Important Updates From Sound Obstetrics & Gynecology

March 2021

Wow. It’s hard to believe it has been one year since we started scouring the internet to buy toilet paper and first heard words like shelter in place, distance learning, home quarantine. A lot about our lives has changed over the past year and much has stayed the same. The same can be said for COVID.

We are getting many questions about the COVID vaccine. The arrival of the first COVID vaccines has been an exciting and hopeful new chapter in turning a corner in this global pandemic. The currently available COVID vaccines appear to be highly effective at preventing COVID-19 infection as well as severe infection, and we are very supportive of vaccination. Even patients who have had COVID-19 are encouraged to consider vaccination. For information about how these vaccines work, please refer to the information on our website.

Specific to our pregnant population, despite the lack of published data regarding these vaccines in pregnant women many have already been vaccinated, and there is increasing confidence in the safety of the vaccine in pregnant women. In addition, there is evidence that pregnant women who were sick with COVID-19 may transmit antibodies to the SARS-CoV-2 spike protein through the placenta to their babies, providing hope that the antibody response to the vaccines given to pregnant women will similarly provide some immune protection for newborn babies. Consistent with the recommendations put forth by ACOG and SMFM, we recommend that pregnant women at high risk of contracting COVID-19 (including health care and front-line workers, especially those with high-risk underlying medical conditions – including obesity, hypertension, diabetes, asthma) consider vaccination. Here is a link to ACOG’s official statement: Vaccinating Pregnant and Lactating Women Against COVID-19. In addition, non-pregnant women, women who are trying to conceive and women who are currently breastfeeding are strongly encouraged to vaccinate. It is clear that there is no evidence that vaccination leads to issues with fertility and our top reproductive scientists at Yale have refuted any scientific plausibility. Thus, women without contraindications who are considering getting pregnant or who are breastfeeding should receive the vaccination without reservation.

It is important to understand that vaccination does not alleviate the need to continue to use the now well-established precautions to prevent the spread of infection: wear masks, wash hands frequently and maintain social distance. COVID-19 is not going away any time soon. Please maintain vigilance in your infection prevention efforts. SARS-CoV-2 spreads primarily through respiratory droplets produced when an infected person coughs, sneezes or talks, and therefore basic but consistent precautions can be taken to reduce the risk of contracting COVID-19.

OFFICE UPDATES:

CURES ACT: The 21st Century Cures Act is a Federal regulation requiring that test results and clinical notes be made available to patients (via MyChart) as soon as they are finalized. For the Yale New Haven Hospital system this change went into effect on February 2, 2021 for clinical notes and March 2, 2021 for test results. This includes all in-patient and out-patient clinical notes as well as laboratory and diagnostic test results, including pathology, radiology and genetic tests. You will be sent an email advising you of new results through the MyChart system as soon as they are available. This means that you may see your test results before your physician has reviewed them. We look at every result and will contact you via MyChart or a phone call with anything that is concerning. Some results appear abnormal because they are outside of the normal range but have little clinical significance. You can choose not to review results either by not opening the result in MyChart or by informing us at the time of ordering that you do not want them automatically released to you.

As always, one of our physicians is available for emergencies through the on-call service 24 hours a day, 7 days a week. This physician is available for urgent patient issues during non-office hours; this physician is not available to review laboratory, diagnostic and pathology results after hours and on weekends. Our doctors and nurses review every test that we order and will communicate any concerns with you once reviewed. In addition, we specifically discuss any urgent pending tests with our on-call doctor when the result will determine the course of your care outside of our usual business hours.

MAMMOGRAMS: The normal immune response to the COVID-19 vaccines has led to swollen lymph nodes in the armpits and near the collarbone in some patients on the same side as the arm where the shot was given. These enlarged lymph nodes may be seen on mammogram imaging. Yale’s clinical experts have revised the management recommendations for women who are low risk for breast cancer and have no personal history of breast cancer who have unilateral axillary lymphadenopathy (swollen armpit lymph nodes on one side) within 4 weeks of COVID-19 vaccination. These recommendations take into consideration whether or not you have dense breast tissue and may involve additional screening breast ultrasounds. If this applies to you, you will be informed of the recommendations for your particular situation and appropriate orders will be placed. If you feel a lump in your armpit that lasts for more than six weeks after your vaccination, please come for an evaluation in the office.

OFFICE HOURS: Our offices are open Monday through Friday from 8am to 5pm. We continue to carefully space our patients to adhere to appropriate social distancing and infection control procedures.

CORONAVIRUS SCREENING: All patients are pre-screened by phone and undergo additional screening at check-in for recent travel, symptoms of COVID-19 and recent contacts with confirmed or suspected COVID-19. In addition, we are conducting routine temperature checks for both our patients and our staff. If you are sick with COVID-19 and need care, please reach out to us so that we can coordinate the best approach to provide you with the care that you need. All patients continue to come alone to all appointments, and appointments are spaced to optimize our ability to directly move patients to the exam room and minimize time in the waiting room.

INFECTION PREVENTION: We meticulously sanitize our exam rooms and all equipment used in the course of your care, as well as high-touch surfaces. We have clear physical barriers at check-in and check-out as an added layer of protection beyond the masks that you and we are already wearing.

FACEMASKS: Facemasks are required in all clinical care sites, including our office. A regular surgical mask or homemade fabric facemask is just fine. If you need a facemask, please let us know. We have a limited supply of extra masks that we can give to you.

VISITOR POLICY: We continue to request that all patients come to office appointments unaccompanied, including partners and children. This includes appointments in our office as well as for outpatient ultrasounds. We have started to allow a single support person to accompany our patients to their first pregnancy ultrasound, so you may see an occasional partner in the offices.

MENTAL HEALTH: Many people are experiencing anxiety, depression and other mental health issues during the pandemic, as it is a time of stress and uncertainty. Make sure you are taking care of yourself, and reach out to us if you need help.

PERSONAL SAFETY: We know that some of our patients are suffering in silence, and we want to encourage you to speak up. Whether you reach out to us over the phone, through MyChart, or during an office appointment, we want to remind you that you can safely and confidentially share with us any concerns you might have about intimate partner violence, food insecurity, or other devastating impacts the coronavirus has caused to your life. We want to help. There is a statewide hotline that is open 24/7 at 888.774.2900 or online at www.CTSafeConnect.org. The Special Supplement Nutrition Program for Women, Infants and Children (better known as “WIC”) provides supplemental food, nutrition services, health care referrals and breastfeeding support to low income pregnant and postpartum women and to children up to age 5. If you have lost your job, you have 60 days to enroll in health care access through Access Health CT, Connecticut’s health insurance marketplace.

This unprecedented time brings unusual challenges, but as always we are all in this together. Please know that we continue to be here for you.

Warm Regards,

Thomas Hanson, MD, FACOG
Musa Speranza, MD, FACOG
Steven Fleischman, MD, FACOG
Michael Reel, MD, FACOG
Margaret Baumbusch, MD, FACOG
Meagan Haynes, MD, FACOG
Erin Moroni, FNP-BC