Antenatal anaesthetic assessment of parturients with BMI > 40 kg/m2

Introduction: Frimley Park Hospital criteria for referral to High-Risk Obstetric Anaesthetic Clinic (HROAC) included all parturients with BMI > 40. The COVID-19 pandemic necessitated HROAC becoming virtual. It was still possible to discuss risk and assess patients' airways, but not to reliably assess the likely ease of neuraxial techniques or cannulation. Observationally, little useful clinical information was gained, and airway problems rarely noted. An audit was planned to assess how often clinically useful information about the women's airways was gained during appointments. Method(s): HROAC database search for women referred with BMI > 40 with estimated date of delivery 20/04/20-03/04/21 to see whether any airway difficulties were predicted (Mallampati 3 or 4;limited neck movement;jaw slide B or C;limited mouth opening). Result(s): 82 women had BMI > 40, of which 3 were assessed as having a potentially difficult airway: two had BMI > 50 and one had retrognathism causing difficult airway prediction unrelated to her BMI of 41.7. One woman, BMI 58.7, was assessed as having a straightforward airway but her notes revealed her airway had been challenging to intubate in the past. One was assessed in video consultation as straightforward but an airway assessment during admission at the end of her previous pregnancy was Mallampti 3. Five women declined a video consultation. Discussion(s): In view of the minimal gain of clinically useful information and the routine presence of difficult airway kit for the obstetric emergency theatre, it was deemed safe and more relevant to make airway and neuraxial assessments on admission to labour ward rather than in the antenatal clinic for women with BMI<50. The assessment would therefore be made by the duty trainee anaesthetist who would be responsible for managing the patient, thus facilitating appropriate planning and communication if a woman with a challenging airway was identified. It is therefore also made at the very end of pregnancy when weight gain and its impact on airway is likely to be at its maximum. This approach, in conjunction with an antenatal information leaflet, and the ability of any obstetrician to refer to the HROAC, complies with the need for timely assessment of women as required by GPAS [1]. By formalising the assessment of women with high BMI on the labour ward it is hoped that patient safety and planning can be maximised.Copyright © 2023 Elsevier Ltd

COVID-19 and pregnancy

The current COVID-19 pandemic has resulted in an unprecedented worldwide health crisis. The increased vulnerability of pregnant women as well as past experience from previous coronavirus epidemics are cause for concern of maternal and fetal complications. The rapid outbreak of the disease combined with the uncertainty, as a direct result of the lack of strong scientific data, has forced obstetricians to adapt their current practices pragmatically. This article reviews obstetrical management of pregnant patients infected by SARS-CoV-2 based on the current knowledge.Copyright © 2020 Editions Medecine et Hygiene. All rights reserved.

Teaching Effect after Changing Mode of Continuing Medical Education during the COVID-19 Pandemic

Objective To explore the teaching effect of the teaching mode changed from traditional teaching to online teaching after the outbreak of coronavirus disease 2019 (COVID-19) pandemic. Methods Relying on the Beijing Women's Health Care Technology Improvement Project, the online and offline continuing medical education was carried out, to train the obstetrician and gynecologist working in 16 maternal and child health care hospitals in 16 administrative regions of Beijing, which was planned from September 2020 to December 2025. This study retrospectively collected the assessment results of the two teaching modes from March 2021 to December 2021 (the first year of the teaching plan), and compared the teaching effects. Results Online teaching completed three sessions of 30 live online conference courses, with about 25 000 participants, including 4757 obstetricians and gynecologists from 16 maternal and child health care hospitals in Beijing. A total of 82 on-site teaching courses were held for offline teaching, and 1771 gynecologists and obstetricians from 16 maternity and child care hospitals in Beijing participated in the study. The scores of online teaching and offline teaching were 90.88+/-4.88 and 88.65+/-4.35, respectively. Conclusions Online teaching maybe has similar teaching effects as offline teaching. Compared with offline teaching, online teaching has more advantages, such as convenience, efficiency and economy, which is worthy of promotion and application in the context of the COVID-19 pandemic.Copyright © 2022, Peking Union Medical College Hospital. All rights reserved.

