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

Kugelman, Nir; Toledano-Hacohen, Mirit; Karmakar, Debjyoti; Segev, Yakir; Shalabna, Eiman; Damti, Amit; Kedar, Reuven; Zilberlicht, Ariel

doi:10.1002/ijgo.13633

Cited by 6 publications

(4 citation statements)

References 24 publications

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“…Our results show a reduction in prolonged maternal hospital stays, a finding supported by other studies [ 44 – 46 ]; early discharge from the hospital may have been initiated by either the clinician or the woman to reduce the perceived risk of infection associated with hospital stay, or to reunite with family members unable to visit maternity units. Rates of maternal readmission were also reduced during the pandemic period, which may reflect that women were less likely to seek care for postpartum issues.…”

Section: Discussionsupporting

confidence: 89%

Obstetric interventions and pregnancy outcomes during the COVID-19 pandemic in England: A nationwide cohort study

et al. 2022

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Background The COVID-19 pandemic has disrupted maternity services worldwide and imposed restrictions on societal behaviours. This national study aimed to compare obstetric intervention and pregnancy outcome rates in England during the pandemic and corresponding pre-pandemic calendar periods, and to assess whether differences in these rates varied according to ethnic and socioeconomic background. Methods and findings We conducted a national study of singleton births in English National Health Service hospitals. We compared births during the COVID-19 pandemic period (23 March 2020 to 22 February 2021) with births during the corresponding calendar period 1 year earlier. The Hospital Episode Statistics database provided administrative hospital data about maternal characteristics, obstetric inventions (induction of labour, elective or emergency cesarean section, and instrumental birth), and outcomes (stillbirth, preterm birth, small for gestational age [SGA; birthweight < 10th centile], prolonged maternal length of stay (≥3 days), and maternal 42-day readmission). Multi-level logistic regression models were used to compare intervention and outcome rates between the corresponding pre-pandemic and pandemic calendar periods and to test for interactions between pandemic period and ethnic and socioeconomic background. All models were adjusted for maternal characteristics including age, obstetric history, comorbidities, and COVID-19 status at birth. The study included 948,020 singleton births (maternal characteristics: median age 30 years, 41.6% primiparous, 8.3% with gestational diabetes, 2.4% with preeclampsia, and 1.6% with pre-existing diabetes or hypertension); 451,727 births occurred during the defined pandemic period. Maternal characteristics were similar in the pre-pandemic and pandemic periods. Compared to the pre-pandemic period, stillbirth rates remained similar (0.36% pandemic versus 0.37% pre-pandemic, p = 0.16). Preterm birth and SGA birth rates were slightly lower during the pandemic (6.0% versus 6.1% for preterm births, adjusted odds ratio [aOR] 0.96, 95% CI 0.94–0.97; 5.6% versus 5.8% for SGA births, aOR 0.95, 95% CI 0.93–0.96; both p < 0.001). Slightly higher rates of obstetric intervention were observed during the pandemic (40.4% versus 39.1% for induction of labour, aOR 1.04, 95% CI 1.03–1.05; 13.9% versus 12.9% for elective cesarean section, aOR 1.13, 95% CI 1.11–1.14; 18.4% versus 17.0% for emergency cesarean section, aOR 1.07, 95% CI 1.06–1.08; all p < 0.001). Lower rates of prolonged maternal length of stay (16.7% versus 20.2%, aOR 0.77, 95% CI 0.76–0.78, p < 0.001) and maternal readmission (3.0% versus 3.3%, aOR 0.88, 95% CI 0.86–0.90, p < 0.001) were observed during the pandemic period. There was some evidence that differences in the rates of preterm birth, emergency cesarean section, and unassisted vaginal birth varied according to the mother’s ethnic background but not according to her socioeconomic background. A key limitation is that multiple comparisons were made, increasing the chance of false-positive results. Conclusions In this study, we found very small decreases in preterm birth and SGA birth rates and very small increases in induction of labour and elective and emergency cesarean section during the COVID-19 pandemic, with some evidence of a slightly different pattern of results in women from ethnic minority backgrounds. These changes in obstetric intervention rates and pregnancy outcomes may be linked to women’s behaviour, environmental exposure, changes in maternity practice, or reduced staffing levels.

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Section: Discussionsupporting

confidence: 89%

Obstetric interventions and pregnancy outcomes during the COVID-19 pandemic in England: A nationwide cohort study

et al. 2022

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“…Another study found that though women were discharged from the hospital on average 24 hours earlier during the pandemic than before its onset, emergency department visits and readmissions among postpartum women remained the same. The authors suggested that shorter postpartum stays may therefore represent a cost-effective alternative to pre-pandemic practice (Kugelman et al, 2021). Aside from this study, our review of the literature found no other studies examining postnatal care for mothers not infected with COVID-19 and their families during the pandemic.…”

Section: Introductionmentioning

confidence: 67%

Opportunities and Challenges for Family-Centered Postpartum Care During the COVID-19 Pandemic: A Qualitative Study of Nurse Perspectives

