|
164       ABSTR​ACTS​
=5.2% (stillbirth) in a missed SGA where final scan was
undertaken by registrar. This is higher than the general
population.
There was 1 missed LGA (5.2%).
Conclusions: Despite being scanned by senior members of
the team including consultants 10.5% SGA and 5% LGA
were missed. The overall incidence of SGA was 15.7%.
Recommendation US service by specialist midwife or ultra
sonographer could help to detect more SGA and prevent ad-
verse outcomes.
PA N DE M IC A N D I M PAC T OF C OV I D/
I N F E C T IOUS DISE A SE S
PP.0109  |  Risk factors for SARS-­CoV-­2 positivity in
neonates born to mothers with COVID-­19
Sangamithra Ravi1; Oluwadamilola Akande1; Halimah
Khalil1; Maurie Kuha Kumaran1; Jameela Sheikh1; John
Allotey2; Javier Zamora2,3; Shakila Thangaratinam2,4;
Tania Kew1
1
College of Medical and Dental Sciences, University of
Birmingham, Birmingham, UK; 2Institute of Metabolism
and Systems Research, WHO Collaborating Centre for
Global Women's Health, University of Birmingham,
Birmingham, UK; 3Head of Clinical Biostatistics Unit,
Hospital Ramon y Cajal of Biomedical Research, Madrid,
Spain; 4Birmingham Women's and Children's NHS
Foundation Trust, Birmingham, UK
Objective: To evaluate outcomes of SARS-­CoV-­2 positive
neonates born to SARS-­CoV-­2 positive mothers, determine
maternal and perinatal risk factors associated with neonatal
SARS-­CoV-­2 positivity and report positivity rates in differ-
ent regions.
Design: Living systematic review and meta-­analysis.
Method: Major databases, preprint servers and websites
were searched from 1st December 2019 to 25 April 2022 for
studies reporting outcomes of neonates from SARS-­C oV-­2
positive mothers. The 2021 World Health Organisation
classification was used for infection timing and classifica-
tion; outcomes were assessed narratively. Two independent
reviewers screened studies in a two-­stage process, with a
third reviewer resolving disagreements. Data was extracted
on maternal and perinatal risk factors including maternal
condition (severe COVID-­ 19, intensive care admission,
death), exposure timing, intrapartum factors, postnatal
care and offspring SARS-­C oV-­2 status. Information re-
garding predominant variant of concern was reported by
the author or determined by the dominant variant in that
country during the study period. SARS-­C oV-­2 positivity
rates were evaluated from various World Bank regions.
Random-­effects meta-­a nalysis was used to report odds ra-
tios (OR) with 95% confidence intervals (CI).
Results: 643 studies (343 cohort studies, 300 case series and
case reports; 44552 mothers, 30822 babies) were included.
2.7% (95% CI 2.1% to 3.5%; 210 studies, 24040 babies) born
to SARS-­ CoV-­2 positive mothers tested positive for the
virus with reverse transcriptase-­polymerase chain reaction
(RT-­PCR). Of the 1213 SARS-­CoV-­2 positive babies with
outcome data, there were 64 stillbirths, 36 neonatal deaths
and 9 early pregnancy losses; 1104 babies were alive after
follow-­up. Severe maternal COVID-­19 (OR 3.5, 95% CI 1.5
to 8.1), maternal death (14.1, 4.1 to 48.0), maternal postnatal
infection (5.0, 1.2 to 20.1), caesarean section (1.4, 1.1 to 1.8)
and preterm delivery (1.5, 1.2 to 1.9) were associated with
neonatal SARS-­CoV-­2 positivity. Positivity rates in offspring
using RT-­PCR varied regionally: 0.1% (95% CI 0.0% to 0.5%)
in North American studies and 8.5% (4.6% to 13.3%) in
Latin American and Caribbean studies. Positivity rates for
variants of concern were 1.7% (95% CI 0.3% to 9%) in a study
during Gamma variant predominance and 4.3% (2.5% to
7.4%) during Delta variant predominance. Where the pre-
dominant variant was unknown, positivity rates were 13.7%
(0.0% to 42.3%).
