Assistência obstétrica e as medidas de quarentena durante o contexto da pandemia por Covid-19

Abstract

The coronavirus infection spread rapidly from China to other parts of the world in 2019. According to the World Health Organization from January 3, 2020 to April 11, 2022 there are 2022497,493,302 confirmed cases of COVID-19. 19, including 6,174,449 deaths worldwide. As epidemiological risk factors, there are people who have traveled to epidemic countries or regions, close contact with infected people, elderly people over 60 years of age, pre-existing respiratory morbidities, pregnant and postpartum women. Pregnant women of any gestational age and women who had miscarriage or fetal loss were included in this group. It is still unclear what medium- and long-term impacts the necessary adjustments in care will have on the well-being of women and babies, or on women's childbirth experiences. Considering that COVID-19 appears to increase the risk of complications in the puerperal pregnancy cycle, the management of these women should ideally be controlled and rigorous. This research aimed to identify the impact of COVID-19 quarantine measures on the obstetric care of pregnant women. This is an online prospective quantitative approach study carried out with women who gave birth between the lockdown period that was from March 6th to April 4th, 2020 in the southern region of the country. Information on demographic, social, pregnancy, delivery and birth data was collected and compared between the two periods: pre-alert (March 6 to March 20, 2020) and post-alert period (March 21 to April 04, 2020). All births that occurred during the aforementioned period were considered eligible for the study. Sampling was for convenience. For the data collection stage, a duly trained team carried out the recruitment through digital media. The data collection form included 34 questions about demographic, social, pregnancy, delivery and birth characteristics, as well as those related to outbreak response measures, such as symptoms, diagnosis, social isolation, contact with infected people, among others. A hierarchical approach and conditional logistic regression were used in the data analysis. The collected data were exported and analyzed by the IBM® SPSS software, version 20.0. The study included 412 women who gave birth during the lockdown period. Among obstetric care during pregnancy, it was possible to notice significant pre and post lockdown associations in the reduced number of consultations, unscheduled consultations, fewer laboratory and imaging tests performed and change of obstetrician in the pandemic. A higher proportion of women remained in social isolation during the period, although the presence of symptoms for COVID-19 and confirmed diagnosis of the disease were significantly associated with the pre-lockdown period. Insufficient number of consultations during prenatal care, early clamping of the umbilical cord, cesarean section, preterm labor and symptoms for COVID-19 were also associated with the pre-lockdown period. COVID-19 quarantine measures impacted care management during pregnancy, childbirth and the puerperium, resulting in unnecessary interventions and an increase in cesarean sections.