Direct and indirect impact of COVID-19 pandemic on maternal mortality at tertiary care institute of north India
Keywords:COVID-19 pandemic, Hypertensive disorders pregnancy, Obstetric transition, Maternal mortality ratio, World Health Organization
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.
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