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Umbilical cord clamping and skin‐to‐skin contact in deliveries from women positive for SARS‐CoV‐2: a prospective observational study

Authors:
Inmaculada Mejía at Hospital 12 de Octubre
Inmaculada Mejía
R Salvador López
R Salvador López
R Salvador López
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E García Rosas
E García Rosas
E García Rosas
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I Rodriguez de la Torre
I Rodriguez de la Torre
I Rodriguez de la Torre
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Abstract

Objective: To demonstrate that delayed cord clamping (DCC) is safe in mothers with confirmed SARS-CoV-2 infection. Design, setting and participants: Prospective observational study involving epidemiological information from 403 pregnant women with SARS-CoV-2 between 1 March and 31 May 2020. Data were collected from 70 centres that participate in the Spanish Registry of COVID-19. Methods: Patients' information was collected from their medical chart. Main outcomes and measures: The rate of perinatal transmission of SARS-CoV-2 and development of the infection in neonates within 14 days postpartum. Results: The early cord clamping (ECC) group consisted of 231 infants (57.3%) and the DCC group consisted of 172 infants (42.7%). Five positive newborns (1.7% of total tests performed) were identified with the nasopharyngeal PCR tests performed in the first 12 hours postpartum, two from the ECC group (1.7%) and three from the DCC group (3.6%). No significant differences between groups were found regarding neonatal tests for SARS-CoV-2. No confirmed cases of vertical transmission were detected. The percentage of mothers who made skin-to-skin contact within the first 24 hours after delivery was significantly higher in the DCC group (84.3% versus 45.9%). Breastfeeding in the immediate postpartum period was also significantly higher in the DCC group (77.3% versus 50.2%). Conclusions: The results of our study show no differences in perinatal outcomes when performing ECC or DCC, and skin-to-skin contact, or breastfeeding. Tweetable abstract: This study demonstrates that delayed cord clamping is safe in mothers with confirmed SARS-CoV-2 infection.
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Umbilical cord clamping and skin-to-skin contact
in deliveries from women positive for SARS-CoV-
2: a prospective observational study
I Mej
ıa Jim
enez,
a
R Salvador L
opez,
b
E Garc
ıa Rosas,
c
I Rodriguez de la Torre,
d
J Montes Garc
ıa,
e
ML de laCruz Conty,
f
O Mart
ınez P
erez,
g
in collaboration with the Spanish Obstetric Emergency
Group
†
a
Obstetrics and Gynaecology Service, Hospital Universitario 12 de Octubre, Madrid, Spain
b
Obstetrics and Gynaecology Service, Hospital
Universitario Puerta de Hierro, Majadahonda, Spain
c
Obstetrics and Gynaecology Service, Hospital del Mar, Barcelona, Spain
d
Obstetrics
and Gynaecology Service, Hospital Universitario 12 de Octubre, Madrid, Spain
e
Statistics Department, Effice, Madrid, Spain
f
Fundaci
on de
Investigacion Biomedica, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
g
Obstetrics and Gynaecology Service, Hospital
Universitario Puerta de Hierro, Majadahonda, Universidad Aut
onoma de Madrid, Madrid, Spain
Correspondence: O Mart
ınez P
erez, Obstetrics and Gynaecology Service, Hospital Universitario Puerta de Hierro. C/ Joaqu
ın Rodrigo 1, 28222,
Majadahonda (Madrid), Spain. Email: oscarmartinezgine@gmail.com
Accepted 10 November 2020. Published Online 30 November 2020.
Objective To demonstrate that delayed cord clamping (DCC) is
safe in mothers with confirmed SARS-CoV-2 infection.
Design, setting and participants Prospective observational study
involving epidemiological information from 403 pregnant women
with SARS-CoV-2 between 1 March and 31 May 2020. Data were
collected from 70 centres that participate in the Spanish Registry
of COVID-19.
Methods Patients’ information was collected from their medical
chart.
Main outcomes and measures The rate of perinatal transmission
of SARS-CoV-2 and development of the infection in neonates
within 14 days postpartum.
Results The early cord clamping (ECC) group consisted of 231
infants (57.3%) and the DCC group consisted of 172 infants
(42.7%). Five positive newborns (1.7% of total tests performed)
were identified with the nasopharyngeal PCR tests performed in
the first 12 hours postpartum, two from the ECC group (1.7%)
and three from the DCC group (3.6%). No significant differences
between groups were found regarding neonatal tests for SARS-
CoV-2. No confirmed cases of vertical transmission were detected.
