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1.
ARS Medica Tomitana ; 27(4):184-188, 2021.
Article in English | EMBASE | ID: covidwho-2215105

ABSTRACT

The coronavirus pandemic influenced the way medical care was provided, in ambulatory and hospital environment. We analysed of the situation on the Obstetrics-Gynecology section of the Emergency County clinical Hospital .,Saint Andrew the Apostle"in Constanta, for a period of two years, regarding the protocol of pregnant patients, gynecopats and shoots infected with Covid-19, measurement of hospital costs, prevention and limitation measures against the infection of medical personnel with the above-mentioned virus. Copyright © 2021 Ilici Olimpia et al., published by Sciendo.

2.
Russian Journal of Human Reproduction ; 28(6):88-100, 2022.
Article in Russian | Scopus | ID: covidwho-2204279

ABSTRACT

Post-COVID-19 syndrome is an urgent and acute problem with a diverse clinical picture, including reproductive disorders. The key to minimizing Post-COVID-19 complications is timely vaccination, active treatment of covid-associated inflammation and hypercoagulation syndrome, an individual rehabilitation program to maintain gynecological health and reproductive potential of each woman. The article presents the results of the work of the of the obstetric department of the Filatov City Clinical Hospital No.15 for the period of the COVID-19 pandemic from 03/27/2020 to 03/26/2022 (inclusive). The results of the study «Post-COVID-19 syndrome in Obstetrics and Reproductive Medicine» are presented. Issues of the impact of COVID-19 on the reproductive and sexual health of women and men were brought up for discussion. A clinical case with an effective multidisciplinary treatment and diagnostic tactics of management and a personalized rehabilitation program is demonstrated. © 2022, Media Sphera Publishing Group. All rights reserved.

3.
International Journal of Infertility and Fetal Medicine ; 13(3):91-95, 2022.
Article in English | EMBASE | ID: covidwho-2202488

ABSTRACT

Background: Perinatal care is important to improve the outcome of the pregnancy and reduce associated morbidity and/or mortality to the pregnant mother and the developing fetus. Ideally, preconception counseling and preparedness for conception are necessary for an optimal pregnancy outcome. But this is not practiced by everyone due to various reasons. In such a scenario, an early antenatal visit will provide an opportunity for early screening and prepare a plan of care that will result in a better outcome of the pregnancy. In many countries, pregnant women still start their first antenatal visit late. Hence this study aims to determine the mean gestational age at booking, the magnitude and the factors associated with late booking for antenatal care in a tertiary care referral hospital. Objective(s): (1) To assess the gestational age of booking for antenatal care in a tertiary referral healthcare facility. (2) To assess the prevalence of late booking and factors contributing to it. Material(s) and Method(s): This is a prospective study conducted on pregnant women visiting the outpatient Obstetrics and Gynaecology Department at Saveetha Medical College and Hospital from February 2020 to July 2020. A total of 203 pregnant mothers, who consented to the study, were interviewed at the antenatal clinic by using a structured questionnaire. The data was compiled and assessed using Microsoft Excel. The mean gestational age at booking and prevalence of late booking visit and their causes are assessed. Bivariate and multivariate data analysis was performed using Statistical Software for the Social Sciences (SPSS) for Windows version 16.0. Result(s): This study showed that 203 pregnant women who participated in the study were between 19 and 40 years of age. A total of 121 patients were nulliparous, and 82 were multiparous. The mean gestational age at booking was found to be approximately 11 weeks of gestation in the study group. Around 83 were late for their booking visit (40.89%). Lack of knowledge of early booking and its benefits was the most common cause of increased gestational age at the first antenatal visit (28.92%). The recent COVID-19 outbreak this year has caused a delay in the booking of 12 patients (14.46%). Copyright © The Author(s). 2022.

