Aziz Nuzhat, Chandra Ravula Pallavi, Devi Sailaja, Yerubandi Siri
Department of Obstetrics, Fernandez Foundation, Hyderabad, India.
J Perinat Med. 2022 Jun 17;50(6):660-667. doi: 10.1515/jpm-2022-0122. Print 2022 Jul 26.
The Covid-19 pandemic affected antenatal care in many parts of the world. It brought about many changes as part of control and containment measures. We examined the effect of the first and second waves of the pandemic in India on stillbirth rates, as indicators of quality of maternity care.
Observational study at a tertiary referral perinatal centre with approximately 10,000 births annually. The Covid-19 first wave period was taken as January to December 2020 with lockdown March to June 2020, which included complete shut down of clinics and ultrasound services. The second wave was from January to September 2021. All women with singleton pregnancy who had hospital based antenatal care were included. We investigated monthly trends in obstetric load (new antenatal registrations, total obstetric clinic numbers and total births) with stillbirth numbers as the pandemic continued (daily Covid case trend). We compared first and second wave stillbirth rates, overall as well as those that were small for gestational age (<10th centile) at delivery.
There were 9,251 births with 32 stillbirths in the first wave (rate 3.46/1,000) and 6,228 births with 14 stillbirths in the second wave (2.25/1,000). This represented a 54% higher rate in the first phase and extended lockdown period (p=0.08). The incidence of stillbirths that were SGA was significantly higher in the first wave: 14 vs. 2, (p=0.03).
Reduced access to planned antenatal care during Covid-19 pandemic lockdown was associated with a significant increase in SGA stillbirths.
新冠疫情影响了世界许多地区的产前护理。作为防控措施的一部分，它带来了许多变化。我们研究了印度疫情第一波和第二波对死产率的影响，将其作为孕产妇护理质量的指标。
在一家每年约有10000例分娩的三级围产期转诊中心进行观察性研究。新冠疫情第一波期间为2020年1月至12月，2020年3月至6月实施封锁，包括诊所和超声服务完全关闭。第二波为2021年1月至9月。纳入所有在医院接受产前护理的单胎妊娠妇女。随着疫情持续（每日新冠病例趋势），我们调查了产科负荷（新的产前登记、产科诊所总数和总出生数）的月度趋势以及死产数。我们比较了第一波和第二波的死产率，包括总体死产率以及分娩时小于胎龄儿（<第10百分位数）的死产率。
第一波有9251例分娩，32例死产（率为3.46/1000），第二波有6228例分娩，14例死产（2.25/1000）。这表明第一阶段和延长封锁期的死产率高出54%（p=0.08）。第一波中小于胎龄儿的死产发生率显著更高：14例对2例，（p=0.03）。
新冠疫情封锁期间计划内产前护理的可及性降低与小于胎龄儿死产的显著增加有关。
