COVID-19 FAQs for Obstetrician–Gynecologists, Gynecology

• Q: Should I screen patients before they come in for in-person appointments?

  Last updated March 30, 2020 at 9:55 a.m. EST.

  A remote approach can be considered for the routine screening of patients (and their companions, if permitted by local regulation) for potential exposure to or symptoms of COVID-19 (eg, cough, sore throat, fever) before their in-person appointment to prevent persons with COVID-19 symptoms from entering the facility. This can be done through phone calls before in-person appointments asking about recent travel, potential exposure, and symptoms. Patients should be proactively instructed to call on or before the day they are scheduled to be seen to discuss the need to reschedule their appointment if they develop symptoms of a respiratory infection (eg, cough, sore throat, fever) or if they think they have been exposed to COVID-19. Additionally, health care clinicians should confirm whether a person currently is undergoing testing for COVID-19.

  If, after screening, the patient reports symptoms of or exposure to a person with COVID-19 infection, the patient should be instructed not to come to the health care facility for the appointment and health care clinicians should contact the local or state health department to report the patient as a possible person under investigation. However, if the patient is experiencing urgent symptoms, local policies should be in place to accommodate the in-person appointment (eg, see the patient as the last appointment of the day so the room can be disinfected afterward; see the patient in an area separate from other patient examination rooms).  
  
  Because of the risk of exposure to COVID-19 by health care personnel and patients, it may be necessary to modify visitor policies. Limitations to the number of persons accompanying the patient, guests, and visitors should be based on guidance from local and state health departments and institutional or practice policies, community spread, state recommendations, and patient need.  

  Additional Resources on COVID-19 From Other Organizations

  (These links are for resource purposes only and should not be considered developed or endorsed by the American College of Obstetricians and Gynecologists):

  • Steps to help prevent the spread of COVID-19 if you are sick (CDC)

   
• Q: What are some considerations regarding the use of telehealth? REVISED

  Last updated March 19, 2021 at 4:10 p.m. EST.

  ACOG encourages practices and facilities that do not yet have the infrastructure to offer telehealth to strategize how telehealth could be integrated into their services as appropriate. Importantly, the ability to access telemedicine may vary by patient resources and some assessment of the patient’s condition and the patient’s available resources—although often challenging in times of crisis—is necessary to ensure equitable care. Some patients may not be able to access technology appropriate for telehealth services; practices and facilities are encouraged to explore ways to ensure those patients still have access to care. 

  As part of the COVID-19 emergency response, several new federal telehealth allowances have been made. These may be subject to ongoing changes; please see ACOG’s Managing Patients Remotely: Billing for Digital and Telehealth Services for the latest information on federal policy changes and coding advice.
  
  The Department of Health and Human Services Office for Civil Rights has announced that it will exercise enforcement discretion and waive penalties for HIPAA violations against health care professionals who serve patients in good faith through everyday communications technologies, such as FaceTime or Skype, during the COVID-19 nationwide public health emergency. See HHS.gov for more information on the Department of Health and Human Services response to COVID-19 and HIPAA.
  
  For obstetrician–gynecologists, maintaining confidentiality when meeting with a patient by phone or virtual visit is essential. Confidentiality is a vital component of the patient-physician relationship; it may be especially important for adolescent patients or adult patients at high risk of intimate partner violence.

  The ability to use telehealth for purposes of obtaining informed consent is affected by state rules and regulations; members are encouraged to become familiar with local, regional, and state rules, regulations, and polices regarding the use of telehealth and informed consent. The Department of Health and Human Services offers information on obtaining informed consent for care provided via telehealth.
  
  The Drug Enforcement Administration has released guidance allowing health care professionals registered by the administration to issue prescriptions for controlled substances without an in-person medical evaluation for the duration of the public health emergency.

  For more information on telehealth, see COVID-19 FAQs for Obstetrician-Gynecologists, Telehealth.

  ACOG Resources

  • Committee Opinion No. 803, Confidentiality in Adolescent Health Care
  • Committee Opinion No. 518, Intimate Partner Violence
  • Patient Education: Intimate Partner Violence

  Additional Resources on COVID-19 From Other Organizations

  (These links are for resource purposes only and should not be considered developed or endorsed by the American College of Obstetricians and Gynecologists):

  • Current State Laws & Reimbursement Policies (The National Telehealth Policy Resource Center)
  • Obtaining Informed Consent (The Agency for Healthcare Research and Quality)
  • Easy-to-Understand Telehealth Consent Form (The Agency for Healthcare Research and Quality)
    
     
• Q: What are special considerations for intimate partner violence and domestic violence screening and prevention services? REVISED

  Last updated June 30, 2021 at 9:35 a.m. EST.

