Belfast Health and Social Care Trust, 274 Grosvenor Road, Belfast, BT12 6BA, Northern Ireland.
NHS Fife, Kirkcaldy, Scotland.
Int Urogynecol J. 2023 Jun;34(6):1219-1225. doi: 10.1007/s00192-022-05333-z. Epub 2022 Aug 30.
During the COVID-19 pandemic, guidance was issued in the United Kingdom advising a delay in routine pessary reviews. The impact of this has not been fully explored. The null hypothesis for this study is that delayed routine pessary reviews during the COVID-19 pandemic did not result in a statistically significant increase in complication rate.
A retrospective comparative cohort study was conducted in NHS Tayside, Scotland, involving 150 patients pre-pandemic and 150 patients during the COVID-19 pandemic (before exclusions). Their notes were reviewed identifying age, care provider, pessary type, length of pessary usage, review date, time elapsed since the previous review, bleeding/infection/ulceration, removal issues, pessary replacement and outcome. Patients excluded were those with no pessary in situ at review, reviews at ≤4 months and >8 months (pre-pandemic) and reviews at ≤8 months (COVID-19 pandemic).
The pre-pandemic group (n=106) had average review times of 10.1,6.2 and 6.2 months for cubes, rings and all others. Overall rates of bleeding/infection/ulceration; reported removal issues; and pessary subsequently not replaced were 9.4%, 11.3% and 5.7% respectively. The COVID-19 pandemic group (n=125) had average review times of 14.7, 10.8 and 11.4 months for cubes, rings and all others. Overall rates of bleeding/infection/ulceration; reported removal issues; and pessary subsequently not replaced were 21.6%, 16.0%, and 12.0% respectively.
Overall, there was a significant increase in rates of bleeding/ulceration/infection (p=0.01). When individual pessaries were considered, this only remained true for rings (p=0.02). Our data would suggest that routine ring pessary reviews should not be extended beyond 6 months or risk bleeding/ulceration/infection.
在 COVID-19 大流行期间，英国发布了指南，建议推迟常规子宫托复查。但这一举措的影响尚未得到充分探索。本研究的零假设是，COVID-19 大流行期间推迟常规子宫托复查不会导致并发症发生率出现统计学上的显著增加。
本研究在苏格兰泰赛德 NHS 进行了回顾性比较队列研究，纳入了 150 名大流行前患者和 150 名 COVID-19 大流行期间（排除前）患者。回顾他们的病历，记录年龄、护理提供者、子宫托类型、子宫托使用时间、复查日期、上次复查后时间间隔、出血/感染/溃疡、取出问题、子宫托更换和结局。排除的患者为复查时无子宫托在位、复查时间在 4 个月及以内（大流行前）和 8 个月及以内（COVID-19 大流行期间）的患者。
大流行前组（n=106）中，方块型、环型和其他类型子宫托的平均复查时间分别为 10.1、6.2 和 6.2 个月。总体出血/感染/溃疡率、报告的取出问题率和随后未更换的子宫托率分别为 9.4%、11.3%和 5.7%。COVID-19 大流行组（n=125）中，方块型、环型和其他类型子宫托的平均复查时间分别为 14.7、10.8 和 11.4 个月。总体出血/感染/溃疡率、报告的取出问题率和随后未更换的子宫托率分别为 21.6%、16.0%和 12.0%。
总体而言，出血/溃疡/感染发生率显著增加（p=0.01）。当考虑个别子宫托时，这种情况仅在环型子宫托中仍然成立（p=0.02）。我们的数据表明，常规环型子宫托复查不应超过 6 个月，否则可能会出现出血/溃疡/感染。
