VP59.13: COVID‐19: the impact on gynecology

Abstract

In March 2020, due to the COVID-19 pandemic, a tertiary referral gynecology department suspended all elective surgery and benign outpatient clinics. In 2019 there were 32,000 outpatient visits and 2,400 operations performed for benign disease. We examined the impact that this decision had on the timing and route by which women accessed gynecology care and the outcome. A prospective registry was established. Any woman reviewed by the emergency gynecology team who stated they had delayed their presentation due to concerns about COVID-19, who had presented due to an inability to access alternative services, or whose outpatient appointment or surgery had been postponed was eligible. Details were entered at the time of presentation and electronic records and operation notes subsequently reviewed. Each case was assessed by two senior gynecologists to determine if delayed presentation or change in service structure influenced the clinical course of pathology and outcome. We currently have 7 weeks of data and will continue to collect through all phases of the pandemic. The age range is 14 to 56 years. Two cases of ectopic pregnancy remained in the community despite significant pain because of confusion over availability of services and fear of coming to hospital. Portable scanning identified significant hemoperitoneum. Surgery confirmed tubal rupture. Two non pregnant patients under elective monitoring for known ovarian cysts presented after prolonged, severe pain at home. Portable scanning confirmed the clinical suspicion of torsion and both went on to have laparoscopic detorsion. We await confirmation of ovarian viability and if confirmed interval cystectomy. We have early evidence that suspension of elective gynecological services, altered access to GP surgeries and concern over whether it is safe to come to hospital has affected the time and manner in which pregnant and non pregnant women present. This has led to only more invasive forms of management being safe, more technically challenging surgery and for some, the need for a second procedure.