Impact of the COVID-19 Pandemic on Obstetric Interventions at a Public Hospital

• Type of Material: Article
• Authors: Tatyana A Johnson, Northwestern University; Denise Jamieson, Emory University; Franklyn H Geary, Morehouse School of Medicine; Kaitlyn K Stanhope, Emory University; Sheree Boulet, Emory University
• Language: English
• Date: 2022-12-15
• Publisher: ELSEVIER SCIENCE INC
• Publication Version: Final Published Version
• Copyright Statement: © 2022 Jacobs Institute of Women's Health, George Washington University. Published by Elsevier Inc. All rights reserved.
• Final Published Version (URL): http://dx.doi.org/10.1016/j.whi.2022.08.003
• Title of Journal or Parent Work: WOMENS HEALTH ISSUES
• Volume: 33
• Issue: 1
• Start Page: 10
• End Page: 16
• Keywords: Women's Studies; DISEASE; PREGNANCY; REGRESSION; Social Sciences; Public, Environmental & Occupational Health; Life Sciences & Biomedicine; PRETERM BIRTH; Science & Technology
• Research Categories: Health Sciences, Obstetrics and Gynecology; Health Sciences, Medicine and Surgery

Abstract

Introduction: In response to the COVID-19 pandemic, health systems quickly implemented changes in care delivery with a goal of balancing patient-focused obstetric care with the need to protect pregnant persons and health care providers from infection. Yet, there is no consensus within the scientific community on the impact these measures have on obstetric outcomes in vulnerable populations. We aimed to assess the impact of the COVID-19 pandemic on rates of obstetric procedures and severe maternal morbidity (SMM) among births at an urban safety net institution. Methods: We used an interrupted time series design to calculate risk ratios (RRs) and 95% confidence intervals (CIs) comparing monthly rates of labor induction, cesarean births (overall and among nulliparous, term, singleton, vertex births), operative vaginal births, and SMM among births occurring at a public hospital before (March 1, 2016, to February 29, 2020) and during (March 1, 2020, to May 31, 2021) the COVID-19 pandemic. Results: There were 10,714 and 2,736 births in the prepandemic and postpandemic periods, respectively. Overall, the rates of obstetric interventions and SMM were constant over the two time periods. There were no significant differences in rates of labor induction (42% during prepandemic period vs. 45% during pandemic period; RR, 1.12; 95% CI, 0.93–1.34), operative vaginal births (5% vs. 6%; RR, 1.24; 95% CI, 0.88–1.76), cesarean births (28% vs. 33%; RR, 1.10; 95% CI, 0.94–1.28), or nulliparous, term, singleton, vertex cesarean births (24% vs. 31%; RR, 1.27; 95% CI, 0.92–1.74). Rates of SMM (7% vs. 8%; RR, 1.19; 95% CI, 0.86–1.65) were also unchanged. Conclusions: Our findings indicate that the rapid implementation of measures to reduce viral transmission in the labor and delivery setting did not materially affect routine clinical management or rates of serious maternal complications.