The impact of COVID-19 pandemic on obstetrics and gynecology hospitalization rate and on reasons for seeking emergency care: a systematic review and meta-analysis

Figures & data

Figure 1. Flow-diagram of studies identified in the systematic review.

Table 1. Features of the included studies.

Authors, year	Study location	Study design	Sample size	Period considered	Ienclusion criteria	Exclusion criteria	NOS scale
Abel et al. 2021 [25]	San Francisco, USA	Retrospective case-control	11,788 (4903 vs. 6885)	March 4 – May 19, 2020 vs January 1 – March 3, 2020	Females aged 18 or older presenting at ED for obstetrical or gynaecological conditions	None	8
Athiel et al. 2020 [26]	France	Retrospective case-control	39,690 (14,708 vs. 24,982)	March–May 2020 vs 2019	All patients admitted to gynaecological ED and the proportion of later hospitalized	None	6
Carbone et al. 2020 [3]	Naples, Italy	Retrospective case-control	3269 (1483 vs. 1786)	March–May 2020 vs 2019	All patients admitted to the obstetric A&E unit	None	7
Dell’Utri et al. 2020 [29]	Milan, Italy	Retrospective case-control	9291 (3647 vs. 5644)	February–June 2020 vs 2019	All consecutive women admitted to the ES during the considered periods were included, independently of their age or reason for admission.	None	7
Goyal et al. 2020 [30]	Jodhpur, India	Prospective, case-control	1749 (633 vs 1116)	1 April , 2020 – 31 August 2020 vs. 1 October , 2019 – 29 February 2020	all pregnant women hospitalized during the study period	Outpatient visits	8
Grandi et al. 2020 [28]	Modena-Sassari-Cagliari, Italy	Retrospective case-control	691 (209 vs. 482)	March 11 – 9 April , 2020 vs. 1 November– 30 November 2019	Only women who presented to the ED for gynecological reasons (not pregnancy) or for problems related to the first trimester of pregnancy (threatened miscarriage, EP, and PUL), were considered as a non-deferrable activity.	Admissions during the 2^nd and 3^rd trimesters of pregnancy and the puerperium.	6
Kugelman et al. 2020 [32]	Haifa, Israel	Retrospective case-control	942 (398 vs. 544)	15 March 2020 –12 April 2020 vs 15 March 2019 –12 April 2019.	All the women above 20 weeks of pregnancy who presented to the obstetrical ED during the study period due to an obstetrical or non-obstetrical self-complaint. Women who were referred by their physicians after presenting with acute complaints such as contractions, vaginal bleeding, and RFM.	All the women with missing data and those referred by their physicians after incidental findings at regular surveillance or who were invited for a follow-up visit.	7
Meyer et al. 2020 [31]	Israel	Retrospective case-control	7964 (3897 vs 4067)	February –March 2020 vs 2019	All women referred to the ED during the study period	None	7
Salsi et al. 2020 [27]	Bologna, Italy	Retrospective case-control	1456 (484 vs. 972)	March 2020 vs 2019	Patients were divided into three groups: gynecological patients, pregnant women up to 16 weeks, and pregnant women > 16 weeks.	None	6
Spurlin et al. 2020 [33]	New York City, USA	Retrospective case-control	354 (79 vs 275)	February 1 to March 15 vs. March 16 to April 15	All consult requests from the ED to the GYN, GYN oncology, or OB services were included.	Inpatient OB-GYN consults for patients who were hospitalized and patients who were seen in labor and delivery triage.	5

ECS: elective cesarean section; ED: emergency department; EP: ectopic pregnancy; HBP: high blood pressure; ICU: intensive care unit; IOL: induction of labor; IUD: intra-uterine death; GDM: gestational diabetes mellitus; GYN: gynecology unit; NICU: neonatal intensive care unit; OB: obstetric unit; PE: Preeclampsia; PID: pelvic inflammatory disease; PIH: pregnancy-induced hypertension; pPROM: preterm premature rupture of membranes; PROM: premature rupture of membranes; PTB: preterm birth; PUL: pregnancy of unknown location; RFM: reduced fetal movements; TOP: termination of pregnancy.

