Pain Management in Outpatient Intrauterine DevicePlacement and Hysteroscopy: A Survey of CurrentPractices

The SARS-CoV 2 pandemic is now responsible for over 48 million infections and one million deaths worldwide. Pandemics impact population growth not only by excessive mortality, but also by preventing births. In previous pandemics occurring in the 20th and 21st centuries, a trend towards birth rate reduction was observed 9 months later (Figure 1). After the 1928-20 HIN1 influenza pandemic, birth rates dropped by 5 to 15% in comparison to average rates before the pandemic [1]. This drop was related to higher death rates in pregnant patients (case fatality rate of 27%), as well as miscarriages and stillbirths (increased by 0.4% and 2.2% respectively as compared to prior average rates) [1,2]. A rebound in birth rates, however, occurred 1-2 years after this decline [3]. Moreover, several studies have shown that children born in 1929, and thus exposed to the H1N1 virus in utero, experienced worse health and socioeconomic outcomes in older ages than surrounding birth cohorts [4]. SARS-CoV and Ebola were also associated with similar trends in birth rates during and after the pandemics in 2004 and 2015, respectively. In Brazil, the Zika virus pandemic led to a 10 to 20% drop in birth rates [5].