4.
BMC Pregnancy and Childbirth ; 22:1-13, 2022.
Article in English | ProQuest Central | ID: covidwho-2196104

ABSTRACT

Background: Pregnancy is often conceptualised as a ‘teachable moment' for health behaviour change. However, it is likely that different stages of pregnancy, and individual antenatal events, provide multiple distinct teachable moments to prompt behaviour change. Whilst previous quantitative research supports this argument, it is unable to provide a full understanding of the nuanced factors influencing eating behaviour. The aim of this study was to explore influences on women's eating behaviour throughout pregnancy. Methods: In-depth interviews were conducted online with 25 women who were less than six-months postpartum. Interviews were audio-recorded and transcribed verbatim. Data were analysed thematically. Results: Five themes were generated from the data that capture influences on women's eating behaviour throughout pregnancy: ‘The preconceptual self', ‘A desire for good health', ‘Retaining control', ‘Relaxing into pregnancy', and ‘The lived environment'. Conclusion: Mid-pregnancy may provide a more salient opportunity for eating behaviour change than other stages of pregnancy. Individual antenatal events, such as the glucose test, can also prompt change. In clinical practice, it will be important to consider the changing barriers and facilitators operating throughout pregnancy, and to match health advice to stages of pregnancy, where possible. Existing models of teachable moments may be improved by considering the dynamic nature of pregnancy, along with the influence of the lived environment, pregnancy symptoms, and past behaviour. These findings provide an enhanced understanding of the diverse influences on women's eating behaviour throughout pregnancy and provide a direction for how to adapt existing theories to the context of pregnancy.

5.
BMJ Paediatrics Open ; 6(Suppl 1):A31-A32, 2022.
Article in English | ProQuest Central | ID: covidwho-2193831

ABSTRACT

ObjectivesIn response to the COVID-19 pandemic all paediatric and adolescent gynaecology (PAG) outpatient appointments in a tertiary teaching hospital were temporarily converted to telephone consultations.Telemedicine is a developing area with on-going research into its safety and effectiveness. The cohorts of patients attending PAG clinics have unique needs and requirements, both due to their own individual characteristics, and their presenting symptoms. There is currently a paucity of data regarding the utility of telemedicine in PAG. This study therefore aimed to review the impact on PAG outpatient follow up journey looking specifically at the patient journey from a first remote appointment by analysing number of follow ups required.MethodsA retrospective cohort study was completed of patients presenting to the general paediatric and adolescent gynaecology clinics from April 2019-April 2020 aged 11–18 years at their first appointment. Those referred to specialist PAG clinics for complex congenital gynaecology or differences of Sex Development were excluded.Patients managed pre-pandemic with their first appointment with the PAG service in person were compared to those with a telephone first appointment as part of the COVID-19 response.The first 30 patients from each clinic list who met inclusion criteria were included in the study.The electronic patient notes were reviewed with data collected on age, referring issue, number of follow ups, and whether still under PAG follow up collected. Data was collected and analysed using Excel.ResultsMedian age in both cohorts were similar;12 years old (11–17 years) face to face (f2f) and 13 years old (11–18y) in the telephone cohorts. Problems were categorised to those affecting the vulva or vagina (17/30 in telephone;21/30 f2f), menstrual concerns (15/30 telephone;14/30 f2f), or ovarian cyst (2/30 telephone;0/30 f2f).Patients with an initial telephone appointment during the pandemic had a significantly greater number of follow-up appointments compared to those with an in-person clinic appointment initially (chi-square, p = 0.044). Patients with an initial telephone appointment were significantly more likely to require follow-up compared to those seen first to face (OR 0.18 [95%CI 0.05–0.65]).Patients referred with vulval or vaginal issues (clear indication for clinical examination) were more effected by greater follow up requirements than those seen F2F first.ConclusionsPatients who had a first telephone clinic consultation were more likely to need follow-up than those seen face to face, and if follow-up was required, they had a greater number of follow up appointments than those seen first in person.In Paediatric and Adolescent Gynaecology (PAG) remote consultations are compromised by the lack of examination and reliable privacy for an adolescent to have time alone in the consultation without their parent/care-giver.The potential need for an intimate examination cannot be replicated with a remote review. It is not appropriate for video review live or review photos of an adolescent's genitals- even if technology means it can be sent securely.Whilst there is scope for the use of telemedicine for follow up consultations, further dedicated studies considering this are needed to confirm their role in the PAG setting.

6.
BMJ : British Medical Journal (Online) ; 379, 2022.
Article in English | ProQuest Central | ID: covidwho-2193697

ABSTRACT

Black women's menstrual and reproductive health: a critical call for action in the UK

7.
The New England Journal of Medicine ; 388(3):278-279, 2023.
Article in English | ProQuest Central | ID: covidwho-2186493

ABSTRACT

Discovery of Ectopic Pregnancy after Attempted Self-Managed AbortionAn ectopic pregnancy found after an attempted self-managed abortion highlights the need for high suspicion for the condition in the context of medical abortion without confirmation of intrauterine pregnancy.

