Vitamins and minerals, education, and self-care need during preconception to 1000 days of life in Southeast Asia: An expert panel opinion.

Addressing maternal malnutrition and its drivers is paramount in Southeast Asia. This article summarizes the key clinical learnings and evidence-based opinions from the experts to understand the need for vitamins and minerals supplementation, education, and self-care from preconception to the first 1000 days of life, which warranted further attention since COVID-19 pandemic. Evidence describing the importance of vitamins and minerals during preconception, pregnancy, and lactation stages was identified using literature databases. A pre-meeting survey was conducted to determine the current practices and challenges in Southeast Asia. Based on the literature review and clinical experience, experts defined the topics, and an online meeting was held on 13th July 2021. During the meeting, nine experts from Southeast Asia provided evidence-based opinion on the vitamins and minerals supplementation, education, and self-care need during preconception, pregnancy, and lactation stages. The expert opinions underpin maternal malnutrition as a prevalent issue and discuss appropriate interventions and prevention strategies for women in Southeast Asia. The recent pandemic further impacted nutrition status, pregnancy, and neonatal health outcomes. The expert panel emphasized a need to improve existing inadequacies in education, self-care, and social support, and discussed the role of policymakers in addressing the barriers to dietary changes. As inadequacies in regular vitamins and minerals supplementation, education, and self-care for women of reproductive age implicate maternal and child health outcomes, there is an urgent need for addressing malnutrition concerns in this population. Thus, a strong partnership between policymakers, healthcare professionals, and other relevant sectors is required.

Power doppler versus saline infusion sonography in the diagnosis of endometrial polyps in patients who present with abnormal uterine bleeding / Philippine Journal of Obstetrics and Gynecology

OBJECTIVE: To compare the diagnostic performance of Power Doppler versus Saline Infusion Sonography (SIS) in the diagnosis of endometrial polyps in patients who present with abnormal uterine bleeding using histopathological confirmation. METHODS: This is a 2-year cohort study involving non-pregnant patients with abnormal uterine bleeding examined prospectively and subjected to both transvaginal sonography with power Doppler and SIS. Single-vessel pattern/comma-like patterns on power Doppler were considered positive. Results were compared to the gold standard histopathological examination obtained by endometrial biopsy, curettage, or hysteroscopic resection of endometrial polyp. RESULTS: A total of 42 patients completed the study and were included in the final analysis. Thirty-five (35) patients had confirmed endometrial polyp by histopathology. Power Doppler was positive in 32 of these patients. SIS, on the other hand was positive in 16 patients. The results are as follows: sensitivity 89%, specificity 83%, and positive and negative predictive values 97% and 56% respectively for power Doppler. For SIS, on the other hand, sensitivity 46%, specificity 86%, positive and negative predictive values of 94% and 24% respectively. CONCLUSION: Power Doppler is as useful in identifying patients with endometrial polyps and can be used in place of the traditional test SIS. Its diagnostic accuracy is better than SIS.  

Salivary ferning as an alternative to sonographic follicle monitoring for determining ovulation: A comparative study / Philippine Journal of Obstetrics and Gynecology

OBJECTIVE: To determine if salivary ferning correlates significantly with sonographic indices in identifying the fertile period, and whether it may be used as a cheaper, and more convenient way to aid infertility patients in achieving pregnancy. POPULATION: Subjects who complain of difficulty achieving pregnancy and for whom follicle monitoring was indicated were recruited from the Outpatient Department in a tertiary hospital in Manila. METHODOLOGY: Patients (n=40) with Primary or Secondary Infertility from April 2013 to August 2015 who require serial follicle monitoring as part of infertility work up were recruited in the study. For every follicle monitoring by ultrasound done by one sonologist, a salivary sample was obtained from the subject and the ferning pattern was determined and recorded by one pathologist blinded as to the day of the subject's menstrual cycle. RESULTS: There was a total of 40 subjects who underwent 2 serial follicle monitoring during the study. The 1 st TVS (preovulatory) was done between Day 9 to 14 of the cycle with an average of Day 11. Correspondingly, salivary ferning done showed that there were 26 (65.0%) with Salivary Ferning 1 pattern and 14 (35.0%) with Salivary Ferning 2 pattern (p=0.35). This showed no significant difference between follicle monitoring and salivary ferning pattern and either may be used in identifying fertile period preovulatory. The 2nd TVS (postovulatory) was done between Day 12 to 21 with an average of Day 16. All the second ultrasound findings showed signs of ovulation. Correspondingly, there were 1 (2.0%) showed Salivary Ferning 1 pattern, 11 (27.5%) showed Salivary Ferning 2 Pattern and 28 (70.0%) showed Salivary Ferning 3 Pattern 9 (p=0.05). This showed no significant difference between follicle monitoring and salivary ferning pattern, hence, TVS follicle monitoring remains more reliable in identifying that ovulation has occurred. CONCLUSION: Salivary ferning corresponded well with ultrasonographic findings during the preovulatory phase of the cycle, while no correlation was noted between the salivary ferning pattern and the postovulatory phase of the cycle. Hence, sonographic follicle monitoring remains a better predictor of ovulation, and more effective in identifying the fertile period

Correlation of sonographic parameters of ovarian reserve with menstrual pattern among women in reproductive age / Philippine Journal of Obstetrics and Gynecology

The goal of this study was to determine the ovarian reserve by sonographic measurement of ovarian volume and antral follicle count, then correlate with menstrual pattern in women belonging reproductive age. All patients were grouped accordingly into early, mid and late reproductive age group. Transvaginal or transrectal sonography was performed on the follicular phase of the menstrual cycle. Ovarian volumes and antral follicle counts of both ovaries were determined sonographically and recorded. METHODS: A total of 160 subjects were included in the study. Infrequent; menstrual pattern were noted in half (50%) of the subjects. Irregular menstrual pattern were noted in more than half (55%) of the subjects. Almost 60% were noted to have shortened duration of menstrual pattern. There were 92 (57.5%) with light menstrual pattern. RESULTS: Results showed ovarian volume and antral follicle count decreases with increasing age. Ovarian volume of subjects with infrequent menstrual pattern was significantly higher than those with frequent menstrual pattern but is significantly higher than those with normal menstrual pattern. Ovarian volume of subjects with irregular menstrual pattern were significantly higher than those with regular menstrual pattern. Antral follicle count of subjects with infrequent menstrual pattern was significantly higher than those with frequent menstrual pattern but is significantly higher than those with normal menstrual pattern. Antral follicle count of subjects with irregular menstrual pattern were significantly higher than those with regular menstrual pattern. Results showed that there was a significant difference both in the ovarian volume and antral follicle count according to age as well as frequency and regularity of menstrual pattern.

Virilizing tumor in pregnancy: a case report

Virilizing tumors during pregnancy are extremely rare. This case of a 33 year old, gravid 3 para 2, presented with hirsutism and clitoromegaly at 5 months age of gestation. Her past medical and menstrual histories were non-contributory. Ultrasound done during her prenatal check-up at 34 weeks age of gestation revealed an ovarian new growth on the left ovary features suggestive of a benign nature. On her 38th week of pregnancy, LTCS III with right tubal ligation and left salpingooophorectomy were performed and a baby boy weighing 3000 grams without any gross abnormalities was delivered. Histopathologically, the tumor proved to be a benign mucinous cystadenoma. This paper presented an ovarian mucinous cystadenoma with virilizing features that are transient and reversible. Therefore, an ovarian neoplasm should always be considered as a differential diagnosis for causes of virilization during pregnancy.