Impact of the COVID-19 pandemic and the emergency measures on abortion care taken during this period in a French region (Provence Alpes Côte d'Azur).

INTRODUCTION: On March 17, 2020, the first mandatory national lockdown was implemented in France, followed by an adaptation of health services to ensure access to abortion care. The objective of this study is to evaluate the impact of COVID-19 and the emergency measures on abortion care taken during this period in the Provence Alpes Côte d'Azur region (PACA) in France. MATERIALS AND METHODS: This retrospective study was based on the health insurance information system national database (SNDS), which included all women who had an abortion between January 1, 2019 and December 31, 2020 in the PACA region. We compared the total number of abortions, the distribution (surgical abortion, medical abortion (MA) at home (MAH) or in a clinic between 2019 and 2020 and the use of teleconsultation (TC) in 2020. RESULTS: The total number of abortions in the PACA region decreased by 3.5% between 2019 and 2020. The rate of MA was higher in 2020 than in 2019 [17,489/22,444 (79.3%) vs. 17,042/22,354 (74.5%) (P < 0.0001)]. The rate of MAH was higher in 2020 than in 2019 [(8,177/17,489 (46.8%) vs. 7,264/17,042 (42.6%) (P < 0.0001)]. TC was used in 96 MAH in 2020. CONCLUSION: A decrease in the number of abortions in the PACA region was observed in 2020. There was an increase in MA, mainly MAH, allowing easier and more adapted access to the health situation. TC was poorly used.

Enhanced prevalence of plasmatic soluble MHC class I chain-related molecule in vascular pregnancy diseases.

The major histocompatibility complex class I related chain (MIC) is a stress-inducible protein modulating the function of immune natural killer (NK) cells, a major leukocyte subset involved in proper trophoblast invasion and spiral artery remodeling. Aim of the study was to evaluate whether upregulation of soluble MIC (sMIC) may reflect immune disorders associated to vascular pregnancy diseases (VPD). sMIC was more frequently detected in the plasma of women with a diagnostic of VPD (32%) than in normal term-matched pregnancies (1.6%, P < 0.0001), with highest prevalence in intrauterine fetal death (IUDF, 44%) and vascular intrauterine growth restriction (IUGR, 39%). sMIC levels were higher in preeclampsia (PE) than in IUFD (P < 0.01) and vascular IUGR (P < 0.05). sMIC detection was associated with bilateral early diastolic uterine notches (P = 0.037), thrombocytopenia (P = 0.03), and high proteinuria (P = 0.03) in PE and with the vascular etiology of IUGR (P = 0.0038). Incubation of sMIC-positive PE plasma resulted in downregulation of NKG2D expression and NK cell-mediated IFN-γ production in vitro. Our work thus suggests that detection of sMIC molecule in maternal plasma may constitute a hallmark of altered maternal immune functions that contributes to vascular disorders that complicate pregnancy, notably by impairing NK-cell mediated production of IFN-γ, an essential cytokine favoring vascular modeling.