COVID-19 vaccination: patient uptake and attitudes in a multi-ethnic North London maternity unit.

PURPOSE: COVID-19 vaccine uptake among pregnant women has been low, particularly in younger and ethnic minority mothers. We performed a 'snapshot' survey to explore vaccine uptake and factors which influence this, as well as underlying beliefs regarding COVID-19 vaccination among pregnant women in a North London hospital. STUDY DESIGN: Pregnant women were invited to complete an anonymised survey, where data were collected on demographics, personal and household vaccination status, and beliefs about the vaccine. Free-text comments were analysed thematically. RESULTS: Two hundred and two women completed the survey, of whom 56.9% (n=115) were unvaccinated and 43.1% (n=87) had received at least one dose of COVID-19 vaccine, with 35.6% (n=72) having received two doses. Factors associated with acceptance of vaccination included: (a) age over 25 years (57.6% vaccinated vs 17.2% under 25 years); (b) Asian ethnicity (69.4% vaccinated vs 41.2% white ethnicity, 27.5% black/Caribbean/African/black-British ethnicity and 12.5% mixed ethnicity) and (c) living in a vaccinated household (63.7% vaccinated vs 9.7% living in an unvaccinated household) (all p<0.001). Vaccine uptake was higher in women who had relied on formal medical advice as their main source of information compared with other sources (59.0% vs 37.5% friends and family, 30.4% news and 21.4% social media). Qualitative data revealed concerns about a lack of information regarding the safety of COVID-19 vaccination in pregnancy. CONCLUSION: Age, ethnicity, household vaccination status and information source influenced vaccination status in our pregnant population. These findings highlight the urgent need to tackle vaccine mistrust and disseminate pregnancy-specific vaccine safety data to pregnant women. TRIAL REGISTRATION NUMBER: 5467.

Does temperature of distending medium matter in outpatient hysteroscopy? A double-blinded cohort control observational study of room temperature versus warmed saline.

AIM: There is little data assessing outcomes of outpatient hysteroscopy using warmed versus room temperature saline. The aim of this study was to determine if the temperature of the distending medium during outpatient hysteroscopy affect ease of procedure, clarity of view, procedural discomfort/pain and patient satisfaction. METHODS: This was a double-blinded cohort control quasi-randomized prospective study involving 100 women undergoing outpatient diagnostic and operative hysteroscopy for abnormal uterine bleeding, intrauterine contraceptive devices retrieval and removal of endometrial polyps. Outpatient hysteroscopy was performed either with normal saline either at room temperature (control at 25°C) or warmed to body temperature (37°C). RESULTS: Confounding variables such as age, parity, previous cervical surgery, previous vaginal births, menopausal status and indications for hysteroscopy were similar in the room temperature (n = 48) and warmed saline (n = 52) groups. Mean procedure duration (256 vs 233 s), ease of entry (Visual Analogue Scale [VAS] 9.55 vs 9.4) and the clarity of view (VAS 9.02 vs 9.3) were statistically similar in both groups (all P > 0.05) as was discomfort experienced during hysteroscopy (VAS 6.6/10 vs 6.8/10) and at 5 min post-procedure (VAS 4.2/10 vs 3.2/10) (both P > 0.05). The likelihood of recommending the procedure to a friend was similar in both groups (mean VAS 6.9/10 vs 7.2/10; P = 0.1). CONCLUSION: The temperature of the distension medium did not influence ease of procedure, clarity of hysteroscopy view, procedural discomfort/pain and patient satisfaction. Patients were not any more likely to recommend the procedure to a friend in the warmed saline compared to the room temperature group.

Abdomino-pelvic packing revisited: An often forgotten technique for managing intractable venous obstetric haemorrhage.