Challenges of being a maternity service leader during the COVID-19 pandemic: a descriptive analysis of the journey.

BACKGROUND: In Australia, maternity care services provide care for pregnant and postpartum women and their newborns. The COVID-19 pandemic forced these services to quickly adapt and develop policies and procedures for dealing with transmission in health care facilities, as well as work under public health measures to counter its spread within the community. Despite well-documented responses and adaptations by healthcare systems, no studies have examined the experiences of maternity service leaders through the pandemic. This study aimed to explore the experiences of maternity service leaders, to understand their perspectives on what happened in health services and what was required of a leader during the COVID-19 pandemic in one Australian state. METHODS: A longitudinal qualitative study collected data from 11 maternity care leaders during the pandemic in the state of Victoria. Leaders participated in a series of interviews over the 16-month study period, with a total of 57 interviews conducted. An inductive approach to developing codes allowed for semantic coding of the data, then a thematic analysis was conducted to explore patterned meaning across the dataset. RESULTS: One overarching theme, 'challenges of being a maternity service leader during the pandemic', encompassed participant's experiences. Four sub-themes described the experiences of these leaders: (1) needing to be a rapid decision-maker, (2) needing to adapt and alter services, (3) needing to filter and translate information, and (4) the need to support people. At the beginning of the pandemic, the challenges were most acute with slow guideline development, rapid communications from the government and an urgent need to keep patients and staff safe. Over time, with knowledge and experience, leaders were able to quickly adjust and respond to policy change. CONCLUSION: Maternity service leaders played an important role in preparing and adapting services in accordance with government directives and guidelines while also developing strategies tailored to their own health service requirements. These experiences will be invaluable in designing high quality and responsive systems for maternity care in future crises.

Semmelweis: his fight for hand hygiene

Clinicians today have never, perhaps, been more aware of the utmost importance of handwashing prior to clinical examination and surgery. However, in the 1800s this was not the case. The simple act of handwashing was once ridiculed and debated with considerable controversy within the medical profession. It was obstetrician Ignaz Semmelweis (1818-1865) who put forward its importance, and thereafter Joseph Lister who, in 1864, developed antiseptic techniques in surgery, following on from Pasteur and Koch's work on germ theory. In 1846, Dr Semmelweis was working in Vienna, responsible for the first division of maternity services. He noticed the striking difference in mortality rate in women who had deliveries by doctors and medical students, compared with deliveries by midwives. This mortality was known as puerperal fever or childbed fever. He hypothesized that doctors and medical students were transferring 'cadaverous particles' as they handled cadavers during autopsies, and then went on to examine pregnant women. The mortality rate was lower when midwives, who did not handle cadavers, performed deliveries. Thereafter, he initiated mandatory handwashing for all those delivering babies, using chloride of lime solution. The mortality rate reduced significantly after the implementation of handwashing and the washing of medical instruments. However, Semmelweis's hypothesis was not supported by many in the medical profession, and most senior academics questioned and disregarded his conclusions. He subsequently returned to Budapest where he continued to work and undertake handwashing. He published 'The etiology, concept, and prophylaxis of childbed fever' in 1861, but it was deemed a laborious read and was poorly received. Unfortunately, reports indicate that Semmelweis's behaviour and actions deteriorated, some speculated due to early-onset dementia or syphilis. He was admitted to a Viennese psychiatric hospital and died in 1865 aged 47 years. Ironically, given his passion for hygiene, he died from sepsis due to a wound infection. Semmelweis has been acknowledged with a university hospital and museum named after him, as well as a postage stamp, issued in Austria in 1965 on the 100th anniversary of his death. Many lessons have been learned from Semmelweis. The medical establishment was slow to adopt his advice. Handwashing effectively reduces healthcare-associated infections, and clinician adherence to hand hygiene advice has increased since the advent of the COVID-19 pandemic. The World Health Organization's 'My 5 moments for hand hygiene' is known worldwide, with its most recent caption (2021) 'Seconds save lives - clean your hands'.

