Experiences of health care providers on pregnancy and childbirth care during the COVID-19 pandemic in Iran: a phenomenological study.

BACKGROUND: Coronavirus currently cause a lot of pressure on the health system. Accordingly, many changes occurred in the way of providing health care, including pregnancy and childbirth care. To our knowledge, no studies on experiences of maternity care Providers during the COVID-19 Pandemic have been published in Iran. We aimed to discover their experiences on pregnancy and childbirth care during the current COVID-19 pandemic. METHODS: This study was a qualitative research performed with a descriptive phenomenological approach. The used sampling method was purposive sampling by taking the maximum variation possible into account, which continued until data saturation. Accordingly, in-depth and semi-structured interviews were conducted by including 12 participants, as 4 gynecologists, 6 midwives working in the hospitals and private offices, and 2 midwives working in the health centers. Data were analyzed using Colaizzi's seven stage method with MAXQDA10 software. RESULTS: Data analysis led to the extraction of 3 themes, 9 categories, and 25 subcategories. The themes were as follows: "Fear of Disease", "Burnout", and "Lessons Learned from the COVID-19 Pandemic", respectively. CONCLUSIONS: Maternal health care providers experience emotional and psychological stress and work challenges during the current COVID-19 pandemic. Therefore, comprehensive support should be provided for the protection of their physical and mental health statuses. By working as a team, utilizing the capacity of telemedicine to care and follow up mothers, and providing maternity care at home, some emerged challenges to maternal care services can be overcome.

Indirect effects of COVID-19 in referring women to gynecologic oncology, perinatology and gynecology clinics in Iran.

PURPOSE: COVID-19 has captured the world. We hypothesized that this pandemic reduced referral of other non-COVID-19 patients to the hospitals or clinics, including gynecological and perinatological referrals. Women can be at risk in limited use of health services. METHODS: In this retrospective study, referrals from gynecologic oncology, perinatology, and gynecology clinics in a large teaching hospital of Tehran University of Medical Sciences (TUMS) were compared from February 20 to May 20, 2020, with the same period in 2019. Finally, referral trends in 2020 were compared with the COVID-19 admission pattern. RESULTS: Total admissions to all three clinics declined 63% in 2020 compared to 2019. There was a significant relationship between the number of visits to three clinics during these2  years (p < 0.001). The reduction in referrals to the gynecology clinic was more than gynecologic oncology and perinatology. The COVID-19 referral pattern was conversely linked to gynecology-related admissions. CONCLUSION: As the pandemic situation makes patients hesitant to go to the hospitals or not, health policymakers should consider other non-COVID issues, including maternal and fetal concerns. Providing safe places for other patients to visit is a goal that can be achieved through developing guidelines for nosocomial hygiene and training informed healthcare staff. Moreover, non-urgent visits should be avoided or postponed. This issue calls for new strategies, including telemedicine in situations similar to the current pandemic to both identify and manage such conditions.

Virtual visits among gynecologic oncology patients during the COVID-19 pandemic are accessible across the social vulnerability spectrum.

OBJECTIVE: The COVID-19 pandemic has quickly transformed healthcare systems with expansion of telemedicine. The past year has highlighted risks to immunosuppressed cancer patients and shown the need for health equity among vulnerable groups. In this study, we describe the utilization of virtual visits by patients with gynecologic malignancies and assess their social vulnerability. METHODS: Virtual visit data of 270 gynecology oncology patients at a single institution from March 1, 2020 to August 31, 2020 was obtained by querying a cohort discovery tool. Through geocoding, the CDC Social Vulnerability Index (SVI) was utilized to assign social vulnerability indices to each patient and the results were analyzed for trends and statistical significance. RESULTS: African American patients were the most vulnerable with a median SVI of 0.71, Asian 0.60, Hispanic 0.41, and Caucasian 0.21. Eighty-seven percent of patients in this study were Caucasian, 8.9% African American, 3.3% Hispanic, and 1.1% Asian, which is comparable to the baseline institutional gynecologic cancer population. The mean census tract SVI variable when comparing patients to all census tracts in the United States was 0.31 (range 0.00 least vulnerable to 0.98 most vulnerable). CONCLUSIONS: Virtual visits were utilized by patients of all ages and gynecologic cancer types. African Americans were the most socially vulnerable patients of the cohort. Telemedicine is a useful platform for cancer care across the social vulnerability spectrum during the pandemic and beyond. To ensure continued access, further research and outreach efforts are needed.

Gynecologic oncology treatment modifications or delays in response to the COVID-19 pandemic in a publicly funded versus privately funded North American tertiary cancer center.

