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).