Short Time: Postnatal Hospital Care during Covid-19 Pandemic. The Results of a Psychological Wellbeing Screening in the Immediate Postpartum

Introduction: During the Covid-19 pandemic, isolation, fear of contagion, changes in care circumstances, and suspended or restricted visitor access impacted the psychological wellbeing of puerperae. As shown in literature [1,2], Covid-19 pandemic increased depressive and post-traumatic stress related symptoms in mothers in the postnatal period. Moreover, it could determine serious psychological challenges for pregnant and postpartum women, with potential "short" and "long" term consequences for the health of mothers and their children [2]. Healthcare providers should guarantee easy access to mental health services, as a primary strategy to support the health of both mothers and children [2]. After the worldwide spread of Covid-19 the organization of every hospital ward changed, including the obstetric and neonatal units. Compared to the pre-pandemic period, a reduction of the average length of stay in hospital for the new mothers was instituted [3]. This was the result of a reduction of the hospital beds, mostly because of the need to allocate mothers tested positive for Covid-19 in a separate area and to lower the risk of Covid-19 transmission in hospitals. The Obstetric Psychological Service of the Spedali Civili hospital in Brescia started a screening program for the wellbeing of the perinatal period in 2018, with a gradual development and improvement of the organization of this activity [4]. Screening was suspended during the first wave of Covid-19 pandemic from 6th of March to 4th of May 2020. Nevertheless, it was necessary to cope with the Covid-19 pandemic changing demands and methods in order to continue with the screening of women admitted in obstetrics ward. Method(s): A screening of psychological perinatal wellbeing was performed in puerperae admitted to the Second Department of Obstetrics at Spedali Civili hospital in Brescia. Screening consisted in a psychological consult, during which the psychologist illustrated the Obstetric Psychological Service to the woman and identified her psychological need, without using tests. This was eventually followed by an assessment consultation, specialist care and referral to the out-of-hospital psychological services, if required by the woman or considered necessary by the psychologist. It was made a comparison between data collected from October 2019 to January 2020 and from May 2020 to December 2021. Result(s): Compared to the pre-pandemic period, average length of stay in the Second Division of Obstetrics was reduced. In particular, starting from March 2020, the expected discharge of the puerpera was about 24 hours after vaginal birth and 48 hours after cesarean delivery, if no complications occurred for both mother and newborn. Previously, discharge was expected after about 48 hours and 72 hours, respectively. Discharge that occurs 24 hours after vaginal birth is named "Early discharge" and requires the activation of the out-of-hospital services, with home visits by an obstetrician. From October 2019 to January 2020, 470 admitted women were screened, of which 23 (4,9%) demanded a further psychological consultation[4]. Between May 2020 and December 2021, 5145 screening were performed. Among them 550 (10.7%) demanded a further psychological consultation. From those data we can affirm that there was an increase in psychological consultations (from 4.9% to 10.7%), after exhibiting a psychological need during the postnatal screening. Conclusion(s): Covid-19 pandemic changed the care conditions of the woman during the pregnancy and the immediate post-partum. The reduction of the average length of hospital stay of the women in the postpartum did not stop the Psychological Service prevention program. The Obstetric Psychological Service of the Spedali Civili hospital in Brescia implemented his activity increasing the pace of work, to be able to screen as many admitted women as possible. It was noticed that, after the Covid-19 first outbreak, the demand for psychological consultation after the screening consult was more than doubled in comparison to the pre-pandemic perio . This emphasized the benefit of an early interception of the psychological need of the women in the immediate post-partum period, especially during the Covid-19 pandemic.

Maternity care provider acceptance of a future Group B Streptococcus vaccine - A qualitative study in three countries.

