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Cock and balls

December 27, 2020

Mr & Mrs Andrews, and Thomas Gainsborough’s sexual innuendo

Although they had commissioned it, the Andrews’s disliked this painting so much that they never let Gainsborough finish it, and hid it away for nearly 200 years. Now in the National Gallery, it is recognised as the unquestioned masterpiece of Thomas Gainsborough’s early years.  

Part of its fame comes from its mention in “Civilisation”, Kenneth Clark’s book and BBC series, and later in “Ways of Seeing”, John Berger’s critique of Clark (click here). Clark, and the general public, loved the romantic landscape. Berger argued that the painting was an arrogant statement of wealth and privilege. Both were correct.

Thomas Gainsborough was living hand to mouth when he painted it – his father, John Gainsborough, had gone bankrupt – and he found it hard to remain deferential. This couple from his home of Sudbury – Thomas had been to school with Robert Andrews – were inheritors of “new money”. The marriage linked the fortunes of Mr Andrews’ father, also Robert, with that of his neighbour William Carter. Carter and the older Mr Andrews owned equal shares in Auberies, the estate pictured in the painting. Frances, the future Mrs Andrews, was Carter’s daughter, and her mother, Carter’s wife, the daughter of John Gainsborough’s principle creditor. Thomas was commissioned to celebrate the marriage and inheritance. 

Gainsborough considered himself primarily a landscape painter, and although the composition, with the figures off-centre, revealing so much landscape, was unusual for this sort of dynastic art – one reason it is so popular today – it is unlikely that this caused the ruction. Robert was surely happy to show off his modern farming techniques. Gainsborough also catches Frances’ disdainful expression, perhaps the lowly painter was rather over familiar, but there was a bigger reason for the falling out. Look closely at Robert’s waist1

At Robert’s belt, a bag for his shot and powder hangs – the shot in the left section, the powder in the tube with the knot in it on the right. This is what Robert’s muzzle loading flintlock needs to fire. Now whatever does the bag look like? Yes, its shape unmistakeably echoes male genitalia, while its form and proximity to the gun demonstrates explosive purpose. It is placed decidedly beside the crotch, so we may be being led to understand that Robert is remarkably well hung. However, on the left, above the tower of what is possibly Long Melford Church, dark clouds are gathering, and in the enclosure below, more or less where a swimming pool is now, and set on the same horizontal line as Robert’s significant powder-and-shot bag, are a pair of trapped donkeys. Did Gainsborough see his patrons as trapped donkeys?

Or the unfinished space on Frances’s lap. Was it intended to add a baby, a pet dog, or what?

The empty space is more or less egg shaped […] in her right hand an apparently meaningless furry or feathery extension, nearly as long as her lower arm, emerges from the partially expressed object on her lap. The drily painted beginnings of a small oval, merely a swish or two of the brush, runs over thin grey under-drawing which extends down to a dangling knob-shape. It is unquestionably there, in plain sight. This is not a pet cat, or a lap-dog, or a baby, but a dead cock pheasant – or it was going to be. Had Gainsborough completed it, the pheasant’s head and neck would rhyme exactly, and rather too clearly, with the limp game bag at Robert’s waist and the flabby glove in his hand. As it is, as Gainsborough has left it, Frances Andrews has a drawing of a penis on her skirt.

We can only guess what Frances said when she saw the painting. But we know the result. 

Jim Thornton

  1. None of this was worked out by me. Most of the facts, and both quotations, are from Gainsborough, a Portrait by James Hamilton. Weidenfeld & Nicholson, London, 2017.

Birth carers lost to Covid-19

December 13, 2020

Looking after mothers and babies during childbirth never stops – nights, weekends, holidays, the lights in the labour and neonatal wards are always on – and it didn’t stop for Covid.  Midwives, obstetric and neonatal nurses, neonatologists, anaesthetists, sonographers, cleaners, porters, auxiliaries, doulas, obstetricians, and many others, carried on as usual. A few paid with their lives.

Some caught Covid-19 in the line of duty, some elsewhere; I’ve made no attempt to separate them. Listed by month of death. Email Jim Thornton for those missed. Thank you Shakila Thangaratinam and Tara Pauly for initial encouragement and for alerting me to some names. 

There seem to be more OBGYN’s than midwives, which is implausible. The explanation is probably that some countries don’t use the term midwife, and that the internet is biased towards recording deaths of doctors before other health professions. 

Some resources used – Venezuela (click here), Italy (click here), Russia (click here), UK/BMJ (click here), US physicians (click here), Iran (click here), Medscape (click here), New York State Nurses Association (click here), Lancet (click here).

I will update.

March 2021 – Jim Dornan added

March 2021 

Jim Dornan age 73, OBGYN, Belfast, Northern Ireland. Death announced on 15 March (click here).  

January 11 update – Jose Jimenez, Gregory Michael, Unnamed midwife from Whittingdon, Adaín Landeros, Tomás Hernández Quijano, Jaime Hernández Rodríguez, Georgi Hubchev, José Alfredo Jiménez Turrubiates, Duško Kljakić, Halil Yucel Kutun, Katia Kohler, Mark Laser, and Biljana Natic ​​Ljumovic added. Details below.

January 2021

An unnamed midwife “originally from Zimbabwe” is reported to have died from Covid-19 at the Whittingdon Hospital in London in early January (click here).

Gregory Michael, age 56, OBGYN, Miami Beach, Florida on 3 January (click here). Cause thrombocytopaenia, two weeks after receiving the BioNTech/Pfizer Covid vaccine. The relation between the two events is under investigation.




Joel Antonio Contreras Gámez, age 87, OBGYN, Táchira, Venezuela, on 24 November (click here).

Liliana Somogy, OBGYN, Carabobo, Venezuela, on 19 November (click here). 

Pierantonio Meroni, age 83, OBGYN from Como, Italy, on 17 November (click here or here).

Héctor Enrique Torrealba Rodríguez, age 68, OBGYN, Carabobo, Venezuela, on 12 November (click here).

Adaín Octavio Girón Landeros, age 42, OBGYN, Hospital General de Zacatecas, Zacatecas, Mexico, on 12 November (click here).


Carlos Fayanás, age 73, OBGYN, Juncal Sanatorium in Temperley, Lomas de Zamora, Argentina, on 22 October (click here). 

Georgi Hubchev, age 66, OBGYN, University Hospital “Virgin Mary” Burgas, Bulgaria, on 17 October (click here).

Jose Inés Alcántara Jimenez, age about 64, OBGYN, Hospital General Iguala, Iguala, Guerrero, Mexico on 12 Octobe (click here).

Rafael Colmenares, OBGYN, Trujillo, Venezuela, on 1st October (click here).

Nikolay Vasechko, age 59, a doctor in diagnostic ultrasound in Dobrinsky Regional Hospital, Lipetsk, Russia, in October (click here). 

Jagadish Rai, age 70, OBGYN, Raju Clinic, BC Road, Bantwal, India, in October (click here). 


Tatyana Babaytseva, age 53, ultrasound doctor, Uryupinsk District Hospital, Volgograd, Russia, in September (click here).

Pedro Sánchez, age 65, Distrito Capital, Venezuela, on 21 September (click here).

Freddy Lacroix, OBGYN, Carabobo, Venezuela, on 20 September (click here).

Adeline Fagan, age 28, trainee OBGYN, Houston, Texas, on 19 September (click here).

Ana Mercedes Flores, OBGYN, Maternidad del Sur, Carabobo, Venezuela, on 13 September (click here).

Elio José Margiotta Figueroa, age 60, OBGYN, Nueva Esparta, Venezuela, on 7 September (click here).

Manuela Fernández Lanz, age 60, OBGYN, Bolívar, Venezuela, on 3 September (click here).


Pedro Luis Cedeño, age 56, OBGYN, on 30 August (click here).

Andrés del Orbe, OBGYN, Táchira, Venezuela on 30 August (click here).

Julia Morales, OBGYN, Trujillo, Venezuela, on 28 August (click here).

Franklin Urdaneta, OBGYN, Zulia, Venzuela, on 24 August (click here). 

Junny Macabril, OBGYN, Bolivar, Venezuela, on 24 August (click here).

Kathlynne Abat-Senen, age 43, neonatologist from Manila, Philippines, On 23 August (click here). 

Dalia Gabriela Sosa Atondo, age 28, OBGYN, Culiacán, Mexico, on 21 August (click here or here). She was pregnant. Her baby survived. 

Jesús García, OB/GYN, Hospital Materno Infantil “Dr Pastor Oropeza,” Caracas, Venezuela on 20 August (click here). 

Carlos Alberto Amaya, neonatologist, Hospital de Niños Benjamín Bloom, San Salvador, El Salvador on 18 August (click here).

Ángel Ruben Alzurutt Riera, OBGYN, from Ciudad Guayana, Venezuela on 17 August (click here). 

Yamil Abou Assali, age 60, OBGYN, Barinas, Venezuela, on 8 August (click here).

Felipe De La Cruz Luna, OBGYN, Apartadó, Colombia on 5 August (click here). 

Halil Yucel Kutun, age 67, OBGYN, Ozel Bag Hospital, Diyarbakir, Turkey, on 4 August (click here).

Jesús Peña Peña, age 67, OBGYN, Hospital de Santa Bárbara, Mérida, Venezuela on 4 August (click here). 


Alcira Perache, age 52, OBGYN, Hospital Dr Raúl Leoni, Ciudad Guayana, Bolívar, Venezuela, on 31 July (click here).  

Germán Mauricio Erazo Santos, OBGYN, Hospital Gabriela Alvarado, Danlí, Honduras on 29 July (click here). 

Óscar Urenda, age 72, OBGYN, Santa Cruz, La Paz, Bolivia, On July 23 (click here).

Ana Henríquez Salazar, age 52, OBGYN, Distrito Capital, Venezuela, on 22 July (click here).

María Consuelo González, OBGYN, Distrito Capital, Venezuela, on 13 July (click here).

Doreen Lugaliki, age 39, OBGYN in Kenya on 10 July (click here). 

Jesús Romero, age 54, OBGYN,  Rosario de Perijá, Zulia, Venezuela. on 10 July (click here).

Elias José Hani Jimeno, age 64, OBGYN, Clínica Misericordia, Ciénaga, Magdalena, Colombia in July (click here).

Matilde Ramírez García,  OB-GYN, Hospital Regional de Coatzacoalcos “Dr. Valentin Gomez Farias,” Coatzacoalcos, Veracruz, Mexico, on 3rd July (click here). 

José Alfredo Jiménez Turrubiates, OBGYN, Hospital General Matamoros “Dr. Alfredo Pumarejo,” Matamoros, Tamaluipas, Mexico, on 2 July (click here)

Nola Mae Moore, age 98, family practitioner, King County, Washington, USA, who had delivered almost 5,000 babies in partnership with her husband, in June (click here). 


Jorge Leal, age 56, OBGYN, Zulia, Venezuela, on 28 June (click here).

Manuel Romero, age 54, OBGYN, Maracaibo, Zulia, Venezuela, on 24 June (click here). 

Sergio de la Fuente Burton, age 73, OBGYN, American Hospital, Cancun, Mexico, on 2nd June (click here).


Ramon César Aparicio Osorio, OBGYN, director of Hospital Materno Infantil Vicente Guerrero, Chimalhuacán, Mexico in May (click here).

Carla de Oliveira Obelar, age 42, neonatal nurse, Rio de Janeiro, Brazil, in May (click here).

Ahmed Al-Annie, OBGYN, from Banha Insurance Hospital, Banha, Egypt in May (click here).

Eder Aguilar Rojas, OBGYN from Iquitos, Peru in May (click here).

Nicolás Hernández Hernández, OBGYN from Iquitos, Peru in May (click here).

Margaret Njenga, midwife, Barts Health NHS Trust, London, UK, in May (click here). 

Safaa Alam, age 30, midwife, Birmingham, UK in May (click here or here).

Jaime Hernández Rodríguez, OBGYN, General Hospital of Zona 13 de Matamoros.Tamaluipas, Mexico  (click here).

Esperanza Bravo Ruíz, neonatologist, Puebla, Mexico, on May 13 (click here). 

Daniel Mojica, administrator, Hospital de Gineco Obstetricia No. 3 de La Raza, Mexico City, Mexico on 9 May (click here).

Duško Kljakić, age 52, OB-GYN,  General Hospital “Blažo Orlandic,” Bar, Montenegro, on 9 May (click here).

Veselago Larisa Mikhailovna, age 71, OBGYN, St. Petersburg, Russia on 8 May (click here).

Claudio Antonio Figueiredo Reis, age 63, OBGYN, Hospital Anita Gerosa, Ananindeua, Brazil on 6 May (click here).

Svetlana Vinokur, age 56, obstetric nurse, NYC Health+Hospitals/Coney Island, Brooklyn, New York, on 1 May (click here).


Reinaldo Albernás, age 54, OBGYN, in Hospital San Rafael de Alajuela, Alajuela, Costa Rica, in April (click here).

Khanyafi Garifullin, age 61, OBGYN from Dzerzhinsk City hospital, Moscow, Russia, on 30 April (click here).

Avelar Feitosa Ribeiro, OBGYN, Hospital Divina Providência, Marituba, Pará, Brazil, on 27 April (click here). 

Azinet Pudpud, age 61, neonatal nurse, Lincoln Hospital, New York, on 27 April (click here). 

Elma Cavalida, a maternity assistant at Northwick Park Hospital, on April 26 (click here). 

Gerardo Zenteno Gutiérrez, OBGYN, Clínica de Especialidad Nuestra Señora de Los Ángeles, Puebla, Mexico, on April 25 (click here).

Shree Vishna Rasiah, age 49, neonatologist, Birmingham, UK, on 23 April 2020 (click here or here)

Arthur Tayengco, age 81, OBGYN, University of Nevada-Las Vegas School of Medicine, USA, on 22 April (click here or here).

Alicia Soto Guerrero, age 65, radiologist, Sinaloa, Mexico, previously intern in OBGYN, on 20 April (click here or here).

Tomás Hernández Quijano, OBGYN IMSS Hospital Vicente Guerrero, Acapulco, Mexico between 19 and 23 April (click here).

Joshua Yasuo Suzuki, age 78, OBGYN, Seattle, USA, on April 19 (click here or here).

Linda Clarke, age 66, midwife, Wigan, UK, on 16 April (click here). 

Alberto Guidetti, age 76, OBGYN, Arzignano and Valdagno Hospitals in Creazzo, Italy, on 15 April (click here).

Emeka Chugbo, age 60, OBGYN, Lagos, Nigeria, on 15 April (click here. See also here).

Emma Altagracia Barba Demorizi, Dominican Republic, on 14 April (click here).

Katia Kohler, OBGYN, Santana de Parnaiba, Brazil, on 13 April (click here).

Raimundo Ferreira Rodrigues, age 75, OBGYN, Manaus, Brazil, on 12 April (click here). 

Betty Cruz Yagual, age 61, OBGYN, Santiago de Guayaquil, and El Cisne, Health Centers, in Ecuador, on 10 April (click here). 

