No evidence of vertical transmission of SARS-CoV-2 after induction of labour in an immune-suppressed SARS-CoV-2-positive patient

Grimminck, Koen; Santegoets, Lindy A.M.; Siemens, Frederike C.; Fraaij, Pieter L. A.; Reiss, Irwin K M; Schoenmakers, Sam

doi:10.1136/bcr-2020-235581

Cited by 24 publications

(24 citation statements)

References 13 publications

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“…# cases only included if specified as spontaneous preterm birth. Maternal Medical Condition Number of women Percentage of total cases examined (%) References Gestational diabetes 7 2 [ 19 , 20 , 28 , 33 , 60 ] Pre-existing diabetes 2 0.6 [ 21 , 57 ] Hypertensive disorders of pregnancy 18 5 [ 18 , 19 , 21 , 24 , 25 , 28 , 31 , 53 , 60 ] Obstetric cholestasis 1 0.3 [ 28 ] Acute cholecystitis 1 0.3 [ 52 ] Cardiovascular disease 1 0.3 [ 21 ] Metabolic acidosis 1 0.3 [ 51 ] Respiratory failure 2 0.6 [ 24 , 25 ] Preterm prelabour rupture of membrane …”

Section: Resultsmentioning

confidence: 99%

“…Corticosteroids were administered to a total of 43 women (in 15 reports) [ 16 , 17 , 19 , 20 , 32 , 33 , [37] , [38] , [39] , 41 , 45 , 46 , 49 , 51 , 53 ]. Four studies reported that the corticosteroids were primarily given for prophylaxis against fetal lung disease [ 32 , 38 , 49 , 51 ].…”

Section: Resultsmentioning

confidence: 99%

“…Across all studies, the following samples were tested for the presence of SARS-CoV-2 RNA: placenta (19 studies), placental membranes (2 studies), amniotic fluid (10 studies), umbilical cord (3 studies), and umbilical cord blood (11 studies). Of the 19 studies that tested for SARS-CoV-2 RNA in the placenta [ 16 , 17 , [19] , [20] , [21] , 24 , 26 , 37 , 38 , 41 , 42 , 44 , [46] , [47] , [48] , [49] , 52 , 53 , 55 ], 14 reported negative results (three neonates tested positive [ 19 , 26 , 41 ]), 4 studies reported positive results [ 26 , 42 , 44 , 55 ] and one study did not report the findings [ 20 ]. Additionally, 2 studies reported testing placental membranes with 2 positive [ 26 ], and 3 negative results [ 52 ].…”

Section: Resultsmentioning

confidence: 99%

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A structured review of placental morphology and histopathological lesions associated with SARS-CoV-2 infection

et al. 2020

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The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel coronavirus, was first identified after a cluster of cases in Wuhan, China in December 2019. Whether vertical transmission or placental pathology might occur following maternal infection during pregnancy remains unknown. This review aimed to summarise all studies that examined the placenta or neonates following infection with SARS-CoV-2, or closely related highly pathogenic coronavirus (SARS-CoV-1, or the Middle East respiratory syndrome coronavirus (MERS-CoV)). Structured literature searches found 50 studies that met the inclusion criteria. Twenty studies reported placental histopathology findings in third trimester placentas following maternal SARS-CoV-2 infection. Using the Amsterdam Consensus criteria to categorise the histopathology results, evidence of both fetal vascular malperfusion (35.3% of cases; 95% Confidence Interval (CI) 27.7–43.0%) and maternal vascular malperfusion (46% of cases; 95% CI 38.0–54.0%) were reported, along with evidence of inflammation in the placentas (villitis 8.7% cases, intervillositis 5.3% of cases, chorioamnionitis 6% of cases). The placental pathologies observed in SARS-CoV-2 were consistent with findings following maternal SARS-CoV-1 infection. Of those tested, a minority of neonates (2%) and placental samples tested positive for SARS-CoV-2 infection (21%). Limited conclusions can be drawn about the effect of maternal SARS-CoV-2 infection on placental pathology as most lack control groups and the majority of reports followed third trimester infection. Collaboration to maximise the number of samples examined will increase the reliability and generalisability of findings. A better understanding of the association between maternal SARS-CoV-2 infection and placental pathology will inform maternity care during the coronavirus pandemic.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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A structured review of placental morphology and histopathological lesions associated with SARS-CoV-2 infection

et al. 2020

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“…The meta-analysis was based on 745 COVID infected cases and 219 controls. A total of 34 case reports [ [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] , [68] , [69] , [70] , [71] , [72] , [73] , [74] , [75] , [76] , [77] , [78] , [79] , [80] , [81] , [82] , [83] , [84] , [85] , [86] , [87] , [88] ] yielding 45 cases were also included in the descriptive data analysis. Majority of the studies (12/34) were from China, 7 from the USA [ 62 , 67 , 68 , 70 , 76 , 85 , 87 ], 2 from Iran [ 63 , 80 ], 2 from Netherlands [ 82 , 83 ], 1 from Peru [ 75 ], 1 from Italy 1 [ 84 ], 1 from Sweden [ 64 ], 1 from Spain [ 73 ], 1 from Korea [ 55 ], 1 from Turkey [ 56 ], 1 from UK [ 78 ], 1 from Australia [ 88 ], 1 from Canada [ 79 ], 1 from Jordon [ 86 ], and 1 from India [ 72 ].…”

