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      The effect of the COVID‐19 pandemic on maternal health due to delay in seeking health care: Experience from a tertiary center

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          Abstract

          Objective

          To assess the effects of the COVID‐19 pandemic on obstetric care and outcomes.

          Methods

          A prospective observational single‐center study was performed, including all antenatal and parturient women admitted from April to August, 2020. Data were collected regarding number of admissions, deliveries, antenatal visits, reason for inaccessibility of health care, and complications during pregnancy, and compared with data from the pre‐COVID period of October 2019 to February 2020.

          Results

          There was a reduction of 45.1% in institutional deliveries ( P < 0.001), a percentage point increase of 7.2 in high‐risk pregnancy, and 2.5‐fold rise in admission to the intensive care unit of pregnant women during the pandemic. One‐third of women had inadequate antenatal visits. The main reason for delayed health‐seeking was lockdown and fear of contracting infection, resulting in 44.7% of pregnancies with complications. Thirty‐two symptomatic women who tested positive for COVID‐19 were managed at the center with good maternal and fetal outcomes.

          Conclusion

          Although COVID‐19 does not directly affect pregnancy outcomes, it has indirect adverse effects on maternal and child health. Emergency obstetric and antenatal care are essential services to be continued with awareness of people while maintaining social distancing and personal hygiene.

          Abstract

          There are indirect adverse effects of COVID‐19 on maternal health as the rate of complications increases.

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          Most cited references11

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          Early estimates of the indirect effects of the COVID-19 pandemic on maternal and child mortality in low-income and middle-income countries: a modelling study

          Summary Background While the COVID-19 pandemic will increase mortality due to the virus, it is also likely to increase mortality indirectly. In this study, we estimate the additional maternal and under-5 child deaths resulting from the potential disruption of health systems and decreased access to food. Methods We modelled three scenarios in which the coverage of essential maternal and child health interventions is reduced by 9·8–51·9% and the prevalence of wasting is increased by 10–50%. Although our scenarios are hypothetical, we sought to reflect real-world possibilities, given emerging reports of the supply-side and demand-side effects of the pandemic. We used the Lives Saved Tool to estimate the additional maternal and under-5 child deaths under each scenario, in 118 low-income and middle-income countries. We estimated additional deaths for a single month and extrapolated for 3 months, 6 months, and 12 months. Findings Our least severe scenario (coverage reductions of 9·8–18·5% and wasting increase of 10%) over 6 months would result in 253 500 additional child deaths and 12 200 additional maternal deaths. Our most severe scenario (coverage reductions of 39·3–51·9% and wasting increase of 50%) over 6 months would result in 1 157 000 additional child deaths and 56 700 additional maternal deaths. These additional deaths would represent an increase of 9·8–44·7% in under-5 child deaths per month, and an 8·3–38·6% increase in maternal deaths per month, across the 118 countries. Across our three scenarios, the reduced coverage of four childbirth interventions (parenteral administration of uterotonics, antibiotics, and anticonvulsants, and clean birth environments) would account for approximately 60% of additional maternal deaths. The increase in wasting prevalence would account for 18–23% of additional child deaths and reduced coverage of antibiotics for pneumonia and neonatal sepsis and of oral rehydration solution for diarrhoea would together account for around 41% of additional child deaths. Interpretation Our estimates are based on tentative assumptions and represent a wide range of outcomes. Nonetheless, they show that, if routine health care is disrupted and access to food is decreased (as a result of unavoidable shocks, health system collapse, or intentional choices made in responding to the pandemic), the increase in child and maternal deaths will be devastating. We hope these numbers add context as policy makers establish guidelines and allocate resources in the days and months to come. Funding Bill & Melinda Gates Foundation, Global Affairs Canada.
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            The health impact of the 2014-15 Ebola outbreak.

            The 2014-15 outbreak in West Africa was the largest and deadliest Ebola outbreak recorded; however, there remains uncertainty over its wider health consequences. Our objective was to provide a comprehensive overview of the impact of the Ebola outbreak on population health in the three most affected countries: Sierra Leone, Liberia and Guinea.
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              The impact of the SARS epidemic on the utilization of medical services: SARS and the fear of SARS.

              Using interrupted time-series analysis and National Health Insurance data between January 2000 and August 2003, this study assessed the impacts of the severe acute respiratory syndrome (SARS) epidemic on medical service utilization in Taiwan. At the peak of the SARS epidemic, significant reductions in ambulatory care (23.9%), inpatient care (35.2%), and dental care (16.7%) were observed. People's fears of SARS appear to have had strong impacts on access to care. Adverse health outcomes resulting from accessibility barriers posed by the fear of SARS should not be overlooked.
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                Author and article information

                Contributors
                drmanu_8@yahoo.co.in
                Journal
                Int J Gynaecol Obstet
                Int J Gynaecol Obstet
                10.1002/(ISSN)1879-3479
                IJGO
                International Journal of Gynaecology and Obstetrics
                John Wiley and Sons Inc. (Hoboken )
                0020-7292
                1879-3479
                21 December 2020
                February 2021
                21 December 2020
                : 152
                : 2 , Special section: From the FIGO Safe Motherhood & Newborn Health Committee ( doiID: 10.1002/ijgo.v152.2 )
                : 231-235
                Affiliations
                [ 1 ] Department of Obstetrics and Gynecology All India Institute of Medical Sciences Jodhpur India
                Author notes
                [*] [* ] Correspondence

                Manu Goyal, Quarter No. 403/2, AIIMS Residential Complex, AIIMS Campus, Basni Industrial Area, Jodhpur, 342005, India.

                Email: drmanu_8@ 123456yahoo.co.in

                Article
                IJGO13457
                10.1002/ijgo.13457
                9087665
                33128794
                8d38105f-75eb-4942-9e4d-91a969d06cf0
                © 2020 International Federation of Gynecology and Obstetrics

                This article is being made freely available through PubMed Central as part of the COVID-19 public health emergency response. It can be used for unrestricted research re-use and analysis in any form or by any means with acknowledgement of the original source, for the duration of the public health emergency.

                History
                : 20 October 2020
                : 10 October 2020
                : 28 October 2020
                Page count
                Figures: 1, Tables: 4, Pages: 5, Words: 3622
                Categories
                Clinical Article
                Clinical Articles
                Obstetrics
                Custom metadata
                2.0
                February 2021
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.1.5 mode:remove_FC converted:10.05.2022

                Obstetrics & Gynecology
                complications,covid‐19,delay,health care,maternal,pregnancy
                Obstetrics & Gynecology
                complications, covid‐19, delay, health care, maternal, pregnancy

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