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COVID-19 Evidence Alerts
from McMaster PLUSTM

Current best evidence for clinical care (more info)

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Prognosis Della Gatta AN, Rizzo R, Pilu G, et al. Coronavirus disease 2019 during pregnancy: a systematic review of reported cases. Am J Obstet Gynecol. 2020 Jul;223(1):36-41. doi: 10.1016/j.ajog.2020.04.013. Epub 2020 Apr 18.
Abstract

OBJECTIVE: This study aimed to conduct a systematic review of the clinical outcomes reported for pregnant patients with coronavirus disease 2019.

DATA SOURCES: The PubMed, CINAHL, and Scopus databases were searched using a combination of key words such as "Coronavirus and/or pregnancy," "COVID and/or pregnancy," "COVID disease and/or pregnancy," and "COVID pneumonia and/or pregnancy." There was no restriction of language to allow collection of as many cases as possible.

STUDY ELIGIBILITY CRITERIA: All studies of pregnant women who received a coronavirus disease 2019 diagnosis using acid nucleic test, with reported data about pregnancy, and, in case of delivery, reported outcomes, were included.

STUDY APPRAISAL AND SYNTHESIS METHODS: All the studies included have been evaluated according to the tool for evaluating the methodological quality of case reports and case series described by Murad et al.

RESULTS: Six studies that involved 51 pregnant women were eligible for the systematic review. At the time of the report, 3 pregnancies were ongoing; of the remaining 48 pregnant women, 46 gave birth by cesarean delivery, and 2 gave birth vaginally; in this study, 1 stillbirth and 1 neonatal death were reported.

CONCLUSION: Although vertical transmission of severe acute respiratory syndrome coronavirus 2 infection has been excluded thus far and the outcome for mothers and neonates has been generally good, the high rate of preterm delivery by cesarean delivery is a reason for concern. Cesarean delivery was typically an elective surgical intervention, and it is reasonable to question whether cesarean delivery for pregnant patients with coronavirus disease 2019 was warranted. Coronavirus disease 2019 associated with respiratory insufficiency in late pregnancies certainly creates a complex clinical scenario.

Ratings
Discipline / Specialty Area Score
General Internal Medicine-Primary Care(US)
Family Medicine (FM)/General Practice (GP)
Infectious Disease
Obstetrics
Pediatric Neonatology
FM/GP/Obstetrics
Comments from MORE raters

FM/GP/Obstetrics rater

This systematic review scoured the literature for cases and found only 48! That's probably because it was so early in the pandemic. We have heard case series from individual institutions in NYC with far more cases on their own than this systematic review. Thus I'd say that no one needs to know about information in this systematic review because it was too early and too sparse.

General Internal Medicine-Primary Care(US) rater

Well done SR of COVID 19 during pregnancy (6 studies and 51 cases of pregnancies). 2 cases in the second trimester and 1 case in the third trimester (33 w gestation) were reported as ongoing. Of the remaining 48 women, 2 had a spontaneous vaginal delivery and 46 patients underwent cesarean delivery. (The indications to the cesarean delivery were not clearly reported in all cases, although authorities have taken a stance that COVID-19 is not a contraindication to vaginal delivery). The outcome was generally favorable for both mothers and neonates. 2 patients required ICU admission (1 with multiple organ dysfunction syndrome had intrauterine fetal demise; the other was discharged). 48 neonates (with 1 set of twins) were in good condition at the time of birth. In all but 1 case, neonatal throat swab samples tested negative. There was 1 stillbirth in a severely compromised mother, and there was 1 neonatal death that may not be independent from the infection.