Edoardo Valli, age 63, OBGYN at Santa Famiglia obstetric clinic, Rome, on 9 April (click here).

Luis Caldera-Nieves, age 63, OBGYN, from Jackson South Community Hospital in Palmetto Bay, Miami, Florida on 8 April (click here). 

Susan Sisgundo, neonatal nurse, Bellevue Hospital, New York, on April 8 (click here).

Alice Kit Tak Ong, age 70, midwife from North London, UK, on 7 April (click here or here).

Aria Sigaroudi, midwife, Sari, Iran, on 7 April (click here). 

Mark Laser, age 63, OBGYN, Women’s Healthcare, Trumbull, Connecticut, on 7 April (click here).

Luis Caldera-Nieves, age 63, OBGYN, Miami, Florida, on 7 April (click here).

Jack Zoller, OBGYN, New Orleans, Louisiana on 2 April (click here). 

Lynsay Coventry, age 54, midwife, Princess Alexandra Hospital Trust, Harlow, Essex, UK, on 2 April (click here). 

Hamza Pacheeri, age 80, OBGYN, Birmingham, United Kingdom on April 1 (click here). 


Ricardo A. Alcivar Zambrano, age 67, Neonatologist, Guayaquil, Ecuador, in March (click here).

Gianfranco D’Ambrosio, OBGYN and GP, Italy, on 30 March (click here).

Irving Buterman, age 78, OBGYN, New York, on March 30 (click here).

Washington Germán Tutasi Jaramillo, age 68, OBGYN, Ambate, Ecuador, on March 28 (click here). 

Carlos Enrique Burbano Freire, age 50, Guayaquil, Ecuador, on 26 March (click here).

Biljana Natic ​​Ljumovic, age 59, OBGYN, Niš, Serbia, on 25 March (click here). 

Liliana Ortega Miranda, age 45, OBGYN, Hospital Nacional Sergio Bernales, Comas, Peru, on 23 March (click here). 

Jean-Marie Boegle, age 66, OBGYN, Mulhouse, France, on 22 March (click here or here).

Valter Tarantini, age 72, OBGYN, Forlì, Italy, on 19 March (click here or here).

Roberto Mileti, age 59, OBGYN, San Marco, Italy, on 30 March (click here).

Month unknown

Bugornikova Galina Valentinovna, age 59, OBGYN, Ust-Pristanskiy, Altai Territory, Russia (click here).

Anusheh Beikian, OBGYN, Rasht, Iran (click here).

Seyyedeh Azemat Mousavi, OBGYN, Sari, Iran (click here). 

Dr. Ali İhsan BULUT, OBGYN, Istanbul (click here)

Ibtihal Hammoud, OBGYN, Aden, Yemen (click here)

Walid Yahya Abdelhaleem, age 32, OBGYN, Almuneerah General Hospital, Cairo, Egypt (click here)

Jim Thornton

Note. For ease of searching, and because many countries use the generic term gynaecologist to include obstetrician, I’ve classified obstetricians, gynaecologists and doctors who practice both, all as OBGYNs. Similarly I’ve classified paediatricians who practice neonatology as neonatologists. 

Wild swimming in the Trent gravel pits

November 30, 2020

Sand and gravel has been quarried along the Trent for hundreds of years. The two official swimming lakes, Colwick Park (click here) and the Notts County Sailing Club lake at Hoveringham (click here or here for details) will suit many. But organised wild swimming? Not me.

Some lakes are inaccessible, or too closely guarded by their owners, but a few are perfect for a discreet dip. For swimming spots on the river click here.

9 Sept 2021 update – No swimming in Bleasby Lake


Three lakes run alongside the railway line here. The smaller ones at either end are heavily  fished – no swimming. But the middle and largest, Railway Lake, is perfect. A sailing, canoeing & windsurfing club has put up all sorts of entry barriers, and their groundsman believes the whole lake is “no swimming”, so be discreet.


Enter by the path at Thurgaton station, but avoid the main footpath along the railway line. It’s over a mile before you can cross the ditch separating you from the lake.  Instead follow the permissive path signs, through an unlocked gate and along the north shore. The further you go, the more private it gets.


The best spots are where the trees give way to grass and reeds.

Lovely clean gravel beds. No weeds. Just me and the dragon flies.


The Gunthorpe lakes are all owned by angling clubs, who fish all year, and don’t like swimmers. I swam in Dollar Lake, the largest one adjacent to the river. If you walk in from the river bank on a quiet day, there no fences, and the fishermen tend to drive in from the opposite direction.


Bleasby Lake, at the end of Sycamore Lane, near the sawmill, is the only swimmable lake in Bleasby. There’s usually a few fishermen, but it’s rarely crowded, and they’ve never objected to me swimming. Loads of good access points. Weedy in parts.

Update 9 September 2021 – Swimming is not allowed in the fishing pond at the end of Sycamore Lane. See comment from Ruth Dyson below.

Jubilee Ponds would be perfect, and they’re accessible on foot down Borrow Bread Lane, but sadly, “No swimming”.


Gibsmere lake is also private fishing only – “No swimming”.  But don’t despair. There’s a couple of good spots on the Trent at Hazleton (click here).

Newark/South Muskham

There are many flooded pits between Newark and South Muskham, mostly around the sugar factory. But they’re all fishing lakes, or inaccessible, or both.

North Muskham

North Muskham Lake Nature Reserve (click here) is “no swimming”.  But walk north (downstream) from The Muskham Ferry pub (click here), past the fenced-off Nature Reserve lake. The second lake is set back behind grassland and invisible from the path, but the third is adjacent to the path with easy access. An idyllic spot.



You can swim in the river (click here) but the local gravel pit is still being worked by Tarmac – definitely no swimming!

Jim Thornton

Women’s Work

October 26, 2020

Two poems by UA Fanthorpe


Degas painted dozens of “La Repasseuse” Woman Ironing pictures. The one Fanthorpe refers to (right above) is in the Walker Art Gallery in Liverpool. It’s the last in a series of three of this particular pose. The George Bernard Shaw quote is from the play Man & Superman.

Woman Ironing

I thought I knew what was coming when he said,
He wanted to do my likeness at the ironing.
I live in the city, people tell you things. Me looking at him,
It would be, across the ironing board, my hair and my eyes
In a good light, and something a bit off the shoulder

But it wasn’t. He rushed around drawing curtains
Made it hard to iron. O yes, I had to keep ironing.
He need to see the strength, he said. Kept on
About my dynamic right shoulder, then left it out
Though you can see where he ought to have put it.

Come on, what’s-your-name, he kept saying,
Show us that muscle power! That’s what I’m after.
I might’ve been an engine, not a person
No, I didn’t take to him, I’m used to rudeness,
But he was making such a sketch of me.

If someone’s paying you, it isn’t easy
To speak your mind. Still, Sir, I said,
I really don’t want to see my hair like that,
all scraped back, like a hot person’s hair,
And anyone can tell that under my arms I’m sweating.

Hair? Sweat? That’s how it is when you iron,
Says he. You’re not here to tell me what to do.
I’ll make you permanent, the way you look
When you’re ironing. O yes, he says, I’ll show you
The way you look when no one’s watching.

UA Fanthorpe

Mother Scrubbing the Floor

She had a dancer’s feet, elegant, witty.
We had our father’s, maverick spreaders of dirt.

Dirt from London, dirt from Kent
Mud, dust, grass, droppings, wetness, things,
Dirt barefaced, dirt stinking, dirt invisible.

Whatever it was, she was ready:
The rubber kneeler, clanking galvanised bucket,
The Lifebuoy, the hard hot water.

Let me! we’d say, meaning Hate to see you do this.
Too old. Too resentful. Besides, you’ll blame us
That you had to do it.

She never yielded. We couldn’t do it right,
Lacking her hatred of filth, her fine strong hands.

Don’t want you to do this, she said. Don’t want you to have to.
Just remember this: love isn’t sex.
But the dreary things you do for the people you love.
And ‘Home is the girl’s prison,
The woman’s workhouse.’ Not me; Shaw.

I do remember. I stand where she knelt.

UA Fanthorpe

Indirect effects of the Covid-19 pandemic on pregnancy

October 8, 2020

Primary sources has been collecting primary scientific (click here) & newspaper reports (click here) of Covid-19 or SARS-CoV-2 infection in pregnancy since early in the pandemic (click here for our Covid-19 in pregnancy navigation page).

Here we (Jim Thornton, Keelin O’Donoghue and Kate Walker) collect primary scientific reports of the indirect effects of the pandemic on pregnancy.  As usual facts but no comments. For convenience we list papers in roughly reverse order, newest first. We will update regularly.

Clarification added 1 October 2021 – We exclude studies of the effect of the pandemic on psychological scores in pregnant women, but include studies reporting effects on mental health events. Anxiety and depression scores are out. Suicide and suicide attempts are in.

Update 7 April – paper 126 added

Paper 126 – fewer iatrogenic preterm births in USA

A decline in pre-term birth post-lockdown driven primarily by births by Cesarean or induced (click here or paper). Citation: Dench D, Joyce T, Minkoff H. United States Preterm Birth Rate and COVID-19. Pediatrics. 2022;149(5):e2021055495

Update 12 February – papers 124 and 125 added

Paper 125 – no effect of lockdown in Bangladesh

Data from the Rajbari district, collected by the International Centre for Diarrhoeal Disease Research (click here or paper). Citation: Mhajabin S, Hossain AT, Nusrat N, Jabeen S, Ameen S, Banik G, Tahsina T, Ahmed A, Sadeq-Ur Rahman Q, Gurley ES, Bari S, Chowdhury AI, Arifeen SE, Mehta R, Rahman AE. Indirect effects of the early phase of the COVID-19 pandemic on the coverage of essential maternal and newborn health services in a rural subdistrict in Bangladesh: results from a cross-sectional household survey. BMJ Open. 2022 Feb 3;12(2):e056951. doi: 10.1136/bmjopen-2021-056951. PMID: 35115357; PMCID: PMC8814430.

Paper 124 – Experience from Africa

From Guinea, Nigeria, Tanzania, and Uganda (click here or paper). Citation: Semaan A, Banke-Thomas A, Amongin D, Babah O, Dioubate N, Kikula A, Nakubulwa S, Ogein O, Adroma M, Anzo Adiga W, Diallo A, Diallo L, Cellou Diallo M, Maomou C, Mtinangi N, Sy T, Delvaux T, Afolabi BB, Delamou A, Nakimuli A, Pembe AB, Benova L. ‘We are not going to shut down, because we cannot postpone pregnancy’: a mixed-methods study of the provision of maternal healthcare in six referral maternity wards in four sub-Saharan African countries during the COVID-19 pandemic. BMJ Glob Health. 2022 Feb;7(2):e008063. doi: 10.1136/bmjgh-2021-008063. PMID: 35144921.

Update 10 February – paper 123 added (HT Vivienne Souter)

Paper 123 – no major effects in USA

Data from 15 hospitals in the Pacific Northwest from 2017 to 2020 (click here or paper). Citation: Riley T, Nethery E, Chung EK, Souter V. Impact of the COVID-19 pandemic on perinatal care and outcomes in the United States: An interrupted time series analysis. Birth. 2021 Dec 26. doi: 10.1111/birt.12606. Epub ahead of print. PMID: 34957595.

Update 22 January – papers 121 and 122 added

Paper 122 – worse outcomes for TTTS during pandemic in Mexico

Twin pregnancies complicated by twin to twin transfusion syndrome (TTTS) referred to the Fetal Medicine and Surgery Center, Queretaro (click here or paper). Citation: López-Briones H, Villalobos-Gómez R, Chávez-González E, Martínez-Rodríguez M, Helue-Mena A, Gámez-Varela A, Cruz-Martinez R. Twin-to-twin transfusion syndrome and coronavirus disease 2019: Impact on diagnosis, referral, eligibility for fetoscopic laser therapy and outcomes. AJOG Glob Rep. 2022 Jan 13:100040. doi: 10.1016/j.xagr.2021.100040. Epub ahead of print. PMID: 35039807; PMCID: PMC8755450.

Paper 121 – No major effects in UK

From author affiliations data from St. Mary’s Hospital in Manchester (click here or paper). Citation: Wilkinson M, Johnstone ED, Simcox LE, Myers JE. The impact of COVID-19 on pregnancy outcomes in a diverse cohort in England. Sci Rep. 2022 Jan 18;12(1):942. doi: 10.1038/s41598-022-04898-5. PMID: 35042979; PMCID: PMC8766432.

Update 11 January – paper 120 added

Paper 120 – No major effects in UK

From the Hospital Episode Statistics database (click here or paper). Citation: Gurol-Urganci I, Waite L, Webster K, Jardine J, Carroll F, Dunn G, et al. (2022) Obstetric interventions and pregnancy outcomes during the COVID-19 pandemic in England: A nationwide cohort study. PLoS Med 19(1): e1003884.

Update 7 Janurary 2022 – Paper 77 citation updated.

Update 27 December – papers 118 and 119 added

Paper 119 – fear of Covid associated with preterm birth & low birth weight in Canada

Data from the Pregnancy During the COVID-19 Pandemic (PdP) study, collected between April 5 and December 17, 2020 (click here or paper). Citation: Giesbrecht GF, Rojas L, Patel S, Kuret V, MacKinnon AL, Tomfohr-Madsen L, Lebel C. Fear of COVID-19, mental health, and pregnancy outcomes in the Pregnancy During the COVID-19 Pandemic study: Fear of COVID-19 and pregnancy outcomes. J Affect Disord. 2021 Dec 21:S0165-0327(21)01370-7. doi: 10.1016/j.jad.2021.12.057. Epub ahead of print. PMID: 34952107.

Paper 118 – effect of lockdown in France

From four unnamed French maternity hospitals (click here or paper). Citation: Bertholdt C, Epstein J, Alleyrat C, Ambroise G, Claudel L, Banasiak C, Morel O. Comparative evaluation of the impact of the COVID-19 lockdown on perinatal experience: a prospective multicentre study. BJOG. 2021 Dec 26. doi: 10.1111/1471-0528.17082. Epub ahead of print. PMID: 34954895.

Update 13 December – papers 116 and 117 added

Paper 117 – higher risk out-of-hospital births in USA

From the CDC&P WONDER online natality database 2019 and 2020 (click here or paper). Citation: Amos Grünebaum, Eran Bornstein, Adi Katz, Frank A. Chervenak. Worsening risk profiles of out-of-hospital births during the COVID-19 pandemic Am J Obstet Gynecol. 2021

Paper 116 – Delays in obtaining abortion during pandemic in USA

From Chicago, Illinois (click here or paper). Citation: Dahl CM, Turner A, Bales C, Cheu L, Singh A, Cowett A, McCloskey L. Influence of the Coronavirus Disease 2019 (COVID-19) Pandemic on Delays in and Barriers to Abortion. Obstet Gynecol. 2021 Nov 1;138(5):805-808. doi: 10.1097/AOG.0000000000004569. PMID: 34619741; PMCID: PMC8522335.