BACKGROUND: Surgical packing should not be seen as a 'bail out' for the less skilled obstetrician who is unable to control obstetric haemorrhage using conventional techniques. Rather, this should be considered in cases of coagulopathy or where haemorrhage persists from raw surfaces, venous plexuses and inaccessible areas. MATERIALS AND METHODS: Data from seven women who underwent abdomino-pelvic packing for intractable postpartum bleeding were collected. The primary outcome was success of intra-abdominal packing and secondary outcomes included estimated blood loss, units transfused, length of stay and postoperative complications. RESULTS: All seven women (median age 39 years, interquartile range (IQR) 3.25) had caesarean section deliveries with median estimated blood loss of 5521.4 mL (IQR 4475) and median of 6.9 (IQR 4.75) units transfused. Abdomino-pelvic packing was successful in all cases including in three women who had continued bleeding after peripartum hysterectomy. In the remaining four, bleeding stopped with packing, enabling the uterus to be conserved. The median number of packs inserted was 6.1 (IQR 4.2) and median shock index at time of decision to pack was 0.98 (IQR 0.13). The median pack dwell time was 30.8 h (IQR 24), while median length of stay following removal was 48 h (IQR 2.14). CONCLUSION: Intractable bleeding in these seven cases was successfully controlled by abdomino-pelvic packing, allowing supportive correction of hypothermia, tissue acidosis, coagulopathy and hypovolemia. The technique of packing is an essential skill in managing massive obstetric haemorrhage, in addition to uterine balloon tamponade, compression sutures and peripartum hysterectomy.

Cost effectiveness of enhanced recovery after surgery programme for vaginal hysterectomy: a comparison of pre and post-implementation expenditures.

Enhanced Recovery After Surgery programmes were first conceived to optimise perioperative patient care and have been delivered by surgical specialities in the UK for over a decade. Although their safety and acceptability have been ratified in many surgical fields including gynaecology and colorectal surgery, the cost effectiveness of its implementation in benign vaginal surgery remains unclear. In this case-control study, the perioperative expenditure for 45 women undergoing vaginal hysterectomy at a North London teaching hospital after implementation of an enhanced recovery pathway was compared with 45 matched controls prior to implementation. Frequency of catheter use (84.4% vs. 95.6%) and median length of stay (23.5 vs. 42.9 h) were significantly lower following implementation of pathway (both p < 0.05). Although enhanced recovery patients were more likely to attend the accident and emergency department for minor symptoms following discharge (15.6% vs. 0%, p < 0.05), the inpatient readmission rate (6.7% vs. 0.0%, p > 0.05) was similar in both groups. Establishing the programme incurred additional expenditures including delivering a patient-orientated gynaecology 'school' and employing a specialist enhanced recovery nurse, but despite these, we demonstrated a saving of 15.2% (or £164.86) per patient. The cost efficiency savings, coupled with increased satisfaction and no rise in morbidity, offers a very attractive means of managing women undergoing vaginal hysterectomy. We believe that our data can be reproduced in other centres and recommend that the pathway be used routinely in women undergoing these procedures.

Bullying workshops for obstetric trainees: a way forward.

BACKGROUND: In sector-wide surveys, trainees in obstetrics and gynaecology have consistently reported the experience of being undermined in the workplace. Bullying has serious implications within the UK's National Health Service (NHS), for both the individual experiencing it and the wider system. CONTEXT: Obstetrics and gynaecology is a high-pressure specialty: the workload is intense, staffing is often suboptimal and litigation levels are high. Obstetrics alone accounted for 50 per cent of litigation claims in the NHS in 2012. This 'cocktail', when combined with the target-based management style common in the current financial climate, easily lends itself to a culture of bullying. INNOVATION: In order to manage this problem a workshop was developed with the initial aim of raising awareness, entitled 'Undermining and Harassment: A Practical Workshop for Trainees'. A typical workshop comprises the following interlinking topics relevant to bullying: (1) what is bullying (interactive session); (2) case scenarios (based on real events) and discussion (audiovisual clips); (3) how bullying affects patient safety (presentation); (4) how to support senior staff displaying bullying behaviour (interactive session); (5) how to be assertive without being aggressive (role-play); and (6) practical tips, including the 'Survivors' Guide to Bullying' (interactive session). EVALUATION: These workshops were designed as practical tools to raise awareness of workplace harassment, and not as a research project to assess the longitudinal impact of the workshops. Feedback from six such workshops as well as informal focus groups from trainees who had previously attended indicated that the subject was useful and necessary. CONCLUSION: The aim of the workshops was to raise awareness of bullying and undermining in the workplace, and the serious implications they can have for the individual, patients and the NHS as a whole. This will enable a positive culture shift and encourage health care professionals to think before they speak or act.