在比利时新冠疫情初期，我们是否观察到感染新型冠状病毒的孕妇产科干预措施的变化？一项基于全国人口的研究结果。
Did we observe changes in obstetric interventions in SARS-CoV-2 infected pregnant women at the beginning of COVID-pandemic in Belgium? Results of a nationwide population-based study.
作者信息
Vercoutere An, Racapé Judith, Zina Mbiton Joel, Alexander Sophie, Benoit Karolien, Boulvain Michel, Goemaes Régine, Leroy Charlotte, Van Leeuw Virginie, Costa Elena, Derisbourg Sara, Goffard Jean-Christophe, Roelens Kristien, Vandenberghe Griet, Daelemans Caroline
机构信息
Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (H.U.B), CUB Hôpital Erasme, Department of Obstetrics and Gynecology, Belgium.
Ecole de santé publique, Université libre de Bruxelles (ULB), Belgium.
出版信息
Eur J Obstet Gynecol Reprod Biol X. 2024 Jul 25;23:100328. doi: 10.1016/j.eurox.2024.100328. eCollection 2024 Sep.
BACKGROUND
Pregnant women are more vulnerable to the severe effects of COVID-19 compared to their non-pregnant peers. Early in the pandemic, there was a rise in cesarean deliveries and preterm births among infected pregnant women. This study aims to evaluate whether there were any changes in obstetric interventions during the first two waves of the pandemic in Belgium.
METHODS
Between March 2020 and February 2021, the Belgian Obstetric Surveillance System (B.OSS) conducted an extensive, nationwide population-based registry study, that included nearly all births to women with a confirmed SARS-CoV-2 infection within six weeks before hospitalization in Belgium. The perinatal outcomes of these women were analyzed and compared with pre-pandemic regional perinatal data.
RESULTS
A total of 923 SARS-CoV-2 infected pregnant women were admitted to the hospital; 9.3 % were hospitalized for severe COVID-19, while the remaining were hospitalized for obstetric reasons. Infected women had a higher median BMI, a higher incidence of diabetes, and a greater proportion were overweight or obese compared to the reference group (p < 0.001). While the majority of women gave birth vaginally, symptomatic women and those with a severe infection had slightly higher rates of cesarean delivery, though not statistically significant after adjusting for confounders. Only severely ill women had an increased risk of preterm delivery (aOR 2.3; 95 %CI [1.2-2.5]; p = 0.02) and of induced labor (OR 1.8; 95 %CI [1.1-2.8]; p = 0.01). The use of general anesthesia for cesarean delivery was more common in the infected group (OR 2.6; 95 %CI [1.6-4.1]; p < 0.001).
CONCLUSIONS
Obstetric interventions, such as cesarean delivery and induction, remained at pre-pandemic levels. However, a SARS-CoV-2 infection appears to have increased medically induced preterm delivery and the use of general anesthesia for cesarean delivery.
背景
与未怀孕的同龄人相比，孕妇更容易受到新冠病毒疾病严重影响。在疫情早期，感染新冠病毒的孕妇剖宫产和早产率有所上升。本研究旨在评估比利时疫情前两波期间产科干预措施是否有任何变化。
方法
2020年3月至2021年2月期间，比利时产科监测系统（B.OSS）开展了一项广泛的、基于全国人群的登记研究，纳入了比利时住院前六周内确诊感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的几乎所有产妇。分析了这些妇女的围产期结局，并与疫情前的地区围产期数据进行比较。
结果
共有923名感染SARS-CoV-2的孕妇入院；9.3%因新冠病毒疾病严重而住院，其余因产科原因住院。与参照组相比，感染妇女的体重指数中位数更高，糖尿病发病率更高，超重或肥胖的比例更大（p<0.001）。虽然大多数妇女经阴道分娩，但有症状的妇女和严重感染的妇女剖宫产率略高，不过在调整混杂因素后无统计学意义。只有重症妇女早产风险增加（调整后比值比2.3；95%置信区间[1.2 - 2.5]；p = 0.02）和引产风险增加（比值比1.8；95%置信区间[1.1 - 2.8]；p = 0.01）。剖宫产使用全身麻醉在感染组更为常见（比值比2.6；95%置信区间[1.6 - 4.1]；p<0.001）。
结论
剖宫产和引产等产科干预措施维持在疫情前水平。然而，感染SARS-CoV-2似乎增加了医源性早产和剖宫产全身麻醉的使用。
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