The American College of Obstetricians and Gynecologists (ACOG) posted a useful resource on its website on March 30 for clinicians practicing ambulatory gynecology. The guidance, “COVID-19 FAQs for Obstetrician–Gynecologists, Gynecology” ( https://www.acog.org/), is based on expert opinion and is intended to supplement guidance from the Centers for Disease Control and Prevention as well as previously issued ACOG guidance. 1
Which patients need to be seen, and when
The ACOG guidance provides examples of patients needing in-person appointments, video or telephone visits, or for whom deferral of a visit until after the COVID-19 outbreak would be appropriate. Highlights include:
In-person appointments
- suspected ectopic pregnancy
- profuse vaginal bleeding
Video or telephone visits
- contraceptive counseling and prescribing
- management of menopausal symptoms
Deferral of a visit until after the COVID-19 outbreak
- routine well-woman visits for average-risk patients.
Cervical screening
With respect to patients with abnormal cervical cancer screening results, ACOG recommends the ASCCP’s guidance that 2:
- for patients with low-grade test results, colposcopy/cervical biopsies be deferred up to 6 to 12 months
- for patients with high-grade results, colposcopy/cervical biopsies be performed within 3 months.
Contraception
Regarding contraceptive services, the ACOG guidance suggests that placement of intrauterine devices (IUDs) and contraceptive implants should continue “where possible.” If initiation of long-acting reversible contraception (LARC) is not feasible, the guidance recommends that use of self-administered contraceptives (including subcutaneous injections, oral, transdermal patch, and vaginal ring contraception) be encouraged as a bridge to later initiation of LARC.
The guidance suggests that removal of IUDs and implants be postponed when possible.
Finally, the guidance suggests that patients with an existing IUD or implant who seek removal and replacement of their contraceptives be counseled regarding extended use of these devices.
Individualize your approach
ACOG emphasizes that no single solution applies to all situations and that each practice or clinic should evaluate the individual situation, including the availability of local and regional resources, staffing, and personal protective equipment; the prevalence of COVID-19 in the region; and the type of practice.
A roadmap for care
This guidance from ACOG should help clinicians caring for women during the COVID-19 outbreak to counsel and guide patients in a prudent manner.