INTRODUCTION: There are vaccines in clinical trials that target the bacterium Group B Streptococcus (GBS). When approved, GBS vaccines will be intended for administration to pregnant women to prevent infection in their infants. The success of any vaccine will depend on its' uptake in the population. Experience with prior maternal vaccines, e.g. influenza, Tdap and COVID-19 vaccines, teaches us that acceptance of vaccines, especially if novel, is challenging for pregnant women, and that provider recommendation is a key driver of vaccine uptake. METHODS: This study investigated attitudes of maternity care providers towards the introduction of a GBS vaccine in three countries (the United States (US), Ireland, and the Dominican Republic (DR)) with different GBS prevalence and prevention practices. Semi-structured interviews with maternity care providers were transcribed and coded for themes. The constant comparative method, and inductive theory building were used to develop conclusions. RESULTS: Thirty-eight obstetricians, 18 general practitioners and 14 midwives participated. There was variability in provider attitudes towards a hypothetical GBS vaccine. Responses ranged from enthusiasm to doubts over the need for a vaccine. Attitudes were influenced by perceived additional benefits of a vaccine over current strategy and confidence in the safety of vaccines during pregnancy. Knowledge, experience and approaches to GBS prevention differed geographically and according to provider type, and influenced how participants assessed the risks and benefits of a GBS vaccine. CONCLUSION: Maternity care providers are engaged in the topic of GBS management and there is opportunity to leverage attitudes and beliefs that will support a strong recommendation for a GBS vaccine. However, knowledge of GBS, and of the limitations of current prevention strategies vary among providers in different regions, and between different provider types. Targeted educational efforts with antenatal providers should focus on highlighting safety data the potential benefits of vaccination over current strategies.

Using QR Codes as a Form of eHealth to Promote Health Among Women in a Pandemic: Cross-sectional Study.

BACKGROUND: QR codes have played an integral role during the pandemic in many sectors, but their use has been limited in the health care sector, especially by patients. Although some authors have stated that developing specific content for women on how to cope with health problems could be an effective way to prevent problems, especially during pandemics, there is little research regarding the use of QR codes to promote health during a pandemic, and even fewer studies are focused on women. Moreover, although the importance of assessing these interventions from the users' perspective has been stated, research carried out from this point of view is still scarce. OBJECTIVE: This study aimed to assess the usefulness of using QR codes with information to promote women's health in the context of a pandemic. We also sought to design and validate a questionnaire to assess this. METHODS: A cross-sectional study was conducted among women in the gynecology waiting rooms of a reference hospital. Exploratory factorial analysis with the split-half method and Cronbach α values was performed for questionnaire validation. Univariant and bivariant analyses were performed to analyze the data obtained. RESULTS: In total, 186 women took part in the study. Exploratory factor analysis identified 2 domains: usability and applicability in medical practice. The Cronbach α value was .81. Overall, 83.7% of the answers to the first domain and 56.4% of those to the second were favorable. Women with university education or those who had used QR codes before scored better in the usability domain, while no differences were observed in the applicability scores. CONCLUSIONS: Using QR codes in the gynecology clinics' waiting rooms can help promote women's health during a pandemic, regardless of their education level or whether they have used QR codes before. The questionnaire developed herein is a helpful tool to assess this. These findings are important for clinical practice. This research can be performed in other ambits, specialties, or countries.

2022 Adult Immunization Schedule Updates

Each year, the U.S. Centers for Disease Control and Prevention (CDC) releases the adult vaccine schedule. The 2022 adult vaccine schedule has several changes which will be discussed in the following manuscript. The Advisory Committee on Immunization Practices reviews the preliminary schedules usually at their October or November meetings. The following professional societies also approve the adult schedules prior to the 2022 publications: American College of Physicians (ACP), American Academy of Family Physicians (AAFP), American College of Obstetricians and Gynecologists (ACOG), American College of Nurse-Midwives (ACNM), American Academy of Physician Assistants (AAPA) and the Society for Healthcare Epidemiology of America (SHEA). Once the final draft is approved by the CDC, it is published in the Morbidity and Mortality Weekly Report (MMWR) and released to healthcare providers and the general public with a cover page, tables, notes and—new for the 2022 schedule—an appendix with contraindications and precautions for the different approved vaccines.

