Background
In response to the COVID-19 pandemic, hospitals nationwide have implemented modifications to labor and delivery unit practices designed to protect delivering patients and healthcare providers from infection with SARS-CoV-2. Beginning March 2020, our hospital instituted labor and delivery unit modifications targeting visitor policy, use of personal protective equipment, designation of rooms for triage and delivery of persons suspected or infected with COVID-19, delivery management and newborn care. Little is known about the ramifications of these modifications in terms of maternal and neonatal outcomes.
Objective
The objective of this study was to determine whether labor and delivery unit policy modifications we made during the COVID-19 pandemic were associated with differences in outcomes for mothers and newborns.
Study Design
We conducted a retrospective cohort study of all deliveries occurring in our hospital between January 1, 2020 and April 30, 2020. Patients who delivered in January and February 2020 before labor and delivery unit modifications were instituted were designated as the pre-implementation group, and those who delivered in March and April 2020 were designated as the post-implementation group. Maternal and neonatal outcomes between the pre-and post-implementation groups were compared. Differences between the two groups were then compared to the same time period in 2019 and 2018 to assess whether any apparent differences were unique to the pandemic year. We hypothesized that maternal and newborn lengths of stay would be shorter in the post-implementation group. Statistical analysis methods included Student’s T-tests and Wilcoxon tests for continuous variables and chi square or Fisher’s exact tests for categorical variables.
Results
Postpartum length of stay was significantly shorter after implementation of labor unit changes related to COVID-19. A postpartum stay of 1 night following vaginal delivery occurred in 48.5% of patients in the post-implementation group compared to 24.9% of the pre-implementation group (p<0.0001). Postoperative length of stay after cesarean delivery of ≤2 nights occurred in 40.9% of patients in the post-implementation group as compared to 11.8% in the pre-implementation group (p<0.0001). Similarly, after vaginal delivery, 49.0% of newborns were discharged home after one night in the post-implementation group compared to 24.9% in the pre-implementation group (p <0.0001). After cesarean delivery, 42.5% of newborns were discharged after ≤2 nights in the post-implementation group compared to 12.5% in the pre-implementation group (p<0.0001). Slight differences in the proportions of earlier discharge between mothers and newborns were due to multiple gestations. There were no differences in cesarean delivery rate, induction of labor, or adverse maternal or neonatal outcomes between the two groups.
Conclusion
Labor and delivery unit policy...
Objective
To determine if fertility treatment is associated with increased risk of severe maternal morbidity (SMM) compared to spontaneous pregnancies.
Design
Retrospective cohort study
Setting
Single academic medical center
Patients
In 2012, 6543 women delivered live births >20 weeks gestation at our center. Women were categorized based on mode of conception: in vitro fertilization (IVF), non-IVF fertility treatment (NIFT), or spontaneous pregnancies.
Interventions
None
Outcome Measure
The main outcome was presence of true SMM, such as eclampsia, respiratory failure, and peripartum hysterectomy. Deliveries were screened using 1) ICD-9 codes, 2) prolonged postpartum stay, 3) maternal ICU admissions, and 4) blood transfusion. The charts of women meeting the screening criteria were reviewed to identify true SMM based on a previously validated method, recognizing that medical record review is the gold standard.
Results
Of the 6543 deliveries, 246 (3.8%) were IVF conceptions and 109 (1.7%) NIFT conceptions. Sixty nine (1.1%) cases of true SMM were identified. In multivariate analyses, any fertility treatment (IVF + NIFT) was associated with increased risk of SMM compared to spontaneous conceptions (OR 2.40, 95%CI 1.10–5.23). In a subset analysis of singletons only, the association between any fertility treatment (IVF + NIFT) and SMM was not statistically significant (OR 2.11, 95% CI 0.83–5.37, P=0.12).
Conclusions
Overall, fertility treatment increased risk for SMM events. Given the limited sample size, the negative finding with singleton gestations is inconclusive. Larger multi-center studies with accurate documentation of fertility treatment and SMM cases are needed to further clarify the risk associated with singletons.
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