Conclusions: Maternal COVID-­19 severity may be associ-
ated with neonatal SARS-­ CoV-­2 positivity. Determining
whether neonatal mortality and other complications were
related to SARS-­CoV-­2 was difficult due to inconsistent re-
porting practices. Follow-­up of positive neonates is needed
to evaluate long-­term outcomes and guide precautionary
measures.
EP.0047  |  COVID-­19 lockdowns association with
maternal and perinatal outcomes in high-­income
countries
Iona Hindes1; Hawa Nuralhuda Sarwar1; Lizbeth Burgos
Ochoa2; Benjamin Gravesteijn3; Jasper Been4; Dominik
Zenner1; Stamatina Iliodromiti1
1
Queen Mary University London, London, UK; 2Department
of Obstetrics and Gynecology at Erasmus MC, Rotterdam,
Netherlands; 3Department of Public Health Erasmus MC,
Rotterdam, Netherlands; 4Erasmus MC –­Sophia Children's
Hospital, University Medical Centre Rotterdam, Rotterdam,
Netherlands
Objective: The study's aim is to systematically review the
impact of lockdowns on maternal and perinatal outcomes
specifically in high-­income countries (HICs), and assess how
outcomes differed by region, lockdown period, deprivation,
and ethnicity.
Design: A systematic review and meta-­analysis compared
maternal and perinatal outcomes during lockdowns to
pre-­pandemic years in HICs. The design rationale was
COVID-­19 lockdowns and the way they were implemented
varied greatly among countries and income levels. There is
evidence that pregnancy outcomes during lockdowns were
different in high compared to low-­or middle-­income coun-
tries, but systematically reviewed evidence on HICs is scarce.
A​B ST​R ACTS
Method: We searched PubMed, EMBASE, MedRxiv, Web of
Science, and Cochrane, following PRISMA guidelines, from
Jan 1, 2019 –­June 10th, 2022. The search included studies
comparing the rates of maternal and perinatal outcomes, in-
cluding physical and mental health, before, during, and after
COVID-­19 lockdowns. Studies exploring the direct outcomes
of COVID-­19 infection, without pre-­pandemic comparison
groups, systematic reviews, or qualitative studies were ex-
cluded. Meta-­analysis was conducted using random-­effects
and estimated pooled risk ratios (RR) (95% confidence inter-
vals (CI)), and subgroup analysis was conducted per region,
lockdown period, ethnicity group, and deprivation level. A
secondary nested analysis meta-­analyzed studies included
quasi-­experimental time-­adjusted results. We registered the
study with Prospero (registration ID CRD42022327448).
Results: The systematic review identified 156 studies, 126 of
which were included in meta-­analysis. Analysis of 213,005,342
live births and 2,488,292 preterm births showed preterm
birth decreased in the first lockdown compared to pre-­lock
down (RR 0.95 (95%CI 0.93–­0.98)), this decrease was greater
in Europe (0.95 (0.92–­0.98)) and Australia (0.94 (0.90–­0.99)),
it was not observed in the second lockdown (1.01 (1.01–­1.02))
or post-­lockdown periods (0.98 (0.93–­1.04)). The decrease in
the risk of preterm birth was only observed in white women
and women living in areas of low deprivation (0.97 (0.95–­0.99))
and (0.95 (0.91–­0.98)) respectively. No significant changes were
observed for stillbirth, neonatal death & admissions, cesarean
section, clinically relevant maternal mental health scores, low-­
birthweight, severe perineal tears, and maternal readmission.
Conclusions: In HICs, the first COVID-­19 lockdown was
associated with a decrease in preterm births, mainly spon-
taneous, which was observed in women from white ethnic
backgrounds and lower deprivation. There was no associa-
tion with other adverse outcomes. Further research is needed
to disentangle the complex environmental, social, and care
access factors that may have led to a disproportional de-
crease in preterm births.
