The associated factors of cesarean section during COVID-19 pandemic: a cross-sectional study in nine cities of China

Impact of COVID-19 pandemic on the circadian rhythm of cesarean section deliveries

Circadian rhythms synchronize all biological functions, enabling humans to foresee and respond better to periodic environmental changes. The coronavirus disease (COVID-19) lockdown regulations significantly changed the lighting conditions in pregnant women, leading to chronological disruption. This study aimed to investigate the impact of the COVID-19 on the circadian rhythm of cesarean deliveries. We investigated whether the circadian rhythm of cesarean section deliveries changed during the first year of the COVID-19 pandemic at a tertiary hospital in Van Province, eastern Turkey. We analyzed the distribution of birth times for 1476 cesarean deliveries performed between March 01, 2020 and January 20, 2021 (1st year of the COVID-19 pandemic) and compared this information with data from 1194 cesarean deliveries performed during a similar period in the previous year. The primary outcome was the change in the circadian rhythm of cesarean deliveries. Secondary outcomes included cesarean section (CS) delivery rates, indications for CS, 1st and 5th minutes Appearance (skin color), Pulse (heart rate), Grimace (reflex irritability), Activity (muscle tone), and Respiration scores, and anesthesia technique use rates. Regarding the time distribution of CS deliveries in the first year of the COVID-19 pandemic, the maximum number of cesarean deliveries (n = 234, 16%) occurred between 14:00 and 16:00 (P = .112). Cesarean deliveries in pre-COVID-19 group were most frequently performed between 10:00 and 12:00, at a rate of 18% (n = 216) (P = .001). In both groups, the time point at which CS deliveries were the least performed was 04:00 to 06:00, and the rates were different (n = 35, 2% and n = 14, 1%, respectively) (P = .022). A 4-hour phase shift was detected at the peak of the birth time in the first year of the COVID-19 pandemic compared to the previous year. These results suggest that the circadian rhythm of cesarean deliveries is affected by the pandemic.

Is the surge in cesarean section rates during the COVID-19 pandemic truly substantiated?

BACKGROUND

Cesarean section (C-section) rates, deemed a critical health indicator, have experienced a historical increase. The advent of the COVID-19 pandemic significantly impacted healthcare patterns including delays or lack of follow-up in treatment and an increased number of patients with acute problems in hospitals. This study aimed to explore whether the observed surge is a genuine consequence of pandemic-related factors.

METHODS

This study employs an Interrupted Time Series (ITS) design to analyze monthly C-section rates from March 2018 to January 2023 in Kurdistan province, Iran. Segmented regression modeling is utilized for robust data analysis.

RESULTS

The C-section rate did not show a significant change immediately after the onset of COVID-19. However, the monthly trend increased significantly during the post-pandemic period (p < 0.05). Among primigravid women, a significant monthly increase was observed before February 2020 (p < 0.05). No significant change was observed in the level or trend of C-section rates among primigravid women after the onset of COVID-19.

CONCLUSION

This study underscores the significant and enduring impact of the COVID-19 pandemic in further increasing the C-section rates over the long term, the observed variations in C-section rates among primigravid women indicate that the COVID-19 pandemic had no statistically significant impact.

Maternal Characteristics and Outcomes Affected by COVID-19 Pandemic in Indonesia

Aim

Compare the impact of the intervention on the outcome of pregnancy of patients receiving obstetric care with and non-COVID-19 diagnosis at a tertiary referral hospital located in the region of East Java, Indonesia.

Methods

This was a cross-sectional analysis of 694 pregnant women. These patients' information was acquired based on the medical data obtained from the hospital. The Mann-Whitney test was used to analyze the disparities among the factors examined in this research investigation.

Results

There was a statistically significant difference in length of stay (LOS). It has been shown that individuals diagnosed with COVID-19 often exhibit a longer length of stay (LOS) in healthcare facilities compared to those who do not have the infection. More than fifty percent of patients gave birth by cesarean section, 83 in COVID-19 group and 283 in non-COVID-19 group. The most prevalent complications among COVID-19 patients were maternal infectious and parasitic diseases (1.3 vs 0%), prolonged labor (12.3 vs 9.6%) and puerperal complications (0.6 vs 0%). In 40.9% of COVID-19 patients, acute respiratory distress syndrome (ARDS) was encountered. Infection due to COVID-19 had no discernible impact on the outcomes of pregnancy.