The percentage of mothers who made skin-to-skin contact within
the first 24 hours after delivery was significantly higher in the
DCC group (84.3% versus 45.9%). Breastfeeding in the immediate
postpartum period was also significantly higher in the DCC group
(77.3% versus 50.2%).
Conclusions The results of our study show no differences in
perinatal outcomes when performing ECC or DCC, and skin-to-
skin contact, or breastfeeding.
Keywords Breastfeeding, COVID-19, safety, SARS-CoV-2, skin-
to-skin, umbilical cord clamping, vertical transmission.
Tweetable abstract This study demonstrates that delayed cord
clamping is safe in mothers with confirmed SARS-CoV-2
infection.
Linked article This article is commented on by AC Katheria and J
Koo, p. 916 in this issue. To view this mini commentary visit
https://doi.org/10.1111/1471-0528.16607.
Please cite this paper as: Mej
ıa Jimenez I, Salvador Lopez R, Garc
ıa Rosas E, Rodriguez de la Torre I, Montes Garc
ıa J, de la Cruz Conty ML, Mart
ınez Perez
O; in collaboration with the Spanish Obstetric Emergency Group. Umbilical cord clamping and skin-to-skin contact in deliveries from women positive for
SARS-CoV-2: a prospective observational study. BJOG 2021;128:908–915.
Introduction
On 12 January 2020, Chinese authorities shared the genetic
sequence of a novel type of virus belonging to the
Coronaviridae family, given the name severe acute respira-
tory syndrome coronavirus 2 (SARS-CoV-2).
1
By interna-
tional consensus, its related disease has been called
coronavirus disease 2019 (COVID-19). The World Health
Organization (WHO) declared COVID-19 a pandemic on
11 March due to the prevalence, spread and severity of the
disease.
2
To date, a higher predisposition to infection of
*A list of the Spanish Obstetric Emergency Group collaborators appears in
the Acknowledgements section.
908 ª2020 John Wiley & Sons Ltd.
DOI: 10.1111/1471-0528.16597
www.bjog.org
Original Article
Intrapartum care
... The process is visually represented in a flow diagram ( Figure 1) following the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines. From 18 studies, 6 studies were conducted in Spain [19][20][21][22][23][24], 4 each in the USA [25][26][27][28] and Italy [29][30][31][32], and 1 study each in France [33], India [34], Israel [35], and Portugal [36]. Four studies were retrospective [27,31,33,36]. ...
... Out of a total of 2763 neonates, 79 (2.8%) had a positive COVID-19 test. According to the maternal practices, 54.7% of neonates (440/804) separated early from their mothers [17,23,26,27,29,32], 56.0% (564/1007) neonates were dried and laid directly on the mother's bare chest after birth (skin-to-skin) [18][19][20]23,30], 66.69% (1199/1798) neonates stayed with the mothers in the same room for 24 h a day from the time they arrived in mothers room after delivery (rooming-in), and 51.5% (971/1886) breastfed exclusively [16,17,[21][22][23][24]26,[28][29][30]34] (Table 2). Only one study examined the factors associated with positive SARS-CoV-2 results among neonates [22]. ...
... The red dotted line represents the line of no effect (ES = 0), where values to the left suggest a negative effect, and to the right a positive effect. The red diamond-shaped figure indicates the overall pooled estimate of effect size and its 95% confidence interval, with the horizontal spread of the diamond reflecting the precision of the pooled estimate [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36]. ...
Breastfeeding Practices for COVID-19-Infected Mothers: A Systematic Review and Meta-Analysis
Article
Full-text available
  • Feb 2024
(1) Background: The ongoing COVID-19 pandemic has led to an increasing number of women giving birth while also grappling with SARS-CoV-2. The objective of this review is to examine the possibility of transmission of the virus from mother to infant through breastfeeding, skin-to-skin contact, and rooming-in and to explore methods for managing COVID-19-positive mother–infant dyads. (2) Methods: A comprehensive search strategy was employed that covered pertinent studies from the Cochrane Library, PubMed Central, and Scopus databases. The Matrix Method and PRISMA guidelines were utilized by the researchers, with the search being updated until 20 December 2021, one year after the initial vaccine delivery. The inclusion criteria for the study involved articles published in English, those employing broad search terms, and those comprising full-text reviews. Additionally, the researchers required that the articles be published from December 2019 onwards. To further analyze the data, a meta-analysis was performed to estimate the rate of infant infection from mothers who engaged in breastfeeding, skin-to-skin contact, and rooming-in practices. (3) Results: Eighteen studies were analyzed in this review, with an infected infant rate of 2.8%. The maternal practices used in these studies ranged from direct separation of the infant to direct skin-to-skin contact, rooming-in, and exclusive breastfeeding. One study investigated the factors associated with positive test results in newborns and found that only the maternal social vulnerability index >90 was a significant predictor. The type of delivery, rooming-in, and the mother’s symptom status were not associated with positive neonatal outcomes. (4) Conclusions: According to current data, the incidence of perinatal infection with SARS-CoV-2 is relatively low. It is advised that mothers adhere to several supportive care measures, including engaging in breastfeeding, skin-to-skin contact, and rooming-in. These measures ought to be complemented by diligent hand hygiene, the wearing of masks, and the cleansing of breasts solely when necessary.
