Implementing the transvaginal natural orifice transluminal endoscopic surgery (vNOTES) "first" strategy in benign gynecological surgeries.

PURPOSE: The use of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) as the first choice of surgical route for patients scheduled to undergo conventional laparoscopy is still being debated. We aimed to evaluate and compare the outcomes of the "vNOTES first" strategy in benign gynecological cases. METHODS: All benign gynecological surgeries were initiated using vNOTES during the study period, regardless of the difficulty. Surgical outcomes, short-term patient satisfaction and sexual pain were compared between hysterectomies, adnexal and diagnostic procedures. Visual Analog Score (VAS), Patients Global Impressions of Improvements scale (PGI-I) and Female Sexual Function Index (FSFI) were used to assess the postoperative pain, satisfaction and sexual pain, respectively. RESULTS: A total of 105 vNOTES procedures were performed during the study period: 63 (60.58%) adnexal procedures, 36 (34.62%) hysterectomies, 5 (4.81%) diagnostic procedures and one (0.96%) myomectomy. The median 24th hour VAS scores for adnexal, hysterectomy, and diagnostic procedures were 1.29 ± 1.41, 2.06 ± 2.08, and 2.6 ± 2.41, respectively. The satisfaction rate was 96.19% at the 1st postoperative week and 97.14% at the first month. There was either no change or a slight improvement in the patients' total score on the FSFI/pain domain before and after surgery. There were two conversions (1.9%) from vNOTES to laparoscopy and laparotomy, and two (5.56%) bladder injuries in hysterectomy cases. CONCLUSION: Implementing the vNOTES technique as an initial approach for all benign gynecological surgeries seems feasible, safe and satisfactory, even in those with a non-prolapsed or enlarged uterus and those that have previously undergone abdominal surgery. The pain scores were found to be low and patients stated a high satisfaction with no or better change in their sexual life.

Pregnant women's knowledge about and beliefs toward COVID-19 vaccine: a cross-sectional study.

Purpose: The aim of this study was to determine the scope of knowledge, attitudes, and behaviors of pregnant women about the coronavirus disease 2019 (COVID-19) vaccine. Materials and Methods: A total of 886 pregnant women were recruited for the study. A cross-sectional questionnaire was conducted on these selected participants. Data about past infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), SARS-CoV-2 infection of closely related people, and deaths due to COVID-19 among their relatives were questioned. Results: The rate of vaccination was higher (64.1%) in pregnant women with higher education levels. Informing about the vaccine, especially by health professionals, showed that the rates of vaccination (25%) increased (p<0.001). In addition, a significant increase was observed in vaccination rates with increasing age and financial income (p<0.001). Conclusion: The main limitation of our study is that the vaccine, which was approved for "emergency use", was just started to be administered to pregnant women during the study. Our findings show that our target audience, low-income, low-education, younger pregnant women should be given more attention than those who apply to the doctor for routine follow-up.

COVID-19 related maternal mortality cases in associated with Delta and Omicron waves and the role of lung ultrasound.

Objective: To present coronavirus disease-2019 (COVID-19) related maternal mortality in relation to Delta and Omicron waves and to investigate the role of lung ultrasound (LUS) in estimating mortality. Materials and Methods: This retrospective cohort study was conducted in the obstetrics and gynecology clinic of a tertiary pandemic hospital between March 2020 and January 2022. The hospitalized pregnant women with COVID-19 diagnosis and maternal deaths were studied in relation with Delta and Omicron waves. The relationship between LUS scores of hospitalized patients and maternal mortality was explored. Results: Thousand and sixty-five pregnant women were hospitalized because of COVID-19 infection. Fifty-one (4.79%) of these patients had critical sickness, 96 (9.01%) of them had severe illness, 62 (5.82%) of them were admitted to the intensive care unit and 28 (2.63%) of all hospitalized pregnant women had died. Of the 1.065 patients, 783 (73.5%) were hospitalized before the Delta wave and the maternal mortality rate was 1.28% (10/783), 243 (22.8%) were hospitalized during the Delta wave and the maternal mortality rate was 7% (17/243) [relative risk (RR)=5.478, 95% confidence interval (CI) (2.54-11.8), z=4.342, p<0.001]. During the Omicron wave 39 (3.66%) patients were hospitalized and the maternal mortality rate was 2.56% (1/39). Maternal mortality rates, according to LUS scores, were 0.37% (1/273) for LUS 0, 0.72% (2/277) for LUS 1, 2.58% (10/387) for LUS 2 and 11.72% (15/128) for LUS 3 respectively (LUS 3 vs. others; maternal mortality: RR=8.447, 95% CI (4.11-17.34), z=5.814, p<0.0001). There were no vaccinated patients in the study cohort. Conclusion: The maternal mortality rate was relatively high, particularly during the Delta wave at our referral center. The Delta wave, delayed vaccination and vaccine hesitancy of pregnant women might have important roles in maternal mortality. Higher LUS scores should warn clinicians of an increased risk of maternal death.

Outcomes of universal SARS-CoV-2 testing program in pregnant women admitted to hospital and the adjuvant role of lung ultrasound in screening: a prospective cohort study.

