Objective Previous studies comparing the COVID-19 pandemic period to prepandemic periods reported either no change or a decrease in extremely preterm birth (PTB) rates during the pandemic. 1, 2 These studies evaluated a limited number of potential PTB confounders and a short pandemic period. We aimed to determine the change in PTB rate and neonatal outcomes during the pandemic in comparison to prepandemic periods by evaluating multiple obstetrical characteristics, during more than three pandemic months. Study design We compared maternal, obstetrical and neonatal outcomes of singleton pregnancies at the Sheba Medical Center, Israel, during three periods: from 20/03/2020 (date of implementation of governmental state of lockdown) to 27/06/2020 (group 1), a parallel period in 2019 (group 2), and to another group that included the parallel annual periods in 2011-2019 (group 3) (see Table). We also compared maternal and pregnancy characteristics during the pandemic and corresponding prepandemic period in 2019 between pregnancies complicated by PTB <34 0/7 versus ≥34 0/7 weeks (see Table). Multivariate regression analysis was performed in order to study independent factors associated with PTB. The institutional review board approved this study (7068-20-SMC, 03/30/2020). Results There were 2,594 deliveries during the pandemic period (group 1) and 2,742 and 28,686 deliveries in the prepandemic periods (groups 2 and 3, respectively). Maternal and obstetrical characteristics did not differ between groups 1 and 2. Predelivery hemoglobin levels were higher in the pandemic period. PTB <34 0/7 weeks rate was significantly lower in the pandemic period compared to group 2 (OR 0.45 95% CI 0.30-0.68, p<0.001), as was the rate of composite neonatal outcome (OR 0.76 95% CI 0.59-0.96, p=0.023). Age, body mass index, parity, diabetes rates and hematologic characteristics differed between groups 1 and 3 with significantly higher predelivery hemoglobin levels in group 1. PTB <34 0/7 weeks rate was lower in the pandemic period (OR 0.60 95% CI 0.41-0.85, p=0.004). On multivariate regression analysis, delivering during the pandemic period was independently associated with a decreased risk for delivery <34 0/7 weeks (adjusted OR 0.29, 95% CI 0.15-0.56, p=0.001). Conclusion We observed more than 50% reduction in the rate of PTB <34 0/7 weeks of gestation, possibly resulting in improved neonatal outcome.

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Introduction Subgaleal hemorrhage (SGH) is a life‐threatening neonatal condition that is strongly associated with vacuum assisted delivery (VAD). The factors associated with the development of SGH following VAD are not well‐established. We aimed to evaluate the factors associated with the development of SGH following attempted VAD. Material and methods A retrospective case‐control study of women who delivered at a tertiary university‐affiliated medical center in Jerusalem, Israel, during 2009‐2018. Cases comprised all parturients with singleton pregnancies for whom attempted VAD resulted in neonatal SGH. A control group of VAD attempts was established by matching one‐to‐one according to gestational age at delivery, parity and year of delivery. Fetal, intrapartum and vacuum procedure characteristics were compared between the groups. Results In all, 313 (89.5%) of the 350 attempted VAD were nulliparous. Baseline maternal and fetal characteristics were similar between the groups except for higher neonatal birthweight in the SGH group. In multivariate logistic regression analysis, only six independent risk factors were significantly associated with the development of SGH: second‐stage duration (for each 30‐minute increase, adjusted odds ratio [OR] 1.13; 95% confidence intervals [CI] 1.04‐1.25; P = .006), presence of meconium‐stained amniotic fluid (adjusted OR 2.61; 95% CI 1.52‐4.48; P = .001), presence of caput succedaneum (adjusted OR 1.79; 95% CI 1.11‐2.88; P = .01), duration of VAD (for each 3‐minute increase, adjusted OR 2.04; 95% CI 1.72, 2.38; P < .001), number of dislodgments (adjusted OR 2.38; 95% CI 1.66‐3.44; P < .001), and fetal head station (adjusted OR 3.57; 95% CI 1.42‐8.33; P = .006). Receiver operating characteristic curves showed that VAD duration of ≥15 minutes had a 96.7% sensitivity and 75.0% specificity in predicting SGH formation, with an area under the curve equal to .849. Conclusions Vacuum duration, the number of dislodgments, the duration of second stage of delivery, fetal head station, the presence of caput succedaneum and the presence of meconium were found to be independently associated with SGH formation.

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