Stillbirths and the COVID-19 pandemic: Looking beyond SARS-CoV-2 infection
Stillbirths and the COVID-19 pandemic: Looking beyond SARS-CoV-2 infection
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DOI：
10.1002/ijgo.13564
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发表时间：
2021-01-13
影响因子：
3.8
通讯作者：
Meena, Deepika
中科院分区：
文献类型：
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作者：
Kumar, Manisha;Puri, Manju;Meena, Deepika
目的 研究 COVID-19 爆发和随后的封锁对死产的发病率、相关原因和可改变因素的影响。方法进行了一项分析性病例对照研究，比较了印度一家三级护理中心 2020 年 3 月至 9 月（病例）和 2019 年 3 月至 9 月（对照）的死产。观察到可改变的因素为I级、II级和III级延迟。结果发现病例（37.4/1000）和对照（29.9/1000）之间的死产率存在显着差异（P = 0.045）。与对照组相比，血压正常女性的心律破裂率显着更高（P = 0.03）。 76.1% 的病例和 59.6% 的对照组注意到可改变的因素或可预防的原因；差异非常显着（P < 0.001，相对风险 [RR] 1.8）。 12.7% 的病例出现 II 级延迟或由于缺乏交通而延迟到达医院分娩，而对照组则没有（P < 0.006，RR 47.7）。 31.3% 的病例和 11.5% 的对照者观察到 III 级延误或在机构提供护理方面的延误（P < 0.001，RR 2.7）。 结论 尽管病例和对照之间死产的原因没有差异，但 II 级和 III 级延误受到大流行的显着影响，导致未感染 COVID-19 的孕妇可预防死产率较高。 COVID-19 大流行已导致与感染本身相比，由于孕妇延迟到达医院以及设施中拒绝提供或次优护理而导致的死产数量更多。
ObjectiveTo study the impact of the COVID-19 outbreak and subsequent lockdown on the incidence, associated causes, and modifiable factors of stillbirth.MethodsAn analytical case-control study was performed comparing stillbirths from March to September 2020 (cases) and March to September 2019 (controls) in a tertiary care center in India. Modifiable factors were observed as level-I, level-II, and level-III delays.ResultsA significant difference in the rate of stillbirths was found among cases (37.4/1000) and controls (29.9/1000) (P = 0.045). Abruption in normotensive women was significantly higher in cases compared to controls (P = 0.03). Modifiable factors or preventable causes were noted in 76.1% of cases and 59.6% of controls; the difference was highly significant (P < 0.001, relative risk [RR] 1.8). Level-II delays or delays in reaching the hospital for delivery due to lack of transport were observed in 12.7% of cases compared to none in controls (P < 0.006, RR 47.7). Level-III delays or delays in providing care at the facility were observed in 31.3% of cases and 11.5% of controls (P < 0.001, RR 2.7).ConclusionAlthough there was no difference in causes of stillbirth between cases and controls, level-II and level-III delays were significantly impacted by the pandemic, leading to a higher rate of preventable stillbirths in pregnant women not infected with COVID-19.The COVID-19 pandemic has caused more stillbirths due to the delay in pregnant women reaching hospital and denial or suboptimal care at facilities than the infection itself.