Codesigning improvements for primary maternity care in Indonesia under the Covid-19 pandemic

Background: Primary maternity care in Indonesia faces significant challenges during the COVID-19 pandemic. The pandemic has exposed the fragility of primary care practice. The setting is pushed to help prevent the spread of the infection while maintaining care for pregnant women, however, with limited available guidance and support in practice. Aim/Objectives: To seek consensus on key recommendations and design a model for improving primary maternity care in Indonesia under the Covid-19 pandemic. Method(s): Four online co-design workshops and interviews were conducted with general practitioners (GPs), midwives, nurses, obstetricians, and patients. The first workshop discussed the way current maternity care was provided and the participants' expectations for improving the service in primary care. The second workshop discussed potential improvements for maternity care identified from a review of international recommendations, as well as discussing opportunities and potential challenges for implementing the recommendations in practice. The third and fourth workshops designed and finalised the maternity care model under the Covid-19 pandemic. Individual substitute interviews were also available for participants who could not attend the workshops. The participants' responses and suggestions were analysed using thematic analysis. Finding(s): Twenty-three participants were recruited, and 23, 20, 17, and 18 participants participated in the first-fourth workshops or substitute interviews. Key recommendations identified from the review and agreed upon in the workshops were health screening, maintaining antenatal-postnatal breastfeeding care, limiting visitors, and using telemedicine. A model of care for improving primary maternity care, covering arrangements for patients' encounters and referral plans, was also agreed and received suggestions from the participants. Potential challenges to the recommendation implementation include the available clinical resources and negotiating providers' authority. Implications: Recommendations and models of care would benefit for improving primary maternity care in Indonesia under the Covid-19 pandemic. Further research includes exploring the acceptability of the recommendations' implementation in practice.

Identification of Latent Safety Threats in an Interprofessional Training Involving On-Site Simulation in a Birthing Unit in Response to the COVID-19 Pandemic

Objectives: We aimed to detect different types of latent safety threats (LSTs) in the setting of suspected or positive COVID-19 pregnant patients in the Birthing Unit using a training program involving on-site simulations. We hypothesized that providing simulation-based training in the actual care areas would greatly help identify high risk events that could affect staff and patient safety. Methods: We conducted a prospective observational study between April 15 and May 06 2020 involving 65 interprofessional health care workers (eg. obstetricians, residents, nurses, midwives) over the course of 8 training sessions. Training scenarios involved presentation of suspected COVID-19 patient to the Birthing Unit, donning & doffing with observer and lastly, transportation of a suspected COVID-19 patient to the operating room for non-urgent cesarean section. LSTs were recorded by two facilitators and further subcategorized into themes;Gaps in Knowledge & Training, Maintenance & Equipment and System & Processes. Areas of improvement and proposed solutions were documented after each simulation and post-simulation surveys were sent to participants. Results: The number of participants involved in on-site simulations was 65. Eighty-one LSTs were observed across all the 3 scenarios amongst any theme: scenario 1 (n = 42, 51.8%), scenario 2 (n = 14, 17.2%) and scenario 3 (n = 25, 30.9%). Amongst the different themes of LSTs, Gaps in Training & Knowledge comprised (n = 29, 35.8%), Maintenance & Equipment comprised (n = 46, 56.8%) and Systems & Processes comprised (n = 6, 7.4%) of total LSTs. There were 80 Areas of Improvement and Proposed Solutions drawn from these recorded LSTs. Fifty participants completed post-simulation surveys. Pre-simulation surveys revealed only 10% of participants felt very prepared to care for a suspected or positive COVID-19 patient in the birthing unit, while 92% responded in the same way post-simulation. Conclusions: Pregnant women with suspected or confirmed COVID-19 presenting to birthing units pose numerous infection control issues. Simulation-based exercises may greatly help units prepare by identifying LSTs. Post-simulation surveys further allowed us to see the benefits. Keywords: COVID-19;simulation;latent safety threats

