The outbreak of COVID-19 has become a health concern worldwide. Chinese government has taken rapid response including quarantining and gathering cancellation, and people under quarantine are expected to be negatively affected [1-3]. In order to assess the psychological impact on those pregnant women residing in an unspecified area, we did a cross-sectional e-survey of anxiety and depression, emotional response to COVID-19, and attitude to media emission among pregnant women in Shanghai during February 24th to March 11th, 2020.The outbreak of COVID-19 was begun around January 22nd 2020, when the diagnosed case in China was 571 and nine cases in Shanghai. According to the Chinese national report, during this survey period from February 24th to March 11th, national diagnosed case number were 77658 to 80793, and that number in Shanghai were 335 to 344. Primary outcome was anxiety and depression self-evaluation by Generalized anxiety disorder screener (GAD-7)  and Edinburgh postnatal depression scale (EPDS) , respectively. The Institutional Review Board of Obstetrics and Gynecological Hospital of Fudan University approved the project, and signed informed consent was obtained.Among 688 pregnant women completing the survey, 80% women were of younger than 35 years old, and of university degree or above (P<0.05). A total of 136 (19.8%) and 174 (25.3%) women were of anxious (Generalized anxiety disorder screener, GAD-7 scale ≥4)  and depressive (Edinburgh postnatal depression scale, EPDS scale ≥9)  mode, respectively. Anxiety and depression among pregnant women were associated with heavy work hours, having higher income, worries about infection and being influenced by media information and preferring more media information access (P<0.05) (Table 1). In logistic regression analysis, those women impacting less by media reports were at a lower risk of anxiety (P=0.001, 95%CI: 0.222-0.659), and those preferring more media access were at higher risk of depression (P=0.007, 95%CI: 1.181-2.800).This psychological survey among pregnant women in unspecified COVID-19 epidemic areas in China indicated that, proper media information is beneficial for relieving anxious and depressive mode. In unspecified areas such as Shanghai, anxiety and depression among pregnant women did not undergo a rise. More importantly, those women most influenced by media reporting were more likely being anxious, and therefore, timely media support is called for reliving anxiety and depression caused by concerns about COVID-19 among pregnant women.
Objective: We aimed to investigate the venous thromboembolism (VTE) status in China, and identify the hospital organizational factors that affect VTE incidence. Design: Retrospective study. Setting: Online survey to evaluate hospital-related factors associated with VTE. Population or sample: Hospital-related general data, and those on system and strategy, diagnosis and treatment, and patient education were collected. Methods: T-tests and analyses of variance were performed to determine whether hospital-related factors were associated with VTE incidence. Main outcome measures: VTE incidence. Results: Totally, 113 hospitals were included. Of 770,828 deliveries, VTE was observed in 526: 423 cases with deep vein thrombosis (DVT), 103 with pulmonary embolism (PE), and three with maternal death due to VTE. Higher prevalence rates of DVT and PE were observed in tertiary hospitals (P<0.001), general hospitals (P=0.006), hospitals with a Cesarean section performance rate >50% or <30% (P<0.001). Women in hospitals with a higher Cesarean section performance rate (relative risk [RR]=1.6), and that did not have emergency transfer facilities (RR=10.6) or early mobilization implementation (RR=1.6) showed a significantly higher risk of DVT. Those in hospitals that did not use B ultrasound of the lower extremity vein (RR=1.4) and anticoagulants (RR=1.2), and did not implement early mobilization after vaginal (RR=1.3) and Cesarean section delivery (RR=1.1) had an increased PE risk. Conclusions: Large hospital-related variations were shown in the incidence of thromboembolism in pregnancy, significantly influenced by hospital-related characteristics and diagnostic competency. Improved patient education levels and VTE treatment availability are vital to reducing the VTE-related maternal mortality and morbidity risk.