University of Wisconsin–Madison Medical College of Wisconsin

Perinatal Outcomes Associated With Institutional Changes Early in the COVID-19 Pandemic

Jenna L. Racine, MD; Scott J. Hetzel, MS; Jesus I. Iruretagoyena, MD; Kara K. Hoppe, DO, MSCI

WMJ. 2022;121(3):201-204

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Objective: Many institutions implemented policy changes to protect patients and clinicians during the COVID-19 pandemic. This study examines how institutional policy changes and patient behaviors affected perinatal outcomes. We hypothesized that obstetric practice changes occurred and that these changes affected perinatal outcomes.

Methods: We conducted a retrospective cohort study of singleton pregnancies delivered at a single institution with low incidence of COVID-19. Deliveries occurring from December 15, 2019 through March 14, 2020 were designated as the pre-COVID-19 group. Those occurring from March 15, 2020, through June 15, 2020, were designated the COVID-19 group. The primary outcome is a perinatal composite defined as delivery ≥ 41 weeks, hypertensive disorder of pregnancy at term, unplanned Cesarean delivery, term neonatal intensive care unit admission, 42-day maternal readmission, and 7-day neonatal readmission. Additional maternal, neonatal, and delivery composites also were analyzed, and we evaluated all individual outcomes secondarily.

Results: Of 2,268 deliveries, 1,210 occurred during the COVID-19 period. Four of the 1,210 (0.3%) were diagnosed with COVID-19. Women during the COVID-19 period were more likely to present in spontaneous labor and less likely to undergo induction. Maternal and neonatal length of stay was also shorter. There was no difference in the perinatal composite between the 2 groups (36.3% vs 36.7% [OR 1.05; 95% CI, 0.86-1.21]). There was a significant increase in deliveries occurring at or after 41 weeks (4.7% vs 6.9% [OR 1.83; 95% CI, 1.00-3.34]). There was no difference in maternal, neonatal, and delivery composites or the outcomes assessed individually.

Conclusions: We demonstrated significant changes in clinical practice secondary to policy changes and patient behaviors during the COVID-19 pandemic. As an institution that globally adopted ARRIVE (A Randomized Trial of Induction Versus Expectant Management) practices, we noted fewer inductions, more women presenting in labor and more women delivering at or after 41 weeks. We also noted a shorter length of hospital stay for the mother-baby dyad. Overall, these changes in clinical practice did not affect perinatal outcomes.

Author Affiliations: Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Wisconsin (UW) School of Medicine and Public Health, Madison, Wisconsin (Racine, Iruretagoyena, Hoppe); Department of Biostatistics and Medical Informatics, UW-Madison, Madison, Wisconsin (Hetzel).
Corresponding Author: Jenna Racine, MD, 1010 Mound St, 4th Floor McConnell Hall, Madison, WI 53715; phone: 608.417.6099; email; ORCID ID 0000-0003-3793-8177
Acknowledgements: We would like to acknowledge Carla Griffin, RN, Kathy Kostrivas, RN, and Carla Ruhland, RN, for their assistance obtaining patient data from our perinatal database, PeriData. We also thank the University of Wisconsin-Madison Institute for Clinical and Translational Research for statistical assistance.
Funding/Support: Clinical and Translation Science Award UL1 TR002372 to the University of Wisconsin-Madison from the National Center for Advancing Translational Science, National Institutes of Health, US Department of Health and Human Services for statistical support.
Financial Disclosures: None declared.
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