Gynaecological Laparoscopic Surgeries in the Omicron Era: Improvising the Management Skills After Lessons Learnt From the Delta Wave.

Background During the peak of the Omicron wave, elective laparoscopic surgeries were restricted; however, semi-emergency and emergency cases were managed despite the limited resources and manpower. We conducted this study to assess the types of gynaecological laparoscopic surgeries performed, the difficulties faced during the Omicron wave, and how we could implement the lessons learnt from the previous Delta wave for better management of gynaecological cases in the Omicron wave. Methodology We conducted a prospective cohort study over a period of three months involving 105 patients who underwent laparoscopic surgeries. Based on the decision regarding surgical incision time, the surgeries were sub-classified into immediate, urgent, and expedited. The surgical outcome and satisfaction rates among the patients were assessed through various parameters. Results Most of the women (81.9%) were pre-menopausal. Diabetes and chronic hypertension were the predominant medical co-morbidities. Three patients had a history of cardiac valve replacement which required switching warfarin to unfractionated heparin in the pre-operative period. Nearly three-fourthsof the study patients were doubly vaccinated against coronavirus disease 2019 (COVID-19) (77; 73.4%). A total of 14 (13.3%) patients had a history of COVID-19 infection in the past two weeks prior to the current admission. Immediate, urgent, and expedited surgeries comprised 11.4%, 22.8%, and 65.8% of total surgeries, respectively. On assessing the ease of pre-operative preparation according to the five-point Likert scale, immediate, urgent, and expedited surgeries were rated with a mean score of two, four, and five, respectively. The mean duration of surgery in the immediate and urgent groups was 37.6 and 44.2 minutes, respectively. The expedited group comprising mostly laparoscopic myomectomies and hysterectomies required an average duration of 92.6 minutes. The mean rating of patient satisfaction measured by the Likert scale was four, five, and five, respectively, in the three subgroups. Pre-operative patient preparation during the Omicron wave was faster, thereby decreasing the decision to incision interval compared to the Delta wave. Conclusions The lessons learnt from the previous Delta wave were used to modify the existing hospital policies in the Omicron wave. More number of vaccinated ground staff, less stringent intubation and extubation protocols during surgery, and lesser duration of post-operative stay helped modify our existing hospital policies for better patient care and satisfaction.

Gynaecological Laparoscopic Surgeries in the Omicron Era: Improvising the Management Skills After Lessons Learnt From the Delta Wave

Background During the peak of the Omicron wave, elective laparoscopic surgeries were restricted;however, semi-emergency and emergency cases were managed despite the limited resources and manpower. We conducted this study to assess the types of gynaecological laparoscopic surgeries performed, the difficulties faced during the Omicron wave, and how we could implement the lessons learnt from the previous Delta wave for better management of gynaecological cases in the Omicron wave. Methodology We conducted a prospective cohort study over a period of three months involving 105 patients who underwent laparoscopic surgeries. Based on the decision regarding surgical incision time, the surgeries were sub-classified into immediate, urgent, and expedited. The surgical outcome and satisfaction rates among the patients were assessed through various parameters. Results Most of the women (81.9%) were pre-menopausal. Diabetes and chronic hypertension were the predominant medical co-morbidities. Three patients had a history of cardiac valve replacement which required switching warfarin to unfractionated heparin in the pre-operative period. Nearly three-fourthsof the study patients were doubly vaccinated against coronavirus disease 2019 (COVID-19) (77;73.4%). A total of 14 (13.3%) patients had a history of COVID-19 infection in the past two weeks prior to the current admission. Immediate, urgent, and expedited surgeries comprised 11.4%, 22.8%, and 65.8% of total surgeries, respectively. On assessing the ease of pre-operative preparation according to the five-point Likert scale, immediate, urgent, and expedited surgeries were rated with a mean score of two, four, and five, respectively. The mean duration of surgery in the immediate and urgent groups was 37.6 and 44.2 minutes, respectively. The expedited group comprising mostly laparoscopic myomectomies and hysterectomies required an average duration of 92.6 minutes. The mean rating of patient satisfaction measured by the Likert scale was four, five, and five, respectively, in the three subgroups. Pre-operative patient preparation during the Omicron wave was faster, thereby decreasing the decision to incision interval compared to the Delta wave. Conclusions The lessons learnt from the previous Delta wave were used to modify the existing hospital policies in the Omicron wave. More number of vaccinated ground staff, less stringent intubation and extubation protocols during surgery, and lesser duration of post-operative stay helped modify our existing hospital policies for better patient care and satisfaction.

