Effect of Sars-Cov-2 Pandemic On Obstetric Management And Pregnancy Complications In Healthy Women

Öz

Objective: We aimed to investigate the effect of the SARS-CoV-2 pandemic on obstetric management and pregnancy complications in healthy pregnant women without SARS-CoV-2 infection. Methods: A total of 750 pregnant women who delivered singleton infants after 11 March 2020, the date when the World Health Organization (WHO) declared a pandemic, formed the study group, while 750 pregnant women who gave birth before this date formed the control group. The study included pregnant women who were found to have no infection clinically or by SARS-CoV-2 serology testing. The groups were compared in terms of demographic characteristics, type and duration of delivery, gestational age, indication for cesarean section, and pregnancy complications. Results: The median±IQR gestational age at delivery was 38±2 weeks in pregnant women who gave birth during the pandemic and 39±1 weeks in women who gave birth before the pandemic (p<0.001). Fetal birth weight was lower during the pandemic (Mean±SD: 3078±688) compared to the pre-pandemic period (Mean±SD: 3182±633) (p=0.002). The rate of primary cesarean section increased during the pandemic compared to the pre-pandemic period (61.2-50.8%, p=0.002). The rate of cesarean section due to maternal anxiety and failure to progress in labor indications was higher during the pandemic compared to the pre-pandemic period (24.3% vs. 10%, p=<0.001 and 18.3% vs. 10.4%, p=0.002, respectively). The time to delivery (vaginal or cesarean section) of patients admitted for vaginal delivery was shorter during the pandemic compared to the pre-pandemic period (Mean±SD: 9.09±3.85 vs. 10.13±3.75, p<0.001). Furthermore, the time to the diagnosis of failure to progress in labor was shorter in patients who were found to have a failure to progress in labor during the vaginal delivery process and who underwent cesarean section during the pandemic compared to the pre-pandemic period (Mean±SD: 3.56±3.04 vs 13.70±8.76, p<0.001). There was no increase in negative obstetric outcomes during the pandemic.

Anahtar Kelimeler

• SARS-CoV-2
• Covid-19
• Pandemic
• Cesarean
• Delivery
• Maternal anxiety

Sars-Cov-2 Pandemisinin Sağlıklı Kadınlarda Doğum Yönetimine ve Gebelik Komplikasyonlarına Etkisi

Öz

Amaç: SARS-CoV-2 pandemisinin, SARS-CoV-2 enfeksiyonu tespit edilmeyen sağlıklı gebelerde doğum yönetimi ve gebelik komplikasyonları üzerine etkisini araştırmaktır. Yöntemler: Dünya sağlık örgütü (WHO)’nün pandemi ilan ettiği tarih olan 11 Mart 2020 tarihinden sonra tekil doğum yapan 750 gebe çalışma grubunu, önce doğum yapan 750 gebe kontrol grubunu oluşturdu. Klinik veya SARS-CoV-2 seroloji testi ile enfeksiyon tespit edilmemiş gebeler çalışmaya dahil edildi. Gruplar demografik özellikleri, doğum şekli ve süresi, doğum haftası, sezaryen endikasyonu, gebelik komplikasyonları yönleri ile karşılaştırıldı. Bulgular: Pandemi dönemindeki gebeler Median±IQR 38±2 hafta’da, pandemi öncesinde gebeler ise Median±IQR: 39±1 hafta’da doğum yapmışlardır (p<0,001). Pandemi dönemindeki fetal doğum ağırlığı (Mean±SD:3078±688), pandemi öncesindeki fetal doğum ağırlığından (Mean±SD: 3182±633) daha düşük saptanmıştır (p=0,002). Primer sezaryen oranı pandemi döneminde, pandemi öncesine göre artmıştır (% 61,2-% 50,8, p=0,002). Pandemi döneminde maternal anksiyete ve ilerlemeyen doğum eylemi endikasyonu nedenli sezaryen, pandemi öncesi döneme göre yüksektir (Sırasıyla; 24,3% vs 10%, p=<0,001 ve 18,3% vs 10,4%, p=0,002). Vajinal doğum için yatırılan hastaların doğuma (vajinal ya da sezaryen) kadar geçen süre pandemi döneminde, pandemi öncesi döneme göre daha kısadır (Mean±SD: 9,09±3,85 vs 10,13±3,75, p<0,001). Yine vajinal doğum sürecinde ilerlemeyen doğum eylemi saptanan ve sezaryene alınan hastaların ilerlemeyen doğum tanı anına anına kadar geçen süre pandemi döneminde, pandemi öncesi döneme göre de daha kısadır (Mean±SD: 3,56±3,04 vs 13,70±8,76, p<0.001). Sonuçlar: Pandemi döneminde doğum için başvuran gebeler SARS-CoV-2 enfeksiyonu tespit edilmemiş sağlıklı gebeler dahi olsa doğum süreçlerindeki yönetimlerinde pandemi öncesine göre farklılıklar yaşamışlardır. Bu süreçte yaşanan sonuçların ve nedenlerinin tespiti devam eden ve gelecek pandemilerde gerekli önlemlerin alınmasını sağlayacağı kanaatindeyiz.

Anahtar Kelimeler

• SARS-CoV-2
• Covid-19
• Pandemi
• Sezaryen
• Doğum
• Maternal anksiyete

Kaynakça

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