COVID-19 in pregnancy and the puerperium: A review for emergency physicians

Abstract

Background Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) is a novel virus responsible for causing the novel coronavirus disease of 2019 (COVID-19). Objective This article discusses the clinical manifestations of COVID-19 in pregnant patients, the effects of pregnancy on the course of COVID-19 disease, and the impact of COVID-19 on pregnancy outcomes. Discussion The physiological and mechanical changes associated with pregnancy increase maternal susceptibility to infections and complicate intubation and mechanical ventilation. The most common symptoms of COVID-19 in pregnant patients are cough and fever, although many infected individuals are asymptomatic. The majority of pregnant women diagnosed with COVID-19 disease have a mild course of illness and will recover without needing to deliver, but the risk of critical illness and need for mechanical ventilation are increased compared to the general population. Risk factors for death and severe disease include obesity, diabetes, and maternal age > 40 years. Women in their third trimester have the highest risk for critical illness, intensive care unit admission, and need for mechanical ventilation. Adverse fetal outcomes of maternal COVID-19 infection include increased risk of miscarriage, prematurity, and fetal growth restriction. Vertical transmission of SARS-CoV-2 is possible but has not been conclusively proven. Conclusions COVID-19 is a potentially deadly infection, but data are limited concerning the pregnant population. Pregnant patients appear to present similarly to the general population, with fever and cough being the most reported symptoms in studies. Knowledge of these presentations and outcomes can assist clinicians caring for these patients.

Severe acute respiratory syndrome (SARS) coronavirus-2 infection (COVID-19) in pregnancy – An overview

“…A meta-analysis of 42 studies of pregnant patients found focal ground glass opacities and bilateral infiltrates as the most common CT abnormalities in those with mild or asymptomatic disease while all those with critical disease had diffuse ground-glass opacities with subpleural involvement and pleural effusion. These abnormal findings were present in 89% of patients, 8.9% of whom were asymptomatic at the time of imaging [53] , [54] . Abnormal chest X-Ray findings include bilateral pneumonia (57.9%), unilateral pneumonia (20%) and multiple patchy pulmonary infiltrates (22.7%) [46] )…”

COVID-19 impact on perinatal care: risk factors, clinical manifestation and prophylaxis. Polish experts’ opinion for December 2020

“…Pregnant women with COVID-19 manifested fewer symptoms than general population while the predominant features of symptomatic COVID-19 in pregnant women were cough (33%) and fever (29%). Compared to non-pregnant women with COVID-19 pregnant women were less likely to report fever (OR = 0.48 CI: 0.22-0.85) and myalgia (OR = 0.48 CI: 0.45-0.51) [1,2].…”

“…SARS-CoV-2 is very sensitive for wide array of disinfection products and chemical inactivators [2]. Bilal et al [15] tested hospital rooms and bathrooms in 15 different locations occupied by COVID-19 patients revealing 87% and 60% positive samples, respectively.…”

“…Four of them (229E, OC43, NL63, HKU1) are known to cause a mild infection in people. The remaining two have shown to be the cause life-threatening acute respiratory distress syndrome (ARDS): SARS (severe acute respiratory syndrome) caused by SARS-CoV and MERS (Middle East respiratory syndrome) caused by MERS-CoV [1][2][3]. COVID-19 is a disease caused by the Wuhan coronavirus (SARS-CoV-2).…”

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“…Boushra et al found that pregnant women are at the highest risk of critical outcome needing intensive care admission or mechanical ventilation during their third trimester. This puts the foetus at a risk of miscarriage, foetal growth restriction, or even prematurity [ 66 ]. In the study conducted by Kotlyar et al , the risk of vertical transmission during the third trimester was found to be 3.2% [ 67 ].…”