8.
Antimicrobial Stewardship and Healthcare Epidemiology ; 2(S1):s48-s49, 2022.
Article in English | ProQuest Central | ID: covidwho-2184967

ABSTRACT

Background: Inappropriate antibiotic use for SARS-CoV-2 infection has the potential to increase the burden of antibiotic resistance. Brazil experienced spread of a new SARS-CoV-2 variant in the fourth quarter (Q4) of 2020, resulting in the highest case counts in Latin America, raising concerns of antibiotic overuse. To better understand antibiotic use during the COVID-19 pandemic, we evaluated prescribing changes in antibiotics commonly used for outpatient respiratory infections (amoxicillin-clavulanate, azithromycin, and levofloxacin or moxifloxacin [AALM]) among adults aged ≥20 years in Brazil in 2020 versus 2019. Methods: We analyzed the IQVIA MIDAS medical data set for AALM prescribing by age group (20–39, 40–59, 60–64, 65–74, ≥75 years), comparing Q4 2020 rates to those in Q4 2019. We estimated crude rate ratios and 95% CIs using prescription number as the numerator (assuming Poisson counts) and age-adjusted population as the denominator. We also determined the most common prescribing specialties for each antibiotic across both time points. Results: Compared to Q4 2019, Q4 2020 azithromycin prescribing increased among all ages, ranging from 90.7% (95% CI, 90.0%–91.4%) in those aged 20–39 years to 927.2% (95% CI, 912.9%–941.7%) in those aged 65–74 years (Fig. 1). Amoxicillin-clavulanate prescribing decreased for most ages, ranging from −78.4% (95% CI, −78.7% to −78.1%) in those aged 60–64 years to −25.8% (95% CI, −26.6% to −25.0%) in those aged 65–74 years. Prescribing of levofloxacin or moxifloxacin decreased for most ages, ranging from −39.1% (95% CI, −39.4% to −38.8%) in those aged 20–39 years to −16.9% (95% CI, −18.1% to −15.7%) in those aged 60–64 years. For those aged ≥75 years, prescribing of amoxicillin-clavulanate and levofloxacin or moxifloxacin increased by 13.2% (95% CI, 11.9%–14.5%) and 43.1% (95% CI, 41.7%–44.5%), respectively. In Q4 2019 and Q4 2020, the 2 most common prescribing specialties for azithromycin were general practice (48%–50% of prescriptions) and gynecology (19%–25%). Compared to Q4 2019, infectious disease specialists in Q4 2020 saw the largest decline in percentage of azithromycin prescriptions (10% to 1%) and surgeons saw the largest increase (0% to 7%). General practitioners were also the most common prescribers of the remaining antibiotics (43%–54%), followed by gynecology for levofloxacin or moxifloxacin (25%–29%) and otolaryngology for amoxicillin-clavulanate (14%–20%). Conclusions: Despite decreases in prescribing of amoxicillin-clavulanate and respiratory fluoroquinolones for most adults, azithromycin prescribing increased dramatically across all adults during the COVID-19 pandemic. Targeting inappropriate outpatient antibiotic use in Brazil, particularly azithromycin prescribing among general practitioners, gynecologists, and surgeons, may be high-yield targets for antibiotic stewardship.Funding: NoneDisclosures: None

