|Year : 2021 | Volume
| Issue : 2 | Page : 142-148
COVID-19 and obstetricians and gynecologist: The Indian perspective
Radhika Anand, Rehana Najam
Department of Obstetrics and Gynaecology, Teerthankar Mahaveer Medical College and Research Center, Moradabad, Uttar Pradesh, India
|Date of Submission||24-Sep-2021|
|Date of Decision||13-Dec-2021|
|Date of Acceptance||13-Dec-2021|
|Date of Web Publication||30-Dec-2021|
Dr. Radhika Anand
Department of Obstetrics and Gynaecology, Teerthankar Mahaveer Medical College and Research Center, Delhi Road, Moradabad - 244 001, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
Introduction: Since its emergence, COVID 19 caused by severe acute respiratory syndrome coronavirus 2, turned out to be a health threat throughout the world. The degree of risk for the health-care workers who are dealing with the COVID-19 patients is uncertain. Questionnaire-based prospective cross-sectional study was done to assess the extent to which the Indian obstetrics and gynecology practice has been affected by the pandemic. Materials and Methods: From August to October 2020, 309 obstetricians (OBs) and gynecologists took part in the survey via Google forms. Impact on the present working scenario during the pandemic compared to the Pre-COVID era was evaluated. The categorical variables got illustrated through frequency (%). The association among the variables Chi-square test was utilized. Statistical significance was contemplated by the P < 0.05. Graphs were prepared using Google Sheets and Microsoft Excel 365. Results: There was drastic fall in parameters of obstetric practice. Over half of the OBs witnessed fall in outpatients over 90%. Significant association seen reduction in earnings with the sector, type of set-up, and duration of practice (P < 0.001) was found. Apprehension among the study group was present still majority 54.8% said that they were working voluntarily in this time of national crisis. Conclusions: This research indicates that the pandemic has entailed practice of obstetrics and gynecology in India. However, the smooth functioning was maintained due to the high degree of knowledge and preparedness among the doctors and the well-laid guidelines by the authorities.
Keywords: COVID-19, novel coronavirus, obstetrics and gynecology, online survey, pandemic, practice
|How to cite this article:|
Anand R, Najam R. COVID-19 and obstetricians and gynecologist: The Indian perspective. Acta Med Int 2021;8:142-8
| Introduction|| |
COVID 19, which is caused by the severe acute respiratory syndrome coronavirus 2, has been a global health issue since its emergence. According to WHO, there were 23,94,37,517 actual cases of COVID-19 worldwide as of October 15, 2021, resulting in 48,79,235 deaths. India recorded 3,40,37,592 confirmed cases of COVID-19, with 4,51,814 deaths. Due to community transmission from asymptomatic persons, the disease burden has been growing. Increased risk of infection among front-line health-care workers, leading to the disease's spread further afield. As a result, the COVID-19 pandemic has imposed significant constraints on the overall health-care system, personnel, and even employees.
As a resource-poor country, there are also concerns regarding the mandatory personal protective equipment (PPEs) and its availability besides other infection deterrence and control aids. The degree of risk for the health-care workers who are dealing with the COVID-19 patients is uncertain, besides that the intentions for them along with their patients and their families. It is accordingly essential to verify the consequence of these stressors over the doctors' mental health that will lead the proper way for addressing the problems and in turn will help and support health-care workers to overcome the mental stressors effectively, it will also be enhancing the clinical execution with a successive advancement in patient outcomes at the time of forthcoming COVID-peaks.
This present study will be evaluating the opinions of the obstetricians/gynecologists (OB/GYNs) working during the pandemic in INDIA. It aims at assessing the awareness and preparedness associated with Covid-19 among them. We evaluated the impact of the present working scenario of the OB during the pandemic and compared it to the Pre-COVID era.
| Subjects and Methods|| |
Prospective cross-sectional study.
Questinnaire-based study among doctors practicing Obstetrics and Gynecology in the various parts of India.
Three hundred and nine.
Three months (August–October 2020).
