Impact of labor and delivery unit policy modifications on maternal and neonatal outcomes during the COVID-19 pandemic

GREENE, Naomi H.; KILPATRICK, Sarah J.; WONG, Melissa S.; OZIMEK, John A.; NAQVI, Mariam

Background In response to the COVID-19 pandemic, hospitals nationwide have implemented modifications to labor and delivery unit practices designed to protect delivering patients and healthcare providers from infection with SARS-CoV-2. Beginning March 2020, our hospital instituted labor and delivery unit modifications targeting visitor policy, use of personal protective equipment, designation of rooms for triage and delivery of persons suspected or infected with COVID-19, delivery management and newborn care. Little is known about the ramifications of these modifications in terms of maternal and neonatal outcomes. Objective The objective of this study was to determine whether labor and delivery unit policy modifications we made during the COVID-19 pandemic were associated with differences in outcomes for mothers and newborns. Study Design We conducted a retrospective cohort study of all deliveries occurring in our hospital between January 1, 2020 and April 30, 2020. Patients who delivered in January and February 2020 before labor and delivery unit modifications were instituted were designated as the pre-implementation group, and those who delivered in March and April 2020 were designated as the post-implementation group. Maternal and neonatal outcomes between the pre-and post-implementation groups were compared. Differences between the two groups were then compared to the same time period in 2019 and 2018 to assess whether any apparent differences were unique to the pandemic year. We hypothesized that maternal and newborn lengths of stay would be shorter in the post-implementation group. Statistical analysis methods included Student’s T-tests and Wilcoxon tests for continuous variables and chi square or Fisher’s exact tests for categorical variables. Results Postpartum length of stay was significantly shorter after implementation of labor unit changes related to COVID-19. A postpartum stay of 1 night following vaginal delivery occurred in 48.5% of patients in the post-implementation group compared to 24.9% of the pre-implementation group (p<0.0001). Postoperative length of stay after cesarean delivery of ≤2 nights occurred in 40.9% of patients in the post-implementation group as compared to 11.8% in the pre-implementation group (p<0.0001). Similarly, after vaginal delivery, 49.0% of newborns were discharged home after one night in the post-implementation group compared to 24.9% in the pre-implementation group (p <0.0001). After cesarean delivery, 42.5% of newborns were discharged after ≤2 nights in the post-implementation group compared to 12.5% in the pre-implementation group (p<0.0001). Slight differences in the proportions of earlier discharge between mothers and newborns were due to multiple gestations. There were no differences in cesarean delivery rate, induction of labor, or adverse maternal or neonatal outcomes between the two groups. Conclusion Labor and delivery unit policy modifications to protect pregnant patients and healthcare providers from COVID-19 demonstrate that maternal and newborn length of stay in the hospital were significantly shorter after delivery without increases in the rate of adverse maternal or neonatal outcomes. In the absence of longer-term adverse outcomes occurring after discharge that are tied to earlier release, our study results may support a review of our discharge protocols once the pandemic subsides to move toward safely shortening maternal and newborn lengths of stay.