Uterine leiomyomas are tumor-associated causes of secondary erythrocytosis. Ectopic erythropoietin production by fibroid smooth muscles has been proposed and demonstrated in the literature. Here, we present three cases of large leiomyomas with an incidental finding of isolated erythrocytosis on preoperative workup. Two patients underwent total abdominal hysterectomy while one patient underwent a myomectomy. Both histologic examination confirming the diagnosis of leiomyoma and serial complete blood counts showing normalization of postoperative hemoglobin levels together with isolated erythrocytosis constitute the criteria to fulfill a diagnosis of myomatous erythrocytosis syndrome. All three criteria were observed in the three cases described. To date, fewer than 40 cases have been reported worldwide. These are the first reported cases of myomatous erythrocytosis syndrome in the Philippines.
Background The COVID-19 pandemic resulted in unprecedented challenges to healthcare systems worldwide, including interruption of antenatal care services. The study aimed to determine the utilization of antenatal care services of Filipino women during the COVID-19 pandemic. Methods A cross-sectional study was conducted among postpartum women using an online self-administered survey in the Philippines from January 1 to March 31, 2022. The questionnaire used to assess health-seeking behavior was validated before the survey proper. Women aged 18 to 45 years who delivered in 2021 were recruited. The participants answered a structured questionnaire to assess their access, perceptions, and utilization of antenatal care. Utilization of antenatal care was evaluated using standard measures, including the timing of initiation of antenatal care, number of subsequent visits, and place of consults. The factors affecting the adequacy of antenatal care were determined for each variable through simple logistic regression. Results A total of 318 women were enrolled in the study. All the respondents agreed on the necessity of antenatal care. However, only 46.37% had six or more in-person antenatal visits, with the majority attended to by midwives at community health centers. Most respondents (71.38%) initiated antenatal care during the first trimester. Almost half reported deferrals of visits mainly due to lockdown restrictions, transportation problems, and financial issues. Positive predictors of adequate antenatal care were prior pregnancies (OR 1.80, 95% CI 1.11–9.20 for 2–3 prior pregnancies; OR 3.02, 95% CI 1.45–6.29 for 4 or more prior pregnancies), live births (OR 1.67, 95% CI 1.04–2.69 for 2–3 prior live births; OR 2.46, 95% CI 1.17–5.16 for 4 or more prior live births), having living children (OR 1.74, 95% CI 1.09–2.79), spousal support (OR 1.75, 95% CI 1.01–3.03 for married women; OR 1.89, 95% CI 1.09–3.28 for women with common-law partners), history of obstetric complications (OR 2.82, 95% CI 1.33–5.97), and use of private vehicles (OR 2.65, 95% CI 1.05–6.68). Negative predictors were employment (OR 0.37, 95% CI 0.22–0.63) and medical examination prior to pregnancy (OR 0.36, 95% CI 0.23–0.58). Conclusion Despite an overall positive perception of the necessity of antenatal care, utilization has been inadequate in more than half of the respondents. Various individual, facility, and policy-level factors affected the utilization of services during the pandemic. There is a need to augment antenatal care services in the country by mitigating barriers to access. The public health response should strengthen collaborative efforts with primary-level healthcare to increase service provision, especially to more vulnerable populations.
Ovarian pregnancy is a type of ectopic pregnancy where the fertilized ovum is implanted in the ovary. It is a rare entity and preoperative diagnosis remains problematic due to its nonspecific clinical presentation and sonographic findings. Here, we present a case of an advanced ovarian pregnancy at 28 weeks’ age of gestation initially managed as a case of suspected abdominal pregnancy. Preoperative aortogram and embolization were done to minimize intraoperative blood loss. Upon exploration of the abdomen, the products of conception were contained within an intact right ovary. The patient underwent right salpingo-oophorectomy. We obtained a stillborn baby girl weighing 1410 grams with no gross deformities. Histopathology confirmed the diagnosis of an ovarian pregnancy. This case highlights the difficulties in diagnosing ovarian pregnancy despite advances in imaging and the use of preoperative embolization to minimize intraoperative blood loss and morbidity.
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