Conclusion

Numerous interventions, including cesarean delivery in COVID-19 and non-COVID-19 patients, require reevaluation. It is imperative to undertake a comprehensive reassessment of the health care delivery system, with particular emphasis on enhancing the efficacy of the referral system.

The impact of covid-19 pandemic on pregnancy outcome

BACKGROUND

The acute respiratory disease caused by the coronavirus (COVID-19) has spread rapidly worldwide yet has not been eliminated. The infection is especially deadly in vulnerable populations. The current studies indicate that pregnant women are at greater risk of getting seriously ill. Even though fetuses protect against disease, the additional finding showed that the COVID-19 pandemic could increase fetal and maternal morbidities. In a situation where COVID-19 and new strains of the virus are still not controlled, scientists predicted that the world might experience another pandemic. Consequently, more research about the effects of COVID-19 infection on pregnancy outcomes is needed. This study aimed to compare the pregnancy outcomes of Iranian pregnant women in the first year of the pandemic with the previous year.

METHODS

This prospective cross-sectional study was performed to compare the pregnancy outcome during the COVID-19 pandemic among Iranian pregnant women who gave birth during the pandemic and one year before the pandemic (2019-2020 and 2020-2021). The sample size was 2,371,332 births registered at hospitals and birth centers platforms. The studied variables include stillbirth, congenital anomaly, birth weight, preeclampsia, gestational diabetes, cesarean section, ICU admission, mean of the gestational age at birth, preterm births, NICU admission, neonatal mortality and the percentage of deliveries with at least one complication such as blood transfusion and postpartum ICU admission. Analyzing data was done by using SPSS version 25 software.

RESULTS

We found statistical differences between pregnancy and birth outcomes during the COVID-19 pandemic compared to one year before. The risk of preeclampsia, gestational diabetes, cesarean section, preterm birth and NICU admission were clinically significant. Also, there was a significant decrease in mean gestational age.

CONCLUSION

The COVID-19 pandemic has affected the pregnancy outcome by increasing morbidities and complications during pregnancy, birth, and postpartum. In addition, extensive quarantine outbreaks disrupted the healthcare system and hindered access to prenatal services. It is necessary to develop preventive and therapeutic care protocols for similar pandemic conditions.

Maternal Healthcare Services in a Rural Area of Haryana during the COVID-19 Pandemic: A Community-Based Study

Background

It is well documented that the utilization of maternal healthcare services during pregnancy and childbirth plays a significant role in reducing maternal morbidity and mortality. Disruptions in maternal healthcare services during the coronavirus disease 2019 (COVID-19) pandemic have been reported. However, there is a paucity of literature from rural areas, as most of the previous studies are either record-based or conducted in tertiary care centers. This study aimed to determine the proportion of women who received the recommended maternal healthcare services during the COVID-19 pandemic and to study various factors associated with the utilization of services.

Material and Methods

In this community-based study, we assessed the utilization of maternal healthcare services among 520 women residing in the Ballabgarh Block of District Faridabad, Haryana, whose antenatal, intrapartum, and postnatal period coincided with the first wave of COVID-19 pandemic. Domiciliary visits were made, and women were interviewed retrospectively regarding maternal healthcare services utilized by them. The antenatal care (ANC) cards were reviewed, and details were corroborated.

Results

Full ANC was received by 15.3% of women, and 45% of women had less than four antenatal visits. 30.9% of participants had cesarean delivery. The proportion of cesarean delivery in private facilities was significantly higher than in government facilities [Odds Ratio (OR) (95% Confidence intervals (CI)) =10.04 (5.87-17.19); P < 0.001]. In multivariate logistic regression, gravidity was negatively associated with full ANC [OR (95% CI) =0.43 (0.25-0.74); P = 0.002].

Conclusion

Fewer women received the recommended maternal healthcare services during the COVID-19 pandemic. Detailed assessment of health systems and factors affecting routine healthcare services, during the pandemic, can help improve the readiness and response in the future.