Update 10 December – papers 114 and 115 added

Paper 115 – fewer male twins in Norway

From the Medical Birth Registry of Norway for the 59 months starting January 2016 and ending November 2020 (click here or paper). Citation: Catalano R, Bruckner T, Casey JA, Gemmill A, Margerison C, Hartig T. Twinning during the pandemic: Evidence of selection in utero. Evol Med Public Health. 2021 Oct 20;9(1):374-382. doi: 10.1093/emph/eoab033. PMID: 34858596; PMCID: PMC8634460.

Paper 114 – no effect on stillbirths, low birth weight or preterm births in France

From Lille, Nantes, Toulouse, Strasbourg, Poissy in Greater Paris, and Necker in central Paris (click here or paper). Citation: Garabedian C, Dupuis N, Vayssière C, Bussières L, Ville Y, Renaudin B, Dugave L, Winer N, Banaszkiewicz N, Rozenberg P, Defrance M, Legris ML, Quibel T, Deruelle P. Impact of COVID-19 Lockdown on Preterm Births, Low Birthweights and Stillbirths: A Retrospective Cohort Study. J Clin Med. 2021 Nov 30;10(23):5649. doi: 10.3390/jcm10235649. PMID: 34884351.

Update 29 November – papers 112 and 113 added

Paper 113 – increased preterm births in China

Singleton live infants born between 2015 and 2020 in five cities in Guangdong Province (click here or paper). Citation: Dong M, Qian R, Wang J, Fan J, Ye Y, Zhou H, Win B, Reid E, Zheng S, Lv Y, Pu Y, Chen H, Jin J, Lin Q, Luo X, Chen G, Chen Y, He Z, He G, Cheng S, Hu J, Xiao J, Ma W, Liu T, Wen X. Associations of COVID-19 lockdown with gestational length and preterm birth in China. BMC Pregnancy Childbirth. 2021 Nov 27;21(1):795. doi: 10.1186/s12884-021-04268-5. PMID: 34837991.

Paper 112 – no increased deaths in Sierra Leone

From the Sierra Leone Sample Registration System (SL-SRS) (click here or paper). Excess maternal or neonatal deaths were not detected in the months of 2020 corresponding to the peak of the COVID-19 pandemic. Citation: Carshon-Marsh R, Aimone A, Ansumana R, Swaray IB, Assalif A, Musa A, Meh C, Smart F, Hang Fu S, Newcombe L, Kamadod R, Saikia N, Gelband H, Jambai A, Jha P. Child, maternal, and adult mortality in Sierra Leone: nationally representative mortality survey 2018-20. Lancet Glob Health. 2021 Nov 25:S2214-109X(21)00459-9. doi: 10.1016/S2214-109X(21)00459-9. Epub ahead of print. PMID: 34838202.

Update 18 November – papers 108 to 111 added

Paper 111 – reduced iatrogenic, but not spontaneous, preterm births in the Netherlands

From the National Institute for Public Health and the Environment (RIVM) as extracted from Praeventis, and the Netherlands national perinatal registry, Perined (click here or paper). Citation: Klumper J, Kazemier BM, Been JV, Bloemenkamp KWM, de Boer MA, Erwich JJHM, Heidema W, Klumper FJCM, Bijvank SWAN, Oei SG, Oudijk MA, Schoenmakers S, van Teeffelen AS, de Groot CJM. Association between COVID-19 lockdown measures and the incidence of iatrogenic versus spontaneous very preterm births in the Netherlands: a retrospective study. BMC Pregnancy Childbirth. 2021 Nov 12;21(1):767. doi: 10.1186/s12884-021-04249-8. PMID: 34772364; PMCID: PMC8586024.

Paper 110 – preterm births in Scandinavia

No effect of lockdown noted (click here or paper). Citation: Oakley LL, Örtqvist AK, Kinge J, Hansen AV, Petersen TG, Söderling J, Telle KE, Magnus MC, Mortensen LH, Anne-Marie NYBOANDERSEN, Stephansson O, Håberg SE. Preterm birth after the introduction of COVID-19 mitigation measures in Norway, Sweden and Denmark: a registry-based difference-in-differences study. Am J Obstet Gynecol. 2021 Nov 11:S0002-9378(21)01231-X. doi: 10.1016/j.ajog.2021.11.034. Epub ahead of print. PMID: 34774824.

Paper 109 – Preterm births in Canada

Data from the perinatal health program and neonatal databases in the Calgary region (click here or paper). Citation: Alshaikh B, Cheung PY, Soliman N, Brundler MA, Yusuf K. Impact of Lockdown Measures during COVID-19 Pandemic on Pregnancy and Preterm Birth. Am J Perinatol. 2021 Nov 14. doi: 10.1055/s-0041-1739357. Epub ahead of print. PMID: 34775579.

Paper 108 – Preterm birth in Denmark again

From the Danish Civil Registration System, the Medical Birth Registry, and The Danish National Patient Registry (click here or paper). Citation: Hedley PL, Hedermann G, Hagen CM, Bækvad-Hansen M, Hjalgrim H, Rostgaard K, Laksafoss AD, Hoffmann S, Jensen JS, Breindahl M, Melbye M, Hviid A, Hougaard DM, Krebs L, Lausten-Thomsen U, Christiansen M. Preterm birth, stillbirth and early neonatal mortality during the Danish COVID-19 lockdown. Eur J Pediatr. 2021 Nov 16:1–10. doi: 10.1007/s00431-021-04297-4. Epub ahead of print. PMID: 34783897; PMCID: PMC8593096.

Update 1 November – paper 67 citation updated

Update 23 October – papers 106 and 107 added

Paper 107 – more gestational diabetes & hypertension in USA

Analysis of commercial and Medicare Advantage medical claims, throughout the US, collected by OptumLabs Data Warehouse (click here or paper). Citation: Sun S, Savitz DA, Wellenius GA. Changes in Adverse Pregnancy Outcomes Associated With the COVID-19 Pandemic in the United States. JAMA Netw Open. 2021;4(10):e2129560. doi:10.1001/jamanetworkopen.2021.29560

Paper 106 – more gestational diabetes & preterm births in Italy

From San Gerardo Hospital, Milan (click here or paper). Citation: Ornaghi, S., Fumagalli, S., Guinea Montalvo, C.K., Beretta, G., Invernizzi, F., Nespoli, A. and Vergani, P. (2021), Indirect impact of SARS-CoV-2 pandemic on pregnancy and childbirth outcomes: A nine-month long experience from a university center in Lombardy. International Journal of Gynecology & Obstetrics. Accepted Author Manuscript.

Update 18 October – papers 104 and 105 added

Paper 105 – small reduction in preterm births in USA

From insurance claims data during the lockdown period April-June 2020 (click here or paper). Citation: Jiajia Chen PhD , Cynthia Ferre MA , Lijing Ouyang PhD , Yousra Mohamoud PhD , Wanda Barfield MD , Shanna Cox MSPH , Changes and Geographic Variation in Rates of Preterm Birth and Stillbirth during the COVID-19 Pandemic According to Health Insurance Claims in the United States, April-June 2019-2020, American Journal of Obstetrics & Gynecology MFM (2021), doi:

Paper 104 – effect on abortion in Belgium

From one Flanders centre during the first lockdown, 16 March-14 June 2020 (click here or paper). Citation: De Kort L, Wouters E, Van de Velde S. Obstacles and opportunities: a qualitative study of the experiences of abortion centre staff with abortion care during the first COVID-19 lockdown in Flanders, Belgium. Sex Reprod Health Matters. 2021 Dec;29(1):1921901. doi: 10.1080/26410397.2021.1921901. PMID: 33982638; PMCID: PMC8128194.

Update 13 October – paper 102 added

Paper 103 – increased maternal and child deaths in 18 low and middle income countries

Lancet preprint (click here or paper). Citation: Ahmed, Tashrik and Roberton, Timothy and Team, Monitoring of Essential Health Services and Alfred, Jean Patrick and Baye, Martina L. and Diabate, Mamatou and Kiarie, Helen and Mbaka, Paul and Mohamud, Nur Ali and Mwansambo, Charles and Ndiaye, Youssoupha and Nzelu, Charles and Ofosu, Anthony and Raharison, Tsihory and Sadat, Husnia and Smart, Francis and Uddin, Helal and Wendrad, Naod and Wesseh, Chea Sanford and Yansane, Mohamad Lamine and Yuma, Sylvain and Vergeer, Petronella and Hansen, Peter Meredith and Friedman, Jed Arnold and Shapira, Gil, Indirect Effects on Maternal and Child Mortality from the COVID-19 Pandemic: Evidence from Disruptions in Healthcare Utilization in 18 Low- and Middle-Income Countries. Available at SSRN: or

Paper 102 – effect on preterm stillbirths and iatrogenic preterms in Australia

From 12 public hospitals Melbourne (click here or paper). Likely overlap with studies 85 and 95. Citation:
Lisa Hui, Melvin Barrientos Marzan, Stephanie Potenza, Daniel L. Rolnik, Natasha Pritchard, Joanne M. Said, Kirsten R Palmer, Clare L. Whitehead, Penelope M. Sheehan, Jolyon Ford, Ben W. Mol, Susan P. Walker Increase in preterm stillbirths and reduction in iatrogenic preterm births for fetal compromise: a multi-centre cohort study of COVID-19 lockdown effects in Melbourne, Australia
medRxiv 2021.10.04.21264500; doi:

Update 30 September 2021 – paper 101 added

Paper 101 – effect of the pandemic in India

Data from a hospital based survey since August 2018 in 15 public and private hospitals in five Indian states: Assam, Maharashtra, Uttar Pradesh, Himachal Pradesh and Meghalaya (click here or paper). Citation: Nair M, MaatHRI Writing Group, On Behalf Of The MaatHRI Collaborators. Reproductive health crisis during waves one and two of the COVID-19 pandemic in India: Incidence and deaths from severe maternal complications in more than 202,000 hospital births. EClinicalMedicine. 2021 Sep;39:101063. doi: 10.1016/j.eclinm.2021.101063. Epub 2021 Jul 29. PMID: 34585123; PMCID: PMC8461242.

Update 28 September – paper 100 added

Paper 100 – increased cannabis use in USA

From Kaiser Permanente Northern California (click here or paper). Citation: Young-Wolff KC, Ray GT, Alexeeff SE, et al. Rates of Prenatal Cannabis Use Among Pregnant Women Before and During the COVID-19 Pandemic. JAMA. Published online September 27, 2021. doi:10.1001/jama.2021.16328

Update 27 September – papers 96 to 99 added

Paper 99 – Reduced obstetric in person visits in USA

Retrospective review of prenatal and postpartum visits at Vanderbilt University Medical Center, Nashville, Tennessee (click here or paper). Citation: Osarhiemen OA, Robinson MA, Zhao Z, Ding T, Crants S, Carpenter HL, Lister RL, Assessing access to obstetric care via telehealth in the era of Covid-19, American Journal of Obstetrics and Gynecology (2021), doi:

Paper 98 – reduced abortions in Mexico

From the Mexico City Metropolitan Area, public abortion program, Interrupcion Legal del Embarazo (ILE) (click here or paper). Citation: Marquez-Padilla F, Saavedra B. The unintended effects of the COVID-19 pandemic and stay-at-home orders on abortions. J Popul Econ. 2021 Sep 15:1-37. doi: 10.1007/s00148-021-00874-x. Epub ahead of print. PMID: 34539084; PMCID: PMC8441247.

Paper 97 – reduced birth rate in USA

From the New York City Maternal Fetal Medicine Research Consortium, a collaboration of 13 hospitals in New York City and Long Island (click here or paper). Citation: McLaren RA Jr, Trejo FE, Blitz MJ, Bianco A, Limaye M, Brustman L, Bernstein PS, Roman AS, Stone J, Minkoff H. COVID-related “Lockdowns” and Birth Rates in New York. Am J Obstet Gynecol MFM. 2021 Aug 31:100476. doi: 10.1016/j.ajogmf.2021.100476. Epub ahead of print. PMID: 34478877.

Paper 96 – no effect on preterm birth in UK

A retrospective study from the South West region of England (click here or paper). Citation: Maslin K, McKeon-Carter R, Hosking J, Stockley L, Southby C, Shawe J, Latour JM. Preterm births in South-West England before and during the COVID-19 pandemic: an audit of retrospective data. Eur J Pediatr. 2021 Sep 17:1–5. doi: 10.1007/s00431-021-04265-y. Epub ahead of print. PMID: 34535831; PMCID: PMC8448660.

Update 10 September – paper 95 added

Paper 95 – reduced preterm births in Australia

From three hospitals in Melbourne (click here or paper). The same three hospitals, time periods and authors as paper 85. This paper analyses by date of conception. Paper 85 analysed by date of birth. Citation: Matheson A, McGannon CJ, Malhotra A, Palmer KR, Stewart AE, Wallace EM, Mol BW, Hodges RJ, Rolnik DL. Prematurity Rates During the Coronavirus Disease 2019 (COVID-19) Pandemic Lockdown in Melbourne, Australia. Obstet Gynecol. 2021 Mar 1;137(3):405-407. doi: 10.1097/AOG.0000000000004236. PMID: 33543904; PMCID: PMC7884082.

Update 2 September – papers 93 and 94 added

Paper 94 – decreased preterm births in Iran

From Akbarabadi hospital in Tehran. The pre-pandemic period (February 19 to April 19, 2019) was compared with the intra-pandemic one (February 19 to April 19, 2020) (click here or paper). Citation: Ranjbar, F., Allahqoli, L., Ahmadi, S. et al. Changes in pregnancy outcomes during the COVID-19 lockdown in Iran. BMC Pregnancy Childbirth 21, 577 (2021).

Paper 93 – Mixed effects of pandemic in Wales

No significant differences in gestation, birth weight, stillbirths, or Caesarean sections, but an increase in births ≥42 weeks during the first lockdown (OR: 1.28, p=0.019) and a decrease in births 32-36 weeks during the second (OR: 0.74, p=0.001). Fewer babies were born in 2020 (29,031) than the 2016-2019 average (32,582) (click here or paper). Citation: Hope Jones, Mike Seaborne, Laura Cowley, David Odd, Shantini Paranjothy, Ashley Akbari, Sinead Brophy. Population birth outcomes in 2020 and experiences of expectant mothers during the COVID-19 pandemic: a ‘Born in Wales’ mixed methods study using routine data. medRxiv 2021.08.23.21262209; doi:

Update 22 August – paper 92 added

Paper 92 – reduced preterm birth in China

From Shanghai First Maternity and Infant Hospital grid.459512.e (click here or paper). Citation: Bian Z, Qu X, Ying H, Liu X. Are COVID-19 mitigation measures reducing preterm birth rate in China? BMJ Glob Health. 2021 Aug;6(8):e006359. doi: 10.1136/bmjgh-2021-006359. PMID: 34385161; PMCID: PMC8361681.

