Obstetrics and Gynecology Emergency Department Activity during Lockdown in a Teaching Hospital, Hub Center, for COVID-19.

Background: The lockdown related to the SARS-CoV-2 pandemic has imposed profound changes in the interaction of the population with hospitals and emergency departments. The main aim of this research was to evaluate the impact of lockdown on the activity of obstetrics and gynecology emergency department (OGED) in a teaching hospital, hub center, for COVID-19. Methods: The study considers all visits to the OGED with their different triage color codes that represent the clinical severity of each case (from the most severe to the least one: red, yellow, green, white). Data were selected through the "PSNet" triage program and collected anonymously. We analyzed frequency distributions of the variables separately for each woman and calculated mean and standard deviations for continuous variables. We then analyzed the association between factors and outcomes for categorical variables (expressed as a number and percentage of the total) using the chi-square test (χ2). The level of significance was established with p < 0.05. Statistical analysis was performed using SPSS Statistics V20.0. Given the fact that the study has a retrospective observational nature and it is based on an anonymous routine database, approval by the Local Ethics Committee was not necessary. Results: The relative decrease of patients presenting to OGED in 2020 was -50.96%. The percentage of nonpregnant women was significantly lower in 2020 compared to 2019 (p ≤ 0.0001; Δ = -79.46%). Regarding the obstetric group, we saw an important decrease of visits in 2020 compared to 2019 (p < 0.0001; Δ = -40%). The prevalence of yellow codes was significantly higher in 2020 (Δ = +29.72%), while that of white (Δ = -61.58%) and green (Δ = -52.22%) codes was significantly lower (p ≤ 0.0001). Comparing the diagnoses at discharge, we could highlight significant reductions in 2020 for more than one diagnosis: bleeding (p ≤ 0.0001; Δ = -70.42%), pain (p ≤ 0.0001; Δ = -81.22%), urinary diseases (p = 0.004; Δ = -75.64%), and gastrointestinal diseases (p ≤ 0.0001; Δ = -87.50%). Conclusions: An evident change emerged in relation to the dynamics between the local obstetrical and gynecological population, and OGED resources. The COVID-19 lockdown greatly reduced the rate of admission to OGED without time-related obstetric and gynecological complications. The reduction of admissions suggests a more appropriate use of the ED by patients that may inspire future policies for the implementation of emergency services.

Covid-19 seroprevalence in a group of pregnant women compared to a group of non-pregnant women

Pregnant women are an interesting population to study in the context of the current Coronavirus Disease 2019 (COVID-19);studies are still controversial in concluding if pregnancy is a protective condition or a risk factor for a more severe form of the illness. We estimated rate of positive serology for SARS-CoV-2 in a population of healthy pregnant women, compared to a population of non-pregnant women of the same age and geographic area. We also made a comparison between the two groups in terms of previous symptoms and lifestyle. This is a transversal study including pregnant women, above 18 weeks of gestation, aged between 18 and 40 years. The control group consisted of 588 non pregnant women from the same area and the same age group. A total of 344 pregnant women and 588 non pregnant women were recruited. The rate of positive serology for SARS-CoV-2 was significantly lower in the pregnant group: 9/344 (2.6%) versus 75/588 (12.8%) in the non-pregnant group (p < 0.0001). The two groups were similar in terms of occupation and in the self-re-ported habit to leave the house during the lockdown. Our hypothesis to explain this result is that pregnant women might have adopted a more prudential lifestyle, due to their special condition, which may have led them to behave with more caution, i.e., concerning the responsibility of wearing all the disposable personal protective equipment, and keeping the recommended 6 feet distance from other people.

The perception of Italian pregnant women and new mothers about their psychological wellbeing, lifestyle, delivery, and neonatal management experience during the COVID-19 pandemic lockdown: A web-based survey