Buek¹,

O’Neil²,

Mandell³

2021

Preprint

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Background The global COVID-19 pandemic has forced the health care sector to make wide-ranging changes to protect patients as well as providers from the risk of infection. Many of these changes are likely to have greatest impact in contexts of care that employ family-centered models, including perinatal and maternity care. Research conducted in prenatal, childbirth and postpartum settings during the pandemic has shown that some of these restrictions have negatively impacted health care practice and outcomes, while others have been beneficial to both providers and patients. The present qualitative study aimed to understand what changes have occurred in postpartum nursing practice during the pandemic, and how these changes have affected nurses, women and families during their stay in the hospital following a new birth.MethodsStructured interviews were completed with 20 postpartum nurses from five hospitals across Texas. The interview protocol was designed to elicit information about changes to hospital policies in postpartum units during the pandemic, nurses’ attitudes about these changes, perceived benefits and challenges for performance of their duties, and perceived effects on patients and their families. Nurses were recruited for the study using a purposive sampling approach. Interviews were conducted by telephone and lasted approximately 30 to 45 minutes. Data were analyzed using a qualitative descriptive approach. ResultsParticipants reported that their hospitals placed restrictions on the number and mobility of support persons allowed to stay with the mother in the unit and prohibited all other visitation. Some challenges of these policies included reduced opportunities for hands-on learning and an increased number of patients opting for early discharge. Perceived benefits for nursing practice as well as patient outcomes included improved frequency and effectiveness of nurse-family communication, increased father involvement, and greater opportunities for maternal rest, breastfeeding, skin-to-skin care and family bonding.ConclusionsStudy findings suggests that some limitations on postpartum hospital visitation may achieve important, family-centered goals. Protected time for family-bonding, maternal rest, breastfeeding, father involvement and individualized education are critical to quality FCC. Research must examine which visitation policies maximize these benefits while preserving patient access to family and social support.

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“…Interestingly, expedited discharge was not one of the hospital policies implemented during their study period to decrease SARS-CoV-2 transmission. The second, a study by Kugelman et al, 27 from a delivery hospital in Israel, examined a cohort of 3,377 obstetric patients and similarly found a decrease in postpartum hospitalization LOS and no difference in hospital readmission within 30 days of discharge. The third study, from a health system in New York, 28 also reported a decrease in postpartum LOS; however, adverse outcomes were not reported.…”

Section: Discussionmentioning

confidence: 99%

Postpartum Length of Stay and Hospital Readmission Before and During the Coronavirus Disease 2019 (COVID-19) Pandemic

Handley

Gallagher

Lindgren

et al. 2022

Obstetrics &Amp; Gynecology

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METHODS:We conducted a retrospective cohort study, using Epic Systems' Cosmos research platform, of obstetric patients who delivered between March 1, 2017, and February 28, 2021, at 20-44 weeks of gestation and were discharged within 7 days of delivery. The primary outcome was short postpartum hospitalization LOS (less than two midnights for vaginal births and less than three midnights for cesarean births) and secondary outcome was hospital readmission within 6 weeks of postpartum hospitalization discharge. Analyses compared outcomes before and during the pandemic using standardized differences and Bayesian logistic mixed-effects models, among all births and stratified by mode of delivery.RESULTS: Of the 994,268 obstetric patients in the study cohort, 742,113 (74.6%) delivered prepandemic and 252,155 (25.4%) delivered during the COVID-19 pandemic. During the COVID-19 pandemic, the percentage of short postpartum hospitalizations increased among all births (28.7-44.5%), vaginal births (25.4-39.5%), and cesarean births (35.3-55.1%), which was consistent with the adjusted analysis (all births: adjusted odds ratio [aOR] 2.35, 99% credible interval 2.32-2.39; vaginal births: aOR 2.14, 99% credible interval 2.11-2.18; cesarean births aOR 2.90, 99% credible interval 2.83-2.98). Although short postpartum hospitalizations were more common during the COVID-19 pandemic, there was no change in readmission in the unadjusted (1.4% vs 1.6%, standardized difference50.009) or adjusted (aOR 1.02, 99% credible interval 0.97-1.08) analyses for all births or when stratified by mode of delivery.CONCLUSION: Short postpartum hospitalization LOS was significantly more common during the COVID-19 pandemic for obstetric patients with no change in hospital readmissions within 6 weeks of postpartum hospitalization discharge. The COVID-19 pandemic created a natural experiment, suggesting shorter postpartum hospitalization may be reasonable for patients who are self-identified or health care professional-identified as appropriate for discharge.

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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

Cited by 6 publications

References 24 publications

Obstetric interventions and pregnancy outcomes during the COVID-19 pandemic in England: A nationwide cohort study

Obstetric interventions and pregnancy outcomes during the COVID-19 pandemic in England: A nationwide cohort study

Opportunities and Challenges for Family-Centered Postpartum Care During the COVID-19 Pandemic: A Qualitative Study of Nurse Perspectives

Postpartum Length of Stay and Hospital Readmission Before and During the Coronavirus Disease 2019 (COVID-19) Pandemic

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