Coronavirus in pregnancy and delivery: rapid review

E Mullins, D Evans, R M Viner, P O'Brien, E Morris, E Mullins, D Evans, R M Viner, P O'Brien, E Morris

Abstract

Objectives: There are limited case series reporting the impact on women affected by coronavirus during pregnancy. In women affected by severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), the case fatality rate appears higher in those affected in pregnancy compared with non-pregnant women. We conducted a rapid review to guide health policy and management of women affected by COVID-19 during pregnancy, which was used to develop the Royal College of Obstetricians and Gynaecologists' (RCOG) guidelines on COVID-19 infection in pregnancy.

Methods: Searches were conducted in PubMed and MedRxiv to identify primary case reports, case series, observational studies and randomized controlled trials describing women affected by coronavirus in pregnancy. Data were extracted from relevant papers. This review has been used to develop guidelines with representatives of the Royal College of Paediatrics and Child Health (RCPCH) and RCOG who provided expert consensus on areas in which data were lacking.

Results: From 9965 search results in PubMed and 600 in MedRxiv, 21 relevant studies, all of which were case reports or case series, were identified. From reports of 32 women to date affected by COVID-19 in pregnancy, delivering 30 babies (one set of twins, three ongoing pregnancies), seven (22%) were asymptomatic and two (6%) were admitted to the intensive care unit (ICU), one of whom remained on extracorporeal membrane oxygenation. No maternal deaths have been reported to date. Delivery was by Cesarean section in 27 cases and by vaginal delivery in two, and 15 (47%) delivered preterm. There was one stillbirth and one neonatal death. In 25 babies, no cases of vertical transmission were reported; 15 were reported as being tested with reverse transcription polymerase chain reaction after delivery. Case fatality rates for SARS and MERS were 15% and 27%, respectively. SARS was associated with miscarriage or intrauterine death in five cases, and fetal growth restriction was noted in two ongoing pregnancies affected by SARS in the third trimester.

Conclusions: Serious morbidity occurred in 2/32 women with COVID-19, both of whom required ICU care. Compared with SARS and MERS, COVID-19 appears less lethal, acknowledging the limited number of cases reported to date and that one woman remains in a critical condition. Preterm delivery affected 47% of women hospitalized with COVID-19, which may put considerable pressure on neonatal services if the UK's reasonable worst-case scenario of 80% of the population being affected is realized. Based on this review, RCOG, in consultation with RCPCH, developed guidance for delivery and neonatal care in pregnancies affected by COVID-19, which recommends that delivery mode be determined primarily by obstetric indication and recommends against routine separation of affected mothers and their babies. We hope that this review will be helpful for maternity and neonatal services planning their response to COVID-19. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.

Keywords: COVID-19; breastfeeding; fetal; miscarriage; neonatal; pregnancy; preterm birth.

© 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.