Section: Resultsmentioning

confidence: 99%

“…Case reports from Korea [ 55 ], India [ 72 ], Netherlands [ 82 , 83 ], Australia [ 88 ], Italy [ 84 ], Ireland [ 82 ], and Turkey [ 56 ] did not show any adverse pregnancy outcomes. All of these cases were detected after the gestation age of 35 weeks except for one case in a study [ 82 ].…”

Section: Discussionmentioning

confidence: 99%

Maternal and neonatal characteristics and outcomes among COVID-19 infected women: An updated systematic review and meta-analysis

Dubey

Reddy

Manuel

et al. 2020

European Journal of Obstetrics & Gynecology and Reproductiv

165

135

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Objective Coronavirus disease 2019 (COVID-19) has become a global pandemic and may adversely affect pregnancy outcomes. We estimated the adverse maternal and neonatal characteristics and outcomes among COVID-19 infected women and determined heterogeneity in the estimates and associated factors. Study Designs PubMed search was performed of confirmed COVID-19 pregnant cases and related outcomes were ascertained prior to July 8, 2020, in this systematic review and meta-analysis. Studies reporting premature birth, low birth weight, COVID-19 infection in neonates, or mode of delivery status were included in the study. Two investigators independently performed searches, assessed quality of eligible studies as per the Cochrane handbook recommendations, extracted and reported data according to PRISMA guidelines. Pooled proportions of maternal and neonatal outcomes were estimated using meta-analyses for studies with varying sample sizes while a systematic review with descriptive data analysis was performed for case report studies. Maternal and neonatal outcomes included C-section, premature birth, low birth weight, adverse pregnancy events and COVID transmission in neonates. Results A total of 790 COVID-19 positive females and 548 neonates from 61 studies were analyzed. The rates of C-section, premature birth, low birth weight, and adverse pregnancy events were estimated as 72 %, 23 %, 7 %, and 27 % respectively. In the heterogeneity analysis, the rate of C-section was substantially higher in Chinese studies (91 %) compared to the US (40 %) or European (38 %) studies. The rates of preterm birth and adverse pregnancy events were also lowest in the US studies (12 %, 15 %) compared to Chinese (17 %, 21 %), and European studies (19 %, 19 %). In case reports, the rates of C-section, preterm birth, and low birth weight were estimated as 69 %, 56 %, and 35 %, respectively. Adverse pregnancy outcomes were associated with infection acquired at early gestational ages, more symptomatic presentation, myalgia symptom at presentation, and use of oxygen support therapy. Conclusions Adverse pregnancy outcomes were prevalent in COVID-19 infected females and varied by location, type, and size of the studies. Regular screening and early detection of COVID-19 in pregnant women may provide more favorable outcomes.

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Azathioprine/prednisolone

2020

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Azathioprine/prednisolone COVID-19 infection: case report A 31-year-old woman developed COVID-19 infection during treatment with prednisolone and azathioprine for systemic lupus erythematosus during pregnancy. The pregnant woman, who had hypertension and systemic lupus erythematous, had been receiving prednisolone and azathioprine [dosages and routes not stated]. In March 2020, she was scheduled for labour induction at 38 weeks and 1 day of gestation. Concomitantly, she had been receiving methyldopa for hypertension, and aspirin [acetylsalicylic acid] for pre-eclampsia prophylaxis till 36 weeks of gestation. Antenatal ultrasound scans at 28, 34 and 36 weeks of gestation revealed normal fetal biometry with an estimated fetal weight of the 16 percentile. However, she developed progressive cough. The PCR of oropharyngeal sample confirmed COVID-19 infection before the scheduled delivery. The diagnosis of COVID-19 infection secondary to immunosuppressive therapy was confirmed. In order to avoid the risk of maternal respiratory distress, the woman was admitted to an isolated zone in delivery ward for scheduled delivery. The results of physical examinations were as follows; temperature 37.2°C, HR 82 beats/min, BP 141/88mm Hg, RR 12 breaths/min and transcutaneous saturation 99% by a FiO2 0.21. Laboratory findings were normal. She received unspecified epidural anaesthesia and oxytocin to assist labour. Also, she received unspecified corticosteroid 100mg in 30 minutes as a part of corticosteroid stress dose scheme. PCR samples during different stages of labour revealed no signs of vertical transmission. Eventually, she delivered a healthy female neonate with a birth weight of 2880g (13 percentile), arterial-umbilical pH 7.19 and Apgar score of 9/10 at 5 and 10 minutes, respectively. There were no signs of congenital abnormalities and neonatal COVID-19 infection. Anti-Sjogren's antigen A/B tests were negative. Twelve hours following the delivery, she was discharged. At a follow-up after one week, she continued to experience coughing and mild dyspnoea. Four weeks following the delivery, all her symptoms resolved.

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No evidence of vertical transmission of SARS-CoV-2 after induction of labour in an immune-suppressed SARS-CoV-2-positive patient

Cited by 24 publications

References 13 publications

A structured review of placental morphology and histopathological lesions associated with SARS-CoV-2 infection

A structured review of placental morphology and histopathological lesions associated with SARS-CoV-2 infection

Maternal and neonatal characteristics and outcomes among COVID-19 infected women: An updated systematic review and meta-analysis

Azathioprine/prednisolone

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