Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
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Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : May | Volume : 16 | Issue : 5 | Page : QC06 - QC09 Full Version

Comparison of Characteristics and Outcomes of Pregnant Women with COVID-19 in First and Second Wave Admitted in a COVID Hospital in Arunachal Pradesh: A Retrospective Observational Study


Published: May 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/56150.16397
Goter Doke, Tamar Paley, Binita Singha, Tomar Basar

1. Assistant Professor, Department of Obstetrics and Gynaecology, Tomo Riba Institute of Health and Medical Sciences, Naharlagun, Arunachal Pradesh, India. 2. Assistant Professor, Department of TB and Respiratory Diseases, Tomo Riba Institute of Health and Medical Sciences, Naharlagun, Arunachal Pradesh, India. 3. Assistant Professor, Department of Pharmacology, Tomo Riba Institute of Health and Medical Sciences, Naharlagun, Arunachal Pradesh, India. 4. Associate Professor, Department of Obstetrics and Gynaecology, Tomo Riba Institute of Health and Medical Sciences, Naharlagun, Arunachal Pradesh, India.

Correspondence Address :
Dr. Goter Doke,
Assistant Professor, Department of Obstetrics and Gynaecology, TRIHMS, Naharlagun-791110, Arunachal Pradesh, India.
E-mail: dokegoter@gmail.com

Abstract

Introduction: Coronavirus Disease-2019 (COVID-19) has affected the pregnant women and newborn child across the world. Empirical data shows that the characteristic of the effect of COVID-19 virus varies between the subsequent wave.

Aim: To compare the demographic characteristics, severity of illness, Intensive Care Unit (ICU) admissions, maternal and neonatal outcomes in COVID-19 positive pregnant women of first and second wave.

Materials and Methods: A retrospective observational study was conducted at dedicated COVID-19 Hospital under Tomo Riba Institute of Health and Medical Sciences (TRIHMS) in Itanagar, Arunachal Pradesh, India. All COVID-19 positive pregnant women admitted between July 2020 and August 2021 were included in the study. The patients admitted during 1st July 2020 to 31st January 2021 were considered in 1st wave of COVID-19 and those from 1st February 2021 to 31st August 2021 as 2nd wave of COVID-19. Data of baseline characteristics, clinical presentations, severity, ICU admissions, abortion, modes of delivery, Neonatal Intensive Care Unit (NICU) admission, maternal and neonatal mortality were analysed and compared.

Results: A total of 144 COVID-19 positive pregnant women admitted from July 2020 to August 2021 were included in the study. Of 144 patients, 58 were in first wave and 86 in second wave of COVID-19. Number of moderate and severe cases admitted was 23.3% and 7% during second wave compared to only 12.1% moderate case only in first wave (p-value=0.015). Three pregnant women died due to severe COVID-19 pneumonia during the second wave. NICU admissions and other neonatal outcomes were comparable in both the study groups.

Conclusion: A significantly increase number of pregnant women were affected with severe COVID-19 morbidity and mortality in second wave. Neonatal outcomes were similar in both waves.

Keywords

Coronavirus disease-2019 pregnancy, Neonatal outcome, Pandemic, Second wave of Coronavirus disease-2019

In December 2019, a series of pneumonia of unknown cause were reported in Wuhan, Hubei Province of China. Deep sequencing analysis from lower respiratory tract samples indicated a novel Coronavirus, which was named 2019 novel coronavirus (1),(2). COVID-19 rapidly triggered a global health emergency alert and spread to numerous countries, forcing World Health Organisation (WHO) to announce the start of a new pandemic on 12th March 2020 (3). Women undergoing pregnancy, and those at the time of childbirth and puerperium constitutes a potentially vulnerable populations for COVID-19 illness (4). The reason could be due to physiologic changes in pregnancy, including increased heart rate and oxygen consumption, oedema of respiratory tract, decreased lung capacity, a shift away from cell-mediated immunity and increased risk for thromboembolic disease (5). The predominant clinical features of COVID-19 pregnancy are fever, cough, sore throat, myalgia, malaise, shortness of breath and diarrhoea (6),(7).