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... All studies included infants born through vaginal and cesarean sections. In 14 studies the mother-infant dyad was enabled to stay together after birth 24 h a day 13,14,18,19,21,[23][24][25][26][27]29,31,32,36 , in 6 it was not allowed 17,20,28,30,33,33 and in the remaining 6 studies 15,16,22,35,37,38 , there was no information about it. In 12 studies two or more preventive measures were undertaken 14,17,19,21,23,26,27,[29][30][31]33,34 , in 10 only one or no one 13,15,16,18,20,22,24,25,28,36 and in the remaining 4 studies there was no information about preventive measures 32,35,37,38 . ...
... In 14 studies the mother-infant dyad was enabled to stay together after birth 24 h a day 13,14,18,19,21,[23][24][25][26][27]29,31,32,36 , in 6 it was not allowed 17,20,28,30,33,33 and in the remaining 6 studies 15,16,22,35,37,38 , there was no information about it. In 12 studies two or more preventive measures were undertaken 14,17,19,21,23,26,27,[29][30][31]33,34 , in 10 only one or no one 13,15,16,18,20,22,24,25,28,36 and in the remaining 4 studies there was no information about preventive measures 32,35,37,38 . Considering only the studies in which rooming in practice was performed, at least two preventive measures were adopted in 8 of these studies 14,19,21,23,26,27,29,31 , one or no preventive measures were adopted in 5 studies 13,18,24,25,36 and in one study it was not specified 32 . ...
... In 12 studies two or more preventive measures were undertaken 14,17,19,21,23,26,27,[29][30][31]33,34 , in 10 only one or no one 13,15,16,18,20,22,24,25,28,36 and in the remaining 4 studies there was no information about preventive measures 32,35,37,38 . Considering only the studies in which rooming in practice was performed, at least two preventive measures were adopted in 8 of these studies 14,19,21,23,26,27,29,31 , one or no preventive measures were adopted in 5 studies 13,18,24,25,36 and in one study it was not specified 32 . The quality assessment evaluation is provided in the supplementary online table. ...
Mother-to-child transmission of SARS-CoV-2 infection in high-income countries: a systematic review and meta-analysis of prospective observational studies
Article
Full-text available
  • May 2023
Mother-to-child transmission of SARS-CoV-2 has been reported since the onset of the COVID-19 pandemic. We conducted a study to summarize evidence on the risk of mother-to-child transmission in the first 30 days after birth in high-income countries and to evaluate the association between preventive measures and the risk of infection for the neonate. A systematic review and meta-analysis were undertaken following PRISMA guidelines. The National Library of Medicine, Web of Science, and Excerpta Medica databases were screened on February 26, 2022. All prospective observational studies addressing the frequency of infection in infants born to mothers SARS-CoV-2 positive were included. Twenty-six studies were included, reporting data of 2653 mothers with SARS-CoV-2 and 2677 neonates. The proportion meta-analysis pointed out an overall estimate of SARS-CoV-2 infection among infants of 2.3% (95% CI: 1.4–3.2%). Data from studies with (1.4%, 95% CI: 0.8–2) and without (1.3%, 95% CI: 0.0–2.7%) rooming-in provided similar risk of infection. Adopting at least two prevention measures during rooming-in resulted in a rate of mother-to-child infection of 1.0% (95%CI: 0.3–1.7%). The results of this study show a low rate of perinatal infection, support the rooming-in and confirm the effectiveness of preventive measures in reducing the risk of mother-to-child viral transmission.
