Safety of vaginal delivery in women infected with COVID-19

Lopian, Miriam; Ligumsky, Lior Kashani; Czeiger, Shelly; Cohen, Rony; Schindler, Yehudit; Lubin, Daniel; Olteanu, Ioanna; Neiger, Ran; Lessing, Joseph B.; Somekh, Eli

doi:10.1016/j.pedneo.2020.10.010

Cited by 18 publications

(21 citation statements)

References 29 publications

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“…Of 27 studies, six (22%) were from China [6] , [7] , [8] , [9] , [10] , [11] ; five (19%) were from Italy [12] , [13] , [14] , [15] , [16] ; three from Spain [17] , [18] , [19] ; two each from Chile [20] , [21] , Turkey [22] , [23] and the United States of America [24] , [25] ; one each from Brazil [26] , France [27] , India [28] , Israel [29] , Mexico [30] , Panama [31] and Peru [32] . Fifteen were classified as high-income countries [24] , [25] , [27] , [29] , [31] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] and 12 as low and middle-income countries [22] , [23] , [26] , [28] , [30] , [32] , [6] , [7] , [8] , [9] , [10] , [11] . Sixteen studies had a retrospective cohort design [14] , [24] , [28] , [29] , [32] , [6] , [7] , [8] , …”

Section: Resultsmentioning

confidence: 99%

“…Fifteen were classified as high-income countries [24] , [25] , [27] , [29] , [31] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] and 12 as low and middle-income countries [22] , [23] , [26] , [28] , [30] , [32] , [6] , [7] , [8] , [9] , [10] , [11] . Sixteen studies had a retrospective cohort design [14] , [24] , [28] , [29] , [32] , [6] , [7] , [8] , [9] , [10] , [17] , [18] , [19] , [20] , [21] , [22] and 11 a prospective cohort design [15] , [16] , [23] , [30] , [31] , [11] , [12] , [13] , [25] , [26] , [27] . There were no randomised controlled trials.…”

Section: Resultsmentioning

confidence: 99%

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Treatment of COVID-19 in pregnant women: A systematic review and meta-analysis

Giesbers

Goh

Kew³

et al. 2021

European Journal of Obstetrics & Gynecology and Reproductiv

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Objective Clinical trials evaluating pharmacological and non-pharmacological treatment of COVID-19, either excluded pregnant women or included very few women. Unlike the numerous systematic reviews on prevalence, symptoms and adverse outcomes of COVID-19 in pregnancy, there are very few on the effects of treatment on maternal and neonatal outcomes in pregnancy. We undertook a systematic review of all published and unpublished studies on the effects of pharmacological and non-pharmacological interventions for COVID-19 on maternal and neonatal pregnancy outcomes. Data sources We performed a systematic literature search of the following databases: Medline, Embase, Cochrane database, WHO (World Health Organization) COVID-19 database, China National Knowledge Infrastructure (CNKI), and Wanfang databases from 1 December 2019 to 1 December 2020. Study eligibility criteria Studies were only included if they involved pregnant or postnatal women who were exposed to pregnancy specific interventions like the mode of delivery and type of anaesthesia, pharmacological or non-pharmacological interventions. Study appraisal and synthesis methods We first screened the titles and abstracts of studies and then assessed the full text of the selected studies in detail for eligibility. Data on study design, population, type of screening for COVID-19, country, hospital, country status (high or low and middle income), treatment given (mode of delivery, type of anaesthesia, type of pharmacological and non-pharmacological treatment was extracted. The pre-defined maternal outcomes we collected were mode of delivery (vaginal or by caesarean section), severe or critical COVID-19 (as defined by the authors), symptomatic COVID-19, maternal death, maternal hospital admission, ICU admission, mechanical ventilation, ECMO and maternal pneumonia. The pre-defined neonatal outcomes we extracted were preterm birth (<37 weeks), stillbirth, neonatal death, NICU admission, neonatal COVID-19 positive, neonatal acidosis (pH<7.0) and Apgar scores (<8 after 5 minutes). Study quality assessment was performed. Results From a total of 342 potential eligible studies, we included 27 studies in our systematic review, including 4943 pregnant women (appendix 3). Sixteen studies had a retrospective cohort design and 11 a prospective cohort design. There were no randomised controlled trials. There was a significant association between caesarean section and admission to ICU (OR 4.99, 95% CI 1.24 to 20.12; 4 studies, 153 women, I 2 =0%), and diagnosis of maternal COVID-19 pneumonia as defined by study authors (OR 3.09, 95% CI 1.52 to 6.28; 2 studies, 228 women, I 2 =0%). Women who had a preterm birth were more likely to have the baby via caesarean section (OR 3.03, 95% CI 1.71 to 5.36, 12 studies; 314 women, I 2 =0%). For pharmacological and non-pharmacological ...