Managing Labour in Women with COVID-19

Since first reported in December 2019 in Wuhan, China, COVID-19 caused by Severe Acute Respiratory Syndrome (SARS) Corona virus2 (SARS CoV-2) quickly spread to become a pandemic that has caused significant morbidity and mortality. The rapidity of the spread of the virus and the high mortality at the outset threatened to overwhelm health systems worldwide, and, indeed, this significantly impacted maternal health, especially since there was minimal experience to draw from. Experience with Covid 19 has grown exponentially as the unique needs of pregnant and labouring women with COVID-19 infection have become more evident. Managing COVID-19 parturients requires a multidisciplinary team consisting of anaesthesiologists, obstetricians, neonatologists, nursing staff, critical care staff, infectious disease and infection control experts. There should be a clear policy on triaging patients depending on the severity of their condition and the stage of labour. Those at high risk of respiratory failure should be managed in a tertiary referral centre with facilities for intensive care and assisted respiration. Staff and patients in delivery suites and operating rooms should be protected by enforcing infection protection principles such as offering dedicated rooms and theatres to SARS CoV-2 positive patients and using personal protective equipment. All hospital staff must be trained in infection control measures which should be updated regularly. Breastfeeding and care of the new-born must be part of the healthcare package offered to COVID-19 parturient mothers.

An increase in cesarean section rate during the first wave of COVID-19 pandemic in Iran

BACKGROUND

The COVID-19 pandemic and its impact on healthcare services is likely to affect birth outcomes including the delivery mode. However, recent evidence has been conflicting in this regard. The study aimed to assess changes to C-section rate during the COVID-19 pandemic in Iran.

METHODS

This is a retrospective analysis of electronic medical records of women delivered in the maternity department of hospitals in all provinces of Iran before the COVID-19 pandemic (February-August 30, 2019) and during the pandemic (February-August 30, 2020). Data were collected through the Iranian Maternal and Neonatal Network (IMAN), a country-wide electronic health record database management system for maternal and neonatal information. A total of 1,208,671 medical records were analyzed using the SPSS software version 22. The differences in C-section rates according to the studied variables were tested using the χ2 test. A logistic regression analysis was conducted to determine the factors associated with C-section.

RESULTS

A significant rise was observed in the rates of C-section during the pandemic compared to the pre-pandemic (52.9% vs 50.8%; p = .001). The rates for preeclampsia (3.0% vs 1.3%), gestational diabetes (6.1% vs 3.0%), preterm birth (11.6% vs 6.9%), IUGR (1.2% vs 0.4%), LBW (11.2% vs 7.8%), and low Apgar score at first minute (4.2% vs 3.2%) were higher in women who delivered by C-section compared to those with normal delivery (P = .001).

CONCLUSIONS

The overall C-section rate during the first wave of COVID-19 pandemic was significantly higher than the pre-pandemic period. C-section was associated with adverse maternal and neonatal outcomes. Thus, preventing the overuse of C-section especially during pandemic becomes an urgent need for maternal and neonatal health in Iran.

Did the first wave of the COVID-19 pandemic impact the cesarean delivery rate? A retrospective cohort study at a primary care center in Switzerland

OBJECTIVES

During the first 3 months of the coronavirus disease 2019 (COVID-19) pandemic, our hospital's quality management team determined a decline in the rate of cesarean deliveries (CD). Thus, in this study we examined both the factors associated with this decrease as well as neonatal outcomes.

METHODS

This was a retrospective observational cohort study comparing deliveries (n=597) between March and May 2020 (first nationwide "lockdown" in Switzerland) with those during the same period in 2018 and 2019 (n=1,063). A multivariable logistic regression analysis was used to examine the association between CD and the pandemic, adjusting for relevant risk factors for CD.

RESULTS

The overall rate of CD during the pandemic period was lower (30.0%), than during the pre-pandemic period (38.7%, unadjusted odds ratio 0.68, 95% confidence interval [95%CI]: 0.55 to 0.84, p=0.0004) a result that was supported by the adjusted odds ratio (0.73, 95%CI: 0.54 to 0.99, p=0.04).

CONCLUSIONS

The results of this study confirmed a significant reduction in the rate of CD in early 2020, during the first lockdown period due to COVID-19, but without major differences in maternal and infant health indicators or in obstetric risk factors than before the pandemic. These results may have been due to a difference in the composition of the obstetric team as well as the behavior of the obstetrics team and in the patients during the pandemic, given the burden it placed on healthcare systems. However, this hypothesis remains to be tested in further research.

