Coronavirus in pregnancy and delivery: rapid review

Abstract

Objectives There are limited case series reporting the impact on women affected by coronavirus during pregnancy. In women affected by severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), the case fatality rate appears higher in those affected in pregnancy compared with non-pregnant women. We conducted a rapid review to guide health policy and management of women affected by COVID-19 during pregnancy, which was used to develop the Royal College of Obstetricians and Gynaecologists' (RCOG) guidelines on COVID-19 infection in pregnancy.Methods Searches were conducted in PubMed and MedRxiv to identify primary case reports, case series, observational studies and randomized controlled trials describing women affected by coronavirus in pregnancy. ResultsFrom 9965 search results in PubMed and 600 in MedRxiv, 21 relevant studies, all of which were case reports or case series, were identified. From reports of 32 women to date affected by COVID-19 in pregnancy, delivering 30 babies (one set of twins, three ongoing pregnancies), seven (22%) were asymptomatic and two (6%) were admitted to the intensive care unit (ICU), one of whom remained on extracorporeal membrane oxygenation. No maternal deaths have been reported to date. Delivery was by Cesarean section in 27 cases and by vaginal delivery in two, and 15 (47%) delivered preterm. There was one stillbirth and one neonatal death. In 25 babies, no cases of vertical transmission were reported; 15 were reported as being tested with reverse transcription polymerase chain reaction after delivery. Case fatality rates for SARS and MERS were 15% and 27%, respectively. SARS was associated with miscarriage or intrauterine death in five cases, and fetal growth restriction was noted in two ongoing pregnancies affected by SARS in the third trimester.Conclusions Serious morbidity occurred in 2/32 women with COVID-19, both of whom required ICU care. Compared with SARS and MERS, COVID-19 appears less lethal, acknowledging the limited number of cases reported to date and that one woman remains in a critical condition. Preterm delivery affected 47% of women hospitalized with COVID-19, which may put considerable pressure on neonatal services if the UK's reasonable worst-case scenario of 80% of the population being affected is realized. Based on this review, RCOG, in consultation with RCPCH, developed guidance for delivery and neonatal care in pregnancies affected by COVID-19, which recommends that delivery 587 mode be determined primarily by obstetric indication and recommends against routine separation of affected mothers and their babies. We hope that this review will be helpful for maternity and neonatal services planning their response to

COVID‐19 in pregnancy with comorbidities: More liberal testing strategy is needed

“…Despite a global pandemic, there are so far, few reports on pregnant women with Coronavirus disease 2019 (COVID-19), testing strategies vary substantially and management guidelines are not uniform. 1,2 A 34-year-old primipara with a dichorionic twin pregnancy was referred to our hospital at 36 +2/7 weeks due to hypertension and proteinuria. Her body mass index (BMI) at the first antenatal visit was 38 kg/m 2 and she was diagnosed with gestational diabetes at 29 weeks.…”

COVID-19 bei hospitalisierten Kindern und Jugendlichen

“…Von Neugeborenen, die von COVID-19-erkrankten Müttern geboren wurden, ist bisher nur über ein infiziertes, aber asymptomatisches Kind berichtet worden [20]. Bislang gibt es keine Belege für eine vertikale Transmission von CO-VID-19 [16,17,25]. Interessanterweise waren im DGPI-Survey unter den ersten 26 stationären Aufnahme insgesamt 15 Säuglinge (45 %), darunter 5 im Neugeborenenalter unter 28 Tagen [9].…”

Public Health Agency of Sweden's Brief Report: Pregnant and postpartum women with severe acute respiratory syndrome coronavirus 2 infection in intensive care in Sweden

“…When analysing the published literature on pregnancy and SARS-CoV-2, gaps in knowledge were identified, especially whether being pregnant represents a risk for increased susceptibility to infection, severity of clinical presentation and adverse outcomes for mothers and neonates. [1][2][3][4][5][6][7] Through dialogue with corresponding authorities in other European countries and the US, it became apparent that none had seen a comparatively increased number of pregnant or postpartum women with SARS-CoV-2 infection requiring intensive care.…”