American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

American College of Surgeons COVID-19 and Surgery Clinical Issues and Guidance COVID-19: Elective Case Triage Guidelines for Surgical Care COVID-19 Guidelines for Triage of Gynecology Patients

COVID-19 Guidelines for Triage of Gynecology Patients

Online March 24, 2020

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View the American College of Obstetrics and Gynecology website for COVID-19 recommendations.

Suggestions from Temple University for handling the scheduling of OB/Gyn surgical cases during COVID19 pandemic.

Emergency surgeries (no delay)

  • Ectopic pregnancy
  • Spontaneous abortion
  • Adnexal torsion
  • Rupture tubal-ovarian abscess
  • Tubal-ovarian abscess not responding to conservative therapy
  • Acute and severe vaginal bleeding
  • Cesarean section
  • Emergency cerclage of the cervix based on pelvic exam/ultrasound findings

Surgeries that if significantly delayed could cause significant harm.

  • Cancer or Suspected cancer
    • Ovarian, Tubal or Peritoneal cancer
    • Ovarian masses cancer is suspected
    • Endometrial cancer and endometrial intraepithelial neoplasia
    • Cervix cancer
    • Vulvar cancer
    • Vaginal cancer
    • Gestational Trophoblastic Neoplasia
  • Cerclage of the cervix to prevent premature delivery based on history
  • Pregnancy termination (for medical indication or patient request)

Surgeries that could be delayed for a few weeks

  • Chorionic villus sampling/amniocentesis (CVS is performed between 11 and 14 weeks of gestation; amniocentesis is performed 15-22 weeks of gestation)
  • D&C with or without hysteroscopy for abnormal uterine bleeding (pre- or postmenopausal) when cancer is suspected
  • Cervical conization or Loop Electro-Excision Procedure to exclude cancer
  • Excision of precancerous or possible cancerous lesions of the vulva

Surgeries that can be delayed several months

  • Sterilization procedures (e.g., salpingectomy)
  • Surgery for fibroids (sarcoma is not suspected)
    • Myomectomy
    • Hysterectomy
  • Surgery for endometriosis, pelvic pain
  • Surgery for adnexal masses that are most likely benign (e.g., dermoid cyst)
  • Surgery for pelvic floor prolapse
  • Surgery for urinary and/or fecal incontinence
  • Therapeutic D&C with or without hysteroscopy with or without endometrial ablation for abnormal uterine bleeding and cancer is not suspected
  • Cervical conization or Loop Electro-Excision Procedure for high grade squamous intraepithelial lesions
  • Infertility procedures (e.g., hysterosalpingograms, most elective embryo transfers)
  • Genital plastic surgery
  • Excision of condyloma acuminata (if cancer is not suspected)

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