RESEARCH ARTICLE |
https://doi.org/10.5005/jp-journals-10006-1857 |
Impact of COVID-19 Lockdown on Admissions to a Tertiary Maternity Hospital in Srinagar
1,2Department of Obstetrics and Gynaecology, GMC Srinagar, Srinagar, Jammu and Kashmir, India
Corresponding Author: Ufaque Muzaffar, Department of Obstetrics and Gynaecology, GMC Srinagar, Srinagar, Jammu and Kashmir, India, Phone: +91 9419984533, e-mail: ufaque3@gmail.com
How to cite this article: Qureshi A, Muzaffar U. Impact of COVID-19 Lockdown on Admissions to a Tertiary Maternity Hospital in Srinagar. J South Asian Feder Obst Gynae 2021;13(1):55–57.
Source of support: Nil
Conflict of interest: None
ABSTRACT
Introduction: The first case of new pneumonia of unknown origin was found in Wuhan (China) on December 31, 2019. The causative virus was identified from throat swab samples in the Chinese Centre for Disease Control and Prevention (CCDC) on January 7, 2020, and it was named severe acute respiratory syndrome coronavirus (SARS‐CoV‐2). Subsequently, World Health Organization (WHO) renamed it COVID‐19. COVID-19 was a highly infectious newly discovered coronavirus, which led to a worldwide pandemic. It has shown an equal number of cases between men and women, but a lower mortality rate in women.
Materials and methods: A retrospective observational study was conducted in the Department of Obstetrics and Gynaecology of GMC, Srinagar, comparing the total number of emergency admissions including obstetric emergencies, such as ectopic pregnancy, intrauterine device (IUD), severe anemia, eclampsia, abruption, obstructed labor, and postpartum hemorrhage (PPH) during a period of 6 months from March 2020 to August 2020 with that from March 2019 to August 2019.
Results: A total of 13,784 patients were admitted over a period of 6 months from March 2020 to August 2020, and there was a significant decline in the admissions as compared to pre-COVID-19 period of March 2019 to August 2019 (p-value, 0.007).
Conclusion: The COVID‐19 lockdown greatly reduced the rate of admission to gynecological and obstetric emergencies. This reduction allowed for more effective and efficient use of emergency services and will inspire policymakers to implement policies for efficient utilization of emergency services in the future.
Keywords: Abruption, Anemia, Eclampsia, Intrauterine death.
INTRODUCTION
The first case of new pneumonia of unknown origin was found in Wuhan (China) on December 31, 2019.1 The causative virus was identified from throat swab samples in the Chinese Centre for Disease Control and Prevention (CCDC) on January 7, 2020, and it was named severe acute respiratory syndrome coronavirus (SARS‐CoV‐2). Subsequently, World Health Organization (WHO) renamed it COVID‐19.2 COVID-19 was a highly infectious newly discovered coronavirus, which led to a worldwide pandemic. It has shown equal number of cases between men and women, but a lower mortality rate in women.3,4 The new beta coronavirus, the SARS-CoV-2, known as COVID-19 was highly infectious, particularly during the asymptomatic period of incubation, with a low rate of consequent mortality. Therefore, it kept spreading, became pandemic, and resulted in a worldwide health crisis of rapid evolution with consequent socioeconomic effect due to international strict measurements of lockdowns and border closures.5–7 On January 30, 2020, the WHO proclaimed that it was a public health emergency of international concern. Already on January 23, 2020, a strict lockdown had been enforced in Wuhan and other cities of Huber province of China as an unprecedented measure to control the spread of the virus. Though this move was met with skepticism even by the WHO, as the virus spread and pandemic worsened, similar measures were taken all around the world. In India, on March 24, 2020, a 21 days lockdown was announced by the Prime Minister after a 14 hours voluntary Janta Curfew. This was to control the spread of the virus when the number of cases was at 500 in India. This lockdown was then extended three times till May 31, 2020, after which the unlock strategy was announced. The lockdown in India, which has been called the biggest and strictest in the world, saw many people pushed out of work, many migrant workers walking barefooted in the hottest months in the subcontinent, and many deaths while these people were walking back home. Pregnant women are affected by this virus. The impact of COVID-19 on this category of patients and their fetuses at the different stages of pregnancy is subjected to multiple discussions. Questions are also raised concerning the long-term effects on the patients and the vertical transmission to newborns. Its impact on pregnancy cannot be negligible, especially if the maternal and fetal complications due to other types of coronaviruses in previous epidemics are taken into consideration.8 It is evident that the sociodemographic characteristics and presumed predisposing risk factors are of high importance. The subject of COVID-19 in pregnancy is a matter of concern. At first, the pregnancy itself is a state of vulnerability due to the correlated physiological and mechanical changes not only at the level of the cardiopulmonary and immune system but also the associated hypercoagulable state. We hereby report the experience of the department of obstetrics and gynaecology at a tertiary maternity unit in LD Hospital, GMC Srinagar.
