L&D discharge profiles in the wake of COVID-19

A retrospective study by researchers from Cedars-Sinai Medical Center in Los Angeles of the impact of COVID-19-driven changes in Labor and Delivery (L&D) protocols shows that shortening lengths of stay (LOS) was safe for both mothers and their babies. The results reflect experience with both vaginal and cesarean deliveries early in the pandemic, in comparison with similar periods in 2018 and 2019.

Beginning in March 2020, in response to COVID-19, Cedars-Sinai modified its L&D practices to reduce risk of infection to patients and staff. Among the measures instituted were:

• Permitting no visitors during the hospital stay for mothers admitted with or suspected to have COVID-19;
• Allowing COVID-19-negative mothers to have only one support person during delivery and no visitors postpartum (after April 20, 2020, a single support person was allowed postpartum for COVID-19-negative mothers);
• Advising COVID-19-positive mothers or those undergoing testing for it to be temporarily separated from their newborns after delivery; and
• Recommending protective measures, such as isolette care in the room and gloving and masking during handling of the newborn, to COVID-19-positive mothers or those undergoing testing who did not want to be temporarily separated from their newborns after delivery.

During the period of study—January 1, 2020 to April 30, 2020—1,936 deliveries occurred: 1,016 before the changes were made and 920 after. Only two COVID-19 laboratory test-positive cases occurred during the study period, both of which were removed from the LOS analysis.

Postpartum LOS was significantly shorter after implementation of the COVID-19-driven measures. Of the patients treated post-implementation, 48.5% had a one-night stay after vaginal delivery, versus 24.9% in the preimplementation group (P < .0001). Among those who delivered by cesarean, 40.9% had an LOS of two nights or less postimplementation, versus 11.8% preimplementation (P < .0001).

Reviewing newborn care, the authors found that 49.0% delivered vaginally were discharged home after one night in the post-implementation group versus 24.9% in the preimplementation group (P < .0001). A similar trend was seen in association with cesarean delivery: 42.5% discharge rate after two nights or less in the post-implementation group vs 12.5% in the preimplementation group (P < .0001).

There were no differences in cesarean delivery rate, induction of labor, or adverse maternal or neonatal outcomes between the two groups. Adjustment for month-to-month variation in length of postpartum hospitalization for mothers and newborns showed no significant differences in neonatal or maternal LOS between January to February and March to April in 2018 and 2019, regardless of mode of delivery.

Writing in The American Journal of Obstetrics & Gynecology Maternal-Fetal Medicine¹, the authors said that “the reasons for this reduction in postpartum length of stay are likely multifactorial but may be attributed partially to changes to our visitor policy…It is likely that the initial restrictions may have motivated patients and providers toward an earlier discharge.”

The researchers said their study “suggests that it is reassuring that these early discharges were not associated with an increased rate of readmissions or postpartum medical complications,” noting that “future studies are needed to determine what long-term effects the shorter stay might have on other outcomes such as maternal health, bonding, and ongoing breastfeeding.”

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Reference

1. Greene NH, Kilpatrick SJ, Wong MS, et al. Impact of labor and delivery unit policy modifications on maternal and neonatal outcomes during the coronavirus disease 2019 pandemic. Am J Obstet Gynecol MFM. 2020;2:100234.