Quality of Care at childbirth during the COVID-19 pandemic: findings of the IMAgiNE EURO study in Belgium (preprint)

Objectives To examine quality of maternal and newborn care (QMNC) around childbirth in facilities in Belgium during the COVID-19 pandemic and trends over time. Design A cross-sectional observational study. Setting Data of the IMAgiNE EURO study in Belgium. Participants Women giving birth in a Belgian facility from March 1, 2020, to May 1, 2023, responded a validated online questionnaire based on 40 WHO standards-based quality measures organised in four domains: provision of care, experience of care, availability of resources, and organizational changes related to COVID 19. Primary and secondary outcome measures Quantile regression analysis was performed to assess predictors of QMNC; trends over time were tested with the Mann Kendall test. Results 897 women were included in the analysis, 67%(n=601) with spontaneous vaginal birth, 13.3%(n=119) with instrumental vaginal birth and 19.7%(n=177) with cesarean section. We found high QMNC scores but also specific gaps in all domains of QMNC. On provision of care, 21.0%(n=166) of women who experienced labor and 14.7%(n=26) of women with a cesarean reported inadequate pain relief; 64.7%(n=74) of women with an instrumental birth reported fundal pressure and 72.3% (n=86) reported that forceps or vacuum cup was used without their consent. On experience of care, 31.1%(n=279) reported unclear communication, 32.9%(n=295) reported that they were not involved in choices,11.5%(n=104) stated not being treated with dignity and 8.1%(n=73) experienced abuse. Related to resources, almost half of the women reported an inadequate number of healthcare professionals (46.2%, n=414). The multivariable analyses showed significantly lower QMNC scores for women with an instrumental vaginal birth. Over time there was a significant increase in QMNC score for experience of care and key organizational changes due to COVID-19. Conclusions and relevance Although overall QMNC scores were high, findings also suggest gaps in QMNC. Underlying causes of these gaps should be explored to design appropriate interventions and policies.

COVID-19 infection and women's health; which women are more vulnerable in terms of gynecological health? (preprint)

Background Given gender-specific differences and ACE2 commonly expressed in the ovaries and uterus, it may be important to know which women are at greater risk of COVID-19 infection. Therefore, this study sought to determine which women are more affected by COVID- 19 infection, especially in terms of gynecological pathologies.Methods This retrospective and descriptive study examined the effect and course of COVID-19 in terms of gynecological pathologies in a total of 380 women of reproductive age without systemic disease. General demographics, obstetric and gynecological conditions, and parameters related to COVID-19 were evaluated. All parameters were compared for three groups defined on the basis of COVID-19 severity (mild, moderate, and severe).Results A total of 380 women with a mean age of 35.39 ± 8.94 were included in the study. The mean body mass index (BMI) of the women was 24.35 ± 4.53. The proportion of women with at least one pregnancy history was 69.2%. The mean gravidity of the women was 1.47 ± 1.34 and the parity was 1.16 ± 1.02. Of the women, 112 (29.5%) mild, 207 (54.5%) moderate and 61 (16.0%) severe cases of COVID-19 were seen. The mean age and median BMI of the women were similar in all three groups (p = 0.163, p = 0.127, respectively). Severe disease rates (29.5%) were significantly higher in women with 2 or more cases of COVID-19 than mild disease (14%) (p = 0.018). Severe disease rates (57.4%) in women with at least one pregnancy history were statistically significantly lower than mild disease rates (78.6%) (p = 0.010). The median parity number was significantly higher in the mild disease group than in the moderate disease group (p = 0.021). The most common benign gynecological pathology in women was chronic urinary tract infection (13.2%). Other common pathologies were chronic vaginal infection (12.6%), and polycystic ovary syndrome (PCOS) (11.6%). A history of chronic urinary tract infection was statistically significantly higher in the severe disease group (24.6%), mild (8.9%, p = 0.015) and moderate (12.1%, p = 0.024) disease groups. PCOS, endometriosis (6.3%), abnormal uterine bleeding (AUB) (8.4%), and hormone therapy history (8.2%) were found to be higher in severe disease groups, although not statistically significant (p = 0.596, p = 0.074, p = 0.305, p = 0.059, respectively). The history of leiomyoma (7.1%) was higher in the mild and moderate disease groups than in the severe disease group, but it was not statistically significant (p = 0.794). Benign gynecological operation history (31.3%) was significantly higher in mild (36.6%, p = 0.007), and moderate (33.3%, p = 0.007) disease groups than in the severe group (9, 14.8%).Conclusion Certain obstetric and gynecological conditions are thought to affect COVID 19 susceptibility and severity in women without systemic disease.

COVID-19 in pregnancy influences the progression of labor: A single-institutional and observational study in Japan (preprint)

The management of vaginal delivery during the COVID-19 pandemic remains unclear due to lack of information on labor characteristics. We aimed to clarify the effects of COVID-19 on the progression of vaginal labor. The single-institutional and observational study of COVID-19 women in pregnancy (COVID-19 group, n = 50) delivering from 2020 to 2022, was conducted. Patients’ backgrounds, perinatal outcomes, labor characteristics (labor time and Bishop score), and the details of maternal COVID-19 were analyzed and compared with non-COVID-19 pregnant women (control group, n = 258). The COVID-19 group showed rapidly progressing labor without adverse effect. The 1st and 2nd stage of labor time, and labor time after rupture of membrane were significantly shorter in the COVID-19 group than in the control group (P < 0.01; P < 0.01; and P < 0.05, respectively). The COVID-19 group had a higher Bishop score on initiation of labor (P < 0.01). Precipitous delivery in the COVID-19 group also significantly increased (P < 0.05). These results indicated that COVID-19 in pregnancy can affect the progression of labor rapidly. This is the first report focusing on the characteristics of labor progression in COVID-19 women, indicating that COVID-19 can affect the progression of labor without complication.