Impacto del COVID-19 en la salud reproductiva: mortalidad materna <span class="so-article-trans-title" dir="auto"> Translated title: Impact of COVID-19 on reproductive health: maternal mortality </span> <span class="so-article-trans-title" dir="auto"> Translated title: Impacto da COVID-19 na saúde reprodutiva: mortalidade materna </span>

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Abstract

RESUMEN El presente artículo tiene como propósito analizar los efectos e impacto de la pandemia COVID-19 en la mortalidad materna de Perú, lo cual afectó la disponibilidad de recursos, equipos, demanda y acceso a los servicios de salud; se agrega el desvío de los recursos humanos, financieros para combatir el brote de la enfermedad infecciosa, el retraso de normas, políticas e insuficiente presupuesto público, fragmentación, desarticulación de los prestadores de salud y vulnerabilidad de los profesionales de salud. Es una investigación de enfoque cualitativo descriptivo y crítico, analizado en el aspecto social y económico de la mortalidad materna, datos epidemiológicos, normas técnicas, y la afectación del COVID-19 en la población gestante. Se analizó el incremento de la mortalidad materna de 45.4% y 56% el año 2020 y 2021 con respecto al año 2019, asimismo el logro alcanzado al 2015 a 68 muertes maternas y una disminución notable de 50% entre el año 2000 y 2019, para sucumbir por la pandemia en un retroceso de 12 años y convertirse la enfermedad COVID-19 en la tercera y primera causa de muerte materna indirecta el año 2020 y 2021. Destacando la aplicación de estrategias que tuvo la Región Lima, como una de las regiones con menor incidencia de 2 y 6 muertes maternas respectivamente. Ante esta problemática se concluyó la priorización de la capacidad resolutiva del primer nivel de atención, capacitación continua del profesional obstetra y la aplicación de estrategias promovidas por la Región Lima.

Translated abstract

ABSTRACT The purpose of this article is to analyze the effects and impact of the COVID-19 pandemic on maternal mortality in Peru, which affected the availability of resources, equipment, demand and access to health services; in addition to the diversion of human and financial resources to combat the outbreak of the infectious disease, the delay of standards, policies and insufficient public budget, fragmentation, disarticulation of health providers and vulnerability of health professionals. It is a qualitative descriptive and critical research approach, analyzed in the social and economic aspect of maternal mortality, epidemiological data, technical norms, and the affectation of COVID-19 in the pregnant population. The increase in maternal mortality of 45.4% and 56% in 2020 and 2021 with respect to 2019 was analyzed, also the achievement reached in 2015 to 68 maternal deaths and a remarkable decrease of 50% between 2000 and 2019, to succumb to the pandemic in a setback of 12 years and become the disease COVID-19 in the third and first cause of indirect maternal death in 2020 and 2021. It is worth highlighting the implementation of strategies that had the Lima Region as one of the regions with the lowest incidence of 2 and 6 maternal deaths respectively. In view of this problem, it was concluded that priority should be given to the capacity of the first level of care, continuous training of obstetricians and the application of strategies promoted by the Lima Region.

Translated abstract

RESUMO O objetivo deste artigo é analisar os efeitos e o impacto da pandemia COVID-19 na mortalidade materna no Peru, que afetou a disponibilidade de recursos, equipamentos, demanda e acesso a serviços de saúde; além do desvio de recursos humanos e financeiros para combater o surto da doença infecciosa, o atraso das normas, políticas e orçamento público insuficiente, a fragmentação, a desarticulação dos provedores de saúde e a vulnerabilidade dos profissionais de saúde. É uma abordagem de pesquisa qualitativa, descritiva e crítica, analisando os aspectos sociais e econômicos da mortalidade materna, dados epidemiológicos, padrões técnicos e o impacto da COVID-19 sobre a população grávida. Foi analisado o aumento da mortalidade materna de 45,4% e 56% em 2020 e 2021 em relação a 2019, bem como a conquista alcançada em 2015 para 68 mortes maternas e uma diminuição notável de 50% entre 2000 e 2019, para sucumbir à pandemia em um retrocesso de 12 anos e se tornar a doença COVID-19 na terceira e primeira causa de morte materna indireta em 2020 e 2021. A implementação de estratégias na Região de Lima foi destacada como uma das regiões com menor incidência de 2 e 6 mortes maternas, respectivamente. Diante deste problema, concluiu-se que deveria ser dada prioridade à capacidade do primeiro nível de atendimento, ao treinamento contínuo dos obstetras e à aplicação das estratégias promovidas pela Região de Lima.

