An Uncomplicated Delivery in a Patient with Covid-19 in the United States

Iqbal, Sara; Overcash, Rachael T.; Mokhtari, Neggin; Saeed, Haleema; Gold, Stacey; Auguste, Tamika; Mirza, Muhammad Usman; Rúiz, María Elena; Chahine, Joeffrey J.; Waga, Masashi; Wortmann, Glenn

doi:10.1056/nejmc2007605

Cited by 98 publications

(127 citation statements)

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“…Seven (1.9%) women were aged 40 years or older. Presenting symptoms were reported in 55 studies, comprising 515 pregnant women 4,5,7,11–19,21–30,32–57 . Of these, the most common symptoms at presentation were fever (n=273, 53.0%), cough (n=224, 43.5%), myalgia/malaise (n=79, 15.3%), dyspnea (n=64, 12.4%), diarrhea (n=18, 3.5%), and sore throat (n=18, 3.5%), regardless of gestational age.…”

Section: Resultsmentioning

confidence: 99%

Clinical characteristics, prognostic factors, and maternal and neonatal outcomes of SARS‐CoV‐2 infection among hospitalized pregnant women: A systematic review

Turan

Hakim

Dashraath

et al. 2020

Intl J Gynecology & Obste

123

192

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Background Pregnant women represent a potentially high‐risk population in the COVID‐19 pandemic. Objective To summarize clinical characteristics and outcomes among pregnant women hospitalized with COVID‐19. Search strategy Relevant databases were searched up until May 29, 2020. Selection criteria Case series/reports of hospitalized pregnant women with laboratory‐confirmed COVID‐19. Data collection and analysis PRISMA guidelines were followed. Methodologic quality was assessed via NIH assessment tools. Main results Overall, 63 observational studies of 637 women (84.6% in third trimester) with laboratory‐confirmed SARS‐CoV‐2 infection were included. Most (76.5%) women experienced mild disease. Maternal fatality, stillbirth, and neonatal fatality rates were 1.6%, 1.4%, and 1.0%, respectively. Older age, obesity, diabetes mellitus, and raised serum D‐dimer and interleukin‐6 were predictive of poor outcomes. Overall, 33.7% of live births were preterm, of which half were iatrogenic among women with mild COVID‐19 and no complications. Most women underwent cesarean despite lacking a clear indication. Eight (2.0%) neonates had positive nasopharyngeal swabs after delivery and developed chest infection within 48 hours. Conclusions Advanced gestation, maternal age, obesity, diabetes mellitus, and a combination of elevated D‐dimer and interleukin‐6 levels are predictive of poor pregnancy outcomes in COVID‐19. The rate of iatrogenic preterm birth and cesarean delivery is high; vertical transmission may be possible but has not been proved.

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Section: Resultsmentioning

confidence: 99%

Clinical characteristics, prognostic factors, and maternal and neonatal outcomes of SARS‐CoV‐2 infection among hospitalized pregnant women: A systematic review

Turan

Hakim

Dashraath

et al. 2020

Intl J Gynecology & Obste

123

192

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“…Case series Total, n/N (%) Chen et al, 13 Liu et al, 14 Li et al, 15 Fan et al, 16 Zhu et al, 17 Wang et al, 18 Chen et al, 19 Zambrano et al, 20 Wang et al, 21 Gidlöf et al, 22 Yu et al, 23 Breslin et al, 24 Iqbal et al, 25…”

Section: Case Reportsmentioning

confidence: 99%

“…The results from 14 case reports are summarized together to facilitate interpretation. [13][14][15][16][17][18][19][20][21][22][23][24][25][26] These were published from 7 March 2020 through 1 April 2020.…”

Section: Re Sultsmentioning

confidence: 99%

Maternal and perinatal outcomes with COVID‐19: A systematic review of 108 pregnancies