Table 2. Outcomes of the included studies.

Variables	Abel et al. 2021 [25]	Athiel et al. 2020 [26]	Carbone et al. 2020 [3]	Dell’Utri et al. 2020 [29]	Goyal et al. 2020 [30]	Grandi et al. 2020 [28]	Kugelman et al. 2020 [32]	Meyer et al. 2020 [31]	Salsi et al. 2020 [27]	Spurlin et al. 2020 [33]	Total
Ob/Gyn ED admissions	4903 vs 6885	14708 vs 24982	1483 vs. 1786	3647 vs 5644	633 vs. 1116	209 vs. 482	398 vs. 544	3897 vs. 4067	484 vs. 972	79 vs. 275	30,441 vs. 46,753
Mean maternal age	NR	NR	NR	NR	NR	38.6 ± 12.9 vs. 38.2 ± 14.8	31.4 ± 4.3 vs. 31.3 ± 4.7	32 ± 5.2 vs. 32 ± 5.5	NR	NR	–
Ectopic pregnancy	NR	NR	15/1483 vs. 17/1786	16/3647 vs. 20/5644	NR	NR	NR	NR	NR	10/79 vs. 55/275	41/5209 vs. 92/7705
PROM	NR	NR	110/1483 vs. 158/1786	NR	NR	NR	82/398 vs. 60/544	NR	53/484 vs. 77/972	NR	245/2365 vs. 295/3302
Reduced fetal movements	NR	NR	28/1483 vs. 41/1786	NR	NR	NR	26/398 vs. 45/544	NR	10/484 vs. 18/972	NR	64/2365 vs. 104/3302
HDP	NR	NR	45/1483 vs. 27/1786	49/3647 vs. 48/5644	NR	NR	NR	NR	22/484 vs. 15/972	NR	116/5614 vs. 90/8402
Uterine contractions*	NR	NR	821/1483 vs. 807/1786	NR	NR	NR	309/398 vs. 389/544	NR	110/484 vs. 168/972	NR	1240/2365 vs. 1364/3302
Vaginal bleeding (ob)	1148/4903 vs. 1802/6885	NR	282/1483 vs. 394/1786	181/3647 vs 339/5644	NR	NR	22/398 vs. 33/544	NR	74/484 vs. 132/972	NR	1707/10915 vs. 2700/15,831
Vaginal bleeding (gyn)	739/4903 vs. 1128/6885	NR	NR	58/3647 vs. 99/5644	NR	42/209 vs 115/482	NR	NR	26/484 vs 85/972	NR	865/9243 vs. 1427/13,983
Pelvic pain (gyn)	1082/4903 vs. 1494/6885	NR	NR	114/3647 vs. 291/5644	NR	41/209 vs. 132/482	NR	NR	26/484 vs. 70/972	25/79 vs. 65/275	1288/9322 vs. 2052/14,258
Hospitalizations	NR	785/14, 708 vs 976/24,982	583/1483 vs. 642/1786	NR	NR	41/209 vs. 50/482	257/398 vs. 279/544	NR	226/484 vs 367/972	27/79 vs 75/275	1919/17361 vs. 2389/29,041
Hospitalization for delivery	NR	NR	579/1483 vs. 520/1786	1126/3647 vs. 1103/5644	583/633 vs. 1062/1116	NR	198/398 vs. 189/544	1666/3897 vs. 1654/4067	NR	NR	4152/10,058 vs. 4528/13,157

*This outcome is a fusion of pelvic pain (obstetrical), meaning non-labor contractions, and proper labor contractions. ED: emergency department; Gyn: gynecological; HDP: hypertensive disorders of pregnancy; NR: not reported; Ob: obstetrical; PROM: premature rupture of membranes.

Table 3. Pooled proportions for the outcomes of interest.