9.
Journal of Obstetrics and Gynecology of India. ; 2023.
Article in English | EMBASE | ID: covidwho-2175213

ABSTRACT

Background: COVID-19 pandemic led to an alarming rise in sickness absenteeism among the radiologists. Anticipating a continued shortage of experienced radiologists in future COVID waves, it is essential to train the medical professionals in basic skills related to ultrasonography to enable them to perform basic Obstetrics and Gynecology (OG) scans safely in emergencies. Virtual reality simulation training is an alternative to conventional ultrasound training. Method(s): A cross-sectional study was conducted during 8-day-long workshop to identify the trainees' basic, after training knowledge and skills in OG ultrasound and to document their perceptions of the training. Statistical analysis was done using descriptive statistics (percentages and mean standard deviations) and paired t test for comparisons. Result(s): A total of 80 health care professionals underwent ultrasound simulation training. It was found that the post-test score in the knowledge domain, instrument handling, basic gynecological skills, and first-trimester antenatal ultrasound skills in the practical domain was significantly higher than the pre-test score (P-value < 0.0001). Out of 80 participants, 45 (56.25%) agreed that ultrasound simulation is an ideal method of teaching and training basic OG skills to the novice. Sixty-six out of 80 (82.5%) felt that the principles of handling a human mannequin are the same as those of real patients. Forty-eight participants out of 80 (60.0%) felt that ultrasound simulation can be used as an ideal tool for self-assessment of health care professionals. Conclusion(s): The study showed that ultrasound-based simulation can provide a realistic setting for training and assessment of novices in learning basic skills. Copyright © 2023, This is a U.S. Government work and not under copyright protection in the US;foreign copyright protection may apply.

10.
BMC Pregnancy and Childbirth ; 22:1-7, 2022.
Article in English | ProQuest Central | ID: covidwho-2171259

ABSTRACT

Background Several common maternal or neonatal risk factors have been linked to meconium amniotic fluid (MAF) development;however, the results are contradictory, depending on the study. This study aimed to assess the prevalence and risk factors of MAF in singleton pregnancies. Methods This study is a retrospective cohort that assessed singleton pregnant mothers who gave birth at a tertiary hospital in Bandar Abbas, Iran, between January 1st, 2020, and January 1st, 2022. Mothers were divided into two groups: 1) those diagnosed with meconium amniotic fluid (MAF) and 2) those diagnosed with clear amniotic fluid. Mothers with bloody amniotic fluid were excluded. Demographic factors, obstetrical factors, and maternal comorbidities were extracted from the electronic data of each mother. The Chi-square test was used to compare differences between the groups for categorical variables. Logistic regression models were used to assess meconium amniotic fluid risk factors. Results Of 8888 singleton deliveries during the study period, 1085 (12.2%) were MAF. MAF was more common in adolescents, mothers with postterm pregnancy, and primiparous mothers, and it was less common in mothers with GDM and overt diabetes. The odds of having MAF in adolescents were three times higher than those in mothers 20–34 years old (aOR: 3.07, 95% CI: 1.87–4.98). Likewise, there were significantly increased odds of MAF in mothers with late-term pregnancy (aOR: 5.12, 95% CI: 2.76–8.94), and mothers with post-term pregnancy (aOR: 7.09, 95% CI: 3.92–9.80). Primiparous women were also more likely than multiparous mothers to have MAF (aOR: 3.41, 95% CI: 2.11–4.99). Conclusions Adolescents, primiparous mothers, and mothers with post-term pregnancies had a higher risk of MAF. Maternal comorbidities resulting in early termination of pregnancy can reduce the incidence of MAF.

11.
Biochimica Clinica ; 46(3):S191, 2022.
Article in English | EMBASE | ID: covidwho-2170019

ABSTRACT

Monoclonal gammopathies (MG) are a group of disorders ranging from the benign to the malignant plasma cell dyscrasias to the lymphoproliferative disorders, typically characterized by the presence of a monoclonal component (MC) at serum protein electrophoresis (SPE). This condition has been also observed in association with a spectrum of acute and chronic inflammatory diseases, including viral infections. We selected for this study pregnant patients hospitalized from 2018 at the Department of Gynecology of the AOU Federico II of Naples (that include from March 2020 a section dedicated to pregnant patients with Sars-Cov2 infection), who presented a MC at the SPE (Capillarys 2, Sebia), at prenatal checks. Our population has involved 20 pregnant patients (average age of 35yo, from 22 to 47), 8 of which tested positive for COVID-19 by real-time reverse-transcriptase polymerase chain reaction of nasopharyngeal swabs. It should be considered that 3 patients came in the prepandemic period. The MC characterization revealed: 7 patients with IgG k ranging from 1 to 10 g/L;5 with IgG k<3 g/L;1 with IgM k 7,7 g/L;5 with IgG k and IgG lambda<2 g/L;1 with 2 IgG lambda 6,7 g/L and 2,0 g/L;1 with 2 IgA k 9,6 g/L and 1,3 g/L. At hospitalization, 2 patients already had a diagnosis of MGUS, while for the others the MC presence was an occasional finding. It should be noted that 2 COVID-19 patients underwent therapy with casirivimab and imdevimab and one non COVID-19 patient to anti-D immunoprophylaxis after having already identified the MC. For 5 patients MC was detected during the second trimester and 4 of these had Sars-Cov2 infection;in the other 15 at the end of pregnancy. We observed that in the pregnant population, where in the pre COVID-19 era in our laboratory the MGUS percentage was of 0.3/year, the incidence increased to 0.6/year since February 2020. The presence of these MGUS must be investigated over time to understand the transience of the MC linked to viral infection. Previous studies hypothesized that the presence of MC during the inflammatory phase could reflect the degree of immune system hyperactivation in patients with severe COVID-19 disease. Further studies are needed to evaluate its frequency in pregnancy, longterm evolution, and prognostic role in this clinical setting.