Hysteroscopy in COVID 19 pandemic: safety concerns.

The coronavirus disease (COVID-19) pandemic is a global health crisis that negatively impacts the health infrastructure by diverting resources to manage this infection. The long-term impact on the health of patients due to a lack of appropriate medical care to avoid COVID-19 infection is already visible in the mortality rates of the general population. The presence of the severe acute respiratory syndrome coronavirus 2 in the female genital tract is not clear. Bubbles produced during hysteroscopy tend to cool down to the temperature of the distension medium and then dissolve. Hence, aerosols are not produced during hysteroscopy, which is usually performed in an office setting. If anesthesia is required, conscious sedation or regional anesthesia should preferably be used to reduce aerosol production. Hence, hysteroscopy is not an aerosol-generating procedure and the risk of COVID-19 infection is low; therefore, hysteroscopy should not be ruled out in emergencies.

Establishing the practice of birth companion in labour ward of a tertiary care centre in India-a quality improvement initiative.

BACKGROUND: Birth companion is a key component for providing respectful maternity care and has been recommended by WHO and Government of India. It is a low-cost beneficial intervention that is vital in improving quality of care during labour and delivery. LOCAL PROBLEM: Despite the available evidence on benefits of birth companion, there was no policy on allowing birth companion at our hospital in the past. METHODS AND INTERVENTIONS: We aimed to establish the practice of allowing birth companions in all eligible women in labour ward from existing 0% to 50% in 6 weeks' duration. This study was conducted in the Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi. A quality improvement (QI) team was formed, and after obtaining the baseline data, problems were analysed using fish bone chart. A new policy of allowing birth companion was made and efforts made to sensitise and train the doctors and nurses posted in labour ward. Changed ideas were executed in multiple plan-do-study-act (PDSA) cycles. Simple interventions such as dress code for birth companions, curtains for ensuring privacy, display of posters and frequent reminders on WhatsApp groups were planned . RESULTS: The median value of women accompanied by birth companion marginally increased to 25% after the first PDSA cycle. Implementation of further changed ideas led to increase in median, which reached 66.6%. Thereafter, there was a decline, but by the end of 6 months, it was possible to attain the goal and sustain it. CONCLUSIONS: Simple steps of QI methodology can be used to address the prevalent problems in our healthcare. Implementation of any new practice comes with major challenges, but we could achieve our goal because of a motivated team working together on multiple changed ideas applied sequentially in PDSA cycles.

Gynecological laparoscopic surgeries in the era of COVID-19 pandemic: a prospective study.

OBJECTIVE: The novel coronavirus pandemic led to the suspension of elective surgeries and the diversion of resources and manpower towards pandemic control. However, gynecological emergencies and malignancies must be addressed despite the restricted resources and the need for protective measures against COVID-19. This study aimed to determine the types of gynecological surgeries performed, difficulties encountered, and their outcomes in the setting of the pandemic. METHODS: We performed a prospective cohort study over 6 months at a single tertiary center, including 60 women with gynecological complaints, categorized as emergencies and semi-emergencies, who underwent further surgery. Their surgical outcomes were measured through various parameters. RESULTS: We found that 68.3% were emergency cases, while the rest were classified as semi-emergencies. Fibroid and adenomyosis with failed medical management (48.3%), followed by cervical intraepithelial neoplasia (10%), and malignancies (10%) accounted for the semi-emergency cases, while ruptured ectopic pregnancies (13.3%) and torsion and ovarian cysts (18.4%) comprised the emergency cases. The decision to incision time between emergency and semi-emergency cases varied widely due to the safety prerequisites during the pandemic, ranging from 1 hour in emergency cases to 48 hours in semi-emergency cases. In addition, we studied the ease of preoperative preparation, patient satisfaction, and the average number of personnel available to run the operation theaters at these times. No serious perioperative adverse events were observed in the present study. CONCLUSION: In conclusion, gynecological surgeries could continue to be safely performed with all precautions in place against COVID-19 infection and related morbidities.

