Medically assisted procreation will never be the same again after this China Virus epidemic. With billions of lives being affected by this damaging global pandemic, medically assisted procreation services were not left unharmed with far-reaching consequences. New challenges are now emerging concerning COVID-19, such as associated reproductive implications and the consequences of assisted and natural procreation in the presence of acute SARS-CoV-2 infection and delayed consequences after patient recovery. There is a hypothesis that testicular damage and subsequent infertility may result following COVID-19 infection and the possibility of sexual transmission, as SARS-CoV-2 has been identified in the semen of infected patients. Vaccine hesitancy in young women planning pregnancies has been heightened because of the spread of misinformation on social media stating that COVID-19 vaccines will cause sterility in women. Reassuring data from accidental pregnancies that have occurred in the clinical trials of approved COVID-19 vaccines indicate that vaccination does not harm fertility or increase the rate of miscarriage. Scientists have quickly related to good tissue practices in vitro fertilization and a rethink is on about encouraging biopsies and focusing on safe vitrification protocols keeping in mind that ova, sperm, and embryos could be possible vectors for disease transmission with the limited research on the SARS-CoV-2 virus. Going ahead with segmented IVF without delay, freezing the generated embryos and pushing back the embryo transfer after the pandemic appears to be the best strategy at present. An international group of researchers have proposed a prognostic stratification of more vulnerable infertility cases in order to plan a progressive restart of worldwide fertility treatments.

Globally reproductive health services such as contraception and abortion are impacted and are not accessible to a considerable population. The International Planned Parenthood Federation reported anticipated shortage of contraception as the lockdown measures led to reduction in the manufacturing of contraceptives. A recent analysis by the Guttmacher Institute estimated the potential effects of the pandemic. It was found that a 10% decline of sexual and reproductive health services due to COVID-19, would mean an additional 15.4 million unintended pregnancies, over 3.3 million unsafe abortions and 28,000 maternal deaths. The UN Secretary General has issued a call to continue the delivery of sexual and reproductive health services even without prescription. The focus is now to provide vaccines, and therefore, a number of research organizations and pharmaceutical industries are working on their production. One of the reasons for vaccine refusal is the concern that it may affect female and male reproductive functions. However, it is important to correct this misunderstanding as vaccination does not affect fertility. In most cases, vaccination during pregnancy and lactation can be considered safe and effective.

Objectives To study the implementation of ERAS (Enhanced recovery after surgery) pathway and its effect on duration of post-operative hospital stay and various phases of post-operative care in comparison with conventional care group.

Materials and Method Prospective study conducted in Amrita institute of medical sciences, Kochi, Kerala. Women planned for elective and scheduled caesarean section were included in the study from September 2020 to October 2020 and compared with women who underwent caesarean section in the same period receiving standard perioperative care. Women who underwent emergency and urgent caesarean section and patients with medical or surgical comorbidities were excluded. Surgical procedure was the same in both arms. Intravenous hydration was goal directed. Oral feeding was started with liquids after 2 hours, solids were given after 4 hours. Intravenous paracetamol and diclofenac were given routinely. Intravenous tramadol and fentanyl were given if needed apart from these analgesics. Foleys catheter was removed after 12 hours. Conventional care group observed 6 h of fasting pre- and post-operatively. Catheter was retained for 24 h, 2500 ml IV fluids were infused on the first day followed by 1000 ml on the second day. The duration of hospital stay was based on clinical criteria and care providers decision.

Results In ERAS arm, post-operative hospital stay was significantly reduced in comparison with conventional care group. (53.91 vs 77.71 h-p = 0.00) Early feeding, early ambulation, early catheter removal, multimodal and preemptive analgesia all contributed to early recovery of the patient.

Conclusion In ERAS pathway length of post-operative stay was significantly reduced as compared to conventional care.

Abstract

Objective To assess knowledge, attitude and practices (KAP) towards COVID-19 among pregnant women at a tertiary care hospital.