12.
European Journal of Molecular and Clinical Medicine ; 9(8):1408-1415, 2022.
Article in English | EMBASE | ID: covidwho-2169487

ABSTRACT

Background: At the onset of Covid-19 pandemic, it was an unknown entity in terms of risk status of the pregnant women for fetomaternal outcome. Both fetus and pregnant women were considered as groups under special concern due to their unique physiological characteristics. Method(s): A retrospective study was conducted in department of Obstetrics & Gynaecology along with Paediatrics department in Maharishi Markandeshwar Medical College and Hospital, Solan on pregnant females admitted to the Covid-19 Ward/ ICU over a period from August 2020 till 31st March 2022. Participants were included into 3 waves of pandemic based upon time of presentation and these 3 groups were further studied for the various fetomaternal parameters such as maternal age, symptom status, need for respiratory support, maternal mortality, abortions, still births, gestational age and weight of newborn and other morbidity and mortality in newborns. Result(s): A total of 171 pregnant were included in the study, of whom 47, 64 and 60 were seen in 1st, 2nd and 3rd waves respectively. Majority of subjects were asymptomatic in 1st, 2nd & 3rd wave, (p=0.30). Age wise distribution of the patients showed majority subjects in the age group of 20-30 years (p= 0.94). LSCS rates in 3 waves were not different significantly (p = 0.67). Maternal mortality rates and need for respiratory support were in similar proportions in all 3 waves (p=0.71) and (p=0.73) respectively. No significant difference was seen in maternal morbidity and neonatal outcome. Conclusion(s): The study showed no significant difference between the waves of Covid-19 pandemic in terms of fetomaternal outcome except no maternal mortality in 3rd wave. Copyright © 2022 Ubiquity Press. All rights reserved.

13.
Midwives ; 25:31-36, 2023.
Article in English | ProQuest Central | ID: covidwho-2167568

ABSTRACT

Members' needs drive the RCM's actions at every level, from local branches to the governing board, individual matters to strategic direction. There are a few RCM committees chaired by board members - for example, looking at audit and risk or the information services for members - and all of those also feed back into the board for oversight. Keelie Barrett MSW MEMBER OF THE RCM BOARD I was the first MSW member of the RCM board, elected in 2019 when MSWs became eligible. Because of this, I feel it's important for me to be a role model to show other MSWs what's possible and encourage them to put themselves forward too. Having been on a board of governors at a school I had an insight into that - but I wasn't aware of all the sub-committees board members get involved in, such as the Investment Committee that I currently chair, all of which feeds back into the whole board meetings every other month.

