Effects of SARS Cov-2 epidemic on the obstetrical and gynecological emergency service accesses. What happened and what shall we expect now?

Abstract

During the lockdown period, the fear about the risk of infection in hospital has reduced the admission to Emergency Services (ES) with possible negative health effects. We have investigated the changes in the emergency flow occurred during SARS-CoV-2 pandemic in an obstetrics and gynecological ES and the short-term adverse outcomes on women's and reproductive health. Study design: The study was conducted in the OBGYN ES of the Clinica Mangiagalli, the largest maternity clinic of Milan, Lombardy, Northern Italy. We analyzed retrospectively the records of all women consecutively admitted at the ES from February 23rd to June 24th 2019, and compared them with the admissions during the lockdown executive order from February 23rd to June 23rd, 2020. Patients were assessed in terms of demographic features, presentation times, triage classification (urgent/not urgent), reason for admission and outcome of the visit (discharge/admission to the ward). A total of 9291 data were retrieved from ES files and automation system, 5644 from 2019 and 3647 from 2020. Categorical variables were compared by the chi-square test calculating the p value and computed were percentage changes (with 95 % Confidence interval, CI). Results: During the period February 24 th-May 31 th 2020 the admissions at the ES decreased by 35.4 % (95 % CI-34.1-36.6) compared with the corresponding period in 2019. The reduction was more marked for gynecological complaints (-63.5 %, 95 %CI-60.5 to-66.5): in particular we observed a reduction of admissions for genital infection/cystitis of 75.7 % (95 %CI-71.4 to-80.1). The admission for complaints associated with pregnancy decreased by 28.5 % (95 %CI-27.2 to-29.9). In the index period, five fetal deaths were diagnosed compared with one observed in the reference period in 2019 (chi square computed using as denominator all observed pregnancies = 4.29, p = 0.04). The frequency of admission for elective caesarean section/labor induction increased from 47.5 % in 2019 to 53.6 % in 2020: this difference was statistically significant. Conclusion: The lockdown negatively influenced ES admissions and consequently the women's/ reproductive health. As possible short-term consequences, we observed an increase of intrauterine deaths and a decrease of natural births.

Effects of the COVID-19 pandemic on maternal and perinatal outcomes: a systematic review and meta-analysis

“…Of 3592 abstracts screened, 192 were relevant for full-text review and 40 met the inclusion criteria for systematic review ( figure 1 ). 4 , 5 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 A list of excluded studies with reasons for exclusion is provided in the appendix (p 6) . Reporting on resource use or service reconfiguration outcomes is summarised in the appendix (p 27) .…”

“…Of the 40 included studies, 31 for which comparable outcomes were also reported in at least one other study were included in the meta-analysis. 4 , 12 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 24 , 25 , 26 , 27 , 28 , 30 , 31 , 32 , 33 , 34 , 37 , 38 , 40 , 42 , 45 , 46 , 47 , 48 , 49 Table 1 shows the characteristics of the 40 included studies, all of which used a historical cohort design. 17 countries were represented, with substantial variation in pandemic mitigation measures among countries.…”

“…17 countries were represented, with substantial variation in pandemic mitigation measures among countries. No study reported data from countries in the lowest WHO Healthcare Efficiency Index quartile, and the majority (28 studies) 4 , 5 , 12 , 14 , 16 , 17 , 19 , 20 , 22 , 23 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 39 , 40 , 42 , 44 , 45 , 46 , 48 , 49 reported data from countries in the highest quartile ( table 2 ). 21 of the 31 studies included in the quantitative analysis were from high-income countries (HICs) according to the World Bank classification.…”

“…21 of the 31 studies included in the quantitative analysis were from high-income countries (HICs) according to the World Bank classification. 4 , 12 , 14 , 16 , 17 , 19 , 20 , 23 , 28 , 30 , 31 , 32 , 33 , 34 , 42 , 45 , 46 , 49 The reported outcomes and outcome measures are listed with the relevant studies in the appendix (p 31) .

Figure 1 PRISMA flow chart

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Effects of the COVID-19 pandemic on timely care for extrauterine pregnancies: A retrospective analysis

“…The importance of diagnosing the exact location of the pregnancy, especially in these troublesome times, was highlighted by the latest International Society of Ultrasound in Obstetrics & Gynecology consensus statement [13] . To the best of our knowledge, only one report on the effect of the COVID-19 pandemic on the rate of emergent surgeries due to EUP has been published thus far [14] . That single-center Italian study showed a 20% reduction in EUP-related hospital admission, but it assessed only 16 women in a four-month timeframe.…”