COVID-19 pandemic’s influence on obstetrical and gynecological conditions in a tertiary unit – then and now

1. Introduction

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the virus that causes coronavirus disease 2019 (COVID-19). In December 2019, the first case was discovered in Wuhan, China^(1-3). The illness spread swiftly around the world, and the World Health Organization (WHO) declared it a pandemic on March 11, 2020⁽⁴⁾. On February 26, 2020, the first verified case of the novel coronavirus infection in Romania was reported. Due to the significant rise in the number of affected individuals, an emergency state was declared on March 16, 2020, which prohibited all activities except for essential necessities. The “lockdown” lasted until the state of alert was declared on May 14, 2020^(5,6).

The public healthcare system in Romania provides the majority of medical services. The growing number of acutely unwell COVID-19 patients at the expense of chronically ill patients, notably those with gynecological and obstetrical diseases, created a new environment to which health professionals had to adjust. As the virus expanded over the world, issues with staffing, operation prioritization, intraoperative virus transmission risk, and implications on surgical education⁽⁸⁾ caused a profound change in the practice and scope of medicine and surgery. The number of COVID-19 patients who needed specialist care for mothers and newborns placed a lot of strain on the perinatal health system^(5,7-9).

In this case, pregnant women and gynecological patients were forced to seek care in hospitals like ours, since some hospitals had to be turned into COVID-19 units.

Since the start of the pandemic, there has been evidence of a decrease in the number of people seeking emergency or chronic care. The reasons for this decline are likely complex and include patient self-management and lifestyle changes in the context of social distancing, as well as patients avoiding emergency care out of fear of SARS-CoV-2 infection⁽¹⁰⁾.

The aim of this study was to find out how admissions for obstetrical disorders differed from those for gynecological pathologies in our unit during the pandemic and post-pandemic years (2020, 2021 and 2022) in comparison to the pre-pandemic year (2019).

2. Methodology

Study protocol

The study was designed as a comparative retrospective analysis of a single tertiary center.

Patients who were admitted to the Obstetrics and Gynecology Unit of the Emergency County Clinical Hospital Craiova, Romania, between March and December 2019 (before the pandemic), in 2020 (during the pandemic), in 2021 (after the vaccine was introduced), and in 2022 (after vaccination) were included in this study. All of the hospitalized patients’ charts from these periods were examined backward. Hospitalization rates per month were compared across the years. 

In the study, there were included obstetrical and gynecological patients. We divided the study group into two sections: obstetrical patients (including natural births and caesarean sections), with bleeding (due to abortion, placenta praevia), common pregnancy-related pathologies (hypertension, diabetes, preeclampsia, thrombophilia, intrauterine growth restriction and anemia), and gynecological patients, including acute and chronic abdominal pain, vaginal bleeding (chronic and acute), different types of genital abdominal masses (ovarian tumors, fibroids), and other pathologies associated with the genital sphere.

Study outcomes

We compared the number of patients admitted to our department during the study period in 2020 (during the pandemic), in 2021 (when the vaccine was introduced), in 2022 (after immunization), and in 2019 (before the pandemic).

Main analysis

For each month of the aforementioned years, the number of patients admitted to the hospital, based on their condition, was noted. The computed numbers contrasted the pre-pandemic, pandemic, and post-vaccination periods with the pre-pandemic year (2019). 

3. Results

As it can be seen from Figure 1, during the COVID-19 period, the number of admissions for patients with gynecological conditions decreased significantly, compared to the admissions of pregnant patients, whose number increased during the COVID-19 pandemic.

Attributes of the population under study. A total of 19,653 patients were included in the study after being admitted to the hospital for both ambulatory and emergency reasons.

Hospitalizations were broken down by year as follows: 5763 in 2019, 5083 in 2020, 4475 in 2021, and 4332 in 2022. Consequently, hospitalization rates during the COVID-19 pandemic have drastically decreased, yet the addressability has not increased since immunization was introduced.

A rise in the number of pregnant patients was noted during the pandemic and lockdown, although this coincided with the closure of numerous obstetrics units in our region or their conversion to COVID-only services. The number of obstetric patients in 2020 increased by 115% compared to 2019.

On the other hand, a dramatic decrease in the number of hospitalizations in the case of patients with gynecological conditions in 2020 compared to 2019 can be highlighted, a decline that was maintained throughout the pandemic and even after the pandemic.

4. Discussion

This study found that, compared to the pre-pandemic year (2019), the average number of hospitalizations during the COVID-19 pandemic (2020, 2021 and 2022) dropped considerably for chronic ill patients, while for pregnant patients, it increased in the first year of the pandemic (2020), to decrease later. This is most likely due to the pandemic and COVID-19 incidents, which caused patients to seek refuge in other private facilities out of fear of the state hospital, but at the same time, it highlights the unchanging need for medical assistance in the case of birth^(11-14). Even though the population’s level of fear significantly dropped following the initial vaccination campaign and even after the lockdown and alert state were lifted, this change persisted. This is most likely because the safety of the vaccine was not first studied during pregnancy and it was unclear in 2021, with recommendations weighing the advantages and disadvantages of immunizing the expectant mothers^(15,16). WHO approved the vaccination as safe for pregnant women at the beginning of 2022⁽⁸⁾.

According to our data, the number of births rose in the first pandemic year (2020) and fell in the subsequent years (2021 and 2022), even though the overall number of hospitalizations fell in the first pandemic year compared to the pre-pandemic year (2019). Other research also show this increasing trend^(17-20). In terms of admissions for gynecological patients, a dramatic decrease in addressability to emergency units during the pandemic period (2020) can be highlighted, a low addressability that was maintained in the following years (2021 and 2022)^(21,22).

5. Conclusions

The COVID-19 pandemic has affected not only the global healthcare system, but also the medical care practices and conceptions of both pregnant and non-pregnant women. According to our research, women stayed out of hospitals during the COVID-19 pandemic and only sought medical attention when it was absolutely necessary. According to the study’s findings, either a significant number of unnecessary admissions occurred prior to pandemics, or women are increasingly choosing the private healthcare system, which is unlikely given the circumstances of the COVID-19 and post-COVID-19 economic crises in our country. The birth rate was the only thing that the SARS-CoV-2 epidemic could not alter, regardless of the women’s decision or other influences.  

CORRESPONDING AUTHORS: Iuliana-Alina Enache, e-mail: alinadica34@gmail.com; Ştefan-Gabriel Ciobanu, e-mail: ciobanustefangabriel1@gmail.com

CONFLICT OF INTEREST: none declared.

FINANCIAL SUPPORT: none declared.

This work is permanently accessible online free of charge and published under the CC-BY.