Materials & Methods
We conducted a cohort study between February and March 2020, the time
period of the COVID-19 pandemic outbreak onset in our country. The Sheba
Medical Center, a tertiary, university affiliated hospital, is the
largest hospital in the Middle East. Our department serves large,
heavily populated urban and rural areas, and treats a heterogeneous
population with over 10,000 deliveries per year.
We collected data from the obstetrical emergency department,
hospitalization and delivery units.
We compared the two-month period in 2020, the pandemic period, to a
parallel period in 2019. We subsequently divided the periods into eight
weeks that we compared week vs. week.
We collected the following data from the ED: number of ED referrals,
referral indications, time duration spent in ED, discharge rate,
delivery unit admission rate and hospitalization rate. Delivery unit
data collected included the number of deliveries, maternal
characteristics ( age and obstetrical history), pregnancy and delivery
characteristics (number of fetuses, gestational age at delivery,
intrapartum fever, mode of the onset of labor, length of the
2nd stage of labor and mode of delivery), and neonatal
outcome (birthweight and a composite of adverse neonatal outcome).
Intrapartum fever was defined as body temperature of 38 degrees Celsius
or above, measured orally or rectally.9 The composite
neonatal adverse outcome consisted of any of the following: stillbirth,
neonatal death during the first 24 hours, mechanical ventilation during
the first 24 hours, asphyxia, 5-minute Apgar score <7, pH
arterial cord blood<7.0, neonatal intensive care unit
admission.
Statistical analysis
Patient characteristics are described as proportions for categorical
variables and as means and standard deviations for continuous variables.
Significance between groups was assessed by the Chi square test and
Fisher’s exact test for categorical variables, and the Mann-Whitney U
test, a non-parametric test for continuous variables without a normal
distribution. A 2-sided P-value < 0.05 indicated statistical
significance. The data were analyzed using Software Package for
Statistics and Simulation (IBM SPSS version 24, IBM Corp, Armonk, NY).