Department of Medical Education, Drexel University College of Medicine, Philadelphia, Pennsylvania.
Department of Obstetrics and Gynecology, Drexel University College of Medicine, Philadelphia, Pennsylvania.
Am J Perinatol. 2021 Mar;38(4):332-341. doi: 10.1055/s-0040-1721658. Epub 2020 Dec 7.
This study aims to review the published literature to determine mode of delivery in pregnant women with coronavirus disease 2019 (COVID-19) and the indications reported for cesarean section early in the pandemic to add information to the current narrative and raise awareness of trends discovered.
A systematic review was conducted by searching PubMed, Scopus, and ScienceDirect databases for articles published between December 2019 and April 29, 2020 using a combination of the keywords such as COVID-19, coronavirus 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), pregnancy, vaginal delivery, cesarean section, vertical transmission, management, and guidelines. Peer-reviewed case studies with confirmed SARS-CoV-2 women who delivered were included to determine mode of delivery, indications for cesarean section, and maternal and neonatal characteristics.
A review of 36 total articles revealed deliveries in 203 SARS-CoV-2 positive pregnant women. A comparable severity of disease in pregnant versus nonpregnant women was noted, as previously determined. Overall, 68.9% of women delivered via cesarean section, with COVID-19 status alone being a common indication. Maternal COVID-19 may also be associated with increased risk of preterm labor, although neonatal outcomes were generally favorable. Despite eight of 206 newborns testing positive for SARS-CoV-2, there remains no definitive evidence of vertical transmission.
COVID-19 status alone became a common indication for cesarean delivery early in the pandemic, despite lack of evidence for vertical transmission. The increase in cesarean rate in this data may reflect obstetricians attempting to serve their patients in the best way possible given the current climate of constantly evolving guidelines on safest mode of delivery for the mother, infant, and provider. Upholding current recommendations from trusted organizations as new data are published, while also providing individualized support to expecting mothers on most appropriate mode of delivery, will reduce the amount of unnecessary, unplanned cesarean sections and could lessen the psychological impact of delivering during the COVID-19 pandemic.
· COVID-19 may result in an increased rate of cesarean delivery for SARS-CoV-2 positive pregnant women.. · COVID-19 is a commonly reported indication for cesarean section, despite management guidelines urging against this.. · Although eight neonates tested positive for SARS-CoV-2, all additional fluid and tissue samples tested negative..
本研究旨在回顾已发表的文献，以确定患有 2019 年冠状病毒病（COVID-19）的孕妇的分娩方式，并补充大流行早期剖宫产的指征，以增加当前叙述的信息并提高对发现趋势的认识。
通过在 PubMed、Scopus 和 ScienceDirect 数据库中搜索 2019 年 12 月至 2020 年 4 月 29 日期间发表的文章，使用 COVID-19、冠状病毒 2019、严重急性呼吸系统综合征冠状病毒 2（SARS-CoV-2）、妊娠、阴道分娩、剖宫产、垂直传播、管理和指南等关键词的组合进行了系统回顾。纳入了经同行评审的伴有 SARS-CoV-2 阳性的产妇病例研究，以确定分娩方式、剖宫产指征以及母婴特征。
共查阅了 36 篇文章，发现 203 例 SARS-CoV-2 阳性孕妇分娩。与之前的研究结果一致，孕妇与非孕妇的疾病严重程度相当。总体而言，68.9%的女性行剖宫产分娩，COVID-19 状态是常见的剖宫产指征。尽管有 8 例 206 名新生儿 SARS-CoV-2 检测呈阳性，但仍没有垂直传播的明确证据。
尽管缺乏垂直传播的证据，但 COVID-19 状态本身在大流行早期成为剖宫产的常见指征。在当前不断演变的关于母婴和医务人员最安全分娩方式的指南下，剖宫产率的增加可能反映了产科医生为满足患者需求而尽其所能。在发布新数据时坚持信任组织的现有建议，同时为产妇提供最适宜的分娩方式的个性化支持，将减少不必要的、无计划的剖宫产数量，并减轻在 COVID-19 大流行期间分娩的心理影响。
·COVID-19 可能导致 SARS-CoV-2 阳性孕妇剖宫产率增加。·COVID-19 是剖宫产的常见指征，尽管管理指南不建议这样做。·尽管 8 例新生儿 SARS-CoV-2 检测呈阳性，但所有其他羊水和组织样本检测均为阴性。