OBJECTIVE: To compare gynecologic oncology surgical treatment modifications and delays during the first wave of the COVID-19 pandemic between a publicly funded Canadian versus a privately funded American cancer center. METHODS: This is a retrospective cohort study of all planned gynecologic oncology surgeries at University Health Network (UHN) in Toronto, Canada and Brigham and Women's Hospital (BWH) in Boston, USA, between March 22,020 and July 302,020. Surgical treatment delays and modifications at both centers were compared to standard recommendations. Multivariable logistic regression was performed to adjust for confounders. RESULTS: A total of 450 surgical gynecologic oncology patients were included; 215 at UHN and 235 at BWH. There was a significant difference in median time from decision-to-treat to treatment (23 vs 15 days, p < 0.01) between UHN and BWH and a significant difference in treatment delays (32.56% vs 18.29%; p < 0.01) and modifications (8.37% vs 0.85%; p < 0.01), respectively. On multivariable analysis adjusting for age, race, treatment site and surgical priority status, treatment at UHN was an independent predictor of treatment modification (OR = 9.43,95% CI 1.81-49.05, p < 0.01). Treatment delays were higher at UHN (OR = 1.96,95% CI 1.14-3.36 p = 0.03) and for uterine disease (OR = 2.43, 95% CI 1.11-5.33, p = 0.03). CONCLUSION: During the first wave of COVID-19 pandemic, gynecologic oncology patients treated at a publicly funded Canadian center were 9.43 times more likely to have a surgical treatment modification and 1.96 times more likely to have a surgical delay compared to an equal volume privately funded center in the United States.

Experiences in Electronic Consultation (eConsult) Service in Gynecology from a Quaternary Academic Medical Center.

To evaluate an academic institution's implementation of a gynecologic electronic consultation (eConsult) service, including the most common queries, turnaround time, need for conversion to in-person visits, and to demonstrate how eConsults can improve access and convenience for patients and providers. This is a descriptive and retrospective electronic chart review. We obtained data from the UCSF eConsult and Smart Referral program manager. The medical system provided institution-wide statistics. Three authors reviewed and categorized gynecologic eConsults for the last fiscal year. The senior author resolved conflicts in coding. The eConsult program manager provided billing information and provider reimbursement. A total of 548 eConsults were submitted to the gynecology service between July 2017 and June 2020 (4.5% of institutional eConsult volume). Ninety-five percent of the eConsults were completed by a senior specialist within our department. Abnormal pap smear management, abnormal uterine bleeding, and contraception questions were the most common queries. Over half (59.3%) of all inquiries were answered on the same day as they were received, with an average of 9% declined. Gynecology was the 10th largest eConsult provider at our institution in 2020. The present investigation describes one large university-based experience with eConsults in gynecology. Results demonstrate that eConsults permit appropriate, efficient triaging of time-sensitive conditions affecting patients especially in the time of the COVID-19 pandemic. eConsult services provide the potential to improve access, interdisciplinary communication, and patient and provider satisfaction.

Examining Inequities Associated With Changes in Obstetric and Gynecologic Care Delivery During the Coronavirus Disease 2019 (COVID-19) Pandemic.

The coronavirus disease 2019 (COVID-19) pandemic is a public health emergency requiring significant changes in obstetric and gynecologic health care delivery to minimize the risk of transmission to healthy patients and health care workers. Although these changes are necessary, they will differentially affect patients in a way that highlights and exacerbates existing inequities in health care access and outcomes. Socially vulnerable groups are already disproportionately affected by COVID-19 infection and more likely to experience severe morbidity and mortality. Some reasons for this include a limited ability to practice risk-reducing behaviors such as physical distancing, higher prevalence of chronic medical conditions, and less access to medical care. Additionally, the structural changes now taking place in health care delivery have negatively affected the ability of socially vulnerable groups to obtain necessary obstetric and gynecologic care, which may lead to poorer outcomes. As physician-leaders enact new policies to respond to the COVID-19 public health crisis, it is important to consider the potential for exacerbating existing health inequities and to be proactive in creating policies that promote equity.

Use of telemedicine in obstetrics and gynaecology in Zimbabwe during a lockdown period.

INTRODUCTION: Telemedicine is an ideal innovation to achieve social distancing, one of the mitigating strategies during the current Covid 19 pandemic. Zimbabwe effected a 21day lockdown from the 2nd of March 2020 to control the spread of the Covid 19 infection. Free teleconsultation service was provided by the researcher. We sought to determine the effectiveness and acceptability of telemedicine in Obstetrics and Gynaecology during this period. METHODS: We conducted a retrospective and prospective analysis of the messages from the WhatsApp consults for demographic characteristics, type and classification of condition, level of urgency, ability to make a diagnosis and the type of recommendation offered. A follow-up message was used to assess effectiveness of the medical advice given and patient satisfaction. RESULTS: Of 109 women who used telemedicine 67consented. The average age was 31 years and most of the women were married, had university or tertiary college education and were urban dwellers. Forty-nine (73.1%) cases were Gynaecological consults and 51 (76.1%) were elective cases. Twenty (29.9%) and fourteen (20.8%) cases needed elective and urgent hospital referral respectively. A diagnosis was made in 33(49.3%) of the cases from the available information during the consult. Thirty-five (52.2%) cases had recovered whilst 27(40.3%) cases were still waiting further assessments at the end of the follow up. The patients were satisfied with the service in 94% of the cases. CONCLUSION: Telemedicine services provided during the lockdown period were effective and acceptable in managing women with Obstetrics and Gynaecological conditions. Telemedicine should be rolled out during this pandemic to limit risk to patients and healthcare providers.

