SARS-CoV-2 Infection and C-Section: A Prospective Observational Study

Abstract

Pregnant women are particularly vulnerable to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. In addition to unfavorable perinatal outcomes, there has been an increase in obstetric interventions. With this study, we aimed to clarify the reasons, using Robson’s classification model, and risk factors for cesarean section (C-section) in SARS-CoV-2-infected mothers and their perinatal results. This was a prospective observational study that was carried out in 79 hospitals (Spanish Obstetric Emergency Group) with a cohort of 1704 SARS-CoV-2 PCR-positive pregnant women that were registered consecutively between 26 February and 5 November 2020. The data from 1248 pregnant women who delivered vaginally (vaginal + operative vaginal) was compared with those from 456 (26.8%) who underwent a C-section. C-section patients were older with higher rates of comorbidities, in vitro fertilization and multiple pregnancies (p < 0.05) compared with women who delivered vaginally. Moreover, C-section risk was associated with the presence of pneumonia (p < 0.001) and 41.1% of C-sections in patients with pneumonia were preterm (Robson’s 10th category). However, delivery care was similar between asymptomatic and mild–moderate symptomatic patients (p = 0.228) and their predisposing factors to C-section were the presence of uterine scarring (due to a previous C-section) and the induction of labor or programmed C-section for unspecified obstetric reasons. On the other hand, higher rates of hemorrhagic events, hypertensive disorders and thrombotic events were observed in the C-section group (p < 0.001 for all three outcomes), as well as for ICU admission. These findings suggest that this type of delivery was associated with the mother’s clinical conditions that required a rapid and early termination of pregnancy.

Desfechos clínicos e perinatais de gestantes com e sem Covid-19 não vacinadas submetidas a parto cesariano: estudo de coorte retrospectivo

“…Em um estudo multicêntrico internacional incluindo vários países, os autores encontraram 36,1% de primíparas de alto risco com Covid-19 (D´Antonio et al, 2021), enquanto, em outro estudo multicêntrico nacional realizado na Espanha, a porcentagem de primíparas foi de 36,5% (Antolín et al, 2021). Neste estudo, descobriu-se 26,4% de primiparidade.…”

“…Outros estudos demonstraram um percentual diferente de internação na UTI em pacientes gestantes com Covid-19, variando de 4,7 a 6,5% (Breslin et al, 2020;Ababneh et al, 2021). O percentual de mortes nessas pacientes (2,2%) também variou em outros estudos, de 0,0% -3,2% (D´Antonio et al, 2021;Antolín et al, 2021;Bartolomé et al, 2022;Ioscovich et al, 2021;Chen et al, 2021).…”

“…O Apgar de 1° minuto foi significativamente menor nos recém-nascidos de gestantes com Covid-19 (23,3%), resultado esse diferente ao de outro estudo multicêntrico (Espanha, Israel, Portugal), que encontrou 5,46% de recém-nascidos com Apgar ≤ 7 (Ioscovich et al, 2021). A maior chance de necessidade de UTI Neonatal (18,3%) em recém-nascidos de gestantes com Covid-19 foi encontrada em outros estudos com variação de 8,7% a 36,4% (D´Antonio et al, 2021;Antolín et al, 2021;Ababneh et al, 2021;Chen et al, 2021;Gurol-Urganci et al 2021. Ao se calcular o risco relativo, encontrou-se que os recém-nascidos de gestantes com Covid-19 não vacinadas possuem 73% mais risco de internação na UTI Neonatal (RR = 1,73; 95% CI: 0,73 -4,14).…”

“…Quatro recém-nascidos (4,3%) evoluíram para óbito durante a internação, com taxa de mortalidade calculada derivada de Covid-19 materna de 2,15% (2/93). Em outros estudos, essa taxa variou de 0,9% -2,2% (Chen et al, 2021;D´Antonio et al, 2021;Antolín et al, 2021). Desse modo, ao se calcular o risco relativo, encontrou-se que os recémnascidos oriundos de gestantes com Covid-19 possuem 2,45 vezes mais risco de ir a óbito, em relação aos recém-nascidos de gestantes sem Covid-19.…”

Evaluation of the effects of COVID‐19 disease and the trimester in which the disease is diagnosed on obstetric and neonatal outcomes: A retrospective cohort study

“…According to the opinions of Antolin et al, to whom we also participated, this may be related to the preferences of the mother and/or obstetrician regarding the presence of COVID‐19 pneumonia in the third trimester of pregnancy. In addition, when the delivery time of mothers diagnosed with SARS‐CoV‐2 infection in their first trimester came, hospitals and physicians had experience in managing vaginal birth in the COVID‐19 scenario 30 . In addition to all these, in our study, we also evaluated the cesarean section indications of patients who had COVID‐19 disease and had a cesarean section afterward.…”