Pregnancy Outcomes during the COVID-19 Pandemic: A Study Based on a Tertiary Care Hospital in Sri Lanka

Abstract

The COVID-19 pandemic response affected maternal and neonatal health services worldwide. This study aimed to explore the impact of the pandemic on pregnancy outcomes, such as monthly stillbirth rates, percentage of monthly lower segment cesarean sections (LSCS), percentage of monthly preterm births, and percentage of monthly neonatal unit admissions at a tertiary care hospital in Sri Lanka. The study was conducted as a retrospective medical record-based study and included a total of 28,292 deliveries from January 2018 to November 2021 at the same tertiary care center. These deliveries were divided into pre-pandemic and during-pandemic deliveries for analysis. The period before the first case of COVID-19 was reported in March 2020 was considered pre-pandemic, while the period after was considered during-pandemic. Statistical analysis was then performed on the above parameters to compare pre-pandemic rates to during-pandemic rates. Increased maternal stress during the pandemic, lockdown measures and movement restrictions, reluctance to obtain hospital treatment when required due to fear of COVID-19 infection and COVID-19 infection of mothers were expected to affect pregnancy outcomes during the pandemic period. The pre-pandemic monthly average stillbirth rate was 9.58 per thousand live births versus the post-pandemic rate of 9.67 per thousand live births. The monthly average LSCS percentage was 49.5% during both periods. The monthly average preterm birth rate decreased from 13.6% to 12.92% during the pandemic, while the monthly average neonatal unit admission rate decreased from 13.3% to 11.37% during the pandemic. The Pearson correlation test confirmed that the monthly LSCS rate is moderately correlated with the monthly preterm rate and monthly stillbirth rate, indicating a positive correlation. The Welch's t test was used to determine the statistical significance of these mean differences between pre-pandemic and during-pandemic, and none of the mean differences in the monthly stillbirth rate, LSCS percentage, preterm birth percentage, or neonatal unit admission percentage were statistically significant (p > 0.05). The F test indicates that there is not enough evidence to reject the null hypothesis that the variances of the two batches of the pre-pandemic and during-pandemic periods are equal at the 3% significance level.