  There have been reports of the exacerbation of intimate partner violence during the COVID-19 pandemic. ACOG recommends screening all patients for intimate partner violence at periodic intervals in a private and safe setting with the patient alone and not in the presence of a partner, friends, family, or caregiver. During this pandemic, screening may need to be provided by telehealth. Screening for intimate partner violence via telehealth may not allow individuals the privacy or safety needed to disclose abuse. In addition to possibly screening during telehealth appointments, physicians should consider screening during continued in-person appointments in a private and safe setting with the patient alone and not in the presence of a partner, friends, family, or caregiver.

  Obstetrician–gynecologists should proactively identify local resources and understand how those services have been adapted to provide support in the current situation. Resources such as local hotline contacts, referral information, and safety procedures can be communicated by a telehealth visit. 

  If a patient needs help, they can call the 24-hour, toll-free National Domestic Violence Hotline: 800-799-SAFE (7233) and 800-787-3224 (TTY). Or they can text LOVEIS to 22522 or use the live chat option at www.thehotline.org.  

  ACOG Resources

  • Committee Opinion No. 518, Intimate Partner Violence

  Additional Resources on COVID-19 From Other Organizations

  (These links are for resource purposes only and should not be considered developed or endorsed by the American College of Obstetricians and Gynecologists)

  • Information on COVID-19 for Survivors, Communities, and DV/SA Programs (Futures Without Violence)
• Q: What is known about the association of COVID-19 with hypercoagulation and how does it affect counseling for use of estrogen-containing medications?

  Last updated May 12, 2020 at 5:15 p.m. EST.

  There are reports of high rates of venous thromboembolism (VTE) in patients with severe COVID-19 disease (eg, patients hospitalized in an intensive care unit). More data are needed on who is likely to develop this complication and how it can be managed in patients with COVID-19. Other risk factors also may be present in patients with COVID-19 who develop VTE, and it is not currently known if COVID-19 infection is an independent risk factor. Based on current data, obstetrician–gynecologists should continue to counsel patients and prescribe estrogen-containing medications, including hormone therapy and hormonal contraception, as indicated––based on the individual patient’s desires, risks factors, and needs.

  Although the risk of VTE is increased among people using estrogen-containing contraceptives compared with progestin-only hormonal contraceptives, and non-hormonal contraceptives, this risk is still very low and is much lower than the risk of VTE during pregnancy and the immediate postpartum period. When prescribing any contraceptive method, clinicians should consider an individual’s risk factors for VTE and refer to the U.S. Medical Eligibility Criteria for Contraceptive Use issued by the Centers for Disease Control and Prevention. 
  
  For postmenopausal estrogen therapy and hormone therapy, as part of the shared decision-making process, the women’s health professional should discuss the risks and benefits when prescribing combination estrogen plus progestin hormone therapy or estrogen therapy. In healthy individuals without  risk factors, the probability of VTE is generally low. Risk increases with age and the presence of co-morbidities, including cardiovascular disease, obesity, fracture, renal disease, and both congenital and acquired thrombophilic disorders. Careful assessment of personal and family history of patients before prescribing hormone therapy or estrogen therapy is critical.
  
  ACOG Resources

  • Practice Bulletin No. 216, Use of Hormonal Contraception in Women With Coexisting Medical Conditions
  • Practice Bulletin No. 84, Prevention of Deep Vein Thrombosis and Pulmonary Embolism
  • Committee Opinion No. 540, Risk of Venous Thromboembolism Among Users of Drospirenone-Containing Oral Contraceptive Pills
  • Committee Opinion No. 556, Postmenopausal Estrogen Therapy: Route of Administration and Risk of Venous Thromboembolism

  Additional Resources on COVID-19 From Other Organizations
  (These links are for resource purposes only and should not be considered developed or endorsed by the American College of Obstetricians and Gynecologists):

  • U.S. Medical Eligibility Criteria for Contraceptive Use (Centers for Disease Control and Prevention)
  • COVID-19 and Coagulopathy: Frequently Asked Questions (American Society of Hematology)
  • COVID-19 resources on coagulation and anticoagulation (International Society on Thrombosis and Haemostasis) 

   
• Q: If a patient reports having a positive antibody test, does that individual need additional testing before having a gynecologic procedure? REVISED

  Last updated July 14, 2020 at 9:12 a.m. EST.

  Depending on capacity and supply, some hospitals have implemented universal preoperative testing for all patients scheduled for surgery. If a health care institution has established universal testing, it is important to note that serologic (antibody) testing does not replace diagnostic testing for COVID-19 infection. Antibody tests are nondiagnostic for acute COVID-19 infection, and it is unknown whether the presence of antibodies confers immunity (WHO). COVID infection is diagnosed by polymerase chain reaction (PCR) testing of a nasopharyngeal sample. Antibody testing should not be used for presurgical screening or other clinical decision making.

