Counting stillbirths and COVID 19—there has never been a more urgent time

Homer, Caroline; Leisher, Susannah Hopkins; Aggarwal, Neelam; Akuze, Joseph; Babona, Delly; Blencowe, Hannah; Bolgna, John; Chawana, Richard; Christou, Aliki; Davies‐Tuck, Miranda; Dandona, Rakhi; Gordijn, Sanne J.; Gordon, Adrienne; Jan, Rafat; Korteweg, Fleurisca J.; Maswime, Salome; Murphy, Margaret; Quigley, Paula; Storey, Claire; Vallely, Lisa M; Waiswa, Peter; Whitehead, Clare; Zeitlin, Jennifer; Flenady, Vicki

doi:10.1016/s2214-109x(20)30456-3

Cited by 55 publications

(66 citation statements)

References 9 publications

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“…None of the women suffering a stillbirth had COVID-19, so these findings may reflect the changes made to the provision of maternity services rather than a direct effect of the virus. However, the Office for National Statistics provided reassurance when it described a decrease in the stillbirth rate in England and Wales from 4.0 stillbirths per 1000 (2019) to 3.9 per 1000 (January–September 2020) [ 47 ]. This is a continuation of the long-standing trend of decreasing rates of stillbirth in the UK [ 47 ].…”

Section: Effect Of Covid-19 On Pregancy Outcomesmentioning

confidence: 99%

Effects of the COVID pandemic on pregnancy outcomes

Elsaddig

Khalil

2021

Best Practice & Research Clinical Obstetrics & Gynaecol

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Pregnant women and neonates are often categorised as being at high risk during the coronavirus-19 (COVID-19) pandemic. Numerous studies have demonstrated that the characteristics of COVID-19 disease in pregnant women and non-pregnant women are very similar. However, pregnant women with COVID-19 in the third trimester are more likely than their non-pregnant counterparts to require intensive care, though this may reflect a lower threshold for intervention in pregnant women rather than more serious disease. Compared with pregnant women without COVID-19, pregnant women with symptomatic COVID-19 requiring admission to hospital have worse maternal outcomes, including death, although the absolute risk remains very low. Outcomes of neonates born to women positive for COVID-19 are generally very good, though iatrogenic preterm birth is more common. Findings from these studies highlight the need for further monitoring of the outcomes of pregnant and post-partum women according to trimester during this pandemic.

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Section: Effect Of Covid-19 On Pregancy Outcomesmentioning

confidence: 99%

Effects of the COVID pandemic on pregnancy outcomes

Elsaddig

Khalil

2021

Best Practice & Research Clinical Obstetrics & Gynaecol

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“…preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in The copyright holder for this this version posted June 12, 2021. ; https://doi.org/10.1101/2021.06.09.21258622 doi: medRxiv preprint Stillbirths and early neonatal mortality rates were not assessed in the three nationwide studies from The Netherlands, USA, and Denmark 1,3,9 . Since PTB rates could be reduced in response to increasing perinatal mortality rates 20 there is a need to assess live birth rates alongside perinatal mortality rates (stillbirth and early neonatal death) during the different periods studied. Accordingly, this study aimed to use data pertaining to all Danish pregnancies and births, captured in the extensive nationwide electronic registers to study the prevalence of PTB, stillbirth, and early neonatal mortality from singleton pregnancies during the first strict lockdown period in Denmark and during the continuous period of COVID-19 restrictions.…”

Section: Introductionmentioning

confidence: 99%

Preterm birth, stillbirth, and early neonatal mortality during the Danish COVID-19 lockdown

