Introduction
Population‐based studies about the consequences of SARS‐CoV‐2 infection (COVID‐19) in pregnancy are few and have limited generalizability to the Nordic population and healthcare systems.
Material and methods
This study examines pregnant women with COVID‐19 in the five Nordic countries. Pregnant women were included if they were admitted to hospital between 1 March and 30 June 2020 and had a positive SARS‐CoV‐2 PCR test ≤14 days prior to admission. Cause of admission was classified as obstetric or COVID‐19‐related.
Results
In the study areas, 214 pregnant women with a positive test were admitted to hospital, of which 56 women required hospital care due to COVID‐19. The risk of admission due to COVID‐19 was 0.4/1000 deliveries in Denmark, Finland and Norway, and 3.8/1000 deliveries in the Swedish regions. Women hospitalized because of COVID‐19 were more frequently obese (p < 0.001) and had a migrant background (p < 0.001) compared with the total population of women who delivered in 2018. Twelve women (21.4%) needed intensive care. Among the 56 women admitted due to COVID‐19, 48 women delivered 51 infants. Preterm delivery (n = 12, 25%, p < 0.001) and cesarean delivery (n = 21, 43.8%, p < 0.001) were more frequent in women with COVID‐19 compared with women who delivered in 2018. No maternal deaths, stillbirths or neonatal deaths were reported.
Conclusions
The risk of admission due to COVID‐19 disease in pregnancy was low in the Nordic countries. A fifth of the women required intensive care and we observed higher rates of preterm and cesarean deliveries. National public health policies appear to have had an impact on the risk of admission due to severe COVID‐19 disease in pregnancy. Nordic collaboration is important in collecting robust data and assessing rare outcomes.
Objective
To study the impact of shoulder dystocia (SD) simulation training on the management of SD and the incidence of permanent brachial plexus birth injury (BPBI).
Design
Retrospective observational study.
Setting
Helsinki University Women’s Hospital, Finland.
Sample
Deliveries with SD.
Methods
Multi‐professional, regular and systematic simulation training for obstetric emergencies began in 2015, and SD was one of the main themes. A study was conducted to assess changes in SD management and the incidence of permanent BPBI. The study period was from 2010 to 2019; years 2010–2014 were considered the pre‐training period and years 2015–2019 were considered the post‐training period.
Main outcome measures
The primary outcome measure was the incidence of permanent BPBI after the implementation of systematic simulation training. Changes in the management of SD were also analysed.
Results
During the study period, 113 085 vertex deliveries were recorded. The incidence of major SD risk factors (gestational diabetes, induction of labour, vacuum extraction) increased and was significantly higher for each of these factors during the post‐training period (p < 0.001). The incidence of SD also increased significantly (0.01% vs 0.3%, p < 0.001) during the study period, but the number of children with permanent BPBI decreased by 55% after the implementation of systematic simulation training (0.05% vs 0.02%, p < 0.001). The most significant change in the management of SD was the increased incidence of successful delivery of the posterior arm.
Conclusions
Systematic simulation‐based training of midwives and doctors can translate into improved individual and team performance and can significantly reduce the incidence of permanent BPBI.
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