Coronavirus Disease 2019 (COVID-19) and the Incidence of Obstetric and Gynecologic Emergency Department Visits in an Integrated Health Care System

Global changes in maternity care provision during the COVID-19 pandemic: A systematic review and meta-analysis

“…The majority of studies reported findings from a single hospital site or group of facilities relating to specific and highly variable changes in protocols made during the pandemic [ 13 , [23] , [24] , [25] , [26] , [37] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] ]. This ranged from the institution of new telehealth services [ 29 , 33 , 35 , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] ], altered hospital admission and discharge protocols [ 27 , 30 , [48] , [49] , [50] ], variance in anaesthetic management [ 27 , 36 , 51 , 52 ], and harmonisation of regional antenatal screening services [ 32 , 53 , 54 ].…”

“…2b). 23,24,31,36,39,68,71 In the two studies that reported the outcome, from Israel and Italy, the associated risk of hospital admission amongst 1042 pregnant women who presented at the emergency department significantly increased, by 214% (pooled RR 1214, 95% CI: 1118À1319, I 2 =0%, P<0.0001) (Table 4, Fig. 2c) [68,71].…”

Obstetric A&E unit admission and hospitalization for obstetrical management during COVID-19 pandemic in a third-level hospital of southern Italy

“…Abnormal uterine bleeding, irrespective of the trimesters, was reduced as well in 2020 compared to the past. Abel et al [ 19 ] and Dell’Utri et al [ 27 ] found the same. A possible reason could be that, as for the increase in hypertensive disorders, a more restful lifestyle determined less pelvic cramps (and pain, as above showed) and so less risk of amnio-chorial detachment or true placental abruption.…”

“…Other nine studies analyzed the issue of the impact of COVID-19 pandemic on the admissions to the A&E unit for obstetrical or gynecological conditions. Two of them were performed in the United States, [ 19 , 20 ] two in Israel, [ 21 , 22 ] one in France, [ 23 ] one in India, [ 24 ] and three in Italy (notably from regions different from ours) [ 25 – 27 ] (Table 4 ). Only Goyal et al [ 24 ] performed a prospective analysis, while all the others were retrospective studies.…”

“…Only Goyal et al [ 24 ] performed a prospective analysis, while all the others were retrospective studies. The biggest cohorts were from Abel et al [ 19 ] and Athiel et al [ 23 ] with overall 11,788 and 39,690 patients seen in the period considered, respectively, although it’s worth mentioning that the French study was multicentric. Looking to the period of analysis considered by the various studies, we noticed that Abel et al [ 19 ] compared 3 periods: pre-pandemic, early pandemic and late pandemic; Athiel et al [ 23 ], Goyal et al [ 24 ], Spurlin et al [ 20 ], and Grandi et al [ 26 ] considered the period preceding the pandemic versus the first lockdown period; Kugelman et al [ 22 ] evaluated the month following the pandemic declaration, Salsi et al [ 25 ] assessed the month of March (therefore, immediately before and during the lockdown), and Dell’Utri et al [ 27 ] comprised almost 4 months, from the case of the first COVID-19 affected Italian patient to after the end of the strict lockdown versus the same period of the year 2019; Meyer et al [ 21 ] included two months in their analysis (February and March, which according to what mentioned by Kugelman et al [ 22 ] regarding the first Israeli patient affected means before and immediately after the recognition of SARS-COV-2 diffusion in Israel), comparing to the previous year.…”