The Profile of the Obstetric Patients with SARS-CoV-2 Infection According to Country of Origin of the Publication: A Systematic Review of the Literature

Abstract

SARS-CoV-2 is the novel member of coronavirus responsible for the worldwide pandemic COVID-19, affecting all types of people. In this context, established research identified pregnant women as a susceptible group of SARS-CoV-2 infection, although there is still limited data regarding the real impact of COVID-19 in this group. With that purpose, we conducted a systematic review describing the maternal-fetal results of pregnant women infected by SARS-CoV-2, in aim to analyze the profile of the obstetric patients according to the country of origin of the publication. A total of 38 articles were included in this systematic review with 2670 patients from 7 countries, with 20 works published from China (52.6%). We reported significative differences according to the median maternal age, with Spain as the country with the highest age (34.6 years); The percentage of tabaquism; proportion of symptomatic patients in the triage; type of radiological exam (China and France conduct CT scans on all their patients in comparison to the use of chest X-Ray in the rest of the countries studied); percentages of C-sections (83.9% in China; 35.9% Spain, p < 0.001); maternal mortality rate, proportion of patients who need treatments, the use of antivirals, antibiotics, and anticoagulants as well as measurements of the newborns. Perinatal results are favorable in the majority of countries, with very low rates of vertical transmission in the majority of works. The studies collected in this review showed moderate to high index of quality. The different works describe the affectation during the first wave of the pandemic, where the pregnant woman with SARS-CoV-2 infection is generally symptomatic during the third trimester of gestation along with other factors associated with worse prognosis of the disease, such as higher age, body mass index, and further comorbidities developed during pregnancy. In the obstetric patient, proportion of C-sections are elevated together with prematurity, increasing maternal perinatal morbimortality. Differences found between countries could be based on the proper profile of the patient in each region, the period of the pandemic directly affecting how it was managed, and the variations regarding in situ medical attention.

Comparing Infection Profiles of Expectant Mothers with COVID-19 and Impacts on Maternal and Perinatal Outcomes between the First Two Waves of the Pandemic

“…Table 1 reveals that the older age of patients in the first wave, as reported by others [ 22 ], along with the presence of comorbidities such as diabetes or chronic hypertension [ 23 ], or coexisting obstetric morbidities such as preeclampsia [ 24 ], are risk factors for the development of more severe COVID-19 [ 20 , 25 ]. An increased level of maternal COVID-19 symptoms, reflected by the pneumonia rate or the need for oxygen therapy and mechanical ventilation during the first months of the pandemic, has been reported previously [ 26 , 27 ].…”

“…These findings are consistent with the results of several systematic reviews [ 21 , 26 ] and large case series [ 19 , 20 ] which have examined the repercussions of COVID-19 on maternal and perinatal morbidity. During the first wave of the pandemic, rapid worsening of symptoms and the scarce therapeutic arsenal available determined the immediate termination of pregnancy [ 22 ] regardless of gestational age, and thus gave rise to more perinatal morbidity–mortality events.…”

A New Multiplatform Model for Outpatient Prenatal and Postpartum Care in a Cohort of COVID-19-Affected Obstetric Patients

“…On the first telephone call, a maternal and fetal medicine specialist used a semi-structural individual questionnaire to assess the early signs of symptoms, severity and duration, prenatal follow-up until the outset of the disease, weeks of gestational age, current COVID-19 and pregnancy-related symptoms, and doubts or questions related to the process ( Figure 2 ). We aimed to match our first telemedicine prenatal program to humane obstetric practice, which was a need COVID-19-affected pregnant patients emphasized [ 6 , 10 ].…”

“…On the first telephone call, a maternal and fetal medicine specialist used a semi-structural individual questionnaire to assess the early signs of symptoms, severity and duration, prenatal follow-up until the outset of the disease, weeks of gestational age, current COVID-19 and pregnancy-related symptoms, and doubts or questions related to the process (Figure 2). We aimed to match our first telemedicine prenatal program to humane obstetric practice, which was a need COVID-19-affected pregnant patients emphasized [6,10]. Following clinical criteria, we offered weekly in-person follow-up at the hospital in the afternoon and after routine visits, with one maternal-fetal medicine expert performing routine and recommended ultrasound examinations, clinical assessment, and laboratory testing (RT-PCR when needed, serology, blood testing for genetic and diabetes screening, genital swab for group B streptococcus) according to national and international guidelines [11][12][13].…”

An Updated Review of SARS-CoV-2 Vaccines and the Importance of Effective Vaccination Programs in Pandemic Times

“…Every person is susceptible to SARS-CoV-2 infection, but certain groups are more likely to suffer from severe presentations of the disease. These groups include older people [ 22 ], patients with comorbidities and non-communicable diseases [ 23 , 24 ], and also pregnant women [ 25 , 26 ]. They all share an altered immune status, which is key to fully understanding SARS-CoV-2’s pathogenesis.…”