EP.0086  |  Systematic review of COVID-­19 vaccine
effectiveness and safety in 930,556 pregnancies
Silvia Fernández-­García1; Dharshini Sambamoorthi2;
Jameela Sheikh2; Karen Lau2; Nana Osei-­Lah2; John
Allotey1; Javier Zamora1,3,4; Shakila Thangaratinam1,5
1
Institute of Metabolism and Systems Research, WHO
Collaborating Centre for Global Women's Health,
University of Birmingham, Birmingham, UK; 2College of
Medical and Dental Sciences, University of Birmingham,
Birmingham, UK; 3Clinical Biostatistics Unit, Hospital
Universitario Ramón y Cajal (IRYCIS), Madrid, Spain;
4
CIBER Epidemiology and Public Health (CIBERESP),
Madrid, Spain; 5Birmingham Women's and Children's NHS
Foundation Trust, Birmingham, UK
Objective: To evaluate the effectiveness and safety of
COVID-­19 vaccines in pregnant women.
   |
   165
Design: Systematic review and meta-­analysis.
Methods: Major databases, preprint servers and websites
were searched from 1st December 2021 until 25 October
2022. Comparative cohort studies, cohorts derived
from RCTs or case-­ control studies reporting maternal
COVID-­19 related, pregnancy or perinatal outcomes in
pregnant women who received any dose of a COVID-­19
vaccine were included. Non-­comparative cohorts were also
included to evaluate rates of side effects. Two independ-
ent reviewers selected studies in a two-­stage process, with a
third reviewer resolving disagreements. Data was extracted
on the type of vaccine and number of doses, COVID-­19
related outcomes (SARS-­CoV-­2 maternal infection, severe
COVID-­19, death), pregnant and perinatal outcomes (any
miscarriage, caesarean section, preterm birth, stillbirth,
NICU admission) and side effects (pain at the injection
site, fever, headache). Random-­effects meta-­a nalysis was
used to report odds ratios (OR) and rates with 95% confi-
dence intervals (CI).
Results: We included 43 comparative cohort studies (930
556 women; 593 934 unvaccinated, 335 584 vaccinated).
Twenty-­eight reported data on women who received any
number of COVID-­19 vaccine doses, one study on women
who received one dose, one on women who received three
doses, and 13 on women who received two doses and were
fully vaccinated. We found that receiving at least one dose
was associated with a reduction in maternal COVID infec-
tion (OR 0.59; 95% CI 0.48 to 0.73), severe COVID (0.10;
0.02 to 0.62) and all-­cause maternal death (0.24; 0.11 to
0.49). We also found a significant protective association with
preterm birth (0.85; 0.74 to 0.96), any miscarriage (0.91; 0.85
to 0.97), and NICU admission (0.80; 0.68 to 0.93). No asso-
ciations were found between being vaccinated and caesarean
section or stillbirths. When restricting the analysis to fully
vaccinated women, the results for maternal COVID infec-
tion (0.60; 0.37 to 0.99), preterm birth (0.74; 0.56 to 0.98)
and NICU admission (0.64; 0.43 to 0.95) remain consistent.
Sixteen non-­comparative studies (74 692 women) reported
data on side effects. Injection site pain was the most com-
mon side effect reported after partial (90%; 83% to 95%) and
complete vaccination (77%; 70% to 83%).
Conclusion: COVID-­19 vaccines prevent SARS-­CoV-­2 in-
fection, severe COVID-­19 and all-­cause mortality in preg-
nant women. There were no safety concerns regarding
maternal and perinatal outcomes and systemic side effects.
Further research is needed to assess COVID-­19 vaccine ef-
fectiveness for different SARS-­CoV-­2 variants of concern.
 |
166       ABSTR​ACTS​
EP.0092  |  Impact of the COVID-­19 pandemic on
inequalities in birth outcomes in England
1 1 2 1
Buthaina Ibrahim ; Jennifer Jardine ; Erik Lenguerrand ;
Andy Judge2; Stamatina Iliodromiti3
1
Royal College of Obstetricians and Gynaecologists, London,
UK; 2University of Bristol, Bristol, UK; 3Queen Mary
University of London, London, UK
Objective: To evaluate the impact of the COVID-­19 pan-
demic on inequalities in adverse outcomes for women giving
birth in England and their babies.