A semi-structured and pre-validated online questionnaire for the survey was concocted with the help of Google forms that has been appended with every consent form of the respondent's. The investigator circulated the link of the questionnaire through emails, Whatsapp forwards, and some more social media channels to prospective respondents. After receiving the link, each respondent were motivated for rolling out the questionnaire for their references and even on to some additional online outlets and platforms. Thereafter, the link was then broadcasted to OBs and GYN besides the primary point of contact.
That questionnaire includes questions associated with the respondent's demographic characteristics, questions relevant to their working environment pre- and post-pandemic. The following section of the questionnaire deals with the personal awareness, preparedness of the respondents and also the institute they are working in during the pandemic. Google sheets® and Microsoft Excel ® were used for data collection. Reporting was done according to STROBE guidelines.
The categorical variables got illustrated through frequency (%). For examining the association (that is; the comparison in proportion) among the variables like the years of their practice, the sector of practice, and kind of set-up, alongside numerous additional variables of obstetric practice along with financial characteristics, the Chi-square test got utilized (while each cell possessed a minimum of 5 anticipated frequency). Statistical significance was contemplated by the P < 0.05. Graphs were prepared using Google Sheets and Microsoft Excel 365.
Ethical considerations Ethical approval was obtained from the Institutional Ethics Committee of Teerthankar Mahaveer Medical College and Research Centre, Moradabad, Uttar Pradesh (TMMC/Ethics/IRB 52/2021). Before interview, informed consent was obtained from each respondent, and they were assured about the confidentiality of information. The research followed the guidelines laid down in the Declaration of Helsinki, updated in 2013.
| Results|| |
A total of 309 OBs and GYN took part in the survey with a survey response rate of 68.6%. [Table 1] reveals that the majority (n = 135, 43.75%) of the participants were in the age group of <30 years of age, and most (99.0%) of them were female. The majority (n = 156, 50.5%) worked as a consultant, (n = 252) 81.6% worked in the private sector, of which (n = 180) 58.3% worked in the set-up of a Medical College. As an elementary specialty, (n = 105) 34% of participants had emergency, (n = 147) 47.6% served 42–72 h per week before the pandemic, majority of participants (n = 264, 85.4%) had no history of chronic diseases, and just (n = 9) 2.9% tested positive for COVID-19.
|Table 1: Frequency and percentage distribution of demographic characteristics of obstetricians and gynecologists|
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Where the outpatient department (OPD) is pertained, prior to the beginning of pandemic, 28.2% (n = 87) of the respondents retained the monthly digits between 50 and 100, 27.2% (n = 84) acquired between 100 and 500, and 16.5% (n = 51) retained excess than 1000. Because of the persistent spread of the disease, these data actually got terribly affected; 22.3% (n = 69) got halted from any aspect of consultations, 13.6% (n = 42) were providing only telemedicine advice, 4.9% (n = 15), 14.6% (n = 45) and 24.3% (n = 75) encountered decline in the number of out-patients issues fairer than 90%, 75% and 50%, accordingly [Figure 1]a.
|Figure 1: (a) Chang in outpatient department during COVID-19 pandemic. (b) Change in emergency and elective case operated upon. (c) Degree to which patients needed to be referred. (d) Change in earnings during this pandemic|
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Most (n = 111, 35.9%) had 10–30 cases a month before the pandemic started if we consider the number of emergency cases just 2.9% (n = 9) of the OBs stopped doing them entirely during the pandemic, while 16.5% (n = 51) had a reduction of more than 90% and 17.5% (n = 54) reduced the number by approximately 75%.
The number of elective procedures during the pre-COVID period among maximum physicians was 10-30 cases every month (n = 114), it was being followed by the ones performing 5–10 each month (n = 96). Nonetheless, in comparison to emergency cases, 31.1% (n = 96) of OBs had absolutely ended performing elective cases [Figure 1]b.
This decline in digits had a noticeable reciprocating impact over the financial facets even. 21.4% of the doctors, pertaining towards the private realm besides operating their individual (own) hospitals, noticed their own earnings getting reduced by >90%. Those working in the government realm had their earnings to remain the same.
