Pregnancy inclusion in US statewide scarce resource allocation guidelines during COVID-19 pandemic

OBJECTIVE: On November 22, 2022, 2 hospitals in Oregon declared crisis standards of care (CSC) in response to the “tripledemic,” or rising rates of influenza, respiratory syncytial virus, and COVID-19. CSC guidelines direct the triage of limited resources when demands for health care exceed standard capacity, such as intensive care unit beds. Hospital CSCs are adopted from statewide CSCs, and many states developed their CSC policies during the COVID-19 pandemic,which placed a global strain on the healthcare infrastructure. A systematic review of allocation guidelines found that the Sequential Organ Failure Assessment (SOFA) score is used to determine priority for allocation of scarce resources among patients seeking the same resource. However, the SOFA score has not been validated in pregnancy when normal physiological changes, such as platelet count and bilirubin level, are expected to affects core parameters compared with non-gravid physiology. In this report, we assess whether statewide CSC guidelines active during COVID-19, included pregnancy. Among those that do, we describe the ethical triage principles used in allocation guidelines when a pregnant patient was among potential recipients

Experiences Navigating the Pregnancy Care Continuum During the COVID-19 Pandemic

Introduction: The COVID-19 pandemic led to unprecedented changes in care delivery across the pregnancy care continuum. Our primary objective with this research was to characterize the range of ways that the early months of the COVID-19 pandemic affected pregnancy, childbirth, and postpartum care experiences. Methods: Pregnant and recently pregnant patients (n = 20) from obstetrics and gynecology clinical sites associated with Massachusetts General Hospital were interviewed about their experiences with prenatal care, childbirth, and postpartum care during the first wave of the COVID-19 pandemic. Interview transcripts were analyzed for emergent themes. Results: This sample included 20 pregnant and postpartum people, including 11 individuals who tested positive for COVID-19 during pregnancy or postpartum and nine with suspected infection. The ways in which COVID-19 or suspected COVID-19 affected experiences of prenatal care, childbirth, and postpartum care were complex and varied. Three themes were identified across narratives of pregnancy, birth, and postpartum care: patient perceptions of diminished access to care, stigma due to COVID-19 infection, and limited capacity of providers to honor patient preferences. Conclusions: A better understanding of pregnant and recently pregnant people's experiences during the early months of the COVID-19 pandemic can inform infection control policies and clinical care delivery practices that are more congruent with the needs and values of pregnant, birthing, and postpartum people as institutions craft responses to future pandemics. Approaches that maximize meaningful access across the pregnancy care continuum, center patients' priorities within adapted care models, and honor patient preferences as much as possible are important aspects of an appropriate response to future waves of COVID-19 and other pandemics