Anaesthetic management of a parturient with Klippel-Trenaunay syndrome

Introduction: Klippel-Trenaunay syndrome (KTS) is a rare congenital vascular disease which is characterised by capillary, venous and lymphatic malformations. We describe the anaesthetic management of a 36 year old parturient with COVID-19 and KTS, who underwent an elective caesarean section. Very few such cases have been described and the multi-system nature of condition poses various challenges to both the obstetrician and the anaesthetist. Case Report: We had a 36-year-old woman who had experienced three previous normal vaginal deliveries and an elective caesarean section (CS) four years previously under general anaesthetic(GA) at 36 weeks gestation. She was told by a vascular surgeon that she was not suitable for regional anaesthesia. There was no recent imaging of her back to rule out arteriovenous(AV) malformations. Her past history included gastric bypass surgery under GA two years ago. She also had depression, varicose veins and three previous deep venous thrombosis andwas on prophylactic lowmolecularweight heparin. She had tested positive for COVID-19 4 days previously, and had mild symptoms of cough and sore throat. After a multi-disciplinary discussion involving an obstetrician, vascular surgeon, haematologist and anaesthetist, a decision was made to proceed with GA despite recent COVID-19, because of the possibility of AV malformations, in agreement with the patient. After securing two wide bore cannulae and adequate preoxygenation, a modified Rapid Sequence Induction was performed, and a tracheal tube was secured. Anaesthesia was maintained with oxygen, nitrous oxide and sevoflurane. After delivery of the baby, oxytocin 5U, followed by an infusion, midazolam, morphine, ondansetron and dexamethasone were administered. Extubation was performed when the patient was fully awake. In recovery, further opioids were given for pain. There were no concerns for the newborn. Estimated blood loss was 200 mL. Discussion: Gestation and its physiology may further exacerbate the manifestations of KTS, with increased obstetric risk. The success in the management of these patients requires the participation of a multidisciplinary team, consisting of obstetrician, anaesthetist, urologist, haematologist and vascular surgeon, with appropriate collaboration among the professionals involved. Periodic imaging and clotting tests are recommended to evaluate the evolution of vascular malformations in the pelvis, uterus and vagina, and identify neuraxial changes, to guide the safest way of delivery and anaesthesia.

Major obstetric haemorrhage - how did we get away with not transfusing blood products?

Introduction: The recent increase in the rate of massive obstetric haemorrhage (MOH) has been associated with an increase in maternal age, body mass index, rate of caesarean sections (CS) and associated co-morbidities [1]. Timely and effective management of MOH is essential for ensuring the safety of both mother and baby. Most literature is aimed at identifying risk factors for MOH and triggers for transfusion. In this service evaluationwe aim to characterise the MOH patients that did not require a blood transfusion and identify any areas for improvement that can be extrapolated to the patients who received transfusions. Methods:We conducted an electronic patient data search (K2 system) to identify all parturients with more than 1500 mL peripartum blood loss, between March 2020 and April 2021. All patientswere included in the service evaluation. We collected demographic data, BMI, parity, cause of haemorrhage, mode of delivery and type of anaesthesia, treatment, initial and post 24 h haemoglobin results, fibrinogen results and COVID-19 status. Approval was requested from the Audit department and the Caldicott Guardian. Results: Data were collected for 139 patients. Mean (±SD) patient age was 31.5 (±5.4) and 38% of patients were ASA1. (Table Presented) Discussion: Patients with an estimated blood loss (EBL) less than 1500 mL were not included as we usually manage them conservatively. Our data support the recommendations of the Royal College of Obstetricians that antenatal anaemia needs investigating and treating appropriately to reduce the morbidity associated with PPH and the need for transfusions [2]. There was higher incidence of CS and atony in the group requiring transfusion suggesting that improved patient information on the use of uterotonics and restricting CS to clear clinical indications could further reduce transfusion rates.

