Obstetric services in the UK during the COVID-19 pandemic: A national survey
James Edward O'Carroll1, Liana Zucco2, Eleanor Warwick3
1Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA.
Insights
Obstetric care during COVID-19 showed variability in guideline adherence. Improvements are needed in vaccination, birth plans, and VTE prophylaxis for pregnant women with COVID-19.
Area of Science:
- Obstetrics and Gynaecology
- Infectious Diseases
- Public Health
Background:
- Management of obstetric patients with coronavirus disease 2019 (COVID-19) requires unique considerations.
- Royal College of Obstetricians and Gynaecologists guidelines were adapted for labour and delivery during the pandemic.
- Adoption and adherence to these COVID-19 guidelines in obstetric care are largely unknown.
Purpose of the Study:
- To assess the adoption and adherence to COVID-19 guidelines in UK obstetric units.
- To evaluate the provision of services and care for peripartum women with COVID-19.
- To identify areas for improvement in obstetric care during the pandemic.
Main Methods:
- A multicentre electronic survey (ObsQoR study) was conducted in October 2021.
- The survey targeted UK obstetric centres and was designed against RCOG COVID-19 guidelines.
- 105 out of 107 centres (98% response rate) participated, representing 54% of UK obstetric units.
Main Results:
- 94.3% of sites had guidelines for managing peripartum women with COVID-19.
- 58.1% had specific guidance for venous thromboembolism (VTE) prophylaxis.
- 35.6% restricted birth plans for COVID-19 positive patients, and 61.2% had vaccination referral pathways.
Conclusions:
- There is significant variability in the delivery of obstetric care and adherence to COVID-19 guidelines.
- Clinical implications regarding the quality of peripartum care due to this variability are unclear.
- There is scope to improve pathways for immunisation, birth plans, and VTE prophylaxis in obstetric units.
Background:
The management of obstetric patients with coronavirus disease 2019 (COVID-19) due to human-to-human transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) requires unique considerations. Many aspects of labour and delivery practice required adaptation in response to the global pandemic and were supported by guidelines from the Royal College of Obstetrics and Gynaecologists. The adoption and adherence to these guidelines is unknown.
Methods:
Participating centres in "Quality of Recovery in Obstetric Anaesthesia study-a multicentre study" (ObsQoR) completed an electronic survey based on the provision of services and care related to COVID-19 in October 2021. The survey was designed against the Royal College of Obstetricians and Gynaecologists COVID-19 guidelines.
Results:
One hundred and five of the 107 participating centres completed the survey (98% response rate representing 54% of all UK obstetric units). The median [IQR] annual number of deliveries among the included sites was 4389 [3000-5325]. Ninety-nine of the 103 (94.3%) sites had guidelines for the management of peripartum women with COVID-19. Sixty-one of 105 (58.1%) sites had specific guidance for venous thromboembolism (VTE) prophylaxis. Thirty-seven of 104 (35.6%) centres restricted parturient birthing plans if a positive diagnosis of COVID-19 was made. A COVID-19 vaccination referral pathway encouraging full vaccination for all pregnant women was present in 63/103 centres (61.2%).
Conclusion:
We found variability in care delivered and adherence to guidelines related to COVID-19. The clinical implications for this related to quality of peripartum care is unclear, however there remains scope to improve pathways for immunisation, birth plans and VTE prophylaxis.
Related Concept Videos
01:30Primary Healthcare Services
In 1978, international leaders convened in Alma-Ata, Kazakhstan, for what would be a pivotal event in global health. The Alma-Ata Declaration was the first to call...
00:59Hospitals-II
Nurses that work in...
01:30Specialized Care Centers and Settings-II
Rural health centers are specialized care facilities in remote locations with very few medical personnel. The primary care providers who run the centers are mostly Registered Nurse Practitioners. Here, emergency treatment is provided to critically ill or injured patients before they are transferred to the closest hospital. Fortunately, due to advancement in technology, many rural healthcare facilities and professionals have easy access to diagnostic and treatment...
01:26Standard Precaution
Hand hygiene is the most crucial means to prevent the transmission of disease. Employers are legally required to provide their workers with personal protective equipment (PPE) to minimize exposure or contact with...
01:22Birth Control Methods
01:29Issues And Trends In Healthcare Delivery System
Cost Containment
Payment for healthcare services has historically promoted adoption of costly and often unnecessary or inefficient...