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... Nesta linha do processo de humanização, o Ministério da Saúde lançou ainda outra forma de cuidados em 2011, a Rede Cegonha, instituída no âmbito do Sistema Único de Saúde (SUS) por meio da portaria nº1459, que consiste em uma rede de cuidados à mulher quanto ao planejamento reprodutivo e atenção humanizada à gravidez, parto e puerpério, bem como à criança o direito ao nascimento seguro e ao crescimento e Revista Conexão Ciência I Vol. 18 ...
... Revista Conexão Ciência I Vol. 18 O recém-nascido a termo que apresenta peso e apgar adequado não deve ser submetido a intervenções imediatas; dessa forma, o contato pele a pele precoce deve ser priorizado sempre que possível, em ambiente adequado e confortável. É válido ressaltar que a prática mencionada diminui o sentimento de ansiedade da puérpera que, muitas vezes, é evidenciado quando ocorre a separação do binômio, principalmente quando este é evitável. ...
Golden Hour - Benefícios para o binômio mãe-filho e atuação da equipe de enfermagem: uma revisão integrativa de literatura
Article
Full-text available
  • Nov 2023
Introdução: Tendo em vista que o parto é considerado um fator de grande importância na vida da mulher, a implementação de boas práticas de atenção ao parto e nascimento, dentre elas a Golden Hour, possui o objetivo de qualificar o atendimento e minimizar intervenções desnecessárias. Objetivo: objetivo desse estudo consiste em identificar os benefícios dessa prática para os recém-nascidos e qual a atuação da equipe de Enfermagem. Metodologia: Foi realizada uma revisão integrativa de literatura, utilizando artigos disponíveis online na Biblioteca Virtual de Saúde (BVS) e na National Library of Medicne (PubMed) publicados nos últimos 5 anos, sendo excluídos teses, dissertações, artigos duplicados e que não se adequavam ao tema proposto. Resultados: Dos 144 estudos encontrados, foram selecionados 9 artigos das bases de dados citadas para a construção do trabalho. Foi realizado a leitura na íntegra dos estudos selecionados para identificar os benefícios da prática e a atuação da equipe de Enfermagem. Conclusão: Foi possível identificar algumas falhas com relação ao conhecimento transmitido para gestantes e puérperas, bem como a necessidade de aumentar o conhecimento da equipe profissional e das parturientes no que diz respeito aos benefícios das práticas executadas na Golden Hour. Palavras-chave: Aleitamento Materno; Relações Mãe-Filho; Período Pós-Parto; Enfermagem Obstétrica.
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... In total, 1476 neonates born to SARS-CoV-2-positive mothers were included. One study [14] met the inclusion criteria but was excluded due to overlapping study populations with another study [15] . In one case report, the mother's PCR was negative at birth and day 5 while serology was positive at day 10 (type of serology not mentioned). ...
... Timing of CC was defined in two case reports as 30 and 50 seconds, respectively [17 , 18] . One cohort defined a cut-off timing of delayed CC ( ≥30 seconds) [15] . ...
View
... Referente ao contato pele a pele, a maior parte das mulheres relataram ter sido realizado, o que está condizente ao que as pesquisas atuais mostram que esse contato precoce não teve relação com o aumento da transmissão neonatal. No que concerne à amamentação, as evidências mostram que esta deve ser realizada em todas as situações, até mesmo nas infectadas com o SARS-CoV-2, tendo em vista que há a presença de Imunoglobulina A no leite materno que pode favorecer imunidade para o lactante (Sbp, 2020;Mejía et al., 2021;Demers & Mathieu et al., 2020;Fox et al., 2020). ...
Percepção da mulher quanto a parir durante pandemia da COVID-19
Article
Full-text available
  • Jan 2023
Introdução: O nascimento é um evento fisiológico e natural, que agrega vários significados culturais e por isso é um momento marcante na vida da mulher. Objetivo: Compreender a percepção das mulheres acerca de parir em uma maternidade de baixo risco durante a pandemia da COVID-19. Métodos: Estudo qualitativo composto por 18 puérperas que tiveram parto vaginal durante pandemia da COVID-19 assistidas por enfermeiros obstetras. Realizado entre setembro e novembro de 2021 em uma maternidade pública do agreste pernambucano, referência para gestantes de risco habitual. A análise de conteúdo foi feita a partir de entrevistas que seguiam um roteiro semiestruturado, transcrita de forma fidedigna, e por meio de dados extraídos do cartão pré-natal. Foram indagadas questões sobre as características obstétricas, o trabalho de parto e o sentimento de estar gestante/parturiente na pandemia. Essa pesquisa seguiu todas as recomendações do Comitê de Ética em Pesquisa. Resultados: Puérperas multíparas, com a média de idade de 27,8 (± 6,9) anos, prevaleceu a cor da pele parda, com residência na zona urbana, com companheiro e trabalho remunerado, metade apresentava renda familiar de 1 salário. A análise de conteúdo qualitativa clínica revelou duas categorias: 1) Orientações e medidas de enfrentamento a SARS-CoV-2; 2) Sentimentos das parturientes quanto a parir em uma pandemia. Conclusão: Houve um impacto negativo referente a fatores psicológicos atrelados, como o medo e insegurança, devido o temor de contrair o vírus e desenvolver possíveis complicações. Entretanto, na assistência ao parto não foram evidenciadas muitas alterações, além do uso de máscara e distanciamento social.