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Is Open Access

The impact of the COVID-19 pandemic on maternal and perinatal health: a scoping review

Bethany Kotlar, Emily Gerson, Sophia Petrillo … (2021)

Introduction The Covid-19 pandemic affects maternal health both directly and indirectly, and direct and indirect effects are intertwined. To provide a comprehensive overview on this broad topic in a rapid format behooving an emergent pandemic we conducted a scoping review. Methods A scoping review was conducted to compile evidence on direct and indirect impacts of the pandemic on maternal health and provide an overview of the most significant outcomes thus far. Working papers and news articles were considered appropriate evidence along with peer-reviewed publications in order to capture rapidly evolving updates. Literature in English published from January 1st to September 11 2020 was included if it pertained to the direct or indirect effects of the COVID-19 pandemic on the physical, mental, economic, or social health and wellbeing of pregnant people. Narrative descriptions were written about subject areas for which the authors found the most evidence. Results The search yielded 396 publications, of which 95 were included. Pregnant individuals were found to be at a heightened risk of more severe symptoms than people who are not pregnant. Intrauterine, vertical, and breastmilk transmission were unlikely. Labor, delivery, and breastfeeding guidelines for COVID-19 positive patients varied. Severe increases in maternal mental health issues, such as clinically relevant anxiety and depression, were reported. Domestic violence appeared to spike. Prenatal care visits decreased, healthcare infrastructure was strained, and potentially harmful policies implemented with little evidence. Women were more likely to lose their income due to the pandemic than men, and working mothers struggled with increased childcare demands. Conclusion Pregnant women and mothers were not found to be at higher risk for COVID-19 infection than people who are not pregnant, however pregnant people with symptomatic COVID-19 may experience more adverse outcomes compared to non-pregnant people and seem to face disproportionate adverse socio-economic consequences. High income and low- and middle-income countries alike faced significant struggles. Further resources should be directed towards quality epidemiological studies. Plain English summary The Covid-19 pandemic impacts reproductive and perinatal health both directly through infection itself but also indirectly as a consequence of changes in health care, social policy, or social and economic circumstances. The direct and indirect consequences of COVID-19 on maternal health are intertwined. To provide a comprehensive overview on this broad topic we conducted a scoping review. Pregnant women who have symptomatic COVID-19 may experience more severe outcomes than people who are not pregnant. Intrauterine and breastmilk transmission, and the passage of the virus from mother to baby during delivery are unlikely. The guidelines for labor, delivery, and breastfeeding for COVID-19 positive patients vary, and this variability could create uncertainty and unnecessary harm. Prenatal care visits decreased, healthcare infrastructure was strained, and potentially harmful policies are implemented with little evidence in high and low/middle income countries. The social and economic impact of COVID-19 on maternal health is marked. A high frequency of maternal mental health problems, such as clinically relevant anxiety and depression, during the epidemic are reported in many countries. This likely reflects an increase in problems, but studies demonstrating a true change are lacking. Domestic violence appeared to spike. Women were more vulnerable to losing their income due to the pandemic than men, and working mothers struggled with increased childcare demands. We make several recommendations: more resources should be directed to epidemiological studies, health and social services for pregnant women and mothers should not be diminished, and more focus on maternal mental health during the epidemic is needed.