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127 Gynaecology and Colposcopy NMH Annual Rep t | 2020 T he Ambulatory Gynaecology service at The National Maternity Hospital provides an important diagnostic and treatment facility for women with a wide range of gynaecological presentations. COVID-19 has had a significant impact on gynaecology outpatient and theatre waiting lists. In response to this increased demand, Outpatient Hysteroscopy clinics increased from three to four sessions per week in 2020. The service continued without interruption throughout 2020. The service is led by a lead clinician and provided by four Consultant Gynaecologists. The service is supported by nursing staff and health care assistants from the Gynaecology Outpatient Department. Pelvic ultrasounds are performed by ultra-sonographers in the Fetal Medicine Unit. Most referrals come directly from general practice. Referrals also come from our affiliated hospitals. In 2020, we introduced a dedicated referral form which is available on the hospital website as well as a dedicated e-mail address in order to facilitate improved triage of referrals. Many women are seen and treated in one visit. We are performing more operative cases under local anaesthetic, thereby significantly reducing the numbers of women needing to have procedures in theatre. In 2020 only 4% of our patients required procedures under general anaesthetic. This service has a significant impact on decreasing theatre waiting times and increasing theatre capacity. 2020 saw a 32% increase in the numbers of outpatient hysteroscopy procedures performed with an 84% increase in the numbers of operative hysteroscopy procedures performed. A recent audit of women referred to NMH with postmenopausal bleeding indicated that 91% of women were evaluated and had a histological diagnosis within 8 weeks and 100% within 12 weeks. A patient experience survey showed that women were very satisfied with the service provided and that procedures were well tolerated. We plan to continue expansion and development of this important service in 2021. Ambulatory Gynaecology Procedures 2016 2017 2018 2019 2020 Total no. of Patients 317 477 471 582 718 Total Outpatient Hysteroscopy Procedures 290 401 432 543 713 Diagnostic Hysteroscopy 355 395 563 Operative Hysteroscopy 76 102 150 Cases requiring general anaesthetic 13.5% 6.7% 4.5% Ambulatory Gynaecology Referral Indications 2020 2019 Hysteroscopy +- Mirena IUD insertion 563 395 Truclear / Myosure polypectomy 112 61 Betocci Hysteroscopic removal Mirena 38 39 Total 713 543 Outpatient Hysteroscopy Post Menopausal Bleeding 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% Menstrual irregularity / IUD Fertility / Rec Miscarriage Other 47 32 20 1 Ambulatory Gynaecology Referral Indications