Update 19 August – papers 89 to 91 added

Paper 91 – no effect of pandemic in USA

Data from Epic’s Cosmos research platform which covers one third of the hospitals in the United States (click here or paper). The period March 1 to December 31, 2020 was compared with the 3 years before the pandemic (2017–2019). See also study 794 here. Citation: Moeun Son, Kieran Gallagher, Justin Y. Lo, Eric Lindgren, Heather H. Burris, Kevin Dysart, Jay Greenspan, Jennifer F. Culhane, and Sara C. Handley. Coronavirus Disease 2019 (COVID-19) Pandemic and Pregnancy Outcomes in a U.S. Population Obstet Gynecol 2021;00:1–10) DOI: 10.1097/AOG.0000000000004547

Paper 90 – less post-partum depression screening & long acting contraception in USA

From Northwestern Memorial Hospital, Chicago, Illinois (click here or paper). Citation: Allie Sakowicz, Chloe N. Matovina, Sidney K. Imeroni, Maya Daiter, Olivia Barry, William A. Grobman, Emily S. Miller. The association between the COVID-19 pan-demic and postpartum care provision. American Journal of Obstetrics & Gynecology MFM(2021),

Paper 89 – no major effects of lockdown in China

From the first affiliated hospital of Jinan university, Guangzhou, grid.412601.0, which has not previously reported the effects of lockdown (click here or paper). Citation: Wang J, Wang Y, He MY, Li YX, Cheng X, Yang X, Li RM, Wang G. Maternal and infant outcomes during the COVID-19 pandemic: a retrospective study in Guangzhou, China. Reprod Biol Endocrinol. 2021 Aug 17;19(1):126. doi: 10.1186/s12958-021-00807-z. PMID: 34404413.

Update 9 August – paper 88 added

Paper 88 – Fewer preterm & emergency Caesarean births in Australia

Retrospective comparison conducted in Queensland, including the Sunshine Coast University Hospital, with April 1-May 31, 2020 (lockdown), and June 1-July 31 (post-lockdown), compared to the same periods in 2018-2019 (click here or paper). Citation: Brittany Jasper, Tereza Stillerova, Christopher Anstey, Edward Weaver. Preterm birth rates during the COVID-19 lockdown in Queensland Australia. medRxiv 2021.08.06.21261711; doi:

Update 8 August – paper 87 added

Paper 87 – fewer Caesareans & low birth weight babies during the pandemic in Spain

From the University Hospital Marqués de Valdecilla, in Santander (click here or paper). Citation: Llorca J, Lechosa-Muñiz C, Frank de Zulueta P, López-Gómez S, Orallo V, Alonso-Molero J, Arozamena-Llano B, Jubete Y, Paz-Zulueta M, Cabero MJ, On Behalf Of The Moacc-Group. Results of Pregnancy Control before and during the COVID-19 Pandemic: A Comparison of Two Cohorts. Int J Environ Res Public Health. 2021 Aug 2;18(15):8182. doi: 10.3390/ijerph18158182. PMID: 34360483.

Update 5 August – paper 86 added

Paper 86 – No effect of first wave in Canada

No special cause variation in rates of preterm births or stillbirths during the first 12 months of the pandemic, compared with the previous 17.5 years in Ontario (click here or paper). The data likely include data reported in papers 78 and 84. Citation: Prakesh S. Shah, Xiang Y. Ye, Jie Yang, Michael A. Campitelli. Preterm birth and stillbirth rates during the COVID-19 pandemic: a population-based cohort study. CMAJ Aug 2021, 193 (30) E1164-E1172; DOI: 10.1503/cmaj.210081

Update 2 August – papers 84 and 85 added

Paper 85 – reduced preterm births in Australia

From three maternity hospitals in Melbourne (click here or paper). Citation: Rolnik DL, Matheson A, Liu Y, Chu S, McGannon C, Mulcahy B, Malhotra A, Palmer KR, Hodges RJ, Mol BW. The impact of COVID-19 pandemic restrictions on pregnancy duration and outcomes in Melbourne, Australia. Ultrasound Obstet Gynecol. 2021 Jul 26. doi: 10.1002/uog.23743. Epub ahead of print. PMID: 34309931.

Paper 84 – Effect of first wave in Canada

Singleton hospital births between March to August 2020 (and same period 2015–2019) in all of Canada, excluding Quebec (click here or paper). Citation: Liu S, Dzakpasu S, Nelson C, Wei SQ, Little J, Scott H, Joseph KS. Pregnancy outcomes during the COVID-19 pandemic in Canada, March to August 2020. J Obstet Gynaecol Can. 2021 Jul 28:S1701-2163(21)00581-8. doi: 10.1016/j.jogc.2021.06.014. Epub ahead of print. PMID: 34332116.

Update 22 July – papers 80 to 83 added

Paper 83 – no effect on stillbirths in Germany

Stillbirth rates rose slightly from 2013 to 2019, but during the first wave in early 2020, were non-significantly lower than in 2019 (click here or paper). Citation: Kniffka MS, Nitsche N, Rau R, Kühn M. Stillbirths in Germany: On the rise, but no additional increases during the first COVID-19 lockdown. Int J Gynaecol Obstet. 2021 Jul 20. doi: 10.1002/ijgo.13832. Epub ahead of print. PMID: 34287881.

Paper 82 – excess maternal deaths in Mexico.

From goverment statistics (click here or paper). This is study 271 here. Citation: Lumbreras-Marquez MI, Campos-Zamora M, Seifert SM, Kim J, Lumbreras-Marquez J, Vazquez-Alaniz F, Fields KG, Farber MK. Excess Maternal Deaths Associated With Coronavirus Disease 2019 (COVID-19) in Mexico. Obstet Gynecol. 2020 Dec;136(6):1114-1116. doi: 10.1097/AOG.0000000000004140. PMID: 32909969.

Paper 81 – reduced hospital birth in India

From Jodpur (click here or paper). This is study 343 here. The authors are from All India Institute of Medical Sciences,
Jodhpur, which is the same instutue as the different authors of paper 37. Since the time periods overlap there may some patietn overlap. Citation: Goyal M, Singh P, Singh K, Shekhar S, Agrawal N, Misra S. The effect of the COVID-19 pandemic on maternal health due to delay in seeking health care: Experience from a tertiary center. Int J Gynaecol Obstet. 2021 Feb;152(2):231-235. doi: 10.1002/ijgo.13457. Epub 2020 Dec 21. PMID: 33128794.

Paper 80 – shortened post-partum stay during first wave

From New York (click here or paper). Citation: Bornstein E, Gulersen M, Husk G, Grunebaum A, Blitz MJ, Rafael TJ, Rochelson BL, Schwartz B, Nimaroff M, Chervenak FA. Early postpartum discharge during the COVID-19 pandemic. J Perinat Med. 2020 Nov 26;48(9):1008-1012. doi: 10.1515/jpm-2020-0337. PMID: 32845868.

Update 20 July – paper 79 added

Paper 79 – reduced miscarriage during first wave

From the Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, New York (click here or paper). Citation: Bortoletto P, Romanski PA, Stewart J, Rosenwaks Z, Pfeifer SM. Incidence of first trimester pregnancy loss in the infertile population during the first wave of the coronavirus disease 2019 pandemic in New York City. F S Rep. 2021 Apr 28;2(2):209-214. doi: 10.1016/j.xfre.2021.04.005. PMID: 34278356; PMCID: PMC8267398.

Update 18 July – paper 78 added

Paper 78 – fewer Caesarean and preterm births during lockdown in Iceland

National data (click here or paper). Citation: Einarsdóttir K, Swift EM, Zoega H. Changes in obstetric interventions and preterm birth during COVID-19: A nationwide study from Iceland. Acta Obstet Gynecol Scand. 2021 Jul 13. doi: 10.1111/aogs.14231. Epub ahead of print. PMID: 34255860.

Update 16 July – paper 46 citation updated. Paper 77 added

Paper 77 – lower ASQ scores for infants born during pandemic

According to this MedRxiv preprint, infants born during the pandemic had lower Ages & Stages Questionnaire scores than those born pre-pandemic (click here or paper). See also study 751 (click here). Citation: Lauren C. Shuffrey, Morgan R. Firestein, Margaret Kyle, Andrea Fields, Carmela Alcantara, Dima Amso, Judy Austin, Jennifer M. Bain, Jennifer Barbosa, Mary Bence, Catherine Bianco, Cristina Fernandez, Sylvie Goldman, Cynthia Gyamfi-Bannerman, Violet Hott, Yunzhe Hu, Maha Hussain, Pam Factor-Litvak, Maristella Lucchini, Arthur Mandel, Rachel Marsh, Danielle McBrian, Mirella Mourad, Rebecca Muhle, Kimberly Noble, Anna A. Penn, Cynthia Rodriguez, Ayesha Sania, Wendy G. Silver, Kally C. O Reilly, Melissa Stockwell, Nim Tottenham, Martha G. Welch, Noelia Zork, William P. Fifer, Catherine Monk, Dani Dumitriu. Birth during the COVID-19 pandemic, but not maternal SARS-CoV-2 infection during pregnancy, is associated with lower neurodevelopmental scores at 6-months medRxiv 2021.07.12.21260365; doi: Update 7 January 2022 Peer reviewed version (click here or paper) Citation; Shuffrey LC, Firestein MR, Kyle MH, et al. Association of Birth During the COVID-19 Pandemic With Neurodevelopmental Status at 6 Months in Infants With and Without In Utero Exposure to Maternal SARS-CoV-2 Infection. JAMA Pediatr. Published online January 04, 2022. doi:10.1001/jamapediatrics.2021.5563

Update 29 June – paper 76 added

Paper 76 – delayed diagnosis of ectopic pregnancy in Israel

From Tel Aviv (click here or paper). Citation: Anteby M, Van Mil L, Michaan N, Laskov I, Grisaru D. Effects of the COVID-19 pandemic on timely care for extrauterine pregnancies: A retrospective analysis. Lancet Reg Health Eur. 2021 Mar;2:100026. doi: 10.1016/j.lanepe.2021.100026. Epub 2021 Jan 13. PMID: 34173625; PMCID: PMC7804379.

Update 6 June – paper 75 added

Paper 75 – increased thromboembolism during lockdown in Israel

In 2020 the rate of pregnancy-related thromboembolic events was significantly higher than in 2018 and 2019 at the Mount Scopus and Ein Kerem campuses of Hadassah-Hebrew University Medical Center in jerusalem (click here or paper). Citation: Gabrieli D, Cahen-Peretz A, Shimonovitz T, Marks-Garber K, Amsalem H, Kalish Y, Lavy Y, Walfisch A. Thromboembolic events in pregnant and puerperal women after COVID-19 lockdowns: A retrospective cohort study. Int J Gynaecol Obstet. 2021 Jun 2. doi: 10.1002/ijgo.13777. Epub ahead of print. PMID: 34077561.

Update 3 June – paper 74 added

Paper 74 – Reduced prematurity in France

Preamature births fell in single but not in multiple pregnancies (click here or paper). There was no alteration in stillbirths. Citation: Simon E, Cottenet J, Mariet A-S, Bechraoui-Quantin S, Rozenberg P, Gouyon J-B, Quantin C, Impact of the COVID-19 pandemic on preterm birth and stillbirth: a nationwide, population-based retrospective cohort study, American Journal of Obstetrics and Gynecology (2021), doi:

Update 29 May – paper 73 added

Paper 73 – emergency dept avoidance but no adverse effects in Canada

In Ontario, after an initial reduction, ED presentations for ectopic pregnancy quickly returned to expected levels. In contrast presentations for miscarriage showed sustained reductions but complications and mortality rates did not alter during the pandemic (click here or paper). Citation: Gomez D, Simpson AN, Sue-Chue-Lam C, de Mestral C, Dossa F, Nantais J, Wilton AS, Urbach D, Austin PC, Baxter NN. A population-based analysis of the impact of the COVID-19 pandemic on common abdominal and gynecological emergency department visits. CMAJ. 2021 May 25;193(21):E753-E760. doi: 10.1503/cmaj.202821. PMID: 34035055.

Update 27 May – paper 72 added

Paper 72 – the first wave in Ethiopia

Government health facilities in Bench Sheko, Sheka, Keffa, and West Omo zones in southern Ethiopia reported reduced antenatal, family planning and newborn immunization visits, and health facility births, and more teenage pregnancies, abortions, institutional stillbirths and neonatal deaths during March–June 2020 (click here or paper). Citation: Kassie A, Wale A, Yismaw W. Impact of Coronavirus Diseases-2019 (COVID-19) on Utilization and Outcome of Reproductive, Maternal, and Newborn Health Services at Governmental Health Facilities in South West Ethiopia, 2020: Comparative Cross-Sectional Study. Int J Womens Health. 2021 May 19;13:479-488. doi: 10.2147/IJWH.S309096. PMID: 34040456; PMCID: PMC8141395.

Update 17 May – papers 70 and 71 added

Paper 71 – more ruptured ectopic pregnancies in USA

From Newark, Delaware (click here or paper). Citation: Toma, Helen V. MD, MSPH; Bank, Tracy Caroline MD; Hoffman, Matthew K. MD, MPH Care for Women With Ectopic Pregnancies During the Coronavirus Disease 2019 (COVID-19) Pandemic, Obstetrics & Gynecology: May 06, 2021 – Volume Latest Articles – Issue – 10.1097/AOG.0000000000004392 doi: 10.1097/AOG.0000000000004392

Paper 70 – no change in preterm birth or stillbirth during first 6 months of pandemic

From Ontario, Canada (click here or paper). Citation: Simpson AN, Snelgrove JW, Sutradhar R, Everett K, Liu N, Baxter NN. Perinatal Outcomes During the COVID-19 Pandemic in Ontario, Canada. JAMA Netw Open. 2021;4(5):e2110104. doi:10.1001/jamanetworkopen.2021.10104

Update 16 May – paper 69 added

Paper 69 – More Caesareans in Brazil

From Dr. Miguel Riet Corrêa Jr., University Hospital of the Universidade Federal do Rio Grande (HU-FURG), in the state of Rio Grande do Sul (click here or paper). Citation: Manoela de Azevedo Bicho, Mayra Pacheco Fernandes, Luís Paulo Vidaletti, Juliana dos Santos Vaz. Cesarean section prevalence at a baby-friendly hospital in southern Brazil: current context in the face of COVID-19. medRxiv 2021.05.03.21256516; doi:

Update 15 May – paper 68 added

Paper 68 – fewer very preterm births during lockdown in Vienna

From the Viennese Danube Hospital (click here or study). Citation: Kirchengast S, Hartmann B. Pregnancy Outcome during the First COVID 19 Lockdown in Vienna, Austria. Int J Environ Res Public Health. 2021 Apr 5;18(7):3782. doi: 10.3390/ijerph18073782. PMID: 33916365; PMCID: PMC8038559.

