key: cord-0867369-in5m2d3d
authors: Alsharaydeh, Ibrahim; Rawashdeh, Hasan; Saadeh, Noura; Obeidat, Basil; Obeidat, Nail
title: Challenges and solutions for maternity and gynecology services during the COVID‐19 crisis in Jordan
date: 2020-06-17
journal: Int J Gynaecol Obstet
DOI: 10.1002/ijgo.13240
sha: 066281c87737eccf5d4841ffb66c3656ec2030d2
doc_id: 867369
cord_uid: in5m2d3d

OBJECTIVE: To describe regional experiences and measures implemented to safely maintain obstetrics and gynecology services during the COVID‐19 pandemic at King Abdullah University Hospital in Jordan. METHODS: All policies and measures were implemented in keeping with World Health Organization and other international recommendations and guidelines. RESULTS: With concerted effort and a multidisciplinary approach, most maternity and gynecology services were provided and all other training and educating responsibilities were maintained. CONCLUSION: COVID‐19 caused an unprecedented global healthcare crisis. Our institution addressed the challenges and implemented several measures at different levels to maintain services and facilitate the training and teaching of trainees and medical students.

After closing routine prenatal and gynecology clinics along with other specialty clinics, the hospital system kept some clinics open to refill prescriptions for patients with chronic diseases. During the lockdown our aim was to continue providing care for all our patients (Table 1) .

Patients with acute obstetric and gynecologic complaints were advised by official authorities, national TV, social media, and front desk personnel to attend the emergency department, where an in-house team was available 24/7 to evaluate patients. In general, patients were hospitalized for the lowest number of days possible without compromising their care to decrease their chance of becoming infected with hospital-acquired COVID-19.

As is tradition in Muslim and Arabic countries, patients often present to hospital accompanied by a large number of family members to show sympathy and support. Hence, KAUH cancelled visiting hours and created a clear and strict policy to limit access to hospital to patients with only one or a maximum of two family members granted access if their presence was necessary. 

We developed a triaging system based on COVID-19 risks. Risk factors covered the risk of exposure to COVID-19, including women T A B L E 1 Measures implemented for maternity and gynecology services at King Abdullah University Hospital, Jordan, during the COVID-19 pandemic.

Confirmed living in closed endemic areas, history of travel to endemic areas, or being in contact with someone with confirmed COVID-19 infection.

A pathway color-coded red was designated for pregnant women considered high risk (women living in closed areas, history of travel to endemic areas, contact with virus-positive patients, or mild respiratory symptoms). These patients were admitted to isolation rooms and were cared for by a separate team, taking all necessary precautions and wearing appropriate PPE.

A pathway color-coded green was designated for low-risk pregnant women who were cared for per the normal routine.

Although routine gynecology clinics were deferred, we managed to maintain our care for cancer patients. Several measures were taken to reduce the risk of spreading infection and to protect patients and staff; for example, laparoscopic procedures such as total laparoscopic hysterectomy were converted to an open approach, and length of hospital stay was shortened by utilizing telephone follow-up.

Regarding the work schedule of maternity consultants and trainees, the emergency policy put forth by the hospital's administration-to minimize the exposure of healthcare providers to COVID-19-was applied. Of the 10 consultants on the unit, each one covered the service for 1 day, with no weekend block, to reduce the risk of viral exposure with high viral load.

We also modified the rota for residents who covered the in-house 24-hour call service. Furthermore, we reduced resident numbers and assigned fewer duties for trainees at high risk themselves (e.g. pregnant trainees). All consultants were available by phone to answer queries from both patients and hospital staff, and to help reading cardiotocograph traces.

The number of midwives and nursing staff was also reduced to the minimum number required to maintain the service safely.

Multiple adjustments were introduced to residency programs. Before the lockdown, we canceled the morning report to avoid the gathering of residents and consultants and adhere to the social distancing rule.

We used messaging applications to send learning materials to residents 

The medical student teaching program has also been facilitated by technology. Coordinators for fifth-and sixth-year medical students uploaded course materials through an e-learning program, which is hosted by the official website of JUST. Clinical case discussions were also conducted via Zoom for these students. The process of distance learning is continuously monitored and assessed by the Center for E-Learning and Open

Educational Resources of JUST. The feedback has been excellent.

Use of telemedicine could be beneficial during this pandemic because it facilitates care of patients through video consultation while they are isolated at home. Some countries like the USA, UK, and France have adopted and promoted the use of telemedicine during this pandemic. 7 In our hospital, work is ongoing to overcome technical and financial blockers hindering the full utilization of telemedicine.

We also adopted ordering via the internet and phone, and a home delivery system.

As the government planned for reduced restrictions and relaxed the level of lockdown, we prepared several measures to implement once routine outpatient clinics were restored (Table 2) .

T A B L E 2 Outpatient department measures implemented at King Abdullah University Hospital, Jordan, during the COVID-19 pandemic.

Reduce risk of patient crowding and exposure Laparoscopic procedures should be avoided unless the clinical advantages substantially exceed the risks of viral transmission to surgical and theater teams.

Our institution addressed the challenges, learned several lessons, and implemented several measures at different levels using a multidisciplinary approach to serve our patients, ensure patient and staff safety, and facilitate the teaching of trainees and medical students.

IA was the principal investigator and author. HA contributed to data analysis. BO and NS edited the manuscript. NO contributed to analysis and manuscript editing.

The authors have no conflicts of interest.

Jordan Ministry of Health. Corona Virus-2019 Disease

World Health Organization. COVID-19 Dashboard

College Royal of Obstetricians and Gynaecologists. Coronavirus (COVID-19) Infection in Pregnancy