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The pandemic’s impact on stillbirth

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It’s been almost an entire year that the world was challenged with the unprecedented coronavirus pandemic. Not only are vulnerable people and businesses affected, but also high-risk pregnancies. In the latest news article by world’s leading science journal “Nature”, we learn yet another disturbing trend: a sharp rise in the proportion of pregnancies ending in stillbirths since the beginning of this pandemic. This trend has been corroborated by several studies around the world, warning us that high-risk pregnancies may be going undetected during the pandemic.

One study conducted across 9 hospitals in Nepal involved more than 20,000 women. It reported that stillbirths increased from 14 per 1000 births before lockdown in late March, to 21 per 1000 births by the end of May. This is a shocking 50% increase! During this time, the steepest rise was during the first four weeks of the lockdown, which corresponds to the time that people were only allowed to leave their homes for essential food and care.

Interestingly, although the rates of stillbirths spiked, the overall number was unchanged during the pandemic. This can be explained by an halved total hospital birth number, which was likely accompanied by an increase in home births. There was also a higher proportion of hospital births with complications. Birth data from a large hospital in the UK shows a similar trend. A nearly fourfold increase in the incidence of stillbirths was reported at the St George’s Hospital between February and mid-June. Similarly, two thirds fewer women in India were referred to emergency pregnancy care during the pandemic.

The spike in stillbirths was not directly caused by COVID-19 infections, but most likely a result of how the pandemic has impaired access to antenatal care. For example, pregnant women may have been unable to travel to healthcare facilities for the lack of public transport, or they voluntarily chose to cancel antenatal appointments. Others may have avoided hospital visits intentionally for fear of contracting the coronavirus, leading to undiagnosed complications or delayed diagnosis. As such, treatment was not given or given too late, ultimately resulting in stillbirths.

How many times should you see a medical professional during pregnancy?

The World Health Organisation recommends that pregnant women be seen by medical professionals at least 8 times during pregnancy, even if the pregnancy is considered as low risk. This is to detect and manage problems that may harm the mother, baby or both, which is particularly important for the last trimester.

In addition, prospective mothers can take precautions to prevent stillbirths, including:

  • Avoid smoking

  • Sleep on the side from 28 weeks’ gestation onwards

  • Notify your midwife or doctor if the baby is moving less

During the pandemic, some face-to-face consultations may be substituted with remote appointments to protect mothers from infectious exposure. However, there are instances where taking blood pressure, listening to a baby's heartbeat and an ultrasound scan are absolutely essential.

High risk pregnancies and first-time mothers who are less likely to know when an abnormality occurs may be dangerously underserviced through remote consultations. In Australia, we have managed the pandemic relatively well and you should not be overly worried about attending appointments. In fact, it is really important that you do not miss antenatal appointments with your GP, midwife or obstetrician, as well as necessary scans and tests. Rest assured that the hospitals and medical centres are well prepared to protect pregnant women and babies during this pandemic by taking special precautions.

If you have concerns about pregnancy during this pandemic time, feel free to contact Melbourne-based obstetrician, Dr. Alex Polyakov here.