Zaigham

Andersson

2020

Acta Obstet Gynecol Scand

792

763

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Abbreviations: BMI, body mass index; ICU, intensive care unit; qRT-PCR, quantitative real-time polymerase chain reaction; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2. AbstractIntroduction: The pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has exposed vulnerable populations to an unprecedented global health crisis. The knowledge gained from previous human coronavirus outbreaks suggests that pregnant women and their fetuses are particularly susceptible to poor outcomes. The objective of this study was to summarize the clinical manifestations and maternal and perinatal outcomes of COVID-19 during pregnancy. Material and methods:We searched databases for all case reports and series from 12 February to 4 April 2020. Multiple terms and combinations were used including COVID-19, pregnancy, maternal mortality, maternal morbidity, complications, clinical manifestations, neonatal morbidity, intrauterine fetal death, neonatal mortality and SARS-CoV-2. Eligibility criteria included peer-reviewed publications written in English or Chinese and quantitative real-time polymerase chain reaction (PCR) or dual fluorescence PCR-confirmed SARS-CoV-2 infection. Unpublished reports, unspecified date and location of the study or suspicion of duplicate reporting, cases with suspected COVID-19 that were not confirmed by a laboratory test, and unreported maternal or perinatal outcomes were excluded. Data on clinical manifestations, maternal and perinatal outcomes including vertical transmission were extracted and analyzed.Results: Eighteen articles reporting data from 108 pregnancies between 8 December 2019 and 1 April 2020 were included in the current study. Most reports described women presenting in the third trimester with fever (68%) and coughing (34%).Lymphocytopenia (59%) with elevated C-reactive protein (70%) was observed and 91% of the women were delivered by cesarean section. Three maternal intensive care unit admissions were noted but no maternal deaths. One neonatal death and one intrauterine death were also reported. Conclusions:Although the majority of mothers were discharged without any major complications, severe maternal morbidity as a result of COVID-19 and perinatal deaths were reported. Vertical transmission of the COVID-19 could not be ruled out. Careful monitoring of pregnancies with COVID-19 and measures to prevent neonatal infection are warranted.

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“…[2][3][4] In contrast, the majority of reported cases of COVID-19 infection in pregnant patients have shown a mild or asymptomatic course of the disease, with only few cases requiring intensive care unit (ICU) admission, and only a few reported cases requiring mechanical ventilation. 2,3,[5][6][7] To date, there is no concrete evidence of whether there is in utero transmission of SARS-CoV-2. Two cases of neonates with positive real-time polymerase chain reaction (RT-PCR) testing soon after delivery have been described.…”

mentioning

confidence: 99%

Severe COVID-19 during Pregnancy and Possible Vertical Transmission

Alzamora¹,

Paredes²,

Cáceres³

et al. 2020

Am J Perinatol

576

615

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There are few cases of pregnant women with novel corona virus 2019 in the literature, most of them with a mild illness course. There is limited evidence about in utero infection and early positive neonatal testing. A 41-year-old G3P2 with a history of previous cesarean deliveries and diabetes mellitus presented with a 4-day history of malaise, lowgrade fever, and progressive shortness of breath. A nasopharyngeal swab was positive for COVID-19, COVID-19 serology was negative. The patient developed respiratory failure requiring mechanical ventilation on day 5 of disease onset. The patient underwent a cesarean delivery, and neonatal isolation was implemented immediately after birth, without delayed cord clamping or skin-to-skin contact. The neonatal nasopharyngeal swab, 16 hours after delivery, was positive for severe acute respiratory syndromecoronavirus 2 (SARS-CoV-2) real-time polymerase chain reaction (RT-PCR), and immunoglobulin (Ig)-M and IgG for SARS-CoV-2 were negative. Maternal IgM and IgG were positive on postpartum day 4 (day 9 after symptom onset). We report a severe presentation of COVID-19 during pregnancy. To our knowledge, this is the earliest reported positive PCR in the neonate, raising the concern for vertical transmission. We suggest pregnant women should be considered as a high-risk group and minimize exposures for these reasons.

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An Uncomplicated Delivery in a Patient with Covid-19 in the United States

Cited by 98 publications

References 0 publications

Clinical characteristics, prognostic factors, and maternal and neonatal outcomes of SARS‐CoV‐2 infection among hospitalized pregnant women: A systematic review

Clinical characteristics, prognostic factors, and maternal and neonatal outcomes of SARS‐CoV‐2 infection among hospitalized pregnant women: A systematic review

Maternal and perinatal outcomes with COVID‐19: A systematic review of 108 pregnancies

Severe COVID-19 during Pregnancy and Possible Vertical Transmission

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