NW 16:08:31 21-01-2021
LN1620NW.111
111 - SOCIETY - MATERNITY HOSPITAL - COVID - TRENDS - INTERVIEW

BTA Interview: How a Maternity Hospital Operates
During a Pandemic and
Some Positive Trends


Sofia, January 21 (Velina Vassileva of BTA) Bulgarian maternity hospitals learned the lessons of the first lockdown in the spring of 2020 and were better prepared when the government imposed a new lockdown in November, said Dr. Donka Ouzounova, head of Neonatology at Sheinovo maternity hospital and Chair of the Control Council of the Bulgarian Neonatology Association. In a BTA interview on the occasion of the professional day of midwives, January 21, she spoke on how the coronavirus pandemic has affected the work of maternity hospitals and how they operate safely for their patients and staff, and tells of some positive trends regarding reproduction, fertility and births.

During the first wave of coronavirus and the strict lockdown last spring, Dr. Ouzounova's hospital suspended antenatal checks and screening. Only emergency hospitalizations and, naturally, births were allowed. Monthly postnatal consultations were also suspended.

УIt was not good. It so happened that in this difficult and stressful period, pregnant women were left without support and monitoring. Medical care is not based on emergency hospitalizations. Rather, high quality healthcare is based on prophylactics and doctors in the field practically had little opportunity to do that [during the first lockdown],Ф Dr Ouzounova says.

So, with the second round of restrictions in November, they had to adapt without stopping the routine checkups for pregnant women and women in labour or post-natal patients. The schedule of checkups was stricter, precautions were enforced for staff and patients, including strict disinfection and hygiene rules, no accompanying family members or friends were allowed or visits during hospital stay. УThose were measures everyone had to abide by more strictly than usual,Ф Dr Ouzounova says.
The hospital designated separate rooms for patients with COVID-19, as well as separate staff for them.

Dr. Ouzounova says the protection of staff and isolating confirmed coronavirus carriers proved most difficult and stressful.

She says all measures planned by the health authorities are adequate but her hospital does not have enough staff to dedicate part of them for patients with coronavirus and leave enough for its usual work.

УAcross the health care system, that meant neglecting patients who did not have COVID-19, focusing on how to protect oneself, forgetting other pathology and people with chronic diseases, cardiac emergencies and oncological pathology or even dental services.Ф

Dr Ouzounova recalls that infant check-ups were done partly remotely at first, but as that was not enough, doctors began to resume routine operations earlier than the official reopening, asking parents to remain outside the hospital and leave the children in for checks, vaccinations and tests. They also spaced out visits to hospitals, but no one complained.

Visits to hospitalized children were also completely suspended, particular those who were sick and in post-natal care. This was replaced by twice-daily phone calls, video and photos. УEveryone is doing their best. The hospital is currently operating round the clock in spite of everything and is trying to go back on track,Ф the doctor says.

Women with coronavirus come to the maternity hospital to give birth, not for COVID-19 treatment and maternity hospital staff resorted to isolation, remote consultations with specialists and patient-specific care for every one of them.
The virus was not found in any of the newborns, there were virus IgG antibodies in their blood that had passed through the placenta, says Dr Ouzounvoa. She explains that the virus does not pass through the placenta but the antibodies do.

Doctors in Bulgaria have mentioned cases newborns with IgG against the coronavirus but these remain isolated cases, Dr Ouzounova says adding that babies are believed to contract the coronavirus after birth, not during or before it.

She remembers having cases of perfectly healthy newborns who could not be discharged from the maternity hospital and had to be kept longer because of a sick family members at home.

Some optimistic trends

Speaking about any expectations for a baby boom due to the coronavirus lockdown last spring, Dr. Ouzounova says it is early days for big conclusions on a national scale but the forecast is certainly optimistic. Her Sheinovo hospital had 200 babies more than it did in 2019.

The birth rate is also changing as more and more families plan second, third and even
fourth child, which means that fertility is rising.

There is an increase in multiple pregnancies, which is largely due to infertility treatment.

WomenТs age of first birth remains higher in cities, which Dr Ouzounova says is quite logical.

The number of children born with anomalies is declining due to good and more accessible prenatal diagnostics, genetic screening and pregnancy monitoring.
The percentage of birth trauma is also declining, somewhat due to the frequency of C-sections.

Neonatologists are also proud of the increasing survival rate of premature babies and successfully overcome long-term complications in such cases.

The infant mortality rate in Bulgaria, however, remains high compared to other EU countries, with minor fluctuations in the last ten years.

In the case of mortality under 1, which is directly linked to medical conditions or mortality during or early after birth, the development of the foetus and the additional complications or infections, Bulgaria is second worst in the EU. It had the second worst record in 2015 after Romania, closely followed by Slovakia and Croatia. Over 6,300 premature babies were born in 2018, including 92 under 800 grams. The same year, 47 babies per mil died. The figure from 2008 to 2019 decreased from 67 to 39 per mil. УHowever, the infant mortality rate in 1980 were triple that figure,Ф Dr Ouzounvoa says. УRegrettably, along with the successes with premature babies, experts still face the challenge of additional pathology and high death rate of this age group,Ф she adds. LN/BR//