  Health care professionals should be aware of the limitations of antibody tests; they should not be used as the sole basis to diagnose COVID-19, to determine staffing decisions or decisions regarding the need for personal protective equipment (PPE), or to determine if a person has immunity to COVID-19 (AMA, AAFP, IDSA). Instead, these tests should be used to ascertain information about whether a person may have previously been exposed. On June 19, 2020, the U.S. Food and Drug Administration (FDA) released guidance recommending that  clinical laboratories and health care professionals stop using COVID-19 antibody tests that are listed on FDA’s “removed” test list. Additionally, for those patients who have been evaluated with an antibody test on FDA’s “removed” test list, FDA recommends considering the patient’s clinical presentation, medical history, and whether prior test results generated using these tests may have been incorrect when deciding whether the patient should be retested using an FDA-authorized test. 
  
  A recent Cochrane review on the diagnostic accuracy of antibody tests concluded that the timing of testing is important. Antibody testing appears to be most accurate when used 15 or more days after the onset of symptoms. However, there are currently scarce data on the efficacy of antibody tests beyond 35 days after symptom onset. 

  As recommended by the Centers for Disease Control and Prevention, regardless of a positive or negative antibody test, individuals should take preventive measures to protect themselves and others.
  
  Additional Resources on COVID-19 From Other Organizations

  (These links are for resource purposes only and should not be considered developed or endorsed by the American College of Obstetricians and Gynecologists):

  • Interim Guidelines for COVID-19 Antibody Testing in Clinical and Public Health Settings (CDC)
  • FAQs on Testing for SARS-CoV-2 (FDA)
  • “Removed” Test  List (see “What Tests Should No Longer Be Distributed for COVID-19?”) (FDA)

   
• Q: How should gynecologic patient care be prioritized? NEW

  Last updated August 9, 2021 at 10:32 a.m. EST.

  Plans for modifying care are best made at the local level with consideration of patient populations and available resources. Determining how best to care for patients given the COVID-19 pandemic depends on the patient’s signs and symptoms, the patient’s comorbidities and underlying medical condition, the acuity of the presentation (eg, acute versus chronic condition), available health resources, and other factors.

  Modifying the approach to care only is appropriate when the risk of exposure to COVID-19 is elevated and health care resources for outpatient care are reduced; normal care approaches and schedules should resume when this risk subsides.

  Examples of how a practice or institution may consider distinguishing urgent patient issues from those that can be addressed by telehealth or deferred until after the COVID-19 outbreak are listed below (This list is not meant to be exhaustive). Categorization or triaging of medical services should be based on the needs and resources of the individual practice, hospital, or health system and should be individualized based on patient considerations.

  In-person appointment: situations in which delay would be harmful to patient health and safety; presence of fever or concern for gynecologic infection not related to COVID-19; suspected ectopic pregnancy; severe postoperative concerns that cannot be triaged by phone; profuse abnormal vaginal bleeding with symptoms of anemia.

  By telehealth (virtual visit or phone appointment): contraceptive counseling and prescribing; asymptomatic ovarian cyst; management of menopausal symptoms; routine gynecologic or postoperative follow-up; routine medication abortion care; mental or behavioral health screening.

  May potentially be deferred until after the COVID-19 outbreak: preventive visits; routine screenings for average-risk patients.

  ACOG Resources

  Position Statement, Resumption of Comprehensive Women’s Health Care Policies and Processes

  Additional Resources on COVID-19 From Other Organizations

  (These links are for resource purposes only and should not be considered developed or endorsed by the American College of Obstetricians and Gynecologists):

  • Interim Guidance for Timing of Diagnostic and Treatment Procedures for Patients with Abnormal Cervical Screening Tests (ASCCP)
  • COVID-19 Updates and Resources (American Society for Reproductive Medicine)
  • Surgical Considerations for Gynecologic Oncologists During the COVID-19 Pandemic (Society of Gynecologic Oncology)  
  • Interim Guidance for COVID-19 and Persons with HIV (National Institutes of Health) 
  • COVID-19 and Human Reproduction Joint Statement (American Society for Reproductive Medicine, European Society of Human Reproduction and Embryology, and International Federation of Fertility Societies)
  • Patient Management and Clinical Recommendations During The Coronavirus (COVID-19) Pandemic (American Society for Reproductive Medicine)
• Q: What surgeries should be postponed? NEW

  Last updated August 9, 2021 at 10:32 a.m. EST.

  Surgical procedures performed by obstetrician–gynecologists are generally medically indicated procedures necessary for the furtherance of patient health and safety. In areas where COVID-19 is particularly prevalent or where there is particular stress on the health care system, it may be necessary to modify surgical scheduling, including for procedures that are medically indicated, when a patient’s health and safety would not be harmed by such delay. Obstetric and gynecologic procedures for which a delay will negatively affect patient health and safety should not be delayed. Criteria for delaying gynecologic procedures should be based on disease severity rather than a specific surgical procedure.

  For more information, see the Joint Statement on Elective Surgeries (American College of Obstetricians and Gynecologists, American Association of Gynecologic Laparoscopists, American Society for Reproductive Medicine, the American Urogynecologic Society, the Society of Family Planning, the Society of Gynecologic Surgeons, the Society for Maternal-Fetal Medicine, and the Society of Gynecologic Oncology).

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