Impact of COVID-19 on Pregnancy Outcome in the First Wave, Second Wave, and Third Wave of the Pandemic at a Tertiary Care Centre Mysuru, Karnataka, India: A Prospective Cohort Study

Abstract

Introduction: The Coronavirus Disease-2019 (COVID-19) pandemic has subjected us all to difficult times in managing patients, particularly pregnant women. Numerous studies have been conducted during each wave, but limited data is available on maternal and neonatal outcomes. Given that people must coexist with COVID-19, it is crucial to enhance the understanding of antenatal patient management. Aim: To compare the clinical presentation, co-morbidities, and maternal and neonatal outcomes among pregnant women with COVID-19 during the first, second, and third waves of the pandemic. Materials and Methods: This prospective cohort study was conducted in the Department of Obstetrics and Gynaecology (OBG) at JSS Hospital, Mysore, Karnataka, India, from January 2020 to February 2022. A total of 33 expectant mothers with COVID-19 presented during the first wave (from January 30, 2020, to the end of February 2021), 50 expectant mothers with COVID-19 during the second wave (from March 2021 to the end of September 2021), and 19 expectant women with COVID-19 during the third wave (from January 2022 to the end of February 2022). Data were collected for each wave, and a comparison of different variables in all three waves was performed. Microsoft Excel was used for data entry, and analysis was conducted using Statistical Package for Social Sciences (SPSS) version 22.0. Chi-square test was employed to compare the different variables as a test of significance. Results: The mean age of the expecting mothers in the first wave was 27.12±4.35 years, in the second wave was 25.86±3.98 years, and in the third wave it was 24.61±3.98 years, with a p-value=0.103. Symptoms like cough, cold, running nose were highest in the second wave (22 cases, 44.0%), followed by breathlessness in 6 (12.0%) cases, and fever, chills, myalgia, generalised weakness, vomiting in 45 (90.0%) cases. Hypertensive disease of pregnancy was highest in the first wave (8 cases, 24.2%). In the first, second, and third waves, a total of 23 (69.7%), 30 (60.0%), and 12 (63.1%) individuals, respectively, did not have any co-morbidities. The majority of women in the first wave 18 (54.6%) cases and second wave 27 (54.0%) cases were multigravida, while in the third wave, they were primigravida 14 (73.7%) cases. Pre-term deliveries 22 (44.0%) cases and intrauterine deaths 8 (16.0%) cases were highest in the second wave. There was a higher frequency of Preterm Premature Rupture of Membranes (PPROM) and Premature Rupture of Membranes (PROM) in the first wave 6 (18.2%) cases. Neonatal Intensive Care Unit ( NICU) admission of babies was found to be highest in the third wave 8 (42.1%) cases, compared to the first two waves. There was no statistically significant association between these parameters and the waves of the pandemic. The mean Haemoglobin (Hb) levels of the study subjects were least in the first wave, compared to those in the rest of the waves (p-value=0.499). Mean Erythrocyte Sedimentation Rate (ESR) levels were significantly lower in the first wave (p-value=0.041), and C-reactive Protein (CRP) was highest in women in the second wave (p-value=0.036). Conclusion: It is important that always study the features of the disease over a period of time so that the management protocols can be modified.

Keywords

• coronavirus disease-2019
• laboratory investigations
• maternal outcome
• neonatal outcome
• pregnancy