Diagnosis of endometriosis in the United Kingdom takes on average eight years, with delay to diagnosis contributing to physical, psychological and social burden for women experiencing endometriosis. This study aimed to explore experiences of diagnosis in women with confirmed endometriosis. The study was informed by Constructivist Grounded Theory. Purposeful sampling was used to recruit fifteen women with confirmed endometriosis to participate in semi-structured interviews. Delay to diagnosis was identified as a key finding after analysis of four interviews and was therefore a focus for subsequent theoretical sampling. Constant comparative analysis generated codes and categories and ultimately a draft theory. A novel theoretical framework was developed, illustrating how participants fluctuated through four contexts of refusal, strong disbelief, weak disbelief and belief in their diagnosis journey, underpinned by a core category of ‘making sense of a fluctuating life’. Within each context, the framework explicates how relational power and self-perception engenders a strong psychosocial influence on recognition of risk of harm from symptoms of endometriosis and consequent investigating behaviour. The journey to diagnosis of endometriosis involves a complex interplay of psychological, social and relational factors in driving or inhibiting help-seeking behaviour, requiring sensitivity, understanding and a commitment to listen and value women’s experiences within the clinical consultation to ensure timely and appropriate investigation and management.

Delay to diagnosis of endometriosis is an increasing problem. As it stands, the mean delay to diagnosis time is nine years. There is limited research exploring the perceptions of healthcare professionals regarding the diagnosis and respective delay to diagnosis of endometriosis in the United Kingdom. This study aims to explore this further. This study used an interpretive qualitative approach involving healthcare professional perspectives on reasons for delay to diagnosis of endometriosis. A series of focus group interviews with 15 healthcare professionals (General Practitioners (GP), gynaecologists and nurses) were conducted to explore their experiences of (the pathway to) diagnosing endometriosis. The data were analysed using reflexive thematic analysis. Three main themes were identified: (1) masking and unmasking the symptoms, (2) power of the witness in diagnosis and (3) experiences that hinder the threshold to diagnosis. The presence of the patient alone is not always enough to facilitate a diagnosis, and as such, the presence of another individual, quite often a male partner enables the threshold to referral and diagnosis to be crossed. Healthcare professionals in this study described how endometriosis is often masked or rendered invisible, and how the presence of another person—most often a male partner—can legitimise symptom severity and influence referral decisions. Healthcare professionals should consider reflecting on how another individual in a consultation influences their thinking process regarding the diagnostic journey of an individual with suspected endometriosis. They should also consider their own preconceptions of endometriosis as an illness to explore how best they can support individuals with suspected endometriosis. These practical suggestions can be used to reduce the delay to diagnosis of endometriosis and bring positive change to the diagnostic process of people living with endometriosis. Not applicable.

There are few population-based studies of sufficient size and follow-up duration to have reliably assessed perinatal outcomes for pregnant women hospitalised with SARS-CoV-2 infection. The United Kingdom Obstetric Surveillance System (UKOSS) covers all 194 consultant-led UK maternity units and included all pregnant women admitted to hospital with an ongoing SARS-CoV-2 infection. Here we show that in this large national cohort comprising two years' active surveillance over four SARS-CoV-2 variant periods and with near complete follow-up of pregnancy outcomes for 16,627 included women, severe perinatal outcomes were more common in women with moderate to severe COVID-19, during the delta dominant period and among unvaccinated women. We provide strong evidence to recommend continuous surveillance of pregnancy outcomes in future pandemics and to continue to recommend SARS-CoV-2 vaccination in pregnancy to protect both mothers and babies.

The use of tranexamic acid for postpartum hemorrhage has entered obstetrical practice globally with the evidence-based expectation of saving lives. This improvement in the care of women with postpartum hemorrhage has come at a price. For the anesthetist, having tranexamic acid ampoules close at hand would seem an obvious strategy to facilitate its use during cesarean delivery, an important setting for severe hemorrhage. Tragically, we have identified a number of recent instances of inadvertent intrathecal administration of tranexamic acid instead of local anesthetic for spinal anesthesia. Reported cases of this catastrophic error seem to be increasing. The profound neurotoxicity of tranexamic acid causes rapid-onset convulsions, with mortality of 50%. How can these tragic errors be averted? Drug safety alerts have been issued by the US Food and Drug Administration and the World Health Organization, but that is not enough. We recommend extensive dissemination of information to raise awareness of this potential hazard, and local hospital protocols to ensure that tranexamic acid is stored separately from anesthetic drugs, preferably outside the operating room and with an auxiliary warning label. Implementation of safety strategies on a very large scale will be needed to ensure that the life-saving potential of tranexamic acid is not eclipsed by drug-error mortality.