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Treatment of COVID-19 in pregnant women: A systematic review and meta-analysis

Giesbers

Goh

Kew³

et al. 2021

European Journal of Obstetrics & Gynecology and Reproductiv

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show abstract

“…Emerging reports have reported SARS-CoV-2 being detected in amniotic uid, vaginal uid and the placenta [20,21], highlighting the possibility of infection in utero and during delivery. Systematic review of cases reported in the literature have indicated no substantial evidence for increased transmission risk during vaginal birth [28][29][30][31]. Even so, most of the women in our cohort had expressed uncertainty regarding the optimal mode of delivery in women with COVID-19.…”

Section: Discussionmentioning

confidence: 75%

Knowledge and Expectations of Perinatal Care Among Pregnant Women During the COVID-19 Pandemic

Lim

Goh

Chua

et al. 2021

Preprint

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Background: This study aimed to investigate the knowledge and expectations of pregnant women on perinatal and neonatal care during the coronavirus disease 2019 (COVID-19) pandemic in Singapore. Methods: A cross-sectional survey was administered to pregnant women attending antenatal clinics between August and September 2020 via a secure online platform. Participants aged ≥21 years without a history of confirmed COVID-19 were included. The survey consisted of 10 questions which evaluated the knowledge and expectations on perinatal and neonatal care during the current pandemic. Results: A total of 313 pregnant women completed the survey. The mean age of the participants was 30 years (SD 4; range 22-43 years). The median gestational age was 25 weeks (range 4-40 weeks). The participants were predominantly multiparous (54%) and almost all (98%) had completed secondary level education. Majority of participants were aware of the spread of COVID-19 by respiratory secretions and contact (90%), and the importance of prevention strategies (94%). Up to 72% agreed or strongly agreed that in-utero transmission of SARS-CoV-2 was possible. Most were unsure of the optimal mode of delivery (77%) and only 22% believed that breastfeeding was safe in a pregnant woman with active COVID-19. There was no significant association between the sociodemographic factors evaluated and maternal agreement with the possibility of in-utero SARS-CoV-2 transmission and the risk associated with vaginal delivery in women with COVID-19. Although 46% of participants were concerned about the increased risk of contracting COVID-19 during routine clinic appointments, only 37% of the cohort were agreeable with teleconferencing of clinic appointments. More than half (56%) of the participants reported that their postnatal confinement plans were affected by the current pandemic. Conclusions: Our survey revealed that majority of participants were aware of modes of transmission, prevention strategies and in utero transmission of SARS-CoV-2. Significant gaps were identified in their knowledge related to method of delivery and safety of breastfeeding, along with significant variability to the agreement with alterations to the perinatal care. For best practice we recommend provision of evidence-based information early to expectant mothers by the healthcare professionals to reduce misinformation and anxiety amongst pregnant women.

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“…Parturients with COVID-19 were managed in similar fashion to healthy women with the mode of delivery dictated by obstetric indications as shown safe in previous studies [16,17]. This is contrary to many reports during the early phase of the pandemic, mainly from China, that showed an increased rate of cesarean deliveries [18].…”

Section: Discussionmentioning

confidence: 91%

Does the presence of symptoms affect pregnancy outcomes in third trimester in women with SARS-CoV-2

Harel

Eliasi

Lifshitz

et al. 2021

The Journal of Maternal-Fetal & Neonatal Medicine

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Objective: Parturients with symptoms to COVID-19 have an increased risk for neonatal adverse outcomes and for any adverse outcome compared to the asymptomatic COVID-19 positive parturients and to the COVID-19-negative parturients. The purpose of this study was to determine the effect of COVID-19 on obstetric outcomes based on symptom status of parturients at or near term. Methods: Retrospective cohort study of parturients diagnosed with COVID-19 between 26 March and 30 September 2020. Maternal and neonatal outcomes were assessed by comparing three groups of parturients: COVID-19 negative, asymptomatic COVID-19, and symptomatic COVID-19. Results: A total of 2299 COVID-19-negative parturients and 172 patients with confirmed diagnosis of COVID-19 delivered during the study period. The median gestational age at the time of delivery was 39 (interquartile range 39-40) weeks. The most common symptom was cough (28/ 56, 50%). Gestational diabetes mellitus was significantly less common in COVID-19-negative than in COVID-19-positive patients. There was no significant increase in cesarean delivery in women who were COVID-19 positive and the incidence of preterm deliveries was not significantly different among the three groups. Of the 172 cases of COVID-19, only one parturient needed mechanical ventilation, and there were no maternal deaths in this group. There were no cases of severe neonatal asphyxia or neonatal death. Composite maternal adverse outcomes were not significantly different between the three groups. The aOR for composite neonatal adverse outcome and overall composite adverse outcome comparing COVID-19 positive to negative parturients was 2.1 (95% confidence interval [CI], 1.1-3.8; p ¼ .02) and 1.6 (95% CI, 1.1-2.3; p ¼ .02), respectively. Conclusions: An increased risk for neonatal adverse outcomes and for any adverse outcome was found in the symptomatic COVID-19 group compared to the asymptomatic COVID-19-positive parturients and to the COVID-19-negative parturients.

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Safety of vaginal delivery in women infected with COVID-19

Cited by 18 publications

References 29 publications

Treatment of COVID-19 in pregnant women: A systematic review and meta-analysis

Treatment of COVID-19 in pregnant women: A systematic review and meta-analysis

Knowledge and Expectations of Perinatal Care Among Pregnant Women During the COVID-19 Pandemic

Does the presence of symptoms affect pregnancy outcomes in third trimester in women with SARS-CoV-2

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