However, there still existed 1% (n = 3) of the people whose earnings went up [Figure 1]d. We strived to discover if there was any substantial association amongst (a) sector (government, private, etc.), (b) the set-up variety (individual hospital, multispecialty hospital, medical college, etc.,) they were working at, (c) the years of practicing and having numerous parameters of gynecology and obstetric practice: consequence on patients, quantity of OPD patients, earnings and sustainability, emergency, and elective cases conducted. We noticed a substantial association between the difference in income around both of the sectors (P < 0.001) [Figure 2]a and the category of hospital/set-up an OB were operating at (P < 0.001) [Figure 2]b.
|Figure 2: (a) Changes in earning in relation to the sector. (b) Changes in earning in relation to the type of working. (c) Changes in earning in relation to the duration of clinical practice|
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The working scenario had altered dramatically during the pandemic, but we noticed some contributory variables that lead to smooth functioning. It was noticed that the PPE availability in health facilities was sufficient in terms of gloves (98%), Face mask (94.1%), N95 masks (83.3%), PPE kit (80.4%).
The main source of knowledge and information regarding the management of COVID 19 patients according to the majority of respondents (49.3%) was the hospital policy in which they were working while the others government regulated (37%), social media (4.1%), and scientific papers (6.8%) were also found to be significant sources of information.
As seen in [Table 2] it was noticed that 84.3% of the study participants thought they might deliver care for emergency obstetric cases, 79.4% of establishments were able to conduct cesarean sections, and 86.3% of setups obtained referral patients from distinct health establishments. 96.1% of the hospitals possessed capabilities for sequestering COVID-19 presumed cases, also 89.2% of the health-care establishments had screening sectors particular for the COVID-19 suspects. According to 84.3% of respondents screening protocols were present for maternity cases who were COVID-19 suspects. Appointed team for COVID-19 supervision existed according to 78.4% of respondents. Healthcare setups provided protocols to fight the COVID-19 pandemic to 97.1%. 84.3% found themselves to be well versed with updated approaches for managing laboring females, pregnant women, and postpartum women especially in the duration of the COVID-19 pandemic.
| Discussion|| |
The measures taken by the Government of India has been instrumental to some extent in flattening the curve of the pandemic.,, Most of the human, infrastructural and financial resources have been directed to somehow control this pandemic. One of the downsides of these measures has been the tremendous amount of trouble it has caused to the non-COVID-positive patients. Routine OPDs were shut down in most of the states leaving them aghast with agony The persistent spread of the disease, these data actually got terribly affected; 22.3% (n = 69) got halted from any aspect of consultations, 13.6% (n = 42) were providing only telemedicine advice, 4.9% (n = 15), 14.6% (n = 45) and 24.3% (n = 75) encountered decline in the number of out-patients issues fairer than 90%, 75% and 50%, accordingly. This is comparable to the findings established in a study performed among orthopedic surgeons that 28% of OPD patients dropped 90% more than and about 7.6% had fully ceased seeing OPD.
A significant decline was seen in the number of elective and emergency cases being performed which was concurrent to other studies like the study performed among orthopedic surgeons, where the whopping 63.9% of orthopedic surgeons had completely ceased performing elective cases.
As far as the hospital infrastructure was concerned it was noticed that 84.3% of study subjects thought they might deliver care for emergency obstetric cases, 79.4% of establishments were able to conduct cesarean sections, and 86.3% of set-ups obtained referral patients from distinct health establishments. About 96.1% of the hospitals possessed capabilities for sequestering COVID-19 presumed cases, also 89.2% of the healthcare establishments had screening sectors particular for the COVID-19 suspects. This was analogous to the results shown in the study by Elhadi et al., who stated that 81% of respondents had availability or intensive care for obstetrics emergencies, while 89.1% found that emergency C-Section was feasible.
Although the patients are better to judge, our doctors underwent that the ones who suffered harshly because of the pandemic prevailed in around 11.7% and 42.7% amongst the emergency along with nonemergency groups, accordingly. Also, the digits with concern to the ones who were moderately affected was 43.7% and 26.2% (n = 124), respectively [Figure 1]c The challenge with our branch is that obstetric emergencies do not always possess the time to undergo COVID-reverse transcription-polymerase chain reaction testing for them to get operated as urgent treatment is compelled, which is why during the pandemic the emergency cases have shown to have suffered as they had to be referred.
