Direct and indirect impact of COVID-19 pandemic on maternal mortality at tertiary care institute of north India
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20232286Keywords:
COVID-19 pandemic, Hypertensive disorders pregnancy, Obstetric transition, Maternal mortality ratio, World Health OrganizationAbstract
Background: During COVID-19 pandemic, healthcare services and infrastructures have been utilized primarily in screening and management of COVID-19 infected patients that might have compromised routine antenatal health care services especially in low- and middle-income countries. This study was planned to know impact of COVID-19 pandemic on antenatal care and maternal mortality at our institute.
Methods: This retrospective cohort study compared labour room and maternal mortality statistics before (group ‘A’) and after declaration of COVID-19 pandemic in our country (group ‘B’). One year data (from 1st April, 2019 to 31st March, 2020) before declaration of lockdown in India on 24th March, 2020 was compared with (group ‘B’) data of 1 year after first nation wise lockdown (from 1st April, 2020 to 31st March 2021). Outcomes which were studied included impact on Institutional delivery, cesarean section and still birth rate along with maternal mortality ratio and its causes in both the groups. Modifiable factors such as level-I, level-II, and level-III delay were also considered.
Results: There was 66% decline (fall from 5867 before to 1985 during pandemic) observed in institutional delivery, statistically significant rise observed in still birth (p=0.0030) and cesarean section rate (p=0.0007) during pandemic. Maternal mortality ratio (MMR) increased from 649 to 1786 per one lac live birth (64% rise, p=0.0001) during COVID-19 pandemic. Demographic profiles of deceased women were comparable between both the groups. Hypertensive disorder of pregnancy remained the leading direct cause of maternal mortality. COVID-19 associated maternal mortality observed during second wave of pandemic. Delay in seeking care remains the leading indirect cause of maternal mortality like before (23/38,61% versus 21/35,60%, p=1 before and during pandemic).
Conclusions: COVID-19 pandemic resulted in fall in institutional delivery and rise still birth rate and maternal mortality ratio. Gestational hypertension remained the leading cause of maternal mortality during COVID-19 pandemic. Type 1 delay was the leading modifiable factor of maternal mortality before and during pandemic. Hence, it is recommended to strengthen health care services at primary health centers and redeployment of staff involved in obstetrical care should be strictly abandoned for timely care and referrals of complicated cases from peripheral health center.
References
WHO. Trends in maternal mortality 2000 to 2020: estimates by WHO, UNICEF, UNFPA, World Bank Group and UNDESA/Population Division. Geneva: WHO; 2023.
WHO, UNICEF, UNFPA, World Bank Group, and the United Nations Population Division. Trends in Maternal Mortality: 2000 to 2017 Geneva, World Health Organization; 2019.
Brolin Ribacke KJ, van Duinen AJ, Nordenstedt H, Höijer J, Molnes R, Froseth TW, et al. The impact of the West Africa Ebola outbreak on obstetric health care in Sierra Leone. PLoS One. 2016;11:e0150080.
Riley T, Sully E, Ahmed Z, Biddlecom A. Estimates of the potential impact of the COVID-19 pandemic on sexual and reproductive health in low- and middle-income countries. Int Perspect Sex Reprod Health. 2020;46:73-6.
Roberton T, Carter ED, Chou VB, Stegmuller AR, Jackson BD, Tam Y, et al. Early estimates of the indirect effects of the COVID-19 pandemic on maternal and child mortality in low-income and middle-income countries: a modelling study. Lancet Glob Health. 2020;8:e901-8.
Goyal M, Singh P, Singh K, Shekhar S, Agrawal N, Misra S. The effect of the COVID-19 pandemic on maternal health due to delay in seeking health care: Experience from a tertiary center. Int J Gynecol Obstet. 2021;152:231-5.
Ashish KC, Gurung R, Kinney MV, Sunny AK, Moinuddin M, Basnet O, et al. Effect of the COVID-19 pandemic response on intrapartum care, stillbirth, and neonatal mortality outcomes in Nepal: a prospective observational study. Lancet Glob Health. 2020;8(10):e1273-81.
Kumari V, Mehta K, Choudhary R. COVID-19 outbreak and decreased hospitalization of pregnant women in labour. Lancet Glob Health. 2020;8(9):e1116-7.
Kumar M, Puri M, Yadav R, Biswas R, Singh M, Chaudhary V, et al. Stillbirths and the COVID‐19 pandemic: looking beyond SARS‐CoV‐2 infection. Int J Gynecol Obstet. 2021;153(1):76-82.
Stowe J, Smith H, Thurland K, Ramsay ME, Andrews N, Ladhani SN. Stillbirths during the COVID-19 pandemic in England, April-June 2020. JAMA. 2021;325(1):86-7.
Chmielewska B, Barratt I, Townsend R, Kalafat E, van der Meulen J, Gurol-Urganci I, et al. Effects of the COVID-19 pandemic on maternal and perinatal outcomes: a systematic review and meta-analysis. Lancet Glob Health. 2021;9(6):e759-72.
Mendoza M, Garcia-Ruiz I, Maiz N, Rodo C, Garcia-Manau P, Serrano B, et al. Pre-eclampsia-like syndrome induced by severe COVID-19: a prospective observational study. BJOG. 2020;127(11):1374-80.
Ahmed I, Eltaweel N, Antoun L, Rehal A. Severe pre-eclampsia complicated by acute fatty liver disease of pregnancy, HELLP syndrome and acute kidney injury following SARS-CoV-2 infection BMJ Case Rep. 2020;13:e237521.
Werner, S, Katz, A. Change in ectopic pregnancy presentations during the covid-19 pandemic. Int J Clin Pract. 2021;75:e13925.
Di Mascio D, Khalil A, Saccone G, Rizzo G, Buca D, Liberati M, et al. Outcome of coronavirus spectrum infections (SARS, MERS, COVID-19) during pregnancy: a systematic review and meta-analysis. Am J Obstet Gynecol MFM. 2020;2(2):100107.
Pramanick A, Rathore S, Peter JV, Moorthy M, Lionel J. Pandemic (H1N1) 2009 virus infection during pregnancy in South India. Int J Gynecol Obstet. 2011;113(1):32-5.
Advisory Committee on Immunization Practices. Prevention and control of influenza with vaccines: interim recommendations of the Advisory Committee on Immunization Practices (ACIP), 2013. Morb Mortal Week Rep. 2013;62:356.
Mosby LG, Rasmussen SA, Jamieson DJ. 2009 pandemic influenza A (H1N1) in pregnancy: a systematic review of the literature. Am J Obstet Gynecol. 2011;205:10-8.
Blitz MJ, Grünebaum A, Tekbali A, Bornstein E, Rochelson B, Nimaroff M, et al. Intensive care unit admissions for pregnant and nonpregnant women with coronavirus disease 2019. Am J Obstet Gynecol. 2020;223(2):290-1.
Tekbali A, Grünebaum A, Saraya A, McCullough L, Bornstein E, Chervenak FA. Pregnant vs nonpregnant severe acute respiratory syndrome coronavirus 2 and coronavirus disease 2019 hospital admissions: the first 4 weeks in New York. Am J Obstet Gynecol. 2020;223(1):126-7.
World Health Organization (WHO). WHO Recommendations on Antenatal Care for a Positive Pregnancy Experience: Summary. Geneva, Switzerland: WHO; 2018. Licence: CC BY-NC-SA 3.0 IGO.
