UAE and myomectomy both result in significant and equal improvements in QoL. UAE allows a shorter hospital stay and fewer major complications but with a higher rate of reintervention.

What are the novel findings of this work? Preterm delivery occurred in a higher proportion of women with SARS-CoV-2 infection in the PAN-COVID and AAP-SONPM registries compared to contemporaneous and historical national data from uninfected women in the UK and USA. The majority of preterm deliveries occurred between 32 + 0 and 36 + 6 weeks' gestation. SARS-CoV-2 infection in pregnancy did not appear to be associated with a clinically significant effect on fetal growth, adverse neonatal outcome or the rate of stillbirth. Although maternal death was uncommon, the rate was higher than expected based on UK and USA population data, which is likely explained by underascertainment of women affected by milder or asymptomatic infection in pregnancy in the PAN-COVID study, although not in the AAP-SONPM study. What are the clinical implications of this work? Pregnant women should be counseled that SARS-CoV-2 infection increases the risk of preterm delivery but not stillbirth, early neonatal death or a small baby. Healthcare providers should recommend SARS-CoV-2 vaccination in pregnant women and women planning pregnancy, alongside enhanced social distancing.

The use of intravaginal pessaries has been proven integral in the conservative treatment of pelvic organ prolapse (POP) and urinary incontinence (UI). Although there is no shortage of studies supporting the efficacy of intravaginal devices for conservative management of POP and UI and a large variety of pessaries are widely used in the UK, data on the clinical practice and recommended changing intervals are lacking. To evaluate the current clinical practice and management of patients with vaginal pessaries, self-administered questionnaires were mailed to all UK-based consultant obstetricians and gynaecologists. A total of 640 out of 1,173 (54.6%) clinicians approached returned the questionnaire, out of which 555 (86.7%) used vaginal pessaries. A total of 129 out of 555 (23.3%) clinicians claimed to change their patients pessaries every 3-6 months; 372 (67.0%) every 6 months and 54 (9.7%) reported a frequency of 6-12 months before changing the device. Complication rates of 40.3%, 35.2% and 18.5% were observed by clinicians performing 3-6 monthly, 6-monthly and up to 12-monthly changing intervals. Discontinuation of pessary use was related to recurrent involuntary expulsion in 54.0% (268/496), discomfort (27.4%, 136/49), vaginal bleeding and infection (7.8%, 39/496 clinicians) and dislike of the changing procedure (10.7%, 53/496). Changing intervals greatly vary between clinicians all over the country. The lack of differences in proportions of complications observed in 3-monthly and even up to 12-monthly observation periods suggest that 6-monthly and probably up to 12-monthly intervals represent a safe and cost-effective regimen to follow-up patients with vaginal pessaries.

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