Update 1 May – paper 67 added

Paper 67 – fewer antenatal attendances in Uganda

The authors of this MedRxiv preprint report many changes in maternity care and outcomes during the first wave at Kawempe National Referral Hospital in Kamapala (click here or paper). Citation: Jessica Burt, Joseph Ouma, Alexander Amone, Lorna Aol, Musa Sekikubo, Annettee Nakimuli, Eve Nakabembe, Robert Mboizi, Philippa Musoke, Mary Kyohere, Emily Namara, Asma Khalil, Kirsty Le Doare. Indirect Effects of COVID-19 on Maternal, Neonatal, Child, Sexual and Reproductive Health Services in Kampala, Uganda medRxiv 2021.04.23.21255940; doi: Update 1 November 2021 – Peer reviewed publication (click here or paper). Citation: Burt JF, Ouma J, Lubyayi L, et alIndirect effects of COVID-19 on maternal, neonatal, child, sexual and reproductive health services in Kampala, Uganda. BMJ Global Health 2021;6:e006102.

Update 21 April – Paper 66 added

Paper 66 – increase in molar pregnancy in Israel

A doubling in the incidence of molar pregnancies at Galilee Medical Center, Nahariya, in January–October, 2020 (click here or paper). Citation: Aiob A, Naskovica K, Sharon A, Bornstein J. A possible association between hydatidiform mole and the COVID-19 pandemic: A retrospective cohort study. Gynecol Oncol. 2021 Mar 5:S0090-8258(21)00192-X. doi: 10.1016/j.ygyno.2021.02.035. Epub ahead of print. PMID: 33712273; PMCID: PMC7934616.

Update 11 April – papers 64 and 65 added

Paper 65 – fewer births and terminations in Italy

From the Institute for Maternal and Child Health, Trieste (click here or paper). Citation: Trombetta A, Travan L, Elefante P, Canton M, Rispoli F, Maso G, Barbi E, Risso FM. The first Italian COVID-19 lockdown reduced births and voluntary terminations by just under a fifth. Acta Paediatr. 2021 Mar 29. doi: 10.1111/apa.15862. Epub ahead of print. PMID: 33780031.

Paper 64 – reduced preterm birth rate in Saudi Arabia

From King Saud Medical City, Riyadh (click here or paper). Citation: Huseynova R, Bin Mahmoud L, Abdelrahim A, Al Hemaid M, Almuhaini MS, Jaganathan PP, Career H, Huseynov O. Prevalence of Preterm Birth Rate During COVID-19 Lockdown in a Tertiary Care Hospital, Riyadh. Cureus. 2021 Mar 1;13(3):e13634. doi: 10.7759/cureus.13634. PMID: 33816033; PMCID: PMC8011548.

Update 30 March – paper 63 added

Paper 63 – national changes in US

This MedRxiv preprint reports a fall in live births, preterm births and low birth weight babies in the United States during the pandemic (click here or paper). Citation: Alison Gemmill, Joan A. Casey, Ralph Catalano, Deborah Karasek, Tim Bruckner. Changes in live births, preterm birth, low birth weight, and cesarean deliveries in the United States during the SARS-CoV-2 pandemic. medRxiv 2021.03.20.21253990; doi:

Update 21 March – papers 61 and 62 added

Paper 62 – fewer OBGYN emergency hospital visits during first wave

Data from Kaiser Permanente Northern California, Oakland (click here or ). Citation: Abel, Mary Kathryn AB; Alavi, Mubarika X. MS; Tierney, Cassidy MD; Weintraub, Miranda Ritterman PhD, MPH; Avins, Andrew MD, MPH; Zaritsky, Eve MD Coronavirus Disease 2019 (COVID-19) and the Incidence of Obstetric and Gynecologic Emergency Department Visits in an Integrated Health Care System, Obstetrics & Gynecology: March 10, 2021 – Volume Latest Articles – Issue – 10.1097/AOG.0000000000004331 doi: 10.1097/AOG.0000000000004331 

Paper 61 – more abortion referrals and procedures during first wave.

From author affiliations the unnamed Northern California tertiary referral center may have been Dept. OBGYN, University of California, Davis, in Sacramento (click here or PgwZqt-PIIS0002937821001587). Citation: Creinin MD, Tougas H, Wilson M, Matulich MC, COVID-19 impact on abortion care at a Northern California tertiary family planning program American Journal of Obstetrics and Gynecology (2021), doi: 

Update 20 March – paper 60 added

Paper 60 – no change in ethnic disparities in preterm birth in New York

Women who delivered from March 28 to July 31, 2020, in New York City, were compared with women who delivered from March 28 to July 31, 2019 (click here or janevic_2021_oi_210084_1615398911.43761). Citation: Janevic T, Glazer KB, Vieira L, Weber E, Stone J, Stern T, Bianco A, Wagner B, Dolan SM, Howell EA. Racial/Ethnic Disparities in Very Preterm Birth and Preterm Birth Before and During the COVID-19 Pandemic. JAMA Netw Open. 2021 Mar 1;4(3):e211816. doi: 10.1001/jamanetworkopen.2021.1816. PMID: 33729505.

Update 3rd March – papers 58 and 59 added. Additional data & citation paper 10. Paper 15 (abstract) and paper 22 (full paper) noted to report the same data.

Paper 59 – no change in preterm births in Massachussetts

Preterm birth rates, defined in various ways, did not alter significantyl in four Boston hospitals during the pandemic, compared with the previous year (click here or Preterm_Birth_During_the_Coronavirus_Disease_2019.2). Citation: Wood, Rachel MD; Sinnott, Colleen MD; Goldfarb, Ilona MD; Clapp, Mark MD, MPH; McElrath, Thomas MD, PhD; Little, Sarah MD, MPH Preterm Birth During the Coronavirus Disease 2019 (COVID-19) Pandemic in a Large Hospital System in the United States, Obstetrics & Gynecology: March 2021 – Volume 137 – Issue 3 – p 403-404. doi: 10.1097/AOG.0000000000004237 

Paper 58 – Increased stillbirths in India

Stillbirths were significantly increased during the pandemic in a large New Delhi hospital compared with the previous year (click here or ijgo.13564). Citation: Kumar, M., Puri, M., Yadav, R., Biswas, R., Singh, M., Chaudhary, V., Jaiswal, N. and Meena, D. (2021), Stillbirths and the COVID‐19 pandemic: Looking beyond SARS‐CoV‐2 infection. Int J Gynecol Obstet.

Update 27 February – Papers 56 and 57 added

Paper 57 – Slightly fewer preterm births in Pittsburg

At University of Pittsburgh Medical Centres, Magee-Womens Hospital, births <37 weeks fell from 11.1% (1 Jan 2018 to 31 Jan 2020 pre-pandemic) to 10.1% (1 April 2020 to 27 October 2020 pandemic) (click here or 1-s2.0-S2589933321000252-main). Citation: Lara Lemon, Robert P. Edwards, Hyagriv N. Simhan. What is driving the decreased incidence of preterm birth during the COVID-19 pandemic? American Journal of Obstetrics & Gynecology MFM (2021), doi:;

Paper 56 – Effect of lockdown in Beijing, China

No major effects seen (click here or e047900.full). Citation: Du M, Yang J, Han N, et alAssociation between the COVID-19 pandemic and the risk for adverse pregnancy outcomes: a cohort studyBMJ Open 2021;11:e047900. doi: 10.1136/bmjopen-2020-047900

Update 25 February – paper 55 added

Paper 55 – HSIB first wave maternal death report

The UK Healthcare Safety Investigation Branch (HSIB) reviewed 20 maternal deaths (19 included in review) that occurred between 1 March and and 31 May 2020 (the first peak of the COVID-19 pandemic in England) (click here or HSIB_Maternal_Death_Report_V13). Citation: National Learning Report. Maternal death: learning from maternal death investigations during the first wave of the COVID-19 pandemic. Independent report by the Healthcare Safety Investigation Branch I2020/017. February 2021. 

Update 21 February – paper 54 added

Paper 54 – Delayed diagnosis of ectopic pregnancy in Israel

From Shaare Zedek Medical Center, Jerusalem (click here or ijgo.13647). Citation: Barg M, Rotem R, Mor P, Rottenstreich M, Fayez K, Grisaru-Granovsky S, Armon S. Delayed presentation of ectopic pregnancy during the COVID-19 pandemic: A retrospective study of a collateral effect. Int J Gynaecol Obstet. 2021 Feb 18. doi: 10.1002/ijgo.13647. Epub ahead of print. PMID: 33599285.

Update 13 February – paper 53 added

Paper 53 – no effect of pandemic on assisted reproduction outcomes in Italy

From Lombardy (click here or LeviSetti preprint 2021). Citation: Paolo Emanuele Levi-Setti, Federico Cirillo, Valentina Immediata et al. First Trimester Pregnancy Outcomes in a Large&nbsp;ART Center From the Lombardy County (Italy) During the Peak COVID-19 Pandemic., 08 February 2021, PREPRINT (Version 1) available at Research Square []

Update 1 February – paper 52 added

Paper 52 – first wave hospital births in Israel

Poster presented at the Society of Materno-Fetal Medicine 2021 conference (SMFM 2021) . Fewer hospital births, and higher induction and Caesarean rates during the first wave at Shaare Zedek Medical Center in Jerusalem. Citation to follow.

Update 13 January – paper 51 added

Paper 51 – no association with preterm birth or stillbirth in Sweden

In this national registry study there was no increase in preterm births, or in stillbirths, over the period 1 April through 31 May 2020, compared with the same period over the previous five years (click here or m20-6367). Citation: Pasternak B, Neovius M, Söderling J, Ahlberg M, Norman M, Ludvigsson JF, Stephansson O. Preterm Birth and Stillbirth During the COVID-19 Pandemic in Sweden: A Nationwide Cohort Study. Ann Intern Med. 2021 Jan 12. doi: 10.7326/M20-6367. Epub ahead of print. PMID: 33428442.

Update 9 January – paper 50 added

Paper 50 – fewer & later pregnancy terminations in Texas

The effect of an executive order between March 22 and April 21, to postpone surgery that was not medically necessary, and which was interpreted by some as including abortion, is described (click here or jama_white_2021_ld_200123_1609269106.91809). Citation: White K, Kumar B, Goyal V, Wallace R, Roberts SCM, Grossman D. Changes in Abortion in Texas Following an Executive Order Ban During the Coronavirus Pandemic. JAMA. Published online January 04, 2021. doi:10.1001/jama.2020.24096

Update 2 January – paper 49 added

Paper 49 – more ruptured ectopics during first wave

The ratio of ruptured to unruptured ectopic pregnancies rose between March 15th and May 17th 2020 at Lenox Hill Hospital, New York (click here or ijcp.13925). Citation: Werner, S, Katz, A. Change in ectopic pregnancy presentations during the covid‐19 pandemic. Int J Clin Pract. 2020; 00:e13925.

Update 23 December – Paper 48 added

Paper 48 – No major adverse effect of lockdown in Botswana

No increase in adverse perinatal outcomes during or after lockdown in Botswana. Rather, a modest reduction, driven primarily by reduced preterm birth and growth restriction (click here or caniglia AJOG 2020 (002)). Time period of lockdown validated against Facebook geolocation data. Citation: CANIGLIA EC, MAGOSI LE, ZASH R, DISEKO M, MAYONDI G, MABUTA J, POWIS K, DRYDEN-PETERSON S, MOSEPELE M, LUCKETT R, MAKHEMA J, MMALANE M, LOCKMAN S, SHAPIRO R, Modest reduction in adverse birth outcomes following the COVID-19 lockdown, American Journal of Obstetrics and Gynecology (2021), doi:

Update 19 December – papers 46 and 47 added

Paper 47 – Antenatal care during lockdown in Ethiopia

Pregnant women attending ANC services at public hospitals in Northeast Ethiopia between February 2 & August 30, 2020 (click here or ijwh-287534-antenatal-care-service-utilization-of-pregnant-women-attendi). No control group. Citation: Tadesse E. Antenatal Care Service Utilization of Pregnant Women Attending Antenatal Care in Public Hospitals During the COVID-19 Pandemic Period. Int J Womens Health. 2020;12:1181-1188. Published 2020 Dec 8. doi:10.2147/IJWH.S287534

Paper 46 – Fewer planned moderately preterm births in an Australian hospital

During the 2020 lockdown, rates of planned (iatrogenic) moderately preterm birth fell in the Mater Mothers’ Hospital, South Brisbane, Queensland (click here or 2020.11.24.20237529.full). Outcomes not reported. Citation: Linda A. Gallo, Tania F. Gallo, Danielle J. Borg, Karen M. Moritz, Vicki L. Clifton, Sailesh Kumar. Preterm birth rates in a large tertiary Australian maternity centre during COVID-19 mitigation measures medRxiv 2020.11.24.20237529; doi: Update 16 July – peer reviewed version published (click here or paper). Citation: Gallo LA, Gallo TF, Borg DJ, Moritz KM, Clifton VL, Kumar S. A decline in planned, but not spontaneous, preterm birth rates in a large Australian tertiary maternity centre during COVID-19 mitigation measures. Aust N Z J Obstet Gynaecol. 2021 Jul 12. doi: 10.1111/ajo.13406. Epub ahead of print. PMID: 34254286.

Update 15 December – paper 45 added

Paper 45 – fewer visits during lockdown in Nanjing, China

Hospital visits for pregnancy care fell during lockdown in Zhongda Hospital, Southeast University, Nanjing, Jiangsu Province, China grid.452290.8 (click here or 10.1177_0300060520939337). There were no reported harms. Citation: Gu XX, Chen K, Yu H, Liang GY, Chen H, Shen Y. How to prevent in-hospital COVID-19 infection and reassure women about the safety of pregnancy: Experience from an obstetric center in China. J Int Med Res. 2020;48(7):300060520939337. doi:10.1177/0300060520939337

Update 14 December – paper 44 added

Paper 44 – increased stillbirths during 1st wave in Israel

Stillbirth were increased in the period  February 21 to April 30 2020, compared with the corresponding periods for 2017 to 2019 in Shamir Medical Center, Zerifin, Israel (click here or s-0040-1721515). Citation: Matan Mor, Nadav Kugler, Eric Jauniaux, Moshe Betser, Yifat Wiener, Howard Cuckle, Ron Maymon. Impact of the COVID-19 Pandemic on Excess Perinatal Mortality and Morbidity in Israel. Am J Perinatol DOI: 10.1055/s-0040-1721515

Update 10th December – paper 43 added

Paper 43 – rise in the rate of ruptured ectopic pregnancies

In Sant’Orsola-Malpighi University Hospital in Bologna, Italy, the rate of ruptured ectopic pregnancies normally 52/201 (26%) rose to 6/9 (66%) during the first lockdown period (click here or uog.22126). Citation: Casadio, P., Youssef, A., Arena, A., Gamal, N., Pilu, G. and Seracchioli, R. (2020), Increased rate of ruptured ectopic pregnancy in COVID‐19 pandemic: analysis from the North of Italy. Ultrasound Obstet Gynecol, 56: 289-289.