MONITORING OF COVID-19 VACCINATION IN PREGNANT WOMEN OF SIBERIA AND THE RUSSIAN FAR EAST

Objective: To evaluate the dynamics of vaccination against the new coronavirus infection COVID-19 in pregnant women in the Far Eastern and Siberian Federal Districts from October 29, 2021 to December 24, 2021. Materials and methods: A total of 127787 pregnant women were monitored for vaccination from October 29, 2021 to December 24, 2021 in 11 regions of the Far Eastern Federal District and 10 regions of the Siberian Federal District. The findings were presented by the chief obstetricians-gynecologists of the regions. Statistical processing of the obtained data was carried out using the software package Microsoft Excel 2007. The level of null hypothesis testing was considered to be statistically significant at p<0.05. Results: According to the presented data, 126897 pregnant women were registered in the regions of the Far East and Siberia as of October 29, 2021, and 127787 women as of December 24, 2021. The results of the study showed an extremely low percentage of preconception specific prevention in pregnant women in the Far East and Siberia as of October 29, 2021. This indicator increased within two months by more than 2.26 times, namely from 4.2% to 9.5%. During monitoring, the proportion of vaccinated women before 22 weeks gestation increased by 2.1 times, from 0.7 to 1.5%;after 22 weeks gestation, it increased by 3.7 times, from 1.5 to 5.5%. The proportion of pregnant women who were ill with COVID-19 or vaccinated in the regions of the Far Eastern and Siberian Federal Districts increased from 13.0% to 26.3% during the monitoring period (p<0.001). There were no serious adverse events during COVID-19 vaccination with the Gam-COVID-Vac vaccine (Sputnik V) in 9667 pregnant women. Conclusion: Despite the absence of serious adverse events during COVID-19 vaccination with the Gam-COVID-Vac (Sputnik V) vaccine in pregnant women, it is necessary to conduct further detailed studies of the safety of vaccination during pregnancy, and also to develop a set of organizational measures aimed at increasing compliance with vaccination against COVID-19 at the period of pregnancy planning.

The Impact of COVID-19 on Pregnancy, and the Management of Infected Patients

INTRODUCTION: This seminar will focus on prevention of and management of patients with SARS-CoV-2 in pregnancy. METHODS: Federal (Centers for Disease Control and Prevention), state, and society (American College of Obstetricians and Gynecologists, Society for Maternal-Fetal Medicine) guidelines will be reviewed. RESULTS: The accuracy of coronavirus diagnosis is dependent on the specific test and the timing.Once correctly diagnosed, the impact of infection at various stages of pregnancy requires unique and specific management protocols, which are continually evolving as new data is reported. Innovative antepartum management strategies, including telemedicine, are emerging. Management protocols and treatment of COVID-19 in pregnancy require additional attention, and protocols for labor and delivery highlighting protection of both patients and the obstetric staff need to develop. New data on vertical transmission is also evolving. CONCLUSION: SARS-CoV-2 infection in pregnancy requires novel and specific treatment and management strategies which undergo continued updates and modifications as new data is presented. The seminar will first focus on establishing a correct diagnosis, and then, assessing and counseling the patient and her family of the impact of coronavirus infection on the pregnancy. Risk factors for adverse outcomes will be reviewed, including obesity, chronic medical conditions, and socioeconomic disparities. Antepartum management will be reviewed regarding the development of testing strategies for the patient, family, and staff, and protocols for safe office visits including telehealth. Intrapartum and postpartum management and treatment of infected and/or symptomatic patients will be reviewed, with specific attention to federal and society guidelines. All prevention (vaccines) and evolving treatment options and their safety in pregnancy will be discussed.