The impact of the COVID-19 pandemic on respiratory morbidity during infancy: A birth-cohort study

OBJECTIVE

To evaluate the incidence of wheezing and overall respiratory morbidity in healthy infants born during the first peak of the coronavirus disease-2019 (COVID-19) pandemic, compared with infants born during the preceding year.

METHODS

This was a single-center retrospective birth cohort study to compare a cohort of children born between February and March 2020 (COVID-19 group) to a control group of children born between February and March 2019 (pre-COVID-19 group). At 1 year of age, we collected respiratory data using parental and telephone questionnaires.

PRIMARY OUTCOME

wheezing incidence and/or bronchodilator use.

SECONDARY OUTCOMES

recurrent wheezing, emergency-room visits, hospital admissions, pneumonia diagnosis, and admissions due to lower-respiratory-tract-infections (LRTI). We included the following covariate risk factors in the logistic regression models; atopy, daycare attendance, breastmilk feeding, parental smoking, C-section, siblings, and gestational age.

RESULTS

We enrolled 588 infants, 294 in each group (48% males). Demographic, perinatal, and atopic characteristics were similar between the groups. Compared to the pre-COVID-19 group, infants born during the COVID-19 period were significantly less likely to report wheezing and/or bronchodilator use (adjusted-odds ratio [OR], 0.4; 95% confidence interval [CI] 0.28-0.59), systemic steroid use, (adjusted-OR, 0.47; 95% CI 0.24-0.91), emergency-room visits (adjusted-OR, 0.36; 95% CI 0.17-0.72), LRTI admissions (adjusted-OR, 0.2; 95% CI 0.05-0.74), or pneumonia diagnosis (adjusted-OR, 0.22; 95% CI 0.09-0.53).

CONCLUSIONS

This study investigated wheezing and respiratory morbidity over the first year of the COVID-19 pandemic in infants born during the first peak of COVID-19. The study demonstrated a significant decrease in most aspects of respiratory morbidity. A longitudinal follow-up study to explore the subsequent impact of these findings is warranted.

The Impact of the Coronavirus Pandemic Curfew on the Psychosocial Lives of Pregnant Women in Jordan

Objectives

Worldwide the COVID-19 pandemic has negatively affected the health and psychosocial lives of people. International guidelines recommend special attention to pregnant women during pandemics and national emergencies. This study aimed to report the impact of the COVID-19 pandemic curfew on the psychosocial lives of pregnant women in Jordan.

Design

A cross-sectional study was conducted and included women who were pregnant during the COVID-19 curfew in Jordan, which took place between mid-March and mid-June of 2020.

Settings

A web-based survey that was posted on various social media platforms.

Participants

Women who at the time of the study were 18 years of age or more, were living in Jordan, and were pregnant during the curfew.

Measurements and findings

Data collected included women's characteristics, the impact of the curfew on the pregnancy, physical activity, and psychosocial lives and the barriers to seeking healthcare, in addition to pregnancy and delivery details, and changes in nutrition and supplements intake.

A total of 877 women responded to the survey. The results showed that 21.1% of the respondents did not receive any antenatal care (ANC) during the curfew. The respondents also reported that the main barriers for seeking ANC included healthcare facilities being closed (85.2%), the need for travel permits (76.8%), financial difficulties (63.9%), and fear of catching the COVID-19 virus (60.1%). Furthermore, 93.3% reported that they had psychological stress, and 29.9% reported that they had at least one form of domestic violence. Statistically significant associations existed between various women's characteristics, obstetric, psychosocial factors, and the level of psychological stress.

Key conclusions

The COVID-19 pandemic curfew, which was applied in Jordan, resulted in a negative impact on the psychosocial lives of pregnant women. As a result, pregnant women did not receive optimal antenatal care and experienced higher degrees of psychological stress and domestic violence.

Implications for practice

The findings of our study may encourage national healthcare policymakers to ensure the provision of appropriate psychosocial support of pregnant women during large scale emergencies.

Could thermodynamics and heat and mass transfer research produce a fundamental step advance toward and significant reduction of SARS-COV-2 spread?