AIMS AND OBJECTIVES
The aim of the present study was to evaluate the extent by which the lockdown, imposed by the government, has impacted the activity of admissions to the tertiary maternity hospital in Srinagar.
MATERIALS AND METHODS
A retrospective observational study was conducted in the Department of Obstetrics and Gynecology of GMC Srinagar, comparing the total number of emergency admissions including obstetric emergencies, such as ectopic pregnancy, intrauterine device (IUD), severe anemia, eclampsia, abruption, obstructed labor, and postpartum hemorrhage (PPH) during a period of 6 months from March 2020 to August 2020 with that from March 2019 to August 2019.
RESULTS
- As mentioned in table (Table 1) the total of 13,784 patients were admitted over a period of 6 months from March 2020 to August 2020, and there was a significant decline in the admissions as compared to pre-COVID-19 period of March 2019 to August 2019 (p-value, 0.007).
- There was a significant increase in the number of patients admitted with IUD from March 2020 to August 2020 as compared pre-COVID-19 data of March 2019 to August 2019 (p-value, 0.00008)
- There was a significant increase in the number of patients with eclampsia from March 2020 to August 2020 as compared to pre-COVID-19 data of March 2019 to August 2019 (p-value, 0.04)
- There was a significant increase in the number of patients with severe anemia admitted from March 2020 to August 2020 as compared to pre-COVID-19 data of March 2019 to August 2019 (p-value, 0.03)
- There was no significant difference observed in patients admitted with ectopic, abruption (p-value, 0.30), obstructed labor (p-value, 0.80), and PPH (p-value, 0.80)
| March 2020 to August 2020 (COVID-19 data) | March 2019 to August 2019 (pre-COVID-19) | p-value | |
|---|---|---|---|
| Total admission | 13,784 | 17,937 | 0.007 |
| Intrauterine death | 486 | 212 | 0.00008 |
| Ectopic pregnancy—ruptured | 128 | 108 | 0.90 |
| Ectopic pregnancy—unruptured | 112 | 109 | 0.80 |
| Severe anemia | 342 | 159 | 0.03 |
| Eclampsia | 50 | 27 | 0.40 |
| Abruption | 22 | 27 | 0.30 |
| Obstructed labor | 20 | 29 | 0.80 |
| PPH | 20 | 24 | 0.80 |
DISCUSSION
Emergencies were increasingly being utilized for nonemergent obstetric care during non-COVID-19 times.9 Up to one‐third of patients seen in the emergencies have problems that could have potentially been addressed in an outpatient setting.10 Use of the emergencies for nonurgent conditions may lead to excessive health care spending, unnecessary testing and treatment, and weaker relationships between patients and primary health-care providers.11
The results of the present study suggest that during the COVID‐19 lockdown, real emergencies have been filtered from more deferrable cases, increasing the number of hospitalized women, especially for emergent surgeries. Furthermore, the COVID‐19 epidemic could have challenged the capability of health-care systems to deal with emergencies.12 Many governments and directors of hospitals and other medical institutions decided to restrict the number of outpatient medical consultations, as well as routine elective surgeries, because they face challenges providing health care to patients with COVID‐19 and also argue that these restrictions are to reduce the risk of contamination to both health-care providers and patients. No restrictions were possible on the opportunity to seek medical attention in the emergencies for urgent health problems. As in the present study, the total number of admissions was significantly reduced as was observed by Oseran et al.13 In our study, it was observed that there was a significant increase in patients with eclampsia as observed by Rodruguez et al.14
CONCLUSION
The COVID‐19 lockdown greatly reduced the rate of admission to gynecological and obstetric emergencies. This reduction allowed for more effective and efficient use of emergency services and will inspire policymakers to implement policies for efficient utilization of emergency services in the future.
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