Prevention and practice during the COVID-19 emergency declaration period in Japanese obstetrical/gynecological facilities.

AIM: A nationwide questionnaire survey was performed to evaluate how Japanese Society of Obstetrics and Gynecology (JSOG) members dealt with the coronavirus disease (COVID-19) pandemic during the declared nationwide emergency. METHODS: We sent questionnaires to members of JSOG via official email. Participants answered anonymously using Google forms. RESULTS: Two (0.08%) JSOG members had contracted COVID-19. There was a clear decrease in the number of patients scheduled for operation, not only for malignant but also for benign diseases. A decrease in the number of outpatients for infertility treatment was also observed. Polymerase chain reaction testing for severe acute respiratory syndrome coronavirus 2 was available in 20.4% of the facilities. Inpatients and outpatients were requested to wear masks, limit the number of contacts and check body temperature when visiting hospitals/clinics. During parturition care, caregivers and physicians wore gloves, masks (other than N-95), face shields and gowns. About 66% and 80% of the facilities decided to transfer pregnant women if they had asymptomatic and symptomatic infection, respectively. Cesarean section was typically chosen as delivery mode in infected women. CONCLUSION: The COVID-19 pandemic provoked significant changes in obstetrics and gynecology practices in Japan. Apparently, nosocomial infections were largely prevented due to these changes, although some of them might not have been necessary.

Effects of SARS Cov-2 epidemic on the obstetrical and gynecological emergency service accesses. What happened and what shall we expect now?

OBJECTIVE: During the lockdown period, the fear about the risk of infection in hospital has reduced the admission to Emergency Services (ES) with possible negative health effects. We have investigated the changes in the emergency flow occurred during SARS-CoV-2 pandemic in an obstetrics and gynecological ES and the short-term adverse outcomes on women's and reproductive health. STUDY DESIGN: The study was conducted in the OBGYN ES of the Clinica Mangiagalli, the largest maternity clinic of Milan, Lombardy, Northern Italy. We analyzed retrospectively the records of all women consecutively admitted at the ES from February 23rd to June 24th 2019, and compared them with the admissions during the lockdown executive order from February 23rd to June 23rd, 2020. Patients were assessed in terms of demographic features, presentation times, triage classification (urgent/not urgent), reason for admission and outcome of the visit (discharge/admission to the ward). A total of 9291 data were retrieved from ES files and automation system, 5644 from 2019 and 3647 from 2020. Categorical variables were compared by the chi-square test calculating the p value and computed were percentage changes (with 95 % Confidence interval, CI). RESULTS: During the period February 24 th - May 31 th 2020 the admissions at the ES decreased by 35.4 % (95 % CI-34.1-36.6) compared with the corresponding period in 2019. The reduction was more marked for gynecological complaints (-63.5 %, 95 %CI -60.5 to -66.5): in particular we observed a reduction of admissions for genital infection/cystitis of 75.7 % (95 %CI -71.4 to -80.1). The admission for complaints associated with pregnancy decreased by 28.5 % (95 %CI -27.2 to-29.9). In the index period, five fetal deaths were diagnosed compared with one observed in the reference period in 2019 (chi square computed using as denominator all observed pregnancies = 4.29, p = 0.04). The frequency of admission for elective caesarean section/labor induction increased from 47.5 % in 2019 to 53.6 % in 2020: this difference was statistically significant. CONCLUSION: The lockdown negatively influenced ES admissions and consequently the women's/reproductive health. As possible short-term consequences, we observed an increase of intrauterine deaths and a decrease of natural births.

Mental health amongst obstetrics and gynaecology doctors during the COVID-19 pandemic: Results of a UK-wide study.

OBJECTIVE: To explore the impact of the COVID-19 pandemic on the mental health of Obstetricians and Gynaecologists. STUDY DESIGN: A cross-section survey-based study amongst doctors working within Obstetrics and Gynaecology in the United Kingdom. RESULTS: A total of 207 doctors completed the survey. Obstetricians and Gynaecologists reported significantly higher rates of both Major Depressive Disorder (versus, p = 0.023) and Generalised Anxiety Disorder (versus, p = 0.044) as compared to the UK-wide estimates. Sub-group analysis showed that anxiety was more common amongst female doctors as compared to males (versus, p = 0.047). Although the prevalence of GAD was higher amongst registrars compared to their Consultant and/or Senior House Officer counterparts, this was not statistically significant. Respondents felt that the most significant factor for work-related changes to mental health was keeping up to date with frequently changing guidelines and protocols related to COVID-19. Only of respondents felt able to talk to colleagues about their mental health. CONCLUSIONS: Key findings include the high prevalence of mental health conditions amongst doctors, demonstration of the persistent taboo that mental health carries within the speciality and the key contributory factors to poor mental health. Further work should be done to assess if changes to the way new and updating guidelines, protocols and pathways are disseminated reduces the impact on the mental health of doctors. With the threat of a second COVID-19 peak looming, now more than ever, it is vital that steps are taken to break the stigmatisation of mental health amongst doctors, encouraging doctors to seek help when required.