Clinical and Obstetric Aspects of Pregnant Women with COVID-19: A Systematic Review

Abstract

Objective To analyze the clinical and obstetric aspects of pregnant women with COVID-19. Methods A systematic literature review in the MEDLINE/PubMed, LILACS, SCIELO, and CNKI databases was performed from March to May 2020, with the descriptors: Pregnancy; 2019-nCov; Coronavirus; SARS-Cov-2, Covid-19. Of those chosen were original titles, without language and period restriction and that addressed pregnant women with a clinical and/or laboratory diagnosis of COVID-19. Revisions, editorials, and duplicate titles were excluded. The Newcastle-Ottawa (NOS) and Murad et al. scales were used to assess the quality of the studies. Results We included 34 articles with 412 pregnant women infected with severe acute respiratory syndrome (SARS-Cov-2), with an average age of 27.5 years of age and 36.0 gestational weeks. The most common symptom was fever (205 [49.7%]), and 89 (21.6%) pregnant women progressed to severe viral pneumonia. Laboratory tests showed an increase in C-reactive protein (154 [37.8%]), and radiological tests showed pneumonia with peripheral ground-glass pattern (172 [51.4%]). Emergency cesarean delivery was indicated for most pregnant women, and the most common gestational complication was premature rupture of ovarian membranes (14 [3.4%;]). We detected 2 (0.5%) neonatal deaths, 2 (0.5%) stillbirths, and 1 (0.2%) maternal death. Conclusion Pregnant women with COVID-19 presented a clinical picture similar to that of non-infected pregnant women, with few obstetric or neonatal repercussions. There was a greater indication of cesarean deliveries before the disease aggravated, and there was no evidence of vertical transmission of the infection.

Covid-19, Clinical Manifestations in Pregnant Women, Aftermaths on Timing and Mode of Delivery at Hail, Saudi Arabia

“…Our study participants who acquired Covid infection during pregnancy delivered significantly more by vaginal deliveries. Contrary to the past studies (14,15) this study highlighted that having a Covid infection during pregnancy doesn't put the baby at risk of low birth weight.…”

“…Similarly, the mean gestational age was also the same in-between the two groups. Similar findings were seen from the study conducted by Aydin GA et al (12) Some of the studies published before in the previous few years indicated an increased risk of cesarean delivery in Covidpositive women (13,14) but our findings don't match their results. Our study participants who acquired Covid infection during pregnancy delivered significantly more by vaginal deliveries.…”

Neuroimaging assessment of pediatric cerebral changes associated with SARS-CoV-2 infection during pregnancy

“…A systemic inflammatory response to the SARS-CoV-2 virus and consequent endothelial damage has been implicated in COVID-19 pathogenesis, with replicated evidence in many studies in both biochemical and clinical settings ( 9 – 11 ). Although there is extensive epidemiologic evidence of systemic COVID-19 effects ( 12 , 13 ), the neurologic consequences of SARS-CoV-2 exposure in the pediatric group are still uncertain, and current evidence is mostly based on case reports ( 14 , 15 ). It is not clear whether and to what extent the blood-brain barrier functions as a protective factor in blocking inflammatory cytokines ( 16 – 19 ).…”

Infecção pelo COVID-19 e as complicações associadas à gestação: uma revisão integrativa

“…No que tange as complicações obstétricas/neonatais foram reportados nos estudos avaliados altas frequências de cesáreas, trabalho de parto prematuro, ruptura prematura de membrana (RUPREMA), oligodrâmnio, anidrâmnio, síndrome HELLP, abortos espontâneos, morte fetal e natimortos, além de neonatos prematuros e de baixo peso que necessitam de UTI neonatal posterior ao parto. A ocorrência desses desfechos está de acordo com os estudos de Soheili et al (2021), Bastos et al (2021) e Wang et al (2021) que apresentam as mesmas principais complicações. Ainda sobre esse tópico, Soheili et al (2021) conclui que mulheres sintomáticas são mais susceptíveis de passar por um parto prematuro e de seus neonatos necessitarem de cuidados intensivos após o nascimento.…”

“…Ainda sobre esse tópico, Soheili et al (2021) conclui que mulheres sintomáticas são mais susceptíveis de passar por um parto prematuro e de seus neonatos necessitarem de cuidados intensivos após o nascimento. A maior frequência de cesáreas pode ser explicada pelo fato de que gestantes infectadas com COVID-19, com hipóxia e grandes fatores inflamatórios, aumentam a contratilidade do útero o que pode provocar trabalho de parto prematuro e hemorragia pós-parto (Bastos et al, 2021).…”