ABSTRACT
Introduction: The obstetric impact of COVID-19 remains undetermined, with case series scarce and reported outcomes variable. The UK Obstetric Surveillance System (UKOSS) recently reported on a national cohort of pregnant women who required hospital admission due to COVID-19 between March and April 2020.1 We aimed to assess the demographics and outcomes for obstetric patients with COVID-19 infection within our Scottish, inner-city health board and compare this against that reported by UKOSS. Methods: Caldicott Guardian approval was obtained and the requirement for ethical approval waved by the local research ethics service. All female patients of child-bearing age (age 16–49) with a positive SARS-CoV-2 test between 16 March – 3 June 2020 were identified by the local Infection Prevention and Control team. These data were cross-referenced with local electronic notes systems to identify pregnant or recently pregnant women (within 6 weeks post-partum). Collected data were de-identified prior to analysis and analyses performed using R statistical software. Descriptive statistics are reported with results expressed as mean (SD), median [IQR], or n (%). Results: In total, 741 eligible women tested positive for SARS-CoV-2 within the study period. Twenty-three (3%) were pregnant or recently pregnant, with 14 of these women (60%) requiring hospital admission (representing 5.1 cases per 1000 maternities). All identified patients of Black or Asian ethnicity were admitted to hospital (5 in total), whilst only 47% of women of white ethnicity were admitted. The most common symptoms in admitted patients were cough (present in 64% of cases) and fever (present in 57% of cases). Amongst admitted patients, median age was 31.5 [29.3–34.0], median gestation at diagnosis 30.5 [24.3–37.5] weeks and 6 patients (43%) had a booking BMI [Formula presented]0 kg/m2. Three hospitalised patients (21.4%) required oxygen therapy and one required post-operative ICU monitoring. Two fetal losses occurred before 22 weeks gestation. No neonatal deaths occurred and no infants tested positive for SARS-CoV-2. Discussion: During this “first wave” of the pandemic, rates of COVID-19 were in keeping with those reported by UKOSS. This may reflect local adherence to shielding advice, or that testing was performed only on symptomatic patients. Also in keeping with results from UKOSS, patients from minority ethnic groups (and those with high BMIs) were over represented in hospital admission rates. All patients studied have subsequently been discharged home and mainly required level 1 care during admission. Numbers for neonatal outcomes are low and further conclusions cannot be made from these data.
ABSTRACT
Introduction: The UK Obstetric Surveillance System (UKOSS) has reported on risk factors for admission to hospital amongst obstetric patients with SARS-CoV-2, however, it did not evaluate deprivation as a risk factor.1 Deprivation is a recognised risk factor for mortality from COVID-19 amongst the general population.2 We, therefore, investigated the demographics, including deprivation scores, of obstetric patients diagnosed with SARS-CoV-2 within our local health board. Methods: Caldicott Guardian approval was obtained and requirement for ethical approval was waived by the local research ethics service. All pregnant or recently pregnant patients (within 6 weeks post-partum) within our health board area with a positive SARS-CoV-2 test between 16 March 2020 and 18 December 2020 were retrospectively identified from regional infection surveillance and local obstetric unit reports. Residential area deprivation was classified using the Scottish Index for Multiple Deprivation (SIMD), with quintile 1 representing the most deprived and quintile 5 representing the least deprived areas. R version 4.0.3 (R Foundation for Statistical Computing) was used to perform analyses. Results: Over the study period, 97 patients tested positive for SARS-CoV-2. Comparison between those in the lowest and highest SIMD quintiles is as shown below. Those from a black or ethnic minority background accounted for 31.9% of positive test results and 50% of admissions to critical care. [Formula presented] Discussion: In this cohort of obstetric patients, mothers from socioeconomically disadvantaged areas accounted for a higher proportion of SARS-CoV-2 positive cases (and hospital / critical care admissions) than those from more affluent areas. This is, to our knowledge, the first study to investigate this association in obstetric patients. The relationship demonstrated between ethnicity, deprivation and SARS-CoV-2 requires further investigation and may have implications for future resource allocation and service planning.
ABSTRACT
Introduction: The Enhanced Recovery after Obstetric Surgery in Scotland (EROSS) programme aims to reduce variation in care for women undergoing planned caesarean delivery (CD) and optimise patient experience, facilitating timely hospital discharge.1 In four years since its introduction, compliance with bundles of care has improved with day 1 discharge increasing from 5% to 32% Scotland-wide (unpublished data). The initial wave of coronarivus infections saw a predominantly consultant-delivered service, limited antenatal education and restrictions on hospital visitors. We assessed the impact of the pandemic on adherence to EROSS bundles and hospital discharge. Methods: Caldicott Guardian approval was obtained to review data regarding planned CD across three maternity units in our health board over two time periods: 18 March – 14 July 2019 (“baseline”) and 16 March – 12 July 2020 (“COVID”). Data were extracted from electronic patient records (Badgernet) and cross-referenced with theatre data (Opera). Patient characteristics, EROSS bundle adherence and postoperative length of stay (LoS) were compared. Results: A total of 1306 planned CD were reviewed. Patient characteristics were similar. Bundle adherence, where recorded, was variable. LoS was recorded in all cases – median LoS was reduced in the COVID cohort, and day 1 discharge rates increased significantly. [Formula presented] Discussion: Despite challenges posed by the coronavirus pandemic, a planned CD service was successfully maintained in our region. Continuing the trend established over the preceding 4 years, median LOS was reduced. Day 1 discharges were significantly increased despite variable bundle compliance. Are these changes a natural continuation of the embedded EROSS pathway, or have perceived barriers to discharge (eg staff shortages, limited antenatal education, non-compliance with care bundles) been superseded by concerns around exposure to coronavirus while in hospital? Further qualitative research with staff and patient surveys may provide greater insight.