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COVID-19 and Women’s Health

Active COVID-19 Infection During Labor and Delivery and Associated Risks

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BACKGROUND AND PURPOSE:

  • Zlatkin et al. (BMC Pregnancy Childbirth, 2022) determined maternal, obstetrical, and perinatal outcomes of women who gave birth while infected with SARS-CoV-2

METHODS:

  • Case-control study
    • April 2020 to February 2021
    • Tertiary care center
  • Population
    • Patients diagnosed with COVID-19 during pregnancy
  • Exposures
    • Active SARS-CoV-2 infection during delivery
    • Recovery from infection at least 10 days before labor and delivery
  • Study design
    • All pregnant women are routinely screened upon admission
    • Patients with active SARS-CoV-2 infection give birth in a positively pressured delivery room | Each patient is supervised by a dedicated midwife
    • Antepartum and/or postpartum COVID-19 treatment for hospitalized patients: Prophylactic LMWH alone if symptomatic | Combined with dexamethasone 6 mg daily for 10 days or until discharge for patients with severe disease 
  • Primary outcome
    • Mode of delivery
  • Secondary outcomes
    • Maternal infection characteristics such as disease severity
    • Perinatal complications

RESULTS:

  • Infected at time of delivery: 84 participants | Recovered: 92 participants
  • There was no statistically significant between-group difference in
    • Mean gestational age at delivery (P=0.71)
      • Infected: 39 weeks
      • Recovered: 39 weeks
    • Overall rate of cesarean delivery (P=0.35)
      • Infected: 26.2%
      • Recovered: 17.4%
    • Rate of non-elective cesarean delivery (P=0.48)
      • Infected: 10.71%
      • Recovered: 4.34%
  • Disease severity in the active-infection group
    • Severe diseases: 2.4% | 5 women
    • Critical disease: 3.6% | 3 women admitted to ICU, requiring cesarean delivery to facilitate care
    • There were no severe or critical disease cases in the recovered group
  • There were no differences between the groups for adverse perinatal outcomes

CONCLUSION:

  • Overall, delivery with an active SARS-CoV-2 infection appears to be as safe as delivery is in those who have recovered from a SARS-CoV-2 infection
  • Most women admitted with active infection were asymptomatic
  • Among the active infection group, the authors found that there was

… a trend toward higher rates of severe and critical COVID-19 disease, ICU admission, mechanical ventilation, preterm delivery, and emergent caesarean deliveries mostly related to COVID-19 severity

Learn More – Primary Sources:

Obstetric and perinatal outcomes in parturients with active SARS-CoV-2 infection during labor and delivery: a retrospective cohort study

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Related ObG Topics:

Pregnant Women with COVID-19 at Time of Delivery: NYC Cohort Characteristics and Outcomes
Results from INTERCOVID Multinational Cohort Study: Pregnancy and Neonatal Outcomes
Does SARS-CoV-2 Infection Increase the Risk of Maternal Mortality or Severe Morbidity?

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