Impact of healthcare restrictions due to COVID-19 on early pregnancy complications: A cross-sectional study.

Background: In March 2020, the World Health Organization declared COVID-19 a global pandemic. Healthcare organizations across the world introduced various measures to restrict the spread of the disease, with an increasing reliance on telephonic consultations as a key measure to limit exposure to COVID-19 in hospital facilities. This study assesses the impact of restrictive measures on gynecological emergency services by comparing services before the COVID-19 pandemic with services during the first and second waves of the pandemic (COVID-19 Peak 1 and COVID-19 Peak 2).

Method: This was a retrospective single-center cross-sectional study comparing the first 50 women attending the emergency department (ED) of the Women's Wellness and Research Center in Qatar with a gynecological complaint during three distinct periods. The peak of the first COVID-19 wave from June 2020 was considered COVID-19 Peak 1, and the peak of the second wave from April 2021 was COVID-19 Peak 2. The control group included 50 women who attended the ED during non-COVID-19 times. Early pregnancy complications (miscarriage and ectopic pregnancy) were compared between the three periods to determine the impact of the COVID-19 restrictions on the clinical presentation, subsequent management, and any patient safety issues arising out of this in terms of complications.

Results: Data from 50 patients were analyzed during each study period (total = 150). There were no statistically significant differences in age, nationality, and parity between the three groups. The gestational age at diagnosis of ectopic pregnancy or miscarriage was significantly higher, 12.4 ± 4.0 weeks during COVID-19 Peak 1 compared to 10.9 ± 3.6 in pre-COVID-19 and 9.7 ± 3.9 in COVID-19 Peak 2 (p = 0.002). The length of hospital stays (median ± interquartile range) for women with the diagnosis of miscarriage was significantly shorter during COVID-19 Peak 1(1 ± 2 days) compared to pre-COVID-19 (2 ± 1.5) and COVID-19 Peak 2 (1 ± 2), with p < 0.001. There was no difference in patient demographics, symptoms at presentation, type of management, and timing of surgical management.

Conclusion: The COVID-19 restrictions led to a major shift in the way healthcare was delivered, with increased use of telephone consultations and prompt early discharge from the hospital. Although we did not record safety issues or adverse outcomes, we found a delay in gestational age at presentation and diagnosis, which has the potential to lead to adverse outcomes. The COVID-19 pandemic has further highlighted the importance of telemedicine in healthcare practice.