Clinical characteristics and pregnancy outcomes of women diagnosed with SARS-CoV-2 in London's most ethnically diverse borough: A cross-sectional study.

INTRODUCTION: It is unclear whether pregnant women from ethnic minority groups and with metabolic disorders are disproportionately affected by SARS-CoV-2 infection within deprived areas. No previous studies have compared pregnancy outcomes with an appropriate comparator group. METHODS: Cross-sectional study of 32 women with SARS-CoV-2 compared to background departmental figures from the three months prior to the outbreak. Clinical characteristics were compared to the UK Obstetric Surveillance System report. RESULTS: Estimated incidence was 10 times the national average (50.3 vs 4.9 per 1000 maternities). Women from Black (OR, 95% CI: 3.01, 1.08-7.38) and Asian (OR, 95% CI: 2.68, 1.23-6.05) ethnic groups were over-represented; however, there was no association with metabolic disorders. Babies born to women diagnosed with coronavirus were more likely to be born premature, or by caesarean delivery, however there was no difference in birthweight centile for gestational age. CONCLUSION: Women from Black and Asian backgrounds are disproportionately affected, even within an area of high ethnic diversity. Mothers do not appear more severely affected than women nationally; however, babies are more likely to be born preterm, or by caesarean delivery, compared to usual departmental figures. It is unclear whether this is due to increased intervention or a direct result of coronavirus infection.

Mental health amongst obstetrics and gynaecology doctors during the COVID-19 pandemic: Results of a UK-wide study.

OBJECTIVE: To explore the impact of the COVID-19 pandemic on the mental health of Obstetricians and Gynaecologists. STUDY DESIGN: A cross-section survey-based study amongst doctors working within Obstetrics and Gynaecology in the United Kingdom. RESULTS: A total of 207 doctors completed the survey. Obstetricians and Gynaecologists reported significantly higher rates of both Major Depressive Disorder (versus, p = 0.023) and Generalised Anxiety Disorder (versus, p = 0.044) as compared to the UK-wide estimates. Sub-group analysis showed that anxiety was more common amongst female doctors as compared to males (versus, p = 0.047). Although the prevalence of GAD was higher amongst registrars compared to their Consultant and/or Senior House Officer counterparts, this was not statistically significant. Respondents felt that the most significant factor for work-related changes to mental health was keeping up to date with frequently changing guidelines and protocols related to COVID-19. Only of respondents felt able to talk to colleagues about their mental health. CONCLUSIONS: Key findings include the high prevalence of mental health conditions amongst doctors, demonstration of the persistent taboo that mental health carries within the speciality and the key contributory factors to poor mental health. Further work should be done to assess if changes to the way new and updating guidelines, protocols and pathways are disseminated reduces the impact on the mental health of doctors. With the threat of a second COVID-19 peak looming, now more than ever, it is vital that steps are taken to break the stigmatisation of mental health amongst doctors, encouraging doctors to seek help when required.

Universal screening for SARS-CoV-2 in pregnant women at term admitted to an East London maternity unit.

OBJECTIVE: To explore the prevalence of asymptomatic SARS-CoV-2 in the maternity population. STUDY DESIGN: Newham University Hospital based in East London serving a population with the highest death rate secondary to SARS-CoV-2 in the UK, commenced universal screening of all admissions to the Maternity Unit from 22nd April to 5th May, 2020. A proforma was created to capture key patient demographics, indication for admission and presence of SARS-CoV-2 related symptoms at the point of presentation. RESULTS: A total of 180 women with a mean age of 29.9 (SD 7.4) years, at a median gestation of 39 (IQR 37 + 1-40 + 3) weeks underwent universal screening with nasopharyngeal PCR swabs during the two-week period of the study. BAME identity or parity was not associated with the likelihood of a positive result. Seven women (3.9 %, 1.6-7.8) were tested positive for SARS-CoV-2, of whom 6 (3.3 %, 1.2-7.1) were asymptomatic; 85.7 % (42.1-99.6) of the SARS-CoV-2 positive women were asymptomatic. The sensitivity of symptom-driven testing was 14.3 % (0.36-57.87) and specificity was 91.86 % (86.72-95.48) with a positive predictive value of 6.67 % (1.08-31.95) and a negative predictive value of 96.34 % (95.10-97.28). CONCLUSION: The prevalence of SARS-CoV-2 in the maternity population served by Newham University Hospital was 3.9 %, four weeks after lockdown. Of the women who were found to be SARS-CoV-2 positive, a high proportion (87.9 %) were asymptomatic. These findings support the need for universal testing to enable targeted isolation and robust infectious control measures to mitigate outbreaks of SARS-CoV-2 in maternity units.