BACKGROUND In response to the COVID-19 pandemic, drastic measures for social distancing have been introduced also in Italy, with a substantial impact in delicate conditions like pregnancy and puerperium. The study aimed to investigate the changes in lifestyle, access to health services, and mental wellbeing during the first Italian lockdown in a sample of Italian pregnant women and new mothers. METHODS We carried out a web-based survey to evaluate how pregnant women and new mothers were coping with the lockdown. We collected data about healthy habits (physical exercise and dietary habits), access to health services (care access, delivery and obstetric care, neonatal care, and breastfeeding), and mental wellbeing (psychological wellbeing and emotive support). Descriptive analysis was performed for both groups of participants, whereas a Poisson analysis was used to measure the association between some structural variables (age, education, socio-economic data, partner support, contact, free time, previous children, and pregnancy trimester) and anxiety or depression, difficulties in healthy eating and reduction in physical activity after lockdown started. Chi2 and Adjusted Prevalence Ratios were estimated only for pregnant women. RESULTS We included 739 respondents (response rate 85.8 %), 600 were pregnant (81.2 %), and 139 (18.8 %) had delivered during lockdown (new mothers). We found a high score for anxiety and depression in 62.8 % of pregnant women and 61.9 % of new mothers. During the lockdown, 61.8 % of pregnant women reduced their physical exercise, and 44.3 % reported eating in a healthier way. 94.0 % of new mothers reported to have breastfed their babies during the hospital stay. Regarding the perceived impact of restrictive measures on breastfeeding, no impact was reported by 56.1 % of new mothers, whereas a negative one by 36.7 %. CONCLUSIONS The high prevalence of anxiety and depressive symptoms in pregnant women and new mothers should be a public health issue. Clinicians might also recommend and encourage 'home' physical exercise. On the other hand, about half of the sample improved their approach towards healthy eating and a very high breastfeeding rate was reported soon after birth: these data are an interesting starting point to develop new strategies for public health.

COVID-19 seroprevalence in a group of pregnant women compared to a group of non-pregnant women

INTRODUCTION Pregnant women are an interesting population to study in the context of the current Coronavirus Disease 2019 (COVID-19);studies are still controversial in concluding if pregnancy is a protective condition or a risk factor for a more severe form of the illness particularly when the cardiorespiratory system is affected [1,2]. Some theories support the hypothesis that, since COVID-19 is an immune condition marked by reduced lymphocytes and elevated selected proinflammatory cytokines, and similar immune expression has been demonstrated in pregnancy, pregnant women might be on higher risk for a severe form of the illness [3]. Pregnancy itself can be considered an immunological paradox: the woman must develop an immunological tolerance towards a semi-allogenic fetus, which has exposed pregnant women in history to an increased risk of infection, especially viral with maternal and neonatal unfavourable outcomes [4,5]. According to other authors, immunomodulatory mechanisms employed by the pregnant status may mitigate violent immune response, may soften cytokine storm, tightly associated with severely ill COVID-19 patients, and potentially reduce SARS-CoV-2 transmission [6]. We estimated the rate of positive serology for SARS-CoV-2 in a population of healthy pregnant women, compared to a population of non-pregnant women of the same age and geographic area. We also made a comparison between the two groups in terms of previous symptoms and lifestyle. METHODS This is a transversal study including 344 pregnant women, above 18 weeks of gestation, aged between 18 and 40, attending the obstetrical clinic of the 'Maggiore della Carità' Hospital-Novara. The control group consisted of 588 non-pregnant women from the same area and the same age group. Women consented to participate in the study after being informed on the nature of the research and data managing and processing;an informed consent was therefore signed. Recruitment period was from 27th April 2020 to 1st July 2020. RESULTS A total of 344 pregnant women and 588 non-pregnant women were recruited. The rate of positive serology for SARS-CoV-2 was significantly lower in the pregnant group: 9/ 344 (2.6%) vs 75/588 (12.8%) in the non-pregnant group (p < .0001). The two groups were similar in terms of occupation and in the self-reported habit to leave the house during the lockdown. Furthermore, our study does not demonstrate important differences between pregnant and non-pregnant in symptomatology except that pregnant women mostly have fever and cough while symptoms for non-pregnant women were more varied. CONCLUSIONS Pregnant women are less infected than the equivalent female population. This could be either a better immunological response or due to a more prudential lifestyle. Pregnant women might have adopted a more prudential lifestyle, due to their special condition, which may have lead them to behave with more caution, concerning the responsibility of wearing all the disposable personal protective equipment, and keeping the recommended 6 feet distance from other people.

What may happen if you are pregnant during COVID-19 lockdown? A retrospective study about peripartum outcomes