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... COVID-19 infection is transmitted via respiratory droplets exhaled by infected patients through direct contact or through contaminated surfaces. Vertical transmission from mother to baby is a rare event and it will not depend on mode of delivery, delayed cord clamping or mode of baby feeding 7,8 . ...
Management of COVID-19 infection during pregnancy
Article
Full-text available
  • Mar 2021
“COVID-19” infection is caused by the SARS-CoV-2 virus (severe acute respiratory syndrome coronavirus 2), which is a single chain, enveloped RNA virus. The index case was reported on 17th November 2019 from Hubei province, China, and it is believed to be of animal origin. Thereafter, the outbreak of COVID-19 infection has rapidly spread worldwide causing significant morbidity and mortality, including pregnant mothers. This was named as “COVID-19” by the WHO on 11th February 2020 and declared as a global pandemic on 11th March 20202. More than 2.4 billion cases have been reported so far, with nearly 5 million deaths. The pandemic has affected countless more lives as relatives and friends of those who were infected. Majority of the pregnant mothers infected with COVID-19 infection are asymptomatic. Among the symptomatic patients, majority have mild symptoms. Both these groups can be managed in a home-based setting. However, supervised observation and effective communication should be maintained to identify alarming symptoms and signs early. Patients with moderate to severe disease should be managed at hospital-based setting and close monitoring should be done to identify disease progression, development of multi organ failure and critical disease. Early identification of alarming symptoms and signs, early hospitalization of the patients with moderate to severe disease, early intubation and mechanical ventilation and effective MDT management are the key steps in reducing maternal morbidity and mortality associated with COVID-19 infection.
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Impact of SARS-COV-2 Infection on Maternal, Obstetric and Neonatal Outcomes in a Cohort of Vaccinated Women: A Pilot Study
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  • Mar 2024
  • BIOL RES NURS
We aimed to investigate the impact of COVID-19 infection on maternal characteristics and obstetric and neonatal outcomes in a cohort of women in labor previously vaccinated who tested positive for SARS-CoV-2 infection, compared to aged-matched healthy controls. A retrospective case-control study was conducted among 66 women in labor. Clinical data were obtained from medical records. The attendance rates at childbirth and parenting classes, as well as the implementation of a birth plan, were significantly lower in the COVID-19 infection group (6.1% vs. 48.5%, <0.001; 6.1% vs. 33.3%, p = .005, respectively). Women with COVID-19 had a higher prevalence of prolonged postpartum hospital stay (33.3% vs. 9.1%, p = .016), and significantly higher prevalence of spontaneous preterm birth (27.3% vs. 1.09%, p = .006). Breastfeeding within the first 24 hr was also lower in women with COVID-19 (72.7% vs. 97.0%, p = .006). Maternal characteristics and neonatal outcomes are influenced by COVID-19 infection in vaccinated women. Complications include spontaneous preterm birth, prolonged postpartum hospital stay, and lack of breastfeeding within the first 24 hr. Childbirth education, parenting classes and implementing a birth plan may be associated with a decreased risk of COVID-19 infection.
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Prevalence and Obstetric Management Changes During the COVID-19 Pandemic in Peripartum SARS-CoV-2-Positive Women – an Analysis of the CRONOS Registry Data
Article
  • Feb 2024
The analysis of CRONOS data for this article presents the infection prevalence among parturients and subsequent changes in obstetric management over time in Germany. 2,184 women with peripartum SARS-CoV-2 infection (<14d before birth) were included. Monthly period prevalence was calculated using the number of affected women on the CRONOS registry relative to total monthly births in each hospital from March 2020 to May 2022 and compared to RKI data. Trends related to changes in obstetric management were calculated based on severity of illness. By June 2021, the obstetric population shows a discretely higher infection prevalence compared to the general population, falling below the RKI reported prevalence by October 2021. The overall rate of iatrogenic deliveries remains unchanged over time (p-value for trend=0.779). During wave 1 to 4, deliveries due to SARS-CoV-2 infection rose among moderately to severely ill women (p-value for trend 0.0000) and was increased compared to moderately ill women (p=0.001). We showed that comprehensive screening provides timely information on infection prevalence. Recruitment fatigue caused by higher clinician workload due to increased admissions and more cases with severe illness probably caused reduced prevalence reporting. Changes in obstetric management were related to COVID-19 symptom severity. A comprehensive national perinatal registry is needed to examine other areas of perinatal care in Germany.
