Related Experiment Video
Updated: Jul 11, 2025
External Cephalic Version: Is it an Effective and Safe Procedure?
Published on: June 6, 2020
Cesarean Delivery Outcomes for Patients with Coronavirus Disease-2019 in the USA
Michael Mazzeffi1, David Miller2, Ashley Garneau3
1Department of Anesthesiology, University of Virginia Health, PO Box 800710, Charlottesville, VA, 22908, USA. mmazzeff@virginia.edu.
Insights
Coronavirus disease-2019 (COVID-19) significantly increased mortality for Cesarean delivery (CD) patients in the USA. Hispanic and Medicaid patients faced disproportionately higher risks, highlighting the need for targeted pandemic protections.
Area of Science:
- Obstetrics and Gynecology
- Infectious Diseases
- Public Health
Background:
- Coronavirus disease-2019 (COVID-19) posed a significant threat to maternal health, particularly for those undergoing Cesarean delivery (CD).
- Pre-existing disparities in healthcare access and socioeconomic status may have exacerbated COVID-19 outcomes in pregnant populations.
Purpose of the Study:
- To investigate the impact of COVID-19 on mortality and morbidity in patients undergoing Cesarean delivery in the USA.
- To identify demographic and comorbidity factors associated with increased mortality in CD patients with COVID-19.
Main Methods:
- A retrospective cohort study utilizing the national inpatient sample for the year 2020.
- Comparison of demographics, comorbidities, complications, mortality rates, and costs between COVID-19 positive and negative Cesarean delivery patients.
Main Results:
- Patients with COVID-19 undergoing CD had a 30-fold higher mortality rate compared to non-COVID-19 CD patients (30 vs. 1 per 10,000).
- COVID-19 patients were more likely to be Hispanic, have Medicaid insurance, and present with comorbidities like chronic hypertension, diabetes, pre-eclampsia, and eclampsia.
- The adjusted odds ratio for mortality in COVID-19 positive CD patients was 29.3 (P < 0.001).
Conclusions:
- Cesarean delivery patients with COVID-19 experienced substantially higher mortality rates prior to widespread vaccination, with notable disparities among Hispanic and Medicaid populations.
- Socioeconomic factors and reduced access to personal protective equipment and testing likely contributed to these disparities.
- Enhanced strategies are crucial to protect vulnerable pregnant populations during future pandemics.
Introduction:
Coronavirus disease-2019 (COVID-19) may have increased morbidity and mortality in patients having Cesarean delivery (CD) in the USA.
Methods:
We performed a retrospective cohort study of patients who had CD in 2020 using the national inpatient sample. After stratification by COVID-19 status, demographics, comorbidities, complications, mortality, and costs were compared.
Results:
There were 31,444,222 hospitalizations in the USA in 2020 with a mortality rate of 2.8%. Among these, 1,453,945 patients had COVID-19 and mortality was 13.2%. There were 1,108,755 patients who had CD and 15,550 had COVID-19. Patients with COVID-19 more frequently had Medicaid and were Hispanic. Patients with COVID-19 had more comorbidities including chronic hypertension, diabetes mellitus, pre-eclampsia, and eclampsia. Mortality in CD patients with COVID-19 was 30 in 10,000 patients, while for non-COVID-19 patients, it was 1 in 10,000 patients, P < 0.001. The crude odds ratio for mortality in COVID-19 patients was 32.1 (95% confidence interval = 22.9 to 44.7), P < 0.001 and the adjusted odds ratio was 29.3 (95% confidence interval = 20.7 to 41.4), P < 0.001.
Conclusions:
CD patients with COVID-19 had 30-fold higher mortality before widespread vaccination was available with Hispanic and Medicaid patients disproportionately impacted. Potential explanations for this disparity include reduced access to personal protective equipment (e.g., masks) and testing, as well as socio-economic factors. Further research is needed to understand the factors that contributed to disparities in infection and clinical outcomes among obstetric patients during the COVID-19 pandemic. In future pandemics, enhanced efforts will be needed to protect economically disadvantaged women who are pregnant.
More Related Videos
05:46Introduction of Intracapsular Rotary-cut Procedures IRCP: A Modified Hysteromyomectomy Procedures Facilitating Fertility Preservation
Published on: January 17, 2019
11:27A Modified Sonographic Algorithm for Image Acquisition in Life-Threatening Emergencies in the Critically Ill Newborn
Published on: April 7, 2023
