ABSTRACT
Objective: The ongoing COVID-19 pandemic has been associated with greater risk of infection and severe complication in solid organ transplant recipients compared to the general population, yet sparse data exists on the effect of COVID-19 on uterus transplant (UTx) recipients. Though immunosuppressed individuals, including organ transplant recipients, experience higher rates of morbidity and mortality following COVID-19 infection, vaccination for COVID-19 has been shown to effectively reduce mortality for these patients. Despite these encouraging results, and statements from professional societies including ASRM recommending vaccination, vaccine hesitancy remains elevated in the infertility population. The goal of this report is to provide details regarding COVID-19 infection and vaccination rates in UTx recipients in the US. Material(s) and Method(s): We performed a retrospective cohort analysis on individuals who have undergone UTx as of March 2021 in the US. Five UTx recipients at two centers (Baylor Scott and White, Dallas, Texas, and Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania) were diagnosed with COVID-19 infection as defined by the presence of a positive SARS-CoV-2 on reverse transcriptase-polymerase chain reaction (RT-PCR) testing from a nasopharyngeal swab. Data collected included demographic features, transplant history, transplant-related complications, vaccination status and pregnancy history. Result(s): The median time from transplant to diagnosis of COVID-19 was 22.8 months. Despite the availability of the COVID-19 vaccine, only one out of 5 UTx recipients was vaccinated at the time of diagnosis. Two recipients were pregnant at the time of diagnosis, one in the first trimester and one in the second trimester of pregnancy. One recipient experienced COVID reinfection three months following the first infection. All COVID positive UTx recipients experienced no or mild symptoms;one recipient was asymptomatic, 4 had nasal congestion, 2 had headaches, and one patient was febrile. Four recipients received Casirivimab-imdevimab. In 80% of patients, no changes were made to patients' immunosuppression regimens. Conclusion(s): All UTx recipients who were diagnosed with COVID-19 infection as of 3/2021 recovered without complications. As in other infertility patients, vaccine hesitancy remains a significant concern despite the UTx population having a higher risk of severe disease. Data continues to accrue demonstrating the safety of vaccination in pregnancy, and communication of these results to the UTx population is essential to promote maternal and child health. Impact Statement: This data provides reassuring information regarding outcomes for COVID-19 infection in UTx population;however also demonstrate that similar to other pregnant patients or patients with infertility, vaccine hesitancy remains a significant issue. Copyright © 2022
ABSTRACT
Objective: During the COVID-19 pandemic, institutions turned to telehealth as the primary method of postpartum care delivery. We aimed to determine the impact of telehealth on the completion of postpartum care goals. Study Design: We compared a 14-week period, March-June 2019, before implementation of telehealth to the same calendar months post-implementation during 2020. Patients with a postpartum visit (PPV) scheduled at our institution during the study period were included. Our primary outcome was attendance to the PPV. Secondary outcomes included completion of postpartum depression (PPD) screening, contraception selection, breastfeeding status at PPV, completion of postpartum 2-hour glucose tolerance test (GTT) for women with gestational diabetes, and cardiology follow-up when recommended. Multivariable logistic regression with backward elimination was used to control for confounders. Results: Of the 1,579 patients meeting inclusion criteria, 780 were in the pre-telehealth group and 799 were in the post-telehealth group. Subjects in the post-telehealth group were 90% more likely to attend a PPV compared to those in the pre-telehealth group, even when controlling for race, prenatal care provider, parity, gestational age at delivery, and insurance status (82.9% vs. 72.4%, p < 0.001;aOR 1.90, 95% CI [1.47-2.46]). Patients in the post-telehealth group were also more likely to get screened for PPD (86.3% vs. 65.1%, p < 0.001). While subjects were as likely to choose a contraceptive method at the PPV, those in the post-telehealth group were less likely to choose long-acting reversible contraception (LARC) or permanent sterilization (26.2% vs. 33.2%, p=0.03). There was no difference in breastfeeding status at the PPV, completion rate of postpartum 2-hour GTT, or attendance to cardiology follow-up appointments between groups. Conclusion: Availability of telehealth during the COVID-19 pandemic is associated with increased PPV attendance and PPD screening. However, the availability of telehealth was also associated with a decrease in the utilization of LARC or permanent sterilization. [Formula presented]
ABSTRACT
Objective: During the COVID-19 pandemic, institutions turned to telehealth as the primary method of postpartum care delivery. We aimed to understand the patient experience around telehealth for delivery of postpartum care using a qualitative approach. Study Design: We performed individual, semi-structured patient interviews (n=25) within two weeks of a scheduled telehealth postpartum visit (PPV) at our institution. Interviews were performed by phone from 10/1/2020-1/1/2021, more than 6 months into the COVID-19 pandemic. Transcriptions were analyzed using grounded theory and coded with a systematic approach. Results: Overall, participants reported mixed preferences for the modality of the postpartum visit (in-person vs. telehealth). Those in favor of telehealth focused on its convenience and flexibility. When performed via video and audio rather than audio alone, participants felt telehealth well-simulated in-person engagement. Participants also reported similar experiences by modality regarding contraceptive planning. On the other hand, several participants raised concerns about the limitations of telehealth for physical examination, such as providing patient reassurance regarding healing after delivery. Reported facilitators to telehealth were lack of need for childcare or transportation to an in-person encounter, minimized disruption to maternal-newborn routine, and prioritizing safety during the COVID-19 pandemic. Reported barriers also included the need for childcare during the telehealth encounter, as well as difficulty finding a private space for the visit, scheduling and logistic challenges, privacy concerns, and technological difficulties. Conclusion: Telehealth is becoming an increasingly utilized modality of PPVs in the United States. In this qualitative analysis, we characterize patients’ experiences with telehealth postpartum care, and identify areas of patient concern. Future work should determine how best to provide reassurance regarding postpartum healing to further optimize telehealth for postpartum care. [Formula presented]