Two systematic review and meta-analysis published at end of first wave suggested that pregnant women with COVID-19 are at increased risk of ICU admission, mechanical ventilation and maternal death compared with both pregnant women without Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) infection and non pregnant women with SARS-CoV-2 infection (8),(9). COVID-19 is a rapidly evolving situation, and there is still paucity of limited data reporting its impact on pregnant women. Also only one study on comparison of first and second COVID-19 wave has been reported from India (10). Thus, present study aims to compare the demographic characteristics, severity of illness, ICU admissions, maternal and neonatal outcomes in COVID-19 positive pregnant women of first and second wave admitted in the Obstetrics ward of a Dedicated COVID-19 hospital of Arunachal Pradesh, India.

Material and Methods

This was a retrospective observational study conducted in the Department of Obstetrics and Gynaecology of Dedicated COVID-19 Hospital under TRIHMS in Itanagar, Arunachal Pradesh, serving as referral for all districts of Arunachal Pradesh, India. Institutional Ethical Committee (IEC) approval was obtained (No. TRIHMS/ETHICS/01/2019-20).

Inclusion criteria: All pregnant women who were tested positive by Rapid antigen test, Truenat and Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) for (SARS-CoV-2) and got admitted in the Dedicated COVID-19 hospital between July 2020 to August 2021 were included in the study.

Exclusion criteria: No exclusion criteria were made as all admitted pregnant women were analysed.

First pregnant woman with COVID-19 infection was admitted on 21st July 2020 at our centre. The patients admitted during 1st July 2020 to 31st January 2021 were considered in 1st wave of COVID-19 and those from 1st February 2021 to 31st August 2021 as 2nd wave of COVID-19 and the data analysis was done in the month of October 2021.

Sample size: The study by Mahajan NN et al., reported that 2.4% pregnant women with COVID-19 infection required ICU admissions (10). Taking this value as reference, the minimum required sample size with 5% absolute precision and Z(1-α/2)=1.96 at 5% level of significance was calculated to be 36.

Total of 144 admitted pregnant women (58 in first wave and 86 in second wave) were included in present study.

Data collection and analysis were done from the Medical Record Department of Dedicated COVID-19 Hospital under TRIHMS, Naharlagun, Arunachal Pradesh, India. Details of patients like age, parity, gestational age, co-morbid conditions, COVID-19 disease severity, ICU admissions, mode of delivery, maternal deaths, neonatal birth weight, Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) score, NICU admissions and neonatal outcomes were noted. All women were tested by deep nasopharyngeal swab sampling as per Indian Council of Medical Research (ICMR) guidelines (11). Women were categorised into mild/moderate/severe disease and managed according to the Ministry of Health and family Welfare, Government of India treatment guidelines (12). Neonatal swab test were sent within 24 hours of birth and rooming-in was recommended. Direct breastfeeding was also encouraged and mothers were instructed to wear mask and perform hand hygiene before close contact with the baby.

Statistical Analysis

The data entry was done in Microsoft Excel spreadsheet and the Statistical analysis was done with Statistical Package for the Social Sciences (SPSS) version 28.0 (SPSS Inc., Chicago, IL, USA). Categorical variable were expressed as number (n) and percentage (%). Continuous variable was done as mean±Standard Deviation (SD) and median values. Chi-square test was used for comparison of categorical variables between the groups. Student’s Independent-Samples t-test was used for continuous variables like age, gestational age and duration of hospital stay. A 2-tailed “p<0.05” was considered as statistically significant.

Results

A total of 144 COVID-19 pregnant women admitted from July 2020 to August 2021 were included in the study. Of 144 patients, 58 were in first wave and 86 in second wave of COVID-19 (Table/Fig 1). All women had singleton pregnancy and no case of multiple pregnancy were reported in present study.

Mean age of pregnant patients in first wave was 27.24 ±5.75 years while that of second wave was 26.73±5.1 years. The median gestational age at admission was 39.5 weeks in first wave and 40 weeks for second wave. As many as 29 (50%) women in first wave and 50 (58.1%) in second wave had co-morbidities (Table/Fig 2).

