Current best evidence for clinical care (more info)
INTRODUCTION: The emergence and fast spread of 2019 novel coronavirus (2019-nCoV) threatens the world as a new public health crisis. This study aimed to clarify the impact of novel coronavirus disease (COVID-19) on pregnant patients and maternal and neonatal outcomes.
METHODS: A comprehensive literature search was conducted in databases including PubMed, Scopus, Embase, ProQuest, and Science Direct. All studies including original data; case reports, case series, descriptive and observational studies, and randomized controlled trials were searched from December 2019 until 19 March 2020.
RESULTS: The search identified 1472 results and 939 abstracts were screened. 928 articles were excluded because studies did not include pregnant women. Full texts of eleven relevant studies were reviewed and finally nine studies were included in this study. The characteristics of 89 pregnant women and their neonates were studied. Results revealed that low-grade fever and cough were the principal symptoms in all patients. The main reported laboratory findings were lymphopenia, elevated C-Reactive Protein (CRP), Amino alanine transferase (ALT), and Aspartate amino transferase (AST). In all symptomatic cases, chest Computerized Tomography (CT) scans were abnormal. Fetal distress, premature rupture of membranes and preterm labor were the main prenatal complications. Two women needed intensive care unit admission and mechanical ventilation, one of whom developed multi-organ dysfunction and was on Extracorporeal Membrane Oxygenation (ECMO). No case of maternal death was reported up to the time the studies were published. 79 mothers delivered their babies by cesarean section and five women had a vaginal delivery. No fetal infection through intrauterine vertical transmission was reported.
CONCLUSIONS: Available data showed that pregnant patients in late pregnancy had clinical manifestations similar to non-pregnant adults. It appears that the risk of fetal distress, preterm delivery and prelabor rupture of membranes (PROM) rises with the onset of COVID-19 in the third trimester of pregnancy. There is also no evidence of intrauterine and transplacental transmission of COVID-19 to the fetus in the third trimester of pregnancies.
| Discipline / Specialty Area | Score |
|---|---|
| FM/GP/Obstetrics | |
| Family Medicine (FM)/General Practice (GP) | |
| Infectious Disease | |
| Pediatric Neonatology | |
| Public Health | |
| Intensivist/Critical Care | |
| Obstetrics | |
| Emergency Medicine | |
| Hospital Doctor/Hospitalists | |
| Internal Medicine | |
This systematic review is based on studies comprised of case reports and case series. However given lack of information on COVID19 impact in pregnant women, the study provide useful information for the management of pregnant women with COVID19.
Neonatal findings that there was no maternal to fetal transfer of COVID is important in view of the high cesarean rate.
As an obstetrician, I find this systematic review of the literature provides an useful summary of the available evidence about the impact of COVID-19 on the obstetric population. The review suggests a clinical presentation similar to the general population for the monther. Nevertheless, an effect on pregnancy appears to be present. Noteworthy, the reasons underlining the higher cesarean section rate represent an interesting point of investigation. The risk of vertical transmission does not seem an appropriate reason to perform a cesarean section.
This field is evolving so rapidly, and the early reports are sometimes not fully reviewed, so I wonder if it is too soon for this meta-analysis. They report multiple cases of sick infants, including symptoms that could be ascribed to this virus (e.g., multi-organ failure, pneumonia, gastric bleeding). It may be too soon to rule out vertical transmission completely.
Covid-19 is still a relatively new disease with evolving knowledge about it. Recently, there is valid evidence that transplacental Covid-19 infection is possible. This review may be a bit too early and may rapidly be overtaken by emerging information.