Reproductive health crisis during waves one and two of the COVID-19 pandemic in India: Incidence and deaths from severe maternal complications in more than 202,000 hospital births

Abstract

Background: The SARS-CoV-2 pandemic in India has adversely affected many aspects of population health. We need detailed evidence of the impact on reproductive health in India so that lessons can be learnt. Methods: Hospital-based repeated monthly survey of nine severe maternal complications and death in 15 hospitals across five states in India covering a total of 202,986 hospital births, December-2018 through to May-2021. We calculated incidence rates (with 95% confidence intervals (CIs)) per 1000 hospital births, casefatality and rate ratios (RR) with 95% CIs. Linear regression was used to examine the association between the Government Response Stringency Index (GRSI) for India and changes in hospital births, incidence and case-fatality. Findings: There was a significant decrease in hospital births per month during the pandemic period with a 4.8% decrease per 10% increase in the GRSI scores (p < 0.001). The overall incidence of severe complications in the pandemic period was not significantly different from the pre-pandemic period, but hospital admissions from septic abortion was 56% higher (RR=1.56; 95% CI=1.22À1.99; p < 0.001). The overall case-fatality of complications increased by 23% (RR=1.23; 95% CI=1.03À1.46; p = 0.022) and remained high across the different phases of the pandemic with a notable significant increase in deaths from heart failure in pregnancy. Interpretation: Our study supports the legitimacy of the calls made to maintain sexual and reproductive health services as essential services during the pandemic. Lessons learnt should be used to avert the ongoing reproductive health crisis while India plans to manage a third wave of the pandemic.

‘We are not going to shut down, because we cannot postpone pregnancy’: a mixed-methods study of the provision of maternal healthcare in six referral maternity wards in four sub-Saharan African countries during the COVID-19 pandemic

“…3 4 Currently, there is evidence that women diagnosed with COVID-19 have higher risk of eclampsia/pre-eclampsia, maternal mortality, stillbirth, preterm birth and congenital birth defects. [5][6][7][8][9] A multinational cohort study showed that delivery by caesarean section, but not breastfeeding, was associated with an increased risk of SARS-CoV-2 transmission to newborns. 8 The WHO recommends that for women confirmed with COVID-19, labour induction and caesarean section should only be undertaken when medically indicated, and that breastfeeding should be encouraged.…”

“…This uncertainty was accompanied by reorganisation of care provision models and introduction of mitigation measures that were not supported by evidence, such as separation of mothers confirmed with COVID-19 from newborns and not allowing breastfeeding 3 4. Currently, there is evidence that women diagnosed with COVID-19 have higher risk of eclampsia/pre-eclampsia, maternal mortality, stillbirth, preterm birth and congenital birth defects 5–9. A multinational cohort study showed that delivery by caesarean section, but not breastfeeding, was associated with an increased risk of SARS-CoV-2 transmission to newborns 8.…”

Impact of Severity of Maternal COVID-19 Infection on Perinatal Outcome and Vertical Transmission Risk: An Ambispective Study From North India

“…In our study, we observed a statistically significant increase in maternal mortality (1.5% vs 13.7%; p<0.001) and noted ARDS and DIC as the most common cause of death. Mahajan et al reported pneumonia and respiratory failure as the most common causes of maternal mortality [ 8 ]; while Nair et al attributed the increase in overall case fatality rate to reduced hospital visits and reduced hospital births rather than the COVID-19 infection directly [ 3 ]. Contrary to our findings studies from Spain reported better outcomes in the second wave with a lower case fatality rate (24.0% vs 13.2%) which was attributed to more experience, availability of more effective therapeutic interventions and probably to a new variant of concern (VOC) 20A.EU1 [ 10 , 16 ].…”

“…In South Africa, 22.7% increase in maternal mortality, 4.8% increase in neonatal mortality and 3.4% increase in perinatal mortality have been reported [ 2 ]. India has also experienced 23% increase instead of 5.5% annual decline in maternal mortality ratio during a pandemic, which should draw urgent attention of policymakers [ 3 , 4 ]. The disproportionate impact of pandemic on maternal and perinatal outcome has surfaced in two waves worldwide as well as between high-income countries and low-middle income countries [ 5 ].…”

El enigma del coronavirus – Covid-19 durante el Bicentenario de la Independencia del Perú – El síndrome poscovid – Las vacunas – La gestante

“…Los ingresos hospitalarios por aborto séptico fueron un 56% más elevados (RR=1,56), la letalidad global de las complicaciones aumentó un 23% (RR=1,23, p = 0,022) y se mantuvo elevada en las distintas fases de la pandemia, con notable aumento significativo de las muertes por insuficiencia cardíaca en el embarazo. Este estudio apoya la legitimidad de los llamamientos realizados para mantener los servicios de salud sexual y reproductiva como servicios esenciales durante la pandemia (60) .…”