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Skin‐to‐skin contact in mothers with suspected, probable, or confirmed COVID‐19
Article
Full-text available
  • Feb 2023
  • BIRTH-ISS PERINAT C
Background The World Health Organization recommends skin‐to‐skin contact (SSC) in newborns of mothers with COVID‐19, applying infection prevention and control measures, and after a process of antenatal counseling on the possible risks and benefits. In this study, the reasons given for and against postnatal SSC in mothers with COVID‐19 were reviewed. Method Between November and December 2020, we conducted a scoping review. Twenty‐six relevant studies were identified. The results were extracted and presented narratively. Results The reasons described for avoiding SSC have include contradictory recommendations, risk of virus transmission, impossibility of universal antepartum maternal screening for COVID‐19, work overload, and ethical considerations. The reasons given for the maintenance of SSC include maternal and infant benefits of SSC, previous experiences in viral outbreaks, protection of newborns against infections, decreased contact with professionals, caregivers and surfaces, and preservation of natural processes. Conclusions The recommendation to allow SSC is based primarily on the acceptance that horizontal perinatal transmission is unlikely if correct hygiene precautions are taken and that the benefits of SSC outweigh the potential risks of neonatal COVID‐19 infection. Knowing the reasons that have motivated the current recommendations on SSC is essential to be able to carry out an effective prenatal parental education that allows a shared decision to be made.
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APPROACH TO COVID-19 DURING PREGNANCY: SYMPTOMS, LABORATORY FINDINGS, IMAGING METHODS, AND VERTICAL TRANSMISSION
Chapter
Full-text available
  • Jun 2022
CURRENT COMPREHENSIVE APPROACH TO COVID-19 EDS. PROF.DR. HARUN ALP, PROF.DR. MURAT ÇETİN RAĞBETLİ AND ASST. PROF.DR. HALE KOKSOY
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Incidence and clinical profiles of COVID-19 pneumonia in pregnant women: A single-centre cohort study from Spain
Article
Full-text available
  • Jun 2020
Background Information regarding the incidence and characteristics of COVID-19 pneumonia amongst pregnant women is scarce. Methods Single-centre experience with 32 pregnant women diagnosed with COVID-19 between March 5 to April 5, 2020 at Madrid, Spain. Findings COVID-19 pneumonia was diagnosed in 61·5% (32/52) women. Only 18·7% (6/32) had some underlying condition (mostly asthma). Supplemental oxygen therapy was required in 18 patients (56·3%), with high-flow requirements in six (18·7%). Eight patients (25·0%) fulfilled the criteria for acute distress respiratory syndrome. Invasive mechanical ventilation was required in two patients (6·2%). Tocilizumab was administered in five patients (15·6%). Delivery was precipitated due to COVID-19 in three women (9·4%). All the newborns had a favourable outcome, with no cases of neonatal SARS-CoV-2 transmission. Severe cases of pneumonia requiring supplemental oxygen were more likely to exhibit bilateral alveolar or interstitial infiltrates on chest X-ray (55·6% vs. 0·0%; P-value = 0·003) and serum C-reactive protein (CRP) levels >10 mg/dL (33·0% vs. 0·0%; P-value = 0·05) at admission than those with no oxygen requirements. Interpretation Pregnant women with COVID-19 have a high risk of developing pneumonia, with a severe course in more than half of cases. The presence of bilateral kung infiltrates and elevated serum CRP at admission may identify women at-risk of severe COVID-19 pneumonia. Funding Instituto de Salud Carlos III (COV20/00,181), Spanish Ministry of Science and Innovation.
