Human Papilloma Virus Typing as a Triage Tool for Women with Postcoital Bleeding: A Retrospective Cohort Study.

Objective: To investigate the performance of human papilloma virus (HPV) typing as a triage tool in the management of patients with postcoital bleeding (PCB). Methods: All patients referred for colposcopy at a cervical pathology clinic of a nationwide health insurance organization, due to PCB and had a preceding high-risk HPV (hrHPV) test between 2018 and 2020, were retrospectively located. Demographic and pathologic data were collected from electronic medical files. Sensitivity, specificity, and negative and positive predictive value of hrHPV test according to final pathology were calculated. Results: Three hundred ninety patients referred for colposcopy due to PCB with a preceding hrHPV test were located. HrHPV-positive patients were significantly younger (33.7 ± 10 vs. 37.2 ± 9, p < 0.006) with a higher proportion of nulliparous, nonmarried, and smokers compared with hrHPV-negative patients (75% vs. 47%, p < 0.001; 75.4% vs. 45.1%, p < 0.001; and 24.6% vs. 12.8%, p < 0.028, respectively). No case of high-grade cervical intraepithelial neoplasia (CIN2/3) was identified among hrHPV-negative patients. The sensitivity and NPV of the hrHPV test for high-grade cervical lesions were both 100%, decreasing to 36% and 95%, respectively, for any cervical dysplasia (CIN1/CIN2/CIN3). Adding cytology to HPV typing had a negligible effect on test performance. At univariate analysis, age, HPV vaccine status, nulliparity, and positive HPV typing were independently associated with cervical dysplasia. At multivariate analysis, only positive HPV typing remained significantly associated with cervical dysplasia (hazard ratio 2.75, confidence interval 1.1-6.5, p = 0.023). Conclusion: A negative HPV test even in the presence of PCB may rule out cervical dysplasia with extremely high accuracy and may save unnecessary colposcopies.

Effects of the COVID-19 pandemic on timely care for extrauterine pregnancies: A retrospective analysis.

BACKGROUND: The COVID-19 pandemic may have taken a toll upon the rate of extrauterine pregnancy (EUP)-related admissions and emergent surgeries. METHODS: This retrospective study compared current and past visits to the emergency services of a large metropolitan university-affiliated medical center in Tel-Aviv, Israel. Data on EUP-related and regular early pregnancy care-related presentations to the emergency department (ED) during the COVID-19 pandemic were collected and compared to a historical control group admitted during 2018-2019. The primary outcome was the rate of ruptured EUP. Secondary outcomes included the rate of EUPs requiring surgery, symptoms, blood products, blood loss, embryonic heart rate, ß-HCG levels, and intensive care unit transfer. FINDINGS: During the COVID-19 pandemic there was a 28.3% reduction in women seeking early pregnancy and emergent gynecological medical care. ED visits due to suspected EUP were similar: After exclusion, the study group comprised of 100 women and the combined control group from previous years included 208 women with confirmed EUP. Baseline maternal characteristics were similar between the groups. The rate of ruptured EUP's was significantly more common during the COVID-19 pandemic than in previous years [odds ratio (OR) 2•403 (1•272-4•539), p = 0•006]. Moreover, during the pandemic patients admitted due to EUP were significantly more symptomatic [OR 1•815 (1•072-3•074), p = 0•017] and had more blood loss demonstrated as substantial hemoglobin decline [OR 2•441 (1•07-5•565), p = 0•028] as well as hemoperitoneum during surgery [OR 2•672 (1•095-6•52), p = 0•035] The number of women receiving blood products was higher in the study group yet not reaching statistical significance [7% vs 3•4%, OR 2•161 (0•737-6•339) p = 0•128]. The overall rate of surgically treated EUP was similar between the groups [OR 1•070 (0•660-1•734), p = 0•439] and there was no significant difference in non-surgical management. INTERPRETATION: The COVID-19 pandemic has a toll on early pregnancy emergent care due to EUP with a significantly higher risk of tubal rupture and morbidity. Physicians should expect delayed presentation of symptomatic EUP and act accordingly. FUNDING: This research received no funding.