Laparoscopic gynecological surgery in COVID-19 pandemic.

The major concern that has confronted surgeons during the COVID-19 pandemic is the risk of infection during surgery. So far, no studies have found SARS-CoV-2 in surgical smoke, and if it was found, whether it was infectious or not is unknown. To date, no evidence shows that respiratory viruses can be transmitted through a surgical plume or an aerosolized gas. There are various advantages of laparoscopy over laparotomy that must be kept in mind in the COVID-19 era, such as early recovery and shorter hospital stay, which can greatly help to conserve valuable hospital resources, and reduced risk of spillage of blood and body fluids, which can help to reduce transmission risk; most importantly, the distance between surgeons and between surgeons and patient is greater. Certain precautionary measures can be taken to reduce SARS-CoV-2 transmission during laparoscopy. Whenever possible, it should be the surgical option of choice.

Impact of COVID-19 on psychosocial functioning of peripartum women: A qualitative study comprising focus group discussions and in-depth interviews.

OBJECTIVE: Peripartum is a period of profound hormonal changes in the body and COVID-19 seems to have an additional impact on these women's psychosocial functioning. This calls for a need to address the psychosocial and behavioural impact of COVID-19 on peripartum women's lives. METHODS: Three focus group discussions and ten in-depth interviews were conducted. A format to guide discussions and interviews was made to bring uniformity across groups and participants. Participants were recruited through purposive sampling. In verbatim transcription was done, followed by thematic analysis to extract key conceptual themes. RESULTS: Fourteen pregnant and eleven postpartum women were included. The mean age was 28.5 years. Two major domains were identified: 1) the psychological domain including the categories of thoughts, emotions, and behaviour, and 2) the social domain comprising categories of relationships with family members and friends, perceived loss of social support, doctor-patient relationship, and social determinants of health. CONCLUSION: The pandemic has indeed affected the psychosocial functioning of peripartum women. The study results might prove to be helpful for clinicians and mental health specialists who can suggest and develop different coping strategies for peripartum women during this pandemic.

Redesigning routine antenatal care in low resource setting during COVID-19 pandemic.

Obstetric population because of its unique and varying needs specific for different gestations justifies for distinctive considerations in times of pandemic like COVID-19. Healthcare facilities providing obstetric care need to develop contingency plans for minimizing antenatal visits to limit exposure of both healthy pregnant women and care providers from ill people. However, to mitigate any potential adverse effects of reduced antenatal visits, intelligent and smart use of evolving telemedicine capabilities can provide the continuum of care despite overwhelming burden due to pandemic. A collaborative work-model involving health workers in the community and the regional levels of health centres also has the potential to prevent the catastrophic collapse of obstetric care services during any pandemic like COVID-19.

Family planning and abortion services in COVID 19 pandemic.

Many routine and elective services have already been postponed or suspended by both Government and private setups in most parts of the world because of the unprecedented pandemic of COVID-19. Healthcare systems everywhere in the world are under pressure. Being a component of essential health services, family planning and abortion services should continue to cater the population in order to prevent the complications arising from unintended pregnancies and sudden rise in STIs. Due to airborne nature of transmission of the virus, it is advisable for all consultations relating to family planning services to be done remotely unless and until visit is absolutely necessary. Contraception initiation and continuation can be done by telemedicine in most individuals. Post partum contraception can be advised before discharge from hospital. In an individual planning for pregnancy, currently it is not advisable to discontinue contraceptive and plan for pregnancy as not much is known about the effect of the virus on foetal development. Also, pregnancy requires routine antenatal and peripartum care and complications arising from pregnancy may necessitate frequent hospital visits, exposing the individual to the risk of infection. Abortion services are time sensitive therefore should not be denied or delayed beyond legal limit. We need to change from real to virtual consultation to prevent the rise in unplanned pregnancies, sexually transmitted infections and unsafe abortions.