Design: Retrospective cohort study using electronic health
record data of women who had a singleton birth in the
English National Health Service between 1st April 2018 and
31st March 2021 and their babies.
Methods: Records were extracted from Hospital Episode
Statistics (HES), a dataset used for hospital payment.
Maternal and perinatal composite adverse outcome indi-
cators were chosen following a literature review and input
from the women reference group. Self-­reported ethnicity
was grouped into White, South-­Asian, Black, Mixed and
Other. Modified Poisson regression was used to compare
relative risks of adverse outcomes between women of differ-
ent ethnic groups before and during the first national lock-
down (26/3/2020–­30/6/2020) and ongoing pandemic period
(01/07/2020–­31/3/2021). Missing values were imputed using
chained equations. Models were adjusted for maternal and
perinatal risk factors.
Results: 1,544,290 maternal and 1,431,952 neonatal records
were included. Overall incidence of adverse outcomes de-
creased in the first lockdown (maternal: from 308.0 per 1000
(95% CI 307.0–­309.0) to 291.0 (311.4–­314.9); perinatal: from
133.0 per 1000 (132.3–­133.7) to 111.9 (110.1–­113.7)) and in-
creased in the ongoing pandemic period (maternal: 313.2
(311.4–­314.9); perinatal: 118.9 (117.7–­120.0)).
The risk of developing adverse outcomes was higher in
women and babies from all ethnic minority groups com-
pared to White women in both lockdown and pandemic pe-
riods. In the pre-­pandemic period, Black and South-­Asian
women and babies were a quarter more likely to sustain ad-
verse outcomes (maternal adjRR: Black 1.26 (95% CI 1.24 to
1.27), South-­Asian 1.24 (1.23 to 1.25); perinatal adjRR: Black
1.24 (1.22 to 1.25), South-­Asian 1.24 (1.22 to 1.26)). While
the overall changes (fall and then rise) in adverse outcomes
were seen in all groups, existing inequalities were sustained
throughout the pandemic periods.
Conclusions: Existing inequalities in adverse maternal and
perinatal outcomes were maintained, but not exaggerated,
despite the overall improvement during the first lockdown
and an increased awareness on reducing ethnic inequalities
including nationally mandated priority actions during 2020.
Further work is urgently needed to identify targeted service
and care modifications which will aim to reduce inequality.
EP.0101  |  IUGR: The Silent Killer in COVID's Arsenal
Ying Yi Liaw1; Tony Thomas2; Asma Hassan2
The Royal Wolverhampton NHS Trust, Wolverhampton,
UK; 2Walsall Healthcare NHS Trust, Walsall, UK
Objective: To assess impact of maternal COVID infection
on fetal well-­being by evaluating the incidence of intrau-
terine growth restriction (IUGR), stillbirths, and neonatal
deaths (NND), before and after onset of COVID pandemic.
Design: A retrospective observational study was conducted
at a district general hospital in Walsall to determine effect of
COVID infection on fetal well-­being.
Methodology: A list of pregnant women who had ul-
trasound surveillance for IUGR based on Small-­ for-­
Gestational-­ Age Fetus, Investigation and Management
(Green-­ top Guideline No. 31), from July to September
2019 (pre-­pandemic) and July to September 2021 (post-­
pandemic) were obtained from imaging data team. All
duplicated and missing data were excluded. In each group,
women who delivered babies with birth weight below the
10th centile were identified and their demographic char-
acteristics were reviewed. The results were compared to
the actual total number of IUGR babies obtained from
Badgernet maternity record. The number of total regis-
tered births, stillbirths and NNDs were also determined.
Pregnant women with confirmed positive COVID test were
not identified as people could be asymptomatic and a test
would not have been done.
