Systematic Review of Pregnancy and COVID-19: Clinical Characteristics and Outcomes from 108 Pregnancies

BACKGROUND AND PURPOSE:

Zaigham and Andersson (Acta Obstetricia et Gynecologica, 2020) provide a systematic review of clinical manifestations and maternal and perinatal outcomes for pregnant women with COVID-19

Systematic review
Inclusion criteria
- Case reports and series from December 8 2019 to April 1 2020
  - Peer-reviewed
  - Written in English or Chinese
  - Lab confirmed SARS-CoV-2 infection (quantitative real-time polymerase chain reaction (RT-PCR) or dual fluorescence PCR)
Exclusion criteria
- Unpublished reports
- Unspecified date and location of the study or suspicion of duplicate reporting
- COVID-19 cases not lab confirmed
- Maternal or perinatal outcomes not reported

18 papers | 108 pregnancies with confirmed COVID-19
- Majority presented in the third trimester
- Maternal comorbidities included
  - Preeclampsia | GDM | Hypothyroidism | Placenta previa
Most common presenting symptoms
- Fever: 68%
- Cough: 34%
- Malaise: 13%
- Dyspnea: 12%
- Sore Throat: 7%
- Diarrhea: 6%
Laboratory results
- Lymphocytopenia: 59%
- Elevated C-reactive protein: 70%
Management
- Oxygen: 89%
- Antivirals: 91%
- Antibiotics prescribed in all cases (likely to prevent superimposed bacterial infection)
Cesarean delivery: 91% (indications included COVID-19 and ‘fetal distress’)
Preterm birth (<37 weeks): 42%
Maternal outcomes
- ICU admissions: 3 patients
- Maternal deaths: 0
Perinatal outcomes
- Neonatal deaths: 1
- Intrauterine deaths: 1 (mother with ARDS, intubated and on ECMO)
- SARS-CoV-2 infection; 1 newborn | Fetus did did well clinically but had transient lymphocytopenia and abnormal LFTs

The majority of pregnant women who presented with COVID-19 were discharged without major complications
- However, there were reported cases of maternal morbidity and perinatal mortality
Possibility of vertical transmission from mother to offspring could not be ruled out

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