Perceptions and Acceptance of COVID-19 Vaccine in Pregnancy Using a Health Belief Model in an Inner-City Population

INTRODUCTION: COVID-19 vaccination is safe in pregnancy and has been recommended to reduce severe maternal and fetal morbidity;however, hesitancy still exists. We sought to investigate perceptions and acceptance of vaccination among pregnant patients. METHODS: Pregnant patients were recruited during telehealth visits in a prospective, cross-sectional manner. Participants received an online survey using a health belief model framework to understand factors that predict COVID-19 vaccination acceptance in pregnancy. Perceptions of barriers to and benefits of vaccination as well as susceptibility to and severity of COVID-19 disease during pregnancy were sought. The primary outcome was vaccine acceptance rate pre- and post-recommendations from the American College of Obstetricians (ACOG) and Gynecologists and Society for Maternal-Fetal Medicine (SMFM). Secondary outcomes were perceptions of barriers to and benefits of vaccination. RESULTS: We received 238 responses out of 1,291 (18.4%) from May to November 2021. Among unvaccinated patients, 92.5% stated they would not accept vaccination during pregnancy. There was no difference when ACOG/SMFM recommendations were considered (94.1% pre versus 89.1% post, P=.4). During this period, more patients were fully vaccinated prior to pregnancy post recommendations (46.7% versus 18.8%, P<.01). Post recommendations, study participants had more confidence in the personal and fetal protective effects of vaccination (personal, 53.5% versus 33.7%, P<.01;fetal, 46.5% versus 23.5%, P<.01). However, there was no change in perception of vaccine harm to the pregnancy (30.7% versus 39.8%, P=.1). CONCLUSION: COVID-19 vaccination acceptance rates remained unchanged among unvaccinated pregnant patients following national recommendations. Approximately one third of patients consider the vaccine harmful to their pregnancy. Counseling regarding vaccine safety prior to and during pregnancy is crucial to improve acceptance rates.

American College of Obstetricians and Gynecologists 2022 Annual Clinical and Scientific Meeting

The proceedings contain 344 papers. The topics discussed include: estimating in vivo levonorgestrel release rate and exposure over eight years with levonorgestrel releasing intrauterine system 52 mg use with population pharmacokinetic approach;immediate vs routine postpartum intrauterine device placement after teen pregnancy: a cost-effectiveness analysis;examining the association of immediate postpartum long-acting reversible contraception payment carve-outs and postpartum LARC use in Medicaid;contraceptive congruence: a novel measure of contraceptive use that acknowledges pregnancy ambivalence;charm 2: a gender synchronized family planning intervention for couples in rural India, a cluster randomized trial;telehealth follow-up after medical management for early pregnancy loss;providing mifepristone and misoprostol in emergency departments during the COVID-19 pandemic;and medical students' knowledge of and attitudes towards oocyte cryopreservation.

ASSOCIATION OF CONTINUITY OF CARER AND WOMEN'S EXPERIENCES OF MATERNITY CARE DURING THE COVID-19 PANDEMIC: A CROSSSECTIONAL SURVEY

Background: Recent research highlights the impact of the COVID-19 pandemic on maternity services, although none to date have asked women how they feel about the changes to care or analysed the association between continuity of carer and women's experiences. Aim: The aim of our research was to discover pregnant women's self-reported changes to their planned care and associations between continuity of carer and how women felt about changes to their planned care. Methods: A cross-sectional online survey of pregnant women aged over 18 years in their final trimester of pregnancy in Australia was undertaken. Results: 1668 women completed the survey. Most women reported at least one change to pregnancy care and birthing plans. Women receiving full continuity of carer (from an obstetrician or midwife) were more likely to rate the changes to care as positive (p < 0.001) when compared with women who received partial or no continuity. Conclusions: Pregnant women experienced many changes to their planned pregnancy and birth care during the COVID-19 pandemic. Women who perceived they were experiencing full continuity of carer had fewer changes to care and were more likely to feel positive about the changes than women who did not report they received full continuity of carer. Our study demonstrates that women are better together through continuity of carer models.

COVID-19 and pregnancy

The current COVID-19 pandemic has resulted in an unprecedented worldwide health crisis. The increased vulnerability of pregnant women as well as past experience from previous coronavirus epidemics are cause for concern of maternal and fetal complications. The rapid outbreak of the disease combined with the uncertainty, as a direct result of the lack of strong scientific data, has forced obstetricians to adapt their current practices pragmatically. This article reviews obstetrical management of pregnant patients infected by SARS-CoV-2 based on the current knowledge.