Methods This was a questionnaire-based cross-sectional analysis pertaining to COVID-19 which was conducted at a tertiary care obstetric facility in India among 200 consecutive consenting pregnant women. They were assessed for demographic details and KAP score (knowledge—17 questions, attitude—9 questions and practice—8 questions). Analysis of data was done using Statistical Package for the Social Sciences (SPSS) version 25.0.

Results The participants had adequate mean knowledge score (± SD) of 22.5 (± 3.5) were following good practices [mean score (± SD) = 15.5 (± 2.6)] and showed positive attitude for preventive measures against COVID-19 [n (%) = 194(96%)]. Low knowledge score (p-value 0.030) was seen in non-health care workers.

Conclusion This study demonstrated that majority of the pregnant women had satisfactory knowledge, positive attitude and were following practices in right manner regarding COVID-19 but continued efforts for generating awareness were warranted. As India is battling the second COVID-19 wave and in the absence of definitive cure, strengthening of health policies directed at pregnant women should be prioritized with special focus on significant gaps in KAP.

Abstract

Background COVID-19 pandemic has affected the pregnant women both physically and mentally. This study is conducted to assess, the impact on COVID-19 pandemic on psychiatric symptoms among pregnancy and to compare them with non-pregnant women.

Methods An observational study was conducted at Govt. Medical College & Hospital, Ooty (Udhagamandalam). A validated Edinburgh Depression Scale was used to screen the mental health status. Categorical variables were analysed using Chi-square test and continuous variables by independent t test. A Pearson’s correlation analysis was performed to check the association of Edinburgh postnatal depression scores with the demographic characteristics. Paired t test was conducted to find the difference in EPDS scores at baseline and study conclusion visit. Regression analysis was conducted to predict the outcome variables.

Results The Edinburgh Depression scores were significantly higher in the pregnant women group, (12.48 ± 3.753 vs. 8.00 ± 2.436; p value = 0.001; 95% CI 3.340–5.627), when compared to non-pregnant women (12.90 ± 3.731 vs. 9.20 ± 2.973; p value = 0.001; 95% CI 2.480–4.920). The Edinburgh Depression scores at the study conclusion visit was statistically significant, (11.05 ± 3.839 vs. 10.24 ± 3.872; p value = 0.008; 95% CI −1.40 to −0.213). Education, income, duration of marriage, body mass index, and suicidal ideation are some of the predictors identified in this study to cause depression among pregnant women.

Conclusion The findings of the study indicate a clinically significant increase of depressive symptoms among pregnant women. It is recommended to include routine psychological screenings and interventions during pregnancy.

Abstract

Background The COVID-19 pandemic had not only burdened healthcare systems all over the world but had also affected mental health of frontline Health Care Workers. Purpose Purpose of our study was to compare the psychological morbidity of health care workers posted in Covid labour room with their counter parts in Non Covid labour room.

Material and Methods Present study was a cross-sectional study conducted on HCW of Covid and Non Covid labour in a span of 6 months.

Results Insomnia in Covid labour room was found to be in 57% HCW as compared to none in non Covid labour room (mean score 7.47 ± 2.74 vs 1.82 ± 1.25, P Value < .0001). Depression was prevalent in 92% of participants in Covid labour room as compared to 12.5% in Non Covid labour room; however, severe depression was found in 6% participants (mean score 17.32 ± 4.88 vs 2.12 ± 1.65, P Value < .0001). Prevalence of anxiety in present study was 90% in Covid labour room and 6% in non Covid labour room (mean score 11.47 ± 4.57 vs 1.94 ± 1.43, P Value < .0001). Psychological morbidity as tested by Symptom Check List-k-9 was positive in 21.8% participants in Covid Labour room as compared to 1% in Non Covid labour room (mean score 5.57 ± 2.58 vs 2.22 ± 1.89, P Value < .0001).

Conclusion Study revealed significantly high psychological morbidity, insomnia, anxiety and depression in the health care workers in Covid labour room than Non Covid labour room.

Abstract

Background The objective of this study was to find out the effect, course of disease and management of the COVID-19 infection in pregnant women and compare it with non-pregnant population.

