Severe maternal morbidity and the impact of the Covid pandemic

Aims: The COVID-19 pandemic has affected day to day operations of our entire society including the health sector. From early in the pandemic, it became apparent that pregnant and recently pregnant women were more susceptible to severe COVID infection resulting in severe maternal morbidity (SMM). Our objective was to assess and analyse any impact that the COVID-19 pandemic may have had on rates of SMM in a stand-alone tertiary referral obstetric hospital. Methods: An audit of patients that met the criteria for SMM during 2020 and 2021 was conducted and the incidence and causes of SMM were compared with data previously accrued from 2018 and 2019. Results: The rate of SMM significantly decreased from 9 (2018-2019) to 5.3 (2020-2021) per 1000 deliveries: p=0.0001. While most of the categories for SMM decreased, Major Obstetric Haemorrhage (MOH) showed a statistically significant decrease from 5.7 to 3.4 per 1000 deliveries; p= 0.001 and renal/liver dysfunction decreased from 1.3 to 0.2 per 1000; p= 0.0004. Discussion: SMM rates decreased by almost 50% in the initial two years of the Covid pandemic. Possible explanations for this include less effective capture of cases, the reproductive impact of the pandemic (including avoidance of pregnancy in women with co-morbidities) and potential benefits of lockdowns and social distancing in pregnancy.