We are living an extraordinary season of uncertainty and danger, which is caused by SARS-Cov-2 infection and consequent COVID-19 infection. This preliminary study comes from both a mix of entrepreneurial experience and scientific research. It is aimed by the exigency to reach a new and more effective analysis of the risks on the filed and to reduce them inside a necessary cooperation process which may regard both research and some of the economic activities which are damaged by passive protection measures such as indiscriminate lockdowns. This global emergency requires specific efforts by any discipline that regards specific problems which need to be solved urgently. The characteristic airborne diffusion patterns of COVID-19 shows that the airborne presence of viruses depends on multiple factors which include the dimension of microdroplets emitted by a contagious person, the atmospheric temperature and humidity, the presence of atmospheric particulate and pollution, which may act as a transport vehicle for the virus. The pandemic diffusion shows a particular correlation with the air quality and levels of atmospheric pollution. Specific problems need to solved to understand better the virus, its reliability, diffusion, replication, how it attacks the persons and the conditions, which drives to both positive and deadly evolution of the illness. Most of these problems may benefit from the contribution from both heat and mass transfer and the unsteady thermodynamics of living systems which evolves according to constructal law. After the bibliographic research on the virus, emissive and spread modes, and consequent today adopted protection, a detailed analysis of the contributions which may be assessed by research in thermodynamics, heat and mass transfer, technical and chemical physics. Some possible areas of research have been identified and discussed to start an effective mobilization which may support the effort of the research toward a significant reduction of the impacts of the pandemic infection and the economic risks of new generalized lockdowns.

Family-centered care management strategies for term and near-term neonates with brief hospitalization in a level III NICU in Shenzhen, China during the time of COVID-19 pandemic

BACKGROUND

Adopting the family-centered care (FCC) approach in the neonatal care has been shown to improve breastfeeding rate and parental satisfaction. To minimize the transmission of COVID-19, family visit in neonatal intensive care unit (NICU) was suspended in China. In order to maintain the benefits of FCC, the Hong Kong University-Shenzhen Hospital NICU modified FCC strategies. We evaluated the effects of new strategies and aimed to share our results and experience with other NICUs during the COVID-19 pandemic.

METHODS

Using prospectively collected hospital databases, we retrospectively compared the demographic and clinical data of neonates, rates of breastfeeding at discharge, nosocomial infection and parental satisfaction one month before (open group) and after (closed group) the implementation of alternative FCC management strategies when family visit was suspended during COVID-19 pandemic.

RESULTS

During the COVID-19 pandemic, we organized a multidisciplinary task force and adopted strategies of triage and screening, management of suspected infants, and breastfeeding promotion with effective communication. The nosocomial infection rate and parental satisfaction for open and closed groups (144 and 108 term and near-term neonates with brief hospitalization, respectively) were not different (1% vs. 0%, p = 1.00; 98.6 vs. 98.8, p = .80; respectively). Breastfeeding rate at discharge decreased but the difference was not significant (74% vs. 80%, p = .29).

CONCLUSIONS

In our experience, in term and near-term neonates with brief hospitalization, the alternative FCC strategies maintained high parental satisfaction without increased nosocomial infection rate, but strong support for breastfeeding was needed. Through multidisciplinary collaboration, the continuation of "modified" FCC in a level III NICU is feasible in the context of COVID-19 pandemic with reduced family visitation and participation in the care.

Effects of the COVID pandemic on pregnancy outcomes

Pregnant women and neonates are often categorised as being at high risk during the coronavirus disease-2019 (COVID-19) pandemic. Numerous studies have demonstrated that the characteristics of COVID-19 disease in pregnant women and non-pregnant women are very similar. However, pregnant women with COVID-19 in the third trimester are more likely than their non-pregnant counterparts to require intensive care, though this may reflect a lower threshold for intervention in pregnant women rather than more serious disease. Compared with pregnant women without COVID-19, pregnant women with symptomatic COVID-19 requiring admission to hospital have worse maternal outcomes, including death, although the absolute risk remains very low. Outcomes of neonates born to women positive for COVID-19 are generally very good, though iatrogenic preterm birth is more common. Findings from these studies highlight the need for further monitoring of the outcomes of pregnant and post-partum women according to trimester during this pandemic.