Effect of the COVID-19 pandemic response on intrapartum care, stillbirth, and neonatal mortality outcomes in Nepal: a prospective observational study
Effect of the COVID-19 pandemic response on intrapartum care, stillbirth, and neonatal mortality outcomes in Nepal: a prospective observational study
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DOI：
10.10161/52214-109x(20)30345-4
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发表时间：
2020-10-01
影响因子：
34.3
通讯作者：
Malqvist, Mats
中科院分区：
文献类型：
--
作者：
Ashish, K. C.;Gurung, Rejina;Malqvist, Mats
背景 COVID-19 大流行应对措施正在影响世界各地的孕产妇和新生儿保健服务。我们的目的是评估尼泊尔全国 COVID-19 封锁之前和期间的机构分娩数量、结果（机构死产和新生儿死亡率）以及产时护理质量。 方法 在这项前瞻性观察研究中，我们收集了 2020 年 1 月 1 日至 5 月 30 日期间尼泊尔 9 家医院参加 SUSTAIN 和 REFINE 研究的孕妇的参与者级数据。这一时期包括全国封锁前的 12.5 周和封锁期间的 9.5 周。如果女性的胎龄为 22 周或以上、入院时有胎心音且同意纳入，则她们有资格纳入。多胞胎的妇女及其婴儿被排除在外。我们通过独立临床研究人员的直接观察从病例记录中提取信息，收集有关人口分布学和产科特征的信息，并收集卫生工作者的表现。我们使用回归分析来评估封锁前与封锁期间的机构分娩数量、护理质量和死亡率的变化。调查结果 在 22,907 名符合条件的妇女中，有 21,763 名妇女入组，并有 20,354 名妇女分娩，记录了 10,543 名新生儿的卫生工作者表现。从研究开始到结束，每周平均出生人数从封锁前的 1261.1 人（SE 66.1）下降到封锁期间的 651.4 人（SE 66.9），减少了 52.4%。机构死产率从封锁前的每 1000 名活产儿中 14 例增加到封锁期间的每 1000 名活产儿中 21 人 (p=0.0002)，机构新生儿死亡率从每 1000 名活产儿 13 人增加到每 1000 名活产儿 40 人 (p=0.0022)。在护理质量方面，产时胎心率监测下降了 13.4%（-15.4 至 11.3；p
Background The COVID-19 pandemic response is affecting maternal and neonatal health services all over the world. We aimed to assess the number of institutional births, their outcomes (institutional stillbirth and neonatal mortality rate), and quality of intrapartum care before and during the national COVID-19 lockdown in Nepal.Methods In this prospective observational study, we collected participant-level data for pregnant women enrolled in the SUSTAIN and REFINE studies between Jan 1 and May 30, 2020, from nine hospitals in Nepal. This period included 12.5 weeks before the national lockdown and 9.5 weeks during the lockdown. Women were eligible for inclusion if they had a gestational age of 22 weeks or more, a fetal heart sound at time of admission, and consented to inclusion. Women who had multiple births and their babies were excluded. We collected information on detnographic and obstetric characteristics via extraction from case notes and health worker performance via direct observation by independent clinical researchers. We used regression analyses to assess changes in the number of institutional births, quality of care, and mortality before lockdown versus during lockdown.Findings Of 22 907 eligible women, 21 763 women were enrolled and 20 354 gave birth, and health worker performance was recorded for 10 543 births. From the beginning to the end of the study period, the mean weekly number of births decreased from 1261.1 births (SE 66.1) before lockdown to 651.4 births (49.9) during lockdown a reduction of 52.4%. The institutional stillbirth rate increased from 14 per 1000 total births before lockdown to 21 per 1000 total births during lockdown (p=0.0002), and institutional neonatal mortality increased from 13 per 1000 livebirths to 40 per 1000 livebirths (p=0.0022). In terms of quality of care, intrapartum fetal heart rate monitoring decreased by 13.4% (-15.4 to 11.3; p