Method This is a retrospective study done at Sardar Vallabhbhai Patel Institute of Medical Science and Research (SVPIMSR), Smt. NHL MMC, Ahmedabad, from April 1, 2020, to September 30, 2020. All COVID-19-positive patients were divided into two groups: group A was comprised of pregnant/postpartum and group B of non-pregnant patients

Result A total of 709 women (Group A-205, Group B-504) were included in the study, In group A 90% of patients were asymptomatic, while in group B 48% asymptomatic patients. Group A had 5.9% and group B had 13.1% patients having comorbidities. In group A, smaller number of patients had raised inflammatory markers as compared to group B. Only 4% patients of group A showed significant changes on chest X-ray as compared to 16% in group B. Only 2.9% patients of group A required intensive care unit admission as compared to 10.31% patients of group B. Mean hospital stay of group A was 10.6 days, and that of group B was 12.1 days.

Conclusion In pregnancy, due to the physiological alterations in cardiovascular, respiratory and immune system, the pregnant women are vulnerable to infections. Although pregnancy is immunocompromised state, the severity of Coivd-19 disease is milder as compared to non-pregnant COVID-19-positive patients.

Abstract

Background As the novel coronavirus 2019 (COVID-19) continues its pandemic surge globally along with its social distancing norms, the physical conduction of practical examinations for medical graduates and postgraduates has become difficult. Software-based systems and social media platforms could provide alternatives for ensuring regular medical education and exam-oriented assessments. In this context, we evaluated our own experience with virtual conduction of semester practical exams for medical graduates.

Material and Methods This prospective study was conducted in Gynaecology and Obstetrics department. We employed live streaming educational video conferencing software for virtual consultation between medical students, patients (case presentations), internal and external examiners. The outcomes were evaluated in terms of conduction of various components of practical examination—Viva, case presentations, instruments, slides, specimen examination. Statistical analysis was performed by descriptive statistics through Microsoft Excel sheet.

Results Virtual conduction examination/evaluation was performed on 150 medical students by examiners from a distant location. No problems occurred except few short duration (less than 5 min) interruptions due to internet connectivity issues. 125/150 (83.5%) of medical students and all examiners (2 internal and 2 external) expressed satisfaction with virtual medical evaluation.

Conclusions 83.5% of medical students and all examiners expressed satisfaction with virtual medical evaluation during this COVID pandemic. Our findings suggest that virtual conduction of practical annual medical exams through virtual video conferencing platform appears to be an optimal alternative during COVID pandemic.

The COVID-19 pandemic is threatening the world and our country today. Minimally invasive surgery was initially thought to have a higher risk of spreading the disease through aerosolisation of viral particles through the pneumoperitoneum. This article outlines the various protective measures taken for minimally invasive surgery to decrease the aerosol spread at a Gynecologic Oncology unit during the COVID pandemic period. Precautions taken during anesthesia, trocar insertion, surgery and special precautions for smoke evacuation with viral filters are outlined.

Background Novel coronavirus (SARS-CoV-2) is responsible for the current global pandemic and understandably, Obstetrics is not spared. Private maternity hospitals have a unique challenge of reassuring unaffected patients of uneventful delivery with the lowest possible rate of coronavirus infection while consequently offering compassionate and state of art services to women who turn out to be positive for SARS-CoV-2. This has led to a routine SARS-CoV-2 testing of all patients before admission in many of the private hospitals in India. The current study was undertaken to determine the incidence of SARS-COV-2 among asymptomatic pregnant women and to ascertain the utility of universal screening in these women.

Methodology A retrospective observational multi-center study was conducted over a period of approximately 5 months (1-May-2020 to 10-September-2020) in a chain of privately run maternity hospitals with presence in multiple cities across India. All asymptomatic pregnant women were tested for SARS-CoV-2 prior to elective/emergency hospital admission.

Results Among 4158 women tested, 54 (1.3%) were positive for SARS-CoV-2 and intra partum and postnatal period was uneventful for all of them.

Conclusion Universal screening should be continued as preferred approach to ensure low anxiety levels of delivering women and safety of frontline workers. Further, universal screening helps avoid emergence of maternity centers as virus clusters by effective isolation of identified positive cases and minimizing points of contact.