Riley Taylor, Nethery Elizabeth, Chung Esther K, Souter Vivienne
Department of Epidemiology, University of Washington, Seattle, Washington, USA.
School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
Birth. 2022 Jun;49(2):298-309. doi: 10.1111/birt.12606. Epub 2021 Dec 26.
Hospitals quickly adapted perinatal care to mitigate SARS-CoV-2 transmission at the onset of the COVID-19 pandemic. The objective of this study was to estimate the impact of pandemic-related hospital policy changes on perinatal care and outcomes in one region of the United States.
This interrupted time series analysis used retrospective data from consecutive singleton births at 15 hospitals in the Pacific Northwest from 2017 to 2020. The primary outcomes were those hypothesized to be affected by pandemic-related hospital policies and included labor induction, epidural use, oxytocin augmentation, mode of delivery, and early discharge (<48 hours after cesarean and <24 hours after vaginal births). Secondary outcomes included preterm birth, severe maternal morbidity, low 5-minute Apgar score, neonatal intensive care unit (NICU) admission, and 30-day readmission. Segmented Poisson regression models estimated the outcome level shift changes after the pandemic onset, controlling for underlying trends, seasonality, and stratifying by parity.
No statistically significant changes were detected in intrapartum interventions or mode of delivery after onset of the pandemic. Early discharge increased for all births following cesarean and vaginal birth. Newborn readmission rates increased but only among nulliparas (aRR: 1.49, 95%CI: 1.17, 1.91). Among multiparas, decreases were observed in preterm birth (aRR: 0.90, 95%CI: 0.84, 0.96), low 5-minute Apgar score (aRR: 0.75, 95%CI: 0.68, 0.81), and term NICU admission rates (aRR: 0.85, 95%CI: 0.80, 0.91).
Increases in early discharge and newborn readmission rates among nulliparas suggest a need for more postpartum support during the pandemic. Decreases in preterm birth and term NICU admission among multiparas may have implications beyond the pandemic and deserve further study.
在新型冠状病毒肺炎（COVID-19）大流行初期，医院迅速调整围产期护理措施以减轻严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的传播。本研究的目的是评估美国一个地区与大流行相关的医院政策变化对围产期护理及结局的影响。
本中断时间序列分析使用了2017年至2020年期间太平洋西北地区15家医院连续单胎分娩的回顾性数据。主要结局是那些假设会受到与大流行相关的医院政策影响的指标，包括引产、硬膜外麻醉使用、缩宫素加强、分娩方式以及早期出院（剖宫产术后<48小时和阴道分娩后<24小时）。次要结局包括早产、严重孕产妇发病率、5分钟阿氏评分低、新生儿重症监护病房（NICU）入院以及30天再入院。分段泊松回归模型估计了大流行开始后结局水平的变化，同时控制了潜在趋势、季节性，并按产次分层。
大流行开始后，未发现产时干预措施或分娩方式有统计学意义的变化。剖宫产和阴道分娩后所有分娩的早期出院率均有所增加。新生儿再入院率增加，但仅在初产妇中出现（调整后风险比：1.49，95%置信区间：1.17，1.91）。在经产妇中，早产（调整后风险比：0.90，95%置信区间：0.84，0.96）、5分钟阿氏评分低（调整后风险比：0.75，95%置信区间：0.68，0.81）以及足月新生儿NICU入院率（调整后风险比：0.85，95%置信区间：0.80，0.91）均有所下降。
初产妇早期出院率和新生儿再入院率的增加表明在大流行期间需要更多的产后支持。经产妇中早产和足月新生儿NICU入院率的下降可能产生超出大流行范围的影响，值得进一步研究。