BACKGROUND: The emerging evidence for the asymptomatic carriers of SARS-CoV-2 infection emphasized the critical need for universal screening of pregnant women. OBJECTIVES: This study aimed to present the prevalence of overall and asymptomatic SARS-CoV-2 infection rates in pregnant women admitted to the hospital, and assess the diagnostic accuracy of maternal symptoms and lung ultrasound (LUS) findings in detecting the infection. PATIENTS AND METHODS: This prospective cohort study was conducted at a single tertiary center in Istanbul, Turkey, for a month period starting from 27 April 2020. Women with a confirmed pregnancy regardless of the gestational week admitted to the obstetric unit with any indication were consecutively underwent LUS and PCR testing for SARS-CoV-2. RESULTS: A total of 296 patients were included for the final analysis. The universal screening strategy diagnosed 23 pregnant women (7.77%) with SARS-CoV-2 infection. The rate of symptomatic and asymptomatic patients diagnosed with SARS-CoV-2 was found as 3.72% (n = 11) and 4.05% (n = 12), respectively. Four of nine women who underwent a second testing for SARS-CoV-2 upon abnormal LUS findings were found positive eventually (17.4%, n = 4/23). The asymptomatic pregnant women with LUS score of 1 and those with normal LUS findings were considered as likely to be normal. Symptomatic patients with LUS score of 1 and those with score of 2 or 3 were considered as abnormal. On a secondary diagnostic performance analysis, the positive predictive value and the sensitivity were found as 44% and 47.8% for the triage based on maternal symptoms and, 82.3% and 60.9% for the triage based on LUS, respectively. CONCLUSION: A one-month trial period of universal testing for SARS-CoV-2 infection with RT-PCR in pregnant women who admitted to the hospital showed an overall and asymptomatic infection diagnose rate of 7.77% and 4%, respectively. Using lung ultrasound was found more predictive in detecting the infection than the use of symptomatology solely.

Lung ultrasonography in pregnant women during the COVID-19 pandemic: an interobserver agreement study among obstetricians.

PURPOSE: This study investigated interobserver agreement in lung ultrasonography (LUS) in pregnant women performed by obstetricians with different levels of expertise, with confirmation by an expert radiologist. METHODS: This prospective study was conducted at a tertiary "Coronavirus Pandemic Hospital" in April 2020. Pregnant women suspected to have coronavirus disease 2019 (COVID-19) were included. Two blinded experienced obstetricians performed LUS on pregnant women separately and noted their scores for 14 lung zones. Following a theoretical and hands-on practical course, one experienced obstetrician, two novice obstetric residents, and an experienced radiologist blindly evaluated anonymized and randomized still images and videoclips retrospectively. Weighted Cohen's kappa and Krippendorff's alpha tests were used to assess the interobserver agreement. RESULTS: Fifty-two pregnant women were included, with confirmed COVID-19 diagnosis rate of 82.7%. In total, 336 eligible still images and 115 videoclips were included in the final analysis. The overall weighted Cohen's kappa values ranged from 0.706 to 0.912 for the 14 lung zones. There were only seven instances of major disagreement (>1 point) in the evaluation of 14 lung zones of 52 patients (n=728). The overall agreement between the radiologist and obstetricians for the still images (Krippendorff's α=0.856, 95% confidence interval [CI], 0.797 to 0.915) and videoclips (Krippendorff's α=0.785; 95% CI, 0.709 to 0.861) was good. CONCLUSION: The interobserver agreement between obstetricians with different levels of experience on still images and videoclips of LUS was good. Following a brief theoretical course, obstetricians' performance of LUS in pregnant women and interpretation of pre-acquired LUS images can be considered consistent.

Near-term pregnant women's attitude toward, concern about and knowledge of the COVID-19 pandemic.

Background: COVID-19 is a novel type of the coronavirus family with an incompletely described clinical course. Little is known about the psychological aspects, particularly for vulnerable populations including pregnant women.Objectives: To understand the attitude, concerns, and knowledge of the non-infected pregnant women toward the COVID-19 outbreak in order to constitute base data for detailed counseling and to develop targeted messages.Patients and methods: This cross-sectional survey research presented analysis of prospectively collected data yielded at a single tertiary "Coronavirus Pandemic Hospital" referral center for a ten days period following the first confirmed death due to the COVID-19 pandemic in Turkey. Non-infected women with a confirmed pregnancy over 30th gestational week were consecutively included. A patient-reported non-validated questionnaire formed by the expert committee that includes 15 specific questions was used. Non-infected, pregnant women over 30th gestational week who applied to the outpatient clinic were consecutively included. A total of 213 women were enrolled, 37 were excluded: 7 for being in the first trimester, 3 were illiterate, and 27 were Syrian refugees having difficulties in translation.Results: A total of 172 pregnant women were included. Overall, four women refused to participate to the survey (1.9%). The mean age was 27.5 ± 5.3 years. Median gestational week and parity were 35 ± 11 weeks and 1 ± 2, respectively. Pregnant women were observed to trust the authorities (65%) and the healthcare staff (92.4%), and their respect was increased (82.5%) during the outbreak. Majority of the women (87.2%) comply with the self-quarantine rules. Half of the women (52%) reported that they felt vulnerable and predominantly were concerned (80%). Approximately one-third of the women constantly keep thinking that they may get infected (35.5%) or they might get infected during/following the delivery or their baby might get infected after being born (42%). Half of the women (50%) were reported that they either had no idea about or think the breastfeeding is not safe during the outbreak. About 45% of the women were confused or had doubts about if the mode of delivery may be affected by the pandemic. Greater part of the participants does not know if COVID-19 might cause birth defects (76%) or preterm birth (64.5%). Counseling flow keys helping pregnant women to overcome misleads, regarding the COVID-19 outbreak is proposed.Conclusions: Non-infected pregnant women with a viable pregnancy at near term were observed to have positive attitude and compliance toward the COVID-19 outbreak and frontline healthcare staff; increased concern and vulnerability; and restricted knowledge about the pregnancy-related outcomes. While the clinical evidence was growing rapidly, this data may guide obstetricians and midwives to perceive what accurate information should be provided to the pregnant women.