Intepretation
Contrary to finding from a recent study in London United Kingdom that
reported a significant increase in the incidence of stillbirth during
COVID-19 pandemic vs the prepandemic period9, our
study demonstrated no significant difference in adverse obstetric
outcome between both periods. Although differences in study demography
may have played a role in outcome differences, the significant increase
in antenatal growth scans performed during the pandemic in our study may
have contributed to a much reduced stillbirth rate. Furthermore, despite
the significant reduction in antenatal in-patient admissions and
face-to-face antenatal consultations during the pandemic which are
established risk factors for adverse obstetric
outcomes5,7, the obstetric outcomes (perinatal and
maternal) prepandemic vs during the pandemic are comparable. The
increase in antenatal scans during the pandemic may have played a
significant role in mitigating the resultant adverse impacts from these
risk factors.
The association between COVID-19 infection and poor maternal outcome in
pregnant women with severe infection has been established from previous
studies1,10, however, ongoing controversies abound
about the risk to babies of infected mothers8. The
evidence is conflicting, and while some studies have demonstrated the
absence of coronavirus in amniotic fluid, nasopharyngeal, cord blood,
and placental specimens1,10,11, others have reported
an increased risk of vertical transmission12,13. In
the national cohort study using the UK Obstetric Surveillance System
(UKOSS), 2.5% of babies (n=6) had a positive nasopharyngeal swab within
12 hours of birth4. In our study, no case of vertical
transmission was seen (all 9 women who tested positive to SARS-CoV-2
infection had good perinatal outcome and none of their babies tested
positive to the virus).
It is unlikely that the trend towards adverse perinatal outcome seen in
this study could have been due to the direct impact of coronavirus on
pregnancy. A major risk factor for poor obstetric outcome is the failure
to seek urgent care when necessary particularly in high risk women such
as those with intrauterine growth restriction, hypertensive disorders,
diabetes, or those with reduced fetal movements. This problem was
particularly heightened in the early stages of the pandemic when women
did not attend their routine appointments because of fear of contracting
the virus or anxiety surrounding changes in obstetric
care4.
The significant reduction in general anaesthesia as well as small
increase in labour epidural during the pandemic are consistent with
recommendations from several professional bodies including the Royal
College of Anaesthetists-Obstetric Anaesthetists’ Association
(RCOA-OAA), and the Royal College of Obstetricians and Gynaecologists
(RCOG)8,14. General anaesthesia is an
aerosol-generating procedure and associated with increased risk of
transmission of SAR-CoV-2 infection. Consideration for early regional
(epidural) analgesia for pain relief in labour is recommended to reduce
the need for general anaesthesia in the event of a category 1 emergency
caesarean section14. In this study, all the women who
tested positive to SAR-CoV-2 infection and delivered by caesarean
section had spinal anaesthesia.