Stillbirths and the COVID‐19 pandemic: Looking beyond SARS‐CoV‐2 infection

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Abstract
Objective: To study the impact of the COVID‐19 outbreak and subsequent lockdown on the incidence, associated causes, and modifiable factors of stillbirth. Methods: An analytical case‐control study was performed comparing stillbirths from March to September 2020 (cases) and March to September 2019 (controls) in a tertiary care center in India. Modifiable factors were observed as level‐I, level‐II, and level‐III delays. Results: A significant difference in the rate of stillbirths was found among cases (37.4/1000) and controls (29.9/1000) ( P = 0.045). Abruption in normotensive women was significantly higher in cases compared to controls ( P = 0.03). Modifiable factors or preventable causes were noted in 76.1% of cases and 59.6% of controls; the difference was highly significant ( P < 0.001, relative risk [RR] 1.8). Level‐II delays or delays in reaching the hospital for delivery due to lack of transport were observed in 12.7% of cases compared to none in controls ( P < 0.006, RR 47.7). Level‐III delays or delays in providing care at the facility were observed in 31.3% of cases and 11.5% of controls ( P < 0.001, RR 2.7). Conclusion: Although there was no difference in causes of stillbirth between cases and controls, level‐II and level‐III delays were significantly impacted by the pandemic, leading to a higher rate of preventable stillbirths in pregnant women not infected with COVID‐19.

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