INTRODUCTION
The wide scale socioeconomic disruptions of COVID-19 pandemic and its
impact on health care services are still being felt. Previous viral
epidemics have resulted in adverse obstetric outcomes including maternal
and perinatal mortalities1. Besides the direct impact
of COVID-19 on pregnancy, modification in service provision adopted
following the pandemic in a bid to curb transmission of the infection in
hospital settings, may have far reaching effect on obstetric outcomes.
In the United Kingdom lockdown measures were announced on the 23rd March
20202. Consequently, modification in obstetric care
happened around this time in most UK units3. These
changes included alteration of the provision of antenatal care by
reducing face-to-face clinics, and offering more telephone or virtual
consultations. Antenatal surveillance and screening pathways were also
changed to reduce in-hospital attendance including the use of fasting
blood sugar and HbA1c instead of oral glucose tolerance test, the use of
home blood pressure monitoring and reduction of the frequency of serial
growth scans3,4.
These changes to care were aimed at reducing the risk of COVID-19
infection for pregnant women and healthcare staffs, and while women may
find telephone consultations valuable and acceptable, these changes may
also reduce the sense of communication between women and
midwives4. Reducing face-to-face antenatal
appointments could increase pregnancy complications particularly in
high-risk groups such as victims of domestic violence, deprived
populations with limited access to advanced technology and those with
mental health issues4,5.
While pregnancy will be uncomplicated in many women, these changes in
obstetric care are previously untested and the effect on outcomes is
unknown; high risk women with antenatal complications could be missed,
and anxiety about entering acute hospital settings might deter women
with reduced fetal movements from seeking additional care during
pregnancy4. Several studies have shown that women who
do not attend antenatal services are at increased risk of maternal
death, stillbirth and other adverse perinatal
outcomes6-8.
It is possible that some women may be reluctant to seek urgent care when
necessary for fear of contracting COVID-19. This may result in adverse
perinatal outcomes including intrauterine fetal death in cases of
delayed presentation for no/reduced fetal movements; and adverse
maternal outcomes in high risk women with medical comorbidities
including gestational diabetes and preeclampsia. Furthermore, acute
alterations from familiar service pathways may create anxiety in some
women resulting in failure to seek care with consequent reduced
attendances of antenatal appointments for fetal growth scans and other
antennal surveillance.