Update 8th December – papers 41 and 42 added

Paper 42 – no significant alteration in stillbirths during first wave in England

There was no significant alteration in stillbirths overall, or in any region of the UK during the first wave (click here or jama_stowe_2020_ld_200113_1607178377.6775) Citation: Stowe J, Smith H, Thurland K, Ramsay ME, Andrews N, Ladhani SN. Stillbirths During the COVID-19 Pandemic in England, April-June 2020. JAMA. Published online December 07, 2020. doi:10.1001/jama.2020.21369

Paper 41- no significant alteration in preterm births or in stillbirths during first wave in Philadelphia

There were no significant alterations in the patterns, or overall rates, of preterm births or stillbirths during the first wave, in two Philadelphia hospitals (click here or jama_handley_2020_ld_200111_1607178374.44311 (1)). Citation: Handley SC, Mullin AM, Elovitz MA, et al. Changes in Preterm Birth Phenotypes and Stillbirth at 2 Philadelphia Hospitals During the SARS-CoV-2 Pandemic, March-June 2020. JAMA. Published online December 07, 2020. doi:10.1001/jama.2020.20991

Update 7th December – paper 40 added

Paper 40 – 16 maternal deaths in Indonesia

From March to May 2020, 16 pregnant or postnatal women died in West Sumatra (click here or 10.1080@0167482X.2020.1779216). It is not reported whether these were caused by Covid-19 or other diseases. Citation: Mijke Lambregtse-van den Berg, Julie Quinlivan. (2020) Identifying pregnant women at risk of developing COVID-19 related mental health problems – a call for enhanced psychoeducation and social support. Journal of Psychosomatic Obstetrics & Gynecology 41:4, pages 249-250.

Update 5th December – papers 38 and 39 added

Paper 39 – no major obstetric effects of lockdown in Wuhan, China

The Maternal and Child Hospital of Hubei Province (which I believe is part of Huazhong University of Science and Technology Hospital grid.488485.d) observed no major effects of lockdown compared with the previous year (click here or journal.pone.0237420). The Caesarean rate, for example, rose from 47% to 48%. Citation: Li M, Yin H, Jin Z, Zhang H, Leng B, Luo Y, Zhao Y. Impact of Wuhan lockdown on the indications of cesarean delivery and newborn weights during the epidemic period of COVID-19. PLoS One. 2020 Aug 13;15(8):e0237420. doi: 10.1371/journal.pone.0237420. PMID: 32790709; PMCID: PMC7425855.

Paper 38 – reduced prenatal diagnosis procedures Trabzon, Turkey

Between 11 March and 30 June 2020 prenatal dignosis procedures reduced by about one third at Karadeniz Perinatology Clinic, compared with the same period in the previous year (click here or Effect of COVID 19 pandemic process on prenatal diagnostic procedures (1)). Citation: Mirac Ozalp, Omer Demir, Hümeyra Akbas, Ecem Kaya, Cemre Celik & Mehmet Armagan Osmanagaoglu (2020) Effect of COVID-19 pandemic process on prenatal diagnostic procedures, The Journal of Maternal-Fetal & Neonatal Medicine, DOI: 10.1080/14767058.2020.1815190

Update 3rd December – paper 37 added

Paper 37 – Reduced hospitalisation & increased maternal & perinatal mortality in Jodhpur, India

Reduced hospitlisation and emergency referrals after lockdown, coincided with increased in-hospital maternal mortality, and late intrauterine fetal death and stillbirth in a group of four hospitals associated with Dr S N Medical College, Jodhpur, India (click here or PIIS2214109X20303193). Citation: Kumari V, Mehta K, Choudhary R. COVID-19 outbreak and decreased hospitalisation of pregnant women in labour. Lancet Glob Health. 2020 Sep;8(9):e1116-e1117. doi: 10.1016/S2214-109X(20)30319-3. Epub 2020 Jul 14. PMID: 32679037.

Update 2nd December – papers 35 and 36 added

Paper 36 – freebirth due to fear of Covid in Iran

A woman from Dezful, Khuzestan province in Iran had a normal birth alone at home because she was fearful of contracting Covid-19 in hospital (click here or IJPS-15-366). Both mother and baby were fine. Citation: Nosratabadi M, Sarabi N, Masoudiyekta L. A Case Report of Vaginal Delivery at Home due to Fear of Covid-19. Iran J Psychiatry. 2020;15(4):366-369. doi:10.18502/ijps.v15i4.4306

Paper 35 – delayed presentation in labour in Sao Paolo, Brazil

In São Paulo Hospital betwee March 11 and June 11, more women presented in advanced labour (click here or ijgo.13357). Citation: Sun, S.Y., Guazzelli, C.A.F., de Morais, L.R., Dittmer, F.P., Augusto, M.N., Soares, A.C., Coutinho da Silva, P.M., Abuchaim, E.d.S.V. and Mattar, R. (2020), Effect of delayed obstetric labor care during the COVID‐19 pandemic on perinatal outcomes. Int J Gynecol Obstet, 151: 287-289.

Update 1st December – papers 32 to 34 added

Paper 34 – reduced risk of post partum depression during lockdown

Rates of raised EPDS scores were reduced during lockdown among women cared for at Soroka University Medical Center, Negev, Israel (click here or Pariente2020_Article_RiskForProbablePost-partumDepr). Citation: Pariente, G., Wissotzky Broder, O., Sheiner, E. et al. Risk for probable post-partum depression among women during the COVID-19 pandemic. Arch Womens Ment Health (2020).

Paper 33 – breast feeding during lockdown in Belgium

Reported behaviour of a self-selected sample (click here or ijerph-17-06766). Most women reported continuing breast feeding for longer during lockdown. Citation: Ceulemans, M.; Verbakel, J.Y.; Van Calsteren, K.; Eerdekens, A.; Allegaert, K.; Foulon, V. SARS-CoV-2 Infections and Impact of the COVID-19 Pandemic in Pregnancy and Breastfeeding: Results from an Observational Study in Primary Care in Belgium. Int. J. Environ. Res. Public Health 2020, 17, 6766.

Paper 32 – sexual behaviour during lockdown in China

Reported behaviour of a self-selected sample (click here or pdf (1)). Citation. Li G, Tang D, Song B, Wang C, Qunshan S, Xu C, Geng H, Wu H, He X, Cao Y. Impact of the COVID-19 Pandemic on Partner Relationships and Sexual and Reproductive Health: Cross-Sectional, Online Survey Study. J Med Internet Res. 2020 Aug 6;22(8):e20961. doi: 10.2196/20961. PMID: 32716895; PMCID: PMC7419154.

Update 27 November – paper 31 added

Paper 31 – effect of lockdown in Karnataka, India

The self-reported effects of lockdown of 290/315 pregnant women attending Shri B.M. Patil Medical College, Hospital and Research Center, Vijayapura, Karnataka, India, between 21/05/2020 & 08/06/2020 (click here or pmr-12-03-3). Citation: Dr. Rajasri G. Yaliwal, Dr. Aruna M.Biradar, Dr. Shreedevi S. Kori, Dr. Subhashchandra, R. Mudanur, Dr. Shivakumar U. Pujeri, Dr. Shailaja R. Bidri, Dr. Neelamma G. Patil. CHALLENGES OF PREGNANCY DURING THE COVID19 PANDEMIC AND LOCKDOWN –A CROSS-SECTIONAL STUDY. Pravara Med Rev; September 2020, 12(03) , 23-30 DOI: 10.36848/PMR/2020/13100.51291

Update 26 November – papers 29 and 30 added

Paper 30 – more women not receiving antenatal care in Jordan

The self-reported rate of women not receiving antenatal care in this online survey of self-selected members of women’s and motherhood groups in Jordan, rose from a recalled 38/944 (4%) before lockdown to 562 (60%) during lockdown (click here or ijwh-280342-pregnancy-during-covid-19-outbreak-the-impact-of-lockdown-i). Citation: Muhaidat N, Fram K, Thekrallah F, Qatawneh A, Al-Btoush A. Pregnancy During COVID-19 Outbreak: The Impact of Lockdown in a Middle-Income Country on Antenatal Healthcare and Wellbeing. Int J Womens Health. 2020;12:1065-1073

Paper 29 – couples delaying conception in Shanghai, China

Of 447 couples who had been recorded before the pandemic as planning to conceive a pregnancy, 151 (34%) stated that they had altered their plans, presumably in the direction of cancelling or delaying trying for a baby (click here or ijgo.13366). Citation: Zhu, C., Wu, J., Liang, Y., Yan, L., He, C., Chen, L. and Zhang, J. (2020), Fertility intentions among couples in Shanghai under COVID‐19: A cross‐sectional study. Int. J. Gynecol. Obstet., 151: 399-406.

Update 24th November – paper 28 added

Paper 28 – fewer & later attendances in pregnancy during first wave in Israel

Fewer pregnant women attended the emergency department during the first wave compared with the same period in the previous year, and those that did attended at later gestations or at more advanaced stages of labour. Hower, no differences were seen in outcomes (click here or Changes in the obstetrical emergency department profile during the COVID 19 pandemic). From author affiliations this was probably Carmel Medical Center, Haifa, Israel. Citation: Nir Kugelman, Ofer Lavie, Wisam Assaf, Nadav Cohen, Lena Sagi-Dain, Mordehai Bardicef, Reuven Kedar, Amit Damti & Yakir Segev (2020) Changes in the obstetrical emergency department profile during the COVID-19 pandemic, The Journal of Maternal-Fetal & Neonatal Medicine, DOI: 10.1080/14767058.2020.1847072

Update 23rd November – paper 27 added

Paper 27 – cancelled clinic appointments in Iran

57/103 pregnant or post-partum women reported cancelling clinic appointments for themselves or their child during lockdown (click here or ijerph-17-08272). Participants were patients in the Department of Gynecology and Midwifery of the Arak University of Medical Sciences, Arak, Iran. Citation: Shayganfard, M.; Mahdavi, F.; Haghighi, M.; Sadeghi Bahmani, D.; Brand, S. Health Anxiety Predicts Postponing or Cancelling Routine Medical Health Care Appointments among Women in Perinatal Stage during the Covid-19 Lockdown. Int. J. Environ. Res. Public Health 2020, 17, 8272.

Update 20 November – paper 26 added

Paper 26 – no alteration in miscarriage rate after embryo transfer in New York

The authors of this conference abstract report that early pregnancy loss rates did not alter during the first wave of the SARS-CoV-2 pandemic (click here or PIIS0015028220323165). Citation: Flisser, Eric et al. PREGNANCY LOSS RATES AFTER SINGLE, EUPLOID FROZEN-THAWED EMBRYO TRANSFER IN THE COVID-19 ERA. Fertility and Sterility, Volume 114, Issue 3, e561 – e562

Update 14 November – paper 25 added

Paper 25 – more stillbirths & fewer late preterm births in Rome, Italy

Using the Lazio region hospital discharge database, the authors report fewer 32-36w births, & more stillbirths in March to May 2020, compared with the same period 2019 (click here or archdischild-2020-320682.full). Citation: De Curtis M, Villani L, Polo A. Arch Dis Child Fetal Neonatal Ed Epub ahead of print: doi:10.1136/archdischild-2020-320682 Accepted 21 October 2020 Arch Dis Child Fetal Neonatal Ed 2020;0:F1. doi:10.1136/fetalneonatal-2020-320682

Update 12 November – papers 22 to 24 added

Paper 24 – hospital births and postnatal depression scores in Hong Kong

Queen Mary Hospital, Pokfulam, Hong Kong observed a fall in hospital births and raised rates of Edinburgh postnatal depression scores over 10 during lockdown (click here or hkmj208774). Citation: PW Hui, Grace Ma, Mimi TY Seto, KW Cheung. Effect of COVID-19 on delivery plans and postnatal depression scores of pregnant women. Hong Kong Med J 2020;26:Epub 5 Nov 2020

Paper 23 – stress during lockdown in Cork, Ireland

This survey reported no major differences in a range of self-reported psychological or behavioural outcomes during lockdown (click here or 1-s2.0-S187151922030367X-main). Citation: Karen Matvienko-Sikar, Johanna Pope, Avril Cremin, Hayley Carr, Sara Leitao, Ellinor K. Olander, Sarah Meaney. Differences in levels of stress, social support, health behaviours, and stress-reduction strategies for women pregnant before and during the COVID-19 pandemic, and based on phases of pandemic restrictions, in Ireland. Women and Birth. 2020,ISSN 1871-5192, (

Paper 22 – lockdown did not affect miscarriage rates in Montreal, Canada

There was no difference in miscarriage/non-viable pregnancy rates in this Montreal fertility unit, between the period of the first wave, and an equivalent period in 2019 (click here or Rotshenker-Olshinka2020_Article_COVID-19PandemicEffectOnEarlyP). Citation: Rotshenker-Olshinka, K., Volodarsky-Perel, A., Steiner, N. et al. COVID-19 pandemic effect on early pregnancy: are miscarriage rates altered, in asymptomatic women?. Arch Gynecol Obstet (2020). 3 March update. This is the full report of paper 15 (abstract)

Update 10th November – paper 21 added

Paper 21 – shorter postnatal stay during pandemic in Los Angles

Women and babies who delivered in March and April 2020 at Cedars-Sinai Medical Center, Los Angeles, California, USA, had significantly reduced postpartum stays than those in prepandemic periods (click here or Greene AJOG MFM-main). No adverse effects were reported. Citation: Greene NH, Kilpatrick SJ, Wong MS, et al. Impact of labor and delivery unit policy modifications on maternal and neonatal outcomes during the coronavirus disease 2019 pandemic. Am J Obstet Gynecol MFM 2020;2:100234.

Update 9th November – papers 19 and 20 added

Paper 20 – halving of emergency admissions during the pandemic in Bologna, Italy

In March 2020, the middle of the COVID-19 pandemic, emegency room attendances halved compared with March 2019 in S.Orsola-Malpighi University Hospital of Bologna (click here or Salsi AJOG MFM). Citation: Ginevra Salsi, Anna Seidenari, Josefina Diglio, Federica Bellussi, Gianluigi Pilu, Federica Bellussi. Obstetrics and gynecology emergency services during the coronavirus disease 2019 pandemic. American Journal of Obstetrics & Gynecology MFM, Volume 2, Issue 4, Supplement, 2020, 100214, ISSN 2589-9333, (

Paper 19 – halving of admissions & births during the pandemic in Jodhpur, India

Over the period of the pandemic, hospital admissions in pregnancy, and hospital births halved in the All India Institute of Medical Sciences, Jodhpur, a tertiary referral hospital (click here or ijgo.13457). 32 pregnant women with Covid-19 were included, so this paper is also included as study 343 here. Citation: Goyal, M., Singh, P., Singh, K., Shekhar, S., Agrawal, N. and Misra, S. (2020), The effect of the COVID‐19 pandemic on maternal health due to delay in seeking health care: Experience from a tertiary center. International Journal of Gynecology & Obstetrics. Accepted Author Manuscript.