Post Reproductive Health 2022, Vol. 28(3) 123–125 © The Author(s) 2022 Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/20533691221104879 journals.sagepub.com/home/min Joint position statement by the British Menopause Society, Royal College of Obstetricians and Gynaecologists and Society for Endocrinology on best practice recommendations for the care of women experiencing the menopause

Objective: We aimed to identify changes in rates of early pregnancy complications and how they were managed during the period from MayAugust 2020 of COVID19 pandemic compared to the similar period from the previous year. Did COVID19 pandemic (and restrictions after the first UK Lockdown) shift management of early pregnancy complications towards a more conservative approach? Did it lead to late presentation and more complications? Did it affect the management of miscarriage? Design: Observational, Casecontrol study. Methods: Data on early pregnancy booking from primary care South Tees Hospitals was collected from hospital admissions records and early pregnancy unit records. We compared booking, outcomes and management of early pregnancy complications for the period MayAugust 2020 and compared it to the same period in 2019. Results: There was relatively less early pregnancy bookings in the above period in 2020 (n = 1764) compared to 2019 (n = 1958); however, the final year booking numbers were not significantly different at 4871 in 2020 and 4958 in 2019. The rate of ectopic pregnancy was similar at 19/1764 (1.1%) in 2020 and 23/1958 (1.2%) in 2019 (p = 0.780). One ectopic pregnancy (1/19) had medical management in 2020, all other ectopic pregnancies were surgically managed for 2020 and 2019. The rate of miscarriage was similar at 165/1764 (9.4%) for 2020 and 179/1958 (9.1%) for 2019 (p = 0.839). The women's preference for management of miscarriages (expectant, medical or surgical) did not change significantly despite the restrictions on hospital attendance and the potential fear of acquiring infection. Surgical management rate was 9/88 (10.22%) and 7/98 (7.14%) for 2020 and 2019, respectively. Medical management of miscarriage rate was 42/88 (47.72%) and 49/98 (50%) for 2020 and 2019, respectively. Expectant management rate was 37/88 (42.05%) and 42/98 (42.86%) for 2020 and 2019, respectively (p = 0.754). Conclusion: The rate of early pregnancy complication and the way they were managed did not appear to have been affected by the COVID 19 pandemic and the associated public health measures adopted. Women appear to have delayed booking their pregnancy to limit contact with healthcare professionals during the first lockdown in 2020. ENDOMETRIOSIS AND UTERINE DISOR DERS

There is a lack of population level data on risk factors and impact of severe COVID-19 in pregnancy. The aims of this study were to determine the characteristics, and maternal and perinatal outcomes associated with severe COVID-19 in pregnancy compared with those with mild and moderate COVID-19 and to explore the impact of timing of birth. This was a secondary analysis of a national, prospective cohort study. All pregnant women admitted to hospital in the UK with symptomatic SARS-CoV-2 from March 1, 2020 to October 31, 2021 were included. The severity of maternal infection (need for high flow or invasive ventilation, intensive care admission or died), pregnancy and perinatal outcomes, and the impact of timing of birth were analyzed using multivariable logistic regression. Of 4436 pregnant women, 13.9% ( n  = 616) had severe infection. Women with severe infection were more likely to be aged ≥30 years (adjusted odds ratio [aOR] aged 30–39 1.48, 95% confidence interval [CI] 1.20–1.83), be overweight or obese (aOR 1.73, 95% CI 1.34–2.25 and aOR 2.52 95% CI 1.97–3.23, respectively), be of mixed ethnicity (aOR 1.93, 95% CI 1.17–3.21) or have gestational diabetes (aOR 1.43, 95% CI 1.09–1.87) compared with those with mild or moderate infection. Women with severe infection were more likely to have a pre-labor cesarean birth (aOR 8.84, 95% CI 6.61–11.83), a very or extreme preterm birth (28–31+ weeks’ gestation, aOR 18.97, 95% CI 7.78–14.85; <28 weeks’ gestation, aOR 12.35, 95% CI 6.34–24.05) and their babies were more likely to be stillborn (aOR 2.51, 95% CI 1.35–4.66) or admitted to a neonatal unit (aOR 11.61, 95% CI 9.28–14.52). Of 112 women with severe infection who were discharged and gave birth at a later admission, the majority gave birth ≥36 weeks (85.7%), noting that three women in this group (2.7%) had a stillbirth. Severe COVID-19 in pregnancy increases the risk of adverse outcomes. Information to promote uptake of vaccination should specifically target those at greatest risk of severe outcomes. Decisions about timing of birth should be informed by multidisciplinary team discussion; however, our data suggest that women with severe infection who do not require early delivery have mostly good outcomes but that those with severe infection at term may warrant rapid delivery.

