Abstract
INTRODUCTION: The purpose of this study was to explore the influence of the COVID-19 pandemic on the management of early pregnancy loss. Additionally, we aimed to identify differences in the use of virtual health care for the management of spontaneous abortions (SABs) before and after the COVID-19 pandemic. METHODS: Retrospective cohort study was conducted of patients aged 18–40 receiving obstetric care at Cleveland Clinic hospitals between March 2019 and September 2019 (pre-COVID-19), and between March 2020 and September 2020 (post-COVID-19). SABs were defined as spontaneous pregnancy losses occurring before the 20th week of pregnancy, excluding induced abortions and ectopic pregnancies. Baseline demographic information, medical history, type of SAB management, and use of virtual visits were compared between the pre-COVID-19 and post-COVID-19 groups. RESULTS: Two thousand two hundred eleven patients met inclusion criteria, 1,159 with SAB pre-COVID-19 and 1,052 with SAB post-COVID-19. Demographic factors including race (P=.64) and age (P=.46) did not differ between the two groups. Overall management of SAB differed between the two cohorts, with a higher proportion of post-COVID-19 patients opting for expectant management (49.9%) compared to only 38.1% choosing expectant management in the pre-COVID-19 group (P<.001). Virtual visits for consultation and management of SAB were more prevalent in the post-COVID period with 11.1% of patients choosing to utilize telehealth compared to only 0.09% of patients in the pre-COVID-19 cohort (P<.001). CONCLUSION: The COVID-19 pandemic affected many aspects of the delivery of health care, and women's health is no exception. Our study shows that the pandemic changed the way SABs were managed, with a higher proportion of health care providers and patients opting for expectant management as compared to the pre-pandemic time period. We also saw a change in the way health care was delivered with virtual appointments becoming more popular post-COVID-19, emphasizing the growing role of telehealth in women's health care and in the management of SAB.
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