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Characteristics and outcomes of pregnant women admitted to hospital with confirmed SARS-CoV-2 infection in UK: national population based cohort study
Article
Full-text available
  • Jun 2020
  • Br Med J
Objectives To describe a national cohort of pregnant women admitted to hospital with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the UK, identify factors associated with infection, and describe outcomes, including transmission of infection, for mothers and infants. Design Prospective national population based cohort study using the UK Obstetric Surveillance System (UKOSS). Setting All 194 obstetric units in the UK. Participants 427 pregnant women admitted to hospital with confirmed SARS-CoV-2 infection between 1 March 2020 and 14 April 2020. Main outcome measures Incidence of maternal hospital admission and infant infection. Rates of maternal death, level 3 critical care unit admission, fetal loss, caesarean birth, preterm birth, stillbirth, early neonatal death, and neonatal unit admission. Results The estimated incidence of admission to hospital with confirmed SARS-CoV-2 infection in pregnancy was 4.9 (95% confidence interval 4.5 to 5.4) per 1000 maternities. 233 (56%) pregnant women admitted to hospital with SARS-CoV-2 infection in pregnancy were from black or other ethnic minority groups, 281 (69%) were overweight or obese, 175 (41%) were aged 35 or over, and 145 (34%) had pre-existing comorbidities. 266 (62%) women gave birth or had a pregnancy loss; 196 (73%) gave birth at term. Forty one (10%) women admitted to hospital needed respiratory support, and five (1%) women died. Twelve (5%) of 265 infants tested positive for SARS-CoV-2 RNA, six of them within the first 12 hours after birth. Conclusions Most pregnant women admitted to hospital with SARS-CoV-2 infection were in the late second or third trimester, supporting guidance for continued social distancing measures in later pregnancy. Most had good outcomes, and transmission of SARS-CoV-2 to infants was uncommon. The high proportion of women from black or minority ethnic groups admitted with infection needs urgent investigation and explanation. Study registration ISRCTN 40092247.
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Clinical Findings and Disease Severity in Hospitalized Pregnant Women With Coronavirus Disease 2019 (COVID-19)
Article
Full-text available
  • May 2020
  • OBSTET GYNECOL
Objective: To investigate the clinical evolution of coronavirus disease 2019 (COVID-19) in hospitalized pregnant women and potential factors associated with severe maternal outcomes. Methods: We designed a prospective multicenter cohort study of pregnant women with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection who were admitted to 12 Italian maternity hospitals between February 23 and March 28, 2020. Clinical records, laboratory and radiologic examinations, and pregnancy outcomes were collected. A subgroup of patients with severe disease was identified based on intensive care unit (ICU) admission, delivery for respiratory compromise, or both. Results: Seventy-seven patients were included, 14 of whom had severe disease (18%). Two thirds of the patients in the cohort were admitted during the third trimester, and 84% were symptomatic on admission. Eleven patients underwent urgent delivery for respiratory compromise (16%), and six were admitted to the ICU (8%). One woman received extracorporeal membrane oxygenation; no deaths occurred. Preterm delivery occurred in 12% of patients, and nine newborns were admitted to the neonatal intensive care unit. Patients in the severe subgroup had significantly higher pregestational body mass indexes (BMIs) and heart and respiratory rates and a greater frequency of fever or dyspnea on admission compared with women with a nonsevere disease evolution. Conclusion: In our cohort, one in five women hospitalized with COVID-19 infection delivered urgently for respiratory compromise or were admitted to the ICU. None, however, died. Increased pregestational BMI and abnormal heart and respiratory rates on admission were associated with severe disease.
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Rates of Maternal and Perinatal Mortality and Vertical Transmission in Pregnancies Complicated by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-Co-V-2) Infection: A Systematic Review
Article
  • Jun 2021
  • Obstet Anesth Digest
( Obstet Gynecol. 2020;136:303–312) As of May 1, 2020, more than 3.33 million cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been confirmed globally. This novel coronavirus has the potential to increase adverse outcomes in the more than 140 million births that occur around the globe annually. While there have been a number of case reports of SARS-CoV-2 in pregnancy, the sample sizes have been small, limiting our understanding of the virus’ impact on pregnancy. The aim of this study was to assess the occurrence of maternal and neonatal complications in pregnancies affected by SARS-CoV-2.