Safety and effectiveness of COVID-19 vaccines during pregnancy is a particular concern affecting vaccination uptake by this vulnerable group. Here we evaluated evidence from 23 studies including 117,552 COVID-19 vaccinated pregnant people, almost exclusively with mRNA vaccines. We show that the effectiveness of mRNA vaccination against RT-PCR confirmed SARS-CoV-2 infection 7 days after second dose was 89·5% (95% CI 69·0-96·4%, 18,828 vaccinated pregnant people, I 2 = 73·9%). The risk of stillbirth was significantly lower in the vaccinated cohort by 15% (pooled OR 0·85; 95% CI 0·73–0·99, 66,067 vaccinated vs. 424,624 unvaccinated, I 2 = 93·9%). There was no evidence of a higher risk of adverse outcomes including miscarriage, earlier gestation at birth, placental abruption, pulmonary embolism, postpartum haemorrhage, maternal death, intensive care unit admission, lower birthweight Z-score, or neonatal intensive care unit admission ( p > 0.05 for all). COVID-19 mRNA vaccination in pregnancy appears to be safe and is associated with a reduction in stillbirth.

Objectives:To describe the severity of maternal infection when the omicron SARS-CoV-2 variant (B.1.1.529) was dominant (15 December 2021 to 14 March 2022) and describe outcomes by symptoms and vaccination status. Design:Prospective, national cohort study using the UK Obstetric Surveillance System. Setting:94 hospitals in the UK with a consultant led maternity unit. Participants:Pregnant women admitted to hospital for any cause with a positive SARS-CoV-2 test. Main outcome measures:Symptomatic or asymptomatic infection, vaccination status by doses before admission, and severity of maternal infection (moderate or severe infection according to modified World Health Organization's criteria). Results:Of 3699 women who were admitted to hospital, 986 (26.7%, 95% confidence interval 25.3% to 28.1%) had symptoms; of these, 144 (14.6%, 12.5% to 17.0%) had a moderate to severe infection, 99 (10.4%, 8.6% to 12.5%) of 953 received respiratory support, and 30 (3.0%, 2.1% to 4.3%) were admitted to an intensive care unit. Covid-19 specific drug treatment was given to 13 (43.3%) of the 30 women in intensive care. Four women with symptoms died (0.4%, 0.1% to 1.1%). Vaccination status was known for 845 (85.6%) women with symptoms; 489 (58.9%) were unvaccinated and only 55 (6.5%) had three doses. Moderate to severe infection was reported for 93 (19.0%) of 489 unvaccinated women with symptoms, decreasing to three (5.5%) of 55 after three doses. Among the 30 women with symptoms who were admitted to intensive care, 23 (76.7%) were unvaccinated and none had received three doses. Conclusion:Most women with severe covid-19 disease were unvaccinated and vaccine coverage among pregnant women admitted to hospital with SARS-CoV-2 was low. Ongoing action to prioritise and advocate for vaccine uptake in pregnancy is essential. A better understanding of the persistent low use of drug treatments is an urgent priority. Trial registration:ISRCTN 40092247.