Coronavirus Disease 2019 During Pregnancy: A Systematic Review Of Reported Cases Comment

The presence of coronavirus disease 2019 (COVID-19) in pregnant patients raises concerns for adverse outcomes. The goal of this study was to collect information on mothers and neonates with COVID-19 and shed light on delivery timing and mode of delivery. Information regarding each pregnancy was collected through PubMed, Scopus, and CINAHL. The terms "coronavirus and/or pregnancy," "COVID and/or pregnancy," "COVID disease and/or pregnancy," and "COVID pneumonia and/or pregnancy" were used to search through the databases. Reports discussing recommended management for pregnancies complicated by COVID-19 were included. A total of 205 articles published from 1969 to 2020 were identified and searched. Overall, 199 were excluded because of representing animal studies, abstract not available, contents not related to the topic, significant information not provided, and duplicate articles, leaving a total of 12 articles; 6 articles were then excluded because the data were not comparable. This left a total of 6 studies that were included. There was no restriction on language in order to obtain as many articles and as much information as possible. The researchers analyzed clinical features, symptoms, associated diseases, fetal characteristics, time of delivery, type of delivery, and follow-up for mothers 20 years or older. Overall, a total of 51 cases with pregnancies affected by COVID-19 were analyzed. Median maternal age was 30 years (interquartile range [IQR], 27.5-33 years), and median gestational age at diagnosis was 36 weeks (IQR, 35-37.5 weeks). Of the 48 pregnant women who were included and had delivered before publication, the median gestational age at delivery was 36.5 weeks (IQR, 35-33 weeks). For 22 patients, the range of time between symptom onset and delivery was between 1 and 7 days (median, 2 days; IQR, 1-4 days). In 3 cases, symptoms of COVID-19 appeared after delivery. In all, 35 pregnant women had documented symptoms at the time of diagnosis of COVID-19, which were similar to nonpregnant patients. The symptoms included the following: 17 pregnant women (48%) with fever on hospital admission, 16 (46%) with dry cough, and 8 (23%) with fever in the postpartum period. Other less frequent symptoms included sore throat, dyspnea, fatigue, myalgia, malaise, diarrhea, and cholecystitis. No pregestational comorbidities were reported; however, there was 1 case of gestational hypertension and 1 case of preeclampsia reported after the diagnosis of COVID-19. Through this study, there were no cases identified during the first trimester of pregnancy, 2 cases in the second trimester, and 49 cases during the third trimester. Of the 48 women who delivered, 2 had a spontaneous vaginal delivery, whereas the remaining 46 had a cesarean delivery. The indications for cesarean were not clearly reported for most cases. Of note, premature rupture of membranes occurred in 26% of patients. Of the neonates, 48 (with 1 set of twins) were reported healthy at the time of birth, and 1 fetal death was reported in a critically ill patient. All of the neonates had a throat swab taken within 72 hours of delivery and tested negative for COVID-19, whereas 1 neonate tested positive 36 hours after birth. Overall, the majority of pregnant patients infected with COVID-19 delivered via cesarean and often preterm. This raises concern as the COVID-19 pandemic continues to spread around the world. Notably, there was no evidence of vertical transmission.Moving forward, the rationale behind obstetrical interventions, including cesarean delivery, should be provided in reports in order to better understand the implications of COVID-19 in pregnancy. Further research is necessary to determine the maternal and fetal consequences of a COVID-19 infection during pregnancy.