclusion of metastatic
disease. Treatment of vaginal carcinoma depends primarily on histology, tumor volume,
anatomic location, stage, and age of the patient. The origin, natural history, malignant
transformation, and laboratory management of endometriosis are not yet clearly investigated.
Strategies for prevention, early detection, specific diagnosis, and treatment should be set up
targeting the pathogenesis of endometriosis to better understand endometriosis-associated
cancer.

Keywords: vaginal adenocarcinoma, endometriosis, hysterectomy, postmenopausal bleeding

IC-39

When the Metastatic Tumor Presents as a Primary Tumor:

Gastric Signet Ring Cell Carcinoma Presenting as Advanced Cervical
Cancer with Ovarian Metastasis

Marie Felle P. Flores, MD, Angelito D.L. Magno, MD, FPOGS, FSGOP
De La Salle University Medical Center

Introduction: Primary signet ring cell carcinoma of the ovary and the cervix is rare and is most
commonly metastatic from a primary lesion. Discerning between primary and metastatic signet
ring cell carcinoma of the ovary or cervix may be difficult.
Course of the Patient: This is a case of a 37-year-old nulligravid, who presented with increased
abdominal girth with associated abdominal pain. 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 vs. 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.
On further work up, immunohistochemical stains CK7, CK19, CK20, and CDX2 tested positive in
tumor cells and were noted to be consistent with metastatic carcinoma of gastric vs. pancreatic
primary. Further work-up was done and the biopsy from the esophagogastroduodenoscopy
revealed poorly-differentiated adenocarcinoma with signet ring features, antral mucosa.
Discussion: Gastric cancer is the fifth most frequently diagnosed cancer and the fourth cause of
cancer death worldwide. Studies have shown that the incidence of signet ring cell carcinoma
subtype has been increasing. Diffuse-type gastric carcinoma, referred to signet ring cell
carcinoma has presence of signet ring cells and has poorly cohesive single cells with no gland
formation. Signet ring cell carcinoma is more frequent in women as compared to non-signet ring
cell carcinoma. It occurs among younger patients, with age ranging from 55 to 61 years. It
commonly arises in the stomach. Common metastatic sites are liver, lung, bone, and lymphatics
while gynecologic organs are not common metastatic sites. A thorough clinical history and
physical examination paired with diagnostic modalities may be able to aid in arriving at the
correct diagnosis.

Keywords: signet ring cell carcinoma, primary, metastatic