Indirect impact of the COVID-19 pandemic on emergency department
presentations and hospital admissions for urgent early pregnancy
conditions: a population-based retrospective cohort study
Objective: To compare emergency department (ED) presentations and
hospital admissions for urgent early pregnancy conditions in Victoria
before and after the onset of COVID-19 lockdown on 31 March 2020.
Design: Population-based retrospective cohort study Setting: Australian
state of Victoria Population: Pregnant women presenting to emergency
departments or admitted to hospital Methods: We obtained state-wide
hospital separation data from the Victorian Emergency Minimum Dataset
and the Victorian Admitted Episodes Dataset from January 1, 2018, to
October 31, 2020. A linear prediction model based on the pre-COVID
period was used to identify the impact of COVID restrictions. Main
outcome measures: Monthly ED presentations for miscarriage and ectopic
pregnancy, hospital admissions for termination of pregnancy, with
subgroup analysis by region, socioeconomic status, disease acuity,
hospital type. Results: There was an overall decline in monthly ED
presentations and hospital admissions for early pregnancy conditions in
metropolitan areas where lockdown restrictions were most stringent.
Monthly ED presentations for miscarriage during the COVID period were
consistently below predicted, with the nadir in April 2020 (790 observed
vs 985 predicted, 95% CI 835-1135). Monthly admissions for termination
of pregnancy were also below predicted throughout lockdown, with the
nadir in August 2020 (893 observed vs 1116 predicted, 95% CI 905-1326).
There was no increase in ED presentations for complications following
abortion, ectopic or molar pregnancy during the COVID period.
Conclusions: Fewer women in metropolitan Victoria utilized
hospital-based care for early pregnancy conditions during the first
seven months of the pandemic, without any observable increase in