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Introduction: Conflicting reports of increases and decreases in rates of preterm birth (PTB) and stillbirth in the general population during the COVID-19 pandemic have surfaced. The objective of our study was to conduct a living systematic review and meta-analyses of studies reporting pregnancy and neonatal outcomes by comparing the pandemic and pre-pandemic periods. Material and methods:We searched PubMed and Embase databases, reference lists of articles published up until May 14, 2021 and included English language studies that compared outcomes between the COVID-19 pandemic time period vs. pre-pandemic time periods. Risk of bias was assessed using the Newcastle-Ottawa scale. We conducted random-effects meta-analysis using the inverse variance method.Results: Thirty-seven studies with low-to-moderate risk of bias, reporting on 1,677,858 pregnancies during the pandemic period and 21,028,650 pregnancies during the pre-pandemic period, were included.

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ObjectivesThe secondary impacts of the COVID-19 pandemic on adverse maternal and neonatal outcomes remain unclear. In this study, we aimed to evaluate the association between the COVID-19 pandemic and the risk for adverse pregnancy outcomes.DesignWe conduced retrospective analyses on two cohorts comprising 7699 pregnant women in Beijing, China, and compared pregnancy outcomes between the pre-COVID-2019 cohort (women who delivered from 20 May 2019 to 30 November 2019) and the COVID-2019 cohort (women who delivered from 20 January 2020 to 31 July 2020). The secondary impacts of the COVID-2019 pandemic on pregnancy outcomes were assessed by using multivariate log-binomial regression models, and we used interrupted time-series (ITS) regression analysis to further control the effects of time-trends.SettingOne tertiary-level centre in Beijing, ChinaParticipants7699 pregnant women.ResultsCompared with women in the pre-COVID-19 pandemic group, pregnant women during the COVID-2019 pandemic were more likely to be of advanced age, exhibit insufficient or excessive gestational weight gain and show a family history of chronic disease (all p<0.05). After controlling for other confounding factors, the risk of premature rupture of membranes and foetal distress was increased by 11% (95% CI, 1.04 to 1.18; p<0.01) and 14% (95% CI, 1.01 to 1.29; p<0.05), respectively, during the COVID-2019 pandemic. The association still remained in the ITS analysis after additionally controlling for time-trends (all p<0.01). We uncovered no other associations between the COVID-19 pandemic and other pregnancy outcomes (p>0.05).ConclusionsDuring the COVID-19 pandemic, more women manifested either insufficient or excessive gestational weight gain; and the risk of premature rupture of membranes and foetal distress was also higher during the pandemic.

reterm birth (birth before 37 weeks' gestation) is a leading cause of mortality and morbidities in the neonatal period, 1 childhood and adulthood. 2 Stillbirth has devastating consequences for families. 3 The causes of both preterm birth and stillbirth are multifactorial. During the pandemic, reports described reductions in preterm birth rates in Denmark, 4 the Netherlands, 5 Ireland 6 and the United States. 7 At the same time, increases in stillbirth rates were reported from the United Kingdom, 8 Italy, 9 Nepal 10 and India, 11 with or without changes in rates of preterm births. Meta-analyses have emerged with differing conclusions. 12,13 Some speculated reasons for reductions in preterm births included reductions in physical activity during pregnancy, reduced stress related to work-life balance, less exposure to infection, fewer medical interventions, reduced travel and pollution, 14 and improved hygiene and rest. Proposed reasons for increases in preterm birth rates include higher stress due to worry about the pandemic, employment or financial challenges, home schooling and reduced maternity services. 15 Less stringent fetal surveillance from reduced attendance at medical appointments for fear of infection, cancellation of face-to-face appointments and reduced staffing for maternity services are possible reasons for increased rates of stillbirths. Thus, it is important to evaluate preterm births and stillbirths simultaneously to understand the true impact. 16 Some previous reports compared preterm birth and stillbirth rates during the pandemic to similar time periods in the past few years. However, within a jurisdiction, these rates are known to fluctuate between epochs 17 and, thus, it is preferable to evaluate rates over longer periods to establish whether observed variations are usual (common cause variation) or unusual (special cause variation). Our objective was to evaluate whether the COVID-19 pandemic affected preterm birth or stillbirth rates in Ontario by comparing rates for the early COVID-19 pandemic time period with rates from the previous 17.5 years to identify patterns of variation.

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Study Objective: To compare the surgical and oncologic outcomes between open abdomen radical hysterectomy (ARH) and laparoscopic radical hysterectomy (LRH) for cervical cancer.Methods: Retrospective observational study with propensity score matching was used to ensure balanced groups for ARH and LRH. One-hundred-and-ninety-eight women with cervical cancer, 99 treated using ARH and 99 using LRH, between January 2012 and December 2014. Outcomes included disease-free survival (DFS), overall survival (OS), intra-operative factors, post-operator recovery, urinary retention, and adverse events. Moreover, the inverse probability of the treatment weighting (IPTW) method was also used.Main Results: Compared with ARH, LRH was associated with a lower volume of blood loss (P < 0.001) and transfusion rate (P < 0.001), with a broader resection of the parametrium (P < 0.001). Post-operatively, the time to first flatus was shorter for LRH than ARH (P < 0.001) but the rate of urinary retention was higher for LRH (22.2%) than ARH (8.1%; P = 0.009). DFS and OS were similar between groups. By IPTW, laparoscopy was also not associated with poorer survival in terms of DFS (HR 1.52, CI 0.799–2.891, P = 0.202) or OS (HR 0.942, HR 0.425–2.09, P = 0.883).Conclusion: Compared with ARH, LRH provided better intra-operative and post-operative outcomes, with no significant difference in oncologic outcomes and survival. Urinary retention remains a clinical issue to improve with LRH. The technology of LRH has been improved in China to address the inconsistent results of oncologic outcomes in previous studies. Whether these improvements could be effective needs to be investigated in the future.

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