BACKGROUND AND PURPOSE:

• Ferrazzi et al. (BJOG, 2020) report on the mode of delivery and immediate neonatal outcomes in women infected with COVID-19 in Lombardy, Italy

METHODS:

• Retrospective study
• Setting
  • 12 hospitals in northern Italy
• Participants
  • Confirmed COVID-19 prior to or within 36 hours after delivery
  • Delivered from March 1 to March 20, 2020
  • All consecutive cases admitted to maternity ward for delivery
• Study design
  • Data derived from clinical records
    • General maternal characteristics | Medical or obstetric co-morbidity | Course of pregnancy | Clinical signs and symptoms | Treatment of COVID 19 infection | Mode of delivery | Neonatal data and breastfeeding
• Primary outcome
  • Mode of delivery
  • Neonatal outcome

RESULTS:

• Total 42 women with COVID-19
  • Mean maternal age: 32.9 years (range 21 to 44 years)
• COVID-19 diagnosis
  • Known before admission: 19 cases
  • On hospital admission: 10 cases
  • Delivery room: 27 cases
  • Within 36 hours of delivery: 5 cases (patients still admitted)
• Maternal clinical features
  • Most common symptoms: Fever, cough and mild dyspnoea (80%)
  • Pneumonia: 45.2%
    • Oxygen support: 36.8%
    • Critical care unit: 21.1%
• Mode of delivery
  • Vaginal: 57.1%
  • Elective cesarean: 42.9% (18 women)
    • COVID-19 indication (e.g. worsening dyspnea): 10 cases
    • Unrelated to COVID-19: 8 cases
• Neonatal outcomes
  • Spontaneous term: 30 cases (71.4%)
  • Spontaneous preterm birth: 5 cases
  • Elective cesarean: 6 cases
  • Two women breastfed without a mask because COVID-19 infection was diagnosed in the postpartum period
    • Their newborns tested positive for COVID-19 (days 1 and 3)
  • In one case, a newborn had a positive test after a vaginal operative delivery | Mother did not breastfeed
    • Symptoms day 3 | Recovered after 1 day of mechanical ventilation

CONCLUSION:

• Authors acknowledge that vertical transmission risk with vaginal delivery cannot be excluded
• However, results from this study would suggest that vaginal delivery is associated with a low risk of COVID-19 transmission
• In addition, the author conclude that

Vaginal delivery is appropriate in mild cases and caesarean section should be reserved for women with severe respiratory problems, where delivering the baby will allow improved ventilation

Learn More – Primary Sources:

Vaginal delivery in SARS-CoV-2-infected pregnant women in Northern Italy: a retrospective analysis

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