In the private sector there was a major drop in the financial earnings but not in the government sector. Although the studies performed in this regard are very few, but we noticed a comparable review documented by Shrestha RM et al., who reported that doctors and other health-care staff were dismissed from work in many health institutions or were not paid for months due to the economic hardship of hospital management.
Functioning in both private as well as the government sectors had the terrible hit. Whereas the ones functioning in the government set up the income were noted to have continued the exact. By this category of functioning set-up, over there existed a harsh plunge amongst the ones with particular clinics and hospitals, and the ones who were functioning in the multi/Superspeciality hospitals. Distant from it, a substantial association was also being noticed amongst the income influenced and years of their exercise. Comparatively those with 20–30 and more than 30 years of experience have been hit more than their newer counterparts, that is, (P < 0.001) in [Figure 2]c. Identical results were noticed in the research performed by Kumar K et al.
We discovered in our study that the smooth functioning in these times of peril was related to adequate infrastructure in diverse health settings. This was similar to the study conducted in Libya by Elhadi et al., who found that the PPE and other protection equipment were adequate for 81.6% of OBs. According to the study by Yalçin Bahat et al., 59.8% of respondents found that the hospital's PPE allowance was enough. Contrasting reviews were found by Elhadi et al. who found the PPE to be inadequate in their setup.
However, there was an air of apprehension amongst the doctors and the paramedical staff still in our study we found that around 30.1% of anesthesiologists were willing to take up the cases for surgery same as before while only 1.9% of the participants had the opinion that the anesthetists were not willing at all. Para-medical staff like nurses, ward-boys, OT staff, etc., were willing to do routine work related to OBGYN similar as before according to 27.2% respondents while only 3.9% OBGYNs found them unwilling. Majority of them 54.8% said that they were working voluntarily in this time of national crisis while 38.4% were doing it under pressure from their employer. 65.7% found themselves competent enough to handle patients who were nonserious, who do not require close contacts and procedures like intubation. While 11.4% found themselves equipped enough to handle the ICU patients too. Elhadi et al. found that 46% of their respondents were certain with what is to be done with the Covid positive patients. As stated by Elhadi et al. around half i.e., 45% of the doctors and 37% of the nurses didn't get acclimatized to handle a case covering the signs and symptoms of COVID-19 infection. Furthermore, his data throws light upon the possibility of increased risk of hospital-acquired infections and cross-contamination. Therefore, proper education of healthcare personnel is of utmost importance to prevent the spread of infection by elaborate training and implementation of safety precautions.,
In our study, 94.2% were aware of the COVID-19 WHO recommendations, which contrasted with the Elhadi et al. report, which observed that only about 68.4% were aware. [Table 3] 100%, 84.3% sanitization, and hygiene facilities were available for staff, patients and visitors. This was just 77% and 64.4% according to Elhadi et al. 99% of respondents got supplies for cleaning adequately in contrast to 68.4% according to Elhadi et al. According to 93.1%, there was a hike in regular cleaning practices after the advent of COVID-19.
The major drawback is the small sample size due to the pressing need in the pool of lacking data. Second as majority of respondents in our current study belonged to northern India where multidisciplinary care and health infrastructure is in better shape as compared to other regions of India and also as the load of COVID-positive patients was fairly lighter than regions of southern and Western India. Thirdly online facility to participate in the current study might not be readily available in the peripheral regions so respondents from those regions could not be reached.
| Conclusions|| |
This current research indicates that the pandemic has significantly entailed practice of obstetrics and gynecology in India. It has been in terms of their outpatient and operative numbers, GYN employed in all fields across numerous types of set-ups that got impacted at some level or the other. In terms of income, practitioners employed in the sectors run by private ones and the ones carrying out their own hospitals as well as clinics had been more severely implicated, when compared to the ones practicing in the government sectors besides the medical colleges. In this time of difficulties, however, the smooth functioning was maintained due to the high degree of knowledge and preparedness among the doctors and the well-laid guidelines by the hospitals and different obstetric and gynecological societies. Further research is needed for creating a better working atmosphere for future unpredicted peaks of the pandemic.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3]