Hedley

Hedermann

Hagen

et al. 2021

Preprint

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Importance: Using provisional or opportunistic data, three nationwide studies (The Netherlands, USA, and Denmark) have identified a reduction in preterm or extremely preterm births during periods of COVID-19 restrictions. However, these findings have been challenged as none of the studies accounted for perinatal deaths. Objective: To determine whether the reduction in extremely preterm births, observed in Denmark during the COVID-19 lockdown, could be a result of an increase in number of perinatal deaths; and to assess the impact of extended COVID-19 restrictions on the prevalence of preterm birth and perinatal death. Design: The study is a nationwide Danish register-based prevalence proportion study using detailed data to capture all births (induced abortions were excluded) throughout Denmark. We assessed the prevalence of stillbirth, preterm birth, and early neonatal death. Setting: Population-based study Participants: All singleton pregnancies delivered in Denmark, between February 27, and September 30, 2015-2020. COVID-19 lockdown was studied in 31,164 births and the extended period of COVID-19 restrictions in 214,862 births. Exposure: COVID-19 restrictions broadly (February 27, to September 30, 2020) or COVID-19 lockdown specifically (March 12, to April 14, 2020). Main Outcome: Prevalence of preterm births, stillbirths and early neonatal deaths across the periods under study. Results: The extremely preterm birth rate was reduced (OR 0.27, 95% CI 0.07 to 0.86) during the strict lockdown period, while perinatal mortality was not significantly different. During the extended period of restrictions, the extremely preterm birth rate was marginally reduced, and a significant reduction in the stillbirth rate (OR 0.69, 0.50 to 0.95) was observed. No changes in early neonatal mortality rates were found. Conclusion and Relevance: Stillbirth and extremely preterm birth rates were reduced in Denmark during the period of COVID-19 restrictions and lockdown, respectively, suggesting that aspects of these containment and control measures confer an element of protection. The present observational study does not allow for causal inference; however, the results support design of studies to ascertain whether behavioural or social changes for pregnant women may improve pregnancy outcomes.

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“…According to WHO, Global numbers from the year 2017 estimates show that 295,000 women die during pregnancy and childbirth [1]. It is also estimated that 2 million stillbirths and 2.5 million early newborn deaths occur each year worldwide [2,3]. More than 90% of these deaths happen in low-and middle-income countries, like Rwanda [4].…”

Section: Introductionmentioning

confidence: 99%

The effect of an mLearning application on nurses’ and midwives’ knowledge and skills for the management of postpartum hemorrhage and neonatal resuscitation: pre–post intervention study

et al. 2021

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Background Globally, mobile learning (mLearning) tools have attracted considerable attention as a means of continuous training for healthcare workers. Rwanda like other low-resource settings with scarce in-service training opportunities requires innovative approaches that adapt technology to context to improve healthcare workers’ knowledge and skills. One such innovation is the safe delivery application (SDA), a smartphone mLearning application for Basic Emergency Obstetric and Neonatal Care (BEmONC) content. This study assessed the effect of the SDA intervention on nurses’ and midwives’ knowledge and skills for the management of postpartum hemorrhage (PPH) and neonatal resuscitation (NR). Methods The study used a pre–post test design to compare knowledge and skills of nurses and midwives in the management of PPH and NR at two measurement points: immediately prior to SDA intervention and after 6 months of SDA intervention. The intervention took place in two district hospitals in Rwanda and included 54 participants. A paired-sample t-test was used to measure the pre–post intervention, mean knowledge and skills scores differences. Confidence intervals (CIs) and effect size were calculated. A t-test and a one-way Anova were used to test for potential confounders. Results The analysis included 54 participants. Knowledge scores and skills scores on PPH management and NR increased significantly from baseline to endline measurements. The mean difference for PPH knowledge is 17.1 out of 100; 95% CI 14.69 to 19.49 and 2.6% for PPH skills; 95% CI 1.01 to 4.25. The mean difference for NR knowledge is 19.1 out of 100; 95% CI 16.31 to 21.76 and 5.5% for NR skills; 95% CI 3.66 to 7.41. Increases were unaffected by participants’ attendance to in-service training 6 months prior and during SDA intervention and previous smartphone use. However, pre- and post-intervention skills scores were significantly different by years of experience in obstetric care. Conclusion The SDA intervention improved the knowledge and skills of nurses and midwives on the management of PPH and NR as long as 6 months after SDA introduction. The results are highly relevant in low-income countries like Rwanda, where quality of delivery care is challenged by a lack of in-service continuous training for healthcare providers.

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Counting stillbirths and COVID 19—there has never been a more urgent time

Cited by 55 publications

References 9 publications

Effects of the COVID pandemic on pregnancy outcomes

Effects of the COVID pandemic on pregnancy outcomes

Preterm birth, stillbirth, and early neonatal mortality during the Danish COVID-19 lockdown

The effect of an mLearning application on nurses’ and midwives’ knowledge and skills for the management of postpartum hemorrhage and neonatal resuscitation: pre–post intervention study

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