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The 2022 monkeypox outbreak, caused by the zoonotic monkeypox virus, has spread across 6 World Health Organization regions (the Americas, Africa, Europe, Eastern Mediterranean, Western Pacific, and South-East Asia) and was declared a public health emergency of international concern on July 23, 2022. The global situation is especially concerning given the atypically high rate of person-to-person transmission, which suggests viral evolution to an established human pathogen. Pregnant women are at heightened risk of vertical transmission of the monkeypox virus because of immune vulnerability and natural depletion of population immunity to smallpox among reproductive-age women, and because orthopoxviral cell entry mechanisms can overcome the typically viral-resistant syncytiotrophoblast barrier within the placenta. Data on pregnancy outcomes following monkeypox infection are scarce but include reports of miscarriage, intrauterine demise, preterm birth, and congenital infection. This article forecasts the issues that maternity units might face and proposes guidelines to protect the health of pregnant women and fetuses exposed to the monkeypox virus. We review the pathophysiology and clinical features of monkeypox infection and discuss the obstetrical implications of the unusually high prevalence of anogenital lesions. We describe the use of real-time polymerase chain reaction tests from mucocutaneous and oropharyngeal sites to confirm infection, and share an algorithm for the antenatal management of pregnant women with monkeypox virus exposure. On the basis of the best available knowledge from prenatal orthopoxvirus infections, we discuss the sonographic features of congenital monkeypox and the role of invasive testing in establishing fetal infection. We suggest a protocol for cesarean delivery to avoid the horizontal transmission of the monkeypox virus at birth and address the controversy of mother-infant separation in the postpartum period. Obstetrical concerns related to antiviral therapy with tecovirimat and vaccinia immune globulin are highlighted, including the risks of heart rate-corrected QT-interval prolongation, inaccuracies in blood glucose monitoring, and the predisposition to iatrogenic venous thromboembolism. The possibility of monkeypox vaccine hesitancy during pregnancy is discussed, and strategies are offered to mitigate these risks. Finally, we conclude with a research proposal to address knowledge gaps related to the impact of monkeypox infection on maternal, fetal, and neonatal health.

Introduction: Disruptions of the postgraduate (PG) teaching programmes by COVID-19 have encouraged a transition to virtual methods of content delivery. This provided an impetus to evaluate the coverage of key learning goals by a pre-existing PG didactic programme in an Obstetrics and Gynaecology Specialty Training Programme. We describe a three-phase audit methodology that was developed for this. Methods: We performed a retrospective audit of the PG programme conducted by the Department of Obstetrics and Gynaecology at National University Hospital, Singapore between January and December 2019 utilising a ten-step Training Needs Analysis (TNA). Content of each session was reviewed and mapped against components of the 15 core Knowledge Areas (KA) of the Royal College of Obstetrics & Gynaecology membership (MRCOG) examination syllabus. Results: Out of 71 PG sessions, there was a 64.9% coverage of the MRCOG syllabus. Four out of the 15 KAs were inadequately covered, achieving less than 50% of knowledge requirements. More procedural KAs such as "Gynaecological Problems" and those related to labour were poorly (less than 30%) covered. Following the audit, these identified gaps were addressed with targeted strategies. Conclusion: Our audit demonstrated that our pre-pandemic PG programme poorly covered core educational objectives i.e. the MRCOG syllabus, and required a systematic realignment. The COVID-19 pandemic, while disruptive to our PG programme, created an opportunity to analyse our training needs and revamp our virtual PG programme. [ABSTRACT FROM AUTHOR]

Introduction: Selective fetoscopic laser photocoagulation (SFLP) for twin-to-twin transfusion syndrome (TTTS) is challenging for new surgeons at the start of their learning curve. We described an approach utilising telementoring and team-based training to facilitate rapid attainment of the skills required for safe and efficient practice with a limited caseload.Methods: We conducted a prospective observational study of SFLP performed by the novice primary surgical team in three stages: under direct on-site supervision from an expert mentor (Group 1), with remote tele-guidance from that mentor (Group 2) and independently (Group 3), at an academic tertiary hospital in Singapore. The primary team undertook regular training on high-fidelity tissue models to accelerate skills acquisition and complement the surgical performance.Results: Nine patients diagnosed with Stage 2 TTTS were assessed for procedural characteristics, surgical outcomes and perinatal survival following SFLP. There were no significant differences in operative duration, anastomoses ablated, gestational age or birth weight at delivery. The complications observed were: recurrent TTTS (22.2% of pregnancies), twin anaemia polycythaemia sequence (33.3%), preterm prelabour membrane rupture (22.2%) and delivery at < 32 weeks (44.4%). At least one twin was live-born in 88.9% of cases, while postnatal survival to six months of at least one twin occurred in 77.8%.Conclusion: Systematic mentoring and specialised skills training are useful in aiding new surgeons to negotiate the steep learning curve and achieve good outcomes at the start of a new practice, particularly in the setting of low patient numbers. This is best paired with dedicated model training to achieve and maintain surgical dexterity for this complex procedure. [ABSTRACT FROM AUTHOR]

Author(s): Naomi McGovern [1]; Amanda Shin [1, 2]; Gillian Low [1]; Donovan Low [1]; Kaibo Duan [1]; Leong Jing Yao [3]; Rasha Msallam [1]; Ivy Low [1]; Nurhidaya Binte Shadan [...]