Prioritisation of outpatient appointments and elective surgery in gynaecology.

The coronavirus disease 2019 (COVID-19) pandemic continues to be a global public health concern. It has posed a multitude of challenges from managing the supply chain of personal protective equipment (PPE), reducing the spread of the virus through national restrictions, disrupting the routine delivery of healthcare services to now the race in developing novel treatments and vaccines. As the National Health Service (NHS) considers a phased restoration of non-emergency services, it is imperative to consider the high volume of patients awaiting specialist reviews and surgical procedures. Gynaecology services have to be prioritised according to the patients' clinical needs rather than their individual waiting times. In this chapter, we look at the varying aspects of prioritising non-emergency gynaecology care, including outpatient appointments and elective surgery, how innovative pathways have evolved in response to necessity, what some of the barriers have been to implement these and how this has overall impacted on individual gynaecological specialties.

COVID-19 in Women's health reducing the risk of infection to patients and staff during acute and elective hospital admission for gynaecological surgery.

The novel coronavirus SARS-Cov-2 has changed healthcare on a worldwide scale. This highly contagious respiratory virus has overwhelmed healthcare systems. Many staff were redeployed, and there was widespread cessation of non-urgent outpatient clinics and surgery. Outpatient clinics and theatre areas were converted to COVID-19 wards and intensive care units. Following the first peak, services began to recommence with new triaging and prioritisation guidance to safeguard patients and staff. Different countries and healthcare systems produced differing guidance and, in particular, variation in the best approach to continuing acute and elective surgical procedures. This chapter collates and evaluates the increasing international literature concerning the surgical management of gynaecological conditions during the pandemic, such that clear inferences, recommendations and guidance can be generated to aid clinical practice and safeguard against further major disruption arising from further COVID-19 peaks. The available data are assessed within the context of the current phase of the COVID-19 pandemic.

Vaginoscopy for office hysteroscopy: A systematic review & meta-analysis

OBJECTIVE: To investigate the effect of the vaginoscopic approach to office hysteroscopy on patients'experience of pain, when compared with the traditional approach where a vaginal speculum is used. METHODS: Medline, Embase, CINAHL and the Cochrane library were searched from inception until December 2019, in order to perform a systematic review and meta-analysis of all randomised controlled trials investigating vaginoscopy compared to traditional hysteroscopy on pain experienced by women undergoing diagnostic or operative hysteroscopy in an office setting. Data regarding procedural time, feasibility, incidence of vasovagal reactions and complications, acceptability and satisfaction were also recorded. RESULTS: The literature search returned 363 results of which seven were selected for systematic review, and six for meta-analysis. The vaginoscopic approach was associated with a statistically significant reduction in pain (4 studies including 2214 patients;SMD -0.27, 95 % CI -0.48 to -0.06), procedural time (6 studies including 2443 patients;SMD -0.25, 95 % CI -0.43 to -0.08) and the incidence of vasovagal episodes (3 studies including 2127 patients;OR 0.35;95 % CI 0.15 to 0.82). Failure rates between the two techniques were similar (p = .90). No study reported significant differences in complications or patient or clinician acceptability or satisfaction. CONCLUSION: Clinicians performing office hysteroscopy should use the vaginoscopic technique because it makes office hysteroscopy quicker, less painful and reduces the likelihood of inducing a vasovagal reaction. The traditional approach should only be used when vaginoscopy fails or when the need for cervical dilatation is anticipated.