Outcome	Studies included in the analysis	Lockdown period		Control period
		Observations	Pooled proportions (95% CI)	Observations	Pooled proportions (95% CI)
Hospitalizations	6	1919/17,361	30.6 (10.2−63.0)	2389/29,041	22.7 (7.1−52.7)
Hospitalizations for delivery	5	4152/10,058	53.9 (40.9−66.4)	4528/13,157	48.0 (29.9−66.6)
Hypertensive disorders	3	116/5614	2.6 (1.3−5.2)	90/8402	1.2 (0.8−1.9)
Uterine contractions	3	1240/2365	52.0 (25.6−77.2)	1364/3302	43.0 (18.9−71.0)
PROM	3	245/2365	12.0 (6.2−21.9)	295/3302	9.1 (7.7−10.7)
Pelvic pain	5	1288/9322	12.4 (4.5−30.1)	2052/14,258	14.4 (6.8−28.0)
Ectopic pregnancy	3	41/5209	1.8 (0.3−10.8)	92/7705	2.0 (0.1−25.4)
Reduced fetal movements	3	64/2365	3.0 (1.2−7.0)	104/3302	3.3 (1.3−8.6)
Vaginal bleeding (ob)	5	1707/10915	11.7 (6.1−21.5)	2700/15,831	12.8 (6.5−23.7)
Vaginal bleeding (gyn)	4	865/9243	7.4 (2.2−21.8)	1427/13,983	9.2 (3.3−23.4)

Abel MK, Alavi MX, Tierney C, et al. Coronavirus disease 2019 (COVID-19) and the incidence of obstetric and gynecologic emergency department visits in an integrated health care system. Obstet Gynecol. 2021;137(4):581–583.

 PubMed Web of Science ®Google Scholar

Athiel Y, Civadier MS, Luton D, et al. Impact of the outbreak of SARS-CoV-2 infection on urgent gynecological care. J Gynecol Obstet Hum Reprod. 2020;49(8):101841.

 PubMed Web of Science ®Google Scholar

Carbone IF, Conforti A, Farina A, et al. A practical approach for the management of obstetric and infertile women during the phase two of the novel coronavirus disease 2019 (COVID-19) pandemic. Eur J Obstet Gynecol Reprod Biol. 2020;251:266–267.

 PubMed Web of Science ®Google Scholar

Dell’Utri C, Manzoni E, Cipriani S, et al. Effects of SARS cov-2 epidemic on the obstetrical and gynecological emergency service accesses. What happened and what shall we expect now? European J Obstet Amp 2020;254:64–68.

 PubMed Web of Science ®Google Scholar

Goyal M, Singh P, Singh K, et al. The effect of the COVID‐19 pandemic on maternal health due to delay in seeking health care: experience from a tertiary center. Int J Gynaecol Obstet. 2021;152(2):231–235.

 PubMed Web of Science ®Google Scholar

Grandi G, Del Savio MC, Caroli M, et al. The impact of COVID-19 lockdown on admission to gynecological emergency departments: results from a multicenter Italian study. Int J Gynecol Obstet. 2020;151(1):39–42.

 PubMed Web of Science ®Google Scholar

Kugelman N, Lavie O, Assaf W, et al. Changes in the obstetrical emergency department profile during the COVID-19 pandemic. J Matern Fetal Neonatal Med. 2022;35:(21):4116–4122.

 PubMed Web of Science ®Google Scholar

Meyer R, Levin G, Hendin N, et al. Impact of the COVID-19 outbreak on routine obstetrical management. Isr Med Assoc J. 2020;22(8):483–488.

 PubMed Web of Science ®Google Scholar

Salsi G, Seidenari A, Diglio J, et al. Obstetrics and gynecology emergency services during COVID-19 pandemic. Am J Obstet Gynecol. 2020;2(4):100214.

 Web of Science ®Google Scholar

Spurlin EE, Han ES, Silver ER, et al. Where have all the emergencies gone? The impact of the COVID-19 pandemic on obstetric and gynecologic procedures and consults at a New York city hospital. J Minim Invasive Gynecol. 2021;28(7):1411–1419.e1.

 PubMed Web of Science ®Google Scholar