COVID-19 and preterm birth – Authors' reply
Authors: Rahul Choudhary, Vimla Kumari
Journal: The Lancet Global Health (2020)

We thank Laura Magee and colleagues for providing their feedback on our Comment.1Kumari V Mehta K Choudhary R COVID-19 outbreak and decreased hospitalisation of pregnant women in labour.Lancet Glob Health. 2020; 8: e1116-e1117Summary Full Text Full Text PDF PubMed Scopus (74) Google Scholar Indeed, the reduction in the number of referrals to emergency obstetric care was more alarming than the overall decrease in the number of hospital admissions for management of pregnancy. This reduction in emergency referrals could be due to reluctance by the patient or their caregiver for timely referral to tertiary care in non-urgent cases when suggested by the treating doctor at primary and secondary health-care centres. The fear of contracting COVID-19 at tertiary health-care centres (mostly in overcrowded cities) overshadowed the willingness of patients to seek care at these centres. An absence of public transport during lockdown augmented the plight of pregnant women requiring referral, as most patients in India still use public transport for emergency visits. The proportion of babies born preterm (ie, before 37 weeks gestation) in our institute increased from 8·3% (514 of 6209) in the pre-lockdown period to 10·4% (367 of 3527) in the post-lockdown period. Similar findings were also reported in Nepal, with an almost identical patient demography and health-care system to India.2KC A Gurung R Kinney MV et al.Effect of the COVID-19 pandemic response on intrapartum care, stillbirth, and neonatal mortality outcomes in Nepal: a prospective observational study.Lancet Glob Health. 2020; 8: e1273-e1281Summary Full Text Full Text PDF PubMed Scopus (264) Google Scholar The proportion of cases of preterm labour that were spontaneous increased from 63% (326 of 514) in the pre-lockdown cohort to 67% (246 of 367) in the lockdown cohort, and the proportion of cases of preterm premature rupture of membranes increased from 24% (124 of 514) in the pre-lockdown cohort to 26% (95 of 367) in the lockdown cohort. These observations were probably due to the increased proportion of women at a high risk of complications with care-seeking behaviour. By contrast, the proportion of iatrogenic preterm births decreased from 13% (64 of 514) in the pre-lockdown cohort to 7% (26 of 367) in the lockdown cohort. The drastic reduction in the number of antenatal visits pre-lockdown compared with post-lockdown might have led to a decrease in the identification of pregnancies requiring medically indicated preterm birth, resulting in a decreased proportion of iatrogenic preterm births. We declare no competing interests. Effect of the COVID-19 pandemic response on intrapartum care, stillbirth, and neonatal mortality outcomes in Nepal: a prospective observational studyInstitutional childbirth reduced by more than half during lockdown, with increases in institutional stillbirth rate and neonatal mortality, and decreases in quality of care. Some behaviours improved, notably hand hygiene and keeping the baby skin-to-skin with their mother. An urgent need exists to protect access to high quality intrapartum care and prevent excess deaths for the most vulnerable health system users during this pandemic period. Full-Text PDF Open AccessCOVID-19 and preterm birthIn their Comment (September, 2020), Vimla Kumari and colleagues1 analyse the impact of the COVID-19 pandemic in four tertiary teaching hospitals in western India. The authors report that, compared with before the pandemic, the demographics of pregnant women delivering in their facilities has changed (ie, there are more educated and nulliparous women), and there is an increased number of in-hospital maternal deaths, and an increased number of late pregnancy fetal losses. During the lockdown period there was a 43·2% reduction in hospital admissions when compared with the control period (ie, 10 weeks before lockdown; 6209 vs 3527), and a 66·4% reduction in referred obstetric emergencies compared with the same calendar period in the previous year (905 vs 304). Full-Text PDF Open Access