Effect of COVID-19 on maternal and neonatal services – Authors' reply

Abstract

We thank Asma Khalil and colleagues, Jogender Kumar, and Deepak Jha and colleagues for their feedback in response to our analysis on the indirect effects of the COVID-19 pandemic lockdown in Nepal on intrapartum care and outcomes (preterm births, stillbirths, and neonatal mortality).1 As noted by Khalil and colleagues, our study underestimated the true burden of stillbirths because the data are facility-based and we excluded women who did not have a fetal heart sound at admission and women with an antepartum stillbirth occurring before admission. Although we included stillbirths that occurred after admission, the data were not disaggregated by time of stillbirth. In Nepal, gestational age estimation is commonly based on the last menstrual period, with few women having ultrasonography-dated pregnancy. We are doing additional research now on antenatal care and associated factors.