14.
Journal of Pediatric and Adolescent Gynecology ; 2022.
Article in English | ScienceDirect | ID: covidwho-2159328

ABSTRACT

Background : Since the onset of the COVID-19 pandemic, healthcare systems have increased their telehealth services to meet the changing public health needs. Prior to the pandemic, telehealth was used primarily in surgical specialties for post-op visits and rural medicine. However, out of necessity, nearly all medical and surgical subspecialties incorporated this virtual technology to improve patient access in healthcare access limited time. Few studies have addressed telehealth in Pediatric and Adolescent Gynecology (PAG) to date. Study Objective : To describe the large-scale utilization of telehealth visits and assess patient experience and improve access to care in a large academic ambulatory gynecology PAG clinic. Methods : This retrospective, cross-sectional quality improvement study was performed by administering patient surveys and compiling aggregate data from the EPIC electronic health record (EHR) in the Division of Pediatric and Adolescent Gynecology (PAG) clinics at a single children's hospital between March 2020 and March 2021. Patient demographics, payer characteristics, visit type and purpose, and patient experience were reviewed. Interventions : Wider expansion of telehealth in PAG clinics at a single institution Results : A total of 6,159 telehealth appointments were performed, involving 6 clinic sites and 9 providers. Telehealth visits comprised 50% of the total ambulatory volume (12,527). Most patients were located within the institution's state (99.5%), and the remaining called into their telehealth visits from a neighboring state. Most patients were 18 years of age or younger (73%). Video visits lasted 15-30 minutes and included routine follow-up (66.3%), new/consult (28.4%), post-op (1.6%), and urgent follow-up (0.2%). The patient population was ethnically diverse by self-identification: 61.4% White, 38.4% Hispanic, 16% Black, 4.4% Asian, 0.40% Native Hawaiian/American Indian/Alaska Native. Payor mix included self-pay (45.5%), private payer (32.2%), and Medicaid/CHIP (22.3%). Conditions seen ranged from menstrual management (71%) and routine preventative or acute gynecologic concerns (21%) to surgical evaluation for congenital anomalies, endometriosis, fertility preservation, genital concerns or pelvic masses (8%). Telehealth visits met patient expectations in 87.3% of respondents. Patient-reported opportunities for improvement included: improving set-up instructions and more consistent audio/video connections. Challenges identified by providers included: difficulty utilizing interpreters, technology limitations, and privacy constraints during HEADSS examination. Conclusions : This study demonstrates how a large, diverse volume of patients with PAG needs received appropriate care through a telehealth format during the COVID pandemic. Patients were satisfied with the services, but opportunities for improvement were elicited to allow for continued refining of this healthcare delivery tool in the future.

15.
Contemporary OB/GYN ; 67(12):8-9, 2022.
Article in English | CINAHL | ID: covidwho-2157111

ABSTRACT

The article addresses the issue of leadership in the post-COVID-19-pandemic climate. Topics discussed include differences in leadership styles before and after the pandemic, reasons why employees leave their jobs without another one to replace it, and the need for leaders to be decisive, communicate clearly, and leverage the crisis to create opportunities.

16.
European Psychiatry ; 65(Supplement 1):S513, 2022.
Article in English | EMBASE | ID: covidwho-2154031

ABSTRACT

Introduction: The COVID-19 pandemic has focused attention on the challenges and risks faced by frontline healthcare workers (HCW). Objective(s): To describe the quality of management of HCW affected by the COVID-19. Method(s): This is a cross-sectional study enrolling all HCW of Farhat Hached Academic hospital who had been affected by COVID-19 during the period from september to December 2020. Result(s): During the study period, 267 HCW were affected with a mean age of 42.3 +/-10 years and a ratio-sex of 0.25. The most represented category was nurses (33.3%) followed by technicians (26.1%). Gynecology department had the highest number of affected HCW (14.4%).The majority of participants (97.4%) reported a medical care. Twelve HCW (4.5%) were hospitalized with an average length of hospital stay of 7.55 +/- 6.12 days. The average length of sick leave was 18.68 +/- 10.99 days. During the lockdown, 38.6% of HCW took care of their children without any external help. All of the HCW were supported by phone calls from colleagues in 88.4% of cases, the hierarchy in 67.4% of cases, occupational medicine in 60.3% of cases. Conclusion(s): The impact of COVID 19 is greater in HCW than in the general population. The affected staff should have a multidimensional management to avoid post covid sequelae in both physical and mental levels.

17.
Obstetric Medicine ; 15(4):233-237, 2022.
Article in English | ProQuest Central | ID: covidwho-2153265

ABSTRACT

The number of pregnant women being admitted with severe COVID-19 infection and dying has increased with each wave of the pandemic. These women often present unique challenges to the medical and obstetric teams given the changes in physiology that occur in pregnancy, affecting assessment and management, as well as the practical difficulties such as the ideal location of care. Whilst the basis of treatment remains the same, there are nuances to caring for pregnant women that need considerable thought and multidisciplinary collaboration. Obstetricians, neonatologists, midwives, intensivists, anaesthetists and physicians may all be involved at some point, depending on the gestation and severity of illness. Implementing a COVID-19 in pregnancy guideline or checklist for your hospital will help ensure pregnant women are managed in a safe and timely manner. Here described are some key recommendations to help in the management of pregnant women admitted with COVID-19.