Results: 431 and 393 women had ultrasound surveillance
during pre-­and post-­pandemic period, respectively. 54 out
of 431 (12.5%) women in pre-­COVID cohort delivered babies
who weighed below the 10th centile. 15 out of the 54 (3.48%)
babies weighed below the 3rd centile. In post-­COVID co-
hort, 102 out of 393 (25.95%) women delivered babies with
birth weight below the 10th centile. 49 out of the 102 (12.5%)
babies weighed below the 3rd centile. Review of birth weight
of all babies born in the reference timeframes showed actual
total number of IUGR babies being 81 before COVID and
144 after COVID. Total registered births in pre-­and post-­
pandemic period were 957 and 982, respectively. There were
5 stillbirths and 2 NNDs during pre-­COVID period, while
there were 6 stillbirths and 0 NND during post-­COVID
period. There was a 12% increase of BMI above 35 in the
post-­COVID group. Otherwise, both groups shared similar
demographic profiles.
Conclusion: Our study found a significant rise in inci-
dence of IUGR among pregnant women after the outbreak
of COVID pandemic. Traditional-­risk-­assessment-­based
commencement of ultrasound screening resulted in 42
IUGR babies being missed during pandemic, compared to
27 babies in pre-­pandemic period. This highlights the need
for enhanced vigilance and to make adaptations to exist-
ing screening criteria when the world is faced with similar
health emergencies in the future.
A​B ST​R ACTS
EP.0140  |  Severe maternal perinatal outcomes in
pregnancy with covid-­19 in tertiary hospital Indonesia
Undergraduate medical student Alif Nadya Nurshechah1;
internal medicine Nur Farhanah2; obstetrics and gynaecol-
ogy division Rabiah Adawiyah1; obstetrics and gynaecology
division Arufiadi Anityo Mochtar2; obstetrics and gynae-
cology division Putri Sekar Wiyati2
1
Diponegoro University, Semarang, Indonesia; 2Medical
Faculty of Diponegoro University, Semarang, Indonesia
Objective: To analyze the differences in maternal perinatal
outcomes between confirmed and unconfirmed COVID-­19
cases in Dr. Kariadi General Hospital Medical Center
Semarang.
Methods: This is an analytic observational study with a
case-­control design. The unpaired case-­control sample size
formula was used for sampling. A total of 135 samples were
divided into two groups. The case group consists of 42 con-
firmed COVID-­19 pregnant women and the control group
of 93 unconfirmed COVID-­19 pregnant women. The data
were analyzed using univariate tests, bivariate tests, and
multivariate tests by logistic regression test or multiple lin-
ear regression test.
Results: Maternal outcomes of multiple organ dysfunc-
tion were significantly higher in the confirmed COVID-­19
case group (11.9% vs 1.1%), a higher significant difference
was also found in the use of mechanical ventilators in the
case group (9.5% vs. 1.1%), maternal mortalities was signifi-
cantly higher in the case group (9.5% vs. 1.1%). Mothers with
multiple organ function failure based on the calculation of
the maximum SOFA score. Anemia were more common
in the case group (66.7%) compared to the control group
(49.5%) with p = 0.063. Pregnant women with kidney disease
were more common in the case group (4.8%) than the con-
trol group (3.2%) p = 0.496. The severity of COVID-­19 and
thromboembolic prophylactic therapy have a significant ef-
fect on multiple organ failure. Postpartum bleeding compli-
cations were only found in the case group (2.4%) p = 0.311.
Sepsis was higher in the case group (9.5%) than in the control
group (3.2%) p = 0.135. COVID-­19 complication ARDS were
significantly higher in the case group, (7.1%) compared to the
control group (1, 1%) with p = 0.089. DIC complications were
only found in the case group (2.4%) with p = 0.311. Preterm
delivery was higher in thecase group (19%), compared to the
control group (16.1%) with p = 0.676. The perinatal outcome
of asphyxia and fetal distress was higher in the case group.
Perinatal COVID-­19 status was checked only in confirmed
COVID-­19 mothers with a positive 18.9% of infants with
confirmed COVID-­19 status in the case group. There were
five cases of perinatal death entirely caused by fetal death
in utero, which were more common in the case group (7.1%)
than the control group (2.1%).