Update 31st October – paper 18 added

Paper 18 – no effect on preterm births in California

No effect on preterm births over the pandemic first wave in California, apart from a small “increase” in births between 28 and 32 weeks (click here or Main AJOG 21 oct 2020 (1)). Citation: Main EK, Chang S-C, Carpenter AM, Wise PH, Stevenson DK, Shaw GM, Gould JB, Preterm birth rates for racial and ethnic groups during the COVID-19 pandemic in California, American Journal of Obstetrics and Gynecology (2020), doi:

Update 24 October – papers 16 and 17 added

Paper 17 – reduced general anaesthesia for Caesarean during lockdown, UK

Six hospitals observed a fall in Caesarean general anaesthesia rates from 7.7 to 3.7% during the pandemic (click here or ). Citation; Bhatia K, Columb M, Bewlay A, Eccles J, Hulgur M, Jayan N, Lie J, Verma D, Parikh R. The effect of COVID-19 on general anaesthesia rates for caesarean section. A cross sectional analysis of six hospitals in the north-west of England. Anaesthesia. 2020 Oct 18. doi: 10.1111/anae.15313. Epub ahead of print. PMID: 33073371.

Paper 16 – reduced preterm birth in a Philadelphia hospital

In Thomas Jefferson University Hospital preterm birth fell from 13% in March 1-July 31 2019, to 10% in March 1-July 31 2020 (click here or berghella AJOGMFM). Citation: Berghella V, Burd J, Anderson K, Boelig R, Roman A, Decreased incidence of preterm birth during COVID-19 pandemic, American Journal of Obstetrics & Gynecology MFM (2020), doi:

Update 20 October – papers 13 to 15 added

Paper 15  – miscarriage before and during lockdown in Montreal, Canada

No change (click here or main (4)) Citation: Olshinka KR, Volodarsky-Perel A, Steiner N, Rubenfeld ES, Dahan MH. COVID-19 PANDEMIC EFFECT ON EARLY PREGNANCY – ARE MISCARRIAGE RATES ALTERED, IN ASYMPTOMATIC WOMEN?. Fertil Steril. 2020;114(3):e525-e526. doi:10.1016/j.fertnstert.2020.09.036 March 3rd update. The full version of this abstract is reported in paper 22.

Paper 14 – diabetes control during lockdown in Lille, France

It deteriorated (click here or main (3)). Citation: Ghesquière L, Garabedian C, Drumez E, et al. Effects of COVID-19 pandemic lockdown on gestational diabetes mellitus: A retrospective study [published online ahead of print, 2020 Oct 15]. Diabetes Metab. 2020;doi:10.1016/j.diabet.2020.09.008

Paper 13 – the Covid-19 New Mum survey

Self-selected and self-reported UK maternal birth experiences before and after lockdown (click here or main (2)). Citation: A. Vazquez-Vazquez, Appetite,

Update 18 October – papers 10 to 12 added

Paper 12 – reduced preterm birth in The Netherlands

National study based on dried blood spot screening programme (click here or PIIS2468266720302231). Citation: Been, Jasper V et al. Impact of COVID-19 mitigation measures on the incidence of preterm birth: a national quasi-experimental study. The Lancet Public Health, Volume 0, Issue 0.

Paper 11 – reduced preterm births in Dublin, Ireland

There was a small reduction in preterm birth, but no other effects, between 1st January & 31st July 2020 compared to the same period in 2019 in the Coombe Women & Infants University Hospital (click here or PIIS0301211520306539). Citation: McDonnell S, McNamee E, Lindow SW, O’Connell MP, The impact of the Covid-19 pandemic on maternity services: a review of maternal and neonatal outcomes before, during and after the pandemic, European Journal of Obstetrics and amp; Gynecology and Reproductive Biology (2020), doi:

Paper 10 – reduced preterm births in Israel (update 3 March)

This preprint consists only of results tables (click here or PIIS0002937820311911 (1)). The corresponding author is from Chaim Sheba Medical Center, Israel. Citation: Meyer R, Friedrich L, Maixner N, Bart Y, Tsur A, Yinon Y, Levin G, A marked decrease in Preterm Deliveries during the COVID-19 Pandemic, American Journal of Obstetrics and Gynecology (2020), doi: Update 3 March. This paper (click here or 244117) with overlapping authorship, also reports the effect of lockdown in the same hospital. Citation:  Meyer R, Levin G, Hendin N, Katorza E. Impact of the COVID-19 Outbreak on Routine Obstetrical Management. Isr Med Assoc J. 2020 Aug;22(8):483-488. PMID: 33236580.

Update 12 October – papers 8 and 9 added

Paper 9 – effect of lockdown in one hospital in Israel

Various pregnancy complications  over March–April 2020 (the peak COVID-19 outbreak) in one large hospital, were compared with March–April 2019 in the same hospital (click here or 231152 (002)). From author affiliations the hospital was probably Rambam Health Care Campus in Haifa. Citation: Justman N, Shahak G, Gutzeit O, Ben Zvi D, Ginsberg Y, Solt I, Vitner D, Beloosesky R, Weiner Z, Zipori Y. Lockdown with a Price: The impact of the COVID-19 Pandemic on Prenatal Care and Perinatal Outcomes in a Tertiary Care Center. Isr Med Assoc J. 2020 Sep;9(22):467-471. PMID: 32954690.

Paper 8 – effect of lockdown in one hospital in Japan

The rates of women hospitalised for some pregnancy complications in Keio University Hospital between April 1st and June 30th, 2020, were compared with the same period 2017-19 (click here or jog.14518). No substantive outcomes reported. Citation: Kasuga, Y., Tanaka, M. and Ochiai, D. (2020), Preterm delivery and hypertensive disorder of pregnancy were reduced during the COVID‐19 pandemic: A single hospital‐based study. J. Obstet. Gynaecol. Res.. doi:10.1111/jog.14518

Update 9 October – papers 6 and 7 added

Paper 7 – reduced admission to emergency OBGYN during first wave in Milan, Italy

Between February 24th & May 31st 2020 emergency OBGYN admissions decreased by 35% at Clinica Mangiagalli, the largest maternity clinic in Milan, compared with the corresponding period in 2019   (click here or 1-s2.0-S0301211520305777-main). Five fetal deaths were seen in the emergency clinic in the pandemic period compared with one in the earlier period. Total perinatal deaths were not reported for either period. Citation: Chiara Dell’Utri, Elisabetta Manzoni, Sonia Cipriani, Claudio Spizzico, Andrea Dell’Acqua, Giussy Barbara, Fabio Parazzini, Alessandra Kustermann. Effects of SARS Cov-2 epidemic on the obstetrical and gynecological emergency service accesses. What happened and what shall we expect now? European Journal of Obstetrics & Gynecology and Reproductive Biology, Volume 254, 2020, Pages 64-68, ISSN 0301-2115,;

Paper 6 – four maternal deaths from suicide & two women murdered during UK lockdown

Four women died from suicide during pregnancy or soon after birth and two recently pregnant women died from domestic violence in the UK, between 01/03/2020 and 31/05/2020,causes (click here or ref.-201-mbrrace-uk-maternal-covid-19-report-final-002)). Citation: Knight M, Bunch K, Cairns A, Cantwell R, Cox P, Kenyon S, Kotnis R, Lucas DN, Lucas S, Marshall L, Nelson-Piercy C, Page L, Rodger A, Shakespeare J, Tuffnell D, Kurinczuk JJ on behalf of MBRRACE-UK. Saving Lives, Improving Mothers’ Care Rapid Report: Learning from SARS-CoV-2-related and associated maternal deaths in the UK March – May 2020 Oxford: National Perinatal Epidemiology Unit, University of Oxford 2020.

Paper 5 – no change in extremely preterm births during lockdown in the SafeBoosC-III consortium trial centres

In this Medxiv preprint the rate of extremely preterm births (<28 weeks) in 46 neonatal intensive care units participating in the SafeBoosC-III trial, did not alter during the three months of most rigorous lockdown, compared with the corresponding three months of 2019 (click here or 2020.10.02.20204578v1.full). Citation: Marie Isabel Rasmussen, Mathias Luehr Hansen, Gerhard Pichler, Eugene Dempsey, Adelina Pellicer, Afif EL-Khuffash, Shashidhar A, Salvador Piris-Borregas, Miguel Alsina, Merih Cetinkaya, Lina Chalak, Hilal Ozkan, Mariana Baserga, Jan Sirc, Hans Fuchs, Ebru Ergenekon, Luis Arruza, Amit Mathur, Martin Stocker, Olalla Otero-Vaccarello, Tomasz Szczapa, Kosmas Sarafidis, Barbara Krolak-Olejnik, Asli Memisoglu, Hallvard Reigstad, Elzbieta Rafinska-Wazny, Eleftheria Hatzidaki, Zhang Peng, Despoina Gkentzi, Renaud Viellevoye, Julie De Buyst, Emmanuele Mastretta, Ping Wang, Gitte Hahn, Lars Bender, Luc Cornette, Jakub Tkaczyk, Ruth del Rio, Monica Fumagalli, Evangelina Papathoma, Maria Wilinska, Gunnar Naulers, Iwona Sadowska-Kakrawczenko, Chantal Lecart, Maria Luz Couce, Siv Fredly, Anne Marie Heuchan, Tanja Karen, Gorm Greisen Extremely preterm infant admissions within the SafeBoosC-III consortium during the COVID-19 lockdown  medRxiv 2020.10.02.20204578; doi:

Paper 4 – fall in very & extremely low birthweight infants during lockdown in Limerick, Ireland

The rate of birth of both very low birthweight and extremely low birth weight infants reduced significantly in Jan-April 2020 compared witht the same period over the preceding 10 years (click here or e003075.full). Citation: Philip RKPurtill HReidy E, et al Unprecedented reduction in births of very low birthweight (VLBW) and extremely low birthweight (ELBW) infants during the COVID-19 lockdown in Ireland: a ‘natural experiment’ allowing analysis of data from the prior two decades. 

Paper 3 – halving of hospital births & increased perinatal mortality during lockdown in Nepal

Between Jan 1 and May 30, 2020, births in nine hospitals in Nepal halved during the latter 5 lockdown weeks, and stillbirths and neonatal mortality rose significantly (click here or PIIS2214109X20303454 (1)). Citation: KC, Ashish et al. Effect of the COVID-19 pandemic response on intrapartum care, stillbirth, and neonatal mortality outcomes in Nepal: a prospective observational study. The Lancet Global Health, Volume 8, Issue 10, e1273 – e1281

Paper 2 – fall in extreme prematurity during lockdown in Denmark

Using a national database the numbers of extremely premature singleton births was significantly lower between 12 March and 14 April 2020 than the previous five years (click here or fetalneonatal-2020-319990). There was no significant difference in other gestational age categories. Citation: Hedermann G, Hedley PL, Bækvad-Hansen M, Hjalgrim H, Rostgaard K, Poorisrisak P, Breindahl M, Melbye M, Hougaard DM, Christiansen M, Lausten-Thomsen U. Danish premature birth rates during the COVID-19 lockdown. Arch Dis Child Fetal Neonatal Ed. 2020 Aug 11:fetalneonatal-2020-319990. doi: 10.1136/archdischild-2020-319990. Epub ahead of print. PMID: 32788391; PMCID: PMC7421710.

Paper 1 – rise in stillbirths at a London hospital

St George’s hospital in South London noted a rise in stillbirths between February 1 & June 14, 2020 compared with the previous four months (click here or jama_khalil_2020_ld_200076). Neonatal deaths were not reported. There were no significant differences in preterm birth rates. Citation: Khalil A, von Dadelszen P, Draycott T, Ugwumadu A, O’Brien P, Magee L. Change in the Incidence of Stillbirth and Preterm Delivery During the COVID-19 Pandemic. JAMA. 2020;324(7):705–706. doi:10.1001/jama.2020.12746

Jim Thornton, Keelin O’Donoghue & Kate Walker

Beth Rowley

September 27, 2020

Supporting artists during lockdown


If your spine tingled to the introductory music to the BBC drama Strike (click here) you’re a Beth Rowley fan. She comes from my birthtown, Bristol, and has released two albums. I think she’s right up there with Adele and Amy Winehouse. But it was through Strike that I discovered her. Normally I’d have played her on Spotify and checked if she ever performed near Nottingham. But she won’t be touring now.

Until streaming came along, musicians used to make most of their money from LP & CD sales. Then live performance took over, surely a good thing.  Now that has stopped we need to go back to buying CDs. Her latest Gota Fria is £11.99 on Amazon, and an extra 95p on her own website. I love Amazon but they are doing well out of lockdown. I still have a job and less to spend my money on, so the latter it was (click here).

It’s a wonderful record. Time to buy Little Dreamer.

Jim Thornton

OASI care bundle evaluation project

September 23, 2020

A well-conducted study, but an unclear result

I admit it. I was sceptical. A stepped wedge (type of cluster) trial evaluating a “care bundle” (leaflets, a manoevre called the “Finnish grip”, 60o episiotomy & routine rectal examination) with, at best, a shaky evidence base (click here & here), evaluated by researchers who clearly already believed in it, and driven by two political organisations (RCM & RCOG) whose leaders felt that “something must be done” and were claiming success even before it started (2016 links no longer available). When the project ended, and more press releases announced success (2018 links not available), without any results appearing for over two years, I feared the worst; sample size changes, centres excluded for “low compliance”, participants disappearing from analysis groups, outcome switching, statistical shenanigans.

The “Finnish grip” is a bit odd too. Although mentioned on the Care Bundle website (click here), it doesn’t appear in the protocol or trial registry – I did a word search. Both call the 3rd element “Manual perineal protection”. The “Finnish grip” is mentioned, but not described, in the main trial report, and the references cited as sources (click here and here) describe it as “a technique for guiding the head through the introitus by gripping the baby’s chin with a flexed middle finger of the other hand”. They both refer to (Pirhonen et al 1998 click here) as the original source. In 1998 Jouko Pirhonen was a trainee in Lund, Sweden, and he is now a professor in Oslo, Norway. But Pirhonen is a Finnish name, and his co-authors included three obstetricians (no midwives) from Finland. They wrote:

“The delivery assistant presses the baby’s head with her left hand to control the speed of crowning through the vaginal introitus. Simultaneously, using the thumb and index finger of the right hand to support the perineum while the flexed middle finger is used to take a grip on the baby’s chin. When a good grip has been achieved, the woman is asked to stop pushing, to breathe rapidly, while the midwife slowly helps baby’s head through the vaginal introitus. When most of the head is out, the perineal ring is pushed under the baby’s chin.”

This is anatomically impossible, unless the flexed middle finger enters the rectum – surely they don’t mean that! – and even then it would be a stretch to reach the chin. Something probably got lost in translation. In practice it’s likely that midwives using the Care Bundle controlled delivery of the head by perineal pressure and discouraging maternal pushing.

I confess I feared the whole study would shed more heat than light on the topic, and together with a colleague, Hannah Dahlen, wrote a grumbling opinion piece (click here).

