Obstetric–Neonatal Care during Birth and Postpartum in Symptomatic and Asymptomatic Women Infected with SARS-CoV-2: A Retrospective Multicenter Study

Abstract

This study analyses the obstetric–neonatal outcomes of women in labour with symptomatic and asymptomatic COVID-19. A retrospective, multicenter, observational study was carried out between 1 March 2020 and 28 February 2021 in eight public hospitals in the Valencian community (Spain). The chi-squared test compared the obstetric–neonatal outcomes and general care for symptomatic and asymptomatic women. In total, 11,883 births were assisted in participating centers, with 10.9 per 1000 maternities (n = 130) infected with SARS-CoV-2. The 20.8% were symptomatic and had more complications both upon admission (p = 0.042) and during puerperium (p = 0.042), as well as transfer to the intensive care unit (ICU). The percentage of admission to the Neonatal Intensive Care Unit (NICU) was greater among offspring of symptomatic women compared to infants born of asymptomatic women (p < 0.001). Compared with asymptomatic women, those with symptoms underwent less labour companionship (p = 0.028), less early skin-to-skin contact (p = 0.029) and greater mother–infant separation (p = 0.005). The overall maternal mortality rate was 0.8%. No vertical transmission was recorded. In conclusion, symptomatic infected women are at increased risk of lack of labour companionship, mother–infant separation, and admission to the ICU, as well as to have preterm births and for NICU admissions.

Perinatal Outcomes at Birth in Women Infected and Non-Infected with SARS-CoV-2: A Retrospective Study

“…The prematurity rate observed in our center was 7.6%, close to the pre-pandemic rate (6.4-7%) [23,33]. We did not find a significant relationship between the outcomes and infection, possibly owing to the small number of cases managed in our hospital; pregnant women with threatened preterm deliveries were referred to the referral hospital, and only deliveries of more than 34 weeks of gestation or preterm babies whose transfer was impossible owing to obstetric conditions of an imminent delivery were managed in our center.…”

“…Throughout this period, stringent measures were enforced during states of emergency to curb viral transmission [21]. These measures had direct repercussions on the medical care provided to pregnant women, resulting in discernible adjustments to obstetric protocols [22,23]. Scientific societies remained dynamic, continually adapting obstetric care protocols in response to evolving epidemiological trends [5].…”

“…However, across these successive pandemic waves, certain indispensable practices in maternal and childbirth care underwent necessary adaptation or suspension to mitigate virus spread. As the landscape evolved, practices like labor companionship, early skinto-skin contact, and rooming-in were supplanted by measures such as mother-infant separation and neonatal intensive care unit (NICU) admission [23]. While these adjustments aimed to safeguard both mothers and medical personnel, concerns about care quality inevitably arose.…”

Pregnancy Outcomes, Immunophenotyping and Immunohistochemical Findings in a Cohort of Pregnant Patients with COVID-19—A Prospective Study

“…A multicentric cohort study by Oncel et al revealed high rates of cesarean section (71.2%), prematurity (26.4%), and low-birthweight-infant rates (12.8%) for a cohort of patients with COVID-19 [ 42 ]. Another retrospective multicentric study indicated higher rates of NICU admission among offspring of symptomatic women [ 43 ].…”

Childbirth Satisfaction during the COVID-19 Pandemic in a Hospital in Southwestern Spain

“…This change also led to strong changes in the care of women during pregnancy, childbirth and the postnatal weeks, and basic elements of the midwife–woman relationship, such as meeting in person and providing a comforting touch, were upended in an attempt to maintain distance and reduce cross-infection [ 24 ]. In Spain, during the first months of the pandemic, the care protocols for women underwent several changes, which meant a high change in the measures to be adopted in maternity services, both for SARS-CoV-2-positive women and for others [ 24 , 25 ] These changes during these first months meant an increase in unnecessary interventions and severe limited visiting, even certain limitations to the labor or postpartum companionship [ 24 ].…”