Conclusions: There are differences in maternal and peri-
natal outcomes between confirmed and non-­ confirmed
COVID-­19 pregnant women, namely multiple organ failure,
use of mechanical ventilators, and maternal mortality.
   |
   167
Keywords: COVID-­
19, maternal outcomes, perinatal
outcomes.
EP.0141  |  Timing of mother-­to-­child transmission of
SARS-­CoV-­2: living systematic review and meta-­analysis
(update)
Chloe B Knight1; Oluwadamilola Akande1; Halimah
Khalil1; Maurie Kuha Kumaran1; Jameela Sheikh1; John
Allotey2; Javier Zamora2,3; Shakila Thangaratinam2,4; Tania
Kew1
1
College of Medical and Dental Sciences, University of
Birmingham, Birmingham, UK; 2Institute of Metabolism
and Systems Research, WHO Collaborating Centre for
Global Women's Health, University of Birmingham,
Birmingham, UK; 3Head of Clinical Biostatistics Unit,
Hospital Ramon y Cajal of Biomedical Research, Madrid,
Spain; 4Birmingham Women's and Children's NHS
Foundation Trust, Birmingham, UK
Objective: To determine the likelihood and timing of
mother-­to-­child transmission (MTCT) of SARS-­CoV-­2
in babies born to mothers with coronavirus disease 19
(COVID-­19).
Design: Living systematic review and meta-­analysis.
Method: Preprint servers and major databases, including
Medline, WHO COVID-­19 database and Cochrane data-
base, were systematically searched weekly from 1 December
2019 until 25 April 2022. Cohort studies, case series and case
reports of pregnant and recently pregnant women with a di-
agnosis of COVID-­19 on presentation to a hospital setting
and with their fetus' or neonate's SARS-­CoV-­2 infection sta-
tus confirmed by RT-­PCR or serological tests were included.
Two independent reviewers screened each study for inclu-
sion using a two-­stage process, and a third independent re-
viewer resolved disagreements. Data extraction and quality
assessment was then conducted by two independent review-
ers. The 2021 World Health Organisation (WHO) classifica-
tion system was used to confirm the timing (intrauterine,
intrapartum or early postnatal) and likelihood (confirmed,
possible, unlikely or indeterminate) of MTCT in positive
babies.
Results: 941,678 articles were screened, and 643 studies in-
cluded in final analyses. There was sufficient data to analyse
timing of exposure and likelihood of MTCT in 1036 babies
who tested positive for SARS-­CoV-­2 born to mothers with
confirmed COVID-­19 <2 days postnatally. 32/1036 babies
had a confirmed infection status. 20/857 cases were consist-
ent with in utero transmission: 10/787 live births and 10/70
fetal deaths or miscarriages. There were 3 cases of intrapar-
tum transmission (35 assessed), and 23 early postnatal in-
fections (144 assessed). 168 babies were classified as possible
SARS-­CoV-­2 infection, and it was not possible to determine
the likelihood of MTCT for 685 babies, mainly due to lack of
evidence of repeat testing at prespecified time points.
 |
168       ABSTR​ACTS​
Conclusion: Evidence confirms vertical transmission of
SARS-­CoV-­2, however this is rare.
EP.0152  |  Neonatal pulmonary hypertension at term
following management of severe maternal coronavirus19
infection
Ashima Chawla; Katie Drummond; Tulika Singh
Mid Yorkshire Hospitals NHS Trust, Wakefield, UK
Objective: A case of neonatal Persistent Pulmonary
Hypertension of Newborn (PPHN) delivered to a mother
with severe coronavirus19 (COVID 19) infection on extra-
corporeal membrane oxygenation (ECMO). Few publica-
tions describe adverse events in a term neonate following
successful treatment of severe maternal infection.
Case Report: A 26 years old second gravida of North African
ethnicity was diagnosed in the community with COVID –­19
infection at 25 weeks gestation. She was admitted to the medi-
cal ward at 26+3 weeks with Type 1 Respiratory failure. She
was started on 60% Oxygen, Tocilizumab, Dexamethasone and
Tinzaparin. Due to worsening condition she was transferred to
the intensive care unit, intubated and kept on prone ventilation.