But the results are in (click here or gurol-urganci), together with a qualitative study of the implementation process (click here or bidwell), and I’m eating my words.

The study was registered (click here), and the protocol published (click here). Registration was a bit late 22/09/2017 – the project ran from 1 October 2016 and 31 March 2018 – but that’s made clear in the paper, and the protocol had been publicly available since January 2017. There’s no reason to believe either was written after peeking at the data.

Four regions, each containing a mixture of different size and type of birth unit were studied over the same 18-month period, with routine data collected all through. Only four randomised units is rather few, but unavoidable due to funding contraints.

Regions were randomised to have the care bundle taught and implemented sequentially over months 4-6, 7-9, 10-12 or 13-15 respectively. These transition periods were excluded from analysis. This left four 3, 6, 9 or 12-month duration baseline phases, and four same duration evaluation phases to compare. The Consort flow diagram, for some reason relegated to supplementary material* (click here), shows the design nicely. Exclusions were all for objective reasons, Caesarean, multiple or still-birth and did not alter over the trial.

All women having a singleton vaginal birth were included and the size of the before and after groups was approximately equal (baseline 27,668, evaluation 27,932). This is reassuring. Differential rates of Caesarean birth, baseline 12,807 (31.6%) v evaluation 12,472 (31.3%), had not muddied the waters.

The primary, indeed the only, endpoint was OASI (obsteric anal sphincter injury) as recorded on the hospital routine database, and the primary analysis was done after statistical adjustment for a range of potentially relevant factors. Here are the relevant methods as reported in the paper.

“We used multi-level logistic regression to estimate adjusted odds ratios (aOR) […]. The regression model included a linear term for calendar time […] a random effect to account for clustering at both region and unit levels and individual case-mix factors (maternal age, ethnicity, body mass index, parity, mode of birth and birthweight).”

And here they are as planned in the protocol.

“We will use logistic mixed effects regression to model the log odds of sustaining an OASI, with a fixed effect for each step and a random effect to account for clustering at the unit level. The model will include a linear secular trend and also adjust for risk factors for OASI (maternal age, BMI, ethnicity, mode of delivery, episiotomy, birthweight, prolonged labour, and shoulder dystocia).”

Perfect. The planned analysis was done.

And the result. The recorded OASI rate decreased from 911/27,668 (3.3%) baseline phase to 817/27392 (3.0%) evaluation phase (aOR 0.80, 95% CI 0.65–0.98) p=0.03.

But what does it mean? Did manual perineal protection prevent 94 women suffering OASI? Did the 60o episiotomy do the trick? Did a few women read the leaflet and, fearful of OASI, choose Caesarean? Or a mixture of all three? Or was the difference in the “diagnosis” of OASI?

The original research, which had inspired the trial, had shown a much larger increase in recorded OASI from 1.8% in 2000 to 5.9% in 2011 (click here). The authors of that study, who included many of the current trial authors, had concluded that “improved recognition of tears following the implementation of a standardised classification of perineal tears was the most likely explanation”. They were surely correct. Diagnosing OASI is not easy. It can be both over and underdiagnosed. An effect size of 0.3% in an endpoint which can vary by 4.1% due “improved recognition” must be susceptible to ascertainment bias.

And this was an “open” trial. Staff may not have realised they were in the baseline phase but they certainly knew about the implementation and evaluation phases. This is from the qualitative study report (click here or bidwell).

“Many participants spoke about a well advertised launch, which created a lot of ‘noise’ and got the project off to a good start: ‘Yes, we had a launch day at the unit….on that day they had many sessions talking about it. We had the models.….they had pictures of how you would give an episiotomy, things like that, to add to this…There was quite a lot of noise about this. (Midwife)'”

“Many talked about the positive and passionate way with which the champions delivered the training. ‘She [the champion] was like a hound! …. if you weren’t trained and you were on her list, she would hunt you down….She would come in early to catch people on night shifts and stuff……If you have somebody like that who is passionate about the training and gets the training done, then I think that’s what makes it better. (Obstetrician)'”

How did midwives and doctors in the midst of such a campaign classify borderline cases?

Consider, for example, a woman with suspected OASI transferred to the operating theatre for repair, who when reviewed under good light by a senior staff member was found to have an intact sphincter? Would the theatre staff recode the planned operation to “repair of episiotomy”? In the baseline phase they might not even have realised the diagnosis had changed. But in the implementation and evaluation phases, with champions “hounding” everyone, the coding surely would be altered. Of course the effect might also have gone in the other direction. Routine rectal examination might have increased diagnosis. We just don’t know.

These doubts matter because the underlying evidence base for each component of the bundle is so weak. Well designed individually randomised trials do not support manual perineal protection (click here), there have been no trials of 60o angle episiotomy, and rectal examination after normal birth in the absence of a tear makes no sense (click here).

We can all support information giving, avoiding midline episiotomies and doing rectal examinations in the presence of tears. But the debate over manual perineal protection, extremely lateral episiotomy, and routine rectal examination even after normal birth with an intact perineum, will surely continue.

Jim Thornton

Footnote. *The Consort flow diagram belongs in the main report, especially for complex designs. Come on BJOG!

An improved martini

September 4, 2020

Not a better recipe, but a better technique – freezing water in the glass

Last week, dipping into Kingsley Amis’s Everyday Drinking (click here) on holiday, I came across this under “the Dry Martini”.

“A couple of hours before the party get your glasses together. They should be on the small side – the second half of a too large martini will have become too warm by the time the average drinker gets to it – and have some sort of stem or base to prevent the hand-imparting warmth. […] Fill each with water and put in the refrigerator.”

I read it as “put in the freezer”. As Amis says.

“It is more important that a cold drink should be as cold as possible than that it should be as concentrated as possible.”

I should have realised that in Amis’s day the freezer section of a domestic fridge would barely hold a tray of ice; no chance even a small martini glass. But I’ve got a modern monster freezer, so undaunted I made my martini. Freezing the water in the glass in emulation, and using a modern vermouth, Regal Rogue – Daringly Dry (click here), to annoy him. Click here for the video. It worked a treat.


Only afterwards did I realise he’d never meant “freeze the ice in the glass”. He wrote.

“While the jug is standing, empty the water out of the glasses and drop a bit of lemon rind in each.”

Nor, from a brief google search, does anyone else. People add ice cubes, sometimes large ones to avoid the over-dilution problem, but never my technique.  I offer it to the world.

Jim Thornton

6 September update

I was wrong, or rather right first time. Amis did advocate freezing water in the glass, albeit ten years later. My volume is a compendium of three books; On Drink (1974), Everyday Drinking (1983) and How’s Your Glass? (1985). The quotations were from On Drink. By the time of Everyday Drinking he must have got a larger freezer. He writes.

“The best Dry Martini known to man is the one I make myself. In the cold part of the refrigerator I have a bottle of gin and a small wineglass, half full of water that has been allowed to freeze.”

“When the hour strikes I half fill the remaining space with gin, flick in a few drops of vermouth and add a couple of cocktail onions, the small white hard kind. Now that is a drink.”

Oh well. Nothing new.

Lockdown cocktails

July 13, 2020

Drinking – not paddling – down the Loire

Our small gang have been walking the Camino de Santiago (click here or here), and more recently canoeing the Loire (click here or here). When lockdown put paid to our 2020 trip from Blois to Saumur we met up on Zoom instead, and inspired by Stanley Tucci (click here and here), drank cocktails. Here they are; some with a poem.

Hemingway’s daiquiri (click here).

Philip Larkin’s gin & tonic (click here).

A “No”groni (click here).

A conventional Negroni under adverse conditions (click here).

James Bond’s Vesper martini (click here).

The Gilles Villeneuve martini (click here).

A Radish Walked into a Bar (click here)

The Kingsley Amis martini (click here).

Forgive the rough edges. Filmed on different phones, and once made you’ve gotta drink it, so a second take wouldn’t help.

We also drank appropriate wine from the brothers Yapp, but no videos of that. First day sweet Vouvray (click here), 2nd a dry one (click here), 3rd Bourgueil (click here), 4th Saint-Nicolas-de-Bourgueil (click here) and 5th Saumur (click here). Forgotten the others, but to end with, we popped open a fizz (click here). All more expensive than our usual riverbank plonk, but I guess we’d saved on the ferry crossing. 

Lockdown 2

First zoom cocktail for lockdown 2, the Brexitini (click here).

The Euro martini (click here).

The Roman Moselle citrus sangria a la Kingsley Amis (click here).

Susie’s negroni (click here).

A Moselle martini with a nod to Michael Portillo (click here).

A French sidecar (click here).

A real martini (click here).

Whisky sour with a fairy egg (click here).

Third wave staycation

Dark & Stormy (click here).

Pornstar – hard and softcore (click here).

Tequila sunrise (click here). Ignore my claim to be making a Mojito!

This one really is a Mojito – plenty of mint! (click here).

Jim Thornton

Wild swimming in the river Trent.

June 6, 2020

Downstream of Nottingham

One of my projects for the 2020 lock-down summer has been to swim the best spots. If you don’t mind disclaimer forms, safety briefings, and signing in and out [1], there’s a dedicated centre on Colwick Park lake (click here). But that’s not for me. For swimming spots in the gravel pits click here.

These swims are for privateers. Only East Stoke, Stoke Wharfe, Farndon and Holme are on the right, south/east bank. Update 16 June 2020 – Cromwell. 1 June 2021 – two right (south) bank spots, East Stoke and Stoke Wharf added. 25 July 2021 – Stoke Bardolph revised. 5 August 2022 – Holme added

Stoke Bardolph – Left bank 

Right in front of the Ferry Boat pub, two or three slipways and landing stages provide easy access. Crowded on sunny days. Alternatively follow the first straight section of the metalled riverside path upstream towards Bardolph weir; many good gravelly entry points.

Stoke Bardolph is about 100 yards upstream of the discharge from Severn Trent’s, state of the art, treatment plant. Upsteam’s good!.

Gunthorpe – Left bank

Park in front of the Unicorn Hotel, and swim off the metal boat ramp next to the water ski club.


Don’t forget Gunthorpe gravel pit. Some fishermen claim swimming is prohibited there, so be discreet. Walk under the road bridge for about 1/2 mile, and turn right immediately after footbridge. Lots of easy access and a lovely stony bed. Magical.


Hoveringham – Left bank 

On sunny days the parking along the river bank road gets full early, but the bank is stony and access easy. Any slight smell is from muck-spreading on the surrounding fields, not the river.

Hazleford – Left bank 

One of my favourites. The metal slipway at the end of the road provides easy access, albeit slippery. The car park is private and locked, but there’s plenty of space on the road. The boat moorings leave a sheltered area near the slipway for those who are nervous of venturing into midstream.

If the slipway’s crowded try upstream, along the river path, past the moorings and caravan park. Plenty of the fishing pegs have good access. I swam by the Km 23 mark.

Downstream less good. Although plenty of access below the weir, the water tends to be frothy.

East Stoke – Right (south) bank. New 2021

Travelling south from Farndon, on the old A47 (Fosse Way), turn right into East Stoke and follow the unsurfaced road past Stoke Hall, all the way to the river opposite Fiskerton. Ample parking and a good path to a rickety wooden stage. Muddly, but the stage helps your balance. On sunny days an audience from the Bromley Arms opposite.

Fiskerton – left bank

Park about 1/4 mile downstream of the Bromley Arms and walk upstream. The problem here is the high river wall. Don’t even think of jumping! Some pontoons are barred off, and they all have “private mooring” signs, but no-one has ever objected to me using one of the open ones. Getting back on is tricky. Swim round to the river wall – shallow stony bed – and step back on with your dignity intact.


Peg 18 below Fiskerton – left bank

Park as above and walk downstream. Nottingham Piscatorial Society have marked their fishing pegs with numbers set in the grass. Peg 18’s label is obscured but it’s the best spot. If you avoid the fishing season, usually quiet enough for a skinny dip.

Stoke Wharf – Right (south) bank. New 2021

Midway between Farndon and East Stoke on the Fosse Way, a barred, field entrance has room to park. Fifty yards from the road, each fishing peg has beautiful stone steps providing easy access. Peg 13 for me! Outside of the bend but I just about made headway against the current. The downstream pegs provide easy exits for weaker swimmers. A lovely private spot.

Note added 15 April 2023. An anonymous person calling themselves Secretary Newark Federation has written, “Please be aware that our land at East Stoke is private and says so on the locked gate, which you mention in your description, anyone found parking or swimming will be reported to the police.”

Farndon – Right (South) bank

From the roundabout at the south end of Newark bypass, take the B166, the old Fosse Way to Farndon. Turn right, then left, initially following signs to Farndon marina. Ignore the 2nd right to Farndon marina and follow signs to The Waterfront. Sandy ramp. Lovely.

North Muskham – left bank

Down Ferry Lane to the Muskham Ferry pub, and swim off the slipway.

Holme – right bank (New 2022)

Opposite the Admiral Nelson in Winthorpe follow signs to Holme. Over level crossing, and left at T junction. Footpath from village centre leads to some good spots opposite, and a few hundred yards downstream, of Muskham Ferry. But there were cows and fishermen about, and I had a dog.

Alternatively turn right in Holme, and park at the end of the road. Follow the track downstream, past the active gravel pits right, with their “deep cold water” and “danger of death” signs. About 500 yards upsteam of the weir was very isolated. Perfect for a skinny dip.

Cromwell – left bank

A farm track, signed as a footpath, from Cromwell village, crosses the A1 as a single track road to the lock. Plenty of parking at the sign which says “no parking or boat launching at the lock”. Upstream of the lock, by two brick barbeques, a ramp leads to a pontoon with steps into the water at each end. Perfect.

Carlton-on-Trent – left bank

Head for the Church, and Ferry Lane. The road to the river, Perry Lane, is full of “no access to river” signs so I parked back up in the village. In fact there is parking. Two possible swim spots. Upstream of the commercial wharf, access looks easy via stony muddy banks, but I was nervous of a metal detectorist on the opposite bank.

The wharf itself has a ladder down to the water, but it’s high and muddy and my courage failed again. About 1/4 mile downstream is best. Stony and a bit muddy, but a good gap in the nettles. The opposite bank also looked inviting.

Carlton is downstream of Cromwell weir, so right at the tidal limit. But it’s on the outside of the bend so you’re straight into fast flow. I kept station, but only just. If you got carried downstream, you’d end up clambering out through nettle beds.

I’ve never swum below Carlton. There must be good spots but I doubt they beat the ones above.

Jim Thornton


  1.  One of the annoyances of river swimming is people banging on about the risks. Learn to swim and avoid the river in spate or near weirs. Weil’s disease is rare; only about 30 recreational cases, and less than one death, per year in the UK. Given the number of people coming into contact with river water, the drive to the riverbank is probably more risky, but avoid swimming with an open cut. Gastroenteritis is less of a risk for us older swimmers who don’t wear wet suits, don’t stay in so long, have developed antibodies and are wise enough not to swallow.
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