The number of moderate and severe COVID-19 cases and ICU admissions were significantly higher in the second wave when compared to first wave. Most of the patients with asymptomatic to mild cases were managed on room air in both the study groups. High Flow Nasal Cannula (HFNC) oxygen therapy was used for all the moderate to severe cases. Three (3.4%) patients in second wave needed mechanical ventilation. The mean duration of hospital stay was 7.64±2.07 days in first wave and 11.13±3.29 days in second wave and it was statistically significant (Table/Fig 3).

A total of 54 (93.1%) in first wave and 63 (73.3%) in second wave had outcome of singleton delivery. Four (6.9%) in first and 23 (26.7%) in second wave were undelivered and they were discharged in antenatal period after treatment by COVID-19 management protocol.

In first wave, 41 (76%) had caesarean section and 13 (24%) had vaginal delivery which were comparable to 42 (66.7%) caesarean section and 21 (33.3%) vaginal delivery in second wave. In present study, caesarean sections were done for mostly obstetrics indications only. There were three maternal deaths due to COVID-19 pneumonia and respiratory failure in second wave compared to none in first wave (Table/Fig 4).

First case was a multigravida at 20 weeks of gestation with severe COVID pneumonia and died within five days of ICU admission in antenatal period. Other two cases were multigravida at term with severe COVID pneumonia and refractory hypoxia. Caesarean section were done for both after multidisciplinary team decision with intention of saving the baby and improvement of maternal condition after delivery, but both patients died on third post operative day on mechanical ventilation. Both the babies were admitted in NICU, but one of them died on second postnatal day.

In both the groups, majority of neonates had birth weight more than 3 kg. APGAR score was normal (7-10) in most of the neonates in both the groups. Resuscitation was given to all low APGAR score ≤6 in both the study groups, 2 (3.7%) in first and 4 (6.3%) in second wave. In first wave, one Intrauterine Fetal Death (IUFD) happened in unbooked primigravida at 34 week with severe preeclampsia and HELLP syndrome (Haemolysis, Elevated Liver enzymes, and Low Platelets) with mild COVID-19. Four IUFD were seen in second wave, three of them had moderate symptoms with high fever and chills and were diagnosed with IUFD at admission. Fourth case was multigravida who refused caesarean section for post-term with severe oligohydraminos and suffered IUFD during intrapartum period. Eight (14.8%) neonates in first wave and 12 (19%) neonates in second wave required NICU admissions due to various reasons of low birth weight, low APGAR score, meconium aspiration syndrome and birth asphyxia. In first wave, one baby died on second day postnatal period of unknown cause. Two babies in second wave had early neonatal death in NICU for severe hypoxic ischaemic encephalopathy and meconium aspiration syndrome. All the neonates tested negatives for SARS CoV-2 COVID-19 in both the study groups (Table/Fig 5).

Discussion

Worldwide, SARS-CoV-2 virus has taken its toll on healthcare systems and potentially on maternal and foetal outcomes.The advent of second wave in year 2021 showed a dramatic apparent increase in severe or critical illness, ICU admissions and maternal deaths among COVID-19 pregnant women all over the world (10),(13),(14). The virulent Delta variant (B.1.617.2) of the SARS-CoV-2 virus of second wave was found to be the cause of more severe disease, with an increase in transmissibility and vaccine-breakthrough infections (15),(16).

In the present study, more patients were found to be admitted during the second wave in agreements with other published reports (13),(14). The mean age group was 27.24 (±5.75) years in first and 26.73 (±5.1) years second wave which was comparable with 29.7 years of study by Metz TD et al., (17). Allotey J et al., in their meta-analysis reported adverse outcomes among pregnant patients with pre-existing co-morbidities. Metz TD et al., also suggested pregnant and postpartum patients with SARS-CoV-2 to be significantly increased risk of a composite of death and serious obstetric morbidity related to hypertensive disorders of pregnancy, postpartum haemorrhage and other infections compared with individuals without SARS-CoV-2 infection (8),(17). Present study also demonstrated high pregnancy associated co-morbidities like anaemia, gestational hypertension and other medical disorders in both waves (50% vs 58.1%) though it was not statistically significant on comparison between groups. This high co-morbidity probably was because of inclusion of anaemia in both the groups (25.9% vs 28.1%) as anaemia is prevalent more in our northeast region of India.

