Changes in the obstetrical emergency department profile during the COVID-19 pandemic

Kugelman, Nir; Lavie, Ofer; Assaf, Wisam; Cohen, Nadav; Sagi‐Dain, Lena; Bardicef, Mordehai; Kedar, Reuven; Damti, Amit; Segev, Yakir

doi:10.1080/14767058.2020.1847072

Cited by 32 publications

(49 citation statements)

References 12 publications

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“…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) .…”

Section: Resultsmentioning

confidence: 99%

“…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.…”

Section: Resultsmentioning

confidence: 99%

“…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 …”

Section: Resultsmentioning

confidence: 99%

“…There were five reports from national registries, 5 , 17 , 27 , 37 , 47 six regional reports, 28 , 37 , 41 , 43 , 44 , 45 and four multicentre studies; 16 , 21 , 25 , 46 the remaining 25 were single-centre studies. 11 studies 12 , 15 , 19 , 23 , 24 , 33 , 38 , 39 , 42 , 45 , 49 had a comparison group from the equivalent period in 2019, the year preceding the pandemic. Nine studies 16 , 17 , 20 , 28 , 30 , 31 , 32 , 35 , 47 had a comparison group of annually matched periods from several preceding years ( table 1 ).…”

Section: Resultsmentioning

confidence: 99%

“…Meta-analysis (including 8072 pregnancies during and 37 557 before the pandemic) found no overall difference in the rate of neonatal intensive care unit admissions (OR 0·90 [95% CI 0·80–1·01]; I 2 =0%; table 3 , appendix p 62 ). 4 , 14 , 15 , 19 , 23 , 31 , 32…”

Section: Resultsmentioning

confidence: 99%

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

Chmielewska

Barratt

Townsend

et al. 2021

The Lancet Global Health

844

820

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Background The COVID-19 pandemic has had a profound impact on health-care systems and potentially on pregnancy outcomes, but no systematic synthesis of evidence of this effect has been undertaken. We aimed to assess the collective evidence on the effects on maternal, fetal, and neonatal outcomes of the pandemic. Methods We did a systematic review and meta-analysis of studies on the effects of the pandemic on maternal, fetal, and neonatal outcomes. We searched MEDLINE and Embase in accordance with PRISMA guidelines, from Jan 1, 2020, to Jan 8, 2021, for case-control studies, cohort studies, and brief reports comparing maternal and perinatal mortality, maternal morbidity, pregnancy complications, and intrapartum and neonatal outcomes before and during the pandemic. We also planned to record any additional maternal and offspring outcomes identified. Studies of solely SARS-CoV-2-infected pregnant individuals, as well as case reports, studies without comparison groups, narrative or systematic literature reviews, preprints, and studies reporting on overlapping populations were excluded. Quantitative meta-analysis was done for an outcome when more than one study presented relevant data. Random-effects estimate of the pooled odds ratio (OR) of each outcome were generated with use of the Mantel-Haenszel method. This review was registered with PROSPERO (CRD42020211753). Findings The search identified 3592 citations, of which 40 studies were included. We identified significant increases in stillbirth (pooled OR 1·28 [95% CI 1·07–1·54]; I 2 =63%; 12 studies, 168 295 pregnancies during and 198 993 before the pandemic) and maternal death (1·37 [1·22–1·53; I 2 =0%, two studies [both from low-income and middle-income countries], 1 237 018 and 2 224 859 pregnancies) during versus before the pandemic. Preterm births before 37 weeks' gestation were not significantly changed overall (0·94 [0·87–1·02]; I 2 =75%; 15 studies, 170 640 and 656 423 pregnancies) but were decreased in high-income countries (0·91 [0·84–0·99]; I 2 =63%; 12 studies, 159 987 and 635 118 pregnancies), where spontaneous preterm birth was also decreased (0·81 [0·67–0·97]; two studies, 4204 and 6818 pregnancies). Mean Edinburgh Postnatal Depression Scale scores were higher, indicating poorer mental health, during versus before the pandemic (pooled mean difference 0·42 [95% CI 0·02–0·81; three studies, 2330 and 6517 pregnancies). Surgically managed ectopic pregnancies were increased during the pandemic (OR 5·81 [2·16–15·6]; I 2 =26%; three studies, 37 and 272 pregnancies). No overall significant effects were identified for other outcomes included in the quantitative analysis: maternal gestational diabetes; hypertensive disorders of pregnancy; preterm birth before 34 weeks', 32 weeks',...

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Figure 1 PRISMA flow chart …”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

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

Chmielewska

Barratt

Townsend

et al. 2021

The Lancet Global Health

844

820

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Obstetric and Neonatal Outcomes Associated With Implementation of a COVID-19 Predelivery Screening Policy in a Taiwan Hospital

et al. 2023

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Consequences of the COVID‐19 pandemic on the postpartum course: Lessons learnt from a large‐scale comparative study in a teaching hospital

Kugelman

Toledano-Hacohen

Karmakar

et al. 2021

Intl J Gynecology & Obste

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Objective To evaluate the consequences of COVID‐19 pandemic restrictions on the postpartum course. Methods A retrospective cross‐sectional study compared women who gave birth between March and April 2020 (first wave), between July to September 2020 (second wave), and a matched historical cohort throughout 2017–2019 (groups A, B, and C, respectively). Primary outcomes were postpartum length of stay (LOS), presentations to the emergency department (ED), and readmissions 30 days or longer after discharge. Following Bonferroni correction, p < 0.016 was considered statistically significant. Results In total, 3377 women were included: 640, 914, and 1823 in groups A, B, and C, respectively. LOS after birth (both vaginal and cesarean) was shorter in groups A and B compared to the control group (2.28 ± 1.01 and 2.25 ± 0.93 vs 2.55 ± 1.10 days, p < 0.001). Rates of ED presentations 30 days after discharge were higher in groups C and B compared to group A (6.63% and 6.45% vs 3.12%, p = 0.006). Rates of readmissions 30 days after discharge were 0.78%, 1.42%, and 1.09% (groups A, B, and C, respectively), demonstrating no statistical difference (p = 0.408). Conclusion During the COVID‐19 pandemic, there was a reduction or no change in rates of ED presentations and readmissions, despite the shortened LOS after delivery. A shift in policy regarding the postpartum LOS could be considered.

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Changes in the obstetrical emergency department profile during the COVID-19 pandemic

Cited by 32 publications

References 12 publications

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

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

Obstetric and Neonatal Outcomes Associated With Implementation of a COVID-19 Predelivery Screening Policy in a Taiwan Hospital

Consequences of the COVID‐19 pandemic on the postpartum course: Lessons learnt from a large‐scale comparative study in a teaching hospital

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