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Characteristics and Outcomes of Pregnant Women Admitted to Hospital With Confirmed SARS-CoV-2 Infection in the UK: National Population-based Cohort Study
Article
  • Mar 2021
  • Obstet Anesth Digest
( BMJ . 2020;369:m2107) Although cases of coronavirus disease 2019 (COVID-19) continue to rise, information on the transmission, effect, and prevalence of the disease in pregnant women and their newborns is still emerging. This study aimed to describe the characteristics and outcomes of a national cohort of pregnant women in the UK hospitalized with COVID-19, the disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
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Coronavirus Disease 2019 (COVID-19) Pandemic and Pregnancy
Article
  • Mar 2021
  • Obstet Anesth Digest
( Am J Obstet Gynecol . 2020;222:521–531) Caring for vulnerable populations is a critical component of pandemic management. Pregnant women are susceptible to respiratory illness with an increased infectious morbidity and mortality. While clinical information is limited on the effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on the pregnant population, both the SARS-CoV and MERS-CoV outbreaks of the last 2 decades resulted in approximately one third of infected pregnant women dying from the illness. The purpose of this paper was to summarize the clinical features of coronavirus disease 2019 (COVID-19) in pregnant women, and present a pragmatic and integrated framework for handling complex intricacies involved in disease management.
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Rates of Maternal and Perinatal Mortality and Vertical Transmission in Pregnancies Complicated by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-Co-V-2) Infection: A Systematic Review
Article
  • Jun 2020
  • OBSTET GYNECOL
Objective: To ascertain the frequency of maternal and neonatal complications, as well as maternal disease severity, in pregnancies affected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Data sources: MEDLINE, Ovid, ClinicalTrials.gov, MedRxiv, and Scopus were searched from their inception until April 29, 2020. The analysis was limited to reports with at least 10 pregnant patients with SARS-CoV-2 infection that reported on maternal and neonatal outcomes. Methods of study selection: Inclusion criteria were pregnant women with a confirmed diagnosis of SARS-CoV-2 infection. A systematic search of the selected databases was performed by implementing a strategy that included the MeSH terms, key words, and word variants for "coronavirus," "SARS-CoV-2," "COVID-19," and "pregnancy.r The primary outcomes were maternal admission to the intensive care unit (ICU), critical disease, and death. Secondary outcomes included rate of preterm birth, cesarean delivery, vertical transmission, and neonatal death. Categorical variables were expressed as percentages with number of cases and 95% CIs. Tabulation, integration, and results: Of the 99 articles identified, 13 included 538 pregnancies complicated by SARS-CoV-2 infection, with reported outcomes on 435 (80.9%) deliveries. Maternal ICU admission occurred in 3.0% of cases (8/263, 95% CI 1.6-5.9) and maternal critical disease in 1.4% (3/209, 95% CI 0.5-4.1). No maternal deaths were reported (0/348, 95% CI 0.0-1.1). The preterm birth rate was 20.1% (57/284, 95% CI 15.8-25.1), the cesarean delivery rate was 84.7% (332/392, 95% CI 80.8-87.9), the vertical transmission rate was 0.0% (0/310, 95% CI 0.0-1.2), and the neonatal death rate was 0.3% (1/313, 95% CI 0.1-1.8). Conclusion: With data from early in the pandemic, it is reassuring that there are low rates of maternal and neonatal mortality and vertical transmission with SARS-CoV-2. The preterm birth rate of 20% and the cesarean delivery rate exceeding 80% seems related to geographic practice patterns. Systematic review registration: PROSPERO, CRD42020181497.
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Severe COVID-19 during Pregnancy and Possible Vertical Transmission
Article
  • Apr 2020
There are few cases of pregnant women with novel corona virus 2019 (COVID-19) in the literature, most of them with a mild illness course. There is limited evidence about in utero infection and early positive neonatal testing. A 41-year-old G3P2 with a history of previous cesarean deliveries and diabetes mellitus presented with a 4-day history of malaise, low-grade fever, and progressive shortness of breath. A nasopharyngeal swab was positive for COVID-19, COVID-19 serology was negative. The patient developed respiratory failure requiring mechanical ventilation on day 5 of disease onset. The patient underwent a cesarean delivery, and neonatal isolation was implemented immediately after birth, without delayed cord clamping or skin-to-skin contact. The neonatal nasopharyngeal swab, 16 hours after delivery, was positive for severe acute respiratory syndrome–coronavirus 2 (SARS-CoV-2) real-time polymerase chain reaction (RT-PCR), and immunoglobulin (Ig)-M and IgG for SARS-CoV-2 were negative. Maternal IgM and IgG were positive on postpartum day 4 (day 9 after symptom onset). We report a severe presentation of COVID-19 during pregnancy. To our knowledge, this is the earliest reported positive PCR in the neonate, raising the concern for vertical transmission. We suggest pregnant women should be considered as a high-risk group and minimize exposures for these reasons. Key Points
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