What may happen if you are pregnant during Covid-19 lockdown? A retrospective study about peripartum outcomes

Midwifery care for a COVID-19 cohort of women in Northern Italy: two years of pandemic

BACKGROUND

The rapid development of the COVID-19 pandemic has altered the context of healthcare around the world. SARS-CoV-2 positive pregnant and postnatal women, being at greater risk of complications, require continuous midwifery surveillance as well as specialized medical care. Scientific literature lacks studies related to midwifery care models in hospital settings during the pandemic. The aim of this work is to describe hospitalizations in an obstetric-gynecological COVID care unit and to provide a descriptive analysis of the organizational and care model adopted.

METHODS

A cohort retrospective descriptive study was carried out. The sample was stratified by COVID-related care complexity and by obstetric risk. The sample recruited pregnant women, postnatal women, and gynecological patients with confirmed SARS-CoV-2 infection admitted to the obstetric-gynecological COVID unit of a birth center in Northern Italy, from March 16, 2020, to March 16, 2022.

RESULTS

A number of 1037 women were hospitalized, and of these, 551 were SARS-CoV-2 positive women. The 551 SARS-CoV-2 positive women included 362 pregnant women, 132 postnatal women, 9 gynecological patients with medical diagnosis while 17 with a surgical path, and 31 women undergoing voluntary interruption of pregnancy. The final sample included 536 women. 68.6% of women requested a low care complexity, 22.8% a medium one, and 8.6% a high care complexity. Among the obstetric women population, the majority (70.6%) showed a high obstetric risk.

CONCLUSIONS

The COVID-19 cohort of women required different levels of care with various care complexity and levels of obstetric risk. The model adopted allowed the acquisition of new technical and professional skills as well as the sharing of responsibilities and competences according to the care model of the Buddy System. Future studies could investigate COVID-related care models adopted internationally, but also deepen the technical and professional skills developed by midwives during the pandemic in order to enrich, improve and support midwifery profession.

COVID-19 pandemic and neonatal birth weight: a systematic review and meta-analysis

OBJECTIVES

Lockdown was implemented in many countries during the pandemic, which led to myriad changes in pregnant women's lives. However, the potential impacts of the COVID-19 pandemic on neonatal outcomes remain unclear. We aimed to evaluate the association between the pandemic and neonatal birth weight.

STUDY DESIGN

This was a systematic review and meta-analysis of the previous literature.

METHODS

We searched the MEDLINE and Embase databases up to May 2022 and extracted 36 eligible studies that compared neonatal birth weight between the pandemic and the prepandemic period. The following outcomes were included: mean birth weight, low birth weight (LBW), very low birth weight (VLBW), macrosomia, small for gestational age (SGA), very small for gestational age (VSGA), and large for gestational age (LGA). Statistical heterogeneity among studies was assessed to determine whether a random effects model or fixed effects model was conducted.

RESULTS

Of the 4514 studies identified, 36 articles were eligible for inclusion. A total of 1,883,936 neonates during the pandemic and 4,667,133 neonates during the prepandemic were reported. We identified a significant increase in mean birth weight (pooled mean difference [95% confidence interval (CI)] = 15.06 [10.36, 19.76], I² = 0.0%, 12 studies) and a reduction in VLBW (pooled OR [95% CI] = 0.86 [0.77, 0.97], I² = 55.4%, 12 studies). No overall effect was identified for other outcomes: LBW, macrosomia, SGA, VSGA, and LGA. There was publication bias for mean birth weight with a borderline significance (Egger's P = 0.050).

CONCLUSION

Pooled results showed the pandemic was significantly associated with an increase in mean birth weight and a reduction in VLBW, but not for other outcomes. This review provided clues about the indirect effects of the pandemic on neonatal birth weight and more healthcare measures needed to improve neonatal long-term health.

A COVID Dilemma: How to Manage Pregnancies in Case of Severe Respiratory Failure?

To date, the impact of the COVID-19 pandemic on the world's health, economics and politics is still heavy, and efforts to mitigate virus transmission have caused remarkable disruption. From the early onset of the pandemic, generated by SARS-CoV-2 spread, the scientific community was aware of its impact on vulnerable individuals, including pregnant women. The purpose of this paper is to highlight scientific pitfalls and ethical dilemmas emerging from management of severe respiratory distress in pregnant women in order to add evidence to this topic through an ethical debate. In the here-presented paper, three cases of severe respiratory syndrome are analyzed. No specific therapeutic protocol was available to guide physicians in a cost-benefit balance, and unequivocal conduct was not a priori suggested from scientific evidence. However, vaccines' advent, viral variants lurking on the horizon and other possible pandemic challenges make it necessary to maximize the experience gained through these difficult years. Antenatal management of pregnancies complicated by COVID-19 infection with severe respiratory failure is still heterogeneous and ethical concerns must be pointed out.

Obstetrics and Gynecology Emergency Department Activity during Lockdown in a Teaching Hospital, Hub Center, for COVID-19

Background

The lockdown related to the SARS-CoV-2 pandemic has imposed profound changes in the interaction of the population with hospitals and emergency departments. The main aim of this research was to evaluate the impact of lockdown on the activity of obstetrics and gynecology emergency department (OGED) in a teaching hospital, hub center, for COVID-19.

Methods

The study considers all visits to the OGED with their different triage color codes that represent the clinical severity of each case (from the most severe to the least one: red, yellow, green, white). Data were selected through the “PSNet” triage program and collected anonymously. We analyzed frequency distributions of the variables separately for each woman and calculated mean and standard deviations for continuous variables. We then analyzed the association between factors and outcomes for categorical variables (expressed as a number and percentage of the total) using the chi-square test (χ2). The level of significance was established with p < 0.05. Statistical analysis was performed using SPSS Statistics V20.0. Given the fact that the study has a retrospective observational nature and it is based on an anonymous routine database, approval by the Local Ethics Committee was not necessary.

Results

The relative decrease of patients presenting to OGED in 2020 was −50.96%. The percentage of nonpregnant women was significantly lower in 2020 compared to 2019 (p ≤ 0.0001; Δ = −79.46%). Regarding the obstetric group, we saw an important decrease of visits in 2020 compared to 2019 (p < 0.0001; Δ = −40%). The prevalence of yellow codes was significantly higher in 2020 (Δ = +29.72%), while that of white (Δ = −61.58%) and green (Δ = −52.22%) codes was significantly lower (p ≤ 0.0001). Comparing the diagnoses at discharge, we could highlight significant reductions in 2020 for more than one diagnosis: bleeding (p ≤ 0.0001; Δ = −70.42%), pain (p ≤ 0.0001; Δ = −81.22%), urinary diseases (p = 0.004; Δ = −75.64%), and gastrointestinal diseases (p ≤ 0.0001; Δ = −87.50%).

Conclusions

An evident change emerged in relation to the dynamics between the local obstetrical and gynecological population, and OGED resources. The COVID‐19 lockdown greatly reduced the rate of admission to OGED without time-related obstetric and gynecological complications. The reduction of admissions suggests a more appropriate use of the ED by patients that may inspire future policies for the implementation of emergency services.