18.
Obstetric Medicine ; 15(4):220-224, 2022.
Article in English | ProQuest Central | ID: covidwho-2153262

ABSTRACT

Although the pregnant population was affected by early waves of the COVID-19 pandemic, increasing transmission and severity due to new viral variants has resulted in an increased incidence of severe illness during pregnancy in many regions. Critical illness and respiratory failure are relatively uncommon occurrences during pregnancy, and there are limited high-quality data to direct management. This paper reviews the current literature on COVID-19 management as it relates to pregnancy, and provides an overview of critical care support in these patients. COVID-19 drug therapy is similar to that used in the non-pregnant patient, including anti-inflammatory therapy with steroids and IL-6 inhibitors, although safety data are limited for antiviral drugs such as remdesivir and monoclonal antibodies. As both pregnancy and COVID-19 are thrombogenic, thromboprophylaxis is essential. Endotracheal intubation is a higher risk during pregnancy, but mechanical ventilation should follow usual principles. ICU management should be directed at optimizing maternal well-being, which in turn will benefit the fetus.

19.
International Journal of Gynecological Cancer ; 32(Suppl 3):A127, 2022.
Article in English | ProQuest Central | ID: covidwho-2153038

ABSTRACT

ObjectivesWe evaluated the experience of caregivers on the healthcare of gynaecological cancer patients during the first wave (March-June) of the COVID-19 pandemic in 2020 in the Netherlands.MethodsAn online questionnaire was sent to gynaecologists, gynaecological oncologists, medical- and radiation oncologists throughout the Netherlands. The self-developed questionnaire consisted of questions about gynaecological cancer in general and endometrial, ovarian, cervical and vulvar cancer specifically.ResultsSixty-four (63%) physicians participated: 33 gynaecologists (52%), 13 gynaecological oncologists (20%), 7 medical oncologists (11%) and 11 radiation oncologists (17%). Fifty-nine percent of the respondents (35/59) reported a change in the way of contact with patients during the ‘diagnostic phase’ : patients were more often contacted by telephone during the pandemic (80%, 28/35, e.g. first consult or discussing results). For ovarian cancer 17% (4/23) reported a change in type of surgery and 22% (11/49) in (neo)adjuvant treatment (e.g. delay, more cycles, referral). For endometrial 21% (12/56), cervical 26% (7/27) and vulvar cancer 32% (6/19) longer waiting times for surgery were reported (3% <1 week, 58% 1–3 weeks, 39% >3 weeks). Eighty-nine percent of the respondents (46/52) reported a change in follow-up: 91% (42/46) reported follow-up consultation by telephone or video, 63% (32/51) reported postponed follow-up appointments.ConclusionsThe questionnaire showed that during the first wave of the COVID-19 pandemic, most caregivers experienced a different way of contact during the diagnostic and follow-up phase. Consultation by telephone could a good alternative in the follow-up phase, e.g. for low risk patients without symptoms, even after the pandemic.

20.
BMJ Case Reports ; 15(12), 2022.
Article in English | ProQuest Central | ID: covidwho-2152939

ABSTRACT

An invasive mole is an uncommon type of gestational trophoblastic disease, and if considering its implantation in an interstitial extrauterine location, we are facing a rarer condition.There are 14 cases described of interstitial ectopic gestational trophoblastic disease. As far as we know, we present the third case of invasive mole within interstitial location, in this case with pulmonary metastases.The diagnosis of an interstitial implantation is challenging. Our patient was initially diagnosed with an intrauterine hydatidiform molar pregnancy, and a uterine aspiration was performed. Two weeks later, she presented with haemodynamical instability due to a severe haemoperitoneum. A laparotomy was immediately performed and revealed a ruptured interstitial pregnancy with molar vesicle extrusion. Besides its rarity, we highlight the clinical presentation with hypovolaemic shock due to rupture of ectopic pregnancy in a young nulliparous woman, which required an emergent surgical approach with lifesaving purpose while preserving future fertility.

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