Impact of labor and delivery unit policy modifications on maternal and neonatal outcomes during the coronavirus disease 2019 pandemic.
Impact of labor and delivery unit policy modifications on maternal and neonatal outcomes during the coronavirus disease 2019 pandemic.
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DOI：
10.1016/j.ajogmf.2020.100234
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发表时间：
2020-11
影响因子：
6.3
通讯作者：
Naqvi M
中科院分区：
文献类型：
--
作者：
Greene NH;Kilpatrick SJ;Wong MS;Ozimek JA;Naqvi M
为应对2019年冠状病毒病大流行，全国各地的医院已对分娩和分娩部门的做法进行了修改，旨在保护分娩患者和医疗服务提供者免受严重急性呼吸系统综合征冠状病毒2的感染。自2020年3月起，我们医院针对访客政策、个人防护设备的使用、2019年疑似或感染冠状病毒病的人员的分诊和分娩房间的指定、分娩管理和新生儿护理，对分娩和分娩单位进行了修改。关于这些修改对孕产妇和新生儿结局的影响知之甚少。这项研究的目的是确定我们在2019年冠状病毒病大流行期间所做的分娩和分娩单位政策修改是否与母亲和新生儿结局的差异有关。我们对2020年1月1日至2020年4月30日期间在我院发生的所有分娩进行了回顾性队列研究。在分娩和分娩单位修改之前于2020年1月和2月分娩的患者被指定为实施前组，而在2020年3月和4月分娩的患者被指定为实施后组。比较实施前和实施后两组产妇和新生儿的结局。然后将两组之间的差异与2019年和2018年同期进行比较，以评估任何明显差异是否是大流行年所独有的。我们假设，产妇和新生儿的住院时间将在postimplementation组较短。统计分析方法包括连续变量的Student t检验和Wilcoxon检验，分类变量的卡方或Fisher精确检验。2019年实施与冠状病毒病相关的分娩单位变更后，产后住院时间显著缩短。实施后组中48.5%的患者阴道分娩后产后住院1晚，而实施前组为24.9%（P<0.0001）。剖宫产术后住院时间≤2晚的发生率，实施后组为40.9%，实施前组为11.8%（P<0.0001）。同样，阴道分娩后，实施后组49.0%的新生儿在1晚后出院回家，而实施前组为24.9%（P<0.0001）。剖宫产后，实施后组42.5%的新生儿在≤2晚后出院，而实施前组为12.5%（P<0.0001）。母亲和新生儿之间提前出院的比例略有差异是由于多胎妊娠。两组之间的剖宫产率、引产率或不良产妇或新生儿结局无差异。2019年，为保护孕妇和医疗服务提供者免受冠状病毒病的影响，对分娩和分娩部门政策进行了修改，这表明产妇和新生儿在分娩后的住院时间显著缩短，而产妇或新生儿不良结局的发生率没有增加。在出院后没有发生与早期释放有关的长期不良后果的情况下，我们的研究结果可能支持一旦大流行消退，就对我们的出院协议进行审查，以安全地缩短产妇和新生儿的住院时间。
In response to the coronavirus disease 2019 pandemic, hospitals nationwide have implemented modifications to labor and delivery unit practices designed to protect delivering patients and healthcare providers from infection with severe acute respiratory syndrome coronavirus 2. Beginning in March 2020, our hospital instituted labor, and delivery unit modifications targeting visitor policy, use of personal protective equipment, designation of rooms for triage and delivery of persons suspected or infected with coronavirus disease 2019, delivery management, and newborn care. Little is known about the ramifications of these modifications in terms of maternal and neonatal outcomes. The objective of this study was to determine whether labor and delivery unit policy modifications we made during the coronavirus disease 2019 pandemic were associated with differences in outcomes for mothers and newborns. We conducted a retrospective cohort study of all deliveries occurring in our hospital between January 1, 2020, and April 30, 2020. Patients who delivered in January and February 2020 before labor and delivery unit modifications were instituted were designated as the preimplementation group, and those who delivered in March and April 2020 were designated as the postimplementation group. Maternal and neonatal outcomes between the pre- and postimplementation groups were compared. Differences between the 2 groups were then compared with the same time period in 2019 and 2018 to assess whether any apparent differences were unique to the pandemic year. We hypothesized that maternal and newborn lengths of stay would be shorter in the postimplementation group. Statistical analysis methods included Student’s t-tests and Wilcoxon tests for continuous variables and chi-square or Fisher exact tests for categorical variables. Postpartum length of stay was significantly shorter after implementation of labor unit changes related to coronavirus disease 2019. A postpartum stay of 1 night after vaginal delivery occurred in 48.5% of patients in the postimplementation group compared with 24.9% of the preimplementation group (P<.0001). Postoperative length of stay after cesarean delivery of ≤2 nights occurred in 40.9% of patients in the postimplementation group compared with 11.8% in the preimplementation group (P<.0001). Similarly, after vaginal delivery, 49.0% of newborns were discharged home after 1 night in the postimplementation group compared with 24.9% in the preimplementation group (P<.0001). After cesarean delivery, 42.5% of newborns were discharged after ≤2 nights in the postimplementation group compared with 12.5% in the preimplementation group (P<.0001). Slight differences in the proportions of earlier discharge between mothers and newborns were due to multiple gestations. There were no differences in cesarean delivery rate, induction of labor, or adverse maternal or neonatal outcomes between the 2 groups. Labor and delivery unit policy modifications to protect pregnant patients and healthcare providers from coronavirus disease 2019 indicate that maternal and newborn length of stay in the hospital were significantly shorter after delivery without increases in the rate of adverse maternal or neonatal outcomes. In the absence of long-term adverse outcomes occurring after discharge that are tied to earlier release, our study results may support a review of our discharge protocols once the pandemic subsides to move toward safely shortening maternal and newborn lengths of stay.
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