INTRODUCTION One of the main implemented provisions to contain the spread of COVID-19 infections in Italy was the lockdown. Effects of the lockdown on childbirth outcomes and on the well-being of both the mother and the child have not yet been defined. The lifestyle of pregnant women has a fundamental impact on maternal health and fetal development. An inadequate diet during pregnancy and a reduced physical activity can predispose women to become overweight or obese and trigger the development of various complications and maternal-fetal adverse outcomes. Stressful situations, such as those caused by this new confinement, could be also the cause of overeating and of weight gain. Indeed, some studies suggested that psychological and emotional responses to the COVID-19 outbreak may have also increased the risk of developing dysfunctional eating behaviors and overeating as a consequence of boredom. Moreover, Body Mass Index (BMI) and maternal weight gain during pregnancy could be related to a higher rate of breech presentations. Fetal malpresentation is one of the main causes of the high rate of cesarean delivery. This pandemic could also influence women's attitude to routine checkups and pregnancy scans, antenatal appointments and consultations. METHODS This is a retrospective study including all consecutive patients who delivered at University Hospital Maggiore della Carità in Novara, Italy, in April-May 2017 (group 1, n=294), a period prior to the pandemic, and during the same months in 2020 (group 2, n=256) during and immediately after lockdown. Clinical data were extracted from The Report 'Childbirth Assistance Certificate (CedAP) - Birth Event Analysis'. RESULTS Demographic characteristics were similar between the two study groups, except for a decreased number of married couples in group 2 (p-value .018) and an increased percentage of patients with clinical checkups at Family Planning facilities in 2020 (p-value .04). The number of hospitalizations during pregnancy was 26 (8.9%) vs 10 (3.9%) with a significative reduction during 2020 (p-value .004). Regarding obstetric outcomes, we observed a significant increase in induction of labour in 2020 (23.9% vs 35.9%;p-value . 002), a reduction of amniorrhexis (11.3% vs 5.5% p-value .015), a reduction of supine positions with an increase of vertical and all fours positions in 2020 (49.3% vs 61.9% and 9.5% vs 12.4% respectively, p .023), and a reduction of left occipito-anterior presented part (63.2% vs 55.4%) in favor of right occipito-anterior (34.7% vs 41.2%, p-value .019) as shown in Table 1. CONCLUSIONS It is the first time in modern, age that humankind faces a lockdown, so the short- and long-term effects are unknown. There were no significant differences either for antepartum or intrapartum complications. Long-term studies are needed to evaluate possible psychological, behavioral, and epigenetic effects on obstetric outcomes.

Obstetrics and gynecology emergency department activity during lockdown: What did we learn?

INTRODUCTION The main problems of Emergency Departments (ED) is overcrowding. The lockdown related to SARS-CoV2 pandemic imposed changes in the interaction of population with ED. This study evaluates the impact of lockdown on the activity of obstetrics and gynecology emergency department (OGED) in a teaching hospital, hub centre for COVID-19. METHODS This is a retrospective monocentric study, comparing all admissions to OGED during the lockdown period in 2020 (from March 09 to May 04) with the same period of 2019. The data were selected through the triage program 'PS NET' and collect anonymously. We analyzed frequency distributions of the variables separately for each woman, calculated mean and standard deviations for continue variables. Then we analyzed the association between factors and outcomes for the categorical variables (expressed as number and percentage of the total) by using Chi-square test (v2).The level of significance was set with p < .05. Statistical analysis was performed using SPSS Statistics V20.0. RESULTS The decrease of patients presenting to OGED was -50.96%, with a significant reduction for both Italian (Δ = -55.22%) and other nationalities (Δ = -41.77%) more significant for the first group (p=.006). The percentage of nonpregnant women was lower (p =< .0001;Δ = -79.46%). Regarding the obstetrical group we saw a reduction of -40%. We saw a decrease of the permanence times, mainly regarding stays that exceeded 120 min (Δ = -60.92%), in a similar way the range from 30 to 60 min (Δ = -58.49%). The prevalence of yellow codes was higher in 2020 (D=+29.72%), while it was lower for white (Δ = -61.58%) and green (Δ = -52.22%) codes (p =< .0001). Regarding the admission symptoms and signs the decrease was significant for Pain (Δ = -73.58%, p < .0001) and for gastrointestinal problems (Δ = -80.00%;p=.036). We observed a reduction for all the diagnosis at discharge with significant reductions for: bleeding (p =< .0001;Δ = -70.42%), pain (p =< .0001;Δ = -81.22%), urinary (p=.004;D= -75.64%) and gastrointestinal diseases (p =< .0001;Δ = -87.50%). Among obstetrical patients we found an increase of yellow codes (Δ = +51.6%;p=.005);70.9% was in the third trimester, with a decrease in the rate of accesses during the first trimester of Δ = -56.16% and of Δ = -66.01% during the second trimester of pregnancy(p < .0001). The rate of hospitalization rose from 21.9% to 34.9% (p < .0001). The percentage of patients admitted to OGED for contractions and then hospitalized rose (p < .0001;Δ = +360.7%). None of long term adverse outcomes showed significant changes despite the reduction in the number of accesses during lockdown. CONCLUSIONS An evident change emerged, describing the dynamics of the interactions between the local population and OGED. The COVID-19 lockdown reduced the rate of admission without adverse long term fetal or maternal outcomes. This reduction suggests a more appropriate use of the OGED that may inspire future policies for the implementation of emergency services. Implementing local health services to manage non-specific symptoms, more clear communication regarding how to manage pregnancy related symptoms during planned check ups, more expensive bills for accessing for non urgent reasons, could be useful for an appropriate use of OGED, resulting in less crowding, shorter waiting times and at ease staff during working hours.