INTRODUCTION
The wide scale socioeconomic disruptions of COVID-19 pandemic and its impact on health care services are still being felt. Previous viral epidemics have resulted in adverse obstetric outcomes including maternal and perinatal mortalities1. Besides the direct impact of COVID-19 on pregnancy, modification in service provision adopted following the pandemic in a bid to curb transmission of the infection in hospital settings, may have far reaching effect on obstetric outcomes.
In the United Kingdom lockdown measures were announced on the 23rd March 20202. Consequently, modification in obstetric care happened around this time in most UK units3. These changes included alteration of the provision of antenatal care by reducing face-to-face clinics, and offering more telephone or virtual consultations. Antenatal surveillance and screening pathways were also changed to reduce in-hospital attendance including the use of fasting blood sugar and HbA1c instead of oral glucose tolerance test, the use of home blood pressure monitoring and reduction of the frequency of serial growth scans3,4.
These changes to care were aimed at reducing the risk of COVID-19 infection for pregnant women and healthcare staffs, and while women may find telephone consultations valuable and acceptable, these changes may also reduce the sense of communication between women and midwives4. Reducing face-to-face antenatal appointments could increase pregnancy complications particularly in high-risk groups such as victims of domestic violence, deprived populations with limited access to advanced technology and those with mental health issues4,5.
While pregnancy will be uncomplicated in many women, these changes in obstetric care are previously untested and the effect on outcomes is unknown; high risk women with antenatal complications could be missed, and anxiety about entering acute hospital settings might deter women with reduced fetal movements from seeking additional care during pregnancy4. Several studies have shown that women who do not attend antenatal services are at increased risk of maternal death, stillbirth and other adverse perinatal outcomes6-8.
It is possible that some women may be reluctant to seek urgent care when necessary for fear of contracting COVID-19. This may result in adverse perinatal outcomes including intrauterine fetal death in cases of delayed presentation for no/reduced fetal movements; and adverse maternal outcomes in high risk women with medical comorbidities including gestational diabetes and preeclampsia. Furthermore, acute alterations from familiar service pathways may create anxiety in some women resulting in failure to seek care with consequent reduced attendances of antenatal appointments for fetal growth scans and other antennal surveillance.