The Impact of the COVID-19 Pandemic on the Care of Women Experiencing Abortion in a University Hospital in Brazil

Dantas, Priscilla Brenda Fonseca; Trabach, Carolina Braga; Junqueira, Aline Aparecida; Nunes, Carina Cordeiro; Veiga-Junior, Nelio Neves; Baccaro, Luiz Francisco

doi:10.1055/s-0042-1759749

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Revista Brasileira de Ginecologia e Obstetrícia

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Original Article • Rev Bras Ginecol Obstet. 45 (3) • Mar 2023 • https://doi.org/10.1055/s-0042-1759749 copy

The Impact of the COVID-19 Pandemic on the Care of Women Experiencing Abortion in a University Hospital in Brazil

O Impacto da pandemia de COVID-19 no atendimento de mulheres que vivenciam o aborto em um hospital universitário no Brasil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To evaluate the impact of the coronavirus disease 2019 (COVID-19) pandemic on the care of patients with miscarriage and legal termination of pregnancy in a university hospital in Brazil.

Methods

A cross-sectional study of women admitted for abortion due to any cause at Hospital da Mulher Prof. Dr. J. A. Pinotti of Universidade Estadual de Campinas (UNICAMP), Brazil, between July 2017 and September 2021. Dependent variables were abortion-related complications and legal interruption of pregnancy. Independent variables were prepandemic period (until February 2020) and pandemic period (from March 2020). The Cochran-Armitage test, Chi-squared test, Mann-Whitney test, and multiple logistic regression were used for statistical analysis.

Results

Five-hundred sixty-one women were included, 376 during the prepandemic period and 185 in the pandemic period. Most patients during pandemic were single, without comorbidities, had unplanned pregnancy, and chose to initiate contraceptive method after hospital discharge. There was no significant tendency toward changes in the number of legal interruptions or complications. Complications were associated to failure of the contraceptive method (odds ratio [OR] 2.44; 95% confidence interval [CI] 1.23–4.84), gestational age (OR 1.126; 95% CI 1.039–1.219), and preparation of the uterine cervix with misoprostol (OR 1.99; 95% CI 1.01–3.96).

Conclusion

There were no significant differences in duration of symptoms, transportation to the hospital, or tendency of reducing the number of legal abortions and increasing complications. The patients’ profile probably reflects the impact of the pandemic on family planning.

Keywords
CLAP MUSA network; perinatal information system; population surveillance; abortion; EviSIP; COVID-19

Period	Variable	Mean	SD	Median	Min	Max	P-value*
Pre-pandemic	Age^a	30.13	7.55	30.0	12.0	48.0	0.806
	Births^b	1.18	1.22	1.0	0	7.00	0.014
	BMI^c	27.25	5.90	26.45	15.60	45.34	0.014
	Gestational age^d	11.03	3.56	10.43	2.14	24.71	0.232
	Duration of symptoms^e	3.59	7.80	1.00	0	90.00	0.872
	Duration of transportation^f	53.16	125.57	30.00	0	1800.0	0.136
Pandemic	Age	30.21	7.55	30.0	11.0	46.0
	Births^g	1.41	1.19	1.00	0	5.00
	BMI^h	26.16	6.09	24.65	14.57	51.86
	Gestational ageⁱ	11.39	3.53	10.71	5.00	23.43
	Duration of symptoms^j	4.30	7.99	1.00	0	40.00
	Duration of transportation^k	33.94	18.81	30.00	5.00	40.00

	PrP n	PrP%	PP n	PP%	P-value*
Age^a
< 20years	24	6.40	12	6.49	0.988
20–29 years	160	42.67	79	42.70
30–39 years	144	38.40	69	37.30
40–49 years	47	12.53	25	13.51
Marital status^b
Married/cohabiting	223	60.93	88	48.35	0.005
Single/other	143	39.07	94	51.65
Comorbidities^c
No	343	91.96	178	96.74	0.031
Yes	30	8.04	6	3.26
Alcohol intake
No	327	87.90	175	94.59	0.013
Yes	45	12.10	10	5.41
Planned pregnancy^e
No	251	67.29	140	75.68	0.042
Yes	122	32.71	45	24.32
Companion^f
Partner	158	42.36	53	28.96	0.012
Family	64	17.16	31	16.94
Other	23	6.17	16	8.74
None	128	34.32	83	45.36
Contraception^g
No	234	62.73	86	46.99	< 0.001
Yes	139	37.27	97	53.01
Uterine emptying procedures^h
None	34	9.04	13	7.10	< 0.001
MVA	0	0.00	74	40.44
VA	0	0.00	1	0.55
CTG	146	38.83	69	37.7
MED	40	10.64	16	8.74
CTG/MED	156	41.49	10	5.46

Variables	Complications		P-value
Contraceptive^a	No (n/%)	Yes (n/%)	p = 0.002
No	399/77.93	21/55.26
Yes	113/22.07	17/44.74
Misoprostol use^b
No	203/39.04	24/61.54	p = 0.006
Yes	317/60.96	15/38.46
Uterine evacuation^c
None	45/8.65	2/5.13	p = 0.009
MVA	68/13.08	6/15.38
VA	0/0	1/2.56
CTG	194/37.31	21/53.85
MED	56/10.77	0
CTG/MED	157/30.19	9/23.08

Complication	Variable	Mean	SD	Median	Min	Max	P-value
No	Age^a	30.34	7.59	30.0	11.0	48.0	0.031
	Gestational age^b	11.01	3.44	10.43	8.43	24.71	0.010
	Duration of symptoms^c	3.51	6.69	1.00	0	60.00	0.045
Yes	Age	27.69	6.52	26.0	16.0	41.0
	Gestational age^d	13.03	4.54	14.00	4.00	20.29
	Duration of symptoms^e	7.77	16.47	2.00	0	90.00

Variables	Categories	OR	OR (95% CI)	P-value
Contraceptive	No (ref.)	1.00	–	–
Contraceptive	Yes	2.77	1.34–5.74	0.006
Gestational age	Continuous variable (weeks)	1.149	1.051–1.256	0.002
Misoprostol use	Yes (ref.)	1.00	–	–
Misoprostol use	No	2.18	1.05–4.51	0.037

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[1] Address for correspondence Priscilla Brenda Fonseca Dantas, specialist doctor in Gynecology and Obstetrics, Rua Alexander Fleming, 101, 13083-881, Cidade Universitária Zeferino Vaz, Campinas, SP, Brazil (e-mail: prisbrenda_@hotmail.com).