Present study demonstrated a higher frequency of severe cases, ICU admissions, need of mechanical ventilation, longer duration of hospital stay and maternal deaths during the second wave compared to first wave of COVID-19. This findings were quite similar with the other studies and meta-analysis (10),(13),(16). In present study, 11 patient in second wave needed ICU admissions and out of which 3 (3.4%) needed invasive ventilation but succumbed to death due to COVID-19 related refractory hypoxia and respiratory failure. Mahajan NN et al.,reported a significantly higher ICU or High Dependency Unit (HDU) admission of 45 (11.6%) compared to 27 (2.4%) in first wave with high maternal mortality rate of 83.3 per 1000 births in second wave (10). Seasely AR et al., also reported significant increase in severe-critical disease, ICU admission, intubation and pharmacologic treatment in the Delta cohort (18). Only contradiction was a study from Spain which cited marked increase in hospital admission among pregnant women compared with first wave, but no mortality was reported (14). One of the reasons for high morbidity and mortality during second wave other than delta strain virulence and high transmissibility can be attributed to the non vaccination of pregnant women in India before July 2021 as it was not approved for pregnancy.

In the present study, most of the women presented at gestational age ≥37 weeks with median gestational age at admission of 39.5 weeks in first and 40 weeks in second wave. The mean gestational age at presentation by Chen H et al., and Mahajan NN et al., were 260±14 days and 273 days, respectively (6),(10). Reports from China and systematic review by Khalil A et al., published higher incidence of caesarean section, mostly done for COVID-19 severe maternal pneumonia and fear of sudden maternal decompensation (6),(19). Present study also showed higher number of caesarean delivery in first and second wave (76% and 66%), although indication were only for obstetrical reasons. Present study found no increase in abortion and preterm delivery which was comparable with meta-anlysis by Chmielewska B et al., (20). But there were reports of increase preterm delivery risk among COVID-19 pregnant women by few systematic review by Allotey J et al., and Khalil A et al (8),(19).

Mahajan NN et al., reported a stillbirth rate of 15.3 and 34.1 per 1000 births respectively for first and second wave, which were not significant on comparison (10). Present study demonstrated four IUFD of which cause of two intrauterine death were known but other two could not be ascertained as they were unbooked and had IUFD at admission. Allotey J et al., reported higher risk of NICU admission (odds ratio 4.89, 95% confidence interval 1.8 to 12.8) than women without COVID-19 (8). In other study by Seasely AR et al., reported significantly higher NICU admission among delta cohort than pre-delta period (18). In this study, NICU admissions were comparable and not significant between study groups.

The data for vertical transmission is limited. One systematic review by Kotlyar AM et al., reported SARS-Cov-2positivity in neonate of 2 % by nasopharyngeal swab, 2.9% in neonatal cord blood, 7.7% of placental samples, 9.7% of rectal swabs and 3.7% in neonatal IgM serology (21). Present study found no SARS-CoV-2 test positivity among the neonates, even though some of the baby born to severe pregnant women needed NICU admissions. However, authors recommend further studies on vertical transmission and long term follow-up of these babies to see any delayed effects is necessary. The findings of present study supports and suggest vaccination to pregnant and lactating women during the ongoing COVID-19 pandemic.

Limitation(s)

Present study lacks age matched comparison between the groups. Present study data was limited to a single centre only and hence it cannot be generalised to the whole population.

Conclusion

More severe cases, ICU admissions, longer duration of hospital stay and maternal deaths were observed in second wave of COVID-19 in comparison to first wave. Vertical transmission was also not found. More studies are recommended with larger samples size to assess the effect of COVID-19 on pregnancy and neonatal outcomes.

Acknowledgement

Authors would like to acknowledge the contribution of all their Doctor colleagues and nursing staffs of Dedicated COVID hospital Chimpu, TRIHMS, Naharlagun, Arunachal Pradesh, India.

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DOI and Others

DOI: 10.7860/JCDR/2022/56150.16397

Date of Submission: Mar 06, 2022
Date of Peer Review: Mar 29, 2022
Date of Acceptance: Apr 09, 2022
Date of Publishing: May 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Mar 10, 2022
• Manual Googling: Mar 21, 2022
• iThenticate Software: Apr 08, 2022 (17%)

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