References

REFERENCES

    1. Royal College of Obstetricians and Gynaecologists. Coronavirus (COVID-19) infection and pregnancy, 2020.
    1. Chen H, Guo J, Wang C, Luo F, Yu X, Zhang W, Li J, Zhao D, Xu D, Gong Q, Liao J, Yang H, Hou W, Zhang Y. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet 2020; 6736: 1-7.
    1. Wang X, Zhou Z, Jianping Z, Zhu F, Tang Y, Shen X. A case of 2019 Novel Coronavirus in a pregnant woman with preterm delivery. Clin Infect Dis 2020. DOI: 10.1093/cid/ciaa200.
    1. Zhu H, Wang L, Fang C, Peng S, Zhang L, Chang G, Xia S, Zhou W. Clinical analysis of 10 neonates born to mothers with 2019-nCoV pneumonia. Transl Pediatr 2020; 9: 51-60.
    1. Liu Y, Chen H, Tang K, Guo Y. Clinical manifestations and outcome of SARS-CoV-2 infection during pregnancy. J Infect 2020. DOI: 10.1016/j.jinf.2020.02.028.
    1. Robertson CA, Lowther SA, Birch T, Tan C, Sorhage F, Stockman L, McDonald C, Lingappa JR, Bresnitz E. SARS and Pregnancy: A Case Report. Emerg Infect Dis 2004; 10: 345-348.
    1. Li AM, Ng PC. Severe acute respiratory syndrome (SARS) in neonates and children. Arch Dis Child Fetal Neonatal Ed 2005; 90: 461-465.
    1. Wong SF, Chow KM, Leung TN, Ng WF, Ng TK, Shek CC, Ng PC, Lam PW, Ho LC, To WW, Lai ST, Yan WW, Tan PY. Pregnancy and perinatal outcomes of women with severe acute respiratory syndrome. Am J Obstet Gynecol 2004; 191: 292-297.
    1. Lam CM, Wong F, Leung N, Chow M. A case-controlled study comparing clinical course and outcomes of pregnant and non-pregnant women with severe acute respiratory syndrome. BJOG; 2004; 111: 771-774.
    1. Schwartz D, Graham A. Potential Maternal and Infant Outcomes from Coronavirus 2019-nCoV (SARS-CoV-2) Infecting Pregnant Women: Lessons from SARS, MERS, and Other Human Coronavirus Infections. Viruses 2020; 20: 1-16.
    1. Shek CC, Ng PC, Fung GPG, Cheng FWT, Chan PKS, Peiris MJS, Lee KH, Wong SF, Cheung HM, Li AM, Hon EK, Yeung CK, Chow CB, Tam JS, Chiu MC, Fok TF. Infants Born to Mothers With Severe Acute Respiratory Syndrome. Pediatrics 2020; 112: e254.
    1. Alserehi H, Wali G, Alshukairi A, Alraddadi B. Impact of Middle East Respiratory Syndrome coronavirus (MERS-CoV) on pregnancy and perinatal outcome. BMC Infect Dis 2016; 16: 1-4.
    1. Jeong SY, Sung SI, Sung J, Ahn SY, Kang E, Chang YS, Park WS, Kim JH. MERS-CoV Infection in a Pregnant Woman in Korea. J Korean Med Sci 2017; 3: 5-8.
    1. Assiri A, Abedi G, Malak M, Abdulaziz B, Gerber S, Watson JT. Pregnancy: A Report of 5 Cases From Saudi Arabia. Clin Infect Dis 2016; 63: 951-953.
    1. Park MH, Kim HR, Choi DH, Sung JH, Kim JH. Emergency cesarean section in an epidemic of the middle east respiratory syndrome. Korean J Anesthesiol 2016; 69: 287-291.
    1. Malik A, Medhat K, Masry E, Ravi M, Sayed F. Middle East Respiratory Syndrome Coronavirus during Pregnancy, Abu Dhabi, United Arab Emirates, 2013. Emerg Infect Dis 2016; 22: 515-517.
    1. Payne D, Ibrahim I, Sultan A. Stillbirth During Infection With Middle East Respiratory Syndrome Coronavirus. J Infect Dis 2014; 209: 1870-1872.
    1. Alfaraj S, Al-Twfiq J, Memish Z. Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection during pregnancy: Report of two cases & review of the literature. J Microbiol 2019; 52: 501-503.
    1. Zhang J, Wang Y, Chen L, Zhang R, Xie Y. Clinical analysis of pregnancy in second and third trimesters complicated severe acute respiratory syndrome. Zhonghua Fu Chan Ke Za Zhi 2003; 38: 516-520.
    1. Ng WF, Wong SF, Lam A, Mak YF, Yao H, Lee KC, Chow KM, Yu WC, Ho LC. The placentas of patients with severe acute respiratory syndrome: A pathophysiological evaluation. Pathology 2006; 38: 210-218.
    1. Gagneur A, Dirson E, Audebert S, Vallet S. Materno-fetal transmission of human coronaviruses: a prospective pilot study. Eur J Clin Microbiol Infect Dis 2008; 2005: 863-866.
    1. Yudin M, Steele D, Sgro M, Read S, Kopplin P, Gough K. Severe acute respiratory syndrome in pregnancy. Obstet Gynecol 2005; 105: 124-127.
    1. Bottomley C, Van Belle V, Pexsters A, Papageorghiou AT, Mukri F, Kirk E, Van Huffel S, Timmerman D, Bourne T. A model and scoring system to predict outcome of intrauterine pregnancies of uncertain viability. Ultrasound Obstet Gynecol 2011; 37: 588-595.
    1. Bignardi T, Condous G, Kirk E, Van Calsters B, Van Huffel S, Timmerman D, Bourne T. Viability of intrauterine pregnancy in women with pregnancy of unknown location: prediction using human chorionic gonadotropin ratio vs. progesterone. Ultrasound Obstet Gynecol 2010; 35: 656-661.
    1. Wang L, Shi Y, Xiao T, Fu J, Feng X, Mu D, Feng Q, Hei M, Hu X, Li Z, Lu G, Tang Z, Wang Y, Wang C, Xia S, et al.; Working Committee on Perinatal and Neonatal Management for the Prevention and Control of the 2019 Novel Coronavirus Infection. Chinese expert consensus on the perinatal and neonatal management for the prevention and control of the 2019 novel coronavirus infection (First edition). Ann Transl Med 2020; 8: 1-8.
    1. Poon LC, Yang H, Lee JCS, Copel JA, Leung TY, Zhang Y, Chen D, Prefumo F. ISUOG Interim Guidance on 2019 novel coronavirus infection during pregnancy and puerperium: information for healthcare professionals. Ultrasound Obstet Gynecol 2020; 55: 700-708.
    1. Centers for Disease Control and Prevention. Interim Considerations for Infection Prevention and Control of Coronavirus Disease 2019 (COVID-19) in Inpatient Obstetric Healthcare Settings, 2020.
    1. British National Formulary. Kaletra.
    1. British National Formulary. Chloroquine.
    1. Mulangu S, Dodd L, Davey R, Mbaya O, Proschan M, Mukadi D, Lusakibanza Manzo M, Nzolo D, Tshomba Oloma A, Ibanda A, Ali R, Coulibaly S, Levine AC, Grais R, Diaz J, Lane HC, et al.; PALM Consortium Study Team. A Randomized, Controlled Trial of Ebola Virus Disease Therapeutics. NEJM 2019; 381: 2293-2203.

Source: PubMed

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