Pregnancy during a Pandemic: A Cohort Study Comparing Adverse Outcomes during and before the COVID-19 Pandemic.

OBJECTIVE: This study was aimed to evaluate how the novel coronavirus disease 2019 (COVID-19) pandemic may have negatively impacted birth outcomes in patients who tested negative for the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) virus. STUDY DESIGN: We conducted a retrospective cohort study using electronic health records of pregnant women admitted to a tertiary medical center in New York City, an epicenter of the pandemic. Women with a singleton gestation admitted for delivery from March 27 to May 31, 2019, and March 27 to May 31, 2020, were included. Women less than 18 years of age, those with a positive SARS-CoV-2 polymerize chain reaction (PCR) test on admission, fetal anomaly, or multiple gestation were excluded. Adverse pregnancy outcomes were compared between groups. Univariable and multivariable logistic regression analyses were used to assess outcomes. The primary outcome was preterm birth. RESULTS: Women who delivered during the 2020 study interval had a significantly higher rate of hypertensive disorders of pregnancy (gestational hypertension [GHTN] or preeclampsia; odds ratio [OR] = 1.40, 95% confidence interval [CI]: 1.05-1.85; p = 0.02), postpartum hemorrhage (PPH; OR = 1.77, 95% CI: 1.14-2.73; p = 0.01), and preterm birth (OR = 1.49, 95% CI: 1.10-2.02; p = 0.01). Gestational age at delivery was significantly lower in the 2020 cohort compared with the 2019 cohort (39.3 versus 39.4 weeks, p = 0.03). After adjusting for confounding variables, multivariate analysis confirmed a persistent increase in hypertensive disorders of pregnancy (OR = 1.56, 95% CI: 1.10-2.20, p = 0.01), PPH (OR = 1.74, 95% CI: 1.06-2.86, p = 0.03), and preterm birth (OR = 1.72, 95% CI: 1.20-2.47, p = 0.003) in patients who delivered in 2020 compared with the same period in 2019. Specifically, medically indicated preterm births increased during the pandemic (OR = 3.17, 95% CI: 1.77-5.67, p < 0.0001). CONCLUSION: Those who delivered during the COVID-19 pandemic study interval were more likely to experience hypertensive disorders of pregnancy, medically indicated preterm birth, and PPH even in the absence of SARS-CoV2 infection. KEY POINTS: · Stressful life events can lead to adverse pregnancy outcomes.. · Even patients negative for COVID-19 experienced GHTN, preeclampsia, PPH and preterm birth during the pandemic.. · Pandemic-related stress may adversely affect perinatal outcomes..

The impact of COVID 19 on cervical cancer screening and triage

Introduction/BackgroundPrior studies have demonstrated decreased rates of cervical cancer (CC) screening during the height of the COVID-19 pandemic. Delayed CC screening and management may increase incidence and mortality. This study examines the impact of the COVID-19 pandemic on rates of guideline-indicated colposcopy.MethodologyThis study used retrospective data from a large, urban, academic institution-based clinic comprised of publicly-insured patients. Patients were non-pregnant, 21 to 65 years old without HIV or other immunocompromise. Three time periods were used: pre-COVID (pC) (3/1/2019–2/28/2020), COVID (C) (3/1/2020–2/28/2021), post-COVID vaccine (pv) (3/1/2021–2/28/2022). Primary outcomes were compared between groups using T-tests or Wilcoxon-Rank Sum tests for continuous measures and Chi-square or Fisher’s exact tests for categorical measures.ResultsN=486. The interval between pap smears significantly increased from a pC mean of 490 days, to a C mean of 607 days, to a pv mean of 670 days (p=0.0128). The proportion of patients who underwent guideline-indicated colposcopy did not differ significantly between time periods (p=0.0740). The interval between abnormal pap smear and colposcopy significantly decreased from 104 days pC (SD 69–188) to 67 days C (SD 42–147), to 57 days pv (SD 33–104) (p=0.0001). There were no significant differences in pap smear cytology, colposcopic pathology or rate of referral for excisional procedure over time. There was a significant increase in the percentage of patients being contacted regarding abnormal pap smear results, specifically by by MD providers from 43% pC, to 53% C, to 61.6% pv (P=0.0029).ConclusionThis study demonstrates an increased interval between pap smears;however, those patients undergoing screening had significantly decreased time from pap to colposcopy which may be secondary to increased MD-to-patient telehealth communication and optimization of systems during the pandemic when routine clinics were limited. Future studies are needed to assess long-term outcomes of delayed CC screening on incidence and mortality.

The Impact of the COVID-19 Pandemic on Postpartum Readmission Rates at a Single Tertiary Care Center in New York City.

OBJECTIVE: The aim of this study was to mitigate transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and decrease exposure to the hospital setting, Mount Sinai Hospital implemented new protocols, including early postpartum discharge. Early discharge would allow for more single-bedded rooms, limiting exposure to other patients and their support persons. During the pandemic, patients were discharged to home on postpartum day 1 or 2 after vaginal or cesarean delivery, respectively, instead of day 2 or 3, unless longer hospitalization was needed for medical indications. We aim to determine if the readmission rate was increased in the setting of earlier discharge during the coronavirus disease 2019 (COVID-19) pandemic. STUDY DESIGN: Historical cohort study comparing the readmission rate in SARS-CoV-2 negative women who presented to Mount Sinai Hospital for delivery admission from March to May 2019 versus March to May 2020. The primary outcome was readmission rate within 6 weeks of discharge day. Maternal and neonatal characteristics and outcomes were compared between groups using t-tests or Wilcoxon's rank-sum test for continuous measures and chi-squared or Fisher's exact tests for categorical measures, as appropriate. Primary and secondary outcomes were assessed using linear and logistic univariable and multivariable regression. RESULTS: Patients in the 2020 cohort (n = 1,078) were significantly less likely to have public/state insurance (p = 0.02), more likely to have pregestational diabetes (p = 0.02), gestational diabetes (p = 0.04), gestational hypertension (p < 0.01), and an operative vaginal or cesarean delivery (vs. spontaneous vaginal delivery, p = 0.01) compared with 2019 cohort patients (n = 1,910). Patients in the 2020 cohort were significantly more likely to have an earlier postpartum day of discharge and a shorter median length of stay compared with 2019 cohort patients (both p < 0.01). Despite differences in length of stay, the rate of readmission was similar between the two groups (p = 0.45). CONCLUSION: During the COVID-19 pandemic, there was no difference in readmission rate despite shorter hospital stays. KEY POINTS: · Maternal length of stay during COVID-19 was shorter.. · Earlier maternal discharge occurred during COVID-19.. · Shorter maternal postpartum stay did not increase readmission rate..