key: cord-0827897-cupdnj8q
authors: Kearns, R.J.; McCallum, A.R.; Campbell, R.; Shaw, M.; Litchfield, K.
title: P.1 Deprivation and SARS-CoV-2 in obstetric patients
date: 2021-06-09
journal: Int J Obstet Anesth
DOI: 10.1016/j.ijoa.2021.102999
sha: 2a47c807ef3dff440dd4b361e3109bb07b69345c
doc_id: 827897
cord_uid: cupdnj8q

Introduction: The UK Obstetric Surveillance System (UKOSS) has reported on risk factors for admission to hospital amongst obstetric patients with SARS-CoV-2, however, it did not evaluate deprivation as a risk factor.1 Deprivation is a recognised risk factor for mortality from COVID-19 amongst the general population.2 We, therefore, investigated the demographics, including deprivation scores, of obstetric patients diagnosed with SARS-CoV-2 within our local health board. Methods: Caldicott Guardian approval was obtained and requirement for ethical approval was waived by the local research ethics service. All pregnant or recently pregnant patients (within 6 weeks post-partum) within our health board area with a positive SARS-CoV-2 test between 16 March 2020 and 18 December 2020 were retrospectively identified from regional infection surveillance and local obstetric unit reports. Residential area deprivation was classified using the Scottish Index for Multiple Deprivation (SIMD), with quintile 1 representing the most deprived and quintile 5 representing the least deprived areas. R version 4.0.3 (R Foundation for Statistical Computing) was used to perform analyses. Results: Over the study period, 97 patients tested positive for SARS-CoV-2. Comparison between those in the lowest and highest SIMD quintiles is as shown below. Those from a black or ethnic minority background accounted for 31.9% of positive test results and 50% of admissions to critical care. [Formula presented] Discussion: In this cohort of obstetric patients, mothers from socioeconomically disadvantaged areas accounted for a higher proportion of SARS-CoV-2 positive cases (and hospital / critical care admissions) than those from more affluent areas. This is, to our knowledge, the first study to investigate this association in obstetric patients. The relationship demonstrated between ethnicity, deprivation and SARS-CoV-2 requires further investigation and may have implications for future resource allocation and service planning.

to deliver is challenged by raised body mass index (BMI). Conversion to GA during CS is challenging and potentially distressing for the mother. The study aims were to quantify how surgical time (ST) and anaesthesia time (AT), at CS, vary by BMI.

Methods: A cross-sectional, retrospective review of electronic patient records (EPR) and theatre database. Women delivering in NHS Lothian between 1 Jan 2011 and 31 Dec 2019, were identified (n = 83,713). Data collected included mode of delivery, BMI and where applicable urgency of CS, ST, AT and mode of anaesthesia (GA, spinal, epidural top-up or combined spinal-epidural (CSE)). Missing data were excluded.

Results: Of 81,929 women, 29.8% delivered by CS. In BMIP40 kg/ m 2 (n=2099), 47% had CS compared with 29% of controls (P <0.001). Emergency CS occurred in 516 (24.6%) of BMIP40 kg/m 2 compared with 13,839 (17.3%) of controls ( P <0.001). Data were available for 20,989 singleton CS, 900 (4%) with BMIP40 kg/m 2 . AT and ST both increased with BMI (Kruskal-Wallis test: AT v 2 (3) = 256.4, P <0.001; ST v 2 (3) = 294.7, P<0.001). 10% of BMIP40 kg/m 2 and 8.2% controls had GA. Of these, more occurred following regional or attempted regional in BMIP40 kg/m 2 vs. controls (39% vs 21%, P <0.001). When GA was used for emergency CS, mean AT in BMIP40 kg/m 2 was 22.3 min vs. 16.8 min in controls. In BMIP40 kg/m 2 , AT for epidural and GA were similar (25.3 vs. 22.3 min).

Discussion: Approximately 50% of BMIP40 kg/m 2 women delivered by CS; 25% had an emergency CS. AT and ST increase with BMI. In BMIP40 kg/m 2 difficulty with regional anaesthesia may increase need for GA. Mean ST in BMIP50 kg/m 2 was >60 min. CSE is appropriate in these women and may reduce conversion to GA. In BMIP40 kg/m 2 emergency CS, the similar AT for epidural top-up and GA supports use of labour epidurals. In women with BMIP40 kg/m 2 , anaesthesia for CS is high risk and technically challenging. Senior multidisciplinary involvement is required. Introduction: The UK Obstetric Surveillance System (UKOSS) has reported on risk factors for admission to hospital amongst obstetric patients with SARS-CoV-2, however, it did not evaluate deprivation as a risk factor. 1 Deprivation is a recognised risk factor for mortality from COVID-19 amongst the general population. 2 We, therefore, investigated the demographics, including deprivation scores, of obstetric patients diagnosed with SARS-CoV-2 within our local health board.

Methods: Caldicott Guardian approval was obtained and requirement for ethical approval was waived by the local research ethics service. All pregnant or recently pregnant patients (within 6 weeks postpartum) within our health board area with a positive SARS-CoV-2 test between 16 March 2020 and 18 December 2020 were retrospectively identified from regional infection surveillance and local obstetric unit reports. Residential area deprivation was classified using the Scottish Index for Multiple Deprivation (SIMD), with quintile 1 representing the most deprived and quintile 5 representing the least deprived areas. R version 4.0.3 (R Foundation for Statistical Computing) was used to perform analyses.

Results: Over the study period, 97 patients tested positive for SARS-CoV-2. Comparison between those in the lowest and highest SIMD quintiles is as shown below. Those from a black or ethnic minority background accounted for 31.9% of positive test results and 50% of admissions to critical care.

Discussion: In this cohort of obstetric patients, mothers from socioeconomically disadvantaged areas accounted for a higher proportion of SARS-CoV-2 positive cases (and hospital / critical care admissions) than those from more affluent areas. This is, to our knowledge, the first study to investigate this association in obstetric patients. The relationship demonstrated between ethnicity, deprivation and SARS-CoV-2 requires further investigation and may have implications for future resource allocation and service planning.

Characteristics and outcomes of pregnant women admitted to hospital with confirmed SARS-CoV-2 infection in UK: national population based cohort study

Deaths involving covid-19 by local area and socioeconomic deprivation: deaths occurring between 1