A multidisciplinary team (MDT) decided as she was intubated
and prone, supine position was not safe for her outcome. Hence
an earlier decision for delivery was changed and she was trans-
ferred to regional center for ECMO. She was stable on ECMO,
improved clinically and was discharged at 28 weeks, on thera-
peutic anticoagulation for pulmonary embolism and continued
with antenatal care. She was induced at 39+5 weeks [TS1], to
limit time off anticoagulation and delivered vaginally a baby
boy weighing 3.0 kg with apgar of 8 at 1 and 5 min. At 20 min
of age baby was found to be cyanosed with increased work of
breathing, oxygen was commenced and transferred to neonatal
unit. He was intubated, ventilated with increasing oxygen re-
quirements, was treated with nitric oxide and antibiotics. A di-
agnosis of PPHN secondary to sepsis was made. He was noted
to have raised mean arterial pressure, commenced on hydrala-
zine and investigated for causes of hypertension. He was extu-
bated on day 5, blood cultures were negative. He was discharged
on day 8 with a plan for follow up in outpatient clinic.
Discussion: One study detected a 3-­fold increase in the
number of cases of term and near-­term neonates with PPHN
during the COVID 19 pandemic in 2020. This increase in
incidence of PPHN may suggest an intrauterine effect of ma-
ternal COVID-­19 infection on fetal pulmonary circulation.
Conclusion: The importance of MDT approach in manage-
ment of obstetric cases complicated by severe COVID-­19 is
highlighted. This case of PPHN in a neonate born at term
suggests a possible intrauterine effect of maternal COVID
-­19 infection on fetal pulmonary circulation. Further stud-
ies are required to investigate the pathogenesis and clinical
implications of this phenomenon.
EP.0213  |  The impact of Covid-­19 on ethnic
inequalities in pregnancy: a mixed-­method exploration
Jemima Dooley1,2; Jennifer Jardine2; Buthaina Ibrahim2;
Rohan Mongru2; Farrah Pradhan2; Dan Wolstenholme2;
Erik Lenguerrand1; Faye Bruce3,4; Tim Draycott1; Stamatina
Iliodromiti5
1
University of Bristol, Bristol, UK; 2Royal College of
Obstetricians and Gynaecologists, London, UK; 3Manchester
Metropolitan University, Manchester, UK; 4Carribean &
African Health Network, Manchester, UK; 5Queen Mary
University of London, London, UK
Objective: To identify changes in maternity care which re-
duced inequalities in maternal and perinatal outcomes in
England, during the period of rapid organisational change
during the COVID-­19 pandemic.
Design: Mixed methods analysis to identify “positive devi-
ant” NHS Trusts (organisations that provide maternity care
via one or more hospitals and community services), which re-
duced inequalities in maternity outcomes, and changes made
in care provided in those organisations.
Methods: A Women's Reference Group of public advisors
guided the project. Maternal and perinatal composite ad-
verse outcome indicators were used to compare outcomes
between White and Minority ethnic groups, before and dur-
ing the pandemic to identify “positive deviants”. Positive devi-
ant Trusts were identified for qualitative interview, alongside
comparators. Senior clinicians, heads of midwifery and repre-
sentatives of women giving birth were interviewed to identify
clinical care changes during the pandemic. Reflexive thematic
analysis was employed.
Results: We conducted 20 interviews from six positive devi-
ant and four comparator Trusts. Positive deviants reported
that necessary shifts in roles led to productive and novel use
of expert staff; comparators reported senior staff ‘stepping
in’ where needed and no benefits of this. They reported pro-
activity and quick reactions, increased team working, and
rapid implementation of new ideas. Comparators found
constant changes overwhelming, and no increase in team
working. No specific differences in care processes were
identified.
Conclusions: Proactivity, flexibility, staffing resource, and
increased team working were associated with a reduction
in ethnic inequalities in maternal and perinatal outcomes.
Hence, harnessing these strengths of high-­f unctioning units
proves vital in reducing health inequalities.